Texas Children's hospiTal 2011 Benefits and Wellness … · 2 3 Texas Children’s hospiTal 2011...

Health Matters…Choose Wisely.

Texas Children’s Hospital

2011 Benefits and Wellness Guide

OUR BENEFITS

1 Texas Children’s hospiTal2011BenefitsandWellnessGuide

dearfelloWemployees,i’msoproudtobeanemployeeoftexasChildren’s,votedbyyouasoneoftheHoustonBusinessJournal’stoptenBestplacestoWorkfor

the5thconsecutiveyear,andoneofonlyeightchildren’shospitalsnationally(andtheonlyoneintexasandtheentiresouthwest)namedtothe

U.S. News and World Report Honorroll!thankstoyourefforts,Vision2010isbecomingarealityevenaswefacethechallengesofanuncertain

economyandhealthcareenvironment.asweexpandourservicesforpatientsandourcommunity,wemustrememberhowimportantitistofirst

takecareofourselvesandourfamilies.

texasChildren’scompetitivetotalrewardspackagehelpsourtalentedemployees,likeyou,meettheirownneedsaswellasthoseoftheir

families.yourincomeiscertainlyabigreasonthatyouwork,butitisonlyonepartofthetotalpackageyoureceive.sometimesit’sgoodtoremind

ourselvesaboutsomeoftheotherthingsthatalsohelpmakethisagreatplacetowork,like:

n Comprehensivehealthcare,lifeinsurance,andlong-termdisabilitybenefitsn retirementandcollegesavingsplanstohelpyouachievefinancialsecurityn subsidizedclose-to-campusparking,bus/rail,park&ride,andvanpoolservicesn Wellnessprogramsthatpromoteahealthylifestylen agenerouspaidtimeoffprogramn Work/lifeprograms,suchastheemployeeassistanceprogram,thathelpbalanceyourcareerwithyourpersonalpriorities

texasChildren’sstrivestoofferbenefitsthatarebothmeaningfulandaffordable.in2011,mostbenefitsremainthesameasthoseofferedin

previousyears,thoughtherearesomedifferences.somechangesaretheresultofHealthCarereformlegislation,andotherswereputinplace

becauseofourongoingcommitmenttoprovidingyouwiththebestbenefitsatthebestprice.

onesignificantchangethati’mpleasedtoannounce,afterathoroughreviewprocess,istheselectionofBlueCross BlueShield of Texas (BCBSTX)asourmedicalanddentalproviderfor2011.Knownforexcellentcustomerservice,BCBstXprovidesaccesstooneofthelargest

networksofdoctorsandhospitalsintexasandnationwide.

tCHselectdollarswillcontinuetobeprovidedtohelpoffsetbenefitscostsandreducethetotalamountyoupayforbenefitseachpayperiod.

SelectPlus Dollarswillbeaddedin2011tohelpminimizetheimpactofhigherbenefitscostsforemployeesenrolledinourtexasChildren’s

medicalplanandearning$14perhourorless.

in2011,beonthelookoutformoreinformationpromotinghealthierlifestylesforyouandyourfamily.takeadvantageofourfocusedHealth

solutionsoffering,designedtoimprovethehealthofthoseemployeeslivingwithachronicillness.participationcouldmeancopayrebatesand

monetaryincentives.Healthmatters,andweareallaboutsustainingthehealthiestpossibleworkforceandtakingactionsthathelplowerhealth

carecostsandyourout-of-pocketexpenses.

pleaseusethisguidetotakefulladvantageofthecomprehensivebenefitsandservicesavailabletoyouandyourfamily–andkeepithandyfor

futurereference.ifyouhaven’trecentlycheckedoutthevalueofyourcompletepackageonyourpersonaltotalrewardse-statement,simply

opentheConnecthomepage,clickonthelinktologontomoli,andthenclickon“tCHtotalrewards.”asalways,ifyouhavequestionsor

feedbackaboutyourbenefits,youmay:

n Callthetotalrewardsmainlineat832-824-2421,press1forBenefitsn [email protected] reviewthebenefitspolicyinformationlocatedonthetexasChildren’sConnectWebsite

iwishyouandyourfamilyasuccessfulyearfilledwithjoyandwell-being.

sincerely,

lindaaldred

sr.Vicepresident

texasChildren’sHospitalsiprefierediscutirsusoptcionesdebeneficiosenespanolo’tienepreguntas,favordellamaralnumber

832-824-2421optionnumber1,o’puedevisitoreldepartamentodeHrorelcentrodeservicio.


2011BenefitsandWellnessGuide

tHisreferenCeGuideand‘detailed’BenefitsinformationisalsoaVailaBleontHeteXasCHildren’sConneCt/HrWeBsite.

TO ACCESS FROM HOME: https:/myprofile.texaschildrenshospital.orgtheBenefitssummaryplandescription(spd),alsoavailableonlinedescribesmajorplanprovisions,limitationsandexclusionsofthe

tCHselectplans.Calltotalrewardsat832-824-2421(option1forBenefits)withanyquestionsyoumayhave.

Eligibility. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Medical Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 BlueCrossBlueshieldoftexas–ppo(pre-existingconditionsforadultsonly) BlueCrossBlueshieldoftexas–epo BlueCrossBlueshieldoftexas–onlineresourcesthroughBlueaccessformembers(Bam) WaivingmedicalCoverage WhenCoverageends tCHCoreBenefitsExpress Scripts for Prescription Drugs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Genericspreferredprogram steptherapyprogram priorauthorizationprogram specialtydrugs(tier4)throughCurascript selectHomedeliveryprogram Maternity Care (The St. Luke’s Labor and Delivery Experience and Savings!). . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Fertility and Advanced Reproductive Technology Benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Disease Management through Focused Health Solutions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Wellness In The Workplace (preventiveCare,BlueextrasavingsandtypesofCare). . . . . . . . . . . . . . . . . . . . . . . . . . 14Medical Comparison Chart (ppoandepoplans). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Dental Benefits(HighandlowoptionComparisonChart) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Vision Benefits through VSP. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Flexible Spending Accounts through PayFlex..................................................... 18 dependentCarefsa HealthCarefsaandmasterCarddebitCardviaHealthHub Life Insurance through Prudential. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 BasiclifeandBasicad&d optionallifeandoptionalad&d spouseanddependentlife longtermdisabilityBenefit WillpreparationserviceLong Term Care through John Hancock. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Retirement and Savings Plan Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 403(b)savingsplanthroughfidelity CashBalancepensionplan fidelity529CollegesavingsplanCommuter Benefits and Employee Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28Balancing Work, Home and Family:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 time-offBenefits,adoptionassistance,ticketdiscounts,servicerecognition&teamssportssubsidy Interim Backup Care Benefit through Bright Horizons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Employee Education and Development Opportunities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Benefit Election (Status) Changes and CHIP Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32Special Enrollment Rights..................................................................... 35Continuation Coverage Rights Under COBRA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36Your Rights. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Vendor Contact Information (websites, passwords, etc.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43TCH Select Dollars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44TCH Select Plans and 2011 Per Pay Period Premium Costs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

printedonpapermadefrom10%post-consumerwaste.

THE COST TO PRInT THIS gUIDE WAS gEnEROUSLY DOnATED BY BLUECROSS BLUESHIELD OF TEXAS.

2 Texas Children’s hospiTal2011BenefitsandWellnessGuide3 Texas Children’s hospiTal2011BenefitsandWellnessGuide HealtHmatters…CHooseWisely. 3

texasChildren’stotalrewardslogo

encompassestheoverallpackageof

diversebenefits,employeewellness

initiativesandwork~lifebalance

offeringsthat,whenutilized,can

promoteandprovidesecurityand

comforttoyouandyourfamily.

The TCH Select Plan includesyourmedical,dental,Vision,life,accidentaldeath

anddismemberment,disability,andlong-termCareinsurance,alongwithHealthCareand

dependentCareflexiblespendingaccountoptions.

Employee Select DollarsareadditionaldollarsprovidedbytCHtohelpemployees

offsetthecostoftheirbenefitspremiums.

Employee Healthoverseestheemployeeassistanceprogram(eap),employmenthealth

screenings,immunizationandon-sitemobilemammographyofferings,aswellasmanagelong-

termdisability,familymedicalleavesandpersonalleaves.

Parking and Commuter Benefitsincludebusandvanpoolsubsidiesandfree

off-campusparking.

Retirement and Savings Plansareavailabletoprovidefinancialsecurityforyouand

yourfamily’sfuture.retirementbenefitsincludethetexasChildren’sCashBalancepensionplan

andthetexasChildren’s403(b)savingsplan.the529collegesavingsplanisagreattoolto

helpemployeessave(tax-free)foryourfamily’sfutureeducationalneeds.

Tuition Assistanceallowsemployeestheopportunitytooffsetthecostoftheircollege

tuition(includingcourses,mostfeesandrequiredbooks)foracourseofstudythatwould

supportyouinyourroleattexasChildren’s.

Work~Life Benefitsoffermultiplewaystohelpyoubalanceyourworkandpersonallife.

adoptionassistance,temporaryback-upcare(forchildrentoelders)andagenerouspaidtime

offprogramarebenefitsavailabletotCH-paidemployees.additionalwork~lifebalancebenefits

areavailable,primarilyforbutnotalwayslimitedto,tCH-paidemployees.


ELIGIB

ILITY

HR encourages you, as a healthcare consumer, to fully educate yourself before making important benefit decisions for you and your dependents. This guide is intended to be a valuable resource to inform you of new Health Care Reform, your benefit plan options and other important details you need to know.

eliGiBilityEMPLOYEEStexasChildren’sfull-time(atleast36hours/week)andpart-time

employees(atleast17.5hours/week)areeligibletoparticipateinallthe

benefitsandwellnessprogramsonthefirstdayofthefullpayperiod

following30-daysofemployment.perdiememployees(under17.5

hours/week)areeligibletoparticipateintheparkingandcommuter

benefits,403(b),employeeassistanceplan(eap)andvariouswellness

initiatives.

You may enroll your eligible dependents in the medical,

dental, and vision plans.

ELIgIBLE DEPEnDEnTS InCLUDE:n legal spouse

n Child.yournaturalchild,stepchild,adoptedchild,orchildwho

hasbeenplacedforadoptionwithyouorachildforwhomyouare

involvedinasuitinwhichyouareseekingtoadoptsuchchild,a

childforwhomyouhavebeenappointedlegalguardian,orachild

whoisrecognizedunderaQualifiedmedicalsupportorder.

n Child(ren) under age of 26(nolongerrequiredtobefull-time

studentsbetween19-25).

n Grandchildren under age 26 for whom you have custody and who

reside in your householdareeligibleforthedentalandvisionplans

withoutbeingenrolledinschool.

n incapacitated Child.physicallyormentallyunmarriedchild

incapableofself-supportiseligibleundertexasChildren’sselect

planaslongastheyweredeemedincapacitatedpriortotheir26th

birthday.

