MRCY_BRC-Open Enrollment Guide(final) - Mercy

Choosing the Right Benefits
2012
Open Enrollment Guide
for Mercy Benefit Eligible Co-workers
Open Enrollment October 17-November 7
https://2012benefits.mercy.net

Mercy strives to offer a strong
benefits package that reflects our commitment
to you, while meeting the diverse needs of our many co-workers.
This guide contains important information about your benefits.
The most important thing to know is that you will need to
enroll to continue benefits coverage in 2012.
In 2012 the enrollment period is October 17 through November
7. You must complete enrollment even if there are no changes in
your elections for 2012. The benefits you elect during this period
are effective from January 1, 2012, through December 31, 2012.
You can’t change the benefits you elect after open enrollment
unless you have a change in family status event such as a
marriage, divorce or birth of a child. (See Change in Family
Status section for more information).
What’s New in 2012
• MyChoice will not be offered.
• Changes have been made to the Mercy Medical, Dental
and Vision Plans.
• MetLife will administer the Mercy Dental Plan.
• VSP will administer the Mercy Vision Plan.
• LDI, Inc. will administer the pharmacy benefit for all Mercy
co-workers.
• Some co-worker premiums have changed.
All 2012 Open Enrollment
information is found:
1
1. Go to: https://2012benefits.mercy.net
2
2. Or, go to: http://baggotstreet.mercy.net. Click on the My
Worklife tab, then select the My Benefits Home link.
You will find:
• 2012 Open Enrollment Guide
• 2012 Mercy Benefit Summary Booklet
• 2012 Mercy Medical Benefit Summary of Benefits
• Additional information about the Mercy Dental Plan with
MetLife
• Additional information about the Mercy Vision Plan
with VSP
• Information about the Mercy prescription drug benefit
• And much more

Who Is Eligible
For Benefits?
• Full-time co-workers who regularly work at least 72
hours per pay period.
• Part-time co-workers who regularly work at least 32
hours per pay period.
• Your lawfully married spouse of the opposite sex.
• Your common law spouse (in the state of Oklahoma
only).
• Your children, married or unmarried, up to age 26:
• Natural child
• Legally adopted child
• A child placed with you for adoption
• Your step-child
• A child who has been legally placed with you by an
authorized placement agency or by judgment,
decree or other order of any court of competent
jurisdiction, including a foster child.
You don’t have to cover the same dependents in each plan. For
example, you may cover your entire family for medical and only
yourself for dental.
Mercy requires co-workers to provide specific
documentation when covering their eligible dependents.
Without the required documents, co-workers will not be
allowed to add dependents.
Change In Family Status
The choices you make now remain in effect for 2012 unless
you experience a change in family status event. This applies to
medical, dental, vision, supplemental life, LTD and FSA
elections. A change in family status includes:
• Marriage or divorce.
• Birth, adoption or placement for adoption of a child.
• Death of a spouse and/or dependent.
• Loss or gain of coverage due to a change in your spouse’s
employment status, or open enrollment with their
employer.
• Change of employment status from eligible to ineligible
status, full-time to part-time, or vice versa.
• A dependent’s loss of eligibility because he/she has
reached age 26.
• Any other change that is permissible under IRS regulations
and rulings as determined by Mercy.

