YOUR HEALTH. YOUR WEALTH.
YOUR WELLBEING.
HOUSE OFFICER ENROLLMENT GUIDE
BMC
1
About Boston Medical Center’s
Benefits Program
Boston Medical Center (BMC) is proud of its long history of offering eligible employees access to high quality, competitive and affordable benefits. Our employee benefits program features both choice and flexibility and is designed to meet the diverse needs of our workforce. Benefits include comprehensive health care, income protection in the event of disability, and security during retirement through long-term savings opportunities. This Guide is intended as a resource to help you understand your benefits and take advantage of the many resources available to you through BMC, our insurance carriers and our third-party vendors—so that you can make informed benefits decisions for yourself and your family.
You can find additional information in the Summary Plan Description, the Summary of Benefits and Coverage booklets, and an online video available on the benefits intranet page and in the Benefits Office. We also encourage you to use the various websites hosted by our carriers and
vendors, as they contain a wealth of information about your benefit plans and how to use them. The contact list at the end of this Guide contains the website and customer service phone number for each of the BMC benefit plans.
Eligibility and Enrollment
Eligibility
BMC’s definition of “benefits-eligible employee” includes those employees who are regularly scheduled to work 20 or more hours per week. If you meet this requirement, then you are eligible to enroll in any of the benefit plans described in this Guide, unless otherwise noted.
Your eligible dependents include:
• Your legal spouse;
• Your former legal spouse, until he/she or you remarries;
• Your legal children and stepchildren up to the age of 26;
• Your children of any age who are physically or mentally disabled and dependent on you for their support, provided they became disabled before age 26; and
• Your covered child’s child until their parent turns age 19 or is no longer a covered dependent, whichever comes first.
Please note that your former spouse is eligible for medical, dental and vision coverage only.
Dependents in active military service and those who live permanently outside the United States are not eligible for BMC coverage.
Table of Contents
1 About BMC’s Benefits Program
1 -2 Eligibility and Enrollment 2 Cost of Coverage
3 How to Choose the Plan That’s Right for You
4-6 Your Medical Plan Options 7 Prescription Drug Benefits
7-8 Medical Plan Comparison Chart
9-10 Dental Benefits 11 Vision Care Benefits
12-13 Life Insurance and AD&D Benefits 13 Disability Benefits
14 Flexible Spending Accounts 14 Legal Service Plan
15 403(b) Retirement Plan Information 16 Wellbeing Benefits
17 Employee Discounts
17 Benefit Workshops & Seminars 17 Employee Resource Guides 18 Commuting to Work 18 Payroll Information
19-20 Legal Information
2
Enrollment / Elections
There are three opportunities in which you will be able to make elections or changes to your benefits.
Newly Hired
If you are a new hire, you have 30 days from your hire date to elect your benefits. Your benefits begin on your first day of employment.
Open Enrollment
Each year, you will have the opportunity to change your current benefit elections or enroll in any of BMC’s benefit plans for the first time. The elections you make during Open Enrollment become effective the following January 1. If you do not enroll or make changes online by the Open Enrollment deadline, your current benefit elections, except for the Flexible Spending Accounts (FSA), will carry over to the new plan year and be subject to the new payroll deductions for that year. FSA elections must be made each year and do not automatically carry over from year to year.
If you are hired during the Open Enrollment period, you will need to enroll in the current benefits for the remainder of the year in which you were hired and make your benefit elections for the upcoming year.
Mid-Year Changes (Qualifying Events, Special Enrollment Rights)
IRS regulations restrict your ability to change your elections during the year unless you experience a “qualifying event” or you qualify under a HIPAA Special Enrollment Right. You have 30 days from the date of the event to notify the Benefits Office. Some examples include:
• Marriage or divorce;
• Birth or adoption of a child;
• Death of your spouse or child;
• Your child no longer qualifying as an eligible dependent under the plan(s);
• A change in your spouse’s employment status that affects his/her benefits eligibility;
• A change in your employment status that affects your benefits eligibility;
• Your spouse has a conflicting Open Enrollment period.
If you or your family have experienced an employment or life event, you must complete the mid-year change request within 30 days of the event. Requests are made online at www.myworkday.com/bmc and you must attach supporting documentation. The Benefits Office will review your request and documentation to see if you qualify to make your requested changes.
If you have missed the 30-day limit to notify the Benefits Office or if you do not provide the documentation required, you will have to wait until the next Open Enrollment period to make your change(s).
Cost of Coverage
Weekly Employee Contributions for 2016
36 – 40 hour work week 20 – 35 hour work week
Individual EE + One Family Individual EE + One Family Medical
BMC Select $0.00 $0.00 $0.00
Medical
BMC Select $0.00 $0.00 $0.00 BMC Tiered HMO $26.99 $53.53 $79.78 BMC Tiered HMO $53.99 $107.07 $159.56 HPHC PPO $29.86 $59.63 $89.07 HPHC PPO $59.71 $119.25 $178.14 Dental BU Dental $6.90 $15.65 $24.39 Dental BU Dental $7.82 $16.58 $25.32
BCBS Dental Blue $12.19 $26.22 $36.74 BCBS Dental Blue $13.11 $27.14 $37.67 Vision Davis Vision $1.29 N/A $2.58 Vision Davis Vision $1.29 N/A $2.58
3
How to Choose the Plan That’s
Right for You
Choosing a medical plan can be challenging, so it’s important to think about your needs and the needs of your family members as you make your selection. You’ll need to consider the total out of pocket costs as well as the types of providers and facilities you and your family are likely to use over the course of the plan year. Here are some points you may want to think about:
With BMC Select:
• The plan is offered for free to employees and their family members and includes no or low cost copayments for all services.
• You and your covered family members will be required to receive care from the BMC Select network which includes Boston Medical Center, Boston University affiliated providers (BUAP) and some providers at the Boston HealthNet Community Health Centers.
