2018 Benefits Enrollment Guide

Enroll Eligibility Health Prescription Drug Dental Vision FSA Life Disability Contacts Other Benefits Notices
2018 Benefits
Enrollment Guide
Enroll between
October 30 – November 17
This document includes links. Easily move to another section by clicking on words in the banner. Visit
a website by clicking a hyperlink. Go to another page by clicking the arrows on the side of the page.
For staff and faculty who are employees of Wake Forest Baptist Medical Center, Wake Forest University Health Sciences,
Cornerstone Health Care, Davie Medical Center, Lexington Medical Center, Community Physicians, Wilkes Medical Center
and The Hawthorne Inn and Conference Center
Welcome to Benefits Enrollment 2018

This is your annual opportunity to make new benefit choices!
Think of Open Enrollment as an annual checkup for your
benefits. Are your current plans still right for you and your Do I need to enroll?
family? Are you getting the most out of all Wake Forest Baptist Here’s what happens to your benefits if you do not
Medical Center offers? Use this time to review your current enroll by November 17:
health plans as well as all the other plans we provide. If you are currently enrolled in Wake Forest Baptist benefits, your
benefit elections will roll over except your flexible spending account
elections (you must enroll in flexible spending accounts each year
Make your elections online at WakeHealth.edu to participate).
between October 30 – November 17, 2017. If you are not currently enrolled in Medical Center benefits and
do not take action during the Open Enrollment period, you will not
have these benefits in 2018:
Once you’ve explored the benefit options available to you,
• Health • Supplemental life insurance
you’re ready to enroll. Choose your benefits carefully—
• Dental • Dependent life insurance
you won’t be able to make changes until the next Open
• Vision • Short term disability (STD)
Enrollment period unless you have a qualifying life event
• Health care or dependent care FSAs
(see “Making Mid-Year Changes” on page 6).
You will continue to have benefits provided by the Medical Center,
such as: basic life and AD&D insurance and long term disability (LTD).
The information presented in The 2018 Wake Forest University Baptist Health Special Note to Cornerstone Employees: Because Cornerstone
Benefits Guide is not intended to be construed as a contract between Wake Forest
Baptist and any Wake Forest Baptist associate or former employee for purposes of is transitioning to Wake Forest Baptist benefits in 2018, you must
employment or payment of benefits. In the event that the content of this guide or enroll in Wake Forest Baptist benefits to be covered in 2018. Your
any oral representations made by any person regarding the plan conflict with or are
inconsistent with the provisions of the plan document, the provisions of the plan current elections will not roll over. (See above).
document will control. Wake Forest Baptist reserves the right to amend, modify,
suspend, replace or terminate any of its plans, policies or programs, in whole or in
part, including any level or form of coverage, by appropriate company action, without
your consent or concurrence.
QUESTIONS? Call PeopleLink at 336-716-6464 or go to PeopleLink.WakeHealth.edu. | Enroll for benefits Oct. 30 – Nov. 17 2
What’s New or Changing Who Pays Health Care Costs?

Paying for coverage is a shared responsibility:
Health the Medical Center pays about 70% and you
Enroll from anywhere! • Your Health plan costs will increase. The
percentage of the increase depends on the
pay 30%, more or less, depending on the
plan option you choose and who you choose
Take some time to review your choices, then plan and coverage level you choose. See to cover.
enroll at work, home or on any computer with page 10 for “2018 Health Plan Costs.”
internet access 24/7. Just remember to act • Deductibles and annual out-of-pocket
before the November 17 deadline! maximums will increase for the Health Choice
You Pay
Go to WakeHealth.edu and Health Choice Plus plans, but only if you
1 30%
seek care outside the Wake Forest Baptist
2 lick on Employees and select PeopleSoft
C Health Network. See “An Overview of Your
HR/Payroll Medical Center
Health Plan Options” on page 8 for details.
pays 70%
3 L og in and select Main Menu, Self Service,
Dental and Vision
Benefits, then Benefits Enrollment
• Your Dental plan costs will stay the same.
Important! Before submitting your elections, What does the insurance company pay?
• Your Vision plan costs will increase. See
print the confirmation page for your records. Nothing.
page 16 for “2018 Vision Plan Costs.”
If you don’t have a printer, you can take a clear
photo of the confirmation page with your • You will no longer be able to pay for vision That’s because our health plans are self-
smartphone. materials, such as frames and contact lenses, insured. That means the Medical Center pays
purchased from Wake Forest Baptist Health the health and pharmacy claims for you and
The benefits you elect will go into effect on Optical Designs through payroll deductions. your family after you pay your out-of-pocket
January 1, 2018. The first payroll deductions costs (e.g., pay period contribution, co-pay,
for benefits will be on January 12, 2018, for Supplemental Life Insurance coinsurance). MedCost administers our plans,
employees paid biweekly, and January 26, 2018, • Your Supplemental Life Insurance costs processes claims and negotiates discounts
for employees paid monthly. will decrease by 10%. with doctors and hospitals.
When health care costs go up, the Medical
Center must pass along employees’ share
of the costs as increases in plan benefits
(deductibles, out-of-pocket maximums,
co-pays) and/or premium rates. But the
cost-sharing percentage stays the same.
If You Are Adding a

Dependent for 2018
In early 2017, we conducted an audit to verify
that all dependents enrolled in the health plan
met the requirements for enrollment. If you
submitted documentation to confirm your
dependents’ eligibility, you’re all set!
If you are enrolling dependents for the first
time (including Cornerstone employees) or
adding dependents to your benefit plans, the
Dependent Verification Center (an outside
vendor), who audits our dependents will contact
you to provide documentation to confirm
dependent eligibility. For example, if you Working Spouse Exclusion
want to add your spouse, you will be asked to
If your spouse works full time (30 hours or more weekly) for an employer other than the
provide a copy of a legal marriage certificate.
Medical Center and has ACA creditable health insurance available from his/her employer,
Dependents found to be ineligible will be
you cannot enroll him/her in the Medical Center’s health plan or vision plan. You may enroll
removed from the plans.
your spouse in dental coverage and dependent life insurance.
If you have questions, contact PeopleLink.
The only exceptions to this Working Spouse Exclusion occur when your spouse:
• Works for an employer that does not offer • Works part time (less than 30 hours weekly).
health insurance. • Is self-employed.
• Works for an employer that does not • Is disabled.
offer ACA creditable insurance coverage.
• Is retired.
(Employers with fewer than 50 employees are
not required to provide health insurance.)
If you are enrolled in a Medical Center health plan and your spouse loses other coverage during
the year (or after our Open Enrollment has ended), this is considered a qualifying life event
change, and you have 31 days from the date he/she loses coverage to add him/her to your
coverage.
Contact PeopleLink at 336-716-6464 or PeopleLink.WakeHealth.edu for assistance.
Computer Access for $100 Personal Care

Benefits Enrollment Management Incentive
You can enroll online at work or on any
Employees or dependents who have
computer with Internet access by going to
complex medical needs will be eligible for
WakeHealth.edu. If you do not have computer
a $100 incentive for active participation in
access, you can complete enrollment at any of
the MedCost Personal Care Management
the following Employee Computer Kiosks in
Program (PCM). The PCM program
locations throughout the Medical Center:
provides enrolled patients help with
• A1 Dean – Lobby prescription drug adherence and answers
• Fresh Inspirations Café – ActionHealth corner to treatment questions, as well as support
or in back, near patio exit and encouragement in dealing with difficult
• Ardmore, 2 Sub-Basement – Dietary and confusing medical conditions. The first
Breakroom $50 of the incentive will be paid after three
• Cancer Center, 2nd Floor – Breakroom near phone meetings with a PCM nurse. The
Taking Care of You!

Allegacy Kiosk remaining $50 will be paid upon completion
of the program.
• Gray Building, 1st Floor – Carpenter Library
All three 2018 health plans offer generous
• Medical Plaza Miller (formerly Comp Rehab) –
Basement Lobby Save Money and Time health benefits, including—at no charge to
you— annual physicals, wellness visits for
• Meads Hall, Ground Floor – ActionHealth with Coordinated Care your family, colonoscopies, mammograms,
information area bone density screenings, and prostate
If you use the Wake Forest Baptist Health
• Nutrition (Commons) Building, M Floor – screenings.
Network instead of going out of network, you:
Environmental Services Breakroom
• Receive care from one of America’s Also available to you: HOPE Program for
• Reynolds Tower, 1 Sub-Basement – Laundry diabetes, asthma, COPD and hypertension
consistently top-rated health systems.
Breakroom or Outside Elevators management; no-cost screening for smokers;
• Pay less for your care with lower copays,
• Sticht Center, Ground Floor – Breakroom Area smoking cessation classes; two low-cost
deductibles and out-of-pocket maximums.
• Watlington Hall – Left of pedestrian entrance fitness centers and more!
• Can take advantage of same day/next day
• Wilkes Human Resources office o find out more, visit
T
primary care and priority specialty care
appointments. ActionHealthNow.com.
Call 336-716-WAKE (9253).
Eligibility Making Mid-Year Changes