Mercy Medical Plan
Next year, Mercy will still offer the same three-tier plan design and the
same provider networks, but MyChoice will no longer be offered. This
means you won’t have to complete the three steps of participation.
Wellness continues to be a very important part of Mercy’s commitment
to co-workers. We believe in the value of preventive care and screenings
because the more you know about your health (and risk factors), the
healthier you can be.
Mercy currently offers wellness incentives through Healthification for
taking online courses and completing at least 600 minutes of physical
activity each month.
While these incentives are not the same as premium discounts, they help
us continue to reward healthy behaviors in a meaningful way. Additional
incentives through Healthification will be offered that reward
participation in disease management programs — asthma, depression
and diabetes — as well as participation in the Maternity Support Program
and/or a tobacco cessation program.
Managing the cost of health care remains a challenge, so some of the
co-pays and co-insurances have increased. They are bolded in the table
below.
We’re committed to working together to ensure coverage is competitive,
affordable and focused on overall health.
For a list of medical benefits by tier, see the 2012 Mercy Medical Benefit
Summary. This can be found on https://2012benefits.mercy.net, or on
Baggot Street (http://baggotstreet.mercy.net), click the My Worklife tab,
then the Benefits Home link.
Mercy Advantage Comprehensive Out-of-Network My Notes
(Tier 1) (Tier 2) (Tier 3)
Deductible
Co-worker only $200 $500 $3,000 If I have a claim, I pay the
Co-worker + 1 $400 $1,000 $6,000 deductible first, then the plan
Co-worker + 2 or more $600 $1,500 $9,000 pays a co-insurance.
Co-insurance 15% 30% 50% This is the amount I pay after
(after deductible)
the deductible. The plan pays the
most when I go to a Mercy
provider.
Out-of-Pocket Max
Co-worker only $1,450 $3,500 Unlimited Once I’ve met my out-of-pocket
Co-worker + 1 $2,900 $7,000 max for the year, the plan pays 100%
Co-worker + 2 or more $4,350 $10,500 except for co-pays and prescriptions.
Lifetime Max Unlimited Unlimited Unlimited
Primary Care Co-pay $20 $35 50% When I go to a network doctor in
Tier 1 or 2, I only pay a co-pay.
Specialist Co-pay $35 $50 50%
Preventive Care $0 $0 Not covered Mercy pays for certain preventive
care when I stay in-network.
Emergency Room $125/$250 $125/$250 $125/$250 If I call Nurse-on-Call before
(True/Non-True)
going to the ER, I may eliminate
an unnecessary visit.
Urgent Care $50 $50 $50
Maternity One time $100 One time $200 50% One time co-pay includes two
co-pay for all co-pay for all ultrasounds .
office visits associated office visits associated
with prenatal care with prenatal care
during a single
during a single
pregnancy
pregnancy
Lab and x-ray 15% 30% 50%
High cost diagnostics 25% after 40% after 50%
(MRI and PET scans) deductible deductible
Chiropractic Services $25 co-pay per visit $25 co-pay per visit In-network only
up to $500 up to $500
annual max
annual max
Page 3

Prescription Drug Benefit
On January 1, LDI, Inc. will be the pharmacy benefit manager for all Mercy
co-workers and their dependents. This will result in some changes to the
current formulary and the requirements of some prescription drugs on
the formulary, such as prior authorization, quantity limits or step therapy.
You and your provider will receive a letter before January 1 if a
prescription medication you are currently taking is affected by this
change.
First Fills at any Pharmacy,
Refills at a
Refills at a Preferred Pharmacy Non-Preferred Pharmacy My Notes
Tier 1 $4 $20 Using generics and buying them from a
(Generic)
Preferred pharmacy saves me money.
Tier 2 $35 $50
(Brand)
Tier 3 $55 $75 Includes specialty
(Non-preferred Brand)
90-Day Supply 2½ times co-pay Mail order is a good choice for maintenance
Mail Order for a 90-day supply drugs. Specialty drugs, 30-day supply only.
* Mercy pharmacies and LDI are the only mail order options. Wal-Mart is not an option for mail order.
• Co-workers who don’t have access to a Mercy pharmacy can use Wal-Mart as their preferred pharmacy for 30-day fills and pay the lower co-pay.
• If you are employed by one of the following facilities, your preferred pharmacy is Mercy: Ft. Smith, Kansas, Aurora, Cassville, Lebanon, Springfield,
Mountain View, Ministry Office, St. Louis and Washington.
If you are a retiree or you are employed by one of the following facilities your preferred pharmacy is Walmart or Mercy: Oklahoma City, Ardmore,
Maude Norton, Joplin, Hot Springs, NW Arkansas, Springfield (living in Arkansas), Berryville, and out-of-area Mercy.
Mercy Dental Plans
On January 1, Mercy’s new dental plan administrator will be MetLife. You will have access to their website where you can review the plan details, look
up your claims, print ID cards and even receive an email when your claim has been processed.
Some Important Dental Plan Details
• The new Mercy dental plan includes a network of dentists. When you
use a network dentist, you don’t need an ID card and there are no
claim forms or paperwork to complete. Just tell your dentist you have
MetLife.
• You can still choose any dentist you want. But if you go out of network,
you could pay more out-of-pocket and you may need to show an ID
card or file your own claim with MetLife for reimbursement.
• You can find a participating dentist by going to www.metlife.com and
clicking on Find A Dentist on the right side of the screen, or calling
1-800-942-0854.
• Additional materials can be found on
https://2012benefits.mercy.net, or on Baggot Street
(http://baggotstreet.mercy.net). Click the My Worklife tab, then
the Benefits Home link.
• Some co-insurances have changed. Changes are bolded in the
table below.
Provision Basic Dental Plan Premium Dental Plan My Notes
Deductible (single/family) $50/$150 $50/$150 Family is considered 3 or more
Preventive Care 100% of Reasonable 100% of Reasonable Exams & cleanings twice a year
and Customary (R&C)
and Customary (R&C)
Basic Restorative 70% of R&C following 80% of R&C following Includes fillings, wisdom teeth
deductible
deductible
Major Restorative 40% of R&C 50% of R&C Includes crowns, bridges & dentures
following deductible
following deductible
Orthodontia No Coverage 50% to $2,000 lifetime The difference between the Basic
limit per participant & Premium plans are orthodontia
& annual maximums.
Annual Benefit Maximum $1,000 per $2,000 per
participant
participant

