2014 Employee Benefits Your Benefits Package Eligibility
Dependent Coverage Coverage Options
Qualifying Status Changes Enrolling in Benefits
Effective Date of Benefits Summary of Available Benefits
3 3 3 3 4 4 4 5 Medical and Prescription Drug Plans
Medical Waiver Credit
Medical and Prescription Drug Plan Costs Medical Plan Selector Tool
BestLife Basic Plan BestLife Plus Plan
BestLife Health Reimbursement Account
BestLife Wellness Plan
6 6 6 7 8 10 12 13 Dental Plans 14 Vision Plan 15
Flexible Spending Accounts 16
Basic Life and Accidental Death and Dismemberment Insurance 17
Supplemental Life Insurance 17
Short-Term Disability Insurance 18
Long-Term Disability Insurance 18
Supplemental Disability Insurance 18
Voluntary Accident, Cancer, Critical Illness, & Medical Bridge Hospital Confinement Plans 18
Employee Assistance Program 19
Retirement Savings Plans 20
Education Assistance 21
Paid Time Off 22
Your Benefits
We offer a comprehensive benefits package consisting of: • Medical and prescriptiondrug coverage
• Health reimbursement account
• Dental coverage • Vision coverage
• Flexible spending accounts • Basic life and accidental
death and dismemberment (AD&D) insurance
• Voluntary life insurance • Short- and long-term
disability insurance • Supplemental disability
insurance
• Employee assistance program
• Retirement savings plans • Education assistance • Paid time off
Your Benefits Package
Benefits are an integral part of the overall compensation package provided by Cheyenne Regional. We are pleased to provide you with this Employee Benefits Guide to assist you in making your benefit elections. The objective of the employee benefits program is to provide you and your eligible dependents with comprehensive coverage and protection through choices that enable you to select options that meet your individual needs. Good News...Your medical, dental, and vision premiums are staying the same for 2014!
We are pleased to provide you with the Plan Selector Tool to help you determine which medical plan is right for you (see page 7 for more information).
Please take a moment to review the benefits Cheyenne Regional provides, to determine which offering is best for you.
Eligibility
Full-time (regularly scheduled to work 32 hours per week) and part-time (regularly
scheduled to work between 16 and 31.75 hours per week) employees are eligible for benefits. Temporary and PRN (as needed) employees are not eligible for benefits unless stated otherwise.
Dependent Coverage
Many of the benefit plans also offer coverage for your eligible dependents, including: • Your legal spouse or domestic partner. To enroll a domestic partner, you must
complete and sign the Affidavit of Domestic Partnership, which is available at www.cheyenneregional.org/staffemployees/benefits.
• Dependent children up to age 26 (for medical, dental, vision, and employee assistance program).
• Dependent children of any age who are disabled, live with you, and depend on you for support.
Coverage Options
Benefits-eligible employees may elect the following coverage levels for the medical/ prescription drug, dental, and vision plans:
• Employee only (deductions are pre-tax) • Employee plus spouse (deductions are pre-tax)
• Employee plus domestic partner (deductions are post-tax)
Qualifying Status Changes
Due to IRS regulations, once you have made your elections for the 2014 plan year, you cannot change your benefits until the next annual enrollment period. The only exception is if you experience a qualifying life event listed below. Election changes must be consistent with your life event and be submitted to Human Resources within 30 days.
Qualifying Life Events:
• Marriage, legal separation, or divorce • Birth or adoption of a child
• Change in employment status for you, your spouse, or your child • Change in a dependent’s benefits eligibility (e.g., child attains age 26)
• A significant change in the cost or coverage of your spouse’s/domestic partner’s or child’s benefits • Change in cost of dependent care (for dependent care flexible spending account only)
• Loss of a covered dependent (death)
To request a change in benefits, complete and submit the required forms (available at www.cheyenneregional.org/
staffemployees/benefits) to Human Resources within 30 days of the qualifying life event. You may need to provide proof of the change, such as a marriage certificate, record of birth, etc.
Enrolling in Benefits
You may enroll in the Cheyenne Regional benefit plans by completing the required enrollment forms and returning them to the Human Resources Department within the following time frames:
• Eligible new hires and employees with a qualifying job status change have 30 calendar days from their date of employment or date of the qualifying job status change to make enrollment elections or changes.
• Employees who experience a qualifying life event have 30 calendar days from the date of the event to make enrollment elections or changes.
Effective Date of Benefits
Basic Life, Short-Term Disability, Long-Term Disability, and Employee Assistance Program
Benefits that are fully paid by Cheyenne Regional are effective on the first day of employment. These benefits are provided at no cost to you and do not require enrollment.
Voluntary Benefits
Benefits in which you share in the cost through payroll deduction require enrollment and are effective as follows:
• Medical and prescription drug coverage and flexible spending accounts are effective on your first day of employment. In the case of a status change to an eligible status, coverage is effective on the first day of eligibility.
• Dental and vision benefits are effective on the first day of the month following employment. If your first day of
employment is the first of the month, the effective day is the first day of employment. In the case of a status change to an eligible status, coverage is effective on the first day of the month following the change in status.
Employees who do not submit enrollment information within the required time frame will not be eligible for coverage and will not be able to make election changes until the next annual enrollment period.
