Hap Insurance Booklet 2018 1rs2x

MY CHOICE REWARDS

2018

MY CHOICE REWARDS Enrollment Workbook

Inside this Workbook Important Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Introduction/How My Choice Rewards Works. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Dependent Eligibility/Documentation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 New for 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 2018 Medical Plan Changes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Employee contributions for other benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Health Engagement is being replaced by Reward Your Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 New Voluntary Benefit Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Integrative medicine program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Health Care Coverage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Consumer Driven Health Plans. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Health Savings s. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Health Engagement/Reward Your Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Medical/Vision Comparison Charts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Special Medical Credit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Sponsored Dependents/Spouse Surcharge. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Dental Plans/Dental Plan Comparison Chart. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Flexible Spending s. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Income Replacement and Survivor Benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Employee Term Life/Dependent Term Life (after tax). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Accidental Death and Dismemberment (AD&D). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Long-Term Disability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Web Enrollment Instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Additional Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Choose Henry Ford. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Employee Wellness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Important Federal Notices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Events Permitting Mid-Year Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Important . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Every effort has been made to ensure the accuracy and completeness of the benefit descriptions contained within this workbook. However, in the event of any interpretation, discrepancy, application and/ or decision in specific circumstances, the official text or of the plan document will govern. This workbook is not intended to create or to be construed as a contract between Henry Ford Health System (HFHS) and its employees for any matter, including for the provision of benefits described.

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Important Information Employee Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 855-874-7100 1 Ford Place - 4E, Detroit, MI 48202 [email protected] Health Alliance Plan / Alliance Health and Life. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 866-766-4709 (Medical/Vision) hap.org 2850 W. Grand Blvd., Detroit, MI 48202 Blue Cross/Blue Shield of Michigan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 877-790-2583 (Medical/Vision) bcbsm.com 600 E. Lafayette, Detroit, MI 48226 Delta Dental Plan of Michigan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-524-0149 (Point-of-Service Dental) deltadentalmi.com 27500 Stansbury St., Farmington Hills, MI 48334-3811 Manulife. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-268-3763 (Medical/Vision) coverme.com 557 Southdale Road East, Suite 205, London, Ontario, Canada N6E 1A2 (Canadian residents only) CIGNA Group Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-238-2125 (Life Insurance) cigna.com 1600 W. Carson St., Suite 300, Pittsburgh, PA 15219 CIGNA Disability Management Solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-362-4462 (Long-Term Disability Insurance) cigna.com P.O. Box 22325, Pittsburgh, PA 15222-0325 CIGNA Group Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-238-2125 (AD&D Insurance) cigna.com P.O. Box 22328, Pittsburgh, PA 15222-0328 Health Equity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 866-346-5800 (Flexible Spending s/Health Savings s) healthequity.com 10 W. Scenic Pointe DR., Suite 100, Draper, UT 84020

If you have questions about your enrollment, Employee Services or your local Human Resources department.

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Introduction _______________________________________________________________________________ My Choice Rewards continues to give you more choices. Whether it’s enhancing new medical options, helping you make healthier lifestyle choices or making the employee enrollment selection experience easier, it’s all about choice. Open enrollment for 2018 My Choice Rewards will take place Monday, Nov. 6 – Monday, Nov. 20, 2017. Benefit selections will be effective Jan. 1, 2018. Annually, you have the opportunity to re-examine your benefit needs and make any changes you choose. Once open enrollment begins, click here. Employees who are new hires or rehires during 2018 will receive an email notification to enroll in their benefits and will have 10 days from receipt of that email to make their benefit elections. Employees who experience a qualified life event (see chart on pages 38-40) have 30 days from the date of the life event to make benefit changes. Internal Revenue Service (IRS) regulations allow changes to benefits during an annual open enrollment or if an employee experiences a qualified life event.

How My Choice Rewards Works _______________________________________________________________________________ My Choice Rewards offers a variety of options under each benefit category. Each option has a different cost, corresponding to the degree of coverage provided. You can select a particular benefit category, depending on your changing needs. My Choice Rewards provides all full-time employees with credits to assist in purchasing their benefit selections. Part time employees do not receive credits. Once you’ve made all of your selections, simply add up the costs of each option and subtract them from your total credits. If you’ve chosen to purchase more benefits than you have credits for, the difference will be subtracted from your pay in equal amounts per pay period. Most benefits can be purchased on a pre-tax basis, with the exception of dependent life insurance and voluntary benefits.

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The benefits offered under My Choice Rewards are designed to conform to Section 125 of the Internal Revenue Code, and as such may provide significant tax advantages to you as well as Henry Ford Health System. To maintain its tax-qualified status, the My Choice Rewards plan must adhere to the regulations established by the IRS. These requirements will be summarized in the appropriate sections of this workbook. This workbook is intended to summarize the key features of each benefit offered under My Choice Rewards. You are encouraged to consult with your financial planner or tax advisor before making your benefit selections. HFHS reserves the right to modify or discontinue any of its benefits at any time.

YOUR MY CHOICE REWARDS SELECTIONS

Eligible employees may purchase benefits from the following categories: • Medical/vision • Dental • Standalone vision • Employee term life insurance • Dependent term life insurance • Accidental death and dismemberment (AD&D) • Long-term disability • Health savings (HSA) • Health care flexible spending (FSA) • Dependent care flexible spending (FSA) • Critical illness insurance • Accident insurance • Group legal insurance • Identity theft insurance

TAX IMPLICATIONS The Social Security benefit you will be eligible to receive is based in part on the amount of income you have that is subject to Social Security tax. By enrolling in My Choice Rewards, you will have less income subject to Social Security taxes. Consequently, the benefits you or your family may receive from Social Security may be reduced based on the amount of the reduction in your pay as a result of your pretax contributions for My Choice Rewards.

ALL BENEFITS-ELIGIBLE EMPLOYEES, INCLUDING THOSE WHO HAVE NO CHANGES TO THEIR BENEFITS, ARE ENCOURAGED TO REVIEW THEIR BENEFITS ONLINE. You must go online and enroll:  If you want to choose a different plan or option.  If you want to update your dependents.  If you participate in a flexible spending , you must re-enroll in that .  If you participate in a health savings , you must re-enroll in that .  If you cover your spouse on a Henry Ford medical plan. You must complete an online Spouse Verification Form every year or you will be assessed a surcharge.

Dependent Eligibility/ Documentation __________________________________________________________________________ Documentation for newly-added dependents is required. It is your responsibility to ensure that only people who are eligible for dependent coverage are covered by your HFHS benefits. This helps keep benefits costs at reasonable levels for everyone. Use the following guidelines to determine if your enrolled dependents meet eligibility requirements:

Eligible dependents: • Your spouse.

• Young adult children may remain on your benefits plan through the end of the month they turn 26. They do not have to be your IRS dependent, full-time student, or live with you. They can also be married. • Any unmarried disabled child regardless of age who depends primarily on you for , provided the physical or mental disability occurred before age 19. • “Child” is defined as natural children, legally adopted children (including children placed for adoption for whom legal adoption proceedings have started), step-children, and alternate recipients under qualified medical child orders (QMCSO), and any other child for whom you have obtained legal guardianship and who is in a regular parent-child relationship.

• You may also cover certain sponsored dependents. Sponsored dependents are age 20 or older, related to you by blood or marriage and residing in your household, and claimed as dependents on your most recent tax return.

Ineligible dependents:

• Your spouse becomes ineligible when he or she is no longer legally married to you. • Your child becomes ineligible at the end of the month he or she reaches age 26. • Your sponsored dependent when he or she no longer resides with you or is no longer claimed on your income tax return.

Acceptable forms of documentation are: Spouse • Proof of spousal relationship from any one of the following documents: - Copy of marriage license that includes date of marriage. - Copy of legal, presently valid marriage certificate. - Copy of the first page of the most recently filed federal income tax return that indicates “married filing tly.” Financial amounts may be blocked out. - Copy of the first page of the most recently filed federal income tax return that indicates “married filing separately.” Your spouse’s name must appear on the tax form on the line provided after the “married filing separately” status. Financial amounts may be blocked out. - Canadian employees who do not claim dependents on their U.S. federal income tax must submit their Canadian income tax form listing eligible dependents. If an identification number is used in place of a dependent name, documentation such as the social insurance number card must be submitted that links the dependent’s name to the identification number. Unmarried, natural and legally adopted children, and step-children (until the end of the month they reach age 26) • Proof of parent/child relationship from any one of the following documents: - Copy of legal birth certificate (employee must be listed as a parent), Canadian employees must provide the long form birth certificate. - Copy of hospital certificate (employee must be listed as parent and must include date of birth). 2018 MY CHOICE REWARDS

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- Affidavit of Parentage that is certified and filed with the state. - Copy of the first page of the most recently filed federal income tax return showing the child listed as a dependent and indicating that child lived with you. Financial amounts may be blocked out). - Canadian employees who do not claim dependents on their U.S. federal income tax must submit their Canadian income tax form listing eligible dependents. If an Identification Number is used in place of a dependent name, documentation such as the social insurance Number card must be submitted that links the dependent’s name to the identification number. - Copy of qualified medical child order (QMCSO). • Documentation from Social Security or physician certification of total and permanent disability incurred before age 19.

Sponsored dependent: • Copy of the first page of the most recently filed federal income tax return showing the individual listed as a dependent and indication that they lived with you. Financial amounts may be blocked out. • If your sponsored dependent is Medicare eligible, provide a copy of their Medicare card parts A and B AND a copy of the first page of the most recently filed federal income tax return as noted above.

MIDYEAR LIFE EVENTS Employees have 30 days to make changes to certain benefits when they experience a qualified midyear life event. For a list of life events and eligible changes see the midyear life event chart on pages 38-40.

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HEALTH PLANS FOR THOSE TURNING 26 HAP Personal Alliance provides coverage for individuals turning 26 and aging off their parents’ health plan. This is a life event that qualifies the individual to sign up by the end of the month the individual turns 26. During the special enrollment period, you or your dependent can obtain coverage under a separate contract/policy. Visit hap.org for more information on the policies designed for young adults.

NEW FOR 2018: The former HFHS Preferred Network and the Full HAP Network HMO are combined into a single plan

____________________________________________________________________________________________________________________________________ Medical plan designs for 2018 are intended to encourage employees and their families to receive their care from Henry Ford providers using HAP insurance products. The benefit to employees is lower out-of-pocket costs and high quality, coordinated care through Henry Ford providers. The HFHS Preferred Network and the Full HAP Network HMO options have been combined into one new medical option called the HFHS Advantage Tiered Access plan. The plan has two “in-network” tiers. Tier 1 has a network of HFHS and other providers and offers lower deductibles and co-pays. Employees may choose physicians from the Henry Ford Physician Network (HFPN), the Jackson Health Network and the Genesys Network. As a reminder, the HFPN includes the Henry Ford Medical Group, hospital-employed physicians and some private practice physicians on staff at Henry Ford facilities. Tier 1 also includes all Henry Ford facilities, as well as Genesys Regional Medical Center.

Tier 2 has a broader network of HAP providers and facilities but also comes with significantly higher deductibles and co-pays. This new plan encourages employees to use Henry Ford providers and facilities but does provide flexibility for those who may want or need to go outside Henry Ford for care without changing plans. Instead of choosing one plan over another at open enrollment, the two-tier system allows employees to determine the network they want to use at the time service is required. For example, if your P is in Tier 1 but you want to see a specialist in Tier 2, you can do that within this new, single-plan option. However, employees who use both tiers are required to meet the deductible maximums of both.

2018 MEDICAL PLAN CHANGES FORMER HFHS PREFERRED NETWORK

FORMER FULL HAP OPTION

THE TWO PLANS ARE NOW ONE PLAN...

NEW HFHS ADVANTAGE PLAN ...WITH TWO TIERS.

TIER 1 $$

Henry Ford Providers/Facilities Lower Deductibles & Co-pays

TIER 2 $$$$

Non Henry Ford Providers/Facilities Higher Deductibles & Co-pays

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Other important points to consider: • Employees who choose this option – whether they were in the HFHS Preferred or Full HAP option previously – will have the same per-pay contribution because it is now a single plan. • Employees previously enrolled in the HFHS Preferred Network (HMO) option who choose the new option will see their per pay contribution increase by $3.57 for employee only coverage and $21.52 for family coverage. • Employees in the current Full HAP option will see a per-pay decrease ranging from $39.67 for employee only coverage to $90.56 less for family coverage. Although this is a significant reduction for employees currently enrolled in the Full HAP option, it is important to think about the higher out of pocket costs associated with providers/services in Tier 2. Do not just focus on the reduced medical deduction taken from each pay. • Due to increased deductibles, co-pays and coinsurance in Tier 2, employees currently enrolled in the Full HAP Network option should review all medical plans - including the Consumer Driven Health Plans (CDHP) – and select the one that best meets their needs. See page 8 for details.

Employee contributions for other benefits Medical and dental s and contributions do change annually, however, this year an increase is being ed on to employees in the majority of plans. Effective Jan. 1: • Employees in the CDHP Basic Full HAP option will see a slight increase for employee only coverage at $2.19 per pay and $12.26 per pay for family coverage. • Employees in the CDHP Comprehensive HFHS Preferred option will see a slight increase of $1.13 for employee only coverage and $10.41 per pay for family coverage. • Employees in the CDHP Comprehensive Full HAP option will have an increase of $9.93 per pay for employee only coverage and $40.56 per pay for family coverage. • Employees in the Community Blue (PPO) option will have a significant increase of $55.77 per pay for employee only coverage and $134.71 per pay for family coverage. • Employees enrolled in the Dental options, Long Term Disability and the Standalone Vision options will have a slight decrease in their per pay contributions. • To simplify employee contributions for 2018, the medical credit of $25.38 per pay and the dental 7 2018 MY CHOICE REWARDS

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credit of $2.31 have already been reduced from the employee contributions and will no longer appear in the online enrollment process or on the paycheck. For employee medical contributions see pages 12 and 21. For employee vision and dental contributions see pages 23 and 26. The deductibles for the CDHP Comprehensive HFHS Preferred and CDHP Comprehensive Full HAP options are increasing slightly. For employee only, the deductible is $1,350 and for family coverage (two or more individuals) it is $2,700. The maximum limit employees may contribute to their HSA (including employer contributions) are increasing to $3,450 for an individual and $6,900 for family (two or more). The maximum limit for the health care flexible spending is increasing to $2,650.

