Norton Benefits
Norton Benefits
Tony Bohn System Vice President and Chief Human Resources Officer Norton Healthcare
Life insurance plans remain the same as last year. Disability plans remain the same as last year. The voluntary benefits suite remains the same as last year. Three medical plans (HDHP, PCA and PPO) remain available; each
plan offers a three-tiered network benefits structure.
Some medical plans medications have changed drug levels; refer to the Forms Library on Nsider for these documents:
2013 RX4 Drug List 2013 RX4 Drug List Changes 2013 RX4 Prior Authorization Changes 2013 RX4 Quantity Limit Changes
Costs for benefits plans in 2013: Medical plan rates have increased due to escalating medical
costs, mandated coverage and actual plan claims costs.
Dental plan rates have increased slightly. Vision rates remain the same. Supplemental life insurance rates have increased slightly, and premiums for employee supplemental life insurance will be deducted after taxes. Spouse life and child life insurance rates have increased slightly. Short-term disability rates have increased slightly. Long-term disability rates remain the same.
Important
If you do not re-enroll during the open enrollment period, your benefits will expire on Dec. 31, 2012, and you will not have benefits for 2013.
Highlights for 2013 Effective Jan. 1, 2013, employees must be statused to work at
least 32 hours per pay period (.4 FTE) to be eligible for Norton Healthcares standard benefits suite, which includes medical, dental, vision, life insurance, disability plans, voluntary benefits and perks.
All changes are effective Jan. 1, 2013. 2013 open enrollment awareness bonanza Oct. 22 to 29, 2012
Benefits education specialists will be traveling to Norton Healthcare facilities during an open enrollment awareness bonanza to:
Raise awareness about open enrollment Provide guidance for those needing enrollment assistance
Dental plan offerings remain the same as last year with three
options: DMO, PPO and traditional.
Vision plan offerings remain the same as last year with two options:
VSP Basic and VSP Plus.
Need help? Call the Norton Service Center at (502) 629-8911, option 2.
Visit the Open Enrollment page on Nsider. View Humana Smart Summaries for a history of your claims usage. Use the medical plan selection tool at www.MyBenefitsPlanner.com. Call the Humana hotline at (888) 393-6765, available Monday
through Friday from 8 a.m. to 8 p.m.
Important
Dont forget you must enroll to have benefits in 2013; open enrollment ends Nov. 16 at 5 p.m.
Qualifying event status changes must be submitted within 31 days from date of hire or date of event.
Important things to remember: You must enroll within 31 days of your date of hire. If you do not enroll within 31 days, you will not have benefits except basic
life insurance and basic long-term disability, which Norton Healthcare provides to eligible employees at no cost. No other option is available for enrolling except during annual open enrollment in the fall or if you experience a qualifying event status change.
If you have a qualifying event status change, you must submit a Benefits
Enrollment/Change form with your requested benefits changes within 31 days of the event. Use the Benefits Enrollment area of Employee Self-Service on Nsider to enroll in benefits.
Remote access from off campus requires a free software download. For
additional details about remote access, see page 41. Call the Norton Service Center at (502) 629-8911, option 1, if you need further assistance.
Important
Dont forget you must enroll within 31 days of your date of hire to have benefits in 2013.
If you already have a Humana medical plan, view Humana Smart Summaries
for a history of your claims usage.
Use the medical plan selection tool at www.MyBenefitsPlanner.com. Take advantage of a one-on-one personal enrollment consultation with
a benefits education specialist and/or retirement education specialist by contacting (502) 629-BENE (2363).
Need help? Call the Norton Service Center at (502) 629-8911, option 2.
Staying informed
Benefits communications
The Benefits Department works to keep you informed about your benefits. It is important that you read all communications sent to you. Information about benefits and enrollment are provided in multiple ways: To complete your benefits enrollment or make benefits changes, follow these steps: 1. Go to MyHR on Nsider. 2. Click on Employee Self-Service at the bottom of the page. 3. Enter username (AHSN) and password. 4. Click Login. 5. Click on Employee Self-Service. 6. Click on Benefits. 7a. Click on Benefits Enrollment if you are completing annual open enrollment. 7b. Click on New Hire Enrollment if you are completing new hire enrollment. 8. Follow the instructions. 9. A confirmation email will be sent to your Norton Healthcare email address within 60 minutes of submitting your enrollment. If you do not receive an email, call the Norton Service Center at (502) 629-8911, option 2.
Norton eNews Today, a daily email that also is posted on Nsider Letters mailed to your home when important changes are being made Emails to your Norton Healthcare email address about specific
benefits you are enrolled in
Important
To complete your benefits enrollment, you must:
Verify and update dependent information. Click Submit. Print your Benefits Elections Page as proof of your enrollment.
To enroll in or modify your retirement plan elections: 1. Go to the Human Resources page on Nsider. 2. Under Benefits Providers, select Principal Financial Group. 3. Follow the login instructions. To enroll in or modify your voluntary benefits plan elections:
Ready to enroll?
Online benefits enrollment is available 24/7 during the enrollment period through Employee Self-Service and can be accessed from:
Call the Norton Service Center at (502) 629-8911, option 2, or call (502) 629-BENE (2363) and request a personal benefits enrollment consultation with a benefits education specialist.
Any on-campus computer. Any computer lab or kiosk in a Norton Healthcare facility. A list of
locations is available on the Human Resources page on Nsider or by calling any facility Human Resources office.
Important
This booklet highlights many Norton Healthcare benefits. Refer to the respective summary plan descriptions for more details. Every effort has been made to ensure the accuracy of this information. However, the actual administration of the plans is governed by plan documents and insurance agreements. In the event of a discrepancy between these highlights and the plan documents and agreements, the documents and agreements take precedence.
Qualifying event status changes must be submitted within 31 days from date of hire or date of event.
What if I change my mind after I enroll? New employees who wish to change benefits
elections after their initial election may do so by submitting a Benefits Enrollment/Change Form to the Benefits Department within 31 days of their date of hire or rehire.
When will my elections be effective? For new or rehired employees, enrollment elections
are effective on the first day of the month following the date of hire or rehire.
What is my deadline for enrolling? New employees must enroll within 31 days of the
date of hire or rehire.
Need help? Call the Norton Service Center at (502) 629-8911, option 2.
Coverage under all plans except medical, dental and vision will end
on the separation date or the day status changes.
Medical, dental and vision benefits end on the last day of the
month in which status changes or employment ends.
Marriage, divorce, legal separation, annulment or death of a spouse Birth, adoption or death of a dependent child The beginning or end of an employees or spouses employment A change in your or your spouses benefits eligibility status (e.g., a
reduction or increase in hours of employment that may occur when switching between part-time and full-time, or the start or end of an unpaid leave of absence)
If the hours you are statused to work are reduced to less than 32
hours per pay period (.1 to 3.9 FTE), you may continue medical coverage only but must re-enroll to continue the existing medical plan. Premiums will increase, must be paid monthly and are not eligible for payroll deduction. For continuation options for all benefits plans, refer to the respective summary plan descriptions on Nsider.
A dependent child becoming eligible or ineligible for coverage You, your spouse or a child becoming ineligible for other coverage A court order requiring you, your spouse or a former spouse to
provide coverage for a child
Important
Qualifying event status changes must be requested within 31 days from the date of the event. Refer to the summary plan description language regarding detailed administration of qualifying event status changes located in the Forms Library on Nsider.
Employee only Employee plus spouse Employee plus child(ren) Family If both my spouse and I are employed at Norton Healthcare, can we both elect the same level of coverage?
Both of you can select employee plus child(ren); both of you cannot select employee plus spouse or family.
Qualifying event status changes must be submitted within 31 days from date of hire or date of event.
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Will I get new ID cards? If you are currently enrolled in Norton Healthcare benefits, dont
throw away your cards! Whether you will keep the same cards or get new ones depends on your benefits choices (see below).
If youre enrolling for the first time, you will receive ID cards. ID cards are issued/available only for the benefits listed below.
Medical ID cards
New medical ID cards are issued only if:
Medical coverage is elected for the first time Medical coverage level changed (e.g., switched from employee
only to employee with children or family coverage, or vice versa)
Employees who choose the PCA plan will receive a card like this.
Employees who choose to have an HSA with the HDHP plan will receive a separate Visa card for the HSA like this.
Need help? Call the Norton Service Center at (502) 629-8911, option 2.
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Dental ID cards
New dental ID cards are issued only if:
Dental coverage is elected for the first time Dental coverage level changed (e.g., switched from employee only
to employee with children or family coverage, or vice versa)
A new dental plan is elected Dependents are added or deleted from the employee with
children or family coverage levels of the CompBenefits plan Employees who choose the PPO or Traditional plan will receive a card like this.
Vision ID cards
Vision ID cards are not required for services but are available through www.vsp.com. Employees who choose the CompBenefits plan will receive a Humana Advantage Plus card like this. Employees who choose a VSP plan can print a card like this from the VSP site.
When will I receive my ID cards? New employees should receive ID cards within
14 days of enrolling as long as all of the necessary information has been provided.
Qualifying event status changes must be submitted within 31 days from date of hire or date of event.
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Medical coverage
Norton Healthcare offers three medical plans. The structure and customization of these plans is based on employee use in previous years. The medical plans include a choice of high-deductible, low-premium plans and a low-deductible, high-premium plan. These choices are available because in 2011 more than 53 percent of Norton Healthcare employees spent less than $1,000 in medical expenses; 81 percent spent less than $4,000.
