Benefit highlights guide plan year

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Benefit highlights guide

2014 plan year

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Oregon Health & Science University knows how important it is to have good, affordable

health and welfare benefits. That’s why we offer competitive benefits that can provide

protection, peace of mind and savings. Whether it’s health care, income protection,

or other benefits, we’ve got you covered.

This guide provides a general overview of your benefit choices and enrollment information

to help you select the coverage that is right for you.

Know enrollment

When can I enroll?

New employees

As a new employee, you must enroll in benefits within 60 days of your date of hire. Our benefits plan year runs from Jan. 1 through Dec. 31.

Open enrollment

As a benefits-eligible employee, you have an opportunity once a year to enroll in or make changes to your benefit plans during the open enrollment period, unless you experience a qualified family status change. Open enrollment is typically held in October. Open enrollment for your 2014 benefits is Oct. 1 through Oct. 31, 2013 with elections effective Jan. 1, 2014.

Note: With the exception of flexible spending accounts, your current benefit selections will remain unchanged in 2014 unless you go online and make a change. However, if you did not complete the plan requirements for 2013, you will be moved to the OHSU PPO Standard or 250 PPO Standard medical plan for the 2014 plan year (see page 6).

How do I enroll?

Log on to Oracle Employee Self Service at http://ais.ohsu.edu/ to enroll in or make changes to your benefits.

Before logging on, have a list of your benefit selections/changes, as well as the names, Social Security Numbers, birthdates and addresses of those you wish to designate as beneficiaries or enroll as dependents. If you plan to opt out of OHSU medical or OHSU dental coverage, you must provide the other employer’s name, group name and group plan number under which you are covered.

• Go to http://ais.ohsu.edu/ and click “Click Here” to begin.

—Login using your regular OHSU network username and password. —In the Main Menu under Employee Self Service, choose “Benefits”

to enroll or make changes.

• Click “Add Dependents or Beneficiaries” to update before selecting benefits. • Click “Next” and follow the onscreen instructions to select your benefits. • Once you have successfully submitted your selections and completed

enrollment, print the confirmation page for your records.

Verification of dependents

In 2013, OHSU began the

practice of verifying dependents

enrolled in medical coverage—

a practice very common at

other employers. An audit of

all dependents was conducted

during the summer of 2013.

OHSU Benefits is working on an

ongoing audit process for newly

added dependents not verified

as part of that audit. Stay tuned

for updates from Benefits about

the new ongoing verification

process for new dependents.

Know how to choose

When you think about your health care costs, the first thing that comes to mind is probably your premium—the amount that comes out of every paycheck for coverage. But to see the total picture, you also have to consider what you’re likely to pay out of your pocket, such as when you go to the doctor or get a prescription. Keep this in mind as you review the following health care options.

Know who is eligible

Who can I cover?

You can enroll in the benefits listed in this guide if you are a 0.5 FTE or greater and working in a benefits-eligible position. For more detailed information on employee and dependent eligibility, visit the Benefits O2 website at: https://o2.ohsu.edu/human-resources/benefits. If you participate in OHSU benefits, you also may enroll:

• Your spouse (opposite or same sex) or domestic partner (opposite or same sex; registered or unregistered);

• Your child(ren) (including child(ren) of a domestic partner or spouse) up to age 26 who does not have access to their own employer coverage. This applies regardless of marital or student status;

• Your child(ren) of any age who is incapable of supporting themselves due to a mental or physical disability and who is totally dependent on you; and

• Your child(ren) by adoption or court-ordered judgment who otherwise meet the dependent eligibility.

Please refer to the plan summaries or contact OHSU Benefits for additional information.

What if things change?

The benefits you choose will be effective through the end of the calendar year. You cannot make changes to your coverage during the year, unless you have a qualified family status change including:

• Marriage, establishment of a domestic partnership, legal separation, divorce or termination of a domestic partnership;

• Birth, legal adoption of a child, or placement of a child with you for legal adoption; • Death of your spouse/domestic partner or dependent child; or

• Change in residence (only if your current coverage isn’t available in the new location or if you are offered an option that you were not previously offered).

