2014
EMPLOYEE BENEFITS
T A B L E
O F
C O N T E N T S
2014 Employee Benefits
Your Benefits Package
Eligibility
Dependent Coverage
Coverage Options
Qualifying Status Changes
Enrolling in Benefits
Effective Date of Benefits
Summary of Available Benefits
2
3
3
3
3
4
4
4
5
Medical and Prescription Drug Plans
Medical Waiver Credit
Medical and Prescription Drug Plan Costs
Medical Plan Selector Tool
BestLife Basic Plan
BestLife Plus Plan
BestLife Health Reimbursement Account
BestLife Wellness Plan
6
6
6
7
8
10
12
13
Dental Plans
14
Vision Plan
15
Flexible Spending Accounts
16
Basic Life and Accidental Death and Dismemberment Insurance
17
Supplemental Life Insurance
17
Short-Term Disability Insurance
18
Long-Term Disability Insurance
18
Supplemental Disability Insurance
18
Voluntary Accident, Cancer, Critical Illness, & Medical Bridge Hospital Confinement Plans
18
Employee Assistance Program
19
Retirement Savings Plans
20
Education Assistance
21
Paid Time Off
22
Important Contact Information
23
Cheyenne Regional 2014 Benefits
Your Benefits
We offer a comprehensive
benefits package consisting of:
• Medical and prescription
drug coverage
• Health reimbursement
account
• Dental coverage
• Vision coverage
• Flexible spending accounts
• Basic life and accidental
death and dismemberment
(AD&D) insurance
2014
E M P L O Y E E
B E N E F I T S
Your Benefits Package
Benefits are an integral part of the overall compensation package provided by Cheyenne
Regional. We are pleased to provide you with this Employee Benefits Guide to assist you in
making your benefit elections. The objective of the employee benefits program is to provide
you and your eligible dependents with comprehensive coverage and protection through
choices that enable you to select options that meet your individual needs. Good News...Your
medical, dental, and vision premiums are staying the same for 2014!
We are pleased to provide you with the Plan Selector Tool to help you determine which
medical plan is right for you (see page 7 for more information).
• Voluntary life insurance
Please take a moment to review the benefits Cheyenne Regional provides, to determine
which offering is best for you.
• Short- and long-term
disability insurance
Eligibility
• Supplemental disability
insurance
• Employee assistance
program
Full-time (regularly scheduled to work 32 hours per week) and part-time (regularly
scheduled to work between 16 and 31.75 hours per week) employees are eligible for benefits.
Temporary and PRN (as needed) employees are not eligible for benefits unless stated
otherwise.
• Retirement savings plans
Dependent Coverage
• Education assistance
Many of the benefit plans also offer coverage for your eligible dependents, including:
• Your legal spouse or domestic partner. To enroll a domestic partner, you must
complete and sign the Affidavit of Domestic Partnership, which is available at
www.cheyenneregional.org/staffemployees/benefits.
• Dependent children up to age 26 (for medical, dental, vision, and employee assistance
program).
• Dependent children of any age who are disabled, live with you, and depend on you for
support.
• Paid time off
Coverage Options
Benefits-eligible employees may elect the following coverage levels for the medical/
prescription drug, dental, and vision plans:
• Employee only (deductions are pre-tax)
• Employee plus spouse (deductions are pre-tax)
• Employee plus domestic partner (deductions are post-tax)
• Employee plus child(ren) (deductions are pre-tax)
• Employee plus family—spouse and children (deductions are pre-tax)
• Employee plus family—domestic partner and children (deductions are post-tax)
www.cheyenneregional.org/staffemployees/benefits
3
Qualifying Status Changes
Due to IRS regulations, once you have made your elections for the 2014 plan year, you cannot change your benefits until the
next annual enrollment period. The only exception is if you experience a qualifying life event listed below. Election changes
must be consistent with your life event and be submitted to Human Resources within 30 days.
Qualifying Life Events:
• Marriage, legal separation, or divorce
• Birth or adoption of a child
• Change in employment status for you, your spouse, or your child
• Change in a dependent’s benefits eligibility (e.g., child attains age 26)
• A significant change in the cost or coverage of your spouse’s/domestic partner’s or child’s benefits
• Change in cost of dependent care (for dependent care flexible spending account only)
• Loss of a covered dependent (death)
To request a change in benefits, complete and submit the required forms (available at www.cheyenneregional.org/
staffemployees/benefits) to Human Resources within 30 days of the qualifying life event. You may need to provide proof of the
change, such as a marriage certificate, record of birth, etc.
Enrolling in Benefits
You may enroll in the Cheyenne Regional benefit plans by completing the required enrollment forms and returning them to
the Human Resources Department within the following time frames:
• Eligible new hires and employees with a qualifying job status change have 30 calendar days from their date of employment
or date of the qualifying job status change to make enrollment elections or changes.
• Employees who experience a qualifying life event have 30 calendar days from the date of the event to make enrollment
elections or changes.
Effective Date of Benefits
Basic Life, Short-Term Disability, Long-Term Disability, and Employee Assistance Program
Benefits that are fully paid by Cheyenne Regional are effective on the first day of employment. These benefits are provided at
no cost to you and do not require enrollment.
Voluntary Benefits
Benefits in which you share in the cost through payroll deduction require enrollment and are effective as follows:
• Medical and prescription drug coverage and flexible spending accounts are effective on your first day of employment. In
the case of a status change to an eligible status, coverage is effective on the first day of eligibility.
• Dental and vision benefits are effective on the first day of the month following employment. If your first day of
employment is the first of the month, the effective day is the first day of employment. In the case of a status change to an
eligible status, coverage is effective on the first day of the month following the change in status.
Employees who do not submit enrollment information within the required time frame will not be eligible for coverage and will
not be able to make election changes until the next annual enrollment period.
