2021 OGHS Benefits Summary

2021 OGHS Benefits Summary

2021 BENEFITS SUMMARY

BENEFITS OVERVIEW

Opelousas General Health System is proud to offer a comprehensive benefits package to eligible, full-time employees (working 32+ hours per week with at least 2 full months of service) or part-time employees (working 20+ hours per week that have completed their waiting period). The complete benefits package is briefly summarized in this booklet. Plan booklets are available for distribution, which give you more detailed information about each of these programs.

TABLE OF CONTENTS

Benefits Overview ………………………….. 2

Annual Benefits Enrollment for 2021……... 3

Effective Date of Coverage & Open Enrollment Information…….……………….. 4

Benefits Offered

 Medical & Pharmacy  Dental  Vision

Medical & RX Benefits ..…………………… 5

FSA / HSA Spending Accounts …………... 9

 Flexible Spending Account (FSA)  Health Savings Account (HSA)

Dental & Vision Benefits …………….…… 10

 Short Term Disability  Long Term Disability  Basic Life & AD&D Insurance  Voluntary Group Term Life & AD&D Insurance  Other Voluntary Insurance Benefits

Short & Long Term Disability ....................11

Life & AD&D Insurance ………………….. 12

Additional Voluntary Benefits ...................13

Eligibility You and your dependents are eligible for Opelousas General Health System’s benefits if you are a full-time employee (working 32+ hours per week) or part-time employee (working 20+ hours per week) OR classified as full-time by Human Resources. Eligible dependents are your spouse, children under age 26, disabled dependents of any age, or other eligible dependents, including your naturally born children, legally adopted child, stepchild, foster child, any child for whom you have legal custody who resides in your household on a regular parent-child relationship and is principally dependent on you for his/her support and maintenance, and is named as an exemption on your most recent federal income tax return (proof may be required), and any child for whom you are required to provide healthcare coverage under a Qualified Medical Support Order. For voluntary life coverage, dependents are covered up to age 19 (25 if a Full- Time Student). Elections made now will remain until the next open enrollment unless you or your family members experience a qualifying event. If you experience a qualifying event, you must contact HR within 30 days.

Identity Theft ………………………………. 14

Employee Contributions for Benefits ........15

Contact Information ..................................16

Legal Notices ……………………………… 17

This document is an outline of the coverage proposed by the carrier(s), based on information provided by your company. It does not include all of the terms, coverage, exclusions, limitations, and conditions of the actual contract language. The policies and contracts themselves must be read for those details. Policy forms for your reference will be made available upon request. The intent of this document is to provide you with general information regarding the status of, and/or potential concerns related to, your current employee benefits environment. It does not necessarily fully address all of your specific issues. It should not be construed as, nor is it intended to provide, legal advice. Questions regarding specific issues should be addressed by your general counsel or an attorney who specializes in this practice area.

2

Annual Benefits Enrollment for 2021

ANNUAL BENEFITS ENROLLMENT FOR 2021 For You and Your Family

November is Open Enrollment for Opelousas General Health System’s Employee Benefit Plans. This guide provides information about your health and welfare benefits for 2021. The company provides options to help you take better care of yourself and your healthcare costs. Carefully review this enrollment guide to select the plans that best fit your health and financial needs. During this open enrollment period you have the ability to enroll and/or make changes to your current benefits with an effective date of January 1st. You may add or drop a family member, discontinue coverage, or enroll in new coverage during this time. By law, many of your 2021 elections must stay in effect for an entire year, unless you experience a qualified life event.

HOW TO ENROLL: Current Employees: The FIRST STEP is to login to the ADP portal at http://workforcenow.adp.com. Once logged in please:

 Review your current benefit elections.

Verify your personal information.



Verify beneficiary Information.



The NEXT STEP is to complete the Open Enrollment Process through ADP:

 Make benefit election changes if desired; some benefits may require additional forms to be completed in order to add or change coverage. Please contact Human Resources with any questions.

 Update personal information such as your address or phone number if applicable.

 Update beneficiary information if applicable.

*Once you have made your elections, you will not be able to change them until next open enrollment period unless you have a qualified change in status.

