Your 2025 Benefits Guide YOUR BENEFITS January 1 – December 31, 2025
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. 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 the benefit programs as appropriate without advance notification. Ensign Services, Inc. is the plan administrator of the Ensign Services, Inc. Comprehensive Health and Welfare Benefit Plan.
Contents Important Benefits 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 Medical . . . . . . . . . . . . . . . . . . ................... 8 Medical Plans . . . . . . . . . . . . . . . ................. 8 Centivo PCP Partnership Plan . . . . . . . . . ........... 9 Personify Health (formerly HealthComp) . . . . . ....... 9 2025 Medical Plans At-a-Glance . . . . . . . . ......... 10 Prescription Drug Coverage . . . . . . . . . . ........... 12 Find Providers in Your Medical Plan Network . . . ..... 13 Garner Top Provider Network/Health Reimbursement Account Program . . . . . . . ......... 14 Hinge Health: Virtual Physical Therapy Program . . .... 15 Vida Health Diabetes Management . . . . . . . ........ 16 Lyra Mental Health Support . . . . . . . . . ........... 16 Health Savings Account . . . . . . . . . . . ............ 17 Telemedicine through Teladoc . . . . . . . . . .......... 18 Centivo Virtual Primary Care . . . . . . . . . ........... 19 Text-Based Telemedicine . . . . . . . . . . . ............ 19 Video or Phone Appointments with Kaiser HMO with HSA Plan (CA, CO, OR, WA) . . . . . . . ......... 19 Supplemental Medical . . . . . . . . . . . . ............. 20 • Voluntary Hospital Insurance . . . . . . . ......... 20 • Voluntary Accident Insurance . . . . . . . ......... 20 • Voluntary Critical Illness Insurance . . . . . ....... 20 1 Dental . . . . . . . . . . . . . . . . . . ................... 21 Vision . . . . . . . . . . . . . . . . . . ................... 22 Financial Protection Flexible Spending Accounts (FSAs) . . . . . . . ......... 23 • Health Care FSA . . . . . . . . . . . . . . . . . . . . . . . . . 23 • Limited Purpose FSA . . . . . . . . . . ............ 23 • Dependent Care FSA . . . . . . . . . . ............ 23 Transportation/Commuter Benefit Program . . . . ..... 25 Life and AD&D Insurance . . . . . . . . . . ............ 25 • Basic Life and AD&D Insurance . . . . . . ........ 25 • Supplemental Life Insurance . . . . . . . ......... 26 • Supplemental AD&D Insurance . . . . . . ........ 27 Voluntary Long-Term Disability Insurance (LTD) . . .... 27 Voluntary Benefits . . . . . . . . . . . . . ............... 28 • Voluntary Short-Term Disability Insurance (STD) .. 28 • Farmers Auto and Home Insurance . . . . . ...... 28 • ARAG Legal Insurance . . . . . . . . . . ........... 29 • Cyber Security/Identity Theft Protection . . . ..... 29 • Pet Insurance . . . . . . . . . . . . . ............... 30 Work-Life Employee Assistance Program (EAP) . . . . . . ........ 31 TicketsatWork . . . . . . . . . . . . . . . ................ 31 Tuition Reimbursement Program . . . . . . . . ......... 32 Purchasing Power . . . . . . . . . . . . . ............... 32 Child Care Benefit Program . . . . . . . . . . ........... 32 The Emergency Fund . . . . . . . . . . . . .............. 33 Retirement 401(k) Savings Plan . . . . . . . . . . . . . .............. 34 Innovative Ways to Manage Your Pay DailyPay . . . . . . . . . . . . . . . . . .................. 35 Wisely . . . . . . . . . . . . . . . . . . ................... 35
2 Health Policy/Group Number Website/Phone Medical: Administered by Personify Health (formerly HealthComp) Value Copay Plan, Choice HSA Plan, Premier EPO Plan N35 https://hconline.healthcomp.com/ensign 833-549-2867 CerpassRx Pharmacy Benefit Manager n/a https://cerpassrx.com/ensign 844-622-4369 Garner Top Provider Network Health Reimbursement Account Program n/a https://getgarner.com/start 866-761-9586 Teladoc Telemedicine n/a www.teladoc.com 800-835-2362 98point6 Text-based Telemedicine n/a https://www.98point6.com/ensign n/a Hinge Health Virtual Physical Therapy n/a https://bit.ly/ensignhingehealth 855-902-2777 Vida Health Diabetes Support n/a https://vida.com/ensign 855-442-5885 Lyra Mental Health Support n/a https://ensign.lyrahealth.com 833-872-0268 Email: care@lyrahealth.com Medical available