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Health Matters…Choose Wisely.
Texas Children’s Hospital
2011 Benefits and Wellness Guide
OUR BENEFITS
1 Texas Children’s hospiTal2011BenefitsandWellnessGuide
dearfelloWemployees,i’msoproudtobeanemployeeoftexasChildren’s,votedbyyouasoneoftheHoustonBusinessJournal’stoptenBestplacestoWorkfor
the5thconsecutiveyear,andoneofonlyeightchildren’shospitalsnationally(andtheonlyoneintexasandtheentiresouthwest)namedtothe
U.S. News and World Report Honorroll!thankstoyourefforts,Vision2010isbecomingarealityevenaswefacethechallengesofanuncertain
economyandhealthcareenvironment.asweexpandourservicesforpatientsandourcommunity,wemustrememberhowimportantitistofirst
takecareofourselvesandourfamilies.
texasChildren’scompetitivetotalrewardspackagehelpsourtalentedemployees,likeyou,meettheirownneedsaswellasthoseoftheir
families.yourincomeiscertainlyabigreasonthatyouwork,butitisonlyonepartofthetotalpackageyoureceive.sometimesit’sgoodtoremind
ourselvesaboutsomeoftheotherthingsthatalsohelpmakethisagreatplacetowork,like:
n Comprehensivehealthcare,lifeinsurance,andlong-termdisabilitybenefitsn retirementandcollegesavingsplanstohelpyouachievefinancialsecurityn subsidizedclose-to-campusparking,bus/rail,park&ride,andvanpoolservicesn Wellnessprogramsthatpromoteahealthylifestylen agenerouspaidtimeoffprogramn Work/lifeprograms,suchastheemployeeassistanceprogram,thathelpbalanceyourcareerwithyourpersonalpriorities
texasChildren’sstrivestoofferbenefitsthatarebothmeaningfulandaffordable.in2011,mostbenefitsremainthesameasthoseofferedin
previousyears,thoughtherearesomedifferences.somechangesaretheresultofHealthCarereformlegislation,andotherswereputinplace
becauseofourongoingcommitmenttoprovidingyouwiththebestbenefitsatthebestprice.
onesignificantchangethati’mpleasedtoannounce,afterathoroughreviewprocess,istheselectionofBlueCross BlueShield of Texas (BCBSTX)asourmedicalanddentalproviderfor2011.Knownforexcellentcustomerservice,BCBstXprovidesaccesstooneofthelargest
networksofdoctorsandhospitalsintexasandnationwide.
tCHselectdollarswillcontinuetobeprovidedtohelpoffsetbenefitscostsandreducethetotalamountyoupayforbenefitseachpayperiod.
SelectPlus Dollarswillbeaddedin2011tohelpminimizetheimpactofhigherbenefitscostsforemployeesenrolledinourtexasChildren’s
medicalplanandearning$14perhourorless.
in2011,beonthelookoutformoreinformationpromotinghealthierlifestylesforyouandyourfamily.takeadvantageofourfocusedHealth
solutionsoffering,designedtoimprovethehealthofthoseemployeeslivingwithachronicillness.participationcouldmeancopayrebatesand
monetaryincentives.Healthmatters,andweareallaboutsustainingthehealthiestpossibleworkforceandtakingactionsthathelplowerhealth
carecostsandyourout-of-pocketexpenses.
pleaseusethisguidetotakefulladvantageofthecomprehensivebenefitsandservicesavailabletoyouandyourfamily–andkeepithandyfor
futurereference.ifyouhaven’trecentlycheckedoutthevalueofyourcompletepackageonyourpersonaltotalrewardse-statement,simply
opentheConnecthomepage,clickonthelinktologontomoli,andthenclickon“tCHtotalrewards.”asalways,ifyouhavequestionsor
feedbackaboutyourbenefits,youmay:
n Callthetotalrewardsmainlineat832-824-2421,press1forBenefitsn [email protected] reviewthebenefitspolicyinformationlocatedonthetexasChildren’sConnectWebsite
iwishyouandyourfamilyasuccessfulyearfilledwithjoyandwell-being.
sincerely,
lindaaldred
sr.Vicepresident
texasChildren’sHospitalsiprefierediscutirsusoptcionesdebeneficiosenespanolo’tienepreguntas,favordellamaralnumber
832-824-2421optionnumber1,o’puedevisitoreldepartamentodeHrorelcentrodeservicio.
1 Texas Children’s hospiTal2011BenefitsandWellnessGuide
2011BenefitsandWellnessGuide
tHisreferenCeGuideand‘detailed’BenefitsinformationisalsoaVailaBleontHeteXasCHildren’sConneCt/HrWeBsite.
TO ACCESS FROM HOME: https:/myprofile.texaschildrenshospital.orgtheBenefitssummaryplandescription(spd),alsoavailableonlinedescribesmajorplanprovisions,limitationsandexclusionsofthe
tCHselectplans.Calltotalrewardsat832-824-2421(option1forBenefits)withanyquestionsyoumayhave.
Eligibility. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Medical Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 BlueCrossBlueshieldoftexas–ppo(pre-existingconditionsforadultsonly) BlueCrossBlueshieldoftexas–epo BlueCrossBlueshieldoftexas–onlineresourcesthroughBlueaccessformembers(Bam) WaivingmedicalCoverage WhenCoverageends tCHCoreBenefitsExpress Scripts for Prescription Drugs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Genericspreferredprogram steptherapyprogram priorauthorizationprogram specialtydrugs(tier4)throughCurascript selectHomedeliveryprogram Maternity Care (The St. Luke’s Labor and Delivery Experience and Savings!). . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Fertility and Advanced Reproductive Technology Benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Disease Management through Focused Health Solutions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Wellness In The Workplace (preventiveCare,BlueextrasavingsandtypesofCare). . . . . . . . . . . . . . . . . . . . . . . . . . 14Medical Comparison Chart (ppoandepoplans). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Dental Benefits(HighandlowoptionComparisonChart) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Vision Benefits through VSP. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Flexible Spending Accounts through PayFlex..................................................... 18 dependentCarefsa HealthCarefsaandmasterCarddebitCardviaHealthHub Life Insurance through Prudential. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 BasiclifeandBasicad&d optionallifeandoptionalad&d spouseanddependentlife longtermdisabilityBenefit WillpreparationserviceLong Term Care through John Hancock. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Retirement and Savings Plan Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 403(b)savingsplanthroughfidelity CashBalancepensionplan fidelity529CollegesavingsplanCommuter Benefits and Employee Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28Balancing Work, Home and Family:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 time-offBenefits,adoptionassistance,ticketdiscounts,servicerecognition&teamssportssubsidy Interim Backup Care Benefit through Bright Horizons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Employee Education and Development Opportunities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Benefit Election (Status) Changes and CHIP Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32Special Enrollment Rights..................................................................... 35Continuation Coverage Rights Under COBRA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36Your Rights. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Vendor Contact Information (websites, passwords, etc.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43TCH Select Dollars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44TCH Select Plans and 2011 Per Pay Period Premium Costs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
printedonpapermadefrom10%post-consumerwaste.
THE COST TO PRInT THIS gUIDE WAS gEnEROUSLY DOnATED BY BLUECROSS BLUESHIELD OF TEXAS.
2 Texas Children’s hospiTal2011BenefitsandWellnessGuide3 Texas Children’s hospiTal2011BenefitsandWellnessGuide HealtHmatters…CHooseWisely. 3
texasChildren’stotalrewardslogo
encompassestheoverallpackageof
diversebenefits,employeewellness
initiativesandwork~lifebalance
offeringsthat,whenutilized,can
promoteandprovidesecurityand
comforttoyouandyourfamily.
The TCH Select Plan includesyourmedical,dental,Vision,life,accidentaldeath
anddismemberment,disability,andlong-termCareinsurance,alongwithHealthCareand
dependentCareflexiblespendingaccountoptions.
Employee Select DollarsareadditionaldollarsprovidedbytCHtohelpemployees
offsetthecostoftheirbenefitspremiums.
Employee Healthoverseestheemployeeassistanceprogram(eap),employmenthealth
screenings,immunizationandon-sitemobilemammographyofferings,aswellasmanagelong-
termdisability,familymedicalleavesandpersonalleaves.
Parking and Commuter Benefitsincludebusandvanpoolsubsidiesandfree
off-campusparking.
Retirement and Savings Plansareavailabletoprovidefinancialsecurityforyouand
yourfamily’sfuture.retirementbenefitsincludethetexasChildren’sCashBalancepensionplan
andthetexasChildren’s403(b)savingsplan.the529collegesavingsplanisagreattoolto
helpemployeessave(tax-free)foryourfamily’sfutureeducationalneeds.
Tuition Assistanceallowsemployeestheopportunitytooffsetthecostoftheircollege
tuition(includingcourses,mostfeesandrequiredbooks)foracourseofstudythatwould
supportyouinyourroleattexasChildren’s.
Work~Life Benefitsoffermultiplewaystohelpyoubalanceyourworkandpersonallife.
adoptionassistance,temporaryback-upcare(forchildrentoelders)andagenerouspaidtime
offprogramarebenefitsavailabletotCH-paidemployees.additionalwork~lifebalancebenefits
areavailable,primarilyforbutnotalwayslimitedto,tCH-paidemployees.
2 Texas Children’s hospiTal2011BenefitsandWellnessGuide3 Texas Children’s hospiTal2011BenefitsandWellnessGuide HealtHmatters…CHooseWisely. 3
ELIGIB
ILITY
HR encourages you, as a healthcare consumer, to fully educate yourself before making important benefit decisions for you and your dependents. This guide is intended to be a valuable resource to inform you of new Health Care Reform, your benefit plan options and other important details you need to know.
eliGiBilityEMPLOYEEStexasChildren’sfull-time(atleast36hours/week)andpart-time
employees(atleast17.5hours/week)areeligibletoparticipateinallthe
benefitsandwellnessprogramsonthefirstdayofthefullpayperiod
following30-daysofemployment.perdiememployees(under17.5
hours/week)areeligibletoparticipateintheparkingandcommuter
benefits,403(b),employeeassistanceplan(eap)andvariouswellness
initiatives.
You may enroll your eligible dependents in the medical,
dental, and vision plans.
ELIgIBLE DEPEnDEnTS InCLUDE:n legal spouse
n Child.yournaturalchild,stepchild,adoptedchild,orchildwho
hasbeenplacedforadoptionwithyouorachildforwhomyouare
involvedinasuitinwhichyouareseekingtoadoptsuchchild,a
childforwhomyouhavebeenappointedlegalguardian,orachild
whoisrecognizedunderaQualifiedmedicalsupportorder.
n Child(ren) under age of 26(nolongerrequiredtobefull-time
studentsbetween19-25).
n Grandchildren under age 26 for whom you have custody and who
reside in your householdareeligibleforthedentalandvisionplans
withoutbeingenrolledinschool.
n incapacitated Child.physicallyormentallyunmarriedchild
incapableofself-supportiseligibleundertexasChildren’sselect
planaslongastheyweredeemedincapacitatedpriortotheir26th
birthday.
NEWiN 2011
NEWiN 2011
socialsecuritynumbersarerequiredtoenrollalldependentsin
themedical,dentalandVisionplans.
ifyouandyourdependent(spouseorchild)arebotheligible
employeesoftexasChildren’sandelecttohaveanycoverage,
youeachneedtoelectindividualcoverage(s)orifyouelect
familycoverage,youwillonlybeallowedonefamilyplanandthe
otheremployeeshouldwaivecoverage.onlyoneemployeemay
coveradependentchildonanyplan.
WHEn COVERAgE BEgInS FOR TEXAS CHILDREn’S SELECT PLAnSn new hire full or part-time employees -Health
carecoveragebeginsonthefirstdayofthefull
payperiodfollowing30daysofemployment.you
have31daysfromyourhiredate(initialperiodof
eligibility)tocompleteenrollmentpaperworkand
submitforms.
n For employees currently eligible -eachyear
duringthefallopenenrollmentperiod,you
choosebenefitcoverage(s)forthecoming
year.yourbenefitelectionchoicestakeeffect
onJanuary1standremainineffectthrough
december31st.
n employees in a non-benefit eligible status
who transfer to a regular full-time or part-time
status -Coveragewillbeginontheeffective
dateofthechange,providedyouhavebeen
employedfor30daysormore.yourbenefit
electionformisduetoHrBenefitswithin31days
fromthedateofthestatuschange.
4 Texas Children’s hospiTal2011BenefitsandWellnessGuide5 Texas Children’s hospiTal2011BenefitsandWellnessGuide
mediCalplanoptions
BlueCrossBluesHieldofteXas(BCBstX)The TCH Select Plan Provides Two Medical Plan Options in 2011:nBlueCross Blueshield of Texas (ppo)
nBlueCross Blueshield of Texas (epo)
BothtCHselectplanoptionsprovidecomprehensive
medicalcoveragethroughtheBCBstXprovidernetworkand
prescriptiondrugcoveragethroughexpressscripts.
anenhancementtoourprogramistheadditionofaspecialized
providertohelpmanageanychronicconditionsyoumayhave,
suchasdiabetesorheartdisease.focusedHealthsolutionswill
bemanagingyourchroniccareneedsandadministeringyour
Healthriskassessment.
BCBSTX Preferred Provider network (PPO) - Similar to Current aetna PoSii
thismedicaloptionoffersyouopenaccesstothepponetwork
ofprovidersofBlueCrossBlueshieldoftexas.This option
offers enhanced benefits for using a network provider,
yet also provides benefits when a non-network provider
is selected.
n mostservicesaresubjecttoanannualdeductibleandrequire
youtoshareinthecostofservicesthroughcoinsurance.your
coinsuranceamountissubjecttoanannualout-of-pocket
maximum.However, copayments for all services will still
apply even once the out-of-pocket maximum is met.
n ppoplanincludescopaymentsforprimaryandspecialist
care.acopaymentwillapplyforservicesbilledbythe
physicianoffice.allotHerserViCesnotBilledBytHe
pHysiCianwillbesubjecttodeductibleandcoinsurance.
nEW
nEW
NEWiN 2011
MED
ICA
L P
LAN
S
nEW CARRIER
WHEn CAn I EnROLL?uponyourdateofhireorthedateyoubecomeinaneligiblestatusyouwillbeinvitedtoattendaBenefitsorientation.duringthis
orientationyouwillbegivenyourpersonalizedbenefitsenrollmentformforyourcompletion.thisformmustbecompletedand
returnedtotheBenefitsdepartmentpriortoyoureligibilitydate.youshouldcarefullyreadyourenrollmentGuidetohelpyoumakethe
bestelectionsforyouandyourfamily’sneeds.iftheBenefitsdepartmentdoesnotreceiveyourbenefitsenrollmentformpriortoyour
eligibilitydate,youwillbeautomaticallyenrolledintexasChildren’sCoreBenefitplan.refertotheCoreBenefitstabwithinthisguide.
n minorX-rayandlabserviceswillalsohaveaseparate
copayment,ifobtainedinaphysicianofficeor
independentlabonaseparatedate.majorX-rayand
lab(suchasmri,Catscan,petscan,etc.)willbe
subjecttothedeductibleandcoinsurance.anyx-rayor
labserviceobtainedinanoutpatienthospitalsettingor
inthehospitalwillbesubjecttotheannualdeductible
andcoinsurance.
n networkproviderswillcertifyanyhospitalstayyou
require.You are responsible for certifying any
non-network hospitalizations with BCBSTX prior
to receiving services.failuretodoso,mayresult
inthedenialofbenefits.BCBstX’spre-certification
numberisonthebackofyourmemberidcard.
PPO PLAn COnTAInS PRE-EXISTIng COnDITIOnS FOR ADULTS OnLY
The pre-existing condition limitation does not apply
to children under age 19. ifyouareanewlyeligible
employeeandhaveeligibledependents,areadding
dependentsoraretransferringtoaneligiblestatus,you
maybesubjecttoapre-existingconditionlimitation.ifyou
havesignsorsymptomsofaconditionintheninety(90)
dayspriortoyoureffectivedateofcoverage,and
n do not have current coverage, and
n are age 19 and over
claimsforthatconditionwillnotbecoveredfor365days
followingyoureffectivedateofcoverage.Claimsforall
otherunrelatedconditionswillbecoveredunderthe
provisionsofeitherplan.
ifyouhadothercoveragepriortobecomingeffectiveand
youhavenothadabreakincoverageof63daysormore,
thenyoumaynotbesubjecttothepre-existingcondition
ruleandcanprovideproofofpriorcoverage.
nEW
4 Texas Children’s hospiTal2011BenefitsandWellnessGuide5 Texas Children’s hospiTal2011BenefitsandWellnessGuide HealtHmatters…CHooseWisely. 5
BCBSTX Exclusive Provider network (EPO) - Similar to Current aetna Hmo
thismedicaloptionprovidescoveragefornetworkservicesonly.You
must access all medical care from network providers or the
plan will not pay any benefits.BCBstX’sbroadnetworkoffers
youawiderangeofprovidersfromwhichtoselectyourprimaryCare
physicianandanynecessaryspecialists.inaddition,mosthospitalsin
theHoustonareaareincludedinthenetwork.
n theepomedicalplanisanopenaccessplan.thatmeansyou
mayreceiveservicesfromanynetworkproviderwithoutareferral
fromaprimarycarephysician,however,youwillpaymoretoaccess
aspecialist.internalmedicine,familyandgeneralpractitioners,
pediatriciansandob/gynpractitionersareconsideredprimarycare.
allotherproviders,includingurgentcareandafterhourscarewillbe
consideredspecialistsandyouwillpaythehighercopayforservices.
n theBCBstXnetworkisnationwidewithprovidersinmostareasof
theunitedstates;however,ifyouhaveadependentlivingoutside
oftheHoustonarea(ex.childawayatcollege),youshouldcheck
tomakesurenetworkprovidersareintheirlocation.otherwise,only
carethatisconsideredan‘emergency’willbecovered.underthe
epoplan,youmustusenetworkprovidersinorderforservicestobe
covered;therearenonon-networkbenefitsintheepoplan.
n servicesarepaidforthroughcopaymentseachandeverytimeyou
accesscare.theamountyoupaywilldependonthelevelandtypeof
careyoureceive.
n networkproviderswillcertifyanyhospitalstayyourequire.the
BCBstXnumberisonthebackofyourmemberidcard.
BCBstXisyouronlineresourCeforCaretHruBAMResources you can access now:1. findanetworkprovider
under“providerfinder”2. findadentistunder“dental
providerfinder”3. takeatourofBam4. accesstransitionofCare
form
n printtemporaryidcardsn estimatethecostofmedical
servicesunder“treatmentCostadvisor”
n ViewandprintyourexplanationofBenefitsforfinalizedmedicalanddentalclaims
n findthemedicalplanthatisrightforyouat“HealthplanCostestimator”
n estimatethecostofdentalcareunder“dentalCostadvisor”
n receiveemailnotificationofclaimactivity
n seeyourmedicalanddentalbenefitcoveragesummaries
n downloadformsn Comparequalityindicators
forsurgeryorhospitalizationthrough“CareComparisontool”
n Getinformationonwellnessandhealthissues
n finddiscountsthroughBlueextraforComplementaryalternativemedicine(Cam),lifetimefitness,JennyCraigandtruHearing.
n Confirmcoverageonemployeeandfamilymembers
n Contactcustomerserviceviaemail
n GetanswerstofrequentlyaskedQuestions
n locateanurgentcareproviderinyourarea
go to www.bcbstx.com/tch and register on Blue Access for Members (BAM) with a username and password as of 1/1/11. Once registered, you will be able to:
TEXAS CHILDREn’S PEDIATRIC ASSOCIATES (TCPA) PARTICIPATES In THE PPO AnD EPO PLAnS.
BothplansareincludedintheBCBstX
networksoyoucancontinuetoaccess
ourtexasChildren’sproviders.Goto
www.texaschildrenspediatrics.orgto
findalocationorpediatriciannearyou.tCpa
has44locationsthroughouttheHouston
communitywithover140boardcertifiedor
boardeligiblephysicianswithfullservicecare
forchildren(newborntoage18).
nO FACILITY CHARgE FOR In-PATIEnT STAY AT TEXAS CHILDREn’S HOSPITAL-MEDICAL CEnTER AnD WEST CAMPUS
ifyou1)usethemedicalCenterortheWest
CampustexasChildren’sHospitalfacilityand
2)arecoveredthroughoneofthetCHselect
medicalplans,youwillnotberesponsiblefor
thefacilitycharges.