To make a change due to a qualified family status change, you must notify and submit any applicable forms and/or documentation to OHSU Benefits within 31 days* of the event. OHSU Benefits will review your request and determine whether the change you are requesting is allowed. Only benefit changes which are consistent with the qualified family status change are permitted.

*60 days if you, your spouse/domestic partner, or eligible dependent child loses coverage under Medicaid or a state Children’s Health Insurance Program (CHIP) or becomes eligible for state-provided premium assistance.

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Know the cost of your benefits

OHSU provides benefit-eligible employees benefit dollars to apply toward the cost of benefits. OHSU provides you a set amount of monthly funds depending on your employee representation and the coverage level you select. The funds are applied to the cost of the medical and dental benefit options you choose to enroll in. If your benefit dollars don’t cover the complete cost of the benefits you choose, the difference will be deducted from your paycheck 24 times a year.

Below are the benefit dollars that OHSU is contributing to your benefit selections for 2014.

OHSU’s monthly benefit

contribution

Unclassified ONA represented* AFSCME represented

Full-time

(.75 – 1.0) Part-time (.50 – .74) (.70 – 1.0)Full-time Part-time (.50 – .69) (.75 – 1.0)Full-time Part-time (.50 – .74)

Medical opt out** $100 $50 $50 $50 $50 $0

Employee only $664.00 $500.00 $662.64 $496.98 $662.64 $510.24

Employee & spouse/domestic partner $880.00 $630.00 $848.42 $636.32 $899.52 $692.64

Employee & child(ren) $765.00 $580.00 $697.62 $523.22 $739.64 $569.52

Employee & family $970.00 $650.00 $938.76 $704.08 $995.30 $766.38

*As of the time of Open Enrollment, the ONA contract with the 2014 benefit dollars had not been finalized. ONA benefit dollars are calculated here based on the current contract but may change when the ONA contract is ratified.

**The medical opt out rate reflects the contribution amount employees will receive and can use for dental, life and optional coverage.

Medical and dental costs for 2014

The rates listed below are the monthly costs for the medical and dental plans by coverage level (number of dependents) you choose. Your benefit dollars paid to you by OHSU (shown above) help you pay for these premiums, along with FSA benefits you select.

(See pages 5 and 8 for medical and dental benefit summaries)

Monthly medical premiums

Employee only

Employee & spouse/

_{domestic partner}

Employee &

_child(ren)

Employee & family

OHSU PPO $619.54 $928.38 $735.76 $979.18

OHSU PPO Standard $650.82 $978.64 $772.92 $1,028.64

250 PPO $760.40 $1,143.32 $902.60 $1,247.26

250 PPO Standard $797.48 $1,199.10 $946.62 $1,308.10

Kaiser Permanente $905.18 $1,348.72 $1,059.06 $1,412.18

Monthly dental premiums

Employee only

Employee & spouse/

_{domestic partner}

Employee &

_child(ren)

Employee & family

Moda Health $43.10 $93.80 $104.74 $151.84

Kaiser Permanente $87.08 $174.18 $156.76 $261.26

Williamette Dental Group $45.40 $88.50 $80.30 $137.50

How it works

Here are two examples of how to apply benefit dollars to your benefit selections and understand your paycheck deduction.

Example 1—Mya:

Meet Mya. She is a single, full-time employee classified as an unclassified employee. She’s selected the OHSU PPO medical plan and Moda Health dental plan for 2014. Since she’s completed the requirements listed on page 6, she’s eligible for lower medical plan premiums in 2014 and to participate in the OHSU PPO, instead of the OHSU PPO Standard.

