2017 Physician and Executive Benefit Guide - PRINT

myBenefits 2017
2017 Benefits Resource Guide
Physicians and Executives

Table of Contents

Eligibility, Coverage, Enrollment.......................................................................................................... 4
Medical Plan Descriptions/Prescription/Wellness Credit Program ............................................... 5-15
Dental and Vision.......................................................................................................................... 16-17
Medical, Dental and Vision Rates ...................................................................................................... 18
Flexible Spending Accounts (FSA)...................................................................................................... 19
Disability and Life Insurance.............................................................................................................. 20
Voluntary Benefits ........................................................................................................................ 21-23
Retirement ................................................................................................................................... 23-27
Work Life Benefits ........................................................................................................................ 28-30
Rights, Legal Notices and Disclaimers .......................................................................................... 31-38
Contact Information .......................................................................................................................... 39

IMPORTANT ACKNOWLEDGMENT
By enrolling in a Northwell Health benefit plan, your enrolled dependents and you may be
contacted by a service provider (which may be a Northwell Health employee) offering information,
support or assistance related to the usage of plan benefits. Any participation in, or cooperation
with, such services or provides is completely voluntary and without extra charge. Any personal
health information that is voluntarily provided will not be used for purposes other than the services
offered.

Transforming care for our patients begins with caring for you.

As one of New York’s leading health care providers, Northwell Health is committed to
transforming care not only for patients, but for our employees as well. Providing our senior
leadership and physicians with a comprehensive benefits program that offers stability and
flexibility is at the heart of this mission.
Your benefits—including rich health care plans, a generous retirement program, and robust
work/life programs—comprise a significant part of your total rewardspackage.
I encourage you to review this informative resource guide to see how you can maximize your
benefits for you and your dependents.
If you have any questions about the enclosed material, please contact the Physician & Executive
Concierge team at 844-697-4947.
As always, thank you for the contributions you make every day to ensure our patients receive
world-class health care.
Sincerely,

Michael J. Dowling
President and Chief Executive Officer

3

Eligibility & Coverage | Enrollment

Your Health Matters to Us! Dependent Coverage
Coverage is also available for your dependents. Those
Northwell Health offers an extraordinary and who qualify as a dependent include:
comprehensive health, and welfare benefits package
which includes:  Your legal spouse
 Medical and Prescription  Your child(ren), until the end of the month in
 Dental
 Vision which he or she reaches age 26
 Flexible Spending Accounts  Child(ren) who are eligible must be natural or
 Disability
 Life Insurance adopted children, or stepchildren your
child(ren) cannot be in the military or residing
Eligibility outside the U.S. or Canada
To be considered benefits eligible, you must be a full-  Any unmarried child(ren) who are incapable of
time or part-time employee scheduled to work at self-support due to physical or mental
least .5 of the full time equivalent (FTE) per week. To disability
be eligible for full-time benefit rates you must work
.8 FTE or greater (30 hours). Temporary employees Enrollment/Changes
are not eligible. New employees must elect or waive health and
welfare benefits within the first 30 days of
If you drop below part-time coverage eligibility you employment. Coverage begins on the first of the
can go to the Health Insurance Market place. A month following 32 days of employment. Existing
regular full-time or part-time employee refers to an employees may change their benefits during the
employee who is paid by Northwell Health through health system’s annual Open Enrollment or in the
its HR software, PeopleSoft. event of a Qualifying Life Event (QLE).

Spousal Coverage Qualifying Life Events include, but are not limited to:
If your spouse is eligible for coverage through his or marriage; divorce; death of a spouse, or child; birth or
her own employer and you choose to cover them adoption of a child; an unpaid leave of absence; a
under the Northwell Health plan, you will be substantial change in your family health coverage due
subject to an annual surcharge of $1,040 for to a change in your spouse’s employer sponsored
enrolling your spouse in the health system’s health coverage; and the gain or loss of a
medical benefits. dependent’s coverage. If you have a QLE, contact the
Physician and Executive Concierge team at 844-697-
If you are married to another Northwell Health, 4947 or [email protected]
nonunion, benefits-eligible employee, the employee
in the higher benefit group has to elect his/her own Coverage will end at the end of the month in which:
coverage at a higher cost. The spouse in the lower  You terminate employment;or
benefit group does have the option to cover as  Become ineligible forcoverage
single, or employee + child(ren) rather than moving Note: Life Insurance and Disability end on the day
to the higher cost plan. you terminate employment.

Cost of Coverage
You and the health system share in the cost of the
plan. Your contribution (referred to as rates)
depends on the benefit coverage you select for you
and your family.
2017 rates can be found on page 18.

4

Medical | Health Plans

Important note from the IRS: Due to a new IRS
reporting requirement it is required that your social
security number and those of your dependents must
be recorded in mySelfService. Login at
Northwell.edu/mySelfService, go to the myBenefits
tab and view/edit your dependent’s information.
Please make sure that you and your dependent(s)
names are recorded in mySelfService exactly the same
as you report them when you file your taxes with the
IRS.

Medical Plans

Northwell Health offers two medical plans (refer to
the charts within this document). All plans cover you
100% for in-system/in-network qualified preventive
care visits.

Northwell Health’s Value Plan
This plan is designed for those who utilize in-system
providers and Northwell Health facilities but would
like access to out-of-network care. There are low
copays with no deductibles and coinsurance for in-
system care.

Northwell Health’s Buy-Up Plan
Although the Buy-Up Plan costs more per pay check, it
offers lower deductibles and out-of-pocket
maximums, especially if you choose to use providers
outside of the Northwell Health and outside of United
Healthcare’s network.

Regardless of which plan you choose, you will always
save significantly on medical care costs by using
network doctors, providers and facilities within the
Northwell Health network.

Out-of-Area Plans
Northwell Health offers employees who live outside
our primary service area who choose the Value or
Buy-Up plans, the option of an Out-of-Area Plan
(OOA). The two differences are:
1. If you are admitted to a non-Northwell

Health hospital your copay will be$0.
2. A visit to your neighborhood physician’s

office will only cost you a copay ($20/$40)
rather than the deductible and coinsurance.

5

Medical | Health Plans

United Healthcare Value Plan Out-of-Network

Northwell Health In-Network Out-of-Network reimbursement = 140% of
In-System Medicare. Participant pays the difference
between United Healthcare payment and
the provider charges.

Deductible $0 $1,000 Individual/ $3,000 Individual/
$2,000 Family $6,000 Family

Deductible $0 $750 Individual/ $2,500 Individual/
Out-of-Area Plan $1,500 Family $5,000 Family

Coinsurance 30% 50%

Out-of-Pocket $5,000 Individual/ $5,000 Individual/ $8,500 Individual/
Max $10,000 Family $10,000 Family $17,000 Family

(Includes deductibles,
coinsurance/copays)

Hospital Copay $0 $1,250 Per Admission $1,500 Per Admission
$0 Deductible/30% Coinsurance Deductible/50% Coinsurance
Hospital Copay No Copay $1,250 Per Admission
Out-of-Area Plan Deductible/30% Coinsurance Deductible/50%
Coinsurance

Lifetime Maximum Unlimited Unlimited Unlimited

Home/Office/Outpatient Care

Preventive Care 100% Covered 100% Covered Deductible/50% Coinsurance
-Annual Exams
-Immunizations

Office Visits $20 Primary Care Deductible/30% Coinsurance Deductible/50% Coinsurance
$40 Specialist Copay

Office Visits $20 Primary Care/ $20 Primary Care/ Deductible/50% Coinsurance
For Out-of-Area $40 Specialist Copay $40 Specialist Copay

Emergency Room Visit $200 Copay (Waived if $200 Copay (Waived if $200 Copay (waived if admitted
admitted within 24 hrs) admitted within 24 hrs) within 24 hrs)

Urgent Care $20 Copay at Go Health, $60 Copay Deductible/50% Coinsurance

ProHEALTH, PM Pediatrics
& CareMount UC

Maternity Care (Out- 100% Covered $20 Copay for Office Visit Deductible/50% Coinsurance +
of-Area included) (first visit only) $1,500 Hospital Copay

Deductible/ 30% Coinsurance Out of Area Plan
+ $1,250 Copay
Deductible/50% Coinsurance +
For Delivery $1,250 Hospital Copay
Deductible/Coinsurance and
hospital copay (waived for
Out-of-Area)

Home Healthcare 100% Covered 100% Covered Deductible/50% Coinsurance
200 visits max per calendar year
200 visits max per calendar
year

Home Infusion Therapy 100% Covered Deductible/30% Coinsurance Deductible/50% Coinsurance

6

Medical | Health Plans

United Healthcare Value Plan Out-of-Network

Out-of-Network reimbursement = 140% of

Northwell Health In-Network Medicare. Participant pays the difference
In-System between United Healthcare payment and
the provider charges.

Hospice Care 100% Covered/ Deductible/ Deductible/
No Copay 30% Coinsurance 50% Coinsurance

Outpatient Surgery, 100% Covered/ Deductible/ Deductible/
Pre-surgical Testing, No Copay 30% Coinsurance 50% Coinsurance
Anesthesia

Chemotherapy, 100% Covered/ Deductible/ Deductible/
Radiation No Copay 30% Coinsurance 50% Coinsurance

Lab Tests, X-Rays, MRI, 100% Covered/ Deductible/ Deductible/
MRA, CAT, PET and No Copay 30% Coinsurance 50% Coinsurance
Nuclear Scans

Artificial 100% covered at any Deductible/ Deductible/
Insemination IPA*, no lifetime max 30% Coinsurance 50% Coinsurance

Assisted Reproductive 80% Covered up to 3 Not Covered Not Covered
Technology cycles/Lifetime
at CHR**

Fertility Medication Covered with $15K, Covered with $15K, Covered with $15K,
lifetime max lifetime max lifetime max

Chiropractic Care $20 Specialist Copay Deductible/ Deductible/
30% Coinsurance 50% Coinsurance

Acupuncture $20 Specialist Copay Deductible/ Deductible/
30% Coinsurance 50% Coinsurance

Second Surgical $40 Specialist Copay Deductible/ Deductible/
Opinion 30% Coinsurance 50% Coinsurance

Kidney Dialysis 100% Covered/ Deductible/ Deductible/
No Copay 30% Coinsurance 50% Coinsurance

Physical Therapy, 100% Covered/ $20 Copay Deductible/
Speech/Language, No copay for all in- (60 visits max annually) 50% Coinsurance
Occupational, system facilities and (60 visits max annually)
Developmental Delay IPA PTs only. (60
visits max annually)

Substance Abuse 100% Covered/ 100% Covered/ Deductible/50%
No Copay No Copay Coinsurance

*IPA stands for Independent Physician Association. IPA includes the Northwell Health Premium Network, faculty and select
community providers, with locations in Queens, NYC, Staten Island and Long Island.
**CHR stands for Center for Human Reproduction, located at 300 Community Drive, Manhasset.

