2013 BENEFITS & WELLNESS GUIDE
Growing our services. Caring for more people.
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thers, and babies.
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Rewards e-Statement?
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ntly
think you’ll be pleasa
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‘TCH Total Rewards’. I
then press option 1 or sen
inline at 832-824-2421
Ma
rds
wa
Re
al
Tot
the
ll
estions or feedback, ca
As always, if you have qu
[email protected].
an email to TotalReward
and well-being.
year ﬁlled with goodness
ul
ssf
ce
suc
a
ily
fam
r
I wish you and you
ely yours,
erely
er
ce
Sinc
a Aldred
da
d
nd
Lin
Li
L
Senior Vice President
Human Resources
español o
ciones de beneﬁcios en
Si preﬁere discutir sus op
opción 1.
llamar al 832-824-2421
tiene preguntas favor de
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el departamento de rec
Tambien puede visistar
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o de ser
humanos (HR) o el centr
TABLE OF CONTENTS
:PVS5PUBM3FXBSET1BDLBHF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
&MJHJCJMJUZ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
&OSPMMJOHJO#FOFmUT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
.BLJOH#FOFmU$IBOHFT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
&NQMPZFF)FBMUI8FMMOFTT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Employee Medical Clinic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Employee Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Employee Assistance Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
.FEJDBMBOE1SFTDSJQUJPO%SVH$PWFSBHF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
BlueCross BlueShield of Texas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Prime Therapeutics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Condition Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Pavilion for Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
%FOUBM1MBO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
7JTJPO1MBO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
'MFYJCMF4QFOEJOH"DDPVOUT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
-JGF*OTVSBODFBOE"DDJEFOUBM%FBUI%JTNFNCFSNFOU. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
-POH5FSN%JTBCJMJUZ. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
$PNNVUFS#FOFmUT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
3FUJSFNFOUBOE4BWJOHT1MBOT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
8PSL-JGF#BMBODF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Paid Time Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Interim Backup Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
E.A.R.N. Program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Adoption Assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Other Beneﬁts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
&NQMPZFF&EVDBUJPOBOE%FWFMPQNFOU . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
-FHBM/PUJDFT:PVS3JHIUT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
$POUBDU*OGPSNBUJPO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
$PTUPG$PWFSBHF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Select and SelectPlus Dollars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Determining Cost of Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
2013 Beneﬁt Rates. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
If you (and/or your dependents) have Medicare or will become eligible for Medicare
in the next 12 months, a new Federal Law gives you more choices about your
prescription drug coverage. Please see the notice on pages 39-40 for more details.
2013 BENEFITS AND WELLNESS GUIDE
1
YOUR TOTAL REWARDS PACKAGE
Your Texas Children’s Total Rewards package encompasses a range
of diverse beneﬁts that, when utilized, can promote a healthy
work-life balance, as well as provide you and your family with
a level of added comfort, support, and security.
YOUR TOTAL REWARDS PACKAGE
5IF5FYBT$IJMESFOT4FMFDU1MBO includes your Medical, Prescription Drug, Dental,
Vision, Life, Accidental Death and Dismemberment, and Long Term Disability Insurance,
along with Healthcare and Dependent Care Flexible Spending Account options.
4FMFDUBOE4FMFDUPLUS%PMMBST are additional dollars provided by Texas Children’s
to help you offset the cost of your beneﬁt election coverage.
&NQMPZFF)FBMUIBOE8FMMOFTTbeneﬁts include employment health screenings,
immunizations, and administration of all types of leaves (medical, personal and catastrophic).
The on-campus Employee Medical Clinic provides access to preventive care, primary
care and urgent care for minor personal illnesses. Additional support services include the
Employee Assistance Program (EAP) and ongoing wellness initiatives.
1BSLJOHBOE$PNNVUFS#FOFmUT include close-to-campus no-cost parking, and
bus and vanpool subsidies.
3FUJSFNFOUBOE4BWJOHT1MBOTare available to provide ﬁnancial security for you and
your family’s future. Retirement beneﬁts include the Texas Children’s Cash Balance Pension
Plan and the Texas Children’s 403(b) Savings Plan.
&EVDBUJPO"EWJTJOH4FSWJDFTBOEUIF5VJUJPO"TTJTUBODF1SPHSBNsupport
you in seeking a college degree while also helping to offset the cost of college courses, most
fees and required books for a course of study that would be of beneﬁt to you in a role at
Texas Children’s.
8PSL-JGF#FOFmUToffer multiple ways to help you balance your work and personal life.
Adoption assistance, temporary backup care for family members, a generous paid time off
program (including “My Day”), as well as the PTO Sell Program, are all beneﬁts which offer
everyday choices and options to ﬁt your family’s needs.
2
TEXAS CHILDREN’S
T
ELIGIBILITY
This guide is a valuable resource to inform you and your dependents of the
many beneﬁt plan options available as you make important election choices.
ELIGIBILITY
Employees
"MMFNQMPZFFTmay access the Employee Medical Clinic and Employee
Assistance Program (EAP) services starting on date of hire.
t'VMMUJNFFNQMPZFFTBUMFBTUIPVSTQFSQBZQFSJPE
are eligible to
participate in all other beneﬁt and wellness programs on the ﬁrst day of the full
pay period following 30-days of employment.
t1BSUUJNFFNQMPZFFTMFTTUIBOIPVSTQFSQBZQFSJPE
are eligible to
participate in all other beneﬁt and wellness programs on the ﬁrst day of the full
pay period following 30-days of employment.
t1FSEJFNFNQMPZFFTVOEFSIPVSTQFSQBZQFSJPE
are eligible to
participate in the parking and commuter beneﬁts, retirement and savings
plans, and various wellness initiatives.
NEW HIRES,
REHIRES AND
NEWLY BENEFITSELIGIBLE
EMPLOYEES
HAVE %":4
TO ENROLL.
Eligible dependents are deﬁned as any of the following:
$PNQVUFSTBSFBWBJMBCMF
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t-FHBMTQPVTFA person of the opposite sex who is legally married to you or
tHR Service Center (1st ﬂoor –
t$IJMESFO
VOEFSUIFBHFPG Your natural child, stepchild, adopted child,
tMeyer Building – Beneﬁts
Dependents
recognized as your spouse by the state of Texas.
or child who has been placed for adoption with you, or a child for whom
you are involved in a lawsuit in which you are seeking to adopt such child,
a child for whom you have been appointed legal guardian, or a child who is
recognized under a Qualiﬁed Medical Child Support Order.
(SBOEDIJMESFOVOEFSUIFBHFPGfor whom you have custody and who
reside in your household are eligible for the dental and vision plans only.
*ODBQBDJUBUFE$IJMEUnmarried child, physically or mentally incapable of
self-support is eligible under the Texas Children’s Select Plan as long as they
were deemed incapacitated prior to their 26th birthday.
Abercrombie Rm A-130)
(3rd ﬂoor)
tTexas Children’s West Campus –
(2nd ﬂoor)
For questions, call the Total
Rewards Mainline at 832-824-2421
(option 1 for Beneﬁts).
When a Spouse or a Dependent also Works for Texas Children’s
If you and a dependent (spouse or child) are both employees, eligible for
Texas Children’s beneﬁts, you cannot elect dual coverage; meaning one of the
following:
tYou each need to elect individual coverage(s), or
tOne employee may elect family coverage and the other elect to waive
coverage since only one employee may cover a dependent on any plan.
2013 BENEFITS AND WELLNESS GUIDE
3
ELIGIBILITY
TY
ENROLLING IN BENEFITS
ENROLLING
IN BENEFITS
New hires and rehires enroll in benefits
through Texas Children’s online selfservice module, MOLI.
:PVXJMMSFDFJWFZPVS/5-PHJOBOE1BTTXPSEGSPN
ZPVSTVQFSWJTPSUPBDDFTT.Z0OMJOF*OGPSNBUJPO
.0-*
BOEFMFDUSPOJDBMMZFOSPMMJOZPVSCFOFmUT
Enroll in Beneﬁts
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Via MOLI on the
Texas Children’s Connect homepage.
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IUUQTNZQSPmMFUFYBTDIJMESFOTIPTQJUBMPSH
ENROLLMENT INSTRUCTIONS
S Enter your NT login and password within 30 days from your date
of hire.
- Contact the IS Service Desk at 832-824-3512 (option 2)
if you experience problems logging in to MOLI.
S Click on “Beneﬁts” and then “eBeneﬁts Intro.”
S Click on “Beneﬁts Enrollment.”
S You may enroll in or waive coverage for each of the following:
Medical, Dental, Vision, Life, LTD and Flexible Spending Account
(FSA) plans.
S Click the yellow “Edit” button to review options and elect
coverage.
S To add a dependent, click “Add Dependents.” Click “Store” to
save.
- Dependent Social Security numbers (SSNs) are required to
enroll dependents in the Medical, Dental or Vision plans. SSNs
for newborns are not required at the time of initial enrollment.
Please provide to HR upon receipt.
S To designate or review beneﬁciaries and corresponding
allocation percentages, you must open each Life and AD&D plan
and click “Save” to store information.
S If you choose to participate in either or both of the FSA plans,
enter an annual contribution amount to calculate your pre-tax
cost per paycheck. Click “Save” to store your FSA election.
4
TEXAS CHILDREN’S
5PmOBMJ[FBOETVCNJUZPVSFMFDUJPOT
1. 3FBEUIFi"VUIPSJ[F&MFDUJPOTw
TUBUFNFOUClick “Submit” at the
bottom of page.
2. $MJDLi7JFX:PVS$POmSNBUJPOw
and print your online conﬁrmation
statement.
3. :PVXJMMSFDFJWFBOFMFDUSPOJD
DPOmSNBUJPOFNBJMTUBUFNFOU
immediately upon submitting
your enrollment elections. Keep
the ‘conﬁrmation email’, both as
documentation of completion, as well
as your ‘anytime reference’ of your
speciﬁc enrollment election choices.
3&.*/%&3
Annual Flexible Spending Account
elections do not roll from year to year.
Remember to enroll or re-enroll in the
Healthcare and/or Dependent Care FSAs
if you wish to participate.
When Coverage Begins - Effective Date
t/FXIJSFGVMMPSQBSUUJNFFNQMPZFFToMost coverages
begin on the ﬁrst day of the full pay period following 30 days
of employment. You have 30 days from your hire date (initial
period of eligibility) to complete your Online Enrollment election
and click ‘Submit’ through MOLI (My Online Information).
EFFECTIVE DATE
OF COVERAGE
t'PSFNQMPZFFTDVSSFOUMZFMJHJCMFoEach year during the
Annual Enrollment period, you choose beneﬁt coverage(s)
for the coming year. Your beneﬁt election choices become
effective on January 1 and remain in effect through December
31, unless you experience what is called a ‘family status
change’ at anytime throughout the year. Refer to Making
Beneﬁt Changes (page 6).
t&NQMPZFFTJOBOPOCFOFmUFMJHJCMFTUBUVTXIPUSBOTGFS
UPBSFHVMBSGVMMPSQBSUUJNFTUBUVT Provided you have
been employed for 30 days or more and your election is made
within 30 days of your status change, coverage will begin on
the effective date you make your election and your Beneﬁts
Change Form is received by HR Beneﬁts.
Medical, Prescription Drug, Dental, Vision, Life, AD&D, LTD,
Healthcare and Dependent Care Flexible Spending Accounts,
Employee Medical Clinic, and EAP will end on: 1) the last day of
the pay period containing the last day worked or, 2) the day a
covered dependent becomes ineligible for coverage.
Of the beneﬁts listed above, when you transfer to an ineligible for
beneﬁts status, you maintain only Employee Medical Clinic and
EAP beneﬁts.
Waiving Medical Coverage
You have the option to waive medical beneﬁts. If you elect no
medical coverage and you lose your other coverage during the
year, or if you elect no medical coverage and have a qualifying
Family Status Change, you may elect one of the medical plans for
you and your dependents within 30 days of the loss of coverage.
Proof of loss of coverage is required. Refer to Making Beneﬁt
Changes (page 6).
Core beneﬁts provide you with basic medical PPO
coverage and basic (term) life and AD&D insurance.
Additionally, full-time employees also receive Long
Term Disability insurance protection.
&MJHJCMFFNQMPZFFTBSFBVUPNBUJDBMMZFOSPMMFE
JO$PSFCFOFmUTFGGFDUJWFXJUIZPVSDPWFSBHF
CFHJOEBUFVOMFTTZPVFMFDUPUIFSXJTF
Coverage Begins
January 7 / January 14
February 17, 2013
January 21 / January 28
March 3, 2013
February 4 / February 11
March 17, 2013
February 18 / February 25
March 31, 2013
March 4 / March 11
April 14, 2013
March 18 / March 25
April 28, 2013
April 1 / April 8
May 12, 2013
April 15 / April 22
May 26, 2013
April 29 / May 6
June 9, 2013
May 13 / May 20
June 23, 2013
May 27 / June 3
July 7, 2013
June 10 / June 17
July 21, 2013
June 24 / July 1
August 4, 2013
July 8 / July 15
August 18, 2013
July 22 / July 29
When Coverage Ends
CORE BENEFITS
2013 Monday Hire Dates
September 1, 2013
August 5 / August 12
September 15, 2013
August 19 / August 26
September 29, 2013
September 2 / September 9
September 16 / September 23
October 13, 2013
October 27, 2013
September 30 / October 7
November 10, 2013
October 14 / October 21
November 24, 2013
October 28 / November 4
December 8, 2013
November 11 / November 18
December 22, 2013
November 25 / December 2
January 5, 2014
December 9 / December 16
January 19, 2014
December 23 / December 30
February 2, 2014
EMPLOYEE ONLY
CORE BENEFITS
FULL-TIME
EMPLOYEE
PART-TIME
EMPLOYEE
PPO Medical
Basic Life & AD&D
Long Term Disability
If you do not make your elections within 30 days you will automatically be
enrolled in Core beneﬁts.
2013 BENEFITS AND WELLNESS GUIDE
5
MAKING BENEFIT CHANGES
BENEFIT ELECTION CHANGES
MAKING BENEFIT CHANGES
6OEFS*344FDUJPOSVMFTZPVNBZPOMZNBLFDIBOHFTUPZPVSCFOFmUFMFDUJPOTGPSQSFUBYQMBOT
NFEJDBMQSFTDSJQUJPOESVHEFOUBMWJTJPOBOEnFYJCMFTQFOEJOHBDDPVOUT
1. During Annual Enrollment; or
2. If you have a family status change (life event) such as:
t Change in legal marital status (marriage, divorce, etc.)
t Change in number of dependents due to birth, adoption, or death
t Change in employment status resulting in the gain or loss of coverage
t Change in coverage due to a court order which requires you to cover a dependent
t Changes in entitlement to Medicare or loss of Medicare eligibility
t Signiﬁcant change in cost of coverage
t Change in coverage of employee, spouse or dependent under another employer’s plan
t Commencement or return from leave under FMLA, or an unpaid leave that affects eligibility
t Change in Medicaid, Children’s Health Insurance Program (CHIP) or State Premium Assistance Eligibility/Coverage
for an employee or his/her eligible dependent who:
- loses Medicaid or CHIP coverage because he/she is no longer eligible, or
- becomes eligible for a state premium assistance program under Medicaid or CHIP
(such as the Health Insurance Premium Payment Program in the state of Texas). Refer to page 35.
If you have a life event, you may only submit changes to your
pre-tax plans that are consistent with the event. You must submit
changes that require a change in coverage level and/or a change
in your contribution amount within 30 days of the date of the event
to HR Beneﬁts. If your change is not received within the required
timeframe, you will not be able to make the change until the
next Annual Enrollment period, with the exception of an ineligible
dependent who must be dropped from coverage effective the date
the dependent is no longer eligible. Occasionally, you may not have
the supporting documentation until after 30 days. Therefore, if you
have not received your documentation in a timely manner, you will
need to submit your Beneﬁt Change Form within the deadline and
forward the supporting documentation within 30 days.
8IFO#FOFmU&MFDUJPO$IBOHFT#FDPNF&GGFDUJWF
In compliance with IRS regulations that govern pre-tax deductions,
changes will become effective on the date you make your election
or change, and your Beneﬁts Change Form is received by HR
Beneﬁts, except in the event you are adding a child, in which
case coverage becomes effective on the date of birth, adoption,
marriage, or court order.
Please contact HR with questions at 832-824-2421 (option 1).
6
TEXAS CHILDREN’S
When and How to add a Newborn
to the Medical Plan
t"5FYBT$IJMESFOT#FOFmU$IBOHF
'PSNBMPOHXJUIBDPQZPGUIFCJSUI
GBDUTIFFUGSPNUIFIPTQJUBMNVTU
CFEFMJWFSFEPSGBYFEUP)3#FOFmUT
XJUIJOEBZTGSPNUIFCJSUI
tThe baby’s Social Security number is not
required at the time of enrollment; however,
should be provided to HR Beneﬁts
promptly upon receipt.
tThe form is available on Connect/HR/
Beneﬁts or at an HR Beneﬁts location.
tIf the Beneﬁt Change Form and the birth
fact sheet are not received within the
allowable 30 days from the infant’s date
of birth, the child will not be added to
the Medical Plan until the next Annual
Enrollment (for an effective date of January
1 of the following calendar year).