• Employee only benefit premiums (monthly) —OHSU PPO Medical: $619.54

—Moda Health Dental: $43.10 • OHSU Benefit Contribution: $664.00

• Mya’s cost: Nothing, Mya will receive back $1.36 monthly [($619.54 + $43.10) - $664.00 = $1.36]

Example 2—John:

Meet John. He is a married, full-time employee classified as an AFSCME represented employee. He wants to cover his wife and three children under the 250 PPO medical plan and Moda Health dental plan for 2014. Since he’s not completed the requirements listed on page 6, he’s not eligible for lower medical plan premiums in 2014 so cannot participate in the 250 PPO, only the 250 PPO Standard.

• Employee & family benefit premiums (monthly) —250 PPO Standard Medical: $1,308.10

—Moda Health Dental: $151.84 • OHSU benefit contribution: $995.30 • John’s cost: $464.64 monthly

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Know your medical and prescription drug benefits

Providing comprehensive and quality medical coverage at a reasonable cost is a challenge for all employers. OHSU meets that challenge by providing employees with two medical plan options (three for certain long-term employees eligible for the Kaiser medical plan, described below). If you enroll in the OHSU PPO or 250 plans, you automatically receive pharmacy and vision coverage. See page 8 for vision benefit information. The information below is a summary of medical coverage only. Please visit www.modahealth.com or www.kp.org (depending on the medical plan you are enrolled in) or https://o2.ohsu.edu/human-resources/benefits for plan summaries detailing coverage information, limitations and exclusions. Any coinsurance or copays shown in the chart below are amounts for which you are responsible.

Medical benefits summary

Key features

OHSU PPO/OHSU PPO Standard

250 PPO/250 PPO Standard

Kaiser Permanente

OHSU provider Non-OHSU _provider Network provider Non-network _provider Network provider only

Requirements Must select Primary Care Physician (PCP) and complete two of six requirements (see

page 6).

Employees who didn’t participate in wellness programs in 2013 can only select

the Standard option in 2014.

Must select Primary Care Physician (PCP) and complete two of six requirements

(see page 6).

Employees who didn’t participate in wellness programs in 2013 can only select

the Standard option in 2014.

Available only to AFSCME represented employees hired before 10/1/1998 and ONA represented and unclassified

employees hired before 1/1/1998. All care must be received by a participating Kaiser Permanente facility,

except for true emergencies.

Annual calendar year deductible $250/person or $750/family $500/person or $1,500/ family None

Medical out-of-pocket (OOP) max

(includes deductible) $1,600/person or $3,250/family $4,250/person or $8,750/family $3,500/person or $7,000/family $4,250/person or $8,750/family $1,000/person or $2,000 family

Lifetime maximum Unlimited Unlimited Unlimited

Home and doctor’s office visits $25 copay 40% of allowable

charges $25 copay 40% of allowable charges $15 copay

Preventive care No charge, not subject to deductible; frequency limitations apply 40% of allowable charges; subject to deductible; frequency limitations apply No charge, not subject to deductible; frequency limitations apply 40% of allowable charges; subject to deductible; frequency limitations apply No charge

Lab and X-ray services _20% 40% of allowable

charges 20% 40% of allowable charges No charge

Hospital services Inpatient (per admission) Outpatient 20% 20% 40% of allowable charges 40% of allowable charges 20% 20% 40% of allowable charges 40% of allowable charges

$200 copay per visit for hospital/facility charge

Emergency care

(waived if admitted) $150 copay, then 20% of allowable charges $150 copay, then 20% of allowable charges $75 copay (waived if admitted) Prescription OOP max $1,500/person or $2,500/family $1,500/person or $2,500/family Included in medical OOP max

Retail prescription drug (30-day supply) Value Generic Preferred Non-preferred $2 20%, $100 max 30%, $100 max 50%, $100 max $4 25%, $10 min & $100 max 35%, $10 min & $100 max 50%, $10 min & $100 max $2 20%, $100 max 30%, $100 max 50%, $100 max $4 25%, $10 min & $100 max 35%, $10 min & $100 max 50%, $10 min &