The benefit elections you make during Open Enrollment remain in
For You effect for the plan year (January 1 through December 31). You may
change coverage only when you experience a qualifying life event,
You are eligible if you are a full-time (30 standard hours or more) and you must do so within 31 days of the event.
or part-time (20 – 29 standard hours) staff or faculty member.
Qualifying Life Events
For Your Dependents • Change in status, which includes marital, number of dependents,
employment (yours or your spouse’s), change in residence or a
Your eligible dependents include your: dependent satisfies or ceases to satisfy eligibility requirements
Spouse A person to whom you are legally married under state • Change due to a legal judgment, decree or court order
law and with whom you have a certificate of marriage. • Significant cost or coverage changes
Children Your dependent children up to age 26. This includes • FMLA special requirements
your natural children, adopted children, stepchildren, • Entitlement to Medicare or Medicaid
foster children or children for whom you have
• HIPAA special enrollment rights
a Qualified Medical Child Support Order. With
certification, “child” may also include an adult child of Important! You must make your enrollment changes within
any age if disabled and dependent on you for support. 31 days of the event by contacting the PeopleLink team at
PeopleLink.WakeHealth.edu or calling 336-716-6464. PeopleLink
Grandchildren Your adopted grandchildren or grandchildren for
representatives are available 7:30 am to 5 pm, Monday – Friday.
whom you have legal guardianship.
Note: All changes must be consistent with your type of qualifying
life event, and you will be required to submit proper documentation.
PeopleLink will provide you with instructions on what documentation
is needed and how to submit it.
Health
You have a choice of three health plan options for 2018:
• Wake Forest Baptist Health Exclusive
• Wake Health Choice
• Wake Health Choice Plus
Highlights of the Health Plans

Wake Forest Baptist Health Exclusive Plan
• You and your covered dependents must receive care from a provider
with Wake Forest Baptist Health. Exceptions include Ob/Gyn, general
pediatrics and emergency care. Otherwise there is no coverage*,
and you are responsible for 100% of the costs.
• All inpatient, outpatient and ancillary surgical procedures must be
performed at a Wake Forest Baptist Health facility. See the Summary Save money with the
Plan Description for a full list of Wake Forest Baptist Exclusive facilities. Wake Forest Baptist Health Network
Wake Health Choice and Wake Health Choice Plus Plans No matter which plan you select, you and your family are encouraged
When you and your covered dependents need care, you can choose to use Wake Forest Baptist Health’s coordinated care network for health
a provider from one of these networks: services. You’ll receive care from one of America’s top-ranked health
• WFBH coordinated care network, or systems AND you’ll pay less for care with lower copays, deductibles
• MedCost network and out-of-pocket maximums.
With both plans, you pay less when you go to a provider within the
If You Earn $17 per Hour or Less…
WFBH coordinated care network. For example, you have no copay if you
go to a WFBH coordinated care network primary care physician (PCP); If you earn $17 per hour or less, are full-time and are covered under
however, if you go to a MedCost network PCP, you will have a $35 copay. the Medical Center’s health plan you will be eligible for a Medical
Center contribution of up to $200 annually to a health care flexible
If you go outside of these two networks for care, you are responsible
spending account debit card. These contributions will be made in
for 100% of the costs.*
January ($100) and July ($100).
* Exception: Coverage may be available for covered dependents who live outside the
network. See “If You Have Dependents Who Live Out-of-Area” on page 11.
An Overview of Your Health Plan Options

The chart reflects your costs for services.
Plan Feature Wake Forest Baptist Health Exclusive* Wake Health Choice Wake Health Choice Plus
WFBH Network MedCost Network WFBH Network MedCost Network WFBH Network MedCost Network
Deductibles
Individual $1,000 N/A $2,500 $4,500 $2,000 $3,500
Family $2,000 N/A $4,500 $8,000 $4,000 $7,000
Annual Out-of-pocket Maximums (includes coinsurance and medical/prescription copays)
Individual $3,000 N/A $6,000 $8,150 $4,000 $8,150
Family $6,000 N/A $8,000 $16,300 $7,000 $16,300
Copays and Coinsurance
Primary Care $0 N/A $0 $35 $0 $35
Physician
Specialist $10 N/A $20 $75 $20 $75
General Pediatrician $0 $15 $0 $15 $0 $15
Coinsurance 10% 30% 40% 50% 25% 40%
Urgent Care $10 (includes $35 copay $10 $35 $10 $35
FastMed)
Outpatient $50 copay N/A 40% after deductible $100 copay, then 50% 25% after deductible $100 copay, then 40%
Advanced Imaging after deductible after deductible
(MRI, PET and CT
scans)
Mental Health and 10% 30% 40% 50% 25% 40%
Substance Abuse $20 copay for any approved provider through Carolina Behavioral Alliance Network.
You must call 1-800-475-7900 for coverage.
*This plan requires that you use providers in the Wake Forest Baptist Health (WFBH) coordinated care network. In the event that WFBH coordinated care network does not have a
provider in the specialty that you seek, you may seek care from a provider in the MedCost network. For more guidance refer to the Summary Plan Description on the Intranet or call
MedCost at 1-800-475-7900.
Plan Feature Wake Forest Baptist Health Exclusive* Wake Health Choice Wake Health Choice Plus
WFBH Network MedCost Network WFBH Network MedCost Network WFBH Network MedCost Network
Emergency Room Copay (if not admitted as inpatient*)
Emergency Visit** $200 $200 $200 $200 $200 $200
Non-emergency 30% after deductible 30% after deductible 50% after deductible 50% after deductible 40% after deductible 40% after deductible
Visit
Hospital & Surgeon Fees
Inpatient 10% N/A 40% 50% 25% 40%
Hospital Care
Outpatient 10% N/A 40% 50% 25% 40%
Hospital Care
Surgeon/ 10% N/A 40% 50% 25% 40%
Physician Fees
Maternity Benefits
Maternity Physician $10 copay $50 copay $20 copay $75 copay $20 copay $75 copay
(SmartStarts) (non- SmartStarts) (SmartStarts) (non- SmartStarts) (SmartStarts) (non- SmartStarts)
Maternity Hospital 0% 0% 0% 0% 0% 0%
Charges, if enrolled (deductible waived) (deductible waived) (deductible waived) (deductible waived) (deductible waived) (deductible waived)
in the SmartStarts
prenatal program in
the first 20 weeks
and completed the
program.
Maternity Hospital 30% after deductible 30% after deductible 50% after deductible 50% after deductible 40% after deductible 40% after deductible
Charges, If NOT
enrolled in the
SmartStarts prenatal
program in the first
20 weeks or have
not completed the
program.
Please see inpatient coverage for benefits if admitted from the ER. Copay is waived.
** Emergency Medical Condition – This is a serious medical condition or symptom resulting from injury or illness that arises suddenly and requires immediate care and treatment to
avoid endangering life or health. Examples include, but are not limited to: heart attack, poisoning, loss of consciousness, convulsions and serious falls.
2018 Health Plan Costs (Pre-tax) Ob/Gyn Care

Coverage Level If You Are Paid Biweekly If You Are Paid Monthly
For routine care (such as PAP smears), the plan pays 100%. For non-routine
care, Ob/Gyn physicians are considered specialists. For pregnancy, you pay
Full-time Part-time Full-time Part-time
the specialist copay on the first visit, then professional services are covered in
Employees Employees Employees Employees
full for the remainder of the pregnancy; no copays are required for additional
Wake Forest Baptist Health Exclusive
visits. An Ob/Gyn specialist visit has a $20 copay at Wake Forest Baptist Health
You only $49.38 $228.00 $107.00 $494.00 and a $75 copay at a MedCost network provider. Please see the MedCost
You plus children $156.92 $455.54 $340.00 $987.00 website (MedCost.com) for more details.
You plus spouse
Infertility Services
$180.00 $480.92 $390.00 $1,042.00
You plus family $249.23 $630.00 $540.00 $1,365.00
• There is a $30,000 lifetime maximum dollar limit that applies to medical
Wake Health Choice
and prescriptions combined.
You only $26.31 $205.85 $57.00 $446.00
• You pay 20% of the contracted price of prescriptions, which must be filled
You plus children $87.69 $427.85 $190.00 $927.00 at a Medical Center pharmacy.
You plus spouse $99.23 $443.08 $215.00 $960.00 • Infertility services are covered as other medical conditions except for
You plus family $143.08 $570.00 $310.00 $1,235.00 dollar limits.
Wake Health Choice Plus • Services must be through the Wake Forest Baptist Health program.
You only $59.08 $255.23 $128.00 $553.00 • The covered employee or spouse is required to have been covered under
one of our health plans for a minimum of one year. The patient must be
You plus children $173.08 $498.46 $375.00 $1,080.00
insured by the Wake Health Choice Plus plan or Wake Forest Baptist
You plus spouse $212.31 $525.69 $460.00 $1,139.00 Health Exclusive plan to qualify for infertility services.
You plus family $274.62 $690.92 $595.00 $1,497.00
Bariatric Surgery
• The lifetime maximum for surgical-related expenses (including gastric
sleeve) is $35,000.
• See the Summary Plan Description (available on the Intranet) for guidelines.
• Services must be through the Wake Forest Baptist Health program.
• The covered employee or spouse is required to have been covered
under one of our health plans for a minimum of three years. The patient
must be insured by the Wake Health Choice Plus plan or Wake Forest
Baptist Health Exclusive plan in order to qualify.
If You Have Dependents Employee Assistance