4
Cheyenne Regional 2014 Benefits
Summary of Available Benefits
Benefit
Enrollment Time
Who Pays
Paid Time Off (PTO)
1
Cheyenne Regional
Basic Life Insurance
1
Cheyenne Regional
Short-Term Disability
1
Cheyenne Regional
Long-Term Disability
1
Cheyenne Regional
Employee Assistance Program (EAP)
1
Cheyenne Regional
BestLife Medical and Prescription Drug Plans
2, 3, 4
You and Cheyenne Regional
BestLife Health Reimbursement Account (HRA)
2, 3, 4
Cheyenne Regional
5
Cheyenne Regional
BestLife Wellness Plan
Medical Waiver Credit
5
Cheyenne Regional
Dental Plans
2, 3, 4
You and Cheyenne Regional
Vision Plan
2, 3, 4
You
Flexible Spending Accounts (FSAs)
2, 3, 4
You
403(b) Retirement Plan
5
You
403(b) Retirement Plan (Roth)
5
You
457(b) Deferred Compensation Plan
5
You
457(b) Deferred Compensation Plan (Roth)
5
You
401(a) Retirement Plan Employer Match
Supplemental Insurance Plans
Education Assistance
1*
Cheyenne Regional
2, 4, 6
You
6
Cheyenne Regional
*Eligibility for the 401(a) employer matching contribution requires enrollment in and making pre-tax contributions to at least one of the
403(b) Retirement or 457(b) Deferred Compensation Plans.
1
Enrollment
Automatic
2
Upon employment
3
With eligible status change
4
At annual enrollment
5
Any time during eligible employment
6
Special rules may apply
www.cheyenneregional.org/staffemployees/benefits
5
MEDICAL AND PRESCRIPTION DRUG PLANS
Cheyenne Regional is committed to the good health of its employees and the region we serve. We offer eligible employees our
own BestLife medical and prescription drug insurance plans. These plans are designed to provide benefits in harmony with
your BestLife wellness plan and BestLife health reimbursement account.
The tables listed on the pages that follow provide a brief summary of the benefits provided under the BestLife medical plans.
The copay and coinsurance amounts listed reflect what you pay. A current list of providers is available at
bestlife.healthtrioconnect.com and www.cheyenneregional.org/staffemployees/benefits.
Medical Waiver Credit
If you do not require medical coverage through Cheyenne Regional, you may be
eligible for the Medical Waiver Credit. Eligible employees who waive medical
coverage and provide proof of other coverage may receive a credit of up to $960 per
year.
Full-time employees will receive the credit in $40 increments per paycheck,
24 times throughout the year. Part-time employees will receive the credit
in $20 increments. In order to receive the credit, you must waive medical
coverage, complete the Medical Waiver Credit Application form (located
at www.cheyenneregional.org/staffemployees/benefits), and provide proof
of other coverage (such as a Certificate of Creditable Coverage) to Human
Resources.
Medical and Prescription Drug Plan Costs
Cheyenne Regional is pleased that it is able to pay a large portion of the cost of
medical premiums. Listed below are the monthly and per-pay-period employee
costs for medical and prescription drug coverage.
MEDICAL RATES
Basic Plan
Monthly
(*FT)
Monthly
(*PT)
Per-Pay-Period
(*FT)
Per-Pay-Period
(*PT)
$66.88
$133.76
$33.44
$66.88
Employee + Spouse
$207.34
$311.00
$103.67
$155.50
Employee + Child(ren)
$197.98
$296.96
$98.99
$148.48
Family
$282.24
$423.36
$141.12
$211.68
Monthly
(*FT)
Monthly
(*PT)
Per-Pay-Period
(*FT)
Per-Pay-Period
(*PT)
$89.36
$178.70
$44.68
$89.35
Employee + Spouse
$276.98
$415.48
$138.49
$207.74
Employee + Child(ren)
$264.48
$396.72
$132.24
$198.36
Family
$377.06
$565.60
$188.53
$282.80
Level of Coverage
Employee
MEDICAL RATES
Plus Plan
Level of Coverage
Employee
*FT = Full-Time, PT = Part-Time
6
Cheyenne Regional 2014 Benefits
MEDICAL PLAN SELECTOR TOOL
Each of the BestLife medical and prescription drug plans has a different employee cost, which is the amount you pay out of
your paycheck. As you consider which plan makes the most sense for you, think about whether you prefer to pay more each
paycheck but less when you need care, or less per paycheck but more when you need care.
Cheyenne Regional is pleased to provide you with the Plan Selector Tool to assist you in selecting a medical
plan.
How Does the Plan Selector Tool Work?
1. Access the Plan Selector Tool at
www.cheyenneregional.org/staffemployees/benefits
and carefully read the instructions.
2. Enter the number of people covered by the medical
plan.
3. Then enter you and your family’s expected medical
plan utilization (physician office visits, expected
emergency room (ER) usage, prescription drugs, etc.).
You may want to review your utilization from the past
2–3 years to help you determine appropriate numbers
to input.
4. The Plan Selector Tool will approximate your annual
costs for both plans based on the information you
entered and the premium you would pay for coverage.
5. The Plan Selector Tool will highlight your lowest cost
option. You can click back to the Input tab and change
the utilization numbers you entered to see how it
affects the results
When determining the plan that is best for you, please
be sure to review the out-of-pocket (OOP) expenses
(copays, deductible, coinsurance) as well as the premium
contribution (payroll deduction amount). The OOP
expenses must be paid at the time of the visit/service,
whereas the premium contribution is deducted evenly
throughout the year. You need to determine what
payment method best fits your needs and cash-flow
situation.
