2014 Benefits At-A-Glance

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2014

Benefits

At-A-Glance

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This brochure explains some of the features of the Mount Sinai benefit plans. Complete details of each of the plans are contained in the official plan documents or insurance contracts. If there is ever a conflict between this brochure and the official plan documents or insurance contracts, the plan document or insurance contract will prevail.

Eligibility does not guarantee employment - this benefit brochure does not create a contract of employment between Mount Sinai and Faculty and Staff or any candidate for a Faculty or Staff position.

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B e n e F l e x

What is BeneFlex?

BeneFlex is the name of the Mount Sinai Health Systems health and welfare program. It is available to eligible faculty and staff and provides you with the option to enroll in the plans that will best meet you and your family members’ needs.

What does BeneFlex Provide?

BeneFlex provides flexibility! It is a cafeteria style plan offering several options for medical, prescription and dental

coverage. BeneFlex also offers vision coverage, short-term disability, long-term disability, basic and supplemental life insurance.

Who’s eligible for BeneFlex?

Mount Sinai Health System faculty and staff who are scheduled to work at least 60% of a normal work week are eligible for BeneFlex. Coverage begins on the first day of work provided it is the first day of the month. Otherwise, coverage begins on the first day of the following month.

Can I enroll my dependents?

Faculty and Staff may elect to enroll the following dependents in the BeneFlex medical, prescription drug, dental, vision and life insurance plans:

•

Spouses, same gender spouses or same gender

domestic partners. Proof of marriage or domestic partnership will be required.

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Contact Info

Mount Sinai Benefits Center (ADP) mtsinaibenefits.com

866.700.6762

Enrollment is easy!

Just log on to the benefits enrollment website at:

www.mtsinaibenefits.com and enter your social security number and your PIN number. Your PIN number is the first two digits of your birth month and the last two digits of your birth year. How do I enroll in

the BeneFlex Plans?

•

Dependent children, regardless of their student and/or marital status may be enrolled through the end of the month in which they reach age 26. Proof of dependent status will be required.

When can I enroll?

Faculty and Staff may enroll after one (1) week of employment by logging on to the Benefits Enrollment website. All elections must be made within 30 days of the date of hire. Faculty and Staff who do not elect or decline benefits will receive default coverage. Once you have selected your benefits they will be in effect for the remainder of the year, unless you have a qualifying event.

What is the Benefits Center and how does it help Faculty and Staff?

The Mount Sinai Benefits Center is the administrator of the Beneflex Program. Faculty and Staff may contact the Benefits Center to ask questions about their plans and/or receive assistance with:

•

Enrolling in Benefits

•

Adding or removing a dependent

•

Making mid-year plan changes

•

Submitting a Flexible Spending Account Claim (HCRA, DCRA, TRIP Transit or TRIP Parking)

•

Obtaining information regarding the Online Commuter Benefit Program (OCB)

•

Signing up for COBRA when terminating employment

Representatives may be contacted at 866.700.6762 and are available Monday through Friday from 6:00 a.m. to 6:00 p.m. Faculty and Staff wishing to monitor their FSA account contributions or submit claims electronically may log onto the Benefits Center’s flexible spending website at www.flexdirect.adp.com.

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B e n e F l e x

Default Coverage

Faculty and staff who do not enroll within the 30 day period will receive default coverage; United- Healthcare PPO Basic, Express Scripts Basic prescription coverage, basic short-term disability and long-term disability. Dependents are not covered when an employee receives default coverage.

Declining Coverage

Faculty and Staff wishing to decline enrollment in any of the offered plans may do so by selecting the “waive” coverage option on the benefits enrollment website. (The “waive”

option is not available for all benefits). When waiving

medical coverage a waiver form must be completed and faxed to the Benefits Administration department at 646-537-9287.

Qualifying Events

Once benefits selections have been made, they will remain in effect until the end of the year unless the employee has a qualifying event. A qualifying event signifies a change in an employee’s family status such as: a marriage, divorce, birth, adoption of a child or if a dependent gains new insurance. A qualifying event allows the employee to make changes to their benefits within 31 days of the event. If you experience a Qualifying Event and you wish to make benefit plan changes, log onto the benefits enrollment website at

www.mtsinaibenefits.com, select “Family Status Change” and make your new elections. Proof of your family status change is required; marriage certificate, birth certificate and other forms of proof must be faxed to the Benefits Administration Department at 646.537.9287.