NEWiN 2011

NEWiN 2011

socialsecuritynumbersarerequiredtoenrollalldependentsin

themedical,dentalandVisionplans.

ifyouandyourdependent(spouseorchild)arebotheligible

employeesoftexasChildren’sandelecttohaveanycoverage,

youeachneedtoelectindividualcoverage(s)orifyouelect

familycoverage,youwillonlybeallowedonefamilyplanandthe

otheremployeeshouldwaivecoverage.onlyoneemployeemay

coveradependentchildonanyplan.

WHEn COVERAgE BEgInS FOR TEXAS CHILDREn’S SELECT PLAnSn new hire full or part-time employees -Health

carecoveragebeginsonthefirstdayofthefull

payperiodfollowing30daysofemployment.you

have31daysfromyourhiredate(initialperiodof

eligibility)tocompleteenrollmentpaperworkand

submitforms.

n For employees currently eligible -eachyear

duringthefallopenenrollmentperiod,you

choosebenefitcoverage(s)forthecoming

year.yourbenefitelectionchoicestakeeffect

onJanuary1standremainineffectthrough

december31st.

n employees in a non-benefit eligible status

who transfer to a regular full-time or part-time

status -Coveragewillbeginontheeffective

dateofthechange,providedyouhavebeen

employedfor30daysormore.yourbenefit

electionformisduetoHrBenefitswithin31days

fromthedateofthestatuschange.

4 Texas Children’s hospiTal2011BenefitsandWellnessGuide5 Texas Children’s hospiTal2011BenefitsandWellnessGuide

mediCalplanoptions

BlueCrossBluesHieldofteXas(BCBstX)The TCH Select Plan Provides Two Medical Plan Options in 2011:nBlueCross Blueshield of Texas (ppo)

nBlueCross Blueshield of Texas (epo)

BothtCHselectplanoptionsprovidecomprehensive

medicalcoveragethroughtheBCBstXprovidernetworkand

prescriptiondrugcoveragethroughexpressscripts.

anenhancementtoourprogramistheadditionofaspecialized

providertohelpmanageanychronicconditionsyoumayhave,

suchasdiabetesorheartdisease.focusedHealthsolutionswill

bemanagingyourchroniccareneedsandadministeringyour

Healthriskassessment.

BCBSTX Preferred Provider network (PPO) - Similar to Current aetna PoSii

thismedicaloptionoffersyouopenaccesstothepponetwork

ofprovidersofBlueCrossBlueshieldoftexas.This option

offers enhanced benefits for using a network provider,

yet also provides benefits when a non-network provider

is selected.

n mostservicesaresubjecttoanannualdeductibleandrequire

youtoshareinthecostofservicesthroughcoinsurance.your

coinsuranceamountissubjecttoanannualout-of-pocket

maximum.However, copayments for all services will still

apply even once the out-of-pocket maximum is met.

n ppoplanincludescopaymentsforprimaryandspecialist

care.acopaymentwillapplyforservicesbilledbythe

physicianoffice.allotHerserViCesnotBilledBytHe

pHysiCianwillbesubjecttodeductibleandcoinsurance.

nEW

nEW

NEWiN 2011

MED

ICA

L P

LAN

S

nEW CARRIER

WHEn CAn I EnROLL?uponyourdateofhireorthedateyoubecomeinaneligiblestatusyouwillbeinvitedtoattendaBenefitsorientation.duringthis

orientationyouwillbegivenyourpersonalizedbenefitsenrollmentformforyourcompletion.thisformmustbecompletedand

returnedtotheBenefitsdepartmentpriortoyoureligibilitydate.youshouldcarefullyreadyourenrollmentGuidetohelpyoumakethe

bestelectionsforyouandyourfamily’sneeds.iftheBenefitsdepartmentdoesnotreceiveyourbenefitsenrollmentformpriortoyour

eligibilitydate,youwillbeautomaticallyenrolledintexasChildren’sCoreBenefitplan.refertotheCoreBenefitstabwithinthisguide.

n minorX-rayandlabserviceswillalsohaveaseparate

copayment,ifobtainedinaphysicianofficeor

independentlabonaseparatedate.majorX-rayand

lab(suchasmri,Catscan,petscan,etc.)willbe

subjecttothedeductibleandcoinsurance.anyx-rayor

labserviceobtainedinanoutpatienthospitalsettingor

inthehospitalwillbesubjecttotheannualdeductible

andcoinsurance.

n networkproviderswillcertifyanyhospitalstayyou

require.You are responsible for certifying any

non-network hospitalizations with BCBSTX prior

to receiving services.failuretodoso,mayresult

inthedenialofbenefits.BCBstX’spre-certification

numberisonthebackofyourmemberidcard.

PPO PLAn COnTAInS PRE-EXISTIng COnDITIOnS FOR ADULTS OnLY

The pre-existing condition limitation does not apply

to children under age 19. ifyouareanewlyeligible

employeeandhaveeligibledependents,areadding

dependentsoraretransferringtoaneligiblestatus,you

maybesubjecttoapre-existingconditionlimitation.ifyou

havesignsorsymptomsofaconditionintheninety(90)

dayspriortoyoureffectivedateofcoverage,and

n do not have current coverage, and

n are age 19 and over

claimsforthatconditionwillnotbecoveredfor365days

followingyoureffectivedateofcoverage.Claimsforall

otherunrelatedconditionswillbecoveredunderthe

provisionsofeitherplan.

ifyouhadothercoveragepriortobecomingeffectiveand

youhavenothadabreakincoverageof63daysormore,

thenyoumaynotbesubjecttothepre-existingcondition

ruleandcanprovideproofofpriorcoverage.

nEW


BCBSTX Exclusive Provider network (EPO) - Similar to Current aetna Hmo

thismedicaloptionprovidescoveragefornetworkservicesonly.You

must access all medical care from network providers or the

plan will not pay any benefits.BCBstX’sbroadnetworkoffers

youawiderangeofprovidersfromwhichtoselectyourprimaryCare

physicianandanynecessaryspecialists.inaddition,mosthospitalsin

theHoustonareaareincludedinthenetwork.

n theepomedicalplanisanopenaccessplan.thatmeansyou

mayreceiveservicesfromanynetworkproviderwithoutareferral

fromaprimarycarephysician,however,youwillpaymoretoaccess

aspecialist.internalmedicine,familyandgeneralpractitioners,

pediatriciansandob/gynpractitionersareconsideredprimarycare.

allotherproviders,includingurgentcareandafterhourscarewillbe

consideredspecialistsandyouwillpaythehighercopayforservices.

n theBCBstXnetworkisnationwidewithprovidersinmostareasof

theunitedstates;however,ifyouhaveadependentlivingoutside

oftheHoustonarea(ex.childawayatcollege),youshouldcheck

tomakesurenetworkprovidersareintheirlocation.otherwise,only

carethatisconsideredan‘emergency’willbecovered.underthe

epoplan,youmustusenetworkprovidersinorderforservicestobe

covered;therearenonon-networkbenefitsintheepoplan.

n servicesarepaidforthroughcopaymentseachandeverytimeyou

accesscare.theamountyoupaywilldependonthelevelandtypeof

careyoureceive.

n networkproviderswillcertifyanyhospitalstayyourequire.the

BCBstXnumberisonthebackofyourmemberidcard.

BCBstXisyouronlineresourCeforCaretHruBAMResources you can access now:1. findanetworkprovider

under“providerfinder”2. findadentistunder“dental

providerfinder”3. takeatourofBam4. accesstransitionofCare

form

n printtemporaryidcardsn estimatethecostofmedical

servicesunder“treatmentCostadvisor”

n ViewandprintyourexplanationofBenefitsforfinalizedmedicalanddentalclaims

n findthemedicalplanthatisrightforyouat“HealthplanCostestimator”

n estimatethecostofdentalcareunder“dentalCostadvisor”

n receiveemailnotificationofclaimactivity

n seeyourmedicalanddentalbenefitcoveragesummaries

n downloadformsn Comparequalityindicators

forsurgeryorhospitalizationthrough“CareComparisontool”

n Getinformationonwellnessandhealthissues

n finddiscountsthroughBlueextraforComplementaryalternativemedicine(Cam),lifetimefitness,JennyCraigandtruHearing.

n Confirmcoverageonemployeeandfamilymembers

n Contactcustomerserviceviaemail

n GetanswerstofrequentlyaskedQuestions

n locateanurgentcareproviderinyourarea

go to www.bcbstx.com/tch and register on Blue Access for Members (BAM) with a username and password as of 1/1/11. Once registered, you will be able to:

TEXAS CHILDREn’S PEDIATRIC ASSOCIATES (TCPA) PARTICIPATES In THE PPO AnD EPO PLAnS.

BothplansareincludedintheBCBstX

networksoyoucancontinuetoaccess

ourtexasChildren’sproviders.Goto

www.texaschildrenspediatrics.orgto

findalocationorpediatriciannearyou.tCpa

has44locationsthroughouttheHouston

communitywithover140boardcertifiedor

boardeligiblephysicianswithfullservicecare

forchildren(newborntoage18).

nO FACILITY CHARgE FOR In-PATIEnT STAY AT TEXAS CHILDREn’S HOSPITAL-MEDICAL CEnTER AnD WEST CAMPUS

ifyou1)usethemedicalCenterortheWest

CampustexasChildren’sHospitalfacilityand

2)arecoveredthroughoneofthetCHselect

medicalplans,youwillnotberesponsiblefor

thefacilitycharges.

BothtCHselectmedicalplansofferfacility

chargespaidat100%fordependentswho

areineitherplan;however,youwillstillpayfor

somephysicianchargesandothercharges.


CoreBenefitsWAIVIng MEDICAL COVERAgEyouhavetheoptiontowaivemedicalbenefits

entirelyifyouareenrolledinanothermedicalplan.

ifyouelectnomedicalcoverageandyouloseyour

othercoverageduringtheyear,orifyouelectno

medicalcoverageandhaveaqualifyingstatus

Change,youmayelectoneofthemedicalplansfor

youandyourdependentswithin31daysoftheloss

ofcoverage(proofoflossofcoverageisrequired).

refertotheBenefitelectionChangetabwithinthis

guidefordetails.