• With only a few exceptions, like emergency/urgent care, there is no coverage for services received outside the BMC Select network.
With BMC Tiered HMO:
• All providers and hospitals are placed onto one of three tiers. Your copayments vary depending on which tier the provider or hospital is assigned.
• You and your covered family members can receive care from any hospital or provider in the Harvard Pilgrim Health Care (HPHC) network.
• You do not select a tier, but instead may use any provider on any tier at any time.
With HPHC PPO:
• You are responsible for paying annual deductibles for both in and out-of-network services. Once you have met the deductible, you are also responsible for a percentage (up to 30% in some cases) of the cost of most services you receive, until you reach the annual out-of-pocket maximum that applies to you.
• You may see providers that are not part of the HPHC network.
•
If you use out-of-network benefits and your provider bills you a higher amount than HPHC will reimburse, you are responsible for those added costs and they will not be applied to your out-of-pocket maximum.New employees default coverage
IMPORTANT:
If you do NOT elect to enroll in
one of BMC’s medical plans during your new
hire election period and do NOT opt out of
medical coverage online by electing “Waive,”
you will automatically be enrolled in the BMC
Select plan at the individual coverage level.
Even if you have other medical insurance, you
are still required to complete the enrollment
process by either waiving coverage or selecting
one of BMC’s medical plans.
4
Your Medical Plan Options
About BMC Select –
A “Limited Network” Plan
BMC Select is offered at no weekly cost to employees. There are limitations as to where you can receive your care if you join this plan. Except in an emergency, you are required to receive all of your inpatient care at Boston Medical Center. This includes all BMC and BU affiliated providers, as well as some providers affiliated with the Boston HealthNet Community Health Centers, as described below.
In addition to emergency room visits, care that may be received outside the BMC Select network includes urgent care, chiropractic services, behavioral health, dialysis and pediatric dental. However, these providers must be part of the HPHC network.
Here is a list of affiliated providers that are part of the BMC Select network:
Boston HealthNet
Community Health Centers*
Dorchester
Codman Square Health Center Dorchester House Multi-Service Center Upham’s Corner Health Center
East Boston East Boston Neighborhood Health Center Mattapan Mattapan Community Health Center
Roslindale Greater Roslindale Medical and Dental Center Roxbury Whittier Street Health Center
South Boston South Boston Community Health Center South End South End Community Health Center
*Please note that not all doctors in the HealthNet Community Health Centers listed above are part of the BMC Select Network. Please call HPHC Member Services or view a provider directory online at www.hphc.org/bmcto confirm.
With BMC Select, you’ll need to choose a Primary Care Provider (PCP), but you won’t need referrals for specialty care covered under the plan. If you don’t already have a PCP who participates in the BMC Select network, you can choose one after you enroll, or Harvard Pilgrim will assign one to you. You can change your PCP for any reason and at any time by simply calling Harvard Pilgrim’s Member Services Department at the phone number on your ID card,
888-333-HPHC (4742).
An online provider directory is available at www.hphc.org/bmc, so you can check which providers are in the BMC Select network.
BMC Select may be a great option for you if you already use BMC and its affiliated providers. In terms of annual premium contributions and your out-of-pocket expenses when you use the plan, it’s also the most cost effective plan you can choose. BMC Select features the lowest copays among our three medical plan options. If you go to an urgent care facility, your copay is just $5.
In the rare event that a member requires a service not provided at BMC, the member may submit a request for an “extra-contractual” payment to Harvard Pilgrim. Employees who receive their care at BMC have access to MyChart, a free and secure
health information portal. With MyChart you can view details of your appointments, review your medical history, receive test results, and search health education topics. Go to mychart.bmc.organd click the “Sign Up Now” button to get started.
For more details about the BMC Select and how it compares to your other medical plan options, see the Medical Plan Comparison Chart on pages 7 and 8.
Boston University Affiliated Providers Copley Square
Charles River (Commonwealth Ave) Norwood
Urgent Care Centers
Multiple locations available for urgent care, including CVS Minute Clinic. Visit www.hphc.org/bmcfor a complete listing.
Office Visit: $5
Inpatient: No charge
Emergency Room: $75
5
About BMC Tiered HMO -
A “Tiered Network” Plan
A “Tiered Network” plan means that all providers and hospitals are placed on one of three tiers. Each year Harvard Pilgrim places its network of providers onto a tier based on quality and cost of care. Copays differ depending on tier.
Tier 1 includes BMC inpatient hospital care. It also includes BMC and BU Affiliated Providers, as well as some Boston HealthNet Community Health Center providers. This tier matches the BMC Select network.
Tier 2 includes most providers and hospitals in Harvard Pilgrim’s network. It also includes providers that are not affiliated with a hospital, such as chiropractors and optometrists.
Tier 3 includes the providers and hospitals in Harvard Pilgrim’s network that have been identified as the most costly for the services they provide.
An online provider directory is available at www.hphc.org/bmcso you can determine which tier your providers and hospitals have been assigned and therefore what your out-of-pocket costs will be.
Note: If you receive most or all of your care from Tier 1 providers, you may want to consider joining the lower cost BMC Select plan.
The BMC Tiered HMO requires you to choose a Primary Care Provider (PCP), and get referrals for most kinds of specialty care, but your PCP and specialists can be in different coverage tiers. This option gives you the opportunity to choose your care from any provider in the Harvard Pilgrim network.
Keep in mind that your copays will vary depending on the providers you see and the hospitals you use. For
example, if a Tier 2 specialist sends you to a Tier 3 hospital, you would pay the Tier 2 specialist copay and the Tier 3 hospital copay.
Here’s a look at the Tiered HMO copays for PCP visits, specialist office visits, inpatient hospital services and emergency room visits.
Tier 1 Tier 2 Tier 3
PCP Visits $5 $20 $35
Specialist Visits $5 $25 $50
Inpatient Hospital Visits No charge $100 $250
Emergency Room Visits $75 $75 $75
As you can see, you’ll have lower out-of-pocket costs with Tier 1, which is BMC and its affiliated providers, but you can still choose to go to Tier 2 and Tier 3 providers and hospitals and pay higher copays.
