Employee Benefits Guide
Plan Year: July 1, 2015 – July 1, 2016
Prepared by:
Table of Contents
Introduction ... 1
Eligibility and Enrollment Requirements ... 3
Making Changes in the Future ... 4
Health Care Plans ... 5
Group Health – HMO Plan ... 7
Group Health – Access PPO Plan ... 10
Group Health Cooperative Preventive Care Guidelines ... 13
Uniform Glossary of Health Coverage and Medical Terms ... 15
Delta Dental of Washington – PPO Plan ... 19
Delta Dental of Washington – Enhanced PPO Plan ... 21
MHN – Employee Assistance Program (EAP) ... 23
Prudential – Group Life/Accidental Death & Dismemberment ... 24
Ameritas – Voluntary Vision Plan ... 25
Prudential – Voluntary Life Insurance ... 26
Prudential – Voluntary AD&D Insurance ... 27
Prudential – Voluntary Short Term Disability ... 28
Prudential – Voluntary Long Term Disability ... 29
PacificSource– Flexible Spending Account ... 30
Employee Cost Share with Wellness Incentive ... 32
Employee Cost Share without Wellness ... 33
Introduction
This booklet is designated to give you a general summary of the benefits provided to you through The Hearthstone. Should you have additional questions, please refer to the last page of this guide where you will find a listing of the service providers along with their websites and customer service phone numbers.
The Hearthstone is pleased to offer you a program that lets you design your own combination of benefits - a combination that makes a personal difference. Our employee benefits program is
designed to provide you with the flexibility to choose coverage that best fits your needs and the needs of your family.
Our program offerings include:
Medical
Dental
Life and Accidental Death & Dismemberment (AD&D)
Employee Assistance Program (EAP)
In addition, the following voluntary plans are available to you on a payroll deduction basis:
Vision
Life
AD&D
Short Term Disability
Long Term Disability
Flexible Spending Accounts
Employees may enroll their eligible dependents in any of the benefit plans (excluding STD and LTD) they have selected for themselves. Plan costs are outlined on pages 32 and 33.
Introduction
The Hearthstone pays the entire cost of the following benefits for full time eligible employees working 72-80 hours per pay period and who participate in the wellness incentive program:
Medical Core Plan for full time employees Dental for full time employees
Employee Assistance Program (EAP) for all employees Basic Life/AD&D for full time employees
Employees who work 60-71 hours per pay period and participate in the wellness incentive program receive 80% contribution towards the premium costs for the Medical Core Plan and Dental insurance. You are also eligible for the Employee Assistance Program and have the opportunity to participate in the voluntary benefit plans.
Our employee benefits program is designed to provide you with the flexibility to choose coverage that best fits your needs and the needs of your dependents. Because at The Hearthstone your needs are important to us!
Eligibility and Enrollment Requirements
Employees
For new hires, coverage is effective on:
the first of the month following or coinciding with date of hire for Officers & Directors;
the first of the month following 60 days of employment for All other Active Employees If you are a Regular Full-Time employee with The Hearthstone then you are eligible for benefits under this program once you have completed your introductory period. The Hearthstone will pay a portion of the premiums for employees enrolled in the company sponsored plans. Cost of coverage for dependents is the responsibility of the employee. You may elect to have your share of the cost deducted from your pay through a pre-tax payroll deduction.
Regular Full-Time employees are those who work at least 30 or more hours per week.
For further information on these employee classifications, please consult your Employee Handbook.
If you do not enroll in any of the benefit offerings provided by The Hearthstone when first eligible, you will not be able to enroll until the next open enrollment period or until you have a change in family status event (see Making Changes in the Future section on the next page). Late enrollees in the Voluntary Life Insurance Plan will be required to submit evidence of insurability when applying for coverage after they are first eligible.
Dependents
Eligible Dependents include your spouse, domestic partners and children to age 26. Children means the children of the Subscriber, including adopted children, stepchildren, children for whom the Subscriber has a qualified court order to provide coverage and any other children for whom the Subscriber is the legal guardian. Further clarification is available through the insurance carrier. Upon age 26 and beyond, a child may continue to be eligible for medical, dental and vision coverage if he or she is unable to earn a living because of a developmental disability or physical handicap. The child must be chiefly dependent on you for support on the date his or her eligibility for benefits would otherwise end. Coverage may continue for the duration of the incapacity as long as you continue to be an eligible employee.