Who Live Out-of-Area Program
Each of the 2018 health plans offers an out-of- The Employee Assistance Program (EAP)
is provided as an employer-paid benefit
area plan option for dependents. Dependents
to Medical Center staff/faculty and their
living outside the MedCost Network, including immediate family members. It is a confidential
college students, will be assigned a local service in which trained counselors offer
provider network in the state where the assessment and referral services to help
dependent resides if an out-of-area plan is resolve a range of personal/emotional
elected. Here’s how each plan pays benefits concerns, including:
SmartStarts Prenatal Program for out-of-area care for dependents. • Marital problems • Depression
• Family difficulties • Stress at home
If you or your spouse are pregnant, you
Wake Forest Baptist Health
or work
probably have many questions and need
Exclusive Plan • Anxiety
• Grief • Alcohol and
sound medical advice. MedCost offers a Dependents may use the assigned out-of- drug abuse
special program for patients who are pregnant area network for all covered services, and
Services are available at no cost to the
to answer difficult questions. This program the coverage will be the same as a MedCost
employee or immediate family members.
can also help prevent complications by network provider. Dependents will also have
teaching patients healthy habits and providing access to the Wake Forest Baptist Health To contact EAP or make an appointment,
practical tips. Exclusive Network when visiting the area. please call 336-716-5493. All calls and
Emergency care will be covered at the Wake appointments with EAP are strictly confidential.
If you are enrolled in the SmartStarts Prenatal
Forest Baptist rates, regardless of where the
Program in the first 20 weeks of pregnancy
and the program is completed, the hospital
emergency occurs. Elder Care Choices
delivery coinsurance and deductible will be Health Choice and Choice Plus Plans Elder Care Choices is an employer-paid benefit
waived. If enrolled after the first 20 weeks of that provides resources and assistance for
Dependents may use the assigned out-of-
pregnancy or if the SmartStarts Program is employees with caregiver concerns, Medicare
area network for all covered services, and the
not completed, the patient will be subject to questions, and other long-term care needs. This
coverage will be same as a Wake Forest Baptist
deductible and coinsurance for the delivery benefit is provided at no cost to the employee.
Health network provider.
based on their health plan (see “Maternity
Benefits” in the chart on page 9). Elder Care counselors are available
from 8 am – 5 pm, Monday through Friday.
For more information about the SmartStarts To contact Elder Care, call 336-748-2171
Prenatal Program, call 1-800-795-1023. or email ecc@seniorservicesinc.org.
ActionHealth Use the My MedCost Mobile Health Care Terms to Know

ActionHealth, the Medical Center’s employee App for Health and Dental Coinsurance: The percentage of the total
wellness program, supports the physical, mental cost you pay for health care services after
Once you’ve registered for an online
and spiritual well-being of all employees. The you’ve met the deductible. In other words,
account at www.MedCost.com,
program helps employees make voluntary if you have a diagnostic test that costs
you also can use the My MedCost
lifestyle changes that reduce their health risks $200 and your plan has 10% coinsurance,
Mobile App to access some of your favorite
and enhance their quality of life. you pay $20.
web features on your mobile device.
ActionHealth offers free programs and services Copay: A defined amount of money you pay
The App is free and available for quick
such as health assessments, consults (by phone for health care services. For example, if your
download from iTunes and Android markets.
or in person) with a registered dietitian or plan includes a $15 copay for a vision exam,
With the My MedCost App you can:
health coach, lunch-n-learns, classes, online that’s what you’ll pay for the visit — even if
• Review your ID card and email a copy to your
wellness challenges, lactation support and the total bill for the visit is higher.
doctor or dentist office
supplies, and more. The online wellness portal,
Deductible: The amount you must pay out
ActionHealthNow.com, promotes wellness • Order a new ID card
of pocket before your health plan begins
programs and allows employees to track their • Review your health & dental claims
to pay benefits for medical care other than
progress toward personal health and fitness • Check your flex balance services that have a copay.
goals.
• Look up a covered provider
In-network provider: A provider who
In January, employees will be invited to • Check your deductible and out of pocket has contracted with a health care plan (a
complete the 2018 Health Risk Assessment status medical, dental or vision plan) and agreed
(HRA) and blood work. Benefit-eligible
• Send a message to MedCost customer to certain rates. In most cases, you pay less
employees who complete both the HRA and
service and receive a higher benefit when you use
blood work will be entered into two grand-
in-network providers. Check with your plan
prize drawings per month, from January To register for an online account, select login
for coverage details.
through June. In addition, employees will have under the member portal at MedCost.com and
the opportunity to set a personal wellness follow the instructions to set up your account. Out-of-pocket maximum: The most
goal in January. For more details, please visit you’ll pay per plan year for covered health
ActionHealthNow.com. expenses before the plan pays 100%
of covered medical services including
prescription drug expenses.
Contact 336-716-WAKE (9253) to schedule appointments with a Wake Forest Baptist Health
physician. To find a provider, visit MedCost.com.
Prescription Drug Benefits Cornerstone and Wilkes employees do not currently have a local
Wake Forest Baptist pharmacy location and may use a local retail
If you enroll in a Medical Center health plan, you automatically receive pharmacy for their 30-day acute medications. Copays for these
prescription drug benefits. medications will be the same as using a Medical Center pharmacy.
Maintenance and specialty drugs must be filled via the Employee
Your cost will be lower if you use Wake Forest Baptist Health pharmacies Prescription Mail Service or at a Medical Center pharmacy.
for acute prescriptions (less than 30 days). Other retail pharmacies may be
used for acute prescriptions, but may require a higher copay.
Maintenance and specialty drugs must be filled at a Medical Why Generic?
Center pharmacy or by mail order. For generic and preferred brand
Using generic drugs reduces costs for you and the Medical Center.
maintenance drugs, you can get a three-month supply for a two-month
Generic drugs have the same active ingredients as brand-name drugs and
copay at Medical Center pharmacies (including mail order).
are subject to the same Food and Drug Administration (FDA) standards
The plan pays benefits according to the chart below. for quality, strength and purity as their brand name counterparts.
Drug Type WFBMC Pharmacy Non-WFBMC/Retail
(30-day supply) Copay Pharmacy Coverage Copay Healthy Outcomes Partnership for Employees
Generic $12 $20 Pharmacy Care Clinic administers an innovative program to care for
Preferred $30 35% coinsurance with $35 employees and their dependents with diabetes, asthma, COPD or
minimum and $80 maximum hypertension. Under the Healthy Outcomes Partnership for Employees
Non-preferred $60 40% coinsurance with $60 (HOPE) program, participants are offered enhanced care management
minimum to $120 maximum and waived copays for certain medications and supplies. Participants
must be covered by a Medical Center health plan. To find out more
Please note: Prescriptions will be automatically dispensed as generic
about this program, please email HopeProgram@WakeHealth.edu.
if available. You are required to pay the brand name copay plus the
difference in cost between the brand name and generic if you choose
a brand name when a generic is available.
Outpatient Pharmacies
Wake Forest Baptist Health operates seven pharmacies that can
be used by employees and patients.
Outpatient Pharmacy and Gift Shop 336-716-3363

Main floor, North Tower lobby Monday–Friday, 7 am–9 pm
(Winston-Salem campus) Saturday–Sunday, 9 am–5 pm
Comprehensive Cancer Center 336-713-6808
Outpatient Pharmacy Monday– Friday, 9 am– 6 pm
First floor, Cancer Center
(Winston-Salem campus)
Downtown Health Plaza Outpatient 336-713-9800
Pharmacy Monday–Wednesday, 8 am–7 pm
Martin Luther King Jr. Drive Thursday, 9 am–7 pm
Friday, 8 am–7 pm
Using the Prescription Mail Service Saturday, 9 am–1 pm
No more waiting in line at the pharmacy. Save time by receiving Medical Plaza–Clemmons Pharmacy 336-713-0900
2311 Lewisville-Clemmons Road Monday–Friday, 7:30 am–7 pm
prescriptions at home. Saturday–Sunday, 8:30 am–6 pm
• Possible savings with lower-cost • Pharmacists check each Medical Park– Lexington Pharmacy 336-243-2428
mail delivery pricing prescription for accuracy 2316 S. Main St., Lexington Monday– Friday, 9 am–6 pm
Saturday, 9 am–1 pm
• 90-day refills on most medicine • Pharmacists are available by
Bermuda Run Pharmacy 336-998-1030
• Refill your prescription online, via phone to answer your questions Davie Medical Center, Plaza 1 Monday– Friday, 8:30 am–5 pm
smartphone, telephone or email • Free standard shipping Hwy 801 N, Bermuda Run
Please note that prescriptions for controlled substances cannot Piedmont Plaza I Outpatient 336-716-5800
Pharmacy Monday–Tuesday, Thursday–Friday,
be filled via the Prescription Mail Service.
1920 W. First St. Lobby 8:30 am–6 pm
To enroll, go to Prescriptions.WakeHealth.edu. Call Wednesday, 9 am–6 pm
336-716-2982 or email RxMailOrder@WakeHealth.edu.
Need a prescription filled over the weekend?
Several of our pharmacies have weekend hours. If the outpatient
pharmacy you normally use is not open, we can electronically transfer
prescriptions and information to another of our pharmacies that has
weekend hours. Check the list for a pharmacy near you.
Dental 2018 Dental Plan Costs

