2015 Benefits Open Enrollment

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2015 Benefits Open Enrollment

November 4 - 21, 2014

Review

changes to

your 2015

benefits!

For House Staff

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Inside This Guide

• What’s New for 2015 ... 4

Overview of what’s new and changing for 2015

• How to Enroll ... 5

Instructions on how to make your 2015 benefit elections

• Medical Plan Options ... 6

Important information, including medical plan comparisons and 2015 contributions, to help you decide which medical plan might be right for you in 2015

• Dental Plans ... 13

A high-level overview of the two dental plan options

• Vision Plan ... 14

Information on the vision plan

• HealthySteps to Wellness ... 15

Information about the HealthySteps to

Wellness program

• Health Incentive Account and Flexible Sending Accounts ... 16

Overview of the Health Incentive Account (HIA) and Details on the Health Care and Dependent Daycare Flexible Spending Accounts (FSAs)

• Additional Benefits ... 18

Information about the Life Insurance, AD&D, and Group Legal Plan

Open Enrollment ends

November 21, 2014

at 10PM PST

Are you taking an active role in managing your well-being?

Have you explored all of the health and wellness benefits

offered to you to help you improve and maintain better

health?

The health of our employees remains a top priority for

Stanford Health Care. We continuously review our health

and wellness programs to ensure we have the best tools

and resources available to help you improve your health,

but ultimately, it’s up to each of you to take initiative and

achieve your health and wellness goals.

Open Enrollment is your once-a-year opportunity to

enroll in or make changes to your health benefits. You’ll

notice some enhancements to our plans for 2015 that

not only improve the quality of care you have access to,

but also reinforce our commitment to the success of our

organization. Take advantage of this time to review your

options and your current situations, and choose the plans

that make the most sense for you.

Let’s continue taking steps together toward improving the

health of our organizations.

Kety Duron

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2015 Benefits Open Enrollment

November 4 - 21, 2014 at 10PM PST

Your benefits Open Enrollment period is your once-a-year opportunity to enroll in or make changes to your hospital benefits. Any new elections or changes to coverage or dependents will be effective on January 1, 2015. Keep in mind: You may only make changes to your benefits during Open Enrollment, unless you experience a mid-year qualifying life event, such as having a baby or getting married. Changes to your benefits due to a qualifying life event must be made within 31 days of the event, and will require proof of dependent eligibility (e.g. birth certificate, marriage certificate), as applicable.

Your 2015 Benefits Action Checklist

Here’s what you need to do before 10PM PST on November 21, 2014:

Learn: Visit www.healthysteps4u.org to see what’s new and what your options are for 2015.

Look for an announcement for upcoming Open Enrollment meetings on the GME website.

Review: Look at your current elections and family members you may be covering. Decide if you would like to enroll in coverage, make changes to your current benefit elections and whether you want/need to add, change or remove any dependents.

Enroll: Log in to the Benefitsolver enrollment portal any time between November 4, 2014, and November 21, 2014, to make changes to your current benefits or enroll for 2015.

Accessing the Benefitsolver Enrollment Portal Online

Stanford Health Care

• Visit the HealthySteps website — www.healthysteps4u.org

• Click on the Benefitsolver link on the left • Enter your User Name and Password

– When you visit for the first time, click on “Register” to set up your User Name, Password and security questions. The Company Key is “healthysteps”, all lowercase letters.

Remember:

• Enroll in the Health Care or Dependent Daycare Flexible Spending Account (FSA) for 2015. You must re-enroll in FSAs each year. Don’t forget, the money you set aside in these accounts does not roll over from year to year. Any money remaining in your FSA at the end of the year will be forfeited.

— Note: If your residency is ending in 2015, please make sure you only contribute the amount you would need in your FSA between January and the month your Residency will be ending. You must submit all claims incurred during that period within 90 days of the date of your termination.

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What’s New for 2015

We remain committed to providing you with competitive benefits that meet the various needs of our employees. We continually review our programs to ensure that we’re effectively managing our plans, and making adjustments as necessary to better align our programs with our health and wellness goals.

• Increased annual benefits maximum and lifetime orthodontia limit for the Delta Dental PPO Plan. The annual benefits maximum will increase from $1,500 to $2,000, and the orthodontia lifetime maximum will increase from $1,000 to $1,500.