Making Changes in the Future
Once you make your benefit selections, these elections ordinarily cannot be changed until you make your next year’s selections. An exception may be made if you have a change in your family status. For this purpose, a “change in family status” means:
Your Marriage Your Divorce
Birth or adoption of a child (or if you become a child’s legal guardian) Death of your spouse or child
A change for you or your spouse from part-time to full-time or from full-time to part-time employment
An unpaid leave of absence taken by you or your spouse
A significant change in your, or your spouse’s healthcare coverage because of your spouse’s employment
Child’s loss of dependent status
Any benefit changes you make must be consistent with changes in your family status. It is up to you
Health Care Plans
The Health Care Plans are funded by a combination of employee and employer contributions. See the Cost Share on pages 32 and 33for a complete cost breakdown.
Dependents can enroll in either the medical and/or dental plans in which you have enrolled. Medical and Dental premiums for your dependents are your responsibility. The Employee Assistance
Program is funded entirely by The Hearthstone for employees and their families.
Medical Plans – Group Health
Medical insurance provides valuable protection for your health and financial security. It ensures that you may obtain the care you need while keeping the financial burden manageable. To use this medical protection wisely, you should understand some of the important features of the plans: The Medical Plans combine comprehensive medical coverage with incentives to encourage use
of network providers and facilities. You may choose from the following Group Health Plans: HMO Plan (HMO) – This plan has the lower monthly premium but a limited network.
If you choose the HMO plan, you must receive services at Group Health or a Group Health contracted facility unless authorized in advance by Group Health.
Access PPO Plan – This plan is replacing the Options plan offered in the past. This plan still allows members to go to both Group Health providers/facilities as well as other providers outside Group Health. While still a strong network across the state, this Access PPO plan is narrower than the Options plan. If you choose this plan, you have the option of seeking services at Group Health at a lower out-of-pocket cost to you. You may also seek services out-of-network at a higher out-of-pocket cost.
Health Care Plans (continued) Dental Plans – Delta Dental of Washington
At this time we are pleased to offer two dental options through Delta Dental – a Base and a Buy Up option. The Base Plan has the lower monthly premium but less rich benefits than the Buy Up plan. You will want to pay close attention to which Delta Dental Network you are accessing, as the benefits are richer through the PPO network. Please Reference page 19 for further details.
Employee Assistance Program – MHN
We are pleased to continue offering our Employee Assistance through MHN. This benefit provides short-term confidential counseling for you, all household members, and your dependents, wherever they reside. This program is at no cost to you, and provides confidential assistance for a wide variety of life’s more challenging personal circumstances. The EAP is separate from your medical benefits and licensed, professional counselors are available to help you. You, household members and your dependents may call Monday through Friday to make an appointment; and crisis services are available 24 hours a day, 7 days a week.
MHN provides up to 3 assessment/brief counseling sessions, per issue, per individual, per year, for any problem, issue, stress or concern. Please reference page 23 for further detail.
Section 125 Plan
The Hearthstone is pleased to offer various ways to reduce taxes related to Medical Care and Dependent Day Care expenses.
1. Deductions from your company-sponsored benefits – these are automatically taken from your paycheck on a pre-tax basis and no action is required.
2. The Health Care FSA – this reimburses your out-of-pocket health care expenses on a pre-tax basis for you and your dependents. Each year in December you must elect to participate in this program.
3. The Day Care FSA – this benefit allows you to be reimbursed for day care expenses on a pre-tax basis and can also be used for elder day care expenses under certain criteria. Like the Health Care FSA, each year you must elect to participate in this program in December. Premium amounts you pay for medical and dental coverage may be deducted from your paycheck either on a pre-tax or post-tax basis. Having payroll deductions done on a pre-tax basis will save you money by reducing your taxable income.