www.cheyenneregional.org/staffemployees/benefits
7
MEDICAL AND PRESCRIPTION DRUG PLANS
BestLife Medical/Prescription Drug BASIC PLAN
Network Option
Tier 1
Exclusive Network
Tier 2
Extended Network
Tier 3
Out-of-Network
Calendar Year Deductible
$2,500 individual
$5,000 family
$5,000 individual
$7,500 family
$7,000 individual
$10,000 family
$5,000 individual
$7,000 family
$10,000 individual
$14,000 family
$20,000 individual
$28,000 family
Benefit Maximums
Out-of-Pocket Maximum (per plan year)
Annual Benefit Maximum
Unlimited
Lifetime Benefit Maximum
Professional Services/Physician
You pay no deductible
You pay
$0 copay
30% coinsurance
100%
You pay after deductible
You pay after deductible
You pay after deductible
$30 copay/visit
$60 copay/visit
$30 copay/visit
30% coinsurance
30% coinsurance
30% coinsurance
50% coinsurance
50% coinsurance
50% coinsurance
$400 global copay
30% coinsurance
50% coinsurance
$30 copay
$75 copay
After Tier 1 deductible:
N/A
$75 copay
After Tier 1 deductible:
N/A
$75 copay
Home Health Care Visit
$0
30% coinsurance
50% coinsurance
Hospice
$0
30% coinsurance
50% coinsurance
Behavioral Health Visit
$30 copay
30% coinsurance
50% coinsurance
Chiropractic Visit
20 visit maximum per year
$25 copay
30% coinsurance
50% coinsurance
You pay after deductible
You pay after deductible
You pay after deductible
$500 copay per day;
max $2,000 copay per
admission
30% coinsurance
50% coinsurance
Outpatient Surgery
Hospital or Surgical Center
Office Procedure
$300 copay
$200 copay
30% coinsurance
30% coinsurance
50% coinsurance
50% coinsurance
Emergency Room/Treatment Room
Emergency Room Care
ER Referred by Nurseline
$300 copay
$125 copay
$300 copay after Tier 1 ded.
$125 copay after Tier 1 ded.
$300 copay after Tier 1 ded.
$125 copay after Tier 1 ded.
Ambulance
$100 copay
$100 copay after Tier 1 ded.
$100 copay after Tier 1 ded.
$0
30% coinsurance
50% coinsurance
Preventive Exam/Services
Professional Services/Physician
Office Visit
Primary Care Physician
Specialist
Allergy Injection
Prenatal Service Package Initial Visit
Urgent Care Visit
Cheyenne Regional Urgent Care Clinic
All Other Urgent Care Facilities
Requires notification within 48 hours if out-of-network
Requires physician referral and preauthorization
Requires physician referral
Facility Services
Inpatient/Observation Hospital
Requires preauthorization
Skilled Nursing Facility
100 days lifetime maximum
Requires physician referral and preauthorization
8
Unlimited
You pay no deductible
Cheyenne Regional 2014 Benefits
MEDICAL AND PRESCRIPTION DRUG PLANS
BestLife Medical/Prescription Drug BASIC PLAN Continued
Tier 1
Exclusive Network
Tier 2
Extended Network
Tier 3
Out-of-Network
You pay after deductible
You pay after deductible
You pay after deductible
Laboratory Testing
$0
30% coinsurance
50% coinsurance
Radiology
$0
30% coinsurance
50% coinsurance
Diagnostic Studies (e.g., MRI, CT, PET)
$300 copay per study
30% coinsurance per study
50% coinsurance per study
Physical Therapy/Occupational Therapy
20 visits per incident per year
$25 copay
30% coinsurance
50% coinsurance
Speech Therapy
20 visits per incident per year
$25 copay
30% coinsurance
50% coinsurance
Cardiac Rehabilitation
$25 copay
30% coinsurance
50% coinsurance
50% coinsurance
50% coinsurance
50% coinsurance
20% coinsurance
30% coinsurance
50% coinsurance
Network Option
Diagnostic and Therapeutic Services
Requires physician referral and preauthorization
Requires physician referral
Requires physician referral and preauthorization;
benefit limited by diagnosis
Requires physician referral and preauthorization
Durable Medical Equipment
Requires physician prescription and preauthorization
Growth Hormone Injectable Medication
Requires physician prescription and preauthorization
$5,000 out-of-pocket maximum
Pharmacy Services
(Copayments for mail order or retail 90-day supply are
twice the listed amount. Deductible waived for mail
order services.)
Deductible
(per person)
You pay
$0
Generic Prescriptions
$10 copay + 15% coinsurance
Preferred Brand Prescriptions
$15 copay + 15% coinsurance
Non-Preferred Brand Prescriptions
$40 copay + 15% coinsurance
This benefit summary describes the coinsurance and/or copayment amounts that apply to specific types of covered services
under the Cheyenne Regional medical plans. Some services require preauthorization for coverage. Other services may have
limits, and certain services are excluded altogether. Members may also be responsible for additional costs that exceed regional
reasonable and customary fees when utilizing the out-of-network option. For a more complete description, please refer to the
Summary Plan Description (SPD) that discusses general information about health care services, obtaining covered services,
covered services, and limitation and exclusions. The SPD can be found at www.cheyenneregional.org/staffemployees/benefits.
Drugs listed as “preventive” in the Summary Plan Description are not subject to any medical or prescription deductible and/or
copay when prescribed according to preventive guidelines.