Health Engagement is being replaced by Reward Your Health •

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The Health Engagement program has been redesigned and is taking wellness to a new level. Reward Your Health is the new wellness program for HFHS employees and their spouses enrolled in a HAP plan. Annual deductibles and co-pays will no longer be affected. Instead, employees and covered spouses who meet the requirements, will pay a lower employee contribution to their medical coverage each pay and/or receive funding to a health savings for those employees enrolled in one of the three CDHP options. For 2018, all employees enrolled in a HAP plan will receive the reduced employee contribution and/or funding to their HSA. To keep receiving this reward in 2019, employees and their covered spouse must meet the Reward Your Health wellness program requirements between Jan. 1 and July 31, 2018. Rewards are adjusted annually and communicated during open enrollment. Reward Your Health has five requirements that must be completed by employees and their covered spouse by July 31, 2018. 1. Know your numbers (BMI, blood pressure, cholesterol, fasting blood glucose) 2. Take your online health assessment 3. Be tobacco free 4. Complete a wellness activity 5. Commit to complete all recommended preventive screenings. Health Fairs will be conducted in the first quarter of 2018.

New Voluntary Benefit Options HFHS is offering accident insurance, critical illness insurance and identity theft protection insurance. These are new, voluntary benefits, which means there is a cost associated with them. • Accident insurance pays you benefits for specific injuries and events resulting from a covered accident that you or a family member may have on or after your coverage effective date. Critical illness insurance pays a lump-sum benefit if you are diagnosed with a covered illness or condition on or after your coverage effective date. Identity Theft coverage provides identity, financial and privacy protection. • As part of the online enrollment process, employees will now be able to enroll in any of the three new voluntary benefits options, as well as group legal. Employees no longer have to ARAG directly to enroll in the group legal plan. • HFHS continues to offer auto/home insurance, pet insurance and Purchasing Power, a purchasing program offering brand name products through payroll deduction. • To find out more go to HFHSVB.com or call 313-879-0755.

Integrative medicine program In 2017, Integrative medicine was launched as a pilot program. It will continue to be offered in 2018. Research shows that integrative medicine can help cancer patients with potential treatment side-effects. It also can reduce fatigue and stress, while improving physical function and sleep. With these quality of life outcomes in mind, massage therapy, acupuncture and yoga will be covered benefits for employees and their family with a cancer diagnosis within the past three years. Eligibility for the program is limited and requires employees and their family be enrolled in the CDHP Comprehensive HFHS Preferred or the new HFHS Advantage Tiered Access options (Tier 1 only). Services can be received at the following locations: • Center for Athletic Medicine – Detroit • Henry Ford Medical Center – Cottage • Henry Ford Medical Center – Novi • Henry Ford West Bloomfield – Vita • Henry Ford Macomb – Wellspring • Quick Care Clinic – Detroit

A $20 co-pay per visit will be applied to massage therapy and acupuncture benefits. There is no co-pay for yoga. For more information about the pilot program, HAP. Employees and their family who do not meet the requirements to participate in the program can still receive 20% off at the Henry Ford Center for Integrative Medicine in Novi, Grosse Pointe, the QuickCare Clinic in Detroit and Vita in West Bloomfield. Wellspring in Macomb provides discounts for certain services as well. To make an appointment, call the Center for Integrative Medicine at 248-3806201 or Vita at 248-325-3870.

Health Care Coverage __________________________________________________________________________ For most of us, health care coverage is the first thing that comes to mind when we hear the word “benefits.” Satisfying our family’s health care needs is a significant concern for many of us. HFHS understands this and continues to offer medical/vision and dental options to meet these needs. You can enhance your health care coverage by carefully reviewing every option and considering how each will work with the other plans in the My Choice Rewards program or other coverage you may have. For example, if you choose a medical/vision plan option with co-pays, you may want to put pretax dollars in a Health Care FSA to cover the total co-pays you expect to incur during the year.

Consumer Driven Health Plans (CDHP) HFHS offers three CDHP Plans.

CDHP Basic Full HAP – This plan provides catastrophic care only. This plan protects you from worst-case scenarios like serious accidents or illnesses. While the employee contribution is low, the deductible is $4,500 for an individual and $9,000 for family (two or more individuals). Employees must pay the full cost of their medical services, including prescription drugs, until the deductible has been reached. Preventive care is covered at 100% and the deductible does not apply. This option allows to choose from a broader network of HAP d providers.



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CDHP Comprehensive HFHS Preferred Network – Employees choosing this option are required to use CDHP HFHS Preferred Network providers. Employees must pay the full cost of their medical services, including prescription drugs, until the deductible has been reached. The deductible is $1,350 for an individual and $2,700 for family (two or more individuals). Preventive care is covered at 100% and the deductible does not apply. By selecting the CDHP Comprehensive HFHS Preferred HMO, employees and their dependents will receive services from providers and facilities comprised of HFPN, Jackson Health Network and Genesys PHO. Enrollees must select a JHN, HFPN or Genesys PHO primary care physician and can see any specialist within the preferred network. Enrollees will have access to all of the pediatric (dependents 18 & under) and OB/GYN providers who are in a HAP d network.

Health Saving s

All CDHP plans offer a Henry Ford-funded health savings (HSA). HSAs offer flexibility when it comes to planning for medical costs now and in the future. • For employees who enroll in any of the CDHP options, Henry Ford will contribute $500 (single), $750 (two people) or $1,000 (family) to the HSA by Jan. 3, 2018, which can be used toward the deductible. • Employees also may contribute to their HSA using pretax dollars. The annual limit combining the Henry Ford and employee contributions is $3,450 for an individual or $6,900 for a family (two or more individuals). Employees over age 55 may contribute an additional $1,000 over the maximum amounts listed above. • HSA funds roll over from year to year and the benefit is portable between employers and even into retirement. This makes it a good way to save for future medical 9 2018 MY CHOICE REWARDS

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CDHP Comprehensive Full HAP – Employees who choose this option will pay more than the CDHP Basic Full HAP option depending on their level of coverage (single, two-person or family.) Employees choosing this option may choose any provider within the broader HAP network. Employees must pay the full cost of their medical services, including prescription drugs, until the deductible has been reached. The deductible is $1,350 for an individual and $2,700 for family (two or more individuals). Preventive care is covered at 100% and the deductible does not apply.

HEALTH SAVINGS

If you plan to contribute to an HSA in 2018 and you currently are enrolled in the health care FSA for 2017, be sure that the balance of your health care FSA is $0.00 on Dec. 15, 2017 in order for you to contribute and receive the employer funding to your HSA on Jan. 3, 2018. If your health care FSA balance is $0.00 on Dec. 31, you can expect to receive your contributions and the employer funding on Jan. 12. If your health care FSA balance is not $0.00 on Dec. 31, your contributions and the employer funded portion will be deposited on payday Friday, April 6, 2018. Claims must be paid and reimbursed by Dec. 31 not incurred or in a review status.

costs in retirement. In addition to saving for retirement, there are opportunities to invest your HSA contributions. • If you participate in one of the CDHPs with an HSA you cannot enroll in the health care flexible spending (FSA). You are still eligible for the dependent care FSA. • There are eligibility requirements to participate in the HSA. For example, if you have Medicare or are eligible for Canadian Health Care, you are not eligible. For these and other HSA details, visit http://healthequity.com. • HealthEquity is the vendor used for the HSA and FSA programs. • New hires, benefit status changes and mid-year events after Jan. 1 will have the employer contribution prorated.

Additional Medical Options

In addition to the CDHP options, My Choice Rewards is offering the HFHS Advantage Tiered Access plan (see page 17) and continues to offer Community Blue PPO and Manulife. Community Blue PPO allows employees to choose from the broadest network of providers at the highest employee contribution level. For a Community Blue PPO directory go to bcbsm.com.

Health Engagement Achieve is being replaced with Reward Your Health __________________________________________________________________________ The Health Engagement program has been redesigned and is taking wellness to a new level. Reward Your Health is the new wellness program for HFHS employees and their spouses enrolled in a HAP plan.

For 2018, all employees enrolled in a HAP plan will receive the reduced employee contribution and/or funding to their HSA. To keep receiving this reward in 2019, you and your covered spouse must meet the Reward Your Health wellness program requirements between Jan. 1 and July 31, 2018. Rewards are adjusted annually and communicated during open enrollment. Who’s eligible? • All employees enrolled in a HAP health plan. If you have a covered spouse, both you and your spouse must complete all requirements. • All new hires and employees new to a HAP health plan from Jan. 1 to March 31, 2018. When do I participate? • Jan. 1 through July 31, 2018. • All requirements must be completed and submitted by July 31, 2018. You’re encouraged to start early so you can meet the requirements by July 31.

1. Know your numbers (BMI, blood pressure, cholesterol, fasting blood glucose) 2. Take your online health assessment 3. Be tobacco free 4. Complete a wellness activity 5. Commit to complete all recommended preventive screenings. Health Fairs will be conducted in the first quarter of 2018. For additional details about Reward Your Health, click here. NG YOUR BEN IZI

You and your dependents can change your P and remain part of the CDHP HFHS Preferred Network option, as long as the new P is part of the CDHP HFHS Preferred Network. Changing your P will not affect your contribution for medical coverage. Changing your network assignment will affect your medical contribution. If you need to change from the CDHP Henry Ford Preferred Network option to the CDHP Basic or Full HAP option, you will continue to have a pre-tax deduction up to the cost of the CDHP Henry Ford Preferred Medical option. The added contribution will be an after-tax deduction. ITS EF

Annual deductibles and co-pays will no longer be affected. Instead, employees and covered spouses who meet the requirements, will pay a lower employee contribution to their medical coverage each pay and/or receive funding to a health savings for those employees enrolled in one of the three CDHP options.

What are the requirements? Reward Your Health has five requirements that must be completed by the employee and their covered spouse by July 31, 2018.

OPT IM

Manulife is offered to Canadian residents only. The plan is designed to subsidize Canada’s OHIP insurance and is not intended to provide a full range of services. For more information click here.

For example, if you have single coverage under the CDHP Henry Ford Preferred option at $33.89 per pay pre-tax, and you change your network selection to the CDHP Full HAP Network option, which is $77.47 per pay pre-tax, your pre-tax contribution will be $33.89 and your aftertax contribution will be $43.58 per pay for the remainder of the year.

What do I earn? A reduction in the contribution you pay for medical coverage for plan year 2019 based on your benefit plan and/or a health savings contribution. 2018 MY CHOICE REWARDS

10

Henry Ford MyChart Patient Portal This online tool offers patients a convenient way to manage their health care. MyChart is secure, free and available 24 hours per day. MyChart can be viewed on the internet or on various smartphone applications. Some of the key features include: • Message with your Henry Ford physician’s office • Review most lab and x-ray results when they become available • Have an e-visit (a non-urgent electronic visit) with your Henry Ford primary care physician for select conditions • Schedule return visit appointments with primary care and certain other physicians • View your appointment schedule and cancel appointments • Request prescription renewals and receive a message when the prescription has been sent to the pharmacy • Review key medical record information including current health issues, allergies, medications and summaries from office visits or hospital issions • Enter home monitoring information like home blood pressure, weight or glucose readings • View and pay your HFHS patient . With a MyChart Proxy , you can access all of the above information for your minor children. (A Parent or Legal Guardian of a minor may be granted permission to view the child’s record up to age 18 upon which permission will be revoked. Children between the ages 0-13, the parent/guardian has full functionality to view and act on behalf of the child within MyChart. In line with HIPAA regulations, children ages 14 to 17, the parent/guardian may only ‘Request an Appointment’ and view billing information on behalf of the child. They will not be able to view any medical information in the child’s record.) Seniors and others who may want help managing their health care can give proxy access to another adult.

11 2018 MY CHOICE REWARDS

Choose Wisely Don’t base your medical plan decision solely on the per pay contribution. Selecting the least costly plan could actually cost you more. For example, the Consumer Driven Basic Full HAP option per pay contribution is $25.90 for employee only coverage. However, you are required to pay $4,500 out of pocket for all your medical care including prescription drugs. Only preventive care is covered at 100% without having to meet the deductible.

2018 CDHPEmployee EMPLOYEE CONTRIBUTIONS 2018 CDHP Contributions (per pay) (PER PAY) CDHP BASIC Full HAP Network (EPA)*

CDHP Comprehensive Preferrred Network (HMO)**

CDHP Comprehensive Full HAP Network (EPA)**

Single Two Person Family

$25.90 $73.81 $90.21

$33.89 $65.36 $79.89

$77.47 $174.30 $213.04

Part Time

Single Two Person Family

$51.79 $132.08 $161.43

$70.20 $147.07 $179.75

$113.78 $256.01 $312.90

Highly Compensated ($270,000+)

Single Two Person Family

$41.44 $118.09 $144.34

$54.23 $104.58 $127.82

$123.95 $278.88 $340.88

N/A $225.99

N/A $315.25

N/A $319.98

Status Full Time*

Medical Plan Coverage Levels

Sponsored With Medicare Dependent Cost Without Medicare

Vision Included

Vision Included

Vision Included

* Plan has deductibles of $4,500 / $9,000 that must be paid by you before benefits are paid by the plan (including prescription drugs). ** Plans have deductibles of $1,350 / $2,700 that must be paid by you before benefits are paid by the plan (including prescription drugs).

Save time and hassles. Go paperless with HAP. Did you know that HAP offers secure electronic delivery of Explanation of Benefits (EOB) to its ? You currently can view your EOBs online, but now you have the option to stop receiving paper copies altogether. To enroll, at hap.org and follow the prompts. If you sign up, you’ll be notified by email each time an EOB is posted on the HAP secure member portal. This hassle-free method of EOB delivery is fast, safe and convenient – good for the environment and a great way for HAP and HFHS to save costs. For questions or more information, call 866-766-4709.

