Table of Contents
Eligibility
Changes During the Plan Year
Overview of Medical Plans
DeKalb Medical Copay Plan
Choice Plus Plans
HRA Plan
HDHP with Health Savings Account (HSA)
HSA Account Benefits
Medical Plan Comparison At-a-Glance
Medical Plan Benefit Summaries
Prescription Drug Coverage
Dental Plans Overview
Dental Plan Comparison At-a-Glance
Maximizing the Value of Dental Benefits
Vision Care
DeKalb Medical 2014 Employee Premium Rates
Flexible Spending Accounts
Life Insurance
Disability Insurance
Critical Illness Insurance
Accident Insurance
Long Term Care
Family Protection Plan
Retirement Benefits
Other Valuable Benefits
Clean Air Campaign
Paid Time Off and Extended Illness Bank
New Hire & Status Change Benefits Enrollment
Dependent Verification Information
How to enroll in DeKalb Medical Voluntary Benefits
Benefits - Frequently Asked Questions
Employee Rights And Responsibilities
Continuation Coverage Rights Under COBRA
Important Contact Information
DeKalb Medical Payroll Calendar
3
4
5
5
5
7
8
9
10
11
14
15
16
17
18
20
23
26
27
27
27
28
28
29
30
31
32
34
38
39
42
44
46
50
51
This booklet is only an overview of our benefit plans. Complete descriptions of these plans and their provisions are available to you through the Summary Plan Documents (SPD). The SPDs are available on the Benefits Homepage of intranet site or with the Benefits Department. If any information in this brochure conflicts with the detailed plan documents, the plan documents take precedent. DeKalb Medical reserves the right to make changes at any time.
DeKalb Medical is proud to partner with you in our ongoing mission to deliver a superior patient experience. We realize that your partnership is critical to our success. While you serve in your significant role, we will strive to provide you with resources that help you make choices that promote health and wellness.
Our comprehensive benefits package focuses on prevention while providing resources to protect and care for you and your family. Our health plan options consist of a choice of three medical plans, prescription drug benefits, mental health, three dental plans, vision, retirement and a vast number of voluntary benefits and employee discounts. We encourage you to review this information so that you are able to make informed decisions in reference to your benefits.
BENEFIT
64 HRS OR MOREFULL-TIME
32 HRS OR MOREPART-TIME
ELIGIBILITY
Health, Dental and Vision Plans X X Immediate; coverage begins the first day of month after enrollment
Flexible Spending Accounts X X Immediate; coverage begins the first day of month after enrollment
Supplemental Life Insurance for
Employees and Dependents X X Immediate; coverage begins the first day of month after enrollment
Basic Life and AD&D Insurance X X continuous employment at benefit eligible statusFirst day of month on or after one year of
Long Term Disability Insurance X Not Eligible continuous employment at full-time statusFirst day of month on or after one year of
Whole Life Insurance X X Immediate; coverage begins the first day of month after enrollment
Short Term Disability Insurance X X Immediate; coverage begins the first day of month after enrollment
Critical Illness Insurance X X Immediate; coverage begins the first day of month after enrollment
Accident Insurance X X Immediate; coverage begins the first day of month after enrollment
Long Term Care Coverage X X Immediate; coverage begins the first day of month after enrollment
Family Protection Plan X X Immediate; coverage begins the first day of month after enrollment
Wellness Center X X Immediate upon enrollment
Employee Assistance Program X X Immediate upon enrollment
Credit Union X X Immediate upon enrollment
Tuition Reimbursement X X After six months of continuous employment
Adoption Allowance X X After six months of continuous employment
Paid Time Off (PTO) X X Accrued from employment date; accessible after 3 months of continuous employment
Extended Illness Bank (EIB) X Not Eligible Accrued from employment date; accessible after 3 months of continuous employment
Jury Duty/Bereavement Leave X X Immediate
Eligibility
Dependent Eligibility
Employees who wish to enroll eligible dependent(s) under a DeKalb Medical Health Plan must provide proof of eligibility within 31 days before the dependent(s) can be added to the employee’s medical coverage. The 31 day deadline begins on the first day of the employee’s hire date or qualified status change date. To see what types of written documentation are required for verification of your dependent(s), please refer to the Dependent Verification information provided in this booklet.
Eligible dependents include:
•
Your legal Spouse*•
Same-Sex Domestic Partner (SSDP)*•
Your biological child up to age 26•
Your adopted child(ren), stepchild(ren), SSDP’s child(ren) or any child for whom you have legal custody up to age 26.•
Disabled dependent (e.g., part-time to full-time)*Spouses and Same-Sex Domestic Partners are not eligible for coverage on a DeKalb Medical health plan if they are eligible for health coverage through their employer or government plan.
** Dependent verification documents must be received by Benefits within the 31day deadline or the employee’s dependent(s) will not be eligible for medical coverage until the next qualified family status change (FSC) or the next open enrollment period.
Changes During the Plan Year
The decisions you make now for your benefits will remain in effect until the next open enrollment period, unless you experience a qualified family status change (FSC). A qualified family status change (FSC) would include:
•
Marriage or divorce•
Birth, adoption, or legal change in custody•
Death of spouse or child, or loss of an eligible dependent for any reason•
You or your eligible dependents lose or gain medical coverage under your spouse’s, same-sex domestic partner’s or dependent’s group plan•
Loss of eligible dependent status or status change•
A change in your employment statusIMPORTANT REMINDER: You must notify the Benefits Department within 31 days of a Qualified Family Status Change, along with written documentation of the FSC; otherwise, you will have to wait until the open enrollment period. Plan option changes are only permitted during the open enrollment period.
Coverage Levels
Within each plan option, DeKalb Medical offers four coverage levels:
•
Employee Only•
Employee + Spouse•
Employee + 1 ChildDeKalb Medical Co-Pay Plan
Prescription Benefit Plan - 3 level copays & mail order available during the plan year Preventive Care covered 100%
DeKalb Network UHC Choice Plus Network
Primary Care Physician (PCP) $40 $80
Specialist $50 $90
Urgent Care $90 $90
ER $250 $250
Outpatient Surgery $450 $900
Outpatient Hospital Services $90 $300
Inpatient Services $1,000 $1,750
Maternity (Vaginal) $750 + one office visit copay $2,000 + one office visit copay Maternity (C-Section) $1,000 + one office visit copay $2,250 + one office visit copay
DeKalb Medical’s Choice Plus Plans
DeKalb Medical HRA Plan
DeKalb Medical HDHP w/a Health Savings Account
DeKalb Medical’s Choice Plus plans are structured differently than the copay plan. The plan structure of DeKalb Medical’s HRA and HDHP with HSA can best be described as an (A+B=C) plan structure.
Overview of Medical Plans
We offer three Medical Plans, all administered by UMR, a United Healthcare Company. The next few pages provide detailed information on each plan. DeKalb Medical health plans are self-funded; this means that every dollar spent for medical and pharmacy claims for employees and their family members are paid directly by DeKalb Medical. Each year we evaluate our medical plans’ designs to meet the needs of our employees, while making an effort to effectively manage increasing medical plan costs.