in southern CA, Denver, CO, Dallas, TX, Kansas City KS and MO, Seattle and Spokane, WA Centivo PCP Partnership Plan ENSGN https://ensign.centivo.com 800-981-8925 CerpassRx Pharmacy Benefit Manager n/a https://cerpassrx.com/ensign 844-622-4369 Hinge Health Virtual Physical Therapy n/a https://bit.ly/ensignhingehealth 855-902-2777 Vida Health Diabetes Support n/a https://vida.com/ensign 855-442-5885 Medical: Administered by Kaiser Permanente Kaiser HMO NoCal with HSA Kaiser HMO SoCal with HSA Kaiser HMO CO with HSA Kaiser HMO OR with HSA Kaiser HMO WA with HSA KP NoCal: #39044 KP SoCal: #225775 KP CO: 44324 KP OR: 25517 KP WA: 21134 www.kp.org 800-464-4000 Medical: Available in San Diego County SIMNSA Baja CA Premier Access HMO #529 www.simnsa.com 619-407-4082 Health Savings Account (HSA) Fidelity n/a www.netbenefits.com 800-835-5095 Supplemental Medical Coverage Unum Hospital Insurance, Accident Insurance, Critical Illness Insurance n/a www.unum.com 866-679-3054 Dental Cigna Dental PPO Plan, Cigna Dental DHMO Delta Dental PPO Plan Cigna Dental: #2499682 Cigna DHMO: #3333164 Delta Dental: #19192 www.cigna.com 800-244-6224 www.deltadentalins.com 800-765-6003 Vision Vision Service Plan #30019528 www.vsp.com 800-877-7195 Financial Protection Flexible Spending Accounts (FSAs) HealthEquity Health Care FSA, Limited Purpose FSA, Dependent Care FSA n/a www.healthequity.com 877-924-3967 Transportation/Commuter Benefits Program HealthEquity n/a www.healthequity.com 877-924-3967 Life and Accidental Death & Dismemberment (AD&D), Short-Term Disability, and Long-Term Disability Insurance Plans Unum Basic Group Term Life and AD&D, Supplemental Group Term Life and AD&D, Short-Term Disability (STD), Long-Term Disability (LTD) Basic Life and AD&D: #415402 Supp. Life and AD&D: #415403 STD: n/a LTD: #145912 www.unum.com Basic, Supp. Life and AD&D: 800-421-0344 STD: 800-635-5597 LTD: 800-633-7479 Auto and Home Insurance Farmers Auto and Home Insurance n/a www.farmers.com 855-498-3697 Important Benefits Contacts Contact Information for Our Carriers Included when you are enrolled in a Personify Health medical plan. Included when you are enrolled in the Centivo PCP Partnership 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. For resources online, go to www.ensignbenefits.com/resources. Financial Protection (continued) Policy/Group Number Website/Phone Legal Insurance ARAG n/a https://ARAGlegal.com/myinfo 800-247-4184 Cyber Security/Identity Theft Protection LifeLock with Norton n/a https://my.norton.com 800-607-9174 Pet Insurance Nationwide n/a https://benefits.petinsurance.com/ensign 877-738-7874 Work-Life Employee Assistance Program Health Advocate EAP n/a www.unum.com/lifebalance 800-854-1446 Tuition Reimbursement Scholarship Management Services n/a Email: benefits@ensignservices.net 949-540-1940 Discounted Entertainment Tickets TicketsatWork Company code: Ensign www.ticketsatwork.com 800-331-6483 866-273-5825 Employee Purchase Program Purchasing Power Group code: ENS2293 https://ensign.purchasingpower.com 866-670-3479 Child Care Benefit Program KinderCare n/a www.kindercare.com/ensign 888-525-2780 Retirement 401(k) Savings Plan Fidelity n/a www.netbenefits.com 800-835-5095 3 Contact Information for Our Carriers (continued) Ensign Benefits Website The Ensign Benefits website is your go-to source for information about your benefit plans. Start with high level 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 if you need more information. The website is easy to navigate on your computer, tablet or smartphone. Go to www.ensignbenefits.com
4 Complete Your Benefits Enrollment in Workday When you’re ready to enroll in your 2025 benefits, sign in to Workday with your user name and password. Your user name 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. HR & Benefits Support Call the HR Services Support Center 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 support@ensignservices.net to reset your password. Call 888-659-3616 weekdays 8 AM to 5 PM PT or email benefits@ensignservices.net. Resources (continued) 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. It’s 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. To get started using ALEX, go to https://start.myalex.com/ensign.