You pay dental coverage with pre-tax dollars.
You can choose between two dental options: Wake Dental Choice and
Wake Dental Choice Plus. Both options cover services up to a reasonable Coverage Level If You Are Paid Biweekly If You Are Paid Monthly
and customary charge. Full-time Part-time Full-time Part-time
Employees Employees Employees Employees
Plan Feature Wake Dental Wake Dental
Choice Choice Plus Wake Dental Choice
Annual Deductible (does not apply to $50 Individual; $50 Individual; You only $4.62 $12 $10 $26
preventive care or orthodontia) $150 Family $150 Family You plus children $10.62 $26.77 $23 $58
Annual Maximum Per Covered Individual You plus spouse $10.15 $25.85 $22 $56
$750 $1,750
(does not include orthodontia)
You plus family $12.92 $32.31 $28 $70
Orthodontia Lifetime Maximum
Orthodontia benefit limited to dependents Not covered $2,000 Wake Dental Choice Plus
only, up to age 19. You only $8.77 $21.69 $19 $47
Preventive Care (includes: oral exams You plus children $21.23 $53.08 $46 $115
[2 per year], prophylaxis [2 per year],
topical fluoride up to age 15 [2 per year], 100%, no 100%, no You plus spouse $19.38 $48.46 $42 $105
emergency treatment of pain, bitewing deductible deductible You plus family $24.92 $62.77 $54 $136
X-rays [1 per year], full mouth services [once
every 3 years], sealants, space maintainers)
Restorative and Surgical Services Choose Any Dentist You Want
(includes: anesthesia, office visits, pulp cap, 80% after 80% after
root canal, periodontal scaling, replantation, deductible deductible Dental coverage is open access with MedCost. This means you can visit
oral surgery) the dentist of your choice. If your dentist will not file claims to MedCost
Prosthetics (includes: bridges, dentures, on your behalf, you can pay your dentist up front, then file a claim for
50% after
partials, inlays, onlays, crowns and dental Not covered reimbursement to MedCost.
deductible
implants)
Call MedCost Customer Service at 1-800-795-1023 or visit
Orthodontia
MedCost.com.
(includes: treatment plan, retention
appliance, full-banded orthodontia, and 50%, no
Not covered
fixed or removable appliance for tooth deductible
guidance.) Orthodontia benefit limited to
dependents only, up to age 19.
Vision Eyewear
If you enroll in one of the Medical Center health plans, you also can
choose vision eyewear coverage for yourself and covered dependents.
MedCost administers the vision plan (you’ll use the same ID card for
health, dental, and vision).
An annual eye exam is provided to all staff and dependents enrolled
in any of the three health plans with a $15 copay. If you only wish to
have an annual eye exam, you do not have to elect this coverage, which
covers vision hardware only.
The vision plan covers:
• Lenses up to $100 annually
• Frames and/or contacts up to $175 annually
• Contact lens fitting at 100% up to $35 annually
Employees can purchase their frames, lenses or contacts from the vendor
of their choice.
2018 Vision Plan Costs

Material Vision Plan Health Plan Enrollees
Cost (Pretax)
If You Are Paid Biweekly If You Are Paid Monthly
You only $5.19 $11.25
You plus child(ren) $9.35 $20.26
You plus spouse $10.91 $23.63
You plus family $16.62 $36.01
Note: You cannot pay for vision materials through payroll deductions.
Flexible Spending Accounts

Flexible spending accounts (FSAs), administered by MedCost, help you
save money on taxes by paying for a single year’s eligible health care and
dependent care expenses with pre-tax dollars. You choose the amount of
pre-tax money you want to have deducted from your paycheck, and it will
be deposited directly into your FSA. You must elect these accounts each
year. You cannot change your contribution rate during the year unless you
experience a qualifying life event like marriage or the birth of a child. So
make sure you plan ahead! See “Making Mid-year Changes” on page 6.
Health Care FSA

Even though your benefits cover many of your health care expenses, A Convenient Way to Pay for Health Care Expenses
you may need to pay some costs out-of-pocket. You can contribute
up to $2,600 each year to the health care FSA to pay for copays, Once enrolled in the health care FSA, you will automatically
deductibles and coinsurance related to your or your dependents’ receive an FSA Debit Card. The card makes it easy to use funds
out-of-pocket medical, dental, vision or prescription drug costs. in your health care FSA—and you don’t pay any fees to use the card.
The full amount you elect to contribute to your health care FSA You can use your debit card to pay eligible expenses at most healthcare
is available in your account on the first day of the plan year. Your providers that display the Visa® logo.
contributions will be deducted from your paycheck evenly over the If you had a flexible spending account in 2017 and currently have a
calendar year. debit card, please keep your card for 2018. Your 2018 election will be
Eligible expenses include: automatically added to your existing card.
• Medical expenses: copays, deductibles, coinsurance Important Health Care FSA Dates
• Dental expenses: deductibles and copays, braces
Payroll contribution period January 1 to December 31, 2018
• Vision expenses: prescription glasses, contact lenses, copays
Period to incur expenses January 1, 2018 to March 15, 2019
• Prescription drug costs
Period to file claim for 2018 January 1, 2018 to March 31, 2019
• Over-the-counter drugs with a prescription
• Hearing aids and batteries You have secure, 24-hour access to your account status, transaction
• And much more! details, and plan balance information by visiting MedCost.com.
Dependent Care FSA Use it or lose it!

The dependent care FSA offers you a tax-free way to pay yourself back Any money left in your flexible spending accounts at the end of the plan
for eligible dependent care expenses throughout the year. You can year will be forfeited under IRS rules. That’s why it’s so important that
contribute up to $5,000 each year to the dependent care FSA to pay you plan your expenses carefully and conservatively and not put more
for dependent day care expenses on a pre-tax basis if both you and money in your FSA than you think you’ll spend within a year on things like
your spouse work, your spouse goes to school full-time or your spouse copayments, coinsurance, drugs, and other allowed health care costs.
isn’t able to provide self-care. If both parents of a dependent child are
employed by the Medical Center, they must share the benefit with a
maximum total contribution of $5,000. Need Help or More Information?
Eligible expenses include: Daycare, day summer camp, after-school • For complete lists of eligible expenses, visit:
programs,and preschool expenses for children 12 years old and younger
–– Health care: IRS Publication 502 at
or disabled dependents of any age. Sleep-away or overnight camps
https://www.irs.gov/publications/p502 or MedCost.com
are not covered. You may also use this account to pay for adult daycare
services for an elderly parent who is your tax dependent. –– Dependent care: IRS Publication 503 at
https://www.irs.gov/publications/p503 or MedCost.com
Important Dependent Care FSA Dates • To view balances, file claims, upload receipts, and more:
Payroll contribution period January 1 to December 31, 2018 MedCost.com
Period to incur expenses January 1 to December 31, 2018 • For claims: MedCost.com/ClaimHelp.aspx
Period to file claim for 2018 January 1, 2018 to March 31, 2019
• For questions contact:
–– Medcost: Call 800-795-1023 from 8:30 am - 5:00 pm Monday
through Friday or go to MedCost.com. For requests outside
normal business hours, email MedCost Customer Service Contact
Center at mbscs@MedCost.com. MedCost will respond to your
request within 24 hours.
–– PeopleLink: Call 336-716-6464 or go to
PeopleLink.WakeHealth.edu.
Life Insurance
The Medical Center’s Life and AD&D coverage offers you and your dependents financial protection
in the event of your death or dismemberment. This coverage is provided through Cigna.
Basic Life and AD&D Insurance

As a Wake Forest Baptist employee, you automatically receive basic life insurance and accidental
death and dismemberment (AD&D) coverage at no cost to you — equal to one times your annual
salary, rounded up to the next $1,000 (up to $200,000). Life and AD&D coverage is an employer-
paid benefit for eligible employees.
Supplemental Life Insurance

If you think you need more coverage than the basic coverage provides, you may buy supplemental
life and AD&D insurance equal to one, two, three or four times your basic annual salary, rounded
up to the next $1,000, subject to the maximum benefit level and approval by Cigna. Supplemental
Life rates will be reduced by 10% effective January 2018.
If you elect or increase supplemental life or disability coverage, Cigna will contact you to provide an
Evidence of Insurability (EOI) form. This is sometimes called “proof of good health” and is used to
qualify for certain amounts of life insurance or disability coverage.
Exception for Cornerstone employees: Since you are enrolling in the Medical Center benefits
for the first time for 2018, you will not be required to provide EOI to enroll in coverage.
Dependent Life Insurance

