1. 2014 Benefits
Riverside Healthcare
Choices and
Advantages for
Riverside
Employees

2. Open Enrollment
 Benefit Enrollment Timeline
 November 4-24: Open Enrollment
 Nov 4 – Benefit and Wellness Mini Fair
 Rounding to Hospital Departments–10pm to Midn.
 Nov 5 – Benefit and Wellness Fair
 Riverside Lobby from 11:00 am to 3:00 pm
 Nov 4-14: Benefit meetings and Q&A sessions
 Nov 24: Enrollment period ends
 Dec 3: Confirmation of benefit elections will be
mailed to employees’ homes
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3. Open Enrollment
 Confirm your benefit elections and make any
necessary changes.
 It’s important to confirm your enrollment if you…
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would like to make changes to your existing elections
have NEW dependents to add to your plan(s) (you will need to
submit proof of eligible status)
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Opt Out of health insurance (you must supply proof of insurance each
year)
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want to continue your Flexible Spending Account (the IRS
prohibits the automatic rollover of FSA elections from year to year)
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want to avoid the spousal surcharge (if your spouse is not eligible
for benefits with their employer, you must complete the exemption form)
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want to avoid the tobacco surcharge (if you are enrolled in health
insurance, you must indicate your tobacco status for yourself and each dependent
enrolled in your plan)
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4. Enrollment Process
 Log on to the BenefitsTalk™ website at
www.benefitstalk.com/riverside
 Review online plan information
 Review your current elections
 Process your enrollment for 2014
 Benefit Call Center representatives are
available toll free at (866) 932-6851
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Monday through Friday from 7AM-6PM
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5. Benefits are part of Total Compensation
 To continue managing costs in 2014 while providing
competitive benefits, premium adjustments have
occurred for health insurance.
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Rates can be viewed online during enrollment at
www.benefitstalk.com/riverside or by calling the Benefit Center.
Riverside continues to pay 80% of the total cost of healthcare
coverage for employees.
 There are no premium increases for dental, life
insurance, or long term disability; however there is a 2%
increase on vision premiums.
 After enrollment, employees will receive a confirmation
statement that details employee’s total compensation
including Riverside’s contributions to benefits costs.
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6. PPO Changes
See Benefit Booklet Plan Summaries for complete details
 Preferred Plus Medical Plan no longer available
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If you are currently enrolled in the Preferred Plus Plan, you
must elect another plan. If you fail to elect another plan, you
will be defaulted into the Gold PPO (Preferred) Plan.
 New Names
 Preferred Plan ($1500 Deductible) is “Gold PPO”
 Basic Plan ($3000 Deductible) is “Silver PPO”
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7. PPO Plan Design Changes
See Benefit Booklet Plan Summaries for complete details
 Co-Pays accumulate to annual max out of pocket
(except for Rx co-pays)
 Riverside In-Network Providers Primary office visit
co-pay decreased to $20
 Prescription Specialty Drugs - Co-pay $100
 Out-of-Network expenses do not count toward
In-Network deductibles and max out of pocket
and vice versa.
 Gold Plan - increased max out of pocket for Tier 2 and
increased deductible and max out of pocket for Tier 3
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8. New Plan – HDHP Silver
HSA Qualified Plan
 For services other than preventive care, you are responsible for
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paying out-of-pocket until your deductible is met. No co-pays
for office visits or ER visits and prescriptions.
Deductible $2500 at Riverside (tier 1) and Humana (tier 2);
$5000 out of network (tier 3).
Co-Insurance 90% at Riverside, 70% at Humana, 40% out of
network.
Max out-of-pocket (up to two per family) $3500 at Riverside,
$6000 at Humana, and $12000 out of network.
Once you meet the out of pocket maximum, services will be
covered in full (for any covered benefit) up to the allowable
amount.
Preventive services are covered in full at the first two tiers.
Generic preventative drugs not subject to deductible at tier 1
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9. New Plan – HDHP Bronze
HSA Qualified Plan
 For services other than preventive care, you are responsible for
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paying out-of-pocket until your deductible is met. No co-pays
for office or ER visits and prescriptions.
Deductible $4000 at Riverside and Humana; $6000 out of
network.
Co-Insurance 80% at Riverside, 60% at Humana, 40% out of
network.
Out-of-pocket annual limit (up to two per family) $5000 at
Riverside, $6350 at Humana, and $12000 out of network.
Once you meet the out of pocket maximum, services will be
covered in full (for any covered benefit) up to the allowable
amount.
