Live your best life! YOUR BENEFITS YOUR 2022 BENEFITS GUIDE January 1—December 31, 2022 For viewing instructions, click here.
Disclaimer: This guide presents an overview of the benefits program offered on behalf of your employer and is not intended to be all inclusive, nor is it to be used as a summary plan description. It does not include all plan rules and details and is not considered a certificate of coverage. The terms of your benefits are governed by legal plan documents, including insurance contracts. If there are any differences between this guide and the legal plan documents and insurance contracts, the legal plan documents and insurance contracts are the final authority. We reserve the right to change or modify its benefit programs as appropriate without advanced notification. Ensign Services, Inc. is the plan administrator of the Ensign Services, Inc. Comprehensive Health and Welfare Benefit Plan. Our Core Values Our core values guide us in how we treat our residents and patients, their families, our business partners and each other. CAPLICO Customer Second In order for our patients to receive the care they deserve, we put our employees first. Accountability We hold ourselves to the highest standards of care and professionalism. Passion for Learning Ongoing training and innovation are a part of our DNA. Love One Another We strive to see and treat each other as people whose interests matter as much as our own. Intelligent Risk Taking We trust your judgment. Be innovative. Be entrepreneurial. Celebration We love to celebrate success and make work fun. Ownership We reward and support our employees who treat this organization as if they owned it.
Contents Important Benefit Contacts Contact Information for Our Carriers . . . . . . . 2 Resources To Help You Learn About Your Benefits and Enroll Online . . . . . . . . . . . . . . 3 Benefit Basics About Our Benefits . . . . . . . . . . . . . . 5 Eligibility . . . . . . . . . . . . . . . . . . 5 When Coverage Begins . . . . . . . . . . . . 6 Making Changes to Your Benefit Elections During the Year . . . . . . . . . . . . . . . 6 When Coverage Ends . . . . . . . . . . . . . 6 Enrollment . . . . . . . . . . . . . . . . . 7 Health About HealthComp . . . . . . . . . . . . . . 8 Medical . . . . . . . . . . . . . . . . . . 9 • 2022 Medical Plans At-a-Glance . . . . . . 10 • Prescription Drugs . . . . . . . . . . . . 12 • Health Savings Account . . . . . . . . . . 13 • Telemedicine . . . . . . . . . . . . . . 14 • Text-Based Telemedicine . . . . . . . . . . 15 • Video or Phone Appointments (Kaiser) . . . . 15 Supplemental Medical . . . . . . . . . . . . 16 • Voluntary Hospital Indemnity Insurance . . . . 16 • Voluntary Group Accident Insurance . . . . . 16 • Voluntary Critical Illness Insurance . . . . . . 16 Improve Your Health with Wellvolution . . . . . 16 Dental . . . . . . . . . . . . . . . . . . 17 Vision . . . . . . . . . . . . . . . . . . 18 Financial Protection Flexible Spending Accounts (FSAs) . . . . . . . . 19 • Health Care FSA . . . . . . . . . . . . . . . . . . . . . . . . . 19 • Limited Purpose FSA . . . . . . . . . . . 19 • Dependent Care FSA . . . . . . . . . . . 19 Transportation/Commuter Benefit Program . . . . 21 Life and AD&D Insurance . . . . . . . . . . . 21 • Basic Life and AD&D Insurance . . . . . . . 21 • Supplemental Life Insurance . . . . . . . . 22 • Supplemental AD&D Insurance . . . . . . . 23 Voluntary Long-term Disability Insurance (LTD) . . . 23 Voluntary Benefits . . . . . . . . . . . . . . 24 • Voluntary Short-term Disability Insurance (STD) . 24 • Farmers GroupSelectSM Auto and Home Insurance . . . . . . . . . . . . . . . 24 Work-Life Employee Assistance Program (EAP) . . . . . . . 25 Intalere Marketplace . . . . . . . . . . . . . 25 TicketsatWork . . . . . . . . . . . . . . . 25 Tuition Reimbursement Program . . . . . . . . 26 Purchasing Power . . . . . . . . . . . . . . 26 Child Care Benefit Program . . . . . . . . . . 26 The Emergency Fund . . . . . . . . . . . . . 27 Retirement 401(k) Savings Plan . . . . . . . . . . . . . 28 1
2 Health Policy/Group Number Phone/Website Medical Plans Administered by HealthComp (EPO 500, PPO 1500 with HSA, EPO 2000 with HSA, EPO Copay 5000, PPO 5000 with HSA) N35 https://hconline.healthcomp.com/ensign 833-549-2867 CerpassRx Pharmacy Benefit Manaqer n/a www.cerpassrx.com 844-636-7506 Teladoc Telemedicine n/a www.teladoc.com 800-835-2362 98point6 Text-based Telemedicine n/a https://www.98point6.com/ensign n/a Kaiser Permanente Medical (Kaiser No. CA HMO 2000 with HSA) (Kaiser So. CA HMO 2000 with HSA) No. CA: #39044 So. CA: #225775 www.kp.org 800-464-4000 SIMNSA Health Plan Medical (SIMNSA Baja CA Premier Access HMO) San Diego County Employees Only #529 www.simnsa.com 619-407-4082 HealthEquity Health Savings Accounts n/a www.healthequity.com 866-346-5800 The Hartford Accident Insurance Critical Illness Insurance Hospital Indemnity Insurance n/a n/a n/a www.TheHartford.com 866-547-4205 866-547-4205 866-547-4205 Delta Dental (Dental PPO Plan) Cigna Dental (Dental PPO Plan, Cigna Dental DHMO) Delta Dental: #19192 Cigna: #2499682 www.deltadentalins.com 800-765-6003 www.cigna.com 800-244-6224 Vision Service Plan Vision #30019528 www.vsp.com 800-877-7195 Financial Protection HealthEquity Flexible Spending Accounts (Health Care FSA, Limited Purpose FSA, Dependent Care FSA) n/a www.healthequity.com 866-346-5800 HealthEquity Transportation/Commuter Benefits Program n/a www.healthequity.com 866-346-5800 Unum Basic Group Term Life and AD&D Supplemental Group Term Life and AD&D Short-Term Disability Long-Term Disability #415402 #415403 n/a #145912 www.unum.c om 800-421-0344 800-421-0344 800-635-5597 800-633-7479 Farmers Insurance Farmers Group SelectSM Auto and Home Insurance n/a www.farmers.com 855-4978-3697 Work-Life Health Advocate EAP Employee Assistance Program n/a www.unum.com/lifebalance 800-854-1446 Scholarship Management Services Tuition Reimbursement n/a Email: firstname.lastname@example.org 949-540-1204 TicketsatWork Discounted Entertainment Tickets n/a www.TicketsatWork.com Company Code: Ensign 800-331-6483 866-273-5825 Intalere Marketplace n/a https://amerinet.corporateperks.com Purchasing Power Group code: ENS2293 www.ENSIGN.PurchasingPower.com 866-670-3479 KinderCare Child Care Benefit Program n/a www.careiseverywhere.com 888-525-2780 Retirement Fidelity 401(k) Savings Plan n/a www.netbenefits.com 800-835-5095 Important Benefits Contacts Contact Information for Our Carriers Included when you are enrolled in a HealthComp medical plan