Special Enrollment Rights Notice
If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance
or group health plan coverage, you may be able to enroll yourself and your dependents in the Texas Children’s Select Plan
if you or your dependents lose eligibility for the other coverage (or if the employer stops contributing toward your or your
dependent’s other coverage). :PVNVTUFOSPMMXJUIJOEBZTBGUFSDPWFSBHFFOETPUIFSXJTFZPVNVTUXBJUVOUJMUIF
OFYU"OOVBM&OSPMMNFOU
If you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll
yourself and your eligible dependents. To request enrollment, you must provide a Beneﬁts Change Form to HR Beneﬁts within
30 days after the marriage, birth, adoption, or placement for adoption.
To request enrollment or obtain more information, contact HR at 832-824-2421 (option 1 for Beneﬁts).
Allowable Changes
.FEJDBM%FOUBM7JTJPO
You may change your coverage level, but not your plan
option (e.g., you can change from the PPO plan Employee
Only to the PPO plan Employee and Family, but not to the
EPO plan). The same for the dental plan; you can change
coverage levels, but not plans.
-5%-JGF*OTVSBODFBOE"%%
You may increase or decrease your coverage level election.
tChanging from part-time to full-time, you gain the LTD
Basic Plan Beneﬁt and the option to purchase the LTD
Buy-up Plan. For Optional Life Insurance and AD&D you
are eligible to purchase up to four times your annual base
salary subject to plan provisions.
tChanging from full-time to part-time, your Optional Life
Insurance and AD&D coverage reduces to your annual
base salary, and you lose eligibility for LTD.
)FBMUIDBSF'4"
You may change your elections to the Healthcare and
Dependent Care FSAs if you experience a change in family
or job status; however, in the event of a deﬁcit balance in an
FSA, you may not stop or decrease your FSA contribution.
If you resign your employment and then return to Texas
Children’s in the same calendar year, or if you change from
an eligible status to an ineligible status and back again, you
will retain the options that you had previously unless you
have since incurred a family status change.
%FQFOEFOU$BSF'4"
You may not end or change your election until the next
Annual Enrollment period unless you have a family status
or job status change. If you resign your employment and
then return to Texas Children’s in the same calendar year, or
if you change from an eligible status to an ineligible status
and back again, you will retain the options that you had
previously unless you have since incurred a family status
change.
&OSPMMNFOU$IBOHF'PSN$IFDLMJTU
Beneﬁt elections or changes that are not made when you are
ﬁrst eligible or during Annual Enrollment must be submitted
on a Beneﬁts Change Form, located online on Texas
Children’s Connect website: Human Resources/Beneﬁts/
Beneﬁt Forms. You may also obtain forms from your HR
Beneﬁts department in the Service Center/Abercrombie
A -130, Meyer Building 3rd ﬂoor Beneﬁts, and West Campus
HR 2nd ﬂoor.
tIf you are enrolling a new dependent, additional
documentation is required such as:
- marriage license
- birth certiﬁcate/birth facts
- adoption papers
- court documents
- Social Security numbers (SSNs), unless newborn
tIf you have not received your documentation in a timely
manner, you will still need to submit your Beneﬁts Change
Form within the 30-day required deadline and forward
all supporting documentation within 30 days. Due to
IRS regulations regarding changes to pre-tax plans,
your change cannot be processed until all supporting
documentation is received.
2013 BENEFITS AND WELLNESS GUIDE
7
EMPLOYEE HEALTH & WELLNESS
EMPLOYEE HEALTH
& WELLNESS
Employee Medical Clinic
The Employee Medical Clinic supports your personal health needs
by offering access to primary, preventive and urgent care services.
Eligibility
Full-time, part-time or per diem employees may access the clinic beginning on your date of hire.
Services
.JOPS"DVUF$BSF
tUrgent care for minor
personal illness and injury
tSeasonal allergy symptoms
tSinus infection
tBronchitis
tCold/cough
tSore throat
tInﬂuenza-like illness
tEar infection
$PPSEJOBUJPOPG3FGFSSBMT
tSpecialty care services
tOccupational and
physical therapy
tRadiology
&MJHJCMF
$PTU
1SFWFOUJWF$BSF
tWell-woman exam
tWell-man exam
tRoutine physical
tBiometric screening
tMedication for travel
$ISPOJD)FBMUI
$POEJUJPO.BOBHFNFOU
tHeart disease
tHigh blood pressure
tHigh cholesterol
tAsthma
tDepression
tDiabetes Management
Program
-BCT"WBJMBCMF
0OTJUF
tRapid strep throat
tGlucose/
Hemoglobin A1c
tBlood lipid panel
tUrinalysis
tPregnancy test
tand other Providerrecommended labs
Texas Children’s
PPO/EPO Medical Plan
Employees with Other,
Non-Texas Children’s Plan
Employees with
No Coverage
tPreventive care: $0
tOfﬁce visit: $10 copay
tRoutine labs:
- At clinic: $0
- Other labs:
$20 PPO, $25 EPO
tOfﬁce visit and copay
subject to your plan
provisions
t$70 Ofﬁce Visit Copay
tIndependent lab
subject to fee schedule
tYou will be billed
directly for outside lab
services
-PDBUJPO Employee Health & Wellness Center: 5 Tower by the yellow elevators
1IPOF
832-824-2150 (option 2)
)PVST
Mon, Wed, Thu, Fri: 7:30 a.m. to 4:30 p.m.
Tues: 10 a.m. to 7 p.m.
8
TEXAS CHILDREN’S
Brett Perkison, M.D.
.FEJDBM%JSFDUPS
Dr. Perkison completed his
undergraduate degree at
Texas A&M University
and his medical degree at
the University of Texas –
Galveston. In addition to
active duty in the U.S. Navy
as a general medical ofﬁcer
for three years, he is board
certiﬁed in both Family
Medicine and Occupational
Medicine.
Lily Odukoya, MMS PA-C
1IZTJDJBO"TTJTUBOU
Lily is board certiﬁed by the
National Commission on
Certiﬁcation of Physician
Assistants (NCCPA). She
graduated from Cook County
Physician Assistant program
in Chicago, IL, and completed
her postgraduate studies at
St. Francis University. She has
a strong background in both
Internal Medicine and Family
Medicine.
Taking care of our patients and their families
begins with taking care of ourselves.
Employee Wellness Program
Part of our wellness mission is
to provide you with engaging
and educational programs to
help you achieve optimal health
and well-being.
4FSWJDFTJODMVEF
tKnow Your Numbers wellness screenings
tHealth and behavior change coaching
tHealth and ﬁtness challenges and events
tWellness education booths and presentations
Employee Health
Employee Assistance Program
Employee Health promotes a safe,
healthy work environment for all
employees by providing outstanding
occupational health services including:
The Employee Assistance Program (EAP)
provides confidential and professional
consultation, counseling, and educational
services at no cost to Texas Children’s staff
and their eligible dependents. The EAP team
provides many services including:
tNew hire processing
tAnnual ﬂu vaccine and immunization programs
tTuberculosis (TB) Testing Program
tTreatment of workplace injuries
tAbility-to-work assessments
tLeave of Absence (LOA)
tFamily Medical Leave (FML)
tWorkers’ Compensation management
tMedications for business travel
."*/$".164
-PDBUJPO
Employee Health & Wellness Center;
5 Tower by the yellow elevators
1IPOF
832-824-2150 (option 1)
)PVST
Monday – Friday, 7:30 a.m. to 4:30 p.m.
8&45$".164
-PDBUJPO
2nd ﬂoor, Human Resources
1IPOF
832-227-1365
tPrograms for grief recovery, family or relationship issues,
workplace concerns, critical incident stress, legal
and ﬁnancial concerns, substance abuse, and stress
management clinics
tThe Employee Financial Assistance Fund, for employees
who face unavoidable, unforeseeable ﬁnancial hardship
tGuidance for employees and work teams to enhance their
health, wellness, and productivity
-PDBUJPO
Meyer Building basement, MB1201
1919 S. Braeswood Blvd.
Houston, TX 77030
8FTU$BNQVT By appointment only
1IPOF
832-824-3327
&NBJM
[email protected]
)PVST
Monday – Friday, 7:30 a.m. to 4:30 p.m.
"GUFSIPVST
For urgent after-hour needs, call
832-824-2099 and ask for an
EAP representative.
Your wellness is our mission.
2013 BENEFITS AND WELLNESS GUIDE
9
MEDICAL AND PRESCRIPTION DRUG COVERAGE
YOUR MEDICAL PLAN PROVIDER
BLUECROSS BLUESHIELD
OF TEXAS
In 2013, Texas Children’s is pleased to offer a choice of two plans administered by
BlueCross BlueShield of Texas (BCBSTX) in partnership with Prime Therapeutics,
our new pharmacy benefit manager replacing Express Scripts.
Medical Coverage
t1101MBO – Network and non-network coverage; services subject to deductible and coinsurance
t&101MBO – Network-only coverage; no referrals needed; services subject to copay schedule
If you are a participant in either medical plan, you also have prescription drug coverage with Prime Therapeutics.
1101-"/015*0/
&101-"/015*0/
5IJTNFEJDBMPQUJPOPGGFSTOFUXPSLDPWFSBHFBTXFMMBT
OPOOFUXPSLDPWFSBHFBUBOBEEJUJPOBMDPTUUPZPV
5IJTNFEJDBMPQUJPOQSPWJEFT
OFUXPSLPOMZDPWFSBHF
tThe PPO plan offers you the ﬂexibility of choosing network or non-
tThe EPO medical plan is an open access
tMost covered services are subject to an annual calendar year deductible
tUnder the EPO plan, you must use
network providers. You pay less when you choose BCBSTX network
providers. NOTE: For any non-network hospitalizations, you are
responsible to pre-certify with BCBSTX prior to receiving services.
and require you to share in the cost of services through coinsurance.
Your coinsurance amount is subject to an annual out-of- pocket
maximum; however, copays for all services will still apply even after the
out-of-pocket maximum is reached.
- The PPO plan includes copays for primary and specialist care.
A copay will apply for services billed by the physician’s ofﬁce.
- All other services not billed by the physician will be subject to copays,
deductible, and coinsurance.
t4FQBSBUFDPQBZTXJMMCFJODVSSFEGPSNJOPSMBCBOEYSBZTFSWJDFT
XIFOUIPTFTFSWJDFTPDDVS
- on a different day than your ofﬁce visit, or
- on the same day as your ofﬁce visit, but at a different (building) facility
- on the same day as your ofﬁce visit, in the same building, but for care
under a different billing system.
t.BKPSEJBHOPTUJDTMRI, CT and PET scans, are subject to the annual
deductible and coinsurance.
tSome pre-existing condition limitations may apply to the PPO plan.
Refer to page 35 for details.
10
TEXAS CHILDREN’S
plan, meaning you do not need a referral
from a Primary Care Physician to visit a
specialist.
network providers in order for services to
be covered. There are no non-network
beneﬁts in the EPO plan.
tServices are paid for through copays
each and every time you access care.
The amount you pay will depend on the
level and type of care you receive.
tThe network of providers is the same for
both PPO and EPO plan options. You
can view all participating providers at the
www.bcbstx.com/tch website.
tPre-existing condition limitations do not
apply to the EPO plan.
2013 PRESCRIPTION DRUG PROVIDER
PRIME THERAPEUTICS
We are pleased to announce Prime Therapeutics as Texas Children’s
Pharmacy Benefit Manager for 2013. As a BlueCross BlueShield
company, your prescription drug benefits will be integrated with your
medical plan. Visit www.bcbstx.com/tch to learn more.
Prescription Drug Coverage – PPO/EPO Plan Beneﬁts
3FUBJM1IBSNBDZEBZTVQQMZ
tGeneric: $10 copay
tPreferred Brand: $35 copay
tNon-preferred Brand: $50 copay
)PXEP*mOEBQIBSNBDZJOUIFOFUXPSL
Use the “Find A Pharmacy” feature by accessing
www.bcbstx.com/tch. Walgreens is not included in the
Texas Children’s Pharmacy Network.
4QFDJBMUZ.FEJDBUJPOT
tPrime Specialty: 10% copay, $50 minimum &
$150 max per prescription ($2,000 maximum
annual out-of-pocket per person)
tPhysician’s Ofﬁce: $150 copay each visit
(No maximum annual out-of-pocket per person)
If you use a non-network pharmacy, you will pay the full cost
of your prescription. Additional charges may also apply. You
may be eligible for reimbursement for some of the cost. You
will need to ﬁll out a claim form. Claim forms are available
from Member Services. See contact information below.
.BJM0SEFS1IBSNBDZEBZTVQQMZ
tGeneric: $20 copay
tPreferred Brand: $70 copay
tNon-preferred Brand: $100 copay
0UIFS1SFTDSJQUJPO%SVH$PWFSBHF
tMost contraceptives: 100% coverage
tFertility Treatment: Combined lifetime coverage
(medical and prescription drug) up to $20,000
One BCBSTX ID card for your medical,
prescription drug, dental, EAP and
Employee Medical Clinic services.
www.bcbstx.com/tch
Register for BAM
(Blue Access for Members)
as your BCBSTX online resource to:
tAssess which medical plan is right for you
with the “Health Plan Cost Estimator”
tFind a network provider
tConﬁrm coverage on you or a family
member
tSee your medical and dental beneﬁt
coverage summaries
tView and print Explanation of Beneﬁts
(EOB) for ﬁnalized medical, RX and dental
claims
tReceive email notiﬁcation of claim activity
tPrint temporary ID cards
tEstimate the cost of medical services
tDownload forms
tGet answers to Frequently Asked
Questions (FAQs)
tReceive discounts
2013 BENEFITS AND WELLNESS GUIDE
11
Step Therapy and Prior Authorization
Texas Children’s and Prime are working together to ﬁnd better ways to
effectively manage prescription drug costs. They realize how important it is
to offer safe, high-quality and affordable healthcare options. With the cost of
prescription drugs increasing faster than any other healthcare expense, Prime’s
step therapy program is an effective way to encourage appropriate drug use
and to reduce costs for everyone.
8IBUJTBTUFQUIFSBQZQSPHSBN
A step therapy program is a “step” approach to providing the medications your
physician prescribes for you. This means that you may ﬁrst need to try a more
clinically appropriate or cost-effective medication before certain high-cost
medications are approved by Prime Therapeutics.
Step therapy is based on FDA guidelines, clinical evidence and research to
ensure that you are taking the most appropriate medication. Your health plan’s
physicians and pharmacists review medications that may have the potential
for overuse or are known to be very expensive. Together they determine what
appropriate or lower-cost drugs are available as alternative medications.
8IBUJTQSJPSBVUIPSJ[BUJPO
Some drugs your doctor prescribes will require special approval or ‘prior
authorization’ before being ﬁlled. This means that Prime will need to make sure
these prescriptions meet the plan’s conditions for coverage. Prior authorization
encourages appropriate drug therapy for certain designated conditions.
)PXEPFTTUFQUIFSBQZQSJPSBVUIPSJ[BUJPOBGGFDUNF
If you are currently taking a drug that is not included within Prime’s step
therapy program, please contact your physician. Together you can discuss
what medication options are best for you. Your physician will be able
to determine whether to write a new prescription or to submit a prior
authorization request for your current medication. Remember, it is always
important to follow your physician’s instructions when taking prescription
medications.
Look it up on Prime’s website
The PrimeMail website is a good source of
information about your prescriptions and
your prescription drug beneﬁts. Accessing
your prescription beneﬁt information online
is quick and easy.
Visit www.myprime.com and complete the
brief registration process to get started.
tLocate participating retail pharmacies
near you
tFind out what you’ll pay for a speciﬁc
drug using a retail pharmacy and home
delivery
tOrder reﬁlls through PrimeMail and track
the status of your order
tSee if there is a generic equivalent
available
tReview your 12-month prescription
history
tDetermine if prior authorization is
required
tIdentify ﬁrst-line medications for step
therapy
tDetermine how to request generics from
your physician
)&"-5)'*5/&44 CONDITION MANAGEMENT
Employees currently managing or who
become diagnosed (at any time) with
one or more of the following conditions
are encouraged to participate in this
conﬁdential program designed to help
manage conditions and improve overall
health and well-being.
Enrolled employees are assigned
a personal coach to assess their
condition and provide guidance to help
12
TEXAS CHILDREN’S
minimize symptoms, complications,
and questions related to the following
conditions:
tChronic Obstructive Pulmonary
Disease
tDiabetes
tCongestive Heart Failure
tAsthma
tCoronary Artery Disease
tHypertension (high risk)
For joining the program, you
will automatically be enrolled in
HealthFitness Rewards for the
opportunity to receive cash rewards for
successfully managing your health.
5PMFBSONPSFDBMMB)FBMUI'JUOFTT
TQFDJBMJTUBU
PrimeMail
PrimeMail delivers your maintenance or long-term medications
right where you want them. No driving to the pharmacy.
No waiting for your prescriptions to be ﬁlled.
4BWJOHT
t90-day supplies offer deeper discounts through bulk
purchasing and no dispensing fees — that means lower
out-of-pocket pharmacy costs for you
$POWFOJFODF
tPrescriptions delivered to the address of your choice
tMedications ordered your way — online, over the phone or
through the mail
tUp to a 90-day supply of medication for each order
tPlain-labeled packaging protects your privacy
4FSWJDF
tNotiﬁcation through email or over the phone —
your choice — when your order is received and
when your prescriptions are sent
tMember service representatives available 24/7
tLicensed, U.S.-based pharmacists available
seven days a week
tReﬁll reminder notiﬁcations
tRegular delivery at no additional cost
Specialty Drugs through
Prime Specialty Pharmacy
Starting January 1, you may use Prime Therapeutics’
Specialty Pharmacy (Prime Specialty Pharmacy) to get
coverage for your specialty medications. You won’t need
to make a special trip to the pharmacy. Prime Specialty
Pharmacy will deliver your medication where and when you
need it. Injection supplies (syringes, disposal containers,
etc.) are also sent at no extra cost.