2 Yes, Faculty and Staff may waive medical

coverage simply by selecting the waive option in the Medical Plan section when logged into the benefits enrollment website. You may only waive coverage if you are currently enrolled in another medical plan. You must provide proof of this coverage by submitting a waiver form which is located in the “Forms Library” on the benefits enrollment website, www.mtsinaibenefits.com

Annual Open Enrollment & Medical Cost-Share Premium Savings

During the Annual Open Enrollment period in October, Faculty and Staff are able to make benefit plan changes without having a qualifying event. Prior to open enrollment, Faculty and Staff are asked to see their primary care physician, obtain their biometric data and enter this data into a Health Assessment Survey. Faculty and Staff who meet the criteria within the timeframe allotted by the Benefits Department will receive a reduction in their medical cost-share premium. The reduction is provided in the form of a monetary credit that is added to the employee’s paychecks in the following year. The notation “HRA CRE” can be found on the employee’s paystub and confirms that they are receiving the credit. All new hires

automatically receive the credit for 2014. In order to receive the credit in 2015 and subsequent years, Faculty and Staff will be required to satisfy these requirements.

I have medical coverage under my spouse’s plan; can I decline to enroll in

the medical plans offered by Mount Sinai?

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Benefits Enrollment Website mtsinaibenefits.com

3 Each medical plan option provides comprehensive

health care coverage allowing Faculty and Staff flexibility in choosing a healthcare provider.

Faculty and Staff may select one the following five (5) UnitedHealthcare medical plans listed below. The plans differ by the amount of deductible, co-insurance, co-pay and out-of-network benefits. • UnitedHealthcare Choice Plus (PPO) Basic • UnitedHealthcare Choice Plus (PPO) Plus • UnitedHealthcare Enhanced Plan (PPO) • UnitedHealthcare Sinai Choice Plus EPO • UnitedHealthcare High Deductible Health Plan(HDHP)

(For additional information see plan comparison chart on the next page)

How can I locate a Top Tier Provider?

A list of Top Tier Providers can be found in the Top Tier Directory located at

www.mtsinaibenefits.com.

Special Features of the Plans

The Tier System

The medical plans allow Faculty and Staff a choice of three (3) ways to utilize the plan. Providers belong to one of the three (3) tiers; Top Tier, Middle Tier (In-Network providers) and Out-of-(In-Network. Top Tier refers to Mount Sinai providers who have agreed to accept reduced rates for Faculty and Staff. When an employee utilizes a top tier provider they have the least out-of-pocket expense. Middle tier (In-Network) refers to providers who are members of the UnitedHealthcare Network. The third tier is Out-of-Network. Faculty and Staff who utilize non-united healthcare providers are using providers who do not accept their insurance plan. Faculty and Staff who use Out-of-Network providers will pay out of pocket first and submit a claim to UnitedHealthcare for

reimbursement. The EPO Plan does not have an Out-of- Network benefit.

M e D I C A l P l A n S

United Healthcare 866.936.6007 myuhc.com

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Top Tier

Deductible (EE/EE+1/ Fam) Coinsurance Copay

Preventive Care/Screening/Immunizations Hospital Copay

Emergency Room Copay Out of Pocket Limits (EE/EE+1/ Fam) (Including Deductible)

In-Network

Deductible (EE/EE+1/ Fam) Coinsurance Copay

Preventive Care/Screening/Immunizations Hospital Copay

Emergency Room Copay Out of Pocket Limits (EE/EE+1/ Fam) (Including Deductible)

Out-of-Network

Deductible (EE/EE +1 /Fam) Coinsurance Copays

Preventive Care/Screening/Immunization Hospital Copay

Emergency Room Copay Out of Pocket Limits (EE/EE+1/ Fam) (Including Deductible) Reasonable and Customary

None None $10 No Charge

None $150 (Waived if admitted) $1,000 / $2,000 / $2,000

$300 / $525 / $750 10% $40 PCP / $50 Spec

No Charge $300 $150 (Waived if admitted)

$2,300 / $4,525 / $6,750*

($1,300 / $2,525 / $3,750)

$1,200 / $2,120 / $3,000 40% N/A Deductible & Coinsurance

$600 $150 (Waived if admitted) $5,200 / $10,120 / $15,000

140% of Medicare*(80th percentile of FAIR)

$700 / $1,200 / $1,700*($600 / $1,050 / $1,500)

