MediCorp Benefits Guide for 2009 by M.K.

Mary Washington Hospital

Stafford Hospital Center

Human Resources 1001 Sam Perry Boulevard Fredericksburg, VA 22401 medicorp.org

Disclaimerâ&#x20AC;&#x201D;This document was written for easy readability. It may contain generalizations and colloquialisms, rather than precise legal terms. For full details, including eligibility, you should consult the summary plan descriptions. In all cases, the official plan documents govern and are the final authority on the terms of the plans. MediCorp Health System reserves the right to terminate or amend any and all benefit plans. Participation in the MediCorp Health System benefit plans is neither a contractual right nor a guarantee of current or future employment.

BENEFITS GUIDE 2009

FOR ALL BENEFITS AND ENROLLMENT QUESTIONS, PLEASE CONTACT:

TABLE OF CONTENTS When Coverage Begins

When You Can Make Changes 2

Additional Benefits

Paid Annual Leave

How to Enroll or Make Changes

Child Care: Kidsâ&#x20AC;&#x2122; Station

Your Benefits At A Glance

Personal Services and Resources

Medical Plan

Tuition Assistance

Prescription Drug Benefit

Live Well Program

Dental Plan

Vision Plan

Flexible Spending Accounts

Life Insurance and AD&D

Disability Coverage

Retirement

Bereavement Leave

Allison Black, Benefits Resource Benefits Analyst allison.black@medicorp.org 540.741.1483 If you are unable to reach Allison, or need further assistance, please contact any members of the Benefits Team. Pam Burton Benefits Manager pam.burton@medicorp.org 540.741.3552 Cyndie Imler Senior Benefits Analyst cyndie.imler@medicorp.org 540.741.2585 Cindy Kjar Benefits Analyst cindy.kjar@medicorp.org 540.741.2254 D.L. Sumner Director, Compensation & Benefits dl.sumner@medicorp.org 540.741.2587 Kathy Wall Executive VP, Human Resources & Organizational Development kathy.wall@medicorp.org 540.741.1471

IMPORTANT NUMBERS Aetna 800.291.2953 www.aetna.com ASSIST 866.409.9692 Delta Dental 800.237.6060 www.deltadentalva.com Errand Solutions 540.741.2882 Kidsâ&#x20AC;&#x2122; Station 540.741.3740 Lincoln Financial Group 800.234.3500 www.lfg.com Life Insurance Coverage (ING) 888.571.4075 MHS Health & Wellness 540.741.3621 Senior Care 540.741.3560 Short-Term Disability (ING) 800.328.4090 Vision Service Plan (VSP) 800.877.7195

MediCorp Health System Benefits Guide 2009 We are pleased to provide you with the MediCorp Health System Benefits Guide for 2009. This guide is designed for active MediCorp Associates who are eligible to enroll in the MediCorp benefits plan. cut

We are extremely proud of the MediCorp benefits package. Our goal is to provide our Associates with the best selection of benefits at the lowest possible cost. We believe we have done this and are able to provide a low-cost comprehensive benefits package that is comparable to other organizations. The package includes a wide variety of benefits to choose from and is a valuable part of the total compensation you receive as a MediCorp Associate. Thoughtful consideration should be given to your benefits choices to accommodate your personal health care needs. Take a few minutes to review this guide and decide which plans and coverage levels make the most sense for you and your family. You may access the Self-Evident Application (SEA) to review plan summaries, frequently asked questions and plan Web sites. Your Benefits Team is here to help with any questions you have about your benefits. You will also find a listing of important telephone numbers inside the back cover to assist you. Please keep in mind that the guide provides only an overview of your benefit options. If you need specific plan details, see your Summary Plan description or contact a member of the Benefits Team. While we have done our best to provide an accurate summary, please be aware that if there is any discrepancy between the information in this guide and the official benefits plan documents, the official plan documents will prevail. We look forward to serving you in the coming year. Your MediCorp Health System Benefits Team There are two easy ways to contact the Benefits Team with questions about your benefits: 1. Call 540.741.2255 2. E-mail askbenefits@medicorp.org

MediCorp Health System Benefits Guide

Open Enrollment are effective January 1.

WHO IS ELIGIBLE? Benefit Eligibility for Associates

ENROLLMENT & ELIGIBILITY

STOP

• Please note that you have 31 days from your hire date or qualifying event date to enroll in or make changes to your benefits selections. • Qualifying events include birth or adoption of a child, marriage, divorce or change of status. A complete list of qualifying events is included on this page. • If you fail to enroll or change benefits within 31 days of the date of the event, you will not be allowed to enroll in or make any changes to your benefits until Open Enrollment or you have another qualifying event.

WHEN COVERAGE BEGINS Open Enrollment

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Open Enrollment is held each year during the month of October. You may make any changes desired to your benefits during that time. Any changes or enrollments made during Open Enrollment will take effect on January 1 of the next year. You cannot make any changes to your benefits until the next Open Enrollment period unless you have a qualifying event or change of status as described below. New Associates If you are a newly hired Associate, you must enroll in benefits within 31 days of your hire date. Benefit elections are effective the first of the month following your hire date. If you do not enroll in benefits, you will be automatically enrolled in the opt-out plan—this will be an irrevocable election that cannot be changed until the next Open Enrollment period unless you have a qualifying event or change of status as described below. If you will be covering your spouse or children you will need to provide documentation of eligibility. The following documentation will be required to maintain coverage: • Spouse – state-issued marriage license • Dependents under age 19 – birth certificate • Dependents over age 19 – birth certificate and proof of full-time student status 2

MediCorp Health System Benefits Guide

Description

Benefit & PAL Eligibility

FTE

Active Full-Time

yes

.9 or greater

Active Part-Time

yes

.5 or greater

Educational Leave

yes

.5 or greater

Enhanced

benefit eligible/ not PAL eligible

.9 or greater

COVERAGE LEVELS When you enroll, you will choose your coverage level for medical, dental and vision coverage. You can choose different coverage levels for each plan. The coverage levels include: • Associate Only • Associate and Spouse • Associate Plus One Child • Family

SHARING THE COST FOR COVERAGE You and MediCorp share the cost of your health care. MediCorp pays a major share of the cost and you pay the remainder. Your contribution costs can be found on the enclosed insert.

Newly Benefits–Eligible/Status Change

Flex Support

If you have a change in status, you may make changes to your benefits appropriate to your change in status. You must make any changes/ elections within 31 days of the effective date of the status change. Benefit elections are effective the first of the month following the effective date of the status change. If you do not make changes/ elections within 31 days of the effective date of the status change, you will maintain the benefits in effect or, if not enrolled, you will continue in the opt-out plan. You will not be able to make changes until the next Open Enrollment period.

Full-Time No Benefits

PRE-TAX CONTRIBUTION

Leave of Absence

yes—if regular status was benefit eligible

Per Visit Full-Time

yes

.9 or greater

LPN PRN Plus

PRN

Per Visit Part-Time

yes

.5 or greater

RN PRN Plus

Part-Time No Benefits

Contributions for medical, dental, vision, flexible spending accounts, short-term disability and the retirement savings plan will be deducted from your paycheck on a pre-tax basis. This means you do not pay federal or Social Security taxes on your contributions; they may also be exempt from state taxes, depending on where you live. For more information about pre-tax contributions, consult a tax adviser.

Per Visit

Quick Pick

36-Hour Standard

yes

.9 or greater

Shared Support

Temporary

36-Hour Weekend

yes

.9 or greater

WHEN YOU CAN MAKE CHANGES (QUALIFYING EVENTS) In general, you can change your benefits coverage during the year only if you have a qualifying life event. Any changes you make for yourself and your dependents must be consistent with, and as a result of, your change in status. Life events and changes in status that permit coverage changes are: • You gain a tax dependent through birth, legal adoption or placement for adoption. • You experience a marriage, divorce or annulment. • Your dependent age 19 up to 25 becomes a full-time student. • Your dependent age 19 up to 25 is no longer a full-time student. • Your dependent child marries or reaches age 25. • Your spouse gains, loses or changes coverage due to gaining or losing employment/eligibility with current employer. • You experience the death of spouse or dependent child. • Your spouse/dependent becomes Medicare/Medicaid eligible or ineligible. • You have a change in residence that changes eligibility for coverage. • You have a court-ordered change. • An Associate who wishes to change a benefit election because of a life event or change in status must contact a member of the Benefits Team to complete the necessary forms within 31 days of the event. • Documentation of the qualifying event is required. If you fail to make the changes within 31 days of the event, you cannot make changes until the next Open Enrollment period.

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IMPORTANT INFORMATION FOR ALL ASSOCIATES

Status

ENROLLMENT & ELIGIBILITY

• Open Enrollment is held each year in October. • You may make any changes at that time. Changes made during

AFTER-TAX CONTRIBUTION

Dependent Eligibility You may enroll yourself and your eligible dependents, which generally include: • Your spouse—you will need to provide a state-issued marriage license. • Your dependent children under age 19—you will need to provide a state-issued birth certificate; if legal ward, you will need to provide birth certificate and proof of custody or guardianship. • Your unmarried children between the ages of 19 and 25 who are enrolled as full-time students at an accredited school, college or university and are solely dependent upon you for support—you will need to provide a state-issued birth certificate and proof of full-time student status; if legal ward, you will need to provide a state-issued birth certificate and proof of custody or guardianship. • Your unmarried children over age 19 who have been mentally or physically disabled since before age 19, and who rely on you for support and maintenance—your dependents are eligible for medical, prescription drug, dental, vision, optional life insurance and voluntary benefits (as applicable). You will need to provide a state-issued birth certificate and proof of disability.

Your contributions for optional life insurance, accidental death and dismemberment (AD&D) insurance and voluntary benefits are paid with after-tax contributions.

HOW LONG COVERAGE LASTS The choices you make will remain in effect until the end of the calendar year unless you have a change in family status or you terminate employment, retire or become ineligible for benefits. If your child turns age 19 and/or completes school during the year, he/she will be covered until the end of the calendar year. Upon your termination or transfer to a no-benefit status, your life insurance and disability coverage end on your last day of active work or eligible status. Health, dental and vision end the last day of the month in which you terminate employment or transfer to non-eligible status. You may be eligible for continuation under the COBRA provisions of the plan.

MediCorp Health System Benefits Guide

Open Enrollment are effective January 1.

WHO IS ELIGIBLE? Benefit Eligibility for Associates

ENROLLMENT & ELIGIBILITY

STOP

WHEN COVERAGE BEGINS Open Enrollment

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MediCorp Health System Benefits Guide

Description

Benefit & PAL Eligibility

FTE

Active Full-Time

yes

.9 or greater

Active Part-Time

yes

.5 or greater

Educational Leave

yes

.5 or greater

Enhanced

benefit eligible/ not PAL eligible

.9 or greater

Newly Benefits–Eligible/Status Change

Flex Support

Full-Time No Benefits

PRE-TAX CONTRIBUTION

Leave of Absence

yes—if regular status was benefit eligible

Per Visit Full-Time

yes

.9 or greater

LPN PRN Plus

PRN

Per Visit Part-Time

yes

.5 or greater

RN PRN Plus

Part-Time No Benefits

Per Visit

Quick Pick

36-Hour Standard

yes

.9 or greater

Shared Support

Temporary

36-Hour Weekend

yes

.9 or greater

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IMPORTANT INFORMATION FOR ALL ASSOCIATES

Status

ENROLLMENT & ELIGIBILITY

• Open Enrollment is held each year in October. • You may make any changes at that time. Changes made during

AFTER-TAX CONTRIBUTION

Your contributions for optional life insurance, accidental death and dismemberment (AD&D) insurance and voluntary benefits are paid with after-tax contributions.

MediCorp Health System Benefits Guide

Your Benefits At A Glance

You must enroll online using the Lawson system’s Self-Evident Application (SEA). You can access the online enrollment

The chart below summarizes the benefit options available to you. Benefits with a checkmark ( ✔ ) next to them are paid

system on the Internet from the “Associates Log In” link at www.medicorp.org. Additionally, there are kiosks located

in full by MediCorp. All the benefits are explained in greater detail on the following pages.

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NEW HIRES: HOW TO ENROLL

outside the cafeteria at Mary Washington Hospital (MWH) as well as terminals located in Human Resources at MWH and 2300 Fall Hill, and in the Commuter Room at MWH.

Medical*

❑ Premium Waiver

❑ Standard

❑ Enhanced

❑ Premier

(includes prescription drug coverage)

Here are six easy steps to using the online enrollment system: 1. Log on to the SEA (Self-Evident Application). • From any computer with Internet access, go to www.medicorp.org. • Go to the “Associate Log In” and click on “SEA.” 2. Key in your User ID and password,

5. Confirm your benefit selections by clicking on “Keep These Benefits?” “Make Changes?”

• Your User ID is your six-digit employee number.

• Remember to log out of SEA by clicking on the “X” on the right side of the screen.

birth month (lowercase) and your 4-digit birth year.

If you experience technical problems with the application,

For example—January 1955 would be jan1955. You

please call the Information Service Help Desk at 540.741.1122.

❑ Standard Option

❑ Enhanced Option

Vision

❑ Standard Option

❑ Enhanced Option

Flexible Spending

❑ Health Care Flexible Spending Account—contribute up to $120 per pay period.

Accounts (FSAs)

❑ Dependent Care Flexible Spending Account—contribute up to $5,000 pre-tax annually (or $2,500 annually if married and filing separate tax returns).

Life Insurance

are eligible for $5,000 in basic life insurance). Up to a combined maximum of $500,000.

❑ For your dependent children—either $2,500, $5,000 or $10,000 of coverage. Evidence of insurability required.

If you forget your password for SEA, you may call the Help

Accidental Death

❑ Can purchase in $50,000 increments up to $1,000,000 for full-time Associates or $250,000 for part-time Associates.