WHEn COVERAgE EnDSmedical,dental,Vision,life,ad&d,disability,

HealthCareanddependentCareflexiblespending

accountswillendonthelastdayofthepayperiod

containingthelastdayworked,yourtransferdate

toanineligiblestatusforbenefitsorthedaya

dependentbecomesineligibleforcoverage.

eXpresssCriptsforpresCriptiondruGs

FOUR TIER DRUg FORMULARYalldrugsfallintooneofthefollowingcategories:

Tier 1 Generic preferred

Tier 2 Brandformulary Whengenericisnotavailable

Tier 3 Brandnon-formulary leastpreferred

Tier 4 specialtydrugs Bio-techdrugs

gEnERICS PREFERREDtexasChildren’scontinuestoofferacompetitiveprescriptiondrugprogram,evenwhile

prescriptiondrugcostsarerisingatarapidrate.

inordertohelpcontrolthecost,youcanselectgenericdrugsinsteadofbrandnamed

drugswheneverpossibleandaskyourphysicianforthelowestcosteffectivemedication

foryourcondition.

Genericdrugs,whichareapprovedbythefederaldrugadministration,arethechemical

equivalentsofthecorrespondingbrandnamedrugs.therefore,youcantakegeneric

drugswithconfidenceintheireffectivenessandsafety.theonlydifferenceisthe

costyoupay.Genericdrugscostasmuchas80%lessthanbrandnamedrugs.By

purchasinggenericsyoucansave$20-$40perprescription(upto$480perprescription

peryear!)whilealsosavingtexasChildren’smoneyandhelpingtolowerrateincreases

inthefuture.

oneBCBstXidCardforyourpHarmaCy,mediCal,dentalandeapneedspresentyourmemberidcardat

thepharmacywhenreceivingany

prescription.inordertoreceive

benefitsyoumustuseanesi

participatingpharmacyorobtainyour

medicationthroughtheselectHome

deliveryprogram.

nEW

CORE

BEN

EFIT

S

nEW

TCH SELECT PLAn OPTIOnS AUTOMATICALLY PROVIDE YOU WITH A BASIC LEVEL OF CORE BEnEFITSthesebenefitsprovideyouwithbasicmedicalcoverage

aswellasbasiclifeinsuranceandlong-termdisability

protection.youwillautomaticallybeenrolledinthecore

benefitsshownbeloweffectivewithyourcoveragebegin

dateunlessyouwaivecoverageorelectcoveragewithin31

daysfromeligibility.

Medical PPO

employeeonly minimalperpayperioddeduction

Basic Life & AD&D

employeeonly onetimesannualbasesalary

Long Term Disability

fulltimeemployeesonly

50%ofmonthlybasesalary


looKituponeXpresssCriptsWeBsitetheexpressscriptswebsiteisagoodsourceofinformationaboutyourprescriptionsandyour

prescriptiondrugbenefits.accessingyourprescriptionbenefitinformationonlineisquickandeasy.

Visit www.express-scripts.comandcompletethebriefregistrationprocesstogetstarted.

n locateparticipatingretailpharmaciesnearyou

n findoutwhatyou’llpayforaspecificdrugatretailandHome

delivery

n orderrefillsthroughHomedeliveryandtrackthestatusof

yourorder

n realizeifthereisagenericequivalentavailable

n reviewyour12-monthprescriptionhistory

n determineifpriorauthorizationisrequired

n identifyfirst-linemedicationsforsteptherapy

n determinehowtorequestgenericsfromyourphysician

n reviewcurrentformulary

ifyouelecttopurchasethebrandnamedrugwhenageneric

equivalentisavailable,youwillpaythestandardcopayment

forthegenericdrugplustheactualcostofthedifference

betweenthegenericandbrandasshownbelow.thecost

youwillpayisyourchoicetomake.

Example:Generic

DrugBrand Name - Non Formulary

drug Cost: simvastin vs Zocor

$26.83 $139.47

difference in Cost $0.00 $112.64

plan Copayment $5.00 $5.00

Your Cost $5.00 $117.64

note:Zocorisusedtotreathighcholesterol.

ifnogenericisavailableforabrandnamedrug,youwillpay

theapplicableformularyornon-formularybrandcopayment

asshownonthepharmacychart.

STEP THERAPYsteptherapyisaprescriptiondrugprogramdesigned

exclusivelyforpatientswhohavecertainconditionsthat

requireroutine,ongoingmedication.steptherapyhasbeen

proventobeeffectiveinthetreatmentofsuchconditions

asulcers,depression,highbloodpressure,heartdisease,

cholesterolandallergies.

Step Therapy is a Two-Step Programn step 1: prescription drugs:thedrugsrecommended

foryoutotakefirst–usuallygenericmedicationswhich

havebeenprovensafeandeffective.youpaythelowest

copaymentforthesedrugs.

n step 2: prescription drugs:thesetypicallyarebrand-

namedrugs.step2drugsarerecommendedonlyifastep

1drugdoesnotworkforyou.

How it Works

Whenfillinganewprescription,expressscriptswillverify

yourprescriptionhistory.ifyouhavefilledandreceiveda

prescriptionforastep1drugwithin130daysofattempting

tofillastep2medicationanditwasineffective,youwill

beabletogetthestep2drug.ifyoudidnottryastep1

medicationorithasbeenlongerthan130days,youandyour

pharmacistwillneedtoworkwithyourphysicianandexpress

scriptstoauthorizeadifferentmedication.

To Learn More About Step Therapy

Visitwww.steptherapyfacts.comtowatchashortvideo.

Callexpressscriptsat800-316-3102withyourquestions.

PRIOR AUTHORIzATIOnsomedrugsyourdoctorprescribeswillrequirespecial

approvalor“prior-authorization”beforebeingfilled.this

meansthatexpressscriptswillneedtomakesurethese

prescriptionsmeettheplan’sconditionsforcoverage.prior

authorizationencouragesappropriatedrugtherapyforcertain

designatedconditions.

todetermineifyourmedicationrequirespriorauthorization,

callexpressscriptsat800-316-3102orvisitwww.express-

scripts.comandusethe“price-a-drug”feature.asyou

receivenewprescriptions,checktoseeifitwillbecoveredas

thelistissubjecttochange.

ifadrugrequirespriorauthorization,yourdoctorwillneed

tocontactexpressscriptsat800-417-8164toseeifthe

prescriptionmeetsyourplan’sconditionsforcoverage.

note: ifyourprescriptionisnotcoveredandyouandyour

doctordecidethatyoushouldstilltakethisdrug,you

willpaythefullcostofthemedication.

PH

AR

MA

CY

HealtHmatters…CHooseWisely. 7


SPECIALTY DRUgS (TIER 4)specialtymedications(alsoknownasbiotech,

biologicalorinjectibles)arethosemedicationsused

forcertainrareorcomplexconditions.thesedrugs

areextremelyexpensiveandusuallyhavepotentially

serioussideeffectsorinteractions.

thesespecialtymedicationshavebeenmovedto

a4thtierandyouwillpay10%ofthecostofthese

medicationsoraminimumof$50perprescription,

uptoamaximumof$150perprescription.out-

of-pocketcosts(forthesemedicationsonly)willbe

limitedto$2000perpersonpercalendaryear.these

medicationsareonlydispensedina30-daysupply

duetotheneedtocontinuallyadjustdosage.such

medicationsshouldbeobtainedthroughCurascript,

esi’sspecialtymedicationdivision.

presCriptiondruGCoVeraGetHrouGHeXpresssCripts

BENEFITPPO

IN-NETWORKPPO

OUT-OF-NETWORKEPO

(NETWORK ONLY BENEFITS)Retail Pharmacy – up to a 30 day supply

n Generic $5 copayment65% reimbursement

after network copayment applied.

member submits claim.

$10 copayment

n Preferred Brand – Formulary $25 copayment $35 copayment

n non-Preferred Brand – non Formulary

$40 copayment $50 copayment

Express Scripts Home Delivery – up to a 90 day supply

n Generic $10 copayment

not available

$20 copayment

n Preferred Brand – Formulary $50 copayment $70 copayment

n non-Preferred Brand – non Formulary

$80 copayment $100 copayment

Specialty Medications – ( injectables, biotech drugs). only through CuraScript.$2,000 annual out-of-pocket maximum per person for Specialty Medication.

10% copaymentminimum $50

maximum $150/prescriptionnot covered

10% copaymentminimum $50

maximum $150/prescription

Chart represents member cost.

WHAT CURASCRIPT HAS TO OFFERCurascriptisaleadingproviderofspecialtydrugs,offeringthemost

comprehensiveandconvenientspecialtypharmacyservicesavailable–

atnoadditionalcosttoyou.

Curascriptoffersmanyproductsandservicesnotavailableorofferedby

otherpharmacies,alongwiththefollowingservices:

n providespatientswithindividualizedsupporttomeettheirunique

needs.HighlytrainedpatientCareCoordinatorswillworkcloselywith

you,yourphysicianandexpressscriptstoobtainpriorauthorizations,

coordinatebillingwithexpressscriptsandwillevencontactyouwhen

it’stimetorefillyourprescription.

n deliversyourspecialtymedicationsdirectlytoyouoryourdoctor.

n providesyouwiththenecessarysuppliesyouneedtoadministeryour

medicationatnoadditionalcost.

n offersclinicalbasedcaremanagementprograms–whichinclude

consultationwithyourdoctor–tohelpyougetthemostbenefitfrom

thespecialtymedicationsthatyourdoctorhasprescribedforyou.

youcanreachCurascriptat1-866-848-9870oronlineat

www.curascript.com.


freQuentlyasKedQuestionsHow do I Opt In or Opt Out of the Select Home Delivery

program for my maintenance drugs?

simplycalltheexpressscriptsmemberChoiceCenterat1-888-

772-5188.

What if I’d prefer to get some of my maintenance

medications at my retail pharmacy?

youhavetheoptiontooptinoroutforoneorallofyourmaintenance

medications.

What medications are included in this program?

themaintenancemedicationsyoutakeregularlyforongoing

conditions,suchashighbloodpressure,highcholesterol,thyroid

andasthma,areincluded.tofindoutifaspecificprescriptiondrugis

consideredamaintenancemedicationonyourplan,callthe1-800-

316-3102memberservicesnumber.

How do I pay for my prescriptions?

allordersshouldincludepaymentinformationtoallowprocessing

withoutdelay.ordersmaybepaidby:

n flexiblespendingaccount(fsa)debitcard

n Visa,masterCard,americanexpressordiscover

n Bank-issueddebitcard

n personalcheckormoneyorderpayabletoexpressscripts

How long will it take to process and deliver my prescription?

first-timeorders,pleaseallow10to14daysfordeliveryfromthetime

expressscriptsreceivesyourorder.oncetheyhaveprocessedyour

firstorder,subsequentrefillswillbeshippedwithin3to5daysfrom

thetimetherefillrequestisreceived.