$100 max $15 copay per formulary prescription

Mail-order prescription drug (90-day supply) Value Generic Preferred Non-preferred $6 10%, $100 max 20%, $100 max 33%, $100 max

Not covered _{10%, $100 max}$6 20%, $100 max 33%, $100 max

Not covered

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Eligibility for the lowest cost OHSU benefits

For the past several years, OHSU has offered wellness programs that employees can participate in to receive lower premiums on the OHSU PPO and 250 plans. Employees who haven’t participated in the wellness programs have paid 5% higher in premium rates (termed the “Standard” plan option). Employees who participate in the OHSU wellness program offerings will continue to see savings in their medical costs next plan year. Note: New employees automatically are given the lower premium option for their first year but must participate in the OHSU wellness program to continue to see savings in their medical costs.

To qualify for savings on your 2015 medical costs, you must complete the following requirements by Sept. 30, 2014:

• Requirement #1—Designate a primary care provider (PCP) in Oracle. (There’s no need to repeat if you have previously completed and there are no changes.)

• Requirement #2—This requirement only applies if your OHSU PCP has identified you to participate. Employees or their covered dependents receiving an invitation from their OHSU PCP to participate in the OHSU Care Coordination Plus program must enroll and complete the program. If eligible, you will receive a personalized invitation from your PCP.

—The OHSU Care Coordination Plus program is for select patients with chronic conditions that require a range of services. Additional benefits include: a designated Nurse Care Manager, better coordination of information and a single point of access to your care team at OHSU.

• Requirement #3—Additionally, each employee must complete two of the following actions by Sept. 30, 2014. While only two of these six actions are required to quality for the 2015 medical cost savings, employees are welcome to participate in more than one at no cost.

1. Complete the OHSU Benefits Quiz/Survey. 2. Get your flu shot by Oct. 31, 2013 at:

—One of the employee flu shot clinics; or

—A location of your choice. You will need to complete and return the 2013-2014 OHSU influenza declination form and fax the form to 503 494-4457. Forms are available from Occupational Health Services.

3. Earn 1,000 points in the HealthySteps program.

4. Complete the Healthy TEAM Healthy U program.

5. Complete the OHSU-sponsored smoking cessation program; start by calling 1-866-QUIT4 LIFE or visit www.quitnow.net. 6. Complete the OHSU-sponsored weight management program

with Weight Watchers; start by calling 1-800-8-AT WORK and talk to a local Weight Watchers At Work manager about setting up a meeting at your worksite.

Note: Employees not meeting these requirements will not be eligible for medical cost savings for 2015.

Opting out of medical coverage

You must enroll in medical insurance unless you have coverage under another group medical plan. To opt out, you must provide proof of coverage (name of group medical plan and policy number) to OHSU.

If you choose to opt out, you will receive reduced benefit dollars, shown on page 4.

If you lose coverage under another group plan, you must enroll in the OHSU medical coverage within 31 days after losing coverage.

Know your terms

Coinsurance A percentage of costs you pay “out of pocket” for covered expenses after you meet the deductible.

Copay (copayment) A fee you have to pay “out of pocket” for certain services, such as a doctor’s office visit or prescription drug.

Deductible The amount you pay “out of your pocket” before the health plan will start to pay its share of covered expenses.

Network Doctors, pharmacists and other health care providers who make up the plan’s preferred providers. When you use network providers, you pay less because they have agreed to negotiated pricing.

Out-of-pocket maximum (OOP max) The most you pay each year “out of your pocket” for covered expenses. Once you’ve reached the out-of-pocket maximum, the health plan pays 100% for covered expenses.

Preventive care Services you receive when you are not sick or injured—so that you will stay healthy. Preventive care services include annual physicals, wellness screenings and well-baby care.