BothtCHselectmedicalplansofferfacility
chargespaidat100%fordependentswho
areineitherplan;however,youwillstillpayfor
somephysicianchargesandothercharges.
6 Texas Children’s hospiTal2011BenefitsandWellnessGuide7 Texas Children’s hospiTal2011BenefitsandWellnessGuide HealtHmatters…CHooseWisely. 7
CoreBenefitsWAIVIng MEDICAL COVERAgEyouhavetheoptiontowaivemedicalbenefits
entirelyifyouareenrolledinanothermedicalplan.
ifyouelectnomedicalcoverageandyouloseyour
othercoverageduringtheyear,orifyouelectno
medicalcoverageandhaveaqualifyingstatus
Change,youmayelectoneofthemedicalplansfor
youandyourdependentswithin31daysoftheloss
ofcoverage(proofoflossofcoverageisrequired).
refertotheBenefitelectionChangetabwithinthis
guidefordetails.
WHEn COVERAgE EnDSmedical,dental,Vision,life,ad&d,disability,
HealthCareanddependentCareflexiblespending
accountswillendonthelastdayofthepayperiod
containingthelastdayworked,yourtransferdate
toanineligiblestatusforbenefitsorthedaya
dependentbecomesineligibleforcoverage.
eXpresssCriptsforpresCriptiondruGs
FOUR TIER DRUg FORMULARYalldrugsfallintooneofthefollowingcategories:
Tier 1 Generic preferred
Tier 2 Brandformulary Whengenericisnotavailable
Tier 3 Brandnon-formulary leastpreferred
Tier 4 specialtydrugs Bio-techdrugs
gEnERICS PREFERREDtexasChildren’scontinuestoofferacompetitiveprescriptiondrugprogram,evenwhile
prescriptiondrugcostsarerisingatarapidrate.
inordertohelpcontrolthecost,youcanselectgenericdrugsinsteadofbrandnamed
drugswheneverpossibleandaskyourphysicianforthelowestcosteffectivemedication
foryourcondition.
Genericdrugs,whichareapprovedbythefederaldrugadministration,arethechemical
equivalentsofthecorrespondingbrandnamedrugs.therefore,youcantakegeneric
drugswithconfidenceintheireffectivenessandsafety.theonlydifferenceisthe
costyoupay.Genericdrugscostasmuchas80%lessthanbrandnamedrugs.By
purchasinggenericsyoucansave$20-$40perprescription(upto$480perprescription
peryear!)whilealsosavingtexasChildren’smoneyandhelpingtolowerrateincreases
inthefuture.
oneBCBstXidCardforyourpHarmaCy,mediCal,dentalandeapneedspresentyourmemberidcardat
thepharmacywhenreceivingany
prescription.inordertoreceive
benefitsyoumustuseanesi
participatingpharmacyorobtainyour
medicationthroughtheselectHome
deliveryprogram.
nEW
CORE
BEN
EFIT
S
nEW
TCH SELECT PLAn OPTIOnS AUTOMATICALLY PROVIDE YOU WITH A BASIC LEVEL OF CORE BEnEFITSthesebenefitsprovideyouwithbasicmedicalcoverage
aswellasbasiclifeinsuranceandlong-termdisability
protection.youwillautomaticallybeenrolledinthecore
benefitsshownbeloweffectivewithyourcoveragebegin
dateunlessyouwaivecoverageorelectcoveragewithin31
daysfromeligibility.
Medical PPO
employeeonly minimalperpayperioddeduction
Basic Life & AD&D
employeeonly onetimesannualbasesalary
Long Term Disability
fulltimeemployeesonly
50%ofmonthlybasesalary
6 Texas Children’s hospiTal2011BenefitsandWellnessGuide7 Texas Children’s hospiTal2011BenefitsandWellnessGuide HealtHmatters…CHooseWisely. 7
looKituponeXpresssCriptsWeBsitetheexpressscriptswebsiteisagoodsourceofinformationaboutyourprescriptionsandyour
prescriptiondrugbenefits.accessingyourprescriptionbenefitinformationonlineisquickandeasy.
Visit www.express-scripts.comandcompletethebriefregistrationprocesstogetstarted.
n locateparticipatingretailpharmaciesnearyou
n findoutwhatyou’llpayforaspecificdrugatretailandHome
delivery
n orderrefillsthroughHomedeliveryandtrackthestatusof
yourorder
n realizeifthereisagenericequivalentavailable
n reviewyour12-monthprescriptionhistory
n determineifpriorauthorizationisrequired
n identifyfirst-linemedicationsforsteptherapy
n determinehowtorequestgenericsfromyourphysician
n reviewcurrentformulary
ifyouelecttopurchasethebrandnamedrugwhenageneric
equivalentisavailable,youwillpaythestandardcopayment
forthegenericdrugplustheactualcostofthedifference
betweenthegenericandbrandasshownbelow.thecost
youwillpayisyourchoicetomake.
Example:Generic
DrugBrand Name - Non Formulary
drug Cost: simvastin vs Zocor
$26.83 $139.47
difference in Cost $0.00 $112.64
plan Copayment $5.00 $5.00
Your Cost $5.00 $117.64
note:Zocorisusedtotreathighcholesterol.
ifnogenericisavailableforabrandnamedrug,youwillpay
theapplicableformularyornon-formularybrandcopayment
asshownonthepharmacychart.
STEP THERAPYsteptherapyisaprescriptiondrugprogramdesigned
exclusivelyforpatientswhohavecertainconditionsthat
requireroutine,ongoingmedication.steptherapyhasbeen
proventobeeffectiveinthetreatmentofsuchconditions
asulcers,depression,highbloodpressure,heartdisease,
cholesterolandallergies.
Step Therapy is a Two-Step Programn step 1: prescription drugs:thedrugsrecommended
foryoutotakefirst–usuallygenericmedicationswhich
havebeenprovensafeandeffective.youpaythelowest
copaymentforthesedrugs.
n step 2: prescription drugs:thesetypicallyarebrand-
namedrugs.step2drugsarerecommendedonlyifastep
1drugdoesnotworkforyou.
How it Works
Whenfillinganewprescription,expressscriptswillverify
yourprescriptionhistory.ifyouhavefilledandreceiveda
prescriptionforastep1drugwithin130daysofattempting
tofillastep2medicationanditwasineffective,youwill
beabletogetthestep2drug.ifyoudidnottryastep1
medicationorithasbeenlongerthan130days,youandyour
pharmacistwillneedtoworkwithyourphysicianandexpress
scriptstoauthorizeadifferentmedication.
To Learn More About Step Therapy
Visitwww.steptherapyfacts.comtowatchashortvideo.
Callexpressscriptsat800-316-3102withyourquestions.
PRIOR AUTHORIzATIOnsomedrugsyourdoctorprescribeswillrequirespecial
approvalor“prior-authorization”beforebeingfilled.this
meansthatexpressscriptswillneedtomakesurethese
prescriptionsmeettheplan’sconditionsforcoverage.prior
authorizationencouragesappropriatedrugtherapyforcertain
designatedconditions.
todetermineifyourmedicationrequirespriorauthorization,
callexpressscriptsat800-316-3102orvisitwww.express-
scripts.comandusethe“price-a-drug”feature.asyou
receivenewprescriptions,checktoseeifitwillbecoveredas
thelistissubjecttochange.
ifadrugrequirespriorauthorization,yourdoctorwillneed
tocontactexpressscriptsat800-417-8164toseeifthe
prescriptionmeetsyourplan’sconditionsforcoverage.
note: ifyourprescriptionisnotcoveredandyouandyour
doctordecidethatyoushouldstilltakethisdrug,you
willpaythefullcostofthemedication.
PH
AR
MA
CY
HealtHmatters…CHooseWisely. 7
8 Texas Children’s hospiTal2011BenefitsandWellnessGuide9 Texas Children’s hospiTal2011BenefitsandWellnessGuide
SPECIALTY DRUgS (TIER 4)specialtymedications(alsoknownasbiotech,
biologicalorinjectibles)arethosemedicationsused
forcertainrareorcomplexconditions.thesedrugs
areextremelyexpensiveandusuallyhavepotentially
serioussideeffectsorinteractions.
thesespecialtymedicationshavebeenmovedto
a4thtierandyouwillpay10%ofthecostofthese
medicationsoraminimumof$50perprescription,
uptoamaximumof$150perprescription.out-
of-pocketcosts(forthesemedicationsonly)willbe
limitedto$2000perpersonpercalendaryear.these
medicationsareonlydispensedina30-daysupply
duetotheneedtocontinuallyadjustdosage.such
medicationsshouldbeobtainedthroughCurascript,
esi’sspecialtymedicationdivision.
presCriptiondruGCoVeraGetHrouGHeXpresssCripts
BENEFITPPO
IN-NETWORKPPO
OUT-OF-NETWORKEPO
(NETWORK ONLY BENEFITS)Retail Pharmacy – up to a 30 day supply
n Generic $5 copayment65% reimbursement
after network copayment applied.
member submits claim.
$10 copayment
n Preferred Brand – Formulary $25 copayment $35 copayment
n non-Preferred Brand – non Formulary
$40 copayment $50 copayment
Express Scripts Home Delivery – up to a 90 day supply
n Generic $10 copayment
not available
$20 copayment
n Preferred Brand – Formulary $50 copayment $70 copayment
n non-Preferred Brand – non Formulary
$80 copayment $100 copayment
Specialty Medications – ( injectables, biotech drugs). only through CuraScript.$2,000 annual out-of-pocket maximum per person for Specialty Medication.
10% copaymentminimum $50
maximum $150/prescriptionnot covered
10% copaymentminimum $50
maximum $150/prescription
Chart represents member cost.
WHAT CURASCRIPT HAS TO OFFERCurascriptisaleadingproviderofspecialtydrugs,offeringthemost
comprehensiveandconvenientspecialtypharmacyservicesavailable–
atnoadditionalcosttoyou.
Curascriptoffersmanyproductsandservicesnotavailableorofferedby
otherpharmacies,alongwiththefollowingservices:
n providespatientswithindividualizedsupporttomeettheirunique
needs.HighlytrainedpatientCareCoordinatorswillworkcloselywith
you,yourphysicianandexpressscriptstoobtainpriorauthorizations,
coordinatebillingwithexpressscriptsandwillevencontactyouwhen
it’stimetorefillyourprescription.
n deliversyourspecialtymedicationsdirectlytoyouoryourdoctor.
n providesyouwiththenecessarysuppliesyouneedtoadministeryour
medicationatnoadditionalcost.
n offersclinicalbasedcaremanagementprograms–whichinclude
consultationwithyourdoctor–tohelpyougetthemostbenefitfrom
thespecialtymedicationsthatyourdoctorhasprescribedforyou.
youcanreachCurascriptat1-866-848-9870oronlineat
www.curascript.com.
8 Texas Children’s hospiTal2011BenefitsandWellnessGuide9 Texas Children’s hospiTal2011BenefitsandWellnessGuide
freQuentlyasKedQuestionsHow do I Opt In or Opt Out of the Select Home Delivery
program for my maintenance drugs?
simplycalltheexpressscriptsmemberChoiceCenterat1-888-
772-5188.
What if I’d prefer to get some of my maintenance
medications at my retail pharmacy?
youhavetheoptiontooptinoroutforoneorallofyourmaintenance
medications.
What medications are included in this program?
themaintenancemedicationsyoutakeregularlyforongoing
conditions,suchashighbloodpressure,highcholesterol,thyroid
andasthma,areincluded.tofindoutifaspecificprescriptiondrugis
consideredamaintenancemedicationonyourplan,callthe1-800-
316-3102memberservicesnumber.
How do I pay for my prescriptions?
allordersshouldincludepaymentinformationtoallowprocessing
withoutdelay.ordersmaybepaidby:
n flexiblespendingaccount(fsa)debitcard
n Visa,masterCard,americanexpressordiscover
n Bank-issueddebitcard
n personalcheckormoneyorderpayabletoexpressscripts
How long will it take to process and deliver my prescription?
first-timeorders,pleaseallow10to14daysfordeliveryfromthetime
expressscriptsreceivesyourorder.oncetheyhaveprocessedyour
firstorder,subsequentrefillswillbeshippedwithin3to5daysfrom
thetimetherefillrequestisreceived.
How will my order
be mailed?
ordersaresent
byfirst-classmail
inunmarked,
tamper-proof
packaging.there
isnoindicationon
thepackagethatit
isfromapharmacy.
theyaredelivered
byyourregularcarrier,
unlessthemedication
requiresspecialhandling
(suchasrefrigeration).
SAVE
TIME! SAVE
MOnEY! SELECT HOME DELIVERY FROM EXPRESS SCRIPTS IS THE PREFERRED WAY TO FILL MAInTEnAnCE MEDICATIOnSHomedeliveryfromtheexpressscriptspharmacy
providesanaffordablewaytoobtainyour
maintenancemedications,byallowingyoutoorder
uptoa90-daysupplybymailfor2copayments.itis
themostcosteffectivewaytofillprescriptionsand
helpsyousavemoney.
youmayobtainyourfirstandsecondfillsofyour
maintenancemedicationatanyparticipating
pharmacy.startingwithyourthirdfill,youwillpaythe
fullcostofyourprescriptionunlessyoueithermove
totheexpressscriptsmailorderhomedeliveryorlet
expressscriptsknowyouchoosenottoparticipate
inthemailorderhomedeliveryprogram.
4 Easy Ways to get Started!
1.Visitwww.starthomedelivery.comor
2.Call888-772-5188togetstartedor
3.CompleteanexpressscriptsHomedeliveryform
andmailtoexpressscriptswiththeprescription
andcopaymentor
4.expressscriptswillcallyourdoctortogetanew
prescriptionstartedinselectHomedelivery.
onceexpressscriptshastheprescriptionfrom
thedoctor,theprocessmaytakeuptotwoweeks
ifawaitingdocumentation.pleasehavea30-day
supplyofyourmedication(s)onhandwhenyoubegin
theHomedeliveryprogram.
HealtHmatters…CHooseWisely. 9
10 Texas Children’s hospiTal2011BenefitsandWellnessGuide11 Texas Children’s hospiTal2011BenefitsandWellnessGuide HealtHmatters…CHooseWisely. 11
MATERnITY CAREasyouareaware,texasChildren’sisexpanding
throughouttheHoustonarea.inadditiontotheWest
CampusopeningnearKatyinlate2010andearly
2011,wewillbecompletingourtexasChildren’s
maternityCenterin2012.untilthenandthroughout
2011,thefacilitiesopenformaternityservicesfor
texasChildren’sare:
n st.luke’sepiscopalHospitalmedicalCenter
n st.luke’stheWoodlandsHospital
n st.luke’ssugarlandHospital
teXasCHildren’siseXpandinG…
atWWW.BirtH.teXasCHildens.orGyouCan:
n Comparehospitalsandmaternityprograms
n Createabirthplan
n registerforbirthingclasses
n signuptotakeatourofst.luke’s
n seeamapofst.luke’sHospital
n reviewtheamenitiesprovidedtost.luke’s
n Getideasonwhattopackforthedeliverystay
St. Luke’s Facility Charges Paid at 100% for Mom and Baby
expandingourfootprintgivesyouanopportunitytosavemoneybyutilizingourservicesforpediatriccareaswellasformaternitycare
whileobtainingworldrenownedqualityservices.
throughst.luke’ssystem,andwhenourmaternityCenteriscompleted,wewillcontinuetooffermaternityrelatedcareatno
costtoourplanmembersforfacilitycharges.facilitycharges,includingprivatematernityroom,willnotbesubjecttocopayments,
deductiblesorcoinsuranceforyouoryourbaby.so,howcanthissaveyoumoney?
10 Texas Children’s hospiTal2011BenefitsandWellnessGuide11 Texas Children’s hospiTal2011BenefitsandWellnessGuide HealtHmatters…CHooseWisely. 11
UnIqUE FAMILY-CEnTERED MATERnITY CAREn postpartumcareformotherandbabytogether,ratherthanapartn Basedontheprincipalthatthemotheristhebestcareproviderforthebabyn noseparationofmotherandbabyunlessmedicallynecessaryn additionalbabycareandsupportforsuccessfulbreastfeedingn providesaprivateroomforthemotherandbaby
Supportive of natural techniquesn aromatherapy n Breathingtechniques n music
n massage n Walkingduringlabor n Hydrotherapy
n Birthball
Specialized prenatal or neo-natal care by direct transfer to Texas Children’s Hospital should it become necessary.
CompareandsaVe!MATERNITY FACILITY CHARGES (Employee Cost)
PPO EPO
delivery (Baby/Mom) At SLEH not at SLEH At SLEH not at SLEH
deductible $0 $500(each) n/a $0
Coinsurance $0 20% n/a $0
Copayments n/a n/a $0 $300perdayperperson
Baby Cost $0 $800 $0 $900
Mother Cost $0 $1,000 $0 $900
TOTAL COST no facility payment $1,800 + physician charges
no facility payment $1,800
LACTATIOn SUPPORT FOR nURSIng MOTHERSasinternationalleadersincaringforthe
healthofbabiesandchildren,texas
Children’sHospitalknowstheimportanceof
mother’smilktothehealthanddevelopment
ofnewbornbabies.
Breastfeedingsupport,adviceand
resourcesareaphonecallore-mailaway.
VisitthetexasChildren’smilkBankwebsite
formoreinformation.
tHest.luKe’slaBoranddeliVeryeXperienCeisdifferent:
Assumes non-SLEH facility is in the BCBSTX network.
Assumes Facility single baby cost is $2,000 and mother cost is $3,000 for a 3-day stay.
MATERNITY
Fertility benefits through BCBSTX:n pre-certifytoensurecoverage
n allfertilitybenefitsaresubjecttoapplicablecopayments,deductibles,andcoinsurance.
n somediagnosticandtreatmentservicesforunderlyingcausesofinfertilitymaybecovered.CallBCBstXfordetails.
n $20,000lifetimelimitforallfertilityrelatedtreatmentappliestomedicalandprescriptiondrugsservices.
n fertilitymedicationsshouldbecoordinatedthroughfreedomfertilityat1-800-660-4283orwww.freedomfertility.com
–onlineorderingandrefills
–freeexpressshippingonallorders
–educationmaterials
–onlinevideocoaching
–aroundtheclocktelephoneaccesstonursesandclinicalpharmacistswhospecializeinfertilitycare.
Advanced Reproductive Technology (ART) includes,butisnotlimitedto,in-Vitrofertilization(iVf).
ART Benefits provided through one of the following ART providers only.
Physician Phone AddressWilliam e. Gibbons, Md 713-798-7500 6620mainstreet,suite1450,Houston,tX77030-2346
ertug Kovanci, Md 713-798-7500 6620mainstreet,suite1450,Houston,tX77030-2346
Michael Joseph heard, Md 713-797-1144 6624fanninstreet,suite1800,Houston,tX77030-2330
fertilityBenefitsteXasCHildren’soffersBenefitsforfertilitytreatmentunderBotHmediCaloptionsupto$20,000perlifetime
12 Texas Children’s hospiTal2011BenefitsandWellnessGuide
FERT
ILIT
Y BE
NEFI
TS
CHROnIC COnDITIOn MAnAgEMEnTtexasChildren’scaresaboutyou!ahealthyyoumeansahealthy
placetowork.WehavepartneredwithfocusedHealthsolutionsto
helpyoumanagecertainhigh-riskchronicconditions.
n diabetes
n Chronicobstructivepulmonarydisease(Copd)
n CongestiveHeartfailure(CHf)
Bytakingyourmedicationsregularlyandgettinganyrequired
testing,improvingyournutritionandengaginginexercise,youmay
beabletosloworreversetheprogressofyourdisease!effectively
managingchronicconditionscanimprovethequalityofyourwork
andpersonallife.
Weallwanttoknowhowwecantakebettercareofourselves
andimproveourhealth.throughfocusedHealthsolutionsnurse
engagementprogramyouwilldeterminehowreadyyouaretomake
changes,setgoals,learnhowtoachievethem,andprogressdown
thepathtomanagingandcontrollingyourcondition.asaBonus,
WHenyoureaCHyourGoalsyoumayreCeiVemoney
BaCK!improvingyourhealthstartswithyou,makeacommitment
tostarttoday.
improvedhealthstartswithyouandyourpersonalnursecoach!
theywillhelpguideyouthroughouttheprocesstoanswer
questionsaboutsymptoms,medications,exercise,educationand
personalwellnessgoals.
focusedHealthsolutionswillbereachingouttoyouandwill
supportyouwithyourmanagementplan.employeesconcerned
abouttheirchronicconditionmayinquireabouttheprogramby
calling1-888-352-9355.
n You may qualify to receive a refund of some copaymentsifyouactivelyparticipateinadisease
managementprogramwithnurseengagementandachieveyourmutuallyagreedupongoals!thisisa
greatwaytoimproveyourhealthandearnafewdollars!Focused Health Solutions can be reached
at 1-888-352-9355.Callafter1/1/11.
n thenetworkofprovidersisthesameforbothplanoptions.youcanviewallparticipatingprovidersatthe
www.bcbstx.com/tchwebsite.