Summary of Available Benefits
Benefit Enrollment Time Who Pays
Paid Time Off (PTO) 1 Cheyenne Regional
Basic Life Insurance 1 Cheyenne Regional
Short-Term Disability 1 Cheyenne Regional
Long-Term Disability 1 Cheyenne Regional
Employee Assistance Program (EAP) 1 Cheyenne Regional
BestLife Medical and Prescription Drug Plans 2, 3, 4 You and Cheyenne Regional
BestLife Health Reimbursement Account (HRA) 2, 3, 4 Cheyenne Regional
BestLife Wellness Plan 5 Cheyenne Regional
Medical Waiver Credit 5 Cheyenne Regional
Dental Plans 2, 3, 4 You and Cheyenne Regional
Vision Plan 2, 3, 4 You
Flexible Spending Accounts (FSAs) 2, 3, 4 You
403(b) Retirement Plan 5 You
403(b) Retirement Plan (Roth) 5 You
457(b) Deferred Compensation Plan 5 You
457(b) Deferred Compensation Plan (Roth) 5 You
401(a) Retirement Plan Employer Match 1* Cheyenne Regional
Supplemental Insurance Plans 2, 4, 6 You
Education Assistance 6 Cheyenne Regional
*Eligibility for the 401(a) employer matching contribution requires enrollment in and making pre-tax contributions to at least one of the 403(b) Retirement or 457(b) Deferred Compensation Plans.
Enrollment
1 Automatic
2 Upon employment 3 With eligible status change 4 At annual enrollment
5 Any time during eligible employment 6 Special rules may apply
MEDICAL AND PRESCRIPTION DRUG PLANS
Cheyenne Regional is committed to the good health of its employees and the region we serve. We offer eligible employees our own BestLife medical and prescription drug insurance plans. These plans are designed to provide benefits in harmony with your BestLife wellness plan and BestLife health reimbursement account.
The tables listed on the pages that follow provide a brief summary of the benefits provided under the BestLife medical plans. The copay and coinsurance amounts listed reflect what you pay. A current list of providers is available at
bestlife.healthtrioconnect.com and www.cheyenneregional.org/staffemployees/benefits.
Medical Waiver Credit
If you do not require medical coverage through Cheyenne Regional, you may be eligible for the Medical Waiver Credit. Eligible employees who waive medical coverage and provide proof of other coverage may receive a credit of up to $960 per year.
Full-time employees will receive the credit in $40 increments per paycheck, 24 times throughout the year. Part-time employees will receive the credit in $20 increments. In order to receive the credit, you must waive medical coverage, complete the Medical Waiver Credit Application form (located at www.cheyenneregional.org/staffemployees/benefits), and provide proof of other coverage (such as a Certificate of Creditable Coverage) to Human Resources.
Medical and Prescription Drug Plan Costs
Cheyenne Regional is pleased that it is able to pay a large portion of the cost of medical premiums. Listed below are the monthly and per-pay-period employee costs for medical and prescription drug coverage.
MEDICAL RATES
Basic Plan
Level of Coverage Monthly (*FT) Monthly (*PT) Per-Pay-Period (*FT) Per-Pay-Period (*PT)
Employee $66.88 $133.76 $33.44 $66.88 Employee + Spouse $207.34 $311.00 $103.67 $155.50 Employee + Child(ren) $197.98 $296.96 $98.99 $148.48 Family $282.24 $423.36 $141.12 $211.68 MEDICAL RATES Plus Plan
Level of Coverage Monthly (*FT) Monthly (*PT) Per-Pay-Period (*FT) Per-Pay-Period (*PT)
Employee $89.36 $178.70 $44.68 $89.35
Employee + Spouse $276.98 $415.48 $138.49 $207.74
Employee + Child(ren) $264.48 $396.72 $132.24 $198.36
Family $377.06 $565.60 $188.53 $282.80
MEDICAL PLAN SELECTOR TOOL
Each of the BestLife medical and prescription drug plans has a different employee cost, which is the amount you pay out of your paycheck. As you consider which plan makes the most sense for you, think about whether you prefer to pay more each paycheck but less when you need care, or less per paycheck but more when you need care.
Cheyenne Regional is pleased to provide you with the Plan Selector Tool to assist you in selecting a medical plan.
How Does the Plan Selector Tool Work?
1. Access the Plan Selector Tool at www.cheyenneregional.org/staffemployees/benefits and carefully read the instructions.
2. Enter the number of people covered by the medical plan.
3. Then enter you and your family’s expected medical plan utilization (physician office visits, expected emergency room (ER) usage, prescription drugs, etc.). You may want to review your utilization from the past 2–3 years to help you determine appropriate numbers to input.
4. The Plan Selector Tool will approximate your annual costs for both plans based on the information you entered and the premium you would pay for coverage. 5. The Plan Selector Tool will highlight your lowest cost
option. You can click back to the Input tab and change the utilization numbers you entered to see how it affects the results
When determining the plan that is best for you, please be sure to review the out-of-pocket (OOP) expenses (copays, deductible, coinsurance) as well as the premium contribution (payroll deduction amount). The OOP expenses must be paid at the time of the visit/service, whereas the premium contribution is deducted evenly throughout the year. You need to determine what payment method best fits your needs and cash-flow situation.