• Spouses/eligible domestic partners in a hospital medical plan are now eligible to participate in the HealthySteps to Wellness program. Spouses/eligible domestic partners who are in a hospital medical plan are invited to participate in the online Health Risk Assessment (HRA) to learn about their health, and conditions and diseases for which they may be at risk. As a thank you, they will receive a $50 Amazon gift card (taxable to employee) in the mail from Limeade. • A new benefits enrollment portal and service center support team

through Benefitsolver. Benefitsolver is your one-stop-shop when you have questions about your benefits and want to talk to someone, or when you need to enroll in, or make changes to your health care, spending accounts, life and disability benefits.

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How to Enroll

Step 1: Get logged in

Who are your eligible

dependents?

In general, your eligible dependents include: • Spouse (same or opposite sex)

• Eligible domestic partners • Eligible children:

– Your children (including natural children, adopted children or children for whom you have initiated legal adoption proceedings prior to age 18, stepchildren, the children of your eligible domestic partner, children for whom you are the legal guardian up to age 18 and children for whom you are required to provide health coverage resulting from a Qualified Medical Child Support Order [QMCSO]) up to age 26 (age 21 for dependent life insurance). Please note, children ages 19-26 are not eligible if they are eligible for coverage under another employer- sponsored plan.

– Unmarried children, of any age, who are incapable of self-support and principally dependent on you or your spouse/eligible domestic partner, as a result of physical or mental disabilities which began before age 19.

Remember! If you do not enroll during Open Enrollment, your next opportunity will be in the fall of 2015 for 2016, unless you experience a mid-year qualified life event, such as marriage or birth of a child.

Enroll online

November 4 - 21, 2014

by 10PM PST

Accessing the Benefitsolver Enrollment

Portal Online

Stanford Health Care

• Visit the HealthySteps website —

www.healthysteps4u.org

• Click on the Benefitsolver link on the left • Enter your User Name and Password

– When you visit for the first time, click on “Register” to set up your User Name, Password and security questions. The Company Key is “healthysteps”, all lowercase letters.

Step 2: Make your elections

1. Follow the instructions and submit your benefit choices.

Please note your elections will not take effect until you approve and submit.

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Preferred Provider

Organization (PPO)

The House Staff Preferred Provider Organization (PPO) plan offers comprehensive coverage in three ways: • If you use Stanford Health Care and Stanford Children’s

Health providers and facilities, services are covered at no charge to you.

• If you visit other providers and facilities within the UnitedHealthcare Options PPO network (UMR), you will be subject to copays, deductible and coinsurance. Services are generally covered at 80%.

• If you visit out-of-network providers and facilities, you will be subject to deductible and coinsurance. Services are generally covered at 60%.

• Preventive care services like annual physical exams and certain types of screenings are provided at no charge. There is a copayment for prescription drugs and you do not have to meet the plan’s deductible first. Prescription drug coverage is provided by Express Scripts.

Mental health and substance abuse treatment services are provided by United Behavioral Health, operating under the brand Optum. Behavioral health services are provided to House Staff employees at no charge to you. Covered dependents may receive services through the Stanford Health Care and Stanford Children’s Health network at no charge, or may utilize the UnitedHealthcare Options PPO network (UMR), or out-of-network providers and facilities (subject to copays, deductible and coinsurance).

If you earn wellness incentive funds by participating in approved wellness activities through the HealthySteps to

Wellness program, you will receive your funds in a Health

Incentive Account (HIA).

Where Can I Go to Find a

Network Provider?

The PPO Plan offers you two tiers of in-network physicians and facilities. To locate in-network physicians and facilities:

First Tier: www.stanfordhealthcarealliance.org www.pcha.org

Second Tier: www.umr.com

To find an in-network mental health or substance abuse treatment provider, visit www.liveandworkwell.com.

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Kaiser Permanente HMO

With the Kaiser HMO plan, you can only see providers in the Kaiser HMO network.

You must use Kaiser doctors and facilities to receive benefits for non-emergency care. In most cases, each time you need care, you can see any Kaiser doctor. Under this plan, you do not need to select a Primary Care Physician (PCP).

• Preventive care services like annual physical exams and certain types of screenings are provided at no cost to you.

• You are responsible for all medical expenses each year, until you reach your annual deductible amount ($400/employee-only coverage or $1,000/employee + one or more covered dependents for in-network services).