If you need to go to the emergency room, your copay will be the same, regardless of the tier to which the hospital treating you has been assigned. If you are admitted to the hospital from the emergency room, it will be treated as a Tier 1 expense.
For more details about the BMC Tiered HMO and how it compares to your other medical plan options, see the Medical Plan Comparison Chart on pages 7 and 8.
Avoid surprises! Before you make an appointment, confirm your provider’s tier at www.hphc.org/bmc or call 888-333-HPHC (4742).
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About Harvard Pilgrim Health Care PPO
Harvard Pilgrim Health Care PPO (HPHC PPO) is a “preferred provider” plan, which means you can choose to visit any provider or hospital you wish. However, when you visit a provider or use a hospital that is not part of the Harvard Pilgrim network, your out-of-pocket costs will be significantly higher. Not only will you be responsible for a higher deductible that applies to all services received, but you will also pay 20% to 30% of the cost of your care until you reach your annual out-of-pocket maximum.
The PPO plan does not require that you select a Primary Care Physician (PCP) to direct your care, though we strongly encourage you and every covered family member to work with a PCP who knows you, is aware of your family history and can oversee your use of specialists.
There are two sets of benefits under the PPO plan: In-network and out-of-network, and each set of benefits has its own annual deductible.
When visiting providers in the HPHC network, with the exception of preventive care, you must meet the annual deductible before the plan covers services. You are then responsible for a percentage of the cost of all other services until you reach the annual out-of-pocket maximum. The percent you are responsible for is called “coinsurance.”
The out-of-network benefit is much more costly when you receive services. Once you reach the annual deductible, you pay 20% or 30% coinsurance toward the cost of care—depending on the services you receive—until you reach your annual out-of-pocket maximum. If you use the out-of-network benefit and your provider bills you a higher amount than HPHC will reimburse (this is called “balance billing”), YOU are responsible for those added costs—and they will not be applied to your out-of-pocket maximum.
The following chart illustrates what your cost share will be:
In-Network Out-of-Network
In-Network Out-of-Network
Annual Deductible $1,000 individual / $2,000 family $2,000 individual / $5,000 family Annual Out-of-Pocket Maximum $3,000 individual / $6,000 family $3,000 individual / $6,000 family
PCP Visits $35 copay 20% coinsurance after deductible
Specialist Visits $50 copay 20% coinsurance after deductible Inpatient Hospital Services 10% coinsurance after deductible 30% coinsurance after deductible
Emergency Room Visits $75 $75
For more details about the HPHC PPO and how it compares to your other medical plan options, see the Medical Plan Comparison Chart on pages 7 and 8.
7
Prescription Drug Benefits
Your prescription drug benefits are the same, regardless of which BMC medical plan you choose. When you need prescriptions, you have the option of purchasing them at any one of the BMC pharmacies or through pharmacies that belong to Harvard Pilgrim’s network. You can save 60% - 70% off your copays when you get your prescriptions from the BMC pharmacies—and don’t forget the convenience of filling your prescriptions right where you work! The BMC pharmacies can also assist you with transferring your current prescriptions to their locations:
Tier 30-Day Supply 90-Day Supply
BMC Pharmacies Other Pharmacies BMC Pharmacies Mail Service
Tier 1 $5 $20 $10 $40
Tier 2 $10 $35 $20 $70
Tier 3 $20 $50 $60 $150
For more information about your prescription drug coverage, visit www.hphc.org/bmc and choose “Pharmacy Program.”
Medical Plan Comparison Chart
The following chart provides an overview of your costs under the BMC medical plans. More detailed summaries for each plan can be found online at www.hphc.org/bmc, along with a provider directory specific to the BMC plans.
Plan Provision
BMC Select
BMC Tiered HMO
HPHC PPO
Benefits Tier 1 Tier 2 Tier 3 In-Network Out-of-Network
Annual Deductible N/A N/A
$1,000 individual $2,000 family $2,000 individual $5,000 family Out-of-Pocket Maximum Individual/Family $2,500/$5,000 $2,500/$5,000 $3,000/$6,000 $3,000*/$6,000* Physician Services Preventive Primary Care (routine physical,
immunizations)
Covered in full Covered in full
Covered in full
$35
copay Covered in full
20% coinsurance after deductible Primary Care
(consultations, evaluations, and sickness and injury)
$5 copay $5 copay $20 copay $35 copay $35 copay 20% coinsurance after deductible Specialist Office Visits $5 copay $5
copay $25 copay $50 copay $50 copay 20% coinsurance after deductible Infertility Services Cost sharing is dependent upon type of service provided
Cost sharing is dependent upon type of service provided
Cost sharing is dependent upon type of service provided 30% coinsurance after deductible Emergency Room
Care $75 copay $75 copay $75 copay
Emergency Admission Covered in full Covered in full 10% coinsurance after deductible *Any applicable copays and any charges in excess of usual and customary do not apply toward the annual out-of-pocket maximum.