Desk at 540.741.1122. They will immediately reset a temporary password, and you will be prompted to change it the first

Disability

• Click on “Home Address” and confirm your address

time you log on.

is correct. • Click on “Dependents” and enter your dependents. 4. Select your benefits. • To enroll in your benefits, go to “My Benefits” and click on “New Hire Enrollment.” • Under this tab, you will choose your benefit options for the plan year. • Continue until you have entered all benefit selections. • The last screen you see will be a review of your new benefit selections.

❑ For your spouse—any amount between $5,000 and $100,000 of coverage, up to 100% of your life insurance coverage or $100,000 (whichever is less). Evidence of insurability required.

“My Personal Data.”

• Click on “Beneficiary” and enter your beneficiaries.

❑ For you: Supplemental Life Insurance—one to five times your base annual salary (part-time Associates may purchase in $5,000 increments up to $45,000; may require evidence of insurability, up to a combined maximum of $500,000.

and Dismemberment

3. Confirm and/or update your personal data under

✔ Basic Life Insurance1—one and one-half times your base annual salary unless otherwise stated (part-time Associates ❑

are prompted to create your own password after your

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Dental*

6. You’ll see the “Congratulations” screen; enrollment is complete once you click the “Continue” button.

initial login.

✔Live Well—voluntary program to help you maintain good health and manage health risks and chronic conditions. ❑

• If you need to make further changes, click on

then click on “Log In.” • Your initial password is the first three letters of your

Wellness Program

benefits available up to a total disability period of 25 weeks per calendar year.

✔ Long-Term Disability—replaces 60% of your base pay after 180 days of disability, as long as you are a full-time ❑ Associate with at least one year of service. (Part-time Associates are not eligible for short-term and long-term

2009 OPEN ENROLLMENT • Open Enrollment takes place October 1 to 31. • This year is a passive enrollment. This means that if you do not want to make any changes to your 2008 benefits elections do nothing during Open Enrollment and your 2008 elections will roll over to 2009. Except for your Flexible Spending Accounts (FSA), you may not rollover your FSA selection from the previous year. You must make a new election for your medical or dependent care spending account each year.

❑S hort-Term Disability—replaces 60% of your base pay up to $1,000 a week after eight days of disability with

disability coverage.) Voluntary Benefits

❑ Short-Term Disability

❑ Homeowners/Auto

❑ Pet Insurance

❑ Errand Solutions: Personal Services and Resources

Employee Assistance

✔ASSIST®—assistance for personal, financial and relationship issues. ❑

❑ Computer Purchase

❑ Critical Illness

Program Retirement

❑ Retirement Savings Plan (Lincoln Financial Group)—you may set aside pre-tax earnings (within IRS limits)

and invest them in a variety of investment options; MediCorp will match $0.50 on each dollar you contribute

up to 6% of your annual salary if you are 21 years old or older and you have completed one year of service with

1,000 hours worked.

term life or supplemental life, you will need to request a

Paid Annual Leave (PAL)

✔PAL is used for holidays, vacation, personal and sick days; you earn PAL based on your years of service and ❑

form from a member of the Benefits Team.

the number of hours you are paid to work.

Education Assistance

❑ You can be reimbursed for qualifying educational costs.

Child Care*

❑ You may enroll your eligible dependents at Kids’ Station (at competitive rates), providing space is available.

• If you want to purchase or change spouse and/or child

*Associate and MediCorp share the cost for medical, dental and child care benefits. 1

MediCorp Health System Benefits Guide

Directors and above may qualify for more life insurance.

MediCorp Health System Benefits Guide

Your Benefits At A Glance

You must enroll online using the Lawson system’s Self-Evident Application (SEA). You can access the online enrollment

The chart below summarizes the benefit options available to you. Benefits with a checkmark ( ✔ ) next to them are paid

system on the Internet from the “Associates Log In” link at www.medicorp.org. Additionally, there are kiosks located

in full by MediCorp. All the benefits are explained in greater detail on the following pages.

cut

NEW HIRES: HOW TO ENROLL

outside the cafeteria at Mary Washington Hospital (MWH) as well as terminals located in Human Resources at MWH and 2300 Fall Hill, and in the Commuter Room at MWH.

Medical*

❑ Premium Waiver

❑ Standard

❑ Enhanced

❑ Premier

(includes prescription drug coverage)

5. Confirm your benefit selections by clicking on “Keep These Benefits?” “Make Changes?”

• Your User ID is your six-digit employee number.

• Remember to log out of SEA by clicking on the “X” on the right side of the screen.

birth month (lowercase) and your 4-digit birth year.

If you experience technical problems with the application,

For example—January 1955 would be jan1955. You

please call the Information Service Help Desk at 540.741.1122.

❑ Standard Option

❑ Enhanced Option

Vision

❑ Standard Option

❑ Enhanced Option

Flexible Spending

❑ Health Care Flexible Spending Account—contribute up to $120 per pay period.

Accounts (FSAs)

❑ Dependent Care Flexible Spending Account—contribute up to $5,000 pre-tax annually (or $2,500 annually if married and filing separate tax returns).

Life Insurance

are eligible for $5,000 in basic life insurance). Up to a combined maximum of $500,000.

❑ For your dependent children—either $2,500, $5,000 or $10,000 of coverage. Evidence of insurability required.

If you forget your password for SEA, you may call the Help

Accidental Death

❑ Can purchase in $50,000 increments up to $1,000,000 for full-time Associates or $250,000 for part-time Associates.

Desk at 540.741.1122. They will immediately reset a temporary password, and you will be prompted to change it the first

Disability

• Click on “Home Address” and confirm your address

time you log on.

❑ For your spouse—any amount between $5,000 and $100,000 of coverage, up to 100% of your life insurance coverage or $100,000 (whichever is less). Evidence of insurability required.

“My Personal Data.”

• Click on “Beneficiary” and enter your beneficiaries.

and Dismemberment

3. Confirm and/or update your personal data under

✔ Basic Life Insurance1—one and one-half times your base annual salary unless otherwise stated (part-time Associates ❑

are prompted to create your own password after your

cut

Dental*

6. You’ll see the “Congratulations” screen; enrollment is complete once you click the “Continue” button.

initial login.

✔Live Well—voluntary program to help you maintain good health and manage health risks and chronic conditions. ❑

• If you need to make further changes, click on

then click on “Log In.” • Your initial password is the first three letters of your

Wellness Program

benefits available up to a total disability period of 25 weeks per calendar year.

❑S hort-Term Disability—replaces 60% of your base pay up to $1,000 a week after eight days of disability with

disability coverage.) Voluntary Benefits

❑ Short-Term Disability

❑ Homeowners/Auto

❑ Pet Insurance

❑ Errand Solutions: Personal Services and Resources

Employee Assistance

✔ASSIST®—assistance for personal, financial and relationship issues. ❑

❑ Computer Purchase

❑ Critical Illness

Program Retirement

❑ Retirement Savings Plan (Lincoln Financial Group)—you may set aside pre-tax earnings (within IRS limits)

and invest them in a variety of investment options; MediCorp will match $0.50 on each dollar you contribute

up to 6% of your annual salary if you are 21 years old or older and you have completed one year of service with

1,000 hours worked.

term life or supplemental life, you will need to request a

Paid Annual Leave (PAL)

✔PAL is used for holidays, vacation, personal and sick days; you earn PAL based on your years of service and ❑

form from a member of the Benefits Team.

the number of hours you are paid to work.

Education Assistance

❑ You can be reimbursed for qualifying educational costs.

Child Care*

❑ You may enroll your eligible dependents at Kids’ Station (at competitive rates), providing space is available.

• If you want to purchase or change spouse and/or child

*Associate and MediCorp share the cost for medical, dental and child care benefits. 1

MediCorp Health System Benefits Guide

Directors and above may qualify for more life insurance.

MediCorp Health System Benefits Guide

MEDICAL PLAN MediCorp’s medical plan is designed specifically for MediCorp Associates. It is self-funded (instead of an insurance company, MediCorp pays the claims covered by the plan) and administered by Aetna. Aetna has a large national network

For example, when your annual physical includes laboratory tests or imaging done at one of MediCorp’s facilities, the test results are sent to your physician and become part of your confidential patient record. If you should ever need the services of MWH Emergency Department, those test results will be immediately accessible within the health system. MediCorp health care providers will accept all properly written orders for tests and procedures, even if another provider is specified. Remember, it is the right of the patient to determine where they receive health care. You may contact a Benefits Team representative if you have any questions.

of providers—which helps you to better manage your costs. Aetna’s network is particularly strong in Fredericksburg, Richmond and Northern Virginia.

MediCorp Health System services are available at the following facilities:

Outreach Patient Service Centers (Lab Draw Centers)

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This year’s plan includes several changes— please review this guide in its entirety. If you have questions about any of the changes, please contact the Benefits Team at 540.741.2255 or askbenefits@medicorp.org.

Coverage Options You have a variety of options to choose from: Standard Enhanced Premier

Premium Waiver

•Y ou can opt-out of medical coverage and still select other benefits. •Y ou receive the same prescription drug benefits, no matter which medical option you enroll in. All medical options work the same way, cover the same services and include prescription drug coverage. They differ based on cost— the amount of your payroll premium, deductible, co-pay or coinsurance and out-of-pocket maximum. Under all options, you may see any provider—a MediCorp Health System facility (when available), an Aetna provider or an out-ofnetwork provider. No referrals are necessary. On pages 8 and 9 is a chart comparing the out-of-pocket cost of the plan options.

MediCorp Health System Benefits Guide

Breast Reconstruction Following Mastectomy If you have a mastectomy, all MediCorp medical plans provide the following benefits: •R econstruction of the breast on which the mastectomy has been performed. •S urgery and reconstruction of the other breast to produce symmetrical appearance. •P rosthesis and treatment of physical complications of all stages of mastectomy including lymphedemas. To save money, you should consider using MediCorp Health System facilities whenever possible. MediCorp exists to improve the health status of all people within our community. The well-being of MediCorp Associates is of the utmost importance and MediCorp’s benefits package reflects that commitment. Where you go for medical care is entirely your choice; however, consider using MediCorp facilities for two very important reasons. First, your out-of-pocket expenses are reduced for many services (please review the plan details). If you use a non-MediCorpowned facility you will pay a co-pay and coinsurance for the following: • outpatient lab and x-ray • physical, speech and occupational therapy • inpatient services • outpatient surgery services The second, and more important, reason is continuity of care.

MediCorp Medical Center 2216 Princess Anne Street, Suite 100 Fredericksburg, VA 22401 Monday – Friday, 7:00 a.m – 5:30 p.m. Saturday, 7:00 a.m – 3:30 p.m. Tompkins-Martin Medical Plaza 1101 Sam Perry Boulevard, Suite 101 Fredericksburg, VA 22401 Monday – Friday, 7:00 a.m – 5:30 p.m. Professional Plaza at Lee’s Hill 10401 Spotsylvania Avenue, Suite 102 Fredericksburg, VA 22407 Monday – Friday, 8:00 a.m – 4:30 p.m. Massaponax Medical Park 9530 Cosner Drive, Suite 102 Fredericksburg, VA 22408 Monday – Friday, 8:00 a.m – 4:30 p.m. NextCare at Harrison Crossing 5825 Plank Road, Suite 105 Fredericksburg, VA 22407 Monday – Friday, 8:00 a.m – 4:30 p.m. For further information please call 540.741.3415, option #1 *Coming in 2009; Stafford Hospital Patient Service Center*

Health Services MediCorp Health System has partnered with NextCare Urgent Care, a national provider of urgent care, to build three new urgent care centers in the region. The first center opened in June 2008 at Harrison’s Crossing on Plank Road in Spotsylvania County. Opening in late 2008 will be a center in South Stafford. And opening in 2009 will be a center on Route 17 North in Stafford County. These centers offer walk-in medical care with qualified, board-certified physicians who are available during extended hours, 365 days a year.

MEDICAL PLAN

• Mary Washington Hospital (inpatient, outpatient, lab, radiology, emergency services, PT, OT and speech) • Fredericksburg Ambulatory Surgery Center • Medical Imaging of Fredericksburg, Medical Imaging at Lee’s Hill and Imaging Center for Women • MWH Home Health • Cancer Center of Virginia • MWH Hospice • Snowden at Fredericksburg

Please note: timed studies need to be scheduled; call 540.741.3415 for assistance. All other procedures are performed on a walk-in basis. All Patient Service Centers and Outreach Laboratory services are closed on major holidays: New Year’s Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas Day.

Patient-friendly services make walk-in care even more accessible with online registration and check-in before arrival, and a toll-free number to call to find out about waiting times. Physicians at NextCare can treat any non-life-threatening illness or injury that needs immediate attention. Services include: • General medical care • X-rays, lab work and various vaccinations • School and sports physicals • Medical discount programs • Occupational medicine To find out more please visit www.outpatient.medicorp.org or www.nextcare.com/healthlink. Aetna Navigator™—Aetna has online tools to assist you in obtaining information, managing your claims and locating participating providers. Log on to Aetna Navigator at www.aetna.com to: • Review claims payments and history • Find a provider • Take advantage of health education and services

USING AETNA NETWORK PROVIDERS To find out if your doctor is in the Aetna network, you can: • Check Aetna’s online provider directory at www.aetna.com [Plan Type: Aetna Choice™ POS II (Open Access)]. • Contact Aetna by phone at 800.291.2953. • Call your doctor directly. Please review each of your options carefully when you enroll to ensure that you select the right option for you and your family. On the following pages you will find a chart comparing the four options.

MediCorp Health System Benefits Guide

of providers—which helps you to better manage your costs. Aetna’s network is particularly strong in Fredericksburg, Richmond and Northern Virginia.

MediCorp Health System services are available at the following facilities:

Outreach Patient Service Centers (Lab Draw Centers)

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STOP

Coverage Options You have a variety of options to choose from: Standard Enhanced Premier

Premium Waiver

MediCorp Health System Benefits Guide

MEDICAL PLAN

MediCorp Health System Benefits Guide

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Benefit Summary: What’s Covered The following table shows how benefits are paid under the MediCorp medical options. For coinsurance amounts, the percentage shown is the amount you pay. Carefully review the plan for changes in co-pay and coinsurance amounts.