NEWiN 2011
NEWiN 2011
WEB-BASED HEALTH InFORMATIOn CEnTEReffective1/1/11,theeasy-to-usemyfocused
Healthsmprogramwillallowyouaccessto:
n anextensivelibraryofhealth-orientedinformation
andinteractivefeatures
n ahealthcoachtoreviewtheresultsofyouronline
Healthriskassessmentandprovidefeedback.
employeeswillbeabletodeviseapersonalaction
planandtakethatimportantfirststeptowarda
healthieryou.
HealtHmatters…CHooseWisely. 1312 Texas Children’s hospiTal2011BenefitsandWellnessGuide
nEW
CARRIER
DISEA
SE MA
NA
GEM
ENT
foCusedHealtHsolutionsNEWiN 2011
14 Texas Children’s hospiTal2011BenefitsandWellnessGuide15 Texas Children’s hospiTal2011BenefitsandWellnessGuide HealtHmatters…CHooseWisely. 15
n Doctor Care.seeyourdoctorforminorproblemssuchasstrepthroat,ear
infections,check-ups,conditionmanagement,testingandcareofongoing
medicalconditions.
n Urgent care for non-emergencies. urgentcarecentersprovide
carewhenyourdoctorisn’tavailablebutitisnotatruelife-threatening
emergency.forexample,urgentcarecenterscantreatsprainedankles,
fevers,minorcutsandinjuries.
n Emergency room care. forseriousthreatstoyourhealth,youneed
emergencycare.ifyouhaveanemergency:
–Callyourlocalemergencynumber,suchas911orgotothenearester
–onceyouarestable,askthestafftocallyourdoctor.yourdoctorcan
shareinformationregardingyourhealthandmedicationswiththeerstaff
emerGenCyorurGentCare:importanttoKnoWtHedifferenCe
Type of Care PPO EPOUrgent Care $40copay $45copay
emergency room (er) Care
20%after$500annual
deductibleplus
additional$100ercopay
$300copay
HOW TO ACCESS nO-COST PREVEnTIVE CARE UnDER BOTH MEDICAL PLAnSBothmedicalplanoptionscoverpreventivecarebenefitsfor
adultsandchildren.yourbenefitsforpreventivecareservices
arefreeofcosttoyouandyourdependentsifyouutilizea
networkphysician.
preventiveexamsincludeanannualphysicalexam,
basicbiometric/labscreening,amarecommendedwell-
childexamsandimmunizations,well-womanexamswith
associatedtesting,mammogramandwell-manexamsand
prostatescreeningsandcertainotherscreeningtestswhen
performedforpreventivereasons.suggestedexamscan
befoundonthewww.bcbstx.com/tchwebsiteundertab
“suggestedpreventiveservices”.
SAVE MOnEY WITH BLUEEXTRAS
BlueCrossBlueshieldoftexaswantstohelpyousavemoney
withBlueextrasvalue-addedprogramsthatgiveyouand
yourfamilydiscountsonhealth-relatedservices.BCBstXwill
continuetoaddprogramstoBlueextrassobesuretovisitthe
websiteforupdates.
Current BlueExtra discounts include:n membershipsatfitnessCenters
n lifetimefitness:noenrollmentfee,free7-daypassand
freeassessment
n JennyCraig:Weightlossprogramsthatfityourstyle
n Complementaryalternativemedicine:discountsforgym
memberships,massagetherapy,yoga,pilates,personal
trainers,acupuncture,etc.
n truHearing:significantdiscountsonpopularbrandhearing
aids
www.bcbstx.com/tch
WEL
LNES
S
NEWiN 2011
14 Texas Children’s hospiTal2011BenefitsandWellnessGuide15 Texas Children’s hospiTal2011BenefitsandWellnessGuide HealtHmatters…CHooseWisely. 15
mediCalCoVeraGeComparisonCHart
BENEFITPPO
NETWORKPPO
NON-NETWORKEPO
(NETWORK ONLY BENEFITS)Lifetime Maximum unlimited unlimited
Annual Deductiblen individual/Family $500/$1500 $1,500/$4,500 n/a
Coinsurancen employer Paidn employee Share
80%20%
60%40%
n/an/a
Annual Out of Pocket Maximum (not including copays or deductible)n individual/Family $2,500/$5,000 $5,000/$10,000 n/a
Office Visits n Primary Caren Specialistn urgent Caren Preventive Care
$20 copay$40 copay$40 copay
100%, deductible waived
40% after deductible40% after deductible40% after deductible
40%
$25 copay$45 copay$45 copay$0 copay
Ambulance 20% after deductible 20% after deductible $0 copay
Therapyn Physical, Speech and
occupational20% after deductible 40% after deductible $45 copay
Combined maximum 60 visits/calendar year
Chiropractic Care 20% after deductible 40% after deductible $45 copay
maximum 30 visits/calendar year
Minor Diagnostic Testing and Laboratory Testingn Billed by Doctor’s officen outpatient facility n independent lab
included in office Visit copay (if services incurred same day)
20% after deductible$20 copay
40% after deductible40% after deductible40% after deductible
included in office Visit copay (if services incurred same day)
$0 copay$25 copay
All Major Diagnostic TestingCt, mri, Pet scans, etc.
20% after deductible 40% after deductible $45 copay
Emergency Room 20% after $100 copay & deductible
20% after $100 copay & deductible
$300 copay
Hospitalization100% benefit for facility charges if texas Children’s Hospital is used
20% after deductible 40% after $100/admission deductible and calendar
year deductible
$300 copay per day,$900 maximum/person/year
Durable Medical Equipment 20% after deductible 40% after deductible $0 copay
Maternity100% benefit for facility charges if a St. luke’s episcopal Hospital is used
20% after deductible 40% after deductible $300 copay per day,$900 maximum/person/year
Outpatient Surgery 20% after deductible 40% after deductible $500 copay, $500 maximum/person/year
Mental Health and Substance Abuse Treatment
treated the same as any other illness.
Pre-existing Condition Limitations over the age of 19 (refer to eligibility tab)
Some pre-existing conditions may apply. n/a
Chart represents member cost.
nEW
CARRIER
BlueCross
BlueShield
of Texas
16 Texas Children’s hospiTal2011BenefitsandWellnessGuide17 Texas Children’s hospiTal2011BenefitsandWellnessGuide HealtHmatters…CHooseWisely. 17
DENT
AL P
LAN
DEnTAL COVERAgE COMPARISOn CHARTPLEASE REVIEW THIS DEnTAL BEnEFIT CHART CLOSELY. THE DEnTAL BEnEFITS FOR 2011 ARE VERY DIFFEREnT FROM THE PRIOR YEAR!
BENEFITDPPO ‘HIGH’ OPTION
NETWORK AND NON-NETWORKDPPO ‘LOW’ OPTION
NETWORK AND NON-NETWORKAnnual Deductible
n individual $50 $50
n Family $150 $150
Maximum Annual Benefit - per individual
$1,500 $1,000
Preventive Care – exam, cleaning, X-rays up to twice per year
no costno deductible
no costno deductible
Basic Services – Fillings 20% after deductible 50% after deductible
Endodontic and Periodontic Services – gum procedures
20% after deductible 75% after deductible
Major Services – Crowns, inlays, onlays, bridges, dentures
50% after deductible 75% after deductible
Orthodontia
n Diagnosis and treatment (Child)50% after separate
$50 lifetime deductible50% after separate
$50 lifetime deductible
n Diagnosis and treatment (Adult)50% after separate
$50 lifetime deductible50% after separate
$50 lifetime deductible
n orthodontia (Lifetime Maximum) $1,500 $1,000
Chart represents members cost.
BENEFIT DPPO ‘HIGH’ OPTION DPPO ‘LOW’ OPTION
non-network Benefit allowance Subject to 90% of allowable chargeCovered same as network subject to
maximum allowable charge
tCHseleCtdentalplan
NEWiN 2011
nEW CARRIERBlueCross BlueShieldof Texas
texasChildren’swillnolongerofferthe
dHmooptioneffectiveJanuary1,2011.
TEXAS CHILDREn’S SELECT PLAn OFFERS TWO DEnTAL PPO OPTIOnS THROUgH BLUECROSS BLUESHIELD OF TEXAS. theHighplanmostcloselyresemblesthepreviousdppoplanwhilethelowplanprovidesalowercostoption,utilizinganydental
providerswithreducedbenefits.
The benefits are the same whether you use in network
or non-network dental providers. thefollowingarea
fewdifferencesbetweenthetwodentaloptions:
n Highandlowoptionsincludechildandadultorthodontia
n Highoptionhashigherannuallimits
n endodonticsandperiodonticsareconsideredaBasicserviceundertheHigh
plan—paidat80%andconsideredamajorserviceunderthelowplan—
paidat25%.
16 Texas Children’s hospiTal2011BenefitsandWellnessGuide17 Texas Children’s hospiTal2011BenefitsandWellnessGuide HealtHmatters…CHooseWisely. 17
tCHseleCtVisionplan–(Vsp)
undertCHselectyoualsohavetheoptiontoparticipateintheVspvisionplan.Vspisbuiltoncommitmenttoeyecare
wellnessandprivatepracticedoctors.theyhavebuiltthelargestnetworkofoptometristsandophthalmologistsintheindustryto
deliverqualitycare.theVspvisionplanincludesanannualeyeexamsandonepairofprescriptionglassesorcontacts.
out-of-networkprovidersmaybeused;however,reimbursementbenefitswillbelimitedtothoseshowninthechartbelow.
VISIOn COVERAgE THROUgH VSP
BENEFIT FREQUENCY COPAYMENTCOVERAGE USING AN
IN-NETWORK VSP DOCTOROUT-OF-NETWORK REIMBURSEMENT
Eye Examglasses OR contacts
onceperplanyear $0 Coveredinfull upto$45
Lenses
onceperplanyear $0
n singleVision,linedbifocalorlinedtrifocalcoveredinfull
n polycarbonatecoveredfordependentsuptoage19
singlevisionlensesupto$30
linedbifocallensesupto$50
linedtrifocallensesupto$65
Frames onceperplanyear $0
Coveredupto$120retailframeallowance
upto$70
Contact Lenses
onceperplanyear $0
$120allowanceforcontactsandexam(fittingand
evaluation).thisadditionalexaminsuresproperfit.
upto$105
Lasik Vision Correction
VsphascontractedmanylasersurgerycentersandoffersadiscountforlaserVisionCorrection(prKlasiKandCustomlasiK).
average15%offtheregularpriceor5%offthepromotionalpricefromcontractedfacilities.
Other Discounts and Savings
n 20%offlensoptionssuchasprogressiveandscratchresistantandanti-reflectivecoatings.
n 20%offadditionalglassesandsunglasses,includinglensoptions–availablefromanyVspdoctorwithin12monthsofyourlasteyeexam.
n average15%offthecontactlensfittingandevaluationexam
looKituponVsp’sWeBsite
theVspwebsitewww.vsp.com/go/tchisyoursourceforinformation
regardingyourvisioncarebenefits.
n locateaVspprovider
n findlenses,framesandcontactlenssavings
n seebenefitinformation
n printaVspidcard(notrequiredtoreceivecareandservices)
nomemberidcardisrequired.Callthedoctordirectlyforanappointment.
additionalhelpisavailablefrommemberservicesat1-800-877-7195.
Vsp now offers open accesssM
which allows members the flexibility
to use their Vsp benefits at any location,
including specialty optical boutiques or
retail chains.While95%ofourmembers
chooseaVspprovidertomaximizetheirbenefit,
weofferagenerousenhancedreimbursement
forservicesfromall other providers.
NEWiN 2011
VISION
PLA
N
HealtHmatters…CHooseWisely. 19
fleXiBlespendinGaCCounts(Fsa) plans
PAYFLEX WILL BE HAnDLIng ALL YOUR FSA nEEDS. BeginningJanuary1,2011,allflexiblespending
accountexpenses(healthcareanddependentcare)
shouldbesubmittedtopayflexforreimbursement!
Two Flexible Spending Account Options
flexiblespendingaccounts(fsas)offeranattractiveway
tousepre-taxdollarstopayforeligiblehealthcareand
dependentcaredaycareexpenses.
n A Health Care accountreimbursesyouforoutofpocket
medical,dental,visionandprescriptiondrugexpenses,
suchasdeductibles,copaymentsandcoinsurance.
n A Dependent Care accountreimbursesyoufor
expensessuchasdaycare,beforeandafterschool
programs,nurseryschoolorpreschool,summerdaycamp
andevenadultdaycareforirseligibledependents.
Determining Your Pledge Amount
startbyestimatingtheamountthatyouwillincurforeligible
healthcareanddependentdaycareexpensesduringthe
planyeartodetermineyourannualcontribution.theannual
contributionamount,dividedby26,willthenbetheamount
deductedfromyourpaycheckeachpayperiod.
FSA Factsn enrollment is necessaryeachyearinwhichyouwishto
participate.
n Fsas are an optional benefit.
n no Transfers.youcannottransferdollarsfromthehealth
carefsatothedependentcarefsaorviceversa.
n no Changes to the Fsa Contributions.youcannot
changeyourfsacontributionelectionuntilthenextannual
enrollmentunlessyouexperienceaqualifyingfamilystatus
ChangeoraJobstatusChange.refertotheelection
Changetabwithinthisguide.
n no refunds.youwillnotreceivearefundofunused
deductedfsacontributionpledgeamounts.
looKitupontHepayfleXWeBsite
A HealthHub account,poweredbypayflex,isnot
onlyyoursolutiontosavingmoney,butcombined
withapayflexdebitCard(forthosewhoenrollto
participateintheHealthCarefsa),itprovidesa
simplewayforspendingyourmoneytoo!
youcanregisteronlinebyclickingregister.then
createyourownsecurityquestionandpassword.
www.healthhub.comallowsyouto:
n obtainyourbalanceorseeyourCardstatuson
mydashboard
n Viewalltransactions
n seeunsubstantiatedtransactionsthatrequire
additionalclaimvalidation
n fileaclaim(uploaddocuments)orprovide
substantiation
n decideifpaymentsshouldbemadetoyouor
“them”
n Viewlistingofalleligibleexpenses
n Calculatetaxsavingsusingthe“savings
Calculator”
n determineifdependentCarefsaisrightforyou
using“dependentCaretaxWizard”
n orderadditionalcardsforspouseorchildren
n signupforelectronicaccountupdates
n enrollindirectdeposit
n shoponlineforhealthcarerelatedexpenses
n ViewfrequentlyaskedQuestions
18 Texas Children’s hospiTal2011BenefitsandWellnessGuide
nEW
FSA
VEnDORPayFlex
FSA
PLAN
S
HealtHmatters…CHooseWisely. 1918 Texas Children’s hospiTal2011BenefitsandWellnessGuide
thedependentCarefsaissimilartotheHealthCarefsa,
allowingyoutosetasidepre-taxmoneyfordependentcare
expenses.
if you participate in the dCFsa, Texas Children’s will
automatically deposit $260 in your dCFsa for your
immediate reimbursement of eligible expenses.
MAXIMUM DEPEnDEnT CARE PLEDgEthemaximumannualpledgeamountyoucandepositinto
thedCfsaeachyearis$5,000($2,500ifyouaremarried
andfileaseparateincometaxreturn).The maximum
pledge should include the $260 that Texas Children’s
contributes on your behalf to your dCFsa.
eligibledependentexpensesarethosethatwouldqualifyfor
achildcaretaxcreditonyourfederaltaxreturn.youmustfile
aform2411annuallywithyourtaxreturnidentifyingallyour
dependentcareproviders.allprovidersmustbelicensedday
carefacilitiescomplyingwithstateandlocallaws.
ELIgIBLE DEPEnDEnTS InCLUDE:n dependentundertheageof13
n adependentwhoisphysicallyormentallyincapableof
caringforhim/herself,hasthesameprincipalresidence
asyouformorethanhalfoftheyear;andhaslessthan
$3,200intotalincomefor2011ifovertheageof13;or
n aspouseifhe/sheisphysicallyormentallyincapableof
caringforhim/herself,hasthesameprincipalresidenceas
youformorethanhalfoftheyearandhaslessthan$3,200
intotalincomefor2011.
n youmustbeabletoclaimthedependentonyourfederal
taxreturn.
ELIgIBLE EXPEnSES InCLUDEthoseexpensesthatarenecessaryforyou(andifmarried,
yourspouse)towork,unlessyourspouseisafulltime
studentorisdisabled.Belowaresomeeligibleexpense
parameters.foramoredetailedlistofallowableexpenses,
visitwww.healthhub.com.n Careforyourdependentswhileyouwork
n CopaymenttoBrightHorizonsforinterimbackupcare
n summerdayCamp(notovernight)
n Beforeandafterschoolcare
n nurseryschool
n mustbeforservicesreceivedaftertheeffectivedateofthe
electionandduringtheplanyearinwhichitapplies
n mustbeforservicesrendered;notforfutureservices
note:youwillbereimburseduptoonlytheamountcurrently
depositedinyourdCfsaaccount.
Important Dates
DEPENDENT CARE FLEXIBLE SPENDING ACCOUNT (DCFSA) PARAMETERS
IRS DEADLINE DATES
deposits made in calendar year 2011 must be used for expenses incurred:
Jan1,2011-dec31,2011
For claims incurred in calendar year 2011, claims substantiation must be submitted to payFlex by this date to avoid forfeiture of unused contributions:
april30,2012
EXPAnDED PAYFLEX HOURS PROVIDE ADDITIOnAL SUPPORT FOR YOUR FSA qUESTIOnS:n Callpayflexat1-800-284-4885
–monday-friday7a-7p
–saturday9a-2p
dependentCarefleXiBlespendinGaCCount(dCfsa)
nEW FSA VEnDORPayFlex
20 Texas Children’s hospiTal2011BenefitsandWellnessGuide21 Texas Children’s hospiTal2011BenefitsandWellnessGuide HealtHmatters…CHooseWisely. 21
WHAT YOU nEED TO knOW ABOUT A HEALTH CARE FSAn youcanonlypledgeyourcontributiontoanfsaduringopen
enrollmentorwhenyoufirstbecomeeligible.
n onceyouestablishyourplanyearpledgeyoumayonlychange
itifyouexperienceachangeinstatus.refertoelectionChanges
sectionofthisguide.
n Enrollment is required each year in which you wish
to contributebecauseyourcontributionelectiondoesnot
automaticallyroll-overfromyeartoyear.
n youmaycontributeaminimumof$5.00perpayperiodupto
$5000percalendaryear.
n yourtotalannualcontributionpledgetotheHealthCarefsais
availabletoyouimmediately.
n Contributionsarenottaxableaccordingtoirsregulations.
n expensesmaybeforyourselfand/oryoureligibledependents,
whetherornottheyarecoveredunderthetexasChildren’s
selectplanformedical,dentalorvision.
n expensesmustbeincurredduringaperiodinwhichthe
employeeiscoveredundertheHealthCarefsa.
THE HEALTH CARE FSA gRACE PERIODtheHealthCarefsaGraceperiodincludesanextendedperiodof
coverageattheendofeveryplanyearthatallowsyouextratimeto
incurexpensestouseyourremainingflexiblespendingaccount
balanceafterthecloseoftheplanyear.theGraceperiodis2-1/2
monthslong(throughmarch15thofthefollowingyear).
Whatthismeansforyouisthatyouhaveuntilmarch15thofthe
nextplanyeartoincurclaimsagainstyourpreviousyear’sfsa
funds.aneasywaytothinkaboutthisprogrammodificationisthat
every12monthplanyearisactually14-1/2monthslong.
onlythosewhohavefsacoveragethroughdecember31stofthe
previousplanyearcancontinuetoincurclaimsinthegraceperiod.
allfsaclaimsforservicesprovidedduringthegraceperiodwill
automaticallybeprocessedagainstthepreviousyear’splanyear
firstiffiledbythedeadlineforthatplanyear,unlessyourequest
otherwise.ifyourclaimexceedstheavailablefundsfromthe
previousplanyear,anyexcesswillautomaticallybeappliedtothe
newplanyear.yourpayflexCardwillrecognizeanyremaining
balancefromtheprioryear.