WHEN TO ENROLL: Current Employees:

The open enrollment period runs from November 1, 2020 - November 30, 2020 . Benefits elected during open enrollment will be effective from January 1, 2021 through December 31, 2021.

3

Effective Date of Coverage and Open Enrollment

EFFECTIVE DATE OF COVERAGE

CHANGES THAT CAN BE MADE EFFECTIVE JANUARY 1, 2021

NEWLY HIRED EMPLOYEES

• Enroll, Terminate or Change an Individual and/or Dependent Coverage in the Medical/Dental/Vision Plan • Enroll, Terminate or make Changes to your Health Savings Account (HSA) or Flexible Spending Account (FSA) • Add, Terminate or make Changes to the Voluntary Life and AD&D plan which may require medical underwriting approval

A new hire’s effective date will be first of the month following 2 full months of employment.

Example: If you are hired on January 15th, your effective date of coverage will be April 1st.

* If you elect not to enroll during the initial enrollment election period, you will be unable to enroll until the next open enrollment period unless you experience a “Qualified Life Event”.

 Update Beneficiaries for Life Insurance

 Enroll, terminate, or change voluntary benefit coverages

CHANGING YOUR BENEFITS DURING THE YEAR You will be allowed to enroll in benefits or make changes to your benefits during the plan year only if you experience a “Qualified Life Event”:

OPEN ENROLLMENT INFORMATION

• This Year we are continuing to use the Blue Cross Blue Shield of LA Network through the Medical TPA, Blue Cross Blue Shield of South Carolina and the Rx Drug Vendor, MedImpact. Please see the additional BCBSLA and MedImpact documents for full details. There are very minimal changes to our PPO and HDHP medical plans for 2021, and the rates will remain the same as 2020. • Your Dental Benefits will continue to be administered by Blue Cross Blue Shield of LA through SC; The benefits and premiums will remain the same for 2021. • Your Vision benefits will continue to be with Sun Life. The benefits and rates will remain the same for 2021. • Your Basic Life & AD&D, Voluntary Life & AD&D, and Long Term Disability benefits will continue to be offered through Sun Life. The benefits and rates will remain the same. • Your Voluntary Short Term Disability policy will continue to be offered through Aflac. Please see Aflac documents for benefits and rates.

Marriage



Divorce or Legal Separation



 Birth or placement for adoption of a child

Death of a dependent



Ineligibility of a dependent



Loss of other coverage



 Change in your employment status or that of your spouse  Significant change in health coverage attributable to your employment or that of your spouse

 A qualified domestic relations order or similar court order

Entitlement to Medicare or Medicaid



4

Opelousas General Health System

MEDICAL and RX BENEFITS

Blue Cross Blue Shield of Louisiana & MedImpact Comprehensive and preventive healthcare coverage is important in protecting you and your family from the financial risks of unexpected illness and injury. A little prevention usually goes a long way—especially in healthcare. Routine exams and regular preventive care provide an inexpensive review of your health. Small problems can potentially develop into large expenses. By identifying the problems early, often they can be treated at little cost. In case of an illness or injury, you and your family are covered with an excellent medical plan through Opelousas General Health System. OGHS offers two medical plan options using the OGHS & BCBS of LA PPO Network.

PLAN 1

TRADITIONAL PLAN (PPO)

Tier 1 - OGHS OGHS and OGHS Pharmacy $500 Single $1,500 Family $3,000 Single $8,000 Family

Tier 2 - PPO When Services ARE NOT Available at OGHS

Tier 3 - PPO When Services ARE Available at OGHS

Tier 4 Non PPO Provider

Unlimited Lifetime Benefit Maximum

$1,500 Single $4,500 Family $5,000 Single $15,000 Family

$5,000 Single $10,000 Family $6,650 Single $16,625 Family

$6,000 Single $12,000 Family

Annual Calendar Year Deductible

Annual Out-of-Pocket Maximum (includes deductible)