STANDARD OPTION BENEFIT SUMMARY Calendar Year Deductible

for w Ne 009

MEDICORP FACILITY

AETNA PROVIDER

$2,500/$3,000

PREMIER OPTION

AETNA PROVIDER

MEDICORP FACILITY

$300 Individual/$600 Family

Out-of-Pocket Maximum (Individual/Family)

ENHANCED OPTION

MEDICORP FACILITY

$200 Individual/$400 Family $5,000/$6,000

$2,000/$2,500

AETNA PROVIDER

$100 Individual/$200 Family $4,000/$5,000

$1,000/$1,500

$2,000/$3,000

$2,000,000

Well-Baby Care

$30 Co-pay

$25 Co-pay

$15 Co-pay

Well-Adult Care at PCP

$30 Co-pay

$25 Co-pay

$15 Co-pay

Annual Gynecological Visit

$50 Co-pay

$40 Co-pay

$30 Co-pay

Covered @ 100%

PCP Office Visits

$30 Co-pay

$25 Co-pay

$15 Co-pay

Specialist Office Visits

$50 Co-pay

$40 Co-pay

$30 Co-pay

Urgent Care Center

$35 Co-pay

Lifetime Maximum Benefit

PREVENTATIVE CARE

Routine Wellness Screenings (Mammogram, PAP, PSA, Colonoscopy)

PHYSICIAN SERVICES

$50 Co-pay

Chiropractic Care (20-visit maximum)

$40 Co-pay

$30 Co-pay

$75 Co-pay

$25 Co-pay

$60 Co-pay

$15 Co-pay

$45 Co-pay

Inpatient

25% Coinsurance

$350 Co-pay plus 25% Coinsurance

20% Coinsurance

$350 Co-pay plus 20% Coinsurance

15% Coinsurance

$350 Co-pay plus 15% Coinsurance

Outpatient Surgery

25% Coinsurance

$75 Co-pay plus 25% Coinsurance

20% Coinsurance

$75 Co-pay plus 20% Coinsurance

15% Coinsurance

$75 Co-pay plus 15% Coinsurance

Physical, Speech and Occupational Therapy (Combined total of 60 visits per year)

HOSPITAL SERVICES

Emergency Room (Co-pay waived if admitted) Outpatient X-ray & Lab (X-rays, MRI, PET Scan, CAT Scan)

$100 Co-pay plus 25% Coinsurance

$85 Co-pay plus 20% Coinsurance

$75 Co-pay plus 15% Coinsurance

25% Co-insurance

$25 Co-pay plus 25% Coinsurance

20% Coinsurance

$25 Co-pay plus 20% Coinsurance

15% Coinsurance

$25 Co-pay plus 15% Coinsurance

25% Coinsurance

$350 Co-pay plus 25% Coinsurance

20% Coinsurance

$350 Co-pay plus 20% Coinsurance

15% Coinsurance

$350 Co-pay plus 15% Coinsurance

MENTAL HEALTH/SUBSTANCE ABUSE Inpatient* (30-day limit per plan year) Outpatient (First 30 visits of year)

$30 Co-pay

$25 Co-pay

$15 Co-pay

Outpatient (More than 30 visits per year)

$50 Co-pay

$40 Co-pay

$30 Co-pay

Partial Day Treatment (15-day limit per plan year)

$30 Co-pay

$25 Co-pay

$15 Co-pay

Home Health Care (90-visit maximum per plan year)

25% Coinsurance

20% Coinsurance

15% Coinsurance

Skilled Nursing Facility (100-day limit per plan year)

25% Coinsurance

20% Coinsurance

15% Coinsurance

Durable Medical Equipment (Must be reviewed for medical necessity if over $500)

25% Coinsurance

20% Coinsurance

15% Coinsurance

* Biological-based mental health illnesses, such as bipolar disorder, depression, obsessive-compulsive disorder, panic disorder, paranoia, pervasive development disorder or autism, and schizophrenia, will be treated as any other medical diagnosis. Non-biological-based mental health illnesses will be treated as described in this section.

OTHER

Allergy Care

Infertility Treatment (Testing and diagnosis only; treatment not covered)

$30 Co-pay for testing;

$25 Co-pay for testing;

$15 Co-pay for testing;

Injections covered @ 100% (if no office visit charged);

Serum covered @ 100%

$50 office visit Co-pay; 25% Coinsurance for tests

$50 office visit Co-pay; 20% Coinsurance for tests

$50 office visit Co-pay; 15% Coinsurance for tests

$1,500/$3,000 Deductible; $3,000/$6,000 Out-of-Pocket Maximum; 25% Coinsurance; Deductible and Out-of-Pocket

$1,500/$3,000 Deductible; $3,000/$6,000 Out-of-Pocket Maximum; 20% Coinsurance; Deductible and Out-of-Pocket

$1,500/$3,000 Deductible; $3,000/$6,000 Out-of-Pocket Maximum; 15% Coinsurance; Deductible and Out-of-Pocket

OUT-OF-NETWORK Care received from providers that are neither an MHS provider nor a participating provider in Aetna’s network (individual/family) is in addition to above deductible and out-of-pocket.

For benefits summary of Premium Waiver Plan and family income eligibility requirements, please see page 11. Live Well program - New Plan Coming in 2009 8

MediCorp Health System Benefits Guide

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STANDARD OPTION BENEFIT SUMMARY Calendar Year Deductible

for w Ne 009

MEDICORP FACILITY

AETNA PROVIDER

$2,500/$3,000

PREMIER OPTION

AETNA PROVIDER

MEDICORP FACILITY

$300 Individual/$600 Family

Out-of-Pocket Maximum (Individual/Family)

ENHANCED OPTION

MEDICORP FACILITY

$200 Individual/$400 Family $5,000/$6,000

$2,000/$2,500

AETNA PROVIDER

$100 Individual/$200 Family $4,000/$5,000

$1,000/$1,500

$2,000/$3,000

$2,000,000

Well-Baby Care

$30 Co-pay

$25 Co-pay

$15 Co-pay

Well-Adult Care at PCP

$30 Co-pay

$25 Co-pay

$15 Co-pay

Annual Gynecological Visit

$50 Co-pay

$40 Co-pay

$30 Co-pay

Covered @ 100%

PCP Office Visits

$30 Co-pay

$25 Co-pay

$15 Co-pay

Specialist Office Visits

$50 Co-pay

$40 Co-pay

$30 Co-pay

Urgent Care Center

$35 Co-pay

Lifetime Maximum Benefit

PREVENTATIVE CARE

Routine Wellness Screenings (Mammogram, PAP, PSA, Colonoscopy)

PHYSICIAN SERVICES

$50 Co-pay

Chiropractic Care (20-visit maximum)

$40 Co-pay

$30 Co-pay

$75 Co-pay

$25 Co-pay

$60 Co-pay

$15 Co-pay

$45 Co-pay

Inpatient

25% Coinsurance

$350 Co-pay plus 25% Coinsurance

20% Coinsurance

$350 Co-pay plus 20% Coinsurance

15% Coinsurance

$350 Co-pay plus 15% Coinsurance

Outpatient Surgery

25% Coinsurance

$75 Co-pay plus 25% Coinsurance

20% Coinsurance

$75 Co-pay plus 20% Coinsurance

15% Coinsurance

$75 Co-pay plus 15% Coinsurance

Physical, Speech and Occupational Therapy (Combined total of 60 visits per year)

HOSPITAL SERVICES

Emergency Room (Co-pay waived if admitted) Outpatient X-ray & Lab (X-rays, MRI, PET Scan, CAT Scan)

$100 Co-pay plus 25% Coinsurance

$85 Co-pay plus 20% Coinsurance

$75 Co-pay plus 15% Coinsurance

25% Co-insurance

$25 Co-pay plus 25% Coinsurance

20% Coinsurance

$25 Co-pay plus 20% Coinsurance

15% Coinsurance

$25 Co-pay plus 15% Coinsurance

25% Coinsurance

$350 Co-pay plus 25% Coinsurance

20% Coinsurance

$350 Co-pay plus 20% Coinsurance

15% Coinsurance

$350 Co-pay plus 15% Coinsurance

MENTAL HEALTH/SUBSTANCE ABUSE Inpatient* (30-day limit per plan year) Outpatient (First 30 visits of year)

$30 Co-pay

$25 Co-pay

$15 Co-pay

Outpatient (More than 30 visits per year)

$50 Co-pay

$40 Co-pay

$30 Co-pay

Partial Day Treatment (15-day limit per plan year)

$30 Co-pay

$25 Co-pay

$15 Co-pay

Home Health Care (90-visit maximum per plan year)

25% Coinsurance

20% Coinsurance

15% Coinsurance

Skilled Nursing Facility (100-day limit per plan year)

25% Coinsurance

20% Coinsurance

15% Coinsurance

Durable Medical Equipment (Must be reviewed for medical necessity if over $500)

25% Coinsurance

20% Coinsurance

15% Coinsurance

OTHER

Allergy Care

Infertility Treatment (Testing and diagnosis only; treatment not covered)

$30 Co-pay for testing;

$25 Co-pay for testing;

$15 Co-pay for testing;

Injections covered @ 100% (if no office visit charged);

Serum covered @ 100%

$50 office visit Co-pay; 25% Coinsurance for tests

$50 office visit Co-pay; 20% Coinsurance for tests

$50 office visit Co-pay; 15% Coinsurance for tests

$1,500/$3,000 Deductible; $3,000/$6,000 Out-of-Pocket Maximum; 25% Coinsurance; Deductible and Out-of-Pocket

$1,500/$3,000 Deductible; $3,000/$6,000 Out-of-Pocket Maximum; 20% Coinsurance; Deductible and Out-of-Pocket

$1,500/$3,000 Deductible; $3,000/$6,000 Out-of-Pocket Maximum; 15% Coinsurance; Deductible and Out-of-Pocket

For benefits summary of Premium Waiver Plan and family income eligibility requirements, please see page 11. Live Well program - New Plan Coming in 2009 8

MediCorp Health System Benefits Guide

PRESCRIPTION DRUG BENEFIT

LIVE WELL PROGRAM

When you enroll in a medical option, you and your covered dependents will receive prescription drug benefits. (You cannot choose prescription coverage by itself.) Our prescription drug benefits are self-funded and administered through Aetna.

Live Well is a personalized, interactive wellness program that helps you take the right steps toward improving your health and your life. No one at MediCorp will have access to any personal health data you share while participating in the Live Well program. The Live Well program has several key components:

How the Formulary Drug Tiers Work A formulary is a list of drugs approved by the plan. Your plan offers three levels of benefits, depending on the drug prescribed. • Tier 1 drugs – typically common generic drugs in Aetna’s formulary. They contain the same active ingredients as brandname equivalents, and are usually as effective. Your cost will be lowest with a prescription for a generic drug. •T ier 2 drugs – can be either generic or brand-name drugs in Aetna’s formulary. They are generally higher-cost drugs than those in Tier 1; therefore they have a higher co-pay. •T ier 3 drugs – are brand-name drugs not in Tier 1 and Tier 2. These are generally new drugs. Because these drugs are not found in Aetna’s formulary, they can be the most expensive.

PRESCRIPTION DRUG BENEFITS SUMMARY Standard, Enhanced and Premier Options Formulary Drugs—Tier 1 Typically

Aetna Provider

Medical Arts

$15 Co-pay

$10 Co-pay

Generic (30-day supply) Formulary Drugs—Tier 2 Typically

$25 Co-pay

$20 Co-pay

$50 Co-pay

$35 Co-pay

Generic and Brand-Name (30-day supply) Formulary Drugs—Tier 3 Typically BrandName (30-day supply) cut

Mail-Order Pharmacy (90-day supply)

Tier 1: $20 Co-pay Tier 2: $40 Co-pay Tier 3: $70 Co-pay

Online Personal Health Assessment (PHA) Questionnaire and Health Screening Health habits, lifestyle and your makeup may be putting your health at risk. The PHA evaluates potential risks and offers you information on how to manage them. The questionnaire covers your health, lifestyle, story, physical activity, nutrition, stress and coping skills. It also asks you to input your height, weight, body mass index (BMI), cholesterol (total/HDL), glucose, blood pressure and tobacco use. You can learn these values during your new-hire physical.

not be able to afford health care coverage.

BENEFIT SUMMARY

MEDICORP FACILITY

Calendar Year Deductible Out-of-Pocket Maximum (Individual/Family)

AETNA PROVIDER None

$2,500/$3,000

Lifetime Maximum Benefit

$5,000/$6,000 $2,000,000

PREVENTATIVE CARE Well-Baby Care

$30 Co-pay

Well-Adult Care at PCP

$30 Co-pay

Annual Gynecological Visit

$50 Co-pay

Routine Wellness Screenings (Mammogram, PAP, PSA, Colonoscopy)

Covered @ 100%

PHYSICIAN SERVICES $30 Co-pay $50 Co-pay

• A personalized wellness report generated online, showing health issues you can change.

Urgent Care Center

$35 Co-pay

• Online lessons to help you better understand your health risks and how to manage them. • Access to a range of local and community support programs and resources. • Health coaching.

Physical, Speech and Occupational Therapy (Combined total of 60 visits per year)

PREMIUM WAIVER Full-time Associates and their eligible dependents may enroll in the Premium Waiver Medical and/or dental plans without paying premiums if their total family income for the last available federal income tax reporting period does not exceed the Family Income Guidelines below. To apply, simply complete a Premium Waiver Form available from the Benefits Section of Human Resources. MediCorp will pay your medical and dental premiums if you meet all of the following: • Your income does not exceed the family income requirements.

For prescriptions of up to a 30-day supply, fill your prescription at the MediCorp Medical Arts Pharmacy (for the lowest cost) or at an Aetna-participating pharmacy. For a list of Aetna-participating retail pharmacies, visit www.aetna.com or call 800.962.6842.