20%

$60 PCP / $70 Spec*($50 PCP / $60 Spec)

No Charge $500 $150 (Waived if admitted)

$3,900 / $7,600 / $11,300*

($2,600 / $5,050 / $7,500)

$2,000 / $4,000 / $8,000*($1,500 / $2,625 / $3,750 ) 60% *(50%)

N / A

Deductible & Coinsurance($1,000)

Deductible & Coinsurance($1,000) $150 (Waived if admitted)

$7,000 / $14,000 / $23,000*

($5,750 / $11,125 / $16,500)

140% of Medicare

$1,250 / $2,500 / $2,500 None Deductible No Charge Deductible Deductible $1,250 / $2,500 / $2,500

$1,250 / $2,500 / $2,500 20% Deductible & Coinsurance

No Charge Deductible & Coinsurance Deductible & Coinsurance $2,000 / $4,000 / $4,000

$2,000 / $4,000 / $4,000 50% N/A Deductible & Coinsurance Deductible & Coinsurance Same as Network benefit $4,250 / $8,500 / $8,500*

140% of Medicare Plan Tiers Enhanced Plans (New) Plus Plan Sinai Choice EPO (New) Basic Plan High Deductible Health Plan

$600 / $1,050 / $1,500 20% $50 PCP / $60 Spec

No Charge $400 $150 (Waived if admitted) $2,600 / $5,050 / $7,500

Not available except for emergencies;

then same as in-Network benefit None None $10 No Charge None $150 (Waived if admitted) $1,000 / $2,000 / $2,000

$300 / $525 / $750

5%

$30 PCP / $40 Spec No Charge

$1,200 / $2,120 / $3,000

30%

N / A Deductible & Coinsurance

300% of Medicare

2014 Medical Plan Comparisonsat a Glance†

Notes:

The 2013 top tier and Network medical copays did not count toward the out-of-pocket limit. Effective 1/1/2014, all top tier and in-Network medical copays, including PCP, Specialist, Emergency Room, and Hospital copays, will count toward the out-of-pocket limit. The exception to this change will be the Out-of-Network Hospital copays and prescription drug costs.

The durable medical equipment lifetime maximum of $50,000 will be eliminated for 2014.

The chiropractic visit annual dollar maximum of $1,500 will be replaced with an annual 15 visit limit, in and out-of-Network combined. Healthcare reform changes announced on 10/1/13 modified some of the above figures. Aggregate costs remain the same.

* New for 2014

† Detailed summaries for all plans can be found at www.mtsinaibenefits.com

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M e D I C A l P l A n S

The EPO Plan

An employee who elects to enroll in the UHC CHOICE EPO Plan (Exclusive Provider Organization Plan) will benefit from a reduced cost share premium. Like the other UnitedHealthcare plans being offered, the EPO Plan provides access to top-tier and middle tier providers. The EPO Plan

does not provide Out-of- Network coverage for routine care. The only exception is for emergency care. If an emergency arises and a member is forced to use

an Out-of-Network facility, then the claims will be processed as an In-Network claim. The In-Network benefit charges will apply.

The High Deductible Health Plan

The High Deductible Health Plan (HDHP) option requires enrollees to meet a high deductible* before eligible medical services are covered by the plan. The HDHP may protect against catastrophic medical bills and has the lowest medical cost-share premium than the other plans. The HDHP provides access to top-tier, middle-tier (In-Network Providers) and Out-of-Network providers. Faculty and Staff may experience tax advantages by opening a Health Savings Account or by participating in the Limited purpose Health Reimbursement Account.*

Important!

If an employee is enrolled in the EPO plan and elects to see an Out-of-Network provider and the visit is not emergent, the employee will be responsible to pay the entire cost of the visit.

*For detailed information on all plan offerings, including the Health Savings Account and Health Care Reimbursement Accounts, see the 2014 BeneFlex Summary Plan Description located the Benefits section of the Human Resources website at, http://intranet1mountsinai.org/humanresources

or at http://www.mountsinai.org/about-us/careers/new-hires

United Healthcare 866.936.6007 myuhc.com

Medical Plan Cost

The chart on the next page shows the annual cost of the medical plans. To determine the per pay period cost, locate the salary band that contains your salary under the medical plan option. Select your coverage level. (Employee only, Employee plus 1

Dependent or Employee plus 2 or more Dependents) Divide the annual amount by 48 if you’re paid weekly and 24 if you’re paid bi-weekly. The resulting amount is the per-pay period deduction. All medical plan costs include Express-Scripts Basic Prescription coverage. (The Medical Cost- Share Credit is automatically given to all BeneFlex eligible Faculty and Staff who are hired after 9/1/13 and who have elected to enroll in a medical plan. The credit is included in the figures shown on the next page).