HealtHCarefleXiBlespendinGaCCount(HCfsa)
nEW FSA VEnDORPayFlex
Important Dates
Healthcare Flexible Spending Account (HCFSA) Parameters
IRS Deadline Dates
deposits made in calendar year 2011 must be used for expenses incurred:
Jan1,2011-march15,2012
For claims incurred in calendar year 2011, claims substantiation must be submitted to payFlex by this date to avoid forfeiture of unused contributions:
april30,2012
ORTHODOnTIA REIMBURSEMEnTtheirsrecognizesthatorthodontiatreatmentisdifferent
fromanyothertypeofhealthcareexpense.therefore,
reimbursementoforthodontiacanbehandledintheseways:
n Coupon payment option-youcansubmitanitemized
statementofyourorthodontiaexpensesastheserviceis
provided.
n Monthly payment option-youcanobtainacontract
agreementfromtheorthodontistshowingthepatientname,
thedatetheservicebeginsandthelengthofservice,
chargesfortheinitialbandingworkandthedollaramount
chargedeachmonth.submityourcontractwithyourfirst
claimandwewillautomaticallyreimburseyoueachmonth,
accordingtothecontract,eliminatingtheneedtosubmita
claimeverymonth.youwillneedtosendanewclaimform
withyourcontractagreementatthebeginningofthenext
planyearifyouwishtocontinuereimbursements.
n Total payment option-ifyoupaidtheentireamountof
thetreatmentwhentheservicesbegan,submityourclaim
withacopyofyourpaidreceiptandanitemizedstatement
showingtheprovidername,patientname,datetreatment
started,dollaramountandamountyourinsurancewillpay.
underthisoption,youcanonlyfileforthisexpenseonce.
20 Texas Children’s hospiTal2011BenefitsandWellnessGuide21 Texas Children’s hospiTal2011BenefitsandWellnessGuide HealtHmatters…CHooseWisely. 21
HOW DOES THE nEW PAYFLEX CARD WORk?asyouincureligiblehealthcare
expenses,yousimplypresentyourcard
forpayment.thepayflexsystemwillthen
validatethatyouhavefundsavailableto
coverthetransactionandautomatically
deducttheamountfromyourHealthHub
account.
youcanusethecardforonlinepurchasesaswell.throughHealthHub’s
consumercenter,youcanbuyitemssuchasglasses,contacts,prescription
drugs,durablemedicalequipmentusingyourpayflexCard.ifanitemisnot
identifiedas“fsaeligible”youwillneedanotherformofpaymentotherthan
yourpayflexCard.
n Cardismailedtoyourhomeaddressinaplainwhiteenvelope
n activatethecard
n select‘credit’whenmakingapurchase
n savereceiptsandexplanationofBenefits(eoBs)fordocumentationof
eligibleservices
n Respond promptly to Request for Documentation Letters or the
card will be inactivatedn Keepyourcardyearafteryear(goodforupto5years)
n lostorstolencards:1-800-284-4885
n Questions:1-800-284-4885
–monday-friday7a-7p
–saturday9a-2p
eliGiBleHealtHCarefsaeXpenses
eligibleexpensesincludebutarenotlimitedtothefollowing
list:(forfulllistingvisitHealthHub.com)
n deductiblesandcopaymentsforthemedical,dental,
prescriptionsandvisionplan
n orthodontiaorothernoncosmeticdentalexpenses
beyondthemaximumamountreimbursedbythedental
plan
n eyeglassesandcontactlensesnotcoveredbytheVspor
othervisionplan
n medicalsupplies,crutchesandwheelchairs
n smokingcessationprogramsandprescriptiondrugsto
alleviatenicotinewithdrawal
n feesforpsychologicalservices
n dentures
ineliGiBleHealtHCarefsaeXpensesEffective 1/1/11: OVER THE COUnTER DRUgS / MEDICATIOnS (unless prescribed by a physician) WILL nO LOngER COnSTITUTE An ELIgIBLE EXPEnSE PER IRS gUIDELInES.
productsthataremerelybeneficialtoyourhealth,suchas
vitamins,dietarysupplements,cosmetictreatments,teeth
bleachingandoverthecountermedicationsandsuppliesare
consideredineligible.forafulllisting,visithealthhub.com.
Benefits of Using the PayFlex Card for Payment of
HCFSA Expendituresn immediatepaymentofyourexpensesfromyourhealthcare
account
n increasesyourpersonalcashflow
n noclaimfilingduetopointofsaleapproval(unlessclaim
substantiationisneeded)
n easeofuseofyourpre-taxcontributions
nEW
SUBSTAnTIATIOn AnD REqUEST FOR DOCUMEnTATIOn LETTERSifyoureceivearequestfordocumentation
letter,youarerequired,asregulatedbytheirs,
toprovidedocumentationtoverifythatthecard
wasusedtopurchaseaneligibleitemorservice.
If you do not respond within 60 days of
request, your card WILL BE DEACTIVATED
until you provide the requested
documentation or payment.
Three options to respond:
1.submitanitemizedreceiptorexplanationof
Benefits(eoB)forthetransaction(s)listed;
2.submitanitemizedreceiptoreoBforanother
eligibleitemincurredduringtheplanyearthat
hasnotalreadybereimbursed;or
3.sendapersonalcheckormoneyorderforthe
identifiedexpenseifyouareunabletoprovide
documentation.
nEW
22 Texas Children’s hospiTal2011BenefitsandWellnessGuide23 Texas Children’s hospiTal2011BenefitsandWellnessGuide HealtHmatters…CHooseWisely. 23
LIFE InSURAnCE AnD ACCIDEnTAL DEATH AnD DISMEMBERMEnT (AD&D) InSURAnCEunderthetCHselectplan,texasChildren’sofferslife
andaccidentinsurancetoprovidefinancialassistanceat
atimewhenyouoryourfamilymayneeditmost.
BASIC LIFE AnD BASIC ACCIDEnTAL DEATH & DISMEMBERMEnTtexasChildren’sautomaticallyprovidesfull-timeand
part-timeemployeeswithbasiclifeandaccidentaldeath
anddismemberment(ad&d)coverageat1Xyour
annualbasesalary,roundedtothenext$1,000uptoa
millionmaximum—atnocosttoyou.
OPTIOnAL LIFE InSURAnCEyoumayelecttoparticipateintheoptionallife
insuranceplantoprovideyourbeneficiary(ies)additional
financialsecurityintheeventofyourdeath.
n full-timeemployeesmaypurchasecoverageequalto
1to4timesyourbaseannualsalary,roundedtothe
next$1,000,uptoacombined(Basicandoptional
life)maximumof$2,000,000.
n part-timeemployeesmaypurchasecoverageequal
to1timesyourbaseannualsalary,roundedtothe
next$1,000,uptoamaximumof$1,000,000.
evidence of insurability (eoi) must be provided for
amounts over $500,000.
theannualbasesalaryiscalculatedusingyourhourly
ratex2,080xyourelection,thenroundedtothenearest
thousand.
example:$20/hourX2080=$41,600(roundedup
tothenexthigherthousand)=$42,000of
optionallifeinsuranceCoverage
lifeinsuranCeBenefitsWitHprudential
nEW
CARRIER
Prudential
OPTIOnAL ACCIDEnTAL DEATH & DISMEMBERMEnTyoumayalsopurchaseoptionalad&dinsurancecoverageto
provideyourbeneficiary(ies)additionalfinancialsecurityintheevent
ofanaccidentaldeathorseriousinjuryfromanaccidentasdefined
bytheplan.
n full-timeemployeesmaypurchasecoverageequalto1to4
timesyourbaseannualsalary,roundedtothenext$1,000,
uptoacombined(Basicandoptionalad&d)maximumof
$2,000,000.
n part-timeemployeesmaypurchasecoverageequalto1times
yourbaseannualsalary,roundedtothenext$1,000,uptoa
combined(Basicandoptionalad&d)maximumof$1,000,000.
theannualbasesalaryiscalculatedusingyourhourlyratex2,080
xyourelection,thenroundedtothenearestthousand.
example:$20/hourX2080=$41,600(roundeduptothenext
thousand)=$42,000ofad&dinsuranceCoverage
AgE 65 gUIDELInESatage65,yourBasiclifeinsuranceandBasicad&damountwill
bereducedaccordingtotheschedulebelow:
AGE REDUCED TO
65 65%
70 50%
75 30%
ACCELERATED DEATH BEnEFIT (EMPLOYEE OnLY)ifyoubecometerminallyillwithlessthanasix-monthlife
expectancy,youmaybeeligibleforanaccelerateddeathbenefit.
thisbenefitisequalto90%ofyourBasicandoptionallife
insurancein-forceor$500,000,whicheverisless.
SPOUSE LIFE InSURAnCEunderthetCHselectplan,ifyouareafull-timeemployee,you
mayelectspouselifeinsuranceprovidedyouhaveenrolledinthe
optionallifeinsuranceplan.youmaycoveryourspouseatoneof
thecoveragelevelsuptoamaximumof$100,000(nottoexceed
youroptionallifeamount).part-timeemployeesarenoteligibleto
electspouselifeinsurance.
LIFE
INSU
RANC
E
nEW
example: employeeage70
making$50,000.
Basiclifeand
ad&d=$25,000.
22 Texas Children’s hospiTal2011BenefitsandWellnessGuide23 Texas Children’s hospiTal2011BenefitsandWellnessGuide HealtHmatters…CHooseWisely. 23
youhave31daystoenrollyourspousefromthedateof
eligibility.duringthistimeanyamountover$25,000will
requireyourspousetoprovideevidenceofinsurability.
Coverage Benefit Election for Spousal Life
Insurance
upto$25,000
n 1xyourannualbasesalary
n 2xyourannualbasesalary
n 3xyourannualbasesalary
n 4xyourannualbasesalary
yourannualbasesalaryiscalculatedusingyourhourlyrate
x2080xyourelection,roundedtothenextthousandupto
amaximumof$100,000.
DEPEnDEnT LIFE InSURAnCEunderthetCHselectplan,ifyouareafull-timeemployee
youmayelectcoverageforyoureligiblechildrenuptoage
25inthefollowingcoverageamountsprovidedyou(the
employee)haveenrolledintheoptionallifeinsuranceplan:
Coverage Amounts by Age
DEPENDENTS FROM LIVE BIRTH TO AGE 25
$2,500
$5,000
$10,000
EVIDEnCE OF InSURABILITYYou must provide satisfactory Evidence of
Insurability if:
1.youroptionallifecoverageequals$500,000ormore,
or
2.youarecurrentlynotenrolledandareelectingoptional
lifeor
3.youarecurrentlyenrolledin2010andareelectingto
increaseyour2011optionallifeinsurancebymorethan
onelevelor
4.youelectspousecoverageaftertheinitialeligibility
period,or
5.yourspouseenrolls(atanytime)formorethan$25,000
nEW CARRIERPrudentialLOng TERM DISABILITY (LTD)ltdbenefitsaredesignedtoprotectyouandyour
familyfromthefinancialhardshipthatmayaccompanya
personalillnessorinjurythatkeepsyoufromworkingfor
anextendedperiodoftime.Certainpre-existingcondition
limitationswillapplytoBasicandoptionalltd.
Under The TCH Select Plan, Texas Children’s provides
full-time employees with Basic LTD at no cost.
ifyouwantadditionalltdcoverage,youmayincreaseyour
coveragetotheoptionalltdplan.ifyouincreaseyour
coverage,youradditionalltdbenefitsarepurchasedwith
after-taxdollarssothatifyoubecometotallydisabled,no
taxeswillbetakenoutoftheoptionalltdbenefitpayment
youreceive.
yourltdbenefitswillbereducedby:
n socialsecuritybenefits
n Worker’sCompensationbenefit
n anybenefitspaidtoyouunderanystationeryplan(ex:
CashBalancepensionplan)
LTD Benefit Plan Duration
thebenefitperiodisbasedonthedateinwhichyoubecame
disabledasshownbelow.
Basic LTD Plan
AGE ON DATE OF DISABILITY
MAXIMUM BENEFIT DURATION
less than 68 24months
68, less than 69 toage70
69 and over 12months
Buy Up/Optional LTD Plan
AGE ON DATE OF DISABILITY
MAXIMUM BENEFIT DURATION
less than 60 toage65
60 60months
61 48months
62 42months
63 36months
64 30months
65 24months
66 21months
67 18months
68 15months
69 and over 12months
24 Texas Children’s hospiTal2011BenefitsandWellnessGuide25 Texas Children’s hospiTal2011BenefitsandWellnessGuide HealtHmatters…CHooseWisely. 25
Maximum Monthly Long Term Disability Benefit Payment Plan
PLANMONTHLY BENEFIT
MONTHLY MAXIMUM
Basic 50% $5,000
optional 70% $10,000
Items to Remember about Long Term Disabilityn youmaybeaskedtoexploredisabilitybenefitsthroughsocial
security.
n youmaycontinueyourmedical,dentalandvisioncoverage
and,insomecasesHealthCarefsaunderCoBrawithin60
daysofyourterminationdate.
n youmayalsoapplyforportabilityorconversionofyourlife
insurancewithin31daysfromyourterminationdate.youmay
beeligibleforawaiverofyourpremium.
nO-COST WILL PREPARATIOn SERVICE AVAILABLE TO ALL LIFE PLAn PARTICIPAnTStexasChildren’sfullandpart-timeemployeeshaveaccesstothis
importantbenefitwhetherornotyouenrollin‘optional’life.estate
GuidanceisaprogramofferedthroughCompsychthatallows
youtheeaseandsimplicityofonlinelegaldocumentpreparation
(suchasawill).Willsensurethatyourassetswillbedistributed
inaccordancewithyourwishes,shouldsomethinghappento
you.awillalsoallowsyoutonameanexecutorandaguardian
totakecareofyourminorchildren.everyadultshoulddraftawill
andprotecttheirfamily.youwillalsohavetheopportunity(foran
additionalfee)tocreateacreditsheltertrust,alivingwill,anda
healthcarepowerofattorney.toaccesstheseservicesgoto
www.estateguidance.comandenteryourCompanyWebid:
eGp311.
anotherplus,availablethroughprudential,isaccesstotheaXa
travelassistanceprogram,anessentialserviceprovidedbyaXa
assistanceusa,inc.thisserviceoffersyouandyourdependents
medical,travel,legalandfinancialassistanceservices,24hours
aday,365daysayear,worldwide.participantshaveaccess
toassistanceserviceswhenfacedwithanemergencywhile
travelinginternationallyordomesticallywhenmorethan100miles
awayfromhomeforupto120consecutivedays.Withonesingle
phonecall,youandyourdependents(whethertravelingtogether
orseparately)willhaveimmediateaccesstoabroadrangeof
travelassistanceservices.
ifyouhaveanyquestionsabouttheservicesorneed
travelassistance,pleaseaccessbywebsite:
www.axa-assistance.usorcallthetravelassistanceprogram
Hotline:1-800-565-9320.
Long Term Care Insurance (LTC)texasChildren’slongtermCareinsuranceplanisa
voluntarybenefitprogramavailabletoallactivelyatwork
full-timeandpart-timeemployeesandtheirspouses,
children,parents,andgrandparents.longterm
carecomplimentsyourhealthcareplanbyproviding
coveragebenefitsforextendedcarenecessarydueto
chronic,disablingillnessesorinjuriesthatmedicareand
healthplansarenotdesignedtocover.extendedcare
mayincludeassistanceinyourownhome,anadultday
carefacilityandmanyothertypesoflong-termcare
facilities.longtermCareinsurancecoverssomuch
morethannursinghomefacilitiesfortheelderly.long-
termcareinsurancegivesustheabilitytocontinuea
lifeofdignityandindependencewithoutburdeningour
lovedonesshouldwebediagnosedwithadisabling
illnessorinjury.
eligibleapplicantswillchoosefromadailymaximum
benefitof$100,$200or$300.premiumswillbe
determinedbytheapplicant’sageatthetimethe
applicantenrollsforcoverage.
newlyhired,activelyatworkemployeesornewlyeligible
employees(doesnotincludeeligiblefamilymembers),
whoenrollwithinthe90dayperiodfollowinginitial
eligibility,willbeautomaticallyacceptedforcoverage
uponreceiptoftheirapplication,regardlessofcurrent
healthstatus.alleligiblefamilymembers,andeligible
activelyatworkemployeesapplyingaftertheinitial
90-dayenrollmentperiod,willhavetoprovideproofof
goodhealthbeforebeingacceptedintotheplan.
yourageatenrollmentwilldetermineyourmonthly
premiumrate.premiumswillbepaidthroughpayroll
deductionforemployeeandspousalcoverage.allother
eligiblefamilymemberswillhavetheoptionofpaying
premiumsthroughautomaticbankwithdrawalordirect
billing.
JOHn HAnCOCk COnTACT InFORMATIOnn Byphone:1-800-724-3785
n http://tch.jhancock.com
-username:tch
-password:mybenefit
NEWiN 2011
24 Texas Children’s hospiTal2011BenefitsandWellnessGuide25 Texas Children’s hospiTal2011BenefitsandWellnessGuide HealtHmatters…CHooseWisely. 25
texasChildren’spensionbenefitsaredesignedtohelpyoubuild
asolidfinancialfoundationforyourretirementyears.Whenboth
oftheplanslistedbelowarecombinedwithsocialsecurityand
yourpersonalsavings,thetotalpackageisintendedtohelpyou
achieveyourretirementgoals.
reviewthechartsonthefollowingpagesforanoutlineofthe
benefitprovisionsforeachofthetexasChildren’sretirement
plansreferencedbelowandrefertotheplandocumentsfor
greaterdetail.
n THE TEXAS CHILDREn’S 403B SAVIngS PLAn – ADMInISTERED THROUgH FIDELITY
texasChildren’swillmatchupto50%ofthefirst6%ofyour
perpayperiodcontribution.youmayenrollinthisplanatany
timethroughouttheyearbycontactingfidelityat1-800-343-
0860oronlineathttps://www.fidelity.com/atwork.
monthly1-on-1sessionsareheldatthemaincampusto
providecurrentparticipantstheopportunitytoevaluate
thestatusoftheir403bsavingsplanaccount,consider
modificationsandmakechangesasneeded.registration
isrequiredfora30-minuteconsultation.Callfidelityat
1-800-642-7131afterthe20thofthemonthtoschedulean
appointmentforthefollowingmonthoryoumayschedule
onlineatwww.fidelity.com/atwork/reservations.
n THE TEXAS CHILDREn’S CASH BALAnCE PEnSIOn PLAn (CBPP)
employeesdonotneedtoenroll,nordoyoumake
contributionstothisdefinedbenefitretirementplan.texas
Children’spaysthefullcostofthisbenefitonceeligibility
requirementsarefulfilled.(seechartonnextpage)
retirementandsaVinGsplanBenefits
aCCessyourannualCBppstatementtHrouGHmoli
1.Clickonthetotalrewardse-statementicon
2.ClickonBenefits
3.ontheBenefitsscreen,scrolltothebottomtoselect
thecalendaryear
4.ClickonthewordsCashBalancepensionplan
n THE FIDELITY 529 COLLEgE SAVIngS PLAn
throughfidelity’sselectionoffundstrategiesyou
havegreaterflexibilityandmorefreedomtoinvest
foryourchild(ren)orimmediatefamilymember’s
education.
Features of 529 College Savings Plan: - accountearningsgrowtax-deferredandqualified
withdrawalsarefreefromfederalincometax.
- fundsmaybeusedatanyaccreditedpublicor
privatecollegeintheu.s.
- takesaslittleas$25perpayperiod(viadirect
deposit)toopenanaccount.
- multipleinvestmentstrategiestoselectfrom(based
onageorriskpreference).
- Highplanlimitsperbeneficiary,currently$330,000
(adjustedupwardregularlyforinflation).
- Beneficiariesmayincludeyou,yourchild,
grandchild,spouse,etc.
- allowsforlump-sumdepositsatanytime.
youcontributetothe529account(s)yousetupwith
fidelityviaadirectdepositthroughtexasChildren’s
payrollorthroughautomaticdebitofapersonal
checkingorsavingsaccount.
toestablisha529collegesavingsaccountormake
changestoanexistingaccount,callfidelitydirectly
at1-800-544-1914orlogontowww.fidelity.com/
uniquetolearnmore.