7

Medical | Health Plans

United Healthcare Value Plan Out-of-Network

Northwell Health In-Network Out-of-Network reimbursement = 140% of
IPA In-System Medicare. Participant pays the difference
between United Healthcare payment and
the provider charges.

Durable Medical 100% Covered 100% Covered Deductible/50%
Equipment
Coinsurance

Prosthetics, 100% Covered 100% Covered Deductible/50%
Orthotics (when Coinsurance
medically
necessary)

Ambulance 100% Covered 100% Covered 100% Covered

Inpatient Care

Inpatient Hospital 100% Covered Deductible/30% Deductible/50%
(as many days as Coinsurance/and Coinsurance/and
medically needed) $1,250 Per Admission $1,500 Per Admission
Copay Copay

Inpatient Hospital 100% Covered Deductible/30% Deductible/50%
(as many days as Coinsurance Coinsurance/and
medically needed) $1,250 Per Admission
Out-of-Area Plan Copay

Surgery, Surgical 100% Covered Deductible/ Deductible/50%
Assistance, 30% Coinsurance Coinsurance
Anesthesia

Skilled Nursing 100% Covered Deductible/ Deductible/50%
Facility (60 days 30% Coinsurance Coinsurance
max per calendar
year)

Mental Health

Outpatient 100% Covered 100% Covered Deductible/50%
Coinsurance

Inpatient Substance 100% Covered 100% Covered Deductible/50%
Abuse Rehab Coinsurance

Inpatient Substance 100% Covered 100% Covered Deductible/50%
Abuse Detox Coinsurance

Notes:

1. Coinsurance amounts are off of United Healthcare’s contracted rates with providers.
2. Out-of-Network reimbursement= 140% of Medicare. Participant pays the difference between United Healthcare

payment and the provider charges.
3. Specialty drugs administered as home infusion, or in a physician’s office, must be submitted through a prescription

vendor.

8

Medical | Health Plans

United Healthcare Buy-Up Plan Out-of-Network

Out-of-Network reimbursement = 140% of

Northwell Health In-Network Medicare. Participant pays the difference

In-System between United Healthcare payment and
the provider charges.

Deductible $0 $750 Individual/$1,500 Family $2,500 Individual/$5,000 Family
Deductible
Out-of-Area Plan $0 $500 Individual/$1,000 Family $1,000 Individual/$2,000 Family
Coinsurance
Coinsurance 0% 10% 40%
Out-of-Area Plan 0% 10%
Out-of-Pocket Max 30% (applies to all OOA out-of-
(includes deductibles, $5,000 Individual / $5,000 Individual / network benefits)
coinsurance/copays)
Hospital Copay $10,000 Family $10,000 Family $8,500 Individual/
Hospital Copay $17,000 Family
Out-of-Area Plan
$0 $1,250 Per Admission $1,500 Per Admission
Lifetime Maximum Deductible/10% Coinsurance Deductible/40% Coinsurance
$1,250 Per Admission
Preventive Care $0 No Copay Deductible/30%
Annual Exams Deductible/10% Coinsurance Coinsurance
Immunizations Unlimited
Office Visits Unlimited Unlimited
Deductible/40% Coinsurance
Office Visits Home/Office/Outpatient Care
For Out- of-Area
Emergency Room Visit 100% Covered 100% Covered

Urgent Care $20 Primary Care Deductible/10% Deductible/40% Coinsurance
$40 Specialist Copay Coinsurance
Maternity Care (Out- $20 Primary Care/ Deductible/30% Coinsurance
of-Area included) $40 Specialist Copay $20 Primary Care/
$200 Copay (waived if $40 Specialist Copay $200 Copay (waived if
Home Healthcare admitted within 24 hrs) admitted within 24 hrs)
$20 Copay at GoHealth, $200 Copay (waived if Deductible/40% Coinsurance
Home Infusion Therapy ProHEALTH, PM Pediatrics admitted within 24 hrs)
& CareMount UC
100% Covered $60 Copay

100% Covered $20 Copay for Office Visit Deductible/40% Coinsurance
(first visit only)
100% Covered
For Delivery
Deductible/Coinsurance
and hospital copay (waived
for Out-of-Area)

100% Covered/200 visits Deductible/40%
max per calendar year Coinsurance/200 visits max
per calendar year

Deductible/10% Deductible/40% Coinsurance
Coinsurance

9

Medical | Health Plans

United Healthcare Buy-Up Plan Out-of-Network

Hospice Care Northwell Health In-Network Out-of-Network reimbursement = 140% of
In-System Medicare. Participant pays the difference
Deductible/ between United Healthcare payment and
100% Covered/ 10% Coinsurance the provider charges.
No Copay
Deductible/

40% Coinsurance

Outpatient Surgery, Pre- 100% Covered/ Deductible/ Deductible/
10% Coinsurance 40% Coinsurance
surgical Testing, No Copay

Anesthesia

Chemotherapy, 100% Covered/ Deductible/ Deductible/
Radiation No Copay 10% Coinsurance 40% Coinsurance

Lab Tests, X-Rays, MRI, 100% Covered/ Deductible/ Deductible/
MRA, CAT, PET and No Copay 10% Coinsurance 40% Coinsurance
Nuclear Scans

Artificial 100% covered at Deductible/ Deductible/
Insemination any IPA*, no 10% Coinsurance 40% Coinsurance
lifetime max

Assisted Reproductive 80% Covered up to Not Covered Not Covered
Technology 3 cycles/Lifetime
at CHR**

Fertility Medication Covered with $15K, Covered with $15K, Covered with $15K,
lifetime max
lifetime max lifetime max

Chiropractic Care $20 Specialist Deductible/ Deductible/
Copay 10% Coinsurance 40% Coinsurance

Acupuncture $20 Specialist Deductible/ Deductible/
Copay 10% Coinsurance 40% Coinsurance

Second Surgical Opinion $40 Specialist Deductible/ Deductible/
Copay 10% Coinsurance 40% Coinsurance

Kidney Dialysis 100% Covered/ Deductible/ Deductible/
No Copay 10% Coinsurance 40% Coinsurance

Physical Therapy, 100% Covered/ $20 Copay Deductible/
Speech/Language, No copay for all in- (60 visits max annually) 40% Coinsurance
Occupational, system facilities (60 visits max annually)
Developmental Delay and IPA PTs only.

(60 visits max annually)

Substance Abuse 100% Covered/ 100% Covered/ Deductible/40%
No Copay No Copay Coinsurance

*IPA stands for Independent Physician Association. IPA includes the Northwell Health Premium
Network, faculty and select community providers, with locations in Queens, NYC, Staten Island and
Long Island.

**CHR stands for Center for Human Reproduction, located at 300 Community Drive, Manhasset.

10

Medical | Health Plans

United Healthcare Buy-Up Plan Out-of-Network

Northwell Health In-Network Out-of-Network reimbursement = 140% of
In-System Medicare. Participant pays the difference
between United Healthcare payment and
Durable Medical Equipment 100% Covered 100% Covered the provider charges.
Prosthetics, Orthotics (when
medically necessary) 100% Covered 100% Covered Deductible/40% Coinsurance
Ambulance
Deductible/40% Coinsurance
Inpatient Hospital
(as many days as medically 100% Covered 100% Covered 100% Covered
needed) 100% Covered
Inpatient Care Deductible/40%
Inpatient Hospital 100% Covered Coinsurance/and
(as many days as medically Deductible/10% $1,500 Per Admission Copay
needed) Coinsurance/and
Out-of-Area Plan $1,250 Per Admission Deductible/30%
Surgery, Surgical Assistance, Copay Coinsurance/and
Anesthesia $1,250 Per Admission Copay
Skilled Nursing Facility (60 Deductible/10% Deductible/40% Coinsurance
days max per calendar year) Coinsurance
Deductible/40% Coinsurance
Outpatient in office 100% Covered Deductible/
Inpatient Substance Abuse 100% Covered 10% Coinsurance Deductible/40% Coinsurance
Rehab Deductible/40% Coinsurance
Inpatient Substance Abuse 100% Covered Deductible/
Detox 100% Covered 10% Coinsurance

Mental Health

100% Covered

100% Covered

100% Covered 100% Covered Deductible/40% Coinsurance

Notes:

1. Coinsurance amounts are off of United Healthcare’s contracted rates with providers.
2. Out-of-Network reimbursement= 140% of Medicare. Participant pays the difference between United

Healthcare payment and the provider charges.
3. Specialty drugs administered as home infusion, or in a physician’s office, must be submitted through a

prescription vendor.

11

Medical | Health Plans

Coinsurance
Coinsurance amounts are off of United Healthcare’s contracted rates with providers. Out-of-Network
reimbursement = 140% of Medicare. Participant pays the difference between United Healthcare payment and
the provider charges.
Please contact United Healthcare to check how much the plan will reimburse for your specific out-of-network
procedure.
If you use Northwell Diabetes Program copays are $0.
Hospital Pre Certification Applies to Northwell Health Value and Buy-Up Plans
The medical plans require precertification before you are admitted to an out-of-network hospital. To receive
the maximum hospital benefits under your medical plan, you or your primary care physician must call the
carrier’s precertification phone number to pre-certify your hospital admission or emergency visit. You may
have to pay a penalty if you do not receive authorization from your medical plan. For precertification, call 888-
254-3698.
How to Find a Physician or Non-Physician Provider in our IPA
Choosing a physician or provider is a personal choice. We have made it easy to find what you need. You can
search for an IPA physician or non-physician provider based on numerous criteria. Simply go online to the IPA
Provider Directory at: Northwell.edu/insystem and click on “I Am a Member”
Note: If your physician sends your lab work to a non-Northwell Health Lab (such as Lab Corp) you are still
responsible for paying the deductible/coinsurance or full-billed amount, as this is not in-system. Be sure to
have a conversation with your physician(s) so they understand how your medical plan works regarding using in
system services. Quest is considered out-of-network.