• You are a full-time Associate. Eligibility for the Premium Waiver Plan must be met by October 1 prior to the plan year for which coverage is effective. However, new Associates must meet eligibility requirements for the Premium Waiver Plan on their hire date.

FAMILY INCOME GUIDELINES Family Size

Amount of Income

Family Size

Amount of Income

$20,800

$49,600

$28,000

$56,800

$35,200

$64,000

$42,400

$71,200

To get the most cost savings from your prescription drug plan: • Ask your doctor if you can take a generic medication. • Fill prescriptions of 30 days or less at the MediCorp Medical Arts Pharmacy or at a participating Aetna pharmacy. • Use the mail-order service for maintenance and long-term medications (for a 90-day supply).

our Associates and their eligible family members receive quality, affordable health care. The plan was designed to provide assistance to Associates who may

Specialist Office Visits

Retail Versus Mail-Order

If you have a prescription for a maintenance medication—one you use on a regular basis—use mail order for added savings and convenience. You will pay two co-pays and receive a 90-day supply.

MediCorp believes that it is important to offer all Associates the chance to have health care coverage. The purpose of the Premium Waiver Plan is to ensure

PCP Office Visits

The Live Well program offers you:

$50 Co-pay

Chiropractic Care (20-visit maximum) $30 Co-pay

$75 Co-pay

Inpatient

20% Coinsurance

$350 Co-pay plus 20% Coinsurance

Outpatient Surgery

20% Coinsurance

$75 Co-pay plus 20% Coinsurance

HOSPITAL SERVICES

$100 Co-pay plus 20% Coinsurance

Emergency Room (Co-pay waived if admitted) Outpatient X-ray & Lab (X-rays, MRI, PET Scan, CAT Scan)

20% Coinsurance

$25 Co-pay plus 20% Coinsurance

20% Coinsurance

$350 Co-pay plus 20% Coinsurance

MENTAL HEALTH/SUBSTANCE ABUSE Inpatient* (30-day limit per plan year) Outpatient (First 30 visits of year)

$30 Co-pay

Outpatient (More than 30 visits per year)

$50 Co-pay

Partial Day Treatment (15-day limit per plan year)

$30 Co-pay

OTHER Home Health Care (90-visit maximum per plan year)

20% Coinsurance

Skilled Nursing Facility (100-day limit per plan year)

20% Coinsurance

Durable Medical Equipment (Must be reviewed for medical necessity if over $500)

20% Coinsurance

Allergy Care

$30 Co-pay for testing; Injections covered @ 100% (if no office visit charged); Serum covered @ 100%

Infertility Treatment (Testing and diagnosis only; treatment not covered)

$50 office visit Co-pay; 0% Coinsurance for tests

$1,500/$3,000 Deductible; $3,000/$6,000 Out-of-Pocket Maximum; 30% Coinsurance; Deductible and Out-of-Pocket

MediCorp Health System Benefits Guide 10

MediCorp Health System Benefits Guide

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PREMIUM WAIVER PLAN

PRESCRIPTION DRUG BENEFIT

LIVE WELL PROGRAM

PRESCRIPTION DRUG BENEFITS SUMMARY Standard, Enhanced and Premier Options Formulary Drugs—Tier 1 Typically

Aetna Provider

Medical Arts

$15 Co-pay

$10 Co-pay

Generic (30-day supply) Formulary Drugs—Tier 2 Typically

$25 Co-pay

$20 Co-pay

$50 Co-pay

$35 Co-pay

Generic and Brand-Name (30-day supply) Formulary Drugs—Tier 3 Typically BrandName (30-day supply) cut

Mail-Order Pharmacy (90-day supply)

Tier 1: $20 Co-pay Tier 2: $40 Co-pay Tier 3: $70 Co-pay

not be able to afford health care coverage.

BENEFIT SUMMARY

MEDICORP FACILITY

Calendar Year Deductible Out-of-Pocket Maximum (Individual/Family)

AETNA PROVIDER None

$2,500/$3,000

Lifetime Maximum Benefit

$5,000/$6,000 $2,000,000

PREVENTATIVE CARE Well-Baby Care

$30 Co-pay

Well-Adult Care at PCP

$30 Co-pay

Annual Gynecological Visit

$50 Co-pay

Routine Wellness Screenings (Mammogram, PAP, PSA, Colonoscopy)

Covered @ 100%

PHYSICIAN SERVICES $30 Co-pay $50 Co-pay

• A personalized wellness report generated online, showing health issues you can change.

Urgent Care Center

$35 Co-pay

• Online lessons to help you better understand your health risks and how to manage them. • Access to a range of local and community support programs and resources. • Health coaching.

Physical, Speech and Occupational Therapy (Combined total of 60 visits per year)

FAMILY INCOME GUIDELINES Family Size

Amount of Income

Family Size

Amount of Income

$20,800

$49,600

$28,000

$56,800

$35,200

$64,000

$42,400

$71,200

our Associates and their eligible family members receive quality, affordable health care. The plan was designed to provide assistance to Associates who may

Specialist Office Visits

Retail Versus Mail-Order

If you have a prescription for a maintenance medication—one you use on a regular basis—use mail order for added savings and convenience. You will pay two co-pays and receive a 90-day supply.

MediCorp believes that it is important to offer all Associates the chance to have health care coverage. The purpose of the Premium Waiver Plan is to ensure

PCP Office Visits

The Live Well program offers you:

$50 Co-pay

Chiropractic Care (20-visit maximum) $30 Co-pay

$75 Co-pay

Inpatient

20% Coinsurance

$350 Co-pay plus 20% Coinsurance

Outpatient Surgery

20% Coinsurance

$75 Co-pay plus 20% Coinsurance

HOSPITAL SERVICES

$100 Co-pay plus 20% Coinsurance

Emergency Room (Co-pay waived if admitted) Outpatient X-ray & Lab (X-rays, MRI, PET Scan, CAT Scan)

20% Coinsurance

$25 Co-pay plus 20% Coinsurance

20% Coinsurance

$350 Co-pay plus 20% Coinsurance

MENTAL HEALTH/SUBSTANCE ABUSE Inpatient* (30-day limit per plan year) Outpatient (First 30 visits of year)

$30 Co-pay

Outpatient (More than 30 visits per year)

$50 Co-pay

Partial Day Treatment (15-day limit per plan year)

$30 Co-pay

OTHER Home Health Care (90-visit maximum per plan year)

20% Coinsurance

Skilled Nursing Facility (100-day limit per plan year)

20% Coinsurance

Durable Medical Equipment (Must be reviewed for medical necessity if over $500)

20% Coinsurance

Allergy Care

$30 Co-pay for testing; Injections covered @ 100% (if no office visit charged); Serum covered @ 100%

Infertility Treatment (Testing and diagnosis only; treatment not covered)

$50 office visit Co-pay; 0% Coinsurance for tests

$1,500/$3,000 Deductible; $3,000/$6,000 Out-of-Pocket Maximum; 30% Coinsurance; Deductible and Out-of-Pocket

MediCorp Health System Benefits Guide 10

MediCorp Health System Benefits Guide

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PREMIUM WAIVER PLAN

DENTAL BENEFITS SUMMARY PREVENTATIVE/DIAGNOSTIC

STANDARD OPTION

ENHANCED OPTION

80%

100%

80%

50%

80%

Not covered

80%

Not covered

No age restriction – any covered member eligible

Oral exams, prophylaxis/cleaning, fluoride treatments, space maintainers, palliative care, x-rays (full mouth, panorex, bitewings), sealants

BASIC CARE Fillings, endodontics/root canals, general anesthesia, simple extractions, surgical extractions/oral surgery; consultations

PERIODONTICS

DENTAL PLAN

MAJOR RESTORATIVE & PROSTHODONTICS Dentures, bridges, harmful-habit appliance, implants, inlays/onlays,

MediCorp’s dental plan is self-funded and administered by Delta Dental. When you use a Delta Dental Premier ® network dentist you pay less and you don’t have to file a claim form.

crowns, crown buildups, recommendations and repairs, rebases/relines

ORTHODONTICS Orthodontic diagnostics, orthodontic treatment, orthodontic installation

To find a Delta Dental dentist you may call Delta Dental at

and adjustments

800.237.6060 or go to www.deltadentalva.com.

Plan Deductible

$50

$1,000

$1,500

Periodontal Lifetime Maximum

$1,500

Orthodontic Lifetime Maximum

Not covered

$1,500

Plan Year Maximum Coverage

You have two dental options to choose from: • Standard option coverage costs less but has a lower level of benefits. Some services (including orthodontia) are not covered by the plan. (See the comparison chart below.) • Enhanced option coverage costs a bit more but more services are covered by the plan. There is no age restriction on orthodontic coverage—so both children and adults can take advantage of it.

Predetermination Recommended – For any service over $200 we strongly recommend that you ask Delta Dental for a predetermination. This will help you to understand your potential cost before you undergo any treatment.

MAXOVER New this year! This year an added feature to the plan is Delta Dental’s MaxOver. MaxOver is an added feature to the plan’s Annual Benefit Maximum designed to assist Associates who do not use all of their Annual Benefit Maximum during the plan year.

What is MaxOver? The new MaxOver benefit rewards members who receive preventive care services by allowing them to rollover a portion of their annual maximum for use in future years. Generally, members are eligible for MaxOver if they meet the following criteria: • Members must have at least one preventive exam and cleaning during their benefit period. • Claims paid during the benefit period must be less than the MaxOver claims threshold. • Waiting periods on Major Services (if applicable) have been met.

In this example, an Associate can submit claims up to $750, including a minimum of one required claim for a preventive exam and cleaning. If the Associate does not exceed $750 in claims during the plan year, they will receive $375 in additional Annual Benefit Maximum in the next plan year or $1,875. The Associate can continue to add $375 in future benefit periods,

DENTAL

cut

Enhanced Option may be elected at Open Enrollment with no restrictions

Movement Between Options

up to a maximum carryover of an addtional $1,500. MaxOver benefits are determined three months after the end of the plan year. Members who qualify for a deposit into their MaxOver Account will receive a report showing details. MaxOver annual rollover amounts are based on a percentage of the annual benefit maximum. The total MaxOver account limit can never exceed the annual benefit maximum. The following chart represents the Annual Benefit Maximums and related MaxOver amounts:

Once met, the appropriate MaxOver amount will be carried forward for use at a future date. Orthodontia services are excluded from the MaxOver program.

How does MaxOver work? Here’s an example of how the new MaxOver will work: Plan’s Annual Benefit Maximum $1,500

Annual Benefit Maximum

Annual MaxOver Amount

Claims Threshold

MaxOver Account Limit

$1,000

$250

$500

$1,000

$1,500

$375

$750

$1,500

Claim Threshold $750 Annual MaxOver Amount $375 MaxOver Account Limit $1,500

MediCorp Health System Benefits Guide

DENTAL BENEFITS SUMMARY PREVENTATIVE/DIAGNOSTIC

STANDARD OPTION

ENHANCED OPTION

80%

100%

80%

50%

80%

Not covered

80%

Not covered

No age restriction – any covered member eligible

Oral exams, prophylaxis/cleaning, fluoride treatments, space maintainers, palliative care, x-rays (full mouth, panorex, bitewings), sealants

BASIC CARE Fillings, endodontics/root canals, general anesthesia, simple extractions, surgical extractions/oral surgery; consultations

PERIODONTICS

DENTAL PLAN

MAJOR RESTORATIVE & PROSTHODONTICS Dentures, bridges, harmful-habit appliance, implants, inlays/onlays,

MediCorp’s dental plan is self-funded and administered by Delta Dental. When you use a Delta Dental Premier ® network dentist you pay less and you don’t have to file a claim form.

crowns, crown buildups, recommendations and repairs, rebases/relines

ORTHODONTICS Orthodontic diagnostics, orthodontic treatment, orthodontic installation

To find a Delta Dental dentist you may call Delta Dental at

and adjustments

800.237.6060 or go to www.deltadentalva.com.

Plan Deductible

$50

$1,000

$1,500

Periodontal Lifetime Maximum

$1,500

Orthodontic Lifetime Maximum

Not covered

$1,500

Plan Year Maximum Coverage

DENTAL

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Enhanced Option may be elected at Open Enrollment with no restrictions

Movement Between Options

Once met, the appropriate MaxOver amount will be carried forward for use at a future date. Orthodontia services are excluded from the MaxOver program.

How does MaxOver work? Here’s an example of how the new MaxOver will work: Plan’s Annual Benefit Maximum $1,500

Annual Benefit Maximum

Annual MaxOver Amount

Claims Threshold

MaxOver Account Limit

$1,000

$250

$500

$1,000

$1,500

$375

$750

$1,500

Claim Threshold $750 Annual MaxOver Amount $375 MaxOver Account Limit $1,500

MediCorp Health System Benefits Guide

What’s Covered The charts on this page illustrate how vision services are covered when your care is received from either a participating provider or a non-participating provider.

VISION BENEFITS SUMMARY

VISION PLAN Vision care benefits are provided through the Vision Service Plan, better known as VSP. With over 40 million members nationwide, one in eight people rely on VSP for their eye care

VSP PROVIDER

Exam

• Covered in full every 12 months.

Up to $35

Prescription Glasses*

• Lenses (single-vision, lined bifocal and lined trifocal) are covered

• Single-vision lenses

up to $25

• Lined bifocal lenses

up to $40

• Lined trifocal lenses

up to $55

• Frame

up to $45

in full every 12 months.

health coverage. MediCorp offers a Standard option and an

• Frame of your choice is covered up to $130, plus 20% off any out-

Enhanced option through VSP. You may see any licensed vision

of-pocket costs and $10 co-pay.

care provider and receive benefits. However, when you use a VSP-participating provider, you pay less, and you don’t have

NON-VSP PROVIDER REIMBURSEMENT AMOUNTS

Contact Lenses*

• When you choose contacts instead of glasses, your $120

claim forms to file. See the chart for additional details.

