2018 BenefitsGuide_Draft4 (002)

A Guide to
My Benefits

2018 PLAN YEAR

Table of Contents

Welcome................................................................................ 1
Steps to Enroll......................................................................2
Eligibility............................................................................... 3
Medical & Pharmacy..........................................................4
Medical Plan Comparison Chart....................................6
Well-Being............................................................................8
Dental & Vision..................................................................10
Flexible Spending & Health Savings Accounts........... 11
Life Insurance & Disability............................................. 12
Retirement Plan 401(k)................................................... 13
Additional Benefits...........................................................14
Premiums............................................................................16
Legal Notices.....................................................................18
2018 Payroll Calendar..................................................... 20
Contact Information........................................................ 21

Please take time to review this guide carefully—it contains
important information about enrollment and your benefits.
If you have questions about your benefits or how to enroll,
please call a Benefits Representative at 602-933-5658 or
602-933-5637.

Welcome

Phoenix Children’s Benefits Program

Phoenix Children’s benefits add value beyond your paycheck. As an employee of Phoenix
Children’s, you have a total compensation package; a combination of pay and benefit programs
that are among the best in the Valley.
This benefit guide describes the key features of our programs. They are designed to give you
choices about the types and levels of protection you want and are just one of the many ways
Phoenix Children’s helps you take care of yourself and your family. Please take the time to learn
about the benefits so you can make informed choices and decisions.
The benefits described in this guide are governed by certificates of insurance and/or plan
documents. While every effort has been made to ensure the accuracy of these materials,
any errors, omissions or discrepancies will always be governed by the applicable official
plan documents.

This guide is meant to provide basic benefit plan information. For additional details and specific
information review the Phoenix Children’s Summary Plan Descriptions (SPD’s) and Summaries
of Benefits & Coverage, available in a printable format on www.benewise.com/pch or pch4u
under Human Resources > Benefits. If you do not have a personalized computer work station, you
may use one of the employee kiosks located in the Human Resources area or contact a Benefits
Representative at 602-933-5658.

2018 Benefits Guide 1

Steps to Enroll

BeneWise is Phoenix Children’s online benefit enrollment system used during open enrollment, if you
are newly eligible for benefits and if you are updating your benefits when you have a Qualified Life
Event. You will go through a series of steps to complete your enrollment; each screen has instructions
in the notes section. Please complete the entire process and print your confirmation statement.

1. Website Log-On Information: 5. Acknowledgment for electronic distribution of
www.benewise.com/pch legal documents.

• BeneWise User Name: Your last name and last 4 This screen is your consent for electronic distribution
digits of SSN of plan documents including but not limited to
Summary Plan Descriptions (SPDs), Summaries of
• BeneWise Password: Benefits and Coverage (SBCs), Benefit Plan booklets,
etc. If you select the option “I consent,” you will get
– Open enrollment/qualifying events - use the these documents electronically and avoid having them
password you created or click to reset. mailed to you.

– New hires/newly eligible - click first time user 6. Click “Save & Confirm Elections” at the end
to create a password (You will need to validate of the process in order for your enrollment to
your identity by entering your date of birth and
SSN and then clicking “find my record”). be finalized.
Print, review and keep your confirmation statement. If
2. Enter your personal or work email.
completing your new hire enrollment or a qualified
Your email is required in order to begin your life event, your enrollment confirmation statement will
enrollment. not be available until after the event is approved.

3. From the Event Change page, select your event www.benewise.com/pch
and click “Begin Event.”

• Open Enrollment - select the Open Enrollment event.

• New Hires/newly eligible for benefits - select the
New Hire event.

• Qualified Life Event - select appropriate event
except if it is during the open enrollment period,
then contact a Benefits Representative.

4. Add or update your dependent information.

You must include current and complete dependent
information including the dependent’s SSN. Once you
have entered your dependent information, you will
need to ensure that your dependent is selected

in each of the benefit screens where you want
dependent coverage.

2 Phoenix Chidren’s Hospital

Eligibility

If you are a full-time or part-time employee in a FTE of .50 or above, you are eligible for medical, dental
and vision benefits. If you are in a FTE of .60 or above, you are also eligible for life insurance and
disability benefits. Eligible employees may elect to participate or waive coverage. Benefits are effective
the first day of the month following your date of hire or eligibility.

Your eligible dependents include: Loss of Coverage

• Legally married spouse If you lose medical, dental or vision coverage
due to separation of employment or a reduction
• Dependent child to age 26 including: of hours, you may continue coverage under
COBRA regulations. Information will be sent
– Natural, legally adopted child, or child placed to your home regarding the election of COBRA
for adoption eligible benefits.

– Stepchild

– Child for whom you are court-appointed guardian

– Child of any age totally disabled due to a physical
or mental handicap

Dependent Eligibility Verification

Employees, who add dependents to their benefits when
completing their new hire enrollment, or if adding new
dependents during the open enrollment period and
throughout the year as a result of a Qualified Life Event,
are required to provide verification of their dependent(s).
Dependent verification documents include a birth
certificate for children or a marriage certificate for a
spouse. You can also provide a current tax form listing
your eligible dependents.

Qualified Life Events include:
• Marriage

• Divorce / legal separation

• Birth / adoption / legal custody of a child

• Death of a spouse or dependent child

• Employee and / or dependents gain / loss of other
coverage

Your benefit elections will stay in place until the
next Open Enrollment period unless you have a
Qualified Life Event as defined by the IRS. You
must contact the Benefits Department within
30 days of the qualifying event.