How will my order

be mailed?

ordersaresent

byfirst-classmail

inunmarked,

tamper-proof

packaging.there

isnoindicationon

thepackagethatit

isfromapharmacy.

theyaredelivered

byyourregularcarrier,

unlessthemedication

requiresspecialhandling

(suchasrefrigeration).

SAVE

TIME! SAVE

MOnEY! SELECT HOME DELIVERY FROM EXPRESS SCRIPTS IS THE PREFERRED WAY TO FILL MAInTEnAnCE MEDICATIOnSHomedeliveryfromtheexpressscriptspharmacy

providesanaffordablewaytoobtainyour

maintenancemedications,byallowingyoutoorder

uptoa90-daysupplybymailfor2copayments.itis

themostcosteffectivewaytofillprescriptionsand

helpsyousavemoney.

youmayobtainyourfirstandsecondfillsofyour

maintenancemedicationatanyparticipating

pharmacy.startingwithyourthirdfill,youwillpaythe

fullcostofyourprescriptionunlessyoueithermove

totheexpressscriptsmailorderhomedeliveryorlet

expressscriptsknowyouchoosenottoparticipate

inthemailorderhomedeliveryprogram.

4 Easy Ways to get Started!

1.Visitwww.starthomedelivery.comor

2.Call888-772-5188togetstartedor

3.CompleteanexpressscriptsHomedeliveryform

andmailtoexpressscriptswiththeprescription

andcopaymentor

4.expressscriptswillcallyourdoctortogetanew

prescriptionstartedinselectHomedelivery.

onceexpressscriptshastheprescriptionfrom

thedoctor,theprocessmaytakeuptotwoweeks

ifawaitingdocumentation.pleasehavea30-day

supplyofyourmedication(s)onhandwhenyoubegin

theHomedeliveryprogram.



MATERnITY CAREasyouareaware,texasChildren’sisexpanding

throughouttheHoustonarea.inadditiontotheWest

CampusopeningnearKatyinlate2010andearly

2011,wewillbecompletingourtexasChildren’s

maternityCenterin2012.untilthenandthroughout

2011,thefacilitiesopenformaternityservicesfor

texasChildren’sare:

n st.luke’sepiscopalHospitalmedicalCenter

n st.luke’stheWoodlandsHospital

n st.luke’ssugarlandHospital

teXasCHildren’siseXpandinG…

atWWW.BirtH.teXasCHildens.orGyouCan:

n Comparehospitalsandmaternityprograms

n Createabirthplan

n registerforbirthingclasses

n signuptotakeatourofst.luke’s

n seeamapofst.luke’sHospital

n reviewtheamenitiesprovidedtost.luke’s

n Getideasonwhattopackforthedeliverystay

St. Luke’s Facility Charges Paid at 100% for Mom and Baby

expandingourfootprintgivesyouanopportunitytosavemoneybyutilizingourservicesforpediatriccareaswellasformaternitycare

whileobtainingworldrenownedqualityservices.

throughst.luke’ssystem,andwhenourmaternityCenteriscompleted,wewillcontinuetooffermaternityrelatedcareatno

costtoourplanmembersforfacilitycharges.facilitycharges,includingprivatematernityroom,willnotbesubjecttocopayments,

deductiblesorcoinsuranceforyouoryourbaby.so,howcanthissaveyoumoney?


UnIqUE FAMILY-CEnTERED MATERnITY CAREn postpartumcareformotherandbabytogether,ratherthanapartn Basedontheprincipalthatthemotheristhebestcareproviderforthebabyn noseparationofmotherandbabyunlessmedicallynecessaryn additionalbabycareandsupportforsuccessfulbreastfeedingn providesaprivateroomforthemotherandbaby

Supportive of natural techniquesn aromatherapy n Breathingtechniques n music

n massage n Walkingduringlabor n Hydrotherapy

n Birthball

Specialized prenatal or neo-natal care by direct transfer to Texas Children’s Hospital should it become necessary.

CompareandsaVe!MATERNITY FACILITY CHARGES (Employee Cost)

PPO EPO

delivery (Baby/Mom) At SLEH not at SLEH At SLEH not at SLEH

deductible $0 $500(each) n/a $0

Coinsurance $0 20% n/a $0

Copayments n/a n/a $0 $300perdayperperson

Baby Cost $0 $800 $0 $900

Mother Cost $0 $1,000 $0 $900

TOTAL COST no facility payment $1,800 + physician charges

no facility payment $1,800

LACTATIOn SUPPORT FOR nURSIng MOTHERSasinternationalleadersincaringforthe

healthofbabiesandchildren,texas

Children’sHospitalknowstheimportanceof

mother’smilktothehealthanddevelopment

ofnewbornbabies.

Breastfeedingsupport,adviceand

resourcesareaphonecallore-mailaway.

VisitthetexasChildren’smilkBankwebsite

formoreinformation.

tHest.luKe’slaBoranddeliVeryeXperienCeisdifferent:

Assumes non-SLEH facility is in the BCBSTX network.

Assumes Facility single baby cost is $2,000 and mother cost is $3,000 for a 3-day stay.

MATERNITY

Fertility benefits through BCBSTX:n pre-certifytoensurecoverage

n allfertilitybenefitsaresubjecttoapplicablecopayments,deductibles,andcoinsurance.

n somediagnosticandtreatmentservicesforunderlyingcausesofinfertilitymaybecovered.CallBCBstXfordetails.

n $20,000lifetimelimitforallfertilityrelatedtreatmentappliestomedicalandprescriptiondrugsservices.

n fertilitymedicationsshouldbecoordinatedthroughfreedomfertilityat1-800-660-4283orwww.freedomfertility.com

–onlineorderingandrefills

–freeexpressshippingonallorders

–educationmaterials

–onlinevideocoaching

–aroundtheclocktelephoneaccesstonursesandclinicalpharmacistswhospecializeinfertilitycare.

Advanced Reproductive Technology (ART) includes,butisnotlimitedto,in-Vitrofertilization(iVf).

ART Benefits provided through one of the following ART providers only.

Physician Phone AddressWilliam e. Gibbons, Md 713-798-7500 6620mainstreet,suite1450,Houston,tX77030-2346

ertug Kovanci, Md 713-798-7500 6620mainstreet,suite1450,Houston,tX77030-2346

Michael Joseph heard, Md 713-797-1144 6624fanninstreet,suite1800,Houston,tX77030-2330

fertilityBenefitsteXasCHildren’soffersBenefitsforfertilitytreatmentunderBotHmediCaloptionsupto$20,000perlifetime


FERT

ILIT

Y BE

NEFI

TS

CHROnIC COnDITIOn MAnAgEMEnTtexasChildren’scaresaboutyou!ahealthyyoumeansahealthy

placetowork.WehavepartneredwithfocusedHealthsolutionsto

helpyoumanagecertainhigh-riskchronicconditions.

n diabetes

n Chronicobstructivepulmonarydisease(Copd)

n CongestiveHeartfailure(CHf)

Bytakingyourmedicationsregularlyandgettinganyrequired

testing,improvingyournutritionandengaginginexercise,youmay

beabletosloworreversetheprogressofyourdisease!effectively

managingchronicconditionscanimprovethequalityofyourwork

andpersonallife.

Weallwanttoknowhowwecantakebettercareofourselves

andimproveourhealth.throughfocusedHealthsolutionsnurse

engagementprogramyouwilldeterminehowreadyyouaretomake

changes,setgoals,learnhowtoachievethem,andprogressdown

thepathtomanagingandcontrollingyourcondition.asaBonus,

WHenyoureaCHyourGoalsyoumayreCeiVemoney

BaCK!improvingyourhealthstartswithyou,makeacommitment

tostarttoday.

improvedhealthstartswithyouandyourpersonalnursecoach!

theywillhelpguideyouthroughouttheprocesstoanswer

questionsaboutsymptoms,medications,exercise,educationand

personalwellnessgoals.

focusedHealthsolutionswillbereachingouttoyouandwill

supportyouwithyourmanagementplan.employeesconcerned

abouttheirchronicconditionmayinquireabouttheprogramby

calling1-888-352-9355.

n You may qualify to receive a refund of some copaymentsifyouactivelyparticipateinadisease

managementprogramwithnurseengagementandachieveyourmutuallyagreedupongoals!thisisa

greatwaytoimproveyourhealthandearnafewdollars!Focused Health Solutions can be reached

at 1-888-352-9355.Callafter1/1/11.

n thenetworkofprovidersisthesameforbothplanoptions.youcanviewallparticipatingprovidersatthe

www.bcbstx.com/tchwebsite.

NEWiN 2011

NEWiN 2011

WEB-BASED HEALTH InFORMATIOn CEnTEReffective1/1/11,theeasy-to-usemyfocused

Healthsmprogramwillallowyouaccessto:

n anextensivelibraryofhealth-orientedinformation

andinteractivefeatures

n ahealthcoachtoreviewtheresultsofyouronline

Healthriskassessmentandprovidefeedback.

employeeswillbeabletodeviseapersonalaction

planandtakethatimportantfirststeptowarda

healthieryou.

HealtHmatters…CHooseWisely. 1312 Texas Children’s hospiTal2011BenefitsandWellnessGuide

nEW

CARRIER

DISEA

SE MA

NA

GEM

ENT

foCusedHealtHsolutionsNEWiN 2011


n Doctor Care.seeyourdoctorforminorproblemssuchasstrepthroat,ear

infections,check-ups,conditionmanagement,testingandcareofongoing

medicalconditions.

n Urgent care for non-emergencies. urgentcarecentersprovide

carewhenyourdoctorisn’tavailablebutitisnotatruelife-threatening

emergency.forexample,urgentcarecenterscantreatsprainedankles,

fevers,minorcutsandinjuries.

n Emergency room care. forseriousthreatstoyourhealth,youneed

emergencycare.ifyouhaveanemergency:

–Callyourlocalemergencynumber,suchas911orgotothenearester

–onceyouarestable,askthestafftocallyourdoctor.yourdoctorcan

shareinformationregardingyourhealthandmedicationswiththeerstaff

emerGenCyorurGentCare:importanttoKnoWtHedifferenCe

Type of Care PPO EPOUrgent Care $40copay $45copay

emergency room (er) Care

20%after$500annual

deductibleplus

additional$100ercopay

$300copay

HOW TO ACCESS nO-COST PREVEnTIVE CARE UnDER BOTH MEDICAL PLAnSBothmedicalplanoptionscoverpreventivecarebenefitsfor

adultsandchildren.yourbenefitsforpreventivecareservices

arefreeofcosttoyouandyourdependentsifyouutilizea

networkphysician.

preventiveexamsincludeanannualphysicalexam,

basicbiometric/labscreening,amarecommendedwell-

childexamsandimmunizations,well-womanexamswith

associatedtesting,mammogramandwell-manexamsand

prostatescreeningsandcertainotherscreeningtestswhen

performedforpreventivereasons.suggestedexamscan

befoundonthewww.bcbstx.com/tchwebsiteundertab

“suggestedpreventiveservices”.