Resources To Help You Learn About Your Benefits and Enroll Your Ensign-affiliated employer invests in you with some awesome benefits that help you live your best life. An overview of each plan is included in this guide, along with links to valuable tools and resources so you can take a deeper dive and find more details about all of the benefits available. We are focused on helping you play an active role in understanding your options and costs, and what to expect after you enroll. 3 Say Hello to ALEX® ALEX is our interactive benefits counselor who will explain your benefits in simple language in a fun and entertaining way. ALEX can help you choose the benefits and coverage options that will meet your needs and your budget. Three Important Things to Know About the ALEX Tool 1. It’s personalized, so you can see which plans make the most sense for you. 2. Its confidential, so you get the guidance you need without revealing all of your fascinating secrets. 3. IMPORTANT: ALEX is not the online enrollment system. Once you have reviewed your benefits with ALEX, you must enter your elections into Workday to complete your enrollment. Ensign Benefits Website The Ensign Benefits website is your go-to source for information about Ensign benefit plans. Start with high levels overviews of each benefit and drill down to the details including Summary Plan Descriptions and Insurance Certificates. You can also link to Workday when you’re ready to enroll and to carrier websites. The website is easy to navigate on your computer, tablet or smartphone. To get started using ALEX, go to https://www.myalex.com/ensign/2022 Go to www.ensignbenefits.com
4 Complete Your Benefits Enrollment in Workday Go to www.ensignbenefits.com and click on the Benefits Enrollment link at the top of any page to sign in to Workday. • Enter your username and password and click Sign In. Your username is your Workday employee ID printed on your paycheck stub. • Once you are logged in to Workday, go to your Inbox and select Benefit Change – New Hire or Benefit Change – Employment Status Change and proceed with your enrollment. Benefits Support Call Benefits Support when you have questions about your benefits and can’t find the answers in the resources above. You can also call to enroll in your benefits if you don’t have access to a computer connected to the internet. Need help signing in to Workday? Call 949-540-1200 or email email@example.com to reset your password. Call 888-659-3616 weekdays 8 AM to 5 PM PT or email firstname.lastname@example.org. Resources (continued) Download the Workday Mobile App Perform many of the popular self-service tasks of the Workday desktop application with the convenient and time-saving Workday mobile app. • Download the Workday mobile app on your tablet or phone from the App Store or Google Play. • Once you have it downloaded, enter Ensign as the code and then sign in with your normal Workday login (employee ID is your User ID).
5 Benefit Basics About Our Benefits Ensign-affiliated companies provide competitive benefits that will enhance the quality of your life and provide the support you need to achieve your personal and professional goals. Since everyone’s situation is unique and may change as your life changes, your Ensign Benefits give you the flexibility you need to choose the plans and coverage options that help you live your best life. Eligibility Full-time and Part-time Employee Working 32 or More Hours per Week You are eligible for all health and insurance benefits if you work at least 32 hours per week as a part-time or full-time employee of an Ensign-affiliated company and have completed your benefits waiting period. Your eligible dependents may also be enrolled for coverage under the health care and insurance benefits. You can also purchase additional coverage through the voluntary plans. Part-time Employee Working 30 or 31 Hours per Week You are eligible for medical and the Health Savings Account (HSA) if you work 30 or 31 hours as a part-time employee of an Ensign-affiliated company and have completed your benefits waiting period. Your eligible dependents may also be enrolled in these coverages. Eligible Dependents You will be required to provide proof of dependent eligibility at the time of enrollment. Eligible dependents for health care coverage generally include your: • Legal spouse (lawfully wedded spouse): If your spouse is eligible for group medical coverage outside of our plan (through their employer), you will pay a $125 surcharge per pay period if you choose to cover your spouse as your dependent on an Ensign Services plan. • Children: Under age 26, and dependent children of any age who are not able to support themselves due to a physical or mental disability and who became disabled before age 26. An eligible child includes your natural child, adopted child, step child or child for whom you have been appointed legal guardianship by a court of law. Newborns are automatically covered for the first 30 days and must be enrolled within 30 days of their date of birth to be covered thereafter.