2018 Benefits Guide 3

Medical & Pharmacy

Medical Benefits Preventive Care

Phoenix Children’s knows that employees’ health care Preventive services are covered at 100 percent, as
needs vary and even change over time. Therefore, Phoenix long as services are provided by in-network providers.
Children’s offers three medical plan options to choose Regular preventive care visits and health screenings
from: 500 Plan, 1000 Plan and the Consumer Directed may help to identify potential health risks for early
Health Plan (CDHP). All three plans are administered by diagnosis and treatment. Preventive care may include
UMR (United Medical Resources) which is a subsidiary many types of services, subject to age and gender
of United Healthcare. While these plans have different guidelines, including:
features and costs, they also have several things in
common: Physician office services
• Routine physical exams
• They cover the same services and types of care. • Well women exams
• Well-baby and well-child care
• They offer in-network preventive care at no cost to you. • Immunizations

• They use the same UnitedHealthcare Choice Plus Lab, X-ray or health screening tests
Network of providers. • Screening mammography
• Screening colonoscopy or sigmoidoscopy
500 Plan & 1000 Plan • Cervical cancer screening
• Osteoporosis screening
These two plans are very similar. They offer co-pays for
prescription drugs, primary care and specialist office Consult your doctor for your specific preventive
visits. You may elect a Flexible Spending Account (FSA) recommendations, as he or she is your most
with these plans to pay for copays, deductibles and important source of information about your health.
coinsurance with pre-tax dollars. See page 11 for more Register at umr.com for more information on covered
details on FSA. preventive services.

CDHP

This plan gives you more control over how you spend
your health care dollars. You have lower premiums for
the coverage but a higher deductible. If you elect this
plan with one or more dependents, you need to meet the
family deductible before any cost-sharing begins which
means you pay the negotiated rate for all services and
prescriptions until you reach your deductible, with the
exception of preventive care services which are covered
at 100 percent. This plan includes the option of enrolling
in a Health Savings Account (HSA) that you can fund
with pre-tax dollars to help pay for eligible medical,
prescription, dental and vision expenses. See page 11 for
more information on HSA.

Note: : According to the Affordable Care Act, you must have health coverage or face a tax penalty. You have the
opportunity to enroll for Phoenix Children’s medical coverage as a new hire, during our annual open enrollment or
within 30 days of losing other medical coverage. If you do not enroll for health insurance with Phoenix Children’s, you
will need to find coverage from another source.

4 Phoenix Chidren’s Hospital

You can reduce your out-of-pocket expenses when you have services at the
following providers:

Bring your kids to Phoenix Children’s PCCN & ACN

If you are enrolled in the 500 Plan or 1000 Plan and bring Phoenix Children’s Care Network (PCCN) is the state’s
your covered dependents to Phoenix Children’s for care, only pediatric-focused clinically integrated network with
you will have co-pays for primary and specialty office more than 1000 pediatric providers, including our own
visits. For other services provided by Phoenix Children’s, PCMG physicians, along with community pediatricians
no deductible will apply, and Phoenix Children’s will throughout the Valley. PCCN has affiliated with Arizona
pay 100 percent of the first $500 of charges per child, up Care Network (ACN), a Clinically Integrated Network
to $1,000 per family. These amounts are applied to the (CIN) led by physicians and supported by Dignity Health
allowable amount prior to the coinsurance. After that, Arizona and Tenet/Abrazo Health, to offer network
your coinsurance will be only 10 percent. providers with office and hospital locations across the
Valley to serve the health care needs of patients of all ages.
• Office visit co-pays are not included in the
$500/$1000 benefit. In the 500 Plan and 1000 Plan, office visit charges
provided by physician members of either PCCN or ACN
• This benefit applies to Phoenix Children’s Hospital have lower office or specialist visit co-pays than if using
emergency room charges only if the patient is other providers, and for other physician charges, no
admitted. deductible will apply.

The IRS does not allow deductibles to be waived for The IRS does not allow deductibles to be waived for
the CDHP Plan. However, once the deductible is the CDHP Plan. However, once the deductible is
met, coinsurance will be only 10 percent for services met, coinsurance will be only 10 percent for services
provided at Phoenix Children’s. provided by a PCCN or ACN physician.

Pharmacy Benefits

Your prescription drug coverage through CVS Caremark
is automatic when you enroll in one of the Phoenix
Children’s medical plans. You can purchase prescription
drugs through a retail pharmacy or through mail-order.
If you have a prescription that requires ongoing regular
use, you may be required to use the Maintenance Choice
program and receive a 90-day supply of your medication
for the price of a 60-day supply. Your 90-day prescription
can be mailed or picked up at either a CVS Caremark
Pharmacy or the Phoenix Children’s Hospital Retail
Pharmacy. Discounts apply with the 500 Plan and 1000
Plan when you use the on-site Phoenix Children’s Hospital
Retail Pharmacy. Your cost for prescriptions is included in
the medical plan comparison chart on the next pages.

For more information you can review the plan comparison chart on pages 6-7 and also access the Summaries of
Benefits and Coverage (SBCs) for each plan at benewise.com/pch.