www.cheyenneregional.org/staffemployees/benefits
9
MEDICAL AND PRESCRIPTION DRUG PLANS
BestLife Medical/Prescription Drug PLUS PLAN
Network Option
Tier 1
Exclusive Network
Tier 2
Extended Network
Tier 3
Out-of-Network
Calendar Year Deductible
$750 individual
$1,500 family
$1,250 individual
$2,500 family
$2,000 individual
$4,000 family
$2,750 individual
$5,500 family
$4,250 individual
$8,500 family
$6,500 individual
$13,000 family
Benefit Maximums
Out-of-Pocket Maximum (per plan year)
Annual Benefit Maximum
Unlimited
Lifetime Benefit Maximum
Unlimited
Professional Services/Physician
Preventive Exam/Services
Professional Services/Physician
Office Visit
Primary Care Physician
Specialist
Allergy Injection
Prenatal Service Package Initial Visit
You pay no deductible
You pay
$0 copay
20% coinsurance
100%
You pay after deductible
You pay after deductible
You pay after deductible
$15 copay
$35 copay
$15 copay
20% coinsurance
20% coinsurance
20% coinsurance
40% coinsurance
40% coinsurance
40% coinsurance
$0
20% coinsurance
40% coinsurance
$15 copay
$50 copay
After Tier 1 deductible:
N/A
$50 copay
After Tier 1 deductible:
N/A
$50 copay
Home Health Care Visit
$0
20% coinsurance
40% coinsurance
Hospice
$0
20% coinsurance
40% coinsurance
Behavioral Health Visit
$15 copay
20% coinsurance
40% coinsurance
Chiropractic Visit
20 visit maximum per year
$25 copay
20% coinsurance
40% coinsurance
You pay after deductible
You pay after deductible
You pay after deductible
$250 copay per day,
max $1,250 copay per
admission
30% coinsurance
50% coinsurance
Outpatient Surgery
Hospital or Surgical Center
Office Procedure
$150 copay
$100 copay
30% coinsurance
30% coinsurance
50% coinsurance
50% coinsurance
Emergency Room/Treatment Room
Emergency Room Care
ER Referred by Nurseline
$300 copay
$125 copay
$300 copay after Tier 1 ded.
$125 copay after Tier 1 ded.
$300 copay after Tier 1 ded.
$125 copay after Tier 1 ded.
Ambulance
$100 copay
$100 copay after Tier 1 ded.
$100 copay after Tier 1 ded.
$0
20% coinsurance
40% coinsurance
Urgent Care Visit
Cheyenne Regional Urgent Care Clinic
All Other Urgent Care Facilities
Requires notification within 48 hours if out-of-network
Requires physician referral and preauthorization
Requires physician referral
Facility Services
Inpatient/Observation Hospital
Requires preauthorization
Skilled Nursing Facility
100 days lifetime maximum
Requires physician referral and preauthorization
10
You pay no deductible
Cheyenne Regional 2014 Benefits
MEDICAL AND PRESCRIPTION DRUG PLANS
BestLife Medical/Prescription Drug PLUS PLAN Continued
Tier 1
Exclusive Network
Tier 2
Extended Network
Tier 3
Out-of-Network
You pay after deductible
You pay after deductible
You pay after deductible
Laboratory Testing
$0
20% coinsurance
40% coinsurance
Radiology
$0
20% coinsurance
40% coinsurance
Diagnostic Studies (e.g., MRI, CT, PET)
$200 copay per study
20% coinsurance per study
40% coinsurance per study
Physical Therapy/Occupational Therapy
20 visits per incident per year
$25 copay
20% coinsurance
40% coinsurance
Speech Therapy
20 visits per incident per year
$25 copay
20% coinsurance
40% coinsurance
Cardiac Rehabilitation
$25 copay
20% coinsurance
40% coinsurance
20% coinsurance
30% coinsurance
50% coinsurance
20% coinsurance
30% coinsurance
50% coinsurance
Network Option
Diagnostic and Therapeutic Services
Requires physician referral and preauthorization
Requires physician referral
Requires physician referral and preauthorization –
benefit limited by diagnosis
Requires physician referral and preauthorization
Durable Medical Equipment
Requires physician prescription and preauthorization
Growth Hormone Injectable Medication
Requires physician prescription and preauthorization
$5,000 out-of-pocket maximum
Pharmacy Services
(Copayments for mail order or retail 90-day supply are
twice the listed amount. Deductible waived for mail
order services.)
Deductible
(per person)
You pay
$50
Generic Prescriptions
$10 copay
Preferred Brand Prescriptions
$15 copay
Non-Preferred Brand Prescriptions
$40 copay
This benefit summary describes the coinsurance and/or copayment amounts that apply to specific types of covered services
under the Cheyenne Regional medical plans. Some services require preauthorization for coverage. Other services may have
limits, and certain services are excluded altogether. Members may also be responsible for additional costs that exceed regional
reasonable and customary fees when utilizing the out-of-network option. For a more complete description, please refer to the
Summary Plan Description (SPD) that discusses general information about health care services, obtaining covered services,
covered services, and limitation and exclusions. The SPD can be found at www.cheyenneregional.org/staffemployees/benefits.
Drugs listed as “preventive” in the Summary Plan Description are not subject to any medical or prescription deductible and/or
copay when prescribed according to preventive guidelines.
www.cheyenneregional.org/staffemployees/benefits
11
BESTLIFE HEALTH REIMBURSEMENT ACCOUNT
Cheyenne Regional is pleased to offer employees that participate in a BestLife medical
plan and the BestLife wellness plan tax-free contributions to a BestLife Health
Reimbursement Account. You can use the money in your Health Reimbursement
Account to pay your medical and prescription drug deductibles, copays, and
coinsurance.
FOR MORE INFO...
Contact the BestLife Health
Reimbursement Account
administrator, Sterling HSA:
•
Call (800) 617-4729
Cheyenne Regional will deposit the money in your Health Reimbursement Account
• Go to www.sterlinghsa.com
the month following the completion of the Health Risk Assessment or a coaching call.
An eligible participating spouse’s Health Reimbursement Account contribution will
be deposited in the employee’s account. Health Reimbursement Account money that
you do not use during the calendar year automatically rolls over into your account for the next year. If you enroll in one of the
BestLife medical plans, you will automatically be enrolled in the BestLife Health Reimbursement Account.
For more information, go to www.cheyenneregional.org/staffemployees/benefits.
HRA CONTRIBUTIONS THAT YOU CAN EARN IN 2014
Amount*
Requirement
By When
$300**
BestLife Medical Plan Enrollment – For employees enrolled in employee-only
coverage
Upon Enrollment
$500**
BestLife Medical Plan Enrollment – For employees enrolled in employee +
spouse, employee + child(ren), or family coverage
Upon Enrollment
$150***
Employee Health Risk Assessment – ($50 for completing the assessment
and $100 for entering employee biometric information into the Health Risk
Assessment) PLUS receive a free one-year membership to the Health and
Fitness Center if you complete the Health Risk Assessment by 12/14/13.