You also may purchase life insurance for your spouse and your eligible children in the amount of
$10,000 or $25,000 per spouse or child/children, subject to approval by Cigna.
Disability
The Medical Center offers disability coverage, to protect you in case you cannot work for an
extended period of time due to an illness, injury, or other condition. This coverage is provided
through Cigna.
Short Term Disability

Short term disability (STD) pays a weekly benefit of 60% of your pay. Benefits begin after 30 or 60
consecutive days of hospitalization, sickness or injury and continues as long as you are disabled
(up to 26 weeks). STD benefits will end on the date long term disability benefits become payable
to you. STD is an employee-paid option. If you’re not already enrolled in an STD plan, you can
elect STD during Open Enrollment, subject to approval by Cigna. If you’re increasing coverage
(i.e., changing from a 60-day wait to a 30-day wait) or electing STD for the first time, you must
complete an Evidence of Insurability form.
Exception for Cornerstone employees: Since you are enrolling in the Medical Center benefits
for the first time for 2018, you will not be required to provide EOI to enroll in coverage.
Long Term Disability

Long term disability (LTD) benefits begin after you have been disabled for more than 180 days. The
coverage ensures that you will receive 60% of your pay for the duration of your disability until age
65 (or older, if your disability begins on or after age 62) or until other plan limitations have been
met. LTD coverage is an employer-paid benefit for eligible employees. There is no action required
on your part; the Medical Center will automatically enroll you in the LTD plan if you’re eligible.
Contacts
For Questions About Vendor Phone Website/Email
All Medical Center Benefits PeopleLink 336-716-6464 PeopleLink.WakeHealth.edu
Health and Prescription Drug MedCost 800-795-1023 www.MedCost.com
Prescription Drugs 336-716-2982 See page 14 for a list of outpatient pharmacies
Prescription Mail Service 336-716-2982 To enroll, go to Prescriptions.WakeHealth.edu.
Email RxMailOrder@WakeHealth.edu.
Mental Health and Substance Abuse Carolina Behavioral Health 800-475-7900 www.cbhallc.com
SmartStarts Maternity Education Program MedCost 800-795-1023 www.MedCost.com/prenatal/prenatalhome.htm
Dental and Vision MedCost 800-795-1023 www.MedCost.com
Flexible Spending Accounts MedCost 800-795-1023 www.MedCost.com
Life/AD&D Insurance and Disability Cigna 800-362-4462 www.Cigna.com
Elder Care Choices Senior Services 336-748-2171 www.seniorservicesinc.org
Other Benefit Offerings
Legal Insurance Pet Insurance

Legal insurance helps you address everyday situations like dealing with The My Pet Protection insurance plan is available to benefit-eligible
traffic tickets, resolving warranty issues or buying a home. ARAG offers employees through Nationwide. Use any vet, and get 90% reimbursement
legal insurance that features in-office services, telephone advice and on the bill. Enroll at any time.
online resources. Enroll during the Medical Center’s Open Enrollment
For details, visit poi8.PetInsurance.com/benefits/ncbh-npr.
period, October 30—November 17.
For details, call 1-800-247-4184 or visit ARAGlegalcenter.com
and enter access code 14200wfb.
Legal Notices
You have the right to request and receive (free of charge) paper copies of any of the When Can You Join A Medicare Drug Plan?
enrollment materials, including the legal notices. Send your request to PeopleLink
at 336-716-6464 or PeopleLink.WakeHealth.edu. You can join a Medicare drug plan when you first become eligible for Medicare
and each year from October 15th to December 7th.
Important Notice from Your Employer- However, if you lose your current creditable prescription drug coverage,
Sponsored Health Plan About Your 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.
Prescription Drug Coverage and Medicare
What Happens To Your Current Coverage If You Decide to Join
Please read this notice carefully and keep it where you can find it. This notice A Medicare Drug Plan?
has information about your current prescription drug coverage with your
employer-sponsored health plan and about your options under Medicare’s If you decide to join a Medicare drug plan, your current health coverage may
prescription drug coverage. This information can help you decide whether or be affected. However, in most situations, self-funded group health coverage
not you want to join a Medicare drug plan. If you are considering joining, you with prescription drug coverage will not be affected if a member decides to
should compare your current coverage, including which drugs are covered join a Medicare drug plan.
at what cost, with the coverage and costs of the plans offering Medicare If you do decide to join a Medicare drug plan and drop your current health
prescription drug coverage in your area. Information about where you can coverage, be aware that you and your dependents may not be able to get the
get help to make decisions about your prescription drug coverage is at the coverage back until the next open enrollment period. The exception to this is
end of this notice. a ‘change in status’ event that causes a loss of other coverage.
There are two important things you need to know about your current When Will You Pay A Higher Premium (Penalty) To Join
coverage and Medicare’s prescription drug coverage: A Medicare Drug Plan?
1. Medicare prescription drug coverage became available in 2006 to everyone You should also know that if you drop or lose your current coverage with your
with Medicare. You can get this coverage if you join a Medicare Prescription employer-sponsored health plan and don’t join a Medicare drug plan within
Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that 63 continuous days after your current coverage ends, you may pay a higher
offers prescription drug coverage. All Medicare drug plans provide at least premium (a penalty) to join a Medicare drug plan later.
a standard level of coverage set by Medicare. Some plans also may offer
more coverage for a higher monthly premium. 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
2. Your employer-sponsored health plan has determined that the prescription base beneficiary premium per month for every month that you did not have that
drug coverage offered by your employer-sponsored health plan is, on coverage. For example, if you go nineteen months without creditable coverage,
average for all plan participants, expected to pay out as much as standard your premium may consistently be at least 19% higher than the Medicare base
Medicare prescription drug coverage pays and is therefore considered beneficiary premium. You may have to pay this higher premium (a penalty) as long
Creditable Coverage. Because your existing coverage is Creditable as you have Medicare prescription drug coverage. In addition, you may have to
Coverage, you can keep this coverage and not pay a higher premium wait until the following October to join.
(a penalty) if you later decide to join a Medicare drug plan.
For More Information About This Notice Or Your Current