Preventive services are covered in full at the first two tiers
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10. Choices Available
 In order to be eligible to choose from any
insurance plan Riverside offers during Open
Benefit Enrollment, employees must
complete the following by December 1st
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On-line Health Assessment
Screening Lab Work
Physician Wellness Visit
 Those who do not complete these criteria
will only be eligible for the HDHP Bronze
Plan.
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11. Health Savings Account (HSA)
 You must be in a HDHP to contribute to a HSA
 You can contribute in a lump-sum or in any amount and frequency that
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you wish. You can elect a certain amount for payroll deduction per pay
period during your online benefit enrollment.
There is a limit to how much you can contribute to your HSA each year.
The maximum is $3,330 for single coverage and $6,350 for family.
Over age 55 are eligible for additional $1000 catch-up contributions.
There will be instructions for setting up your HSA thru PNC Bank. A
Direct Deposit from you paycheck will go into your HSA account.
Pay qualified medical expenses with your PNC Health Savings Account
Visa® debit card, by transfer of money from your PNC HSA to a
personal bank account, reimbursement via check request or by HSA
check.
If you are enrolled in HDHP HSA account AND want to contribute to a
Flexible Spending Account (FSA), you will only be able to enroll in a
Limited FSA that allow eligible expenses only for dental and vision
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12. Medical Insurance Premium Discounts
 Employees with an FTE of .5 or greater who take
Riverside Insurance can earn an additional $20 per pay
period by completing:
On-line Health Assessment
 Screening Lab Work
 Physician Wellness Visit
 Coaching (if required)
 Flu Shot
 Mammogram (gender/age based)
 100 Healthy Habit Points
 For more information go to http://www.riversidemc.net/reach
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13. Riverside In-Network Physicians
 For a better level of coverage, employees should choose physicians
on the Riverside In-Network Physician List.
 PPO Plans:
 $20 co-pay per office visit
 $40 co-pay for specialists
 90% coverage (after deductible) for inpatient visits at Riverside
 HDHP: Must meet deductible first then co-insurance starts
 This list of physicians is subject to change from time to time,
depending on the hospital affiliations of the physician, relocation
and other criteria.
 An updated list is available…
 online at www.benefitstalk.com/riverside
 on RiverNet (in the Benefit Folder under Human Resources)
 or from Human Resources
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14. FastCare
 Riverside's FastCare clinic offers convenient health
care for minor conditions and non-emergency
illnesses. For Details, go to www.riversidemc.net/fastcare
 If you are enrolled in one of the PPO Plans, you will
only pay a $10 Co-Pay
 If you are enrolled in a HDHP, you will pay the entire
cost of all visits until you have met your deductible,
then the visit is covered in full. (Currently $59 per
visit.)
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15. PPO Prescription Coverage
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$10 co-pay for generics
$40 co-pay for formulary brand names
$60 co-pay for brand names and injectibles
$100 co-pay for Specialty Medications
Use Riverside Family Pharmacy and get a three month
supply of maintenance drugs (excluding specialty drugs)
for…
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TWO co-payments in the Gold (Preferred) Plan
ONE co-payment in the Silver (Basic) Plan
Detailed information about prescription drug coverage
is available at www.benefitstalk.com/Riverside.
Its important to confirm coverage of any prescriptions
drugs you currently fill to see if there are changes in
the formulary that may affect limits, prior authorization,
or step therapy.
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16. HDHP Prescription Coverage
 Silver HDHP
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Generic Preventative – 100% Not Subject to Deductible
Generic Drug – 100%, after Deductible
Formulary – 80%, after Deductible
Non-Formulary - 80%, after Deductible
Specialty - 80%, after Deductible
Then covered at 100% after meet max out of pocket
 Bronze HDHP
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Generic Drug – 100%, after Deductible
Formulary – 80%, after Deductible
Non-Formulary - 80%, after Deductible
Specialty - 80%, after Deductible
Then covered at 100% after meet max out of pocket
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17. Flexible Spending Accounts (FSA)
 FSA’s are a way to save money by paying for certain health and
dependent expenses with before tax dollars. (Max: $2,500 for
Health FSA’s and $5,000 for Dependent Care FSA’s)
 You must elect your contribution amount each year (the IRS
prohibits the automatic rollover of FSA elections from year to year)
 If you are in an HSA, you will be eligible for a “Limited FSA” only
 Go to the BenefitsTalk™ website to access balances and view
recent transactions
 Grace period extends thru March 15, 2014 to incur expenses.