Benefit Basics About Your 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, our benefit plans 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 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 coverage 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 medical coverage. Eligible Dependents You will be required to provide proof of dependent eligibility at the time of enrollment. Eligible dependents for health 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. Common Law Spouse is not an eligible relationship to be covered as a dependent on medical, dental, or vision plans for any state. Domestic Partners may be covered on the fully insured Kaiser and SIMNSA plans. • Children: Eligible dependent children must be under age 26 or any age if they 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. Children of a covered legal spouse are also eligible for the BCBS self-funded medical plans. If your domestic partner is covered under Kaiser or SIMNSA, then their children may also be covered. 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). Newborns are effective as of the date of birth as long as the dependent is enrolled within 30 days of their date of birth. 5
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. You must add your newborn in order for them to continue to be covered. • 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 email scanned copies of documentation to benefits@ensignservices.net. Coverage changes go into effect the first of the month after the qualifying event. For example, if coverage ends on August 31, your coverage 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 benefits@ensignservices.net. Be sure to include your name and employee ID number with your submitted documentation. 6 When Coverage Ends Medical, dental and vision 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 or call the HR Services Support Center at 888-659-3616 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 plan administrator. OPTIONAL NOW Enroll in Workday or call the HR Services Support Center If you are eligible, you must enroll for these benefits within 30 days of your date of hire: • Medical • Voluntary Long-Term Disability • Dental • Voluntary Group Accident • Vision • Voluntary Critical Illness • Flexible Spending Accounts • Voluntary Hospital Indemnity • Supplemental Life • ARAG Legal Insurance • Supplemental AD&D • Cyber Security/Identity Theft Protection OPTIONAL ANYTIME Enroll through carrier or plan administrator If you are eligible, you can elect or change these benefits any time: • Health Savings Account (HSA)* • Transportation Benefit Program* • Voluntary Short-Term Disability • Auto and Home Insurance • 401(k) Savings Plan • Pet Insurance * Optional anytime, enroll 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 benefits@ensignservices.net before your enrollment deadline. Enroll in Your 2025 Benefits in Workday Go to https://www.myworkday.com/wday/authgwy/ensign/login.html. • 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 Benefits and Pay to enroll or make benefit changes. • 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 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 three medical plans administered by Personify Health (formerly HealthComp). If you live in California, Colorado, Oregon or Washington, you also have an HMO option through Kaiser if you live in a Kaiser Permanente service area. If you live in southern California, Denver, Dallas, Kansas City, Seattle or Spokane, you can choose the Centivo PCP Partnership Plan. 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 Personify Health use a national provider network through Blue Shield. Need help choosing the best medical plan? Say hello to ALEX our online benefit counselor. Go to https://start.myalex.com/ensign. Medical Plans Value Copay Plan This plan exclusively covers you for in-network doctors and facilities and gives you access to Blue High Performance Network (HPN) providers in certain geographic locations based on your zip code. Blue HPN providers are selected based on delivery of quality, affordable care offering savings to Affiliate employees in exchange for a smaller provider network and the lowest paycheck deduction. Choice HSA Plan 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, the plan comes with a Health Savings Account (HSA) that you can contribute to. Premier EPO Plan 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-ofnetwork care. Centivo PCP Partnership Plan (Southern CA, Denver, Dallas, Kansas City, Seattle and Spokane employees only) This plan exclusively covers you when you stay in the Centivo network. Except in emergencies, you’ll pay the full price for any care you receive from a non-Centivo doctor or facility. With this plan, you must choose a primary care doctor who will direct your care and provide referrals. Kaiser HMO with HSA (CA, CO, OR and WA employees only) You must live in a Kaiser Permanente service area in one of the following states: California, Colorado, Oregon or Washington. 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 must 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.