Network Option Exclusive NetworkTier 1 Extended NetworkTier 2 Out-of-NetworkTier 3
Calendar Year Deductible $2,500 individual$5,000 family $5,000 individual$7,500 family $7,000 individual$10,000 family
Benefit Maximums
Out-of-Pocket Maximum (per plan year) $5,000 individual$7,000 family $10,000 individual$14,000 family $20,000 individual$28,000 family
Annual Benefit Maximum Unlimited
Lifetime Benefit Maximum Unlimited
Professional Services/Physician You pay no deductible You pay no deductible You pay
Preventive Exam/Services $0 copay 30% coinsurance 100%
Professional Services/Physician You pay after deductible You pay after deductible You pay after deductible Office Visit
Primary Care Physician Specialist Allergy Injection $30 copay/visit $60 copay/visit $30 copay/visit 30% coinsurance 30% coinsurance 30% coinsurance 50% coinsurance 50% coinsurance 50% coinsurance Prenatal Service Package Initial Visit $400 global copay 30% coinsurance 50% coinsurance Urgent Care Visit
Cheyenne Regional Urgent Care Clinic All Other Urgent Care Facilities
Requires notification within 48 hours if out-of-network
$30 copay $75 copay
After Tier 1 deductible: N/A
$75 copay
After Tier 1 deductible: N/A
$75 copay Home Health Care Visit
Requires physician referral and preauthorization $0 30% coinsurance 50% coinsurance
Hospice
Requires physician referral $0 30% coinsurance 50% coinsurance
Behavioral Health Visit $30 copay 30% coinsurance 50% coinsurance
Chiropractic Visit
20 visit maximum per year $25 copay 30% coinsurance 50% coinsurance
Facility Services You pay after deductible You pay after deductible You pay after deductible Inpatient/Observation Hospital
Requires preauthorization
$500 copay per day; max $2,000 copay per
admission 30% coinsurance 50% coinsurance
Outpatient Surgery
Hospital or Surgical Center
Office Procedure $300 copay$200 copay 30% coinsurance30% coinsurance 50% coinsurance50% coinsurance Emergency Room/Treatment Room
Emergency Room Care
ER Referred by Nurseline $300 copay$125 copay $300 copay after Tier 1 ded.$125 copay after Tier 1 ded. $300 copay after Tier 1 ded.$125 copay after Tier 1 ded.
Ambulance $100 copay $100 copay after Tier 1 ded. $100 copay after Tier 1 ded.
Skilled Nursing Facility 100 days lifetime maximum
Requires physician referral and preauthorization $0 30% coinsurance 50% coinsurance
MEDICAL AND PRESCRIPTION DRUG PLANS
Network Option Exclusive NetworkTier 1 Extended NetworkTier 2 Out-of-NetworkTier 3 Diagnostic and Therapeutic Services You pay after deductible You pay after deductible You pay after deductible
Laboratory Testing $0 30% coinsurance 50% coinsurance
Radiology $0 30% coinsurance 50% coinsurance
Diagnostic Studies (e.g., MRI, CT, PET)
Requires physician referral and preauthorization $300 copay per study 30% coinsurance per study 50% coinsurance per study
Physical Therapy/Occupational Therapy 20 visits per incident per year
Requires physician referral $25 copay 30% coinsurance 50% coinsurance
Speech Therapy
20 visits per incident per year
Requires physician referral and preauthorization; benefit limited by diagnosis
$25 copay 30% coinsurance 50% coinsurance
Cardiac Rehabilitation
Requires physician referral and preauthorization $25 copay 30% coinsurance 50% coinsurance
Durable Medical Equipment
Requires physician prescription and preauthorization 50% coinsurance 50% coinsurance 50% coinsurance
Growth Hormone Injectable Medication
Requires physician prescription and preauthorization
$5,000 out-of-pocket maximum 20% coinsurance 30% coinsurance 50% coinsurance
Pharmacy Services
(Copayments for mail order or retail 90-day supply are twice the listed amount. Deductible waived for mail order services.)
You pay
Deductible (per person) $0
Generic Prescriptions $10 copay + 15% coinsurance
Preferred Brand Prescriptions $15 copay + 15% coinsurance
Non-Preferred Brand Prescriptions $40 copay + 15% coinsurance
MEDICAL AND PRESCRIPTION DRUG PLANS
BestLife
Medical/Prescription Drug BASIC PLAN Continued
This benefit summary describes the coinsurance and/or copayment amounts that apply to specific types of covered services under the Cheyenne Regional medical plans. Some services require preauthorization for coverage. Other services may have limits, and certain services are excluded altogether. Members may also be responsible for additional costs that exceed regional reasonable and customary fees when utilizing the out-of-network option. For a more complete description, please refer to the Summary Plan Description (SPD) that discusses general information about health care services, obtaining covered services, covered services, and limitation and exclusions. The SPD can be found at www.cheyenneregional.org/staffemployees/benefits. Drugs listed as “preventive” in the Summary Plan Description are not subject to any medical or prescription deductible and/or copay when prescribed according to preventive guidelines.