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Coverage

Level UHC PPOBasic UHC PPOPlus UHC PPOHDHP EnhancedUHC PPO Sinai EPOUHC

Salary ≤ $30,000

Single Employee + 1 Family

Salary ≤ $30,001 -$40,000

Salary ≤ $40,001 - $60,000

Salary ≤ $60,001 - $80,000

Salary ≤ $80,001 - $135,000

Salary ≤ $135,000 - $175,000

Salary $175,00+

Single Employee + 1 Family $103.29 $209.34 $312.63 $394.63 $729.67 $1,096.50 $69.52 $140.90 $210.43 $2,688.19 $4,854.89 $7,287.45 $99.32 $201.29 $300.61 $623.89 $1,110.06 $1,676.10 $884.61 $1,575.88 $2,377.07 $419.93 $747.15 $1,128.15 $3,178.17 $5,701.10 $8,568.02 $599.89 $1,067.36 $1,611.64 $966.82 $1,754.61 $2,703.52 $1,213.03 $2,195.64 $3,364.97 $650.75 $1,180.98 $1,819.68 $3,506.58 $6,784.35 $10,126.69 $929.64 $1,687.12 $2,599.54 $1,329.04 $2,426.70 $3,602.86 $1,424.91 $2,659.13 $3,935.73 $894.54 $1,633.36 $2,425.00 $3,718.47 $6,784.35 $10,126.69 $1,277.92 $2,333.36 $3,464.29 $1,918.50 $3,448.61 $5,155.01 $2,153.26 $3,864.22 $5,781.76 $1,291.30 $2,321.18 $3,469.72 $3,718.47 $6,784.35 $10,126.69 $1,277.92 $2,333.36 $3,464.29 $2,558.91 $4,474.66 $6,752.61 $2,742.56 $4,809.75 $7,254.35 $1,722.35 $3,011.79 $4,545.03 $5,036.12 $8, 934.96 $13,445.31 $2,460.49 $4,302.55 $6,492.74 $2,814.81 $4,922.12 $7,427.87 $3,016.82 $5,290.72 $7,979.79 $1,894.58 $3,312.97 $4,999.53 $5,310.37 $9,415.94 $14,170.74 $2,706.54 $4,732.81 $7,142.19

Annual Medical Plan Cost

*

(Employee Pre-Tax Deduction)

* Includes Medical Cost-Share Credit. Note: These rates do not apply to the North Shore Practice.

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P R e S C R I P T I O n C O V e R A G e

There are two prescription plans, a basic and a plus option that are provided by Express Scripts, Inc. If you elect to enroll in any of the medical plans you will automatically be enrolled in the basic prescription plan. You may elect to enroll in the Plus plan which allows you to pay less out-of-pocket when filling a prescription. However, if you elect the Plus prescription plan option you will pay more out of your paycheck. The chart below provides a summary of both plans.

1_{To learn which In-Network retail pharmacies participate, obtain a Home Delivery service form and instructions; or to verify if a}

prescription drug requires pre-authorization, call 1-866-340-8984, or visit www.expressscripts.com. This plan does not apply to participants of the Choice Plus/HDHP.

* Drugs that the Hospital can offer at a lower cost because of a favorable contract with the pharmaceutical supplier and because the drugs have been determined to be as effective as medications that are more expensive (e.g. Nexium instead of Prilosec for reducing acid reflux).

Benefits Schedule Plus Option Basic Option

Employee Pharmacy

(Mount Sinai Pharmacy) (30 Day Supply)

• Generic Drugs $5

• Preferred (Brand Formulary) drugs $15* • Preferred (Brand Formulary) drugs $20 Formulary Drugs only.

In-Network Pharmacy

(30 Day Supply)

• Preferred (Brand Formulary) drugs $35 • Non-Preferred (Brand non-Formulary) drugs $55

Out-of-Network Pharmacy • You pay 30% • You pay 30%

Home Delivery Service Pharmacy

(90-day supply for maintenance drugs, such as hypertension medication)

Express Scripts Prescription Drug Benefits At-A-Glance

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Contact Express Scripts at 866.340.8984 to find out if your prescription is covered under the plan.