Prescription Drug Coverage…
Notice of Privacy Practices
THIS NOTICE OF PRIVACY PRACTICES DESCRIBES HOW MEDICAL
Contact the person listed below for further information. NOTE: You’ll get this
INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW
notice each year. You also will get it before the next period you can join a YOU CAN GET ACCESS TO THIS INFORMATION.
Medicare drug plan, and if this coverage through your employer-sponsored PLEASE REVIEW IT CAREFULLY.
health plan changes. You also may request a copy of this notice at any time.
This Notice of Privacy Practices (the “Notice”) describes the legal obligations of your
For More Information About Your Options Under Medicare Group Health Plan (the “Plan”) and your legal rights regarding your protected health
Prescription Drug Coverage…
information held by the Plan under the Health Insurance Portability and Accountability Act
of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health
More detailed information about Medicare plans that offer prescription drug Act (HITECH Act). Among other things, this Notice describes how your protected health
coverage is in the “Medicare & You” handbook. You’ll get a copy of the information may be used or disclosed to carry out treatment, payment, or health care
operations, or for any other purposes that are permitted or required by law.
handbook in the mail every year from Medicare. You also may be contacted
directly by Medicare drug plans. We are required to provide this Notice of Privacy Practices to you pursuant to HIPAA.
The HIPAA Privacy Rule protects only certain medical information known as “protected
For more information about Medicare prescription drug coverage: health information.” Generally, protected health information is health information,
• Visit www.medicare.gov. including demographic information, collected from you or created or received by a health
care provider, a health care clearinghouse, a health plan, or your employer on behalf of a
• Call your State Health Insurance Assistance Program for personalized help.
group health plan, from which it is possible to individually identify you and that relates to:
(See the inside back cover of your copy of the “Medicare & You” handbook for
1. Your past, present, or future physical or mental health or condition;
their telephone number.)
2. The provision of health care to you; or
• Call 1-800-MEDICARE (633-4227). TTY users should call 1-877-486-2048.
3. The past, present, or future payment for the provision of health care to you.
If you have limited income and resources, extra help paying for Medicare If you have any questions about this Notice or about our privacy practices, please contact
prescription drug coverage is available. For information about this extra help, the Plan Administrator, as designated in your Summary Plan Description.
visit Social Security on the Web at www.socialsecurity.gov, or call them at
1-800-772-1213 (TTY 1-800-325-0778). EFFECTIVE DATE
This Notice is effective August 15, 2013.
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 OUR RESPONSIBILITIES
notice when you join to show whether or not you have maintained creditable We are required by law to:
coverage and, therefore, whether or not you are required to pay a higher • Maintain the privacy of your protected health information;
premium (a penalty). • Provide you with certain rights with respect to your protected health information;
• Provide you with a copy of this Notice of our legal duties and privacy practices with
Date: October 15, 2017 respect to your protected health information; and
Name of Entity/Sender: Plan Adminstrator • Follow the terms of the Notice that is currently in effect.
Plan: Wake Baptist University Medical Center We reserve the right to change the terms of this Notice and to make new provisions
& Affiliates Employee Benefits regarding your protected health information that we maintain, as allowed or required
Contact—Position/Office: Benefits Department by law. If we make any material change to this Notice, we will provide you with a copy
Address: Medical Center Boulevard, Winston-Salem, NC 27157 of our revised Notice of Privacy Practices.
Phone Number: 336-716-6464
HOW WE MAY USE AND DISCLOSE YOUR PROTECTED As Required by Law. We will disclose your protected health information when required to
HEALTH INFORMATION
do so by federal, state, or local law. For example, we may disclose your protected health
information when required by national security laws or public health disclosure laws.
Under the law, we may use or disclose your protected health information under certain To Avert a Serious Threat to Health or Safety. We may use and disclose your protected
circumstances without your permission. The following categories describe the different health information when necessary to prevent a serious threat to your health and safety,
ways that we may use and disclose your protected health information. For each category or the health and safety of the public or another person. Any disclosure, however, would
of uses or disclosures, we will explain what we mean and present some examples. Not only be to someone able to help prevent the threat. For example, we may disclose your
every use or disclosure in a category will be listed. However, all of the ways we are protected health information in a proceeding regarding the licensure of a physician.
permitted to use and disclose information will fall within one of the categories.
To Plan Sponsors. For the purpose of administering the plan, we may disclose to certain
For Treatment. We may use or disclose your protected health information to facilitate employees of the Plan Sponsor protected health information. However, those employees
medical treatment or services by providers. We may disclose medical information about will only use or disclose that information as necessary to perform plan administration
you to providers, including doctors, nurses, technicians, medical students, or other functions or as otherwise required by HIPAA, unless you have authorized further
hospital personnel who are involved in taking care of you. For example, we may share your disclosures. Your protected health information cannot be used for employment purposes
protected health information with a utilization review or precertification service provider. without your specific authorization.
For Payment. We may use or disclose your protected health information to determine
your eligibility for Plan benefits, to facilitate payment for the treatment and services you SPECIAL SITUATIONS
receive from health care providers, to determine benefit responsibility under the Plan, In addition to the above, the following categories describe other possible ways that
or to coordinate Plan coverage. For example, we may tell your health care provider we may use and disclose your protected health information without your specific
about your medical history to determine whether a particular treatment is experimental, authorization. For each category of uses or disclosures, we will explain what we mean and
investigational, or medically necessary, or to determine whether the Plan will cover the present some examples. Not every use or disclosure in a category will be listed. However,
treatment. Likewise, we may share your protected health information with another entity all of the ways we are permitted to use and disclose information will fall within one of the
to assist with the adjudication or subrogation of health claims or to another health plan categories.
to coordinate benefit payments.
Organ and Tissue Donation. If you are an organ donor, we may release your protected
For Health Care Operations. We may use and disclose your protected health information health information after your death to organizations that handle organ procurement
for other Plan operations. These uses and disclosures are necessary to run the Plan. or organ, eye, or tissue transplantation or to an organ donation bank, as necessary to
For example, we may use medical information in connection with conducting quality facilitate organ or tissue donation and transplantation.
assessment and improvement activities; underwriting, premium rating, and other
Military. If you are a member of the armed forces, we may release your protected health
activities relating to Plan coverage; submitting claims for stop-loss (or excess-loss)
information as required by military command authorities. We may also release protected
coverage; conducting or arranging for medical review, legal services, audit services, and
health information about foreign military personnel to the appropriate foreign military
fraud and abuse detection programs; business planning and development such as cost
authority.
management; and business management and general Plan administrative activities.
However, we will not use your genetic information for underwriting purposes. Workers’ Compensation. We may release your protected health information for workers’
compensation or similar programs, but only as authorized by, and to the extent necessary
Treatment Alternatives or Health-Related Benefits and Services. We may use and
to comply with, laws relating to workers’ compensation and similar programs that provide
disclose your protected health information to send you information about treatment
benefits for work-related injuries or illness.
alternatives or other health-related benefits and services that might be of interest to you.
Public Health Risks. We may disclose your protected health information for public health
To Business Associates. We may contract with individuals or entities known as Business
activities. These activities generally include the following:
Associates to perform various functions on our behalf or to provide certain types of
• To prevent or control disease, injury, or disability;
services. In order to perform these functions or to provide these services, Business
Associates will receive, create, maintain, transmit, use, and/or disclose your protected • To report births and deaths;
health information, but only after they agree in writing with us to implement appropriate • To report child abuse or neglect;
safeguards regarding your protected health information. For example, we may disclose • To report reactions to medications or problems with products;
your protected health information to a Business Associate to process your claims for Plan
benefits or to provide support services, such as utilization management, pharmacy benefit • To notify people of recalls of products they may be using;
management, or subrogation, but only after the Business Associate enters into a Business
Associate contract with us.
• To notify a person who may have been exposed to a disease or may be at risk for REQUIRED DISCLOSURES
contracting or spreading a disease or condition;
The following is a description of disclosures of your protected health information we are
• To notify the appropriate government authority if we believe that a patient has been the required to make.
victim of abuse, neglect, or domestic violence. We will only make this disclosure if you
agree, or when required or authorized by law. Government Audits. We are required to disclose your protected health information to
the Secretary of the United States Department of Health and Human Services when the
Health Oversight Activities. We may disclose your protected health information to Secretary is investigating or determining our compliance with the HIPAA privacy rule.
a health oversight agency for activities authorized by law. These oversight activities Disclosures to You. When you request, we are required to disclose to you the portion of
include, for example, audits, investigations, inspections, and licensure. These activities are your protected health information that contains medical records, billing records, and any
necessary for the government to monitor the health care system, government programs, other records used to make decisions regarding your health care benefits. We are also
and compliance with civil rights laws. required, when requested, to provide you with an accounting of most disclosures of your
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose your protected health information if the disclosure was for reasons other than for payment,
protected health information in response to a court or administrative order. We may also treatment, or health care operations, and if the protected health information was not
disclose your protected health information in response to a subpoena, discovery request, disclosed pursuant to your individual authorization.
or other lawful process by someone involved in a legal dispute, but only if efforts have
been made to tell you about the request or to obtain a court or administrative order OTHER DISCLOSURES
protecting the information requested. Personal Representatives. We will disclose your protected health information
Law Enforcement. We may disclose your protected health information if asked to do so to individuals authorized by you, or to an individual designated as your personal
by a lawenforcement official in response to a court order, subpoena, warrant, summons, representative, attorney-in-fact, etc., so long as you provide us with a written notice/
or similar process; authorization and any supporting documents (i.e., power of attorney). Note: Under the
• To identify or locate a suspect, fugitive, material witness, or missing person; HIPAA privacy rule, we do not have to disclose information to a personal representative
• About the victim of a crime if, under certain limited circumstances, we are unable to if we have a reasonable belief that: (1) you have been, or may be, subjected to domestic
obtain the victim’s agreement; violence, abuse, or neglect by such person; or (2) treating such person as your personal
representative could endanger you; and (3) in the exercise of professional judgment,
• About a death that we believe may be the result of criminal conduct; and about
it is not in your best interest to treat the person as your personal representative.
criminal conduct.
Spouses and Other Family Members. In most situations, we send mail to the
Coroners, Medical Examiners, and Funeral Directors. We may release protected health employee/member. This includes mail relating to the employee’s spouse and other
information to a coroner or medical examiner. This may be necessary, for example, to family members who are covered under the Plan, and includes mail with information
identify a deceased person or determine the cause of death. We may also release medical on the use of Plan benefits by the employee’s spouse and other family members and
information about patients to funeral directors, as necessary to carry out their duties. information on the denial of any Plan benefits to the employee’s spouse and other
National Security and Intelligence Activities. We may release your protected health family members. If a person covered under the Plan has requested Restrictions or
information to authorized federal officials for intelligence, counterintelligence, and other Confidential Communications (see below under “Your Rights”), and if we have agreed
national security activities authorized by law. to the request, we will send mail as provided by the request for Restrictions or
Inmates. If you are an inmate of a correctional institution or are in the custody of a Confidential Communications.
law-enforcement official, we may disclose your protected health information to the Authorizations. Other uses or disclosures of your protected health information not
correctional institution or law-enforcement official if necessary (1) for the institution to described above will only be made with your written authorization. For example, in
provide you with health care; (2) to protect your health and safety or the health and safety general and subject to specific conditions, we will not use or disclose your psychiatric
of others; or (3) for the safety and security of the correctional institution. notes; we will not use or disclose your protected health information for marketing;
Research. We may disclose your protected health information to researchers when: and we will not sell your protected health information, unless you give us a written
(1) the individual identifiers have been removed; or (2) when an institutional review board authorization. You may revoke written authorizations at any time, so long as the
or privacy board has reviewed the research proposal and established protocols to ensure revocation is in writing. Once we receive your written revocation, it will only be effective
the privacy of the requested information, and approves the research. for future uses and disclosures. It will not be effective for any information that may have
been used or disclosed in reliance upon the written authorization and prior to receiving
your written revocation.
YOUR RIGHTS To request this list or accounting of disclosures, you must submit your request in writing to
the Plan Administrator. Your request must state the time period you want the accounting
You have the following rights with respect to your protected health information: to cover, which may not be longer than six years before the date of the request. Your
Right to Inspect and Copy. You have the right to inspect and copy certain protected request should indicate in what form you want the list (for example, paper or electronic).
health information that may be used to make decisions about your Plan benefits. If the The first list you request within a 12-month period will be provided free of charge. For
information you request is maintained electronically, and you request an electronic copy, additional lists, we may charge you for the costs of providing the list. We will notify you
we will provide a copy in the electronic form and format you request, if the information of the cost involved and you may choose to withdraw or modify your request at that time
can be readily produced in that form and format; if the information cannot be readily before any costs are incurred.
produced in that form and format, we will work with you to come to an agreement on form Right to Request Restrictions. You have the right to request a restriction or limitation
and format. If we cannot agree on an electronic form and format, we will provide you with on your protected health information that we use or disclose for treatment, payment, or
a paper copy. health care operations. You also have the right to request a limit on your protected health
To inspect and copy your protected health information, you must submit your request in information that we disclose to someone who is involved in your care or the payment for
writing to the Plan Administrator. If you request a copy of the information, we may charge your care, such as a family member or friend. For example, you could ask that we not use
a reasonable fee for the costs of copying, mailing, or other supplies associated with your or disclose information about a surgery that you had.
request. Except as provided in the next paragraph, we are not required to agree to your request.
We may deny your request to inspect and copy in certain very limited circumstances. If However, if we do agree to the request, we will honor the restriction until you revoke it or
you are denied access to your medical information, you may request that the denial be we notify you.
reviewed by submitting a written request to the Plan Administrator. We will comply with any restriction request if (1) except as otherwise required by law,
Right to Amend. If you feel that the protected health information we have about you is the disclosure is to a health plan for purposes of carrying out payment or health care
incorrect or incomplete, you may ask us to amend the information. You have the right to operations (and is not for purposes of carrying out treatment); and (2) the protected
request an amendment for as long as the information is kept by or for the Plan. health information pertains solely to a health care item or service for which the health care
To request an amendment, your request must be made in writing and submitted to the provider involved has been paid in full by you or another person. To request restrictions,
Plan Administrator. In addition, you must provide a reason that supports your request. you must make your request in writing to the Plan Administrator. In your request, you
must tell us (1) what information you want to limit; (2) whether you want to limit our
We may deny your request for an amendment if it is not in writing or does not include
use, disclosure, or both; and (3) to whom you want the limits to apply -- for example,
a reason to support the request. In addition, we may deny your request if you ask us to
disclosures to your spouse.
amend information that:
• Is not part of the medical information kept by or for the Plan; Right to Request Confidential Communications. You have the right to request that we
communicate with you about medical matters in a certain way or at a certain location. For
• Was not created by us, unless the person or entity that created the information is no
example, you can ask that we only contact you at work or by mail.
longer available to make the amendment;
To request confidential communications, you must make your request in writing to the
• Is not part of the information that you would be permitted to inspect and copy; or is
Plan Administrator. We will not ask you the reason for your request. Your request must
already accurate and complete.
specify how or where you wish to be contacted. We will accommodate all reasonable
If we deny your request, you have the right to file a statement of disagreement with us requests.
and any future disclosures of the disputed information will include your statement. Right to Be Notified of a Breach. You have the right to be notified in the event that we
Right to an Accounting of Disclosures. You have the right to request an “accounting” (or a Business Associate) discover a breach of unsecured protected health information.
of certain disclosures of your protected health information. The accounting will not Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice.
include (1) disclosures for purposes of treatment, payment, or health care operations; You may ask us to give you a copy of this Notice at any time. Even if you have agreed to
(2) disclosures made to you; (3) disclosures made pursuant to your authorization; (4) receive this notice electronically, you are still entitled to a paper copy of this notice.
disclosures made to friends or family in your presence or because of an emergency; (5)
You may obtain a copy of this notice at the following website: http://www.medcost.com/
disclosures for national security purposes; and (6) disclosures incidental to otherwise
permissible disclosures. To obtain a paper copy of this notice, contact the Plan Administrator.
COMPLAINTS If you live in one of the following states, you may be eligible for assistance paying
your employer health plan premiums. The following list of states is current as of
If you believe that your privacy rights have been violated, you may file a complaint with August 10, 2017. Contact your State for more information on eligibility.
the Plan or with the Office for Civil Rights of the United States Department of Health
and Human Services. To file a complaint with the Plan, contact the Plan Administrator. ALABAMA – Medicaid
All complaints must be submitted in writing. Website: http://myalhipp.com/
You will not be penalized, or in any other way retaliated against, for filing a complaint with Phone: 1-855-692-5447
the Office for Civil Rights or with us. ALASKA – Medicaid
The AK Health Insurance Premium Payment Program
POTENTIAL IMPACT OF STATE LAWS Website: http://myakhipp.com/
The HIPAA Privacy Regulations generally do not ‘preempt’ (or take precedence over) state Phone: 1-866-251-4861
privacy or other applicable laws that provide individuals greater privacy protections. As a Email: CustomerService@MyAKHIPP.com
result, to the extent state law applies, the privacy laws of a particular state, or other federal Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx
laws, rather than the HIPAA Privacy Regulations, might impose a privacy standard under
ARKANSAS – Medicaid
which we will be required to operate. For example, where such laws have been enacted,
Website: http://myarhipp.com/
we will follow more stringent state privacy laws that relate to uses and disclosures of
Phone: 1-855-MyARHIPP (855-692-7447)
protected health information concerning HIV, or AIDS, mental health, substance abuse/
chemical dependency, genetic testing, and reproductive rights. COLORADO – Health First Colorado (Colorado’s Medicaid Program) & Child Health
Plan Plus (CHP+)
Premium Assistance Under Medicaid and Medicaid Website: https://www.healthfirstcolorado.com/
theChildren’s Health Insurance Program Health First Colorado Member Contact Center: 1-800-221-3943/ State Relay 711
CHP+: Colorado.gov/HCPF/Child-Health-Plan-Plus
(CHIP) CHP+ Customer Service: 1-800-359-1991/ State Relay 711
FLORIDA – Medicaid
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health Website: http://flmedicaidtplrecovery.com/hipp/
coverage from your employer, your state may have a premium assistance program that Phone: 1-877-357-3268
can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or
your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium GEORGIA – Medicaid
assistance programs, but you may be able to buy individual insurance coverage through Website: http://dch.georgia.gov/medicaid
the Health Insurance Marketplace. For more information, visit www.healthcare.gov. - Click on Health Insurance Premium Payment (HIPP)
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a Phone: 404-656-4507
State listed below, contact your State Medicaid or CHIP office to find out if premium INDIANA – Medicaid
assistance is available. Healthy Indiana Plan for low-income adults 19-64
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think Website: http://www.in.gov/fssa/hip/
you or any of your dependents might be eligible for either of these programs, contact Phone: 1-877-438-4479
your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov All other Medicaid
to find out how to apply. If you qualify, ask your state if it has a program that might help Website: http://www.indianamedicaid.com
you pay the premiums for an employer-sponsored plan. Phone 1-800-403-0864
If you or your dependents are eligible for premium assistance under Medicaid or IOWA – Medicaid
CHIP, as well as eligible under your employer plan, your employer must allow you to Website: http://dhs.iowa.gov/ime/members/medicaid-a-to-z/hipp
enroll in your employer plan if you aren’t already enrolled. This is called a “special Phone: 1-888-346-9562
enrollment” opportunity, and you must request coverage within 60 days of being
determined eligible for premium assistance. If you have questions about enrolling in KANSAS – Medicaid
your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call Website: http://www.kdheks.gov/hcf/
1-866-444-EBSA (3272). Phone: 1-785-296-3512
KENTUCKY – Medicaid NORTH DAKOTA – Medicaid