PEN
SION
26 Texas Children’s hospiTal2011BenefitsandWellnessGuide27 Texas Children’s hospiTal2011BenefitsandWellnessGuide HealtHmatters…CHooseWisely. 27
CASH BALAnCE PEnSIOn PLAn 403B SAVIngS PLAn
nTexas Children’s Cash Balance Pension Plan is a non-contributory defined benefit retirement plan for employees. nThere are no employee contributions made to this plan. Texas Children’s pays the full cost of this benefit.nEmployees do not need to enroll.
Plan Design
Pension CommitteeATTN: HR Benefits, 1919 S. Braeswood, Suite 1301, Houston, TX 77030832-824-2421, option 1.
Plan Administrator
You will be eligible for the Cash Balance Pension Plan after you meet the following criteria: nYou must be at least 21 years of agenYou must work 1,000 or more hours during the 12 month period following your initial date of hire, or any subsequent
plan year.
If you meet these requirements, you will automatically enter the plan on the following April 1 or October 1.
Eligibility
n You are AuTOmATICAllY enrolled once you meet all eligibility criteria.Enrollment
n Normal retirement is age 65n Early retirement is age 55 with 10 or more years of vested serviceRetirement Eligibility
Interest creditsAt the end of each Plan Year, participants will be credited with interest on such Plan Year’s opening balance. Interest credits are:n Based on the interest crediting rate as defined in
the Plann In no event for a Plan Year, be less than 3.8% or
more than a “market rate of return” (within the meaning of Section 411(b)(5) of the Code and Section 204(b)(5) of ERISA).
Employer Contributions
This is a non-contributory defined benefit retirement plan for employees.Employee Contributions
Your vesting service is one year of service for each fiscal year (Oct. 1 – Sept. 30) in which you complete 1,000 or more hours of service.
Vested Year of Service
nOnce you have three fiscal years of vesting service, you are 100% vested.nBeing vested means the employer paid benefit in your account is yours upon retirement or termination
of employment.Vesting Schedule
Once you are a member of the plan, you will be able to view your annual statement online through your Texas Children’s Total Rewards e-statement in mOlI.Statement
If you leave and are 100% vested, if your CBPP account balance is:n$5,000 or less, you must take a lump sum or rollover distributionn $5,000 to $7,000, you have the following early distributions options: - lump sum / Rollover - An annuityn$7,000 or more, you must wait until age 65 (or age 55, if you had 10 or more years of vesting service).
Termination/ Retirement
nChanges are allowed at any time during the year and do not require a qualifying life event to modify.nPlease contact the Benefits office to obtain a beneficiary-designation/change form NOTE: If you are married, you must obtain spousal consent with notarization to designate anyone other than
your spouse to receive your benefit. Your spouse is entitled to 100% of your retirement account upon your death, unless the spouse has provided written consent otherwise.
Beneficiary DesignationAnd Changes
ContributionIf you complete at least 1000 hours of Service in a Plan Year (Oct. 1 - Sept.), Texas Children’s will credit you with a contribution in the Cash Balance Pension Plan calculated as a percentage of your Plan Year base compensation. The applicable percentage is based on your full years of Vesting Service, as of the end of such Plan Year, as follows:n3%: less than 5 yearsn4%: 5 to 9 yearsn5%: 10 or more years
26 Texas Children’s hospiTal2011BenefitsandWellnessGuide27 Texas Children’s hospiTal2011BenefitsandWellnessGuide HealtHmatters…CHooseWisely. 27
nEW
CASH BALAnCE PEnSIOn PLAn 403B SAVIngS PLAn
n The 403(b) savings plan provides a way for you to save for retirement on a tax-deferred basis. nThis is a voluntary, defined-contribution retirement savings plan.nYour 403(b) contribution is taken directly from your paycheck before taxes.nYou have more than 145 funds in which to invest.
Recordkeeper: Fidelity Investments1-800-343.0860 www.fidelity.com/atwork
Pension CommitteeATTN: HR Benefits, 1919 S. Braeswood, Suite 1301, Houston, TX 77030832-824-2421, option 1.
nYou may begin participating on the first day of your employment or at any time following such date at Texas Children’s.
n To enroll in the Plan, you must contact Fidelity by phone at 1-800-343.0860 or online at www.fidelity.com/atwork.
n There is no age requirement for you to begin drawing benefits; however, you must leave Texas Children’s to receive these benefits.
nTexas Children’s will make a contribution to your 403(b) savings plan every pay period you make a contribution. nTexas Children’s will match up to 50% of the first 6% of your per pay period contribution. nThe maximum employer contribution per pay period is the lesser of 3% of your gross salary or 50% of your contribution.
For example: Your contribution Texas Children’s will match 4% . . . . . . . . . . . . . . . . . . . . . . . 2% 6% . . . . . . . . . . . . . . . . . . . . . . . 3% 10% . . . . . . . . . . . . . . . . . . . . . . . 3%
nYou may elect a percentage of your gross earnings to be deducted on a pre-tax basis each pay period.nYou do not pay any income tax on your investment in your 403(b) account until you withdraw the money.n “Catch-up” Provision: if you are going to reach age 50 or older during the calendar year (Jan. 1 – Dec. 31) and make
the maximum annual contribution, you may make an additional contribution only after the annual maximum is met.nThe maximum contribution amounts for 2011 calendar year are: $16,500 or $22,000 if 50 years of age or more; and subject to change as determined
by the IRS.
You will earn a year of vested service for every fiscal year (Oct. 1 - Sept. 30) in which you complete 1,000 or more hours of service.
nYou are always 100% vested in any contributions you make to the plan.nYou will become partially vested in the contributions made by Texas Children’s according to the following schedule. If you work at least 1,000 hours
per fiscal year (Oct. 1 – Sept. 30), then after:
Years of service You will be Years of service You will be less than 1 year . . . . . . . . . . . . . . . . . . . 0% vested 3 years, but less than 4 . . . . . . . . . . . . 60% vested 1 year, but less than 2 . . . . . . . . . . . . . 20% vested 4 years, but less than 5 . . . . . . . . . . . . 80% vested 2 years, but less than 3 . . . . . . . . . . . . 40% vested 5 years . . . . . . . . . . . . . . . . . . . . . . . . 100% vested
Participants will receive quarterly statements online by accessing your personal account information through Fidelity’s website atwww.fidelity.com/atwork. To request paper statements call 1-800-343-0860.
At any time after you leave Texas Children’s:n You may take 100% of your voluntary contributions.nIf you are 100% vested, you may also take 100% of the match dollars contributed by Texas Children’snIf you have been employed less than five years, you may take the VESTED PORTION of the match dollars
contributed by Texas Children’s.nTax implications may apply with distributions.
n Changes are allowed at any time during the year and do not require a qualifying life event to modify.n Fidelity is the official record keeper of beneficiary designations.n Participant employees should go online to www.fidelity.com/atwork to designate or update beneficiary information.n Employees are encouraged to keep beneficiary information up to date, and beneficiary designations may be changed at any time during the year.
NOTE: If you participate in the 403(b) plan and you are married, you must designate your spouse as beneficiary to 100% of your benefit. Your spouse is entitled to 100% of your retirement account upon your death, unless your spouse has provided written consent otherwise.
28 Texas Children’s hospiTal2011BenefitsandWellnessGuide29 Texas Children’s hospiTal2011BenefitsandWellnessGuide HealtHmatters…CHooseWisely. 29
employeeHealtHandWellnesstexasChildren’siscommittedtoprovidingavarietyofwellness
optionstosupportoptimumhealth,throughhealthychoices.
‘WELLnESS In THE WORkPLACE’ InITIATIVES FOR EMPLOYEESn HandHygieneinitiative(Hy5)
n immunizations(flushots/tBskinteststhroughemployeeHealth)
n preventiveCareBenefitsthroughBlueCrossBlueshield
n HealthandWellnessfairsforemployees(withno-costemployee
Healthscreeningsformedicalplanmembers)
n diseasemanagementthroughfocusedHealthsolutions
n on-sitemobilemammographyofferings
n fitnessClub-membershipdiscounts
InTERnAL EMPLOYEE ASSISTAnCE PROgRAM (EAP) PROVIDES VALUABLE SUPPORTtexasChildren’svaluesyou,bothasanindividualandasan
employee.thedemandsofourworkandpersonallivescan
sometimesconflictwitheachothermakingitdifficulttofeel
successfulateitherone.theeapcanhelpyoumanagelife’s
challenges.
theonsitetrainingsandeducationalopportunitieslistedbelow
provideindividuals,departmentsandleaderswithongoingaccess
tosupporttobettermanagesituationsandcircumstancesthatcan
causedisruption.
n Work&personalstress n family&maritalissues
n Communication&anger n Caregiverstress
n mentalHealthissues n Work-relatedissues
n personal&familyaddictions n Grief&loss
n legal&financialissues
theeapcoversfullandpart-timeemployeesandeligible
dependents,includingyourspouseandchildrenundertheageof
19whodependonyouforsupport(unmarriedchildrenbetweenthe
agesof19and26).
eapservicesarefreeandconfidential.ifit’saconcerntoyou,the
eapcanhelp.tocontactortoscheduleanappointmentwitha
memberoftheeapteam,call832-824-eeap(3327)oremail
foralmostadecadetexasChildren’shasbeen
recognizedasoneofHouston’sBestWorkplaces
forCommutersbytheu.s.environmentalprotection
agency(epa).inadditiontothisgreataccomplishment,
texasChildren’swasdesignatedaCleanairChampion
bytheHouston–GalvestonareaCouncil(H-GaC).
OUTSTAnDIng COMMUTER BEnEFITS FOR TCH-PAID EMPLOYEESn metrobuspasses
n Vanpoolvouchers
n Woodlandsexpresstickets
n offcampusparking
n GuaranteedrideHomeprogram
n availabilityofcoveredbikeracks
n optiontowaiveacommuterelection;(employees
inthemedicalCenterorGreenwayplazawhowaive
theircommuterelectionoptionreceiveamonthlycar
poolallowanceof$20.)eachemployeecanholdonly
oneelectionatatime.
FLEXIBILITY TO CHAngE YOUR COMMUTER ELECTIOn MOnTH-TO-MOnTHemployeesmayaccessthetransportationChange
formonlineorstopbyanHrlocationtocompleteor
turninaform.thenewelectionwillbecomeeffectivethe
firstdayofthefollowingmonth.
Options To Submit a Transportation Change
Request Form to HR:n HrserviceCenter-abercrombieBuilding,1stfloor,
suitea-130
n meyerBuilding–Benefits,3rdfloor
n faxtoHrBenefits:832-825-2829
pleasereadandreviewspecificdetailsofallyourtCH
commutersbenefitsasoutlinedonConneCtandthen
callthetotalrewardsmainlineat832-824-2421,
(options1forBenefits)shouldyouhavequestions.
onceatmCparkingcardhasbeenissued,please
contacttexasmedicalCenter(tmC)Customerservice
lineat713-791-6161withcard-relatedissues.
CommuterBenefits
COM
MUT
ER B
ENEF
ITS
28 Texas Children’s hospiTal2011BenefitsandWellnessGuide29 Texas Children’s hospiTal2011BenefitsandWellnessGuide HealtHmatters…CHooseWisely. 29
BalanCinGWorK,Homeandfamily
TIME-OFF BEnEFITSagenerouspaidtime-off(pto)programprovideseligiblefull
andpart-timeemployeeswithtimeofffromworkforpersonalor
familyneedsandrewardsemployeesforcomingtoworkandfor
schedulingtimeoffinadvance.
additionally,after2daysoffworkforillnessorinjury,eligible
employeesmaythenaccesstheiraccruedextendedillnessBank
(eiB)whichalsoprovidesasourceofearnedhourswithpay.
Payout of PTO balances occur when:n youterminateemployment,or
n yourclassificationchangestoaperdiemstatus
refertoHrpolicy#Hr201whereyoucanalsoviewyourpto
accrualschedule(basedonyourtexasChildren’sentityandyears
ofservice).
OTHER TYPES OF TIME-OFF AnD THEIR CORRESPOnDIng HR POLICIESn Catastrophictimeoff(Cto)-#Hr202
n Holidays/myday-#Hr203
n Bereavement-#Hr204
n military-#Hr205
n Juryduty-#Hr206
n timeofftoVote-#Hr207
n otherleavesofabsence-#Hr208
n familymedicalleave(fml)-#Hr214
PTO SELL PROgRAM - #HR201
Whileemployeesarenotdiscouragedfromtakingearnedtimeoff,
employeeswithatleast120hoursofaccruedptomayelectto
sellablockofhoursbacktotexasChildren’sandbepaidforthe
valueofthosehours.atotalof80hoursmaybesoldatonetime
or40hoursofptomaybesoldtwicepercalendaryearprovided
theeligibilityrequirementismet.processandsubmityourrequest
online,atanytime,throughyourtotalrewardse-statement.
EVERYOnE’S A RECRUITER nOW -- E.A.R.n. PROgRAMthisreferralrewardprogramofferspotentialdollarstoeligible
employeesforqualifiedapplicantswhoarehiredandbegin
employment.Certainrequirementsapply.forquestions,callHr
recruitmentat832-824-2020.
PERSOnAL AnD FAMILY FOCUSED InITIATIVESADOPTIOn ASSISTAnCE PROgRAM
texasChildren’sadoptionassistancebenefitprovides
reimbursementofeligibleadoptionexpensestofulland
part-timeemployeeswhomeetthefollowingcriteria:
n havecompletedthreemonthsof‘continuous’service,
and
n theadoptedchildisnotyourbiologicalchildor
stepchild
REIMBURSABLE ADOPTIOn EXPEnSES
upto$3,000maybereimbursedoncetheadoptionis
finalandforonlyexpensesincurredafteryoubecome
eligibleforadoptionbenefits.
someeligibleexpensesinclude:
n legalfeesandCourtCosts
n placementfees
n travelexpensesincurred(foroneoftheadopting
parentsoraguardian)toescortthechild
awrittenrequestforreimbursementmustbesubmitted
toHrBenefitswhileyouremainanactive,eligibletexas
Children’semployee.
BERTnER CAFETERIA DISCOUnT ST. LUkE’S HOSPITAL – ABERCROMBIE BASEMEnT
employeesreceiveadiscountonfoodpurchasesby
presentingatCHbadgeattimeofpurchase.
TICkET & EVEnT DISCOUnTSemployeescanenjoysavingsonsuchthingsasmovie
tickets,seasonalevents,cellphonemembershipsand
more.neworenhanceddiscountsarecommunicated
throughthemonthlyonlineHrdialogue!ordialogue
newsflashasneeded.alldiscountinformation(prices,
codes,linksandmore)isdetailedundertheemployee
discountdirectoryviatheConnectHrwebpage.simply
gotoanHrlocation(abercrombie7a-4pormeyer
7:30a-4:30p)tocompleteapayrolldeductionform.
note:tCpaandHealthCenteremployeesshould
faxformstoHrat832-825-2829bynoonofeach
Wednesday.
WORK / LIFE BALANCE
BriGHtHoriZonsBaCK-upCareadVantaGe®proGram
thissubsidizedbenefitcanbeutilizedbyemployeeswhen
regularchildorfamilycareneedsandarrangementsare
disrupted.examplesmightinclude:
n primarycare-giverisonvacation,becomesillor
experiencesafamilyemergency
n schoolvacationdays
n infanttransitionasaparentreturnstowork
n travelorrelocationtoacitywhereyoudonotyetknow
anyone
Well Established and Safety-Focused
thisnationalprovidernetworkrequiresbackgroundchecks
andCprtrainingforstaffmembers.
n 3,000+Center-basedChildCareCenters:available
closetoworkorclosetohome
n 2,000+in-HomeCareandnannyagencyresources:
availablecare:days,nightsandweekends
thispro-activeemployeebenefitallowsyoutobeatwork
whenyoumightnototherwisebeableto.thekeyisto
pre-registerfortheBack-upCareadvantage®program
andbereadyforthoseunexpectedsurprises.note:Care
extendstolovedoneswhodonotliveinyourhome.
tCHemployeeshave80hoursavailablepercalendaryear.
Hoursbeyondtheallotted80willbesubjecttoavailability
andtheemployeewillberesponsibleforthefullcost.
n Employee Cost for Center-Based Care:
$2co-pay/perhour/perchild
n Employee Cost for In-home nanny Services:
$4co-pay/perhour/perchildorfamilymember(infant
toelderly)
yourCreditCardnumbermayberequestedto
holdyourreservation;however,paymentwilloccur
viapayrolldeductionandwillbereflectedonyour
paycheckapproximately30-60daysaftercareservices.
Reservations made, must be cancelled timely to
avoid being charged for unused services.review
detailsaboutalloftheresourcesavailableontheBright
Horizonswebsite,including‘Growinglifelongreaders’,
employeewebinars,andtheir‘Win~Winreferralprogram’.
Pre-register, Learn More or to Schedule Care:n Byphone:1-877-242-2737
n www.backup.brighthorizons.com
username:texasChildrenspassword:backup1
SERVICE RECOgnITIOn AnD EMPLOYEE CELEBRATIOnStexasChildren’svaluespeopleandtheircontributions,dedicationand
commitmenttoourpatients,andtooneanother.
Belowareseveraloftheemployeeprogramsthathavebeenimplemented
toconveythanksandgratitudetostaff.
n newemployeereceptions(sponsoredbyrecruitment)
n servicepinsbasedonemploymentservice:1,5,10,15,20,25,30
years,etc.(Benefits)
n superstarandservicewithHeart:personalrecognitionoftCH
employeeswhoexemplifyexceptionalcustomerservice&workethic
(administeredthroughHrandserviceambassadors)
n 25+platinumClub-employeeswith25ormoreyearsoftexas
Children’semploymentservice(Benefits)
n stressBustevents&more(sponsoredbyHr&serviceambassadors)
n employeerecognitionCelebration(erC),anannualeventorganizedby
Hrtotalrewards(Benefits)
30 Texas Children’s hospiTal2011BenefitsandWellnessGuide
TEAM SPORTS SUBSIDYFor Employees Fitness and Fun!
foremployeeswhowishtoplayaleague
sponsoredsportandstartuptheirowntexas
Children’steam,registrationfees(upto$600
perfiscalyear)canbepaidtotheleague
providedatleasthalfoftheplayersonthe
teamareactive,benefitseligibleemployees.
Whatbetterwaytogettoknowyour
co-workers,enjoysomefriendlycompetition
andshowteamspirit?application&Waiver
(consent)formscanbefoundontheHr
webpageofConneCt.
HealtHmatters…CHooseWisely. 31
employeeeduCationanddeVelopmentopportunities
employeesseekingpathwaystoenhancetheircareergoalsthrougheducationcantapintovariousavenuesofsupport.
THE LEARnIng ACADEMY OFFERS InTERnAL EMPLOYEE TRAInIng AnD DEVELOPMEnT CLASSESforinformationaboutstaff,clinicalandleadershiptrainings,
visitthelearningacademyConneCtwebsiteoremail:
TEXAS CHILDREn’S (COLLEgE) TUITIOn ASSISTAnCE PROgRAM (TAP) – ADMInISTERED BY EDLInk®
fullandpart-timeemployeescanutilizethisbenefittosubsidizethecostof
collegecreditcoursesatanaccrediteduniversityandforacourseofstudy
thatwouldbeofbenefitinyourcurrentroleattexasChildren’s.forallthe
detailsandanswersneededtomaximizethisdegree-focusedemployee
benefit,employeesshouldreadthefrequentlyaskedQuestionsonthe
Connectoredlinkwebsitespriortoregistrationorcompletinganonline
application.
Annual Allowable Monetary Support (Cap Limit based on Employee’s TCH Status)n $2,500/calendaryearforfull-timeemployees
n $1,500/calendaryearforpart-timeemployees
unusedannualdollarsdonotcarryoverfromyeartoyear.Covered
expenses(tuition,feesandrequiredbooks)willbecountedtowardthe
annualcaplimitbasedintheyearinwhichthecourseBeGins.