DeKalb Medical Copay Plan
A = Annual Deductible
The “A” represents your annual deductible that must be met before the plan begins paying benefits. Your annual deductible is determined by the coverage level you choose. You will also have a choice of using either in-network or out-of-network providers. However, using DeKalb Medical’s network of providers will save you the most money.
B = Coinsurance
Should you meet your annual deductible (A) you then go into coinsurance (B). Coinsurance means that you are only obligated to pay a percentage of any medical services needed after you have met your deductible. Your coinsurance percentage is based on the type of network your provider is in. Annual coinsurance is capped based on the coverage level you have chosen for your plan.
C = Out of Pocket Maximum
Once you have satisfied your annual deductible (A) and your annual coinsurance maximum (B), DeKalb Medical will pay 100% for any additional medical services because you have satisfied the required out-of-pocket maximum (C) for your coverage level. You will not be financially responsible for any ongoing medical services for the remainder of the plan year.
Additional Plan Benefits:
•
Preventive Care is FREE (as defined by plan; not subject to deductible, co-insurance)•
Employees can expect to pay lower out-of-pocket costs when using DeKalb Medical’s (Tier 1) network of providers.•
Out-of-Network Coverage is available with a higher annual deductible, coinsurance percentage and out-of-pocket maximum.•
Employee + 1 and family coverage tiers for the HRA Plan has an embedded deductible.The sick family member’s coverage automatically defaults to the single coverage level (deductible, coinsurance and out-of-pocket maximum). If needed, the remaining family members are responsible for the difference in the family coverage level and single coverage level. The embedded deductible helps protect families from having to pay total family coverage for one sick family member
DeKalb Medical HRA Plan
DeKalb Medical’s HRA plan includes an employer contribution (HRA dollars), which can be used towards your deductible and coinsurance. As long as the employee remains in the DeKalb Medical HRA Plan, the HRA dollars are valid, and unused dollars can roll over to the next plan year, with a cap of $3,000 at the roll-over period.
DeKalb Medical HRA contributions - HRA dollars are available immediately upon enrollment and can be used
towards expenses related to the plan deductible and coinsurance. *HRA dollars are prorated based on hire date.
In-Network
DeKalb Medical HRA Plan
DM Contribution to HRA
Single = $550, Employee + 1 = $950, Family = $1,100
Out-of-Network
Dekalb Medical’s Network
UHC’s Choice Plus Network
DeKalb Medical HDHP with Health Savings Account
The HDHP medical plan provides a tax free way to help you build savings for current and future medical expenses. The HSA account includes an employer contribution, with an opportunity for the employee to set aside pre-tax dollars that allow the account to accumulate for current and future qualified expenses. You are not eligible for this plan if you are on another health plan or enrolled in Medicare.
*HSA dollars are prorated based on hire date.
In-Network
DeKalb Medical HDHP with HSA
DM Contribution to HSA
Single - $200, Employee + 1 - $350, Family - $450
Employee Pre-Tax HSA Contribution Maximums
Single - $3,100, Employee + 1 / Family - $6,200/$6,100
Ages 55+ can contribute an additional $1,000
Out-of-Network
Dekalb Medical’s Network
UHC’s Choice Plus Network
Health Savings Account Benefits
• Health Savings Accounts are great for the employee who likes to save money, because HSAs have “triple tax
advantage.” Employee contributions are made on a pre-tax basis, withdrawals for qualified health care expenses are not taxed, and there is no tax on earnings made through HSA investments.
• HSAs allow fund portability for employees, meaning if the employee leaves DeKalb Medical thier HSA balance can be transferred to a financial institution of their choice. The former DM employee can use remaining HSA dollars on qualified medical expenses with a new employer’s health plans. If the new employer’s health plan meets the requirements of a Qualified High Deductible Health Plan, then the former DM employee can continue making pre- tax contributions to his/her HSA.
The HSA plan requires that you pay for your prescription drugs in full until your annual deductible has been satisfied. Once the deductible is satisfied then prescription coverage is based on 3 level copayments. This plan counts
prescription payments towards your annual deductible, therefore, helping you reach your annual out-of-pocket maximum faster.
Please Note: HSA plan members will only be able to participate in a Limited Flexible Spending Account (FSA), rather than a Full FSA, due to IRS regulations governing Health Spending Accounts.
Medical Plan Comparison At-a-Glance
Which medical plan is best for you? Your decision should be based on your own individual or family needs.
KNOW YOUR PLAN IN 2014
DeKalb Medical Copay Plan DeKalb Medical HRA Plan HDHP with HSADeKalb Medical
Employee Premiums Highest Premium Lower Premiums than Copay Plan
Lowest Premium w/ HSA Tax Advantages
Preventive Care Covered 100% Covered 100% Covered 100%
Using Dekalb Medical’s Tier 1 Network
No deductible Lower copayments
Lower deductible & coinsurance
Lower deductible & coinsurance Referrals for Specialists None Required None Required None Required Prescription Drug Coverage Copayment Immediate CopaymentImmediate Copayments after deductible
Funding provided by
DeKalb Medical No Employer Funding Provided
Employer Funding provided for Medical
Expenses
Employer Funding provided for Medical,
Pharmacy, Vision & Dental Expenses Reasons to Choose
This Plan
Fixed Copayments for those who may visit
providers often
Low User Employer Provided Funding
for Medical
Low User Health Savings Account Tax Advantages
Tips to Help You Decide
1. Review medical services you expect to use. Are you a high user or low user? 2. Review annual premium costs
3. Review required prescriptions and frequency
4. Take advantage of funds that may be provided by DeKalb Medical and use the DeKalb Medical Network of providers and facilities to reduce your out-of-pocket expenses.