What is an HSA?
An HSA is a health savings account for medical expenses.
About the medical plans Three plans are available to choose from: High-deductible health plan (HDHP) with health savings
account (HSA) option
HSAs are portable; they stay with you if you change employers or
leave the workforce.
HSA contributions
Maximum amounts that can be contributed to an HSA pre-tax each year:
All medical plans are self-insured by Norton Healthcare. All are PPO plans using a custom three-tiered benefits structure. All plans cover preventive services at 100 percent under Tier 1 and
Tier 2.
Single coverage $3,250 All other levels of coverage $6,450 Individuals over age 55 an additional $1,000 catch-up
contribution each year Those who choose the HDHP plan will receive a HumanaAccess Visa debit card to access HSA funds for eligible expenses.
HDHP with HSA option This is a high-deductible, low-premium, IRS-qualified plan that
allows you to elect an optional health savings account to help pay for unreimbursed expenses, similar to a flexible spending account (FSA).
PCA This is a high-deductible plan with low premiums. It includes a benefit allowance provided by Norton Healthcare
based on the coverage level elected.
Advantages of HSA vs. FSA Contributions roll over from year to year; it is portable and employee-owned; and it can be converted to an IRA.
These funds can be used to pay down the deductible, and unused
funds can roll over, up to $4,500; these funds are not portable and are owned by Norton Healthcare.
The PCA medical ID card has a Visa logo on it. The card is
preloaded with the allotted funds provided by Norton Healthcare and can be used just like a credit card for health care expenses only.
Need help? Call the Norton Service Center at (502) 629-8911, option 2.
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Prescription co-pays apply based on the prescription. The RxPlus program, an additional prescription benefit available
with this plan, reduces the co-pay on certain asthma and diabetes medications.
PPO This is a low-deductible plan with higher premiums. Co-pays apply for physician office visits, allergy injections and
chiropractic visits.
You will meet with a specially trained pharmacist who will work
with you and your physician to manage your diabetes.
Prescription co-pays apply based on the medication. The RxPlus program, an additional prescription benefit available
with this plan, reduces the co-pays on certain asthma and diabetes medications.
Who is eligible?
All employees and their family members who have diabetes, are at least 18 years old and are enrolled in one of Norton Healthcares medical plans
Visit NortonHealthcare.com/RxBetterHealth. Call the Rx for Better Health pharmacist at (502) 629-8099.
How do I join?
Call the Norton Healthcare Access Center at (502) 629-1234 or Rx for Better Health at (502) 629-8099.
You will receive cost savings when filling one 90-day prescription
(one co-pay) versus three 30-day prescriptions (three co-pays).
The MyHumana Mobile application provides information at your fingertips so you can manage your health benefits with ease. You can find a cheaper medication alternative while sitting with your doctor and even check the status of your claim after your visit.
Qualifying event status changes must be submitted within 31 days from date of hire or date of event.
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Important
Norton Healthcare recommends verification of provider participation and level of tier coverage prior to every service.
Finding a provider
If you do not have a primary care physician, finding one is as simple as sitting down at your computer or picking up the phone. If you are enrolling in a Norton Healthcare medical plan, follow the instructions below to find a participating provider. If you already have insurance, call the number on your Norton Healthcare medical plan ID card and a customer service representative will assist you. 1. Go to www.humana.com. 2. Select Find a Doctor, then select Find a Doctor again. 3. Select Employer Group Plan, located under Search by Coverage & Network. 4. Type in your ZIP code and click Go. 5. Select Your Network (Norton Healthcare PPO). 6. Choose your search parameters and click Go. If you are not enrolled in a Norton Healthcare medical plan, call (502) 629-1234 to find a Norton Healthcare medical provider who participates in your medical plan.
The cost of claims and administration are paid out of the medical
insurance fund. However, if the costs exceed the amount in the fund, Norton Healthcare must cover those costs.
What is a deductible?
A deductible is an annual amount of medical expenses for which the covered member is responsible before the plan begins paying benefits.
What is co-insurance?
Co-insurance is the percentage of covered costs for which the insured person is responsible after the deductible has been paid. For example, if a plan says that an expense is covered at 90 percent after the deductible, Norton Healthcare is liable for 90 percent of the cost after the deductible and the insured person is responsible for the remaining 10 percent.
What if I have a dependent child living out of the area or away at college?
All health plans provide in-network Tier 2 coverage if your child is in a Humana/ChoiceCare network service area. Hospital facility services must be performed in a Norton Healthcare network facility to receive the highest level/Tier 1 in-network coverage. You may wish to enroll children in the health insurance plan offered by their college. Each college can provide more information about its health care offerings.
Out-of-Network Tier 3
Highest out-of-pocket costs Non-Norton Healthcare and non-Humana ChoiceCare facilities Non-Norton Healthcare or non-Humana ChoiceCare providers Unlimited
Unlimited
Need help? Call the Norton Service Center at (502) 629-8911, option 2.
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Allergies Asthma Colds Ear infections Ear wax removal Eye infections Headaches Influenza (flu)
Injuries
Rash and skin conditions Sinus infections Strep infections Sore throat Sexually transmitted disease
care
Important
Nurse Advice Line 24-hour health information, guidance and support (800) 622-9529
Abrasions, cuts, bruising Bee stings and insect bites Burns and sunburn Eye (foreign body) Finger/toe nail Fracture care (acute
non-displaced) Prevention and wellness Allergy injections
Blood pressure screening Influenza vaccinations Physicals (school, sport, employment, DOT) Travel vaccines (Shelbyville Road location only)
Diagnostics Digital radiology
Drug screens and breath alcohol testing EKG TB testing Laboratory testing (CBC, UA, strep, pregnancy,
RSV and other tests)
Qualifying event status changes must be submitted within 31 days from date of hire or date of event.
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What medical services do you and your family use? Current Humana members can view their Smart
The Norton Mobile application for Androids, iPhones and iPads gives you instant, real-time access to the largest network of physicians, hospitals, immediate care centers and specialty centers in Greater Louisville all at the tap of a finger. Find a doctor near your current location or access a large health encyclopedia with a symptom navigator, recipes, classes and events. Download the app at NortonHealthcare.com/ NortonMobile.
Summaries to analyze previous claims. Log on to www.myhumana.com and select Claims Information then Smart Summaries. You can review 2012 claims and use the planning tools to help determine your needs for 2013.
How often do you use medical services? How much do you want to pay? Plans that cost less in
biweekly premiums generally require larger payments when medical care is provided.
Request a personal benefits enrollment consultation with a benefits education specialist by calling the Norton Service Center at (502) 629-8911, option 2. Use the My Benefits Planner selection tool on www.mybenefitsplanner.com. Dont over-insure yourself!
Employee + child(ren)
Family
Employees statused to work 32 to less than 64 hours per pay period HDHP PCA PPO $ $ $ 40.06 58.40 78.78 $ $ $ 63.96 86.79 136.78 Monthly Employees statused to work less than 32 hours per pay period, including registry HDHP PCA PPO $ $ $ 401.79 441.53 485.68 $ $ $ 803.58 883.05 971.36 $ $ $ 743.31 816.82 898.50 $ 1,245.54 $ 1,368.73 $ 1,505.60 $ $ $ 54.60 70.07 110.08 $ $ $ 76.40 103.26 168.74
Rates for employees statused to work less than 32 hours per pay period and registry employees are not paid through payroll deduction and will appear as $0 on the Benefit Elections page. Premium will be billed directly by WageWorks, our third-party billing vendor.
Need help? Call the Norton Service Center at (502) 629-8911, option 2.
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Important
Dont miss out on the opportunity to earn up to $520 per year in wellness credits through the N Good Health Creating a Healthier You! wellness engagement program. Visit NGoodHealth.com for details. Review the chart below to see how this credit can impact your net pay.
$ 1,922.40
$ 1,922.40
$ 1,232.85
*Sample net savings is based on estimated taxes of an employee claiming married status.
Qualifying event status changes must be submitted within 31 days from date of hire or date of event.
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N/A
N/A
N/A
100% 100% 100% 90% after deductible 90% after deductible 90% after deductible 90% after deductible 90% after deductible 90% after deductible 90% after deductible
100% 100% 100% 90% after deductible 90% after deductible 90% after deductible 90% after deductible 60% after deductible 60% after deductible 60% after deductible
40% after deductible 40% after deductible 40% after deductible 40% after deductible 40% after deductible 40% after deductible 40% after deductible 40% after deductible 40% after deductible 40% after deductible
90% after deductible 100% after deductible and after $10/$30/$55/25% 100% after $10/$30/$55/25% N/A
90% after deductible 100% after deductible and after $10/$30/$55/25% 100% after $10/$30/$55/25% N/A
40% after deductible 40% after deductible and after $10/$30/$55/25% 40% after $10/$30/$55/25% N/A
90% after deductible 100% after $10/$30/$55/25% N/A 100% after $5/$15/$55/25%
(1) Applies to medical services received from Tier 1 and Tier 2 participating providers only. (2) Prenatal co-payment applies to first visit only. (3) Out-of-pocket amounts exclude co-payments and deductibles. (4) Deductible and out-of-pocket limits for participating and nonparticipating benefits calculated separately except for HDHP deductible and out-of-pocket Tier 1 and Tier 2.
(5) You are not required to meet individual deductibles once the family deductible has been met. (6) Emergency room services and/or ambulance transportation charges are covered at the appropriate tier for emergency situations only, as defined in the Summary Plan Description in the Forms Library on Nsider. (7) Day/visit limits are combined for participating and nonparticipating providers.