Up to $120

allowance applies to the cost of your contacts and the fitting and evaluation exam. • No co-pay applies. Second Pair of Prescription Glasses or Contact Lenses

Standard Option Discount only

Enhanced Option You obtain a second pair of glasses or contact lenses for a $10 co-pay, in addition to those received under the Standard option.

*You may choose either prescription glasses or contact lenses for reimbursement.

• You don’t receive an ID card for your vision care benefits—simply tell your provider that you are covered by VSP. • If your provider is part of the VSP network, your benefits will be higher and you won’t have to file a claim. • To find a VSP provider near you, visit www.vsp.com or call 800.877.7195.

VISION

MediCorp Health System Benefits Guide

What’s Covered The charts on this page illustrate how vision services are covered when your care is received from either a participating provider or a non-participating provider.

VISION BENEFITS SUMMARY

VISION PLAN Vision care benefits are provided through the Vision Service Plan, better known as VSP. With over 40 million members nationwide, one in eight people rely on VSP for their eye care

VSP PROVIDER

Exam

• Covered in full every 12 months.

Up to $35

Prescription Glasses*

• Lenses (single-vision, lined bifocal and lined trifocal) are covered

• Single-vision lenses

up to $25

• Lined bifocal lenses

up to $40

• Lined trifocal lenses

up to $55

• Frame

up to $45

in full every 12 months.

health coverage. MediCorp offers a Standard option and an

• Frame of your choice is covered up to $130, plus 20% off any out-

Enhanced option through VSP. You may see any licensed vision

of-pocket costs and $10 co-pay.

care provider and receive benefits. However, when you use a VSP-participating provider, you pay less, and you don’t have

NON-VSP PROVIDER REIMBURSEMENT AMOUNTS

Contact Lenses*

• When you choose contacts instead of glasses, your $120

claim forms to file. See the chart for additional details.

Up to $120

allowance applies to the cost of your contacts and the fitting and evaluation exam. • No co-pay applies. Second Pair of Prescription Glasses or Contact Lenses

Standard Option Discount only

Enhanced Option You obtain a second pair of glasses or contact lenses for a $10 co-pay, in addition to those received under the Standard option.

*You may choose either prescription glasses or contact lenses for reimbursement.

VISION

MediCorp Health System Benefits Guide

Health Care Flexible Spending Account

Did you know that the typical employee saves 35% on eligible expenses through the FSA plan? Flexible spending accounts are like getting a discount on certain health and dependent care expenses— not because the expenses are less but because you are paying them with money that has not been subject to tax. Depending on your tax bracket and where you live, that can mean savings of 20% to 50% that will show up in your disposable income.

Covers eligible health care expenses not reimbursed by your medical, dental and vision plan for you, your spouse and anyone you claim on your federal tax return.

To give you an idea of just how much you can save in taxes by using a flexible spending account, consider this example:

MediCorp offers two Flexible Spending Accounts (FSAs): a health care FSA and a dependent care FSA. These accounts are administered by Aetna, and they allow you to set aside money pre-tax (before federal income and Social Security taxes are deducted) to pay for certain health and dependent care expenses. This is a great way to save for health care or dependent care expenses on a pre-tax basis.

An Associate’s annual taxable income is $30,000. She typically incurs $2,000 in health care expenses each year. Instead of taking that $2,000 in expenses out of her pocket, she puts it into a flexible spending account (FSA) and uses the FSA to pay her health care expenses. This allows her to reduce her taxable income by $2,000, to $28,000. Normally, this Associate would pay $7,500 (25%) in taxes on her $30,000 salary. By using an FSA and lowering her taxable income to $28,000, she pays only $7,000 in taxes—that’s $500 in savings!

FEATURES OF THE MEDICORP FSA PLAN ADMINISTERED BY AETNA: No Claim Forms to File Streamline—Aetna makes it easy to access money in your spending account without ever filing a claim. When you visit an Aetna physician, you pay your co-pay up-front, and then the co-pay amount is automatically deducted from your FSA and mailed to your home or deposited directly into your checking or savings account.

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Use Aetna’s FSA Savings Calculator to estimate your annual tax savings based on your annual income and qualified expenses: http://www.aetnafsa.com/fsa/index.php.

FLEXIBLE SPENDING ACCOUNTS

Tax-Free Savings

AutoDebit—When you use an Aetna-participating pharmacy, your prescription drug co-pay is paid directly to the pharmacy—you don’t pay your co-pay up-front. Direct Deposit—Don’t wait for your reimbursement checks to be mailed to you and waste time driving to the bank. You can request that all your health care and/or dependent care reimbursements be deposited directly into your checking or savings account. When you enroll in a medical FSA you will be automatically enrolled in the Streamline and AutoDebit features. To cut off these features you will need to contact Aetna at 877.392.3862 or access Aetna’s Web site.

Should you enroll in a Flexible Spending Account? You should consider enrolling in one or both of the FSA accounts if you: • Pay deductibles, co-pays or coinsurance (including prescriptions) as part of your health plan. • Purchase over-the-counter medications. • Buy prescription glasses, contact lenses or saline solution, or plan for LASIK® vision correction. • Expect dental and orthodontia expenses to exceed your dental plan. • Pay a day care center to care for your dependent children or elderly parents. The items described above are some of the many expenses that are eligible for reimbursement through an FSA.

MediCorp Health System Benefits Guide

Health Care Flexible Spending Account

Covers eligible health care expenses not reimbursed by your medical, dental and vision plan for you, your spouse and anyone you claim on your federal tax return.

To give you an idea of just how much you can save in taxes by using a flexible spending account, consider this example:

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Use Aetna’s FSA Savings Calculator to estimate your annual tax savings based on your annual income and qualified expenses: http://www.aetnafsa.com/fsa/index.php.

FLEXIBLE SPENDING ACCOUNTS

Tax-Free Savings

MediCorp Health System Benefits Guide

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Estimate Your Expenses Not sure whether to participate? Consider this. The following list describes many expenses that are eligible for reimbursement through an FSA. The most up-to-date and comprehensive list of eligible expenses can be found on the IRS Web site: http://www.irs.gov.

• Acupuncture

• Handicapped persons’ special schools

• Alcoholism treatment

• Hearing devices and batteries

(when under direct supervision

• Artificial teeth

•H ome improvements for medical

and with prescribed medication)

• Birth control pills

considerations

•S moking cessation programs

•S pecial plumbing for the

• Braces

• Hospital bills

• Chiropractors

• Hypnosis for treatment of an illness

• Sterilization fees

• Coinsurance amounts you pay

• Insulin

• Surgical fees

• Contact lenses and solution

• Laboratory fees

•T herapeutic care for drug and

• Cost of operations and related

• Learning disability

treatments • Crutches • Deductible amounts you pay • Dental fees

• L ife fee to retirement home for medical care •M edical charges if they are a part of college or private school tuition fees

handicapped

alcohol addiction • Therapy treatments • Transplants •T ransportation expenses primarily for rendering medical service

• Dentures

• Nursing home

• Weight loss programs

• Diagnostic fees

• Orthopedic shoes

• Wheelchairs

• Drug and medical supplies

• Over-the-counter medications

• X-rays

• Eyeglasses, including examination fees

• Oxygen

• Eye surgery, including laser correction

• Physicians’ fees

eye surgery • Fees for a practical nurse

Under the health care flexible spending account, your entire contribution is available January 1 (so you don’t have to put off necessary medical procedures). You may contribute up to $120 per pay period ($3,120 per year).

DEPENDENT CARE FLEXIBLE SPENDING ACCOUNT

More Time to Use It

Can be used to pay for:

The 2009 plan year for the health care flexible spending account is 15 months long. Therefore, you will have until March 15, 2010 to spend the contributions you make to your health care FSA in 2009.

• Services provided by babysitters or caregivers, including your relatives (as long as you do not claim them as exemptions on your federal tax return). • Expenses for a housekeeper whose services include care of an eligible dependent. • Services provided by a licensed elder care center, child care center or nursery school. • Social Security and other taxes you pay for a caregiver.

Use It or Lose It Remember: Be careful in your planning. According to IRS law, you will forfeit any money that is left in your account at the end of the FSA plan year. Be sure to plan accordingly.

• Psychiatric care • Psychologists’ fees

How do I know if my expenses qualify for reimbursement under the Health Care or Dependent Care FSA? You can link to Aetna’s FSA Web site for a listing of qualified expenses: Health Care: http://www.aetna.com/fsa/understanding/health/healthcareexpenses.html

For more details about qualifying health care expenses, see IRS publication 502, Medical and Dental Expenses at www.irs.gov/pub/irs-pdf/p502.pdf.

Dependent Care: http://www.aetna.com/fsa/understanding/dependent/dependentcareexpenses.html

Web Link to IRS Guidelines on FSA: http://www.irs.gov/publications/p502/index.html

MediCorp Health System Benefits Guide

Under the dependent care flexible spending account, you have access to your contributions only after they have been deducted from your pay.

Cannot be used to pay for the following: • Child support payments. • Food, clothing and entertainment. • Overnight camps. • Extracurricular activities. • Administrative fees and books. Any expenses paid through the dependent care flexible spending account reduce the amount available under the federal child care tax credit (see your tax adviser for details). The 2009 plan year for dependent care flexible spending accounts is 12 months long, ending on December 31. According to IRS law, you will forfeit any money left in your account at the end of the year.

MediCorp Health System Benefits Guide

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• Acupuncture

• Handicapped persons’ special schools

• Alcoholism treatment

• Hearing devices and batteries

(when under direct supervision

• Artificial teeth

•H ome improvements for medical

and with prescribed medication)

• Birth control pills

considerations

•S moking cessation programs

•S pecial plumbing for the

• Braces

• Hospital bills

• Chiropractors

• Hypnosis for treatment of an illness

• Sterilization fees

• Coinsurance amounts you pay

• Insulin

• Surgical fees

• Contact lenses and solution

• Laboratory fees

•T herapeutic care for drug and

• Cost of operations and related

• Learning disability

treatments • Crutches • Deductible amounts you pay • Dental fees

• L ife fee to retirement home for medical care •M edical charges if they are a part of college or private school tuition fees

handicapped

alcohol addiction • Therapy treatments • Transplants •T ransportation expenses primarily for rendering medical service

• Dentures

• Nursing home

• Weight loss programs

• Diagnostic fees

• Orthopedic shoes

• Wheelchairs

• Drug and medical supplies

• Over-the-counter medications

• X-rays

• Eyeglasses, including examination fees

• Oxygen

• Eye surgery, including laser correction

• Physicians’ fees

eye surgery • Fees for a practical nurse

DEPENDENT CARE FLEXIBLE SPENDING ACCOUNT

More Time to Use It

Can be used to pay for:

The 2009 plan year for the health care flexible spending account is 15 months long. Therefore, you will have until March 15, 2010 to spend the contributions you make to your health care FSA in 2009.

Use It or Lose It Remember: Be careful in your planning. According to IRS law, you will forfeit any money that is left in your account at the end of the FSA plan year. Be sure to plan accordingly.

• Psychiatric care • Psychologists’ fees

For more details about qualifying health care expenses, see IRS publication 502, Medical and Dental Expenses at www.irs.gov/pub/irs-pdf/p502.pdf.

Dependent Care: http://www.aetna.com/fsa/understanding/dependent/dependentcareexpenses.html

Web Link to IRS Guidelines on FSA: http://www.irs.gov/publications/p502/index.html

MediCorp Health System Benefits Guide

Under the dependent care flexible spending account, you have access to your contributions only after they have been deducted from your pay.

MediCorp Health System Benefits Guide

LIFE INSURANCE AND AD&D COVERAGE The chart below summarizes your life insurance and AD&D options. Basic Term Life Insurance –

• Full-time Associates receive one and one-half times their annual salary (up to a maximum) in term life insurance.

MediCorp pays the cost for

• Part-time Associates receive a flat $5,000 in coverage.

this coverage

• You are automatically enrolled in this coverage and MediCorp pays the premium for you. There are mandatory reductions in life insurance coverage depending on age. The amount of basic and supplemental insurance on an Associate age 70 or older shall be a percentage of the amount otherwise provided by the plan of insurance applicable to the Associate according to the following table:

LIFE INSURANCE & DISABILITY COVERAGE

AGE OF PARTICIPANT

AMOUNT OF INSURANCE (as a percentage of coverage amount prior to attaining age 70)

70–74

65%

75 and older

50%

Accidental Death and

• Full-time Associates may purchase up to $1,000,000 of coverage in $50,000 increments.

basic term life insurance and long-term disability coverage.

Dismemberment Insurance

• Part-time Associates may purchase up to $250,000 of coverage in $50,000 increments.

(AD&D)

• You must enroll online for this coverage using the SEA. Associates are not eligible for this coverage

MediCorp pays the entire cost of this coverage for you. If you

after reaching age 70.

would like additional coverage, you may purchase accidental death and dismemberment (AD&D) insurance, supplemental

LIFE & DISABILITY

MediCorp automatically provides eligible Associates with

Supplemental Life Insurance

• Full-time Associates may purchase up to five times their annual salary in supplemental life insurance. • Part-time Associates may purchase up to $45,000 of coverage in increments of $5,000.

life insurance, spouse and/or child term life insurance or

• Premiums are based on age and amount of coverage purchased.

short-term disability coverage (if eligible).

• You must complete and submit to Human Resources a paper enrollment form. • Coverage amounts may be subject to evidence of insurability (EOI).

Spouse Term Life Insurance*

AGE OF PARTICIPANT

AMOUNT OF INSURANCE (as a percentage of coverage amount prior to attaining age 70)

70–74

65%

75 and older

50%

For your spouse: • You may purchase any amount of life insurance between $5,000 and $100,000 up to a maximum of 100% of your own life insurance coverage or $100,000, whichever is less.