2014 Medical Plan Benefit Details
Health Reimbursement or Health Savings Account Funded by DM $200 Single $350 Employee + 1 $450 Family $550 Single $950 Employee + 1 $1,100 Family $0BENEFIT SUMMARY HSA HRA Copay Plan
OUT-OF-POCKET EXPENSES
Member Responsibility: Dekalb Medical, UHC Choice Plus Providers & Out of Network Tier 1 DM Tier 2 UHC Tier 3 Out-of-Network Tier 1 DM Tier 2 UHC Tier 3: Out-of-Network Tier 1 DM Tier 2 UHC Annual Deductible Tier 1 $1,300 Single $2,600 Family Tier 2 $1,500 Single $3,000 Family $3,500 Single $8,000 Family Tier 1 $1,500 Single $3,000 EE+1, $4,000 Family Tier 2 $2,000 Single $3,500 EE+1 $4,500 Family $3,000 Single $6,000 EE+1 $8,000 Family $0
Plan Participation after deductible Tier 1 20% Tier 2 40% 50% after deductible Tier 1 20%
Tier 2 40% 50% after deductible copays
Annual Out-of-Pocket Maximum
(Deductible is included in the OOP max)
Tier 1 $4,300 Single, $8,600 Family Tier 2 $4,500 Single $9,000 Family $9,500 Single $19,000 Family Tier 1 $4,500 Single $7,000 EE+1 $9,500 Family Tier 2 $5,000 Single $7,500 EE+1 $10,000 Family $9,000 Single $14,000 EE+1 $19,000 Family $6,350 Single $12,700 family MEDICAL BENEFITS
Routine Care Benefits No Charge Deductible50% After No Charge 50% After Deductible No Charge
These services include but are not limited to:
• Items or services rated a or b in the current recommendations of the us preventive services task force • Immunizations recommended by the advisory committee on immunization practices (acip) of the centers for disease control and prevention (cdc) • Evidence-informed preventive care and screenings for infants, children and adolescents as provided in the comprehensive guidelines supported by the health resources and services administration (hrsa)
• Additional preventing care and screening with respect to women provided in the comprehensive guidelines supported by the hrsa • Well-woman visits
• Hpv dna testing for all women 30 years and older
• Fda-approved contraception methods, sterilization procedures and contraceptive counseling
• Breastfeeding support, supplies, and counseling, including costs for renting breastfeeding equipment – equipment is limited to 1 per pregnancy
No Charge
50%
After Deductible No Charge
50%
BENEFIT SUMMARY HSA HRA Copay Plan
PHYSICIAN SERVICES
Member Responsibility: Dekalb Medical, UHC Choice Plus Providers & Out of Network Tier 1 DM Tier 2 UHC Tier 3 Out-of-Network Tier 1 DM Tier 2 UHC Tier 3 Out-of-Network Tier 1 DM Tier 2 UHC Office Visits Tier 1 20% after deductible Tier 2 40% after deductible 50% After Deductible Tier 1 20% after deductible Tier 2 40% after deductible 50% After Deductible
Primary Care Physician Office Visit
Tier 1 $40 copay Tier 2 $80 copay
Specialist Office Visit Tier 1Tier 2 $50 copay $90 copay Laboratory, X-Ray,
Diagnostic & Allergy Injections provided in
Physician’s Office
Tier 1 & 2 Covers under copay
PREGNANCY AND MATERNITY CARE Vaginal Delivery -
Prenatal & Postnatal physician office visits, all necessary inpatient hospital services
for normal delivery and professional fees Tier 1 20% after deductible Tier 2 40% after deductible 50% After Deductible Tier 1 20% after deductible Tier 2 40% after deductible 50% After Deductible Tier 1 $750 copay + one office visit Tier 2 $2000 copay +
one office visit
C-section Delivery -
Prenatal & Postnatal physician office visits, all necessary inpatient hospital services and
professional fees
Tier 1 $1000 copay + one office visit Tier 2 $2250 copay +
one office visit
OUTPATIENT RADIOLOGY Outpatient Xray, Diagnostic mammograms Tier 1 20% after deductible Tier 2 40% after deductible 50% After Deductible Tier 1 20% after deductible Tier 2 40% after deductible & $250 copay 50% After Deductible & $250 copay
Tier 1 $90 per service Tier 2 $300 per service at
free standing facility, $900 at hospital Advanced Radiology : MRI, MRA Tier 1 20% after deductible Tier 2 40% after deductible & $400 copay 50% After Deductible & $400 copay Tier 1 $200 copay Tier 2 $300 copay(Free Standing)
or
$900 copay(Hospital)
Advanced Radiology : CAT, PET
Tier 1 $90 CAT / $300 PET Tier 2 $300 per service at
free standing facility, $900 at hospital
OUTPATIENT HOSPITAL SERVICES Outpatient Hospital Lab Tier 1 20% after deductible Tier 2 40% after deductible 50% After Deductible Tier 1 20% after deductible Tier 2 40% after deductible 50% After Deductible
Tier 1 $90 per service Tier 2 $300 per service at
free standing facility, $900 at hospital
Outpatient surgery including the physician
Tier 1 $450 copay Tier 2 $900 copay
Outpatient hospital services and outpatient
physician charges
Tier 1 $90 per service Tier 2 $300 per service at
BENEFIT SUMMARY HSA HRA Copay Plan
INPATIENT FACILITY SERVICES
Member Responsibility: Dekalb Medical, UHC Choice Plus Providers & Out of Network Tier 1 DM Tier 2 UHC Tier 3 Out-of-Network Tier 1 DM Tier 2 UHC Tier 3 Out-of-Network Tier 1 DM Tier 2 UHC
Inpatient hospital services
(including semi-private room and board, operating
room, intensive care units, general nursing care, drugs,
medications) Tier 1 20% after deductible Tier 2 40% after deductible 50% After Deductible Tier 1 20% after deductible Tier 2 40% after deductible 50% After Deductible Tier 1 $1,000 copay Tier 2 $1,750 at hospital
Hospice Inpatient (maximum
180 hospital days)
Extended Care Facility
(maximum 100 days)
Tier 1 $300 copay Tier 2 $1,000 at
hospital
MENTAL HEALTH AND CHEMICAL DEPENDENCY
Specialist office visit
(outpatient) These services are subject to the same deductible, coinsurance and out-of-pocket maximum as the
in-network for this medical plan.
Same as HRA/HSA – benefits determined by
place of service Inpatient Care
Inpatient residential treatment Outpatient evening program/
Partial Hospital Program
HOME HEALTHCARE
Home health care services There is a maximum of 100
visits per benefit year.
Tier 1 20% after deductible Tier 2 40% after deductible 50% After Deductible Tier 1 20% after deductible Tier 2 40% after deductible 50% After Deductible Tier 1 $40 copay per visit Tier 2 $80 copay per visit PHYSICAL/OCCUPATIONAL/SPEECH THERAPY Rehabilitation therapy by a physical, occupational, respiratory, or speech therapist for a single illness
or injury. Tier 1 20% after deductible Tier 2 40% after deductible 50% After Deductible Tier 1 20% after deductible Tier 2 40% after deductible 50% After Deductible Tier 1 $40 copay per visit Tier 2 $80 copay per visit URGENT CARE
Urgent care facilities when
medically necessary 20% after deductible for all three tiers Tier 1 & 2 $85
EMERGENCY SERVICES
Emergency room services when medically necessary (waived if
admitted within 24 hours) 20% after deductible Tier 1 & 2 $250 copay
AMBULANCE FOR EMERGENCY SERVICES
Ambulance for emergency
services 20% after deductible
Tier 1 & 2 $150 copay per run
DURABLE MEDUCAL EQIUPMENT, ORTHOTICS AND PROSTHETICS
Durable medical supplies, prosthesis and orthosis
(as defined) Tier 1 20% after deductible Tier 2 40% after deductible 50% After Deductible Tier 1 20% after deductible Tier 2 40% after deductible 50% After Deductible
Tier 1 & 2 $150 copay per visit
CHIROPRACTIC CARE
Chiropractic Care not to exceed 20 visits per benefit year.
Prescription Drug Coverage
Prescription drug coverage is included under your medical plan. You must use a participating pharmacy or the mail order prescription program to receive prescription drug benefits. Optum RX is the pharmacy benefit management company used by UMR.
Buy two, get one free with the mail order prescription program. For maintenance medication, such as those
prescribed for high blood pressure or diabetes, you may obtain a 90-day supply of medications through the mail order prescription program. You can order refills by mail, telephone or Internet. Some medications may not be available through the mail order program or require pre-approval. Our pharmacy service provider will notify you if you place an order for one of these medications.
*Note: All HSA prescription drug copays are after deductible.
• No reimbursement is available if prescription drugs are purchased at a non-participating pharmacy, except in the event of an emergency
• All plans utilize OptumRx’s Prescription Drug Formulary, which is a list of prescription drugs available to you and your doctor. If you choose a drug that is not on the formulary, you will be responsible for a higher copay for the non- formulary drug.