The FSA plan is administered by PacificSource. The plan year begins January 1st and ends
December 31st. Maximum deductions for eligible medical expenses are $2,550 per year. Dependent Day Care expenses cannot exceed $5,000 per year. Please reference page 30 and 31 for further
Group Health – HMO Plan (continued)
Group Health – Access PPO Plan (continued)
Prudential – Group Life/Accidental Death & Dismemberment
Employee Cost Share with Wellness Incentive Base Medical HMO Plan Buy‐up Medical PPO Plan Vision Base Dental PPO Plan Buy‐up Dental Enhanced Plan Employee Total Monthly Cost $543.88 $577.13 $3.84 $46.24 $50.85 The Hearthstone Monthly Cost $543.88 $543.88 $0.00 $46.24 $46.24 Employee Monthly Cost $0.00 $33.25 $3.84 $0.00 $4.61 Employee & Spouse Total Monthly Cost $1,161.91 $1,232.96 $7.68 $89.97 $98.84 The Hearthstone Monthly Cost $543.88 $543.88 $0.00 $46.24 $46.24 Employee Monthly Cost $618.03 $689.08 $7.68 $43.73 $52.60 Employee & Child Total Monthly Cost $870.45 $923.65 $7.68 $110.95 $120.13 The Hearthstone Monthly Cost $543.88 $543.88 $0.00 $46.24 $46.24 Employee Monthly Cost $326.57 $379.77 $7.68 $64.71 $73.89 Employee & Children Total Monthly Cost $1,310.88 $1,388.04 $10.76 $110.95 $120.13 The Hearthstone Monthly Cost $543.88 $543.88 $0.00 $46.24 $46.24 Employee Monthly Cost $767.00 $844.16 $10.76 $64.71 $73.89 Employee, Spouse & Child Total Monthly Cost $1,488.44 $1,579.44 $10.76 $154.67 $168.11 The Hearthstone Monthly Cost $543.88 $543.88 $0.00 $46.24 $46.24 Employee Monthly Cost $944.56 $1,035.56 $10.76 $108.43 $121.87 Employee, Spouse & Children Total Monthly Cost $1,926.15 $2,043.89 $10.76 $154.67 $168.11 The Hearthstone Monthly Cost $543.88 $543.88 $0.00 $46.24 $46.24 Employee Monthly Cost $1,382.27 $1,500.01 $10.76 $108.43 $121.87 Base Medical HMO Plan Buy‐up Medical PPO Plan Vision Base Dental PPO Plan Buy‐up Dental Enhanced Plan Employee Total Monthly Cost $543.88 $577.13 $3.84 $46.24 $50.85 The Hearthstone Monthly Cost $435.10 $435.10 $0.00 $36.99 $36.99 Employee Monthly Cost $108.78 $142.03 $3.84 $9.25 $13.86 Employee & Spouse Total Monthly Cost $1,161.91 $1,232.96 $7.68 $89.97 $98.84 The Hearthstone Monthly Cost $435.10 $435.10 $0.00 $36.99 $36.99 Employee Monthly Cost $726.81 $797.86 $7.68 $52.98 $61.85 Employee & Child Total Monthly Cost $870.45 $923.65 $7.68 $110.95 $120.13 The Hearthstone Monthly Cost $435.10 $435.10 $0.00 $36.99 $36.99 Employee Monthly Cost $435.35 $488.55 $7.68 $73.96 $83.14 Employee & Children Total Monthly Cost $1,310.88 $1,388.04 $10.76 $110.95 $120.13 The Hearthstone Monthly Cost $435.10 $435.10 $0.00 $36.99 $36.99 Employee Monthly Cost $875.78 $952.94 $10.76 $73.96 $83.14 Employee, Spouse & Child Total Monthly Cost $1,488.44 $1,579.44 $10.76 $154.67 $168.11 The Hearthstone Monthly Cost $435.10 $435.10 $0.00 $36.99 $36.99 Employee Monthly Cost $1,053.34 $1,144.34 $10.76 $117.68 $131.12 Employee, Spouse & Children Total Monthly Cost $1,926.15 $2,043.89 $10.76 $154.67 $168.11 The Hearthstone Monthly Cost $435.10 $435.10 $0.00 $36.99 $36.99 Employee Monthly Cost $1,491.05 $1,608.79 $10.76 $117.68 $131.12 Employees Working 72‐80 Hours Per Pay Period Employees Working 60‐71 Hours Per Pay Period