12

Medical | Prescription

Express Scripts Prescription Costs (affiliated with Value and Buy-Up Plan)

One Time Medication Mail Order

Generic Drug $10 copay $20 copay (90day supply)

Brand Formulary 30% or $40 minimum/$80 max 30% or $80 minimum/$160 max
(90day supply)

Brand Non-Formulary 50% or $80 minimum/$160 max 50% or $160 minimum/$320 max
(90day supply)

Specialty Drug (must submit through 20% up to $200 max 20% up to $200 max
Vivo) (30day supply)

Out-of-pocket Max $1,600 Individual/$3,200 Family

Prescription Drugs: Express Scripts for the Value and Buy-Up Plans

Northwell Health Value or Buy-Up
When you enroll in the Value or Buy-Up medical plan through United Healthcare, you are automatically covered
for prescription drugs through Express Scripts. Both medical plans offer the same prescription drug benefit
regardless of which plan you choose. Above is a snapshot of the plan copays and a breakdown of drug types.

Notes:

1. If you are using specialty medication, check with your manufacturer on their copay assistance program
to see if you can apply.

2. After three refills of a maintenance medication at retail, your copay will be 100% at retail unless you refill
through home delivery (mail order).

3. Northwell currently has in place the Member Pay the Difference. This means that when there is a brand
dispensed per your request when generic is available, you will be charged the generic copay plus the
difference in cost between the brand and generic.

4. Northwell Health employees are encouraged to take advantage of the convenience and value that our in-
system pharmacy, Vivo Health, offers. Northwell Health has teamed up with Vivo to provide reduced
pricing on specific medications for all employees, as well as a full line of Over-The-Counter medications,
convenient delivery services and more.
 90day medications offered for the same copay as mail order through Express Scripts
 Specialty medications delivery to your home or office for FREE
 Access to a dedicated and knowledgeable team who can collaborate with your providers to
provide you with the highest level of care
 Medication Therapy Management
 Patient education and drug counseling services
 24 hour a day full time access for assistance to ensure your pharmaceutical care

13

Medical | Wellness Credit Program

Wellness Credit Program Wellness Actions
Once you have committed to completing the online
The Wellness Credit Program was designed to help Health Risk Assessment on the myWellness platform
guide you on the path to a healthy lifestyle and a you can then continue to choose to act on three of the
proactive preventive care routine. Employees enrolled following wellness actions:
in any of the four medical plan choices can participate
by completing four wellness actions (which includes a 1. Physician Wellness Action: Your annual physical
required Health Survey, called Rally, via United 2. Dental Exam Action: Exam or cleaning
Healthcare) in exchange for paycheck credits totaling 3. Vision Exam Action: Eye exam by a licensed
$1,040 ($260 each action). The program runs annually,
with Action Compliance taking place the year before provider
you are credited in your pay. 4. Breast Cancer Screening Action: Mammogram
5. Skin Cancer Screening Action: Full body skin
Current Medical Plan/Credit Program Participants:
Check your Wellness Credit Summary on mySelfService check
for your date-of-service/compliance. If you have 6. Colorectal Cancer Screening Action:
completed the mandatory Health Survey and the
additional three actions before October 31 your Colonoscopy
paycheck credits will begin with the first pay cycle of 7. Cervical Cancer Screening Action: Pap smear
the following year. If you do not complete your actions 8. Financial Wellness Video Action: View a nine
until November/December your paycheck credits will
be delayed for up to 8 weeks into the following minute video in its entirety when logged in to
calendar year, and will not be retroactive. your account on Northwell.edu/myRetirement
9. Feinstein GaP Registry Action: Visit
New Hires and New to the Plan: If this is your first Northwell.edu/FeinsteinGAPPledge
time enrolling in the health organization’s benefits,
you will automatically receive paycheck credits for six Compliance and Confidentiality
months. You must act on four of the nine pledges Once your action has been completed, plan providers
(Health Survey is Mandatory) for the credits to will send information to the insurance company for
continue after your six month grace period is up, or processing. Insurance company or other partners store
your credits will cease. your information securely. They send a date of action
completion to Human Resources IT Department by
NEW: Online Health Risk Assessment Wellness using secure file remittance process. This information
Action: As part of Northwell Health’s commitment to is stored on PeopleSoft mySelfService portal on your
providing exceptional care for its employees, personalized wellness summary. IT Department will
Northwell Health offers you access to an online HRA. send this information to a secure Virgin Pulse portal.
You can find the HRA when registering and logging in You will find the summary of your wellness credits
to Northwell.edu/myWellness. You will see the HRA as under the Rewards page on the myWellness platform.
a “daily card” or you can go the programs page and This entire process can take up to nine weeks to
click on “TAKE THE HRA”. Please note: you must complete. The difference in timing of information
complete the HRA to receive paycheck credits for any provided on mySelfService portal and Virgin Pulse
of the wellness actions. portal can be 10 days.
Timeline for Completion and Compliance
You have until the end of the calendar year to
complete your wellness actions, although if you act
before October 31 your credits will begin with the very
first pay cycle of the new year.

14

Medical | Wellness Credit Program

Paycheck Credits
Although you are encouraged to complete as many
wellness actions that your physician recommends, the
maximum amount of actions that are eligible for
paycheck credits is four. Here’s how it works:

 You must be enrolled in the Northwell Health
Value or Buy-Up medical plan to participate in
the Wellness Credit Program

 Each healthy action is worth $10 per biweekly
paycheck and $10.83 per semi-monthly
paycheck

 If you complete all your actions by October 31
you will receive the maximum amount of
paycheck credits the following year, which
$1,040

 Keep in mind that completing HRA is a
prerequisite for any credits

 If you complete an action or two in
November/December you will still receive the
credits for those actions in the following year,
but they will be delayed up to nine weeks and
will not be retroactive

 If you decide not to enroll in the Northwell
Health benefits you will not receive the
paycheck credits even if you completed the
actions

HEALTH RISK ASSESSMENT CONFIDENTIALITY: Your
personal health and claims information will be stored
in a secure database with Virgin Pulse, the third party
vendor who hosts the myWellness platform.

15

Dental Coverage

Dental Coverage with Cigna Dental

Cigna offers two plans that provide different levels of dental benefits each gives you and your family access to
affordable, quality dental care and dentists. Refer to the charts below and compare the Dental Preferred
Provider Organization (DPPO) and the Dental Health Maintenance Organization (DHMO). With the DHMO you
must choose a primary dentist.

Cigna DPPO website lists:

 DPPO Advantage – benefits are paid at in-network level of benefits
 In network Cigna DPPO – This does not mean that the provider is in CIGNA network. This means that the

provider is Out-of-Network but offers discounts*
 Out-of-Network (does not provide discounts)

*To pay the least out-of-pocket, stay in Advantage network. If a member goes outside the Advantage
network, they will also have access to discounts under Dental PPO network. Cigna refers to this as “In-
Network” these benefits are paid as Out-of-Network, this network will afford the member discounted
rates, but benefits will pay at the out-of-network level of benefits.
Visit mycigna.com> review my coverage>dental

In-Network Out-of-Network
(Advantage only) (with discounts and Out-of-

Deductibles $50 Individual/$100 Family Network)
Maximums $2,000 Annual $50 Individual/$100 Family
Preventive/ Diagnostic Care 100% Twice Annually $2,000 Annual
Basic Restorative Care 80% (After Deductible) 80%
Major Restorative Care 50% (After Deductible) 70% (After Deductible)
Orthodontic Care 50% (After Deductible) 50% (After Deductible)
$1,500 Lifetime 50% (After Deductible)
Referrals to Specialists Not Required $1,500 Lifetime
Not Required

Cigna DHMO (Dental Health Maintenance Organization) you must choose a primary dentist

Deductibles In-Network ONLY
$0

Maximums Unlimited

Preventative/ Diagnostic Care 100% Covered

Major/Basic Restorative Care Fixed Pre-Set Fees
Orthodontic Care Lifetime Maximum Benefits/24Month Treatment

Referrals to Specialists Referral Required

Detailed scheduled of benefits is posted on the intranet.

16

Vision Coverage

Davis Vision Plan

The health system offers vision coverage through Davis Vision. Please visit davisvision.com to locate a
service.

Annual Exam In-Network Coverage Out-of-Network Reimbursement
Spectacle Lenses 100% Covered $30
100% Covered $25 for Single Vision Lenses
Contact Lenses $35 for Bifocal Lenses
Disposables – $45 for Trifocal Lenses
Eyeglass Frame 4 Multi Packs of Lenses $60 for Lenticular (Post Cataract)
Warranty on Eyeglasses (not Planned Replacements Lenses
covered for loss) 2 Multi Packs of Lenses $225 for Medical Reason
Scratch-Resistant Protection 100% (Certain Styles) $75 for Elective
Laser Vision Correction Covered
100% Covered $30

None

100% Covered None
Discounted None

Those who elect vision coverage with Davis Vision are now covered to see a Northwell Health optometrist for

eye exams and contact lens fittings. Same day appointments are available at two convenient locations within

the Ophthalmology Service Line:

 Marta Fabrykowski, OD and Christoper Lee, OD, MEETH Ophthalmology (Manhattan Eye, Ear, and Throat
Hospital) 210 East 64th, NYC, Phone: 2128389200

 Corina Busuioc, OD and Francesca Kim OD, Northwell Health Dept. of Ophthalmology,
600 Northern Boulevard, Great Neck, Phone: 5164702020