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Know how to stay well

Did you know all the plans cover preventive care? It’s true! Network preventive care—like annual

physicals, wellness screenings, immunizations, and well-baby care—is 100% covered without

having to pay your deductible. So, be sure to schedule your annual preventive screening.

Healthy TEAM Healthy U (HTHU) is a health promotion program designed by OHSU faculty and staff and refined by our own employees. It is a behavior-based program to help employees achieve and maintain a healthy lifestyle and capture the power of employees working together. Numerous benefits have been documented, including reduced blood pressure, lower body weight among those who are overweight, improved diet and exercise behaviors and feeling healthier. Furthermore, employees felt less depressed, missed less work, and reported being happier after participating in HTHU. For more information on HTHU, including how to register, visit

https://hthu.ohsu.edu.

HealthySteps

HealthySteps is an individual-initiated employee wellness program offered by OHSU Benefits and managed by The Division of Health Promotion and Sports Medicine. HealthySteps is an OHSU website that allows you to track and record your wellness activities. Being physically active, controlling your body weight, attending health-related seminars, giving blood and others, can all be tracked on the website.

For more information on HealthySteps, including how to register, visit

https://hthu.ohsu.edu.

Weight Watchers

Benefit-eligible OHSU employees can participate in Weight Watchers at no cost. Employees can choose to attend a community Weight Watchers meeting or coordinate a meeting at their worksite with their colleagues. Employees can also participate independently in the Weight Watchers online program.

For more information on the Weight Watchers benefit, including how to register, visit https://o2.ohsu.edu/human-resources/benefits.

Smoking Cessation

If you use tobacco and would like to quit, OHSU Benefits wants to provide support and resources to assist you. OHSU has partnered with the American Cancer Society to provide free resources to employees wanting to quit using tobacco. Resources include unlimited toll-free access to Quit Coaches, free nicotine replacement therapy (patch or gum) mailed directly to your home, and other tools to assist you in your goal to quit using tobacco.

For more information on cessation resources available, please call the American Cancer Society - Quit For Life Program at 1-866-QUIT-4-LIFE (784-8454) or enroll online at

https://www.quitnow.net.

Know more about your benefits

What about acupuncture and chiropractic benefits?—Acupuncture and

chiropractor visits are a drug-free way to minimize pain. Since people

often develop a tolerance to drugs or need higher dosages to achieve the

same effect, these forms of treatment are a great alternative. Also, they

allow your doctor to examine your response immediately and adjust

treatment as needed.

For employees enrolled in the OHSU PPO or 250 plan, OHSU pays for

70% of the allowable charges for acupuncture and chiropractic visits,

with a maximum of 60 visits per calendar year.

You can save money by using the “in” crowd—No matter which health

care options you choose, it’s critical to make sure your providers are in

the insurance carrier’s network before you enroll. It could have a large

impact on your out-of-pocket expenses if your providers are not

in-network. To see if your providers are in the network, refer to the

“Know how to get information” section on page 12.

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Know your dental benefits

Dental coverage is key to your overall health and wellness. You can enroll in dental benefits through Moda Health, Kaiser Permanente or Willamette Dental Group for yourself and your family. If you use network providers, you’ll pay less. You can still get care from any providers out of the network, but you’ll pay more. Any coinsurance shown in the chart below are amounts for which you are responsible.

Dental benefits summary

Key features

Moda (ODS)

Kaiser Permanente

Willamette Dental

_Group

Annual deductible $50 per person or $150 per family None None

Preventive and diagnostic services No charge, not subject to deductible No charge No charge

Annual maximum benefit $1,500 None None

Routine fillings _{20% after deductible is met} _{No charge} _{No charge} Root canals 20% after deductible is met No charge No charge

Prosthodontic care (crowns, bridges

and dentures) 50% after deductible is met $75 copay per procedure/unit; $25 _{copayment for relines and rebases} $75 copay per procedure/unit

Orthodontia services

50% ($1,500 lifetime maximum) Not covered $150 copay for pre-orthodontia; $1,200 copay for comprehensive orthodontia (no lifetime maximum) (See page 4 for dental premiums)

Know your vision benefits

At no additional cost, you automatically are enrolled for Vision Service Provider (VSP) benefits if you participate in the OHSU or 250 Plan. If you participate in the Kaiser medical plan, you are also automatically enrolled for vision benefits through the Kaiser vision plan at no additional cost. This information is a summary of vision coverage only, visit www.vsp.com or www.kp.org for more information on your vision benefits.