When Coverage Begins Coverage for most benefits begins as follows, provided you enroll by the deadline date described below.: • Department heads, nurses, licensed therapists, Service Center/Cornet employees: Your benefits are effective the first day of the month following your date of hire provided you complete enrollment within 30 days following your date of hire. For example, if your date of hire is April 5, your benefits will be effective May 1, provided you enroll by May 5. If you have a status change and become benefit eligible, your benefits are effective the first day of the month following your status change. • All others: Your benefits are effective the first day of the month following 60 days of employment provided you complete enrollment within 30 days following your date of hire. For example, if your date of hire is May 15, your benefits will be effective August 1 provided you enroll by June 14. If you have a status change and become benefit eligible, your benefits are effective the first day of the month following your status change. Making Changes to Your Benefit Elections During the Year You can change your benefit elections outside of Open Enrollment only if you have a Qualified Event or Family Status Change, which include: • Have a baby/adopt a child • Change in marital status • G ain/loss of other group coverage, including Medicare/Medicaid • O ne of your dependents gains/loses other group coverage, including Medicare/Medicaid • Employment change that affects your benefits • Death of a covered dependent If you have a Qualified Event or Family Status Change and want to make benefit changes during the year: • You must make any benefit changes within 30 days of the qualified event. • C hanges must be consistent with the Family Status Change. For example, if you have employee only medical coverage and get married, you may waive coverage or change your medical coverage category to employee + spouse. You may also add your spouse to other coverages. Coverage for a new spouse begins the first of the month following the marriage date. Coverage for a newborn begins on date of birth. • Y ou must provide necessary verification documentation for your dependents (proof of loss or gain of other coverage) within 30 days of the qualified event. You may fax the documentation to 949-328-2763 or email it to email@example.com. Be sure to include a cover sheet with the documentation that includes your name and employee ID number. Email is preferred over faxing. If you fax your documentation, make sure no pages stick together as you feed the pages into your fax machine to ensure all pages are successfully transmitted. Coverage changes go into effect the first of the month after the qualifying event. For example, if coverage ends on August 31, your coverage with Ensign begins on September 1. • I f you are adding new dependents to your coverage based on a qualifying life event, you must provide necessary documentation to confirm eligibility (such as a marriage or birth certificate) at the time of enrollment. Your elections will not be approved until the necessary documentation is received. You can submit your documentation on the last Workday enrollment screen by uploading them before you submit your enrollment elections in Workday. You can also email your documentation to firstname.lastname@example.org. Be sure to include your name and employee ID number with your submitted documentation. 6 When Coverage Ends Most benefits coverage will end on the last day of the month in which you terminate employment or you become ineligible for benefits. Flexible Spending Account participation as well as life insurance and disability coverage end on the last day of full-time employment.
Optional Now vs. Optional Anytime Benefits Benefits that are “optional now” means if you want coverage under these benefits, you must enroll in Workday within 30 days of your date of hire or date of status change to benefit eligible. Benefits that are “optional anytime” means you can enroll in these benefits anytime during the year through the carrier or by calling Benefits Support at 888-659-3616. OPTIONAL NOW Enroll in Workday If you are eligible, you must enroll for these benefits within 30 days of your date of hire. • Medical • Supplemental AD&D • Dental • Voluntary Long-term Disability • Vision • Voluntary Group Accident • Flexible Spending Accounts • Voluntary Critical Illness • Supplemental Life • Voluntary Hospital Indemnity OPTIONAL ANYTIME Enroll through carrier or call the Ensign Benefits Support If you are eligible, you can elect or change these benefits any time. • Health Savings Account (HSA)* • Auto and Home Insurance • Voluntary Short-term Disability • Transportation Benefit Program* • 401(k) Savings Plan * Optional anytime, enrolled in Workday. 7 Enrollment Enrollment Deadline You have 30 days following your hire date or status change date to complete your benefits enrollment in Workday, which includes submitting proof of dependent eligibility, such as a marriage license or birth certificate. You will need to upload these documents directly into Workday during enrollment or email the documents to email@example.com before your enrollment deadline. Enroll in Your 2022 Benefits in Workday Go to www.ensignbenefits.com and click on the Benefits Enrollment link at the top of any page to sign in to Workday. • Enter your username and password and click Sign In. Your username is your Workday employee ID printed on your paycheck stub. • O nce you are logged in to Workday, go to your Workday inbox or click on Benefit Change – New Hire or Benefit Change – Employment Status Change. • I f you are adding new dependents, gather eligibility verification documents to provide proof of dependent eligibility and submit in Workday within 30 days following your hire date or date of status change to benefit eligible to complete your benefits enrollment in Workday.
8 About HealthComp We have partnered with HealthComp as the administrator of our self-funded medical plans. HealthComp manages the EPO 500, PPO 1500 with HSA, EPO 2000 with HSA, EPO Copay 5000 and the PPO 5000 with HSA. HealthComp’s customer service team provides all the guidance you need to choose and use your benefits with confidence, submit claims, find the right doctor and more. If you are enrolled in one of the medical plans listed above that is managed by HealthComp, you can access and manage your health benefits information through an easy-to-use member portal or with the HealthComp mobile app while you’re on the go. HealthComp Online: https://hconline.healthcomp.com/ensign Email: firstname.lastname@example.org Phone: 833-549-2867 (M-F, 6 a.m. – 6 p.m. PT) Mobile App: Search for HCOnline on the App Store or on Google Play
9 Health Medical Our medical plans are designed to give you the options you need to manage your health the way you want. You can choose from five medical plans administered by HealthComp. If you live in California, you also have an HMO option through Kaiser if you live in a Kaiser Permanente service area. If you live in San Diego County, the SIMNSA Baja CA Premier Access HMO may also be an option for you. All of the medical plans include medical and prescription drug coverage. The plans managed by HealthComp use a national provider network through Blue Shield. Need help choosing the best medical plan? Talk to ALEX for a recommendation. Go to https://www.myalex.com/ensign/2022. EPO 500 This plan has a lower deductible and exclusively covers you for in-network doctors and facilities. Except in the case of an emergency, you’ll pay the full price for any out-of-network care. PPO 1500 with HSA You can see both in-network and out-of-network doctors without a referral, but keep in mind staying in-network for care will almost always be cheaper. To help with your share of costs, this plan comes with a Health Savings Account (HSA) that you can contribute to. EPO 2000 with HSA This plan exclusively covers you for in-network doctors and facilities. Except in the case of an emergency, you’ll pay the full price for any out-of-network care. To help with your share of costs, this plan gives you the option to participate in a Health Savings Account (HSA). EPO Copay 5000 This plan exclusively covers you for in-network doctors and facilities. Because this is a copay plan, you’ll usually pay a fixed amount when you see in-network providers, and the plan will pay for the rest. Except in the case of an emergency, you’ll pay the full price for any out-of-network care. PPO 5000 with HSA You can see both in-network and out-of-network doctors without a referral, but keep in mind staying in-network for care will almost always be cheaper. To help with your share of costs, this plan gives you the option to participate in a Health Savings Account (HSA). Kaiser HMO 2000 with HSA (CA employees only) You can select this plan if you live in California in a Kaiser Permanente service area. This plan exclusively covers you when you use Kaiser Permanente doctors and facilities. Except in the case of an emergency, you’ll pay the full price for any care you receive from a non-Kaiser doctor or facility. To help with your share of costs, this plan gives you the option to participate in a Health Savings Account (HSA). SIMNSA Baja CA Premier Access HMO (San Diego County employees only) You can select this plan if you live in San Diego County. This plan exclusively covers you when you access SIMNSA Premier Access HMO providers. The plan covers many health services at 100%. Some services require a small copayment. You are not required to choose a primary care physician to manage your care. Except in the case of an emergency, you’ll pay the full price for any care you receive from a non-SIMNSA doctor or facility. To search for a SIMNSA provider, visit https://www.simnsaee.net/Expediente2010/CitasOnline/proveedores/frm_proveedores.aspx.