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• Spouse coverage is subject to evidence of insurability (EOI). AGE OF PARTICIPANT

AMOUNT OF INSURANCE (as a percentage of coverage amount prior to attaining age 70)

70–74

65%

75 and older

50%

*If your spouse is employed by MediCorp, they may not be eligible for Spouse Term Life Insurance coverage.

Child Term Life Insurance

• You may purchase either $2,500, $5,000 or $10,000 of life insurance. This benefit insures all your eligible children for one monthly premium; and, as your family grows, no action is needed to insure any additional children. If both parents are Associates of MediCorp, only one can carry coverage on the children. Please be sure your covered children meet the eligibility requirements. To be eligible for coverage, your child must be between 6 months and 19 years of age or up to age 25 if a full-time student at an accredited postsecondary school. Dependents 14 days up to 6 months of age are provided 10% of coverage amount. Increases in coverage will require an evidence of insurability (EOI).

Enrollment When enrolling for life insurance, please complete your beneficiary information on the SEA. You pay the full cost for any coverage you purchase on an after-tax basis. You may select any of the additional coverages when you are first hired, during Open Enrollment or within 31 days of a life event change. Any new elections or increases in coverage may be subject to evidence of insurability (EOI). All life insurance coverage or combined life insurance coverage exceeding $500,000 will require evidence of insurability.

MediCorp Health System Benefits Guide

LIFE INSURANCE AND AD&D COVERAGE The chart below summarizes your life insurance and AD&D options. Basic Term Life Insurance –

• Full-time Associates receive one and one-half times their annual salary (up to a maximum) in term life insurance.

MediCorp pays the cost for

• Part-time Associates receive a flat $5,000 in coverage.

this coverage

LIFE INSURANCE & DISABILITY COVERAGE

AGE OF PARTICIPANT

AMOUNT OF INSURANCE (as a percentage of coverage amount prior to attaining age 70)

70–74

65%

75 and older

50%

Accidental Death and

• Full-time Associates may purchase up to $1,000,000 of coverage in $50,000 increments.

basic term life insurance and long-term disability coverage.

Dismemberment Insurance

• Part-time Associates may purchase up to $250,000 of coverage in $50,000 increments.

(AD&D)

• You must enroll online for this coverage using the SEA. Associates are not eligible for this coverage

MediCorp pays the entire cost of this coverage for you. If you

after reaching age 70.

would like additional coverage, you may purchase accidental death and dismemberment (AD&D) insurance, supplemental

LIFE & DISABILITY

MediCorp automatically provides eligible Associates with

Supplemental Life Insurance

• Full-time Associates may purchase up to five times their annual salary in supplemental life insurance. • Part-time Associates may purchase up to $45,000 of coverage in increments of $5,000.

life insurance, spouse and/or child term life insurance or

• Premiums are based on age and amount of coverage purchased.

short-term disability coverage (if eligible).

• You must complete and submit to Human Resources a paper enrollment form. • Coverage amounts may be subject to evidence of insurability (EOI).

Spouse Term Life Insurance*

AGE OF PARTICIPANT

AMOUNT OF INSURANCE (as a percentage of coverage amount prior to attaining age 70)

70–74

65%

75 and older

50%

For your spouse: • You may purchase any amount of life insurance between $5,000 and $100,000 up to a maximum of 100% of your own life insurance coverage or $100,000, whichever is less.

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• Spouse coverage is subject to evidence of insurability (EOI). AGE OF PARTICIPANT

AMOUNT OF INSURANCE (as a percentage of coverage amount prior to attaining age 70)

70–74

65%

75 and older

50%

*If your spouse is employed by MediCorp, they may not be eligible for Spouse Term Life Insurance coverage.

Child Term Life Insurance

MediCorp Health System Benefits Guide

Disability coverage

LONG-TERM DISABILITY COVERAGE

SHORT-TERM DISABILITY COVERAGE

This insurance provides individuals with financial protection

In the event of a medical disability, short-term disability pays a

in the event of long-term medical disability. Long-term disability

percentage of your salary before long-term disability coverage

coverage is available to all full-time Associates.

begins. In order to participate in this program, qualified full-time

• Administered by ING. • Associates are eligible after one year of full-time employment. • Full-time Associates are automatically enrolled in long-term disability coverage. • MediCorp pays the full cost—no cost to Associates. • Long-term disability coverage replaces 60% of base pay monthly (up to $10,000) if you are disabled (as defined by the plan) beyond 180 days. • Preexisting condition clause. • Part-time Associates are not eligible for long-term disability coverage.

Associates must purchase coverage. • Administered by ING. • Only full-time Associates are eligible to elect short-term disability coverage. • If elected, short-term disability coverage replaces 60% of your base pay (up to a $1,000 maximum weekly benefit). • Disability payments begin on day nine of your disability and can last up to 25 weeks per calender year, if eligible. • To qualify for payment, you must be unable to perform any work activity. • Preexisting condition clause. • Claims must be submitted to the carrier within 45 days from the date of disability. • Taxes and regular pay-period deductions will be withheld from short-term disability payments. • You must contact the Benefits Team to initiate the short-term disability process.

RETIREMENT

• You may enroll for this coverage online using the SEA.

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RETIREMENT

Save for a secure financial future by enrolling in the Medicorp Health Systems retirement savings plan. Lincoln Financial Group provides investment options and administrative services for your retirement plan. The retirement savings plan offers programs that meet your needs over the course of your lifetime whether you are busy saving for the future or nearing retirement. • The MediCorp Health System retirement savings plan helps you save money for retirement using a variety of investment options offered through Lincoln Financial Group. • You are immediately eligible upon hire to begin contributing to the plan. • You will be automatically enrolled at 2% of your compensation unless you elect otherwise. • Generally, you can contribute as much of your annual compensation as you wish up to the IRS annual pre-tax limit. • Associates age 21 or older are eligible for MediCorp’s matching contributions once you complete one year of service with at least 1,000 hours worked. For each $1 you contribute, up to 6% of your annual salary, MediCorp will contribute $0.50. • An additional employer contribution of 2% may apply, depending upon your eligibility for other MediCorp retirement programs. • The money you set aside in the plan and the interest it earns are not taxed until you withdraw money from your account (usually at retirement). • You are always 100% vested in your own contributions and the MediCorp match. You are vested in the additional employer contribution after five years. • You may access your money as early as age 59 1/2 without penalty. If you take an early withdrawal from this type of plan, there are penalties. Lincoln Financial Group representatives are on-site at Mary Washington Hospital to help you with your investment needs. You may access their Web site at www.lincolnalliance.com or call their customer service line at 800.234.3500 to make changes in your deferral and investment options.

MediCorp Health System Benefits Guide

Disability coverage

LONG-TERM DISABILITY COVERAGE

SHORT-TERM DISABILITY COVERAGE

This insurance provides individuals with financial protection

In the event of a medical disability, short-term disability pays a

in the event of long-term medical disability. Long-term disability

percentage of your salary before long-term disability coverage

coverage is available to all full-time Associates.

begins. In order to participate in this program, qualified full-time

RETIREMENT

• You may enroll for this coverage online using the SEA.

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RETIREMENT

MediCorp Health System Benefits Guide

PAID ANNUAL LEAVE MediCorp combines vacation, sick leave and some holiday time into one time-off program called paid annual leave (PAL). You are eligible for paid annual leave based on your status (full-time, part-time FTE 0.5 or greater) and how long you have been employed by MediCorp. MediCorp Health System recognizes the following holidays: • New Year’s Day • Labor Day • Independence Day

ADDITIONAL BENEFITS

Your supervisor must approve all requests for PAL in advance. Keep in mind that PAL also includes sick time, so it’s important that you use your PAL days carefully and plan for any unforeseen emergencies. You may carry over 520 hours annually.

• Memorial Day • Thanksgiving Day • Christmas Day

THE ASSIST PROGRAM

What Is The Cost?

FULL-TIME (FTE 0.9 to 1.00) PAL ACCRUAL BASED ON 80-HOUR PAY PERIOD

PART-TIME (FTE 0.5 to 0.899) PAL ACCRUAL BASED ON 80-HOUR PAY PERIOD

The ASSIST program is a service provided through your employer

The ASSIST program is available to you and your family members at no cost! You assume cost only for resources you are referred to.

Years of Service

Full-Time Hourly (Accrual Rate Based on Hours Paid)

Years of Service

Part-Time Hourly (Accrual Rate Based on Hours Paid)

0–3

6.7693

0–3

0.05077

3–5

7.6923

3–5

0.05769

5–10

8.3077

5–10

0.06231

10–15

9.8462

10–15

0.07385

15–20

10.4615

15–20

0.07846

20–25

11.0769

20–25

0.08308

25–30

11.6924

25–30

0.08769

>30

12.3077

>30

0.09231

for employees and their family members who are experiencing stress in their personal or work lives. Short-term services are provided to assist with problems that may be interfering with functioning in any area of one’s life.

What If My Supervisor Refers Me to ASSIST? Your supervisor is offering a helpful resource to address personal concerns that may be affecting your job.

What Problems Can ASSIST Help With? • Relationship issues • Family problems • Parenting concerns • Financial difficulties • Stress • Emotional problems • Conflict with others • Work stress • Substance abuse issues Any problem causing significant concern is an appropriate issue for ASSIST.

Your involvement with ASSIST remains confidential. The only information the supervisor will know is that you did indeed keep your appointment and whether other appointments are scheduled on company time. If you are feeling overwhelmed by personal or work stress, call: Employee Assistance Program We’re Here To ASSIST You Available 24 hours a day ASSIST is one phone call away 540.741.2441, toll-free 1.866.409.9692

ADOPTION ASSISTANCE What Happens When I Call? A trained professional takes your call. You are then offered an appointment with an ASSIST professional who can help determine your needs, help you with short-term problem resolution and/or provide a referral to other resources for help. All ASSIST professionals are Master’s prepared, licensed or certified in their field. What if I Am in Crisis?

Who Will Know I Have Called? The ASSIST program is confidential! No information is released without your specific written consent. All records are kept confidential in accordance with federal and state laws.

MediCorp Health System Benefits Guide

To assist our Associates who adopt, MediCorp will provide $3,500 for full-time Associates and $1,750 for part-time (FTE 0.5 or greater) Associates. Contact the Benefits Section of Human Resources for details.

BEREAVEMENT LEAVE MediCorp recognizes that the death of a family member places unusual stress on an Associate. Thus, MediCorp will provide up to three days of bereavement leave to PAL-eligible Associates in the event of the death of an Associate’s spouse, siblings, parents, children, parents-in-law, son- and/or daughter-in-law, grandparents or grandchildren. These days will not be deducted from the Associate’s PAL bank. You may be required to submit to the Human Resources Department a written request with a copy of your family member’s death notice.

NOTE: PAL is earned each pay period based upon actual hours paid, not to exceed 80 hours for each two-week pay period. Overtime hours are not considered in calculating PAL. PERSONAL DAY: MediCorp gives regular part-time and full-time (FTE 0.5 or greater) Associates one additional personal day each year after one year of service. Hours are prorated based on the Associate’s FTE assignment and will be added to their regular PAL bank. Associates may cash in a total of 120 hours in 2009 during two cash-in opportunities held in August and November. Full-time Associates must have at least 80 hours after a cash-in and part-time Associates must maintain a balance of 40 hours. Retirement savings deduction and all federal and state taxes will be withheld. PAL cash-ins are taxed at the higher supplemental rate.

SENIOR CARE SERVICES

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for

Senior Care Services exist to improve the quality of life for older persons in the Fredericksburg area by providing access to resources. The services listed below are available to MediCorp Associates and their families. • Comprehensive cognitive, psycho-social and physical evaluations of the senior patient by a nationally certified nurse practitioner. • Focus is on preventative measures and preservation of cognitive and physical function. • Evaluations related to depression, mobility, driving, memory loss and socialization issues. • Discussions of living wills and other ethical issues. • Inpatient nurse practitioner consultation service. • Coordination of care with primary care provider. • Information on available resources in the community.

KIDS’ STATION: CHILD CARE As a working parent, you want a safe and innovative environment for your child during the time you are unable to be together. Kids’ Station is a dynamic center for children in a safe and nurturing environment. Kids’ Station was nominated by the National Association of Child Care Professionals as one of the top three child care centers in the country. Kids’ Station offers: • A full range of day care services for children aged three weeks to 13 years. • Occasional Care program for hourly drop-in. • Before- and after-school care.

ADDITIONAL BENEFITS

Even when in crisis, you can receive immediate help. You will talk with a trained professional who can assist you. If you are referred to other resources, ASSIST can often help in facilitating that referral through your insurance. A wide variety of community resources are available through the ASSIST program.

Using PAL Days

Contact Kids’ Station for more information at 540.741.3740.

Contact Senior Care Services at 540.741.3506.

MediCorp Health System Benefits Guide

ADDITIONAL BENEFITS

• Memorial Day • Thanksgiving Day • Christmas Day

THE ASSIST PROGRAM

What Is The Cost?

FULL-TIME (FTE 0.9 to 1.00) PAL ACCRUAL BASED ON 80-HOUR PAY PERIOD

PART-TIME (FTE 0.5 to 0.899) PAL ACCRUAL BASED ON 80-HOUR PAY PERIOD

The ASSIST program is a service provided through your employer

The ASSIST program is available to you and your family members at no cost! You assume cost only for resources you are referred to.

Years of Service

Full-Time Hourly (Accrual Rate Based on Hours Paid)

Years of Service

Part-Time Hourly (Accrual Rate Based on Hours Paid)

0–3

6.7693

0–3

0.05077

3–5

7.6923

3–5

0.05769

5–10

8.3077

5–10

0.06231

10–15

9.8462

10–15

0.07385

15–20

10.4615

15–20

0.07846

20–25

11.0769

20–25

0.08308

25–30

11.6924

25–30

0.08769

>30

12.3077

>30

0.09231

What If My Supervisor Refers Me to ASSIST? Your supervisor is offering a helpful resource to address personal concerns that may be affecting your job.