2018 MY CHOICE REWARDS

12

2018 Medical Plan Options

following pages provide comparisons between the level of benefits offered in the various medical options available to 2018The Medical Options and your thisbetween information carefully to make benefits meet youravailable family’stoneeds. not only at The you following pagesfamily. provide Review comparisons the level of benefits offeredsure in thethe various medical options you andLook your family. Review thisyour information to make sure meet yourbut family's needs. Look not only at the whatplan your will payroll be out-offor what payrollcarefully contribution will bethe forbenefits this coverage, more importantly what paycontribution and whatwill your this pocket coverage, but more importantly what the plan will pay and what your out-of-pocket costs will be. The least costly plan based on a deduction costs will be. The least costly plan based on a deduction from your paycheck, could turn out to be the most costly from your paycheck, could turn out to be the most costly plan for you and your family when you factor in what you pay out-of-pocket when you plan for you and your family when you factor in what you pay out-of-pocket when you see your provider. see your provider. Health Care Services Benefit Period and Annual Deductible Maximums Benefit Period

Annual Deductible Co-Insurance (amount member pays)

Annual Out of Pocket Maximums Preventive Services Preventive Office Visit Related Laboratory and Radiology Services Pap Smears, mammograms and Tubal Ligation Immunizations Outpatient and Physician Services Personal Care Office Visit Telehealth Visit Speciality Physician Office Visit Gynecology Office Visit Audiology Office Visit Eye Exam Office Visit Allergy Treatment and Injections Laboratory and Pathology Imaging MRI's, CT & PET Scans Radiology (Xray) Radiation Therapy & Chemotherapy Dialysis Outpatient Surgery Chiropractic Emergency/Urgent Care Emergency Room Services Urgent Care Emergency Medical Transportation Inpatient Hospital Services Facility Fee Physician Services, Surgery, Therapy, Laboratory, Radiology, Hospital Services and Supplies Bariatric Surgery & Related Services Maternity Services Prenatal Office Visit Postnatal Office Visits Labor, Deliver and Newborn Care

13 2018 MY CHOICE REWARDS

CONSUMER DRIVEN HEALTH PLAN (CDHP) CDHP COMPREHENSIVE HFHS CDHP COMPREHENSIVE FULL LIMITATIONS* PREFERRED HMO HAP EPA Calendar Year $1,350 Self Only, $2,700 Family Deductible does not include copays or If more than one person is covered under this plan, all family must coinsurance. Deductible applies to the collectively meet the family coverage amounts. annual Out-of-Pocket Maximum None

$6,550 Self Only; $13,100 Family Not to exceed $6,550 for any one person Covered. Deductible does not apply

Covered. Deductible does not apply

Covered. Deductible does not apply

Covered. Deductible does not apply

Covered. Deductible does not apply

Covered. Deductible does not apply

Covered. Deductible does not apply

Covered. Deductible does not apply

$20 Copay after the deductible

$20 Copay after the deductible

$20 Copay after the deductible

$20 Copay after the deductible

$40 Copay after the deductible $20 Copay after the deductible $40 Copay after the deductible

$40 Copay after the deductible $20 Copay after the deductible $40 Copay after the deductible

$40 Copay after the deductible

$40 Copay after the deductible

Covered after Deductible Covered after Deductible Covered after Deductible Covered after Deductible Covered after Deductible Covered after Deductible $100 Copay after Deductible Not Covered

Covered after Deductible Covered after Deductible Covered after Deductible Covered after Deductible Covered after Deductible Covered after Deductible $100 Copay after Deductible Not Covered

$150.00 Copay after the deductible $50 Copay after the deductible Covered after the deductible

These values do not accumulate: s, balance-billed charges and health care this plan doesn't cover. All other cost sharing accumulates

Must be performed by Plan's contracted telehealth services provider

One routine eye exam per benefit period at no cost share

Copay waived if itted Emergency transport only

$100 Co-pay per ission Covered after Deductible $500 Copay after Deductible

$500 Copay after Deductible

Covered. Deductible does not apply Covered. Deductible does not apply See Inpatient Services

Limited to one procedure per lifetime.

2018 Medical Plan Options (continued) CONSUMER DRIVEN HEALTH PLAN (CDHP)

Health Care Services Benefit Period and Annual Deductible Maximums Mental Health & Substance Use Disorder Inpatient Services Outpatient Services Other Services: Home Health Care Hospice Care

CDHP COMPREHENSIVE HFHS PREFERRED HMO

CDHP COMPREHENSIVE FULL HAP EPA

LIMITATIONS*

See Inpatient Services $20 Co-pay after the deductible Covered after deductible Covered after deductible Covered after deductible

Skilled Nursing Care

Covered after deductible

Durable Medical Equipment, Prosthetics & Orthotics Hearing Aid Hardware Rehabilitation Services, Physical, Speech and Occupational Therapy

Covered after deductible Covered after deductible

Covered after deductible

Habilitation Services Voluntary Sterilizations

$100 Copay after Deductible Covered after deductible

Infertility Services Covered after deductible

Assisted Reproductive Technologies

HFHS Preferred Pharmacy

Any Other Contracted Pharmacy

30 day supply: $4 / $27 / $45 copay after deductible

30 day supply: $15 / $40 / $60 copay after deductible

Pharmacy

Generic/ Preferred Brand/ Non-Preferred Brand

90 day supply: $12 / $67 / $105 copay after deductible

90 day supply: $30 / $90 / $120 copay after deductible

Unlimited 210 days per lifetime Covered for authorized services. Up to 730 days renewable after 60 days of nonconfinement Coverage provided for approved equipment based on AHLIC's* guidelines Covered for conventional hearing aid May be rendered at home. 80 combined visits per benefit period Limited to Applied Behavioral Analysis (ABA) and Physical, Speech and Occupational Therapy services associated with the treatment of Autism Spectrum Disorders through age 18. Covered for authorized services only. See Outpatient Mental Health for ABA cost share amount. Limited to Vasectomy Services for diagnosis, counseling and treatment of anatomical disorders causing infertility in accordance with AHLIC's benefit referral and practice policies One attempt of artifical insemination per lifetime

A 90-day supply of non-Maintenance drugs must be filled at AHLIC's designated mail order pharmacy. Other exclusions and Limitiations may apply

NG YOUR BEN IZI

ITS EF

OPT IM

*Alliance Health and Life Insurance Company *Hospital issions require that AHLIC be notified within 48 hours of ission. Failure to notify AHLIC within 48 hours could result in a reduction of benefits, or non-payment. *Students away at school are covered for acute illness and injury related services according to AHLIC criteria. *In cases of conflict between this summary and your Self-Funded Benefit Guide, the and conditions of the Self-Funded Benefit Guide govern. Some services require prior authorization. Failure to obtain prior authorization before services are received could result in a denial of benefits.

CHECK OUT ALEX An interactive decision-making tool called “Alex” allows you to compare benefit choices and helps you decide on the best choices for you and your family. Athough “Alex” will provide recommendations, you will make the decision about what’s best for you and your family. “Alex” is available on Employee Self Service.

2018 MY CHOICE REWARDS

14

2018 Medical Plan Options (continued) Health Care Services Benefit Period and Annual Deductible Maximums Benefit Period

Annual Deductible Co-Insurance (amount member pays)

Annual Out of Pocket Maximums Preventive Services Preventive Office Visit Related Laboratory and Radiology Services Pap Smears, mammograms and Tubal Ligation Immunizations Outpatient and Physician Services Personal Care Office Visit

CONSUMER DRIVEN HEALTH PLAN (CDHP) CDHP Basic Full HAP EPA Calendar Year $4,500 Self Only; $9,000 Family Not to exceed $6,550 for any one person

$6,550 Self Only; $13,100 Family Not to exceed $6,550 for any one person

These values do not accumulate: s, balance-billed charges and health care this plan doesn't cover. All other cost sharing accumulates

Covered. Deductible does not apply Covered. Deductible does not apply Covered. Deductible does not apply Covered. Deductible does not apply $20 Copay after the deductible $20 Copay after the deductible $40 Copay after the deductible $20 Copay after the deductible $40 Copay after the deductible

Eye Exam Office Visit Allergy Treatment and Injections Laboratory and Pathology Imaging MRI's, CT & PET Scans Radiology (Xray) Radiation Therapy & Chemotherapy Dialysis Outpatient Surgery Chiropractic Emergency/Urgent Care Emergency Room Services Urgent Care Emergency Medical Transportation Inpatient Hospital Services

$40 Copay after the deductible Covered after Deductible Covered after Deductible Covered after Deductible Covered after Deductible Covered after Deductible Covered after Deductible $100 Copay after Deductible Not Covered

15 2018 MY CHOICE REWARDS

Deductible does not include copays or coinsurance. Deductible applies to the annual Out-of-Pocket Maximum

20%

Telehealth Visit Speciality Physician Office Visit Gynecology Office Visit Audiology Office Visit

Facility Fee Physician Services, Surgery, Therapy, Laboratory, Radiology, Hospital Services and Supplies Bariatric Surgery & Related Services Maternity Services Prenatal Office Visit Postnatal Office Visits Labor, Deliver and Newborn Care

LIMITATIONS*

$150.00 Copay after the deductible $50 Copay after the deductible Covered after the deductible

Must be performed by Plan's contracted telehealth services provider

One routine eye exam per benefit period at no cost share

Copay waived if itted Emergency transport only

$100 Co-pay per ission after deductible Covered after Deductible $500 Copay after Deductible Covered. Deductible does not apply Covered. Deductible does not apply See Inpatient Services

Limited to one procedure per lifetime.

2018 Medical Plan Options (continued) Health Care Services Benefit Period and Annual Deductible Maximums Mental Health & Substance Use Disorder Inpatient Services Outpatient Services Other Services: Home Health Care Hospice Care Skilled Nursing Care Durable Medical Equipment, Prosthetics & Orthotics Hearing Aid Hardware Rehabilitation Services, Physical, Speech and Occupational Therapy

Habilitation Services Voluntary Sterilizations

CONSUMER DRIVEN HEALTH PLAN (CDHP) CDHP Basic Full HAP EPA

LIMITATIONS*

See Inpatient Services $20 Co-pay after the deductible Covered after deductible Covered after deductible

Unlimited 210 days per lifetime Covered for authorized services. Up to 730 days renewable after 60 days of nonconfinement Coverage provided for approved equipment based on AHLIC's guidelines Covered for conventional hearing aid May be rendered at home. 80 combined visits per benefit period

Covered after deductible Covered after deductible Covered after deductible Covered after deductible

Limited to Applied Behavioral Analysis (ABA) and Physical, Speech and Occupational Therapy services associated with the treatment of Autism Spectrum Disorders through age18. Covered for authorized services only. See Outpatient Mental Health for ABA cost share amount. Limited to Vasectomy Services for diagnosis, counseling and treatment of anatomical disorders causing infertility in accordance with AHLIC's benefit referral and practice policies One attempt of artifical insemination per lifetime

Covered after deductible $100 Copay after Deductible

Infertility Services

Covered after deductible

Assisted Reproductive Technologies Pharmacy

Covered after deductible

Generic/ Preferred Brand/ Non-Preferred Brand/Specialty Drug Co-Pay

30 day supply: 20% Coinsurance after the deductible 90 day supply: 20% Coinsurance after the deductible

A 90-day supply of non-Maintenance drugs must be filled at AHLIC's designated mail order pharmacy. Other exclusions and Limitiations may apply

*Hospital issions require that AHLIC be notified within 48 hours of ission. Failure to notify AHLIC within 48 hours could result in a reduction of benefits, or non-payment. Option

Annual Deductible (Individual/Family)

Annual Out of Pocket Limit (OOP) (Individual/Famly)

How the Family Deductible Works

CDHP Basic Full $4,500 / $9,000 $6,550 / $13,100 For family coverage, all family Network work HAP together to meet the family deductible. However, the most any one person in the family will pay toward the deductible is $6,550 (the individual OOP limit). Once a family member meets this amount, HAP pays the entire amount of his/her covered services for the rest of the benefit period. Once the family collectively meets the $9,000 deductible, all family are considered to have met the deductible. CDHP Comprehensive $1,350 / $2,700 $6,550 / $13,100 HFHS Preferred

For family coverage, all family work together to meet the family deductible amount. When one person in the family or all of the family collectively meet the $2,700 deductible, all family are considered to have met the deductible.