2022 Medical Plans At-a-Glance 1) The family deductible must be met before any person receives benefits. 2) After calendar year deductible. 3) Calendar year deductible waived. 4) As specified in the essential drug list. Plan Feature EPO 500 PPO 1500 with HSA EPO 2000 with HSA Calendar Year Deductible Employee Only / Family $500 / $1,0001 $1,5005 / $3,0001,5 $2,000 / $4,0001 Coinsurance (You Pay) 20% 20% 20% Calendar Year Out-of-Pocket Maximum Employee Only / Family $2,000 / $4,000 $5,0006 / $10,0006 $6,000 / $12,000 Health Savings Account (HSA) N/A You can contribute pre-tax dollars to an HSA through HealthEquity. IRS limits for 2022 are $3,650 (employee only) and $7,300 (family). You can contribute an additional $1,000 if you are age 55 or older in 2022. You can contribute pre-tax dollars to an HSA through HealthEquity. IRS limits for 2022 are $3,650 (employee only) and $7,300 (family). You can contribute an additional $1,000 if you are age 55 or older in 2022. NETWORK ONLY YOU PAY IN-NETWORK YOU PAY NETWORK ONLY YOU PAY Preventive Care Covered in full3 Covered in full3 Covered in full3 Telemedicine Doctor Visit Behavioral Health Visit Through Teladoc $20 copay $20 copay Through Teladoc 10%2 (Cost is $40 per visit) 10%2 (Cost is $40 per visit) Through Teladoc 10%2 (Cost is $40 per visit) 10%2 (Cost is $40 per visit) Telemedicine (text-based) Doctor Visit Through 98point6 FREE Through 98point6 $5 copay Through 98point6 $5 copay PCP Office Visit $30 copay 20%2 20%2 Specialist Office Visit $50 copay 20%2 20%2 Urgent Care $50 copay 20%2 20%2 Emergency Room $500 copay2,7, then you pay 20% $500 copay2,7 then you pay 30% $500 copay2,7 then you pay 30% Diagnostic Testing 20%2 20%2 20%2 Outpatient X-ray and Lab 20%2 20%2 20%2 Hospitalization Inpatient Semi-Private Room Inpatient Physician $500 copay2, then you pay 20% 20%2 20%2 20%2 20%2 20%2 Outpatient Treatment (PT, OT, ST) 20%2 20%2 20%2 Mental Health/Substance Abuse Inpatient Outpatient $500 copay then 20%2 $30 copay9 20%2 20%2 20%2 20%2 Pharmacy Retail Specified Preventive Drugs4 Generic Brand Formulary Brand Non-Formulary Specialty Drugs 30-day supply11 100% covered3 $10 copay3 $25 copay3 $40 copay3 20%3,8 up to $125 30-day supply11 100% covered3 $10 copay2 $25 copay2 $40 copay2 20%2,8 up to $125 30-day supply11 100% covered3 $10 copay2 $25 copay2 $40 copay2 20%2,8 up to $125 Pharmacy Mail Service Specified Preventive Drugs4 Generic Brand Formulary Brand Non-Formulary 90-day supply 100% covered3 $20 copay3 $50 copay3 $80 copay3 90-day supply 100% covered3 $20 copay2 $50 copay2 $80 copay2 90-day supply 100% covered3 $20 copay2 $50 copay2 $80 copay2 5) I n-network calendar year deductible is separate from out-of-network calendar year deductible and does not cross accumulate. Refer to the Summary of Benefits and Coverage (SBC) for the plan for information on out-of-network deductible amounts on www.ensignbenefits.com. 6) In-network calendar year out-of-pocket maximum is separate from out-of-network calendar year out-of-pocket maximum and does not cross accumulate. Refer to the Summary of Benefits and Coverage (SBC) for the plan for information on out-of-network out-of-pocket maximum amounts on www.ensignbenefits.com. 10
CA Residents San Diego County Residents EPO Copay 5000 PPO 5000 with HSA Kaiser CA HMO 2000 w/ HSA SIMNSA Baja CA Premier Access HMO $5,000 / $10,0001 $5,0005 / $10,0001,5 $2,000 / $4,00010 N/A 20% 20% 20% None $7,000 / $14,000 $6,5506 / $13,1006 $3,425 / $6,850 $6,350 / $12,700 N/A You can contribute pre-tax dollars to an HSA through HealthEquity. IRS limits for 2022 are $3,650 (employee only) and $7,300 (family). You can contribute an additional $1,000 if you are age 55 or older in 2022. You can contribute pre-tax dollars to an HSA through HealthEquity. IRS limits for 2022 are $3,650 (employee only) and $7,300 (family). You can contribute an additional $1,000 if you are age 55 or older in 2022. N/A NETWORK ONLY YOU PAY IN-NETWORK YOU PAY NETWORK ONLY YOU PAY NETWORK ONLY YOU PAY Covered in full3 Covered in full3 Covered in full3 Covered in full Through Teladoc $25 copay $25 copay Through Teladoc 10%2 (Cost is $40 per visit) 10%2 (Cost is $40 per visit) 20%2 N/A N/A N/A Through 98point6 FREE Through 98point6 $5 copay N/A N/A $45 copay 20%2 20%2 $5 copay $75 copay 20%2 20%2 $5 copay $75 copay 20%2 20%2 $25 copay (provider in Mexico) $50 copay (provider outside Mexico) $500 