Prime Specialty Pharmacy wants to help you achieve the
best results from your medication therapy.
Call and receive:
tAnswers to medication questions
t24/7/365 access to a pharmacist for urgent
medication issues
tInformation about managing potential medication
side effects
tEducational materials about your condition
Get Started
with PrimeMail
0OMJOF
1. Visit www.bcbstx.com/tch and log into Blue Access
for MembersSM.
2. Transition your prescriptions from a retail pharmacy to
mail delivery.
tFill out the online form and PrimeMail will take care
of the rest.
tExpect your medications in ﬁve to eight business
days after PrimeMail receives approval to ﬁll.
5ISPVHIUIF.BJM
1. Talk to your doctor
tAsk for a prescription for a 90-day supply of each of
your maintenance medications.
tAsk for a prescription for a 14-day supply to ﬁll at a
retail pharmacy for immediate use, if needed.
2. Complete the PrimeMail order form.
tMail your prescription, completed order form and
payment to PrimeMail.
tExpect your medications in ﬁve to eight business
days after PrimeMail receives your order.
Get Started with
Prime Specialty Pharmacy
To start using Prime Specialty Pharmacy, call
1-877-627-MEDS (6337) Monday through Friday,
7 a.m. to 6 p.m.
When you call, have your member ID card handy.
Be ready to give:
tYour name, address and phone number
tName and phone number of the pharmacy you are
using now
tYour prescription number and the name of your
medication
tYour doctor’s name, phone and fax numbers
.&%4
GBY
www.PrimeTherapeutics.com/Specialty
2013 BENEFITS AND WELLNESS GUIDE
13
MEDICAL BENEFIT COVERAGE (BCBSTX)
Network
PPO
Non-Network
EPO
Network Only Benefits
$500
$1,500
$1,500
$4,500
N/A
N/A
80%
20%
60%
40%
N/A
N/A
$2,500
$5,000
$5,000
$10,000
N/A
N/A
$10 copay
$20 / $40 copay
$20 copay
$40 copay
$150 copay
$0 copay
N/A
40% after deductible
40% after deductible
40% after deductible
40% after deductible
40%
$10 copay
$25 / $45 copay
$25 copay
$45 copay
$150 copay
$0 copay
$20 copay
$40 copay
$20 copay
20% after deductible
40% after deductible
40% after deductible
40% after deductible
40% after deductible
$25 copay
$45 copay
$25 copay
$0 copay
20% after deductible
40% after deductible
$100 copay
20% after $100
copay & deductible
40% after deductible
$300 copay
tUrgent Care
)PTQJUBMJ[BUJPO*OQBUJFOU
tPhysician Services
tTexas Children’s Facility
20% after $100
copay & deductible
$40 copay
20% after deductible
$0 copay for facility charges
40% after deductible
N/A
tThe Woman’s Hospital
20% after $500/per person
admission copay & deductible
N/A
$0 copay
$0 copay for facility charges
$500 copay/admission plus
$500 copay/day up to $2,500
max/person/year
Chart represents member cost.
"OOVBM%FEVDUJCMF
tIndividual
tFamily
$PJOTVSBODF
tTexas Children’s Paid
tEmployee Paid
"OOVBM0VUPGQPDLFU
.BYJNVN
tIndividual
tFamily
0GmDF7JTJUT
tEmployee Medical Clinic
tPavilion for Women
tPrimary Care Physician
tSpecialist
tSpecialty Rx
1SFWFOUJWF$BSF
-BCBOE9SBZ
tPrimary Care Physician
tSpecialist
tIndependent Lab
tOutpatient Facility
.BKPS%JBHOPTUJDT
tCT, MRI, PET scans, etc.
(ofﬁce & outpatient)
&NFSHFODZ4FSWJDFT
tEmergency Room
tOther Facility
0VUQBUJFOU4VSHFSZ
20% after deductible
20% after deductible
$45 copay
40% after $100/admission
deductible & calendar year
deductible
40% after deductible
$500 copay/day up to $2,500
max/person/year
$500 copay up to
$500 max/person/year
PRESCRIPTION DRUG COVERAGE (PRIME)
Chart represents member cost.
3FUBJMEBZTVQQMZ
tGeneric
tPreferred Brand
tNon-preferred Brand
.BJMEBZTVQQMZ
tGeneric
tPreferred Brand
tNon-preferred Brand
4QFDJBMUZ
tPrime Specialty ($2,000 annual out-of-pocket max per person)
tPhysician’s Ofﬁce (No annual out-of-pocket max per person)
14
TEXAS CHILDREN’S
PPO AND EPO Network Only Benefits
$10 copay
$35 copay
$50 copay
$20 copay
$70 copay
$100 copay
10% copay, $50 minimum, $150 maximum per prescription
$150 copay per prescription
PAVILION FOR WOMEN
PAVILION
FOR WOMEN
Our mission is to provide women, mothers,
and babies with a continuum of high-quality
services and expert healthcare.
Pavilion for Women is one of the ﬁrst to provide family-centered services
in state-of-the-art surroundings. From well-woman services to prenatal,
maternity and postpartum care, leading experts in their ﬁelds offer you the
highest-quality care.
Gynecology
Fertility
Our gynecologists offer complete
care, from annual well-woman
checkups and diagnostic
procedures to treatment for pelvic
ﬂoor disorders and cancer-related
illnesses.
Experts from Baylor College of
Medicine and specialists from
our OB/GYN practices provide
you and your partner with the
most advanced fertility treatments
available.
Obstetrics
Maternal Fetal Medicine
Well-respected private obstetrics
and gynecology (OB/GYN) practices
at the Pavilion for Women provide
personalized prenatal, maternity and
postpartum care.
From our Program for Multiples to
genetic counseling and ultrasound,
our specialists give you and your
unborn child expert care in a
supportive environment.
Labor and Delivery
Behavioral Health
The Pavilion for Women provides
state-of-the-art labor and delivery
services that put your need for
comfort ﬁrst.
If you suffer from mood or
psychiatric conditions related to any
stage of your reproductive cycle –
from premenstrual to postpartum
to menopause – Texas Children’s
Pavilion for Women can help.
Texas Children’s Fetal Center
Our Fetal Center is one of only a few
worldwide to offer a full spectrum
of fetal diagnostic and intervention
therapies, including surgery,
cardiology and echocardiography.
Newborn Care
From quiet time to a nurse
dedicated to your care, we’ll help
you and your baby get off to a
healthy start in our private, spa-like
maternity rooms.
Texas Children’s Medical Plan
covers fertility beneﬁts up to
$20,000
C
ontact BCBSTX to precertify.
Call 1-877-734-8924.
Contact BCBSTX to determine
which diagnostic and treatment
services may or may not be
covered.
t
All fertility beneﬁts are
subject to applicable copays,
deductibles, and coinsurance.
t
$20,000 lifetime limit for all
combined fertility-related
treatment under medical and
prescription drug plans.
"EWBODFE3FQSPEVDUJWF
5FDIOPMPHZ"35
JODMVEFT
CVUJTOPUMJNJUFEUP*O7JUSP
'FSUJMJ[BUJPO*7'
$PWFSFE"35CFOFmUTBWBJMBCMF
POMZUISPVHIPOFPGUIFGPMMPXJOH
FYQFSUGFSUJMJUZ"35QSPWJEFST
tWilliam E. Gibbons, MD
tErtug Kovanci, MD
http://women.texaschildrens.org
1BWJMJPOGPS8PNFO
6651 Main St., Houston, TX 77030
Main Number: 'FSUJMJUZ4FSWJDFT832-826-7500
2013 BENEFITS AND WELLNESS GUIDE
15
SERVICES AT PAVILION FOR WOMEN
When you deliver at Pavilion for Women, your out-of-pocket cost will be signiﬁcantly reduced compared to other
network facilities.
As an additional beneﬁt to covered employees, Texas Children’s will waive certain facility charges for services at Pavilion for Women.
Facility charges are those billed by the Hospital. Employees will still be responsible for applicable copays and physician charges at
Pavilion for Women.
You may continue to visit your preferred network facility; however, effective January 1, 2013, inpatient admissions to The Woman’s
Hospital will be subject to a $500 per admission copay per member plus, if applicable, deductible and coinsurance. Mom and
baby accumulate charges as separate individuals at birth; therefore, each would be subject to applicable copays and deductible/
coinsurance. Charges for lab or diagnostic (sonograms) would be extra. Here’s an example:
NETWORK
Estimated Delivery Charges for
Non-High-Risk 3 day Maternity Stay
PPO*
.PN
#BCZ
5PUBM
EPO
.PN
#BCZ
5PUBM
Facility
Only***
$5,000
Physician/
Anesthesia
$3,330
Pavilion
for Women
The Woman’s
Hospital
Other
Network Facility
(including St. Luke’s)
Non-Network
Facility
Physician/Anesthesia
subject to deductible
and coinsurance.
100% paid for facility
$500 copay per admit
plus deductible and
coinsurance
Deductible and
coinsurance
Deductible and
coinsurance
$1,066
$2,466
$2,066
$4,232
$741
$225
$225
$966
$593
$966
Facility
Only***
Physician/
Anesthesia
$0 copay for facility;
$25 OB copay (high risk
$500 copay per admit
has separate copay/
plus $500/day
visit) + lab and x-ray
(5 day max)
copays, if applicable
$500 copay/day
(5 day max)
Not covered
$5,000
$3,330
$25
$2,000
$1,500
n/a
$741
$225
$0
$741
$741
n/a
$25
OB
* Assumes none of the annual deductible has been met and all maternity charges would apply to deductible and coinsurance.
** The lesser of allowable charges or copay amounts apply.
*** Facility Only: Does not include retail services or suite upgrades at Pavilion for Women.
16
TEXAS CHILDREN’S
DENTAL PLAN
DENTAL PLAN OPTIONS
THROUGH BCBSTX
Similarities of DPPO High and DPPO Low:
Differences in the DPPO High and DPPO Low:
tThe beneﬁts are the same whether you use network
The High Option has a higher annual maximum beneﬁt.
or non-network dental providers, however the cost to
you, for non-network providers, may be higher.
tHigh and Low Options offer child and adult
orthodontia beneﬁts.
tEndodontics and periodontics are considered:
- Basic services under the High Plan and pay at 80%
- Major services under the Low Plan and pay at 25%
tPeriapical x-rays are considered preventive and:
- Pay at 100% under the High Plan
- Pay at 50% after deductible under the Low Plan
DENTAL COVERAGE COMPARISON CHART
NETWORK AND NON-NETWORK BENEFITS
Chart represents member cost.
%FOUBM#FOFmU
"OOVBM%FEVDUJCMF
tIndividual
tFamily
.BYJNVN"OOVBM#FOFmU
tPer individual
1SFWFOUJWF$BSF
Exam, cleaning, bitewing x-rays up to twice per year
#BTJD4FSWJDFT
Fillings
.BKPS4FSWJDFT
Crowns, inlays, onlays, bridges, dentures
Endodontic and periodontic services
(Gum procedures)
0SUIPEPOUJB$IJMEBOE"EVMU
tDiagnosis and treatment
t-JGFUJNF orthodontia maximum per person
DPPO High Option
DPPO Low Option
$50
$150
$50
$150
$1,500
$1,000
No cost
No deductible
No cost
No deductible
20% after deductible
50% after deductible
50% after deductible
75% after deductible
20% after deductible
75% after deductible
50% after a separate
$50 lifetime deductible
50% after a separate
$50 lifetime deductible
$1,500
$1,000
www.bcbstx.com/tch
2013 BENEFITS AND WELLNESS GUIDE
17
VISION PLAN
VISION PLAN
THROUGH VSP
QUALITY EYE CARE OPTIONS WITH A LARGE NETWORK
OF OPTOMETRISTS AND OPHTHALMOLOGISTS.
The Texas Children’s Select Vision Plan includes an annual eye exam, contact lenses or one pair of prescription glasses in addition to
other value-added discounts.
Non-network providers may be used; however, reimbursable beneﬁts will be limited to those shown in the chart below.
BENEFITS
&ZF&YBN
FREQUENCY
COPAY
COVERAGE USING
NETWORK VSP DOCTOR
REIMBURSEMENT USING
NON-NETWORK PROVIDER
Once per
calendar year
$0
Covered in full
Up to $45
-FOTFT
tSingle Vision, lined bifocal or
Once per
calendar year
$0
lined trifocal covered in full
tPolycarbonate covered for
dependents up to age 19
Lined bifocal lenses
Up to $50
Lined trifocal lenses
Up to $65
tRetail allowance - Covered up
'SBNFT
$POUBDU-FOTFT
Single vision lenses
Up to $30
to $120
Once per
calendar year
$0
Once per
calendar year
$0
tAfﬁliate allowance - Covered at
Up to $70
$120 allowance for
contacts, exam & ﬁtting
Up to $105
$70 at Costco and up to $120
at other afﬁliate locations
-BTJL7JTJPO
$PSSFDUJPO
VSP has contracted with multiple laser surgery centers to offer a discount for Laser Vision correction
(PRK LASIK and Custom LASIK).
Average 15% off the regular price or 5% off the promotional price from contracted facilities.
0UIFS%JTDPVOUT
BOE4BWJOHT
t20% off lens options such as progressive and scratch resistant and anti-reﬂective coatings.
t20% off additional glasses and sunglasses, including lens options – available from any VSP doctor
within 12 months of your last eye exam.
tAverage 15% off the contact lens ﬁtting and evaluation exam
No vision card necessary!
VSP offers Open AccessSM which allows
members the ﬂexibility to use their VSP beneﬁts
at any provider location, including specialty
optical boutiques or retail chains. After locating
a provider on the VSP website, call the doctor
directly to schedule an appointment.
18
TEXAS CHILDREN’S
www.vsp.com/go/tch
tLocate a VSP network provider
tFind savings on lenses, frames and contact lenses
tSee more beneﬁt information
FLEXIBLE SPENDING ACCOUNTS
FSA PLANS THROUGH PAYFLEX
Flexible Spending Accounts (FSAs) offer a Pre-tax Beneﬁt
Participating in a Flexible Spending Account (FSA) allows you to set aside a portion of your pay on a pre-tax basis for use to
reimburse for allowable healthcare or dependent care expenses not otherwise covered by other programs.
Two types of FSAs:
t)FBMUIDBSF'MFYJCMF4QFOEJOH"DDPVOU
Reimburses you for out-of-pocket medical, dental,
vision and prescription drug expenses, such as
deductibles, copays and coinsurance.
t%FQFOEFOU$BSF'MFYJCMF4QFOEJOH"DDPVOU
Reimburses you for expenses such as day care,
before and after school programs, nursery school
or preschool, summer day camp and even adult
day care (for IRS-eligible dependents).
Determining your Contribution Amount
To participate, you must elect how many pre-tax
dollars you want to contribute to each FSA in which
you wish to participate. Begin by estimating the
amount you anticipate to spend in 2013 for eligible
healthcare and then separately for dependent
care expenses. This annual contribution amount
will automatically be divided by the number of pay
periods remaining through year-end.
PayFlex Website offers an
FSA Calculator Tool
PayFlex administers each FSA account. Access the
“FSA Savings Calculator” on www.HealthHub.com
to estimate your expenses and determine a possible
contribution amount. $POTJEFSDBSFGVMMZCFDBVTF
*34SFHVMBUJPOTSFRVJSFUIBUBOZVOVTFEGVOET
SFNBJOJOHJOFJUIFS'4"BDDPVOUCFZPOEUIF
EFBEMJOFEBUFTXJMMCFGPSGFJUFE
)FBMUIDBSF'4"&YBNQMF
DPOUSJCVUJPO
EJWJEFECZ
QBZQFSJPET
QFSQBZQFSJPE
Up to the full contribution
amount is available
immediately upon eligibility.
IMPORTANT
FSA FACTS
t'4"TBSFBOPQUJPOBM
QSFUBYCFOFmUfor
which you must enroll
or re-enroll for each
calendar year in which
you wish to participate.
t/PDIBOHFT can
%FQFOEFOU$BSF'4"
&YBNQMF
DPOUSJCVUJPO
EJWJEFECZ
QBZQFSJPET
QFSQBZQFSJPE
Your per pay period
deduction (including the
ﬁrst $260 which Texas
Children’s contributes
to get you started) is
available for request of
reimbursement upon
your eligibility; for those
expenses actually incurred
and only up to the amount
currently available within
your FSA account.
be made to the FSA
contribution amount
until the next Annual
Enrollment unless you
experience a ‘qualifying
event’ (family or job
status change). Refer to
Making Beneﬁt Changes
(page 6).
t/PUSBOTGFST of
FSA dollars from the
Healthcare FSA to the
Dependent Care FSA or
vice versa are allowed.
t/PSFGVOET of
unused deducted FSA
contribution amounts;
so consider carefully.
Upon termination or a transfer to an ineligible status, what happens to an FSA?
Your participation, in either of the FSA plans, will end on 1) the last day of the pay period containing your last day worked, or
2) your transfer date to an ineligible status. You may continue to ﬁle claims for reimbursement through April 30 of the following
calendar year as long as the expenses were incurred prior to your coverage end date. If you have a positive balance in your
account upon termination and want to be reimbursed for eligible expenses incurred after your Texas Children’s employment
end date, you may continue your healthcare spending account for the remainder of the current year, through COBRA.