Shapiro Pharmacy: 617-414-4880
Monday-Friday: 7:00 AM – 7:00 PM
Saturday: 9:00 AM – 5:00 PM
Sunday: 10:00 AM – 3:00 PM Moakley Specialty Pharmacy: 617-638-6770
Monday-Friday: 9:00 AM – 5:00 PM Employee Pharmacy at Yawkey: 617-414-4883 Monday-Friday: 9:00 AM – 8:00 PM
Saturday: 9:00 AM – 4:00 PM Doctor’s Office Building: 617-638-8130
8
Medical Plan Comparison Chart, continued
Plan Provision
BMC Select
BMC Tiered HMO
HPHC PPO
Benefits Tier 1 Tier 2 Tier 3 In-Network Out-of-Network
Inpatient Services
Inpatient Hospital
Services Covered in full
Covered in full $100 copay per admission $250 copay per admission 10% coinsurance after deductible 30% coinsurance after deductible Skilled Nursing Facility (up to 100 days per
calendar year)
Covered in full Covered in full
10% coinsurance after deductible 30% coinsurance after deductible Inpatient Rehabilitation (up to 60 days per
calendar year)
Covered in full Covered in full
10% coinsurance after deductible 30% coinsurance after deductible Hospital Outpatient
Day Surgery Covered in full Covered in full $50 copay per visit $250 copay per visit 10% coinsurance after deductible 30% coinsurance after deductible Laboratory Tests
and X-rays Covered in full
Covered in full Covered in full Covered in full 10% coinsurance after deductible 30% coinsurance after deductible Chemotherapy and
Radiation Therapy Covered in full
Covered in full Covered in full $35 copay per visit 10% coinsurance after deductible 30% coinsurance after deductible Advanced Radiology at a Physician’s Office or Non-Hospital Facility
Covered in full Covered in full $25 copay per visit $25 copay per visit 10% coinsurance after deductible 30% coinsurance after deductible Advanced Radiology at an acute hospital
Covered in full Covered in full $50 copay per visit $250 copay per visit 10% coinsurance after deductible 30% coinsurance after deductible Maternity Services Prenatal and
Postpartum Care Covered in full Covered in full Covered in full
20% coinsurance after deductible All Hospital Services
for Mother Covered in full
Covered in full $100 copay per admission $250 copay per admission 10% coinsurance after deductible 30% coinsurance after deductible Routine Nursery Charges for Newborn
Covered in full Covered in full Covered in full 20% coinsurance after deductible
9
Dental Benefits
You may choose between two dental plan options, the Boston University (BU) Dental Plan and the Blue Cross Blue Shield (BCBS) Dental Blue plan, so you can make the dental care coverage decisions that work best for you.
Following is a summary of your dental coverage options:
Plan Provision BU Dental BCBS Dental Blue
Annual Deductible None None
Preventive/Diagnostic Services 100% 100%
Restorative Services 100% 100%
Major Restorative Services 60% 50%
Orthodontic Services 50% up to $2,000 per person/lifetime 50% up to $2,000 per person/lifetime
Cosmetic Services 60% None
Annual Maximum $1,700 per person $2,000 per person
Boston University Dental Plan
The Boston University (BU) Dental Plan provides comprehensive dental services for care received at the Boston University Dental Health Centers. If you go to a private dentist for care, the Plan will not pay any benefits. The BU Dental Health Centers
When you elect the BU Plan, you can receive care only from the BU Dental Health Centers. At the Dental Health Centers, care is provided by a licensed dentist and other dental care practitioners who are affiliated with Boston University’s School of Dental Medicine. If you or a covered family member requires specialty services such as orthodontics (braces) or oral surgery (extractions), you will be referred to the appropriate specialty department. However, your care will continue to be monitored by your staff dentist at the BU Dental Health Center.
The BU Dental Health Centers are located at:
• 930 Commonwealth Avenue (near Kenmore Square) 617-358-1000
• 100 East Newton Street (in the South End) 617-638-4670
Added Benefits of the BU Plan
Enjoy the following additional features when you enroll in the BU Plan:
• Full coverage for routine cleanings and checkups every 6 months;
• Charges are typically 30% lower than private practice dentists;
• No claim forms to file;
• Some cosmetic services are covered; and
10
Blue Cross Blue Shield Dental Blue (BCBS)
The Blue Cross Blue Shield Dental Blue Program covers a wide range of dental services to meet the needs of you and your family. The Dental Blue Program has a network that includes over 90% of the dentists throughout Massachusetts. BCBS arranges the payment level with its participating dentists, leaving you free from balance billing for any covered services. If you choose a non-participating dentist, or a dentist outside of Massachusetts, the plan will cover you at the percentages listed in the chart on page 9 for the local usual and customary charge. You are responsible for any difference between the plan’s payment and the dentist’s actual charge.
If you need help selecting a new dentist or if you already have a dentist and want to know if he or she participates with BCBS, you may call the dentist or BCBS at 800-348-7921, or go online to www.bcbsma.com/bmc.
You will only receive an ID card with the employees name on it, which can be used for your entire family.
How the Plan Works
Participating Dentists
When you enroll in Dental Blue, you will receive an ID card. You must show this ID card to the dentist before you receive services. The dentist will file a claim for you, and he/she will receive payment directly from BCBS for covered services.
Non-Participating Dentists
You must file a claim within 2 years of the date you receive the covered services. If more information is required to process your claim, BCBS will request it from you within 15 days from the date they receive your claim. Once the completed information is filed with BCBS, a check for covered services at the usual and customary charge will be mailed directly to you within 45 days. Again, you are responsible for any difference between the plan’s payment and the dentist’s actual charge. Claim forms for non-participating dentists/out-of-state dentists are available in the Benefits Office or online at http://internal.bmc.org/hr/Forms.htm.
Pre-Treatment Estimates
A pre-treatment estimate is a detailed description of the procedure that the dentist plans to perform and includes the charge for each procedure. BCBS recommends that a pre-treatment estimate be submitted for services expected to cost more than $250.
Added Benefits of Dental Blue
Dental Blue coverage comes with a number of advantages:
• You receive full coverage for diagnostic, preventive and restorative services;
• There are no claim forms to complete—BCBS provides direct payment to participating dentists; and
• Rollover Benefit – If you have dental claims during the year and the annual expenses do not exceed $800, then $600 will be rolled over for the next year’s annual maximum, giving you a total of $2,600.
11
Vision Care Benefits
To help cover the cost of eyewear, which is not covered under our medical plans, BMC offers a comprehensive vision care plan through Davis Vision. The plan provides a higher level of coverage when you use in-network providers.