• You pay a set copay for prescription drugs. Prescription drugs may only be filled at a Kaiser-affiliated pharmacy.

• Once you’ve reached your annual deductible, you will pay coinsurance or copays for covered expenses until you reach your out-of-pocket maximum for the year ($1,800/employee-only coverage or $3,600/employee + one or more covered dependents for in-network services).

• When you reach your out-of-pocket maximum, you will pay nothing for the rest of the year for covered services.

If you earn wellness incentive funds by participating in approved wellness activities through the HealthySteps to Wellness program, you will receive your funds in a Health Incentive Account (HIA). Note: You must reside in California to enroll in the Kaiser plan.

Annual Deductible Coinsurance Out-of-Pocket Maximum $400/per person $1,000/family limit Varies based on service $1,800/individual $3,600/family

Preventive Care

Covered at 100%

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2015 Medical Plan Monthly Contributions

Need More Help Deciding

on a Plan for 2015?

Contact CareCounsel to speak with a health care advocate to learn more about your benefit plan options and to get help choosing a plan for 2015. Call CareCounsel at

1-888-227-3334 to speak with your personal health care advocate today.

Kaiser Permanente HMO

Coverage Employee Monthly Contribution SHC Monthly Contribution

Employee $0 $590.70

Employee + Child(ren) $0 $1,004.73

Employee + Spouse $0 $1,328.27

Employee + Family $0 $1,742.32

UMR PPO

Coverage Employee Monthly Contribution SHC Monthly Contribution

Employee $0 $801.60

Employee + Child(ren) $0 $1,442.80

Employee + Spouse $0 $1,755.18

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Medical Plan Comparison

Services PPO Kaiser Permanente HMO

Tier 1 – Stanford Health Care and Stanford Children’s

Health Network

Tier 2 – UnitedHealthcare Options PPO Network

(UMR)

Out-of-Network*

Annual Deductible

Applies to services that require coinsurance; not required before copayments

$0/employee-only coverage $0/employee + one or more covered dependents

$300/employee-only coverage $750/employee + one or more covered dependents

$750/employee-only coverage $1,875/employee + one or more covered dependents

$400/per person $1,000/family limit

Wellness Incentive Based on participation in the Healthy Steps to Wellness Program

Annual Out-of-Pocket Maximum

Includes deductible, copays and pharmacy

$0/employee-only coverage $0/employee + one or more covered dependents

$1,300/employee-only coverage

$3,250/employee + one or more covered dependents

$3,250/employee-only coverage

$9,375/employee + one or more covered dependents

$1,800/individual $3,600/family

Maximum Lifetime Benefit Unlimited Unlimited Unlimited Unlimited

Choice of Physicians You must use SHC (including Facility Practice), LPCH, LPCH Facility Practice Organization, PCHA, Stanford Health Care Reference Lab, UHA and Affinity providers

You must use UnitedHealthcare Options PPO network providers for in-network benefits

You may use any licensed provider

You must use Kaiser facilities; all care and covered services must be approved by a Kaiser physician

Claim Forms No, except for out-of-network

emergency services No, except for out-of-network emergency services Yes No, except for non-Kaiser emergency services

Hospital Care

Room and Board, Surgeon, Physician Visit and Anesthesiologist

No charge; precertification

required 80% after deductible; precertification required 60% after deductible; precertification required or $300/ admission penalty applies (waived if emergency admission)

90% after deductible

Office Care

Physician Visit No charge $20/visit 60% after deductible $20/visit Routine Physical No charge No charge 60% after deductible No charge Adult Preventive Services No charge No charge 60% after deductible No charge Child Preventive Services No charge No charge 60% after deductible No charge

Specialist Visit No charge $35/visit 60% after deductible $35/visit

Allergy Tests and Injections No charge 80% after deductible 60% after deductible $3/visit/injection; $20/testing

Immunizations No charge No charge 60% after deductible No charge

Lab and X-ray

(non-preventive) No charge 80% after deductible 60% after deductible 90%

Outpatient Surgery No charge 80% after deductible 60% after deductible 90% after deductible

Chiropractic Care No charge; 30-visit maximum per calendar year (combined Tier 1, Tier 2 and out-of-network maximum)

80% after deductible; 30-visit maximum per calendar year (combined Tier 1, Tier 2 and out-of-network maximum)