• Some drugs may require prior authorization.
• To review the formulary and/or obtain mail order forms go to www.OptumRx.com.
Tip to Save: Use generic drugs whenever possible. Generic drugs may be provided at a lower cost than
the normal prescription benefit copayment.
OUTPATIENT PRESCRIPTION DRUGS COPAYS
SUMMARY Copay Plan HRA Plan HDHP w/HSA
If a member requests a Tier 2 drug when a Tier 1 substitute is available (even if the prescription
is written “Dispense as Written”) the member will be responsible for the Tier 2 CoPay plus the cost difference between the Tier 2 drug and the
available tier 1 substitute.
Retail (30 day supply): $12 Tier 1 $40 Tier 2 $80 Tier 3
*(90 day supply also available at retail for some medications)
Member must use participating
pharmacies on all four plans. Must use Participating Pharmacy
Note: There are quantity limits on some medications. Mail order is available on most
prescriptions (even tier 3 medications).
Mail Order (90 day supply) $24 Tier 1
Dental Plan Overview
DeKalb Medical employees have access to flexible dental benefits plan from MetLife. You have the opportunity to select one of three dental plan options. The next few pages provide detailed information on each plan and how they work.
MetLife plans provide:
• Freedom of choice to go to any dentist with all plans. • Additional savings when you visit an in-network dentist. • Immediate coverage for major services (ortho excluded) • Coverage for dental implants
• Coverage for bruxism (teeth grinding appliances)
• Educational tools and resources to help you and your dentist make better choices.
Plan 1–MetLife Copay Plan
Services under this plan are defined by copayments when in-network providers are used. There is no deductible for Preventive Services when in-network providers are utilized (see MetLife’s copayment fee schedule).
If out-of-network providers are used, preventive Services are covered at 80 percent (no deductible). Basic services are covered at 40 percent ($75 deductible), and major services are covered at 30 percent ($75 deductible). MetLife provides three fee schedules based on provider zip code. The copayment fee schedule is available on the Benefits Homepage of the Intranet.
Plan 2–MetLife Basic PPO
Preventive services are covered 100%.• All other services are subject to a $50 per person per calendar year deductible.
• Basic Services (e.g. fillings, minor periodontal) are covered at 80% after the deductible has been met. • The plan has a $1,500 annual maximum benefit (per person per calendar year).
• Major services such as crowns, bridges, dentures and orthodontic care are not covered.
Plan 3-MetLife Advanced PPO
Preventive services are covered 100%.• All other services are subject to a $50 per person per calendar year deductible.
• Basic Services (e.g., fillings, minor periodontal) are covered at 80 percent after the deductible has been met. • The plan has a $1,500 annual maximum benefit (per person per calendar year).
• Major services are covered at 50 percent after the deductible has been met.
MetLife PPO Plan
MetLife CoPay PlanCOVERAGE TYPE Advanced Plan Basic Plan COVERAGE TYPE PDP In-Network Out-of-Network
Type A – cleanings,
oral examinations 100% of PDP Fee* 100% of PDP Fee*
Type A – cleanings,
oral examinations See Schedule 80% of R&C Fee** Type B – fillings 80% of PDP Fee* 80% of PDP Fee* Type B – fillings See Schedule 40% of R&C Fee** Type C – bridges
and dentures 50% of PDP Fee* Not Covered
Type C – bridges
and dentures See Schedule 30% of R&C Fee** Type D –
orthodontia to age 26
50% of PDP Fee* Not Covered
Type D – orthodontia to
age 26
30% of R&C Fee** 30% of R&C Fee**
TMJ Not Covered Not Covered TMJ Not Covered Not Covered
DEDUCTIBLE† In-Network Out-of-Network DEDUCTIBLE† In-Network Out-of-Network
Individual Individual N/A
Family N/A N/A Family N/A N/A
ANNUAL MAXIMUM
BENEFIT
In-Network Out-of-Network Family In-Network Out-of-Network
Per Person $1,500 $1,500 Per Person $1,500 $1,500
ORTHODONTIA LIFETIME MAXIMUM In-Network Out-of-Network ORTHODONTIA LIFETIME MAXIMUM In-Network Out-of-Network
Per Person $1,500 N/A Per Person $1,500 $1,500
When Plan Participants use In-Network providers they get the benefit of negotiated fees, which often lower the amount the plan participant will pay for Type B, C, and D Services. If an Out-of-Network provider is used, MetLife will pay a percentage
of the R&C Fee (rather than of the PDP fee).
*PDP fee refers to the fees that PDP dentists have agreed to accept as payment in full.
*R&C fee refers to the Reasonable and Customary charge. † Applies only to Type B & C Services. † Applies only to Type B & C Services.
Putting it all together – Maximizing the value of your Dental Benefits.
•
Take advantage of the in-network benefits by visiting a PDP dentist to reduce your out-of-pocket costs.•
Keep a healthy dental regimen by getting routine exams and cleanings – the cost of preventive services (Type A) is usually less than the cost for fillings, root canals, extractions, etc. – and can help to prevent the incidence of these higher-cost treatments.•
Visit the MetLife website, www.metlife.com, and select “Employee Benefits,” then “Dental” – you can use the “Find a Dentist” link on the right-hand side of the page to locate Providers in your area who participate in the MetLife Preferred Dentists program.•
Also at www.metlife.com/individual/employee-benefits, when in the “Dental” area, link to the Dental Insurance Center to locate valuable information in the Oral Health Library.•
Use the Dental Procedure Fee Tool, provided by go2dental.com, to approximate the fees for in or out-of-network services such as exams, cleanings, fillings, crowns, and more. This tool is accessible via the MyBenefits website.•
Use the www.metlife.com/mybenefits site to manage your dental claims – view claim information on-line, receive electronic notices of claim information (if selected), and access dental claim history with MetLife.•
Visit the dental education website at www.metlife.com/mybenefits for important tools and resources to help you become more informed about dental care.PPO ADVANCED PLAN
Your Dentist says you need a Crown,
a Type C service —
• PDP Fee: $681.00
• R&C Fee: $1,296.00
• Dentist’s Usual Fee: $1,150.00
COPAY PLAN
Your Dentist says you need a Crown,
a Type C service —
• R&C Fee: $1,296.00
• Dentist’s Usual Fee: $1.150.00
• Schedule Fee: $ 475.00
IN-NETWORK
When you receive care from a
participating PDP dentist:
OUT-OF-NETWORK
When you receive care from a
non-participating dentist:
Dentist’s Usual Fee $1,150.00 Dentist’s Usual Fee $1,150.00 Dentist’s Usual Fee $1,150.00 Dentist’s Usual Fee $1,150.00 PDP Fee $681.00 PDP Fee $1,296.00Your Plan Pays Your Plan Pays Your Plan Pays
50% X $681
PDP Fee $340.50
50% X $681
R&C Fee $648.00 Your Out-of-Pocket Cost (Schedule Fee) $475.00 50% X $681 R&C Fee $648.00 Your Out-of-Pocket Cost $340.50 Your Out-of-Pocket Cost $502.00 Your Out-of-Pocket Cost $502.00 In this example, you save $162.00 ($502 minus $340)
by using a participating PDP dentist.