SAVE MOnEY WITH BLUEEXTRAS

BlueCrossBlueshieldoftexaswantstohelpyousavemoney

withBlueextrasvalue-addedprogramsthatgiveyouand

yourfamilydiscountsonhealth-relatedservices.BCBstXwill

continuetoaddprogramstoBlueextrassobesuretovisitthe

websiteforupdates.

Current BlueExtra discounts include:n membershipsatfitnessCenters

n lifetimefitness:noenrollmentfee,free7-daypassand

freeassessment

n JennyCraig:Weightlossprogramsthatfityourstyle

n Complementaryalternativemedicine:discountsforgym

memberships,massagetherapy,yoga,pilates,personal

trainers,acupuncture,etc.

n truHearing:significantdiscountsonpopularbrandhearing

aids

www.bcbstx.com/tch

WEL

LNES

S

NEWiN 2011


mediCalCoVeraGeComparisonCHart

BENEFITPPO

NETWORKPPO

NON-NETWORKEPO

(NETWORK ONLY BENEFITS)Lifetime Maximum unlimited unlimited

Annual Deductiblen individual/Family $500/$1500 $1,500/$4,500 n/a

Coinsurancen employer Paidn employee Share

80%20%

60%40%

n/an/a

Annual Out of Pocket Maximum (not including copays or deductible)n individual/Family $2,500/$5,000 $5,000/$10,000 n/a

Office Visits n Primary Caren Specialistn urgent Caren Preventive Care

$20 copay$40 copay$40 copay

100%, deductible waived

40% after deductible40% after deductible40% after deductible

40%

$25 copay$45 copay$45 copay$0 copay

Ambulance 20% after deductible 20% after deductible $0 copay

Therapyn Physical, Speech and

occupational20% after deductible 40% after deductible $45 copay

Combined maximum 60 visits/calendar year

Chiropractic Care 20% after deductible 40% after deductible $45 copay

maximum 30 visits/calendar year

Minor Diagnostic Testing and Laboratory Testingn Billed by Doctor’s officen outpatient facility n independent lab

included in office Visit copay (if services incurred same day)

20% after deductible$20 copay

40% after deductible40% after deductible40% after deductible

included in office Visit copay (if services incurred same day)

$0 copay$25 copay

All Major Diagnostic TestingCt, mri, Pet scans, etc.

20% after deductible 40% after deductible $45 copay

Emergency Room 20% after $100 copay & deductible

20% after $100 copay & deductible

$300 copay

Hospitalization100% benefit for facility charges if texas Children’s Hospital is used

20% after deductible 40% after $100/admission deductible and calendar

year deductible

$300 copay per day,$900 maximum/person/year

Durable Medical Equipment 20% after deductible 40% after deductible $0 copay

Maternity100% benefit for facility charges if a St. luke’s episcopal Hospital is used

20% after deductible 40% after deductible $300 copay per day,$900 maximum/person/year

Outpatient Surgery 20% after deductible 40% after deductible $500 copay, $500 maximum/person/year

Mental Health and Substance Abuse Treatment

treated the same as any other illness.

Pre-existing Condition Limitations over the age of 19 (refer to eligibility tab)

Some pre-existing conditions may apply. n/a

Chart represents member cost.

nEW

CARRIER

BlueCross

BlueShield

of Texas


DENT

AL P

LAN

DEnTAL COVERAgE COMPARISOn CHARTPLEASE REVIEW THIS DEnTAL BEnEFIT CHART CLOSELY. THE DEnTAL BEnEFITS FOR 2011 ARE VERY DIFFEREnT FROM THE PRIOR YEAR!

BENEFITDPPO ‘HIGH’ OPTION

NETWORK AND NON-NETWORKDPPO ‘LOW’ OPTION

NETWORK AND NON-NETWORKAnnual Deductible

n individual $50 $50

n Family $150 $150

Maximum Annual Benefit - per individual

$1,500 $1,000

Preventive Care – exam, cleaning, X-rays up to twice per year

no costno deductible

no costno deductible

Basic Services – Fillings 20% after deductible 50% after deductible

Endodontic and Periodontic Services – gum procedures

20% after deductible 75% after deductible

Major Services – Crowns, inlays, onlays, bridges, dentures

50% after deductible 75% after deductible

Orthodontia

n Diagnosis and treatment (Child)50% after separate

$50 lifetime deductible50% after separate

$50 lifetime deductible

n Diagnosis and treatment (Adult)50% after separate

$50 lifetime deductible50% after separate

$50 lifetime deductible

n orthodontia (Lifetime Maximum) $1,500 $1,000

Chart represents members cost.

BENEFIT DPPO ‘HIGH’ OPTION DPPO ‘LOW’ OPTION

non-network Benefit allowance Subject to 90% of allowable chargeCovered same as network subject to

maximum allowable charge

tCHseleCtdentalplan

NEWiN 2011

nEW CARRIERBlueCross BlueShieldof Texas

texasChildren’swillnolongerofferthe

dHmooptioneffectiveJanuary1,2011.

TEXAS CHILDREn’S SELECT PLAn OFFERS TWO DEnTAL PPO OPTIOnS THROUgH BLUECROSS BLUESHIELD OF TEXAS. theHighplanmostcloselyresemblesthepreviousdppoplanwhilethelowplanprovidesalowercostoption,utilizinganydental

providerswithreducedbenefits.

The benefits are the same whether you use in network

or non-network dental providers. thefollowingarea

fewdifferencesbetweenthetwodentaloptions:

n Highandlowoptionsincludechildandadultorthodontia

n Highoptionhashigherannuallimits

n endodonticsandperiodonticsareconsideredaBasicserviceundertheHigh

plan—paidat80%andconsideredamajorserviceunderthelowplan—

paidat25%.


tCHseleCtVisionplan–(Vsp)

undertCHselectyoualsohavetheoptiontoparticipateintheVspvisionplan.Vspisbuiltoncommitmenttoeyecare

wellnessandprivatepracticedoctors.theyhavebuiltthelargestnetworkofoptometristsandophthalmologistsintheindustryto

deliverqualitycare.theVspvisionplanincludesanannualeyeexamsandonepairofprescriptionglassesorcontacts.

out-of-networkprovidersmaybeused;however,reimbursementbenefitswillbelimitedtothoseshowninthechartbelow.

VISIOn COVERAgE THROUgH VSP

BENEFIT FREQUENCY COPAYMENTCOVERAGE USING AN

IN-NETWORK VSP DOCTOROUT-OF-NETWORK REIMBURSEMENT

Eye Examglasses OR contacts

onceperplanyear $0 Coveredinfull upto$45

Lenses

onceperplanyear $0

n singleVision,linedbifocalorlinedtrifocalcoveredinfull

n polycarbonatecoveredfordependentsuptoage19

singlevisionlensesupto$30

linedbifocallensesupto$50

linedtrifocallensesupto$65

Frames onceperplanyear $0

Coveredupto$120retailframeallowance

upto$70

Contact Lenses

onceperplanyear $0

$120allowanceforcontactsandexam(fittingand

evaluation).thisadditionalexaminsuresproperfit.

upto$105

Lasik Vision Correction

VsphascontractedmanylasersurgerycentersandoffersadiscountforlaserVisionCorrection(prKlasiKandCustomlasiK).

average15%offtheregularpriceor5%offthepromotionalpricefromcontractedfacilities.

Other Discounts and Savings

n 20%offlensoptionssuchasprogressiveandscratchresistantandanti-reflectivecoatings.

n 20%offadditionalglassesandsunglasses,includinglensoptions–availablefromanyVspdoctorwithin12monthsofyourlasteyeexam.

n average15%offthecontactlensfittingandevaluationexam

looKituponVsp’sWeBsite

theVspwebsitewww.vsp.com/go/tchisyoursourceforinformation

regardingyourvisioncarebenefits.

n locateaVspprovider

n findlenses,framesandcontactlenssavings

n seebenefitinformation

n printaVspidcard(notrequiredtoreceivecareandservices)

nomemberidcardisrequired.Callthedoctordirectlyforanappointment.

additionalhelpisavailablefrommemberservicesat1-800-877-7195.

Vsp now offers open accesssM

which allows members the flexibility

to use their Vsp benefits at any location,

including specialty optical boutiques or

retail chains.While95%ofourmembers

chooseaVspprovidertomaximizetheirbenefit,

weofferagenerousenhancedreimbursement

forservicesfromall other providers.

NEWiN 2011

VISION

PLA

N


fleXiBlespendinGaCCounts(Fsa) plans

PAYFLEX WILL BE HAnDLIng ALL YOUR FSA nEEDS. BeginningJanuary1,2011,allflexiblespending

accountexpenses(healthcareanddependentcare)

shouldbesubmittedtopayflexforreimbursement!

Two Flexible Spending Account Options

flexiblespendingaccounts(fsas)offeranattractiveway

tousepre-taxdollarstopayforeligiblehealthcareand

dependentcaredaycareexpenses.

n A Health Care accountreimbursesyouforoutofpocket

medical,dental,visionandprescriptiondrugexpenses,

suchasdeductibles,copaymentsandcoinsurance.

n A Dependent Care accountreimbursesyoufor

expensessuchasdaycare,beforeandafterschool

programs,nurseryschoolorpreschool,summerdaycamp

andevenadultdaycareforirseligibledependents.

Determining Your Pledge Amount

startbyestimatingtheamountthatyouwillincurforeligible

healthcareanddependentdaycareexpensesduringthe

planyeartodetermineyourannualcontribution.theannual

contributionamount,dividedby26,willthenbetheamount

deductedfromyourpaycheckeachpayperiod.