2018 Benefits Guide 5

Medical Plan Comparison Chart

PCH PCCN & 500 Plan In Network Out-of-
ACN*** Mayo AZ Network*
No In Network
deductible No $1,000
Deductible deductible $500 $500 $2,000
Individual $1,000 $1,000
Family $6,500
$3,500 $3,500 $3,500 $6,500 $13,000
Out of Pocket Maximum $7,000 $7,000 $7,000 $13,000
(includes deductible) 50%
Individual 50%
Family Ded/50%

Lifetime Maximum Unlimited Ded/50%

Coinsurance 90% 80% 80% 70% Ded/50%
(After deductible is met you pay coinsurance) 10% 20% 20% 30%
Phoenix Children’s Pays
You Pay 100% 100% 100% 100%
No No No No
Preventative Care Services deductible deductible deductible deductible

Office Visit $20 $20 $30 Ded/30%
Primary Care Physician $30 $30 $50
Specialist

Inpatient Hospitalization No Ded/10% No Ded/20% Ded/20% Ded/30%

Outpatient Surgery No Ded/10% No Ded/20% Ded/20% Ded/30% Ded/50%

Emergency Services** Ded/20% Ded/20% Ded/20% Ded/20% Ded/20%

Urgent Care No Ded/10% No Ded/20% Ded/20% Ded/30% Ded/50%

Prescriptions PCH Retail Pharmacy Retail Pharmacy Out-of-Network
Generic 30 day/90 day $5/$10 $10/$20 Not covered

Preferred Brand 30 day/90 day $20/$40 $35/$70 Not covered

Non-Preferred 30 day/90 day $40/$80 $60/$120 Not covered

Specialty 30 day N/A $125 Not covered

*Balance Billing: The amount the plan pays for a covered service is based on the allowed amount. If an out-of-network provider charges more than the allowed amount, you may have to pay the difference. For example, if
an out-of-network hospital charges $1,500 for an overnight stay and the allowed amount is $1,000, you may have to pay the $500 difference in addition to your out-of-network co-insurance and/or deductible. This amount
does not apply to the annual out of the pocket maximum.

6 Phoenix Chidren’s Hospital

1000 Plan CDHP

PCH PCCN & In In Out-of- PCH PCCN & In In Out-of-
ACN*** Network Network Network* ACN*** Network Network Network*
Mayo AZ $2,000 Mayo AZ
$4,000
No No $1,000 $1,000 $2,000 $2,000 $2,000 $2,000 $4,000
deductible deductible $2,000 $2,000 $4,000 $4,000 $4,000 $4,000 $8,000

$5,000 $5,000 $5,000 $6,500 $6,500 $5,000 $5,000 $5,000 $6,500 $6,500
$10,000 $10,000 $10,000 $13,000 $13,000 $10,000 $10,000 $10,000 $13,000 $13,000

Unlimited Unlimited

90% 80% 80% 70% 50% 90% 90% 80% 70% 50%
10% 20% 20% 30% 50% 10% 10% 20% 30% 50%

100% 100% 100% 100% Ded/50% 100% 100% 100% 100% Ded/50%
No No No No No No No No
deductible deductible deductible deductible deductible deductible deductible deductible

$20 $20 $30 Ded/30% Ded/50% Ded/10% Ded/10% Ded/20% Ded/30% Ded/50%
$30 $30 $50 Ded/30% Ded/50% Ded/10% Ded/10% Ded/20% Ded/30% Ded/50%
Ded/30% Ded/50% Ded/10% Ded/10% Ded/20% Ded/30% Ded/50%
No Ded/ No Ded/ Ded/20% Ded/20% Ded/20% Ded/20% Ded/20% Ded/20%
10% 20% Ded/10% Ded/10% Ded/20% Ded/30% Ded/50%
Ded/20%
No Ded/ No Ded/
10% 20%

Ded/20% Ded/20% Ded/20% Ded/20% Ded/20%

No Ded/ No Ded/ Ded/20% Ded/30% Ded/50%
10% 20%

PCH Retail Pharmacy Out-of-Network PCH Retail Pharmacy Out-of-Network
Retail Pharmacy $10/$20 Not covered Retail Pharmacy Not covered

$5/$10

$20/$40 $35/$70 Not covered Ded/20% Ded/20% Not covered
$40/$80 $60/$120 Not covered Not covered

N/A $125 Not covered Not covered

**The Phoenix Children’s benefit applies to Phoenix Children’s Hospital emergency room charges only if the patient is admitted. The $500 up to $1000 are applied to the allowable amount prior to the coinsurance.
***Charges for physician services provided by Phoenix Children’s Care Network (PCCN) and Arizona Care Network (ACN) physician members.

2018 Benefits Guide 7

Well-Being

ImpACT Your Overall Well-Being

Phoenix Children’s is committed to your health and the health of your family. Our mission is to
provide support, encouragement and tools to live a healthy life. ImpACT is a unique benefit we offer
employees to help you attain your individual wellness goals. Our award-winning program focuses
on multiple pillars of well-being, including physical, mental and financial. We continuously add new
wellness programs and opportunities. Some of our more popular programs include:

Free Onsite Annual Screenings For those employees who enjoy hiking with others and
trying new trails, Phoenix Children’s impACT has a hiking
Phoenix Children’s provides convenient, confidential group that goes on four scheduled hikes together from
biometric screenings at no cost to you (one per year per October through May. Many hikes are family friendly so
employee). The screening includes total cholesterol, bring your loved ones, friends and pets.
HDL cholesterol, glucose, blood pressure, BMI, height
and weight and body composition. Biometric results can Walking, Fitness and Weight Loss Challenges
be entered directly into your Health Risk Assessment
(HRA), found on our Vitality wellness portal, which will Phoenix Children’s impACT features walking, fitness and
generate your comprehensive health status report. You are weight loss challenges (including the $10,000 HealthyWage
also encouraged to schedule an appointment with MOM Team Challenge!). We urge all employees to join in a little
(Mobile Onsite Mammography). MOM is on-site several healthy competition while earning potential rewards.
times throughout the year.
Market Festivals
Vitality – the HUB of Phoenix Children’s
Well-Being Enjoy our Market Festivals held several times throughout
the year on our beautiful Café Patio. The market features
Phoenix Children’s offers an exciting well-being platform a variety of vendors including crafts, oils, salsa, skin care
to support healthy behaviors and lifestyles. Vitality products, spices, fitness centers and more.
is the “hub” of our robust program. Vitality provides
incentives, challenges, goals, tools and health education. Financial Sessions
Our platform leverages cutting-edge technology through
its mobile app, connecting you to the ultimate well-being Throughout the year, Phoenix Children’s offers one-on-
experience. Phoenix Children’s provides best-in-class one 401(k) financial counseling sessions on-site and hosts
wearable device integration by offering the opportunity periodic workshops on various financial topics.
to acquire an Apple Watch. Prefer Garmin, your Fitbit or
smart phone? No problem. Vitality connects with over 100 Fitness Center Discounts
tracking devices.
Phoenix Children’s works with a variety of fitness centers
Earn points to spend on Vitality’s Active Rewards Mall throughout the valley many of which offer discounts. To
by participating in nutrition, physical activity weight receive a complete listing, visit the impACT intranet page
management, financial and resiliency programs all or visit Human Resources.
through our well-being hub.