copay2,7 then you pay 30% $500 copay2,7 then you pay 30% 20%2 $250 copay7 20%2 20%2 20%2 Covered in full 20%2 20%2 20%2 Covered in full 20%2 20%2 20%2 20%2 20%2 20%2 Covered in full Covered in full 20%2 20%2 20%2 $10 copay 20%2 $45 copay 20%2 20%2 20%2 20%2 Covered in full $5 copay 30-day supply11 100% covered3 $10 copay3 $25 copay2 $40 copay2 20%2,8 up to $125 30-day supply11 100% covered3 $10 copay2 $25 copay2 $40 copay2 20%2,8 up to $125 30-day supply 100% covered3 $10 copay2 $30 copay2 N//A 20%2 up to $125 30-day supply 100% covered $5 copay $5 copay $5 copay $5 copay 90-day supply 100% covered3 $20 copay3 $50 copay2 $80 copay2 90-day supply 100% covered3 $20 copay2 $50 copay2 $80 copay2 100-day supply 100% covered3 $20 copay2 $60 copay2 N/A 90-day supply N/A N/A N/A N/A 7) Emergency Room copay waived if admitted. 8) May be available at CerpassRx retail pharmacy or Pharmacy Mail Service if authorized. Note that any specialty drug discounts through copay cards or coupons will not apply towards the calendar year deductible or out-of-pocket maximum. 9) Intensive outpatient: $250 copay per visit plus 20% after calendar year deductible. 10) $2,800 for one member in family coverage. 11) A $10 copay will be added to the cost for any prescriptions filled at Walgreens. 11
All of the medical plans include prescription drug coverage. Prescription Drug Coverage 12 Save Money with Mail Service for Long-term Medications You can take advantage of mail service rates for a 90-day supply of medicines you take on a regular basis for chronic conditions such as high blood pressure, asthma, diabetes or high cholesterol. Prescription Drugs with a HealthComp Plan EPO 500, PPO 1500, EPO 2000, EPO Copay 5000, PPO 5000 When you enroll in a medical plan administered by HealthComp, you automatically receive prescription drug coverage through CerpassRx. The CerpassRx pharmacy network includes all national chains and most local pharmacies. The PPO 1500 and PPO 5000 plans also have out-of-network coverage, but you will save money if you use participating network pharmacies. Specified Preventive Drugs: Certain generic preventive medications (like birth control) are covered at no cost and not subject to annual deductibles provided certain requirements are met. Generic Drugs: Generic drugs have the lowest copays and are considered identical to their brand name equivalents by the FDA in terms of efficacy and safety. Brand Formulary: Drugs on the brand formulary are designated as preferred based on their cost effectiveness and, in some cases, efficacy. If you or your provider choose a brand formulary medication when a generic is available, you’ll pay the brand formulary copay plus the difference in cost between the generic and the brand formulary drug. Brand Non-Formulary: Brand name drugs not on the brand formulary have the highest copays. When you fill a prescription, you can ask the pharmacist whether a generic or brand formulary drug of your medication is available. If you or your provider choose a brand non-formulary medication when a generic is available, you’ll pay the brand non-formulary copay plus the difference in cost between the generic and the brand non-formulary drug. Specialty Drugs: These are high-cost drugs that typically require special handling or administration. You must obtain specialty drugs through a CerpassRx Specialty pharmacy. Prescription Drugs with the Kaiser CA HMO 2000 When you enroll in the Kaiser CA HMO 2000, you automatically receive prescription drug coverage through Kaiser. Many Kaiser Permanente facilities have pharmacies in the building, so you can go there straight after your appointment. You can refill prescriptions in person, online or by phone. Refill in person: Bring your prescription to a Kaiser pharmacy. Online: Visit kp.org/rxrefill to order your prescription refills online. You will need to register first at kp.org/registernow. Phone: Call the pharmacy refill phone number highlighted on your prescription label. Have your medical record number, prescription number, home telephone number, and credit or debit card information handy when you call. Prescription Drugs with the SIMNSA Baja CA Premier Access HMO When you enroll in the SIMNSA Baja CA Premier Access HMO, you automatically receive prescription drug coverage through SIMNSA Health Plan. Visit the SIMNSA website at www.simnsa.com for a list of network pharmacies you can use.