Key

features

OHSU PPO/OHSU PPO Standard

250 PPO/250 PPO Standard

Kaiser Permanente

VSP provider Non-VSP provider VSP provider Non-VSP provider Kaiser provider only Exam No charge Plan reimburses up to $50 No charge Plan reimburses up to $50 $15 copay

Lenses and

frames Single vision, lined bifocals and lined trifocals: $25 copay Up to $150 allowance

for frames

Single vision lenses: $50 copay Bifocal lenses: $75 copay Trifocal lenses: $100 copay

Frames: $70 copay

Single vision, lined bifocals and lined trifocals:

$25 copay Up to $150 allowance

for frames

Single vision lenses: $50 copay Bifocal lenses: $75 copay Trifocal lenses: $100 copay

Frames: $70 copay

Up to $150 allowance for lenses and frames

Contacts Up to $140 allowance for elective contacts in lieu

of glasses

Up to $140 allowance for elective contacts in lieu

of glasses

Frequency Exam allowed every 12 months; lenses and frames

or contacts every 24 months Exam allowed every 12 months; lenses and frames or contacts every 24 months Exam every 12 months; lenses and frames or contacts every 24 months

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Know your income protection benefits

OHSU provides eligible employees with a variety of plans to provide replacement income to you or your beneficiaries in the event of disability, accident or death. This information is a summary of coverage only. Refer to your certificates of coverage for more detail.

Basic life coverage

OHSU provides you with basic life insurance in the amount of $25,000 at no cost to you.

Voluntary life and accidental death and dismemberment

(AD&D) coverage

You can also purchase additional life and AD&D insurance for yourself, your spouse/domestic partner and child(ren). Remember, life insurance isn’t just about paying for memorial services. It’s also about making sure your family can maintain its standard of living over the long run. How much your family would need depends on your situation (debts, expenses, etc.).

You can elect additional coverage for:

• Yourself: In increments of $25,000, from $25,000 up to a maximum of $1,000,000. • Your Spouse/Domestic Partner: In increments of $25,000, up to a maximum of

$500,000.

• Optional Dependent Life: For any dependent, available in the amount of $4,000. This is separate from and/or in addition to spouse/domestic partner life insurance. • Optional AD&D:

—Employee coverage is available in increments of $50,000, up to $500,000. —Family AD&D coverage is set at a fixed percentage of the employee coverage

you select.

Note: Life insurance premiums are based upon the dollar coverage amount you select and your age or the age of the dependent you are covering. AD&D premiums are based upon the dollar coverage amount you select. For more detail on premium costs, visit the OHSU Benefits O2 page at https://o2.ohsu.edu/human-resources/benefits.

For new hires and newly benefit-eligible employees, medical certification for yourself or your spouse/domestic partner is required for life insurance policies above $50,000. For current benefit-eligible employees making changes to their life insurance coverage during open enrollment, medical certification for yourself or your spouse/domestic partner is required for life insurance policies above $25,000. All increases or changes to life insurance amounts must be approved by The Standard before they can go into effect.

Disability

According to the National Safety Council, 490 Americans became disabled in the last 10 minutes. Without disability insurance, those Americans could have no income for as long as they can’t work.

You have the option to buy short-term disability (STD) and long-term disability (LTD) insurance through The Standard.