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PCA
Humana/ChoiceCare Tier 2 In-network $500 Employee $1,000 Employee + spouse $1,500 Employee + child(ren) $1,500 Family 100% 100% 100% 90% after deductible 90% after deductible 90% after deductible 90% after deductible 60% after deductible 60% after deductible 60% after deductible Out-of-network Norton Healthcare Tier 1 In-network
PPO
Humana/ChoiceCare Tier 2 In-network Out-of-network
N/A
N/A
N/A
N/A
40% after deductible 40% after deductible 40% after deductible 40% after deductible 40% after deductible 40% after deductible 40% after deductible 40% after deductible 40% after deductible 40% after deductible
100% 100% 100% 100% after $25/$40 co-pay (11) 100% after $5 co-pay 90% after deductible 90% after deductible 90% after deductible 90% after deductible 90% after deductible 90% after $150 co-pay and after deductible 90% after deductible
100% 100% 100% 100% after $25/$40 co-pay (11) 100% after $5 co-pay 90% after deductible 90% after deductible 60% after deductible 60% after deductible 60% after deductible 90% after $150 co-pay and after deductible 90% after deductible
40% after deductible 40% after deductible 40% after deductible 40% after deductible 40% after deductible 40% after deductible 40% after deductible 40% after deductible 40% after deductible 40% after deductible
90% after deductible 100% after $10/$30/$55/25% N/A 100% after $5/$15/$55/25%
(8) Discounted prescription payments will apply toward the deductible and out-of-pocket amounts. Once the deductible has been satisfied, co-pays will apply and will be credited toward out-of-pocket maximums. (9) Preventative Rx co-pays will be credited toward out-of-pocket maximums. The list of these drugs is in the Forms Library on Nsider.
(10) The list of specific asthma and diabetes drugs is in the Forms Library on Nsider. (11) The co-pay for Norton Immediate Care Center visits is $40. (12) A complete list of diabetes medications with reduced co-payments can be found on the Rx for Better Health page at NortonHealthcare.com/RxBetterHealth.
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Dental coverage
Norton Healthcare offers three dental plan options.
CompBenefits AVK1 The CompBenefits plan is similar to a dental HMO. This is the least expensive of Norton Healthcares dental plans. It requires using a dentist from a list of approved providers. A list of network providers is available at www.compbenefits.com.
Click on Providers/Search and then Find Dental Providers. Next, select Advantage Plus plans, then complete the screen and click Submit.
Humana Traditional Dental This plan charges the highest premium because it covers all dentists
at the same benefit level.
There is no plan benefit maximum, but most services require member co-pays.
For a list of preferred dentists, visit www.humanadental.com. Click on Find a Dentist, enter ZIP code to search and click Go. Next choose PPO/Traditional Preferred as the network. Enter your address or search by state and county, and select Go. Enter your search criteria and select Search.
Humana PPO Dental This plan costs more than the CompBenefits plan but less than the
Traditional plan.
For a list of preferred dentists, visit www.humanadental.com. Click on Find a Dentist, enter ZIP code to search and click Go. Next choose PPO/Traditional Preferred as the network. Enter your address or search by state and county, and select Go. Enter your search criteria and select Search.
Go to the iTunes App Store or Android Market and search MyHumana Mobile to download Humanas mobile app.
Need help? Call the Norton Service Center at (502) 629-8911, option 2.
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Employees statused to work 64 hours per pay period or more CompBenefits AVK1 Humana PPO Humana Traditional $ $ $ 3.69 5.28 7.80 $ $ $ 7.49 10.71 15.80 $ $ $ 7.52 12.81 19.27 $ $ $ 12.20 16.07 23.79
Employees statused to work 32 to less than 64 hours per pay period CompBenefits AVK1 Humana PPO Humana Traditional $ $ $ 5.54 7.92 10.44 $ $ $ 11.23 16.07 21.16 $ $ $ 11.28 19.22 25.68 $ $ $ 18.30 24.10 31.82
CompBenefits
In-network N/A N/A N/A
Humana PPO
In-network $ 50 $ 150 N/A Out-of-network $ 75 $ 225 N/A
Humana Traditional
In-network $ 50 $ 150 N/A Out-of-network $ 50 $ 150 N/A
100% No deductible
100% No deductible
80%* No deductible
100% No deductible
100%* No deductible
Plan pays balance after co-pay is paid per the schedule Plan pays balance after co-pay is paid per the schedule None 24-month treatment maximum; discount offered
50%
50%*
50%
50%*
$ 1,000
$ 1,000
$ 1,000
$ 1,000
$ 1,500
$ 1,500
$ 1,500
$ 1,500
*Coverage under Humana dental plans is based on allowable fees for each service. Out-of-network dentists may charge more than the allowable amount and bill for the difference.
Qualifying event status changes must be submitted within 31 days from date of hire or date of event.
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Vision coverage
Norton Healthcare offers two vision plans.
VSP Basic This plan has the lowest premium. It provides mainly in-network benefits. Out-of-network benefits are limited. VSP Plus This plan has higher premiums. It covers all vision providers but pays a higher benefit level
for in-network usage.
Employee only
$ 0.56 $ 3.41
Employee + spouse
$ 0.90 $ 5.39
Employee + children
$ 0.92 $ 5.50
Family
$ 1.33
$ 8.86
Need help? Call the Norton Service Center at (502) 629-8911, option 2.
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VSP Plus
Out-of-network
Lens options (Uncovered lens options are provided at preferred pricing. Savings average 30%) UV coating and tint Scratch resistance Polycarbonate Progressive and anti-reflective Other add-ons and services Elective contact lenses Contact lens exam Contact lenses Frequency Exam Lenses Contacts (in lieu of glasses) Frames Every 12 months Not covered Not covered Not covered Every 12 months Not covered Not covered Not covered Every 12 months Every 12 months Every 12 months Every 24 months Every 12 months Every 12 months Every 12 months Every 24 months 15% discount on exam only Not covered Not covered 15% discount $ 120 allowance Not covered $ 105 allowance 20% discount 20% discount 20% discount 20% discount 20% discount Not covered Not covered Not covered Not covered Not covered VSP preferred pricing VSP preferred pricing Covered for children; VSP preferred pricing for adults VSP preferred pricing VSP preferred pricing Not covered Not covered Not covered Not covered Not covered
Qualifying event status changes must be submitted within 31 days from date of hire or date of event.
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Evidence of insurability
Proof of insurability, including a health questionnaire and possibly other testing at the expense of the vendor/provider, will need to be completed prior to approval if:
If supplemental coverage is more than $500,000, or You elect supplemental life coverage for the first time and have
been employed by Norton Healthcare more than 31 days, or
Coverage will adjust with each salary change. Minimum coverage is $10,000. Maximum coverage is $400,000. Guarantee issue at initial eligibility is $400,000. Supplemental life and AD&D insurance
Norton Healthcare provides the option of purchasing supplemental life and AD&D insurance.
Coverage will adjust with each salary change. Minimum coverage is $10,000. Maximum coverage is $1.25 million. Guarantee issue at initial eligibility is $500,000. Spouse life and AD&D insurance
You have the option of purchasing spouse life insurance.
Ten options are available in $5,000 increments. Minimum coverage is $5,000. Maximum coverage is the lesser of $50,000 or 50 percent of your
supplemental life amount.
Three options are available: $2,500, $5,000 and $10,000. The biweekly cost covers all eligible children.
Need help? Call the Norton Service Center at (502) 629-8911, option 2.
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To estimate the cost of employee supplemental life coverage, use the supplemental life calculation worksheet below. The supplemental life and AD&D premium is paid with post-tax earnings and will adjust with each change in salary.
Supplemental Life Calculation Worksheet
Action Insert Insert X = X = X = Rounded / X = Current age Current hourly pay rate Annual maximum hours worked Maximum salary Actual FTE Current annual base salary Amount of desired supplemental life 1-4 times salary (Maximum $1.25 million) Maximum amount of supplemental life available Maximum amount available rounded to the next 1,000 By 1,000 for billable life volume Actual age rate (from employee rates table) Estimated biweekly payroll deduction Item Sample 43 23 2,080 $ 47,840 .8 $ 38,272 2 $ 76,544 $ 77,000 77 .051 $ 3.93 2,080 Worksheet
This worksheet provides an estimation of payroll deductions. Actual deductions will be calculated using information in Employee Self-Service. Spouse and child(ren) life insurance premiums are paid with post-tax earnings.
Spouse rates
Option 1 2 3 4 5 6 7 8 9 10 Coverage amount $ 5,000 Biweekly cost $ 0.43 $ 0.85 $ 1.28 $ 1.71 Option 1 2 3
Child(ren) rates
Coverage amount* $ $ 2,500 5,000 Biweekly cost $ 0.29 $ 0.58 $ 1.16
$ 10,000
*For each eligible child (This amount is reduced if child is younger than 6 months of age. Refer to the summary plan description for more details.)
Qualifying event status changes must be submitted within 31 days from date of hire or date of event.
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Disability benefits
If you are unable to work due to illness or injury, disability insurance provides partial income replacement.
Long-term disability
Long-term disability benefits begin after you have been disabled by injury or illness for 26 weeks (180 days) upon approval of the claim.
You are electing disability coverage for the first time You are increasing the coverage option
The insurance company will not pay for benefits for any period of disability caused by, contributed to or resulting from a pre-existing condition. A pre-existing condition is defined as any injury or sickness for which you incurred expenses; received medical treatment, care or services, including diagnostic measures; took prescribed drugs or medicines; or for which a reasonable person would have consulted a physician within six months before his or her most recent effective date of insurance.