If you enroll in the PPO 1500, EPO 2000, PPO 5000, or Kaiser CA HMO 2000, you have the option to contribute to a Health Savings Account (HSA). The HSA offers tax savings and can be used to cover medical, pharmacy, dental and vision expenses now or in the future. Unlike money in a Flexible Spending Account (FSA) that you must “use or lose,” the funds in your HSA roll over each year and continue to build. You can use funds as soon as they are deposited, or you can save them to pay for future eligible health expenses, even those you incur after you retire. Your HSA funds are also portable, so if you leave the Company, you can take your account balance with you. Health Savings Account 13 Want to learn more about the HSA? Talk to ALEX. Go to https://www.myalex.com/ensign/2022. Health Savings Account At-a-Glance Who is eligible? You are eligible to contribute to an HSA if you are: • Enrolled in an HSA-qualified medical plan; • N ot covered by any other medical plan (through your spouse or as a retiree), including a Health Care FSA; • Not enrolled in Medicare, Medicaid or TRICARE; and • Not claimed as a dependent on another person’s tax return. HSA advantages • Your contributions are tax-free* and reduce your overall taxable income. • You never pay taxes on withdrawals for qualified health care expenses. • U nlike the Medical FSA, you won’t lose your HSA balance if you don’t spend it. You take it with you if you change jobs, retire, or leave the health plan How much can be contributed to an HSA? • Up to $3,650 if you have Employee Only coverage. • Up to $7,300 if you have Employee + Dependents coverage. • Additional $1,000 if you are age 55 or older. • I f your account balance reaches at least $1,000, you may choose available investment funds for your balance. What can be paid from your HSA? • Y ou can use your HSA for medical, dental, vision and pharmacy expenses for you and any family member who qualifies as a dependent on your tax return. • F or a complete list of eligible expenses visit the official IRS website at http://www.irs.gov/publications/p502/index.html. Using your HSA Complete instructions are included in your HealthEquity Welcome Kit after you enroll • U se the HealthEquity Visa® health account card, or submit expenses online at www.healthequity.com. • Y our account balance and information on claims is available 24/7 on your HealthEquity member portal, by calling HealthEquity Member Services, or by accessing via your HealthEquity mobile app. • Your account balance is NEVER forfeited; unused amounts stay in your account. *State taxes will apply if you live in California, Alabama or New Jersey.
Telemedicine through Teladoc EPO 500, PPO 1500, EPO 2000, EPO Copay 5000 and PPO 5000 Telemedicine through Teladoc gives you 24/7 access to a doctor through live video chat whenever you need it for nonemergencies so you can get healthy faster. If you are 18 or older, you can also use Teladoc to speak to licensed therapists, psychiatrists and mental health professionals for help with depression, stress, anxiety, grief and more. Behavioral health appointments are available from 9 AM to 7 PM local time, 7 days a week. Your cost for Teladoc is based on your medical plan and the type of visit, as shown in the table. All Teladoc doctors are board certified, practicing primary care physicians, pediatricians, and family physicians. Commonly treated conditions include: • Allergies • Stomach Flu • Flu • Anxiety • Sinus Infection • UTI • Gout • Addiction • Rashes • Hypertension • Sprains • Grief • Bronchitis • Strep Throat • Depression • Panic Attacks When to Use Teladoc • If you’re considering the ER or urgent care center for a nonemergency • When you need medical advice during off hours or late at night • When on vacation, a business trip, or away from home • For prescriptions when medically necessary • If you need support for your mental well-being Get started Go to www.teladoc.com or call 800-835-2362 to set up your account and complete your profile. You can also download the Teladoc mobile app from the App Store or Google Play. 14 Your Cost for Teladoc Visits Medical Visits Behavioral Health Visits EPO 500 $20 copay $20 copay PPO 1500 with HSA 10%1 10%1 EPO 2000 with HSA 10%1 10%1 EPO Copay 5000 $25 copay $25 copay PPO 5000 10%1 10%1 1 After calendar year deductible
Video or Phone Appointments Kaiser CA HMO 2000 If you are enrolled in the Kaiser CA HMO 2000, you can set up video or telephone appointments with your doctor on a computer or mobile device. Go to kp.org/videoappointment to make an appointment and sign on to kp.org to join your appointment. For more information call 844-800-0820 M-F 8:30 AM to 5 PM PT. You can also download the Kaiser Permanente app from the App Store or Google Play. Get started To get started, follow these steps: 1 Install the app Download 98point6 from the App Store or Google Play. 2 Create your account No password to remember. Enter your mobile number and you will be sent a unique pin. 3 Start your visit Get text-based diagnosis and treatment and a personalized Care Plan, with any necessary labs ordered and prescriptions sent to your local pharmacy. 15 Your Cost for 98point6 Visits Medical Visits EPO 500 FREE PPO 1500 with HSA $5 copay EPO 2000 with HSA $5 copay EPO Copay 5000 FREE PPO 5000 $5 copay Text-based Telemedicine Through 98point6 EPO 500, PPO 1500, EPO 2000, EPO Copay 5000 and PPO 5000 98point6 is a new kind of primary care that gives you on-demand access to a U.S. based, board-certified physician via private messaging, right from your mobile phone. You can use this service for yourself and your covered dependents* if you are enrolled in the EPO 500, EPO Copay 5000, PPO 1500, EPO 2000 or PPO 5000. Your cost for a telemedicine visit through 98point6 is based on your medical plan as shown in the table. 98point6 physicians are available 24/7 to diagnose and treat 400+ common conditions and can order labs and write prescriptions. * Dependent children must be at least 1 year old.
16 Supplemental Medical Voluntary benefits through The Hartford complement your medical coverage and can fill in coverage gaps by providing additional financial protection with premiums paid through the convenience of payroll deduction. Note that these voluntary plans should not be used in place of medical coverage. The Hartford provides: • Health Screening claims processing • Assistance with claim submission • Answers to general plan and claims questions Hospital Indemnity Insurance Group Accident Insurance Critical Illness Insurance Pays a cash benefit for an unexpected hospital stay for a covered illness or injury. You must have comprehensive medical coverage to enroll in this plan. Coverage is also available for family members. Enroll in Workday. Contact Benefits Support at 888-659-3616 for questions. Pays benefits for specific injuries and related services resulting from a covered accident such as broken bones, burns or torn ligaments. Examples of covered expenses include emergency room treatment and outpatient surgery. Coverage is also available for family members. Enroll in Workday. Contact Benefits Support at 888-659-3616 for questions. Pays a one-time lump sum benefit amount upon the diagnosis of a covered disease or illness such as a heart attack, stroke, cancer and more. You can choose coverage from $5,000 to $30,000. Coverage is also available for family members. Enroll in Workday. Contact Benefits Support at 888-6593616 for questions. Improve Your Health with Wellvolution Offered through Blue Shield, this program is designed to improve the overall health of you and your covered family members if enrolled in the EPO 500, EPO Copay 5000, PPO 1500, EPO 2000 or PPO 5000. The program offers free tools to help you lose weight, sleep better, manage stress, move more, ditch cigarettes, eat healthier and prevent/reverse disease.