Unlimited

Coinsurance

80%-100%

80%

50%

40%

DOCTOR’S OFFICE

Primary Care & Specialist Visit

80% after Deductible

80% after Deductible

50% after Deductible

40% after Deductible

100%; Deductible Waived 100%; Deductible Waived

100%; Deductible Waived

100%; Deductible Waived

Wellness Care

Not Covered

Diagnostic Tests & Imaging (x-ray, blood work, CT/PT scans, MRI)

80% after Deductible

50% after Deductible

50% after Deductible

Urgent Care

80% after Deductible

80% after Deductible

50% after Deductible

40% after Deductible

HOSPITAL SERVICES

Emergency Room—Accident

$150 Copay

$150 Copay

$150 Copay

$150 Copay

Emergency Room—All Other

80% after Deductible

80% after Deductible

80% after Deductible

80% after Deductible

$500 Copay per Stay, then Deductible/80%

$2,000 Copay per Stay, then Deductible/50%

$3,000 Copay per Stay, then Deductible/50%

Inpatient Services: Facility Fee

90%; Deductible Waived

Inpatient Services: Physician Fee

80% after Deductible

80% after Deductible

50% after Deductible

50% after Deductible

Outpatient Surgery: Facility Fee

100%; Deductible Waived

80% after Deductible

50% after Deductible

50% after Deductible

Outpatient Surgery: Physician Fee

80% after Deductible

80% after Deductible

50% after Deductible

50% after Deductible

Mental Health/Substance Abuse Inpatient Services Mental Health/Substance Abuse Outpatient Services

$500 Copay per Stay, then Deductible / 80%

$2,000 Copay per Stay, then Deductible/50%

$3,000 Copay per Stay, then Deductible / 50%

90%; Deductible Waived

80% after Deductible

80% after Deductible

50% after Deductible

50% after Deductible

PRESCRIPTION DRUGS (30 DAY SUPPLY)

TIER 2 OOP MAX APPLIES TO RX BENEFITS

Calendar Year Rx Deductible (per person)

$150 (Tier 1)

$200

Generic Drugs

75% of theactual cost of the drug; Deductible Waived

Brand Name Drugs, No Generic Available Brand Name Drugs, Generic Available

75% of the actual cost of the drug after Rx Deductible

75% of the cost of the generic drug after Rx Deductible (Member Pays Differential)

Specialty Drugs

Deductible then 70% of the cost of the drug

* Certain Specialty Medications must be dispensed by Ochsner Specialty Pharmacy who can be reached at (855) 312-4193 ; limited to a 30-day supply and may require Prior Authorization. Specialty medications are subject to a copay of 30% of the actual cost of the drug. * Requirement of 90-day supply for Non-Specialty Maintenance Drugs dispensed at the OGHS Pharmacy. * All in-network tiers cross apply; out-of-network tier does not.

5

Opelousas General Health System

MEDICAL and RX BENEFITS

PLAN 2

HIGH DEDUCTIBLE PLAN (HSA QUALIFIED)

Tier 4 Non PPO Provider

Tier 1 - OGHS OGHS and OGHS Pharmacy $2,500 Single $5,000 Family $2,500 Single $5,000 Family

Tier 2 - PPO When Services ARE NOT Available at OGHS

Tier 3 - PPO When Services ARE Available at OGHS

Unlimited Lifetime Benefit Maximum

$3,500 Single $7,000 Family $4,000 Single $8,000 Family

$5,000 Single $10,000 Family $6,650 Single $13,300 Family

$6,000 Single $12,000 Family

Annual Calendar Year Deductible

Annual Out-of-Pocket Maximum (includes deductible)

Unlimited

Coinsurance

100%

100%

50%

50%

DOCTOR’S OFFICE

Primary Care & Specialist Visit

100% after Deductible 100% after Deductible

50% after Deductible

50% after Deductible

100%; Deductible Waived

100%; Deductible Waived

100%; Deductible Waived

Wellness Care

Not Covered

Diagnostic Tests & Imaging (x-ray, blood work, CT/PT scans, MRI)