Website: http://chfs.ky.gov/dms/default.htm Website:http://www.nd.gov/dhs/services/medicalserv/medicaid/
Phone: 1-800-635-2570 Phone: 1-844-854-4825
LOUISIANA – Medicaid OKLAHOMA – Medicaid and CHIP
Website: http://dhh.louisiana.gov/index.cfm/subhome/1/n/331 Website: http://www.insureoklahoma.org
Phone: 1-888-695-2447 Phone: 1-888-365-3742
MAINE – Medicaid OREGON – Medicaid
Website: http://www.maine.gov/dhhs/ofi/public-assistance/index.html Website:
Phone: 1-800-442-6003 http://healthcare.oregon.gov/Pages/index.aspx
TTY: Maine relay 711 http://www.oregonhealthcare.gov/index-es.html
Phone: 1-800-699-9075
MASSACHUSETTS – Medicaid and CHIP
Website: http://www.mass.gov/eohhs/gov/departments/masshealth/ PENNSYLVANIA – Medicaid
Phone: 1-800-462-1120 Website:http://www.dhs.pa.gov/provider/medicalassistance/
healthinsurancepremiumpaymenthippprogram/index.htm
MINNESOTA – Medicaid
Phone: 1-800-692-7462
Website: http://mn.gov/dhs/people-we-serve/seniors/health-care/health-care-
programs/programs-and-services/medical-assistance.jsp RHODE ISLAND – Medicaid
Phone: 1-800-657-3739 Website: http://www.eohhs.ri.gov/
Phone: 401-462-5300
MISSOURI – Medicaid
Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm SOUTH CAROLINA – Medicaid
Phone: 573-751-2005 Website: http://www.scdhhs.gov
Phone: 1-888-549-0820
MONTANA – Medicaid
Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP SOUTH DAKOTA – Medicaid
Phone: 1-800-694-3084 Website: http://dss.sd.gov
Phone: 1-888-828-0059
NEBRASKA – Medicaid
Website: http://dhhs.ne.gov/Children_Family_Services/AccessNebraska/ TEXAS – Medicaid
Pages/accessnebraska_index.aspx Website: http://gethipptexas.com/
Phone: 1-855-632-7633 Phone: 1-800-440-0493
NEVADA – Medicaid UTAH – Medicaid and CHIP
Medicaid Website: http://dwss.nv.gov/ Medicaid Website: https://medicaid.utah.gov/
Medicaid Phone: 1-800-992-0900 CHIP Website: http://health.utah.gov/chip
Phone: 1-877-543-7669
NEW HAMPSHIRE – Medicaid
Website:http://www.dhhs.nh.gov/oii/documents/hippapp.pdf VERMONT– Medicaid
Phone: 603-271-5218 Website: http://www.greenmountaincare.org/
Phone: 1-800-250-8427
NEW YORK – Medicaid
Website:http://www.nyhealth.gov/health_care/medicaid/ VIRGINIA – Medicaid and CHIP
Phone: 1-800-541-2831 Medicaid Website: http://www.coverva.org/programs_premium_assistance.cfm
Medicaid Phone: 1-800-432-5924
NORTH CAROLINA – Medicaid
CHIP Website: http://www.coverva.org/programs_premium_assistance.cfm
Website: https://dma.ncdhhs.gov/
CHIP Phone: 1-855-242-8282
Phone: 919-855-4100
WASHINGTON – Medicaid
Website: http://www.hca.wa.gov/free-or-low-cost-health-care/ NOTICE REGARDING WELLNESS
program-administration/premium-payment-program
Phone: 1-800-562-3022 ext. 15473
PROGRAM
WEST VIRGINIA – Medicaid ActionHealth is a voluntary wellness program available to all eligible WFBH employees.
Website: http://www.dhhr.wv.gov/bms/Medicaid%20Expansion/Pages/default.aspx The program is administered according to federal rules permitting employer-sponsored
Phone: 1-877-598-5820, HMS Third Party Liability wellness programs that seek to improve employee health or prevent disease, including
the Americans with Disabilities Act of 1990, the Genetic Information Nondiscrimination
WISCONSIN – Medicaid and CHIP Act of 2008, and the Health Insurance Portability and Accountability Act, as applicable,
Website: https://www.dhs.wisconsin.gov/publications/p1/p10095.pdf among others.
Phone: 1-800-362-3002
WYOMING – Medicaid
Wellness Program Components
Website: https://wyequalitycare.acs-inc.com/ If you choose to participate in the wellness program, you will be asked to:
Phone: 307-777-7531 • Complete a voluntary health risk assessment or “HRA” that asks a series of questions
about your health-related activities and behaviors and whether you have or had certain
To see if any other states have added a premium assistance program since August 10,
medical conditions (e.g., cancer, diabetes, or heart disease).
2017, or for more information on special enrollment rights, contact either:
U.S. Department of Labor U.S. Department of Health and Human • Complete a biometric screening, which will include a blood test for total cholesterol,
Employee Benefits Security Administration Services HDL, LDL, ratio, glucose, A1C.
www.dol.gov/agencies/ebsa Centers for Medicare & Medicaid Services • Other wellness program offerings include: biometric screenings, weight loss classes,
1-866-444-EBSA (3272) www.cms.hhs.gov stress management classes, smoking cessation classes, lactation classes, Register
1-877-267-2323, Menu Option 4, Ext. 61565 Dietitian (RD) one-on-ones, Health Coaching one-on-ones, and online wellness
challenges.
WOMEN’S HEALTH AND It is important to note that these are not all part of the health plan. The only thing that is
CANCER RIGHTS ACT reimbursed through the plan is Health Coaching and RD one-on-one and Health Coach
and RD lead group classes.
Federal law requires that all plan participants be notified at enrollment and annually of Any information provided by you as part of your participation in the above program(s)
their rights under the “Women’s Health and Cancer Rights Act.” This notice is being will be used to help you understand your current health and potential health risks, and
furnished to you in compliance with the requirements of the law. may also be used to offer you services through the wellness program. Services that might
The law requires that all group health plans that provide coverage for a surgically removed be available include disease management programs and case management programs
breast must also: offered by MedCost Benefit Services, LLC. You are encouraged to share your results or
• Provide coverage for reconstruction of the surgically removed breast; concerns with your own doctor.
• Provide coverage for surgery and reconstruction of the other breast to produce a Incentive Program(s)
symmetrical appearance; and
You are not required to complete the HRA or to participate in the blood test or other
• Provide coverage for prostheses and any physical complications that may occur in any medical examinations. However, employees who choose to participate in the wellness
stage of a mastectomy, including lymphedemas (swelling associated with the removal of program will be eligible for the following incentive(s):
lymph nodes). • Monthly drawings and earning credits that may be traded in for prizes.
Coverage for breast reconstruction and any related services will be subject to any Plan Employees who choose not to participate in the wellness program will be subject to the
deductibles and covered percentage amounts that apply to other covered medical following penalties:
benefits of the Plan. • There is no penalty, only incentives.
The provisions of this law are also detailed in your Summary Plan Description.
Reasonable Accommodations Available