Hiking Group

8 Phoenix Chidren’s Hospital

Connect with impACT Tobacco Cessation
pch4u.phoenixchildrens.com/employeelife/wellness
Being a health care organization, Phoenix
Additional Well-Being Program Offerings Children’s believes that tobacco* use is unhealthy
• Headspace meditation and is not consistent with our mission.
• Yoga & stretching classes
• Walk/race event training Phoenix Children’s offers ongoing tobacco
• Onsite lactation room cessation programs at no cost to you. If, however,
• Fitness/wellness challenges you and/or your spouse decide to continue to
• Weight Watchers at Work use tobacco, there will be a $50-per-pay-period
• Personal growth workshops additional premium to your health plan in 2018.

Tobacco Cessation Programs

Our goal is to help you to successfully discontinue
using tobacco products*.

Pick up or have a Tobacco Cessation Program
brochure mailed or emailed to you today. Contact
Phoenix Children’s Wellness for additional
information and to notify us if you
stop using tobacco. You can avoid the tobacco
use surcharge once you are tested tobacco free or
complete a Phoenix Children’s-approved tobacco
cessation program.

*Tobacco products include, but are not limited to
cigarettes, cigars, pipes, chewing tobacco, snuff, dip,
electric cigarettes and loose tobacco smoked via a pipe,
hookah or hand-rolled cigarettes.

Phoenix Children’s is proud to be recognized as one of The Valley’s Top 10 Healthiest Employers
In addition, we are a Platinum Level Healthy Arizona Worksite, Gold American Heart Association
Fit-Friendly Workplace and Worksite Innovator. These awards recognize employers who champion the
health of their employees and work to create a culture of physical activity and health in the workplace.

2018 Benefits Guide 9

Dental & Vision

Dental

Phoenix Children’s offers three dental plans through Delta Dental of Arizona: Value, Premium and Elite. Each plan
offers both In-Network and Out-of-Network benefits.

With the Phoenix Children’s dental plans, you have the freedom to use any dentist. If you choose to go to a dentist who
is not in the network, you may be balance billed. You can find a provider on the Delta Dental of Arizona website at
deltadentalaz.com/provider-search.

Delta Dental of Arizona Benefits

Service Value Plan Premium Plan Elite Plan

Deductible In Out of In Out of In Out of
(Individual / Family) Network Network Network Network Network Network
Preventive Services
Basic Services $50 / $150 $75 / $225 $25 / $75 $50 / $150 $25 / $75 $50 / $150
Major Services
Orthodontics 100% 70% 100% 80% 100% 90%
Annual Maximum
70% 40% 80% 60% 85% 75%

40% 30% 50% 40% 60% 50%

$1,500 Child Only $1,500 Child Only $1,500 Adult & Child

$1,000 $1,000 $1,000 $1,000 $2,000 $1,000

Vision

The Vision Service Plan (VSP) provides coverage for routine eye exams, eyeglasses and contact lenses. No VSP card
needed! You can find a provider on the VSP website vsp.com and call them directly to schedule an appointment.

Service VSP Benefits Out of Network
Exams In Network Reimbursed up to $35

Prescription Eyeglasses $10 co-pay N/A
$10 co-pay Reimbursed up to $70
Frames (in lieu of contact lenses) $150 allowance Reimbursed up to $105
$150 allowance
Contact Lenses (in lieu of frames)
Frequencies Once every 12 months
Eye exam, Lenses, Frames

10 Phoenix Chidren’s Hospital

Flexible Spending &
Health Savings Accounts

Flexible Spending and Health Savings Accounts allow you to pay for eligible expenses on a pre-tax
basis. You decide how much to put into your account(s) each calendar year.

Flexible Spending Accounts (FSA) Health Savings Account (HSA)
Use it or lose it!
When you are enrolled in the Consumer Directed Health
Health Care Spending Account (HCSA) Plan (CDHP), you can make pre-tax payroll contributions
in an HSA to help pay for eligible health care expenses.
Using the Health Care Spending Account can help you Your HSA is tax-free money to pay for eligible out-
budget for health care expenses, such as your medical of-pocket medical, prescriptions, dental and vision
deductible, co-pays and coinsurance, vision expenses, expenses; or you can save that money for future health
dental expenses, prescription co-pays and several other care expenses or retirement.
eligible expenses. The HCSA can only be combined with
the 500 and 1000 Plans. The IRS annual maximum that The 2018 IRS contribution limits for HSA are:
you may contribute is $2,600. • $3,450 for single plan coverage
• $6,900 for family plan coverage
Dependent Care Spending Account (DCSA)
HSA Advantages:
A Dependent Care Spending Account allows you to
save money for expenses to care for your child or other • If you are 55 or older in 2018, you can make an
eligible dependents so that you and/or your spouse additional $1,000 catch-up contribution.
can work, look for work or attend school full-time. The
provider of care is required to provide a federal tax ID • Unused funds roll over, without limit, from year to
or Social Security Number. The IRS annual maximum year giving you a way to save for future health care
that you may contribute is $5,000. expenses.