Expenses not Covered Include:
Continuingeducationunits(Ceu’s),certifications(prep,testingor
renewals),deferredpaymentfees,evaluation(priorlearningassessment),
financecharges,Gmat,Gre,sat,latefees,parkingfees,graduation
feesandalumnifees.note:tappayments(includingthosepreviously
approvedwithanloCwillbereducedbytheamountofotherfinancial
assistancereceived.(ex:anawardedpellGrant)
Online Enrollment Steps For Success!
step 1:Completeanonlinetuitionapplication.(1-3courseswithsimilar
startandenddatesonthesameapplication)
n tuitionpre-payapplication
(submit3-5weekspriortocoursestart-date)
n tuitionreimBursementapplication
(submitafterpaymentforcourses,yetwithin6-weeksfrom
courseend-date)
step 2:uponapprovalofyourtuitionapplication,clickontothe
applicationnumberforwhichyouwishtosubmitaBook
reimbursementrequest.alwayssubmitacopyofyourcourse
syllabusalongwithyourbookstorereceiptstoedlink.30 Texas Children’s hospiTal2011BenefitsandWellnessGuide
Important TAP Tipsn submitproofofcoursecompletion(grades)to
edlinkWitHin6weeksofcourseenddateto
remaineligible.
n notifyedlinkimmediatelyatTCh@edlinktuition.
comifyouchangeordropaclasssincetheprogram
allowspaymentforeachcourseonlyonce.
Process and Contact Informationn tocompleteanapplication:
http://tamsonline.org/TCh
n toemailaquestion/inquiry:
n tofaxrequireddocumentation(receipts,course
syllabusandgrades):1-866-284-0859
n tospeakwithaCustomerservicerepresentative:
1-888-797-2235
OnLInE CLInICAL PROgRAM…
U.T. ARLIngTOn IS OnE OPTIOn
(Partnership Code: AP1016)
formoredetails(dates,prices,links,etc.)relatedtothis
rntoBsnfast-trackoption,employeesmay:
1.visit www.stateu.com/uta
2.callstateudirectlyat1-866-489-2810,or
3.calltexasChildren’sClinicaltraining&development
at832-824-2460.
participantsofthisprogrammayalsoutilizethetexas
Children’stuitionassistanceprogram;however,uta
studentswillneedtofaxloC’stostateuat:
1-877-647-8560.
32 Texas Children’s hospiTal2011BenefitsandWellnessGuide33 Texas Children’s hospiTal2011BenefitsandWellnessGuide HealtHmatters…CHooseWisely. 33
BenefiteleCtionCHanGes
BENE
FIT
ELEC
TION
CH
ANGE
S
RULE TO ADD DEPEnDEnTS anychangeinfamilystatus,whichresultsinadding/deletingcoverageforyourselforadependentmustbesubmittedtotheBenefits
departmentwithin31daysfromthedateofthequalifyingevent;evenifyoucurrentlyhaveemployee+Childrenoremployee+family
coverageandyouareaddingcoverageforanotherchild(includingaddingcoverageforanewborn).thetCH
Benefitenrollment/ChangeformislocatedonConnect/Hr/Benefits/Benefitforms.
theeffectivedateofyourbenefitchangewillbetheeffectivedateofthequalifiedchangeinfamilystatus.
evenifyouhavenotreceivedallsupportingdocumentation(ex.officialbirthcertificate)untilafterthe31
or60dayelectionperiod,youwillstillneedtosubmityourBenefitChangeformwithinthe31or60
daydeadlineandlaterforwardthesupportingdocumentationuponreceipt.duetoirsregulations
regardingchangestopre-taxplans,Hrwillbeunabletoprocessyourchangeuntilthesupporting
documentationisreceived.
LOSS OF COVERAgE DUE TO MEDICARE OR CHIP PROgRAManemployeewhosedependentlosesinsurancecoverageunderthemedicareorCHipprogramasaresult
oflossofeligibilitymayenrollthedependentintexasChildren’smedical,dentalorvisionplanswithin60
daysfromthedatecoveragewaslost.You must submit a Benefit Change Form to the Benefits
Department within 60 days of losing coverage.
it’simportanttomakeenrollmentchoicescarefullybecausetheywillremainineffectuntildecember31stofthatplanyear.the
internalrevenueserviceimposesstrictlimitationsonwhencoveragecanbeelectedorchangedbecauseyourbenefitcontributions
arepre-taxforsomeplanoptions.You can make limited changes at times other than open enrollment only as a result of
a significant change in family or job status.
SUCH EVEnTS (CALLED FAMILY STATUS CHAngES) InCLUDE, BUT ARE nOT LIMITED TO:n marriage,divorce,legalseparation,orannulment
n death
n Birth,adoption,orplacementforadoptionofachild
n Childbecomesorceasestobeaneligibledependent
n Changeinyourspouse’semploymentand/orother
insurancecoveragethatcausesyouand/oryour
dependentstoloseorgaincoverage
n youand/oryourdependentnolongerresideorworkin
anepo’sserviceareaanddonothaveaccesstoother
benefitoptions
n entitlementorlossofmedicareeligibility
n Changingfromanineligiblestatustoaneligiblestatus,
e.g.perdiemtopart-timeorfull-timestatus
n Changingfromaneligibletoanineligiblestatus,e.g.,
part-timeorfull-timestatustoaperdiemstatus
n Changingfrompart-timestatustofull-timestatus
n Changingfromfull-timestatustopart-timestatus
n Courtorderthatrequiresyoutocoveradependent
n significantchangeincostofbenefitcoverage
n Commencementorreturnfromleaveunderfmlaoran
unpaidleavethataffectseligibilityforcoverage.
n ChangeinmedicaidChildren’sHealthinsurance
program(CHip).
32 Texas Children’s hospiTal2011BenefitsandWellnessGuide33 Texas Children’s hospiTal2011BenefitsandWellnessGuide HealtHmatters…CHooseWisely. 33
ALABAMA–medicaidWebsite:http://www.medicaid.alabama.
govphone:1-800-362-1504
ALASkA–medicaidWebsite:http://health.hss.state.ak.us/
dpa/programs/medicaid/phone(outsideofanchorage):1-888-
318-8890phone(anchorage):907-269-6529
ARIzOnA–CHipWebsite:http://www.azahcccs.gov/
applicants/default.aspxphone:1-877-764-5437
ARkAnSAS–CHipWebsite:http://www.arkidsfirst.com/phone:1-888-474-8275
CALIFORnIA–medicaidWebsite:http://www.dhcs.ca.gov/
services/pages/tplrd_Cau_cont.aspxphone:1-866-298-8443
COLORADO–medicaidandCHipmedicaidWebsite:http://www.colorado.
gov/medicaidphone:1-800-866-3513CHipWebsite:http://www.CHpplus.orgCHipphone:303-866-3243
FLORIDA –medicaidWebsite:http://www.fdhc.state.fl.us/
medicaid/index.shtmlphone:1-866-762-2237
gEORgIA–medicaidWebsite:http://dch.georgia.gov/Clickonprograms,thenmedicaidphone:1-800-869-1150
IDAHO–medicaidandCHipmedicaidWebsite:www.
accesstohealthinsurance.idaho.govmedicaidphone:1-800-926-2588CHipWebsite:www.medicaid.idaho.govCHipphone:1-800-926-2588
InDIAnA–medicaidWebsite:http://www.in.gov/fssa/2408.
htmphone:1-877-438-4479
IOWA–medicaidWebsite:www.dhs.state.ia.us/hipp/phone:1-888-346-9562
kAnSAS–medicaidWebsite:https://www.khpa.ks.govphone:800-766-9012
kEnTUCkY–medicaidWebsite:http://chfs.ky.gov/dms/default.
htmphone:1-800-635-2570
LOUISIAnA–medicaidWebsite:http://www.la.hipp.dhh.
louisiana.govphone:1-888-342-6207
MAInE–medicaidWebsite:http://www.maine.gov/dhhs/
oms/phone:1-800-321-5557
MASSACHUSETTS–medicaidandCHip
medicaid&CHipWebsite:http://www.mass.gov/massHealth
medicaid&CHipphone:1-800-462-1120
MEDICAID AnD THE CHILDREn’S HEALTH InSURAnCE PROgRAM (CHIP) OFFER FREE OR LOW-COST HEALTH COVERAgE TO CHILDREn AnD FAMILIES
ifyouareeligibleforhealthcoveragefromyouremployer,
butareunabletoaffordthepremiums,somestateshave
premiumassistanceprogramsthatcanhelppayforcoverage.
thesestatesusefundsfromtheirmedicaidorCHipprograms
tohelppeoplewhoareeligibleforemployer-sponsored
healthcoverage,butneedassistanceinpayingtheirhealth
premiums.
ifyouoryourdependentsarealreadyenrolledinmedicaidor
CHipandyouliveinastatelistedbelow,youcancontactyour
statemedicaidorCHipofficetofindoutifpremiumassistance
isavailable.
ifyouoryourdependentsarenotcurrentlyenrolled
inmedicaidorCHip,andyouthinkyouoranyofyour
dependentsmightbeeligibleforeitheroftheseprograms,you
cancontactyourstatemedicaidorCHipofficeordial1-877-
KidsnoWorwww.insurekidsnow.govtofindouthowto
apply.ifyouqualify,youcanaskthestateifithasaprogram
thatmighthelpyoupaythepremiumsforanemployer-
sponsoredplan.
onceitisdeterminedthatyouoryourdependentsare
eligibleforpremiumassistanceundermedicaidorCHip,
youremployer’shealthplanisrequiredtopermityouand
yourdependentstoenrollintheplan–aslongasyouand
yourdependentsareeligible,butnotalreadyenrolledin
theemployer’splan.thisiscalleda“specialenrollment”
opportunity,andyoumustrequestcoveragewithin60daysof
beingdeterminedeligibleforpremiumassistance.
ifyouliveinoneofthefollowingstates,youmaybeeligiblefor
assistancepayingyouremployerhealthplanpremiums.
thefollowinglistofstatesiscurrentasofapril16,2010.you
shouldcontactyourstateforfurtherinformationoneligibility.
HealtHmatters…CHooseWisely. 35
MInnESOTA–medicaidWebsite:http://www.dhs.state.mn.us/ClickonHealthCare,thenmedical
assistancephone:800-657-3739
MISSOURI –medicaidWebsite:http://www.dss.mo.gov/mhd/
index.htmphone:573-751-6944
MOnTAnA–medicaidWebsite:http://medicaidprovider.hhs.
mt.gov/clientpages/clientindex.shtmltelephone:1-800-694-3084
nEBRASkA–medicaidWebsite:http://www.dhhs.ne.gov/med/
medindex.htmphone:1-877-255-3092
nEVADA–medicaidandCHipmedicaidWebsite:http://dwss.nv.gov/medicaidphone:1-800-992-0900CHipWebsite:http://www.
nevadacheckup.nv.org/CHipphone:1-877-543-7669
nEW HAMPSHIRE–medicaidWebsite:http://www.dhhs.state.nh.us/
dHHs/mediCaidproGram/default.htmphone:1-800-852-3345x5254
nEW JERSEY–medicaidandCHipmedicaidWebsite:http://www.state.
nj.us/humanservices/dmahs/clients/medicaid/medicaidphone:1-800-356-1561CHipWebsite:http://www.njfamilycare.
org/index.htmlCHipphone:1-800-701-0710
nEW MEXICO–medicaidandCHipmedicaidWebsite:http://www.hsd.
state.nm.us/mad/index.htmlmedicaidphone:1-888-997-2583CHipWebsite:http://www.hsd.state.nm.us/mad/index.
htmlClickoninsurenewmexicoCHipphone:1-888-997-2583
nEW YORk–medicaidWebsite:http://www.nyhealth.gov/
health_care/medicaid/phone:1-800-541-2831
nORTH CAROLInA –medicaidWebsite:http://www.nc.govphone:919-855-4100
nORTH DAkOTA–medicaidWebsite:http://www.nd.gov/dhs/
services/medicalserv/medicaid/phone:1-800-755-2604
OkLAHOMA–medicaidWebsite:http://www.insureoklahoma.
orgphone:1-888-365-3742
OREgOn–medicaidandCHipmedicaid&CHipWebsite:http://www.oregonhealthykids.govmedicaid&CHipphone:1-877-314-5678
PEnnSYLVAnIA–medicaidWebsite:http://www.dpw.state.pa.us/
partnersproviders/medicalassistance/doingbusiness/003670053.htm
phone:1-800-644-7730
RHODE ISLAnD–medicaidWebsite:www.dhs.ri.govphone:401-462-5300
SOUTH CAROLInA–medicaidWebsite:http://www.scdhhs.govphone:1-888-549-0820
TEXAS–medicaidWebsite:https://www.gethipptexas.
com/phone:1-800-440-0493
UTAH –medicaidWebsite:http://health.utah.gov/
medicaid/phone:1-866-435-7414
VERMOnT–medicaidWebsite:http://ovha.vermont.gov/telephone:1-800-250-8427
VIRgInIA–medicaidandCHipmedicaidWebsite:http://www.dmas.
virginia.gov/rcp-Hipp.htmmedicaidphone:1-800-432-5924CHipWebsite:http://www.famis.org/CHipphone:1-866-873-2647
WASHIngTOn–medicaidWebsite:http://hrsa.dshs.wa.gov/
premiumpymt/apply.shtmphone:1-877-543-7669
WEST VIRgInIA–medicaidWebsite:http://www.wvrecovery.com/
hipp.htmphone:304-342-1604
WISCOnSIn–medicaidWebsite:http://dhs.wisconsin.gov/
medicaid/publications/p-10095.htmphone:1-800-362-3002
WYOMIng–medicaidWebsite:http://www.health.wyo.gov/
healthcarefin/index.htmltelephone:307-777-7531
To see if any more states have added a premium assistance program since April 16, 2010, or for more
information on special enrollment rights, you can contact either:
u.s.departmentoflabor u.s.departmentofHealthandHumanservices
employeeBenefitssecurityadministration Centersformedicare&medicaidservices
www.dol.gov/ebsa www.cms.hhs.gov
1-866-444-eBsa(3272) 1-877-267-2323,ext.61565
34 Texas Children’s hospiTal2011BenefitsandWellnessGuide
HealtHmatters…CHooseWisely. 35
SPECIAL EnROLLMEnT RIgHTS nOTICEifyouaredecliningenrollmentforyourselforyourdependents
(includingyourspouse)becauseofotherhealthinsurance
orgrouphealthplancoverage,youmaybeabletoenroll
yourselfandyourdependentsinthisplanifyouoryour
dependentsloseeligibilityforthatothercoverage(orifthe
employerstopscontributingtowardyouroryourdependents’
othercoverage).
However,youmustrequestenrollmentwithin31daysafter
youroryourdependents’othercoverageends(orafterthe
employerstopscontributingtowardtheothercoverage).in
addition,ifyouhaveanewdependentasaresultofmarriage,
birth,adoption,orplacementforadoption,youmaybeable
toenrollyourselfandyoureligibledependents;however,you
mustrequestenrollmentwithin31daysafterthemarriage,
birth,adoption,orplacementforadoption.
ALLOWABLE CHAngESMedical, Dental
youmaychangeyourcoveragelevel,butnotyourplan
option(e.g.,youcanchangefromtheppoplanemployee
onlytotheppoplanemployeeandfamily,butnottothe
epoplan).
LTD, Life and AD&D
youmayincreaseordecreaseyourcoveragelevelelection.
n Changingfrompart-timetofull-time,yougainltdBasic
planBenefitandtheoptiontopurchasetheltdbuy-up
plan.foroptionallifeinsuranceandad&dyouareeligible
topurchaseupto4Xyourannualbasesalarysubjectto
planprovisions.
n Changingfromfull-timetopart-time,youroptionallife
insuranceandad&dreducesto1Xyourannualbase
salary.
Health Care FSA
youmaychangeyourelectionstotheHealthCareand
dependentCarefsasifyouexperienceachangeinfamily
orjobstatus;however,intheeventofadeficitbalanceinan
fsa,youmaynotstopordecreaseyourfsacontribution.
ifyouresignyouremploymentandthenreturntotexas
Children’sinthesamecalendaryear,orifyouchangefrom
aneligiblestatustoanineligiblestatusandbackagain,you
willretaintheoptionsthatyouhadpreviously(unlessyou
incurafamilystatuschange).
Dependent Care FSA
youcannotstop,increaseordecreaseyourcontribution
untilthenextannualenrollmentperiodunlessyouhavea
familystatusorJobstatusChangeasstatedpreviouslyin
thisguide.ifyouresignyouremploymentandthenreturnto
texasChildren’sinthesamecalendaryear,orifyouchange
fromaneligiblestatustoanineligiblestatusandbackagain,
youwillretaintheoptionsthatyouhadpreviouslyunlessyou
haveafamilystatusChange.
Enrollment Change Form Checklist
Benefitelectionsorchangesthatarenotmadewhenyouare
firsteligibleorduringopenenrollmentmustbesubmittedon
aBenefitsChangeform.thisformandallotherbenefitforms
arelocatedonlineonthetexasChildren’sConnectwebsite:
Humanresources/Benefits/Benefitforms.youmayalso
obtainformsfromyourHrBenefitsdepartmentintheservice
Center/abercrombiea-130oratthemeyerBuilding3rdfloor
benefitsdesk.
n ifyouareenrollinganewdependent,additional
documentationisrequiredsuchas,marriagelicense,birth
certificate/birthfacts,adoptionpapers,courtdocuments
n dependentssocialsecuritynumbers
n ifyouhavenotreceivedyourdocumentationinatimely
manner,youwillstillneedtosubmityourBenefitsChange
formwithinthedeadlineandforwardthesupporting
documentationonceitisreceived.duetoirsregulations
regardingchangestopre-taxplans,wewillnotbeableto
processyourchangeuntilthesupportingdocumentationis
received.
n remember,31daystoaddadependentor60daysto
dropadependent
Termination or Change of Status
yourcoverageforyourselfandyourdependentswillendon
thelastdayofthepayperiodcontainingthelastdayworked
oryourtransferdatetoanineligiblestatusforbenefitsorthe
dayadependentbecomesineligibleforcoverage.However,
undercertaincircumstances,youand/oryourdependents
maybeeligibletocontinuemedical,dental,eap,andvision,
andHealthCarefsaparticipationthroughCoBra.
34 Texas Children’s hospiTal2011BenefitsandWellnessGuide
36 Texas Children’s hospiTal2011BenefitsandWellnessGuide37 Texas Children’s hospiTal2011BenefitsandWellnessGuide HealtHmatters…CHooseWisely. 37
ContinuationCoVeraGeriGHtsunderCoBraunderfederallaw,texasChildren’sisrequiredtooffer
coveredemployeesandcoveredfamilymembersthe
opportunityforatemporaryextensionofhealthcoverage
(called“ContinuationCoverage”)atgrouprateswhen
coverageunderthehealthplanwouldotherwiseenddue
tocertainqualifyingevents.thisnoticeisintendedtoinform
allplanparticipants,inasummaryfashion,ofyourpotential
futureoptionsandobligationsunderthecontinuation
coverageprovisionsoffederallaw.shouldanactual
qualifyingeventoccurinthefuture,theplanadministratorwill
sendyouadditionalinformationandtheappropriateelection
noticeatthattime.
WHAT IS COBRA COVERAgE?ConsolidatedomnibusBudgetreconciliationact(CoBra)
coverageisacontinuationofplancoveragewhencoverage
wouldotherwiseendbecauseofalifeeventknownas
a“qualifyingevent.”specificqualifyingeventsarelisted
laterinthisnotice.afteraqualifyingeventoccursandany
requirednoticeofthateventisproperlyprovidedtotexas
Children’s,CoBracoveragemustbeofferedtoeachperson
losingplancoveragewhoisa“qualifiedbeneficiary.”you,
yourspouse,andyourdependentchildrencouldbecome
qualifiedbeneficiariesandwouldbeentitledtoelectCoBra
ifcoverageundertheplanislostbecauseofthequalifying
event.(Certainnewborns,newlyadoptedchildren,and
alternaterecipientsunderQualifiedmedicalsupportorders
mayalsobequalifiedbeneficiaries.thisisdiscussedin
moredetailinseparateparagraphsbelow.)undertheplan,
qualifiedbeneficiarieswhoelectCoBramustpayfor
CoBracoverage.