MEDICAL AND PRESCRIPTION DRUG PLANS
BestLife
Medical/Prescription Drug
PLUS PLAN
Network Option Exclusive NetworkTier 1 Extended NetworkTier 2 Out-of-NetworkTier 3
Calendar Year Deductible $750 individual$1,500 family $1,250 individual$2,500 family $2,000 individual$4,000 family
Benefit Maximums
Out-of-Pocket Maximum (per plan year) $2,750 individual$5,500 family $4,250 individual$8,500 family $6,500 individual$13,000 family
Annual Benefit Maximum Unlimited
Lifetime Benefit Maximum Unlimited
Professional Services/Physician You pay no deductible You pay no deductible You pay
Preventive Exam/Services $0 copay 20% coinsurance 100%
Professional Services/Physician You pay after deductible You pay after deductible You pay after deductible Office Visit
Primary Care Physician Specialist Allergy Injection $15 copay $35 copay $15 copay 20% coinsurance 20% coinsurance 20% coinsurance 40% coinsurance 40% coinsurance 40% coinsurance
Prenatal Service Package Initial Visit $0 20% coinsurance 40% coinsurance
Urgent Care Visit
Cheyenne Regional Urgent Care Clinic All Other Urgent Care Facilities
Requires notification within 48 hours if out-of-network
$15 copay $50 copay
After Tier 1 deductible: N/A
$50 copay
After Tier 1 deductible: N/A
$50 copay Home Health Care Visit
Requires physician referral and preauthorization $0 20% coinsurance 40% coinsurance
Hospice
Requires physician referral $0 20% coinsurance 40% coinsurance
Behavioral Health Visit $15 copay 20% coinsurance 40% coinsurance
Chiropractic Visit
20 visit maximum per year $25 copay 20% coinsurance 40% coinsurance
Facility Services You pay after deductible You pay after deductible You pay after deductible Inpatient/Observation Hospital
Requires preauthorization
$250 copay per day, max $1,250 copay per
admission 30% coinsurance 50% coinsurance
Outpatient Surgery
Hospital or Surgical Center
Office Procedure $150 copay$100 copay 30% coinsurance30% coinsurance 50% coinsurance50% coinsurance Emergency Room/Treatment Room
Emergency Room Care
ER Referred by Nurseline $300 copay$125 copay $300 copay after Tier 1 ded.$125 copay after Tier 1 ded. $300 copay after Tier 1 ded.$125 copay after Tier 1 ded.
Ambulance $100 copay $100 copay after Tier 1 ded. $100 copay after Tier 1 ded.
Skilled Nursing Facility 100 days lifetime maximum
MEDICAL AND PRESCRIPTION DRUG PLANS
BestLife
Medical/Prescription Drug
PLUS PLAN Continued
Network Option Exclusive NetworkTier 1 Extended NetworkTier 2 Out-of-NetworkTier 3 Diagnostic and Therapeutic Services You pay after deductible You pay after deductible You pay after deductible
Laboratory Testing $0 20% coinsurance 40% coinsurance
Radiology $0 20% coinsurance 40% coinsurance
Diagnostic Studies (e.g., MRI, CT, PET)
Requires physician referral and preauthorization $200 copay per study 20% coinsurance per study 40% coinsurance per study
Physical Therapy/Occupational Therapy 20 visits per incident per year
Requires physician referral $25 copay 20% coinsurance 40% coinsurance
Speech Therapy
20 visits per incident per year
Requires physician referral and preauthorization – benefit limited by diagnosis
$25 copay 20% coinsurance 40% coinsurance
Cardiac Rehabilitation
Requires physician referral and preauthorization $25 copay 20% coinsurance 40% coinsurance
Durable Medical Equipment
Requires physician prescription and preauthorization 20% coinsurance 30% coinsurance 50% coinsurance
Growth Hormone Injectable Medication
Requires physician prescription and preauthorization
$5,000 out-of-pocket maximum 20% coinsurance 30% coinsurance 50% coinsurance
Pharmacy Services
(Copayments for mail order or retail 90-day supply are twice the listed amount. Deductible waived for mail order services.)
You pay
Deductible (per person) $50
Generic Prescriptions $10 copay
Preferred Brand Prescriptions $15 copay
Non-Preferred Brand Prescriptions $40 copay
This benefit summary describes the coinsurance and/or copayment amounts that apply to specific types of covered services under the Cheyenne Regional medical plans. Some services require preauthorization for coverage. Other services may have limits, and certain services are excluded altogether. Members may also be responsible for additional costs that exceed regional reasonable and customary fees when utilizing the out-of-network option. For a more complete description, please refer to the Summary Plan Description (SPD) that discusses general information about health care services, obtaining covered services, covered services, and limitation and exclusions. The SPD can be found at www.cheyenneregional.org/staffemployees/benefits. Drugs listed as “preventive” in the Summary Plan Description are not subject to any medical or prescription deductible and/or copay when prescribed according to preventive guidelines.
BESTLIFE HEALTH REIMBURSEMENT ACCOUNT
Cheyenne Regional is pleased to offer employees that participate in a BestLife medical plan and the BestLife wellness plan tax-free contributions to a BestLife Health
Reimbursement Account. You can use the money in your Health Reimbursement Account to pay your medical and prescription drug deductibles, copays, and coinsurance.
Cheyenne Regional will deposit the money in your Health Reimbursement Account the month following the completion of the Health Risk Assessment or a coaching call. An eligible participating spouse’s Health Reimbursement Account contribution will be deposited in the employee’s account. Health Reimbursement Account money that
you do not use during the calendar year automatically rolls over into your account for the next year. If you enroll in one of the BestLife medical plans, you will automatically be enrolled in the BestLife Health Reimbursement Account.
For more information, go to www.cheyenneregional.org/staffemployees/benefits.