If you are unable to participate in any of the health-related activities or achieve any of the
health outcomes required to earn an incentive (or avoid the penalty), you may be entitled
to a reasonable accommodation or an alternative standard. You may request a reasonable
accommodation or an alternative standard by contacting Gretchen Bayne at ActionHealth.
Protections from Disclosure of Medical Information

We are required by law to maintain the privacy and security of your personally identifiable
health information. Although the wellness program and WFBH may use aggregate
information they collect to design a program based on identified health risks in the
workplace, ActionHealth will never disclose any of your personal information either
publicly or to the employer, except as necessary to respond to a request from you for
a reasonable accommodation needed to participate in the wellness program, and as
expressly permitted by law (as described in the WFBH Summary Plan Document). Medical
information that personally identifies you that is provided in connection with the wellness
program will not be provided to your supervisors or managers and may never be used to
make decisions regarding your employment.
Your health information will not be sold, exchanged, transferred, or otherwise disclosed
except to the extent permitted by law to carry out specific activities related to the wellness
program, and you will not be asked or required to waive the confidentiality of your
health information as a condition of participating in the wellness program or receiving an
incentive. Anyone who receives your information for purposes of providing you services as
part of the wellness program will abide by the same confidentiality requirements. The only
individual(s) who will receive your personally identifiable health information is (are):
• A Health Coach or RD within ActionHealth will receive information in order to provide
you with services under the wellness program.
In addition, all medical information obtained through the wellness program will be
maintained separately from your personnel records; information stored electronically will
be encrypted; and no information you provide as part of the wellness program will be
used in making any employment decision. Appropriate precautions will be taken to avoid
any data breach, and in the event a data breach occurs involving information you provide
in connection with the wellness program, we will notify you immediately.
You may not be discriminated against in employment because of the medical information
you provide as part of participating in the wellness program, nor may you be subjected to
retaliation if you choose not to participate.
If you have questions or concerns regarding this notice, or about protections against
discrimination and retaliation, please contact PeopleLink at 336-716-6464.

2018 Benefits Enrollment Guide

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Enroll Eligibility Health Prescription Drug Dental Vision FSA Life Disability Contacts Other Benefits Notices

Welcome to Benefits Enrollment 2018

What’s New or Changing Who Pays Health Care Costs?

If You Are Adding a

Computer Access for $100 Personal Care

Taking Care of You!

Call 336-716-WAKE (9253).

Eligibility Making Mid-Year Changes

Highlights of the Health Plans

An Overview of Your Health Plan Options

2018 Health Plan Costs (Pre-tax) Ob/Gyn Care

If You Have Dependents Employee Assistance

ActionHealth Use the My MedCost Mobile Health Care Terms to Know

Outpatient Pharmacy and Gift Shop 336-716-3363

Dental 2018 Dental Plan Costs

2018 Vision Plan Costs

Flexible Spending Accounts

Health Care FSA

Dependent Care FSA Use it or lose it!

Basic Life and AD&D Insurance

Supplemental Life Insurance

Dependent Life Insurance

Short Term Disability

Long Term Disability

Other Benefit Offerings

Legal Insurance Pet Insurance

For More Information About This Notice Or Your Current

KENTUCKY – Medicaid NORTH DAKOTA – Medicaid

Reasonable Accommodations Available

Protections from Disclosure of Medical Information

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