17

Medical, Dental and Vision Rates

Rates do not include wellness credits and spousal surcharge.
18

Flexible Spending Accounts | Disability your daily commute to and from work. You can also
enroll for parking benefit. It’s a great way to put extra
Flexible Spending Accounts pretax dollars in your pocket each month and make
your commute more convenient and affordable.
Flexible Spending Accounts (FSAs) allow you to set Login to your WageWorks.com and identify the
aside pretax dollars through payroll deduction, which transit agency pass you want to buy, and it will be
you may then use to pay for qualifying expenses, delivered to your home or office. You can choose to
including medical costs that are not covered, such as have passes automatically mailed to office orhome.
out-of-pocket medical expenses and dependent care. You can do this at any time of the year.
 Parking (monthly pretax limit) is$255
You may setup two types of FSAs with WageWorks:  Transit/Vanpooling (monthly pretaxlimit is $255
Healthcare or Dependent Care. For Healthcare
accounts, you will receive a debit card that you may Disability Options
use for all related expenditures. Please visit
wageworks.com for details and restrictions. Disability is an unforeseen circumstance that may
significantly alter your life. The health system offers a
Healthcare FSA solid plan to protect you and your family in the event
 Allows you to set aside before-tax dollars per of a disability or long term illness.
If you become ill or disabled, you are entitled to
paycheck (a minimum of $150 per year, up to a receive 100% of your salary for up to 26 weeks, as long
maximum of $2,600 per year) as you are deemed disabled by your physician and
approved by the insurance carrier. Long-term
 May be used for yourself anddependents disability benefits are payable if a disabling illness or
injury prevents you from working beyond the covered
 Covers healthcare expenses notcovered 26 weeks, as long as you are determined to be
under a healthcare plan, such as: disabled by our carrier.
• Deductibles, copays and otherout-of-
pocket medicalexpenses Long-Term Disability Coverage
• Private hospital rooms or otherpremium
nursing services Option One: Employer-Paid 50% Plan
• Vision, hearing or dental expenses not You are automatically entitled to a monthly benefit
covered under the medicalplan equal to 50% of your base pay (and augmentation
• Lasik Surgery income, if applicable), to a maximum of $10,000 per
month. This coverage can be offset by Social Security
Over-the-counter medications do not qualify under Disability benefits and is provided to you at no cost.
the Healthcare FSA. This benefit is taxable.

Dependent Care FSA Option Two: Buy-Up 60% Plan
 Allows you to set aside before-tax dollars per This Plan provides a monthly benefit up to 60% of your
base pay (and augmentation income, if applicable), to
paycheck (a minimum of $150 per year, up to a a maximum of $20,000 per month.
maximum of $5,000 per year per household) for
dependent care

 Expenses may be claimed for a dependent who
is under the age of 13, or is physically or mentally
incapable of self-support

Dependent Care FSAs are audited by the IRS for
discrimination testing. Highly compensated
employees may have their benefit reduced.

Commuter Benefit
WageWorks Commuter Transit Account is a pretax
benefit account used to pay for public transit—
including train, subway, bus, and ferry — as part of

19

Disability | Life Insurance

You pay the difference in cost between the 50% and existing employee (able to increase your election in
60% options and the higher maximum benefit. increments of 1x up to a maximum of 3x or $500,000
Contributions toward this benefit are made with post- of base salary with no medical underwriting) or a
tax dollars, in the event that you are eligible to receive newly hired employee (able to elect up to 3x your base
this benefit, it is a nontaxable payment. salary to a max of $500,000 at time of hire). Higher
elections will generate a requirement for Evidence of
If your disability continues beyond 26 weeks and you Insurability (EOI) and Aetna will contact you post your
are enrolled in a long-term disability plan, the election. In addition, you may elect life insurance for
disability carrier will automatically process your long- your spouse and/or child(ren). You have the option to
term disability claim. choose dependent life insurance at $5,000 or $10,000,
and spouse at $25,000 or $50,000.
Important Note about All Long-Term Disability Plans:
A preexisting condition limitation will apply if you are Coverage for Spouse and Child(ren)
disabled within 12 months following your coverage You may also elect life insurance for your spouse in
effective date. If you become disabled during this increments of $25,000 to a maximum of $50,000. Life
initial 12month period, the disability carrier will go insurance for your unmarried child under 26 is offered
back six months before your effective date to in increments of $5,000 up to a maximum of $10,000.
determine if you have been treated or if the disabling
condition has manifested itself during this period. Evidence of Insurability
If you elect an amount of supplemental life insurance
If there was treatment, your claim will be denied. If of more than three times your base salary, or
you did not receive treatment, the preexisting $500,000, you must submit Evidence of Insurability
condition limitation does not apply. Regardless, your (proof of good health) to the carrier for approval.
claim may still be subject to review by the disability
carrier. Beneficiary Designation
Assigning a beneficiary is critical in the event your
Disability Benefit Payments monies need to be distributed. You may name anyone
During the period of an authorized Leave of Absence as your beneficiary. If you name more than one
(while you continue to receive a paycheck) your person, you must indicate what percentage of the
benefit deductions will continue for no more than six total payment each should receive. If you do not
months. If you are out on a LOA for more than six specify a percentage, your beneficiaries will receive
months, and/or approved for Long Term Disability, you equal amounts.
will need to elect COBRA to maintain the Northwell
Health medical, dental and vision benefits. If you don’t specify a beneficiary, benefits will be paid
to your estate or surviving spouse, children or parents
Life Insurance in accordance with NYS.

You are automatically covered at no cost for basic
term life insurance/Accidental Death and
Dismemberment equal to 1.5 times your base salary
and augmentation income up to $500,000.

Supplemental Life and AD&D (1 - 5 times your pay up
to 1 million) is offered to you as additional income for
your survivors, with premiums based on group rates,
your age and smoking status. Elections for
Supplemental Life are based on whether you are an

20

Work/Life Programs and Benefits

Voluntary Benefits through Aon Voluntary  Stroke
Benefits & Enrollment Solutions  End stage renal (kidney) failure
 Major organ transplant
Northwell Health has partnered with Aon Voluntary  Coronary artery bypass surgery*
Benefits & Enrollment Solutions to offer you additional *The coverage pays 25% of the face amount of the
insurance/benefit opportunities referred to as policy once per lifetime for non-invasive cancer and
“voluntary benefits.” Voluntary benefit policies are coronary artery bypass surgery.
portable, meaning you can take them with you if you
should leave the organization. For more information, Plan features:
to get a quote and enroll, call the Aon Voluntary  You choose the benefit amount when you
Benefits & Enrollment Solutions Enrollment Center at enroll.
1-888-561-0240, Monday through Friday, 9am to 6pm  Coverage is guaranteed Issue up to $30,000
ET. during this Open Enrollment period.
 You do not have to be terminally ill to receive
Timeline for Enrollment Opportunities benefits.
 Family coverage is available
September 1, 2017: All new hires will be offered the  A specified disease benefit is included, which
additional benefits listed below. Individuals can enroll pays a $50 annual benefit if a covered health
via mySelfService after confirming their health and screening test is performed (blood tests, stress
welfare benefits or by visiting tests, colonoscopies, chest X-rays, etc.).
https://uenroll.net/NorthwellHealthNewHires  Coverage is portable – you can take your policy
with you if you change jobs or retire.
Open Enrollment, November 27 through December 8,
2017: All eligible employees will have the opportunity The policy or its provisions may vary or be unavailable
to remain in their current plans through Benefits in some states. The policy has exclusions and
Planning Corporation or elect the new options listed limitations that may affect any benefits payable. This
below. Below are the seven voluntary benefit plans benefit becomes effective the first of the month in
offered by Aon Voluntary Benefits & Enrollment which your benefit payroll deductions begin.
Solutions:
2. Accident Insurance
1. Critical Illness Insurance Accidents happen. You can’t always prevent them, but
A serious illness can strike at any time. Aside from the you can take steps to reduce the financial impact.
usual anxiety, you have to deal with the harsh financial
impact. The fees for doctors, tests, hospital stays and Accident Insurance is designed to help cover the out-
other services add up quickly, draining your savings of-pocket medical expenses and extra bills you may
and driving up your credit card balances. incur as a result of an accident. The plan pays a benefit
directly to you – not a doctor or hospital – for injuries
Critical illness insurance helps provide financial and accident-related expenses. You can use the money
protection in the event of a covered serious illness. however you choose.

The policy pays the full benefit directly to you if you Benefit amounts are based on the type of injury and
are diagnosed with a covered condition. You can use treatment needed.
this benefit any way you choose – to pay deductibles,
copays, coinsurance, expenses your family incurs to be Covered injuries and accident-related expenses
by your side, or simply to replace your lost earnings include:
from being out of work.
 Fractures
Covered illnesses include:  Dislocations
 Heart Attack  Hospitalizations
 Cancer*  Physical Therapy

21

Work/Life Programs and Benefits

 Emergency Room Treatment  Guaranteed Issue – If you enroll during this
 Transportation Open Enrollment period, you will not be
 Lodging, and more required to provide medical information
Plan features:
 Benefits are paid for accidents that occur on or The policy or its provisions may vary or be unavailable
in some states. The policy has exclusions and
off-the-job, so you have 24-hour coverage. limitations that may affect any benefits payable. This
 You can also elect to cover your spouse, same benefit becomes effective the first of the month in
which your benefit payroll deductions begin.
sex domestic partner and children.
 There are no health questions or physical 4. Permanent Life Insurance
Can your family maintain their lifestyle without you?
exams required. Permanent Life Insurance helps ensure they can.
 You can take your policy with you if you change Permanent Life Insurance is an individual insurance
policy designed to provide a death benefit to your
jobs or retire. beneficiaries if something should happen to you. It can
The policy or its provisions may vary or be unavailable also build cash value that you can utilize while you are
in some states. The policy has exclusions and still living. At an affordable premium, you can have the
limitations that may affect any benefits payable. This added financial protection you and your family may
benefit becomes effective the first of the month in need during times of uncertainty. Find peace of mind
which your benefit payroll deductions begin. knowing your family will be taken care of.