9 Personify Health (formerly HealthComp) We have partnered with Personify Health as the administrator of our self-funded medical plans. Personify Health manages the Value Copay Plan, Choice HSA Plan and Premier EPO Plan. Personify Health’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 Personify Health, you can access and manage your health benefits information through an easy-to-use member portal or with the Personify Health mobile app while you’re on the go. Personify Health Online: https://hconline.healthcomp.com/ensign Email: hconline@healthcomp.com 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 Centivo PCP Partnership Plan Highlights The Centivo PCP Partnership Plan is a different type of health plan that helps provide high-quality care at lower costs by working directly with local healthcare providers you know and trust. With Centivo, you’ll get an affordable health plan that’s easy to use. • T his plan offers FREE primary care visits and set copays for most other care. • T he core of the PCP Partnership Plan is a relationship between you and your primary care doctor who can help keep you healthier, improve your healthcare experience and keep your costs low. • Y our primary care doctor will refer you to high-quality, in-network specialists, ensuring you’ll get the right care for your needs at the best price. • W hen you see your primary care doctor first (remember, these visits are FREE!), get referrals for specialty care and see in-network specialists, you’ll get predictable copays, so you’ll know what you owe before going to the doctor. For more on the Centivo PCP Partnership Plan, see https://ensignbenefits.com/health-wellness/medical/centivo. Centivo Regions and Provider Networks • Southern CA: Providers who are affiliated with MemorialCare, UCLA Health and Scripps Health • Denver, CO: Providers who are affiliated with Advent Health and CommonSpirit (formerly known as Centura) • Dallas, TX: Providers who are affiliated with Baylor Scott & White Quality Alliance, an accountable care organization (ACO) affiliated with Baylor Scott & White Health • Kansas City, KS and MO: Providers who are affiliated with Centrus Health • Seattle, WA: Providers who are affiliated with Embright Health System and University of Washington, Harborview Medical Center • Spokane, WA: Providers who are affiliated with CHAS Health and Multicare Health System
10 2025 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 CENTIVO PCP PARTNERSHIP PLAN (So Cal, Denver, CO, Dallas, TX, Kansas City, KS and MO, Seattle & Spokane, WA) VALUE COPAY PLAN NETWORK ONLY YOU PAY NETWORK ONLY YOU PAY Employee Paycheck Contributions $ $ Preventive Care Covered in full3 Covered in full3 Telemedicine Doctor Visit Behavioral Health Visit Through Centivo Virtual Primary Care FREE N/A Through Teladoc $5 copay $5 copay Telemedicine (text-based) Doctor Visit N/A Through 98point6 FREE Calendar Year Deductible Employee Only / Family In-network Employee Only / Family Out-of-nework $1,000 / $2,000 N/A $5,000 / $10,0001 N/A Coinsurance (You Pay) N/A 20% Calendar Year Out-of-Pocket Maximum Employee Only / Family $4,000 / $8,000 $7,0006 / $14,0006 Health Savings Account (HSA) N/A N/A PCP Office Visit FREE $20 copay Specialist Office Visit $50 copay $75 copay Urgent Care $75 copay $75 copay Emergency Room $500 copay $500 copay2,7 then you pay 30% Diagnostic Testing $20 copay 20%2 Outpatient X-ray and Lab $20 copay 20%2 Hospitalization Inpatient Semi-Private Room Inpatient Physician $900 copay after deductible Included with copay above 20%2 20%2 Outpatient Treatment (PT, OT, ST) Hinge Health Virtual Physical Therapy $50 copay FREE 20%2 FREE Mental Health/Substance Abuse Inpatient Outpatient $900 copay after deductible FREE 20%2 $45 copay Pharmacy Retail Specified Preventive Drugs4 Generic Brand Formulary Brand Non-Formulary Specialty Drugs 30-day supply10 (see footnote) 100% covered3/$5 copay13 $10 copay3 $25 copay2 $40 copay2 20%2,8 up to $125 30-day supply10 (see footnote) 100% covered3/$5 copay13 $10 copay3 $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/$10 copay13 $20 copay3 $50 copay2 $80 copay2 90-day supply 100% covered3/$10 copay13 $20 copay3 $50 copay2 $80 copay2 5) In-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-ofpocket 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.