Flexible Spending Account (FSA) Rules • You own the HSA and it is yours to keep even when
you change plans, jobs or retire.
• FSAs are an optional pre-tax benefit for which
you must enroll or re-enroll each year. • You are allowed to change your contribution during
the year. Any changes to your HSA will be effective the
• No changes can be made to the FSA first of the month following the request.
contribution amount until the next annual
enrollment unless you experience a qualifying Rules You Need to Know
life change event.
You own the funds in your account but there are
• Plan carefully because any money left in a some IRS rules:
Health and/or Dependent Care Spending • You cannot enroll in an HSA
Account at the end of the plan year will be — if you are covered by Medicare
forfeited. — if you are enrolled in another medical

• If you terminate employment, only expenses insurance, such as a spouse’s medical plan,
incurred before your termination date are unless it is a qualified high deductible plan.
eligible expenses. • If you use your HSA for non-eligible expenses,
the money is taxed and there is a 20% penalty if
• Qualified Dependents for child care expenses you are under 65. After 65, there is no penalty but
include: your natural child, stepchild, adopted the expenses are still taxable.
or foster child who is under the age of 13 and is • Avoid going over the contribution limit – it is
claimed as a dependent on your income taxes. your responsibility to monitor your HSA account
balance to ensure you do not exceed the IRS limit.

UMR (United Medical Resources) administers the FSA OPTUM Bank™ administers the HSA. Visit their website

accounts. Visit the UMR website at umr.com to access at optumbank.com for information on HSA requirements
your account and to get a list of eligible expenses. and IRS guidelines.

2018 Benefits Guide 11

Life Insurance &
Disability Benefits

Life and Accidental Death and Dismemberment (AD&D) Insurance

Basic Life and AD&D Disability Benefits

Life and AD&D insurance plans are offered through The Phoenix Children’s provides Disability coverage at no
Hartford and offer financial protection for you and your cost to eligible employees through The Hartford.
family. As part of the benefits at Phoenix Children’s, Disability coverage helps provide financial security
eligible employees are automatically covered for an for you and your family in the event you become sick
amount equal to one times base annual earnings (not to or injured and are unable to work. Employees are
exceed $300,000). automatically enrolled in disability benefits once they
are eligible. Non-exempt employees are eligible the 1st
Supplemental Life and AD&D of the month following six months in a disability eligible
position. Exempt employees are eligible the 1st of the
You also have the opportunity to purchase additional month following date of hire or eligibility.
supplemental coverage for yourself, spouse, and
dependent children.

Employee Options Short Term Disability

Benefit Amount* Increments of $50,000 Non-exempt Hourly Employees

Maximum Amount $700,000 Waiting Period 7 calendar days

Guarantee Issue $300,000 Benefit Amount 66 2/3% of base salary

Spouse Options Weekly Maximum Up to $1,000

Benefit Amount* Increments of $5,000 Maximum Benefit Period 26 weeks (180 days)

Maximum Amount $100,000 Exempt Salaried Employees

Guarantee Issue $30,000 Waiting Period 7 calendar days

Dependent Children Options Benefit Amount 100% of base salary

Benefit Amount $2,500 or $5,000 Maximum Benefit Period 26 weeks (180 days)

Guarantee Issue All amounts elected Long Term Disability

*Life insurance benefits are reduced at age 65 Waiting Period 180 days

Note: Evidence of Insurability may be required for Benefit Amount 60% of base salary
amounts over the guarantee issue or if adding/
Monthly Benefit Up to $10,000
increasing coverage more than one $50,000 increment Maximum Benefit Period
(for employee) or more than one level Up to Social Security
Normal Retirement Age
(for spouse) after initially eligible for this benefit.

12 Phoenix Chidren’s Hospital

Retirement Plan
401(k)

The Phoenix Children’s 401(k) Retirement Plan offers you an easy way to save for your future. Phoenix
Children‘s offers both a pre-tax 401(k) option and an after-tax Roth 401(k) option.

Consider these great advantages to start saving To Enroll:
for your retirement:
• Online: In the middle of the page, click on “Enroll
• For every dollar you put in the Plan, Phoenix Now.” Verify your identity and log into NetBenefits®.
Children’s will contribute $1, up to 4 percent of your You will choose your contribution amount and select
pay. The company matching contribution will happen your investment options. You should also make your
immediately upon your enrollment into the Plan. beneficiary designations online after enrolling in the
plan.
• You are always 100 percent vested in the money you
contribute to the Plan, the company match and the • By Phone: The voice response system will guide you
earnings on that money. through the process to establish your username and
password. You can then continue to enroll through
• Convenient payroll deductions: simply choose how the automated system or opt to speak with a Service
much you want deducted from your pay, and your Representative who can set up your contribution and
contribution will automatically be deducted. investment elections.

Don’t wait to start saving!

To join the plan, visit Fidelity NetBenefits® at netbenefits.
com/pch or contact a representative at 800-343-0860. When
you enroll, you will need to determine the percentage of
pay you want to contribute and choose
your investment options.

Pre-tax: You contribute on a pre-tax basis. The money
will be taxable when you withdraw it.

Roth After-tax: You contribute on an after-tax basis. The
contributions and earnings are tax-free when you take a
distribution if certain criteria are met.