Mercy Vision Plan
On January 1, Mercy’s new vision administrator will be VSP. You will have access to their full-featured website where you can view
plan benefits and claim activity, locate a provider, print an ID card and much more.
Important Vision Plan Details
• The new Mercy vision plan includes a network of providers. When
you choose a VSP network provider, your cost is lower, you don’t
need an ID card and there are no claim forms or paperwork to
complete. Just let your doctor know you have VSP.
• You can still choose any provider you want. But if you go out of
network, you could pay more out-of-pocket and you may need to
show an ID card or file your own claim with VSP for reimbursement.
• To find an in-network provider, visit www.VSP.com or call
1-800-877-7195.
• Additional materials can be found on
https://2012benefits.mercy.net, or on Baggot Street
(http://baggotstreet.mercy.net). Click the My Worklife tab, then the
Benefits Home link.
• The Mercy Vision Plan has changed. See table below.
Provision In-Network Out-of-Network My Notes
Eye Exam $10 co-pay $45 allowance
Contacts $25 co-pay $105 allowance Plan covers one pair of glasses OR
($140 allowance) 12 months of contacts annually.
Lenses $0 $40 allowance If I stay in network, lenses are
Single Vision $0 $30 allowance included in the $25 co-pay, for
Bifocal Vision $0 $50 allowance frames/contacts (not including
Trifocal Vision $0 $65 allowance add-ons, such as tinting).
Lenticular Vision $0 $100 allowance
Frames $25 co-pay $70 frame Plan covers one pair of glasses OR
($140 allowance) allowance 12 months of contacts annually.
A note about “Allowance” — The allowance is the amount you are ‘allowed’ to spend on the particular product or service. Amounts
that exceed the allowance are your responsibility.
Supplemental &
Dependent Life Insurance
Supplemental and
Dependent Life My Notes
Co-worker 1-4 times salary Can only increase by one
up to $2.5 million when times salary. EOI is
combined with basic life required for any increase.
Spouse $10,000 increments EOI is required for any
up to $100,000 increase.
Child(ren) $10,000 for each child No EOI required
Accidental Death &
Dismemberment (AD&D)
AD&D
My Notes
Co-worker $50,000 increments Any amount over $150,000
up to 10x annual salary cannot exceed 10x annual
or $750,000 salary.
Spouse 50% or 100% of
co-worker’s AD&D
up to $500,000
Child(ren) 10% of co-worker This is per child.
amount up to $50,000
• Mercy provides full-time benefit eligible co-workers two times annual salary in basic life and AD&D, at no cost to them.
• Part-time benefit eligible co-workers receive one times annual salary in basic life and AD&D, at no cost to them.
• Full and part-time benefit eligible co-workers can elect supplemental life and AD&D for themselves and their eligible dependents at their expense.
• You may increase your supplemental life insurance by one times your salary during annual enrollment. Increases are subject to Evidence of
Insurability (EOI). See online enrollment site for more information.