17 Dental To find a Delta Dental dentist (ID, OR and WA), go to www.deltadentalins.com. To find a Cigna DPPO Advantage or Cigna DPPO dentist (all states except ID, OR and WA) or a Cigna Dental DHMO dentist (most states) go to www.cigna.com. If the charge for any dental treatment is expected to exceed $300, ask your dentist to submit a dental treatment plan to Delta Dental or Cigna for review. This will help you to know expected out-of-pocket costs before any treatment begins. Our dental plans provide coverage for preventive services, as well as benefits to help pay for more expensive dental procedures such as fillings, root canals, crowns, bridges and orthodontia coverage. 1) After calendar year deductible. 2) Percentage applies to usual, customary and reasonable charges. 3) DHMO copay schedule available on www.ensignbenefits.com. 4) In-network preventive services do not count toward the annual calendar year maximum. 5) Percentage applies to negotiated rate. 2022 Dental Plans At-a-Glance Dental PPO Plan (Delta Dental in ID,OR & WA or Cigna Dental all other states) Cigna Dental DHMO Feature Delta Dental PPO/Cigna DPPO Advantage Dentist Delta Dental Premier/Cigna DPPO Dentist Out-of-Network Cigna DHMO Dentists Only Calendar Year Deductible Waived for preventive $50 per person, $150 per family None Calendar Year Maximum $1,500 per person Unlimited Preventive Services Routine exams, dental cleanings 100% covered4 You pay 20%5 You pay 20%2 $5 office visit copay Basic Services Fillings, oral surgery You pay 10%1 You pay 20%1,5 You pay 20%1,2 Fixed copays3 Major Services Crowns, inlays, endodontics, periodontics You pay 40%1 You pay 50%1,5 You pay 50%1,2 Fixed copays3 Orthodontia You pay 50%1 You pay 50%1,5 You pay 50%1,2 Fixed copays3 Available to children under age 19 only, up to $1,500 lifetime max For children and adults Temporomandibular Joint (TMJ) $1,000 lifetime max You pay 40%1 You pay 50%1,5 You pay 50%1,2 Fixed copays3 Dental PPO Plan For the highest level of benefits, use a provider in the Delta Dental PPO network (ID, OR and WA) or the Cigna DPPO Advantage network (all other states). You can also go out-of-network but will save money if you use a provider in the Delta Dental Premier network (ID, OR and WA) or the Cigna DPPO network (all other states) versus dental providers who are not in a Delta Dental or Cigna provider network. Cigna Dental DHMO DHMO stands for Dental Health Maintenance Organization and provides dental services exclusively from Cigna DHMO dentists. There is no deductible and no annual maximum benefit. You pay fixed copays for preventive, basic and major services. You must select a primary care dentist for your care. Go to www.cigna.com/offered-cigna-through-work/dental/dhmo to see if there is a Cigna DHMO provider available in your location (not available in all geographic areas).
18 Vision Quality eye care benefits are offered through the Vision Service Plan (VSP). Benefits are designed to help reduce the cost of eyeglasses, contact lenses and other vision services. You can use any vision care provider, but will save money when you use a VSP Choice network provider. With VSP providers, you will typically have 100% of expenses paid by VSP after a copayment, up to the maximum allowable benefit for covered services. If you receive services from an out-of-network provider, you are responsible for paying the provider in full and submitting a claim to VSP for reimbursement. Discounts are available for LASIK surgery, non-prescription sunglasses, contact lens solutions, and other eye care accessories. Note that you can use your benefits at certain specialty optical boutiques or retail chains (such as Costco) through VSP’s affiliate provider network. Affiliate providers can check eligibility and submit claims with VSP. Plan Feature VSP Network Provider Out-of-Network Provider Exam for Eyeglasses Once every 12 months $10 copay $10 copay, Plan pays up to $73 Lenses Once every 12 months • Single vision • Lined Bifocal • Lined Trifocal Lens Options • Standard progressive lenses • Premium progressive lenses • Custom progressive lenses $25 materials copay Copay up to $55 Copay of $95 - $105 Copay of $150 - $175 $25 materials copay Plan pays up to $33 Plan pays up to $50 Plan pays up to $65 Plan pays up to $65 Plan pays up to $65 Plan pays up to $65 Frames Once every 24 months Plan pays up to $130 ($70 for Costco) Plan pays up to $70 Contact Lenses Instead of eyeglasses once every 12 months $130 allowance for contacts Up to $60 copay for contact lens exam (filling and evaluation) Plan pays up to $115 2022 Vision Plan At-a-Glance For more information on covered benefits or to find a VSP provider, go to www.vsp.com or call VSP at 800.877.7195. Finding a VSP provider You should always call a doctor to confirm participation in the VSP network. To find a VSP provider: • Go to the VSP website at www.vsp.com. • Find the “Members & Consumers” section. • Follow the directions to register as a site user, or fill in your User ID and password. • Select the “Find a VSP Doctor” tab.