December 14
$100****
Spouse Health Risk Assessment – ($50 for completing the assessment and $50
for entering spouse biometric information into the Health Risk Assessment)
December 14
Employee Coaching Calls
$75
1st Quarter Health Coaching Call
March 31
$75
2nd Quarter Health Coaching Call
June 30
$75
3rd Quarter Health Coaching Call
September 30
$75
4th Quarter Health Coaching Call
December 14
Spouse Coaching Calls
$50****
1st Quarter Health Coaching Call
March 31
$50****
2nd Quarter Health Coaching Call
June 30
$50****
3rd Quarter Health Coaching Call
September 30
$50****
4th Quarter Health Coaching Call
December 14
*When an employee is enrolled in one of Cheyenne Regional’s BestLife medical and prescription drug plans, all wellness
rewards are deposited, tax free, into the employee’s BestLife Health Reimbursement Account and can be used to pay
medical and prescription plan deductibles and copays. Eligible full-time and part-time employees who are not enrolled in
one of Cheyenne Regional’s BestLife medical and prescription drug plans earn after-tax cash wellness rewards included in
their pay based on the employee incentives listed above.
**This one time Health Reimbursement Account contribution is only available to employees enrolled in one of Cheyenne
Regional’s BestLife medical and prescription drug plans.
***New employees and employees who become eligible during the plan year have 30 days from the date of enrollment
in a BestLife medical and prescription drug plan to complete the Health Risk Assessment and receive the corresponding
Health Reimbursement Account contribution(s).
****Only spouses of employees enrolled in a BestLife medical and prescription drug plan are eligible for the Health
Reimbursement Account.
12
Cheyenne Regional 2014 Benefits
BESTLIFE WELLNESS PLAN
Cheyenne Regional knows our employees are our most valuable asset, and we
are pleased to provide a supportive work environment that encourages a culture
of wellness. The BestLife wellness program provides resources, programs,
challenges, and incentives to help employees make healthier lifestyle choices.
Our partnership with US Corporate Wellness brings you exciting new resources
to monitor and manage your health as well as highly trained wellness coaches
to confidentially discuss your wellness goals and support you on your wellness
journey. In addition to many wellness programs and activities throughout the
year, participation in specific BestLife activities through US Corporate Wellness
qualifies you for tax-free contributions to your BestLife Health Reimbursement
Account.
CONTACT INFORMATION
For more information about
the BestLife Wellness Program:
•
Call (307) 633-7897
•
Go to
www.USCorporateWellness.com
(to complete your Health Risk
Assessment)
• Call US Corporate Wellness
at (800) 910-9425
Health and Fitness Facility
Cheyenne Regional offers a full-service fitness facility that is open seven days a week to help you meet your wellness goals. Cheyenne Regional’s Health and Fitness Center is more than just a place where you can exercise—it’s a place where you can
focus on overall mind and body wellness—providing personal wellness training, group exercise, and rejuvenation. State-ofthe-art cardio and weight training equipment have recently been added. Cheyenne Regional’s Health and Fitness Center offers
total fitness assessments, individualized training sessions, and a variety of classes ranging from beginner level to advanced. To help you relax and rejuvenate, spa treatments and massage therapy sessions are also available on site. Discounted
membership rates are available to full-time and part-time employees and volunteers.
NEW for 2014!
If you complete the Health Risk Assessment by December 14, 2013, you will receive a one-year membership to the Cheyenne
Regional Health and Fitness Center for free. New employees and employees who become eligible during the plan year have 30
days from their date of enrollment in a BestLife medical and prescription drug plan to complete the Health Risk Assessment to
receive the free one-year Health and Fitness Center membership.
Cash Rewards
Full-time and part-time employees who are not covered by one of Cheyenne Regional’s BestLife medical plans cannot receive
contributions to a BestLife Health Reimbursement Account*. However, you can still receive cash rewards for completing
BestLife wellness activities as described on the previous page. Cash rewards are paid the month following completion of the
activity, are included in your pay post-tax, and may be used for any purpose.
*As described on page 12
www.cheyenneregional.org/staffemployees/benefits
13
DENTAL PLANS
Cheyenne Regional offers two dental plan options through Delta Dental of Wyoming. We are
pleased to provide this coverage with no increase in premiums for 2014.
The Basic Plan offers basic coverage at a lower premium. The Plus Plan offers enhanced benefits
at a higher premium. Both plans include the same network of providers. Locate a network
provider at www.deltadentalwy.org.
DENTAL PLANS
Benefit
Basic Plan
Plus Plan
$50 individual/$100 family
$75 individual/$150 family
100%
100%
Basic Restorative Services
Fillings, root canals, periodontics, and oral surgery
80% after deductible
80% after deductible
Major Restorative Services
Crowns, bridges, partials, and dentures
50% after deductible
75% after deductible
(includes synthetics)
Not covered
50%
up to $2,000 per person
(adults and dependents)
$1,200 per person
$2,000 per person
Calendar Year Deductible
(Applies to basic and major services)
Preventive Care
One cleaning and exam every 6 months, bite-wing x-rays
every 6 months (cleanings every 3 months for diabetics
and pregnant women)
Orthodontia
Annual Maximum
(Amount the plan will pay each year)
Dental Plan Costs
Listed below are the monthly and per-pay-period employee costs for dental coverage.