Here’s an overview of the benefits available under the BMC Vision Plan:
Plan Provision In-Network Out-of-Network
Eye Exams $5 copay at participating providers $35 reimbursement Eyeglass Frames Plan covers $150 plus 20% off balance $50 reimbursement Eyeglass Lenses Plan covers 100% for most lenses $50 reimbursement Contact Lenses Plan covers $130 plus 15% off balance $75 reimbursement When deciding whether to enroll in the Vision Care Plan you will also want to think about the following:
• Annual eye exams are available through your BMC medical plan as well.
• How much do you estimate you will have to pay for eye exams, glasses and contact lenses for yourself and your family during the year?
• If you are not enrolled in a BMC medical plan, does your medical plan provide coverage for routine eye exams or discounts on eyewear?
• Will your vision care expenses for the year be more than the monthly premium cost for coverage under the Vision Care Plan?
• Are you planning to establish a Medical Flexible Spending Account to reimburse yourself, tax-free, for unreimbursed vision care expenses?
For information about plan benefits and participating providers, log on to www.davisvision.com, then go to the Members page and type 4955 as the Client Code.
12
Life Insurance and AD&D Benefits
Basic Life Insurance -
BMC-paid
BMC provides benefits equal to one times (1x) your salary at no cost to you.
Optional Life Insurance -
You may purchase
• Coverage Options: 1x to 3x your salary, rounded up to nearest $1,000
• Coverage Maximum: $750,000
New Hire Election
You may elect an amount equal to or less than $300,000. Amounts greater than $300,000 require Evidence of Insurability (EOI).
Open Enrollment Election
• If you are electing Optional Life insurance for the first time during Open Enrollment you may elect 1x your salary; EOI is required to elect 2x or 3x your salary.
• If you are currently enrolled in Optional Life insurance you may increase your election by one level without EOI, provided the amount is under $300,000.
• EOI is required for all elections over $300,000.
Basic Accidental Death and Dismemberment Insurance –
BMC paid
• BMC provides benefits equal to one times (1x) your salary at no cost to you.
Optional Accidental Death and Dismemberment Insurance –
You may purchase
• Coverage Options: 1x to 3x your salary rounded up to the nearest $1,000
• Coverage Maximum: $750,000
New Hire Election
You may elect up to the amount that you select for Optional Life Insurance.
Open Enrollment Election
You may elect up to the amount that you select for Optional Life Insurance.
This plan provides additional life insurance coverage if you were to die in an accident or lose a limb due to a non-work related accident. Your weekly premium contributions are significantly lower than the contributions for Optional Group Life Insurance, however, you must enroll in the Optional Life plan for an equal or greater benefit in order to elect the Accidental Death and Dismemberment coverage. For example, if you want 2x salary of Optional AD&D coverage, you must also elect 2x or 3x salary of Optional Life coverage.
13
Life Insurance and AD&D Benefits,
continued
Dependent Life Insurance –
You may purchase
For Your Spouse
Your coverage options for your spouse are: $10,000, $25,000 or $50,000.
For Your Dependent Children
Coverage for your dependent children is:
• Live birth to 14 days: $1,000
• 15 days up to the age of 26: $10,000 each (regardless of how many children you are covering) and is included when you purchase any amount of coverage for your spouse.
If you do not have a spouse, then you may purchase just the $10,000 benefit for your child or children.
New Hire
You may elect up to $50,000 of coverage without providing an Evidence of Insurability for your spouse. Your spouse’s election cannot exceed 50% of your total life (Basic plus Optional) election.
Open Enrollment
If you are not currently enrolled for Dependent Life Insurance and wish to enroll during any Open Enrollment period, or if you wish to increase your current coverage, you will need to provide an Evidence Insurability to our insurance carrier. You will not be required to provide an EOI to enroll your child or children.
Disability Benefits
BMC recognizes the importance of financial security for its employees and their families, so you are covered for disability benefits and BMC contributes to the cost. For details, please contact the Department of Graduate Medical Affairs at 617-414-7409.
14
Flexible Spending Accounts
Flexible Spending Accounts (FSAs) are a convenientway to put aside money, on a tax-free basis, to pay for any eligible dependent day care expenses or any eligible health care expenses not otherwise covered under your group health plan. You determine the amount you want to set aside to cover these eligible expenses each year.
You must enroll each year during the Open Enrollment period if you wish to set up an FSA for the following year. Changes to your annual FSA election(s) during the year are not allowed unless you have a qualifying event. (See the Eligibility and Enrollment section on page 2.)
Medical FSA
You may elect to contribute up to the IRS maximum on an annual basis. The amount you elect is divided evenly by the number of pay periods remaining in the year, and then deducted from each paycheck. If you do not use all the money you set aside for your Medical FSA during the calendar year, up to $500 will be carried over into the following year. This account allows you to be reimbursed for any eligible expenses that your health plans (medical, dental and vision) do NOT cover, such as:
• Deductibles
• Coinsurance
• Copays
• Dental/vision care not covered by your plans
• Parking at your doctor’s office
Debit Card for Medical FSA
When you enroll for a Medical FSA, you’ll receive a debit card which will allow you to access your FSA
money directly at the point of payment. Office visit copays and prescription drug copays will be “auto-adjudicated” (meaning no paperwork will need to be filed). Claims for reimbursement of all dental and vision expenses, as well as deductibles and
coinsurance, will still need to be submitted. You will be notified by email or mail if you are required to submit receipts proving your expense was FSA-eligible. Please respond immediately or your debit card will be turned off until you do!
Dependent Day Care FSA
You may elect to contribute up to $5,000 ($2,500 if married and filing separate tax returns) annually to a Dependent Day Care FSA, to pay for eligible day care expenses that are needed in order for you and your spouse to work full time. Day care for children under the age of 13 and for IRS-recognized disabled dependents of any age is eligible for reimbursement from your account. If you do not use all the money you set aside for your Dependent Day Care FSA during the plan year, you will forfeit any unused amount and may not carry-over any amount into the next year.