3FGFSUPQBHFPGUIJTHVJEFGPS$POUJOVBUJPO$PWFSBHFJOGPSNBUJPO
2013 BENEFITS AND WELLNESS GUIDE
19
FLEXIBLE SPENDING ACCOUNTS
DEPENDENT CARE FSA
For eligible participants who elect to enroll,Texas Children’s will automatically
deposit $260 into the Dependent Care FSA (DCFSA) for your reimbursement of
eligible dependent care expenses as of January 1.
Maximum dependent care contribution
amount based on your tax ﬁling status:
tThe maximum IRS annual contribution amount is
$5,000, minus the $260 from Texas Children’s =
tIf you are married and ﬁle a separate income tax
return: a $2,500 maximum, minus $260 = Eligible dependent care expenses are those that
would qualify for a child care tax credit on your
federal income tax return. You must ﬁle a Form
2411 annually with your tax return identifying all of
your dependent care providers.
Eligible dependents include those
for whom you can claim on your
federal income tax return and…
tDependents under the age of 13
tA dependent who is physically or mentally incapable
of caring for him/herself, has the same principal
residence as you for more than half of the year; and
(if over the age of 13) has less than $3,200 in total
income for 2013; or
Eligible dependent care expenses:
tInclude IRS allowable expenses for dependent care expenses
incurred so you or your spouse are able to attend work. The
exception would be if your spouse is disabled or a full-time student.
Listed below are some eligible expense parameters:
- Care for your dependents while you work
- Bright Horizons copays for interim backup care
- Summer day camp (not overnight)
- Before and after school care
- Nursery school
tMust be for services received after the effective date of the election
and during the plan year in which it applies and for services
rendered; not for future services.
For a more detailed list of allowable expenses,
visit www.HealthHub.com.
How to get reimbursed for dependent care expenses
As you incur eligible dependent care expenses throughout the year,
you can access your funds by submitting a claim for dependent care
via forms available through www.HealthHub.com.
/05&:PVDBOPOMZCFSFJNCVSTFEVQUPUIFBNPVOUDVSSFOUMZ
EFQPTJUFEJOUPZPVS%$'4"BDDPVOU
tA spouse if he/she is physically or mentally incapable
of caring for him/herself, has the same principal
residence as you for more than half of the year, and
has less than $3,200 in total income for 2013.
www.HealthHub.com
GBY
20
TEXAS CHILDREN’S
%FQFOEFOU$BSF'4"o*NQPSUBOU%BUFT
Dependent Care Flexible Spending Account
IRS Deadline Dates
%FQPTJUTNBEFJODBMFOEBSZFBS
NVTUCFVTFEGPSFYQFOTFTJODVSSFE
Jan. 1, 2013 Dec. 31, 2013
'PSDMBJNTJODVSSFEJODBMFOEBSZFBS
DMBJNTTVCTUBOUJBUJPONVTU
CFTVCNJUUFEUP1BZ'MFYCZUIJT
EBUFUPBWPJEGPSGFJUVSFPGVOVTFE
DPOUSJCVUJPOT
April 30, 2014
HEALTHCARE FSA
)FBMUIDBSF'4")$'4"
QFSFNQMPZFFNBYJNVNMPXFSFE
)FBMUIDBSF'4"(SBDF1FSJPE*NQPSUBOU%BUFT
Healthcare Flexible Spending
Account Parameters
IRS Deadline
Dates
Effective January 1, 2013, as a result of healthcare reform
rules, your annual HCFSA election is limited to $2,500.
Deposits made in calendar year 2013
must be used for expenses incurred:
Jan 1, 2013 March 15, 2014
HCFSA Facts:
For claims incurred in calendar year
2013, claims substantiation must
be submitted to PayFlex by this
date to avoid forfeiture of unused
contributions:
April 30, 2014
tYou must contribute a minimum of $5.00 per pay period.
tYou may elect your contribution to an FSA during Annual
Enrollment, when you ﬁrst become eligible, or if you incur a
qualifying event.
tOnce you establish your annual contribution amount, you may
Reimbursement for Orthodontia Treatment
is different and can be handled in one of
three ways:
tEnrollment is required each year in which you wish to participate,
t$PVQPO1BZNFOU0QUJPO - As the services are
tYour total annual contribution amount to the Healthcare FSA is
t.POUIMZ1BZNFOU0QUJPO - Obtain a contract
only change it if you experience a change in status. (Refer to
Making Beneﬁt Changes on page 6).
because your previous contribution election or any remaining
amounts do not carry over from year to year.
available to you as of January 1.
tContributions are not taxable.
tExpenses may be for yourself and/or your eligible dependents,
whether or not they are covered under the Texas Children’s
Select Plan (medical, dental or vision).
tExpenses must be incurred during a period in which you are
covered under the Healthcare FSA.
)PXUPHFUSFJNCVSTFEGPSIFBMUIDBSFFYQFOTFT
As you incur healthcare expenses, you can access your funds
(for payment of eligible healthcare expenses only) by using your
PayFlex MasterCard or you can get reimbursed after you have paid
by submitting a claim form, available through the PayFlex website
at www.HealthHub.com.
Healthcare FSA Grace Period
The Healthcare FSA Grace Period includes an extended period of
coverage at the end of every plan year that allows you extra time to
incur expenses to use your remaining Flexible Spending Account
balance and avoid forfeiture of any remaining contribution dollars.
Provided you ﬁle by the Grace Period deadline, all FSA claims (for
services provided during the grace period) will automatically be
processed towards the previous plan year‘s balance ﬁrst, unless
you request otherwise through PayFlex. Claim amounts in excess
of the available funds from the previous plan year, will automatically
be applied to the new plan year; therefore, no action on your part
is required.
provided, submit an itemized statement of your
orthodontia expenses.
agreement from the orthodontist showing the patient
name, the date the service begins and the length
of service, charges for the initial banding work and
the dollar amount charged each month. To eliminate
the need to submit a claim every month, submit
your contract with your ﬁrst claim and PayFlex will
automatically reimburse you each month, according
to the contract you provided to PayFlex. To continue
reimbursements into the next year, you would need to
1) be enrolled in the HCFSA plan, and 2) send a new
claim form to PayFlex, along with the same contract
agreement, at the beginning of the next plan year.
t5PUBM1BZNFOU0QUJPO - If you paid the entire
balance when services began, ﬁle a one-time claim
with a copy of your paid receipt and an itemized
statement showing the provider name, patient name,
date treatment started, dollar amount and amount
your insurance will pay.
www.HealthHub.com
GBY
2013 BENEFITS AND WELLNESS GUIDE
21
FLEXIBLE SPENDING ACCOUNTS
HEALTHCARE
FSA
EXPENSES
ELIGIBLE:
(include but are not limited to
the following):
tDeductibles and
The Beneﬁts of a HealthHub MasterCard for HCFSA Expenses
tImmediate payment of your expenses from your Healthcare FSA
tConvenience and ease of use of your pre-tax contributions
tNo claim ﬁling, with point-of-sale approval (unless substantiation is needed)
How the
HealthHub MasterCard Works
As you incur eligible healthcare
expenses, simply present your HealthHub
MasterCard for payment instead of paying
by check or cash. The PayFlex system will
validate that you have funds available to
cover the transaction and automatically
deduct the amount from your HealthHub
account.
6TJOHUIFDBSEGPSPUIFSPOMJOF
QVSDIBTFTThrough HealthHub’s
consumer center, you can buy items (such
as glasses, contacts, prescription drugs,
and durable medical equipment) using
your HealthHub MasterCard. If an item is
identiﬁed as “not eligible”, another form of
payment will be needed.
HealthHub MasterCard Facts
tCard is mailed to your home address in
a plain white envelope
tSelect ‘credit’ when paying for an FSAallowable purchase
tActivation of your PayFlex card will
occur upon your ﬁrst use
tCards remain active for up to 5 years
tCall to replace a lost or stolen card
tRespond promptly to any Request for
Documentation letters
t4BWFSFDFJQUTBOE&YQMBOBUJPOPG
#FOFmUT&0#T
GPSEPDVNFOUBUJPO
22
TEXAS CHILDREN’S
4VCTUBOUJBUJPOBOESFRVFTUT
GPSEPDVNFOUBUJPO
IRS regulations require that you provide
appropriate documentation to verify
that the card was used to purchase an
eligible item or service. *GZPVSFDFJWF
B3FRVFTUGPS%PDVNFOUBUJPOMFUUFS
GSPN1BZ'MFYBOEEPOPUSFTQPOE
XJUIJOEBZTPGUIFSFRVFTUZPVS
DBSEXJMMCFEFBDUJWBUFEVOUJMZPV
QSPWJEFUIFSFRVFTUFEEPDVNFOUBUJPO
PSSFQBZNFOUUP1BZ'MFYGPSBOZ
VOTVCTUBOUJBUFEBNPVOUT
Three options to respond to
requests for substantiation:
1. For the transaction(s) listed within your
Request for Documentation letter,
submit an Explanation of Beneﬁts (EOB)
or itemized receipt; or
2. Submit an EOB or itemized receipt for
another ‘eligible’ item incurred during
the calendar year that has not already
been submitted for reimbursement; or
3. If you are unable to provide the
requested documentation, send a
personal check or money order to
PayFlex in the amount of the identiﬁed
expense.
copayments for the medical,
dental, prescriptions and
vision plan
tOrthodontia or other non-
cosmetic dental expenses
beyond the maximum
amount reimbursed by the
dental plan
tEyeglasses and contact
lenses not covered by the
VSP or other vision plan
tMedical supplies, crutches
and wheelchairs
tSmoking cessation
programs and prescription
drugs to alleviate nicotine
withdrawal
tFees for psychological
services
tDentures
INELIGIBLE:
tOver the counter drugs/
medications (unless
prescribed by a physician)
tProducts considered
‘beneﬁcial but not required’,
such as vitamins, dietary
supplements, cosmetic
treatments, teeth bleaching
and supplies are considered
ineligible.
'PSBGVMMMJTUJOHWJTJU
www.HealthHub.com
For questions, call
LIFE INSURANCE AND AD&D
LIFE INSURANCE AND AD&D
THROUGH PRUDENTIAL
With Basic Term Life and Accidental Death and Dismemberment (AD&D)
Insurance, your family will be protected with benefits and a variety of support
services designed to help them cope with both emotional and financial issues.
Basic Term Life and Basic AD&D – Provided at no cost to you
Texas Children’s automatically provides full- and part-time employees with Basic Life coverages equal to your annual base salary,
rounded to the next $1,000 to one million maximum. If you are terminally ill, you can get a partial payment of your group life
insurance beneﬁt. Payment of premium can be waived if you are totally disabled for six months, you are less than 60 years old
when the disability begins, and you continue to be totally disabled. This waiver terminates at age 65. The amount of insurance
reduces by 35% at age 65 and 50% at age 70 and 70% at age 75. Coverage will end on 1) the last day of the pay period
containing the last day worked, or 2) your transfer date to an ineligible status.
Optional Employee Life Insurance
Optional Employee
AD&D Insurance
You may add to your Basic Life and Basic AD&D Insurance amount by purchasing
Optional Life Insurance coverage in increments of your salary.
t'VMMUJNFFNQMPZFFTOne to four times your annual base salary, rounded to the next
thousand, up to a combined Basic and Optional Life maximum of $2,000,000.
t1BSUUJNFFNQMPZFFTYour annual base salary, rounded to the next thousand,
up to a combined Basic and Optional Life maximum of $1,000,000.
The guarantee issue amount for Optional Life Insurance is $500,000. If you elect an
amount over the guarantee issue amount, are requesting an increase in your current
coverage, or if you did not enroll when it was originally offered to you, an Evidence of
Insurability Form must be completed and approved by Prudential before the coverage
becomes effective.
You may add to your Basic Life
and Basic AD&D Insurance
amount by purchasing
Optional AD&D Insurance
coverage in increments of your
salary.
t'VMMUJNFFNQMPZFFT
1SPWJEFEZPVBSFBGVMMUJNFFNQMPZFFBOEIBWFFMFDUFE0QUJPOBM-JGF*OTVSBODF
GPSZPVSTFMGZPVNBZBMTPFMFDUPQUJPOBMDPWFSBHFTGPSZPVSTQPVTFBOEPS
EFQFOEFOUDIJMESFO
Optional Spouse Life Insurance
Coverage for your spouse is available up to the optional amount of coverage you elected
or $100,000, whichever is less.
The guarantee issue amount for Optional Spouse Life insurance is $25,000. If you elect
an amount over the guarantee issue amount, are requesting an increase in your spouse’s
current coverage, or if you did not enroll your spouse when it was originally offered to you,
an Evidence of Insurability Form must be completed and approval secured from Prudential
before the coverage becomes effective.
One to four times your
annual base salary, rounded
to the next thousand, up
to a combined Basic and
Optional AD&D maximum of
$2,000,000.
t1BSUUJNFFNQMPZFFT
Your annual base salary,
rounded to the next
thousand, up to a combined
Basic and Optional AD&D
maximum of $1,000,000.
No Evidence of Insurability
Form will be required.
Optional Dependent (Child) Life Insurance
You may also choose to purchase Optional Life Insurance protection for your eligible
children, live birth to age 26, in the amount of $2,500, $5,000 or $10,000.
2013 BENEFITS AND WELLNESS GUIDE
23
LONG TERM DISABILITY
LONG TERM DISABILITY
THROUGH PRUDENTIAL
Long Term Disability (LTD) insurance is designed to protect you and your family
from the financial hardship that may accompany an extended personal illness or
injury that prevents you from working for an extended period of time.
Basic LTD Insurance – Provided at no cost to you
Optional Buy-up LTD Insurance
As part of your Total Rewards package Texas Children’s
provides LTD insurance to full-time employees, as protection in
the event you become disabled and cannot perform the duties
of your occupation. You will receive Long Term Disability beneﬁts
after a 90-day elimination period.
Full-time employees may also purchase additional LTD
insurance through Prudential. Contributions are taken on a
post-tax basis so that in the event you become disabled,
your beneﬁt would not be taxed.
#BTJD-5%#FOFmU50% of your monthly earnings up to a
maximum monthly beneﬁt of $5,000.
#VZVQ-5%#FOFmU 70% of your monthly earnings up
to a maximum monthly beneﬁt of $10,000.
0QUJPOBM#VZVQ-5%#FOFmU
Beneﬁts will be paid for up to two years if you meet the deﬁnition
of disability. Beneﬁt reductions will occur at age 65. Your beneﬁt
will be reduced by amounts you receive from Social Security, an
employer-sponsored retirement plan and other group disability
beneﬁts.
To apply for beneﬁts, the Long Term Disability Claim Form,
available on the Prudential website, must be completed by you,
your doctor and Texas Children’s.
AGE ON DATE
OF DISABILITY
MAXIMUM
BENEFIT DURATION
-FTTUIBO
MFTTUIBO
BOEPWFS
24 months
to age 70
12 months
AGE ON DATE
OF DISABILITY
MAXIMUM
BENEFIT DURATION
-FTTUIBO
To Social Security
normal retirement age
60 months
48 months
42 months
36 months
30 months
24 months
21 months
18 months
15 months
12 months
60
61
62
63
64
66
67
68
BOEPWFS
.BYJNVN.POUIMZ-5%#FOFmU
Cost is based on an individual’s age and salary.
PLAN
www.prudential.com
tDisability Claims:
tDisability Tax Questions: 24
TEXAS CHILDREN’S
#BTJD
#VZVQ
MONTHLY
BENEFIT
MONTHLY
MAXIMUM
50%
70%
$5,000
$10,000
Long Term Disability Facts
tYou may be asked to explore disability beneﬁts
through Social Security.
tYou may continue your medical, dental and
vision coverage and, in some cases Healthcare
FSA under COBRA within 60 days of your
termination date.
tYou may also apply for portability or conversion
of your life insurance within 30 days from your
termination date.
tYou may be eligible for a waiver of your premium if both of the
following apply:
- you are deemed totally disabled while you are a covered person,
BOE
- you are less than age 60 when your total disability starts.
t:PVS-5%CFOFmUTXJMMCFSFEVDFECZ
1. Social Security beneﬁt
2. Workers’ Compensation beneﬁt
3. Any beneﬁts paid to you under the Texas Children’s Cash Balance
Pension Plan
Other Beneﬁts through Prudential
/PDPTU8JMM1SFQBSBUJPO
Texas Children’s full- and part-time employees have access
to the Estate Guidance program offered through ComPsych
which allows you the ease and simplicity of online legal
document preparation, such as a will. A will ensures that
your assets are distributed in accordance with your wishes,
should something happen to you, and allows you to name an
executor and a guardian to take care of your minor child(ren).
Additionally, (for a fee), you also have access to create a
credit shelter trust, a living will, and a healthcare power of
attorney. Simply go to www.estateguidance.com and enter
your Texas Children’s Web ID: &(1.
"9"5SBWFM"TTJTUBODF1SPHSBN
This service offers you and your dependents worldwide
medical, travel, legal and ﬁnancial assistance services,
24 hours a day, 365 days a year. When faced with an
emergency while traveling internationally (or domestically
when more than 100 miles away from home for up to 120
consecutive days). You and your dependents, whether
traveling together or separately, will have immediate access
to a broad range of services.
t64OVNCFS1-800-565-9320
t*OUFSOBUJPOBMMZ 001-312-935-3654 (collect)
www.prudential.com
tControl number: 005068
tCustomer Service: tLife Claims: tLife Conversion: tMedical Underwriting: tPortability Unit: 2013 BENEFITS AND WELLNESS GUIDE
25
COMMUTER
COMMUTERBENEFITS
BENEFITS
EMPLOYEE PARKING
AND TRANSPORTATION
For almost a decade Texas Children’s has been recognized as one of
Houston’s Best Workplaces for Commuters by the U.S. Environmental
Protection Agency. Additionally, Texas Children’s was designated a Clean
Air Champion by the Houston – Galveston Area Council.