11 Southern CA Residents CHOICE HSA PLAN PREMIER EPO PLAN KAISER HMO WITH HSA (CA, CO, OR, WA) SIMNSA Baja CA Premier Access HMO (San Diego County) IN-NETWORK YOU PAY NETWORK ONLY YOU PAY NETWORK ONLY YOU PAY NETWORK ONLY YOU PAY $$ $$$ $$$ $ Covered in full3 Covered in full3 Covered in full3 Covered in full Through Teladoc 10%2 (Cost is $55 per visit) 10%2 (Cost is $55 per visit) Through Teladoc $5 copay $5 copay 20%2 N/A N/A N/A Through 98point6 $8 copay14 Through 98point6 FREE N/A N/A $2,0005 / $4,0001,5 $4,0005 / $8,0001,5 $1,000 / $2,0001 N/A $3,000 / $6,0001 N/A N/A N/A 20% 20% 20% None $6,0006 / $12,0006 $2,000 / $4,000 $4,425 / $8,850 $6,350 / $12,700 You can contribute pre-tax dollars to an HSA through Fidelity. IRS limits for 2025 are $4,300 (employee only) and $8,550 (family). You can contribute an additional $1,000 if you are age 55 or older in 2025. N/A You can contribute pre-tax dollars to an HSA through Fidelity. IRS limits for 2025 are $4,300 (employee only) and $8,550 (family). You can contribute an additional $1,000 if you are age 55 or older in 2025. N/A 20%2 $30 copay 20%2 $5 copay 20%2 $50 copay 20%2 $5 copay 20%2 $50 copay 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 20% 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 $500 copay2, then you pay 20% 20%2 20%2 20%2 Covered in full Covered in full 20%2 FREE 20%2 FREE 20%2,11 N/A $10 copay N/A 20%2 20%2 $500 copay then 20%2 $30 copay9 20%2,12 20%2 Covered in full $5 copay 30-day supply10 (see footnote) 100% covered3/$5 copay13 $10 copay2 $25 copay2 $40 copay2 20%2,8 up to $125 30-day supply10 (see footnote) 100% covered3/$5 copay13 $10 copay3 $25 copay3 $40 copay3 20%3,8 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/$10 copay13 $20 copay2 $50 copay2 $80 copay2 90-day supply 100% covered3/$10 copay13 $20 copay3 $50 copay3 $80 copay3 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) M ay be available at CerpassRX retail pharmacy or Pharmacy Mail Service if authorized. Note that any specialty drug discount coupons will not apply towards the calendar year deductible our out-of-pocket maximum. 9) O utpatient facility: $250 copay per visit plus 20% after calendar year deductible. 10) A $10 copay will be added to the cost for any prescriptions filled at Walgreens. 11) Max 30 visits per year Kaiser HMO with HSA in OR & SE WA. 12) N o charge after deductible for group therapy visits (Kaiser HMO WA). 13) A pplies to certain brand-name preventive drugs not covered under the Affordable Care Act. 14) F ree after calendar year deductible is met.