2018 MY CHOICE REWARDS

16

2018 Medical Plan Options (continued) HFHS ADVANTAGE TIERED ACCESS PLAN

Health Care Services Benefit Period and Annual Deductible Maximums Benefit Period Annual Deductible Co-Insurance (amount member pays)

TIER 1

TIER 2

Calendar Year $250 Individual; $1,250 Individual; $500 Family (2 or more) $2,500 Family (2 or more) None

30% $6,850 Individual; $13,700 Family (more than 2)

Annual Out of Pocket Maximums Preventive Services Preventive Office Visit Related Laboratory and Radiology Services Pap Smears, mammograms and Tubal Ligation Immunizations Outpatient and Physician Services Personal Care Office Visit Telehealth Visit Speciality Physician Office Visit Gynecology Office Visit Audiology Office Visit Eye Exam Office Visit Allergy Treatment and Injections Laboratory and Pathology Imaging MRI's, CT & PET Scans Radiology (Xray) Radiation Therapy & Chemotherapy Dialysis Outpatient Surgery Chiropractic Emergency/Urgent Care Emergency Room Services Urgent Care Emergency Medical Transportation Inpatient Hospital Services Facility Fee Physician Services, Surgery, Therapy, Laboratory, Radiology, Hospital Services and Supplies Bariatric Surgery & Related Services Maternity Services Prenatal Office Visit Postnatal Office Visits Labor, Deliver and Newborn Care

17 2018 MY CHOICE REWARDS

Covered. Deductible does not apply

Covered. Deductible does not apply

Covered. Deductible does not apply

Covered. Deductible does not apply

Covered. Deductible does not apply

Covered. Deductible does not apply

Covered. Deductible does not apply

Covered. Deductible does not apply

$20 Copay. Deductible does not apply

$40 Copay. Deductible does not apply

$20 Copay. Deductible does not apply

Not Covered

$40 Copay. Deductible does not apply $20 Copay. Deductible does not apply $40 Copay. Deductible does not apply $40 Copay. Deductible does not apply Covered after Deductible Covered after Deductible Covered after Deductible Covered after Deductible Covered after Deductible Covered after Deductible $100 Copay after Deductible Not Covered

$80 Copay. Deductible does not apply $40 Copay. Deductible does not apply $80 Copay. Deductible does not apply $80 Copay. Deductible does not apply 30% Coinsurance after Deductible 30% Coinsurance after Deductible 30% Coinsurance after Deductible 30% Coinsurance after Deductible 30% Coinsurance after Deductible 30% Coinsurance after Deductible 30% Coinsurance after Deductible Not Covered

$200 Copay. Deductible does not apply $50 Copay. Deductible does not apply Covered after Tier 1 Deductible $100 Co-pay per ission after deductible

30% Coinsurance after Deductible

Covered after Deductible

30% Coinsurance after Deductible

$500 Copay after Deductible

Not Covered

Covered. Deductible does not apply

Covered. Deductible does not apply

Covered. Deductible does not apply

Covered. Deductible does not apply

See Inpatient Services

30% Coinsurance after Deductible

LIMITATIONS* Deductible does not include copays or coinsurance. Deductible applies to the annual Out-ofPocket Maximum These values do not accumulate. s, balance-billed charges and health care this plan doesn't cover. All other cost sharing accumulates

Must be performed by Plan's contracted telehealth services provider

One routine eye exam per benefit period at no cost share

Copay waived if itted Emergency transport only

Limited to one procedure per lifetime. Must be performed at a Henry Ford Facility

2018 Medical Plan Options (continued) HFHS ADVANTAGE TIERED ACCESS PLAN

Health Care Services Benefit Period and Annual Deductible Maximums Mental Health & Substance Use Disorder Inpatient Services

TIER 1

TIER 2

See Inpatient Services $20 Co-pay. Deductible does not apply

30% Coinsurance after Deductible $20 Copay. Deductible does not apply

Covered after deductible

30% Coinsurance after Deductible

Covered after deductible

30% Coinsurance after Deductible

Covered after deductible

30% Coinsurance after Deductible

Durable Medical Equipment, Prosthetics & Orthotics Hearing Aid Hardware

Covered after deductible

30% Coinsurance after Deductible

Covered after deductible

Not Covered

Rehabilitation Services, Physical, Speech and Occupational Therapy

Covered after deductible

30% Coinsurance after Deductible

Outpatient Services Other Services: Home Health Care Hospice Care

Skilled Nursing Care

Habilitation Services Voluntary Sterilizations

Covered after deductible

30% Coinsurance after Deductible

$100 Copay after Deductible

30% Coinsurance after Deductible

Covered after deductible

30% Coinsurance after Deductible

Covered after deductible

30% Coinsurance after Deductible

Covered after Deductible

30% Coinsurance after Deductible

HFHS Preferred Pharmacy

Any Other Contracted Pharmacy

30 day supply: $4 / $27 / $45 / $100 co-pay

30 day supply: $20 / $40 / $80 / $100 co-pay

90 day supply: $12 / $67 / $105 / $100 co-pay

90 day supply: $40 / $80 / $160 / $100 co-pay

Infertility Services Assisted Reproductive Technologies Temporomandibular t (TMJ) Disorder Pharmacy

Generic/ Preferred Brand/ Non-Preferred Brand/Specialty Drug Co-Pay

LIMITATIONS*

Unlimited 210 days per lifetime (Combined in Tiers 1 & 2) Covered for authorized services. Up to 730 days renewable after 60 days of nonconfinement (Combined Tiers 1 & 2) Coverage provided for approved equipment based on AHLIC's guidelines Covered for conventional hearing aid May be rendered at home. 80 combined visits per benefit period (Combined in Tiers 1 & 2) Limited to Applied Behavioral Analysis (ABA) and Physical, Speech and Occupational Therapy services associated with the treatment of Autism Spectrum Disorders through age 18. Covered for authorized services only. See Outpatient Mental Health for ABA cost share amount. Limited to Vasectomy Services for diagnosis, counseling and treatment of anatomical disorders causing infertility in accordance with AHLIC's benefit referral and practice policies One attempt of artifical insemination per lifetime Limited to non-invasive reversible procedures only A 90-day supply of non-Maintenance drugs must be filled at AHLIC's designated mail order pharmacy. Other exclusions and Limitiations may apply

*Hospital issions require that AHLIC be notified within 48 hours of ission. Failure to notify AHLIC within 48 hours could result in a reduction of benefits, or non-payment. *Students away at school are covered for acute illness and injury related services according to AHLIC criteria. *In cases of conflict between this summary and your Self-Funded Benefit Guide, the and conditions of the Self-Funded Benefit Guide gover. Some services reuire prior authorization. Failure to obtain prior authorization before services are received could result in a denial of benefits.

2018 MY CHOICE REWARDS

18

2018 Medical Plan Options (continued) BCBSM Community Blue PPO

Health Care Services Benefit Period and Annual Deductible Maximums: Benefit Period

Annual Deductible Co-Insurance (amount member pays)

Out of Pocket Maximums Preventive Services: Preventive Office Visit Well Baby/Child Exam Immunization Related Laboratory and Radiology Services

Pap Smears and mammograms Outpatient and Physician Services: Primary Care Office Visit Specialty Physician Office Visit Gynecology Audiology Examinations Eye Examinations Allergy Treatment and Injections Laboratory and Radiology Services Dialysis Chemotherapy Radiation Outpatient/Office Surgery & Related Services Chiropractic Emergency/Urgent Care:

Emergency Room Services Urgent Care Facility Services

In Network

Out of Network

Calendar Year $250 Individual; $500 Family (Waived if service is performed in a $250 Individual; $500 Family physician's office and for covered inpatient Out of network deductible amounts also and outpatient facility services provided at apply toward the in network deductible HFHS facilities) None $6,850 Individual; $13,700 Family (2 or more)

$6,850 Individual; $13,700 Family (2 or more)

Covered; One per member per calendar year Covered; One per member per calendar year Covered Covered

Not Covered Not Covered

Pap Smear covered; Mammogram covered; One per member per year

$15 Co-Pay $15 Co-Pay Covered; One per member per calendar year Covered; One every 36 months Covered; one eye exam in any period of 12 consecutive months Covered Covered 80% after deductible Covered 80% after deductible Covered 80% after deductible Covered 80% after deductible Covered 80% after deductible

Labor, Deliver and Newborn Care

19 2018 MY CHOICE REWARDS

Not Covered

$125 Co-pay Co-pay waived if itted or for an accidental injury Covered at 60% after deductible; Must be medically necessary Covered 60% after deductible or Covered 80% after deductible in States (like Michigan) where there is no provider network.

$50 Co-pay Covered 80% after deductible

Bariatric Surgery & Related Services Maternity Services: Initial Office Visit to Confirm Pregnancy Subsequent Prenatal and Postnatal Office Visits

Covered 60% after deductible; must be medically necessary Covered 60% after deductible

Not Covered Up to a maximum payment of $25 per exam (member responsible for difference) Covered 60% after deductible Covered 60% after deductible Covered 60% after deductible Covered 60% after deductible Covered 60% after deductible Covered 60% after deductible Covered 60% after deductible; Limited to a $15 Co-pay per visit (up to a maximum of 24 combined maximum of 24 visits per member visits per member per calendar year) per calendar year

Emergency Ambulance Services Inpatient Hospital Services: Hospital Inpatient stay in semi-private room, specialty units as medically necessary, physician services, surgery, therapy, laboratory, radiology, hospital services and supplies

Not Covered Not Covered Pap Smear Not Covered; Mammogram 60% after deductible One per member per year

Covered 80% after deductible

Covered 60% after deductible

Covered 80% after deductible; must meet specific criteria

Covered 60% after deductible; must meet specific criteria

Covered

Covered

Covered 80% after deductible; includes delivery by a certified nurse midwife

Covered 60% after deductible

Covered; 60% after deductible; Includes delivery by a certified nurse midwife

2018 Medical Plan Options (continued) BCBSM Community Blue PPO

Health Care Services Benefit Period and Annual Deductible Maximums: Mental Health: Inpatient Services

In Network

Out of Network

Covered 80% after deductible

Covered 60% after deductible Covered 80% after deductible in participating facilities only; Covered 60% after deductible in physician's office

Covered 80% after deductible Outpatient Services Chemical Dependency: Inpatient Services Outpatient Services Other Services: Home Health Care

Covered 80% after deductible

Covered 60% after deductible

Covered 80% after deductible in approved facilities only Covered 80% after deductible

Covered 60% after deductible

Covered; provided through a participating hospice program only; limited to dollar maximum that is reviewed and adjusted periodically Hospice Care

Skilled Nursing Care Durable Medical Equipment; Prosthetics & Orthotics Hearing Aid (Hardware) Physical, Speech and Occupational Therapy Voluntary Sterilizations Infertility Services Voluntary Termination of Pregnancy Assisted Reproductive Technologies Pharmacy:

Generic/ Preferred Brand/ Non-Preferred Brand/Specialty Drug Co-Pay

Covered; 80% after deductible; up to 120 days per member per calendar year Covered 80% after deductible

Covered 60% after deductible

Covered Not Covered Covered 60% after deductible; Covered 80% after deductible; Limited to a combined maxiumum of 60 visits Limited to a combined maxiumum of 60 visits per member per calendar year per member per calendar year Covered 80% after deductible Covered 60% after deductible Infertility testing covered 60% after Infertility testing covered 80% after deductible; Infertility treatements are not deductible; Infertility treatements are not covered. covered. Not Covered Not Covered

30 day supply: $4 / $17 / $35 co-pay at System Pharmacy $15 / $30 / $50 co-pay at Non-System Pharmacy 90 day supply is not available

30 day supply: $4 / $17 / $35 co-pay at System Pharmacy $15 / $30 / $50 co-pay plus 25% of BCBSM approved amount for the drug at a NonSystem Pharmacy 90 day supply is not available

In case of discrepancies between this summary and the medical plan Contract, the and conditions of the Contract govern.

2018 MY CHOICE REWARDS

20

2018 Medical Plan Options (continued) 2018 EPA/PPO EMPLOYEE CONTRIBUTIONS 2018 EPA/PPO Employee Contributions (per pay) (PER PAY) HFHS Advantage Tiered Access Plan (EPA)

Community Blue BCBSM (PPO) Vision Included

Vision Included

Single Two Person Family

$53.79 $121.02 $147.92

$312.02 $746.86 $936.06

$25.66 $62.18 $70.66

Single Two Person Family

$94.13 $211.79 $258.86

$378.88 $909.30 $1,136.64

$38.33 $101.50 $122.95

Highly Single Compensated Two Person ($270,000+) Family

$86.06 $193.64 $236.67

$445.74 $1,069.76 $1,337.22

$247.32 $337.74

N/A $453.39

Status

Full Time

Part Time

Medical Plan Coverage Levels

Sponsored With Medicare Dependent Cost Without Medicare

Vision Included

Manulife (Canadian)

N/A N/A

All medical plans offered through My Choice Rewards are self-funded plans with the exception of Manulife. To find out if your physician accepts any of the HAP medical options, review the information below: 1. Log onto www.hap.org 2. Select Doctors 3. Under Type of Plan click on Change Plan 4. Click the Provider Look Up Name below based on the plan you elect IF YOU ENROLL IN THIS PLAN. . . . . . . . . . . . . . . . . . . . . . . . Use this Provider Look Up Name HFHS ADVANTAGE TIERED ACCESS PLAN. . . . . . . . . . . . . . . . . HFHS Employee Advantage Tiered Access EPA CDHP COMPREHENSIVE HFHS PREFERRED. . . . . . . . . . . . . . HFHS Employee CDHP Comprehensive Preferred HMO CDHP COMPREHENSIVE FULL HAP. . . . . . . . . . . . . . . . . . . . . . HFHS Employee CDHP EPA CDHP BASIC FULL HAP EPA. . . . . . . . . . . . . . . . . . . . . . . . . . . . HFHS Employee CDHP EPA 5. Enter the information you want to search on to determine if your provider is in the network that accepts your plan.

Final Oct. 09, 2017

21 2018 MY CHOICE REWARDS

Vision Care The vision coverage below is based on the medical option you selected. CDHP Basic Full HAP

CDHP Comprehensive HFHS Preferred Network and CDHP Comprehensive Full HAP Network

HFHS Advantage Tiered Access

Coverage

Services

Tier 1

Tier 2

BCBSM Community Blue PPO

In and Out of Network

Eye Exam

Covered in full

$40 co-pay; after deductible, unlimited exams (waived for preventive care)

Frames

Covered up to $40; one pair every consecutive 12 months

Covered up to $40 after decutible; one pair every 12 consecutive months

Covered up to $40; Covered up to $40; one pair every one pair every consecutive 12 consecutive 12 months months

Lenses

Covered in full up to $40; one pair every 12 months with prescription change; otherwise one pair every 24 months

Covered in full up to the approved charges; one pair every consecutive 12 months

Covered in full up to the approved charges; one pair every consecutive 12 months

Covered in full up to the approved charges; one pair every Covered in full up to the consecutive 12 approved charges; one pair months every 12 months

Lenses

Covered in full up to $80 in lieu of eye glassess; lens fitting exams are not covered

Covered in full up to $80 in lieu of eye glassess; lens fitting exams are not covered

Covered in full up to $80 in lieu of eye glassess; lens fitting exams are not covered

Covered in full up to $80 in lieu of eye glassess; lens Covered in full up to the fitting exams are not approved charges in lieu of covered eye glasses

$40 co-pay; unlimited $60 co-pay; unlimited exams (waived for exams (waived for Annual exam covered in full preventive care) preventive care) up to approved charges

Covered up to $40; one pair every 24 months

In case of discrepancies between this summary and the vision plan Contract, the and conditions of the Contract govern.