HRA CONTRIBUTIONS THAT YOU CAN EARN IN 2014
Amount* Requirement By When
$300** BestLifecoverage Medical Plan Enrollment – For employees enrolled in employee-only Upon Enrollment $500** BestLifespouse, employee + child(ren), or family coverage Medical Plan Enrollment – For employees enrolled in employee + Upon Enrollment $150***
Employee Health Risk Assessment – ($50 for completing the assessment and $100 for entering employee biometric information into the Health Risk Assessment) PLUS receive a free one-year membership to the Health and Fitness Center if you complete the Health Risk Assessment by 12/14/13.
December 14 $100**** Spouse Health Risk Assessment – ($50 for completing the assessment and $50 for entering spouse biometric information into the Health Risk Assessment) December 14
Employee Coaching Calls
$75 1st Quarter Health Coaching Call March 31
$75 2nd Quarter Health Coaching Call June 30
$75 3rd Quarter Health Coaching Call September 30
$75 4th Quarter Health Coaching Call December 14
Spouse Coaching Calls
$50**** 1st Quarter Health Coaching Call March 31
$50**** 2nd Quarter Health Coaching Call June 30
$50**** 3rd Quarter Health Coaching Call September 30 $50**** 4th Quarter Health Coaching Call December 14
Contact the BestLife Health Reimbursement Account administrator, Sterling HSA: • Call (800) 617-4729
• Go to www.sterlinghsa.com
FOR MORE INFO...
*When an employee is enrolled in one of Cheyenne Regional’s BestLife medical and prescription drug plans, all wellness rewards are deposited, tax free, into the employee’s BestLife Health Reimbursement Account and can be used to pay medical and prescription plan deductibles and copays. Eligible full-time and part-time employees who are not enrolled in one of Cheyenne Regional’s BestLife medical and prescription drug plans earn after-tax cash wellness rewards included in their pay based on the employee incentives listed above.
**This one time Health Reimbursement Account contribution is only available to employees enrolled in one of Cheyenne Regional’s BestLife medical and prescription drug plans.
BESTLIFE WELLNESS PLAN
Cheyenne Regional knows our employees are our most valuable asset, and we are pleased to provide a supportive work environment that encourages a culture of wellness. The BestLife wellness program provides resources, programs, challenges, and incentives to help employees make healthier lifestyle choices. Our partnership with US Corporate Wellness brings you exciting new resources to monitor and manage your health as well as highly trained wellness coaches to confidentially discuss your wellness goals and support you on your wellness journey. In addition to many wellness programs and activities throughout the year, participation in specific BestLife activities through US Corporate Wellness qualifies you for tax-free contributions to your BestLife Health Reimbursement Account.
Health and Fitness Facility
Cheyenne Regional offers a full-service fitness facility that is open seven days a week to help you meet your wellness goals. Cheyenne Regional’s Health and Fitness Center is more than just a place where you can exercise—it’s a place where you can focus on overall mind and body wellness—providing personal wellness training, group exercise, and rejuvenation. State-of-the-art cardio and weight training equipment have recently been added. Cheyenne Regional’s Health and Fitness Center offers total fitness assessments, individualized training sessions, and a variety of classes ranging from beginner level to advanced. To help you relax and rejuvenate, spa treatments and massage therapy sessions are also available on site. Discounted membership rates are available to full-time and part-time employees and volunteers.
Cash Rewards
Full-time and part-time employees who are not covered by one of Cheyenne Regional’s BestLife medical plans cannot receive contributions to a BestLife Health Reimbursement Account*. However, you can still receive cash rewards for completing BestLife wellness activities as described on the previous page. Cash rewards are paid the month following completion of the activity, are included in your pay post-tax, and may be used for any purpose.
*As described on page 12
FOR MORE INFO...
For more information about the BestLife Wellness Program: • Call (307) 633-7897 • Go to
www.USCorporateWellness.com (to complete your Health Risk Assessment)
• Call US Corporate Wellness at (800) 910-9425
CONTACT INFORMATION
NEW for 2014!
If you complete the Health Risk Assessment by December 14, 2013, you will receive a one-year membership to the Cheyenne Regional Health and Fitness Center for free. New employees and employees who become eligible during the plan year have 30 days from their date of enrollment in a BestLife medical and prescription drug plan to complete the Health Risk Assessment to receive the free one-year Health and Fitness Center membership.
DENTAL PLANS
Cheyenne Regional offers two dental plan options through Delta Dental of Wyoming. We are pleased to provide this coverage with no increase in premiums for 2014.
The Basic Plan offers basic coverage at a lower premium. The Plus Plan offers enhanced benefits at a higher premium. Both plans include the same network of providers. Locate a network provider at www.deltadentalwy.org.
Dental Plan Costs
Listed below are the monthly and per-pay-period employee costs for dental coverage.