How can I find out if my medication is covered by the Express Scripts prescription plan?

Mount Sinai Employee Pharmacy 212.241.7720

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High Deductible Health Plan

Express Scripts Prescription Drug Benefits At-A-Glance

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Benefits Schedule Prescription Option (after HDHP is satisfied)

Employee Pharmacy

(Mount Sinai Pharmacy) (30 Day Supply)

Coinsurance: 20%, subject to the following: Minimum Maximum

Generic Drugs: $5 $10 Preferred (Brand Formulary) drugs:* $10 $20 Preferred (Brand Formulary) drugs: $15 $30

In-Network Pharmacy

(30 Day Supply)

Coinsurance: 20%, subject to the following:

Generic drugs: $10 $20 Preferred (Brand Formulary) drugs: $30 $60 Non-Preferred (Brand non-Formulary) drugs: $45 $135

Out-of-Network Pharmacy • You pay 30%

Home Delivery Service Pharmacy

(90-day supply for maintenance drugs, such as hypertension medication)

Coinsurance: 20%, subject to the following:

Generic drugs: $25 $55 Preferred (Brand Formulary) drugs: $75 $150 Non-Preferred (Brand non-Formulary) drugs: $110 $335

1 _{To learn which in-Network retail pharmacies participate, obtain a Home Delivery service form and instructions or to verify if a} prescription drug requires pre-authorization, call 1 866-340-8984, or visit www.expressscripts.com.

*Drugs that the Hospital can offer at a lower cost because of a favorable contract with the pharmaceutical supplier and because the drugs have been determined to be as effective as medications that are more expensive (e.g. Nexium instead of Prilosec for reducing acid reflux).

Annual Prescription Plan Cost

The chart at right represents the anuual cost of the Plus prescription plan. The cost of the basic prescription plan is included in the medical plan cost share. To determine the pay period cost for the Plus plan, divide the annual amount by 48 if you are paid weekly, by 24 if you are paid bi-weekly. The resulting amount is the per-pay period deduction.

Single $172.16 Employee + 1 $309.88 Family $464.76

Express-Scripts Plus Prescription Plan

Express Scripts, Inc. 866.340.8984 express-scripts.com

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D e n T A l P l A n S

BeneFlex offers you a choice of three dental plans, two (2) Dental PPO Plans and One (1) DHMO Plan. While the three (3) plans provide different levels of dental care benefits, each plan gives you and your family access to affordable and quality dental care. The dental plan options are:

•

MetLife PPO – Basic

•

MetLife PPO – Plus

•

CIGNA DHMO

The MetLife Basic and Plus options provides both In-Network and Out-of-In-Network coverage. The CIGNA DHMO Plan provides In-Network coverage only.

Annual Dental Plan Cost

To determine the per pay period cost for the dental plan, using the chart at right, divide the annual amount by 48 if you are paid weekly and 24 if you are paid bi-weekly. The resulting amount is the per-pay period deduction.

MetLife

Basic MetLife Plus CIGNA DHMO

$207.51 $414.97 $830.05

$379.22 $760.00 $1,519.99

$98.59 $194.11 $269.35

Dental is not applicable to hourly staff at North Shore and Offsite Physician Practices.

Detailed information for the dental plans is provided in the 2014 BeneFlex Summary Plan Description booklet located in the benefits section on the Human Resources website at http://intranet1mountsinai. org/humanresources or at http://www.

mountsinai.org/about-us/careers/new-hires

United Healthcare Vision 800.638.3120

myuhcvision.com

V I S I O n P l A n

To help Faculty and Staff with the cost of vision care for themselves and their family, the BeneFlex program offers the UnitedHealthcare vision plan. The plan helps you pay the cost of an annual eye examination, eyeglass frames, prescription lenses or contact lenses and is available for use at in-network or out-of-network providers. Faculty and Staff will pay the lowest out of pocket cost when using an in-network provider.