For the Dependent Day Care FSA, you will need to pay for all services at the time they are received and then submit your claims for reimbursement to BMC’s FSA administrator.
Each year, BMC is required by IRS regulations to perform non-discrimination testing to balance FSA participation levels between highly compensated employees and those less highly paid. Depending on the results of this testing, the Dependent Day Care FSA elections for some program participants may need to be reduced.
Legal Service Plan
MetLaw, in partnership with Hyatt Legal Plans, provides a Legal Plan to BMC employees. If you elect this benefit, you and your eligible dependents are entitled to receive certain personal legal services related to family law, real estate, immigration assistance, document preparation, debt matters, and more. To learn more about the Plan call
800-821-6400or visit www.legalplans.comand click on the Employees/Members “Enter Here” link and enter GetLaw into the “Thinking about Enrolling” access code box.
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403(b) Retirement Plans
BMC offers retirement plans to encourage employees to save for their future financial security. We offer a core plan with an employer match and a supplemental plan that allows you to save more of your own money. To watch educational videos on the retirement plans, please visit https://bostonmedical.a.guidespark.com.
BMC Open Plan
This 403(b) plan is open to everyone who receives a paycheck from BMC.
To participate in this plan, you elect to set aside a percentage of your salary. The money is then directed to TIAA-CREF where it is invested in a Life Cycle fund based on your expected year of retirement. You may, however, choose your own investment options by contacting TIAA-CREF. Changes to your investments and contribution elections can be made at any time during the year. There are no employer contributions to this plan.
TIAA-CREF Investment and Savings Advice Sessions
BMC employees are eligible to receive personalized retirement plan advice from a TIAA-CREF Financial Consultant. This session will cover the 403(b) plan’s investment options and how to project the amount of money you’ll need in retirement. This service is available as part of the BMC retirement program at no cost to you and can be done onsite at BMC, online, via the phone or at a local TIAA-CREF office.
For retirement plan and investment information, to enroll in the Plan, or to schedule a 1-on-1 advice session, please contact TIAA-CREF:
Call: 800-410-6649
To meet at a local TIAA-CREF office: TIAA-CREF has three local offices where you can meet with a financial consultant:
o Boston: 800-842-2004 o Waltham: 866-904-7802 o Cambridge: 866-842-2824
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Wellbeing Benefits
BMC employees have access to a wide range of benefits to support your wellbeing.
BMC -
Employee Assistance Program
This service provides employees and their families with confidential counseling and referral services by licensed clinicians who can assist with a wide range of concerns, including behavioral health, alcohol/substance abuse, smoking cessation, family trouble, stress, career concerns and more. Contact the EAP at 866-695-6327.
Care.com -
Back up Child and Adult Care
Last-minute care for your child(ren), adults, and elders for work-related needs. The cost is $6/hour for in-home child and adult backup care or $10/day/child for in-center backup childcare. Each employee may use 10 days of backup care per year. Additionally, all employees have access to bmc.care.comto find pre-screened, high quality caregivers for ongoing child, adult, pet and household needs. Contact Care.com at 855-781-1303.
Circles -
24/7 Personal Assistant Program
Need more time in your day? Contact Circles with any request so they can assist you with finding, planning, buying, recommending, coordinating and delivering the right solution for the task at hand. No request is too big or too small. Circles’ assistance is always free — you only pay for any products and services that you have them purchase on your behalf to fulfill your request. Place a request by calling 877-231-0456.
.
DRB -
Student Loan Refinancing
BMC employees and their families are eligible for rate reductions off already low rates on student loan refinancing with DRB. You can choose from 5, 10, 15 or 20 year loans with either fixed or variable rates, and there are no application fees or prepayment penalties. Visit www.student.drbank.com/bmc.
LearnVest –
Financial Planning
LearnVest is a free financing planning program that is designed to help simplify your financial life so you can work toward goals that matter to you– like saving for retirement, paying down credit card debt, taking a family vacation, saving for college, or buying a house. You will be paired with a financial planner who will work with you to develop an action plan so you can work towards your goals. Register at www.learnvest.com/bmcto get started.
RetirementGuard –
Long Term Care
Insurance
BMC employees have the opportunity to elect a voluntary long term care insurance program for employees and their family members. Contact RetirementGuard at 888-793-6111 for additional information or to schedule an individual meeting.
ScholarShare -
529 College Savings Plan
BMC employees may contribute money on a weekly basis via payroll deduction into a 529 plan to save for a loved one’s future higher education expenses. Withdrawals for qualified higher education expenses are state and federal income tax free. Visit www.scholarshare.com or call 800-544-5248 for more information.
Sleepio –
Sleep Improvement Program
Whether you sleep soundly or spend your nights staring at the ceiling, the sleep experts at Sleepio can help you get the best sleep possible. This 6-week personalized sleep program will teach you techniques to get your sleep schedule, thoughts, lifestyle, and sleep environment into shape. Discover your Sleep Score and how to improve it at www.sleepio.com/work/bmc.
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Employee Discounts
Working Advantage
All employees have exclusive access to the Working Advantage discount network which allows you to save up to 60% on ticketed events and online shopping 24 hours a day. Employees can receive discounts on amusement park tickets, cell phone services, retailers, mortgage & banking providers, gyms, and more.
Visit www.workingadvantage.com/bmcand register to access the entire discount network or view the “For Existing Boston Medical Center Deals” link for exclusive discounts for BMC employees.
For questions on the website, please call Working Advantage Customer Service at 800-565-3712. If you have a question on a specific discount, please contact the vendor directly.
MetLife Auto and Home Insurance
BMC employees are eligible for discounted rates of auto and home insurance through MetLife. Contact MetLife directly to learn more: 800-438-6388or www.metlife.com/bmc.
Cafeteria Discounts
All Boston Medical Center employees receive a 20% discount with a valid employee ID at the BMC cafeterias.