DENTAL RATES
Basic Plan
Level of Coverage Monthly (*FT) Monthly (*PT) Per-Pay-Period (*FT) Per-Pay-Period (*PT)
Employee $6.82 $13.10 $3.41 $6.55 Employee + Spouse $30.88 $44.02 $15.44 $22.01 Employee + Child(ren) $35.88 $48.86 $17.94 $24.43 Family $47.48 $60.76 $23.74 $30.38 DENTAL RATES Plus Plan
Level of Coverage Monthly (*FT) Monthly (*PT) Per-Pay-Period (*FT) Per-Pay-Period (*PT)
Employee $11.02 $21.20 $5.51 $10.60
Employee + Spouse $49.80 $71.00 $24.90 $35.50
Employee + Child(ren) $57.88 $78.84 $28.94 $39.42
Family $76.62 $98.06 $38.31 $49.03
DENTAL PLANS
Benefit Basic Plan Plus Plan
Calendar Year Deductible
(Applies to basic and major services) $50 individual/$100 family $75 individual/$150 family
Preventive Care
One cleaning and exam every 6 months, bite-wing x-rays every 6 months (cleanings every 3 months for diabetics and pregnant women)
100% 100%
Basic Restorative Services
Fillings, root canals, periodontics, and oral surgery 80% after deductible 80% after deductible
Major Restorative Services
Crowns, bridges, partials, and dentures 50% after deductible 75% after deductible(includes synthetics)
Orthodontia Not covered up to $2,000 per person50%
(adults and dependents)
Annual Maximum
VISION PLAN
Benefit
Exams (once every plan year) $10 copay
Prescription Glasses $25 copay
Lenses (once every plan year) 100% (single vision, bifocal, trifocal, progressive) Frames (once every other plan year) $140 allowance
Contact Lenses (in lieu of lenses and
frames; once every plan year) $140 allowance
VISION PLAN
Cheyenne Regional offers a comprehensive vision plan through Vision Service Plan (VSP). We are pleased to provide this coverage with no increase in premiums for 2014.
The vision plan covers eye exams, frames, lenses, and contacts. You have the option to see any provider, but will receive the highest benefits and pay less out of your pocket when you use a VSP participating network provider. Locate a Select network provider at www.vsp.com.
VISION RATES
Level of Coverage Monthly Per-Pay-Period
Employee $10.34 $5.17
Employee + Spouse $16.24 $8.12
Employee + Child(ren) $17.38 $8.69
Family $27.80 $13.90
Vision Plan Costs
Listed below are the monthly and per-pay-period employee costs for vision coverage. Note: The rates are the same for both full- and part-time employees.
FLEXIBLE SPENDING ACCOUNTS
Participating in the flexible spending account (FSA) programs is a great way to plan ahead and save money over the course of the year. FSAs offer you a convenient way to set aside pre-tax dollars to pay for eligible medical and dependent care expenses.
Healthcare FSA
Contribute up to $2,500 per year to pay for eligible healthcare expenses including deductibles, copays, and coinsurance. Healthcare FSA dollars can be used for medical, dental, and vision expenses for you and your dependents.
NOTE: Healthcare FSA dollars cannot be used to reimburse expenses paid
by the insurance plans and/or Health Reimbursement Account dollars. Thus, if you use FSA dollars to pay for eligible healthcare expenses, you cannot be reimbursed from your Health Reimbursement Account.
Dependent Care FSA
Contribute up to $5,000 per year to pay for eligible dependent care expenses including day care facility fees, before- and after-school care, and in-home babysitting fees. You and your spouse must work or attend school full time to participate in the dependent care FSA.
You will receive a debit card that you can use for eligible healthcare FSA and dependent care FSA expenses. Be sure to save your receipts to substantiate the expense.
Know the IRS rules:
1. Your participation cannot be changed during the plan year unless you experience a qualifying life event such as marriage, birth, or loss of coverage (see page 4). You have 30 days to make benefit changes due to a qualifying life event.
2. Money set aside for the healthcare FSA cannot be used to pay dependent care expenses, and dependent care funds cannot be used to pay medical expenses.
3. Unused funds will be forfeited 105 days after the end of the plan year, which is
December 31, 2014.
BASIC LIFE AND ACCIDENTAL DEATH AND
DISMEMBERMENT INSURANCE
Cheyenne Regional provides group term life and accidental death and dismemberment (AD&D) insurance to all eligible employees at no cost. Life insurance plans are designed to provide a source of income protection for your family in the case of death or serious injury. This life insurance policy is payable to your named beneficiary. Your AD&D benefit is equal to the amount of your life insurance benefit and is payable to you if you suffer a covered loss of a limb or sight, or to your named beneficiary if you die as a result of an accident.
Employee Type Coverage Payment
Exempt (salaried), full-time employees 2x annual base salary rounded to the next higher $1,000 multiple—to a maximum of $500,000* Non-exempt (hourly), full-time employees 1x annual base salary rounded to the next higher $1,000 multiple —to a maximum of $500,000*
Part-time employees $10,000*
*Benefit reductions apply to employees age 65+.
SUPPLEMENTAL LIFE INSURANCE
Cheyenne Regional provides eligible employees with the option to purchase supplemental life insurance, which the surviving family may need to maintain its standard of living. Lincoln Financial and Colonial Life offer you the ability to “buy up” life insurance to provide your family with additional financial security. Options include term life insurance and universal life insurance (with long-term care rider). Premiums are based on age, smoking status, and coverage selected. Contact Lincoln Financial and/or Colonial Life for additional information (see page 23 for contact details).
SHORT-TERM DISABILITY
Circumstances can change in an instant—a car or recreational accident, a sudden illness, or a medical crisis—and being prepared gives you peace of mind. Cheyenne Regional provides short- and long-term disability coverage to all eligible employees at no cost.
This benefit is designed to replace a portion of your income in the event that a personal medical illness, injury, or maternity leave* keep you from working.
The first seven calendar days after a disability will be paid by PTO or unpaid leave if PTO is exhausted. The seven-day elimination period is waived if you have an overnight stay in the hospital.