Long Term Disability (LTD)
Basic
Premium
60% of monthly pay up to $10,000 per month
66⅔% of monthly pay up to $10,000 per month
• LTD replaces a portion of your income if you become disabled and can’t work for an
extended period of time.
• Mercy provides full-time co-workers with one or more years of continuous full-time
service with basic LTD coverage at no cost.
• Full-time benefit eligible co-workers can elect to buy-up additional LTD. Part-time
benefit eligible co-workers may purchase the basic LTD (60% plan) only (where
offered).
Flexible Spending Accounts (FSA)
Annual Minimum
Annual Maximum
Health Care $130 $5,000
Dependent Care $480 $5, 000
(total combined limit if married or if
single with eligible dependent)
$2,500
(if you and your spouse file separate
income tax returns)
• You don’t have to be enrolled in Mercy’s other benefits to enroll in an FSA.
• Mercy’s FSA vendor is WageWorks. When you enroll in an FSA, WageWorks will send you a kit
with information about filing claims, eligible expenses, customer service, online support and
how to open and access your account.
• A Visa® “Take Care” debit card can be used to pay for expenses. Money is instantly deducted
from your FSA account. Save all receipts for items purchased with the “Take Care” card. You will
receive this card from WageWorks.
• Eligible expenses you incur between January 1, 2012 and March 15, 2013 must be submitted
for reimbursement by June 15, 2013, or you will lose these dollars.
• Your annual election is withdrawn from your paycheck in equal installments each pay period.
• Upon termination or loss of eligibility, you have only 90 days to submit claims for
reimbursement.
Important Facts About the Dependent Care FSA
• Your total contribution cannot be greater than your earned income or your spouse’s, whichever
is lower.
• You are not eligible for reimbursement if your spouse has no earned income unless your spouse
is a full-time student or is disabled.

How To Enroll in Benefits for 2012
Co-workers hired before October 10 must enroll online at
https://2012benefits.mercy.net between October 17 and
November 7. Co-workers hired after October 10 must
complete a paper enrollment form by December 31 to enroll
in benefits with an effective date of January 1, 2012.
Using the Online Enrollment System
Before you start
The online enrollment system is available from work or home
during open enrollment (October 17 — November 7). Your
computer must have Internet Explorer 5.0 or greater
ºinstalled to access the system.
Logging On
1 Go to https://2012 benefits.mercy.net. This is where
you log on to make your 2012 elections.
2 All enrollment documents are to the right of the screen
under the header Open Enrollment Materials.
3 Log on by entering your co-worker ID (also called
Lawson ID) and password. If you need to set up a
password, click Forgot Your Password or call 866-440-
3399.
Finding my co-worker (Lawson) ID:
1 Look on the top of your pay stub to the right of
your name.
2 Look in Kronos if you have the Kronos software on
your PC. See directions below.
3 Ask your Kronos editor or leader.
To Find Your ID in Kronos:
1 Click on Start > All Programs > Kronos > Kronos
2 Log On to Kronos
Contact the MTS Service Center at x3399
(2‐3399 in Springfield) or 1‐866‐440‐3399 with
any log-on issues or questions.
3 Once logged into Kronos:
• Click on the My Information tab
• Click on My Timecard
• Your name and Lawson ID are at the top of
the page
Completing Your Enrollment
All benefits will show as “no coverage.” You must make an
election for your benefits. (The exceptions are life insurance
and retirement. See step 3 and step 7 below.)
You must verify and save each step. You can proceed to the
next step when you receive the green check mark.
Step 1 | Personal Data
Step 2 | Health, Dental and Vision: The dependent grid at the
bottom of this screen will be populated with all of your
dependents currently in the Lawson Payroll System. You
must select which coverage you want each dependent to
have, if any.
Step 3 | Life Insurance: This is a “read only” screen. Follow
the instructions if you want to make changes to your
current voluntary life elections. Otherwise, your current
elections will rollover to 2012.
Step 4 | Long-Term Disability (LTD)
Step 5 | Flexible Spending Accounts: A link to the
Wageworks website will be available so you can see what
you elected in 2011 and/or use the Wageworks calculator
to determine how much to elect in 2012.
Step 6 | Authorization
Step 7 | Retirement Program: Your current election will show
on the screen, along with a link to the Retirement website.
If you want to change your current election you must
complete the change form on the retirement site.
Step 8 | Final Review: Print your confirmation statement of
your successful enrollment for your records, or email it to
yourself.
Key Contact Information
Benefit Enrollment Site . . . . . . . . . . . . . . . . . . . . . https://2012benefits.mercy.net
Coventry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 855-96-Mercy (6-3729)
Nurse on Call . . . . . . . . . . . . . . . . . . . . . . . . . . 855-530-5300 or 417-820-5662
MetLife Dental . . . . . . . . . . . . . . . . . . . . . . . . . www.metlife.com or 1-800-942-0854
VSP Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . www.vsp.com or 800-877-7195
Flexible Spending Accounts . . . . . . . . . . . . . . . . . . www.myflexonline.com or 877-423-7125
My Retirement Program . . . . . . . . . . . . . . . . . . . . www.myretirementprogram.com or 866-341-5681
Prior Authorization for Mental Health and . . . . . . . . . 314-729-4600 or 800-413-8008
Chemical Dependency Benefits