Vision Care
If you enroll in a DeKalb Medical Health Plan you are allowed one annual routine vision exam by a participating ophthalmologist. In addition to this vision benefit, DeKalb Medical offers you the option to elect vision insurance through EyeMed.
The vision insurance plan provides comprehensive benefits for your vision care needs. You can choose from a nationwide network of optometrists, ophthalmologists and opticians, as well as the nation’s leading optical retailers such as LensCrafters, Sears, Target Optical, Pearle Vision, and many more. You can access a listing of EyeMed providers at the following web address: www.enrollwitheyemed.com/access or by calling toll-free at 1-866-723-0596.
Vision Care Services* Member Cost
Exam with Dilation as Necessary $10 CoPay
Standard Contact Lens Fit and Follow-Up Up to $55
Frames $130 Allowance; 80% of balance over $130
Standard Plastic Lenses No cost to member
Conventional Contact Lenses $130 Allowance; 80% of balance over $130 LASIK and PRK Vision Correction Procedures 15% off retail price OR 5% off promotional price
DeKalb Medical 2014 Employee Medical Plan Premium Rates
The non-tobacco user rates listed below are only for employees and their covered dependents that have not used any tobacco products at any time during the last (6) months – this means that if you or any of your covered dependents are a tobacco user, then the tobacco user rates apply. However, if you and/or your covered dependent are a tobacco user, you may still be able to qualify for the non-tobacco user rate for 2014 as described below.
For tobacco users that are interested in quitting and paying the discounted non-tobacco user rate, the DeKalb Medical Wellness Center offers a free smoking cessation program. If the tobacco user (whether it is you and/or your covered dependent) completes this program during 2014, you will be eligible for the discounted non-tobacco user rate for all of 2014 regardless of whether the tobacco user stops using tobacco. You must provide a certificate or other proof of completion of the program before we will apply the premium discount.
Once we receive such proof you will pay the discounted rate for the remainder of the year plus receive a refund of the difference between the tobacco user and non-tobacco user rates for the period you paid the tobacco user rate. This program is available at no charge to all our employees and their covered dependents who are eligible for the medical plan. For more information call the Benefits Department at 404-501-1108.
It is your responsibility to notify the Benefits Department if you or you covered dependent completes the smoking cessation program and/or stops using tobacco products. You are also required to notify the Benefits Department if you or your covered dependent starts smoking or using tobacco products.
Failure to notify the Benefits Department will be treated as providing false information and considered theft.
Please be aware that providing false information in regards to discounted premium rates will void health insurance coverage and constitute a theft which will be handled according to DeKalb Medical policies and procedures.
DeKalb Medical is committed to helping you achieve your best health. The discounted premium is a reward that is part of DeKalb Medical’s wellness program and is available to all employees and their dependents who are eligible for our health plan. If you think you might be unable to meet a standard to qualify for the reward under this wellness program, you might qualify for an opportunity to earn the same reward by different means.
Contact the Benefits Department at 404-501-1108 and we will work with you (and, if you wish, your
doctor) to find a wellness program with the same reward that is right for you in light of your health status.
Discounted Non-Tobacco User Rates for Health Insurance (Full-Time Employees)
(64-80 Hours/PP) Employees:
Premiums are deducted Pre-tax over 26 pay periods
Coverage Level
Plan Type
HSA Plan
HRA Plan
COPAY
Employee Only
$27.97
$39.15
$58.91
Employee +1 Child
$59.95
$85.17
$134.57
Employee + Spouse
$72.69
$115.85
$157.45
Discounted Non-Tobacco User Rates for Health Insurance(Part-Time Employees)
(32-63 Hours/PP)
Premiums are deducted Pre-tax over 26 pay periods
Coverage Level
Plan Type
HSA Plan
HRA Plan
Copay Plan
Employee Only
$40.97
$63.33
$102.85
Employee +1 Child
$101.81
$152.25
$248.45
Employee + Spouse
$123.13
$186.57
$257.29
Family
$161.09
$246.89
$379.49
Tobacco User Rates for Health Insurance (Full-time/Part-Time Employees)
(64-80 Hours/PP)
Premiums are deducted Pre-tax over 26 pay periods
Coverage Level
Plan Type
HSA Plan
HRA Plan
Copay Plan
Employee Only
$43.57
$54.75
$74.51
Employee +1 Child
$85.95
$111.17
$157.45
Employee + Spouse
$98.69
$141.85
$183.45
Family
$134.31
$177.21
$259.37
(32-63 Hours/PP)
Premiums are deducted Pre-tax over 26 pay periods
Coverage Level
Plan Type
HSA Plan
HRA Plan
Copay Plan
Employee Only
$72.17
$94.53
$134.05
Employee +1 Child
$153.81
$204.25
$300.45
Employee + Spouse
$175.13
$238.57
$309.29
Family
$244.29
$330.09
$462.69
DeKalb Medical 2014 Employee Dental & Vision Plan Premium Rates
Premiums Per Pay Period-All Benefit Eligible Employees:
Premiums are deducted Pre-tax over 26 pay periods
Plan Type
MetLife CoPay Plan MetLife Basic PPO MetLife Advanced PPO
Vision
Employee Only
$5.41
$9.63
$14.84
$3.54
Employee +1 Child
$10.10
$18.60
$26.64
$7.04
Employee + Spouse
$10.04
$19.08
$28.55
$6.86
Voluntary Benefits
Plan
Coverage
Cost
Premiums are Deducted After-tax
Basic Life and Accidental Death &
Dismemberment Insurance
1 X Annual Salary up to $500,000
Employer Paid 100%
Supplemental Life Employee
1 X Annual Salary
2 X Annual Salary
3 X Annual Salary
4 X Annual Salary
$0.056/$1,000 Per Pay Period
Option 1- Supplemental Life for
Dependent(s)
Spouse (50% of employee amount
to a maximum of 150,000)
Child(ren) $10,000 each child
$0.066/$1,000
Option 2 - Supplemental Life for
Dependent(s)
$15,000 on spouse & $5,000 on
each Child
$2.16 Per Pay Period
Whole Life
Varies based on amount selected
Rates vary based on benefit
amount and age
Long Term Disability Income
Pro-tection (Full-time Employees Only)
60 % of base pay
Employer paid 100%
Short Term Disability Income
Protection
50% or 60% of base pay based on
selection
Rates based on benefit amount
and age
Critical Illness Insurance
Varies based on amount selected
Rates based on benefit amount
and age
Accident Insurance
Varies based on amount selected
Rates based on benefit amount
and age
Hospital Indemnity Insurance
Varies based on amount selected
Rates based on benefit amount
Flexible Spending Accounts (FSA)
Flexible Spending Accounts are accounts that are designed to allow an employee to set aside a fixed amount of his/her pre-tax wages to help pay for qualified medical or child care expenses. Money deducted from an employee’s pay into an FSA is not subject to payroll taxes.
How a Flexible Spending Account (FSA) works:
When you enroll in an FSA, you must determine in advance how much money you want to contribute. You will not be able to change this amount for any reason other than a qualifying event that changes a family or employment status (i.e., having a baby, Full-Time to Part-Time).