WHO IS EnTITLED TO ELECT COBRA?ifyouareanemployee,youwillbeentitledtoelectCoBraif
youloseyourgrouphealthcoverageundertheplanbecause
eitheroneofthefollowingqualifyingeventshappens:
n yourhoursofemploymentarereduced,or
n youremploymentendsforanyreason,otherthanforgross
misconduct(onyourpart).
ifyouarethespouseofanemployee,youwillbeentitledto
electCoBraifyouloseyourgrouphealthcoverageunder
theplanbecauseanyofthefollowingqualifyingevents
happens:
n yourspousedies;
n yourspouse’shoursofemploymentarereduced;
n yourspouse’semploymentendsforanyreasonotherthan
hisorhergrossmisconduct;
n youbecomedivorcedorlegallyseparatedfromyour
spouse. also, if your spouse (the employee) reduces or
eliminates your group health coverage in anticipation
of a divorce or legal separation, and a divorce or legal
separation later occurs, then the divorce or legal
separation may be considered a qualifying event for you
even though your coveragewasreducedoreliminated
beforethedivorceorseparation.
apersonenrolledastheemployee’sdependentchildwill
beentitledtoelectCoBraifheorshelosesgrouphealth
coverageundertheplanbecauseanyofthefollowing
qualifyingeventshappens:
n theparent-employeedies;
n theparent-employee’shoursofemploymentarereduced;
n theparent-employee’semploymentendsforanyreason
otherthanhisorhergrossmisconduct;
n theparentsbecomedivorcedorlegallyseparated;or
n thechildstopsbeingeligibleforcoverageundertheplan
asa“dependentchild.”
WHEn IS COBRA COVERAgE AVAILABLE?Whenthequalifyingeventistheendofemploymentor
reductionofhoursofemploymentordeathoftheemployee,
theplanwillofferCoBracoveragetoqualifiedbeneficiaries.
COBR
A
36 Texas Children’s hospiTal2011BenefitsandWellnessGuide37 Texas Children’s hospiTal2011BenefitsandWellnessGuide HealtHmatters…CHooseWisely. 37
YOU MUST gIVE nOTICE OF SOME qUALIFYIng EVEnTSforotherqualifyingevents(divorceorlegalseparationofthe
employeeandspouseoradependentchild’slosing
eligibilityforcoverageasadependentchild),aCoBra
electionwillbeavailabletoyouonlyifyounotifytexas
Children’sinwritingwithin60daysafterthelaterof:(1)the
dateofthequalifyingevent;and(2)thedateonwhichthe
qualifiedbeneficiaryloses(orwouldlose)coverageunder
thetermsoftheplanasaresultofthequalifyingevent.in
providingthisnotice,youmustusetheplan’sformentitled
“ChangesinCoverage”fromtexasChildren’sBenefits
department.iftheformisnotprovidedtotexasChildren’s
Benefitsdepartmentduringthe60-daynoticeperiod,thenall
qualifiedbeneficiarieswilllosetheirrighttoelectCoBra.oral
notice,includingnoticebytelephone,isnotacceptable.
IMPORTAnT: no exceptions can be made.
ELECTIng COBRAeachqualifiedbeneficiarywillhaveanindependentright
toelectCoBra.Coveredemployeesandspouses(ifthe
spouseisaqualifiedbeneficiary)mayelectCoBraon
behalfofallofthequalifiedbeneficiaries,andparentsmay
electCoBraonbehalfoftheirchildren.Any qualified
beneficiary for whom COBRA is not elected within
the 60-day election period specified in the Plan’s
COBRA election notice will lose his or her right to
elect COBRA.
HOW LOng DOES COBRA COVERAgE LAST?CoBracoverageisatemporarycontinuationofcoverage.
Whenthequalifyingeventisthedeathoftheemployee,
thecoveredemployee’sdivorceorlegalseparation,ora
dependentchild’slosingeligibilityasadependentchild,
CoBracoverageundertheplan’smedical,dentaland
Visioncomponentscanlastforuptoatotalof36months.
Whenthequalifyingeventistheendofemploymentor
reductionoftheemployee’shoursofemployment,andthe
employeebecameentitledtomedicarebenefitslessthan18
monthsbeforethequalifyingevent,CoBracoverageunder
theplan’smedical,dentalandVisioncomponentsfor
qualifiedbeneficiaries(otherthantheemployee)wholose
coverageasaresultofthequalifyingeventcanlastuntil
upto36monthsafterthedateofmedicareentitlement.
forexample,ifacoveredemployeebecomesentitledto
medicare8monthsbeforethedateonwhichhisemployment
terminates,CoBracoverageforhisspouseandchildren
wholostcoverageasaresultofhisterminationcanlastup
to36monthsafterthedateofmedicareentitlement,which
isequalto28monthsafterthedateofthequalifyingevent
(36monthsminus8months).thisCoBracoverageperiod
isavailableonlyifthecoveredemployeebecomesentitled
tomedicarewithin18monthsbeforetheterminationor
reductionofhours.
otherwise,whenthequalifyingeventistheendof
employmentorreductionoftheemployee’shoursof
employment,CoBracoverageundertheplan’smedical,
dental,andVisioncomponentsgenerallycanlastforonlyup
toatotalof18months.
CoBracoverageundertheHealthCarefsacomponent
canlastonlyuntiltheendoftheyearinwhichthequalifying
eventoccurred—seetheparagraphbelowentitled“Health
CarefsaComponent.”
theCoBracoverageperiodsdescribedaboveare
maximumcoverageperiods.CoBracoveragecanend
beforetheendofthemaximumcoverageperiodsdescribed
inthisnoticeforseveralreasons,whicharedescribedinthe
plan’ssummaryplandescription.
There are two ways (described in the following
paragraphs) in which the period of COBRA coverage
resulting from a termination of employment or
reduction of hours can be extended. (The period of
COBRA coverage under the Health Care FSA cannot
be extended under any circumstances.)
DISABILITY EXTEnSIOn OF COBRA COVERAgEifaqualifiedbeneficiaryisdeterminedbythesocialsecurity
administrationtobedisabledandyounotifypayflexinatimely
fashion,allofthequalifiedbeneficiariesinyourfamilymaybe
entitledtoreceiveuptoanadditional11monthsofCoBra
coverage,foratotalmaximumof29months.thisextension
isavailableonlyforqualifiedbeneficiarieswhoarereceiving
CoBracoveragebecauseofaqualifyingeventthatwasthe
coveredemployee’sterminationofemploymentorreduction
ofhours.thedisabilitymusthavestartedatsometimebefore
the61stdayafterthecoveredemployee’sterminationof
employmentorreductionofhoursandmustlastatleastuntil
theendoftheperiodofCoBracoveragethatwouldbe
availablewithoutthedisabilityextension(generally18months,
asdescribedabove).
38 Texas Children’s hospiTal2011BenefitsandWellnessGuide39 Texas Children’s hospiTal2011BenefitsandWellnessGuide HealtHmatters…CHooseWisely. 39
thedisabilityextensionisavailableonlyifyounotifypayflexin
writingofthesocialsecurityadministration’sdeterminationof
disabilitywithin60daysafterthelatestof:
n thedateofthesocialsecurityadministration’sdisability
determination;
n thedateofthecoveredemployee’sterminationof
employmentorreductionofhours;and
n thedateonwhichthequalifiedbeneficiaryloses(orwould
lose)coverageunderthetermsoftheplanasaresultofthe
coveredemployee’sterminationofemploymentorreduction
ofhours.
youmustalsoprovidethisnoticewithin18monthsafterthe
coveredemployee’sterminationofemploymentorreduction
ofhoursinordertobeentitledtoadisabilityextension.ifthese
proceduresarenotfollowedorifthenoticeisnotprovidedto
payflexduringthe60-daynoticeperiodandwithin18months
afterthecoveredemployee’sterminationofemploymentor
reductionofhours,thentherewillbenodisabilityextensionof
CoBracoverage.
SECOnD qUALIFYIng EVEnT EXTEnSIOn OF COBRA COVERAgEifyourfamilyexperiencesanotherqualifyingeventwhile
receivingCoBracoveragebecauseofthecovered
employee’sterminationofemploymentorreductionofhours
(includingCoBracoverageduringadisabilityextensionperiod
asdescribedabove),thespouseanddependentchildren
receivingCoBracoveragecangetupto18additionalmonths
ofCoBracoverage,foramaximumof36months,ifnoticeof
thesecondqualifyingeventisproperlygiventotheplan.this
extensionmaybeavailabletothespouseandanydependent
childrenreceivingCoBracoverageiftheemployeeorformer
employeediesorgetsdivorcedorlegallyseparated,orif
thedependentchildstopsbeingeligibleundertheplanasa
dependentchild,butonlyiftheeventwouldhavecausedthe
spouseordependentchildtolosecoverageundertheplan
hadthefirstqualifyingeventnotoccurred.(thisextension
isnotavailableundertheplanwhenacoveredemployee
becomesentitledtomedicareafterhisorherterminationof
employmentorreductionofhours.)
theextensionduetoasecondqualifyingeventisavailable
onlyifyounotifypayflexinwritingofthesecondqualifying
eventwithin60daysafterthedateofthesecondqualifying
event.iftheseproceduresarenotfollowedorifthenoticeis
notprovidedtopayflexduringthe60-daynoticeperiod,then
therewillbenoextensionofcobracoverageduetoasecond
qualifyingevent.
forinformationrelatedtoCoBrarightsforfmlaandmilitary
leave,youmayreferencepolicynumbersHr214
andHr205onthetexasChildren’sConnectwebsite.
HEALTH CARE FSA COMPOnEnTCoBracoverageundertheHealthCarefsawillbe
offeredonlytoqualifiedbeneficiarieslosingcoveragewho
haveunderspentaccounts.aqualifiedbeneficiaryhasan
underspentaccountiftheannuallimitelectedbythecovered
employee,reducedbythereimbursableclaimssubmittedup
tothetimeofthequalifyingevent,isequaltoormorethan
theamountofthepremiumsforHealthCarefsaCoBra
coveragethatwillbechargedfortheremainderoftheplan
year.CoBracoveragewillconsistoftheHealthCarefsa
coverageinforceatthetimeofthequalifyingevent(i.e.,the
electedannuallimitreducedbyreimbursableclaimssubmitted
uptothetimeofthequalifyingevent).theuse-it-or-lose-it
rulewillcontinuetoapply,soanyunusedamountswillbe
forfeitedattheendoftheplanyear,andCoBracoverage
willterminateattheendoftheplanyear.unlessotherwise
elected,allqualifiedbeneficiarieswhowerecoveredunderthe
HealthCarefsawillbecoveredtogetherforHealthCarefsa
CoBracoverage.However,eachqualifiedbeneficiarycould
alternativelyelectseparateCoBracoveragetocoverthat
beneficiaryonly,withaseparateHealthCarefsaannuallimit
andaseparatepremium.
MORE InFORMATIOn ABOUT InDIVIDUALS WHO MAY BE qUALIFIED BEnEFICIARIESChildren Born to or Placed for Adoption With the Covered Employee During COBRA Coverage Period
achildbornto,adoptedby,orplacedforadoptionwitha
coveredemployeeduringaperiodofCoBracoverageis
consideredtobeaqualifiedbeneficiaryprovidedthat,ifthe
coveredemployeeisaqualifiedbeneficiary,thecovered
employeehaselectedCoBracoverageforhimselforherself.
thechild’sCoBracoveragebeginswhenthechildisenrolled
intheplan,whetherthroughspecialenrollmentoropen
enrollment,anditlastsforaslongasCoBracoveragelasts
forotherfamilymembersoftheemployee.tobeenrolledin
theplan,thechildmustsatisfytheotherwiseapplicableplan
eligibilityrequirements(forexample,regardingage).
Alternate Recipients Under qMCSOs
achildofthecoveredemployeewhoisreceivingbenefits
undertheplanpursuanttoaqualifiedmedicalchildsupport
order(QmCso)receivedbytexasChildren’sduringthe
coveredemployee’speriodofemploymentwithtexas
Children’sisentitledtothesamerightstoelectCoBraasan
eligibledependentchildofthecoveredemployee.
38 Texas Children’s hospiTal2011BenefitsandWellnessGuide39 Texas Children’s hospiTal2011BenefitsandWellnessGuide HealtHmatters…CHooseWisely. 39
IF YOU HAVE qUESTIOnSQuestionsconcerningyourplanoryourCoBrarightsshould
beaddressedtothecontactorcontactsidentified
below.formoreinformationaboutyourrightsundererisa,
includingCoBra,theHealthinsuranceportabilityand
accountabilityact(Hipaa)andotherlawsaffectinggrouphealth
plans,contactthenearestregionalordistrictoffice
oftheu.s.departmentoflabor’semployeeBenefitssecurity
administration(eBsa)inyourareaorvisittheeBsa
websiteatwww.dol.gov/ebsa.(addressesandphone
numbersofregionalanddistricteBsaofficesareavailable
througheBsa’swebsite.)
kEEP YOUR PLAn InFORMED OF ADDRESS CHAngESinordertoprotectyourfamily’srights,youshouldkeeptexas
Children’sinformedofanychangesintheaddressesof
familymembers.youshouldalsokeepacopy,foryourrecords,
ofanynoticesyousendordelivertotexasChildren’s.
PLAn COnTACT InFORMATIOnyoumayobtaininformationabouttheplanandCoBra
coverageuponrequestfrom:texasChildren’sHospital,Human
resources,suite1301,1919s.Braeswood,HoustontX
77030,832-824-2421,option1.thiscontactinformation
fortheplanmaychangefromtimetotime.themostrecent
informationwillbeincludedintheplan’smostrecentsummary
plandescription(ifyoudonothaveacopy,youmayrequest
onefromtexasChildren’s).
WOMEn’S HEALTH AnD CAnCERtheWomen’sHealthandCancerrightsactof1998(WHCra)
requiresthatourplanprovidethefollowingmedicaland
surgicalbenefitsaftermastectomiesinamannerdeterminedin
consultationwiththeattendingphysicianandthepatientfor:
n allstagesofreconstructionofthebreastonwhichthe
mastectomyhasbeenperformed
n surgeryandreconstructionoftheotherbreasttoproducea
symmetricalappearance
n prosthesesandphysicalcomplicationsofallstagesof
mastectomies,includinglymphedemas.thesebenefitsare
subjecttothesamedeductiblesandcoinsuranceapplicable
toothermedicalandsurgicalbenefitsprovidedunder
ourplan.pleasefollowtheplanproceduresforobtaining
precertification.
MEnTAL HEALTHtheplancomplieswiththementalHealthparityact,which
generallyrequiresparitybetweenmentalhealthbenefitsand
medical/surgicalbenefits.theplanappliesthesameannual
dollarlimitsandaggregatelifetimelimitsformentalhealth
benefitsandmedical/surgicalbenefits.
MOTHERS AnD nEWBORnSincompliancewithfederallaw,tCHselectplansdonot:(1)
restrictbenefitsforanyhospitallengthofstayinconnection
withchildbirthforthemotherornewbornchildtofewerthan48
hoursfollowinganormalvaginaldelivery,orfewerthan96hours
followingaCesareansection,or(2)requirethataproviderobtain
authorizationfromtheinsurancecarrierforprescribingalengthof
staynotinexcessoftheaboveperiods.
CERTIFICATE OF CREDITABLE COVERAgEyouwillbeprovidedacertificateofcreditablecoveragein
writing,freeofcharge,fromBlueCrossBlueshieldoftexasfor
healthplancoverage:
n Whenyoulosecoverageunderthehealthplan;
n WhenyoubecomeentitledtoelectCoBra;
n WhenyourCoBracoverageends;youmayrequest
acertificateofcreditablecoveragebycallingthetoll-
freenumberonyourmedicalidcard.youmayrequest
acertificateofcreditablecoveragefromanothergroup
healthplan,oryoumayreceiveareductionoreliminationof
exclusionaryperiodsofcoverageforpreexistingconditions
underyourgrouphealthplan.Withoutevidenceofcreditable
coverage,planbenefitsforthetreatmentofapre-existing
conditionmaybeexcludedfor12months(18monthsforlate
enrollees)afteryourenrollmentdateinyourcoverage.
yourriGHts
YOU
R R
IGH
TS
40 Texas Children’s hospiTal2011BenefitsandWellnessGuide41 Texas Children’s hospiTal2011BenefitsandWellnessGuide HealtHmatters…CHooseWisely. 41
qUALIFIED MEDICAL CHILD SUPPORT ORDER (qMCSO)federallawrequiresthetCHselectplan,undercertain
circumstances,toprovidehealthcarecoverageforyourchildren
whenyoudivorce,separate,orareevennevermarried,when
orderedtodosobystateauthorities.theprocessbeginswhen
texasChildren’sHospitalreceivesamedicalchildsupportorder.
thismeansanyjudgment,decree,ororder,includingapprovalof
asettlementagreement,which:
n isissuedfromacourtofcompetentjurisdictionorthroughan
administrativeprocessestablishedunderstatelawandhas
theforceandeffectofanorderunderstatelawpursuanttoa
state’sdomesticrelationslaw;
n requiresyoutoprovidegrouphealthcoverageforyour
childreneventhoughyounolongerhavecustody;
n Clearlyspecifiesthenameofourplan,yournameandyourlast
knownmailingaddressandthenameandaddressesofachild
coveredbytheorder.thenameandmailingaddressofastate
orlocalofficialmaybesubstitutedfortheaddressofthechild;
n areasonabledescriptionofthecoveragetobeprovided;and
n theperiodofcoveragetowhichtheorderapplies.
theplanadministratorwillprovidewrittennotificationtoyouand
eachidentifiedchildforwhichithasreceivedanorderrequiring
coverage.Withinareasonabletimeafterthereceiptoftheorder,
theplanadministratorwilldeterminewhethertheorderisa
QualifiedmedicalChildsupportorder(QmCso)andnotifyyou
andthechild’slegalrepresentativeofthedetermination.this
noticewillincludeanyrequiredenrollmentmaterial,adescription
oftheprocedurestobefollowed,andaformfordesignating
thechild’scustodialparentorlegalguardianashisorher
representativeforallbenefitplanpurposes.planbenefitsthat
havenotbeenassignedwillbeusedtoreimbursechargesfor
coveredexpensesincurredbyanidentifiedchild.
iftexasChildren’sHospitalreceivesaQmCso,itmustpermit
immediateenrollment.thismeansthechildrenidentifiedwillbe
includedforcoverageasyoureligibledependentandyouwill
paytherequiredpremiums.thechild’scustodialparent,legal
guardian,orastateagencycanmakeanapplicationforthe
child’scoverage,evenifyoudonot.
“MICHELLE’S LAW” (H.R. 2851)michelle’slawprovidescontinuedcoverageundergrouphealth
plansforyourdependentchildwhoiscoveredunderthetexas
Children’splanasastudentbutmightlosetheirstudentstatus
becausetheytakeamedicallynecessaryleaveofabsence
fromschoolorbeginachangeinschoolenrollmentthatwould
otherwiseresultinacancellationofcoverageunderourplan.
youmaycontinueforupto12monthsfromthebeginningof
theabsenceaslongasyourchildwascoveredbytheplanand
enrolledinacollegeoruniversity.
ifyoubelieveyourchildiseligibleforthiscontinuedcoverage,
thechild’sphysicianmustprovideawrittencertificationstating
thatyourchildissufferingfromaseriousillnessorinjurythat
necessitatestheleaveorchangeinenrollmentstatus.
attheendofthe12monthsofcoverageundermichelle’slaw,
CoBracoveragewillbeavailableifyourchildisstilltooillto
attendschool.
PRESCRIPTIOn DRUg COVERAgE AnD MEDICARE OPTIOnSpleasereadthisnoticecarefullyandkeepitwhereyoucanfindit.
thisnoticehasinformationaboutyourcurrentprescriptiondrug
coveragewithtexasChildren’sHospitalandaboutyouroptions
undermedicare’sprescriptiondrugcoverage.thisinformation
canhelpyoudecidewhetherornotyouwanttojoinamedicare
drugplan.ifyouareconsideringjoining,youshouldcompareyour
currentcoverage(includingwhichdrugsarecoveredatwhat
cost)withthecoverageandcostsoftheplansofferingmedicare
prescriptiondrugcoverageinyourarea.informationaboutwhere
youcangethelptomakedecisionsaboutyourprescriptiondrug
coverageisattheendofthisnotice.
therearetwoimportantthingsyouneedtoknowaboutyour
currentcoverageandmedicare’sprescriptiondrugcoverage:
1.medicareprescriptiondrugcoveragebecameavailablein
2006toeveryonewithmedicare.youcangetthiscoverageif
youjoinamedicareprescriptiondrugplanorjoinamedicare
advantageplan(likeanHmoorppo)thatoffersprescription
drugcoverage.allmedicaredrugplansprovideatleasta
standardlevelofcoveragesetbymedicare.someplansmay
alsooffermorecoverageforahighermonthlypremium.