Annual Vision Plan Cost

(Divide the annual amount by 48 if paid weekly or 24 if paid bi-weekly to get the per pay-period amount)

Detailed information for the vision plan is provided in the 2014 BeneFlex Summary Plan Description booklet located in the benefits section on the Human Resources website at http://intranet1mountsinai. org/humanresources or at http://www.

mountsinai.org/about-us/careers/new-hires

UnitedHealthcare VISION

$60.12 $105.36 $156.48

MetLife Dental 800.942.0854

metlife.com/mybenefits

CIGNA Dental 800.244.6224 cigna.com

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B A S I C l I F e I n S U R A n C e

Mount Sinai provides basic life insurance coverage to BeneFlex-eligible Faculty and Staff at no cost. In the event of the insured Faculty or Staff member’s death, Aetna Life Insurance will provide a lump sum benefit to the Faculty or Staff member’s designated beneficiary. The plan offers the following two basic options providing up to a maximum benefit of $1,000,000:

1 2

Aetna BASIC Life Insurance

$50,000*

1 ½ times annual base salary

* Employer paid basic coverage in excess of $50,000 is subject to imputed income tax. To avoid paying the imputed income tax, Faculty and Staff may select the employer paid $50,000 coverage in place of the higher 1 ½ times employer paid basic coverage.

Supplemental Life Insurance

Faculty and Staff may increase their life insurance coverage to levels above the basic life insurance amount by electing supplemental life insurance at a cost. Faculty and Staff may view the cost of the supplemental life insurance on the benefits enrollment website at www.mtsinaibenefits.com just prior to electing the coverage. Options range from ½ times annual base salary to 7.5 times annual base salary with a maximum benefit of $1,500,000. Faculty and Staff are urged to designate a beneficiary for the life insurance.

Dependent Life Insurance

Faculty and Staff may purchase Dependent Life Insurance for their spouse and/or dependent children. Aetna Life Insurance offers eight different dependent life insurance options:

Spouse with $5,000/Child

1. $25,000 spouse, $5,000 child

2. $50,000 spouse, $5,000 child

3. $75,000 spouse, $5,000child

4. $100,000 spouse, $5,000 child

Coverage for dependent spouses and children must be elected jointly. The employee is the beneficiary for the dependent life insurance. Evidence of Insurability (EOI) is required for coverage over $25,000.

Coverage for the employee’s spouse may not be greater than 100% of the employee’s total insurance (basic and supplemental life combined). Dependent children are covered through the end of the month in which they reach age 26.

Universal Life Insurance (Supplemental)

Faculty and Staff may purchase Voluntary Universal Life Insurance for themselves and their dependents. This insurance is individually owned and fully portable if you should leave employment for any reason. No physical is required to enroll and premiums are paid through payroll deduction. Universal Life Insurance features a cash value accumulation fund at competitive rates. Open Enrollment is held every April and counselors from EOI Service Company are available onsite to provide you with more information and assistance in enrolling in this valuable program.

Accidental Death & Dismemberment Insurance (AD&D)

In addition to employee life insurance coverage, Aetna provides Accidental Death and

Dismemberment Insurance. This insurance provides a benefit to you or your designated beneficiary if you become dismembered or die as a result of an accident. You may elect or decline this coverage. If you elect the coverage, it must equal to the total amount of your combined life insurance. (Basic and supplemental life insurances.)The cost of AD&D insurance is shown on the benefits enrollment website just prior to enrolling.

Spouse with $10,000/Child

5. $25,000 spouse, $10,000 child

6. $50,000 spouse, $10,000 child

7. $75,000 spouse, $10,000child

8. $100,000 spouse, $10,000 child

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As an employee you are covered for Short-term Disability and Long-term Disability. The disability plan provider is Prudential, Inc.

Short-Term Disability (STD)

Short-term disability benefits begin on the eighth (8) consecutive day of non-occupational illness or injury and can continue for up to 26 weeks from the initial date of disability. Faculty and Staff are provided with Basic short-term disability of 66 2/3 % of their base weekly salary up to $170 a week. This is provided to Faculty and Staff

at no cost. Faculty and Staff may choose to upgrade short- term disability coverage by electing the Enhanced benefit option, which provides 66 2/3 % of their weekly base salary up to $1,000 a week. This is provided at an additional cost to the employee. Cost is shown on the benefits enrollment website just prior to enrolling.

If you elect LTD on a Post-Tax basis, the cost of the coverage is reported as taxable income on your W-2. If you become disabled and are entitled to receive disability pay-ments, those payments are tax-free.

D I S A B I l I T Y P l A n S

If you elect LTD coverage on a Pre-Tax

basis, the cost of the coverage is not reported as taxable income on your W-2. If you become disabled and are entitled to receive disability payments, those payments are taxed as ordinary income. What is the difference

between electing LTD coverage on a Pre-Tax basis

versus a Post tax basis?