Employee Cost Share without Wellness Base Medical HMO Plan Buy‐up Medical PPO Plan Vision Base Dental PPO Plan Buy‐up Dental Enhanced Plan Employee Total Monthly Cost $543.88 $577.13 $3.84 $46.24 $50.85 The Hearthstone Monthly Cost $516.69 $516.69 $0.00 $46.24 $46.24 Employee Monthly Cost $27.19 $60.44 $3.84 $0.00 $4.61 Employee & Spouse Total Monthly Cost $1,161.91 $1,232.96 $7.68 $89.97 $98.84 The Hearthstone Monthly Cost $516.69 $516.69 $0.00 $46.24 $46.24 Employee Monthly Cost $645.22 $716.27 $7.68 $43.73 $52.60 Employee & Child Total Monthly Cost $870.45 $923.65 $7.68 $110.95 $120.13 The Hearthstone Monthly Cost $516.69 $516.69 $0.00 $46.24 $46.24 Employee Monthly Cost $353.76 $406.96 $7.68 $64.71 $73.89 Employee & Children Total Monthly Cost $1,310.88 $1,388.04 $10.76 $110.95 $120.13 The Hearthstone Monthly Cost $516.69 $516.69 $0.00 $46.24 $46.24 Employee Monthly Cost $794.19 $871.35 $10.76 $64.71 $73.89 Employee, Spouse & Child Total Monthly Cost $1,488.44 $1,579.44 $10.76 $154.67 $168.11 The Hearthstone Monthly Cost $516.69 $516.69 $0.00 $46.24 $46.24 Employee Monthly Cost $971.75 $1,062.75 $10.76 $108.43 $121.87 Employee, Spouse & Children Total Monthly Cost $1,926.15 $2,043.89 $10.76 $154.67 $168.11 The Hearthstone Monthly Cost $516.69 $516.69 $0.00 $46.24 $46.24 Employee Monthly Cost $1,409.46 $1,527.20 $10.76 $108.43 $121.87 Base Medical HMO Plan Buy‐up Medical PPO Plan Vision Base Dental PPO Plan Buy‐up Dental Enhanced Plan Employee Total Monthly Cost $543.88 $577.13 $3.84 $46.24 $50.85 The Hearthstone Monthly Cost $407.91 $407.91 $0.00 $36.99 $36.99 Employee Monthly Cost $135.97 $169.22 $3.84 $9.25 $13.86 Employee & Spouse Total Monthly Cost $1,161.91 $1,232.96 $7.68 $89.97 $98.84 The Hearthstone Monthly Cost $407.91 $407.91 $0.00 $36.99 $36.99 Employee Monthly Cost $754.00 $825.05 $7.68 $52.98 $61.85 Employee & Child Total Monthly Cost $870.45 $923.65 $7.68 $110.95 $120.13 The Hearthstone Monthly Cost $407.91 $407.91 $0.00 $36.99 $36.99 Employee Monthly Cost $462.54 $515.74 $7.68 $73.96 $83.14 Employee & Children Total Monthly Cost $1,310.88 $1,388.04 $10.76 $110.95 $120.13 The Hearthstone Monthly Cost $407.91 $407.91 $0.00 $36.99 $36.99 Employee Monthly Cost $902.97 $980.13 $10.76 $73.96 $83.14 Employee, Spouse & Child Total Monthly Cost $1,488.44 $1,579.44 $10.76 $154.67 $168.11 The Hearthstone Monthly Cost $407.91 $407.91 $0.00 $36.99 $36.99 Employee Monthly Cost $1,080.53 $1,171.53 $10.76 $117.68 $131.12 Employee, Spouse & Children Total Monthly Cost $1,926.15 $2,043.89 $10.76 $154.67 $168.11 The Hearthstone Monthly Cost $407.91 $407.91 $0.00 $36.99 $36.99 Employee Monthly Cost $1,518.24 $1,635.98 $10.76 $117.68 $131.12
Your Benefit Costs - Without Wellness Incentive
Employees Working 72‐80 Hours Per Pay Period
Who to Call for Service
If you have questions about the benefits provided by The Hearthstone, please call the appropriate customer service number listed below:
MEDICAL
Group Health Cooperative
888.901.4636 www.ghc.org
DENTAL
Delta Dental of Washington
800.554.1907 www.deltadentalwa.com
EMPLOYEE ASSISTANCE PROGRAM MHN Appointments: 800.977.7593 www.members.mhn.com Access Code: LSNW VOLUNTARY VISION Ameritas Group 800.487.5553 www.ameritasgroup.com
GROUP LIFE/AD&D/VOLUNTARY LIFE, AD&D, STD & LTD
Prudential
Life Insurance Claims: 800.524.0542 Disability Claims: 800.842.1718
www.prudential.com
FLEXIBLE SPENDING ACCOUNT
PacificSource
800.422.7038
www.pacificsource.com/PSA
THE HEARTHSTONE
Human Resources Department