Important
Are you approaching age 65? Keep in mind that long-term disability benefits are payable for the length of time that is greater until you reach your Social Security normal retirement age or for the maximum benefit period as listed in the summary plan description located in the Forms Library on Nsider.
Short-term disability
Norton Healthcare offers eligible employees the opportunity to purchase short-term disability benefits.
Important
Important note regarding short- and long-term disability benefits payments: Refer to the summary plan descriptions for a complete list of other income benefits that may decrease the amount of the benefit payment in the event of a disability.
Need help? Call the Norton Service Center at (502) 629-8911, option 2.
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This worksheet provides an estimation of payroll deductions. Actual deductions will be calculated using information in Employee Self-Service.
This worksheet provides an estimation of payroll deductions. Actual deductions will be calculated using information in Employee Self-Service.
Qualifying event status changes must be submitted within 31 days from date of hire or date of event.
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When are the funds in my FSA available for use? When you elect a health care FSA, your account is funded with the
full amount youve chosen at the beginning of the year. As soon as that happens, its ready to use for eligible expenses.
When you elect a dependent day care FSA, your account is funded
as payments are deducted from your pay each pay period.
With FSA
$ 37,000 $ 2,400
Without FSA
$ 37,000 $ 0
Pay me back. File a claim online, by fax or mail for reimbursement. Mobile. Use a mobile application to file a claim from your
smartphone. Visit www.wageworks4me.com/aboutmobile for details. Health care FSA plan participants also receive a WageWorks health care card, a debit card that looks like a Visa card and can be used to:
Pay for eligible health care expenses at most health care providers,
including doctors offices, dentist offices and pharmacies. If the WageWorks health care card is used for services/products that are different from the normal insurance co-pays, purchases may have to be substantiated by submitting receipts with a Card Use Verification (CUV) form.
$ 28,234 $ 635
Based on 2012 federal and Kentucky state tax rates. Assumes single taxpayer with two children, filing as head of household and claiming three exemptions.
Can I share funds between these accounts? Health care and dependent day care FSA accounts must be
maintained separately.
Funds cannot be transferred from one account to the other. Funds from the health care FSA and dependent day care FSA
cannot be used as one fund.
Can I have an FSA and a health savings account (HSA)? You are not eligible for a health care FSA if you elect to have an
HSA with the HDHP medical plan.
You can participate in a dependent day care FSA if you have eligible
dependents.
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Who is eligible?
All employees and their eligible dependents, including:
Whats not covered? Expenses paid by a health care plan Cosmetic surgery expenses except to improve a deformity Medical expenses that qualify for an itemized tax deduction on a
federal income tax return For a complete list of noneligible expenses, visit www.wageworks.com and click on Eligible Expenses under Participant Quicklinks.
Employees spouse Employees children younger than age 27 as of the end of the
employees taxable year
Qualifying event status changes must be submitted within 31 days from date of hire or date of event.
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Who is eligible?
Eligible dependents include:
Whats not covered? Child care provided by your spouse Someone claimed as an exemption on your federal income tax return Services rendered by a child younger than age 19 Services rendered while you and/or your spouse are not at work Housekeeping expenses Dependent day care expenses that are claimed on your federal tax return Dependent day care expenses from a facility that is not a qualified
dependent day care center
Adult dependents who reside with you for more than half the
year and are unable to care for themselves because of a mental or physical disability and are claimed as a dependent for income tax purposes
For a complete list of noneligible expenses, visit www.wageworks.com and click on Eligible Expenses under Participant Quicklinks.
Important
The WageWorks health care card is for health care expenses only and may not be used for dependent day care expenses.
Need help? Call the Norton Service Center at (502) 629-8911, option 2.
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FlexTime eligibility
All employees who are scheduled to work at least eight hours a week can earn FlexTime. However, new employees may use FlexTime for holiday pay immediately. Registry employees do not accrue FlexTime.
Earning FlexTime
During the year, FlexTime is earned based on the number of hours paid, up to 80 hours per biweekly pay period. The FlexTime rate is based on the years of service you have completed, as shown in the chart below. The chart also shows the maximum total amount that may be accumulated.
Using FlexTime
FlexTime must be used for all scheduled time off. FlexTime also should be used for all unscheduled time off unless you are using disability benefits. You cannot use FlexTime in conjunction with or to subsidize disability benefits to receive 100 percent or more of your income, and it cannot be used to delay the onset of a short-term disability claim.
Years of service Less than 1 year 1-4 years 5-9 years 10-19 years 20 or more years
FlexTime earned per hour of pay .073077 hours .084615 hours .103846 hours .126923 hours .146154 hours
Maximum annual accrual 152 hours 176 hours 216 hours 264 hours 304 hours
Maximum total accumulation 152 hours 352 hours 432 hours 528 hours 608 hours
Qualifying event status changes must be submitted within 31 days from date of hire or date of event.
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Plan components
Automatic payroll deduction Up to $17,000 a year (2012 IRS limit) Employee contribution $5,500 catch-up contribution for those over age 50 (2012 IRS limit) Can be designated as traditional, Roth or a combination of both Norton Healthcares annual matching contribution* 100% of the first 4% you contribute Deposited into traditional 403(b) or 401(k) retirement savings plans Is based on total contributions, including traditional and Roth Employees may receive an additional contribution from Norton Healthcare based on years of service and eligible earnings. The longer you work for Norton Healthcare, the greater your potential contribution. Example: Assuming equal pay, an employee with 15 years of eligible service has the potential to receive four times as much as an employee with 3 years of eligible service.**
Enrollment process
Current employees can enroll at any time. Employees of a for-profit facility participate in the 401(k) retirement savings plan. Employees of a not-for-profit facility participate in the 403(b) retirement savings plan. All full-time and part-time new and rehired employees are enrolled automatically with a 4 percent contribution, unless they take specific action to decline this benefit no later than 45 days from their date of hire. To enroll at any time, use one of the following methods:
Visit The Principal online at www.principal.com. Call The Principal at (800) 547-7754. Contact one of Norton Healthcares on-site participant counselors: Brad Waterman, (502) 629-2733, option 1, or
waterman.brad@principal.com
*To qualify for these discretionary contributions, you must complete 1,000 hours of service during the W-2 reporting plan year and be actively employed on Dec. 31. **For illustrative purposes only. Call The Principal, see an on-site participant counselor, or review the Summary Plan Description for additional details. The plans offer many features and benefits to help you set and achieve your retirement savings goals. Benefits:
Auto-enrollment
If you have been enrolled automatically:
Tools to help you save Use online retirement planning tools and
interactive calculators to help manage your account.
Need help? Call the Norton Service Center at (502) 629-8911, option 2.
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Traditional 403(b) or 401(k) Before federal and most state taxes Tax-deferred as accumulated Taxes due on distributions
Roth 403(b) or 401(k) After tax Tax-deferred as accumulated Tax-free for qualified distributions
For more information about Roth contributions, contact one of the Principal Financial Group on-site participant counselors at (502) 629-2733 or log on to www.principal.com and explore the possibilities of Roth contributions by using the Roth Elective Deferral Calculator. Simply log in to your account and click on the Planning Center tab at the top of the page and then select Calculators on the left-hand side.
Qualifying event status changes must be submitted within 31 days from date of hire or date of event.
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Voluntary benefits
Norton Healthcares voluntary benefits offerings complement the robust benefits package with key programs that you may enroll in as needed. You can participate in these plans at any time during the year with the exception of the Hyatt legal plan, which you must enroll in within the 31-day benefits enrollment period for new employees or during annual open enrollment. All of these programs are portable you can continue coverage even when you retire. To enroll in these benefits, call (502) 629-BENE (2363) to make an appointment with a benefits education specialist.
Whole life insurance through Humana Provides death benefits to designated beneficiaries. Builds cash value that can be used while you are living. Policies are employee-owned, meaning you can take your policy
with you at the same rate if you retire or change jobs.
Hyatt legal plan Provides unlimited telephone advice and office consultations on
personal legal matters with a plan attorney of your choice.
Critical illness insurance through Humana Supplements major medical coverage by helping pay the direct and
indirect costs associated with a critical illness or event.
Representations are available for a number of legal matters. Coverage can be started or terminated during the open enrollment
period and will become effective Jan. 1, 2013. It cannot be canceled during the calendar year.
Accident insurance through Unum Pays specific benefit amounts, depending on the severity of the
injury, for covered, nonwork-related injuries or accidents.
Available for employee, spouse and/or children. Benefits are paid tax-free in a lump sum ranging from $5,000 to
$50,000.
Auto and homeowners insurance through MetLife Discounts on auto and homeowners insurance for employees 24/7 access to claim representatives empowered to make real-time
decisions
For additional information, visit www.mybenefits.metlife.com. VPI pet insurance through MetLife With veterinary pet insurance, you can stop worrying about the
ever-increasing costs of your pets medical care.
Your pet may be covered for more than 6,400 medical conditions at
any licensed veterinarians office.
Need help? Call the Norton Service Center at (502) 629-8911, option 2.
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Domestic partner coverage through HumanaOne Health insurance plan options for employees domestic
partners.
Important
Plan offerings may vary by state. Restrictions and exclusions may apply.