100% after Deductible 100% after Deductible

50% after Deductible

50% after Deductible

Urgent Care

100% after deductible 100% after Deductible

50% after deductible

50% after deductible

HOSPITAL SERVICES

Emergency Room—Accident

100% after Deductible 100% after Deductible

50% after deductible

50% after deductible

Emergency Room—All Other

100% after Deductible 100% after Deductible

50% after deductible

50% after deductible

$2,000 Copay per Stay, then Deductible, / 50%

$3,000 Copay per Stay, then Deductible / 50%

Inpatient Services: Facility Fee

100% after Deductible 100% after Deductible

Inpatient Services: Physician Fee

100% after Deductible 100% after Deductible

50% after deductible

50% after deductible

Outpatient Surgery: Facility Fee

100% after Deductible 100% after Deductible

50% after deductible

50% after deductible

Outpatient Surgery: Physician Fee

100% after Deductible 100% after Deductible

50% after deductible

50% after deductible

Mental Health/Substance Abuse Inpatient Services Mental Health/Substance Abuse Outpatient Services

$2,000 Copay per Stay, then Deductible, / 50%

$3,000 Copay per Stay, then Deductible / 50%

100% after Deductible 100% after Deductible

100% after Deductible 100% after Deductible

50% after deductible

50% after deductible

PRESCRIPTION DRUGS (30 DAY SUPPLY)

TIER 2 DEDUCTIBLE & OOP MAX APPLIES TO RX BENEFITS

Calendar Year Rx Deductible (per person)

Integrated with Medical Deductible (Tier 2)

Generic Drugs

Deductible then 100% of the actual cost of the drug

Brand Name Drugs, No Generic Available Brand Name Drugs, Generic Available

Deductible then 100% of the actual cost of the drug

Deductible then 100% of the actual cost of the drug (Member Pays Differential)

Specialty Drugs

Deductible then 70% of the actual cost of the drug

* Certain Specialty Medications must be dispensed by Ochsner Specialty Pharmacy who can be reached at (855) 312-4193 ; limited to a 30-day supply and may require Prior Authorization. Specialty medications are subject to a coinsurance of 30% of the actual cost of the drug. * Requirement of 90-day supply for Non-Specialty Maintenance Drugs dispensed at the OGHS Pharmacy. * All in-network tiers cross apply; out-of-network tier does not.

6

Opelousas General Health System

Additional Medical & Rx Benefit Information

HOW TO FIND MEDICAL and RX PROVIDERS Finding In-Network Providers

You save the most money when you choose in-network doctors, facilities, and pharmacies. Visit MyHealthToolkitLA.com listed on the bottom of your

medical insurance ID card. On the My Health Toolkit site, the Shopping for Care tool can be found under the Resources menu. Access the tool by selecting Find a Doctor or Hospital . Once in Find Care, you can either search for a specific provider or facility by name or use the Guided Search to find care by category. Use the options on the left side of the screen to refine your results. These include location, patient reviews, specialty, gender, language and more. Results can also be filtered alphabetically and by distance, patient rating and preferred providers. You can print or email Provider Directories by selecting the Quick Link at the bottom of the page. When you find a provider you are interested in, click on the name to view more details, such as patient reviews, other locations, and any certificates, affiliations or licenses the provider may have. Once you have found a provider who meets your needs, you can use the Save feature to add him or her to your saved providers list which is printer friendly.

Refer to the BCBS Shopping for Care document located on the OGHS Intranet for more detailed instructions. You can also refer to the BCBS Booklet for directions on creating an online account, the My Health Toolkit App, Digital ID Cards and more.

Looking for Prescription Drug Information? Visit www.medimpact.com/members to obtain an overview of plan benefits, determine if prescribed medications are on the preferred formulary list, locate an in-network pharmacy and MORE!! You can also call 844-826-3442 to reach customer service. OGHS RETAIL PHARMACY For your convenience and the most cost-effective care, visit our on-site . There are two convenient service windows on the first floor. You can find them next to the Emergency Room and Admissions Department. This service is available to all employees, patients, guests, and the general public so get all of your prescriptions for both you and your family members in one place! Online refills are available, hours of operation are Monday - Friday 7:00am - 5:30pm, for more information call (337) 943-7102. Certain Specialty Medications must be dispensed by the Ochsner Specialty Pharmacy : Specialty medications are limited to a 30-day supply, may require Prior Authorization, and subject to a 30% coinsurance. Ochsner Specialty Pharmacy Phone Number: 855-312-4193