All of the medical plans include 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 (100-day supply with Kaiser HMO with HSA) you take on a regular basis for chronic conditions such as high blood pressure, asthma, diabetes or high cholesterol. Prescription Drugs with a Personify Health Plan or Centivo Value Copay Plan, Choice HSA Plan, Premier EPO Plan or Centivo PCP Partnership Plan When you enroll in a medical plan administered by Personify Health (formerly HealthComp) or you enroll in the Centivo PCP Partnership Plan, you automatically receive prescription drug coverage through CerpassRx. The CerpassRx pharmacy network includes all national chains and most local pharmacies. The Choice HSA Plan also has 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. Some brand name preventive drugs require a $5 copay. Review the CerpassRX preventive drug list for details 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 HMO with HSA Plan (CA, CO, OR, WA) When you enroll in the Kaiser HMO with HSA Plan (CA, CO, OR, WA), 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. Prescription Drug Coverage
13 Find Providers in Your Medical Plan Network Kaiser HMO with HSA (CA, CO, OR, WA) 1. Go to https://healthy.kaiserpermanente.org/ doctors-locations. 2. Click on your geographic location. 3. F ill in the search criteria including search for (doctors or locations), zip code (optional) and keywords (optional). 4. Click on the Search button. Centivo PCP Partnership Plan (So CA, Dallas, TX and Denver, CO) 1. Go to centivo.com/ensign. 2. Click on Find a doctor or facility. 3. Select Doctor or Facility. 4. I f you are searching for a doctor, select a specialty from the dropdown list (optional). Add a doctor or facility name (optional) and enter your address or zip code. 5. Click on the Search button. SIMNSA Baja CA Premier Access HMO 1. Go to https://www.simnsaee.net/Expediente2010/ CitasOnline/proveedores/frm_proveedores.aspx. 2. Select network, type and specialty from the dropdown lists. 3. Click on Start Search button. 4. Click on the Search button. Value Copay Plan 1. Go to https://hconlinex.healthcomp.com/ensign. 2. Click on Find Care. 3. S elect your network from the dropdown list (based on plan name, with HPN providers or No HPN providers and location). 4. E nter your location (city and state or zip code). 5. F ill in other search criteria (such as driving distance, provider type, specialty or name of doctor or facility) or click on Quick Search for Urgent Care, Primary Care Physician or Behavioral Health Care. 6. C lick on the Search button. Choice HSA PPO Plan 1. Go to https://hconlinex.healthcomp.com/ensign. 2. Click on Find Care. 3. S elect your network from the dropdown list (Choice HSA PPO - Utah or Choice HSA PPO - All other states). 4. E nter your location (city and state or zip code). 5. F ill in other search criteria (such as driving distance, provider type, specialty or name of doctor or facility) or click on Quick Search for Urgent Care, Primary Care Physician or Behavioral Health Care. 6. Click on the Search button. Premier EPO Plan 1. Go to https://hconlinex.healthcomp.com/ensign. 2. Click on Find Care. 3. S elect your network from the dropdown list (Premier EPO - Utah or Premier EPO - All other states). 4. E nter your location (city and state or zip code). 5. F ill in other search criteria (such as driving distance, provider type, specialty or name of doctor or facility) or click on Quick Search for Urgent Care, Primary Care Physician or Behavioral Health Care. 6. Click on the Search button.