DENTAL RATES
Basic Plan
Monthly (*FT)
Monthly (*PT)
Per-Pay-Period
(*FT)
Per-Pay-Period
(*PT)
$6.82
$13.10
$3.41
$6.55
Employee + Spouse
$30.88
$44.02
$15.44
$22.01
Employee + Child(ren)
$35.88
$48.86
$17.94
$24.43
Family
$47.48
$60.76
$23.74
$30.38
Monthly (*FT)
Monthly (*PT)
Per-Pay-Period
(*FT)
Per-Pay-Period
(*PT)
Employee
$11.02
$21.20
$5.51
$10.60
Employee + Spouse
$49.80
$71.00
$24.90
$35.50
Employee + Child(ren)
$57.88
$78.84
$28.94
$39.42
Family
$76.62
$98.06
$38.31
$49.03
Level of Coverage
Employee
DENTAL RATES
Plus Plan
Level of Coverage
*FT = Full-Time, PT = Part-Time
14
Cheyenne Regional 2014 Benefits
VISION PLAN
Cheyenne Regional offers a comprehensive vision plan through Vision Service Plan (VSP). We are pleased to provide this
coverage with no increase in premiums for 2014.
The vision plan covers eye exams, frames, lenses, and contacts. You have the option to see any provider, but will receive
the highest benefits and pay less out of your pocket when you use a VSP participating network provider. Locate a Select
network provider at www.vsp.com.
VISION PLAN
Benefit
Exams (once every plan year)
$10 copay
Prescription Glasses
$25 copay
Lenses (once every plan year)
100% (single vision, bifocal, trifocal, progressive)
Frames (once every other plan year)
$140 allowance
Contact Lenses (in lieu of lenses and
frames; once every plan year)
$140 allowance
Vision Plan Costs
Listed below are the monthly and per-pay-period employee costs for vision coverage.
Note: The rates are the same for both full- and part-time employees.
VISION RATES
Level of Coverage
Monthly
Per-Pay-Period
Employee
$10.34
$5.17
Employee + Spouse
$16.24
$8.12
Employee + Child(ren)
$17.38
$8.69
Family
$27.80
$13.90
www.cheyenneregional.org/staffemployees/benefits
15
FLEXIBLE SPENDING ACCOUNTS
Participating in the flexible spending account (FSA) programs is a great way
to plan ahead and save money over the course of the year. FSAs offer you a
convenient way to set aside pre-tax dollars to pay for eligible medical and
dependent care expenses.
Healthcare FSA
Contribute up to $2,500 per year to pay for eligible healthcare expenses
including deductibles, copays, and coinsurance. Healthcare FSA dollars can be
used for medical, dental, and vision expenses for you and your dependents.
NOTE: Healthcare FSA dollars cannot be used to reimburse expenses paid
by the insurance plans and/or Health Reimbursement Account dollars. Thus,
if you use FSA dollars to pay for eligible healthcare expenses, you cannot be
reimbursed from your Health Reimbursement Account.
Dependent Care FSA
Contribute up to $5,000 per year to pay for eligible dependent care expenses
including day care facility fees, before- and after-school care, and in-home
babysitting fees. You and your spouse must work or attend school full time to
participate in the dependent care FSA.
You will receive a debit card that you can use for eligible healthcare
FSA and dependent care FSA expenses. Be sure to save your receipts
to substantiate the expense.
16
Cheyenne Regional 2014 Benefits
FSA SPENDING RULES
Know the IRS rules:
1. Your participation cannot
be changed during the plan
year unless you experience
a qualifying life event such
as marriage, birth, or loss of
coverage (see page 4). You
have 30 days to make benefit
changes due to a qualifying
life event.
2. Money set aside for the
healthcare FSA cannot be
used to pay dependent care
expenses, and dependent
care funds cannot be used to
pay medical expenses.
3. Unused funds will be forfeited
105 days after the end of the
plan year, which is
December 31, 2014.
BASIC LIFE AND ACCIDENTAL DEATH AND
DISMEMBERMENT INSURANCE
Cheyenne Regional provides group term life and accidental death and dismemberment (AD&D) insurance to all eligible
employees at no cost. Life insurance plans are designed to provide a source of income protection for your family in the
case of death or serious injury. This life insurance policy is payable to your named beneficiary. Your AD&D benefit is equal
to the amount of your life insurance benefit and is payable to you if you suffer a covered loss of a limb or sight, or to your
named beneficiary if you die as a result of an accident.
Employee Type
Coverage Payment
Exempt (salaried), full-time employees
2x annual base salary rounded to the next higher
$1,000 multiple—to a maximum of $500,000*
Non-exempt (hourly), full-time employees
1x annual base salary rounded to the next higher
$1,000 multiple­—to a maximum of $500,000*
Part-time employees
$10,000*
*Benefit reductions apply to employees age 65+.
SUPPLEMENTAL LIFE INSURANCE
Cheyenne Regional provides eligible employees with the option to purchase supplemental life insurance, which the
surviving family may need to maintain its standard of living. Lincoln Financial and Colonial Life offer you the ability to
“buy up” life insurance to provide your family with additional financial security. Options include term life insurance and
universal life insurance (with long-term care rider). Premiums are based on age, smoking status, and coverage selected.
Contact Lincoln Financial and/or Colonial Life for additional information (see page 23 for contact details).
www.cheyenneregional.org/staffemployees/benefits
17
SHORT-TERM DISABILITY
Circumstances can change in an instant—a car or recreational accident, a
sudden illness, or a medical crisis—and being prepared gives you peace of mind.
Cheyenne Regional provides short- and long-term disability coverage to all
eligible employees at no cost.
IMPORTANT!
Short-term and long-term
disability are not available if the
illness or injury is work-related.
For work-related illnesses or
injuries, contact Occupational
Health at (307) 633-7897.
This benefit is designed to replace a portion of your income in the event that
a personal medical illness, injury, or maternity leave* keep you from working.
The first seven calendar days after a disability will be paid by PTO or unpaid leave if PTO is exhausted. The seven-day
elimination period is waived if you have an overnight stay in the hospital.
SHORT-TERM DISABILITY (STD)
Benefit
Coverage Payment
Weeks 1-6
90% of pre-disability earnings
Weeks 7-12
70% of pre-disability earnings
Weeks 13-26
50% of pre-disability earnings
*Short-term disability (STD) leave can also be used for maternity leave. An employee eligible for maternity leave may be eligible to obtain
up to eight weeks disability pay.