Benefit Workshops and Seminars
The Benefits Department sponsors a variety of workshops and seminars throughout the year with topics on health and financial wellbeing. For a current list of offerings and to register for a class, please visit
http://internal.bmc.org/benefitsreg.
Employee Resource Guides
These guides are available in the Benefits Office or online at http://internal.bmc.org/hr/forms.htm.
Homebuying
The BMC Homebuying Guide explains the steps involved in purchasing a home and the many resources and discounts available to you as a BMC employee throughout the homebuying process. These include discounts on home insurance, with mortgage lenders and access to a network of lawyers, among others.
Retirement Readiness
As you begin to think about retirement there are questions you’ll need to answer. Can I afford to retire? What about health insurance? How will I spend my time? This guide helps you think through these important questions and lists resources available to you every step of the way.
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Commuting to
Work
Many options are available to Boston Medical Center employees to assist in their commute to work.
Parking Office: Parking Applications
The Office of Parking and Transportation Services (OPTS) administers the parking program. To sign up, visit OPTS at 710 Albany Street Monday - Friday from 7am – 5pm. Bring your cars make, model and license plate number to fill out an application. For current rates and garage locations, call 617-638-4915.
Benefits Department: Discounted MBTA passes
BMC employees who do not participate in the parking program and are scheduled to work at least 24 hours/week are eligible for 35% off the cost of monthly MBTA passes. Passes are paid for through payroll deduction and are taken on a pre-tax basis up to the IRS limit. MBTA pass elections will be effective on 1st of the month following 30 days from
the election date, and the pass will be paid for in the month prior to the coverage month. For example, if you make your election in September, your pass will be effective on November 1st, and you will pay for it
in October. Sign up online at
www.myworkday.com/bmc.
TranSComm: Zipcar, Hubway and bike cages
TranSComm is a transportation management association that develops programs and coordinates
the transportation needs of BMC. They can be reached at bumctranscomm@gmail.comor 617-638-7473 for information on all of the following commuter benefits.
Discounted Zipcar membership
BMC employees receive: No application fee
Reduced annual membership fee of only $25
Discounted weekday rates
Please visit www.zipcar.com and search for Boston Medical Center under the “for business” tab for additional information on the benefit and to sign up with your BMC email address.
Discounted Hubway membership
BMC employees are eligible for a discounted Hubway Corporate Membership. Hubway is a bike sharing system that provides more than 1,300 bikes at 140 stations throughout Boston, Brookline, Cambridge and Somerville. BMC staff are eligible for over 50% off year-long memberships.On campus bike cages
There are many bike racks and bike cages on the BMC Campus for employees to use. The annual fee to use the bike cages is $20.
Payroll Information
The payroll department provides many services for Boston Medical Center employees updating tax forms such as the W4 and M4 and setting up direct deposits. For contact information and links to payroll related forms, please visit http://fis-web.bmc.org/intranet/payroll.php. If you have questions call Payroll at 617-414-1614.
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Legal Information
1. Special Enrollment Rights
If you do not enroll yourself and your dependents in a group health plan after you become eligible or during annual enrollment, you may be able to enroll under the special enrollment rules under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) that apply when an individual declines coverage and later wishes to elect it. Generally, special enrollment is available if (i) you declined coverage because you had other health care coverage that you have now lost through no fault of your own (or employer contributions to your other health care coverage terminate); or (ii) you have acquired a new dependent (through marriage or the birth or adoption of a child) and wish to cover that person. When you have previously declined coverage, you must have given (in writing) the alternative coverage as your reason for waiving coverage under the group health plan when you declined to participate. In either case, as long as you meet the necessary requirements, you can enroll both yourself and all eligible dependents in the group health plan if you provide notice to the Plan Administrator within 30 days after you lose your alternative coverage (or employer contributions to your alternative coverage cease) or the date of your marriage or the birth, adoption, or placement for adoption of your child. See the Plan Administrator for details about special enrollment.
2. CHIP
You may also enroll yourself and your dependents in a group health plan if you or one of your eligible dependent’s coverage under Medicaid or the state Children’s Health Insurance Program (CHIP) is terminated as a result of loss of eligibility, or if you or one of your eligible dependents become eligible for premium assistance under a Medicaid or CHIP plan. Under these two circumstances, the special enrollment period must be requested within 60 days of the loss of Medicaid/CHIP coverage or of the determination of eligibility for premium assistance under Medicaid/CHIP. See the Plan Administrator for details about special enrollment.
3. Grandfathered Status
The Plan believes that none of the group health plans available under the Plan are “grandfathered
health plans” under the Patient Protection and Affordable Care Act (the “Affordable Care Act”).
4. Special Rule for Maternity and Infant Coverage
Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the attending provider or physician, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours, as applicable).
5. Special Rule for Women’s Health Coverage
The Women’s Health and Cancer Rights Act of 1998 (“WHCRA”) requires group health plans, insurance issuers, and HMOs who already provide medical and surgical benefits for mastectomy procedures to provide insurance coverage for reconstructive surgery following mastectomies. This expanded coverage includes (i) reconstruction of the breast on which the mastectomy has been performed; (ii) surgery and reconstruction of the other breast to produce a symmetrical appearance; and (iii)
prostheses and physical complications at all stages of mastectomy, including lymphedemas.
6. Notice Regarding Lifetime and Annual Dollar Limits
In accordance with applicable law, none of the lifetime dollar limits and annual dollar limits set forth in the Plan shall apply to “essential health benefits,” as such term is defined under Section 1302(b) of the Affordable Care Act. The law defines “essential health benefits” to include, at minimum, items and services covered within certain categories including emergency services, hospitalization, prescription drugs, rehabilitative and habilitative services and devices, and laboratory services, but currently provides little further information. Accordingly, a determination as to whether a benefit constitutes an “essential health benefit” will be based on a good faith interpretation by the Plan Administrator of the guidance available as of the date on which the determination is made.