 Deadline to submit 2013 claims is April 15, 2014, to WestLake.
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Use-It-Or-Lose-It Rule still applies
Manual claims processed within 48 hours
 You will also have the option to use the Debit Card. Approved
expenses are automatically deducted from your pre-tax account.
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You may continue to use the same card from last year
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18. Health Flex Spending Account Claims
Automatically Processed
 WestLake (Riverside’s FSA administrator) and Humana
have come together to automate the FSA claims
process.
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Humana provides WestLake with a weekly listing of claims paid
for RMC participants with an FSA eligible balance due.
WestLake will automatically process the balance from your FSA
account for any FSA eligible amount (charges that went to your
deductible, co-pay or coinsurance).
You may elect to opt out of automatic processing by calling the
Benefit Center.
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19. Dependent Eligibility Verification
(DEV)
 Employees who are adding new dependents
to their medical, dental, or vision plan, are
required to submit proof of eligible status to
the Benefit Center by December 14.
 Documents that are acceptable include, birth
certificates, marriage certificates, tax returns,
etc. A full list of acceptable documents is
available online.
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Please remember to put your name and
employee ID number on anything you send to
the benefit center.
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20. Spousal Surcharge
 Employees who choose to cover their spouse in
Riverside’s group medical plan and whose spouse is
eligible for medical coverage with their employer will
pay a $50 surcharge per pay period, in addition to the
health insurance premium.
 The Spousal Surcharge will be waived if:
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Your spouse does not have medical coverage available through
his/her employer
Your spouse is unemployed, self employed, or retired
Your spouse is covered by Medicare
Your spouse is also employed by Riverside Medical Center
 If your spouse meets one of the criteria above, you
must complete the exemption form electronically at
www.benefitstalk.com/Riverside
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21. Tobacco Surcharge
The purpose of the Tobacco Surcharge Program is to provide
additional motivation to encourage healthy lifestyles in our
workplace environment. In addition to promoting healthy
lifestyles, the surcharge will help cover additional health plan
expenses generated by smoking and other tobacco related
health problems.
 The surcharge applies only to employees enrolled in
health insurance.
 $15 per pay period for each covered family member
who uses or has used tobacco products within the
past six months.
 To avoid the surcharge, you must enroll online at
www.benefitstalk.com/riverside or contact the Benefit
Call Center at (866) 932-6851 and indicate your
tobacco-free status.
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22. Quit Smoking Help
 Riverside would like to help make it easier for you to
quit by reimbursing you and your dependents the
cost of the smoking cessation program
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Freedom From Smoking: Cost $30.00 (refunded to
you upon completion) - American Lung Association
program - 8 week series of weekly sessions at Riverside
Medical Center.
 Reimburse up to $100 for out-of-pocket expenses for
quit smoking aids, such as medications, gum,
patches, etc. Bring your receipts to Employee Health
for reimbursement.
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23. Opt Out Information
 If an employee has health insurance coverage elsewhere, they
may OPT OUT of health insurance at Riverside and receive a
benefit credit every pay period.
 To receive this credit, you must…
 Provide proof of insurance each year.
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Fax or mail a copy of your insurance card to the Benefit Center
(Fax: 866-932-6838)
Please remember to put your name and employee ID number
on anything you send to the benefit center.
Participate in the REACH Employee Wellness Program to
get the full credit.
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Full Time Employees who Opt Out must participate in the
REACH wellness program to receive the full $45 opt out credit.
If you do not participate, you will receive a partial opt out credit
of $25.
Part Time Employees who Opt Out must participate in the
REACH wellness program to receive the full $20 opt out credit.
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24. Riverside Health Fitness Center
 Riverside will continue to offer employees monthly
membership at half price with a reduced enrollment
fee of $50 for new employee members.
 Riverside will pay 50% of monthly membership for
the first family member (i.e. spouse or dependent)
and the enrollment fee will be $75.
 This also applies if the second family member is
enrolling in the Fitness Island Membership
program
 To receive discounts, employees must pay through
payroll deduction, commit to a one year
membership, and be a 0.5 FTE or greater
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25. Enrollment Process
 Log on to the BenefitsTalk™ website at
www.benefitstalk.com/riverside
 Review online plan information
 Review your current elections
 Process your enrollment for 2014 by Nov 24
 Benefit Call Center representatives are
available toll free at (866) 932-6851

Monday through Friday from 7AM-6PM
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