24-hour crisis intervention Marital and family-related issues Parent-child/adolescent issues Relationship issues Depression and anxiety Emotional distress Grief and loss Work or school difficulties Substance abuse Financial and legal difficulties
The Wayne Corp. website also has information on a variety of topics, such as:
Alcohol and drug abuse Anxiety Depression Family care and education Health and wellness Money and legal issues Relationships
Qualifying event status changes must be submitted within 31 days from date of hire or date of event.
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Employee perks
Norton Concierge Services
Want the opportunity to save money on thousands of national and local products and services? Look no further than Norton Concierge Services! Norton Healthcare partners with Abenity, a national discount provider, to offer thousands of discounts through a user-friendly website. All new employees receive an email containing login information (your AHSN and a password provided in the welcome email). Norton Concierge Services can be accessed at http:// nortonconciergeservices.employeediscounts.co or on Nsider.
Cafeteria discount
All Norton Healthcare employees receive a 25 percent discount in most hospital cafeterias.
Vendor alerts Stay up-to-date with offers from certain vendors. Favorites Save your favorite vendors in an area on the home
page.
A payment will be requested at the time of service from the provider. A statement with the remaining balance due (if any) will be
provided following the payment from your insurance.
Gift ideas Provides suggestions for common events. Ways to save $20 Suggests easy ways to get big savings on things
like tires, oil changes, movie tickets and restaurants.
Payment can be made by: Cash, credit card or check A health care PCA, FSA or HSA card Payment plan through Patient Financial Services If payment is not received at the time of service, once you receive a
bill for services you must call Patient Financial Services in order to receive the discount. Patient Financial Services also provides information on financial assistance that may be available.
How to save Sign up for a weekly email featuring a savings opportunity. Use popular vendors to stay on top of purchasing trends. Click on interesting offers to learn how to redeem: Online through a coupon code Through a direct link to the affiliate site By phone or mobile device In stores using a printable coupon
There are thousands of ways to save with Norton Concierge Services!
New!
Important
Program discounts and offers are subject to change without notice. Restrictions may apply.
Need help? Call the Norton Service Center at (502) 629-8911, option 2.
37
counseling, homebuyer education and reduced-expense mortgage plans to help you with the complicated process of buying a home. In addition, Norton Healthcare has partnered with Habitat for Humanity to provide the option of buying a Habitat for Humanity home through this program. Information packets, including program details and eligibility requirements, are available in the Forms Library on Nsider or by calling The Housing Partnership Inc. at (502) 585-5451.
Completed one year of employment at Norton Healthcare A minimum salary of $16,000 annually No current non-benefit payroll deductions (uniform deduction,
garnishments, etc.)
Qualifying event status changes must be submitted within 31 days from date of hire or date of event.
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Why participate in a wellness program? You will be more fit. You will have more stamina. You will experience less stress. You will have a better sense of well-being and improved
self-esteem.
You will breathe better, sleep better and be more productive. Your work team will be more engaged as a result of participating
in challenges and group wellness efforts.
Your medical plan options may be more affordable. You may spend less money on medication. Still not sure?
Here are the top 10 reasons for participating in the N Good Health Creating a Healthier You! employee wellness engagement program. 1. Its free no cost to you. Norton Healthcare pays for your access to the N Good Health website and your annual wellness/prevention exam if you are enrolled in a Norton Healthcare medical plan. 2. Its easy. The online health risk assessment is quick and can be finished within 15 minutes. The annual wellness/prevention exam is simple and can usually be completed within 1 hour. 3. Its confidential. Your personal health information will be kept strictly confidential. Human Resources will not have access to your information. Nor will it be used for any employment actions or decisions. The internal wellness team is held to the same federal privacy standards as doctors and other health professionals. 4. Its informative. You will learn what your primary health risk factors are and what you can do to lower your risks and improve your health.
Need help? Call the Norton Service Center at (502) 629-8911, option 2.
39
Qualifying event status changes must be submitted within 31 days from date of hire or date of event.
40
Once you are logged in, click Enroll in Commuter and follow
the steps.
How does the program work? Make a monthly election by going to www.wageworks.com by the
10th of the month prior to the month you want to use the funds. For example, to participate in the program in January, you will need to make an election by Dec. 10.
The monthly election can be changed every month. Expenses covered by the Commuter Benefits Program
The funds in this account can be used to pay for:
Bus passes (TARC) delivered to your home Established van pools (e.g., Ticket to Ride) Qualified vanpooling expenses Parking at or near work Parking at or near public transportation for your commute
Pay my parking Tell us how much and when to pay the parking
garage and well send a check directly from your account.
Pay me back Pay to park and then get reimbursed via check or
direct deposit. You must select this option when you make your monthly election.
Need help? Call the Norton Service Center at (502) 629-8911, option 2.
41
Click Sign In. If you dont remember your password, call the
Norton Access Center at (502) 629-8911, option 1.
Qualifying event status changes must be submitted within 31 days from date of hire or date of event.
Important Notice from Norton Healthcare About Your Prescription Drug Coverage and Medicare
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Norton Healthcare and about your options under Medicares prescription drug coverage. This information can help you decide whether you want to join a Medicare drug plan. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. If neither you nor any of your covered dependents are eligible for or have Medicare, this notice does not apply to you or your dependents, as the case may be. However, you should still keep a copy of this notice in the event you or a dependent should qualify for coverage under Medicare in the future. Please note, however, that later notices might supersede this notice.
Please note again that Norton Healthcare has determined the prescription drug coverage you currently have through its plan is NOT creditable coverage. This means that if you do not enroll in a Medicare drug plan during your initial enrollment period, and dont have or acquire creditable prescription drug coverage during the ensuing 63 days, you will pay a late enrollment penalty when you ultimately enroll in a Medicare drug plan. Special Enrollment Periods and Exceptions to the Late Enrollment Penalty There are special enrollment periods that allow you to enroll in a Medicare drug plan months or even years after you first became eligible to do so. Whether you will be required to pay a late enrollment penalty when you enroll in a Medicare drug plan during a special enrollment period depends on whether you are moving to a Medicare drug plan from creditable, or non-creditable, prescription drug coverage. If after your Medicare Part D initial enrollment period you lose or decide to leave employer-sponsored or union-sponsored prescription drug coverage, you will be eligible to enroll in a Medicare drug plan during a two-month special enrollment period. If your employer- or union-sponsored prescription drug coverage was creditable coverage, your enrollment in a Medicare drug plan will be without penalty (assuming you did not have a 63-consecutive-day or longer break in creditable coverage after your Medicare Part D initial enrollment period). On the other hand, if the coverage was non-creditable your enrollment in the Medicare drug plan will be subject to a late enrollment penalty unless you had non-creditable coverage for fewer than 63 consecutive days after your Medicare Part D initial enrollment period. In addition, if through no fault of your own you otherwise lose creditable prescription drug coverage (e.g., your employer- or union-sponsored plans coverage changes from creditable to non-creditable, or you lose creditable prescription drug coverage under an individual policy), you will be able to join a Medicare drug plan without penalty. This special enrollment period ends two months after the month in which your other coverage ends. Please note again that Norton Healthcare has determined the prescription drug coverage you currently have through its plan is NOT creditable coverage. This means when you lose or decide to leave coverage under the Norton Healthcare health plan after your initial Medicare Part D enrollment period you will pay a late enrollment penalty when you ultimately enroll in a Medicare drug plan. Compare Coverage You should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. See the Norton Healthcare Plans summary plan description for a summary of its prescription drug coverage. If you dont have a copy of the summary plan description, you can get one by contacting us at the telephone number or address listed below. Coordinating Other Coverage with Medicare Part D Generally speaking, if you decide to join a Medicare drug plan while covered under the Norton Healthcare Plan due to your employment (or someone elses employment, such as a spouse or parent) your coverage under the Norton Healthcare Plan will not be affected. For most persons covered under the Plan, the Plan will pay prescription drug benefits first, and Medicare will determine its payments second. For more information about this issue of what program pays first and what program pays second, see the Plans summary plan description or contact Medicare at the telephone number or web address listed below. If you do decide to join a Medicare drug plan and drop your Norton Healthcare prescription drug coverage, be aware that you and your dependents may not be able to get this coverage back. To regain coverage you would have to re-enroll in the Plan, pursuant to the Plans eligibility and enrollment rules. You should review the Plans summary plan description to determine if and when you are allowed to re-enroll or add coverage. For more information about this notice or your current prescription drug coverage Contact the person listed below for further information. NOTE: Youll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Norton Healthcare changes. You also may request a copy. For more information about your options under Medicare prescription drug coverage More detailed information about Medicare plans that offer prescription drug coverage is in the Medicare & You handbook. Youll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage: Visit www.medicare.gov Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the Medicare & You handbook for their telephone number) for personalized help, Call 1-800-MEDICARE (1-800-633-4227). TTY users call 1-877-486-2048. If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800325-0778).
1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. 2. Norton Healthcare has determined that the prescription drug coverage offered by the Norton Healthcare Employee High Deductible Healthcare Plan (Plan) is, on average for all plan participants, NOT expected to pay out as much as standard Medicare prescription drug coverage pays, and is considered non-creditable coverage. This is important, because most likely, you will get more help with your drug costs if you join a Medicare drug plan, than if you only have prescription drug coverage from the Plan. Its also important because if you delay your enrollment in a Medicare drug plan you may have to pay a late enrollment penalty later, when you do enroll in a Medicare drug plan. See the discussion below about late enrollment penalties that might apply when you move from non-creditable coverage to a Medicare drug plan after your first opportunity to do so. 3. You have decisions to make about Medicare prescription drug coverage that may affect how much you pay for that coverage, depending on if and when you join. Read this notice carefully - it explains your options.