• Short-Term Disability: Benefit pays 65% of your weekly pay for up to 180 days from the date of disability (some limitations apply). You may choose an 8-day, 30-day, or 90-day waiting period.

• Long-Term Disability: Benefit pays 65% of your monthly earnings, coordinated with other income and benefits, after you have been disabled for 180 days (some limitations apply).

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Know your additional benefits

Flexible Spending Accounts (FSAs)

OHSU offers two types of FSAs—no matter which medical option you choose—that can help you save for out-of-pocket expenses:

• You can use the Health Care FSA (HFSA) for eligible health care expenses such as deductibles, copays, coinsurance, prescription drugs, dental and vision expenses. • You can use the Dependent Care FSA (DFSA) for eligible child and elder care expenses

so you (and your spouse, if married) can work or go to school.

Each year, you can contribute up to $2,500 to the HFSA and up to $5,000 to the DFSA. The amount you choose to contribute will be deducted from your paycheck 24 times a year. There are tax savings, too, because contributions go from your paycheck into your FSA pre-tax. This lowers your taxable income, so you pay less in taxes. Plus, when you have eligible expenses, you pay for them with tax-free money.

Visit www.benefithelpsolutions.com for a current list of eligible expenses, claims filing deadlines and other information about your accounts.

Employee Assistance Program (EAP)

OHSU’s EAP services are provided by Moda Health. The EAP provides you and eligible members of your household 24/7 access to confidential counseling to help you address issues such as relationships, drug and alcohol abuse, financial hardship and general stress or depression.

Many issues can be addressed directly with your EAP professional; in some cases, you may be referred to other resources. The EAP is available 24 hours, 7 days a week by visiting

www.cascadecenters.com or by calling 1-800-826-9231.

Travel assistance

OHSU provides benefit-eligible employees access to travel assistance through FrontierMEDEX. Resources include help with travel, medical or security problems, anywhere in the world. For more information, call FrontierMEDEX at 1-800-527-0218.

Be ready for the

unexpected

Will you need dental

services—such as a filling,

root canal, or crown—in

the next year? Do you wear

glasses or contact lenses?

If you answered “yes” to

either of these questions,

consider the Health Care

Flexible Spending Account.

This account can help

soften the impact of

unexpected dental and

vision expenses—even if

you don’t enroll in medical

or dental coverage.

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Know your rights

Women’s Health and Cancer Rights Act

Federal law requires a group health plan to provide coverage for the following services to an individual receiving plan benefits in connection with a mastectomy:

• Reconstruction of the breast on which the mastectomy has been performed;

• Surgery and reconstruction of the other breast to produce a symmetrical appearance; and

• Prostheses and physical complications for all stages of a mastectomy, including lymphedema (swelling associated with the removal of lymph nodes).

The group health plan must determine the manner of coverage in consultation with the attending physician and patient. Coverage for breast reconstruction and related services will be subject to deductibles and coinsurance amounts that are consistent with those that apply to other benefits under the plan.

Medicaid and the Children’s Health

Insurance Program (CHIP)

Medicaid and CHIP offer free or low-cost health coverage to children and families. If you are eligible for health coverage from your employer, but are unable to afford the premiums, some states have premium assistance programs that can help pay for coverage. Some states use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, you can contact your state Medicaid or CHIP office by calling 1-877-KIDS-NOW or visiting www.insurekidsnow.gov to find out how to apply. You must request coverage within 60 days of being determined eligible for premium assistance.

Health Care Reform Notice

OHSU believes our Kaiser Permanente medical plan is a “grandfathered health plan” under U.S. Health Care Reform legislation (Patient Protection and Affordable Care Act, or the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that your plan may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits.

Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the plan administrator at www.kp.org. You may also contact the U.S. Department of Health and Human Services at www.healthreform.gov.