Outstanding Commuter Beneﬁts
tNo-cost off-campus parking
tNo-cost shuttle service
tNo-cost METRO bus passes
tNo-cost Woodlands Express / Fort Bend
Express booklets/passes
tVanpool subsidy up to $75/month
tAvailability of Texas Medical Center (TMC)
covered bike racks
t0QUJPOUPXBJWFDPNNVUFSCFOFmU
Employees in the Texas Medical Center
or Greenway Plaza who waive their
commuter election option receive a
monthly allowance of $20.
Flexibility To Change Your Commuter Election
Month-to-Month
tEach employee can hold only one election at a time.
tCommuter election changes become effective on the ﬁrst day of the
following month.
tEmployees may access the Transportation Change Form via:
Connect > HR > Commuter Beneﬁts
$PNQMFUFB5SBOTQPSUBUJPO$IBOHF'PSNBUFJUIFSPGUIFTF
)3MPDBUJPOT
tHR Service Center - Abercrombie Building, 1st ﬂoor, Suite A -130
tMeyer Building – Beneﬁts, 3rd ﬂoor
Please read and review the speciﬁc details related to your Texas Children’s
commuter beneﬁts as outlined on CONNECT and within Policy #HR212.
Call the Total Rewards Mainline at 832-824-2421 (option 1) should you have
questions.
0ODFB5FYBT.FEJDBM$FOUFS5.$
QBSLJOHHBSBHFDBSEIBTCFFO
JTTVFEDBMMXJUIDBSESFMBUFEFOUSBODFPSFYJUJTTVFT
26
TEXAS CHILDREN’S
RETIREMENT & SAVINGS PLANS
RETIREMENT & SAVINGS PLANS
Texas Children’s retirement benefits are designed to help you build a
solid financial foundation for your retirement years.
DEFINED BENEFIT PENSION PLAN ADMINISTERED THROUGH MERCER
Texas Children’s Cash Balance Pension Plan
The Cash Balance Pension Plan (CBPP) is an amazing Texas
Children’s beneﬁt that complements our 403(b) Savings Plan to
create a well-rounded overall retirement package. The CBPP
is a deﬁned-beneﬁt retirement fund that does not require any
employee contributions because Texas Children’s pays the full
cost of this retirement beneﬁt for you!
/PFOSPMMNFOUOFDFTTBSZ
Once the eligibility requirements are fulﬁlled (age 21 and one year
of participation service), Texas Children’s automatically enrolls
employees on the next entry date, April 1 or October 1 – no
paperwork is required!
:PVSBDDPVOUCBMBODFHSPXTJOUXPXBZT
First, Texas Children’s credits your account with 3-5% of your
base salary each year, depending upon your years of service (see
the following page for details). Second, Texas Children’s credits
your account with at least 3.8% interest each year, meaning that
your account balance does not decrease!
&YBNQMFTPGBDDPVOUBDDVNVMBUJPO
The following table shows what your CBPP account balance
would be after 10, 20, 30, or 40 years of service if you joined
Texas Children’s at an annual salary of $30,000, $45,000, or
$60,000.
www.ibeneﬁtcenter.com
BNQN
tUser ID: Your Social Security number
tPassword: Your date of birth (MMDDYY)
The numbers below assume a 2.0% merit increase each
year and the minimum 3.8% interest credit.
1SPKFDUFE
$#11#BMBODF
10 years of service
20 years of service
30 years of service
40 years of service
"//6"-4"-"3:
$12,536
$18,805
$25,073
$41,411
$62,116
$82,822
$88,419 $132,629 $176,839
$162,872 $244,308 $325,744
Mercer’s website, ^^^PILULÄ[JLU[LYJVT, has some
useful tools that allow you to estimate your pension balance
using various assumptions, view your current balance, and
add, update, or verify beneﬁciary information. You can also
reach the Pension Plan Support Team at 1-800-752-8230,
Monday – Friday from 8 a.m. - 5 p.m.
DEFINED CONTRIBUTION SAVINGS PLAN
ADMINISTERED THROUGH FIDELITY
For an outline of the
beneﬁt provisions...
Texas Children’s Hospital 403(b) Savings Plan
Texas Children’s will match up to 50% of
the ﬁrst 6% of your per pay period
contribution. You may enroll in this plan at
anytime throughout the year by contacting
Fidelity at 1-800-343-0860 or online at
O[[WZ!^^^ÄKLSP[`JVTH[^VYR.
Monthly one-on-one sessions, with a Fidelity
Planning and Guidance representative, are
held at various locations to provide current
participants the opportunity to evaluate the
status of their 403(b) Savings Plan account,
consider modiﬁcations and make changes
as needed. Registration is required for a
30-minute consultation.
Call Fidelity at 1-800-642-7131 after the
20th of the month to schedule an
appointment for the following month.
You may also schedule online at
^^^ÄKLSP[`JVTH[^VYRYLZLY]H[PVUZ.
Review the charts on
the following pages
for each of the Texas
Children’s retirement
plans referenced. Refer
to the Summary Plan
Descriptions (available
on Texas Children’s
Connect/Human
Resources/Beneﬁts) for
speciﬁc details.
2013 BENEFITS AND WELLNESS GUIDE
27
CASH
C
ASH BALANCE
BALANCE PENSION
PENSION PLAN
PLAN
CASH BALANCE PENSION PLAN
Plan
Design
Texas Children’s Cash Balance Pension Plan is a non-contributory (employer only contributions) deﬁned beneﬁt retirement plan.
tYou do not need to enroll.
tNo employee contributions are required. Texas Children’s funds the full cost of this beneﬁt.
Plan
Administrator
Pension Committee
ATTN: HR Beneﬁts, 1919 S. Braeswood, Suite MB-1301, Houston, TX 77030
832-824-2421 (option 1 for Beneﬁts).
9LJVYKRLLWLY
Mercer, 1-800-752-8230
^^^PILULÄ[JLU[LYJVT
Eligibility
You will be eligible for the Cash Balance Pension Plan after you meet the following criteria:
tYou must be at least 21 years of age
tYou must work 1,000 or more hours during the 12 month period following your initial date of hire, or any subsequent plan year.
Once you meet these requirements, you will automatically enter the plan coincident with or the next following April 1 or October 1.
Enrollment
tYou are enrolled automatically once you meet all eligibility criteria.
tNormal retirement is age 65
tEarly retirement is age 55 with 10 or more years of Vested Service.
Retirement
Eligibility
Employer
Contributions
Contribution
If you complete at least 1,000 hours of Service in a Plan Year (Oct. 1 Sept. 30), Texas Children’s will credit you with a contribution in the Cash
Balance Pension Plan calculated as a percentage of your Plan Year
base compensation. The applicable percentage is based on your full
years of Vesting Service, as of the end of such Plan Year, as follows:
3% . . . . . . . . . . . . . .less than 5 years
4% . . . . . . . . . . . . . . . . 5 to 9 years
5% . . . . . . . . . . . . . 10 or more years
Employee
Contributions
tEmployee contributions are not permitted.
tThis is a non-contributory deﬁned beneﬁt retirement plan for employees.
Vested Year
of Service
Your Vesting Service is one year of service for each ﬁscal year (Oct. 1 – Sept. 30) in which you complete 1,000 or more Hours of Service.
Vesting
Schedule
tOnce you have three ﬁscal years of Vesting Service, you are 100% vested.
tBeing vested means the employer paid beneﬁt in your account is yours upon normal or early retirement or termination of employment,
Interest credits
At the end of each Plan Year, participants will be credited with
interest on such Plan Year’s opening balance.
Interest credits are:
1) Based on the interest crediting rate as deﬁned in the Plan, and
2) In no event will the interest crediting rate for a Plan Year be
less than 3.8% or more than a “market rate of return” (within
the meaning of Section 411(b)(5) of the Code and Section
204(b)(5) of ERISA).
if your account balance is less than $7,000.
Termination/
Retirement
If you leave and are 100% vested, and if your CBPP account balance is:
t$5,000 or less, you must take a lump sum distribution (cash payment and/or a rollover)
t$5,000 to $7,000, you have the following early distributions options: an annuity or a lump sum /rollover
t$7,000 or more, you must wait until age 65 (Note: With 10 or more years of Vesting Service, you may exercise distribution options as
early as age 55).
Statement
Participants can receive statements online by accessing your personal account information through Mercer’s website at
Beneficiary
Designation
and Changes
tChanges are allowed at any time and do not require a qualifying life event.
tParticipant employees should go online to ^^^PILULÄ[JLU[LYJVT to designate or update beneﬁciary information.
^^^PILULÄ[JLU[LYJVT
56;,!0M`V\HYLTHYYPLKHUK^PZO[VKLZPNUH[LHU`VULV[OLY[OHU`V\YZWV\ZLHZWYPTHY`ILULÄJPHY``V\T\Z[
complete a Spousal Consent Form which must be notarized.
28
TEXAS CHILDREN’S
403(b) SAVINGS PLAN
The 403(b) savings plan is a voluntary deﬁned-contribution retirement plan which allows you to save for retirement on a tax-deferred basis.
tEmployees must enroll to participate.
tYour 403(b) contribution is taken directly from your paycheck before taxes.
Pension Committee
ATTN: HR Beneﬁts, 1919 S. Braeswood, Suite MB-1301, Houston, TX 77030
832-824-2421 (option 1 for Beneﬁts)
9LJVYKRLLWLY
Fidelity Investments, 1-800-343-0860
^^^ÄKLSP[`JVTH[^VYR
tYou may begin participating on the ﬁrst day of your Texas Children’s employment or at any time thereafter.
tTo enroll in the Plan, contact Fidelity at 1-800-343-0860 or online at ^^^ÄKLSP[`JVTH[^VYR.
tThere is no retirement age requirement for you to begin drawing beneﬁts; however, you must no longer be employed by Texas Children’s to initiate this beneﬁt.
Texas Children’s contributes to your 403(b) savings plan account every pay period you make a contribution.
tTexas Children’s will match up to 50% of the ﬁrst 6% of your per pay period contribution.
tThe maximum per pay period employer contribution is the lesser of 3% of your gross salary or 50% of your contribution.
For example:
Your Contribution Texas Children’s Matching Contribution
4% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2%
6% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3%
10% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3%
tThrough Fidelity, you elect the pay period percentage of your gross earnings to be deducted on a pre-tax basis.
tYou do not pay Federal income tax on your investment in your 403(b) account until you withdraw the money.
tThe maximum contribution amounts for 2013 calendar year are: $17,000, or $22,500 if 50 years of age or more.
These amounts are subject to change as determined and when released by the IRS.
tAge 50 or older “Catch-up Provision”: if you are going to reach age 50 or older during the calendar year (Jan. 1 – Dec. 31) and you contribute the IRS maximum
annual contribution, you may make an additional (catch-up contribution) of up to $5,500.
Your Vesting Service is one year of service for each ﬁscal year (Oct. 1 – Sept. 30) in which you complete 1,000 or more Hours of Service.
tYou are always 100% vested in any contributions you make to the plan.
tYou are vested in the contributions made by Texas Children’s according to the following
schedule.
1) When you have worked at least 1,000 hours or more in a ﬁscal year (Oct. 1 – Sept. 30) and
2) You have earned one year of Vested Service
@LHYZVM=LZ[PUN:LY]PJL
You will be
Less than 1 year. . . . . . . . . . . . . . . . . . . . . 0% vested
1 year, but less than 2 . . . . . . . . . . . . . . . . 20% vested
2 years, but less than 3 . . . . . . . . . . . . . . . . 40% vested
3 years, but less than 4 . . . . . . . . . . . . . . . . 60% vested
4 years, but less than 5 . . . . . . . . . . . . . . . . 80% vested
5 years . . . . . . . . . . . . . . . . . . . . . . . . 100% vested
At any time after you leave employment with Texas Children’s:
tYou may take 100% of your voluntary contributions.
tIf you are 100% vested, you may also take 100% of the Texas Children’s Matching Contributions
tIf you have less than ﬁve years of Vesting Service, you may take the vested portion of the Texas Children’s Matching Contributions.
tTax implications, at time of distribution, may apply.
You can receive statements online by accessing your personal account information through Fidelity’s website at ^^^ÄKLSP[`JVTH[^VYR.
To request paper statements call 1-800-343-0860.
tChanges are allowed at any time and do not require a qualifying life event.
tParticipant employees should go online to ^^^ÄKLSP[`JVTH[^VYR to designate or update beneﬁciary information.
56;,!0M`V\WHY[PJPWH[LPU[OLIWSHUHYLTHYYPLKHUK^PZO[VKLZPNUH[LHU`VULV[OLY[OHU`V\YZWV\ZLHZWYPTHY`ILULÄJPHY``V\
must complete a Spousal Consent Form which must be notarized.
2013 BENEFITS AND WELLNESS GUIDE
29
WORK/LIFE BALANCE
BALANCING WORK,
HOME AND FAMILY
To bring balance to your work and family life, Texas Children’s provides
you with a generous Paid Time Off (PTO) bank which can be used for
vacation, holidays, personal reasons, severe weather emergencies, family
illnesses, and/or a short-term personal illness.
Paid Time Off (PTO)
Extended Illness Bank (EIB)
A generous Paid Time Off (PTO) Program provides eligible
full- and part-time employees time off from work for personal
or family needs and rewards employees for coming to work
and for scheduling time off in advance. Additionally, and after
two consecutive days off work for illness or injury, eligible
employees may then access their accrued Extended Illness
Bank (EIB) which provides you with another source of paid
hours.
In addition, you earn EIB hours which can be used in the
event of an illness.
1BZPVUPGZPVS150CBMBODFBVUPNBUJDBMMZ
PDDVSTXIFO
tYou terminate employment with Texas Children’s, or
tYour classiﬁcation changes to a per diem status
Holidays
You have six holidays per year:
tNew Year’s Day
tMemorial Day
tFourth of July
tLabor Day
tThanksgiving
tChristmas Day
Texas Children’s Paid Holidays Plus “My Day”
5PWJFX150"DDSVBM4DIFEVMFTSFGFSUP
)31PMJDZ)3"5$)5$)1
BOE)3#5$1
“My Day” is an additional annual paid holiday that full- and
part-time employees get to choose!
PTO Sell Program
Other Types of Time-Off and
Corresponding HR Policies
Via MOLI / Total Rewards / Compensation / ePTO Sell
While employees are not discouraged from taking earned
time off, employees with at least 120 hours of accrued
PTO have the option to sell a block of hours back to Texas
Children’s and be paid for the value of those hours. A total
of 80 hours may be sold at one time or 40 hours of PTO
may be sold twice per calendar year provided the eligibility
requirement is met.
30
TEXAS CHILDREN’S
tFamily Medical Leave (FML) - HR214
tFMLA Deﬁnitions - HR214A
tHolidays / MY Day - HR203
tBereavement - HR204
tJury Duty - HR206
tTime Off to Vote - HR207
tMilitary - HR205
tCatastrophic Time Off (CTO) - HR202
tOther Leaves of Absence - HR208
INTERIM BACKUP CARE FOR INFANTS TO ELDERS
When you need to be at work, but your regular child or family care needs
and arrangements are disrupted, you have options through The Bright
Horizons Backup Care Advantage® Program.
For many years now, Texas Children’s has partnered
with Bright Horizons and subsidized the majority
of the cost of this beneﬁt for those circumstances
when your primary care-giver is on vacation,
becomes ill, or experiences a family emergency, or
when your children are out of school.
Care extends to loved ones who do not live in your
home but for whom you would otherwise miss work
to care for.
This national provider network requires background
checks and CPR training for staff members at all:
t$FOUFSCBTFE$IJME$BSF$FOUFST
Available close to work or close to home
t*O)PNF$BSFBOE/BOOZ"HFODZ3FTPVSDFT
Back-Up Care Advantage® Program
Full- and part-time Texas Children’s employees can utilize 80 hours of
care per calendar year. Copay amounts will occur via payroll deduction
as a ‘BUCARE’ deduction approximately 30-60 days after utilization of
services. Unused allowable care hours will not roll from one calendar
year to another.
:PVSDPQBZDPTUT
t$FOUFS#BTFE$BSF $2 copay per hour per child
t*OIPNF$BSF $4 copay per hour per child or family member
Costs above reﬂect copay for up to 3 individuals.
If scheduled care is no longer needed, reservations must be cancelled
through Bright Horizons before 5 p.m. the business day prior to
scheduled care to avoid being charged copays for unused services.
Care available: days, nights and weekends
To pre-register or schedule care, call 1-877-242-2737
For more details, visit the Bright Horizons website: ^^^IHJR\WIYPNO[OVYPaVUZJVT
tUser Name: TexasChildrens t Password: backup1
2013 BENEFITS AND WELLNESS GUIDE
31
Everyone’s a Recruiter Now — E.A.R.N. Program
Service Recognition and Employee Celebrations
This referral reward program offers potential dollars to eligible
employees for qualiﬁed applicants who are hired and begin
employment. Certain requirements apply. For questions,
call HR Recruitment at 832-824-2020 or visit the Connect
website for details.
Texas Children’s values people, their contributions,
dedication and commitment to our patients, and to one
another. Several employee programs, designed speciﬁcally
to acknowledge, reward and celebrate individuals, include:
Adoption Assistance Program
Texas Children’s adoption assistance beneﬁt provides
reimbursement of eligible adoption expenses to full- and
part-time employees who meet the following criteria:
thave completed three months of ‘continuous’ service, and;
tthe adopted child is not your biological child or stepchild.