3. Hospital Indemnity Insurance Plan features:
The bills that result from a hospital stay can be  You can purchase coverage for yourself, your
overwhelming for anyone — even when you have spouse, your children and/or your
health insurance. Hospital Indemnity Insurance can grandchildren.
complement your health insurance to help you pay for  Permanent Life Insurance is voluntary, which
the high costs associated with a hospital stay. means you purchase the precise amount of
coverage that is right for your needs.
This coverage pays a benefit to you when you are  The benefit is Guaranteed Issue, so no physical
admitted to the hospital and additional amounts for exams are required to apply for coverage up to
each day you are confined. The funds can be used to a certain amount during this Open Enrollment
pay for out-of-pocket expenses, such as coinsurance period.
and deductibles, and even for non-medical expenses  As the policy builds cash value, you can
like rent or mortgage payments, car payments, eventually use it to make premium payments
groceries, child care and more. or to pay urgent expenses while you are still
living.
Plan highlights:  You can take your policy with you if you leave
 No pre-existing condition limitations. the company or retire.
 No waiting period.  A Long Term Care Rider is included, which
 Benefits do NOT reduce as you get older. provides benefits for nursing home care, home
 Coverage can be purchased for your spouse health care or adult day care
and children (employee must elect coverage).
Permanent Life Insurance never expires. You keep the
Additional plan features: policy as long as you make the payments, which
 Hospital Admission - $1,000 per confinement means the premiums will not go up. Lock in a lower
 Hospital Confinement - $165 per day, up to 31 premium NOW and save thousands of dollars in the
days for each covered sickness or accident future! Cost varies based on age, coverage level and
 Hospital Intensive Care - $165 per day up to 10 tobacco use.
days per confinement for each covered
sickness or accident (paid in addition to
Hospital Confinement benefit)

22

Work/Life Programs and Benefits

The policy or its provisions may vary or be unavailable  Administrative hearings
in some states. The policy has exclusions and  Real estate transfer
limitations that may affect any benefits payable. Your  Debt collection defense
Permanent Life Insurance election is effective the first For more information, visit www.legalplans.com or
of the month following the month in which your call 1-800-821-6400.
benefit payroll deductions begin.
This benefit becomes effective the first of the month in
5. ID Theft which your benefit payroll deductions begin.
In 2014, 17.6 million Americans were victims of
identity theft. The financial losses totaled $15.4 7. Pet Insurance
billion.1 Protecting your identity is more important Pet Insurance reimburses eligible veterinary expenses
now than it ever was before. relating to accidents, illnesses and injuries for dogs,
cats, birds and several exotic pets. Optional wellness
Identity theft protection provides comprehensive, protection coverage is also available for routine
proactive identity theft monitoring and recovery preventative exams and services. The premium is
assistance. By constantly monitoring your personal based on the age of the pet, species and breed.
and financial data, this service catches fraud early, and Coverage includes the option to use your preferred vet
helps you act quickly to limit the damage of stolen and 24/7 access to a vet helpline. For more
information. information, visit www.petinsurance.com.

Identity theft protection is an affordable solution to a This benefit becomes effective the first of the month in
growing problem. which your benefit payroll deductions begin.

1 Blake, A. (2015, September 28). “Identity theft If you were hired before September 1, 2017 and have
affected 17.6M, cost $15.4B in 2014: Justice Dept.” The voluntary benefits through Benefits Planning, you are
Washington Times. grandfathered and should contact 631-991-6050 for a
quote or to make any changes to your benefits.
This benefit becomes effective the first of the month in
which your benefit payroll deductions begin. Retirement Planning

6. Legal Insurance The health system’s generous retirement program
Affordable legal assistance can sometimes be difficult provides a solid foundation to help you save for your
to find. You may enroll in the group legal services plan future. Whether you are rolling over a retirement plan
provided by MetLife. The plan gives eligible employees or just starting to con tribute, it’s never too late to
and their dependents access to a network of local start saving for retirement.
attorneys for telephone and in-office consultations.
The network can provide comprehensive legal Your Retirement Benefits comprise a significant
assistance and discounted representation on a variety portion of your total compensation. The program
of legal needs. consists of three plans which include employer
contributions:
Some covered services include: • The Cash Balance Plan
 Document review • 403(b) Plan
 Wills • 457(b) Plan
 Name changes
 Estate administration The Cash Balance Plan
 Document preparation, including Power of Employees become a participant of the Cash
Attorney, deeds, promissory notes and Balance Plan on the one-year anniversary of their
mortgages date-of-hire.
 Lawyer office work
 Adoptions The Cash Balance Plan is a fixed interest pension plan
funded entirely by the health system. The Plan’s assets

23

Work/Life Programs and Benefits

are held in a trust. At retirement, vested participants designated for at least 50 percent of your account
receive a specified benefit. Being “vested” means that unless he/she signs the consent form designating
you have the right to receive benefits from the Plan otherwise.
when you retire.
403(b) Plan
Vesting Schedule 403(b) retirement savings plans allow employee
You are vested in the Cash Balance Plan after you contributions to grow tax-deferred until withdrawn at
have worked for the health system for three years for retirement.
at least 975 hours per calendar year.
Participation
Note: Employee contributions are not permit ted to All newly hired employees are automatically enrolled
this plan in the plan for 3 percent of annual salary within 30
days of the date of hire. Your contribution will be
Your Cash Balance Plan Account automatically increased by 1% every year until you
Once you meet the eligibility requirements, the reach 10 percent. To receive the maximum employer
health system automatically sets up an account in contribution, you must contribute at least 6 percent of
your name. Each quarter, your account is credited your annual salary. You may waive or change
with pay-based credits equal to 3% of your eligible participation in the plan at any time.
pay for the previous quarter. Interest credits are
added to your account quarterly based on your The plan offers a wide array of investment options
account balance at the end of the previous quarter. which allow you to diversify your investments. If you
You can view your Cash Balance on your quarterly do not designate an investment allocation, you will be
statement, or online, from Transamerica at automatically enrolled in a Vanguard Targeted
northwell.com/myretirement. Retirement Fund. You may change your contributions
and your investment allocation at any time.
Retirement Specifications
The “normal” age of retirement is considered Your Contributions
65. You are eligible for early retirement if you are If you are under the age of 50, you may con tribute
age 55 with a minimum of 5 years of service with from 1 percent to 75 percent of your pay up to the IRS
the health system. If you elect to start receiving limit ($18,000 in 2017). For employees aged 50 or
your Cash Balance Plan distribution before your older, you may contribute from 1 percent to 75
normal retirement age after you satisfy your early percent of your pay up to the IRS limit ($24,000 in
retirement eligibility your distribution will be 2017). Employees may contribute up to 10 percent of
reduced. Your monthly payments will be lessened their salary annually after-tax.
to reflect the longer period of expected payments.
Employer Contributions
If you continue working past your normal retirement You are eligible to receive employer basic and
age, your deferred retirement date is the first day of matching contributions after the first anniversary of
the month coincident with or following your actual your hire date. The health system will contribute 6
retirement. As an active employee the earliest you percent of your eligible earnings to your account after
may start receiving a monthly benefit is the April 1 you have completed one year of service. The health
following the year in which you turn 70½ years old. system will also match 33.33 percent of your voluntary
contributions, up to 2 percent of your eligible pay, if
Automatic Enrollment you contribute at least 6 percent to your account.
You will be automatically enrolled in the Cash Balance Please note: you will not receive an employer match
Plan as long as you meet the eligibility requirements. on after tax contributions.
Remember to elect your Cash Balance Beneficiary -
this will ensure your money will be designated to your Eligible Compensation
beneficiary. Your eligible compensation includes your base pay
Note: If you are married, your spouse must be

24

Work/Life Programs and Benefits

(shift differential, fringe base and augmentation) and Plan like an IRA or another 403(b) Plan. Annuity
any amounts that you contribute on an elective basis distributions will not be treated as eligible rollover
to any tax deferred annuity plan, 403(b) or 457(b) plan distributions if transferred into a qualified Plan, like an
maintained by the health system. Compensation in IRA or another 403(b) Plan. Hardship withdrawals are
excess of the IRS limit is not taken into account (the available from your employer accounts and subject to
limit is $270,000 in 2016); this limit is subject to a cost IRS rules.
of living adjustment in future years.
Each quarter you will receive a personal account
Note: Total employer and employee contributions statement with a detailed summary of all activity,
cannot exceed $54,000 annually/$60,000 if you are including account transactions and history, ending
over age 50 (in2017). account balance, fund performance/benchmarks, and
vesting information.
When You’re Vested
You are 100% vested in your own plan contributions. Distributions
Employer contributions are subject to the following Participants normally request distributions on or
vesting schedule: after their retirement. If you are retired, distributions
must begin no later than when you reach age 70½
• 20 percent after 2 years ofservice years old. To begin receiving benefits, you must elect
• 40 percent after 3 years ofservice to do so during the 30 to 90 day period prior to the
• 60 percent after 4 years ofservice date you would like benefits distributed. If you are
• 80 percent after 5 years of service to receive payments in any other form other than a
• 100 percent after 6 years of service lump sum, such balances must be transferred from
the mutual fund(s) to the record keeper.
Transactions
Normal Forms of Payment
Rollovers If you are single when your benefits begin, the
If you have an existing eligible retirement plan normal form of payment is a single life annuity. If you
account with a prior employer or a rollover IRA, you are married the normal form of payment is a qualified
may transfer or rollover all or some of that account joint and 50 percent survivor annuity. Your spouse
into your 403(b) Plan. Your money will continue to receives monthly benefits equal to 50 percent of your
accumulate on a tax-deferred basis. retirement payment should he/she survive you.

Loans Optional Forms of Payment
You may borrow money from your 403(b) Plan Life annuity (provides monthly payments for your life
account. The Internal Revenue Code limits the amount only; optional for married participants)
you may borrow. Loan repayments are deducted from • Joint and 50/75 percent survivor annuity
a checking or savings account you indicate with the
record keeper. option
• Installments
Withdrawals • Partial withdrawals
There is a 10 percent excise tax on certain • Lump sum (all or a portion of the value of the
distributions and withdrawals. This doesn’t apply if
you: account)
Note: Balances between $1,000 and $5,000 will be
• Are age 59½ rolled over to an individual IRA unless you request a
• Become disabled or lose your life rollover to another plan. Balances under $1,000 will be
• Rollover funds to an eligible plan automatically distributed to you.

Additionally, 20 percent may be withheld if the Cost of Plan Participation
payment is made to yourself. Lump sum distributions There is an annual per plan fee of $60 for the 403(b)
(but not hardship distributions) are treated as eligible
rollover distributions if transferred into a qualified

25

Work/Life Programs and Benefits

plan and $92 for the 457(b) plan from Transamerica change your contribution and to allocate investments:
Retirement Solutions. Fees are not based on a northwell.edu/myretirement or 844-844-675-4547.
percentage of participant plan balances, but are fixed.
Note:Newly hired employees will be automatically
Investment Strategies that Work enrolled unless they designate otherwise.