2.texasChildren’sHospitalhasdeterminedthattheprescription
drugcoverageofferedbythetCHselectplanis,onaverage
forallplanparticipants,expectedtopayoutasmuchas
standardmedicareprescriptiondrugcoveragepaysandis
thereforeconsideredCreditableCoverage.Becauseyour
existingcoverageisCreditableCoverage,youcankeepthis
coverageandnotpayahigherpremium(apenalty)ifyoulater
decidetojoinamedicaredrugplan.
40 Texas Children’s hospiTal2011BenefitsandWellnessGuide41 Texas Children’s hospiTal2011BenefitsandWellnessGuide HealtHmatters…CHooseWisely. 41
When Can You Join A Medicare Drug Plan?
youcanjoinamedicaredrugplanwhenyoufirstbecome
eligibleformedicareandeachyearfromnovember15ththrough
december31st;however,ifyouloseyourcurrentcreditable
prescriptiondrugcoverage,throughnofaultofyourown,you
willalsobeeligibleforatwo(2)monthspecialenrollmentperiod
(sep)tojoinamedicaredrugplan.
What Happens To Your Current Coverage?
ifyoudecidetojoinamedicaredrugplan,yourcurrenttCH
selectplancoveragewillnotbeaffected.
n youmaychoosetoenrollinmedicarepartdinadditionto
theHospitalprovidedmedicalandprescriptiondrugplan.if
youselectthisoption,medicare’sprescriptiondrugplanwill
coordinatecoveragebydeterminingbenefitsasthesecondary
providersaslongasyouremainanactiveemployeeunderthe
Hospitalprovidedplan.
n youmaychoosenottoenrollinthemedicareprescription
drugplanatthistimeandkeepyourmedicalandprescription
drugbenefitsundertheHospitalprovidedplan.ifthisoption
isselected,yourmedicalandprescriptiondrugbenefitswill
continueundertheHospitalprovidedmedicalplanoption
selected.
n ifyoudecidetojoinamedicaredrugplananddropyour
currenttexasChildren’sHospitalcoverage,beawarethatyou
andyourdependentsmaynotbeabletogetthiscoverage
back.
When Will A Higher Premium (Penalty) Be Paid to Join a
Medicare Drug Plan?
ifyoudroporloseyourcurrentcoveragewithtexasChildren’s
Hospitalanddon’tjoinamedicaredrugplanwithin63continuous
daysafteryourcurrentcoverageends,youmaypayahigher
premium(apenalty)tojoinamedicaredrugplanlater.ifyougo
63continuousdaysorlongerwithoutcreditableprescriptiondrug
coverage,yourmonthlypremiummaygoupbyatleast1%ofthe
medicarebasebeneficiarypremiumpermonthforeverymonth
thatyoudidnothavethatcoverage.
forexample,ifyougonineteenmonthswithoutcreditable
coverage,yourpremiummayconsistentlybeatleast19%higher
thanthemedicarebasebeneficiarypremium.youmayhaveto
paythishigherpremium(apenalty)aslongasyouhavemedicare
prescriptiondrugcoverage.inaddition,youmayhavetowaituntil
thefollowingnovembertojoin.
For More Information:n About This Notice or Your Current Prescription Drug Coverage
ContacttheBenefitstotalrewardslineat832-824-2421and
press1forbenefits.you’llgetthisnoticeeachyear.youwill
alsogetitbeforethenextperiodyoucanjoinamedicaredrug
plan,andifthiscoveragethroughtexasChildren’sHospital
changes.youalsomayrequestacopyofthisnoticeatany
time.
n About Your Options under Medicare Prescription Drug
Coverage
moredetailedinformationaboutmedicareplansthatoffer
prescriptiondrugcoverageisinthe“medicare&you”
handbook.employeesaremailedacopyofthehandbook
everyyearfrommedicare.youmayalsobecontacteddirectly
bymedicaredrugplans.
n About Medicare Prescription Drug Coverage
-Visitwww.medicare.gov
-forpersonalizedhelp,callyourstateHealthinsurance
assistanceprogram(seetheinsidebackcoverofyour
copyofthe“medicare&you”handbookfortheirtelephone
number)
-Call1-800-mediCare(1-800-633-4227).ttyusers
shouldcall1-877-486-2048.ifyouhavelimitedincomeand
resources,extrahelppayingformedicareprescriptiondrug
coverageisavailable.forinformationaboutthisextrahelp,
visitsocialsecurityonthewebatwww.socialsecurity.gov,
orcallthemat1-800-772-1213(tty1-800-325-0778).
403(B) PLAn IRS REgULATIOnS RELATED TO 2011 MAXIMUM COnTRIBUTIOn AMOUnTSifbothofthefollowingtwopointsapplytoyou,pleasecontactHr
Benefitssothattheycanworkwithyoutominimizeyourriskof
exceedingthe2011contributionlimit.
1.youcurrentlycontrol(owndirectlyorindirectly)morethana
50%interestofabusiness,and
2.thatbusinessprovidestoyouaQualifieddefinedContribution
retirementplanorasimplifiedemployeepension(“sep”)plan
for2011
duetocertainchangesincomplianceproceduresestablished
bytheinternalrevenueservice(the“irs”),employeeswho
controlmorethana50%interestofabusinessthatprovidesto
youaqualifiedretirementplanorasep,arerequiredbytheirs,
tocombinethecontributionsmadeonyourbehalftoour403(b)
planwiththecontributionsmadeonyourbehalftotheretirement
plan(s)ofthatbusiness(orbusinesses)todetermineifthe
retirementplanannualadditionslimittestisviolated.
42 Texas Children’s hospiTal2011BenefitsandWellnessGuide43 Texas Children’s hospiTal2011BenefitsandWellnessGuide HealtHmatters…CHooseWisely. 43
therefore,texasChildren’sisobligedtomonitorthemaximum
amountofcontributionsmadeonyourbehalftoour403(b)plan
andanyothertax-qualifieddefinedcontributionplansmaintained
byemployersinwhichyouhaveanownershipinterestofmore
than50%.
in2011,thecurrentknownmaximumcontributionisthelesser
of(i)$49,000or(ii)100percentofeligiblecompensation.to
addressanyquestionsorconcernsrelatedtothisirsregulation,
pleasecontactHrat832.824.2421andselectoption1for
Benefits.
ifthereisaviolationtothisannualadditionslimittest,youwillbe
subjecttocurrentfederalincometaxontheexcesscontributions
andyoumayalsobesubjecttocertainfederaltaxpenalties.
YOUR (ERISA) BEnEFITS RIgHTS asaparticipantinthisplan,youareentitledtocertainrightsand
protectionsundertheemployeeretirementincomesecurityact
of1974(erisa).thisstatementofyourerisarightsisrequired
byfederallawandregulations.inaddition,
erisaprovidesthatyou,asaplanparticipantareentitledto:
n receiveinformationaboutyourplanandbenefits.
n examine,withoutcharge,attheofficeoftheplansupervisor
andatotherspecifiedlocationssuchasworksitesand
unionhalls,allplandocumentsgoverningtheplan,including
insurancecontractsandcollectivebargainingagreements,
andcopiesofalldocumentsfiledbytheplanwiththeu.s.
departmentoflaborandavailableatthepublicdisclosure
roomofthepensionandWelfareBenefitsadministration.
n obtain,uponwrittenrequesttotheplansupervisor,copies
ofdocumentsgoverningtheoperationoftheplan,including
insurancecontractsandcollectivebargainingagreements.the
plansupervisormaymakeareasonablechargeforthecopies.
n receiveasummaryoftheplan’sannualfinancialreport.the
plansupervisorisrequiredbylawtofurnisheachparticipant
withacopyofthissummaryannualreport.
PRUDEnT ACTIOnS BY PLAn FIDUCIARIESinadditiontocreatingrightsforplanparticipants,erisaimposes
dutiesuponthepeoplewhoareresponsiblefortheoperationof
theplan.thepeoplewhooperateyourplan,called“fiduciaries”of
theplan,haveadutytodosoprudentlyandintheinterestofyou
andotherplanparticipantsandbeneficiaries.noone,including
youremployer,yourunion,ifapplicable,oranyotherperson,
mayfireyouorotherwisediscriminateagainstyouinanywayto
preventyoufromobtainingawelfarebenefitorexercisingyour
rightsundererisa.
EnFORCE YOUR RIgHTSifyourclaimforabenefitisdeniedorignoredinwholeorinpart,
youhavearighttoknowwhythiswasdone,toobtaincopiesof
documentsrelatingtothedecisionwithoutchargeandtoappeal
anydenial,allwithincertaintimeschedules.
undererisa,therearestepsyoucantaketoenforceyourrights.
forinstance,ifyourequestacopyoftheplandocumentsorthe
latestannualreportfortheplananddonotreceivethemwithin30
days,youmayfilesuitinafederalcourt.insuchacase,thecourt
mayrequirethefiduciaryCommitteetoprovidethematerialsand
payupto$110adayuntilyoureceivethematerials,unlessthe
materialswerenotsentbecauseofreasonsbeyondthecontrol
ofthefiduciaryCommittee.ifyouhaveaclaimforbenefits,which
isdeniedorignored,inwholeorinpart,youmayfilesuitina
federalcourt.inaddition,ifyoudisagreewiththeplan’sdecision
orlackthereofconcerningthequalifiedstatusofadomestic
relationsorder,youmayfilesuitinfederalcourt.ifitshould
happenthatplanfiduciariesmisusetheplan’smoney,orifyou
arediscriminatedagainstforassertingyourrights,youmayseek
assistancefromtheu.s.departmentoflabor,oryoumayfile
suitinafederalcourt.thecourtwilldecidewhoshouldpaycourt
costsandfees.ifyouaresuccessful,thecourtmayorderthe
personyouhavesuedtopaythesecostsandfees.ifyoulose,
thecourtmayorderyoutopaythesecostsandfees,forexample,
ifitfindsyourclaimisfrivolous.
ASSISTAnCE WITH YOUR qUESTIOnSifyouhavequestionsaboutyourplan,youshouldcontactthe
plansupervisor.ifyouhaveanyquestionsaboutthisstatement
oryourrightsundererisa,orifyouneedassistanceinobtaining
documentsfromtheplansupervisor,youshouldcontactthe
nearestemployeeBenefitsadministration,u.s.department
oflabor,listedinthetelephonedirectory.youmaycall
202.693.8673oraddressrequeststopublicdisclosureroom,
roomn-1513,employeeBenefitssecurityadministration,u.s.
departmentoflabor,200Constitutionave.,n.W.,Washington,
d.C.20210.
42 Texas Children’s hospiTal2011BenefitsandWellnessGuide43 Texas Children’s hospiTal2011BenefitsandWellnessGuide HealtHmatters…CHooseWisely. 43
VENDOR PHONE WEB ADDRESS
Backup Care (Temporary care for infant to elder)
nBright Horizons — to pre-register or schedule care 1-877-242-2737www.backup.brighthorizons.comUn: TexasChildrens PW: backup1
COBRA — new 2011 ProvidernPayFlex 1-800-284-4885(option3) www.HealthHub.com
Disease Management — new 2011 ProvidernFocused Health Solutions 1-888-352-9355 TCH.myfocusedhealth.com
FSA’s (Health Care & Dependent Care) — new 2011 VendornPayFlex 1-800-284-4885(option1) www.HealthHub.com
Life Insurance — new 2011 ProvidernPrudential 1-888-598-5671 www.prudential.com
Long-Term CarenJohn Hancock 1-800-724-3785
http://tch.jhancock.comun: tch PW: mybenefit
Medical / Dental — new 2011 Provider and networknBlueCross BlueShield of texas (BCBStX) 1-877-734-8924 www.bcbstx.com/tch
Pharmacy / Prescriptionsnexpress ScriptsnSelect Home Delivery ProgramnCuraScript (specialty medications)nFreedom Fertility (fertility drugs)
1-800-316-31021-888-772-51881-888-773-73761-800-660-4283
www.express-scripts.comwww.StartHomeDelivery.comwww.curascript.comwww.freedomfertility.com
RetirementnFidelity 403b retirement Savings PlannFidelity 529 College Savings PlannFidelity Spanish information line
1-800-343-08601-800-544-19141-877-297-3017
www.fidelity.com/atworkwww.fidelity.com/unique
Texas Medical CenternFor tmC Parking Card issuesnFor changes to Parking elections
713-791-6161
832-824-2421(option1)
Tuition Assistance Programnedlink – Customer Servicenedlink – For online applicationsnedlink – to Fax Documentation
1-888-797-2235
1-866-284-0859http://tamsonline.org/TCH
VisionnVision Service Plan (VSP) 1-800-877-7195 www.vsp.com/go/tch
HUMAN RESOURCES PHONE WEB ADDRESS
Employee HealthnPersonal and Family medical leave (Fml)nemployee assistance Program (eaP)
832-824-2150832-824-3327
Texas Children’s Benefits Departmentmeyer Building, 3rd Floor, 8a - 5p monday - Friday
Texas Children’s HR Service Centerabercrombie Building (a-130), 7a - 4p monday - Friday
832-824-2421(option1) [email protected]
ContaCtinformationBytypeofserViCe
44 Texas Children’s hospiTal2011BenefitsandWellnessGuide45 Texas Children’s hospiTal2011BenefitsandWellnessGuide HealtHmatters…CHooseWisely. 45
tCHseleCtdollarsasasupportivewaytohelpemployeesoffsetthecostofbenefitpremiums,additionaldollars(referredto
as“selectdollars”)arepaidbasedonyouryearsof‘benefit’serviceandjobstatus.selectdollarsbeginon
thesamedayyourpremiumdeductionsbeginandwillchangeonyouranniversarydateoronthedateofa
statuschange.(example:part-timetofull-timestatus)Whetheryouenrollorwaivebenefitcoverage,eligibleemployees will
automaticallyreceiveselectdollarsasadditionaltake-homeincome,subjecttoapplicabletaxes.
selectPLUS’dollars,intheamountof$50/monthor$23.08/payperiod,willbeappliedtoemployeeswho
1)participateinatCHmedicalplanand2)whoearnanhourlywageof$14.00orlessasofJanuary1,2011.
Additional Pay to Offset the Cost of Employee Benefit Premiums
FULL-TIME Employees
(Years of benefit service)
Monthly SELECT
DOLLARS
AMOUNT ADDED TO EMPLOYEE PAYCHECK
SELECT DOLLARS
SelectPLUS DollarsMust be in a TCH Medical Plan
AND make an hourly wage of $14 or less.
0-1 year $60 + $ 0 = $ 60 $27.69 / pay period $50.77 / pay period
1-2 years $60 + $ 5 = $ 65 $30.00 / pay period $53.08 / pay period
3-4 years $60 + $10 = $ 70 $32.31 / pay period $55.39 / pay period
5-6 years $60 + $20 = $ 80 $36.92 / pay period $60.00 / pay period
7-10 years $60 + $30 = $ 90 $41.54 / pay period $64.62 / pay period
11-15 years $60 + $40 = $100 $46.15 / pay period $69.23 / pay period
16-24 years $60 + $50 = $110 $50.77 / pay period $73.85 / pay period
25+ years $60 + $75 = $135 $62.31 / pay period $85.39 / pay period
PART-TIME Employees
(Years of benefit service)
Monthly SELECT
DOLLARS
AMOUNT ADDED TO EMPLOYEE PAYCHECK
SELECT DOLLARS
SelectPLUS DollarsMust be in a TCH Medical Plan
AND make an hourly wage of $14 or less.
0-1 year $25 + $ 0 = $ 25 $11.54 / pay period $34.62 / pay period
1-2 years $25 + $ 5 = $ 30 $13.85 / pay period $36.93 / pay period
3-4 years $25 + $10 = $ 35 $16.15 / pay period $39.23 / pay period
5-6 years $25 + $20 = $ 45 $20.77 / pay period $43.85 / pay period
7-10 years $25 + $30 = $ 55 $25.38 / pay period $48.46 / pay period
11-15 years $25 + $40 = $ 65 $30.00 / pay period $53.08 / pay period
16-24 years $25 + $50 = $ 75 $34.62 / pay period $57.70 / pay period
25+ years $25 + $75 = $100 $46.15 / pay period $69.23 / pay period
Per Pay Period Examples of Select Dollars In Action!
Examples Reflect: New Employeewith ‘Employee ONLY’ coverage with PPO Medical
FULL-TIME Employee
PART-TIME Employee
FULL-TIME SelectPLUS Employee
PART-TIME SelectPLUS Employee
Per Pay Period PPO Premium $35.22 $35.22 $35.22 $35.22
Offset by per pay period Select Dollars -27.69 -11.54 - 50.77 -34.62
Actual per pay period cost for PPO Medical $ 7.53 $23.58 - $15.55 $0.60
NEWiN 2011
SELE
CT D
OLLA
RS
nEW
nEW
44 Texas Children’s hospiTal2011BenefitsandWellnessGuide45 Texas Children’s hospiTal2011BenefitsandWellnessGuide HealtHmatters…CHooseWisely. 45
2011tCHseleCtplansemployeeCosts
per paY periodMEDICAL OPTIONS PPO EPO
employeeonly
employee&spouse
employee&Child
employee&Children
employee,spouse&Child
employee&family
$ 35.22
$ 154.67
$ 111.52
$ 164.98
$ 230.66
$ 284.45
$ 63.94
$ 187.08
$ 143.03
$ 196.50
$ 266.08
$ 319.65
DENTAL OPTIONS DPPO-HIGH DPPO-LOW
employeeonly
employee&1dependent
employee&family
$ 16.01
$ 30.45
$ 42.94
$ 9.25
$ 17.58
$ 24.80
VISION PLAN
employeeonly
employee&spouse
employee&Child
employee&Children
employee,spouse&Child
employee&family
$ 3.83
$ 7.66
$ 7.28
$ 7.28
$ 11.49
$ 11.49
EMPLOYEE LIFE INSURANCE
Basiclife
optional life insurancepaidbytexasChildren’spremiumpaidbyemployeebasedonsalary
SPOUSE LIFE INSURANCE
premiumpaidbyemployee(basedonemployee’sage)uptomaximum$100,000.
EMPLOYEE ACCIDENTAL DEATH AND DISMEMBERMENT (AD&D) INSURANCE
Basicad&d
optional aD&D insurancepaidbytexasChildren’spremiumpaidbyemployeebasedonsalary
DEPENDENT LIFE INSURANCE
$ 2,500 $ 5,000$10,000
$ .26$ .51$ 1.02
LONG-TERM DISABILITY
Basicltd
optionalltd
paidbytexasChildren’spremiumpaidbyemployeebasedonageandsalary
FLEXIBLE SPENDING ACCOUNTS
HealthCarefsaannualmaximum
dependentCarefsaannualmaximum
$5,000peryear(minimum$5.00perpayperiod)
$5,000peryear,including$260.00employercontributions
(minimum$5.00perpayperiod)
Remember Your Select Dollars!
PR
EMIU
MS
thisguideisasummaryofmaterialmodificationstoyourbenefitscoverageandcontainschangestoyourbenefitsasdescribedinyour
summaryplandescription.foracompletedescriptionofyourbenefits,seeyoursummaryplandescriptionontheConnectwebsite.
thisreferenceguidedescribesthevariousbenefitplansofferedbytexasChildren’sinsummaryonly.theactualeligibilityrequirements,
benefits,terms,conditions,limitations,andprovisionsthatgoverntheplansarecontainedintheplandocumentsorgroupinsurancecontracts.
if,inoureffortstomaketheplanseasytounderstand,anyoftheplans’provisionshavebeenomittedormisstated;theofficialplandocuments
orinsurancecontractsmustremainthefinalauthority.thelegaldocumentsalsogoverntheadministrationoftheplansandpaymentofbenefits.
inthecaseofanydispute,theinformationintheplandocumentsorcontractswillprevail.
Copiesofthesedocumentsareavailableforyourinspectionduringnormalbusinesshoursormayberequestedinwritingforanominalfeefrom:
texasChildren’sHospital
Humanresourcesdept.,suite1301
1919s.Braeswood,Houston,tX77030
Texas Children’s Hospital is proud to be one of the Houston Business Journal’sBest Places to Work for the fifth consecutive year.Every day, our team of gifted employees, physicians, researchers and volunteers makes the world a healthier place byproviding the finest possible patient care, education and research.Together, we are redefining the future of pediatrichealth care with a comprehensive growth plan including a state-of-the-art maternity center, a suburban hospital inWest Houston and the Jan and Dan Duncan Neurological Research Institute™. Simply stated,Texas Children’s ismaking a world of difference to the world at large.
Five in a Row!