Consider joining a Medicare drug plan. You can keep your coverage from Norton Healthcare. You can keep the coverage regardless of whether it is creditable or non-creditable, that is, regardless of whether it is as good as a Medicare drug plan. However, because your existing coverage is non-creditable coverage, meaning that on average its NOT at least as good as standard Medicare prescription drug coverage, you may pay a higher premium (a penalty) if you later decide to join a Medicare drug plan. Enrolling in Medicare General Rules As some background, you can join a Medicare drug plan when you first become eligible for Medicare. If you qualify for Medicare due to age, you may enroll in a Medicare drug plan during a seven-month initial enrollment period. That period begins three months prior to your 65th birthday, includes the month you turn 65, and continues for the ensuing three months. If you qualify for Medicare due to disability or end-stage renal disease, your initial Medicare Part D enrollment period depends on the date your disability or treatment began. For more information, you should contact Medicare at the telephone number or web address listed below. Late Enrollment and the Late Enrollment Penalty If you decide to wait to enroll in a Medicare drug plan you may enroll later, during Medicare Part Ds annual enrollment period, which runs each year from Oct. 15 through Dec. 7. But as a general rule, if you delay your enrollment in a Medicare drug plan after first becoming eligible to enroll, you may have to pay a higher premium when you later enroll in a Medicare drug plan. If after your initial Medicare Part D enrollment period you go 63 continuous days or longer without creditable prescription drug coverage (that is, prescription drug coverage thats at least as good as Medicares prescription drug coverage), your monthly Part D premium may go up by at least 1% of the premium you would have paid had you enrolled timely, for every month that you did not have creditable coverage after your initial enrollment period. For example, if you do not enroll in a Medicare drug plan during your Medicare Part D initial enrollment period, and you then go 19 months without creditable prescription drug coverage before enrolling in a Medicare drug plan, your Medicare drug plan premium may be at least 19 percent higher than the premium you otherwise would have paid. You may have to pay this higher premium for as long as you have Medicare prescription drug coverage.
Nothing in this notice gives you or your dependents a right to coverage under the Plan. Your (or your dependents) right to coverage under the Plan is determined solely under the terms of the Plan.
September 1, 2012 Norton Healthcare Norton Healthcare Service Center P.O. Box 35070, Louisville, KY 40232-5070 502-629-8911, Option 2
plan at that time. In addition, if you otherwise lose other creditable prescription drug coverage (such as under an individual policy) through no fault of your own, you will be able to join a Medicare drug plan, again without penalty. These special enrollment periods end two months after the month in which your other coverage ends. Compare Coverage You should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. See the Plans summary plan description for a summary of the Plans prescription drug coverage. If you dont have a copy, you can get one by contacting us at the telephone number or address listed below. Coordinating Other Coverage with Medicare Part D Generally speaking, if you decide to join a Medicare drug plan while covered under the Norton Healthcare Plan due to your employment (or someone elses employment, such as a spouse or parent), your coverage under the Norton Healthcare Plan will not be affected. For most persons covered under the Plan, the Plan will pay prescription drug benefits first, and Medicare will determine its payments second. For more information about this issue of what program pays first and what program pays second, see the Plans summary plan description or contact Medicare at the telephone number or web address listed below. If you do decide to join a Medicare drug plan and drop your Norton Healthcare prescription drug coverage, be aware that you and your dependents may not be able to get this coverage back. To regain coverage you would have to re-enroll in the Plan, pursuant to the Plans eligibility and enrollment rules. You should review the Plans summary plan description to determine if and when you are allowed to add coverage. For more information about this notice or your current prescription drug coverage Contact the person listed below for further information. NOTE: Youll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Norton Healthcare changes. You also may request a copy. For more information about your options under Medicare prescription drug coverage More detailed information about Medicare plans that offer prescription drug coverage is in the Medicare & You handbook. Youll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage: Visit www.medicare.gov Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the Medicare & You handbook for their telephone number) for personalized help, Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800325-0778). Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and whether or not you are required to pay a higher premium (a penalty).
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Norton Healthcare and about your options under Medicares prescription drug coverage. This information can help you decide whether you want to join a Medicare drug plan. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. If neither you nor any of your covered dependents are eligible for or have Medicare, this notice does not apply to you or your dependents, as the case may be. However, you should still keep a copy of this notice in the event you or a dependent should qualify for coverage under Medicare in the future. Please note, however, that later notices might supersede this notice.
Important Notice from Norton Healthcare About Your Prescription Drug Coverage and Medicare
1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. 2. Norton Healthcare has determined that the prescription drug coverage offered by the Norton Healthcare Employee Health Care Plan (Plan) is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is considered creditable prescription drug coverage. This is important for the reasons described below.
Because your existing coverage is, on average, at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to enroll in a Medicare drug plan, as long as you later enroll within specific time periods. Enrolling in Medicare General Rules As some background, you can join a Medicare drug plan when you first become eligible for Medicare. If you qualify for Medicare due to age, you may enroll in a Medicare drug plan during a seven-month initial enrollment period. That period begins three months prior to your 65th birthday, includes the month you turn 65, and continues for the ensuing three months. If you qualify for Medicare due to disability or end-stage renal disease, your initial Medicare Part D enrollment period depends on the date your disability or treatment began. For more information you should contact Medicare at the telephone number or web address listed below. Late Enrollment and the Late Enrollment Penalty If you decide to wait to enroll in a Medicare drug plan you may enroll later, during Medicare Part Ds annual enrollment period, which runs each year from October 15th through December 7th. But as a general rule, if you delay your enrollment in Medicare Part D, after first becoming eligible to enroll, you may have to pay a higher premium (a penalty). If after your initial Medicare Part D enrollment period you go 63 continuous days or longer without creditable prescription drug coverage (that is, prescription drug coverage thats at least as good as Medicares prescription drug coverage), your monthly Part D premium may go up by at least 1% of the premium you would have paid had you enrolled timely, for every month that you did not have creditable coverage. For example, if after your Medicare Part D initial enrollment period you go nineteen months without coverage, your premium may be at least 19% higher than the premium you otherwise would have paid. You may have to pay this higher premium for as long as you have Medicare prescription drug coverage. However, there are some important exceptions to the late enrollment penalty. Special Enrollment Period Exceptions to the Late Enrollment Penalty There are special enrollment periods that allow you to add Medicare Part D coverage months or even years after you first became eligible to do so, without a penalty. For example, if after your Medicare Part D initial enrollment period you lose or decide to leave employer-sponsored or union-sponsored health coverage that includes creditable prescription drug coverage, you will be eligible to join a Medicare drug
Nothing in this notice gives you or your dependents a right to coverage under the Plan. Your (or your dependents) right to coverage under the Plan is determined solely under the terms of the Plan.
September 1, 2012 Norton Healthcare Norton Healthcare Service Center P.O. Box 35070, Louisville, KY 40232-5070 502-629-8911, Option 2
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. This Notice is provided to you on behalf of: Norton Healthcare Medical Plans Norton Healthcare Dental Care Plans Norton Healthcare Vision Plans Norton Healthcare Flexible Benefits Plan
HIPAA COMPREHENSIVE NOTICE OF PRIVACY POLICY AND PROCEDURES NORTON HEALTHCARE IMPORTANT NOTICE HIPAA Comprehensive Notice of Privacy Policy and Procedures
These plans comprise what is called an Affiliated Covered Entity, and are treated as a single plan for purposes of this Notice and the privacy rules that require it. For purposes of this Notice, well refer to these plans as a single Plan. The Plans Duty to Safeguard Your Protected Health Information. Individually identifiable information about your past, present, or future health or condition, the provision of health care to you, or payment for the health care is considered Protected Health Information (PHI). The Plan is required to extend certain protections to your PHI, and to give you this Notice about its privacy practices that explains how, when and why the Plan may use or disclose your PHI. Except in specified circumstances, the Plan may use or disclose only the minimum necessary PHI to accomplish the purpose of the use or disclosure. The Plan is required to follow the privacy practices described in this Notice, though it reserves the right to change those practices and the terms of this Notice at any time. If it does so, and the change is material, you will receive a revised version of this Notice either by hand delivery, mail delivery to your last known address, or some other fashion. This Notice, and any material revisions of it, will also be provided to you in writing upon your request (ask your Human Resources representative, or contact the Plans Privacy Official, described below), and will be posted on any website maintained by Norton Healthcare that describes benefits available to employees and dependents. You may also receive one or more other privacy notices, from insurance companies that provide benefits under the Plan. Those notices will describe how the insurance companies use and disclose PHI, and your rights with respect to the PHI they maintain. How the Plan May Use and Disclose Your Protected Health Information. The Plan uses and discloses PHI for a variety of reasons. For its routine uses and disclosures it does not require your authorization, but for other uses and disclosures, your authorization (or the authorization of your personal representative (e.g., a person who is your custodian, guardian, or has your power-of-attorney) may be required. The following offers more description and examples of the Plans uses and disclosures of your PHI. Uses and Disclosures Relating to Treatment, Payment, or Health Care Operations. Treatment: Generally, and as you would expect, the Plan is permitted to disclose your PHI for purposes of your medical treatment. Thus, it may disclose your PHI to doctors, nurses, hospitals, emergency medical technicians, pharmacists and other health care professionals where the disclosure is for your medical treatment. For example, if you are injured in an accident, and its important for your treatment team to know your blood type, the Plan could disclose that PHI to the team in order to allow it to more effectively provide treatment to you. Payment: Of course, the Plans most important function, as far as you are concerned, is that it pays for all or some of the medical care you receive (provided the care is covered by the Plan). In the course of its payment operations, the Plan receives a substantial amount of PHI about you. For example, doctors, hospitals and pharmacies that provide you care send the Plan detailed information about the care they provided, so that they can be paid for their services. The Plan may also share your PHI with other plans, in certain cases. For example, if you are covered by more than one health care plan (e.g., covered by this Plan, and your spouses plan, or covered by the plans covering your father and mother), we may share your PHI with the other plans to coordinate payment of your claims. Health care operations: The Plan may use and disclose your PHI in the course of its health care operations. For example, it may use your PHI in evaluating the quality of services you received, or disclose your PHI to an accountant or attorney for audit purposes. In some cases, the Plan may disclose your PHI to insurance companies for purposes of obtaining various insurance coverage. However, the Plan will not disclose, for underwriting purposes, PHI that is genetic information. Other Uses and Disclosures of Your PHI Not Requiring Authorization. The law provides that the Plan may use and disclose your PHI without authorization in the following circumstances: To the Plan Sponsor: The Plan may disclose PHI to the employers (such as Norton Healthcare) who sponsor or maintain the Plan for the benefit of employees and dependents. However, the PHI may only be used for limited purposes, and may not be used for purposes of employment-related actions or decisions or in connection with any other benefit or employee benefit plan of the employers. PHI may be disclosed to: the human resources or employee benefits department for purposes of enrollments and disenrollments, census, claim resolutions, and other matters related to Plan administration; payroll department for purposes of ensuring appropriate payroll deductions and other payments by covered persons for their coverage; information technology department, as needed for preparation of data compilations and reports related to Plan administration; finance department for purposes of reconciling appropriate payments of premium to and benefits from the Plan, and other matters related to Plan administration; internal legal counsel to assist with resolution of claim, coverage and other disputes related to the Plans provision of benefits. Required by law: The Plan may disclose PHI when a law requires that it report information about suspected abuse, neglect or domestic violence, or relating to suspected criminal activity, or in response to a court order. It must also disclose PHI to authorities that monitor compliance with these privacy requirements.