In addition to the vision plan you choose, additional savings on out-of-pocket expenses are available to you through Henry Ford OptimEyes. After applying insurance benefits, the following discounts will apply to your balance: • An additional 20% on frame (after current frame promotion) • 20% on all lenses and upgrades • 20% on all s (based on regular retail pricing) • 20% on accessories • 25% on all non-prescription sunglasses

Discounts are not available on:

Discounts may not be combined with other discounts, coupons or promotions. Sale price merchandise is not included in the discount program. These benefits are available to you and your immediate family (spouse and dependents). To take advantage of these discounts, simply present your Henry Ford identification badge and indicate that you are a System employee at the time the eligible service is provided. For a Henry Ford OptimEyes location near you, go online to henryfordoptimeyes.com or call 800-EYE-CARE.

• Professional fees • Co-pays • Warranty replacements • Industrial safety glasses • Exams

2018 MY CHOICE REWARDS 22

Full Time

Single Two Person Family

HAP Standalone Vision Plan

$2.09

$13.97

$4.18 $7.73

$29.84 $55.21

Employees who opt out of medical/vision purchase vision coverage $19.13only. Services and benefits are Single coverage may$9.95 Two Person available throughPart HenryTime Ford OptimEyes and HAP. $19.90 $38.26 Family $36.80 $70.87 v

Services

Coverage

Eye Exam

Covered one per benefit period when performed by a Henry Ford OptimEyes Optometrist

Frames

Covered up to $40; One pair every 12 consecutive months

Lenses

Covered in full up to the approved charges; one pair every 12 consecutive months

Lenses

Covered up to $80 in lieu of eyeglasses; lens fitting exams are not included.

Our Commitment to Affordability _____________________________________ Did you know there are additional benefits available to you that can reduce your out-of-pocket expenses and make your health care more affordable? Read further to see how the Special Medical Credit, Flexible Spending and Health Savings may help you save money.

2018 Vision2018 Employee VISION Contributions (per pay) EMPLOYEE CONTRIBUTIONS (PER PAY) Stand Alone Vision Plan Coverage HAP Vision Levels $4.10 Single $9.42 Two Person $10.65 Family

SPECIAL MEDICAL CREDIT INCOME GUIDELINES Family Size*

1040 Earnings**

1

$24,120

2

$32,480

3

$40,840

4

$49,200

5

$57,560

The Special Medical Credit is available for single-

6

$65,920

person, two-person and family households in 2018:

7

$74,280

• For employee only coverage, the credit is $32.30 per pay ($70 per month).



$82,640

SPECIAL MEDICAL CREDIT

• For two-person coverage, the credit is 64.62 per pay ($140 per month). • For family coverage, the credit is $85.85 per pay ($186 per month).

8+

* Based on the number of exemptions (you, spouse, dependents) reported on your most recent federal tax return under “family size.” ** Based on the total family income amount indicated on your federal income tax Form 1040 or form 1040EZ.

Final Oct. 09, 2017

The credit is available for full-time employees who enroll in the HFHS Advantage Tiered Access Plan. Eligibility for the credit is based on the total family income as indicated on the most recently filed 1040 tax return and the number of dependents indicated on that tax return(s). A new online application must be completed each year. Please refer to chart.

23 2018 MY CHOICE REWARDS

• Employees may also apply for the Special Medical Credit throughout the year due to life events, status changes and new hire eligibility. • An online application can be found on Employee Self Service. Employees have until Dec. 8 to complete the application in time for the first pay of Jan. • After review of the application and tax return information, Employee Services will notify you of the determination. • Cancellation of the Special Medical Credit will occur if you are no longer a full-time employee enrolled in the HFHS Advantage Tiered Access Plan or you are no longer eligible for benefits.

ONLINE SPECIAL MEDICAL CREDIT APPLICATION

Employees can go to Employee Self Service and complete the online Special Medical Credit application. Completion by Dec. 8, 2017 will guarantee credit on the first pay in Jan. 2018.

SPONSORED DEPENDENTS

You may also cover certain sponsored dependents, but no credits are given for this coverage. For related information, see pages 4-5. (Sponsored dependents are not eligible for dental coverage or HAP Standalone Vision.) The rates per pay period for sponsored dependent medical coverage are:

Medical Option

Not Eligible

$225.99

CDHP Comprehensive Preferred Network

Not Eligible

$315.25

CDHP Comprehensive Full HAP Network

Not Eligible

$319.98

$247.32

$337.74

Not Eligible

$453.39

Community Blue PPO

Employees who elect to cover a spouse on an HFHS medical plan who is eligible for health insurance with their own non-HFHS employer will be assessed a surcharge of $46.15 pretax per pay. This surcharge is in addition to the employee’s per pay contribution for medical coverage and is designed to shift the responsibility of coverage to a broader spectrum of employers. Employees who cover their spouses also are required to complete an online verification form stating the spouse does not have the opportunity to be covered by their non-HFHS employer. If your spouse is covered on your medical plan and you do not complete the online verification form, you will be defaulted to receive coverage for your spouse and the surcharge will apply. If you are defaulted for failure to complete the verfication form, you can Employee Services to complete this form, but no refunds of the prior spouse surcharge deduction will occur. Random audits will be conducted and ineligible spouses will be removed. Falsification may result in disciplinary action, which could include termination.

HIGHLY COMPENSATED EMPLOYEES

Highly compensated employees continue to pay more for their medical coverage. A “highly compensated” employee earns a base annual salary of $270,000 or more. The salary is based on the 2017 Annual Compensation Limit as defined by the Internal Revenue Service and is adjusted annually. A highly compensated employee’s contribution is 60 percent higher than the contribution of other employees.

Sponsored Sponsored Dependent Dependent without with Medicare Medicare

CDHP Basic Full HAP Network

HFHS Advantage Tiered Access Plan

SPOUSE SURCHARGE

2018 MY CHOICE REWARDS

24

Dental Plans ______________________________________________________________________________ Henry Ford Health System offers you and your eligible dependents the opportunity to seek quality dental care on a regular, preventive basis. Changes to your dental option may be made every year. Employees enrolled in the Delta Basic or Comprehensive options have two networks from which to choose a Delta Dental participating provider. You will receive the highest level of coverage if you go to a Delta Dental PPO dentist. Although your coverage levels will be lower for some services when you go to a non-PPO dentist, you may still save money if that dentist participates in the Delta Dental Premier Network.

Dental Plan Comparison Chart Delta Basic

Service Diagnositic & Preventive - Class I

PPO

Deductible

$25 Single; $50 Family

Premier

Delta Comprehensive PPO

Premier $25 Single; $50 Family

Diagnostic and Preventive Services - Used to diagnose and/or prevent dental abnormalities or disease (includes exams, cleanings and flouride treatment)

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Emergency Palliative Treatment - Used to temporarily relieve pain

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 60%

Plan pays 40%

Plan pays 85%

Plan pays 65%

Plan pays 60%

Plan pays 40%

Plan pays 85%

Plan pays 65%

Plan pays 60%

Plan pays 40%

Plan pays 85%

Plan pays 65%

Plan pays 60%

Plan pays 40%

Plan pays 85%

Plan pays 65%

Plan pays 60%

Plan pays 40%

Plan pays 85%

Plan pays 65%

Plan pays 60%

Plan pays 40%

Plan pays 85%

Plan pays 65%

Plan pays 60%

Plan pays 40%

Plan pays 60%

Plan pays 40%

No coverage

No coverage

Plan pays 60%

Plan pays 50%

Sealants - to prevent decay of permanent teeth Brush Biopsy - to detect oral cancer Radiographs - X-rays Basic Services - Class II Oral Surgery Services - Extractions and dental surgery, including preoperative and postoperative care Relines and Repairs - Relines and repairs to bridges and dentures Minor Restorative Services - Used to repair teeth damaged by disease or injury (for example, amalgam [silver] and resin [white] fillings Major Restorative Services - Used when teeth can't be restored with another filling materal (for example, crowns) Peridontic Services - Used to treat diseases of the gums and ing structures of the teeth Endodontic Services - Used to treat teeth with diseased or damaged nerves (for example, root canals) Major Services - Class III Posthodontic Services - Used to replace missing natural teeth (for example, bridges and dentures) Orthodontic Services - Class IV Orthodontic Services - Used to correct malposed teeth and/or facial bones (for example, braces) Ortho Lifetime Maximum Maximum Payment Maximum Payment - Per person per contract year

No coverage

$1,500 per person

$750

$1,500

In cases of discrepancies between this summary and the dental plan Contract, the and conditions of the Contract govern.

25 2018 MY CHOICE REWARDS

2018 Employee Dental Contributions 2018 Dental Employee Contributions (per pay)(per pay) Status

Dental Plan Delta Premier Coverage Basic (PPO) Levels

Delta Premier Comprehensive (PPO)

$2.09

$13.97

Full Time

Single Two Person Family

$4.18 $7.73

$29.84 $55.21

Part Time

Single Two Person Family

$9.95 $19.90 $36.80

$19.13 $38.26 $70.87

v

2018 Vision Employee

Dental Plan PPO (Point-of-Service) Questions and Answers Contributions (per pay) Alone Delta Dental PPO (Point-of-Service) is Delta Dental’s nationalStand preferred providerVision organization program that gives you access to two of the nation’s largest networks of participating dentists: Delta Dental PPO and Delta Dental Premier. Plan Coverage HAP Vision Although you can go to any licensed dentist anywhere, your out-of-pocket costs are likely to be lower if you go to a dentist Levels who participates in one of these networks.

How do I find a participating dentist?

$4.10 Single $9.42 Two Person To find out whether your dentist participates in Delta Dental PPO or Delta Dental Premier, you can call his or her office, check our website at www.deltadentalmi.com, or call our Customer $10.65 FamilyService department at 800-524-0149.

Do I have to go to a participating dentist?

No. You can go to any licensed dentist anywhere, regardless of whether he or she participates in Delta Dental PPO or Delta Dental Premier. However, your out-of-pocket costs may be higher if you go to a nonparticipating dentist.

Can I change dentists whenever I’d like?

Yes. You can change dentists at any time.

Can each member of my family choose a different dentist?

Yes. Each member of your family may see a different dentist.

Am I covered if I go to a nonparticipating dentist?

Yes. However, when you seek care from a nonparticipating dentist, you are responsible for all fees charged. We will reimburse you up to our nonparticipating dentist fee, which is generally lower than our fee for participating dentists.

Am I covered for Emergency Services?

Yes.

Will I receive dental cards?

No. Your dentist can your eligibility through the Customer Service department or our online Dental Office Toolkit.

Who do I call if I have questions?

If you have questions, please call the Customer Service department at 800-524-0149.

NG YOUR BEN IZI

ITS EF

OPT IM

What are Delta Dental PPOSM and Delta Dental Premier®

FIRST PAY OF 2018 Review your first paycheck of the New Year – Friday, Jan. 12, 2018, to elections and Final Oct. 09, 2017 contributions.

As a new hire, or newly benefits-eligible employee, you should also review your paycheck to elections and contributions are correct. If you have questions, Employee Services at [email protected] or 855-874-7100.

2018 MY CHOICE REWARDS

26

DELTA DENTAL PPO DENTIST You will receive the highest level of coverage if you go to a Delta Dental PPO (PPO) dentist. Delta Dental will pay PPO dentists directly based on their submitted fee or the amount in their local Delta Dental’s PPO dentist schedule, whichever is less. If the PPO dentist schedule amount for a covered service is lower than the dentist’s submitted fee, the dentist cannot charge you the difference. For example: If a PPO dentist charges $100 for a service covered at 100 percent, and if the PPO dentist schedule amount for that service is $80, we will pay the dentist $80 and you will owe nothing. The dentist cannot charge you the $20 difference between his or her submitted fee and the PPO dentist schedule amount.

Submitted fee: . . . . . . . . . . . . . . . . . . . . . . . . . . . . PPO dentist schedule amount: . . . . . . . . . . . . . . . Delta Dental pays 100% of $80: . . . . . . . . . . . . . . . You pay: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$100.00 $ 80.00 $ 80.00 $ 0.00

DELTA DENTAL PREMIER DENTIST Although your coverage levels will be lower for some services when you go to a non-PPO dentist, you may still save money if that dentist participates in another Delta Dental program called Delta Dental Premier (Premier). We pay Premier dentists directly based on their submitted fee or their local Delta Dental’s maximum approved fee, whichever is less. If the maximum approved fee for a covered service is lower than the dentist’s submitted fee, the dentist cannot charge you the difference. For example: If a non-PPO dentist who participates in Delta Dental Premier charges $100 for a service that is covered at 80 percent, and if the maximum approved fee for that service is $95, we will pay the dentist $76 (80 percent of $95). You will owe the dentist the remaining $19. The dentist cannot charge you the $5 difference between his or her submitted fee and the maximum approved fee.

27 2018 MY CHOICE REWARDS

Submitted fee: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Maximum Approved Fee: . . . . . . . . . . . . . . . . . . . . . Delta Dental pays 80% of $95: . . . . . . . . . . . . . . . . You pay: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$100.00 $ 95.00 $ 76.00 $ 19.00

NON-PARTICIPATING DENTIST If you go to a non-participating dentist (a dentist who does not participate in Delta Dental PPO or Delta Dental Premier), you will probably have to pay more. Our payment for covered services will be based on the dentist’s submitted fee or the local Delta Dental’s nonparticipating dentist fee, whichever is less. Delta Dental will usually send payment directly to you, and you will be responsible for paying the dentist whatever he or she charges. In addition, you might have to pay the dentist at the time of your appointment. For example: If a non-participating dentist charges $100 for a service that is covered at 80 percent, and if the non-participating dentist fee for that service is $82, we will pay you $65.60 (80 percent of $82). You will owe the dentist the remaining $34.40. You will be responsible for paying him or her the full $100.