* LTD is not applicable to North Shore staff, Offsite Physician Practices (hourly Faculty and Staff), Security officers or Pharmacists.

Security officers and Pharmacists, please refer to your union contracts. Contact

Info

Prudential Disability Plans

Short-Term and Long-Term Disability 800.842.1718

Long Term Disability Plan (LTD)*

Long-term disability provides a source of income for an occupational or non-occupational disability lasting beyond the 26 weeks of short-term disability. Once short-term disability has been exhausted and the employee is unable to return to work, the employee’s case is reviewed for eligibility for the long-term disability benefit. If approved, Prudential, Inc., the disability provider, will provide the employee with 60% of their base annual salary up to $15,000/month. This plan can be elected as a pre-tax or post-tax deduction.

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Paid Time Off Program – (PTO)

The Paid Time Off Program* combines vacation, sick and personal time into one PTO “bank”. Employee classification and length of service determines the amount of PTO days that can be taken annually. (See Chart below) Participation in the program begins on the first day of the month coincident with or immediately following the employee’s date of hire or a change in eligibility status. The PTO program is administered at the departmental level. Faculty and Staff may contact their department administrator to confirm the staff classification and PTO allotment.

Staff

Classification Less than4 Years 23 Years4 thru more Years24 or

Non-Exempt Staff Exempt Staff RN Leadership with direct patient care responsibilities and Managerial and Professional positions which require RN licensure, MSW’s Dieticians

19 days 29 Days

31 Days

29 days 29 Days

34 Days

34 days 34 Days

34 Days

Free Pay-Periods

During a free pay-period, health insurance premium deductions and credits are not applied to an employee’s paycheck. Faculty and Staff who are paid weekly have four (4) free pay-periods during the year and Faculty and Staff paid bi-weekly will have (2) two free pay-periods during the year.

A free pay-period has no impact on the accessibility of health insurance as the health insurance remains active. Regular payroll tax deductions are taken during free pay-periods.

PA I D T I M e O F F P R O G R A M ( P T O )

PTO Questions?

Contact Labor Relations 212.241.8381

Payroll Questions? 212.731.3200

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R e T I R e M e n T P l A n S / T A x S H e l T e R e D A n n U I T Y

TIAA-CREF 403(b) Retirement Plan

Faculty and Staff may elect to make voluntary, pre-tax contributions from their paychecks. To enroll, log on to www.tiaa-cref.org/msmc at least one week after receiving your first paycheck. Employee contributions may be as little as 1% of pay and as much as 70% of pay, but may not exceed the 2014 IRS limit of; $17,500 for Faculty and Staff less than 50 years old and $23,000 for Faculty and Staff over 50 years old. An employer contribution may also be available to eligible Faculty and Staff after a one year waiting period. In order to receive full ownership of the employer contribution at the time of termination of employment, the employee must have

completed the three (3) year vesting period.

TIAA-CREF 457(b) Retirement Plan

Faculty and Staff in a non-union management position, with a base salary of $ 140,000 or higher may elect to make voluntary, pre-tax contributions from their paychecks. To enroll, log on to

www.tiaa-cref.org/msmc at least one week after receiving your first paycheck. Employee contributions may be as little as 1% of pay and as much as 70% of pay not to exceed the 2014 IRS limit of $ 17,500. Contributions are considered deferred compensation and as such are deemed to be the property of MSMC and are subject to the claims of its general creditors until the assets are withdrawn by the employee upon separation of service. Therefore, consideration should be given to the risk involved in contributing to this plan. There are no employer contributions to the 457(b) Plan.

TIAA-CREF

tiaa-cref.org/msmc 888.210.3992

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FlexIBle SPenDInG ACCOUnTS

Health Care and Dependent Care Reimbursement Account

The Reimbursement Accounts provides you with a way to pay certain healthcare and dependent care expenses on a pre-tax basis. Contributions are made to the account through payroll deductions. You may contribute a minimum of $240 and up to a maximum of $2,500 annually to the Health Care Reimbursement Account (HCRA). You may contribute a maximum annual contribution of $5,000 to the Dependent Care Reimbursement Account (DCRA). Due to IRS requirements, highly compensated Faculty and Staff with an annual compensation of more than $115,000 a year will be limited to an annual DCRA contribution of $1,385 per household.