For public health activities: The Plan may disclose PHI when required to collect information about disease or injury, or to report vital statistics to the public health authority. For health oversight activities: The Plan may disclose PHI to agencies or departments responsible for monitoring the health care system for such purposes as reporting or investigation of unusual incidents. Relating to decedents: The Plan may disclose PHI relating to an individuals death to coroners, medical examiners or funeral directors, and to organ procurement organizations relating to organ, eye, or tissue donations or transplants. For research purposes: In certain circumstances, and under strict supervision of a privacy board, the Plan may disclose PHI to assist medical and psychiatric research. To avert threat to health or safety: In order to avoid a serious threat to health or safety, the Plan may disclose PHI as necessary to law enforcement or other persons who can reasonably prevent or lessen the threat of harm. For specific government functions: The Plan may disclose PHI of military personnel and veterans in certain situations, to correctional facilities in certain situations, to government programs relating to eligibility and enrollment, and for national security reasons. Uses and Disclosures Requiring Authorization: For uses and disclosures beyond treatment, payment and operations purposes, and for reasons not included in one of the exceptions described above, the Plan is required to have your written authorization. Your authorizations can be revoked at any time to stop future uses and disclosures, except to the extent that the Plan has already undertaken an action in reliance upon your authorization. Uses and Disclosures Requiring You to have an Opportunity to Object: The Plan may share PHI with your family, friend or other person involved in your care, or payment for your care. We may also share PHI with these people to notify them about your location, general condition, or death. However, the Plan may disclose your PHI only if it informs you about the disclosure in advance and you do not object (but if there is an emergency situation and you cannot be given your opportunity to object, disclosure may be made if it is consistent with any prior expressed wishes and disclosure is determined to be in your best interests; you must be informed and given an opportunity to object to further disclosure as soon as you are able to do so). Your Rights Regarding Your Protected Health Information. You have the following rights relating to your protected health information: To request restrictions on uses and disclosures: You have the right to ask that the Plan limit how it uses or discloses your PHI. The Plan will consider your request, but is not legally bound to agree to the restriction. To the extent that it agrees to any restrictions on its use or disclosure of your PHI, it will put the agreement in writing and abide by it except in emergency situations. The Plan cannot agree to limit uses or disclosures that are required by law. Effective February 17, 2010, you can restrict disclosure of PHI for payment or health care operations if you pay the health care provider the full out-of-pocket cost. To choose how the Plan contacts you: You have the right to ask that the Plan send you information at an alternative address or by an alternative means. The Plan must agree to your request as long as it is reasonably easy for it to accommodate the request. To inspect and copy your PHI: Unless your access is restricted for clear and documented treatment reasons, you have a right to see your PHI in the possession of the Plan or its vendors if you put your request in writing. The Plan, or someone on behalf of the Plan, will respond to your request, normally within 30 days. If your request is denied, you will receive written reasons for the denial and an explanation of any right to have the denial reviewed. If you want copies of your PHI, a charge for copying may be imposed but may be waived, depending on your circumstances. You have a right to choose what portions of your information you want copied and to receive, upon request, prior information on the cost of copying. To request amendment of your PHI: If you believe that there is a mistake or missing information in a record of your PHI held by the Plan or one of its vendors, you may request, in writing, that the record be corrected or supplemented. The Plan or someone on its behalf will respond, normally within 60 days of receiving your request. The Plan may deny the request if it is determined that the PHI is: (i) correct and complete; (ii) not created by the Plan or its vendor and/or not part of the Plans or vendors records; or (iii) not permitted to be disclosed. Any denial will state the reasons for denial and explain your rights to have the request and denial, along with any statement in response that you provide, appended to your PHI. If the request for amendment is approved, the Plan or vendor, as the case may be, will change the PHI and so inform you, and tell others that need to know about the change in the PHI. To find out what disclosures have been made: You have a right to get a list of when, to whom, for what purpose, and what portion of your PHI has been released by the Plan and its vendors, other than instances of disclosure for which you gave authorization, or instances where the disclosure was made to you or your
family. In addition, the disclosure list will not include disclosures for treatment, payment, or health care operations. The list also will not include any disclosures made for national security purposes, to law enforcement officials or correctional facilities, or before the date the federal privacy rules applied to the Plan. You will normally receive a response to your written request for such a list within 60 days after you make the request in writing. Your request can relate to disclosures going as far back as six years. There will be no charge for up to one such list each year. There may be a charge for more frequent requests. How to Complain about the Plans Privacy Practices. If you think the Plan or one of its vendors may have violated your privacy rights, or if you disagree with a decision made by the Plan or a vendor about access to your PHI, you may file a complaint with the person listed in the section immediately below. You also may file a written complaint with the Secretary of the U.S. Department of Health and Human Services. The law does not permit anyone to take retaliatory action against you if you make such complaints. Notification of a Privacy Breach A new federal law, the American Reinvestment and Recovery Act of 2009 (ARRA) has made numerous changes to the rules governing PHI that is maintained by the Plan and its service providers (business associates). Effective September 23, 2009, any individual whose unsecured PHI has been, or is reasonably believed to have been used, accessed, acquired or disclosed in an unauthorized manner will receive written notification from the Plan within 60 days of the discovery of the breach. The notice will be provided to you if the breach poses a significant risk of financial, reputational or other harm to you. If the breach involves 500 or more residents of a state, the Plan will notify prominent media outlets in the state. The Plan will maintain a log of security breaches and will report this information to HHS on an annual basis. Immediate reporting from the Plan to HHS is required if a security breach involves 500 or more people. Contact Person for Information or to Submit a Complaint. If you have questions about this Notice please contact the Plans Privacy Official or Deputy Privacy Official(s) (see below). If you have any complaints about the Plans privacy practices, handling of your PHI, or breach notification process, please contact the Privacy Official or an authorized Deputy Privacy Official. Privacy Official. The Plans Privacy Official, the person responsible for ensuring compliance with this Notice, is: System Privacy Officer Norton Healthcare, N-27 201 S. Floyd St., Suite 505, Louisville, KY 40202 (502) 629-8409 Organized Health Care Arrangement Designation. The Plan participates in what the federal privacy rules call an Organized Health Care Arrangement. The purpose of that participation is that it allows PHI to be shared between the members of the Arrangement, without authorization by the persons whose PHI is shared, for health care operations. Primarily, the designation is useful to the Plan because it allows the insurers who participate in the Arrangement to share PHI with the Plan for purposes such as shopping for other insurance bids. The members of the Organized Health Care Arrangement are: Humana Medical Plans Humana Dental Care Plans VSP Vision Plans Effective Date. The effective date of this Notice is: January 1, 2012
To reduce the 12-month (or 18-month) exclusion period by the enrollees prior creditable coverage, you or the enrollee should give us a copy of any certificates of creditable coverage you or the enrollee have. If you do not have a certificate, but you or the enrollee do have prior health coverage, we will help you or the enrollee obtain one from the enrollees prior plan or insurance company. There are also other ways that an enrollee may prove prior creditable coverage. Please contact us if you need help demonstrating creditable coverage. All questions about the pre-existing condition exclusion and creditable coverage should be directed to the Norton Service Center at (502) 629-8911.