“USE-IT OR LOSE-IT”
FSAs include a “use-it or lose-it” IRS provision. At the end of the plan year, any money left in your FSA will be “lost.” The money you contribute does not roll over from year to year. You will need to think ahead about how much to contribute.
The IRS deadline for purchases and claims submission is December 31 of each plan year. DeKalb Medical will have a “Grace Period” that allows employees until March 15 of the following year to incur expenses.
The deadline to submit all purchases and claims will be March 31st of the following year.
Example: Employee elects $1,000 in healthcare FSA for plan year 2014. All expenses must be incurred by
March 15, 2015 and all claims submitted by March 31, 2015.
Healthcare FSA
This account allows you to set aside a maximum of $2,500 of your pre-tax wages for qualified medical expenses* that are not covered by any medical, dental or vision plan. Your annual contribution will be available to you on the first day the account begins, even prior to any payroll deductions. You can never use more than your annual elected amount during the year. A debit card will be issued to you for this account.
Dependent Care FSA
This account allows you to set aside a maximum of $2,500 (if married filing separately) or $5,000 (if single or married filing jointly) of your pre-tax wages for work related daycare expenses* for children or adults. You must be the custodial parent and your dependent must be under the age of 13 or mentally/physically unable to care for themselves. Unlike the Healthcare FSA, what you contribute each payroll cycle into your Dependent Care FSA is the amount available that will be available to be used. A debit card will be issued to you for this account.
Important Reminder
Over-the-Counter (OTC) drugs and medicines require a prescription to be eligible for reimbursement under the Healthcare Flexible Spending Account.
Keep all receipts. You may be required to submit your receipts to document your expenses directly to UMR.
How the Healthcare FSA works when enrolled in each of the DeKalb
Medical Healthcare Plans
Copay Plan
Under this medical plan, you will receive a FSA Debit Card that uses funds directly from your FSA. You may be required to substantiate debit card purchases by submitting your receipts to the FSA administrator, UMR. Another option is to submit manual claims to UMR for reimbursement on claims paid out-of-pocket.
HRA Plan
Under this medical plan, your HRA dollars will be accessed first and paid directly to the provider, so there will be no claims for you to submit. You will receive a FSA Debit Card that uses funds directly from your FSA. For medical expenses, this card should only be used once your HRA dollars have been exhausted and UMR has determined benefits.
HSA Plan
Employees enrolling in the HSA Plan will only be able to participate in a Limited FSA, rather than a Full FSA, due to IRS regulations governing Health Spending Accounts.
When paired with an HSA, the covered services under an FSA are limited to only those IRS eligible expenses that are not covered under the medical plan. Examples of limited FSA expenses are dental services or vision services.
Under the HSA medical plan, if you sign up for a Limited FSA, you will receive one debit card that will only be linked to your HSA (provided by Optum Bank) and one debit card for the Limited FSA (provided by UMR). You may be required to substantiate debit card purchases by submitting your receipts to the FSA administrator, UMR. Another option is to submit manual claims to UMR for reimbursement on claims paid out-of-pocket.
Employees Electing No Medical Coverage
If you sign up for a FSA and do not have medical coverage through DeKalb Medical, you will be issued a debit card that will access funds directly from your FSA. You may be required to substantiate debit card purchases by submitting your receipts to UMR. Another option is to submit manual claims to UMR for reimbursement on claims paid
out-of-pocket.
Debit Cards should remain with the card holder at all times to prevent misuse or theft. Please be aware that as the card
holder, you are liable for any misuse of the card, even if misused by a family member or friend. Misuse of FSA, HRA and
HSA funds is subject to immediate termination. If the card is stolen or missing please contact UMR immediately to cancel the
account and have another card reissued to you.
Life Insurance
Basic Life
DeKalb Medical provides term life insurance equal to one times your annual base pay, up to $500,000, at no cost to you. This basic coverage also provides an additional amount of one times your annual base pay upon accidental death or a defined benefit for dismemberment. This benefit is automatically effective after one year of continuous service in a benefits eligible status.
Employee Supplemental Life
Supplemental life insurance is available to employees. Upon hire, you may purchase coverage up to maximum of four (4) times your annual base salary. The coverage amount that you elect will be effective upon enrollment. Requesting an increase after your current election of more than one (1) times your annual base salary will require you to complete an Evidence of Insurability (EOI)* form and require approval from the life insurance company. During open
enrollment, you can purchase or make changes to this coverage. EOI forms can be obtained and are located on the Benefits Homepage of the intranet.
*EOI required for employee elections over $300,000.
*Failure to provide the required EOI form will result in denial of coverage.
Dependent Supplement Life
Supplemental life insurance is also available for your dependents. The option you elect will be effective upon enrollment. Dependent life insurance offers two options only when you purchase supplemental life for yourself:
Eligible Family Members
Option 1
Option 2
Spouse
1/2 of employee amount, up
to $150,000 (amounts over
$50,000 require EOI)
$15,000
Children
$10,000
$5,000
If employee and spouse are both employed by any DM facility, they cannot both be an insured person and dependent, and only one eligible spouse may cover eligible children.
It is imperative that the Benefits Department has current beneficiary information on file for each full-time and part-time employee. Even if you do not enroll in the supplemental life insurance, please make sure that all beneficiary information is updated with the Benefits Department for your company paid basic life insurance plan.
Interest-sensitive Whole Life Insurance
Unum’s interest-sensitive whole life insurance is designed to pay a death benefit to your beneficiaries but it can also build cash value you can use while you are living. This benefit offers an affordable, guaranteed level of premium that won’t increase with age. Unlike term life insurance offered through the workplace, this coverage can continue into retirement.
•
You can buy coverage for your spouse and dependent children.•
You get affordable rates when you buy this policy through your employer. The premiums do not increase with age and are conveniently deducted from your paycheck.•
You own the policy so you can take your coverage with you if you leave your employer. Unum will bill you directly for the same premium amount.Disability Insurance
Long Term Disability Income Protection
Long Term Disability coverage is provided at no cost to full-time employees with at least one complete year of continuous full-time employment. If you become sick or hurt and unable to work due to an illness or injury, and remain so for 180 days, the plan pays up to 60 percent of your base pay, with a maximum benefit of $12,500 per month. Benefits may continue for the duration of your disability, up to age 65. Monthly benefit payments may be reduced by other income replacement benefits you receive for the same disability, such as benefits from Social Security or Workers’ Compensation.
Short Term Disability Insurance
Short term disability insurance replaces a portion of your income if you are unable to work due to a covered injury or illness. This means you can have some income during a time of need. Common reasons people use this coverage include pregnancy, injuries and digestive problems – such as gall bladder surgery.
Critical Illness Insurance
Group critical illness insurance can help protect your finances from the expense of a serious health problem, such as a stroke or heart attack. Cancer coverage is also available. This plan pays a lump sum benefit directly to you – not to a doctor or health care provider – at the first diagnosis of a covered condition.
•
You can buy coverage for your spouse and dependent children.•
No health questions to answer. If you apply, you automatically receive the base plan.Accident Insurance
Accident insurance can pay benefits based on the injury you receive and the treatment you need, including X-rays, emergency room care and related surgery. The benefit can help offset the out-of-pocket expenses that medical insurance does not pay, including deductibles and copays.
