Advocate Benefits - Advocate Health Care

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Cost Advocate pays the full cost of Basic Life and AD&D Insurance and basic Short-Term Disability (STD) and Long-Term Disability (LTD) coverage for you. You and Advocate share the cost of any medical and dental coverage you choose, while you pay the full cost—based on low group insurance rates—for any Optional Life and AD&D Insurance and “buy-up” STD coverage you choose, as well as the full cost of any other optional benefits coverage you choose (e.g., vision coverage, Hyatt Legal Plan, Commuter Benefits). New for 2011: Salary-based contributions for medical coverage If you’re a Full-time associate, what you pay for medical coverage will be determined by benefits-eligible service AND annual base salary. With this approach: The longer you work for Advocate, the less you’ll pay for medical coverage…in short, it pays to stay. The more you earn, the more you’ll pay and the less you earn, the less you’ll pay. Making good choices Medical benefits Advocate offers two medical plans: PPO/Deductible Reimbursement Plan (PPO/ DRP)—administered by either Blue Cross/Blue Shield (BCBS) or Humana, or Health Maintenance Organization (HMO)— administered by Humana. You and Advocate share the cost of your medical coverage. The cost you pay is based on: The plan you choose—PPO/DRP or HMO The coverage tier you choose—single, associate + spouse/domestic partner, associate + child(ren) or family, and Your years of benefits-eligible service—the more years of benefits-eligible service you complete with Advocate, the less you pay. In addition, if you are a Full-time associate, the cost you pay for medical coverage is also based on your annual base salary. New for 2011: Enhanced medical plan options Changes to Advocate’s medical plan options for 2011 include: More tax-free dollars, better protection for you Salary-based contributions for Full-time Associates New BlueCross/BlueShield PPO/DRP coverage option. Questions regarding network providers, call 800.327.8497. No more lifetime cap on benefits. Lifetime limits on the dollar value of essential health benefits no longer apply. Individuals whose coverage ended by reason of reaching a lifetime limit under the PPO/DRP or HMO plan are eligible to enroll in either plan and have 30 days begining November 1 to enroll. PPO/DRP The two PPO/DRP coverage options—one administered by BCBS, the other by Humana—are identical in terms of deductibles, coinsurance and covered expenses. These two options differ only in that they each offer different provider networks. Both PPO/DRP plans pay: 100%—the full cost—of preventive care services with no deductible when those services are received from a network provider or facility 80% of the cost of network services or 60% of the cost of non-network services—once the annual deductible is met. 4
100%—the full cost—of covered medical services once you reach your annual out-ofpocket maximum. Put tax-free dollars in a Deductible Reimbursement Account (DRA) for you to use equal to: –– $600—if you choose single coverage, or –– $1,200—if you choose associate + spouse/ domestic partner, associate + child(ren) or family coverage. Limit your out-of-pocket expenses—not including deductibles and emergency room copays—to no more than: –– $2,000 per person, or –– $4,000 per family. New for 2011: Increase your tax-free DRA dollars You can double the tax-free dollars Advocate puts in your DRA for 2011 by earning Healthe Measures rewards equal to: $600—if you choose single coverage or associate + child(ren), or $1,200—if you choose associate + spouse/ domestic partner or family coverage. For more details, see Healthe Measures: Earn more tax-free dollars for 2011 on page 8. How PPO/DRP coverage works Preventive Care (100%) PPO coverage pays 100% of the cost of preventive care services with no cost to you. Total Deductible ($1,600, $2,600 or $3,200) Advocate-provided DRA ($600—$1,200) Healthe Measures Incentive (Additional $600—$1,200 added to DRA) Associate Deductible “Gap” ($400—$800) Insurance Coverage Coinsurance (20%) or (10%/10%) Advocate makes a contribution to your DRA at the beginning of the year ($600 for single coverage, $1,200 for all other coverage levels). This account pays first-dollar for all non-preventive medical expenses. By participating in the Healthe Measures program, you can earn additional DRA funds ($600 for single or associate + child(ren) coverage, $1,200 for all other coverage levels). After DRA funds are spent, you are responsible for a deductible “gap” before PPO insurance coverage (“coinsurance”) begins. This gap will be $400 or $800 depending on coverage level. PPO insurance coverage (“coinsurance”) pays 80% of additional costs. For services provided at an Advocate hospital, 10% of the cost will be waived. Once your share of these costs reaches the annual out-of-pocket maximum, coinsurance pays 100% for balance of year. 5
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