MediCorp Health System Benefits Guide

SENIOR CARE SERVICES

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for

ADDITIONAL BENEFITS

Using PAL Days

Contact Kids’ Station for more information at 540.741.3740.

Contact Senior Care Services at 540.741.3506.

MediCorp Health System Benefits Guide

TUITION ASSISTANCE

MediCorp Health System is happy to offer a free employee benefit designed to save you time and money. We have partnered with Errand Solutions, an errand convenience service designed to assist you with just about any personal or business task on your to-do list. Errand Solutions takes care of these everyday tasks while you are at work, so that you have more free time to do the things you truly enjoy. Errand Solutions is a complimentary service that will assist you in balancing the responsibilities of your work and personal life.

MediCorp provides assistance to Associates for qualified education expenses.

Services include: Personal and Convenient

Home Improvement

Referrals

• Full Postal Service

Corporate Tasks

Child and Pet Care

• Dry cleaning and laundry

• Meeting and event planning

Special Occasion

• Car care

• Employee rewards and recognition

• Key date reminder services

• Jewelry repair and battery replacement

• Workplace morale activities

• Event and party planning

• Photo processing

• Philanthropic events

• Holiday supply and decoration assistance

• Research and price travel options

• Customized gift acquisition and

• Bakery and catering

• Event tickets and reservations • Activity research and booking

presentation • Research projects

• Gift cards and gift baskets • Gift wrapping

• Service referrals

A trained professional Errand Solutions representative is located at Mary Washington Hospital to make interaction easy in person, through e-mail or by telephone. Drop off your items to be serviced, including dry cleaning, jewelry, shoes or car keys for vehicle services, to the site during operating hours. You will be notified when your items are ready for pickup. For car services, please make an appointment 24 hours in advance. Coordination of services and any assistance given are free of charge, and payment is accepted only for actual outside services rendered. On-site research and planning tasks are free. Interactions are private and handled with professional excellence, and all service providers are licensed and insured.

Errand Solutions is located past the Atrium next to the information desk. An Errand Solution representative is available to visit MediCorp entities Monday through Friday. For additional information, contact Errand Solutions at 540.741.2882 or at errandsolutions@medicorp.org. Your Errand Solutions representative is on-site at Mary Washington Hospital to accommodate your requests: Monday, Wednesday and Friday 8:30 a.m. – 4:30 p.m. Tuesday and Thursday 7:00 a.m. – 3:00 p.m.

Associates eligible for this benefit must be: • Actively employed • Have completed one year or more of service • Be employed on a full-time or part-time basis with an FTE of .5 or greater Full-time Associates (FTE 0.9–1.00) are eligible for: Graduate $4,000 per year Undergraduate $3,000 per year Part-time Associates (FTE 0.5–0.899) are eligible for: Graduate $2,000 per year Undergraduate $1,500 per year Courses must be offered at an accredited institution, leading to an undergraduate or graduate degree and must satisfy any one of the following criteria: • Prepare Associate for a profession at MediCorp Health System • Enhance current job skills • Prepare for a future need of MediCorp • Support the overall needs of MediCorp Associates may request that benefits be paid in advance by MediCorp directly to the educational institution. Associates must submit a complete copy of the tuition assistance form no later than 30 days after beginning the educational course in order to be eligible for this benefit. Documents of successful completion of the course (“C” or better undergraduate, “B” or better graduate) must be submitted within 60 days of completion of the course. Contact the Benefits Team for details at 540.741.2254.

TOBACCO-FREE ASSOCIATES PROGRAM Overview: As an Associate at MediCorp you have a Tobacco Treatment Specialist dedicated to supporting you through changes in your tobacco use whether this is your first or tenth attempt to quit. By working with a trained counselor you will get support with both parts of your tobacco use: the habit and the physical addiction to nicotine. Process: Appointments are held at MHS Health & Wellness as well as at MediCorp entities by demand. At your first session you will complete an intake packet with questions about your tobacco use over time and the lifestyle factors that may impact your progress. Then you will sit down with your specialist to design a personal quit plan, choose a quit date and learn about the available cessation aids. Short follow-up sessions will be scheduled every two weeks or as needed. Cessation Aids: Research shows that using a medicine to help you quit smoking can double your chance of success. This is because cessation aids blunt many of your withdrawal symptoms, allowing you to actively work on changing the thoughts and behaviors that

MediCorp Health System Benefits Guide

make you a “smoker.” While enrolled in the program you are eligible to use the following aids free of charge:

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ERRAND SOLUTIONS: PERSONAL ASSISTANCE AND RESOURCES

• NicoDerm® CQ® patches • Commit® lozenges • Nicorette® gum You may also be eligible for reimbursement of prescription quitsmoking medications. To ensure you understand the requirements for reimbursement, it is essential that you call for details on eligibility and paperwork BEFORE you fill your prescription. For more information or to schedule an appointment, call Melissa Blasiol, 540.741.3606.

IDENTITY FRAUD EXPENSE REIMBURSEMENT MediCorp is concerned about the financial security and personal well-being of its Associates and has purchased an identity fraud expense reimbursement policy. Coverage is provided by St. Paul Travelers and provides each Associate with limits of liability of $25,000 subject to no deductible. This coverage reimburses identity theft victims for the following (subject to the carrier’s consent): • Lost wages as a result of time taken off from work to deal with the fraud, including wrongful incarceration—up to $1,000 per week for five weeks. • Notary and certified mail charges for completing and delivering fraud affidavits. • Fees to re-apply for loans that were denied due to erroneous credit information due to the identity theft. • Long-distance telephone charges for calling merchants, law enforcement agencies or credit grantors to discuss an actual identity theft. • Attorney fees subject to carrier’s consent. You may call 800.842.8496 to speak to a St. Paul Travelers representative.

ADDITIONAL BENEFITS OFFERED • Savings bonds: Buy U.S. savings bonds by convenient payroll deduction. • Two credit unions convenient to work to handle your banking needs: – The Virginia Credit Union is located at Plank Road in Fredericksburg (540.899.4466) and Route 610 in Stafford. – The Healthcare Systems Federal Credit Union offers a full array of banking services on-site at Mary Washington Hospital on Wednesdays between 10:00 a.m. and 1:00 p.m. as well as an ATM at 2300 Fall Hill. Call 800.250.9676 to reach the Healthcare Systems Federal Credit Union in Fairfax. • Discount database of local merchants: Check out the discount database, which is available from the www.medicorp.org homepage or the Lotus Notes portal.

MediCorp Health System Benefits Guide

TUITION ASSISTANCE

MediCorp provides assistance to Associates for qualified education expenses.

Services include: Personal and Convenient

Home Improvement

Referrals

• Full Postal Service

Corporate Tasks

Child and Pet Care

• Dry cleaning and laundry

• Meeting and event planning

Special Occasion

• Car care

• Employee rewards and recognition

• Key date reminder services

• Jewelry repair and battery replacement

• Workplace morale activities

• Event and party planning

• Photo processing

• Philanthropic events

• Holiday supply and decoration assistance

• Research and price travel options

• Customized gift acquisition and

• Bakery and catering

• Event tickets and reservations • Activity research and booking

presentation • Research projects

• Gift cards and gift baskets • Gift wrapping

• Service referrals

MediCorp Health System Benefits Guide

make you a “smoker.” While enrolled in the program you are eligible to use the following aids free of charge:

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ERRAND SOLUTIONS: PERSONAL ASSISTANCE AND RESOURCES

MediCorp Health System Benefits Guide

Q: Where can I find forms, (i.e., FMLA, PAL Cash-in, Tuition Assistance, etc.)?

Q: Whom do I contact for medical claims information or problems? A: A etna Customer Service at 800.291.2953 or log on to

Q&A

MEDICAL/SELF-FUNDED/ADMINISTERED BY AETNA

A: N otes portal under “Forms”; or Self-Evident Application (SEA) under “Forms”; or 2009 Guide Link on medicorp.org Web site;

www.aetna.com. Create a login and password for Aetna Navigator.

or brochure racks at each MediCorp facility; or contact a member Q: How do I find in-network providers?

of the Benefits Team.

A: Contact Aetna Customer Service or log on to Aetna Navigator. In Navigator: click on “Find a Provider”; or click [Plan type: Aetna

Q: How can I change or start deferral to a retirement savings plan?

Choice POS II (Open Access)]; or contact Aetna Customer Service

A: C ontact the Lincoln Financial Group representative at Mary

at 800.291.2953; or call your doctor directly.

Washington Hospital at 540.741.1456 or internal extension 11456; or contact the Lincoln Financial Group Customer Service at 800.234.3500.

QUESTIONS & ANSWERS

Q: How do I use mail order pharmacy? A: P lace order through Aetna Web site or obtain mail order form

Q: For those Associates who may still have monies in a fixed account

from Benefit Section of Human Resources. (For information about the plan, refer to the SPD).

with AIG Retirement; formerly AIG VALI? A: Contact AIG Retirement Customer Service at 1.800.448.2542. Q: Questions regarding your paid annual leave (PAL)?

DENTAL/SELF-FUNDED/ADMINISTERED BY DELTA DENTAL

A: Contact Cindy Kjar at 540.741.2254 or internal extension 12254.

Q: Whom do I contact for dental claims information or problems? A: Delta Dental Customer Service at 800.237.6060.

Q: How do I apply for Family Medical and Leave Act (FMLA)? A: C ontact Allison Black at 540.741.1483 or internal extension 11483;

Q: How do I find in-network providers?

or stop by either Human Resources office to pick up the form; or

A: C ontact Delta Dental Customer Service or log on to

contact your manager.

www.deltadental.com. (For general information about plan coverage, refer to the SPD.)

Q: How do I get tuition assistance? A: O btain form from forms database or from the Benefits Section of Human Resources.

VISION SERVICE PLAN

a. C oursework must be approved by manager. Human Resources

b. F orm must be completed and turned in to Human Resources

will determine final approval.

Q: Whom do I contact for vision claims information or problems? A: Vision Service Plan Customer Service at 800.877.7195.

within 30 days of the start of the class. Q: How do I find in-network providers?

c. I nvoice for class as well as proof of registration must accompany form.

A: C ontact Vision Service Plan Customer Service or log on to www.vsp.com. (For information about plan coverage,

d. D egree program must be indicated on form.

refer to the SPD.)

e. Associates who are full- or part-time with an FTE assignment are eligible to participate in this program.

SHORT-TERM DISABILITY Q: Whom do I contact for questions on coverage? A: Call Allison Black at 540.741.1483 or internal extension 11483.

f. Copy of grades must be turned in to the Benefits Section

g. If prepay, agreement letter must be signed and turned in to

of Human Resources within 60 days of the class end date. Human Resources before check is issued.

Q: How do I apply for a short-term disability benefit claim? A: Contact ING at 866.228.8742, plan number 64198-7.

MediCorp Health System Benefits Guide

Q: Where can I find forms, (i.e., FMLA, PAL Cash-in, Tuition Assistance, etc.)?

Q: Whom do I contact for medical claims information or problems? A: A etna Customer Service at 800.291.2953 or log on to

Q&A

MEDICAL/SELF-FUNDED/ADMINISTERED BY AETNA

A: N otes portal under “Forms”; or Self-Evident Application (SEA) under “Forms”; or 2009 Guide Link on medicorp.org Web site;

www.aetna.com. Create a login and password for Aetna Navigator.

or brochure racks at each MediCorp facility; or contact a member Q: How do I find in-network providers?

of the Benefits Team.

A: Contact Aetna Customer Service or log on to Aetna Navigator. In Navigator: click on “Find a Provider”; or click [Plan type: Aetna

Q: How can I change or start deferral to a retirement savings plan?

Choice POS II (Open Access)]; or contact Aetna Customer Service

A: C ontact the Lincoln Financial Group representative at Mary

at 800.291.2953; or call your doctor directly.

Washington Hospital at 540.741.1456 or internal extension 11456; or contact the Lincoln Financial Group Customer Service at 800.234.3500.

QUESTIONS & ANSWERS

Q: How do I use mail order pharmacy? A: P lace order through Aetna Web site or obtain mail order form

Q: For those Associates who may still have monies in a fixed account

from Benefit Section of Human Resources. (For information about the plan, refer to the SPD).

with AIG Retirement; formerly AIG VALI? A: Contact AIG Retirement Customer Service at 1.800.448.2542. Q: Questions regarding your paid annual leave (PAL)?

DENTAL/SELF-FUNDED/ADMINISTERED BY DELTA DENTAL

A: Contact Cindy Kjar at 540.741.2254 or internal extension 12254.

Q: Whom do I contact for dental claims information or problems? A: Delta Dental Customer Service at 800.237.6060.

Q: How do I apply for Family Medical and Leave Act (FMLA)? A: C ontact Allison Black at 540.741.1483 or internal extension 11483;

Q: How do I find in-network providers?

or stop by either Human Resources office to pick up the form; or

A: C ontact Delta Dental Customer Service or log on to

contact your manager.

www.deltadental.com. (For general information about plan coverage, refer to the SPD.)

Q: How do I get tuition assistance? A: O btain form from forms database or from the Benefits Section of Human Resources.

VISION SERVICE PLAN

a. C oursework must be approved by manager. Human Resources

b. F orm must be completed and turned in to Human Resources

will determine final approval.

Q: Whom do I contact for vision claims information or problems? A: Vision Service Plan Customer Service at 800.877.7195.

within 30 days of the start of the class. Q: How do I find in-network providers?

c. I nvoice for class as well as proof of registration must accompany form.

A: C ontact Vision Service Plan Customer Service or log on to www.vsp.com. (For information about plan coverage,

d. D egree program must be indicated on form.

refer to the SPD.)

e. Associates who are full- or part-time with an FTE assignment are eligible to participate in this program.