FSA Factsn enrollment is necessaryeachyearinwhichyouwishto

participate.

n Fsas are an optional benefit.

n no Transfers.youcannottransferdollarsfromthehealth

carefsatothedependentcarefsaorviceversa.

n no Changes to the Fsa Contributions.youcannot

changeyourfsacontributionelectionuntilthenextannual

enrollmentunlessyouexperienceaqualifyingfamilystatus

ChangeoraJobstatusChange.refertotheelection

Changetabwithinthisguide.

n no refunds.youwillnotreceivearefundofunused

deductedfsacontributionpledgeamounts.

looKitupontHepayfleXWeBsite

A HealthHub account,poweredbypayflex,isnot

onlyyoursolutiontosavingmoney,butcombined

withapayflexdebitCard(forthosewhoenrollto

participateintheHealthCarefsa),itprovidesa

simplewayforspendingyourmoneytoo!

youcanregisteronlinebyclickingregister.then

createyourownsecurityquestionandpassword.

www.healthhub.comallowsyouto:

n obtainyourbalanceorseeyourCardstatuson

mydashboard

n Viewalltransactions

n seeunsubstantiatedtransactionsthatrequire

additionalclaimvalidation

n fileaclaim(uploaddocuments)orprovide

substantiation

n decideifpaymentsshouldbemadetoyouor

“them”

n Viewlistingofalleligibleexpenses

n Calculatetaxsavingsusingthe“savings

Calculator”

n determineifdependentCarefsaisrightforyou

using“dependentCaretaxWizard”

n orderadditionalcardsforspouseorchildren

n signupforelectronicaccountupdates

n enrollindirectdeposit

n shoponlineforhealthcarerelatedexpenses

n ViewfrequentlyaskedQuestions


nEW

FSA

VEnDORPayFlex

FSA

PLAN

S

HealtHmatters…CHooseWisely. 1918 Texas Children’s hospiTal2011BenefitsandWellnessGuide

thedependentCarefsaissimilartotheHealthCarefsa,

allowingyoutosetasidepre-taxmoneyfordependentcare

expenses.

if you participate in the dCFsa, Texas Children’s will

automatically deposit $260 in your dCFsa for your

immediate reimbursement of eligible expenses.

MAXIMUM DEPEnDEnT CARE PLEDgEthemaximumannualpledgeamountyoucandepositinto

thedCfsaeachyearis$5,000($2,500ifyouaremarried

andfileaseparateincometaxreturn).The maximum

pledge should include the $260 that Texas Children’s

contributes on your behalf to your dCFsa.

eligibledependentexpensesarethosethatwouldqualifyfor

achildcaretaxcreditonyourfederaltaxreturn.youmustfile

aform2411annuallywithyourtaxreturnidentifyingallyour

dependentcareproviders.allprovidersmustbelicensedday

carefacilitiescomplyingwithstateandlocallaws.

ELIgIBLE DEPEnDEnTS InCLUDE:n dependentundertheageof13

n adependentwhoisphysicallyormentallyincapableof

caringforhim/herself,hasthesameprincipalresidence

asyouformorethanhalfoftheyear;andhaslessthan

$3,200intotalincomefor2011ifovertheageof13;or

n aspouseifhe/sheisphysicallyormentallyincapableof

caringforhim/herself,hasthesameprincipalresidenceas

youformorethanhalfoftheyearandhaslessthan$3,200

intotalincomefor2011.

n youmustbeabletoclaimthedependentonyourfederal

taxreturn.

ELIgIBLE EXPEnSES InCLUDEthoseexpensesthatarenecessaryforyou(andifmarried,

yourspouse)towork,unlessyourspouseisafulltime

studentorisdisabled.Belowaresomeeligibleexpense

parameters.foramoredetailedlistofallowableexpenses,

visitwww.healthhub.com.n Careforyourdependentswhileyouwork

n CopaymenttoBrightHorizonsforinterimbackupcare

n summerdayCamp(notovernight)

n Beforeandafterschoolcare

n nurseryschool

n mustbeforservicesreceivedaftertheeffectivedateofthe

electionandduringtheplanyearinwhichitapplies

n mustbeforservicesrendered;notforfutureservices

note:youwillbereimburseduptoonlytheamountcurrently

depositedinyourdCfsaaccount.

Important Dates

DEPENDENT CARE FLEXIBLE SPENDING ACCOUNT (DCFSA) PARAMETERS

IRS DEADLINE DATES

deposits made in calendar year 2011 must be used for expenses incurred:

Jan1,2011-dec31,2011

For claims incurred in calendar year 2011, claims substantiation must be submitted to payFlex by this date to avoid forfeiture of unused contributions:

april30,2012

EXPAnDED PAYFLEX HOURS PROVIDE ADDITIOnAL SUPPORT FOR YOUR FSA qUESTIOnS:n Callpayflexat1-800-284-4885

–monday-friday7a-7p

–saturday9a-2p

dependentCarefleXiBlespendinGaCCount(dCfsa)

nEW FSA VEnDORPayFlex


WHAT YOU nEED TO knOW ABOUT A HEALTH CARE FSAn youcanonlypledgeyourcontributiontoanfsaduringopen

enrollmentorwhenyoufirstbecomeeligible.

n onceyouestablishyourplanyearpledgeyoumayonlychange

itifyouexperienceachangeinstatus.refertoelectionChanges

sectionofthisguide.

n Enrollment is required each year in which you wish

to contributebecauseyourcontributionelectiondoesnot

automaticallyroll-overfromyeartoyear.

n youmaycontributeaminimumof$5.00perpayperiodupto

$5000percalendaryear.

n yourtotalannualcontributionpledgetotheHealthCarefsais

availabletoyouimmediately.

n Contributionsarenottaxableaccordingtoirsregulations.

n expensesmaybeforyourselfand/oryoureligibledependents,

whetherornottheyarecoveredunderthetexasChildren’s

selectplanformedical,dentalorvision.

n expensesmustbeincurredduringaperiodinwhichthe

employeeiscoveredundertheHealthCarefsa.

THE HEALTH CARE FSA gRACE PERIODtheHealthCarefsaGraceperiodincludesanextendedperiodof

coverageattheendofeveryplanyearthatallowsyouextratimeto

incurexpensestouseyourremainingflexiblespendingaccount

balanceafterthecloseoftheplanyear.theGraceperiodis2-1/2

monthslong(throughmarch15thofthefollowingyear).

Whatthismeansforyouisthatyouhaveuntilmarch15thofthe

nextplanyeartoincurclaimsagainstyourpreviousyear’sfsa

funds.aneasywaytothinkaboutthisprogrammodificationisthat

every12monthplanyearisactually14-1/2monthslong.

onlythosewhohavefsacoveragethroughdecember31stofthe

previousplanyearcancontinuetoincurclaimsinthegraceperiod.

allfsaclaimsforservicesprovidedduringthegraceperiodwill

automaticallybeprocessedagainstthepreviousyear’splanyear

firstiffiledbythedeadlineforthatplanyear,unlessyourequest

otherwise.ifyourclaimexceedstheavailablefundsfromthe

previousplanyear,anyexcesswillautomaticallybeappliedtothe

newplanyear.yourpayflexCardwillrecognizeanyremaining

balancefromtheprioryear.

HealtHCarefleXiBlespendinGaCCount(HCfsa)

nEW FSA VEnDORPayFlex

Important Dates

Healthcare Flexible Spending Account (HCFSA) Parameters

IRS Deadline Dates

deposits made in calendar year 2011 must be used for expenses incurred:

Jan1,2011-march15,2012

For claims incurred in calendar year 2011, claims substantiation must be submitted to payFlex by this date to avoid forfeiture of unused contributions:

april30,2012

ORTHODOnTIA REIMBURSEMEnTtheirsrecognizesthatorthodontiatreatmentisdifferent

fromanyothertypeofhealthcareexpense.therefore,

reimbursementoforthodontiacanbehandledintheseways:

n Coupon payment option-youcansubmitanitemized

statementofyourorthodontiaexpensesastheserviceis

provided.

n Monthly payment option-youcanobtainacontract

agreementfromtheorthodontistshowingthepatientname,

thedatetheservicebeginsandthelengthofservice,

chargesfortheinitialbandingworkandthedollaramount

chargedeachmonth.submityourcontractwithyourfirst

claimandwewillautomaticallyreimburseyoueachmonth,

accordingtothecontract,eliminatingtheneedtosubmita

claimeverymonth.youwillneedtosendanewclaimform

withyourcontractagreementatthebeginningofthenext

planyearifyouwishtocontinuereimbursements.

n Total payment option-ifyoupaidtheentireamountof

thetreatmentwhentheservicesbegan,submityourclaim

withacopyofyourpaidreceiptandanitemizedstatement

showingtheprovidername,patientname,datetreatment

started,dollaramountandamountyourinsurancewillpay.

underthisoption,youcanonlyfileforthisexpenseonce.


HOW DOES THE nEW PAYFLEX CARD WORk?asyouincureligiblehealthcare

expenses,yousimplypresentyourcard

forpayment.thepayflexsystemwillthen

validatethatyouhavefundsavailableto

coverthetransactionandautomatically

deducttheamountfromyourHealthHub

account.

youcanusethecardforonlinepurchasesaswell.throughHealthHub’s

consumercenter,youcanbuyitemssuchasglasses,contacts,prescription

drugs,durablemedicalequipmentusingyourpayflexCard.ifanitemisnot

identifiedas“fsaeligible”youwillneedanotherformofpaymentotherthan

yourpayflexCard.

n Cardismailedtoyourhomeaddressinaplainwhiteenvelope

n activatethecard

n select‘credit’whenmakingapurchase

n savereceiptsandexplanationofBenefits(eoBs)fordocumentationof

eligibleservices

n Respond promptly to Request for Documentation Letters or the

card will be inactivatedn Keepyourcardyearafteryear(goodforupto5years)

n lostorstolencards:1-800-284-4885

n Questions:1-800-284-4885

–monday-friday7a-7p

–saturday9a-2p

eliGiBleHealtHCarefsaeXpenses

eligibleexpensesincludebutarenotlimitedtothefollowing

list:(forfulllistingvisitHealthHub.com)

n deductiblesandcopaymentsforthemedical,dental,

prescriptionsandvisionplan

n orthodontiaorothernoncosmeticdentalexpenses

beyondthemaximumamountreimbursedbythedental

plan

n eyeglassesandcontactlensesnotcoveredbytheVspor

othervisionplan

n medicalsupplies,crutchesandwheelchairs

n smokingcessationprogramsandprescriptiondrugsto

alleviatenicotinewithdrawal

n feesforpsychologicalservices

n dentures

ineliGiBleHealtHCarefsaeXpensesEffective 1/1/11: OVER THE COUnTER DRUgS / MEDICATIOnS (unless prescribed by a physician) WILL nO LOngER COnSTITUTE An ELIgIBLE EXPEnSE PER IRS gUIDELInES.

productsthataremerelybeneficialtoyourhealth,suchas

vitamins,dietarysupplements,cosmetictreatments,teeth

bleachingandoverthecountermedicationsandsuppliesare

consideredineligible.forafulllisting,visithealthhub.com.