Diabetic Care Supplies are provided by

Customer Service: 1-877-777-4710

7

Opelousas General Health System

Wellness, Tobacco Cessation & Spousal Surcharge Programs

OGHS Wellness Program Participation in an annual wellness screening allows you to “know your numbers” and health risk factors with the resources available through our wellness experts on staff here at OGHS. By participating in an Annual Wellness Screening , you will be able to waive a $25 per pay period surcharge that will be paid by employees who choose not to do their annual screening. OGHS provides you with a digital health platform that makes it easier for you to improve and maintain your overall health through the Rally® Wellness Program of Blue Cross Blue Shield. Rally tracks your wellness performance in order to not receive a wellness surcharge and can show you how to make simple changes to your daily routine, set smart goals for yourself, and stay on target. You’ll get personalized recommendations to get you moving more, eating better, & feeling happier — and you’ll have fun doing it. Get started today! 1. Go to www.MyHealthToolkitLA.com

2. Log in to your My Health Toolkit® account 3. Select Health and Wellness, then Rally

*Rally is available to you at no additional cost as part of your health benefits.

OGHS Tobacco Surcharge A new Tobacco Policy will be in effect for January 1, 2021.  In lieu of cotinine swab testing, ALL EMPLOYEES enrolled in an OGHS health Plan will have to complete a Tobacco Attestation Quiz.  This quiz must be completed by December 15, 2020 through the Relias Learning Management System at https://opelousasgeneral.training.reliaslearning.com/.  Verified tobacco users and employees that do not complete the Tobacco Attestation by 12/15/20 will incur the Tobacco Surcharge of $25 per pay period for the 2021 plan year. A tobacco user is defined as a participant who has smoked, inhaled (excluding second-hand smoke), snuffed, chewed, or otherwise ingested tobacco products within the preceding thirty (30) calendar days before completing Annual Enrollment or New Hire Benefits Enrollment. All New Hires continue to be subject to a Tobacco Screening upon hire. Once you submit the Tobacco Attestation Affidavit stating that you use tobacco products, your tobacco premium surcharge will become effective 1/1/2021. Those who complete the tobacco cessation program will not pay the monthly surcharge. As a resource for tobacco users, tobacco cessation medication is payable under the OGHS health plan. If you state that you are not a tobacco user, you will not be responsible for the additional surcharge. *** If falsification of your tobacco-user status is identified, Opelousas General Health System reserves the right to terminate employment of the employee. OGHS Spousal Surcharge If your spouse is offered coverage through his/her employer, and they choose to remain on the OGHS plan, you will pay a $30 surcharge per pay period. New Hires: This will be determined by signing an affidavit upon hire, proof may be required.

8

Opelousas General Health System

Flexible Spending Account - FSA Health Savings Account - HSA

Flexible Spending Account A Health Care Flexible Spending Account (FSA) is offered by Opelousas General Health System through AccrueHealth. You can save money on your health care and/or dependent day care expenses with an FSA. You set aside funds each pay period on a pre-tax basis and use them tax-free for qualified expenses. You pay no federal income or Social Security taxes on your contributions to an FSA. That’s where the savings comes in! The maximum annual FSA limit for 2021 is $2,750, and the entire amount elected is available for use on the first day of the plan year (1/1/2021). Some examples of FSA eligible expenses are: Vision, hearing, dental and physical exams, prescription drugs, orthodontics, acupuncture, ambulance services, LASIK surgery, wheelchairs, medical equipment and more. For further information on federal requirements and what can be covered by FSA funds, see Publication 502 at www.IRS.gov. OGHS also offers a Dependent Care Flexible Spending Account through BCBS of LA. This is a reimbursement account that al lows you to set aside a certain amount of money each paycheck, on a pre-tax basis to help pay for your eligible dependent day care expenses. The maximum annual limit you can elect is $5,000 per household; the minimum contribution amount is $500. PLEASE REMEMBER to use the funds in these accounts within the calendar year. You are allowed to carryover $500 in your Health Care FSA to use the following year, but will lose any remaining balance in excess of $500 if not used by December 31st. Please refer to www.IRS.gov for a list of approved expenses or contact HR with any questions. Link up with AccrueHealth through My Health Toolkit at MyHealthToolkitLA.com or through the AccrueHealth Mobile App. You can view your FSA balance, submit claims, store receipts and much more! Please check your FSA balance today. Health Savings Account If you enroll for coverage in the High Deductible Health Plan (Plan 2), you are eligible to contribute to a Health Savings Account offered through St. Landry Bank. YOU WILL NEED TO GO TO ST. LANDRY BANK TO COMPLETE THE FORMS TO OPEN YOUR HSA ACCOUNT. Opelousas General Health System offers several ways to set aside pre-tax dollars to pay for medical, prescription drug, dental and vision care expenses. The health care accounts available to you depend on the medical plan you choose.