With the 403(b) Plan, you have a choice of two 457(b) Plan
investment strategies—Target Retirement Funds and The 457(b) Plan provides another opportunity to
Core Funds. Whether you’re an experienced or a contribute to your retirement on a tax-deferred basis,
novice investor, choosing the right plan can help you allowing you to direct your contributions into existing
create an investment portfolio that fits your needs. investment options.
Read on to determine which strategy suits you. The rules permit you to participate in both the 403(b)
and 457(b) Plans simultaneously. Generally, if you
Target Retirement Funds choose to participate in the 457(b) Plan, you should
These funds simplify investing for retirement. Choose first consider maximizing your elective salary deferral
the date specific fund nearest your expected year of contributions to the 403(b) Plan.
retirement. As that date approaches, each fund
gradually and automatically reduces risk by shifting Eligibility
from stocks to bonds and short-term reserves. This benefit is available to employees whose annual
Although Target Retirement Funds are geared to base pay and augmentation are greater than or equal
simplify investment selection, all mutual fund to $175,000. If your annual base pay decreases below
investing is subject to risk. Each Target Retirement $175,000, your contributions will be stopped in the
Fund invests in up to seven broadly diversified following year.
Vanguard funds and is subject to the risks associated
with these funds. Contributions
You may contribute up to 100% of your eligible pay
Core Funds (up to $18,000 in 2017). If your contribution exceeds
If you have some investment experience and the the annual dollar limit, the excess contribution must
time to research your fund options, consider be distributed to you by no later than the following
creating a diversified portfolio made up of Core April 15. There are no employer contributions to the
Funds. To see a chart of both Target Retirement and 457(b) Plan.
Core Funds available, please refer to the
Transamerica website Withdrawals
northwell.com/myretirement. In accordance with regulations, as long as you are an
active employee, you may only access your
Note About Risk contributions and/or earnings after age 70½ or in the
event of a documented unforeseeable emergency. An
Investments in bond funds are subject to interest rate, unforeseeable emergency is defined as a participant,
credit and inflation risk. Prices of mid and small cap spouse or a dependent experiencing a severe
stocks often fluctuate more than those of large financial hardship resulting from an illness, accident or
company stocks. Foreign investing involves additional property loss due to a casualty. This is subject to Plan
risks including currency fluctuations and political qualification; all other alternatives to raising money
uncertainty. Funds that concentrate on a relatively must first beexhausted.
narrow market sector face the risk of higher share
price volatility. Please note diversification does not Please contact Transamerica at844-675-4547, if you
ensure a profit or protect against loss in a declining need to apply for an unforeseeable emergency
market. withdrawal.

Enrollment Investment Options
Contact Transamerica Retirement Solutions to enroll,

26

Work/Life Programs and Benefits

You are responsible for directing the investment of
these contributions among the options offered under
the Plan, which may change at the health system’s
discretion. You assume the risk related to your
investment options. Refer to the “Investment
Options” document posted on the employee intranet.

Transfers and Account Changes
You have complete control to determine the types of
transactions you wish to make, as well as the
frequency of those transactions. You may transfer
balances between different investment options or
reallocate future contributions.

Ownership of Assets
Regulations that govern 457(b) Plans require that
your salary deferrals into the Plan, including any
attributed income resulting from your deferrals, be
deemed property of the health system. This property
is subject to the claims of its general creditors until
you withdraw the assets upon separation from
employment or through an unforeseeable emergency
withdrawal.

Enrollment
You may enroll in the 457(b) Plan at any time. Upon
meeting your eligibility you will receive a welcome
letter with additional instructions. Please note
elections become effective the following month.

Transamerica Retirement Solutions
Take advantage of the many interactive tools available
on northwell.com/myretirement, such as the
OnTrack® tool. Based on information we know about
you, such as your expected years to retirement,
income, investment strategy, and contribution
amount, Your Retirement Outlook will be displayed in
easy to understand graphic weather icons. If you are in
good shape for your retirement the sun will be shining
on your OnTrack tool. In addition, Transamerica offers
one-on-one retirement planning session with all
employees.
Visit Northwell.edu/myretirement and contact a rep
today.

27

Work/Life Programs and Benefits

Work/Life Programs and Benefits Unused PTO
We encourage you to use and enjoy your PTO.
Our Work/Life Benefits are comprised of sever al However, if you do not use all of your days, you may
programs designed to add value to you and your carry over time from one year to the next, up to a
family. In many cases, your dependents may take maximum of 42 days per year. If your PTO bank
advantage of these benefits and services as well. exceeds 42 days, any addition al days will
automatically be carried over into the Catastrophic
Paid Time-Off Bank. The Catastrophic Bank may only be used in the
The Paid Time-Off (PTO) program provides an event of an approved disability once your PTO days
entitlement of days away from work with pay for any and salary continuation are fully exhausted. More
purpose, including vacation, holidays, emergency or information is available from your Human Resources
personal business. PTO allows flexibility in scheduling representative. Physicians hired after September 1,
time-off to meet family needs and unexpected events 2014 are not eligible for a PTO payout upon
that may arise. You may use PTO for scheduled termination.
absences such as vacation or unscheduled absences,
such as emergencies, after completing three months Disability/Leave of Absence
of employment. You are entitled to 20 PTO days per You are entitled to up to 26 weeks of salary
year. After completing 15 years of service, you are continuation in the event of an illness, disability or
entitled to an additional 5 days, for a total of 25 PTO any other extended leave. If you are out of the office
days. Note: If hired prior to January 1, 2009, you are for a disability, any other illness or personal reason
entitled to 25 PTO days per year. After completing 15 for more than seven consecutive calendar days, you
years of service, you are entitled to an additional 5 must apply for a Leave of Absence. Note: PTO is
days, for a total of 30 PTO days peryear. integrated with all leaves and will be used in
conjunction with any leave. Please contact a Human
Holidays Resources representative forclarification.
The health system observes the following eight legal
holidays to which you are entitled: New Year’s Day, Family Medical Leave Act
Martin Luther King, Jr.’s Birth day, Presidents’ Day, Employees may take up to 12 weeks of job protected
Memorial Day, Independence Day, Labor Day, leave under the Family and Medical Leave Act (FMLA),
Thanksgiving Day and Christmas Day. in any rolling 12month period. FMLA leave may be
used for the employee’s own–or his/her immediate
Note: As of January 1, 2015 physicians and executives family member’s (spouse, son, daughter, parent) –
are no longer eligible for a pay out of holiday pay serious health condition, for the birth or adoption of a
accrual balances should they leave the organization. child, or to care for a child after birth or placement for
adoption or foster care.
Other Time-Off
You may take up to three days off with pay in the Employees are eligible for FMLA leave if they worked
event of the death of an immediate family member at least 1,250 hours in the year before the requested
(defined as a spouse, child, sibling, parent, leave. Employees may take FMLA leave on an
grandparent, mother-in-law, father-in-law or intermittent basis and the FMLA entitlement shall run
grandchild), or in the event of your marriage. If you concurrentlywith other FMLA eligible leaves.
are required to serve Jury Duty, the health system
will continue your salary. Proof of service is Employees who are the spouse, son, daughter,
required. Full-time physicians and Medical Chairs parent or next of kin of a covered service member
receive five days for paid Continuing Medical who is recovering from a serious illness or injury
Education (CME). sustained while on active duty, may take up to 26
weeks of leave (inclusive of FMLA leave), in a rolling
12month period, to care for the service member.
Employees are also eligible to take up to 12 weeks

28

Work/Life Programs and Benefits

of leave for a “qualifying exigency” arising out of the eligible dependent’s undergraduate or graduate
fact that the employee’s spouse, child or parent is tuition. There is no limit on the number of eligible
on active duty or has been notified of an impending children for whom this benefit applies, however, no
call to activeduty. more than $10,000 can be provided for any one child.

Tuition Reimbursement Dependent tuition reimbursement benefits from the
The health system recognizes that development undergraduate program cannot be allocated to the
through continued education is an integral component graduate program benefit, nor can graduate
of personal and professional growth. By providing program benefits be allocated to the undergraduate
financial assistance, the Tuition Reimbursement program benefit. To apply, refer to the Tuition
Program encourages you and your dependents to Reimbursement application. If you have questions,
pursue continuing education. please contact a Human Resources representative.

Dependent Reimbursement Employee Tuition Reimbursement
This benefit is available to those who are regular, If you are a full-time employee you are entitled to
active full-time employees with a title of: Vice receive up to $5,000 per calendar year towards
President, Senior Vice President,System Chairman, qualified tuition expenses. The total lifetime
full-time Physician, Executive Director or Deputy maximum tuition benefit is limited to no more than
Executive Director. Upon meeting the conditions for $20,000 for each degree level.
eligibility, participation and documentation, you are
entitled to receive dependent tuition reimbursement Hofstra University/Northwell Health Master’s
for undergraduate and graduate education in the Program is offered to full-time employees who have
amounts listed below. Note: this benefit is fully been employed for one year. Employees who would
taxable. like to participate in the program must submit an
initial application to their Department Head for review
Health System contribution towards Undergraduate and completion. The application is then sent to the
& Graduate Education site Human Resources Associate Executive Director for
their approval, and then will be sent to Corporate
Senior Vice President, System Chairman and Human Resources Tuition Reimbursement Committee.
Executive Director If approved by the committee, this application will be
$15,000 annual maximum per child; 2 or more in force for the duration of their degree program. If
children at $30,000 total maximum per calendar year; the employee wishes to change majors, he/she must
$120,000 for undergraduate, $120,000 for graduate; complete a new application. Please refer to the
$240,000 total lifetime maximum Hofstra University/Northwell Health Master’s Program
Policy for detailed information.
Note: This benefit provides up to $30,000 per year
for eligible dependent’s undergraduate or graduate Continuing Education
tuition. There is no limit on the number of eligible Northwell Health offers an array of exciting
children for whom this benefit applies, however, no opportunities to continue your professional education
more than $15,000 can be provided for any one and development through the Center for Learning and
child. Innovation (CLI), as well as continuing medical
Vice President, Associate Executive education (CME) for full time physicians. Please inquire
Director and full-time Physician about these programs through your Human Resources
$10,000 annual maximum per child; 2 or more representative.
children at $20,000 - total maximum per calendar
year; $80,000 for undergraduate, $80,000 for Adoption Assistance Program
graduate; $160,000 lifetime maximum. Northwell Health provides you the opportunity of
financial assistance for full time employees with one
Note: This benefit provides up to $20,000 per year for

29

Work/Life Programs and Benefits

year of service in the health system. The benefit
provides up to $5,000 per family, per lifetime, for
direct costs related to the adoption process.