NOTICE OF SPECIAL ENROLLMENT RIGHTS Norton Healthcare Employee Health Care Plan
If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to later enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents other coverage). Loss of eligibility includes but is not limited to: Loss of eligibility for coverage as a result of ceasing to meet the plans eligibility requirements (i.e., legal separation, divorce, cessation of dependent status, death of an employee, termination of employment, reduction in the number of hours of employment); Loss of HMO coverage because the person no longer resides or works in the HMO service area and no other coverage option is available through the HMO plan sponsor; Elimination of the coverage option a person was enrolled in, and another option is not offered in its place; Failing to return from an FMLA leave of absence; and Loss of coverage under Medicaid or the Childrens Health Insurance Program (CHIP). Unless the event giving rise to your special enrollment right is a loss of coverage under Medicaid or CHIP, you must request enrollment 30 days after your or your dependents(s) other coverage ends (or after the employer that sponsors that coverage stops contributing toward the coverage). If the event giving rise to your special enrollment right is a loss of coverage under Medicaid or the CHIP, you may request enrollment under this plan within 60 days of the date you or your dependent(s) lose such coverage under Medicaid or CHIP. Similarly, if you or your dependent(s) become eligible for a state-granted premium subsidy towards this plan, you may request enrollment under this plan within 60 days after the date Medicaid or CHIP determine that you or the dependent(s) qualify for the subsidy. In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. To request special enrollment or obtain more information, contact: Norton Healthcare Service Center at (502) 629-8911, option 2. * This notice is relevant for health care coverages subject to the HIPAA portability rules.
The Norton Healthcare Employee Health Care Plan imposes a pre-existing condition exclusion on adults over the age of 18 (individuals under age 19 are not subject to the pre-existing condition restriction). This means that if a 19-year-old or older enrollee has a medical condition before coming to the Plan, the enrollee might have to wait a certain period of time before the Plan will provide coverage for that condition. This exclusion applies only to conditions for which medical advice, diagnosis, care, or treatment was recommended or received within a six-month period. Generally, this six-month period ends the day before coverage becomes effective. However, if the enrollee was in a waiting period for coverage, the six-month period ends on the day before the waiting period begins. The pre-existing condition exclusion does not apply to pregnancy nor to an employee or dependent child under the age of 19 who is enrolled in the plan. This exclusion may last up to 12 months (18 months if the enrollee is a late enrollee) from the first day of coverage, or, if the enrollee was in a waiting period, from the first day of the waiting period. However, the enrollee can reduce the length of this exclusion period by the number of days of his or her prior creditable coverage. Most prior health coverage is creditable coverage and can be used to reduce the pre-existing condition exclusion if the enrollee has not experienced a break in coverage of at least 63 days.
If you are eligible for health coverage from your employer, but are unable to afford the premiums, some States have premium assistance programs that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, you can contact your State Medicaid or CHIP office to find out if premium assistance is available. 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, ALABAMA Medicaid Website: http://www.medicaid.alabama.gov Phone: 1-855-692-5447 ALASKA Medicaid Website: http://health.hss.state.ak.us/dpa/programs/ medicaid/ Phone (Outside of Anchorage): 1-888-318-8890 Phone (Anchorage): 907-269-6529 ARIZONA CHIP Website: http://www.azahcccs.gov/applicants Phone (Outside of Maricopa Cty): 1-877-764-5437 Phone (Maricopa Cty): 602-417-5437 COLORADO Medicaid Medicaid Website: http://www.colorado.gov/ Medicaid Phone (In state): 1-800-866-3513 Medicaid Phone (Out of state): 1-800-221-3943 FLORIDA Medicaid Website: https://www.flmedicaidtplrecovery.com/ Phone: 1-877-357-3268 GEORGIA Medicaid Website: http://dch.georgia.gov/ Click on Programs, then Medicaid Phone: 1-800-869-1150 IDAHO Medicaid and CHIP Medicaid Website: www.accesstohealthinsurance. idaho.gov Medicaid Phone: 1-800-926-2588 CHIP Website: www.medicaid.idaho.gov CHIP Phone: 1-800-926-2588 INDIANA Medicaid Website: http://www.in.gov/fssa Phone: 1-800-889-9948 IOWA Medicaid Website: www.dhs.state.ia.us/hipp/ Phone: 1-888-346-9562 KANSAS Medicaid Website: http://www.kdheks.gov/hcf/ Phone: 1-800-792-4884 KENTUCKY Medicaid Website: http://chfs.ky.gov/dms/default.htm Phone: 1-800-635-2570 LOUISIANA Medicaid Website: http://www.lahipp.dhh.louisiana.gov Phone: 1-888-695-2447 MAINE Medicaid Website: http://www.maine.gov/dhhs/OIAS/publicassistance/index.html Phone: 1-800-572-3839 MASSACHUSETTS Medicaid and CHIP Website: http://www.mass.gov/MassHealth Phone: 1-800-462-1120
Medicaid and the Childrens Health Insurance Program (CHIP) Offer Free Or Low-Cost Health Coverage To Children And Families
you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan. Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, your employers 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 in the employers plan. This is called a special enrollment opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you live in one of the following States, you may be eligible for assistance paying your employer health plan premiums. The following list of States is current as of January 31, 2012. You should contact your State for further information on eligibility.
MINNESOTA Medicaid Website: http://www.dhs.state.mn.us/ Click on Health Care, then Medical Assistance Phone: 1-800-657-3629 MISSOURI Medicaid Website: http://www.dss.mo.gov/mhd/participants/ pages/hipp.htm Phone: 573-751-2005 MONTANA Medicaid Website: http://medicaidprovider.hhs.mt.gov/ clientpages/clientindex.shtml Phone: 1-800-694-3084 NEBRASKA Medicaid Website: http://dhhs.ne.gov/medicaid/Pages/med_ kidsconx.aspx Phone: 1-877-255-3092 NEVADA Medicaid Medicaid Website: http://dwss.nv.gov/ Medicaid Phone: 1-800-992-0900 NEW HAMPSHIRE Medicaid Website: www.dhhs.nh.gov/ombp/index.htm Phone: 603-271-5218 NEW JERSEY Medicaid and CHIP Medicaid Website: http://www.state.nj.us/ humanservices/dmahs/clients/medicaid/ Medicaid Phone: 1-800-356-1561 CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710 NEW YORK Medicaid Website: http://www.nyhealth.gov/health_care/ medicaid/ Phone: 1-800-541-2831 NORTH CAROLINA Medicaid and CHIP Website: http://www.ncdhhs.gov/dma Phone: 919-855-4100 NORTH DAKOTA Medicaid Website: http://www.nd.gov/dhs/services/medicalserv/ medicaid/ Phone: 1-800-755-2604 OKLAHOMA Medicaid and CHIP Website: http://www.insureoklahoma.org Phone: 1-888-365-3742 OREGON Medicaid and CHIP Website: http://www.oregonhealthykids.gov http://www.hijossaludablesoregon.gov Phone: 1-877-314-5678 PENNSYLVANIA Medicaid Website: http://www.dpw.state.pa.us/hipp Phone: 1-800-692-7462 RHODE ISLAND Medicaid Website: www.ohhs.ri.gov Phone: 401-462-5300
SOUTH CAROLINA Medicaid Website: http://www.scdhhs.gov Phone: 1-888-549-0820 SOUTH DAKOTA - Medicaid Website: http://dss.sd.gov Phone: 1-888-828-0059 TEXAS Medicaid Website: https://www.gethipptexas.com/ Phone: 1-800-440-0493 UTAH Medicaid and CHIP Website: http://health.utah.gov/upp Phone: 1-866-435-7414 VERMONT Medicaid Website: http://www.greenmountaincare.org/ Phone: 1-800-250-8427 VIRGINIA Medicaid and CHIP Medicaid Website: http://www.dmas.virginia.gov/rcpHIPP.htm Medicaid Phone: 1-800-432-5924 CHIP Website: http://www.famis.org/ CHIP Phone: 1-866-873-2647 WASHINGTON Medicaid Website: http://hrsa.dshs.wa.gov/premiumpymt/ Apply.shtm Phone: 1-800-562-3022 ext. 15473 WEST VIRGINIA Medicaid Website: www.dhhr.wv.gov/bms/ Phone: 1-877-598-5820, HMS Third Party Liability WISCONSIN Medicaid Website: http://www.badgercareplus.org/pubs/ p-10095.htm Phone: 1-800-362-3002 WYOMING Medicaid Website: http://health.wyo.gov/healthcarefin/ equalitycare Phone: 307-777-7531
To see if any more States have added a premium assistance program since January 31, 2012, or for more information on special enrollment rights, you can contact either: U.S. Department of Labor Employee Benefits Security Administration Centers for Medicare & Medicaid Services www.dol.gov/ebsa 1-866-444-EBSA (3272) U.S. Department of Health and Human Services www.cms.hhs.gov 1-877-267-2323, Ext. 61565 OMB Control Number 1210-0137 (expires 09/30/2013)
Benefits support
Questions? Call (502) 629-8911, option 2.
Benefits specialists
Belinda Dobbins Medical Dental Vision COBRA
Employee Assistance Program Flexible spending accounts (FSAs) Dawn Manning Short-term and long-term disability Life insurance FlexTime FMLA (coordinator) Other benefits Medicare settlements and offerings Employee Purchase Program Childrens Choice Learning Center Employer Assisted Housing Adoption Assistance
Nathan Cluff
John Graybeal
Robert Larson
Rebecca Callister
Brad Waterman
Don Edlin
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Norton Healthcare 9/12 HR-5269