Claims for expenses incurred between January 1 and December 31 must be submitted to ADP by March 31st of the following year. Any funds remaining in your account after March 31st will be forfeited. ADP administers the Health Care Reimbursement Account and Dependent Care Reimbursement Account. Please call ADP at 866.414.8455, if you have any questions.

Limited Purpose Flexible Spending Account (Limited HCRA)

If you are a High Deductible Health Plan participant and elect to contribute to an HSA account, you may enroll in the Limited HCRA. The Limited Healthcare Reimbursement Account provides Faculty and Staff with a way to pay certain limited healthcare expenses on a pre-tax basis. Contributions to the account are made through payroll deductions. Faculty and Staff may contribute a minimum of $240 up to a maximum of $2,500. Claims for expenses incurred between January 1 and December 31 must be submitted to ADP by March 31st of the following year. Any funds remaining in your account after March 31st will be forfeited. ADP administers the Limited (HCRA). Please call ADP at 866.414.8455, if you have any questions.

Transportation Reimbursement Incentive Program (TRIP)

The Transportation Reimbursement Incentive Program (TRIP) provides a way for Faculty and Staff to pay for transit and parking expenses on a pre-tax basis. Contributions to the account are made through payroll deductions. Faculty and Staff may contribute a maximum of $130 a month for transit expenses and $250 a month for parking expenses. You may submit claim forms to ADP for reimbursement or enroll in the On-Line Commuter Benefits (OCB) program at www.flexdirect.com Please call ADP at 866.414.8455 for FSA questions or 800.654.6695 for questions regarding Online Commuter Benefits.

Please note: If you are currently participating in the Mount Sinai Pre-Tax Parking Program, you cannot participate in the TRIP Parking Pre-Tax Program.

ADP (FSA) flexdirect.com 866.414.8455

Online Commuter Benefits (OCB) 800.654.6695

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Workers’ Compensation

Faculty and Staff are eligible for Workers’

Compensation benefits if they are injured at work. For additional information please contact our on-site Workers’ Compensation Manager at 212.731.7759.

New York State 529 College Savings Program

The New York State 529 College Savings Program provides a flexible, convenient and low cost way to save for college for a child, grandchild, or yourself. It is a voluntary program administered by Upromise Investment, Inc. You can use this investment to pay for tuition, room and board, books, supplies, and other qualified higher education expenses. Contributions to this plan are deducted automatically from your paycheck. Please consult your tax advisor regarding tax advantages. To obtain additional information on investment options, contribution limits or to enroll, please visit the savings plan website at

www.nysaves.org or call 877. NY-SAVES.

Employee Assistance Program

The Employee Assistance Program (EAP) is an employer sponsored program that provides free confidential short-term counseling services to Mount Sinai Faculty and Staff and their covered dependents. Counseling services are provided by licensed social workers who are trained to treat individuals who are in need of personal assistance. EAP is located at 19 East 98th Street, 3rd Floor. To obtain additional information or to make an appointment, please contact EAP at 212.241.8937.

Quit For Life Program - Smoking Cessation Plan

Quit For Life is a program that provides Faculty and Staff, who wish to become non-smokers, the techniques and tools needed to quit using tobacco for life. The program is sponsored by the American Cancer Society and Alere Wellbeing. Quit For Life will help Faculty and Staff create a quitting plan that is designed to meet each individual’s need and provide as much help as needed. The tools available in the program include calls from expert Quit Coaches, access to an on-line learning and a social support community, a printed workbook, medication support and toll-free access to expert Quit Coaches. If Faculty and Staff are not successful on the first try, re-enrollment to the program is available. The program is confidential and offered at no cost to faculty, staff and their spouses who are enrolled in one of the Mount Sinai medical health plans (I.e., United Healthcare Basic, Plus, Enhanced, Sinai Choice EPO or the HDHP Plan).

To join the program, please call866.Quit-4-Life or 866.784.8454. A registration specialist will verify eligibility and transfer you to a Quit Coach to get started.

ADDITIOnAl BeneFITS

New York State 529 College Savings Program 877.NY.SAVES

nysaves.org

Fax Payroll Deduction Form to: 646.537.9287 Quit for Life

866.Quit-4-Life or 866.784.8454 quitnow.net

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This Brochure explains some of the key features of your Mount Sinai Medical Center Benefits Plans. Complete details of each plan are contained in the official plan documents, if there is ever a conflict between this guide and the official plan documents, the plan document will prevail.

Mount Sinai reserves the right to change or end the plans at any time. This guide does not create a contract of employment.

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