SHORT-TERM DISABILITY Q: Whom do I contact for questions on coverage? A: Call Allison Black at 540.741.1483 or internal extension 11483.

f. Copy of grades must be turned in to the Benefits Section

g. If prepay, agreement letter must be signed and turned in to

of Human Resources within 60 days of the class end date. Human Resources before check is issued.

Q: How do I apply for a short-term disability benefit claim? A: Contact ING at 866.228.8742, plan number 64198-7.

MediCorp Health System Benefits Guide

NOTIFICATIONS MEDICORP HEALTH SYSTEM IMPORTANT NOTICE COMPREHENSIVE NOTICE OF PRIVACY POLICY AND PROCEDURES This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

These plans comprise what is called an “Affiliated Covered Entity,” and are treated as a single plan for purposes of this Notice and the privacy rules that require it. For purposes of this Notice, we’ll refer to these plans as a single “Plan.” The Plan’s Duty to Safeguard Your Protected Health Information. Individually identifiable information about your past, present, or future health or condition, the provision of health care to you, or payment for the health care is considered “Protected Health Information” (“PHI”). The Plan is required to extend certain protections to your PHI, and to give you this Notice about its privacy practices that explains how, when and why the Plan may use or disclose your PHI. Except in specified circumstances, the Plan may use or disclose only the minimum necessary PHI to accomplish the purpose of the use or disclosure.

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The Plan is required to follow the privacy practices described in this Notice, though it reserves the right to change those practices and the terms of this Notice at any time. If it does so, and the change is material, you will receive a revised version of this Notice either by hand delivery, mail delivery to your last known address, or some other fashion. This Notice, and any material revisions of it, will also be provided to you in writing upon your request (ask your Human Resources representative, or contact the Plan’s Privacy Official, described below), and will be posted on any website maintained by MediCorp Health System that describes benefits available to employees and dependents. You may also receive one or more other privacy notices, from insurance companies that provide benefits under the Plan. Those notices will describe how the insurance companies use and disclose PHI, and your rights with respect to the PHI they maintain. How the Plan May Use and Disclose Your Protected Health Information. The Plan uses and discloses PHI for a variety of reasons. For its routine uses and disclosures it does not require your authorization, but for other uses and disclosures, your authorization (or the authorization of your personal representative (e.g., a person who is your custodian, guardian, or has your power-of-attorney)) may be required. The following offers more description and examples of the Plan’s uses and disclosures of your PHI. Uses and Disclosures Relating to Treatment, Payment, or Health Care Operations. •T reatment: Generally, and as you would expect, the Plan is permitted to disclose your PHI for purposes of your medical treatment. Thus, it may disclose your PHI to doctors, nurses, hospitals, emergency medical technicians, pharmacists and other health care professionals where the disclosure is for your medical treatment. For example, if you are injured

MediCorp Health System Benefits Guide

Other Uses and Disclosures of Your PHI Not Requiring Authorization. The law provides that the Plan may use and disclose your PHI without authorization in the following circumstances: • To the Plan Sponsor: The Plan may disclose PHI to the employers (such as MediCorp Health System) who sponsor or maintain the Plan for the benefit of employees and dependents. However, the PHI may only be used for limited purposes, and may not be used for purposes of employment-related actions or decisions or in connection with any other benefit or employee benefit plan of the employers. PHI may be disclosed to: the human resources or employee benefits department for purposes of enrollments and disenrollments, census, claim resolutions, and other matters related to Plan administration; payroll department for purposes of ensuring appropriate payroll deductions and other payments by covered persons for their coverage; information technology department, as needed for preparation of data compilations and reports related to Plan administration; finance department for purposes of reconciling appropriate payments of premium to and benefits from the Plan, and other matters related to Plan administration; internal legal counsel to assist with resolution of claim, coverage and other disputes related to the Plan’s provision of benefits. • Required by law: The Plan may disclose PHI when a law requires that it report information about suspected abuse, neglect or domestic violence, or relating to suspected criminal activity, or in response to a court order. It must also disclose PHI to authorities who monitor compliance with these privacy requirements. • For public health activities: The Plan may disclose PHI when required to collect information about disease or injury, or to report vital statistics to the public health authority. • For health oversight activities: The Plan may disclose PHI to agencies or departments responsible for monitoring the health care system for such purposes as reporting or investigation of unusual incidents. • Relating to decedents: The Plan may disclose PHI relating to an individual’s death to coroners, medical examiners or funeral directors, and to organ procurement organizations relating to organ, eye, or tissue donations or transplants. • For research purposes: In certain circumstances, and under strict supervision of a privacy board, the Plan may disclose PHI to assist medical and psychiatric research. • To avert threat to health or safety: In order to avoid a serious threat to health or safety, the Plan may disclose PHI as necessary to law enforcement or other persons who can reasonably prevent or lessen the threat of harm. • For specific government functions: The Plan may disclose PHI of military personnel and veterans in certain situations, to correctional facilities in certain situations, to government programs relating to eligibility and enrollment, and for national security reasons.

ses and Disclosures Requiring Authorization: U For uses and disclosures beyond treatment, payment and operations purposes, and for reasons not included in one of the exceptions described above, the Plan is required to have your written authorization. Your authorizations can be revoked at any time to stop future uses and disclosures, except to the extent that the Plan has already undertaken an action in reliance upon your authorization. ses and Disclosures Requiring You to have an Opportunity to Object: U The Plan may share PHI with your family, friend or other person involved in your care, or payment for your care. We may also share PHI with these people to notify them about your location, general condition, or death. However, the Plan may disclose your PHI only if it informs you about the disclosure in advance and you do not object (but if there is an emergency situation and you cannot be given your opportunity to object, disclosure may be made if it is consistent with any prior expressed wishes and disclosure is determined to be in your best interests; you must be informed and given an opportunity to object to further disclosure as soon as you are able to do so). Your Rights Regarding Your Protected Health Information. You have the following rights relating to your protected health information: •T o request restrictions on uses and disclosures: You have the right to ask that the Plan limit how it uses or discloses your PHI. The Plan will consider your request, but is not legally bound to agree to the restriction. To the extent that it agrees to any restrictions on its use or disclosure of your PHI, it will put the agreement in writing and abide by it except in emergency situations. The Plan cannot agree to limit uses or disclosures that are required by law. •T o choose how the Plan contacts you: You have the right to ask that the Plan send you information at an alternative address or by an alternative means. The Plan must agree to your request as long as it is reasonably easy for it to accommodate the request. •T o inspect and copy your PHI: Unless your access is restricted for clear and documented treatment reasons, you have a right to see your PHI in the possession of the Plan or its vendors if you put your request in writing. The Plan, or someone on behalf of the Plan, will respond to your request, normally within 30 days. If your request is denied, you will receive written reasons for the denial and an explanation of any right to have the denial reviewed. If you want copies of your PHI, a charge for copying may be imposed but may be waived, depending on your circumstances. You have a right to choose what portions of your information you want copied and to receive, upon request, prior information on the cost of copying. •T o request amendment of your PHI: If you believe that there is a mistake or missing information in a record of your PHI held by the Plan or one of its vendors, you may request, in writing, that the record be corrected or supplemented. The Plan or someone on its behalf will respond, normally within 60 days of receiving your request. The Plan may deny the request if it is determined that the PHI is: (i) correct and complete; (ii) not created by the Plan or its vendor and/or not part of the Plan’s or vendor’s records; or (iii) not permitted to be disclosed. Any denial will state the reasons for denial and explain your rights to have the request and denial, along with any statement in response that you provide, appended to your PHI. If the request for amendment is approved, the Plan or vendor, as the case may be, will change the PHI and so inform you, and tell others that need to know about the change in the PHI. • To find out what disclosures have been made: You have a right to get a list of when, to whom, for what purpose, and what portion of your PHI has been released by the Plan and its vendors, other than instances of disclosure for which you gave authorization, or instances where the disclosure was made to you or your family. In addition, the disclosure list will not include disclosures for treatment, payment, or health care operations. The list also will not include any disclosures made for national security purposes, to law enforcement officials or correctional facilities, or before the date the federal privacy rules applied to the Plan. You will normally receive a respond to your written request for such a list within 60 days after you make the request in writing. Your request can relate to disclosures going as far back as six years. There will be no charge for up to one such list each year. There may be a charge for more frequent requests.

How to Complain about the Plan’s Privacy Practices. If you think the Plan or one of its vendors may have violated your privacy rights, or if you disagree with a decision made by the Plan or a vendor about access to your PHI, you may file a complaint with the person listed in the section immediately below. You also may file a written complaint with the Secretary of the U.S. Department of Health and Human Services. The law does not permit anyone to take retaliatory action against you if you make such complaints. Contact Person for Information, or to Submit a Complaint. If you have questions about this Notice please contact the Plan’s Privacy Official or Deputy Privacy Official(s) (see below). If you have any complaints about the Plan’s privacy practices or handling of your PHI, please contact the Plan’s Privacy Official (see below). Privacy Official. The Plan’s Privacy Official, the person responsible for ensuring compliance with this Notice, is: N ame: Jina Haikey Title: Vice President, Regulatory Affairs Telephone Number: 540.741.1821

NOTIFICATIONS

This Notice is provided to you on behalf of: MediCorp Health System, Associate Medical Plan MediCorp Health System, Associate Dental Care Plan MediCorp Health System, Associate Vision Plan MediCorp Health System, Associate Assistance Program MediCorp Health System, Health Care Flexible Spending Account

in an accident, and it’s important for your treatment team to know your blood type, the Plan could disclose that PHI to the team in order to allow it to more effectively provide treatment to you. • Payment: Of course, the Plan’s most important function, as far as you are concerned, is that it pays for all or some of the medical care you receive (provided the care is covered by the Plan). In the course of its payment operations, the Plan receives a substantial amount of PHI about you. For example, doctors, hospitals and pharmacies that provide you care send the Plan detailed information about the care they provided, so that they can be paid for their services. The Plan may also share your PHI with other plans, in certain cases. For example, if you are covered by more than one health care plan (e.g., covered by this Plan, and your spouse’s plan, or covered by the plans covering your father and mother), we may share your PHI with the other plans to coordinate payment of your claims. • Health care operations: The Plan may use and disclose your PHI in the course of its “health care operations.” For example, it may use your PHI in evaluating the quality of services you received, or disclose your PHI to an accountant or attorney for audit purposes. In some cases, the Plan may disclose your PHI to insurance companies for purposes of obtaining various insurance coverage.

The Plan’s Deputy Privacy Official(s) is/are: Name: Lauren Blalock Title: Director Regulatory Affairs Telephone Number: 540.741.1821 Organized Health Care Arrangement Designation. The Plan participates in what the federal privacy rules call an “Organized Health Care Arrangement.” The purpose of that participation is that it allows PHI to be shared between the members of the Arrangement, without authorization by the persons whose PHI is shared, for health care operations. Primarily, the designation is useful to the Plan because it allows the insurers who participate in the Arrangement to share PHI with the Plan for purposes such as shopping for other insurance bids. The members of the Organized Health Care Arrangement are: MediCorp Health System Associate Medical Plan MediCorp Health System Associate Dental Care Plan MediCorp Health System Associate Assistance Program MediCorp Health System Health Care Flexible Spending Account MediCorp Health System Associate Vision Plan Effective Date. The effective date of this Notice is September 8, 2008.

MediCorp Health System Benefits Guide

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MediCorp Health System Benefits Guide

NOTIFICATIONS

MediCorp Health System Benefits Guide

IMPORTANT NOTICE FROM MEDICORP ABOUT YOUR PERSCRIPTION DRUG COVERAGE Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with MediCorp Health System 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. M edicare 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. M ediCorp has determined that the prescription drug coverage offered by MediCorp Health System 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? You can join a Medicare drug plan when you first become eligible for Medicare and each year from November 15th through December 31st. 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.

For More Information About This Notice Or Your Current Prescription Drug Coverage… Contact the person listed below for further information. 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 MediCorp Health System 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 1.800.MEDICARE 1.800.633.4227. TTY users should call 1.877.486.2048.

WOMEN’S HEALTH & CANCER RIGHTS ACT As required by the Women’s Health and Cancer Rights Act (WHCRA) of 1998, this plan provides coverage for: 1. A ll stages of reconstruction of the breast on which the mastectomy has been performed; 2. S urgery and reconstruction of the other breast to produce a symmetrical appearance; and 3. P rostheses and physical complications of mastectomy, including lymphedemas, in a manner determined in consultation with the attending physician and the patient. Such coverage may be subject to annual deductibles and coinsurance provisions as may be deemed appropriate and are consistent with those established for other benefits under the plan or coverage. Written notice of the availability of such coverage shall be delivered to the participant upon enrollment and annually thereafter. Contact your plan administrator for more information.

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). 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: 09/08/2008 Name of Entity/Sender: MediCorp Health System Contact–Position/Office: Benefit Manager, Human Resources Address: 2300 Fall Hill Avenue, Suite 207, Fredericksburg, VA 22405 Phone Number: 540.741.3552

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 MediCorp Health System coverage will not be affected. If you do decide to join a Medicare drug plan and drop your current MediCorp Health System coverage, be aware that you and your dependents will 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 MediCorp Health System 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 November to join.

MediCorp Health System Benefits Guide

FOR ALL BENEFITS AND ENROLLMENT QUESTIONS, PLEASE CONTACT:

TABLE OF CONTENTS When Coverage Begins

When You Can Make Changes 2

Additional Benefits

Paid Annual Leave

How to Enroll or Make Changes

Child Care: Kidsâ&#x20AC;&#x2122; Station

Your Benefits At A Glance

Personal Services and Resources

Medical Plan

Tuition Assistance

Prescription Drug Benefit

Live Well Program

Dental Plan

Vision Plan

Flexible Spending Accounts

Life Insurance and AD&D

Disability Coverage

Retirement

Bereavement Leave

Mary Washington Hospital

Stafford Hospital Center

Human Resources 1001 Sam Perry Boulevard Fredericksburg, VA 22401 medicorp.org

BENEFITS GUIDE 2009