Benefits of Using the PayFlex Card for Payment of

HCFSA Expendituresn immediatepaymentofyourexpensesfromyourhealthcare

account

n increasesyourpersonalcashflow

n noclaimfilingduetopointofsaleapproval(unlessclaim

substantiationisneeded)

n easeofuseofyourpre-taxcontributions

nEW

SUBSTAnTIATIOn AnD REqUEST FOR DOCUMEnTATIOn LETTERSifyoureceivearequestfordocumentation

letter,youarerequired,asregulatedbytheirs,

toprovidedocumentationtoverifythatthecard

wasusedtopurchaseaneligibleitemorservice.

If you do not respond within 60 days of

request, your card WILL BE DEACTIVATED

until you provide the requested

documentation or payment.

Three options to respond:

1.submitanitemizedreceiptorexplanationof

Benefits(eoB)forthetransaction(s)listed;

2.submitanitemizedreceiptoreoBforanother

eligibleitemincurredduringtheplanyearthat

hasnotalreadybereimbursed;or

3.sendapersonalcheckormoneyorderforthe

identifiedexpenseifyouareunabletoprovide

documentation.

nEW


LIFE InSURAnCE AnD ACCIDEnTAL DEATH AnD DISMEMBERMEnT (AD&D) InSURAnCEunderthetCHselectplan,texasChildren’sofferslife

andaccidentinsurancetoprovidefinancialassistanceat

atimewhenyouoryourfamilymayneeditmost.

BASIC LIFE AnD BASIC ACCIDEnTAL DEATH & DISMEMBERMEnTtexasChildren’sautomaticallyprovidesfull-timeand

part-timeemployeeswithbasiclifeandaccidentaldeath

anddismemberment(ad&d)coverageat1Xyour

annualbasesalary,roundedtothenext$1,000uptoa

millionmaximum—atnocosttoyou.

OPTIOnAL LIFE InSURAnCEyoumayelecttoparticipateintheoptionallife

insuranceplantoprovideyourbeneficiary(ies)additional

financialsecurityintheeventofyourdeath.

n full-timeemployeesmaypurchasecoverageequalto

1to4timesyourbaseannualsalary,roundedtothe

next$1,000,uptoacombined(Basicandoptional

life)maximumof$2,000,000.

n part-timeemployeesmaypurchasecoverageequal

to1timesyourbaseannualsalary,roundedtothe

next$1,000,uptoamaximumof$1,000,000.

evidence of insurability (eoi) must be provided for

amounts over $500,000.

theannualbasesalaryiscalculatedusingyourhourly

ratex2,080xyourelection,thenroundedtothenearest

thousand.

example:$20/hourX2080=$41,600(roundedup

tothenexthigherthousand)=$42,000of

optionallifeinsuranceCoverage

lifeinsuranCeBenefitsWitHprudential

nEW

CARRIER

Prudential

OPTIOnAL ACCIDEnTAL DEATH & DISMEMBERMEnTyoumayalsopurchaseoptionalad&dinsurancecoverageto

provideyourbeneficiary(ies)additionalfinancialsecurityintheevent

ofanaccidentaldeathorseriousinjuryfromanaccidentasdefined

bytheplan.

n full-timeemployeesmaypurchasecoverageequalto1to4

timesyourbaseannualsalary,roundedtothenext$1,000,

uptoacombined(Basicandoptionalad&d)maximumof

$2,000,000.

n part-timeemployeesmaypurchasecoverageequalto1times

yourbaseannualsalary,roundedtothenext$1,000,uptoa

combined(Basicandoptionalad&d)maximumof$1,000,000.

theannualbasesalaryiscalculatedusingyourhourlyratex2,080

xyourelection,thenroundedtothenearestthousand.

example:$20/hourX2080=$41,600(roundeduptothenext

thousand)=$42,000ofad&dinsuranceCoverage

AgE 65 gUIDELInESatage65,yourBasiclifeinsuranceandBasicad&damountwill

bereducedaccordingtotheschedulebelow:

AGE REDUCED TO

65 65%

70 50%

75 30%

ACCELERATED DEATH BEnEFIT (EMPLOYEE OnLY)ifyoubecometerminallyillwithlessthanasix-monthlife

expectancy,youmaybeeligibleforanaccelerateddeathbenefit.

thisbenefitisequalto90%ofyourBasicandoptionallife

insurancein-forceor$500,000,whicheverisless.

SPOUSE LIFE InSURAnCEunderthetCHselectplan,ifyouareafull-timeemployee,you

mayelectspouselifeinsuranceprovidedyouhaveenrolledinthe

optionallifeinsuranceplan.youmaycoveryourspouseatoneof

thecoveragelevelsuptoamaximumof$100,000(nottoexceed

youroptionallifeamount).part-timeemployeesarenoteligibleto

electspouselifeinsurance.

LIFE

INSU

RANC

E

nEW

example: employeeage70

making$50,000.

Basiclifeand

ad&d=$25,000.


youhave31daystoenrollyourspousefromthedateof

eligibility.duringthistimeanyamountover$25,000will

requireyourspousetoprovideevidenceofinsurability.

Coverage Benefit Election for Spousal Life

Insurance

upto$25,000

n 1xyourannualbasesalary




yourannualbasesalaryiscalculatedusingyourhourlyrate

x2080xyourelection,roundedtothenextthousandupto

amaximumof$100,000.

DEPEnDEnT LIFE InSURAnCEunderthetCHselectplan,ifyouareafull-timeemployee

youmayelectcoverageforyoureligiblechildrenuptoage

25inthefollowingcoverageamountsprovidedyou(the

employee)haveenrolledintheoptionallifeinsuranceplan:

Coverage Amounts by Age

DEPENDENTS FROM LIVE BIRTH TO AGE 25

$2,500

$5,000

$10,000

EVIDEnCE OF InSURABILITYYou must provide satisfactory Evidence of

Insurability if:

1.youroptionallifecoverageequals$500,000ormore,

or

2.youarecurrentlynotenrolledandareelectingoptional

lifeor

3.youarecurrentlyenrolledin2010andareelectingto

increaseyour2011optionallifeinsurancebymorethan

onelevelor

4.youelectspousecoverageaftertheinitialeligibility

period,or

5.yourspouseenrolls(atanytime)formorethan$25,000

nEW CARRIERPrudentialLOng TERM DISABILITY (LTD)ltdbenefitsaredesignedtoprotectyouandyour

familyfromthefinancialhardshipthatmayaccompanya

personalillnessorinjurythatkeepsyoufromworkingfor

anextendedperiodoftime.Certainpre-existingcondition

limitationswillapplytoBasicandoptionalltd.

Under The TCH Select Plan, Texas Children’s provides

full-time employees with Basic LTD at no cost.

ifyouwantadditionalltdcoverage,youmayincreaseyour

coveragetotheoptionalltdplan.ifyouincreaseyour

coverage,youradditionalltdbenefitsarepurchasedwith

after-taxdollarssothatifyoubecometotallydisabled,no

taxeswillbetakenoutoftheoptionalltdbenefitpayment

youreceive.

yourltdbenefitswillbereducedby:

n socialsecuritybenefits

n Worker’sCompensationbenefit

n anybenefitspaidtoyouunderanystationeryplan(ex:

CashBalancepensionplan)

LTD Benefit Plan Duration

thebenefitperiodisbasedonthedateinwhichyoubecame

disabledasshownbelow.

Basic LTD Plan

AGE ON DATE OF DISABILITY

MAXIMUM BENEFIT DURATION

less than 68 24months

68, less than 69 toage70

69 and over 12months

Buy Up/Optional LTD Plan

AGE ON DATE OF DISABILITY

MAXIMUM BENEFIT DURATION

less than 60 toage65

60 60months

61 48months

62 42months

63 36months

64 30months

65 24months

66 21months

67 18months

68 15months

69 and over 12months


Maximum Monthly Long Term Disability Benefit Payment Plan

PLANMONTHLY BENEFIT

MONTHLY MAXIMUM

Basic 50% $5,000

optional 70% $10,000

Items to Remember about Long Term Disabilityn youmaybeaskedtoexploredisabilitybenefitsthroughsocial

security.

n youmaycontinueyourmedical,dentalandvisioncoverage

and,insomecasesHealthCarefsaunderCoBrawithin60

daysofyourterminationdate.

n youmayalsoapplyforportabilityorconversionofyourlife

insurancewithin31daysfromyourterminationdate.youmay

beeligibleforawaiverofyourpremium.

nO-COST WILL PREPARATIOn SERVICE AVAILABLE TO ALL LIFE PLAn PARTICIPAnTStexasChildren’sfullandpart-timeemployeeshaveaccesstothis

importantbenefitwhetherornotyouenrollin‘optional’life.estate

GuidanceisaprogramofferedthroughCompsychthatallows

youtheeaseandsimplicityofonlinelegaldocumentpreparation

(suchasawill).Willsensurethatyourassetswillbedistributed

inaccordancewithyourwishes,shouldsomethinghappento

you.awillalsoallowsyoutonameanexecutorandaguardian

totakecareofyourminorchildren.everyadultshoulddraftawill

andprotecttheirfamily.youwillalsohavetheopportunity(foran

additionalfee)tocreateacreditsheltertrust,alivingwill,anda

healthcarepowerofattorney.toaccesstheseservicesgoto

www.estateguidance.comandenteryourCompanyWebid:

eGp311.

anotherplus,availablethroughprudential,isaccesstotheaXa

travelassistanceprogram,anessentialserviceprovidedbyaXa

assistanceusa,inc.thisserviceoffersyouandyourdependents

medical,travel,legalandfinancialassistanceservices,24hours

aday,365daysayear,worldwide.participantshaveaccess

toassistanceserviceswhenfacedwithanemergencywhile

travelinginternationallyordomesticallywhenmorethan100miles

awayfromhomeforupto120consecutivedays.Withonesingle

phonecall,youandyourdependents(whethertravelingtogether

orseparately)willhaveimmediateaccesstoabroadrangeof

travelassistanceservices.

ifyouhaveanyquestionsabouttheservicesorneed

travelassistance,pleaseaccessbywebsite:

www.axa-assistance.usorcallthetravelassistanceprogram

Hotline:1-800-565-9320.