Submitted fee: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Non-participating dentist fee: . . . . . . . . . . . . . . . . Delta Dental pays 80% of $82: . . . . . . . . . . . . . . . . You pay: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$100.00 $ 82.00 $ 65.60 $ 34.40

Flexible Spending s ____________________________________ Flexible spending s (FSAs) allow you to pay for out-of-pocket health care and dependent care expenses with pre-tax dollars. Your contributions are subtracted from your paycheck before federal, state and FICA taxes are calculated on your pay, so you save money on taxes. There are two types of FSAs. You may participate in either or both: • Health Care FSA – covers eligible health care expenses for you and your eligible dependents. • Dependent Care FSA – covers eligible dependent daycare or elder care expenses so you and your spouse can work or attend school full-time.

How the s Work • You decide how much you want to deposit during the calendar year. The maximum you can contribute to a health care FSA is $2,650. The maximum for a dependent care FSA is $5,000. • HealthEquity is the third party for the FSA program. • The annual limit you elect is calculated over 26 pay periods (or for a new hire, over the remaining pay periods in the year) to determine the per pay deduction. • When you have an eligible health care FSA expense, such as a prescription drug co-pay, save the itemized receipt. You can pay the expense with your HealthEquity health care FSA card at the point of purchase. HealthEquity may request a copy of your itemized receipts. For a list of eligible expenses click here. • For more information on the health care FSA click here. • You should retain receipts for your health care and dependent care expenses. To reduce the amount of substantiation that may be required, both HAP and Delta Dental provide medical and dental claims data to HealthEquity. HealthEquity is more rigorous in reviewing and processing claims. This is good for Henry Ford Health System and you from an IRS compliance perspective and any audits that could occur.

• For dependent care claims, save the itemized receipts from your day care provider and submit a claim form with your receipt to HealthEquity. For more information on eligible expenses click here. • Eligible expenses for a dependent care include but are not limited to, care for dependents age 12 or younger, or dependents regardless of age who are physically or mentally incapable of caring for themselves and whom you claim as a dependent on your federal income tax return. You (and your spouse if you are married) must maintain a home that you live in for more than half of the year with your qualifying child or dependent. • If you are married, your spouse must also be at work, school (as a full-time student), searching for a job, or mentally or physically disabled and unable to provide care for a dependent. • For more information on dependent care s click here.

Things to consider when enrolling in an FSA There are some IRS rules you need to know before you decide to participate in a health care and/or dependent care FSA. You must enroll each year if you want to participate. FSAs do not carry over from year to year. Health Care FSA • The annual amount you elect for a health care FSA is available as of Jan. 1, 2018, or the date you become benefit eligible and enroll in the plan. • Your 2018 contributions for a health care FSA must be used for eligible expenses you incur between Jan. 1, 2018 and March 15, 2019. • You incur an expense on the date the service is provided – not when you are billed or when you pay it. • You cannot submit a claim for services incurred prior to becoming eligible for the FSA. • By law, any money remaining in your health care FSA after April 30, 2019 is forfeited and will not be returned to you. This is known as the “use it or lose it” rule. • If you terminate employment or have a status change mid-year and you are no longer eligible to participate in a health care FSA, you have 90 days from the date of your event to submit eligible expenses incurred on or before your mid-year event. Dependent Care FSA • Your 2018 contributions for a dependent care FSA must be used for eligible expenses you incur between 2018 MY CHOICE REWARDS

28

• • •

•

•

•

•

Jan. 1 and Dec. 31, 2018, or the date you become eligible and enroll in the plan. You can only receive reimbursement up to the amount available in your dependent care . You cannot submit a claim for services provided prior to becoming eligible and enrolled in the plan. By law, any money remaining in your dependent care FSA after Dec. 31, 2018 is forfeited and will not be returned to you. This is known as the “use it or lose it” rule. If you terminate employment or have a status change mid-year and you are no longer eligible to participate in a dependent care FSA, you have 30 days from the date of your event in which to submit eligible expenses incurred on or before your mid-year event. The health care and dependent care FSAs must maintain separate s. Money cannot be transferred between the s. Health care services cannot be reimbursed from a dependent care or vice versa. See pages 38-40 for qualified mid-year events that may allow you to change your election to a health care and/or dependent care FSA. For more information, HealthEquity at 866346-5800 or click here

Health Care FSA (Flexible Savings ) and HSA (Health Savings ) A side-by-side comparison

Description

FSA

Use it to pay for medical expenses before you meet the deductible for your consumer driven health plan (CDHP)



Use it to pay for a variety of eligible health and medical expenses including dental expenses.



You must use it by the end of the year or first quarter of the new year or forfeit the remaining funds.





Rolls over from year to year.



You can take it with you when you change employers or retire.



You can invest the funds in your . Make contributions with pre-tax dollars. Employees can contribute a maximum of $2,650 annually.

 

Employee and employer together may contribute $3,450 to $6,900 depending on family status (individual/family).

All funds available beginning Jan. 3, 2018.

  

Catch-up contributions up to an additional $1,000 for employees age 55+.

 

Only funds that have already been deposited into the are available.



HFHS contributes funds to the at the beginning of the benefit year for 2018.



Designed to be used with the CDHP plans.



Can be used with any health plan except CDHPs.

29 2018 MY CHOICE REWARDS

HSA



Income Replacement and Survivor Benefits ____________________________________ Protecting our family’s income in the event of a serious injury or death is a concern that many of us have. Financial security can be achieved through personal financial planning, including employer-sponsored voluntary life and disability insurance.

EMPLOYEE TERM LIFE INSURANCE

My Choice Rewards provides you with a variety of life insurance options. You may choose either more or less coverage, in the increments shown below, based on your projected needs. Coverage can be purchased with pretax dollars. The maximum protection you can receive from this benefit is $1 million. Coverage Maximum Benefit • 1 x Your Base Pay . . . . . . . . . . . . . . . . . . . . . . $250,000 • 2 x Your Base Pay. . . . . . . . . . . . . . . . . . . . . . $500,000 • 3 x Your Base Pay . . . . . . . . . . . . . . . . . . . . . $750,000 • 4 x Your Base Pay. . . . . . . . . . . . . . . . . . . . . . $1 million • $10,000* • $25,000* • $50,000* • Opt out* *Options available to part time employees. Life insurance deductions are based on an employee’s age and salary. Deductions change based on the following age groups: Age

Rate per $1,000 of coverage

29 and less

$0.023

30 to 34

$0.035

35 to 39

$0.052

40 to 44

$0.076

45 to 49

$0.116

50 to 54

$0.192

55 to 59

$0.343

60 to 64

$0.471

65 to 69

$0.954

70 and older

$2.188

If you move up more than one coverage level, or you are electing coverage when you previously waived coverage, you must furnish evidence of insurability (EOI).

COVERAGE AFTER AGE 65

If you continue to work after age 65, the amount of your life insurance will decrease on Jan. 1 following your 65th birthday as follows: • Age 65-69 . . . . . . . . . . . . . . . . . . . 65% of elected option • Age 70-74 . . . . . . . . . . . . . . . . . . . . 50% of elected option • Age 75+ . . . . . . . . . . . . . . . . . . . . . 20% of elected option Dependent Term Life Insurance coverage does not decrease if you continue working past age 65.

IMPUTED INCOME

When you purchase insurance in excess of $50,000, you are subject to the IRS imputed income rules. Imputed Income is the value of your life insurance in excess of $50,000. You are required to pay federal and state income taxes as well as Social Security tax on this “excess” amount. The amount of tax you pay is based on your age. The value of the life insurance in excess of $50,000 will be reported on your W-2.

TERMINAL ILLNESS BENEFIT

Enrollees who are diagnosed with a terminal illness (life expectancy of 12 months or less) may apply to have up to 50 percent of their Employee Life Insurance paid out to them in advance. Information is available from Employee Services.

DEPENDENT TERM LIFE INSURANCE

My Choice Rewards also provides dependent term life Insurance options on an after-tax basis. Because of IRS regulations, no pretax dollars or credits may be used for this coverage. Your dependent term life Insurance options are: Spouse Coverage

Child(ren) Coverage

$50,000

$15,000 each child

$25,000

$10,000 each child

$10,000

$5,000 each child

If you choose to enroll, you must designate who will be covered by the dependent term life Insurance. You may choose spouse-only coverage or, child(ren)-only coverage. For dependent eligibility requirements, see pages 4-5 of this workbook. You are the beneficiary for

2018 MY CHOICE REWARDS 30

your spouse or dependent’s life insurance. If you are electing dependent coverage when you have previously waived coverage, you must furnish evidence of insurability (EOI) for your spouse; children do not require EOI. Any dependents you cover must live with you.

ACCIDENTAL DEATH AND DISMEMBERMENT (AD&D) AD&D insurance provides protection against financial hardship when you or a covered dependent suffer an accidental death, loss of limb, paralysis or loss of sight. Your AD&D coverage options are indicated in the above chart. If you choose to enroll in AD&D coverage, you must designate who will be covered. You may choose either employee-only coverage or employee and dependents coverage. For dependent eligibility requirements, see pages 4-5 of this workbook. Any dependents you cover must live with you. Coverage level and maximum benefits. 5 x base annual salary for employee ($1.25 million) 2.5 x employee’s base annual salary for spouse ($500,000) 0.1 x employee’s base annual salary for each child ($50,000) 4 x base annual salary for employee ($1 million) 2 x employee’s base annual salary for spouse ($500,000) 0.1 x employee’s base annual salary for each child ($50,000) 3 x base annual salary for employee ($750,000) 1.5 x employee’s base annual salary for spouse ($375,000) 0.1 x employee’s base annual salary for each child ($50,000) $100,000 employee $50,000 spouse $10,000 each child $50,000 employee* $25,000 spouse $5,000 each child $20,000 employee* $10,000 spouse $5,000 each child *Options available to part time employees.

31 2018 MY CHOICE REWARDS

COVERAGE AT AGE 75 AND OLDER

When you or your spouse reach age 75, the coverage amount is reduced on Jan. 1 following the 75th birthday as follows : • Age 75-79. . . . . 57.5% of the elected coverage amounts • Age 80-84. . . . . 37.5% of the elected coverage amounts • Age 85+. . . . . . . . 20% of the elected coverage amounts This reduction also applies to any dependents you have chosen to cover.

LONG-TERM DISABILITY (LTD)

Long-term disability Insurance or LTD provides a source of income for you if you are unable to work due to a serious illness or injury. If you have previously waived LTD and would now like to elect coverage, or you are increasing more than one level of coverage, you will have to furnish evidence of insurability (EOI). If you are initially enrolling in or increasing your LTD coverage during open enrollment, you will not be eligible for the higher coverage amount for any disability resulting from a pre-existing condition that begins three months before the coverage effective date and in the first 12 months after the effective date of coverage. Since your LTD benefit is paid for on a pretax basis or by the company, any long term disability benefit you receive will be subject to income taxes. Your LTD options are as follows: 50% of base annual salary: maximum monthly benefit of $10,700* 60% of base annual salary: maximum monthly benefit of $12,850 70% of base annual salary: maximum monthly benefit of $15,000 *Option available to part time employees.

My Choice Rewards Enrollment Instructions ____________________________________ During Open Enrollment, all benefits-eligible employees must log on to https://idoc-pub.cinepelis.org/cdn-cgi/l/email-protection" class="__cf_email__" data-cfemail="85eaf5e0ebe0ebf7eae9e9e8e0ebf1c5ede3edf6abeaf7e2">[email protected].

HOW TO ENROLL STEP 1

Go to https://workforceconnect.hfhs.org from any computer that has access to the web starting Monday, Nov. 6.

STEP 2 Enter your corporate ID and . If

you don’t your , click on . (Your Employee Self Service log on is your Corporate ID and .)

STEP 3 Access your Personal Enrollment Summary. STEP 4 Make your benefits selections for 2018. STEP 5 Update your dependent information.

If you add new dependents, birth certificates and/or marriage certificates while online. Include your employee ID on all documents.

STEP 6 After completing your benefit selections, if

you are satisfied with your choices, proceed to receive your confirmation number. Record this number. You must obtain a confirmation number, as this completes your enrollment and confirms your benefit selections have been recorded and submitted. This does not mean your elections are correct. It only means the information you entered was recorded.

STEP 8 Review the confirmation statement for accuracy and keep it as proof of your enrollment for 2018.

STEP 9 A final confirmation statement will be

available for you to print beginning the week of Dec. 11, 2017. Go to Employee Self Service/Benefits Home and print the final confirmation statement.

DEFAULT PLAN – NEW HIRES

• Flexible Spending s or Health Savings s default to non-participation unless you enroll each year. • For new hires and rehires as of Jan. 1, 2018, the default package for full and part time employees is no coverage. If you are enrolled in the default package, you will have no coverage for the rest of the plan year. Also, if you experience a life event, you may not be able to make a change to your benefits until the next open enrollment period. Receiving a confirmation number does not mean your benefit elections are correct. It only means the information you entered was recorded. You must thoroughly review the confirmation statement provided to you at the end of the enrollment process to ensure you made the right choices and that your dependents have coverage. Your covered dependents must have a “Y” in the medical and or dental columns if they are to have coverage in 2018.

STEP 7 Your temporary confirmation statement will be emailed to you. Confirmation statements will not be mailed home.

2018 MY CHOICE REWARDS

32

Making Choices... the Enrollment Experience _____________________________________ Henry Ford continues to provide information about your benefits: •

•

Web Page Visit https://mychoicerewards.hfhs.org. This is the hub for My Choice Rewards information during open enrollment. Materials are organized and housed together on an easy-to-navigate web page. Alex An interactive decision-making tool called “Alex” will allow you to compare benefits options and help you decide on the best choices for you and your family. Although Alex will provide recommendations, you will make the decisions about what’s best for you and your family. You’ll be able to use Alex as you prepare to enroll for benefits.