HSA

What is an HSA?

An HSA (Health Savings Account) is a tax-free account you can use to pay for current and future medical expenses (even medical expenses during your retirement). The money goes in tax-free and grows tax-free. Your withdrawals for qualified medical expenses – including any earnings – are tax free. These funds help you pay for out of pocket medical, dental and vision expenses. You’re eligible to open an HSA if: 1. You enroll in a qualified high-deductible health plan. 2. Your only coverage is a high deductible health plan, and you have not signed up for Medicare coverage. 3. If you’re covered under your spouse’s plan and that plan is not a high-deductible plan or then you are not eligible to contribute to an HSA. You decide how much you want to contribute up to (minus employer contributions): 1. $3,550 if you enrolled in employee only medical coverage 2. $7,100 if you enrolled in family coverage (one or more covered dependents) 3. $1,000 additional if you are age 55 or older You are not required to make HSA contributions, though it is a good idea to add to your account for the tax savings and help pay for medical expenses. Each time you have a qualified expense, you decide whether to: Pay out of your pocket and let your HSA grow for future expenses or use your HSA to pay for eligible medical expenses, such as your annual deductible and coinsurance. Your HSA can also help pay for vision care, dental care, prescription drugs, medical equipment and more. (For a complete list of eligible expenses, visit www.irs.gov.) Money you don’t spend rolls over from year to year. So if you change jobs, switch to another medical plan or even retire, your HSA and the money in it is still yours to keep. You can choose to save it to pay for eligible health care expenses tax free in retirement. OGHS will also contribute to this account each month . For Single coverage they will con- tribute $50 a month and $76 for family coverage. This accounts for $600 of annual employer contributions for Single coverage and $900 for Family coverage.

Who’s Eligible?

You can contribute to your account

Pay Health Care Expenses

Roll over your balance, or take it with you if you leave OGHS

Opelousas General Health System Contribution

9

Opelousas General Health System

DENTAL and VISION BENEFITS Dental Benefits Administered by Blue Cross Blue Shield of La (Coverage available to FT & PT EEs) Good oral care enhances overall physical health, appearance and mental well-being. Problems with the teeth and gums are common and easily treated health problems. Keep your teeth healthy and your smile bright with the Opelousas General Health System’s dental benefit plan. Please refer to the plan document for complete details.

Vision Benefits Administered by Sun Life– VSP Network Regular eye examinations can not only determine your need for corrective eyewear, but also may detect general health problems in their earliest stages. Protection for the eyes should be a major concern to everyone. Keep your eyes healthy with Opelousas General Health System’s vision benefit plan. Please refer to the plan document for complete details.