3FJNCVSTBCMF"EPQUJPO&YQFOTFT
Once the adoption is ﬁnal and for only expenses incurred
after you become eligible for adoption beneﬁts, up to $3,000
may be reimbursed for eligible expenses:
tLegal fees and court costs
tPlacement fees
tTravel expenses incurred (for one of the adopting parents
or a guardian) to escort the child
A written request for reimbursement must be submitted
to HR Beneﬁts while you remain an active, eligible Texas
Children’s employee.
Ticket & Event Discounts
Employees can enjoy savings on such things
as movie tickets, seasonal events, cell phone
memberships and more. New or enhanced
discounts are communicated through the monthly
online HR Dialogue!
Find discount codes, links, prices and more via:
Connect/Human Resources/Discount Directory
Payment is made via Payroll Deduction, except
when an online link is provided for credit card
purchases.
32
TEXAS CHILDREN’S
t/FX&NQMPZFF3FDFQUJPOT
t4FSWJDF1JOT based on employment service: 1, 5, 10, 15,
20, 25, 30 years, etc.
t1MBUJOVN$MVC.FNCFSTEmployees with 25 or
more years of Texas Children’s employment service are
offered VIP parking privileges in Garage 19, an invitation to
an annual retirement and savings-focused dinner, as well
as other periodic events.
t4VQFS4UBSBOE4FSWJDFXJUI)&"35 Recipients
of these awards are nominated by others for their
commitment to excellence and exceptional customer
service and are formally recognized at the annual
Employee Recognition Celebration.
t&NQMPZFF3FDPHOJUJPO$FMFCSBUJPOEmployees of
long-tenure are celebrated at an annual luncheon event
and presented with a specially selected gift awarded by
Executive leadership and presented with a certiﬁcate of
appreciation for dedication and service.
Team Sports Subsidy
'PS'JUOFTT'VOBOE'SJFOEMZ5FBN4QJSJU$PNQFUJUJPO
Application & Waiver (consent) forms can be found on
the HR webpage of CONNECT for those Texas Children’s
employees who wish to play a league sponsored sport and
start up their own Texas Children’s Team. League registration
fees (up to $600 per ﬁscal year) can be paid to the league
provided at least half of the players on the team are active,
beneﬁts-eligible Texas Children’s employees. (HR Policy
#HR213 and #HR213A).
EMPLOYEE EDUCATION AND DEVELOPMENT
SUPPORT & RESOURCES
FOR YOUR GOALS
8IBUJTJODMVEFEXJUIJOBOBEWJTJOHTFTTJPO
Employee Training and Development
Through The Learning Academy
tAssessment of prior learning and work experience to
For information about staff, clinical and leadership trainings,
visit The Learning Academy CONNECT website or email
[email protected].
tCareer counseling and skills assessment to help you
reduce time and save you money
determine best ﬁt for course of study
tDetermining best value programs and schools that align
with your academic objectives
EdAssist: A Specialist in Education Advising
for Adult Learners
tDiscovering which learning environment (online or
$PMMFHF&EVDBUJPO"EWJTJOHGPS&NQMPZFFT
"ENJOJTUFSFECZ&E"TTJTU
This employee beneﬁt provides no-cost college career
assessment and coaching to help employees navigate the
obstacles toward degree completion in the quickest, most
efﬁcient manner.
tAssistance in navigating the various college admissions
on-campus/one course or more, etc.) is suited for an
individual based on current or upcoming work schedule
and family obligations
and ﬁnancing processes
8IP$BO#FOFmU.PTUGSPN6UJMJ[JOH5IFTF4FSWJDFT 1) Employees considering a college degree (Associates,
Bachelors)
2) Employees considering re-entering the college sector
to ﬁnish their ﬁrst degree or seeking to begin a higher
degree (Bachelors, Masters, etc.)
3) Employees currently taking courses, in a stop and
start pattern, who want to speed through to degree
completion.
6TFUIJTBEWJTJOHCFOFmUBTBmSTUSFTPVSDF
n
Scheduling an education coaching session before you begin
e
the tuition assistance program application process can save
you valuable time and money.
"CPVUUIF/P$IBSHF1IPOF"EWJTJOH4FTTJPOT
tEach session is unique and customized
t30-45 minutes per session
tMultiple appointments may be scheduled to help you
achieve your target outcome
Let EdAssist Do the Upfront Work For You!
Call Monday – Friday,
7 a.m. – 7 p.m. for general information or to
schedule a no-charge advising session.
2013 BENEFITS AND WELLNESS GUIDE
33
Texas Children’s (College) Tuition Assistance Program (TAP) – Administered by Edlink®
Full- and part-time employees can utilize this beneﬁt
to subsidize the cost of college credit courses at an
accredited university and for a course of study that would
be of beneﬁt to you in a Texas Children’s role. For details
of how to maximize this degree-focused employee beneﬁt,
employees should read the Frequently Asked Questions
on the Connect or EdLink website prior to completing an
online application with EdLink.
"OOVBM"MMPXBCMF.POFUBSZ4VQQPSU$BQ-JNJU
#BTFEPO&NQMPZFFT5FYBT$IJMESFOT4UBUVT
tFull-time employees: $2,500/calendar year
tPart-time employees: $1,500/calendar year
Unutilized annual allowable CAP dollars do not carry over
from year to year. Covered expenses (tuition, fees and
required books) will be counted toward the annual cap
limit, based on the year in which the course begins.
&YQFOTFTBOE'FFT/PU$PWFSFE*ODMVEF
Continuing Education Units (CEUs), certiﬁcations (prep,
testing or renewals), deferred payment fees, evaluation
(prior learning assessment), ﬁnance charges, GMAT, GRE,
SAT, late fees, parking fees, graduation fees and alumni
fees.
Important TAP Tips
tSubmit proof of course completion (grades) to
EdLink within six weeks of course end date to
remain eligible.
0/-*/&"11-*$"5*0/45&14
4UFQ56*5*0/"11-*$"5*0/
Complete a single online tuition application for up to
three courses (provided all courses have the same or
very similar start and end dates).
8IJDIUZQFPGUVJUJPOBQQMJDBUJPO
UPTVCNJUBOEXIFO
It is important to submit the appropriate type of
application based on timeframes, since a PrePay application cannot later be changed to a
Reimbursement application.
t Submit a 5VJUJPO1SF1BZ application only if you
can apply two to six weeks prior to course start
date or the date by which your school requires
guarantee of payment.
t Submit a 5VJUJPO3FJNCVSTFNFOU application if
you have already paid for the course(s) or if you
decide to enroll in a course less than two weeks
from the course start date or the date by which
your school requires full payment.
4UFQ#00,3&*.#634&.&/5"11-*$"5*0/
Policy allows for reimbursement (to the employee)
of required (not recommended) books. After you
have purchased your book(s) and upon approval of
the corresponding tuition application, click onto that
application number and the option to click on Book
Reimbursement will appear. Documentation will be
required before the book application review process
will begin. Upload or fax your course syllabus, as well
as book store receipts to EdLink.
tReimbursement requests (tuition or books) must
be submitted to EdLink within six weeks from the
course end date.
tIf you change or drop a course, notify EdLink
immediately at ;*/'LKSPUR[\P[PVUJVT, since the
program allows approval for payment for each
course only once.
EdLink Contact Information
tApplication website:
http://tamsonline.org/TCH
tEmail application inquiries to
;*/'LKSPUR[\P[PVUJVT (allow 24 hours for response)
tFAX required documentation to: tEdLink Customer Service: 34
LEGAL NOTICES / YOUR RIGHTS
Pre-existing Condition Clause - PPO Plan only
This plan imposes a pre-existing condition exclusion. This
means that if you have a medical condition before coming to
our plan, you might have to wait a certain period of time before
the plan will provide coverage for that condition. This exclusion
applies only to conditions for which medical advice, diagnosis,
care, or treatment was recommended or received within a
3-month period. Generally, this 3-month period ends the day
before your coverage becomes effective. However, if you were
in a waiting period for coverage, the 3-month period ends
on the day before the waiting period begins. The pre-existing
condition exclusion does not apply to pregnancy nor to a child
who is enrolled in the plan within 30 days after birth, adoption,
or placement for adoption.
This exclusion may last up to 12 months (18 months if you are
a late enrollee) from your ﬁrst day of coverage, or, if you were
in a waiting period, from the ﬁrst day of your waiting period.
However, you can reduce the length of this exclusion period by
the number of days of your prior “creditable coverage.” Most
prior health coverage is creditable coverage and can be used
to reduce the pre-existing condition exclusion if you have not
experienced a break in coverage of at least 63 days. To reduce
the 12-month (or 18-month) exclusion period by your creditable
coverage, you should give us a copy of any certiﬁcates of
creditable coverage you have. If you do not have a certiﬁcate,
but you do have prior health coverage, we will help you obtain
one from your prior plan or issuer. Please contact us if you
need help demonstrating creditable coverage.
All questions about the pre-existing condition exclusion and
creditable coverage should be directed to HR Beneﬁts at
832-824-2421 (option 1).
MEDICAID AND CHIP
Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and you
are eligible for health coverage from your employer, your State
may have a premium assistance program that can help pay for
coverage. These States use funds from their Medicaid or CHIP
programs to help people who are eligible for these programs,
but also have access to health insurance through their employer.
If you or your children are not eligible for Medicaid or CHIP, you
will not be eligible for these premium assistance programs.
If you or your dependents are already enrolled in Medicaid or
CHIP and you live in a State listed below, you can contact your
State Medicaid or CHIP ofﬁce to ﬁnd out if premium assistance
is available.
If you or your dependents are NOT currently enrolled in
Medicaid or CHIP, and you think you or any of your dependents
might be eligible for either of these programs, you can contact
your State Medicaid or CHIP ofﬁce or dial 1-877-KIDS NOW or
^^^PUZ\YLRPKZUV^NV] to ﬁnd out how to apply. If you qualify,
you can ask the State if it has a program that might help you
pay the premiums for an employer-sponsored plan. Once
it is determined that you or your dependents are eligible for
premium assistance under Medicaid or CHIP, as well as eligible
under your employer plan, your employer must permit you
to enroll in your employer plan if you are not already enrolled.
This is called a “special enrollment” opportunity, and you must
request coverage within 60 days of being determined eligible
for premium assistance.
GEORGIA – Medicaid
Website: http://dch.georgia.gov/
Click on Programs, then Medicaid, then
Health Insurance Premium Payment (HIPP)
Phone: 1-800-869-1150
MAINE – Medicaid
Website: http://www.maine.gov/dhhs/oﬁ/
publicassistance/index.html
Phone: 1-800-977-6740
TTY 1-800-977-6741
LOUISIANA – Medicaid
Website: http://www.lahipp.dhh.louisiana.gov
Phone: 1-888-695-2447
MISSOURI – Medicaid
Website: http://www.dss.mo.gov/mhd/
participants/pages/hipp.htm
Phone: 573-751-2005
To find information about other
states’ premium assistance
programs, or for more information
on special enrollment rights, you
can contact either:
64%FQBSUNFOUPG-BCPS
Employee Beneﬁts Security Administration
^^^KVSNV]LIZHor
^^^HZRLIZHKVSNV]
1-866-444-EBSA (3272)
TEXAS - Medicaid
Website: https://www.gethipptexas.com/
Phone: 1-800-440-0493
64%FQBSUNFOUPG)FBMUI
BOE)VNBO4FSWJDFT
Centers for Medicare & Medicaid Services
^^^JTZOOZNV]
1-877-267-2323, Ext. 61565
2013 BENEFITS AND WELLNESS GUIDE
35
LEGAL NOTICES / YOUR RIGHTS
Continuation Coverage Rights Under COBRA
Under federal law, Texas Children’s is required to offer
covered employees and covered family members the
opportunity for a temporary extension of health coverage
(called “Continuation Coverage”) at group rates when
coverage under the health plan would otherwise end
due to certain qualifying events. This notice is intended
to inform all plan participants, in a summary fashion, of
your potential future options and obligations under the
continuation coverage provisions of federal law. Should
an actual qualifying event occur in the future, Texas
Children’s will send you additional information and the
appropriate election notice at that time.
8IBU*T$0#3"$PWFSBHF
Consolidated Omnibus Budget Reconciliation Act
(COBRA) coverage is a continuation of Plan coverage
when coverage would otherwise end because of a life
event known as a “qualifying event.” Speciﬁc qualifying
events are listed later in this notice. After a qualifying
event occurs and any required notice of that event is
properly provided to Texas Children’s, COBRA coverage
must be offered to each person losing Plan coverage
who is a “qualiﬁed beneﬁciary.” You, your spouse,
and your dependent children could become qualiﬁed
beneﬁciaries and would be entitled to elect COBRA
coverage if coverage under the Plan is lost because of
the qualifying event. (Certain newborns, newly adopted
children, and alternate recipients under Qualiﬁed Medical
Support Orders may also be qualiﬁed beneﬁciaries. This is
discussed in more detail in separate paragraphs below.)
8IFO*T$0#3"$PWFSBHF"WBJMBCMF
When the qualifying event is the end of employment,
a reduction of hours of employment, or death of the
employee, the Plan will automatically offer COBRA
coverage to qualiﬁed beneﬁciaries.
Under the Plan, qualiﬁed beneﬁciaries who elect COBRA
must pay for COBRA coverage.
8IP*T&OUJUMFEUP&MFDU$0#3"
If you are an employee, you will be entitled to elect
COBRA if you lose your group health coverage under the
Plan because either one of the following qualifying events
happens:
tYour hours of employment are reduced, or
tYour employment ends for any reason, other than for
gross misconduct (on your part).
If you are the spouse of an employee, you will be entitled
to elect COBRA if you lose your group health coverage
36
TEXAS CHILDREN’S
under the Plan because any of the following qualifying events
happens:
tYour spouse dies;
tYour spouse’s hours of employment are reduced;
tYour spouse’s employment ends for any reason other than his
or her gross misconduct;
tYou become divorced or legally separated from your spouse.
Also, if your spouse (the employee) reduces or eliminates your
group health coverage in anticipation of a divorce or legal
separation, and a divorce or legal separation later occurs, then
the divorce or legal separation may be considered a qualifying
event for you even though your coverage was reduced or
eliminated before the divorce or separation.
A person enrolled as the employee’s dependent child will be
entitled to elect COBRA if he or she loses group health coverage
under the Plan because any of the following qualifying events
happens:
tThe parent-employee dies;
tThe parent-employee’s hours of employment are reduced;
tThe parent-employee’s employment ends for any reason other
than his or her gross misconduct;
tThe parents become divorced or legally separated; or
tThe child stops being eligible for coverage under the Plan as a
“dependent child.”
&MFDUJOH$0#3"
Each qualiﬁed beneﬁciary will have an independent right to elect
COBRA. Covered employees and spouses (if the spouse is a
qualiﬁed beneﬁciary) may elect COBRA on behalf of all of the
qualiﬁed beneﬁciaries, and parents may elect COBRA on behalf
of their children. "OZRVBMJmFECFOFmDJBSZGPSXIPN$0#3"
JTOPUFMFDUFEXJUIJOEBZTPGUIF1MBOT$0#3"FMFDUJPO
OPUJDFMFUUFSXJMMMPTFIJTPSIFSSJHIUUPFMFDU$0#3"
)PX-POH%PFT$0#3"$PWFSBHF-BTU
COBRA coverage is a temporary continuation of coverage.
When the qualifying event is the death of the employee, the
covered employee’s divorce or legal separation, or a dependent
child’s losing eligibility as a dependent child, COBRA coverage
under the Plan’s Medical, Dental and Vision components can
last for up to a total of 36 months. When the qualifying event is
the end of employment or reduction of the employee’s hours of
employment, and the employee became entitled to Medicare
beneﬁts less than 18 months before the qualifying event,
COBRA coverage under the Plan’s Medical, Dental and Vision
components for qualiﬁed beneﬁciaries (other than the employee)
who lose coverage as a result of the qualifying event can last
until up to 36 months after the date of Medicare entitlement.
For example, if a covered employee becomes entitled to
Medicare 8 months before the date on which his employment
terminates, COBRA coverage for his spouse and children
who lost coverage as a result of his termination can last up
to 36 months after the date of Medicare entitlement, which
is equal to 28 months after the date of the qualifying event
(36 months minus 8 months). This COBRA coverage period
is available only if the covered employee becomes entitled
to Medicare within 18 months before the termination or
reduction of hours.
Otherwise, when the qualifying event is the end of
employment or reduction of the employee’s hours of
employment, COBRA coverage under the Plan’s Medical,
Dental, and Vision components generally can last for up to
18 months only.
COBRA coverage under the Healthcare FSA component can
last only until the end of the year in which the qualifying event
occurred—see the paragraph below entitled “Healthcare
FSA Component.”
The COBRA coverage periods described above are
maximum coverage periods. COBRA coverage can end
before the end of the maximum coverage periods described
in this notice for several reasons, which are described in the
Plan’s Summary Plan Description.
Two ways (described in the following paragraphs) in which
the period of COBRA coverage resulting from a termination
of employment or reduction of hours can be extended.
%JTBCJMJUZ&YUFOTJPOPG$0#3"$PWFSBHF
If a qualiﬁed beneﬁciary is determined by the Social Security
Administration to be disabled and you notify PayFlex in a
timely fashion, all of the qualiﬁed beneﬁciaries in your family
may be entitled to receive up to an additional 11 months of
COBRA coverage, for a total maximum of 29 months. This
extension is available only for qualiﬁed beneﬁciaries who are
receiving COBRA coverage because of a qualifying event
that was the covered employee’s termination of employment
or reduction of hours. The disability must have started at
some time before the 61st day after the covered employee’s
termination of employment or reduction of hours and must
last at least until the end of the period of COBRA coverage
that would be available without the disability extension
(generally 18 months, as described above).