Additional notices

Please contact OHSU Benefits for additional information and full notices on: • Medicaid and the Children’s Health Insurance Program (CHIP) • Health Insurance Portability and Accountability Act (HIPAA) of 1996; • Family and Medical Leave Act of 1993;

• Continuation of Coverage Rights under COBRA; • Medicare Part D Creditable Coverage Notice; and • Other additional important notices about your rights.

You have urgent care options

OHSU Family Medicine clinics at Richmond, Scappoose and the South Waterfront offer evening and Saturday hours.

• Richmond and Scappoose are open Monday through Friday 8 a.m. to 8 p.m. and Saturday 9 a.m. to 1 p.m.

• South Waterfront is open Monday through Friday 7 a.m. to 8 p.m. and Saturday 9 a.m. to 1 p.m.

Employees enrolled in the OHSU PPO or 250 plan also can use urgent care services at a ZoomCare clinic. With locations throughout the Portland area, ZoomCare can be a convenient option when an employee or family member is faced with an urgent need.

For more information on ZoomCare locations and appointments, visit www.zoomcare.com.

You have a voice - the Employee

Benefits Council

The EBC is a unique and valuable group that functions on the idea of “by the people, for the people.” The Council is made up of your fellow employees to discuss the important topics - like what medical plans you are offered - and make decisions on how to move forward with your needs in mind.

OHSU believes you know yourself best and you should have a voice in the benefits available to you. It’s important you have good, affordable health and welfare benefits to keep you and your family healthy. Much like our tree, which is a symbol of life, growth,and renewal, the EBC represents you to make sure you have an array of health, wellness and financial components available for your total compensation and rewards at OHSU.

For more information about the EBC, visit

https://o2.ohsu.edu/human-resources/benefits

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Know how to get information

Refer to the charts below for additional contact information about your OHSU benefit options.

For individual benefits…

Contact ...

Call...

Visit...

OHSU PPO or OHSU PPO Standard 250 PPO or 250 PPO Standard

Medical: Moda Health

Group #10001819 1-855-232-6898 www.modahealth.com Prescription: Moda Health

Group #10001819 1-855-232-6898 www.modahealth.com Vision: VSP

Group #12157430 1-800-877-7195 www.vsp.com

Kaiser Permanente HMO (medical,

prescription and vision) Kaiser Permanente Group #8553 Outside Portland: 1-800-813-2000In Portland: 503-813-2000 www.kp.org

Dental options

Moda Health

Group #10001819 Outside Portland: 1-888-217-2365 In Portland: 503-265-2965 www.modahealth.com Kaiser Permanente

Group #8553 Outside Portland: 1-800-813-2000 In Portland: 503-813-2000 www.kp.org Willamette Dental Group

Group #OR102 1-855-433-6825 www.willamettedental.com

Life and disability options _{Group #631050}The Standard 1-800-378-2390 www.standard.com

Flexible Spending Accounts

(HFSA and/or DFSA) Benefit Help Solutions Outside Portland: 1-888-398-8057 In Portland: 503-219-3679 www.benefithelpsolutions.com

EAP Moda Health 1-800-826-9231 www.cascadecenters.com

Travel assistance FrontierMEDEX 1-800-527-0218 N/A

For all benefits…

Contact ...

Call...

E-mail/Visit...

General benefit questions OHSU Benefits In and outside Portland: 503-494-7617

[email protected] https://o2.ohsu.edu/human-resources/

benefits

OHSU Benefits Mail code: HR 3181 S.W. Sam Jackson Park Road Portland, OR 97239 tel 503 494-7617 fax 503 494-5990 [email protected]

About this guide

This guide highlights your benefits. Official plan and insurance documents govern your rights and benefits under each plan. For more details about your benefits, including covered expenses, exclusions and limitations, please refer to the individual summary plan descriptions (SPDs), plan document, or certificate of coverage for each plan. If any discrepancy exists between this guide and the official documents, the official documents will prevail. OHSU reserves the right to make changes at any time to the benefits, costs and other provisions relative to benefits.

Benefit highlights guide plan year