Do not use your FSA and HRA for the same expenses. • You can’t use FSA dollars to pay for medical costs that will be reimbursed by Garner. • Since they are both tax advantaged benefits, the IRS considers this “double dipping”. To avoid double dipping, use FSA funds on services not covered by the Garner HRA such as over the counter medication, hygiene products and dental/vision needs. 14 Garner Top Provider Network/Health Reimbursement Account Program If you enroll in the Premier EPO, Choice HSA or Value Copay medical plan, you are eligible to earn a FREE annual Health Reimbursement Account (HRA) incentive. The incentive is “use it or lose it” and is designed to help steer you to high quality providers when you seek care. When you add a Garner Top Provider to your care team on the Garner App prior to your Garner provider visit, you will earn reimbursement dollars to help cover expenses such as your annual deductible, copays and co-insurance. Here’s How Garner Works Garner pays your out-of-pocket expenses when you see a Top Provider. 1 Use Garner to find a Top Provider 2 See the Top Provider 3 Get reimbursed for eligible out-of-pocket costs Get Started with Garner Garner pays your out-of-pocket costs when you see a Top Provider. 1 Download the Garner Health app from the App Store or Google Play or scan the QR Code. 2 Go to getgarner.com/start. 3 Create an account with Garner and search for Top Providers. For organization name, use ENSIGN. 4 Garner will reimburse your out-of-pocket costs for services provided or ordered by a Top Provider. Questions? Contact a Garner Concierge for help via the Garner Health app or website or by calling 866-761-9586. Annual Health Reimbursement Account (HRA) Incentive Plan Plan Deductible Annual HRA Incentive Maximum Premier EPO $1,000 Emp Only $2,000 Family $1,000 Emp Only $2,000 Family Choice HSA $2,000 Emp Only* $4,000 Family* $1,000 Emp Only $2,000 Family Value Copay $5,000 Emp Only $10,000 Family $1,000 Emp Only $2,000 Family * If you are enrolled in the Choice HSA, IRS provisions require that you must meet $1,650 of your employee only deductible or $3,300 of your family deductible before qualifying out-of-pocket costs from services by Top Providers can be reimbursed through the HRA.
15 If you’re struggling with joint or muscle pain, Hinge Health can help. Their virtual programs combine gentle exercise with 1-on-1 support to improve your condition, reduce your pain and help you move with confidence. Whether your goal is to go hiking more, spend time in your garden or take the stairs (or all three), you can get pain relief with exercises that can be done in as little as 15 minutes – anytime, anywhere you’re comfortable. Hinge Health offers complete clinical care including innovative virtual physical therapy programs for back, knee, hip, pelvis, neck and shoulder pain in easy-to-do 15-minute exercise sessions. Hinge Health also offers wearable pain relief and motion tracking, along with spinal and neck surgery support. Join Hinge Health for exercise therapy without leaving home. No copays. No office visits. Reduce your back and joint pain in just 15 minutes a day. Best of all, there’s no cost to you — your Hinge Health benefit is 100% covered if you are enrolled in the Value Copay PPO, Choice HSA, Premier EPO or Centivo PCP Partnership plans. Hinge Health: Virtual Physical Therapy Program Learn More About Hinge Health Online: https://bit.ly/ensignhingehealth Call: 855-902-2777 Email: hello@hingehealth.com
16 Vida Health is a free program for members diagnosed with type 2 diabetes who are enrolled in the Value Copay, Choice HSA, Premier EPO and Centivo PCP Partnership Plans. • Vida program participants may be eligible to receive our preferred GLP-1 medication (Mounjaro) for free. • Vida Health matches you to a health coach with proven success helping people with type 2 diabetes make the kind of lifestyle changes that lead to happier, healthier lives. • Learn how to monitor and improve blood sugar levels and other symptoms with the help of medications and mobile app tools. Lyra provides free mental health support for members enrolled in the Value Copay, Choice HSA and Premier EPO Plans. Find confidential care for your emotional and mental health, how, when, and where you need it. Access 8 free therapy or mental health coaching sessions per year or tap into digital wellness tools anytime, anywhere. Vida Health Diabetes Management Lyra Mental Health Support Get Started with Vida Health Download the Vida Health app from the App Store or Google Play. Online: vida.com/ensign Call: 855-442-5885 Learn More About Lyra Mental Health Support Online: https://ensign.lyrahealth.com Call: 833-872-0268 Email: care@lyrahealth.com In-person & video therapy Mental health coaching On-demand, self-care library Meet with a licensed therapist for diagnosis and treatment of mental health conditions like depression, PTSD, and more. Receive personalized support from a mental health coach via video or live chat to help address mild challenges like parenting, burnout, or life transitions. Tap into Lyra Essentials for unlimited access to digital wellness tools for managing stress, improving sleep, and strengthening relationships.