IN NETWORK Discounted Fee Schedule

DENTAL SERVICES

VISION SERVICES

IN NETWORK

OUT OF NETWORK

OUT OF NETWORK

Eye Exam (EVERY 12 MONTHS)

$10 Copay

Up to $52

UCR 85th%

Benefits Paid On

Materials

$25 Copay

N/A

$50 Single; $150 Family

Annual Deductible

FRAMES (EVERY 24 MONTHS)

$1,000

Annual Benefit Maximum

Frame Allowance

Up to $130

Up to $57

Class 1: Preventive Services  Oral Exams  Bitewing X-rays  Full Mouth / Panoramic X-rays

STANDARD PLASTIC LENSES (EVERY 12 MONTHS)

Single Vision

$25 Copay

Up to $55

100%; no deductible

100%; no deductible

Bifocal

$25 Copay

Up to $75

Max Age 17:  Fluoride Treatments  Sealants (per tooth)  Space Maintainers

Trifocal

$25 Copay

Up to $95

Lenticular

$25 Copay

Up to $125

Class 2: Basic Services  Non-Routine Visits  Fillings  Endodontics  Periodontics/Periodontal Maintenance  Surgical Extractions Class 3: Major Services  Bridges and Dentures  Crowns, Inlays, Onlays  Repairs of Dentrures, Crowns, Inlays & Onlays Class 4: Orthodontia  Calendar Year Max—$1,000

CONTACT LENSES (EVERY 12 MONTHS) in lieu of glasses

$130 allowance (insured is responsible for any charges in excess of allowance)

80% after Deductible

80% after Deductible

Contact Lenses

Up to $105

Finding In-Network Dental Providers You pay less for services when you use a provider in the BCBS of LA Network. To find network providers near you, visit www.myhealthtoolkitla.com.

50% after Deductible

50% after Deductible

50%

50%

 Covered to age 19  $3,000 Lifetime Max

Finding In-Network Vision Providers You can find an eye doctor in the Sun Life VSP Network by visiting www.vsp.com or calling (800) 877-7195 .

10

Opelousas General Health System

Short & Long Term Disability Insurance

SHORT-TERM DISABILITY INSURANCE (STD) Insured by Aflac Insurance Short-Term Disability (STD) insurance provides income if you become disabled due to a non-work related injury or illness. Opelousas General Health System offers two VOLUNTARY Short Term Disability (STD) insurance options. This insurance is paid 100% by the employee.

*Please see Patrice Fisher, Benefits Coordinator, for Aflac benefits and rates.

LONG-TERM DISABILITY INSURANCE (LTD) Insured by Sun Life Group Insurance

Meeting your basic living expenses can be a real challenge if you become disabled. Your options may be limited to personal savings, spousal income and possibly Social Security. Disability insurance provides protection for your most valuable asset – your ability to earn income. Opelousas General Health System provides full-time employees Long Term Disability Insurance coverage at NO COST TO YOU ! These benefits are given to you on the first of the month following 18 months of employment. LTD coverage provides income when you have been disabled for 180 days or more from a non-work related injury or sickness. This amount may be reduced by other deductible sources of income or disability earnings such as worker’s compensation or social security benefits. This is a brief description of your benefits used for illustrative purposes only. Please refer to your policy for complete details.

LONG TERM DISABILITY

Benefits Begin

After 180 Days

Benefit Amounts

60% of monthly earnings

Benefit Maximum

$10,000 per month

Benefit Maximum Period

To Age 65 or SSNRA

*If your disability occurs before age 62, benefits will be payable until age 65. If your disability occurs at or after 62, benefits would be paid according to a benefit duration schedule.

11

Opelousas General Health System

Life & AD&D Insurance

LIFE AND ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE Administered by Sun Life Group Insurance

Life insurance provides financial security for the people who depend on you. Your beneficiaries will receive a lump-sum payment if you die while employed by Opelousas General Health System. OGHS provides all full-time employees with Term Life Insurance and Accidental Death & Dismemberment (AD&D) coverage in the amount of $25,000 at NO COST TO YOU!

VOLUNTARY LIFE AND AD&D INSURANCE

Administered by Sun Life Group Insurance

Voluntary Term Life offers both FT and PT employees and their spouses the opportunity to choose the life insurance benefit(s) they want at a price they can afford. Both full and part time employees are eligible to purchase additional Life and Accidental Death & Dismemberment insurance. Employee’s who have previously declined coverage cannot elect coverage without completing medical questions. Further, employee’s who elect an increase in excess of $10,000 or in excess of the guarantee issue amount will be required to complete medical questions .