SHORT-TERM DISABILITY (STD)
Benefit Coverage Payment
Weeks 1-6 90% of pre-disability earnings Weeks 7-12 70% of pre-disability earnings Weeks 13-26 50% of pre-disability earnings
*Short-term disability (STD) leave can also be used for maternity leave. An employee eligible for maternity leave may be eligible to obtain up to eight weeks disability pay.
LONG-TERM DISABILITY INSURANCE
Long-term disability replaces 50 percent of pre-disability earnings after an employee has exhausted 26 weeks of short-term disability coverage. Long-term disability is payable until you reach the social security normal retirement age or until you are no longer disabled.
Lincoln Financial, the insurance provider, will determine how long the disability will be approved for payment based upon medical verification provided by your physician. Income replacement is calculated upon your base pre-disability earnings and does not include shift differential or overtime.
SUPPLEMENTAL DISABILITY INSURANCE
Cheyenne Regional provides eligible employees with the option to purchase additional disability coverage through Colonial Life to help offset financial losses when you are unable to work due to an illness or injury. This benefit can supplement your income to help you pay some of your everyday expenses such as mortgage or rent payments, utility bills, as well as other household expenses, food and clothing. Premiums are based on age, salary, and coverage selected. Contact Colonial Life for additional information (see page 23 for contact details).
VOLUNTARY ACCIDENT, CANCER, CRITICAL ILLNESS, AND
MEDICAL BRIDGE HOSPITAL CONFINEMENT PLANS
IMPORTANT!
Short-term and long-term disability are not available if the illness or injury is work-related. For work-related illnesses or
injuries, contact Occupational Health at (307) 633-7897.
EMPLOYEE ASSISTANCE PROGRAM
Cheyenne Regional cares about its employees’ health and well-being, which is why we offer the employee assistance program (EAP) through Resources for Living. The EAP is a confidential resource designed to help you and your family members manage challenges that are affecting your quality of life. This benefit is free to all Cheyenne Regional employees, dependents, and family members. You do not need to be enrolled in a Cheyenne Regional benefit plan to participate.
Confidentiality is totally assured for you, your dependents, and your household members. Cheyenne Regional will not be informed of your participation. Information will only be released with your permission, or as required by law for child or elder abuse, or in a life-threatening situation. The EAP includes resources to help with:
The EAP is available 24 hours a day, seven days a week, for crisis calls, counseling, and referral.
Call (800) 284-1819 -or-
Visit www.mylifevalues.com Login ID: Cheyenne Regional Password: eap
CONTACT INFORMATION
• Conflicts at home or work • Child behavior issues • Family concerns • Depression • Managing stress
• Marriage or life partner problems • Alcohol and drug problems • Grieving the loss of a loved one
• Coping with serious illness or injury • Caring for elderly family members • Financial resources
• Legal resources • Work-life services
• Health and wellness resources • Face-to-face counseling sessions • ID theft counseling
RETIREMENT SAVINGS PLANS
The Cheyenne Regional retirement plans, administered by Great-West Financial, described below are powerful tools to help you reach your retirement goals. As a supplement to other retirement benefits or savings that you have, these plans allow you to save and invest extra money for retirement consistently and automatically. In additional to the brief information provided below, Cheyenne Regional has a separate Retirement Plans Brochure and Enrollment Kit available from Human Resources. Be sure to obtain and review that additional information for important legal information regarding eligibility and participation in the plans.
403(b) Defined Contribution Plan
Cheyenne Regional’s 403(b) plan is a retirement plan designed for public employers. Contributions and any earnings are tax deferred until money is withdrawn.
Distributions are usually taken at retirement, when participants are typically receiving less income and may be in a lower tax bracket. You are always 100 percent vested in the contributions you make to the Cheyenne Regional 403(b) plan.
403(b) Roth Defined Contribution Plan
Your 403(b) plan also offers a Roth contribution option. This gives you the flexibility to designate all or part of your 403(b) elective deferrals as Roth contributions. Roth contributions are made with after-tax dollars, as opposed to the pre-tax dollars you contribute to a traditional 403(b) account. In other words, with the Roth option, you’ve already paid taxes on the money you contribute. You are always 100 percent vested in the Roth contributions you make to the plan. The 401(a) employer match described below does not apply to your Roth contributions.
457(b) Deferred Compensation Plan
The governmental 457(b) deferred compensation plan offered by Cheyenne Regional is a retirement savings plan that eligible employees may use in addition to any existing retirement benefits by saving and investing before-tax dollars through voluntary salary deferral. Distributions are usually taken at retirement, when participants are typically receiving less income and may be in a lower income tax bracket. You are always 100 percent vested in the contributions you make to the Cheyenne Regional 457(b) plan.
457(b) Roth Deferred Contribution Plan
Your 457(b) plan also offers a Roth contribution option. This gives you the flexibility to designate all or part of your 457(b) elective deferrals as Roth contributions. Roth contributions are made with after-tax dollars, as opposed to the pre-tax dollars you contribute to a traditional 457(b) account. In other words, with the Roth option, you’ve already paid taxes on the money you contribute. You are always 100 percent vested in the Roth contributions you make to the plan. The 401(a) employer match described below does not apply to your Roth contributions.