•
You own the policy so you can keep this coverage if you change jobs or retire. Unum will bill you for your premiums.•
This plan includes convenient payroll deduction, so you don’t have to remember to write a check for your premiums.Hospital Indemnity Insurance
Long Term Care
An accident or illness can happen at any time. DeKalb Medical offers eligible employees the option to obtain Long Term Care insurance (LTC). LTC covers the actual costs for in-home and facility care. The coverage is available to eligible employees, spouses, parents, grandparents and in-laws up to age 79. This coverage is portable and can move with you should you change jobs or retire.
Family Protection Plan - Legal and Identity Theft
Every year one in two families will require the services of an attorney. In many instances, legal issues are precipitated by other personal and professional challenges. Mounting debt, tax season, substance abuse, stress on the job, or a personal crisis may be the catalyst for legal assistance. To help address these multiple needs, Legal Club of America created the Family Protection Plan (FPP).
Free and Discounted Legal Care
Unlimited free and discounted legal care from the nation’s largest network of plan attorneys.
Identity Theft Restoration & Insurance
Expert assistance with the restoration of member’s identity should they become victim of identity theft. $25,000 worth of ID Theft insurance to restore member’s identity to pre-theft status. Lost or stolen credit card assistance.
Free Tax Preparation Advice
Toll Free access to CPAs who will provide members with free, unlimited tax advice and free tax return preparation.
Financial Education & Credit Counseling Services
Unlimited, free, non-biased financial information and decision-making assistance.
Life Events Counseling
Retirement Benefits
DeKalb Medical offers a 403(b) Retirement Plan to help employees prepare for their future. Employees have the option to contribute to VALIC Retirement Services Company.
Eligibility
All employees are eligible to make contributions to their retirement plan immediately upon hire or anytime thereafter. Contributions can be made on either a Traditional 403(b) (pre-tax) or Roth 403(b) (after-tax) basis.
•
Traditional/Pre-Tax: contributions or investment earnings will not be taxed until you elect to take a distribution.•
Roth 403(b)/After-Tax: contributions are taxed prior to going into your account. You will not be taxed on your contributions or investment earnings when you elect to take a distribution.Employer Matching Contributions
The plan provides for DeKalb Medical to make contributions towards your Retirement Plan. In order to be fully vested in the plan employees must work at least three years with 1,000 hours
or more each year. Once the vesting period is met employees are able to keep the Matching Employer Contributions at 100 percent for each year that they earn 1,000 hours. PRN employees are not eligible.
Employee contributions are immediately 100 percent vested.
Employee Deferral Percentage Employer Matching Contribution Percentage
0-1% 100%
2-6% 50%
How To Enroll
There are three easy ways to enroll in your retirement plan.
•
Enroll Online – Go to www.valic.com/dekalbmedical, click “Enroll” under Links to Login. You will be prompted to enter your SSN or Access Code, which is 67160001. Upon completion of your onlineenrollment, see your DeKalb Medical Benefits Representative to complete your Salary Reduction Agreement.
•
Enroll by Phone – Call 1-888-569-7055 and provide the Enrollment Special-ist with the following Access Code: 67160001. Enrollment Specialists are available 8:00 a.m. – 9:00 p.m., Monday – Friday.•
Contact your VALIC Financial Advisor:Other Valuable Benefits
The Wellness Center at DeKalb Medical
Your membership to wellness starts here, and you are invited to start working out the minute you join. The center is open seven days a week and some holidays. Please try the pool, track, all the cardio equipment, aerobic classes and the free weights — it’s all waiting for you. Membership fees are available through payroll deduction. No contract or initiation fee is required. Membership is available to anyone 16 years of age and older.
The Wellness Center amenities include: 18,000 usable square feet, 18.5 meter (20 feet wide by 60 feet long) indoor heated pool, indoor 1/15-mile track, spacious aerobic rooms, cardiovascular equipment, Cybex weight equipment, free-weight equipment, classrooms and demonstration kitchen, massage therapy room, locker rooms with showers and private dressing areas, mini lockers and validated parking. Call 404-501-2222 or visit the website at
www.dekalbmedical.org.
Employee Medical Discount
Employees who are not covered on a DeKalb Medical health plan will receive a 50 percent discount when using DeKalb Medical for inpatient, outpatient and emergency room services (up to $1,500 per account). To qualify you must identify yourself as a DeKalb Medical Employee when you pay your bill and make sure that the remaining balance is paid within 45 days of the bill date.
Employee Assistance Program (E.A.P.)
DeKalb Medical provides a confidential Employee Assistance Program at no cost to all employees and their eligible dependents. The E.A.P. offers assessment, counseling, referral, and follow-up services to address a variety of concerns of daily living, such as financial issues, addiction, domestic violence, psychological issues, and stress, to name a few. For more information, please call 678-579-9662.
Tuition Reimbursement
DeKalb Medical encourages employees to participate in healthcare related education. To support this effort, eligible employees will be reimbursed a portion of their tuition costs for required education in job-related or hospital-related programs or degrees. The guidelines and application can be obtained on the Benefits Homepage of the Intranet.
Educational Partnerships
In a continued effort to promote employee education, DeKalb Medical has partnerships with several private higher education institutions. Through these partnerships our employees are eligible to receive a discount on tuition for degree programs, that range from 5% to 15 %, depending on the institution. Our current partners are Chamberlain College of Nursing, Grand Canyon University, Keller Graduate School of Management at DeVry University, University of Phoenix and Walden University. Additional information and links to each partner webpage is available on the Benefits Homepage of the Intranet.
Direct Deposit
31
MembersFirst Credit Union
MembersFirst Credit Union provides DeKalb Medical employees with banking options that meet most financial needs and is as easy as direct deposit. Products and services include checking accounts, savings and Investments, christmas club, money market accounts, certificates of Deposit, youth accounts, loans, IRA’s, Visa credit cards and electronic services just to list a few. Visit the credit union at www.membersfirstga.com for more details.
Clean Air Campaign
Earn cash and win prizes with the Clean Air Campaign Commuter Rewards Programs. If you are currently driving alone, join The Cash for Commuters Program, which rewards commuters for using clean commute alternatives. Earn $3 per day, up to $100 over an assigned 90-day period. If you are already using a clean commute option, each time you log in a commute, you are entered to win $25 gift cards each month.
Participants of the Commuter Prizes Program have a 1 in 20 chance of winning. If you are carpooling, you deserve free gas. Carpools with three people can earn a $40 gas card each month or carpools with four or more people can earn $60 per month in free gas.
With the Carpool Rewards Program, you can earn a gas card each month for 12 months (within a three year period). To sign up or for more information please visit The Clean Air Campaign link on the Benefits Homepage of the Intranet.
Child Care Center
The Sunshine House is an excellent on-site child care center. For details and discounts, please call 404.501.5659 or visit their website at www.sunshinehouse.com.
529 College Savings Plan
DeKalb Medical offers employees the convenience of payroll deduction for participation in a Georgia College Savings 529 Plan. This offers employees the opportunity to open an account and contribute money via payroll deduction to Georgia’s Path2College 529 Plan on behalf of a beneficiary who may include: a child, grandchild, niece, nephew or other relative. Employees can contribute as little as $15 per pay period. DeKalb Medical’s enrollment process and forms are available on the Benefits homepage of the intranet. Detailed information about Georgia’s Path2College 529 Plan can be found at www.path2college529.com.