Employee Coverage:

Benefit Amount - $10,000 increments Benefit Minimum - $10,000 Benefit Maximum - up to the lesser of 5 times your annual salary rounded to the next highest $10,000 or $500,000 Guarantee Issue Amount - up to the lesser of 5 times your annual salary or $200,000 Coverage Reduces to - 50% upon Person’s attainment of age 70 Voluntary Life Benefit features : • Portability

• Employee Life Insurance Premium Waiver • Accelerated Death Benefit (Living Benefit) • Conversion is available when insurance terminates • Dependent continuation provision

Spouse Coverage:

Benefit Amount - $5,000 increments Benefit Minimum - $5,000 Benefit Maximum - $500,000, not to exceed the employee’s benefit amount Guarantee Issue Amount - $50,000

Dependent Children Coverage:

For eligible children, you may choose to purchase a benefit in increments of $1,000 up to $10,000 and not to exceed the employee’s benefit amount. Maximum benefit under 6 months old is $1,000

12

Opelousas General Health System

Voluntary Benefits and EAP Programs ACCIDENT PLAN Administered by CHUBB Group Insurance

Opelousas General Health System offers a voluntary accidental plan through CHUBB. This plan covers you in the event that you have a life-threatening accident, including the loss of life and dismemberment. This coverage is available to both full-time and part -time employees the first of the month following 2 months of employment. Please refer to the plan document for more information and detailed benefits.

CHUBB ACCIDENT PLAN SUMMARY

Increments of $25,000 up to $1,000,000 (cannot exceed 10 times your annual salary)

Employee Coverage

Covered at 60% of the employee benefit if no dependent children are on the plan; covered at 50% if there are dependent children on the plan. Covered at 25% of the employee benefit if there is no spouse covered; covered at 20% if there is a spouse covered on the plan.

Spouse Coverage

Child(ren) Coverage

VOLUNTARY INSURANCE BENEFIT OPTIONS Administered by AFLAC (Group #23944) The following voluntary insurance coverage is available for employees to purchase through payroll deduction. Open enrollment is held during the month of November each year for a January1st effective date. See Aflac materials for benefit details and rates!

AFLAC VALUE ADD SERVICES Administered by AFLAC If you are enrolled in at least 1 AFLAC product, you have access to the following 3 products. For more information, contact AFLAC at 855-423-8585.  Employee Assistance Program - Health Advocate’s Telephonic Employee Assistance Program provides support for a range of personal, family and work/life balance matters. This EAP provides 24/7 phone access to licensed, professional counselors, prepared to help with your personal situation. They can also provide referrals for long-term counseling or specialized care, with customized plans to meet your specific needs.  Medical Bill Saver - Aflac already pays claims quickly. Now, with Medical Bill Saver™, Health Advocate professionals also help you negotiate medical bills not covered by health insurance.  GROUP CANCER+CRITICAL ILLNESS INSURANCE  GROUP ACCIDENT COVERAGE  GROUP HOSPITAL INDEMNITY  GROUP SHORT TERM DISABILITY

OGHS Employee Assistance Program Administered by OGHS OGHS also offers its own personal EAP program that is 100%confidential at NO COST to its employees!  Life’s personal, family, or work-related issues shouldn’t make it hard to get through the day. Take advantage of this wonderful free program knowing that you have someone who will listen, understand, and suggest the next steps.  This program includes 8 confidential, one-hour face-to- face Counseling Sessions.  Please contact Margie Quebedeaux in Opelousas at (337) 945-5545 or Harmony House Counseling LLC in Eunice, LA at (337) 466-3530.

 Health Advocacy - 24/7 access to Personal Health Advocates who start helping from the first call.

13

Opelousas General Health System

Identity Theft Insurance

IDENTITY THEFT ADMINISTERED BY IDENTITY GUARD

 ALERT SPEED —The sooner you’re alerted, the more you can minimize the impact of a stolen identity. With many alerts in as little as 3 seconds, Identity Guard offers you a good chance of stopping an attempt before any harm can be done at all.

 BREADTH OF DATE MONITORED —The more >Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20

Made with FlippingBook Publishing Software