This is only a general overview of the plan. You should consult the Summary Plan Description (SPD)
to obtain more detailed information about the plan. To print or view a copy of the SPD, you can access
the Phoenix Children’s employee intranet. If information contained herein differs from the applicable
provisions of the plan document, the plan document will prevail.

2018 Benefits Guide 13

Additional Benefits

Employee Assistance Program (EAP) Bright Horizons Care Advantage

Your ComPsych Employee Assistance Program is a The Bright Horizons Care Advantage program is
network of services that can help you improve your subsidized by Phoenix Children’s and is available to all
health, achieve more at work and home and handle employees. This program offers up to seven days a year
any personal or professional challenges you face. It is of high-quality temporary back-up child and adult/elder
provided free of charge and offers someone to talk to or care to use when disruption to your regular arrangements
resources to consult whenever and wherever you need occurs. Bright Horizons Care Advantage also gives you
them. These services are strictly confidential and are access to resources such as help locating ongoing child,
available to you and your immediate family members 24 adult or pet care and discounts to high-quality education
hours a day, seven days a week, by phone or online. assistance such as tutoring and test preparation.

We encourage you to take advantage of this valuable To be prepared for the care emergency, contact Bright
resource, which offers: Horizons today at 877-242-2737 or careadvantage.com/
• Confidential emotional support PCH (Username: PCH, Password:4backup).
• Financial resources
• Legal guidance Educational Assistance
• Work-Life solutions
• Tobacco cessation Phoenix Children’s provides educational assistance to
• Online Support regular full and part-time (.4 FTE and greater) employees
who take approved programs of study and approved
844-209-0463 or compsych.com Web ID: PCH certifications related to their job or future career at
Phoenix Children’s. The amount reimbursed is based
upon the employee’s current FTE status at the time of
payment processing. Non-taxable reimbursements for
a calendar year may not exceed the IRS annual limit of
$5,250.00.

The Educational Assistance program policy can be found in
My Employee Portal at ep.phoenixchildrens.com/ep/Login

To submit an Educational Assistance Request, login to
eRequest using your PCH username and password at
erequest.phoenixchildrens.com

14 Phoenix Chidren’s Hospital

Hyatt Legal Liberty Mutual

The Hyatt Legal Plan offers you, your spouse and Liberty Mutual offers a group discount for auto and/
dependents legal services from experienced attorneys or home insurance with convenient (after-tax) payroll
at a low group rate of $8.31 (after-tax) per pay period, deductions. You may enroll anytime and your enrollment
which is deducted through the convenience of automatic will be effective the 1st of the following month.
payroll deductions. You can only elect this benefit as a
new hire or during open enrollment. Once you enroll, you You can contact Valerie Mowers at 480-483-8467,
must remain in the plan for the entire plan year. ext. 58148, to learn more about this discount benefit.

Services provided include: United Pet Care
• Court appearances
• Document review & preparation United Pet Care is a group discount with convenient
• Debt collection defense (after-tax) payroll deductions. You may enroll anytime
• Will or living trust and your enrollment will be effective on the 1st of the
• Family law following month.
• Real estate matters
To enroll or make changes to current membership,
You can contact the Hyatt Legal Plan as a non-member contact United Pet Care directly at 602-266-5303 or
at 800-821-6400 or Info.legalplans.com and (access code unitedpetcare.com/pch.
GetLAW) to learn more about services provided.

The supplemental benefit programs are not Phoenix Children’s benefit plans and are not covered by the Employee Retirement
Income Security Act of 1974, as amended (ERISA). Phoenix Children’s does not endorse, recommend or guarantee any of these
insurance arrangements, and you should review them carefully to determine whether they are appropriate for your needs. Phoenix
Children’s does not guarantee or verify the accuracy of any statements made in the carriers’ printed materials or websites. At your
option, you may consult with your own personal accounting, legal and tax professionals before electing any of the offered services.

2018 Benefits Guide 15

Premiums

Premiums for medical, dental and vision are deducted (pre-tax) for 26 pay periods per year.

Medical Plan

An additional $50 per pay period premium will be charged if you and/or your covered spouse use tobacco.

.90 - 1.0 FTE (36 - 40 hours) EE Only EE + Spouse EE + Children EE + Family
500 Plan $48 $142 $99 $225
1000 Plan $34 $112 $74 $187
CDHP $6 $63 $32 $120
.50 - .89 FTE (20 - 35.6 hours)
500 Plan EE Only EE + Spouse EE + Children EE + Family
1000 Plan $55 $163 $114 $259
CDHP $39 $129 $85 $215
$7 $72 $37 $138

Dental Plan EE Only EE + Spouse EE + Children EE + Family
$2 $3 $4 $5
.90 - 1.0 FTE (36 - 40 hours) $5 $8 $10 $13
Value $8 $13 $16 $21
Premium
Elite EE Only EE + Spouse EE + Children EE + Family
.50 - .89 FTE (20 - 35.6 hours) $4 $5 $6 $7
Value $7 $10 $12 $15
Premium $10 $15 $18 $23
Elite
EE Only EE + Spouse EE + Children EE + Family
Vision Plan $2 $3 $3 $4

.50 - 1.0 FTE (20 - 40 hours)
Vision Plan

16 Phoenix Chidren’s Hospital

Premiums for life insurance are deducted (after-tax) for 26 pay periods per year.

Life Insurance

Employee Life Insurance and AD&D is provided through The Hartford - (.60 - 1.0 FTE). Phoenix Children’s provides
Basic Life and AD&D insurance equal to 1X your base annual salary at no cost to you.