60% after deductible; 30-visit maximum per calendar year (combined Tier 1, Tier 2 and out-of-network maximum)

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Services PPO Kaiser Permanente HMO Tier 1 –

Stanford Health Care and Stanford Children’s

Health Network

Tier 2 – UnitedHealthcare Options PPO Network

(UMR)

Out-of-Network*

Acupuncture No charge; 12-visit maximum per calendar year (combined Tier 1, Tier 2 and out-of-network maximum)

80% after deductible; $30/ visit benefit maximum; 12-visit maximum per calendar year (combined Tier 1, Tier 2 and out-of-network maximum)

60% after deductible; $30/ visit benefit maximum; 12-visit maximum per calendar year (combined Tier 1, Tier 2 and out-of-network maximum)

Discounts apply through Kaiser Permanente’s Healthyroads program

Infertility Diagnosis No charge; covered expenses include counseling and consultation, infertility studies and tests

80% after deductible; covered expenses include counseling and consultation, infertility studies and tests

60% after deductible; covered expenses include counseling and consultation, infertility studies and tests

50% for all services related to covered infertility treatment

Physical, Speech and Occupational Therapy

(Restorative services only)

Outpatient Hospital No charge; 60-visit maximum per calendar year (combined with physical, occupational or speech therapy for outpatient hospital and office visits) (combined Tier 1, Tier 2 and out-of-network maximum)

80% after deductible; limited to a 60-visit maximum per calendar year (combined with physical, occupational or speech therapy for outpatient hospital and office visits) (combined Tier 1, Tier 2 and out-of-network maximum)

60% after deductible; limited to a 60-visit maximum per calendar year (combined with physical, occupational or speech therapy for outpatient hospital and office visits) (combined Tier 1, Tier 2 and out-of-network maximum)

$20/visit

Office Visit No charge; 60-visit maximum per calendar year (combined with physical, occupational or speech therapy for outpatient hospital and office visits) (combined Tier 1, Tier 2 and out-of-network maximum)

$35/visit; limited to a 60-visit maximum per calendar year (combined with physical, occupational or speech therapy for outpatient hospital and office visits) (combined Tier 1, Tier 2 and out-of-network maximum)

60% after deductible; limited to a 60-visit maximum per calendar year (combined with physical, occupational or speech therapy for outpatient hospital and office visits) (combined Tier 1, Tier 2 and out-of-network maximum)

Emergency and Urgent Care

Emergency in Area No charge $50/visit $50/visit 90% after deductible Emergency Out-of-Network No charge $50/visit $50/visit 90% after deductible Urgent Care No charge $20/visit $20/visit $20/visit at Kaiser facilities Ambulance No charge No charge after deductible No charge after deductible No charge when medically indicated and authorized by plan physician

Skilled Nursing Facility Not applicable 80% after deductible; 100-visit maximum per calendar year (combined Tier 1, Tier 2 and out-of-network maximum)

60% after deductible; 100-visit maximum per calendar year (combined Tier 1, Tier 2 and out-of-network maximum)

90% up to 100 days per benefit period

Home Health Care Not applicable 80% after deductible; 100-visit maximum per calendar year; one visit equals 4 hours or less (combined Tier 2 and out-of-network maximum)

60% after deductible; 100-visit maximum per calendar year (combined Tier 2 and out-of-network maximum)

100% with Kaiser approval; part-time or intermittent only; 100-visit maximum per calendar year (must live within the service area)

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Services PPO Kaiser Permanente HMO Tier 1 –

Stanford Health Care and Stanford Children’s

Health Network

Tier 2 – UnitedHealthcare Options PPO Network

(UMR)

Out-of-Network*

Hearing Exams No charge 80% after deductible 60% after deductible No charge

Dental Benefits Not applicable Not covered, except for emergency treatment; 80% after deductible

Not covered, except for emergency treatment; 60% after deductible

Not covered

Durable Medical Equipment Not applicable 80% after deductible; includes hearing aids (limited to one hearing aid per ear every three years)

60% after deductible; includes hearing aids (limited to one hearing aid per ear every three years)

80% when prescribed by a Kaiser physician (must live within the service area) 50% for external sexual dysfunction devices

Transplant Services No charge 80% after deductible; must be performed at a Center of Excellence facility and subject to utilization review program

Must use Center of Excellence For covered transplant services, you pay the same cost sharing as other services not related to a transplant