401(a) Employer Matching Contribution Plan
Cheyenne Regional’s 401(a) plan is a retirement savings plan designed to allow Cheyenne Regional to supplement its
employees’ existing retirement benefits by contributing to the plan on the employees’ behalf. Contributions and any earnings on contributions are tax deferred until the money is withdrawn. When you contribute to the 403(b) plan or 457(b) plan, Cheyenne Regional will match 100 percent of the first 4 percent of your combined compensation that you contribute in pre-tax deferrals (subject to IRS limits). The 401(a) match will be made to your account each pay period. Employer contributions to the 401(a) plan plus any earnings they generate have a one-year vesting requirement, which means the balance is 100 percent yours after you complete one year of service as an eligible employee in which you worked a minimum of 800 hours. Once you have fulfilled that criteria, the total account balance is yours when you separate service or retire from Cheyenne Regional.
• You may contribute from 1% to 100% of your earnings, not to exceed the annual IRS maximum.
• Employees age 50+ by December 31, 2014, may contribute an additional catch-up contribution in 2014.
RETIREMENT PLAN
CONTRIBUTION LIMITS
EDUCATION ASSISTANCE
Eligibility: Employees who are classified as full-time or part-time exempt or hourly, have worked at Cheyenne Regional for
a minimum of 120 days, and have received no corrective action in the past 120 days are eligible for Education Assistance. Ineligible staff include: PRN, temporary, contract staff, and staff with disciplinary action within 120 days of application.
Course Criteria: All secondary education courses must be through an accredited degree granting institution. The institution
must be accredited by the Institutional Accrediting Bodies, which are recognized by the Council for Higher Education
Accreditation. Certification and/or continuing education that is not required as a condition of employment may be eligible for reimbursement.
Course Consideration: Only courses/degrees that apply to positions that benefit Cheyenne Regional will be eligible for
consideration of reimbursement.
Employment Commitment: Staff who receive Education Assistance must agree to continued employment at Cheyenne
Regional. Commitment period is based on amount reimbursed (see table below), and begins after successful completion of approved course(s), and is extended for each amount received.
*Reimbursement will be provided for tuition/cost of the course(s), lab fees, and any associated textbook(s) only. *Maximum allowance during fiscal year is $5,000 for a full-time employee and $3,000 for a part-time employee.
Amount Borrowed Commitment Period
$1–$1,500 6 months
$1,501–$3,000 12 months
PAID TIME OFF
At Cheyenne Regional, we recognize that achieving work-life balance means something different for everyone and can include going on vacation, spending time with friends and family, or attending a child’s school activities. We value this balance because we know an employee with a well-balanced life is a happier and more productive employee. We encourage employees to take time away from work, when the situation allows, using paid time off (PTO). Accrued PTO is available for sick leave, holidays, vacation, and other personal time off, as approved by your supervisor. It’s one of the many ways we at Cheyenne Regional offer flexibility and choice for our employees. Eligible employees accrue PTO immediately upon hire, and PTO is available for use as soon as it is accrued. The accrual rates are listed in the tables below.
An employee may trade PTO hours for cash during a scheduled election period as long as his or her PTO account remains above 40 hours. An employee may elect to cash out PTO hours up to two times per calendar year. The PTO cash out benefit is subject to change.
Employee Type Length of Service Accrual Rate Maximum Accrual
Non-Exempt/Hourly 1 year .0885 x hours workedmax 7.08 hours 184 hours Non-Exempt/Hourly 2–4 years .1077 x hours workedmax 8.62 hours 328 hours Non-Exempt/Hourly 5–9 years .1304 x hours workedmax 10.43 hours 328 hours Non-Exempt/Hourly 10–19 years .1607 x hours workedmax 12.86 hours 328 hours Non-Exempt/Hourly 20+ years .1872 x hours workedmax 14.98 hours 328 hours
Exempt/Salaried 1 year .0885 x hours regularly scheduled per pay period
max 7.08 hours 184 hours Exempt/Salaried 2–4 years .1077 x hours regularly scheduled per pay period
max 8.62 hours 328 hours Exempt/Salaried 5–9 years .1304 x hours regularly scheduled per pay period
max 10.43 hours 328 hours Exempt/Salaried 10–19 years .1607 x hours regularly scheduled per pay period
max 12.86 hours 328 hours Exempt/Salaried 20+ years .1872 x hours regularly scheduled per pay period
max 14.98 hours 328 hours
Note: Managers, Directors, Administrators, and Executive-level positions earn an additional .019 x regularly schedule hours
IMPORTANT CONTACT INFORMATION
Contact
Phone #
Website
BestLife Medical Plan administration provided by WINhealth Partners
(307) 773-1305 bestlife.healthtrioconnect.com BestLife Wellness Program
administration provided by US Corporate Wellness
(307) 633-7897
(800) 910-9425 www.USCorporateWellness.com
BestLife Health Reimbursement Account and FSA administration provided by Sterling HSA
(800) 617-4729 www.sterlinghsa.com Nurse Response Line 24/7 (307) 773-1305 option #2 N/A
Delta Dental Benefits (307) 632-3313 www.deltadental.com
VSP Vision Benefits (800) 877-7195 www.vsp.com
Colonial Life Supplemental Benefits
(800) 325-4368 for claims (866) 270-6733 for the Denver office
www.coloniallife.com Lincoln Financial Supplemental Life
and AD&D (800) 423-2765 www.lincoln4benefits.com
Resources for Living Employee
Assistance Program (800) 284-1819
www.mylifevalues.com Login: Cheyenne Regional
Password: eap
Great-West Financial (866) 467-7756 www.gwrs.com
Cheyenne Regional Human Resources and Benefits
(307) 633-7871 (307) 633-7700
www.cheyenneregional.org/ staffemployees/benefits