If you enroll in the Choice HSA Plan or a Kaiser HMO with HSA Plan (CA, CO, OR, WA), 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 Open Your HSA with Fidelity If you enroll in the Choice HSA Plan or Kaiser HMO with HSA, you must open your HSA online with Fidelity using the netbenefits.com website. Follow these steps: 1) After you make your enrollment elections in Workday, watch for an email or postcard from Fidelity with information about your Fidelity HSA. 2) Log in to netbenefits.com. You will be prompted to create an account if you don’t already have an account for your 401(k). 3) Once you are logged in to the Fidelity website, click on the link to Open Your HSA. If you have questions, call Fidelity at 800-835-5095. 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 $4,300 if you have Employee Only coverage. • Up to $8,550 if you have Employee + Dependents coverage. • Additional $1,000 if you are age 55 or older. • I f your spouse contributes to an HSA, your combined contributions may not exceed $4,300 if you have Employee Only coverage or $8,550 if you have Employee + Dependents coverage. • You can invest your HSA balance, and there is no minimum account balance required. 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 • U se the Fidelity HSA debit card, or submit expenses online at netbenefits.com. • Y our account balance and information on claims is available 24/7 on your netbenefits.com or in the Fidelity 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. 17
Telemedicine through Teladoc Value Copay Plan, Choice HSA Plan, Premier EPO Plan 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. 18 Your Cost for Teladoc Visits Medical Visits Behavioral Health Visits Value Copay Plan $5 copay $5 copay Choice HSA Plan 10%1 10%1 Premier EPO Plan $5 copay $5 copay 1 After calendar year deductible
Video or Phone Appointments with Kaiser HMO with HSA Plan (CA, CO, OR, WA) If you are enrolled in a Kaiser HMO with HSA Plan (CA, CO, OR, WA), 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. 19 Your Cost for 98point6 Visits Medical Visits Value Copay Plan FREE Choice HSA Plan $8 copay* Premier EPO Plan FREE Centivo Virtual Primary Care If you are enrolled in the Centivo PCP Partnership Plan, you can see your primary care doctor for free from home or on the go. Centivo’s Virtual Primary Care practice is a convenient alternative to in-person primary care. If you need to be seen in person, your Virtual Primary Care Team will coordinate in-person care with local, in-network providers. Text-Based Telemedicine Value Copay Plan, Choice HSA Plan, Premier EPO Plan 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 Value Copay Plan, Choice HSA Plan, Premier EPO Plan. 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. * Free after calendar year deductible is met.
20 Supplemental Medical Voluntary benefits through Unum complement your medical coverage and can fill in coverage gaps by providing additional financial protection with premiums paid through the convenience of payroll deduction. Two important notes: * These voluntary plans should not be used in place of medical coverage. * Your basic life insurance beneficiary designation will apply if you participate in voluntary benefits. Hospital Insurance A hospital stay or medical procedure can cost thousands of dollars. You can use this coverage to help pay for the out-of-pocket expenses medical insurance doesn’t cover, such as co-insurance, co-pays and deductibles. You can get coverage for yourself and your family members. Accident Insurance If you are accidentally injured, this coverage can pay you money for more than 50 types of injuries, services and treatments. You can use this benefit to help cover expenses your health insurance doesn’t, like co-pays and deductibles. You can get coverage for yourself and your family members. Critical Illness Insurance Severe illnesses often have out-of-pocket expenses that medical insurance doesn’t cover. This coverage pays you a lump sum if you are diagnosed with a covered condition. It can help you worry less about expenses so you can focus on your recovery. You can get coverage for yourself and your family members. $50 Be Well Benefit The Unum Critical Illness Insurance plan pays a wellness benefit of $50 when you and other covered family members receive important tests and screenings. You can learn more about the annual Unum Be Well benefit at www.ensignbenefits.com/ health-wellness/voluntary-critical-illness.
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