Mental or Nervous

Disorders Mental Health Care Provided through Optum

Mental Health Care Provided through Optum

Mental Health Care Provided through Optum

Mental Health Care Provided through Kaiser Permanente

Inpatient

Employee No charge No charge No charge 90% after deductible Dependent No charge 80% after deductible 60% after deductible 90% after deductible

Outpatient

Employee No charge No charge No charge Individual: $20/visit; Group: $10/visit Dependent No charge $20/visit 60% after deductible Individual: $20/visit;

Group: $10/visit

Substance Abuse Substance abuse care provided

through Optum Substance abuse care provided through Optum Substance abuse care provided through Optum Substance abuse care provided through Kaiser Permanente

Inpatient

Employee No charge No charge No charge 90% after deductible Dependent No charge 80% after deductible 60% after deductible 90% after deductible

Outpatient

Employee No charge No charge No charge Individual: $20/visit; Group: $10/visit Dependent No charge $20/visit 60% after deductible Individual: $20/visit;

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Services PPO Kaiser Permanente HMO Tier 1 –

Stanford Health Care and Stanford Children’s

Health Network

Tier 2 – UnitedHealthcare Options PPO Network

(UMR)

Out-of-Network*

Prescription Drugs Not applicable Prescription Drugs provided

through Express Scripts Prescription Drugs provided through Express Scripts Prescription Drugs provided through Kaiser Permanente Not applicable Retail 30-day Supply**

Generic: $5/prescription Brand Formulary: $20/ prescription Brand Non-Formulary: $50/prescription

Mail Order 90-day Supply

Generic: $10/prescription Brand Formulary: $40/ prescription Brand Non-Formulary $100/ prescription: Retail** 60% after deductible Mail Order Not covered

Retail 30-day Supply

Generic: $10/prescription Brand Formulary: $25/ prescription when prescribed by a plan physician

Mail Order 100-day Supply

Generic: $20/prescription Brand Formulary: $50/ prescription

Women’s Contraceptives Not applicable Provided through Express

Scripts Provided through Express Scripts Provided through Kaiser Permanente Pharmacy

Contraceptives examples include: oral, patch, emergency

For a full list, visit the HealthySteps website

Not applicable Retail & Mail-order Generic and Brand Formulary: 100%

Brand Non-Formulary: $50/ prescription (retail); $100/ prescription (mail-order)

Retail: 60% after deductible Mail-order: Not covered

No charge (see plan for details)

Women’s Contraceptives covered under the Medical Plan

Services through Stanford Health Care and Stanford Children’s Health Network

Services through

UnitedHealthCare Options PPO Network (UMR)

Services through any licensed

provider Services through Kaiser HMO

Contraceptive injections, and contraceptive devices such as, IUDs, implants, (including the insertion and removal)

See medical plan for additional details

No charge No charge 60% after deductible No charge

* Out-of-Network means out of the Tier 2 network. Usual Customary and Reasonable (UCR) charges are the fees normally charged for medical services or supplies in a particular geographic location.

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Dental Plans

You have the option to choose between two dental plans. Remember, the DeltaCare USA DHMO is provided to you with no monthly premium.

2015 Monthly Dental Contributions

2015 Dental Plan Comparison Chart

DeltaCare USA DHMO Delta Dental PPO

• No employee premiums

• You can choose a primary care dentist from the DeltaCare network

• You can select up to three different primary care dentists for your family

• Most preventive, diagnostic and basic services are covered at 100%

• You pay a copayment for major and restorative services • Must reside in California to enroll in the DeltaCare

USA DHMO and you must receive services in California • Includes adult orthodontia

• Employee premiums required for spouse/eligible domestic partner and family coverage

• You can visit any dental care provider you wish

• When you use a provider in the PPO network, you typically pay less because network providers have agreed to provide dental care to members at lower, negotiated rates • After you pay an annual deductible, you pay a percentage

of the bill, called coinsurance, for most dental services • Diagnostic and preventive care are covered at 100% and

are not subject to the deductible

• Includes adult orthodontia, up to age 26 for employees and dependent children only

Coverage DeltaCare USA DHMO Delta Dental PPO

Employee Monthly

Contribution Hospital Monthly Cost Sharing Employee Monthly Contribution Hospital Monthly Cost Sharing