Parking
FREE parking for all employees.
MetLife Home and Auto
DeKalb Medical employees are entitled to special employee discounts on home and auto insurance. Just mention you work for DeKalb Medical and you can receive a personalized quote. Premiums are payroll deducted. Please call 800-438-6388.
Employee Vendor Discounts
Paid Time Off (PTO) and Extended Illness Bank (EIB)
The PTO program allows benefit eligible full-time and part-time employees to earn paid time off for personal use, such as vacation, holidays, or sick leave. PTO accrual is based upon your length of service and will vary based on hours worked during each pay period. Accrual is not calculated on the usage of PTO or EIB. PTO may be used after 3 months of employment.
PTO ACCRUAL SCHEDULE Full-time and
Part-time Eligible (Factor per worked hour)PTO Accrual Rate Approximate PTO
Less than 5 years .0885 23 days per year
5-9 years .1077 28 days per year
10-14 years .1154 30 days per year
15-19 years .1231 32 days per year
20+ years .1270 33 days per year
The maximum PTO accrual is 400 hours. After 12 months of employment, you will be able to cash in any unused PTO above 40 hours. (Please review PRB 5441.1 for details and other criteria.) Full-time and eligible part-time employees are encouraged to take at least two (2) weeks of PTO each calendar year.
Full-time employees also accrue time in an Extended Illness Bank (EIB) that may be used after three months of
employment. Full-time employees may use EIB hours beginning on the fifth day of an illness (scheduled workdays), or immediately for an inpatient or outpatient procedure or illness for which the employee is hospitalized. The maximum EIB accrual is 520 hours. (Please review PRB 5441.1 for details and other criteria.)
EXTENDED ILLNESS BANK (EIB) ACCRUAL SCHEDULE
Full-time Only (Factor per paid hour)EIB Accrual Rate Maximum EIB
Less than 4 years .0193 5 days per year
5+ years .0270 7 days per year
Paternity and Adoption Leave is offered through a combination of PTO and EIB for employees who meet eligibility as defined in the Paid Time Off, Extended Illness Bank and Sick Leave Policy (PRB 5441.1)
Additional Benefits
Adoption Benefits
In addition to being able to use Extended Sick Leave for adoptions, employees may qualify to receive up to $4,000 toward the cost of adopting a child (including legal, agency and travel expenses).
Bereavement Leave
DeKalb Medical provides assistance and demonstrates concern for those full and part-time employees who suffer the death of an immediate family member. All bereavement leave is based on one-tenth of the employee’s budgeted hours and must meet requirements defined in the “Bereavement Leave” policy.
Jury Duty Pay
NEW HIRE & STATUS CHANGE BENEFITS ENROLLMENT
Lawson Employee Self Service (ESS) Reference Guide
LOGGING INTO THE SYSTEM:
You can log in at the following web address: http://lawpa.c10r.netaspx.com/lawson/portal/ or by visiting
www.dekalbmedical.org and choosing the Lawson ESS link listed under the “For Employees” section (at the bottom of
the home page)
User ID = employee # +”e” (for example, 123456e)
(NEW HIRE) Initial Password = Enter two zeroes followed by the first initials of the first and last name and the last 4 digits of your social security number. (for example, Jane Smith Social 123-456-7890= 00js7890).
You will be prompted to change your password after your initial log in.
You will also be prompted to answer a series of questions. Using the Forgot Password Answers screen, answer at least three (3) questions and click “Submit”. By answering these questions, you will be able to use the Forget/Change Password feature to reset your own password in the future.
PRIOR TO GETTING STARTED, MAKE SURE YOU KNOW WHICH BENEFITS YOU WOULD
LIKE TO ELECT. TO VIEW THE BENEFITS BOOKLET, PLEASE FOLLOW THE EXAMPLE BELOW:
Click on
“Benefits”
NAVIGATION OF THE SYSTEM:
Upon Successful login, you will see a navigation pane on the left side of the screen. To get started on enrolling in your benefits, you will need to click on “New Hire”.
ENROLLING IN BENEFITS:
(Please follow the order as listed below)Step 1: ADDING DEPENDENTS:
(If you are not adding any dependents to Benefits, skip to Step 2)
From the menu choose “Dependents”.
To Add: Click Add. Enter dependent’s information, including all required fields (represented by the
asterisks*). Once all fields have been completed, click “Update”.
To Change/Update: Select the name of the dependent by clicking on the name. Change the desired fields. Once the changes have been completed, click “Update”.
NOTE: When adding new dependents, be sure to provide the Benefits Department with the required dependent verification forms/affidavits.
Step 2: ELECTING MEDICAL, DENTAL, VISION & LIFE INSURANCE BENEFITS:
From the menu choose “Benefits”. This will take you to the next menu options where you will choose “New Hire Enrollment”.
For each benefit type, you will be presented with both coverage plan and coverage level options.
Selecting a Benefit Plan: For each benefit type you will be presented with the available plan options or the option to waive coverage. After making your election you will need to click the “Continue” button to proceed.
Selecting a Coverage Level: Once your Benefit Plan has been chosen the next screen will be the coverage level options. Make your election and click the “Continue” button to proceed.
Confirmation Screen: After each Benefit Plan and Coverage Level has been elected you will reach a confirmation screen. If your elections are correct, click “Continue” to proceed. If you need to make changes, click “Previous” to return to your election options.
Step 3: ELECTING SHORT-TERM DISABILITY BENEFITS:
Once you have completed the medical, vision, dental and life insurance benefits, you will arrive to the Short-Term Disability enrollment screen. You will want to first select the benefit period option you desire.
You will then proceed to the monthly coverage election screen where you can choose any amount between the minimum and maximum amounts listed. (The enrollment options for Short-Term Disability Benefits are based on your budgeted monthly gross income and cannot exceed 70% of that amount)
Once you click ‘Continue’ the calculation will be done for you. If you are not satisfied with the amount in the confirmation page please click ‘Previous’ until you reach your satisfied coverage level
Step 4: CONFIRMING BENEFIT ELECTIONS:
After making all elections you will be presented with a confirmation screen of all benefits you have elected and their premium cost.
If you are not satisfied with the elections listed please click ‘Make Changes”. You will then be prompted to make new elections from a list of benefit plans.
If you are satisfied with the elections listed, click “Continue”.
PLEASE NOTE: If you do not choose the “Continue” button your enrollment is incomplete! You will be given the option to print a Confirmation of your Benefit Elections. It is recommended to keep a copy on file for future reference.
ADDING/UPDATING BENEFICIARIES:
You will be eligible for Basic Life and Accidental Death and Dismemberment (AD&D) coverage after one year of benefits eligible employment. Please add beneficiary information for these benefits.
From the menu choose “Beneficiaries”.
To Add a Beneficiary: Click the “Add Individual” or “Add Trust” option under the plan type you would like to add a beneficiary for. Complete the required fields and Click “Update” once complete.
(Note: If there are multiple beneficiaries, each one will need to be added individually)
To Update a Beneficiary: Click on the name of the individual/trust. Change the required information and click “Update”.
To Delete a Beneficiary: Click on the name of the individual/trust. Click “Delete”.