Supplemental Life Insurance Employee Age Band Monthly Rate
<30 per $1,000
You can elect to take supplemental life for you and your 30-34 $0.032
dependents (you must enroll in employee life in order to 35-39 $0.054
enroll in spouse and/or dependent child(ren) life). 40-44 $0.065
45-49 $0.086
Employee Life 50-54 $0.129
55-59 $0.205
• You can elect increments of $50,000 up to a maximum of 60-64 $0.355
$700,000 (guarantee issue amount is $300,000). $0.495
65-69* $0.894
• Evidence of Insurability (EOI) is required for amounts over 70+* $1.443
the guarantee issue.

Spouse Life

• Spouse life is elected in $5,000 increments up to a maximum
of $100,000 (guarantee issue amount is $30,000). Spouse
Life rate is based on employee’s age.

• Evidence of Insurability (EOI) is required for any amounts
over the guarantee issue.

*Life insurance benefits are reduced at age 65.

Employee - Accidental Death & Dismemberment (AD&D)
Your AD&D election amount is equal to your employee life election.

Per $1,000 coverage / $0.022 (Monthly Rate)

Dependent Children Life Monthly Rate
One flat rate, no matter how many children are covered. $0.63
$1.26
$2,500 coverage

$5,000 coverage

2018 Benefits Guide 17

Legal Notices

Summary Plan Description & Summary of In addition, if you have a new dependent as a result of
Benefits & Coverage Notification marriage, birth, adoption, or placement for adoption, you
may be able to enroll your dependents. However, you
The Affordable Care Act (ACA) requires health plans must request enrollment within 30 days of the event.
and health insurance issuers to provide applicants and
enrollees with a concise document providing simple and Special enrollment rights also may exist in the following
consistent information about health plan benefits and circumstances:
coverage. The document, which is called a summary of
benefits and coverage (SBC), is intended to help health • If you or your dependents experience a loss of
plan consumers better understand the coverage that they eligibility for Medicaid or a state Children’s Health
have and to help them make easier comparisons when Insurance Program (CHIP) coverage and you request
shopping for new coverage. enrollment within 60 days after that coverage ends; or

Phoenix Children’s 2016 Summary Plan Descriptions • If you or your dependents become eligible for state
(SPD’s) and 2016 Summary of Benefits & Coverage are premium assistance subsidy through Medicaid or a
available for viewing in a printable format on www. state CHIP with respect to coverage under this plan
benewise.com/pch or pch4u under Human Resources > and you request enrollment within 60 days after the
Benefits. If you do not have a personalized computer work determination of eligibility for such assistance.
station, you may use one of the employee kiosks located
in the Human Resources area. You can also request a Note: The 60-day period for requesting enrollment
hardcopy to be mailed or provided to you at no cost by applies only to state CHIP and/or Medicaid. As
visiting the Employee Benefits Department or calling described above, a 30-day period applies to most
(602) 933-5658. special enrollments.

Making Changes If you have a Qualifying Status change during the year,
contact your Employee Benefits Department immediately.
When you pay your share on a pre-tax basis, you cannot Changes become effective on the first of the month
change your benefits coverage during the year unless following the event and the approval of the change
you experience a special enrollment event or have a (except for birth or adoption of a child (ren), which are
qualifying status change during the year. covered retroactive to the date of the event). To request
special enrollment or obtain more information, contact
HIPAA Special Enrollment Notice your Employee Benefits Department.

If you are declining enrollment for yourself or your Notice Lifetime Limit No Longer Applies and
dependents (including your spouse) because of other Enrollment Opportunity
health insurance or group health plan coverage, you may
be able to enroll yourself and your dependents in this The lifetime limit on the dollar value of benefits under
plan if you or your dependents lose eligibility for that your group health plan no longer applies. Individuals
other coverage (or if the employer stops contributing whose coverage ended by reason of reaching a lifetime
towards your or your dependents’ other coverage). limit under the plan are eligible to enroll in the plan.
However, you must request enrollment within 30 days Individuals have 30 days from the date of this notice to
after the other coverage ends (or after the employer stops request enrollment. For more information please contact
contributing to-ward the other coverage). the plan administrator or your employer group.