5IFEJTBCJMJUZFYUFOTJPOJTBWBJMBCMFPOMZJGZPV
OPUJGZ1BZ'MFYJOXSJUJOHPGUIF4PDJBM4FDVSJUZ
"ENJOJTUSBUJPOTEFUFSNJOBUJPOPGEJTBCJMJUZXJUIJO
EBZTBGUFSUIFMBUFTUPG
tThe date of the Social Security Administration’s disability
determination;
tThe date of the covered employee’s termination of
employment or reduction of hours; and
You Must Give Notice for Some Qualifying Events
For other qualifying events (divorce or legal separation of the
employee and spouse or a dependent child’s losing eligibility
for coverage as a dependent child), a COBRA election will be
available to you only if you notify Texas Children’s in writing
within 60 days after the later of: (1) the date of the qualifying
event; and (2) the date on which the qualiﬁed beneﬁciary loses
(or would lose) coverage under the terms of the Plan as a result
of the qualifying event. In providing this notice, you must use the
Plan’s form entitled “Changes in Coverage” from Texas Children’s
Beneﬁts Department. If the form is not provided to Texas
Children’s Beneﬁts Department during the 60-day notice period,
then all qualiﬁed beneﬁciaries will lose their right to elect COBRA.
Oral notice, including notice by telephone, is not acceptable.
tThe date on which the qualiﬁed beneﬁciary loses (or would lose)
coverage under the terms of the Plan as a result of the covered
employee’s termination of employment or reduction of hours.
You must also provide this notice within 18 months after the
covered employee’s termination of employment or reduction of
hours in order to be entitled to a disability extension.
If these procedures are not followed or if the notice is not provided
to Payﬂex during the 60-day notice period and within 18 months
after the covered employee’s termination of employment or
reduction of hours, then there will be no disability extension of
COBRA coverage.
&YUFOTJPOPG$0#3"$PWFSBHFGPSB
4FDPOE2VBMJGZJOH&WFOU
If your family experiences another qualifying event while receiving
COBRA coverage because of the covered employee’s termination
of employment or reduction of hours (including COBRA coverage
during a disability extension period as described above), the
spouse and dependent children receiving COBRA coverage
can get up to 18 additional months of COBRA coverage, for a
maximum of 36 months, if notice of the second qualifying event is
properly given to the Plan. This extension may be available to the
spouse and any dependent children receiving COBRA coverage if
the employee or former employee dies or gets divorced or legally
separated, or if the dependent child stops being eligible under
the Plan as a dependent child, but only if the event would have
caused the spouse or dependent child to lose coverage under the
Plan had the ﬁrst qualifying event not occurred. (This extension is
not available under the Plan when a covered employee becomes
entitled to Medicare after his or her termination of employment or
reduction of hours.)
The extension due to a second qualifying event is available only if
you notify PayFlex in writing of the second qualifying event within
60 days after the date of the second qualifying event. If these
procedures are not followed or if the notice is not provided to
PayFlex during the 60-day notice period, then there will be no
extension of COBRA coverage due to a second qualifying event.
2013 BENEFITS AND WELLNESS GUIDE
37
LEGAL NOTICES / YOUR RIGHTS
For information related to COBRA Rights for FMLA and
Military Leave, you may reference Policy Numbers HR214
and HR205 on the Texas Children’s Connect website.
)FBMUI$BSF'4"$PNQPOFOU
COBRA coverage under the Healthcare FSA will be
offered only to qualiﬁed beneﬁciaries losing coverage who
have underspent accounts. A qualiﬁed beneﬁciary has an
underspent account if the annual limit elected by the covered
employee, reduced by the reimbursable claims submitted up
to the time of the qualifying event, is equal to or more than
the amount of the premiums for Healthcare FSA COBRA
coverage that will be charged for the remainder of the plan
year. COBRA coverage will consist of the Healthcare FSA
coverage in force at the time of the qualifying event (i.e.,
the elected annual limit reduced by reimbursable claims
submitted up to the time of the qualifying event). The use-itor-lose-it rule will continue to apply, so any unused amounts
will be forfeited at the end of the plan year, and COBRA
coverage will terminate at the end of the plan year.
Unless otherwise elected, all qualiﬁed beneﬁciaries
who were covered under the Healthcare FSA will be
covered together for Healthcare FSA COBRA coverage.
However, each qualiﬁed ‘beneﬁciary could alternatively
elect separate COBRA coverage to cover that beneﬁciary
only, with a separate Healthcare FSA annual limit and
a separate premium. The period of COBRA coverage
under the Healthcare FSA cannot be extended under any
circumstances.
.PSF*OGPSNBUJPO"CPVU*OEJWJEVBMT
8IP.BZ#F2VBMJmFE#FOFmDJBSJFT
$IJMESFOA#PSO5PA"EPQUFE#ZPSA1MBDFEGPS
"EPQUJPO8JUIUIF$PWFSFE&NQMPZFF
%VSJOHB1FSJPEPG$0#3"$PWFSBHF
These individuals are considered to be a qualiﬁed beneﬁciary
provided that, if the covered employee is a qualiﬁed
beneﬁciary, the covered employee has elected COBRA
coverage for himself or herself. The child’s COBRA coverage
begins when the child is enrolled in the Plan, whether
through special enrollment or annual enrollment, and it
lasts for as long as COBRA coverage lasts for other family
members of the employee. To be enrolled in the Plan, the
child must satisfy the otherwise applicable Plan eligibility
requirements (for example: age of individual).
"MUFSOBUF3FDJQJFOUT6OEFS2.$40T
A child of the covered employee who is receiving beneﬁts
under the Plan pursuant to a Qualiﬁed Medical Child Support
Order (QMCSO) received by Texas Children’s during the
covered employee’s period of employment with Texas
Children’s is entitled to the same rights to elect COBRA as
an eligible dependent child of the covered employee.
38
TEXAS CHILDREN’S
*G:PV)BWF2VFTUJPOT
Questions concerning your Plan or your COBRA rights should be
addressed to the contact or contacts identiﬁed below. For more
information about your rights under ERISA, including COBRA,
the Health Insurance Portability and Accountability Act (HIPAA)
and other laws affecting group health plans, contact the nearest
Regional or District Ofﬁce of the U.S. Department of Labor’s
Employee Beneﬁts Security Administration (EBSA) in your area
or visit the EBSA website at ^^^KVSNV]LIZH. (Addresses
and phone numbers of Regional and District EBSA Ofﬁces are
available through EBSA’s website.)
,FFQ:PVS1MBO*OGPSNFEPG"EESFTT$IBOHFT
In order to protect your family’s rights, you should keep Texas
Children’s informed of any changes in the addresses of family
members. You should also keep a copy, for your records, of any
notices you send or deliver to Texas Children’s.
1MBO$POUBDU*OGPSNBUJPO
You may obtain information about the Plan and COBRA
coverage upon request from: Texas Children’s Hospital, Human
Resources, Suite MB-1301, 1919 S. Braeswood, Houston, TX
77030 or by calling Human Resources at 832-824-2421 (option
1 for Beneﬁts). This contact information for the Plan may change
from time to time. The most recent information will be included
in the Plan’s most recent Summary Plan Description (if you do
not have a copy, you may request one from Texas Children’s at
[email protected]).
Your Rights
8PNFOT)FBMUIBOE$BODFS
The Women’s Health and Cancer Rights Act of 1998 (WHCRA)
requires that our plan provide the following medical and
surgical beneﬁts after mastectomies in a manner determined in
consultation with the attending physician and the patient for:
tAll stages of reconstruction of the breast on which the
mastectomy has been performed
tSurgery and reconstruction of the other breast to produce a
symmetrical appearance
tProstheses and physical complications of all stages of
mastectomies, including lymphedemas. These beneﬁts are
subject to the same deductibles and coinsurance applicable to
other medical and surgical beneﬁts provided under our plan.
Please follow the plan procedures for obtaining precertiﬁcation.
.FOUBM)FBMUI
The plan complies with the Mental Health Parity Act, which
generally requires parity between mental health beneﬁts and
medical/surgical beneﬁts. The plan applies the same annual
dollar limits and aggregate lifetime limits for mental health
beneﬁts and medical/surgical beneﬁts.
.PUIFSTBOE/FXCPSOT
In compliance with federal law, Texas Children’s Select Plans
do not: (1) restrict beneﬁts for any hospital length of stay in
connection with childbirth for the mother or newborn child to
fewer than 48 hours following a normal vaginal delivery, or fewer
than 96 hours following a Cesarean section, or (2) require that
a provider obtain authorization from the insurance carrier for
prescribing a length of stay not in excess of the above periods.
$FSUJmDBUFPG$SFEJUBCMF$PWFSBHF
You will be provided a certiﬁcate of creditable coverage in
writing, free of charge, from BlueCross BlueShield of Texas for
health plan coverage:
tWhen you lose coverage under the health plan;
tWhen you become entitled to elect COBRA;
tWhen your COBRA coverage ends; You may request a
certiﬁcate of creditable coverage by calling the toll free
number on your medical ID card. You may request a
certiﬁcate of creditable coverage from another group health
plan, or you may receive a reduction or elimination of
exclusionary periods of coverage for preexisting conditions
under your group health plan. Without evidence of creditable
coverage, Plan beneﬁts for the treatment of a pre-existing
condition may be excluded for 12 months (18 months for
late enrollees) after your enrollment date in your coverage.
(FOFUJD*OGPSNBUJPO/POEJTDSJNJOBUJPO"DU(*/"
GINA was passed on May 21, 2008, to protect Americans
against discrimination based on their genetic information when
it comes to health insurance and employment. Restrictions
on the request and use of genetic information by health
insurers to determine eligibility and premiums went into effect
on May 21, 2009. Prohibitions on employers from using a
person’s genetic information in making employment decisions
such as hiring, ﬁring, job assignments, or any other terms of
employment went into effect November 21, 2009.
2VBMJmFE.FEJDBM$IJME4VQQPSU0SEFS2.$40
Federal law requires The Texas Children’s Select Plan, under
certain circumstances, to provide healthcare coverage for
your children when you divorce, separate, or are even never
married, when ordered to do so by state authorities. The
process begins when Texas Children’s receives a medical child
support order. This means any judgment, decree, or order,
including approval of a settlement agreement, which:
tIs issued from a court of competent jurisdiction or through
an administrative process established under State law
and has the force and effect of an order under State law
pursuant to a state’s domestic relations law;
tRequires you to provide group health coverage for your
children even though you no longer have custody;
tClearly speciﬁes the name of our plan, your name and your
last known mailing address and the name and addresses of
a child covered by the order. The name and mailing address
of a state or local ofﬁcial may be substituted for the address of
the child;
tA reasonable description of the coverage to be provided; and
tThe period of coverage to which the order applies.
The plan administrator will provide written notiﬁcation to you and
each identiﬁed child for which it has received an order requiring
coverage. Within a reasonable time after the receipt of the order,
the plan administrator will determine whether the order is a
Qualiﬁed Medical Child Support Order (QMCSO) and notify you
and the child’s legal representative of the determination. This
notice will include any required enrollment material, a description
of the procedures to be followed, and a form for designating
the child’s custodial parent or legal guardian as his or her
representative for all beneﬁt plan purposes. Plan beneﬁts that have
not been assigned will be used to reimburse charges for covered
expenses incurred by an identiﬁed child.
If Texas Children’s Hospital receives a QMCSO, it must permit
immediate enrollment. This means the children identiﬁed will be
included for coverage as your eligible dependent and you will
pay the required premiums. The child’s custodial parent, legal
guardian, or a state agency can make an application for the child’s
coverage, even if you do not.
i.JDIFMMFTMBXw)3
Michelle’s Law provides continued coverage under group health
plans for your dependent child who is covered under the Texas
Children’s plan as a student but might lose their student status
because they take a medically necessary leave of absence
from school or begin a change in school enrollment that would
otherwise result in a cancellation of coverage under our plan.
You may continue for up to 12 months from the beginning of
the absence as long as your child was covered by the plan and
enrolled in a college or university.
If you believe your child is eligible for this continued coverage,
the child’s physician must provide a written certiﬁcation stating
that your child is suffering from a serious illness or injury that
necessitates the leave or change in enrollment status. At the end
of the 12 months of coverage under Michelle’s Law, COBRA
coverage will be available if your child is still too ill to attend school.
1SFTDSJQUJPO%SVH$PWFSBHFBOE.FEJDBSF0QUJPOT
Please read this notice carefully and keep it where you can ﬁnd it.
This notice has information about your current prescription drug
coverage with Texas Children’s and about your options under
Medicare’s prescription drug coverage. This information can help
you decide whether or not you want to join a Medicare drug plan.
If you are considering joining, you should compare your current
coverage (including which drugs are covered at what cost) with
the coverage and costs of the plans offering Medicare prescription
drug coverage in your area. Information about where you can get
help to make decisions about your prescription drug coverage is
at the end of this notice.
2013 BENEFITS AND WELLNESS GUIDE
39
LEGAL NOTICES / YOUR RIGHTS
There are two important things you need to know about your
current coverage and Medicare’s prescription drug coverage:
1. Medicare prescription drug coverage became available in
2006 to everyone with Medicare. You can get this coverage
if you join a Medicare Prescription Drug Plan or join a
Medicare Advantage Plan (like an HMO or PPO) that offers
prescription drug coverage. All Medicare drug plans provide
at least a standard level of coverage set by Medicare. Some
plans may also offer more coverage for a higher monthly
premium.
2. Texas Children’s has determined that the prescription drug
coverage offered by the Texas Children’s Select Plan is, on
average for all plan participants, expected to pay out as
much as standard Medicare prescription drug coverage pays
and is therefore considered Creditable Coverage. Because
your existing coverage is Creditable Coverage, you can keep
this coverage and not pay a higher premium (a penalty) if you
later decide to join a Medicare drug plan.
8IFO$BO:PV+PJO".FEJDBSF%SVH1MBO You can join a Medicare drug plan when you ﬁrst become
eligible for Medicare and each year from October 15 through
December 7; however, if you lose your current creditable
prescription drug coverage, through no fault of your own, you
will also be eligible for a two (2) month Special Enrollment
Period (SEP) to join a Medicare drug plan.
8IBU)BQQFOT5P:PVS$VSSFOU$PWFSBHF
If you decide to join a Medicare drug plan, your current Texas
Children’s Select Plan coverage will not be affected.
tYou may choose to enroll in Medicare Part D in addition to
the Hospital provided medical and prescription drug plan.
If you select this option, Medicare’s prescription drug plan
will coordinate coverage by determining beneﬁts as the
secondary provider as long as you remain an active employee
under the Hospital provided plan.
tYou may choose not to enroll in the Medicare prescription
drug plan at this time and keep your medical and prescription
drug beneﬁts under the Hospital-provided plan. If this option
is selected, your medical and prescription drug beneﬁts will
continue under the Hospital-provided medical plan option
selected.
tIf you decide to join a Medicare drug plan and drop your
current Texas Children’s coverage, be aware that you and
your dependents may not be able to get this coverage back.
8IFO8JMM")JHIFS1SFNJVN1FOBMUZ
#F1BJEUP+PJOB
.FEJDBSF%SVH1MBO
If you drop or lose your current coverage with Texas Children’s
and don’t join a Medicare drug plan within 63 continuous
days after your current coverage ends, you may pay a higher
premium (a penalty) to join a Medicare drug plan later. If you go
40
TEXAS CHILDREN’S
63 continuous days or longer without creditable prescription
drug coverage, your monthly premium may go up by at least
1% of the Medicare base beneﬁciary premium per month for
every month that you did not have that coverage.
For example, if you go nineteen (19) months without
creditable coverage, your premium may consistently be
at least 19% higher than the Medicare base beneﬁciary
premium. You may have to pay this higher premium (a
penalty) as long as you have Medicare prescription drug
coverage. In addition, you may have to wait until the
following October to join.
'PS.PSF*OGPSNBUJPO
tAbout This Notice or Your Current Prescription Drug Coverage
Contact the Beneﬁts Total Rewards line at 832-824-2421
and press 1 for beneﬁts. You’ll get this notice each year.
You will also get it before the next period you can join a
Medicare drug plan, and also, if this coverage through
Texas Children’s changes. You also may request a copy of
this notice at any time.
tAbout Your Options under Medicare Prescription Drug
CoverageMore detailed information about Medicare plans
that offer prescription drug coverage is in the “Medicare
& You” handbook. Employees are mailed a copy of the
handbook every year from Medicare. You may also be
contacted directly by Medicare drug plans.
tAbout Medicare Prescription Drug Coverage
— Visit www.medicare.gov
— For personalized help, call your State Health
Insurance Assistance Program (see the inside back
cover of your copy of the “Medicare & You” handbook
for their telephone number)
— Call 1-800-MEDICARE (1-800-633-4227).
TTY users should call 1-877-486-2048. If you have
limited income and resources, extra help paying for
Medicare prescription drug coverage is available. For
information about this extra help, visit Social Security
on the web at www.socialsecurity.gov, or call 1-800772-1213 (TTY 1-800-325-0778).
C
1MBO*343FHVMBUJPOT3FMBUFEUP
.BYJNVN$POUSJCVUJPO"NPVOUT
If both of the following two points apply to you, please
contact HR Beneﬁts so that they can work with you to
minimize your risk of exceeding the 2012/2013 contribution
limit.