Employee Discounts locally and nationally provide a
true value to all employees. Visit the employee
intranet for more information.

Employee Appreciation is shown in many ways across
the health system, such as seasonal celebrations and
special events. In addition, there are awards that
recognize extraordinary employees, such as the
President’s Award, and the High-Potential Program.

myRecognition is a new online platform that gives all
employees the opportunity to recognize one another
for exemplifying one or more of Northwell Health’s six
behavioral expectations: Patient/Customer Focus,
Teamwork, Execution, Enable Change, Organizational
Awareness, Develop Self. Once logged into the
platform you can send a certificate to the recipient,
with or without reward points attached. Recognizing
colleagues with a simple Thank You card or On-the-
Spot recognition cards is also encouraged to increase
pride and positive behavior. Visit
Northwell.edu/myRecognition to register and
participate.

myWellness is a new online platform designed to
improve the level of awareness of three key areas of
health and wellness: proper nutrition, stress
management and physical activities. Wellness
Challenges are offered to all employees throughout
the year – with the ability to earn reward points,
eligible to redeem for lifestyle gifts. Visit
Northwell.edu/myWellness to register and
participate.

30

Rights, Legal Disclaimers and Notices

Affordable Care Act (ACA)
The coverage offered to you by Northwell Health exceeds the minimum value standard set forth by the ACA. The
coverage is affordable to you and your family if your cost share does not exceed 9.5% of your household income. If
you are, or become, ineligible for Northwell Health benefits, you may be eligible for subsidies on the New York State
Health Exchange. The Exchange is the only body that can make determinations about your eligibility for subsidy.

COBRA Notice: Comprehensive Omnibus Budget Reconciliation Act

The health system offers continuation of health care coverage to employees and dependents who lose coverage
due to a qualifying event under the Northwell Health Benefits Plan. A qualifying event occurs under the
following circumstances:

Qualifying Event Maximum COBRA Continuation Period

Employee Spouse Dependent

Employer’s termination (other than gross 18 months 18 months 18 months
misconduct) or reduction in hours worked

Employee death N/A 36 months 36 months

Divorce of legal separation N/A 36 months 36 months

Cessation of dependent status N/A N/A 36 months

Medicare entitlement N/A 36 months 36 months

Disability* 29 months 29 months 29 months

*Qualified beneficiaries who are approved for Social Security Disability may continue coverage for an additional 11
months beyond the initial 18 month period at an increased premium rate.

The Human Resources Department will notify Wage Works, the third party administrator of who is eligible for
continuation of benefit coverage and initiate a COBRA notification to the employee within fourteen (14) days
of his/her eligibility event. The Plan will offer COBRA continuation coverage only after the health system has
been timely notified that a qualifying event has occurred. For the other qualifying events (divorce/legal
separation, cessation of dependent status), you must notify the health system in writing within 31 days after
the qualifying event or the date your dependent would lose coverage under the Plan as a result of the
qualifying event.

If either you, your spouse or any of your dependent children covered under the Plan, is determined by the
Social Security Administration to be disabled on the date of the employee’s termination of employment or
reduction in work hours, or at any time during the first 60 days of COBRA continuation coverage, due to such
qualifying event, each individual (whether or not disabled) may be entitled to receive up to an additional 11
months of COBRA continuation coverage, for a total maximum of 29 months.

The disability would have to have started at some time before the 60th day of COBRA continuation of
coverage and must last at least until the end of the 18 month period of continuation coverage. To qualify for
this disability extension, you must notify the health system of the person’s disability status both at the initial
qualifying event date and before the original 18 month COBRA continuation coverage period ends. Also, if
Social Security determines the individual is no longer disabled, you are required to notify the health system
within 30 days after this determination.

31

Rights, Legal Disclaimers and Notices

Any terminated employee and/or dependent electing continuation of coverage is required to pay a monthly
premium to cover the full cost of his/her coverage plus a 2% administrative fee. Continued benefit coverage
will terminate prior to the end of the 18, 29, or 36 month period if:

• Initial payment is not received within 45 days of its due date;
• Subsequent payments are not received within 30 days of their due date;
• The individual becomes covered under another group plan;
• The individual becomes eligible for Medicare;
• The plan is terminated for all employees.

HIPAA Notice
HIPAA is a law that requires employers (or their insurers or their administrators) to provide certification of the
healthcare coverage you had while you were employed. You may present the HIPAA Certificate to another employer
if they request it as proof that you had healthcare coverage.

Patient Protection and Affordable Care Act ("PPACA") Patient Protection Notices
Generally you will be permitted to designate a primary care provider under any benefit plan. You have the right
to designate any primary care provider who participates in either United HealthCare (Value or Buy-Up plan) and
who is available to accept you or your family members. For information on how to select a primary care
provider, and for a list of participating primary care providers, contact United HealthCare at 1-888-254-3698.

Protected Health Information (PHI)
PHI is “individually identifiable health information in any form that relates to: (i) the past, present or future
physical or mental health or condition of an individual; (ii) the provision of health care to an individual; or (iii) the
past, present or future payment for the provision of health care to an individual. “Individually identifiable health
information” is health information that identifies the individual to whom it relates, or for which there is a
reasonable basis to believe that it can be used to identify the individual to whom it relates. Under the law, the
Plans may disclose your PHI without your authorization when the use and/or disclosure are for the purposes of: (i)
treatment, (ii) payment, or (iii) health care operations.

Notice of Creditable Coverage
This notice has information about your current prescription drug coverage with Northwell Health and about
your options under Medicare’s prescription drug coverage. This information can help you decide whether or
not you want to join a Medicare drug plan. If you are considering joining, you should compare your current
coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering
Medicare prescription drug coverage in your area. Information about where you can get help to make
decisions about your prescription drug coverage is at the end of this notice.

There are two important things you need to know about your current coverage and Medicare’s prescription

drug coverage:

1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this
coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or
PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of
coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.

2. Northwell Health has determined that the prescription drug coverage offered by the Northwell Health
Medical Plan is, on average for all plan participants, expected to pay out as much as standard Medicare
prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing
coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you
later decide to join a Medicare drug plan.

When can you join a Medicare drug plan?

32

Rights, Legal Disclaimers and Notices

You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15
through December 7. However, if you lose your current creditable prescription drug coverage, through no
fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a
Medicare drug plan.

What happens to your current coverage if you decide to join a Medicare drug plan?
If you decide to join a Medicare drug plan, your current Northwell Health coverage will not be affected.
You can keep your Northwell Health coverage if you elect Part D and this plan will coordinate with your Part D
coverage.
If you do decide to join a Medicare drug plan and drop your Northwell Health prescription drug and medical
coverage, be aware that you and your dependents may not be able to get this coverage back.

When will you pay a higher premium (penalty) to join a Medicare drug plan?
You should also know that if you drop or lose your current coverage with Northwell Health and don’t join a
Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium
(a penalty) to join a Medicare drug plan later.
If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium
may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not
have that coverage. For example, if you go nineteen months without creditable coverage, your premium may
consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this
higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have
to wait until the following October to join.

For more information about this notice or your current prescription drug coverage: Contact Corporate Human
Resources for further information at 516-734-7000. NOTE: You’ll get this notice each year. You will also get it
before the next period you can join a Medicare drug plan, and if this coverage through Northwell Health
changes. You also may request a copy of this notice at any time.

For more information about your options under Medicare prescription drug coverage: More detailed
information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook.
You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by
Medicare drug plans.

For more information about Medicare prescription drug coverage:
 Visit www.medicare.gov
 Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the
“Medicare & You” handbook for their telephone number) for personalized help
 Call 1800MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available.
For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at
1-800-772-1213 (TTY 1-800-325-0778).

33

Rights, Legal Disclaimers and Notices

Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you
may be required to provide a copy of this notice when you join to show whether or not you have maintained
creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).

Date: October 10, 2016
Name of Entity/Sender: Northwell Health/Total Rewards
Contact Position/Office: Human Resources Dept.
1111 Marcus Ave, Suite LL20, NY 11042
Address: (516) 7347000
Phone Number:

CMS Form 10182CC According to the Paperwork Reduction Act of 1995, no persons are required to respond to a
collection of information unless it displays a valid OMB control number. The valid OMB control number for this
information collection is 09380990. The time required to complete this information collection is estimated to
average 8 hours per response initially, including the time to review instructions, search existing data resources,
gather the data needed, and complete and review the information collection. If you have comments concerning
the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security
Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C42605, Baltimore, Maryland 212-441-850.

Medicaid and the Children’s Health Insurance Program (CHIP)
If you are eligible for benefits but are unable to afford the premiums, some states have premium assistance
programs that can help pay for coverage. These states use funds from their Medicaid or CHIP programs to help
people who are eligible for employer sponsored health coverage, but need assistance in paying their health
premiums. If you or your dependents are already enrolled in Medicaid or CHIP you can contact your state Medicaid
or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in
Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, you
can contact your state Medicaid or CHIP office or dial 877-KIDS-NOW or insurekidsnow.gov.

Disclaimers
Benefit Summaries referenced in this Guide are intended only to highlight your benefits and should not be relied
upon to fully determine your coverage. If this Benefit Summary conflicts in any way with the Summary Plan
Description (SPD), the SPD shall prevail. If this Benefit Summary conflicts in any way with certificates, the
certificates will prevail. It is recommended that you review your SPD for an exact description of the services and
supplies that are covered, those which are excluded or limited, and other terms and conditions of coverage. Visit the
employee intranet for the SPD for Northwell Health benefit-eligible employees.

WHCRA Notice
WHCRA is the Women’s Health and Cancer Rights Act of 1998 that entitles individuals who have had or are going
to have a mastectomy, certain benefits under the law. For those individuals receiving mastectomy-related
benefits, coverage will be provided in a manner determined in consultation with the attending physician and the
patient.

Michelle’s Law

Under Michelle’s Law, a group health plan cannot terminate a child’s coverage for loss of full-time student status
if the change in student status is due to a “medically necessary leave of absence.” The plan may be required to
allow such a child to remain covered as an employee’s dependent for up to a year after the leave of absence
begins.