PHONE OR EMAIL

As always, after reading the key messages and enrollment workbook, if you still have questions, call Employee Services at 855-874-7100 or email [email protected],

Additional Information ____________________________________ COVERAGE FOR HFHS COUPLES

If both a husband and wife are HFHS employees, they cannot be “double covered” under My Choice Rewards. A person covered as an employee cannot be an eligible dependent. However, one spouse could opt out of health care coverage and be covered as a dependent by the other spouse under two-person or family coverage. Eligible dependents of a couple employed by HFHS can be double covered under My Choice Rewards. Keep in mind that coordination of benefits rules apply for health care coverage, so that not more than 100 percent of eligible expenses can be paid. Similarly, an employee cannot be covered as a dependent on a spouse’s life insurance contract. However, an eligible dependent may be covered under both spouse’s dependent life insurance contracts. If that dependent dies, both spouses could collect on the dependent life coverage in which they were enrolled. An eligible expense may only be reimbursed once, even if both spouses participate in flexible spending s.

33 2018 MY CHOICE REWARDS

LEAVE OF ABSENCE

If you are on a leave of absence during open enrollment, changes made to your medical/vision or dental plans will be effective Jan. 1. All other benefit changes made during open enrollment will not be in effect until you have returned to work in the new plan year.

TERMINATION OF BENEFITS

Benefit coverage for you and your family will terminate on the last day of the month in which you terminate your employment or are in an ineligible benefit status. Long-term disability coverage ends on the date of termination. If you become ineligible for coverage, you and your eligible dependents may have continuation rights for medical/vision, dental and health care flexible spending benefits under the federal law known as COBRA. If you terminate your employment or are in an ineligible benefit status, you will be notified about your continuation rights.

HAP Personal Alliance Coverage for Gaps _____________________________________ Employees who are leaving the System or are no longer eligible for coverage because of a life event will experience a discontinuation of coverage. For these gaps in coverage, HAP offers health plans for individuals and families that may be a lower-cost alternative to COBRA. If your loss of coverage is due to a qualifying life event, you can sign up during a special enrollment period (SEP). The loss of previous coverage is considered a qualifying event. Call HAP Personal Alliance at (855) WITH-HAP, or visit hap.org for information about special enrollment period qualifying events.

Health Plans for Those Turning 26 _____________________________________ HAP provides coverage for individuals turning 26 and aging off their parents’ health plan. This is a life event that qualifies the individual to sign up by the end of the month the individual turns 26. During the SEP, you or your dependent can obtain coverage under a separate contract/policy. Visit hap.org for more information about the policies designed for young adults.

YOUR RIGHTS AND RESPONSIBILITIES

You are responsible for notifying Employee Services at the time a covered dependent no longer remains eligible for benefit coverage by going online to Employee Self Service within 30 days of the event to remove your dependent,

HFHS Rewards _____________________________________ As a Henry Ford employee, your benefits extend beyond compensation and health insurance coverage. Rewards are benefits employees receive at no cost as valued of the health system. To find out more about Rewards, click here.

Choose Henry Ford _____________________________________ Adding value for employees and aligning the healthcare and insurance sides of our organization Henry Ford employees are also healthcare consumers and we know they are looking for the best value. At the same time, HFHS and HAP are working on how to better align services as part of an overall growth strategy. Changes in the medical plan options aim to increase the healthcare value employees receive. We are also encouraging all employees to use Henry Ford providers and facilities, and be insured by HAP. This is a win-win because: • Patients (employees), will receive better continuity of care and a broad range of services. • HFHS, HAP and by extension, employees, will benefit from a strong business model. Henry Ford has an extensive presence in Southeastern Michigan and beyond, including: • Five acute care hospitals • 200 care sites • More than 20 retail pharmacies • More than 2,000 physicians

FREE PRESCRIPTION HOME DELIVERY

Have your medications shipped right to your door. Henry Ford Pharmacy offers free home delivery of your medications, whether you need a simple refill or even a new prescription. To find out how, call 800-456-2112 or ask a Henry Ford pharmacist.

Henry Ford OptimEyes Additional savings on out-of-pocket vision expenses are available for employees through Henry Ford Optimeyes. To find a location click here.

Same Day Appointments If you need care today, more than 35 Henry Ford outpatient medical locations in Wayne, Oakland and Macomb counties, provide same-day appointments. For more information click here.

Walk-In Clinic When it’s not an emergency, but you need to be seen today, Henry Ford Walk-In Clinics treat patients of all ages. For more information and to find a location click here.

Urgent Care When the unexpected happens and you need medical care quickly, Henry Ford’s certified urgent care locations allow you to get in, get out and feel better fast. Urgent care is a convenient option, for all ages, to treat non-threatening illnesses or injuries. To find a location click here.

QuickCare Clinic Located in downtown Detroit, this walk-in health boutique clinic caters to busy professionals who live or work in the city. Board certified nurse practitioners at the clinic treat minor illnesses and injuries, perform basic lab tests, ister vaccinations and much more. For more information click here.

This large geographic footprint makes it easy to access the following services.

HFHS Pharmacies Employees and their family enrolled in any of the medical plans provided by HFHS will continue to pay reduced co-pays for their prescriptions filled at a Henry Ford Pharmacy. To find a pharmacy click here. 2018 MY CHOICE REWARDS 34

ADDITIONAL PERKS eVisits eVisits with a primary care doctor and select specialists conducted through MyChart for nonemergency care.

Inside Connection Inside Connection is Henry Ford’s employee referral program for accelerated appointments with Henry Ford specialists for yourself, friends or family.

MyCare Advice Line Talk to Henry Ford providers who offer free medical advice over the phone, 24/7, to established Henry Ford Medical Group patients regarding nonemergency primary care concerns. Avoid a trip to the emergency room for minor medical concerns. To learn more, call 1-844-262-1949.

MyChart MyChart is tthe online health tool that provides patients with all of their health information in one place for immediate access.

Employee Wellness _____________________________________ Emotional Well-Being

Managing stress, finding a healthy work/life balance and developing conflict resolution and relationshipbuilding skills are all part of wellness. Take advantage of the many resources available through the Enhance Program (formerly EAP) that can help you improve your emotional well-being. It’s confidential and free to employees. Enhance even offers a six-step program to better manage stress. For more information click here.

Henry Ford LiveWell WorkWell

Wellness is at the core of Henry Ford Health System’s vision statement. “Transforming lives and communities through health and wellness – one person at a time.” Employees learning to “live well” is important for a number of reasons: • If you feel good, it’s easier for you to feel good about your work and deliver exceptional service. • You are role modeling for your patients, your community and your family – showing what wellness looks like and how to get there.

35 2018 MY CHOICE REWARDS

The journey is different for everyone and we want to make sure there are initiatives, programs and series that meet your needs. Learn more about wellness programs available to all employees.

HFHS Wellness Innovators

Wellness innovators are essential to creating a culture of wellness at HFHS. They coordinate programming at local levels and ensure that System-wide programs have high participation rates at each site. Are you interested in a session on healthy eating? How about a yoga class? Stress management techniques? All this and more may be available through your wellness innovator. Review the list of wellness innovators arranged by location. If you are interested in becoming a wellness innovator (and we welcome more than one per site), email [email protected].

WELLNESS PROGRAMS BY THE NUMBERS • Nearly 20,000 employees have participated in or been touched by a LiveWell WorkWell program. • Close to 10,000 apples were handed out to employees on National Employee Health and Fitness Day in May. • 1,500 employees participated in recess events. • Close to 500 employees attended “lunch and learn” sessions. • The first ever day conference focused on wellness for nursing staff was offered to 200 nursing employees. • Approximately 200 wellness innovators provided local programs to more than 5,000 employees in their departments.

Important Federal Notices _____________________________________ Women’s Health & Cancer Rights Act

The Women’s Health & Cancer Rights Act requires group health plans that provide coverage for mastectomy to provide coverage for certain reconstructive services. This law also requires that written notice of the availability of the coverage be delivered to all plan participants upon enrollment and annually thereafter. This language serves to fulfill that requirement for 2018. These services include: • Reconstruction of the breast upon which the mastectomy has been performed, • Surgery/reconstruction of the other breast to produce a symmetrical appearance, • Prostheses, and • Treatment for physical complications during all stages of mastectomy, including lymphedema. In addition, the plan may not: • Interfere with a woman’s rights under the plan to avoid these requirements, or • Offer inducements to the health provider, or assess penalties against the health provider, in an attempt to interfere with the requirements of the law. However, the plan may apply deductibles and co-pays consistent with other coverage provided by the plan.

HIPAA Rights

HFHS sponsors a group health plan. As such, the System has access to the individually identifiable health information of plan participants (1) on behalf of the plan itself; or (2) on behalf of the System, for istrative functions of the plan. The Health Insurance Portability and ability Act of 1996 (HIPAA) and its regulations restrict the System’s ability to use and disclose protected health information (PHI). Protected health information means any information relating to the past, present or future physical or mental condition of an individual (or payment thereof) that identifies the individual or can be used to identify the individual. It is Henry Ford Health System’s policy to comply fully with HIPAA requirements. Consequently, if you become a covered participant under the group health plan, you have a right under HIPAA to receive a Notice of Privacy Practices for Protected Health Information. To request a copy, call 855-874-7100 or email [email protected].

Newborns’ Mothers’ Health Protection Act

Group health plans and health plan issuers generally may not, under federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a Cesarean section. However, federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under law, require that a provider obtain authorization from the plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).

Summary of Benefits and Coverage (SBC) and Uniform Glossary

In addition to the detailed Medical Plan Comparison Chart on pages 13-20, a document called a Summary of Benefits and Coverage (SBC) is also here. An SBC is a federally mandated document intended to help individuals across the nation compare health plans. Each health plan is required to issue an SBC for every group health plan it offers. An SBC details deductibles, co-insurance and out-of-pocket limits for various services in a prescribed format. A Uniform Glossary of Health Coverage and Medical to accompany the SBC is also available. To view a health plan SBC and/or the Uniform Glossary, log on to HR Connect/Benefits.

Special Enrollment Rights

Under the federal Health Insurance Portability and ability Act of 1996 (HIPAA), a special enrollment period for health plan coverage may be available if you lose health care coverage under certain conditions, or when you acquire new dependents by marriage, birth, or adoption. If during open enrollment you decline enrollment for yourself or your dependents (including your spouse) because you have other health care coverage and later you involuntarily lose that coverage, you may be able to enroll yourself or your dependents in health care coverage outside the annual open enrollment period, provided you previously declined enrollment due to coverage elsewhere and you request enrollment within 30 days after your other coverage ends. If you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be

2018 MY CHOICE REWARDS

36

able to enroll yourself and your dependents for health coverage outside the annual Open Enrollment period, provided you previously declined enrollment due to coverage elsewhere and you request enrollment within 30 days after the marriage, birth, adoption or placement for adoption.

Special Rules for Gain or Loss of Eligibility for Medicaid/CHIPRA

When you experience a change that results in a gain or loss of eligibility for Medicaid/CHIP*, you may be able to make certain adjustments to your benefits correlating to your status change within 60 days. Effective April 1, 2009, the Children’s Health Insurance Program Reauthorization Act of 2009 (“CHIPRA”) adds two new special enrollment events. You or your dependent(s) will be permitted to enroll or cancel your medical coverage in either of the following circumstances: 1. You or your dependent’s Medicaid or state Children’s Health Insurance Program (“CHIP”) coverage is canceled due to a loss of eligibility. You must go online to Employee Self Service within sixty (60) days from the date you or your dependent loses coverage and make this change. 2. You or your dependent(s) enrolls in Medicaid or the state CHIP. You may cancel your HFHS provided medical coverage within 60 days of your or your dependent’s coverage effective date by going online to Employee Self Service to make this change. For further details on Medicaid or Michigan’s CHIP program, call the Michigan Department of Community Health at 888-988-6300 toll-free. *The state Children’s Health Insurance Program in Michigan is called MIChild.

Medicaid and the Children’s Health Insurance Program (CHIP)

If you are eligible for health coverage from your employer, but are unable to afford the s, some states have assistance programs that can help pay for coverage. (For a list of participating states, visit dol.gov/ebsa/chipmodelnotice.doc) 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 your state Medicaid or CHIP office, or you may 1-877-KIDS NOW or visit insurekidsnow.gov to find out

37 2018 MY CHOICE REWARDS

how to apply. If you qualify, you can ask the state if it has a program that might help you pay the s for an employer-sponsored plan. Once it is determined that you or your dependents are eligible for assistance under Medicaid or CHIP, your employer’s health plan is required to permit you and your dependents to enroll in the plan — as long as you and your dependents are eligible, but not already enrolled. As of the date of this publication the State of Michigan does not participate in this program.

Events Permitting Mid-Year Election Changes Consistent with Event IRS Qualifying Event* Explanation of Event Medical/Vision and Dental Marriage

This event allows you to add your new spouse within 30 days of your marriage. Stepchildren may be added. Proof is required.

You may: Enroll Add spouse Change Option Opt Out

Health Care/Day Care Flexible Spending s

Life, Accidental Death & Dismemberment, Long Term Disability

Dependent Life

You may: Enroll Increase Coverage Decrease Coverage Opt Out

You may: Increase coverage Decrease coverage Opt Out

You may: Enroll Increase coverage Decrease coverage Opt Out

Divorce, legal separation/annulment or death of spouse

Birth, Adoption, Placement for Adoption of a child or gain stepchild(ren)

Death of Dependent

Other eligible dependents (Aged Parents)

This event allows you to remove your spouse within 30 days of the event. Proof is required.

This event allows you to add your newborn child or newly adopted child within 30 days of the event. Proof is required.

This event allows you to remove your dependent within 30 days of the event. Proof is required.

This event allows you to add a sponsored dependent to your existing medical coverage only within 30 days of the event. Proof is required. A sponsored dependent must be an IRS dependent such as a parent or adult child who lives with you and is claimed on your Federal Income Tax.

Employee changes status Part time to full time

This event allows you to enroll in medical/vision or dental if your status changes from part time to full time. You are now eligible to receive credits. You have 30 days to make your elections.