19 Financial Protection Flexible Spending Accounts If you are not already participating in the company’s Flexible Spending Accounts (FSAs) for health care and/or dependent care expenses, you may be missing an opportunity for significant tax savings. There are three types of FSA’s — a Health Care FSA, Limited Purpose FSA and Dependent Care FSA. You are eligible for the Limited Purpose FSA only if you participate in a Health Savings Account. All three FSAs let you use pre-tax dollars to pay eligible out-of-pocket expenses not covered by other insurance plans. Annual elections are “use it or lose it” so estimate wisely. Key features of each FSA are highlighted below. Type of FSA Eligible Expenses Pre-tax Contribution Health Care FSA Most medical, dental and vision care expenses that are not covered by your health plan, such as deductibles, copays, eyeglasses and doctor-prescribed over the counter medications. Up to $2,850 per year Limited Purpose FSA Dental and vision care expenses that are not covered by other insurance plans, such as deductibles, copays and eyeglass expenses that exceed plan limits. Up to $2,850 per year Dependent Care FSA Dependent care expenses such as daycare, summer camp, after school programs or elder care programs so you and your spouse can work or attend school full-time. Up to $5,000 per year ($2,500 if married and filing separate tax returns) Health Care FSA A Health Care FSA gives you a tax break on many expenses that are not reimbursed by any other health plan, such as deductibles, copays, coinsurance, vision expenses, and more. You must enroll each year, as contribution amounts are not carried forward from one year to the next. You can set aside up to $2,850 each plan year on a pre-tax basis to cover eligible health care expenses. Limited Purpose Health Care FSA (for use with Health Savings Account) If you participate in a Health Savings Account (HSA), you can maximize your tax savings by also participating in a Limited Purpose Flexible Spending Account (FSA) that covers dental and vision expenses only. A Limited Purpose Health Care FSA is a great way to conserve your HSA funds and still benefit from tax savings. You may contribute up to $2,850 each plan year on a pre-tax basis to cover eligible dental and vision expenses. More information is available on the benefits website at www.ensignbenefits.com. Dependent Care FSA The Dependent Care Account can be used for dependent care and elder care expenses that enable you (or you and your spouse) to work or attend school full-time. Eligible expenses include daycare, preschool programs and after-school care for qualifying children under age 13. They also include elder care or care for qualifying dependents and qualifying relatives of any age who are living with you and not capable of self-care. The amount you contribute to a Dependent Care FSA cannot be greater than your income or your spouse’s income, whichever is less. If your spouse contributes to a Dependent Care FSA through his or her employer, your combined contributions may not exceed $5,000. If you are married and file separate tax returns, you can contribute up to $2,500 per year. Have Questions About Flexible Spending Accounts? ALEX can help. Go to https://www.myalex.com/ensign/2022.
20 Careful Planning Required You should plan your FSA contributions carefully. Here’s why: • Use it or lose it. IRS rules require that any money left in a Dependent Care FSA at the end of the plan year must be forfeited. • Money set aside for health care expenses cannot be used to reimburse dependent daycare expenses and vice-versa. • Any health care or dependent care expenses that are paid from FSAs cannot be claimed as a deduction or credit when filing your income tax return. • You cannot stop or change contributions during the year unless you have qualified status change. • Once you terminate employment, only expenses incurred before you terminated are eligible for reimbursement for your FSA, unless you elect to continue your Health Care FSA through COBRA. • You will be reimbursed for dependent care expenses only up to the amount of your dependent care spending balance and only after the care has been provided. HealthEquity is the FSA Plan Administrator If you enroll in Flexible Spending Accounts (FSAs), it’s easy to manage your FSAs through HealthEquity, the plan administrator. Access the HealthEquity website to review your account, including current balance, status of any claims, and other helpful information including a list of eligible health care and dependent care expenses. Tax Savings! The Flexible Spending Accounts (FSAs) let you pay for eligible health care and/or dependent day care expenses and reduce your taxes at the same time. Dependent Care FSA Rules • F or expenses to be eligible, they must be incurred because you and your spouse or domestic partner are working • C hildren must be under age 13 • C are providers can be anyone except your spouse, a dependent claimed on your tax return, or child under age 19 • D isabled dependents (a child, spouse, or parent) also qualify for reimbursement if they spend at least 8 hours a day in your home • E ligible dependent care expenses include nursery schools, day camps, licensed day care centers and day care in your home (except if the provider is the child’s parent or your child under age 19) HealthEquity Online: www.healthequity.com Phone: 866-346-5800
21 Transportation/Commuter Benefit Program Set aside pre-tax dollars for transportation. Use our Transportation/Commuter Benefit Program administered by HealthEquity to save money instantly on your commuting expenses. Eligible expenses include fares for bus, vanpool, subway, ferry and train. This benefit can be enrolled through the Workday Benefits worklet, the normal enrollment task in your inbox, or by calling Benefits Support. For questions, contact HealthEquity at 866-346-5800 or visit www.healthequity.com. Life and AD&D Insurance Basic Life and AD&D Insurance To protect those who rely on your income for their support, your employer pays the full cost of basic life and accidental death & dismemberment (AD&D) insurance. This coverage is available to all full-time benefit eligible employees of an Ensign Services-affiliated company. The plan is administered by Unum and pays benefits upon your death. AD&D benefits are paid if your death is the result of a covered accident. If you die from an accidental injury, your beneficiary will receive both the basic life and AD&D benefit. AD&D also pays benefits if you are severely injured and suffer a loss such as the loss of a limb or eyesight. Coverage When Payment Is Made Benefit Amount 1,2 Basic Life Insurance If you die from any cause • 1X salary - Service Center/Cornet/Topside/ Executive Directors/Directors of Nursing • $25,000 all other eligible employees AD&D Insurance If you die from an accident the benefit amount is paid in addition to basic life insurance • 1X salary - Service Center/Cornet/Topside/ Executive Directors/Directors of Nursing • $25,000 all other eligible employees If you are severely injured due to an accident and suffer a loss specified in the policy such as the loss of a limb or eyesight • A portion of the benefit, as specified in the policy 1 The benefit amount is reduced after age 65. 2 If Basic Life is greater than $50,000, you can cap your coverage at $50,000 to avoid imputed income tax. 2022 Transit Maximum: $280 per month How much life insurance do I need? In deciding how much life insurance you need, consider your personal situation, age and whether or not you support a family. If you have limited financial obligations, you may need less life insurance compared to someone who has a mortgage to pay or children to put through college. Let Alex help you decide how much life insurance you need. Go to http://www.myalex.com/ensign/2022.