Employee $0.00 $16.17 $0.00 $58.85

Employee + Child(ren) $0.00 $28.62 $0.00 $112.35 Employee + Spouse $0.00 $30.39 $27.00 $82.06 Employee + Family $0.00 $43.64 $27.00 $135.61

Services DeltaCare USA DHMO Delta Dental PPO

Annual Deductible No annual deductible $50 per person / $150 per family each calendar year

Annual Benefits Maximum Please refer to plan documents for

more information $2,000 per person each calendar year

Choice of Providers DeltaCare USA network providers Visit the provider of your choice

Diagnostic & Preventive Services Most services covered at 100% 100%

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Vision Plan

When you enroll in one of the medical plans, you and any family members enrolled in your medical plan automatically receive vision coverage through VSP at no additional cost.

You may visit any provider, but you will save the most money when you visit VSP network providers. To find a VSP provider near you, visit www.vsp.com.

Services Description Copay Frequency

WellVision Exam Focuses on your eyes and overall wellness

$10 Every calendar year

Prescription Glasses $25 See frame and lenses

Frames • $130 allowance for a wide selection of frames • $150 allowance for

featured frame brands • 20% off amount over your

allowance

Included in Prescription Glasses

Every other calendar year

Lenses • Single vision, lined bifocal and lined trifocal lenses • Polycarbonate lenses for

dependent children

Included in Prescription

Glasses Every calendar year

Lens Options • Standard progressive lenses

• Premium progressive lenses

• Custom progressive lenses

• Average 35-40% off other lens options

$50 $80 - $90 $120 - $160

Every calendar year

Contacts (instead of glasses)

• $105 allowance for contacts and contact lens exam (fitting and evaluation)

• 15% off contact lens exam (fitting and evaluation)

$0 Every calendar year

Extra Savings and Discounts

• Glasses and sunglasses • Retinal screening • Laser vision correction

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HealthySteps to Wellness

We want to help you improve and maintain your health and well-being — personally, financially and in the workplace. Through the HealthySteps to Wellness program and www.healthysteps4u.org, you have access to a variety of resources and tools

to help you take a step in the direction of better health.

By participating in the healthy lifestyle activities, you can earn up to $500 for employee coverage and up to $1,000 for employee plus one or more dependents coverage in 2015. Spouses/eligible domestic partners who are covered by a hospital medical plan are eligible to participate in the online Health Risk Assessment (HRA) to learn about their health, and the diseases and conditions for which they may be at risk. As a thank you, they will receive a $50 Amazon gift card (taxable to employee) in the mail from Limeade. More information will be coming in the December HealthySteps4U Newsletter about the 2015 HealthySteps to Wellness program.

For more information about the HealthySteps to Wellness program, visit www.healthysteps4u.org.

HealthySteps to Wellness

Your First Steps must be completed by April 30, 2015, to earn wellness dollars. All steps must be completed by October 31, 2015. Remember, to earn wellness incentive dollars, you must be enrolled in a hospital medical plan and be an active employee at the time funds are deposited, or funds will be forfeited.

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Health Incentive Account

and Flexible Sending

Accounts

Health Incentive Account (HIA)

If you are enrolled in the PPO Plan, or Kaiser HMO, any wellness incentive dollars you earn by participating in the HealthySteps to Wellness program (up to $500 for employee-only or $1,000 for employee + one or more covered dependents) will be deposited into a HIA that will be set up for you.

You’re free to use this money any time during the year to help pay for your medical expenses. The funds in this account do not roll over at the end of the year, so you must use all your HIA money during 2015. Note: If your Residency will be ending in 2015, you must

submit all claims incurred during that period within 90 days of the date of your termination.

What Health Care Expenses

Qualify HIA Reimbursement?

You can use your HIA to pay for or be reimbursed for a variety of health care goods and services. A few examples of qualified expenses include:

• Prescription drugs

• Physician and specialist visits • Lab and x-rays

• Dental care • Orthodontia • Surgery • Therapy

• Vision correction surgery

A few examples of non-qualified health care expenses

include:

• Babysitting and child care for a healthy baby (use your Dependent Daycare FSA instead) • Elective cosmetic surgery

• Non-prescription drugs, medicines and supplements (unless prescribed)

• Health club dues

The complete list of qualified and non-qualified medical

A Health Incentive Account (HIA):

• Is funded by the hospital based on your participation in the HealthySteps to Wellness program (you cannot make contributions) • Is 100% owned by you

• Does not accumulate from year to year • Funds not used during the year will be forfeited

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Flexible Spending Accounts

Flexible Spending Accounts (FSAs) allow you to set aside pre-tax money each year to pay for certain eligible health care and dependent daycare expenses.

