REQUIREMENTSREQUIREMENTS

Must be Full-timeHealth, Dental, Vision, LTD, 1 x Life, Supplemental Life & Long Term Care

Insurance. Enrollment must be completed in your first 30 days of employment. Short term disability enrollment is held twice a year, in

December and June.

COVENTRY

Health Insurance You must complete enrollment within the first 30

days of employment in order to be insured. Eligible employees’ insurance will then begin on the first day of the month following.

If you currently have coverage, please bring a Certificate of Creditable Coverage from current Provider. Insurance will be in effect immediately upon receipt (after 30 days of employment).

If you choose to enroll dependents, please bring their social security numbers and dates of birth.

COVENTRY

SELECT HEALTH PLANPremier Plus:

Single Coverage – $ 32.00

Employee + Spouse – $ 115.00

Employee + Child/Children – $ 95.00

EE + Family - $ 195.00

per pay period for 26 pay periods.

COVENTRY

SELECT HEALTH PLANHealth Savings Account:

Single Coverage - $0

Employee + Spouse – $ 50.00

Employee + Child/Children – $ 62.00

EE + Family - $ 140.00

per pay period for 26 pay periods.

What is covered under the Coventry Premier Plus Health Plan?

25 Copay for Primary Physician.

50 Copay for Specialist.

100% payment to Emanuel Medical Specialist. i.e. Women’s Health Clinic, Pediatric Center Clinic and Promptcare.

100% paid at Emanuel Medical Ctr.

Deductible + 40% paid at all Out of Network providers.

Prescription Drugs

Generic Drugs – $15 Copay plan pays 60% after deductible

Brand Name Drugs - $30 Copay plan pays 60% after deductible

Non Preferred Drug – $60 Copay after deductible

Mail order maintenance drug - $60 Copay per prescription

Premier Plus

What is covered under the Coventry HSA Plan?

$2500 deductible. In network –

100% after deductible.

Out of network – 70% after deductible.

Health Savings Account available

100% paid at Emanuel Medical Ctr.

100% payment to Emanuel Medical Specialist. i.e. Women’s Health Clinic, Pediatric Center Clinic and Promptcare.

Prescription Drugs Generic Drugs – $15 Copay plan

pays 60% after deductible Brand Name Drugs - $30 Copay

plan pays 60% after deductible Non Preferred Drug – $60 Copay

after deductible Mail order maintenance drug - $60

Copay per prescription

HSA

How do I know who is in the Network?

Always pre-certify all claims before going to the doctor or having labs/tests done by calling BCBS at (800) 662-9023.

Log onto bcbsga.com and select “Find A Doctor” from the home page. Select Georgia or National providers. Choose your plan (POS) from the list provided. Select the provider type and specialty. Enter as little or as much to start your search.

Human Resources has a complete listing.

AVESIS Vision Plan

EMPLOYEE = $ 3.15 ppeEMPLOYEE + 1 = $ 5.51 ppeFAMILY = $ 8.18 ppe

VISION EXAMINATION $ 10.00 ANNUALLYMATERIALS $ 15.00 ANNUALLY

See attachments for more details.

Delta Dental Insurance

Cost is 100% paid for by Emanuel Medical Ctr. for Employee coverage.

Family Coverage is $18.78 per pay period.

Delta Dental What is Covered?

Pays 100% on Preventive care {class I}.

Pays 80% on Basic services {class I}.

Pays 50% on Major services {Class II}

Pays a maximum of $1000 per adult/child for orthodontia services {class III {braces}.

Calendar year maximum amount of $1000

$25 deductible per year for single coverage.

$75 deductible per year for family coverage.

UNUM Life Insurance 1 X Salary of life Insurance is

provided at no charge for employee only.

Supplemental Life Insurance may be purchased for Employee and Dependents.

Unum Long Term Disability

Basic Coverage 100% paid for employee.

Basic Coverage pays after 6 months at 40% of salary.

Buy-Up option is offered to Employee. Cost is based on age, salary, tobacco or non tobacco user.

Buy-Up option pays after 3 months at 60% of salary.

Short Term Disability Receive a predetermined monthly

income while your out of work. Elect a 7 or 14 day elimination period. Elect up to the maximum amount you

would want to receive each month. An open enrollment is held each year by

licensed personnel to enroll in this benefit. Please watch postings for next enrollment.

LONG TERM CARE OPTIONS

•You can purchase coverage on yourself;• You also can purchase coverage on:SpouseChildren 18 years or olderYour Parents Spouse’s Parents

Ask for more information regarding this program.

Valic Retirement Plan Full-time and Part-time employees who

work 1000 hours / year are eligible for the retirement plan. PRN employees are not eligible.

Emanuel Medical Center gives ½% towards your retirement, and will match up to 2 ½% of your contributions.

Employees can contribute money after the 90 day waiting period is met, and the hospital gives ½% with matching contribution up to2 ½% after you work your first 1000 hours.

What do you need to do to Enroll in Plans?

Please contact Sharon Peebles x 372, H.R. Assistant in the Human Resources Department to schedule an appointment.

You must enroll for all plans that Emanuel Medical Ctr. pays for. Decline forms must be signed if you choose to waive election.

You must enroll within 30 days of your hire date or open enrollment is once per year.

Additional Information

This brochure is a brief synopsis and is not to be used as a substitute for the plan documents. Please refer to the plan documents for accurate plan coverage's.