LONG-TERM DISABILITY INSURANCE
Long-term disability replaces 50 percent of pre-disability earnings after an employee has exhausted 26 weeks of short-term
disability coverage. Long-term disability is payable until you reach the social security normal retirement age or until you are
no longer disabled.
Lincoln Financial, the insurance provider, will determine how long the disability will be approved for payment based upon
medical verification provided by your physician. Income replacement is calculated upon your base pre-disability earnings and
does not include shift differential or overtime.
SUPPLEMENTAL DISABILITY INSURANCE
Cheyenne Regional provides eligible employees with the option to purchase additional disability coverage through Colonial
Life to help offset financial losses when you are unable to work due to an illness or injury. This benefit can supplement your
income to help you pay some of your everyday expenses such as mortgage or rent payments, utility bills, as well as other
household expenses, food and clothing. Premiums are based on age, salary, and coverage selected. Contact Colonial Life for
additional information (see page 23 for contact details).
VOLUNTARY ACCIDENT, CANCER, CRITICAL ILLNESS, AND
MEDICAL BRIDGE HOSPITAL CONFINEMENT PLANS
Cheyenne Regional has partnered with Colonial Life to offer you voluntary benefits at discounted group rates. These plans are
paid by you through regular payroll deduction, and are designed to pay you in the event of accident, cancer, critical illness,
hospital confinement, or surgery. Family coverage is available. Contact Colonial Life for additional information (see page 23
for contact details).
18
Cheyenne Regional 2014 Benefits
EMPLOYEE ASSISTANCE PROGRAM
Cheyenne Regional cares about its employees’ health and well-being, which
is why we offer the employee assistance program (EAP) through Resources
for Living. The EAP is a confidential resource designed to help you and your
family members manage challenges that are affecting your quality of life.
This benefit is free to all Cheyenne Regional employees, dependents, and
family members. You do not need to be enrolled in a Cheyenne Regional
benefit plan to participate.
Confidentiality is totally assured for you, your dependents, and your
household members. Cheyenne Regional will not be informed of your
participation. Information will only be released with your permission, or as
required by law for child or elder abuse, or in a life-threatening situation.
CONTACT INFORMATION
The EAP is available 24 hours
a day, seven days a week, for
crisis calls, counseling, and
referral.
Call (800) 284-1819
-orVisit www.mylifevalues.com
Login ID: Cheyenne Regional
Password: eap
The EAP includes resources to help with:
•
•
•
•
•
•
•
•
Conflicts at home or work
Child behavior issues
Family concerns
Depression
Managing stress
Marriage or life partner problems
Alcohol and drug problems
Grieving the loss of a loved one
•
•
•
•
•
•
•
•
Coping with serious illness or injury
Caring for elderly family members
Financial resources
Legal resources
Work-life services
Health and wellness resources
Face-to-face counseling sessions
ID theft counseling
www.cheyenneregional.org/staffemployees/benefits
19
RETIREMENT SAVINGS PLANS
The Cheyenne Regional retirement plans, administered by Great-West Financial,
described below are powerful tools to help you reach your retirement goals. As a
supplement to other retirement benefits or savings that you have, these plans allow
you to save and invest extra money for retirement consistently and automatically.
In additional to the brief information provided below, Cheyenne Regional has a
separate Retirement Plans Brochure and Enrollment Kit available from Human
Resources. Be sure to obtain and review that additional information for important
legal information regarding eligibility and participation in the plans.
RETIREMENT PLAN
CONTRIBUTION LIMITS
• You may contribute from
1% to 100% of your
earnings, not to exceed
the annual IRS maximum.
403(b) Defined Contribution Plan
• Employees age 50+ by
Cheyenne Regional’s 403(b) plan is a retirement plan designed for public employers.
December 31, 2014, may
Contributions and any earnings are tax deferred until money is withdrawn.
contribute an additional
Distributions are usually taken at retirement, when participants are typically
catch-up contribution in
receiving less income and may be in a lower tax bracket. You are always 100 percent
2014.
vested in the contributions you make to the Cheyenne Regional 403(b) plan.
403(b) Roth Defined Contribution Plan
Your 403(b) plan also offers a Roth contribution option. This gives you the flexibility to designate all or part of your 403(b)
elective deferrals as Roth contributions. Roth contributions are made with after-tax dollars, as opposed to the pre-tax dollars
you contribute to a traditional 403(b) account. In other words, with the Roth option, you’ve already paid taxes on the money
you contribute. You are always 100 percent vested in the Roth contributions you make to the plan. The 401(a) employer match
described below does not apply to your Roth contributions.
457(b) Deferred Compensation Plan
The governmental 457(b) deferred compensation plan offered by Cheyenne Regional is a retirement savings plan that eligible
employees may use in addition to any existing retirement benefits by saving and investing before-tax dollars through voluntary
salary deferral. Distributions are usually taken at retirement, when participants are typically receiving less income and may
be in a lower income tax bracket. You are always 100 percent vested in the contributions you make to the Cheyenne Regional
457(b) plan.
457(b) Roth Deferred Contribution Plan
Your 457(b) plan also offers a Roth contribution option. This gives you the flexibility to designate all or part of your 457(b)
elective deferrals as Roth contributions. Roth contributions are made with after-tax dollars, as opposed to the pre-tax dollars
you contribute to a traditional 457(b) account. In other words, with the Roth option, you’ve already paid taxes on the money
you contribute. You are always 100 percent vested in the Roth contributions you make to the plan. The 401(a) employer match
described below does not apply to your Roth contributions.
401(a) Employer Matching Contribution Plan
Cheyenne Regional’s 401(a) plan is a retirement savings plan designed to allow Cheyenne Regional to supplement its
employees’ existing retirement benefits by contributing to the plan on the employees’ behalf. Contributions and any earnings
on contributions are tax deferred until the money is withdrawn. When you contribute to the 403(b) plan or 457(b) plan,
Cheyenne Regional will match 100 percent of the first 4 percent of your combined compensation that you contribute in pre-tax
deferrals (subject to IRS limits). The 401(a) match will be made to your account each pay period. Employer contributions to
the 401(a) plan plus any earnings they generate have a one-year vesting requirement, which means the balance is 100 percent
yours after you complete one year of service as an eligible employee in which you worked a minimum of 800 hours. Once you
have fulfilled that criteria, the total account balance is yours when you separate service or retire from Cheyenne Regional.