Your contributions are automatically deducted from your paycheck before taxes are withheld, which means your taxable income will be lower.

Health Care FSA — Contribute up

to $2,500 in 2015

• Can be used to pay for medical, dental and vision expenses incurred on or before December 31, 2015, by you, your spouse or eligible dependents. (You can use your FSA funds to pay for your eligible domestic partner’s medical expenses only if they are considered a tax dependent under IRS qualifications.)

• You may be reimbursed for eligible expenses at any time during the plan year, up to the amount you elected for the year, even if you have not yet contributed that amount to the FSA. You must submit all claims incurred for the 2015 calendar year by March 15, 2016.

Dependent Daycare FSA —

Contribute up to $5,000 in 2015

• Can be used to pay for child care up to age 13, or elder care while you are at work.

• Submit claims for reimbursement of eligible expenses, up to the amount of contributions available in your account at the time of submission.

• The IRS limits your annual contributions to the Dependent Daycare FSA to $5,000 or less depending on your marital and tax-filing status.

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Additional Benefits

In addition to providing coverage for your health care needs, the hospital also offers you and your family additional benefits to help you protect your finances and manage your life. Some of the benefits below are automatic and paid for by the hospital. You may elect additional coverage, such as Supplemental Life, AD&D, and Group Legal.

For more information about these benefits, including a worksheet to calculate Life Insurance rates, visit

www.healthysteps4u.org.

Life Insurance

You may also increase or decrease supplemental Life coverage for yourself or your spouse/eligible domestic partner. If you would like to change your Supplemental Life or spouse/eligible domestic partner coverage, you must do so during Open Enrollment.

Supplemental Life Insurance for your spouse/eligible domestic partner is available in increments of $1,000 up to $200,000 and cannot exceed 100% of the employee’s Life Insurance approved value. You pay the cost for this coverage with after-tax dollars. The cost is based on your age and the amount of coverage elected.

Basic Life

The hospital provides Basic Life coverage of one times salary ($50,000 maximum) at no cost to you.

Please note if your annual pay changes (due to a change in your hourly rate or scheduled hours), Life amounts will automatically increase or decrease.

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Learn more about voluntary benefits at

www.shclpchvoluntarybenefits.com

Accidental Death &

Dismemberment (AD&D)

Accidental Death & Dismemberment (AD&D) insurance helps protect you and your family against financial loss if you or a family member are severely injured or killed in an accident.

Optional coverage is for you or for family coverage in amounts of $10,000, up to $1,000,000.

Optional AD&D

Coverage Vendor 2015

AD&D per $1,000 — EE Only

Liberty Mutual $0.0165 AD&D per $1,000 — EE + Family $0.0187

Statement of Health (SOH)

A SOH is required if you decide to enroll in supplemental LTD or Life coverage during Open Enrollment. SOHs must be submitted within 60 days of the close of Open Enrollment. Visit www.mylibertyconnection.com and

complete the one-time user registration by using the company code, “SHCLPCH”. For more information about this process, contact Liberty Mutual at 1-888-287-8494, extension 60936.

Group Legal Plan

The Group Legal plan gives you and your family access to legal advice and professional legal representation at an affordable price, through a voluntary, after-tax payroll deduction. You can obtain services from attorneys in much the same way as you do from the doctors who participate in your medical plan. This legal plan relies on a network of over 11,000 participating attorneys in private practice or participating law firms to provide covered services. You can add, drop or change coverage during Open Enrollment. To enroll in or change your current coverage, visit www.shclpchvoluntarybenefits.com.

Stanford Coordinated Care

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About this Open Enrollment Guide

The information in this guide provides an overview of your Stanford Health Care 2015 benefit plans. More complete descriptions of the plans are contained in your Benefits Handbook and other plan documents that govern these plans. If there is a discrepancy between this guide and the plan documents, the plan documents will govern in all cases.

For more information about key provisions for each plan, please refer to the Summary of Benefits and Coverage (SBC) posted on www.healthysteps4u.org. You may also request a glossary that includes all key terms described in the SBC.

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