Newborns’ and Mothers’ Protection (Newborns’ Act)

34

Rights, Legal Disclaimers and Notices

The Newborns’ and Mothers’ Health Protection Act (Newborns’ Act) includes important protections for mothers
and their newborn children with regard to the length of the hospital stay following childbirth. The Newborns’ Act
requires that group health plans that offer maternity coverage pay for at least a 48 hour hospital stay following
childbirth (96 hour stay in the case of a Cesarean section).

Northwell Health Disclaimer
This material is designed to highlight the features of the employee benefits program offered by Northwell
Health as of January 1, 2017. Complete Summary Plan Descriptions of all plans are available on the employee
intranet. Where there may be discrepancies in the summaries provided in this brochure, the official plan
documents will govern. If you cannot access the Intranet for the Summary Plan Descriptions, please contact the
HR Service Center. Although Northwell Health expects to continue these benefits indefinitely, Northwell Health
reserves the right to amend, modify or discontinue the plans at any time.

Privacy Notice
As part of Northwell Health’s commitment to providing exceptional care for its employees, the health system
partners will provide resources to assist you in a creation of a wellness plan. As part of the wellness credits, you
must completed a free online Health Assessment (HA) and enter personal health data.

Protecting Your Personal and Health Information
The HRA administrator has business practices that are in compliance with the privacy regulations of HIPAA.
Precautions have been taken to protect all submissions against unauthorized access and use. The administrator has
reasonable and customary security measures in place in its physical facilities to protect against the loss, misuse, or
alteration of information collected from you at the site.

Note regarding the Wellness Credit Program
When participating in the Wellness Credit Program your Actions can be viewed on your personal Wellness
Summary on mySelfService. The information recorded and sent from the provider to the carrier, to the health
system, is not your health information it is the date of service of when you acted on your wellness. This includes
the online Health Survey. This process takes 6 to 8 weeks.

Past claims information is securely sent and stored in your health history. It helps serve as a reference for you to
track your health history and it may be useful for your treating medical providers.

Acknowledgment: By enrolling in a Northwell Health medical plan you and your enrolled dependents may be
contacted by a service provider (may be a Northwell Health employee) offering information, support or
assistance, related to the usage of plan benefits. Any participation in, or cooperation with, such services or
providers is completely voluntary and without extra charge. Any personal health information that is voluntarily
provided will not be used for purposes other than the services offered.”

Notice Regarding Northwell Health’s Annual Wellness Credit Program
The Northwell Health Annual Wellness Credit Program is a voluntary wellness program available to employees
eligible for Value, Buy-Up and Care Connect self-insured plans. The program is administered according to
federal rules permitting employer sponsored wellness programs that seek to improve employee health or
prevent disease, including the Americans with Disabilities Act of 1990, the Genetic Information
Nondiscrimination Act of 2008, and the Health Insurance Portability and Accountability Act, as applicable,
among others. If you choose to participate in the wellness program you will be asked to complete a voluntary
health risk assessment or "HRA" that asks a series of questions about your health-related activities and
behaviors and whether you have or had certain medical conditions (e.g., diabetes). You are not required to
complete the HRA or to participate in any medical examinations.

35

Rights, Legal Disclaimers and Notices

Employees who choose to participate in the wellness program can receive paycheck credits the following
calendar year up to a maximum of $1,040. Completing four out of 10 wellness actions will reward participants
$260, per wellness action, in paycheck credits. Although you are not required to complete the HRA, only
employees who do so will receive any paycheck credits. If you are unable to complete any of the wellness
actions required to earn an incentive, you may be entitled to a reasonable accommodation. You may request a
reasonable accommodation by contacting Northwell Health HR Customer Service at 516-734-7000.

The information from your HRA and the results from your biometric screening will be used to provide you with
information to help you understand your current health and potential risks, and may also be used to offer you
services through the wellness program, such as potential action plans to help you improve your wellbeing in a
certain area. You also are encouraged to share your results or concerns with your own doctor.

Protections from Disclosure of Medical Information

We are required by law to maintain the privacy and security of your personally identifiable health information.
Any personal health information that is voluntarily provided will not be used for purposes other than the
services offered. Medical information that personally identifies you that is provided in connection with the
wellness program will not be provided to your supervisors or managers and may never be used to make
decisions regarding your employment.

Your health information will not be sold, exchanged, transferred, or otherwise disclosed except to the extent
permitted by law to carry out specific activities related to the wellness program, and you will not be asked or
required to waive the confidentiality of your health information as a condition of participating in the wellness
program or receiving an incentive. Anyone who receives your information for purposes of providing you services
as part of the wellness program will abide by the same confidentiality requirements. By enrolling in a Northwell
Health plan, your enrolled dependents and you may be contacted by a service provider (in some cases a
Northwell Health employee) offering information, support or assistance, related to the usage of plan benefits.
Any participation in, or cooperation with, such services or providers is completely voluntary and without extra
charge. Any personal health information that is voluntarily provided will not be used for purposes other than the
services offered.

In addition, all medical information obtained through the wellness program will be maintained separate from
your personnel records, information stored electronically will be encrypted, and no information you provide as
part of the wellness program will be used in making any employment decision. Appropriate precautions will be
taken to avoid any data breach, and in the event a data breach occurs involving information you provide in
connection with the wellness program, we will notify you immediately.

You may not be discriminated against in employment because of the medical information you provide as part of
participating in the wellness program, nor may you be subjected to retaliation if you choose not to participate.

The HRA is not intended to elicit any genetic information from employees who participate in Northwell Health’s
Annual Wellness Credit Program, and it is requested that employees refrain from providing any genetic
information when completing the HRA.

If you have any questions or would like more information about Northwell Health’s Annual Wellness Credit
Program, please contact the Human Resources Service Center at 516-734-7000.

Northwell Health Nondiscrimination Notice

Discrimination is Against the Law: Northwell Health complies with applicable Federal civil rights laws and does
not discriminate on the basis of race, color, national origin, age, disability, or sex. Northwell Health does not
exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

36

Rights, Legal Disclaimers and Notices

Northwell Health:
• Provides free aids and services to people with disabilities to communicate effectively with us, such as:

o Qualified sign language interpreters
o Written information in other formats (large print, audio, accessible electronic formats, other formats)
• Provides free language services to people whose primary language is not English, such as:
o Qualified interpreters
o Information written in other languages
If you need these services, contact Magda Ramirez. If you believe that Northwell Health has failed to provide
these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex,
you can file a grievance with: Magda Ramirez, 1111 Marcus Ave. Suite LL20, Lake Success NY 11801, 516-734-
7142, 516-224-3161, [email protected]. You can file a grievance in person or by mail, fax, or email. If you
need help filing a grievance, Magda Ramirez is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil
Rights electronically through the Office for Civil Rights Complaint Portal, available at
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf or by mail or phone at: U.S. Department of Health and Human
Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, 1–800–868–1019,
800–537–7697 (TDD).

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
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5167347142 (TTY: 1 8006621220).
注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 5167347142 (TTY: 1 8006621220).
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Chiamare il numero 5167347142 (TTY: 1 8006621220).
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37

Rights, Legal Disclaimers and Notices

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Appelez le 5167347142 (TTY: 1 8006621220).
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ΠΡΟΣΟΧΗ: Αν μιλάτε ελληνικά, στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης, οι οποίες
παρέχονται δωρεάν. Καλέστε 5167347142 (TTY: 1 8006621220).
KUJDES: Nëse flitni shqip, për ju ka në dispozicion shërbime të asistencës gjuhësore, pa pagesë. Telefononi në
5167347142 (TTY: 1 8006621220).
ATENÇÃO: Se fala português, encontramse disponíveis serviços linguísticos, grátis. Ligue para 5167347142 (TTY:
1 8006621220).

CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 5167347142 (TTY:
1 8006621220)
Wann du [Deitsch (Pennsylvania German / Dutch)] schwetzscht, kannscht du mitaus Koschte ebber gricke, ass
dihr helft mit die englisch Schprooch. Ruf selli Nummer uff: Call 5167347142 (TTY: 1 8006621220).
ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung.
Rufnummer: 5167347142 (TTY: 1 8006621220).

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Contact Information

Northwell Health Physician and Executive Benefits Benefits Planning Corporation for
Concierge Service Is Here for You! Voluntary Plans
benefitsplanningcorp.com 631-991-6050 or
For more information about your benefits or how to 800-565-5764
enroll in the plans, contact 844-697-4947 or
[email protected]. Aon Voluntary Benefits & Enrollment Solutions
https://uenroll.net/NorthwellHealthNewHires or
Other resources include: 888-561-0240

Northwell Health WageWorks for Flexible Spending Accounts, Health
Human Resources Service Center Savings Accounts and Commuter Benefit
[email protected] 516-734-7000 wageworks.com 877-924-3967

Northwell Health IS Help Desk Vivo Health Pharmacy at North Shore University
516-470-7272 Hospital
300 Community Drive
Northwell Health -e mySelfService Manhasset, NY 11030
Northwell.edu/mySelfService 516-562-VIVO (8486)
[email protected]
Northwell Health Find a Physician
Northwell.edu/insystem Vivo Health Pharmacy at CFAM
450 Lakeville Road
United Healthcare for Medical Plans New Hyde Park, NY 11042
myuhc.com 888-254-3698 516-734-7780
[email protected]
Express Scripts for Prescription Plans through United
HealthCare Vivo Health Pharmacy at Long Island Jewish Medical
express-scripts.com 800-864-1140 Center
27005 76th Avenue
Cigna for Dental Plans New Hyde Park, NY 11040
mycigna.com 516-562-VIVO (8486)
PPO Plan: 888-DENTAL8 [email protected]
(336-8258)
DHMO Plan: 800-367-1037 Vivo Health Specialty Pharmacy
410 Lakeville Road
Davis Vision for Vision Plan (company code 2921) New Hyde Park, NY 11042
davisvision.com 800-999-5431 516-465-5250
[email protected]
Aetna for Life Insurance Plans
800-523-5065

Absence One for Disability Plans
absenceone.com/Northwell 877-254-1246

Transamerica Retirement Solutions
for Retirement Plans
Northwell.edu/myRetirement 844-675-4547

39