20
Cheyenne Regional 2014 Benefits
EDUCATION ASSISTANCE
Eligibility: Employees who are classified as full-time or part-time exempt or hourly, have worked at Cheyenne Regional for
a minimum of 120 days, and have received no corrective action in the past 120 days are eligible for Education Assistance.
Ineligible staff include: PRN, temporary, contract staff, and staff with disciplinary action within 120 days of application.
Course Criteria: All secondary education courses must be through an accredited degree granting institution. The institution
must be accredited by the Institutional Accrediting Bodies, which are recognized by the Council for Higher Education
Accreditation. Certification and/or continuing education that is not required as a condition of employment may be eligible for
reimbursement.
Course Consideration: Only courses/degrees that apply to positions that benefit Cheyenne Regional will be eligible for
consideration of reimbursement.
Employment Commitment: Staff who receive Education Assistance must agree to continued employment at Cheyenne
Regional. Commitment period is based on amount reimbursed (see table below), and begins after successful completion of
approved course(s), and is extended for each amount received.
Amount Borrowed
Commitment Period
$1–$1,500
6 months
$1,501–$3,000
12 months
$3,001–$5,000
18 months
*Reimbursement will be provided for tuition/cost of the course(s), lab fees, and any associated textbook(s) only.
*Maximum allowance during fiscal year is $5,000 for a full-time employee and $3,000 for a part-time employee.
www.cheyenneregional.org/staffemployees/benefits
21
PAID TIME OFF
At Cheyenne Regional, we recognize that achieving work-life balance means something different for everyone and can include
going on vacation, spending time with friends and family, or attending a child’s school activities. We value this balance
because we know an employee with a well-balanced life is a happier and more productive employee. We encourage employees
to take time away from work, when the situation allows, using paid time off (PTO). Accrued PTO is available for sick leave,
holidays, vacation, and other personal time off, as approved by your supervisor. It’s one of the many ways we at Cheyenne
Regional offer flexibility and choice for our employees. Eligible employees accrue PTO immediately upon hire, and PTO is
available for use as soon as it is accrued. The accrual rates are listed in the tables below.
An employee may trade PTO hours for cash during a scheduled election period as long as his or her PTO account remains
above 40 hours. An employee may elect to cash out PTO hours up to two times per calendar year. The PTO cash out benefit is
subject to change.
Employee Type
Length of Service
Accrual Rate
Maximum Accrual
Non-Exempt/Hourly
1 year
.0885 x hours worked
max 7.08 hours
184 hours
Non-Exempt/Hourly
2–4 years
.1077 x hours worked
max 8.62 hours
328 hours
Non-Exempt/Hourly
5–9 years
.1304 x hours worked
max 10.43 hours
328 hours
Non-Exempt/Hourly
10–19 years
.1607 x hours worked
max 12.86 hours
328 hours
Non-Exempt/Hourly
20+ years
.1872 x hours worked
max 14.98 hours
328 hours
Exempt/Salaried
1 year
.0885 x hours regularly
scheduled per pay period
max 7.08 hours
184 hours
Exempt/Salaried
2–4 years
.1077 x hours regularly
scheduled per pay period
max 8.62 hours
328 hours
Exempt/Salaried
5–9 years
.1304 x hours regularly
scheduled per pay period
max 10.43 hours
328 hours
Exempt/Salaried
10–19 years
.1607 x hours regularly
scheduled per pay period
max 12.86 hours
328 hours
Exempt/Salaried
20+ years
.1872 x hours regularly
scheduled per pay period
max 14.98 hours
328 hours
Note: Managers, Directors, Administrators, and Executive-level positions earn an additional .019 x regularly schedule hours
per pay period, max 1.54 hours per pay period (40 hours per year).
22
Cheyenne Regional 2014 Benefits
IMPORTANT CONTACT INFORMATION
Contact
Phone #
Website
BestLife Medical Plan
administration provided by
WINhealth Partners
(307) 773-1305
bestlife.healthtrioconnect.com
BestLife Wellness Program
administration provided by US
Corporate Wellness
(307) 633-7897
(800) 910-9425
www.USCorporateWellness.com
BestLife Health Reimbursement
Account and FSA administration
provided by Sterling HSA
(800) 617-4729
www.sterlinghsa.com
(307) 773-1305 option #2
N/A
Delta Dental Benefits
(307) 632-3313
www.deltadental.com
VSP Vision Benefits
(800) 877-7195
www.vsp.com
Colonial Life Supplemental Benefits
(800) 325-4368 for claims
(866) 270-6733
for the Denver office
www.coloniallife.com
Lincoln Financial Supplemental Life
and AD&D
(800) 423-2765
www.lincoln4benefits.com
Resources for Living Employee
Assistance Program
(800) 284-1819
www.mylifevalues.com
Login: Cheyenne Regional
Password: eap
Great-West Financial
(866) 467-7756
www.gwrs.com
Cheyenne Regional Human
Resources and Benefits
(307) 633-7871
(307) 633-7700
www.cheyenneregional.org/
staffemployees/benefits
Nurse Response Line 24/7
www.cheyenneregional.org/staffemployees/benefits
23
2014
EMPLOYEE BENEFITS
Cheyenne Regional Benefits
(307) 633-7700
www.cheyenneregional.org/staffemployees/benefits
This Employee Benefits Guide is intended to show highlights of Cheyenne Regional’s employee
benefit plans. Please refer to the Summary Plan Description (SPD) or Evidence of Coverage for
detailed information on the plans. In the event of a discrepancy between this Benefits Guide
and the plan document, the plan document will rule.
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