7. Patient Protection Disclosure
You have the right to designate any participating primary care provider who is available to accept you
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or your family members (for children, you may designate a pediatrician as the primary care provider). For information on how to select a primary care provider and for a list of participating primary care providers, contact the Plan
Administrator. You do not need prior authorization from the Plan or from any other person, including your primary care provider, in order to obtain access to obstetrical or gynecological care from a health care professional; however, you may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan, or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, contact the Plan Administrator.
8. Affordable Care Act Consumer Protections
(a.) Coverage for Children Up to Age of 26 The Affordable Care Act of 2010 requires that the Plan must make dependent coverage available to adult children until they turn 26 regardless if they are married, a dependent, or a student.
(b.) Prohibition of Lifetime Dollar Value of Benefits The Affordable Care Act of 2010 prohibits the Plan from imposing a lifetime limit on the dollar value of benefits.
(c.) Your Health Insurance Cannot be Rescinded The Affordable Care Act of 2010 prohibits the Plan, or any insurer, from rescinding your health insurance coverage under the Plan for misrepresentation. (d.) Prohibition of Pre Existing Conditions
Effective January 1, 2014 The Affordable Care Act of 2010 prohibits the Plan, or any insurer, from denying any health insurance claim for any person because of pre-existing condition.
(e.) Prohibition of Restrictions on Annual Limits on Essential Benefits
The Affordable Care Act of 2010 prohibits the Plan, or any insurer, effective January 1, 2014 from placing annual limits on the value of essential health
benefits.
(f.) Notice of Marketplace/Exchange
If this health insurance is unaffordable (your cost of the premium exceeds 9.5% of your income) as defined under the Affordable Care Act , you may have the right to subsidized health insurance purchased through an exchange/marketplace created pursuant to the Affordable Care Act.
9. Michelle’s Law
Michelle’s Law provides continued health and dental
insurance benefits under the Plan for dependent children who are covered under the Plan as a student but lose their student status in a post-secondary school or college because they take a medically necessary leave of absence from school. If your child is no longer a student because he or she is out of school because of a medically necessary leave of absence, your child may continue to be covered under the Plan for up to one year from the beginning of the leave of absence.
10. The Genetic Information Nondiscrimination Act (GINA)
GINA prohibits the Plan from discriminating against individuals on the basis of genetic information in providing any benefits under the Plan. Genetic information includes the results of genetic tests to determine whether someone is at increased risk of acquiring a condition in the future, as well as an individual’s family medical history.
11. Wellness
If your Plan includes a Wellness program that provides rewards or surcharges based on your ability to complete an activity or satisfy an initial health standard, you have the right to request a reasonable alternative should it be determined that it is not medically advisable for you to either complete the activity or satisfy the initial health standard.
Summary Plan Description
A full Summary Plan Description can be found on the Benefits intranet or in the Benefits office.
Summary of Benefits and Coverage (SBC)
The Affordable Care Act (ACA) includes a
requirement that all employers who sponsor a group medical plan provide a health benefit plan summary, called the Summary of Benefits and Coverage (SBC), to all eligible employees. This summary is currently posted on www.hphc.org/bmc.
This Guide describes only some of the key features of certain BMC benefit plans as of January 1, 2016. If there is any conflict between this material and the official plan documents, the plan documents will govern. BMC has the right to amend or terminate the plans at any time, with or without notice. In addition, this Guide is not an employment contract, and employment is not guaranteed by your participation in any of the plans described in it.
Contacts
Plan
Vendor
Group Plan
Number
Telephone
Website
BMC Select Harvard Pilgrim
Health Care 084933 888-333-4742 www.hphc.org/bmc BMC Tiered HMO Harvard Pilgrim
Health Care 084934 888-333-4742 www.hphc.org/bmc HPHC PPO Harvard Pilgrim
Health Care 092400 888-333-4742 www.hphc.org/bmc BCBS Dental Blue Blue Cross Blue
Shield 002294044 800-348-7921 www.bcbsma.com/bmc BU Dental Plan Blue Cross Blue
Shield 002330503 800-348-7921 www.bcbsma.com/bmc Vision Plan Davis Vision 4955 877-923-2847 www.davisvision.com
Use client code 4955 Life and AD&D Liberty Mutual
SA3-810-260700-01 800-713-7384 ________ Short-Term Disability &
Long-Term Disability Liberty Mutual
GD/GF3-810-260700-01 800-713-7384
To file a claim, go to www.mylibertyconnection.com
Enter company code: Bostonmedical
COBRA Crosby Benefits BMC 800-462-2235 www.crosbybenefits.com
Flexible Spending
Accounts WageWorks BMC 877-924-3967 www.wageworks.com
Legal Plan MetLaw BMC 800-821-6400 www.legalplans.com
Use password: GetLaw 403(b) Retirement Plan TIAA-CREF Open: 404926
Core: 100910 800-410-6649 www.tiaa-cref.org/bmc Auto & Home Insurance MetLife BMC 800-438-6388 www.metlife.com/bmc Long Term Care RetirementGuard BMC 888-793-6111 www.myltcexchange.com/bmc Employee Discounts Working Advantage BMC 800-565-3712 www.workingadvantage.com/bmc Backup Child and
Adult Care Care.com BMC 855-781-1303 bmc.care.com
Personal Assistant
Program Circles BMC 877-231-0456 www.members.circles.com/bmc
Financial Planning LearnVest BMC 888-389-3298 www.learnvest.com/bmc Student Loan
Refinancing DRB BMC 855-245-0989 www.student.drbank.com/bmc
529 College Savings Plan ScholarShare BMC 800-544-5248 www.scholarshare.com Employee Assistance Program Bensinger, DuPont & Associates BMC 866-695-6327 www.bensingerdupont.com/mla Password: lmeap Sleep Improvement Program Sleepio BMC Email: hello@sleepio.com www.sleepio.com/work/bmc