18 Phoenix Chidren’s Hospital

Privacy Notice Premium Assistance under Medicaid and the
Children’s Health Insurance Program (CHIP)
The Health Insurance Portability and Accountability
Act (HIPAA) of 1996 requires health plans to comply If you or your children are eligible for Medicaid or
with privacy rules. These rules are intended to protect CHIP and you are eligible for health coverage from your
your personal health information (PHI) from being employer, your State may have a premium assistance
inappropriately disclosed. They also give you additional program that can help pay for coverage. These States
rights concerning your healthcare information. Phoenix use funds from their Medicaid or CHIP programs to help
Children’s Hospital HIPAA Privacy Notice explains how people who are eligible for these programs, but also have
the group health plan and your employer handles your access to health insurance through their employer. If you
PHI. You can request a copy of this Notice from the or your children are not eligible for Medicaid or CHIP,
Risk Management Department. Additional information you will not be eligible for these premium assistance
on how medical information about you may be used and programs. If you or your dependents are already enrolled
disclosed and how you can get access to this information in Medicaid or CHIP and you live in Arizona, you can
is available under BeneWise at www.benewise.com/PCH. contact your state Medicaid or CHIP office to find out if
premium assistance is available.
Women’s Health & Cancer Rights Act
Website for Arizona: www.azahcccs.gov/applicants/
If you have had or are going to have a mastectomy, you default.aspx or phone (in state) 1-877-764-5437
may be entitled to certain benefits under the Women’s
Health and Can-cer Rights Act of 1998 (WHCRA). For All Other States: www.dol.gov/sites/default/files/ebsa/
individuals receiving mastectomy-related benefits, laws-and-regulations/laws/chipra/model-notice.pdf
coverage will be provided in a manner determined
in consultation with the attending physician and the If you or your dependents are NOT currently enrolled
patient for: in Medicaid or CHIP, and you think you or any of
your dependents might be eligible for either of these
All stages of reconstruction of the breast on which the programs, you can contact your state Medicaid of CHIP
mastectomy was performed; office or dial 1-877-KIDS NOW or you can visit www.
insurekidsnow.gov to find out how to apply. If you qualify,
Surgery and reconstruction of the other breast to produce you can ask the state if it has a program that might help
symmetrical appearance; you pay the premiums for an employer-sponsored plan.
Once it has been determined that you or your dependents
Prostheses; and are eligible for premium assistance under Medicaid or
CHIP, your employer’s health plan is required to permit
Treatment of physical complications of the mastectomy, you and your dependents to enroll in the plan—as long
including lymph edema as you and your dependents are eligible, but not already
enrolled in the employer’s plan. This is called a “special
These benefits will be provided subject to the same enrollment” opportunity, and you must request coverage
deductibles and coinsurance applicable to other medical within 60 days of being determined eligible for premium
and surgical bene-fits provided under this plan. If you assistance. If you have questions about enrolling in your
would like more information on WHCRA benefits, call employer plan, you can contact the Department of Labor
your plan administrator. electronically at www.askebsa.dol.gov or by calling 1-866-
444-EBSA (3272).

2018 Benefits Guide 19

2018 Payroll Calendar There are 26 paydays in the year and benefit premiums will
be deducted out of each payday. Review your paystub for
these deductions.

JANUARY FEBRUARY MARCH

SMTWT F S SMTWT F S SMTWT F S

123456 123 123

7 8 9 10 11 12 13 4 5 6 7 8 9 10 4 5 6 7 8 9 10

14 15 16 17 18 19 20 11 12 13 14 15 16 17 11 12 13 14 15 16 17

21 22 23 24 25 26 27 18 19 20 21 22 23 24 18 19 20 21 22 23 24

28 29 30 31 25 26 27 28 25 26 27 28 29 30 31

APRIL MAY JUNE

SMTWT F S SMTWT F S SMTWT F S

12345 12

1 2 3 4 5 6 7 6 7 8 9 10 11 12 3 4 5 6 7 8 9

8 9 10 11 12 13 14 13 14 15 16 17 18 19 10 11 12 13 14 15 16

15 16 17 18 19 20 21 20 21 22 23 24 25 26 17 18 19 20 21 22 23

22 23 24 25 26 27 28 27 28 29 30 31 24 25 26 27 28 29 30

29 30

JULY AUGUST SEPTEMBER

SMTWT F S SMTWT F S SMTWT F S

1234 1

1 2 3 4 5 6 7 5 6 7 8 9 10 11 2 3 4 5 6 7 8

8 9 10 11 12 13 14 12 13 14 15 16 17 18 9 10 11 12 13 14 15

15 16 17 18 19 20 21 19 20 21 22 23 24 25 16 17 18 19 20 21 22

22 23 24 25 26 27 28 26 27 28 29 30 31 23 24 25 26 27 28 29

29 30 31 30

OCTOBER NOVEMBER DECEMBER

SMTWT F S SMTWT F S SMTWT F S

123456 123 1

7 8 9 10 11 12 13 4 5 6 7 8 9 10 2 3 4 5 6 7 8

14 15 16 17 18 19 20 11 12 13 14 15 16 17 9 10 11 12 13 14 15

21 22 23 24 25 26 27 18 19 20 21 22 23 24 16 17 18 19 20 21 22

28 29 30 31 25 26 27 28 29 30 23 24 25 26 27 28 29

30 31

Pay period begins Payday Holiday*

*Note: Please refer to the PTO Policy on the Employee Portal for holiday specifics.

20 Phoenix Chidren’s Hospital

Contacts

Benefit Resources Phone Website/Email
800-343-0860
401(k) 480-483-8467 ext. 58148 netbenefits.com/pch
Fidelity Investments 602-933-5637
602-933-5658 [email protected]
Auto & Home Insurance 877-242-2737 Group Number: 112341
Liberty Mutual 800-352-6132
888-687-3842 [email protected]
Benefits 602-933-4062 [email protected]
844-209-0463
Bright Horizons Care Advantage 877-229-3441 careadvantage.com/pch
866-234-8913 Username: PCH Password: 4backup
Dental 800-821-6400
Delta Dental of Arizona 877-229-3441 deltadentalaz.com/member
602-266-5303 Group number: 31489
Disability Benefits 866-329-4025
The Hartford 602-933-2048 TheHartfordatWork.com
800-877-7195 Policy number: 395041
Educational Assistance 602-933-5627
erequest.phoenixchildrens.com
Employee Assistance Program
ComPsych® compsych.com
Web ID: PCH
Flexible Spending Accounts (FSA)
UMR (United Medical Resources) umr.com

Health Saving Account (HSA) optumbank.com
OPTUM Bank™
info.legalplans.com
Legal Plan Access code: GetLaw
Hyatt Legal
umr.com
Medical Group number: 76-411826
UMR (United Medical Resource)
unitedpetcare.com/PCH
Pet Care Discount
United Pet Care caremark.com

Pharmacy phoenixchildrens.com/pharmacy
CVS Caremark
vsp.com
Phoenix Children’s Pharmacy
[email protected]
Vision pch4u.phoenixchildrens.com
Vision Service Provider (VSP)

Wellness Programs

2018 Benefits Guide 21