You may: Remove Spouse and dependents Enroll Change Option

You may: Enroll Increase coverage Decrease coverage Opt out

You may not: Opt out



You may: Enroll Add dependent Change Option

You may: Enroll Increase coverage

You may not: Remove dependents Opt out

You may not: Decrease coverage Opt out

You may: Remove dependent Change Option

You may: Decrease coverage Opt out

You may not: Enroll Add dependents Opt Out

You may not: Enroll Increase coverage

You may: Add your sponsor dependent

You may: Enroll Increase limit

You may not: Enroll Add other dependents Remove other dependents Opt Out Make any changes to dental coverage Part to Full time: You may: Enroll

You may not: Decrease limit Opt Out

No changes are allowed

You may not: Opt out

You may not: Enroll You may: Increase coverage Decrease coverage Opt out You may not: Enroll You may: Increase coverage Decrease coverage Opt out You may not: Enroll You may: Increase coverage Decrease coverage Opt out You may not: Enroll No changes are allowed

You may: Enroll Increase coverage Decrease coverage Opt Out

You may: Enroll You may not Increase coverage Decrease coverage Opt Out You may: Decrease coverage Opt Out You may not: Enroll Increase coverage No changes are allowed



You may: Increase coverage Decrease coverage

You may: Increase coverage Decrease coverage

You may not: Enroll Opt Out

You may not: Enroll Opt Out

Full time to part time

For status changes from full time to part time, please see event for Significant Cost Changes

Please see event for Significant Cost Changes

Please see event for Significant Cost Changes

Please see event for Significant Cost Changes

Please see event for Significant Cost Changes

Employee now ineligible for benefits

You are no longer eligible for active benefits. All benefits will be canceled and COBRA or conversion rights will be provided.

You may: Elect COBRA continuation Active coverage will be cancelled

You may: Elect COBRA continuation Active coverage will be cancelled

You may not: Enroll in active benefits

You may not: Enroll in active benefits Continue COBRA coverage for dependent care FSA

You may: Conversion rights are available Active coverage will be cancelled

You may: Conversion rights are available Active coverage will be cancelled

You may not: Enroll in active benefits

You may not: Enroll in active benefits



* Changes must be made within 30 days of the life event.



2018 MY CHOICE REWARDS

38

Events Permitting Mid-Year Election Changes Consistent with Event (continued) IRS Qualifying Event* Explanation of Event Medical/Vision and Dental Employee rehires within 30 days

Employee rehires after 30 days

Spouse/Dependent now eligible for their employer’s plan

This event allows you to be reinstated in your prior elections within 30 days of your rehire.

This event allows you to enroll in all of your benefits as a new hire within 60 days of your rehire. This event allows you to change some of your options within 30 days of being covered under your spouse/ dependent employer’s plan. Proof is required.

Spouse/Dependent or HFHS employee* lose eligibility for their employer’s plan

This event allows you to change some of your options within 30 days, due to your spouse/dependent losing coverage through their employer’s plan. Losing coverage does not mean voluntarily opting out of coverage. Proof is required. In rare situations, an HFHS employee may waive coverage because they are employed and have full time benefits elsewhere. If the employee loses their eligibility through that employer, they would be entitled to enroll in all of the HFHS benefits listed in this chart. Proof is required

Change in Residence or Worksite of employee, spouse or dependent that causes eligibility or loss of eligibility

Significant cost changes For HFHS Employee

Employee begins FMLA Leave

This event allows you to change your medical/vision or dental coverage, within 30 days, because you or a dependent moved out of the service area (as defined by the insurance contract.) This event allows you to change certain benefits, within 30 days, due to your status change from full time to part time. The loss of credits results in a cost change to you. This event allows you to change certain benefits within 30 days as a result of your FMLA leave.



Health Care/Day Care Flexible Spending s

Life, Accidental Death & Dismemberment, Long Term Disability

Dependent Life

You may: Have your prior elections reinstated

You may: Have your prior elections reinstated

You may: Have your prior elections reinstated

You may: Have your prior elections reinstated

You may not: Make changes to prior elections

You may not: Make changes to prior elections

You may not: Make changes to prior elections

You may not: Make changes to prior elections

You may: Enroll

You may: Enroll

You may: Enroll

You may: Enroll

You may: Remove dependents who now have other coverage Opt out if covered by spouse/ dependent’s plan

You may: Decrease coverage Opt Out

You may: Increase coverage Decrease coverage

No changes are allowed

You may not: Enroll Increase limit

You may not: Enroll Opt out

You may: Enroll Increase limit

You may: Increase coverage Decrease coverage

You may: Increase coverage Decrease coverage

You may not: Decrease limit Opt Out

You may not: Enroll Opt out

You may not: Enroll Opt out

No changes are allowed

No changes are allowed

You may not: Enroll Add dependents You may: Enroll Add dependents who lost coverage You may not: Remove dependents Opt Out

You may: Change option You may not: Enroll Add dependents Remove Dependents Opt Out You may: Switch to less costly option Remove dependents You may not: Enroll Add dependents Opt Out You may: Change Option Opt Out You may not: Enroll Add dependents Remove dependents

* Changes must be made within 30 days of the life event. 39 2018 MY CHOICE REWARDS

No changes are allowed

You may: Enroll Increase limit Decrease limit Opt Out



No changes are allowed

You may: Decrease coverage Opt Out

You may: Decrease coverage Opt Out

You may not: Enroll Increase coverage

You may not: Enroll Increase coverage

You may: Enroll Increase coverage Decrease coverage Opt Out

You may: Enroll Increase coverage Decrease coverage Opt Out

Events Permitting Mid-Year Election Changes Consistent with Event (continued) IRS Qualifying Event* Explanation of Event Medical/Vision and Dental Employee returns from FMLA Leave

This event allows you to change certain benefits within 30 days that were terminated as a result of your FMLA leave.



Special Enrollment Rights Under HIPAA Loss of other coverage or acquisition of new dependent

Judgment, Divorce or Medical Child Order Require coverage for child(ren) under employee’s plan

Coverage required under spouse’s plan



Entitlement to Medicare/Medicaid

Loss of Medicare/ Medicaid eligibility

This event allows you to enroll in medical coverage, within 30 days, even though you previously opted out. Eligibility to enroll is contingent on adding a newborn or adding a dependent that recently lost coverage. Losing coverage does not mean voluntarily opting out of coverage. Proof is required. This event allows you to enroll your dependent, within 30 days, as a result of a Judgment, Divorce or Medical Child Order. Proof is required.

You may: Enroll if coverage was terminated while on FMLA Change option You may not: Enroll if coverage was not terminated while on FMLA Add dependents Remove dependents Opt Out You may: Enroll in medical/vision only Add dependent(s)

Health Care/Day Care Flexible Spending s

Life, Accidental Death & Dismemberment, Long Term Disability

You may: Enroll if coverage was terminated while on FMLA



You may: You may: Enroll if coverage was Enroll if coverage terminated while on FMLA was terminated while on FMLA You may not: Enroll if coverage was not You may not: terminated while on FMLA Enroll if coverage was not terminated while on FMLA

No changes are allowed

No changes are allowed





You may: Elect if Order requires Increase limit if Order requires

No changes are allowed

You may not: Enroll if coverage was not terminated while on FMLA

Dependent Life

No changes are allowed

You may not: Enroll in dental Opt out of dental

You may: Add dependent as a result of the Order You may not: Add dependents not part of the Order Remove dependents Change option Opt out

You may not: Decrease limit Opt Out



You may: Decrease limit Opt out

No changes are allowed

No changes are allowed

No changes are allowed

No changes are allowed

No changes are allowed

No changes are allowed

This event allows you to remove your dependent within 30 days because your dependent is now enrolled under your spouse’s plan. Proof is required.

You may: Remove dependent

This event allows you to remove you or your dependent that is now eligible for Medicare or Medicaid within 30 days of becoming eligible. Proof is required

You may: Remove dependent Opt out

You may: Decrease limit Opt out

You may not: Enroll Add dependent Change option

You may not: Enroll Increase limit

This event allows you to enroll your dependent that is no longer eligible for Medicare or Medicaid within 30 days losing eligibility. Proof is of required

You may: Enroll in medical/vision only Add dependent to medical/ vision only You may not: Change option Remove dependents Opt Out

You may not: Enroll Add dependent Change option Opt out

No changes are allowed

You may not: Enroll Increase limit

You may: Enroll Increase limit You may not: Decrease limit Opt Out

* Changes must be made within 30 days of the life event.



2018 MY CHOICE REWARDS

40

Important

__________________________________________________________________________

• Comparison Chart – A chart that allows you to compare the medical, vision or dental plans available to you. • Confirmation statement – A statement available online to confirm the selections you made. • Consumer-driven health plan (CDHP) – A health plan that has higher deductibles and lower employee contributions. The plan requires a member to meet their deductible before any benefits are paid by the plan. Only preventive care is covered before meeting the deductible. A CDHP is sometimes referred to as a consumer-directed health plan or a qualified high deductible health plan. The are interchangeable and refer to the same type of plan. • Coinsurance – The percentage you pay (20%, for example) toward the cost of a health care service. • Copayment – The percentage or flat dollar amount of covered expenses you must pay. • Credits – A pool of dollars full-time employees receive to use toward the purchase of accidental death and dismemberment insurance and long-term disability insurance. • Deductible – The expense you incur before the plan or insurance carrier begins paying your covered expenses. • Effective date – All benefits are effective as of Jan. 1 for employees making their elections during open enrollment. For employees enrolling outside of open enrollment, benefits are effective first of the month following their date of hire or qualifying life event. • Evidence of insurability (EOI) – This is an application process that you provide information on the condition of your health or your spouse’s health in order to be considered for certain types of employee or dependent life or disability insurance coverage if you did not enroll in coverage when first eligible or you want to increase your coverage. The insurance company (not HFHS) determines your eligibility for this coverage. • Exclusive Provider Arrangement (EPA) - An Exclusive Provider Arrangement (EPA) is similar to a Health Maintenance Organization or HMO. must

41 2018 MY CHOICE REWARDS

choose a primary care physician (P) from the network of providers who they will see for routine medical care. This physician will ensures that receive the most appropriate and efficient care available. There are no out-of-network benefits available to except for treatment of emergency medical conditions. However, he network is much broader. • Flexible spending s (FSAs) – There are two types of FSA s. The health care FSA allows an employee to contribute pretax dollars to pay for medical expenses not covered under the plan. The dependent care FSA allows an employee to use pretax dollars to pay for dependent care expenses for a child or other dependent. Money not used by a certain date is forfeited. • Full time employee eligibility – Employees regularly scheduled to work 72 to 80 hours every two weeks may participate in the My Choice Rewards program. Full-time employees receive credits to assist in purchasing accidental death and dismemberment insurance and long-term disability insurance. • Health assessment (HA) – The health assessment is one of the requirements to qualify for a reduced employee contribution as part of Reward Your Health (formerly Health Engagement). All employees and their spouses enrolled in a HAP medical plan through HFHS are required to complete the online health assessment starting Jan. 1 through July 31. • Health engagement – This program has been redesigned for 2018 and is now Reward Your Health. • Health maintenance organization – A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. You are required to select a primary care provider (P) who coordinates the member’s care and refers the member to a specialist when medically necessary. A HMO generally won’t cover out-of-network care except in an emergency. A HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness. • Heath savings (HSA) – An created for employees who are covered on a CDHP to save for medical or dental expenses that CDHPs or dental

plans do not cover. Contributions (pretax) are made by the employee and/or employer and are limited to a maximum amount each year. Contributions carry over each year and can be invested over time. The HSA is portable between employers and even into retirement. • In-network – A doctor or facility that participates in the EPA, HMO or PPO plan and has agreed to a reduced fee schedule which lowers your out-of-pocket costs. • Options – The choices you have in each benefit area. • Out-of-network – A doctor or facility not part of the EPA, HMO or PPO plan network. Generally services are either not covered or covered at a lower percentage than if your doctor were in network. Using out-ofnetwork physicians or facilities increases your out-ofpocket costs. • Out-of-pocket maximums – The most you would pay in a plan year for eligible medical expenses, excluding deductibles. Once you meet the out-of-pocket maximum, the plan pays 100%. • Part-time employee eligibility – Employees regularly scheduled to work 40 hours every two weeks may participate in the My Choice Rewards program. Part time employees do not receive credits. They have the same medical, vision and dental options as full time employees and may purchase reduced levels of accidental death and dismemberment insurance, longterm disability and life insurances. • Personal enrollment summary – This online form displays your current coverage, available benefit options, and price tag for each option. The online summary will guide you through your online benefits enrollment.

• Price tag – This is the cost to you for the each benefit and coverage level you select. • Primary care provider (P) – The doctor you designate from the EPA or HMO participating network to coordinate all of your medical needs, including referrals to a specialist. • Qualification period – The period of time from Jan. 1 through July 31 when you and your covered spouse enrolled in one of the HAP medical options provided by HFHS will need to (1) know your numbers (BMI, blood pressure, cholesterol, fasting blood glucose), (2) take your online health assessment, (3) be tobacco free, (4) complete a wellness activity and (5) commit to complete all recommended preventive screenings. Completing these requirements will provide you with lower employee contributions toward the cost of your HAP medical coverage and/or funding to a HSA in the following year. • Reward Your Health – A new wellness program that was redesigned to replace Health Engagement. • Spouse surcharge – An additional pretax charge assessed to an HFHS employee who covers their spouse who is also eligible for medical cover through their non-HFHS employer. • Wellness reward – The reward you will receive for you and your spouse completing the requirements of Reward Your Health by the qualification deadline of July 31. Currently the reward is a lower contribution toward the cost of your medical s and/or funding to a HSA.

• Plan year – The My Choice Rewards plan year is Jan. 1 through Dec. 31. Each fall, you will make your selections for the following plan year. • Preferred provider organization (PPO) – A type of managed care plan that gives you the choice to obtain medical services from a network or non-network provider. You make the decision at the time you need medical care. In a PPO, the doctors and hospitals have agreed to provide medical services at a reduced cost. Generally, you will receive a higher level of coverage if you receive care in-network.

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