1. You currently control (own directly or indirectly) more than
a 50% interest of a business, AND
2. That business provides to you a Qualiﬁed Deﬁned
Contribution Retirement Plan or a Simpliﬁed Employee
Pension (“SEP”) Plan for 2012 / 2013.
Due to certain changes in compliance procedures
established by the Internal Revenue Service (the “IRS”),
employees who control more than a 50% interest of a
business that provides to you a qualiﬁed retirement plan or
a SEP, are required by the IRS, to combine the contributions
made on your behalf to our 403(b) Plan with the
contributions made on your behalf to the retirement plan(s)
of that business (or businesses) to determine if the retirement
plan annual additions limit test is violated.
Therefore, Texas Children’s is obligated to monitor the
maximum amount of contributions made on your behalf
to our 403(b) Plan and any other tax-qualiﬁed deﬁned
contribution plans maintained by employers in which you
have an ownership interest of more than 50%.
In 2012 / 2013, the current known maximum contribution
is the lesser of (i) $49,000 or (ii) 100 percent of eligible
compensation. To address any questions or concerns related
to this IRS regulation, please contact HR at 832-824-2421
(option 1 for Beneﬁts).
If there is a violation to this annual additions limit test, you
will be subject to current federal income tax on the excess
contributions and you may also be subject to certain federal
tax penalties.
:PVS&3*4"#FOFmUT3JHIUT
As a participant in this plan, you are entitled to certain rights
and protections under the Employee Retirement Income
Security Act of 1974 (ERISA). This statement of your ERISA
rights is required by federal law and regulations. In addition,
ERISA provides that you, as a plan participant are entitled to:
tReceive information about your plan and beneﬁts.
tExamine, without charge, at the ofﬁce of the plan
administrator and at other speciﬁed locations such as
work sites and union halls, all plan documents governing
the plan, including insurance contracts and collective
bargaining agreements, and copies of all documents
ﬁled by the plan with the U.S. Department of Labor and
available at the Public Disclosure Room of the Pension and
Welfare Beneﬁts Administration.
tObtain, upon written request to the plan administrator,
copies of documents governing the operation of the plan,
including insurance contracts and collective bargaining
agreements. The plan administrator may make a
reasonable charge for the copies.
tReceive a summary of the plan’s annual ﬁnancial report.
The plan administrator is required by law to furnish each
participant with a copy of this Summary Annual Report.
1SVEFOU"DUJPOTCZ1MBO'JEVDJBSJFT
In addition to creating rights for plan participants, ERISA
imposes duties upon the people who are responsible for the
operation of the plan. The people who operate your plan,
called “ﬁduciaries” of the plan, have a duty to do so prudently
and in the interest of you and other plan participants and
beneﬁciaries. No one, including your employer, your union,
if applicable, or any other person, may ﬁre you or otherwise
discriminate against you in any way to prevent you from
obtaining a welfare beneﬁt or exercising your rights under
ERISA.
&OGPSDF:PVS3JHIUT
If your claim for a beneﬁt is denied or ignored in whole or in
part, you have a right to know why this was done, to obtain
copies of documents relating to the decision
without charge and to appeal any denial, all within certain
time schedules.
Under ERISA, there are steps you can take to enforce
your rights. For instance, if you request a copy of the plan
documents or the latest annual report for the plan and
do not receive them within 30 days, you may ﬁle suit in a
federal court. In such a case, the court may require the
Fiduciary Committee to provide the materials and pay up
to $110 a day until you receive the materials, unless the
materials were not sent because of reasons beyond the
control of the Fiduciary Committee. If you have a claim for
beneﬁts, which is denied or ignored, in whole or in part, you
may ﬁle suit in a federal court. In addition, if you disagree
with the plan’s decision or lack thereof concerning the
qualiﬁed status of a domestic relations order, you may ﬁle
suit in federal court. If it should happen that plan ﬁduciaries
misuse the plan’s money, or if you are discriminated against
for asserting your rights, you may seek assistance from the
U.S. Department of Labor, or you may ﬁle suit in a federal
court. The court will decide who should pay court costs and
fees. If you are successful, the court may order the person
you have sued to pay these costs and fees. If you lose,
the court may order you to pay these costs and fees, for
example, if it ﬁnds your claim is frivolous.
"TTJTUBODFXJUI:PVS2VFTUJPOT
If you have questions about your plan, you should contact
the plan supervisor. If you have any questions about this
statement or your rights under ERISA, or if you need
assistance in obtaining documents from the plan supervisor,
you should contact the nearest Employee Beneﬁts
Administration, U.S. Department of Labor, listed in the
telephone directory. You may call 202-693-8673
or address requests to Public Disclosure Room, Room
N-1513, Employee Beneﬁts Security Administration,
U.S. Department of Labor, 200 Constitution Ave., N.W.,
Washington, D.C. 20210.
2013 BENEFITS AND WELLNESS GUIDE
41
CONTACT INFORMATION
CONTACT INFORMATION
BENEFIT
CARRIER
GROUP #
PHONE / FAX
WEB / EMAIL ADDRESS
tMedical / Prescription Drugs
BlueCross BlueShield
of Texas (BCBSTX) /
Prime Therapeutics
# 069712
1-877-734-8924
www.bcbstx.com/tch
tCondition Management
HealthFitness
1-888-352-9355
www.healthﬁtness.com
tDental
BlueCross BlueShield
of Texas (BCBSTX)
High: 071083
Low: 071084
1-877-734-8924
www.bcbstx.com/tch
tVision
VSP
# 12318607
1-800-877-7195
www.vsp.com/go/tch
HEALTHCARE
EMPLOYEE HEALTH & WELLNESS CENTER
tEmployee Medical Clinic
5 Tower by the
yellow elevators
7:30 a.m. 4:30 p.m.
Tuesday:
10 a.m. - 7 p.m.
832-824-2150
tEmployee Health
5 Tower by the
yellow elevators
7:30 a.m. 4:30 p.m.
832-824-2150
tEmployee Assistance Program
Meyer Building
basement, MB1201
7:30 a.m. 4:30 p.m.
832-824-3327
[email protected]
OTHER BENEFITS
tFlexible Spending Accounts (FSAs)
PayFlex
1-800-284-4885 (option 1)
1-877-736-0440 (Fax)
www.HealthHub.com
tCOBRA Administration
PayFlex
1-800-284-4885 (option 3)
www.HealthHub.com
tLife Insurance and Accidental Death and
Dismemberment (AD&D)
Prudential
# 005068
1-800-524-0542 Life Claims
1-877-889-2070 Life Conversion
1-888-257-0412 Underwriting
www.prudential.com
tLong Term Disability (LTD)
Prudential
# 005068
1-800-842-1718 LTD Claims
www.prudential.com
832-824-2421 (option 1)
Form available on Connect
COMMUTER
tTransportation Elections & Changes
HR Beneﬁts
tParking Card Entrance/ Exit Issues
Texas Medical Center
(TMC)
713-791-6161
RETIREMENT
t403(b) Retirement Savings Plan
Fidelity
1-800-343-0860
www.ﬁdelity.com/atwork
t529 College Savings Plan
Fidelity
1-800-544-1914
www.ﬁdelity.com/unique
tSpanish Information Line
Fidelity
1-877-297-3017
tTexas Children’s Cash Balance Pension Plan
Mercer
1-800-752-8230
www.ibeneﬁtcenter.com
tBackup Care Advantage Program
Bright Horizons
1-877-242-2737
www.backup.
brighthorizons.com
UN: TexasChildrens
PW: backup1
tEducation Advising
EdAssist
1-855-222-2394
[email protected]
tTuition Assistance Program
EdLink
1-888-797-2235
1-866-284-0859 (Fax)
[email protected]
http://tamsonline.org/TCH
HUMAN RESOURCES
LOCATION
MONDAY-FRIDAY
PHONE / FAX
EMAIL ADDRESS
tHR Service Center
Abercrombie Building
(A-130)
7 a.m. - 4 p.m.
832-824-2421 (option 1)
totalrewards@
texaschildrens.org
tHR Beneﬁts Department
Meyer Building 3rd ﬂoor
8 a.m. - 5 p.m.
832-824-2421 (option 1)
832-825-2829 (Fax)
totalrewards@
texaschildrens.org
tHR @ West Campus
W.C. 2nd ﬂoor
7:30 a.m. - 5 p.m.
832-227-1352
WORK-LIFE BALANCE
42
TEXAS CHILDREN’S
SELECT & SELECTPLUS DOLLARS
SELECT & SELECTPLUS DOLLARS
"TBTVQQPSUJWFXBZUPIFMQFNQMPZFFTPGGTFUUIFDPTUPGCFOFmUDPWFSBHFT
BEEJUJPOBMEPMMBSTBSFQBJECBTFEPOZPVSZFBSTPGACFOFmUTFSWJDFBOEKPCTUBUVT
SELECT DOLLARS
Select Dollars begin on the same day your
coverage deductions begin. As your years
of service increase, your Select Dollars
will automatically change the ﬁrst pay
period following your service anniversary
or status change. Whether you enroll or
waive beneﬁt coverage, eligible employees
will automatically receive Select Dollars
as additional take-home income, which is
subject to applicable taxes.
Per pay period amounts added to paycheck
Full-Time Employees
Part-Time Employees
Years of Benefit
Service
ZFBS
ZFBST
ZFBST
ZFBST
ZFBST
ZFBST
ZFBST
ZFBST
SELECT & SELECTPLUS DOLLARS
In addition to Texas Children’s Select
Dollars, full- and part-time employees who
meet BOTH of the following criteria:
1) enroll in the medical plan, and
2) earn an hourly wage of $14 or less
will also receive Texas Children’s
SelectPLUS Dollars equal to an additional
$50 per month, or $23.08 per pay period.
The table reﬂects the TOTAL per-payperiod amount an eligible full- or part-time
employee would receive.
SELECT DOLLARS + SELECTPLUS DOLLARS =
Per pay period amounts added to paycheck
Full-Time Employees
Part-Time Employees
Years
of Benefit
Service
ZFBS
$27.69 + 23.08 = $11.54 + 23.08 = ZFBST
$30.00 + 23.08 = $13.85 + 23.08 = ZFBST
$32.31 + 23.08 = $16.15 + 23.08 = ZFBST
$36.92 + 23.08 = $20.77 + 23.08 = ZFBST
$41.54 + 23.08 = $25.38 + 23.08 = ZFBST
$46.15 + 23.08 = $30.00 + 23.08 = ZFBST
$50.77 + 23.08 = $34.62 + 23.08 = ZFBST
$62.31 + 23.08 = $46.15 + 23.08 = EXAMPLE
EXAMPLES REFLECT:
New hire employee with employee only PPO medical coverage
FULL-TIME
Employee
PART-TIME
Employee
SELECTPLUS SELECTPLUS
FULL-TIME
PART-TIME
Employee
Employee
Per pay period PPO cost of coverage
$
Offset by per pay period Select Dollars
$ -27.69
$ -11.54
$ -50.77
$ -34.62
1FSQBZQFSJPEDPTUGPSFNQMPZFFPOMZ110NFEJDBM
$ $ $ $
38.83
$
38.83
$
38.83
$
38.83
2013 BENEFITS AND WELLNESS GUIDE
43
DETERMINING COST OF COVERAGE
DETERMINING COST OF COVERAGE
OPTIONAL (TERM) LIFE INSURANCE
WORKSHEET
1. Select desired amount of coverage. Coverage is available for 1-4x
times your covered annual earnings, not to exceed $2,000,000. Make
sure amount is allowed.
$ _____________________________
2. Locate your age-based rate and calculate Annual Base Salary.
The monthly rate per $1,000 is $ ___________
3. Divide your selected amount of coverage by $1,000.
$ ________ divided by $1,000 = $ ___________
Then multiply the result by the monthly rate for your age. The answer
is your monthly cost of insurance.
Multiply times 12 and divide by 26 to get biweekly deduction.
$ ________ multiplied by $ _______ = $___________
$ ____________ x 12 / 26 = $ ___________
Total Monthly Cost of Insurance
OPTIONAL SPOUSE (TERM) LIFE INSURANCE
WORKSHEET
1. Select desired amount of coverage. Coverage is available for your
spouse for an equal amount of your Optional Term Life coverage
amount, not to exceed $100,000. Refer to the Dependent Term Life
section for evidence of insurability details.
$ _______________________________
2. Locate your age on the Rate Sheet and note the corresponding
monthly rate.
The monthly rate per $1,000 is $ __________
3. Divide the selected amount of coverage by $1,000.
$ ________ divided by $1,000 = $ ___________
Then multiply the result by the monthly rate for your age.
The answer is your spouse’s monthly cost of insurance.
$ _______ multiplied by $_________ = $_______
Total Monthly Cost of Insurance
OPTIONAL AD&D INSURANCE
WORKSHEET
1. Select desired amount of coverage. Coverage is available for 1-4x
times your covered annual base earnings, not to exceed $2,000,000
(basic and optional combined).
$ _______________________________
2. Locate your rate on the optional AD&D rate chart on page 45.
The monthly rate per $1,000 is $ __________
3. Divide your selected amount of coverage by $1,000.
$ ________ divided by $1,000 = $ ___________
Then multiply the result by the monthly rate for your age. The answer is
$ ________ multiplied by $ _______ = $___________
your monthly cost of insurance.
Multiply times 12 and divide by 26 to get biweekly deduction.
44
TEXAS CHILDREN’S
$ ____________ x 12 / 26 = $ ___________
Total Monthly Cost of Insurance
2013 BENEFIT RATES
2013 BENEFIT RATES
EMPLOYEE PER PAY PERIOD COST OF COVERAGE
MEDICAL PLAN OPTIONS
PPO
EPO
DENTAL (DPPO) PLAN OPTIONS
High
VISION
Low
VSP
&NQMPZFF0OMZ
$ 38.83
$ 72.18
$ 18.13
$ 9.62
$ 3.83
&NQMPZFF4QPVTF
$ 170.52
$ 211.17
$ 34.48
$ 18.29
$ 7.66
&NQMPZFF$IJME
$ 122.95
$ 161.45
$ 34.48
$ 18.29
$ 7.28
&NQMPZFF$IJMESFO
$ 181.89
$ 221.80
$ 48.62
$ 25.79
$ 7.28
&NQMPZFF4QPVTF$IJME
$ 254.31
$ 300.34
$ 48.62
$ 25.79
$ 11.49
&NQMPZFF'BNJMZ
$ 313.61
$ 360.80
$ 48.62
$ 25.79
$ 11.49
OPTIONAL TERM LIFE, AD&D AND LTD INSURANCE RATES
0QUJPOBM&NQMPZFFBOE4QPVTF-JGF
EMPLOYEE
SPOUSE
Rate based on
employee’s age
AGE
Initial rates based on age
as of effective date of your
coverage. Rates will change
based on the following age
schedule.
MONTHLY COST
Rates per $1,000
of Coverage
MONTHLY COST
Rates per $1,000
of Coverage
6OEFS
$0.050
$0.054
$0.055
$0.063
$0.075
$0.080
$0.085
$0.090
$0.100
$0.117
$0.150
$0.198
$0.230
$0.342
$0.430
$0.504
$0.660
$0.711
0QUJPOBM%FQFOEFOU$IJME
-JGF
Regardless of the number of children
COVERAGE AMOUNT
PER PAY PERIOD
$2,500
$0.26
$5,000
$0.51
$10,000
$1.02
0QUJPOBM"%%
INSURED
MONTHLY COST
Rates per $1,000 of Coverage
Employee
$ 0.02
0QUJPOBM#VZVQ-5%1MBO
$1.220
$1.270
INSURED
BOEPMEFS
$2.000
$2.060
Employee
MONTHLY COST
Rates per $100 of Coverage
$0.43
FLEXIBLE SPENDING ACCOUNTS
Enrollment is required each year if you wish to participate.
)FBMUIDBSF'4"
IRS per year maximum
$2,500 per employee per year ($5.00 minimum contribution amount per pay period)
%FQFOEFOU$BSF'4"
IRS per year maximum
$5,000 per family per year ($5.00 minimum contribution amount per pay period)
Texas Children’s contributes the ﬁrst $260.00; therefore maximum contribution is $4,740.
Remember...
ZPVS5FYBT$IJMESFOT4FMFDU4FMFDUPLUS%PMMBSTIFMQUPPGGTFUZPVSQFSQBZQFSJPEDPTUT
2013 BENEFITS AND WELLNESS GUIDE
45
CONFIDENTIAL TEXAS CHILDREN’S ETHICS HOTLINE: 1-866-478-9070
This guide is a Summary of Material Modiﬁcations to your beneﬁts
and contains changes to your beneﬁts as described in your Summary
Plan Description. For a complete description of your beneﬁts, see your
Summary Plan Description on the Connect website.
This reference guide describes the various beneﬁt plans offered by
Texas Children’s in summary only. The actual eligibility requirements,
beneﬁts, terms, conditions, limitations, and provisions that govern
the plans are contained in the plan documents or group insurance
contracts.
If, in our efforts to make the plans easy to understand, any of the
plans’ provisions have been omitted or misstated, the ofﬁcial plan
documents or insurance contracts must remain the ﬁnal authority.
The legal documents also govern the administration of the plans
and payment of beneﬁts. In the case of any dispute, the information
in the plan documents or contracts will prevail.
Copies of these documents are available for your inspection during
normal business hours or, for a fee, may be requested in writing from:
Texas Children’s Hospital
Human Resources, Suite MB-1301
1919 S. Braeswood
Houston, TX 77030