Long Term Care Insurance (LTC)texasChildren’slongtermCareinsuranceplanisa

voluntarybenefitprogramavailabletoallactivelyatwork

full-timeandpart-timeemployeesandtheirspouses,

children,parents,andgrandparents.longterm

carecomplimentsyourhealthcareplanbyproviding

coveragebenefitsforextendedcarenecessarydueto

chronic,disablingillnessesorinjuriesthatmedicareand

healthplansarenotdesignedtocover.extendedcare

mayincludeassistanceinyourownhome,anadultday

carefacilityandmanyothertypesoflong-termcare

facilities.longtermCareinsurancecoverssomuch

morethannursinghomefacilitiesfortheelderly.long-

termcareinsurancegivesustheabilitytocontinuea

lifeofdignityandindependencewithoutburdeningour

lovedonesshouldwebediagnosedwithadisabling

illnessorinjury.

eligibleapplicantswillchoosefromadailymaximum

benefitof$100,$200or$300.premiumswillbe

determinedbytheapplicant’sageatthetimethe

applicantenrollsforcoverage.

newlyhired,activelyatworkemployeesornewlyeligible

employees(doesnotincludeeligiblefamilymembers),

whoenrollwithinthe90dayperiodfollowinginitial

eligibility,willbeautomaticallyacceptedforcoverage

uponreceiptoftheirapplication,regardlessofcurrent

healthstatus.alleligiblefamilymembers,andeligible

activelyatworkemployeesapplyingaftertheinitial

90-dayenrollmentperiod,willhavetoprovideproofof

goodhealthbeforebeingacceptedintotheplan.

yourageatenrollmentwilldetermineyourmonthly

premiumrate.premiumswillbepaidthroughpayroll

deductionforemployeeandspousalcoverage.allother

eligiblefamilymemberswillhavetheoptionofpaying

premiumsthroughautomaticbankwithdrawalordirect

billing.

JOHn HAnCOCk COnTACT InFORMATIOnn Byphone:1-800-724-3785

n http://tch.jhancock.com

-username:tch

-password:mybenefit

NEWiN 2011


texasChildren’spensionbenefitsaredesignedtohelpyoubuild

asolidfinancialfoundationforyourretirementyears.Whenboth

oftheplanslistedbelowarecombinedwithsocialsecurityand

yourpersonalsavings,thetotalpackageisintendedtohelpyou

achieveyourretirementgoals.

reviewthechartsonthefollowingpagesforanoutlineofthe

benefitprovisionsforeachofthetexasChildren’sretirement

plansreferencedbelowandrefertotheplandocumentsfor

greaterdetail.

n THE TEXAS CHILDREn’S 403B SAVIngS PLAn – ADMInISTERED THROUgH FIDELITY

texasChildren’swillmatchupto50%ofthefirst6%ofyour

perpayperiodcontribution.youmayenrollinthisplanatany

timethroughouttheyearbycontactingfidelityat1-800-343-

0860oronlineathttps://www.fidelity.com/atwork.

monthly1-on-1sessionsareheldatthemaincampusto

providecurrentparticipantstheopportunitytoevaluate

thestatusoftheir403bsavingsplanaccount,consider

modificationsandmakechangesasneeded.registration

isrequiredfora30-minuteconsultation.Callfidelityat

1-800-642-7131afterthe20thofthemonthtoschedulean

appointmentforthefollowingmonthoryoumayschedule

onlineatwww.fidelity.com/atwork/reservations.

n THE TEXAS CHILDREn’S CASH BALAnCE PEnSIOn PLAn (CBPP)

employeesdonotneedtoenroll,nordoyoumake

contributionstothisdefinedbenefitretirementplan.texas

Children’spaysthefullcostofthisbenefitonceeligibility

requirementsarefulfilled.(seechartonnextpage)

retirementandsaVinGsplanBenefits

aCCessyourannualCBppstatementtHrouGHmoli

1.Clickonthetotalrewardse-statementicon

2.ClickonBenefits

3.ontheBenefitsscreen,scrolltothebottomtoselect

thecalendaryear

4.ClickonthewordsCashBalancepensionplan

n THE FIDELITY 529 COLLEgE SAVIngS PLAn

throughfidelity’sselectionoffundstrategiesyou

havegreaterflexibilityandmorefreedomtoinvest

foryourchild(ren)orimmediatefamilymember’s

education.

Features of 529 College Savings Plan: - accountearningsgrowtax-deferredandqualified

withdrawalsarefreefromfederalincometax.

- fundsmaybeusedatanyaccreditedpublicor

privatecollegeintheu.s.

- takesaslittleas$25perpayperiod(viadirect

deposit)toopenanaccount.

- multipleinvestmentstrategiestoselectfrom(based

onageorriskpreference).

- Highplanlimitsperbeneficiary,currently$330,000

(adjustedupwardregularlyforinflation).

- Beneficiariesmayincludeyou,yourchild,

grandchild,spouse,etc.

- allowsforlump-sumdepositsatanytime.

youcontributetothe529account(s)yousetupwith

fidelityviaadirectdepositthroughtexasChildren’s

payrollorthroughautomaticdebitofapersonal

checkingorsavingsaccount.

toestablisha529collegesavingsaccountormake

changestoanexistingaccount,callfidelitydirectly

at1-800-544-1914orlogontowww.fidelity.com/

uniquetolearnmore.

PEN

SION


CASH BALAnCE PEnSIOn PLAn 403B SAVIngS PLAn

nTexas Children’s Cash Balance Pension Plan is a non-contributory defined benefit retirement plan for employees. nThere are no employee contributions made to this plan. Texas Children’s pays the full cost of this benefit.nEmployees do not need to enroll.

Plan Design

Pension CommitteeATTN: HR Benefits, 1919 S. Braeswood, Suite 1301, Houston, TX 77030832-824-2421, option 1.

Plan Administrator

You will be eligible for the Cash Balance Pension Plan after you meet the following criteria: nYou must be at least 21 years of agenYou must work 1,000 or more hours during the 12 month period following your initial date of hire, or any subsequent

plan year.

If you meet these requirements, you will automatically enter the plan on the following April 1 or October 1.

Eligibility

n You are AuTOmATICAllY enrolled once you meet all eligibility criteria.Enrollment

n Normal retirement is age 65n Early retirement is age 55 with 10 or more years of vested serviceRetirement Eligibility

Interest creditsAt the end of each Plan Year, participants will be credited with interest on such Plan Year’s opening balance. Interest credits are:n Based on the interest crediting rate as defined in

the Plann In no event for a Plan Year, be less than 3.8% or

more than a “market rate of return” (within the meaning of Section 411(b)(5) of the Code and Section 204(b)(5) of ERISA).

Employer Contributions

This is a non-contributory defined benefit retirement plan for employees.Employee Contributions

Your vesting service is one year of service for each fiscal year (Oct. 1 – Sept. 30) in which you complete 1,000 or more hours of service.

Vested Year of Service

nOnce you have three fiscal years of vesting service, you are 100% vested.nBeing vested means the employer paid benefit in your account is yours upon retirement or termination

of employment.Vesting Schedule

Once you are a member of the plan, you will be able to view your annual statement online through your Texas Children’s Total Rewards e-statement in mOlI.Statement

If you leave and are 100% vested, if your CBPP account balance is:n$5,000 or less, you must take a lump sum or rollover distributionn $5,000 to $7,000, you have the following early distributions options: - lump sum / Rollover - An annuityn$7,000 or more, you must wait until age 65 (or age 55, if you had 10 or more years of vesting service).

Termination/ Retirement

nChanges are allowed at any time during the year and do not require a qualifying life event to modify.nPlease contact the Benefits office to obtain a beneficiary-designation/change form NOTE: If you are married, you must obtain spousal consent with notarization to designate anyone other than

your spouse to receive your benefit. Your spouse is entitled to 100% of your retirement account upon your death, unless the spouse has provided written consent otherwise.

Beneficiary DesignationAnd Changes

ContributionIf you complete at least 1000 hours of Service in a Plan Year (Oct. 1 - Sept.), Texas Children’s will credit you with a contribution in the Cash Balance Pension Plan calculated as a percentage of your Plan Year base compensation. The applicable percentage is based on your full years of Vesting Service, as of the end of such Plan Year, as follows:n3%: less than 5 yearsn4%: 5 to 9 yearsn5%: 10 or more years


nEW

CASH BALAnCE PEnSIOn PLAn 403B SAVIngS PLAn

n The 403(b) savings plan provides a way for you to save for retirement on a tax-deferred basis. nThis is a voluntary, defined-contribution retirement savings plan.nYour 403(b) contribution is taken directly from your paycheck before taxes.nYou have more than 145 funds in which to invest.

Recordkeeper: Fidelity Investments1-800-343.0860 www.fidelity.com/atwork

Pension CommitteeATTN: HR Benefits, 1919 S. Braeswood, Suite 1301, Houston, TX 77030832-824-2421, option 1.

nYou may begin participating on the first day of your employment or at any time following such date at Texas Children’s.

n To enroll in the Plan, you must contact Fidelity by phone at 1-800-343.0860 or online at www.fidelity.com/atwork.

n There is no age requirement for you to begin drawing benefits; however, you must leave Texas Children’s to receive these benefits.

nTexas Children’s will make a contribution to your 403(b) savings plan every pay period you make a contribution. nTexas Children’s will match up to 50% of the first 6% of your per pay period contribution. nThe maximum employer contribution per pay period is the lesser of 3% of your gross salary or 50% of your contribution.

For example: Your contribution Texas Children’s will match 4% . . . . . . . . . . . . . . . . . . . . . . . 2% 6% . . . . . . . . . . . . . . . . . . . . . . . 3% 10% . . . . . . . . . . . . . . . . . . . . . . . 3%

nYou may elect a percentage of your gross earnings to be deducted on a pre-tax basis each pay period.nYou do not pay any income tax on your investment in your 403(b) account until you withdraw the money.n “Catch-up” Provision: if you are going to reach age 50 or older during the calendar year (Jan. 1 – Dec. 31) and make

the maximum annual contribution, you may make an additional contribution only after the annual maximum is met.nThe maximum contribution amounts for 2011 calendar year are: $16,500 or $22,000 if 50 years of age or more; and subject to change as determined

by the IRS.

You will earn a year of vested service for every fiscal year (Oct. 1 - Sept. 30) in which you complete 1,000 or more hours of service.

nYou are always 100% vested in any contributions you make to the plan.nYou will become partially vested in the contributions made by Texas Children’s according to the following schedule. If you work at least 1,000 hours

per fiscal year (Oct. 1 – Sept. 30), then after:

Years of service You will be Years of service You will be less than 1 year . . . . . . . . . . . . . . . . . . . 0% vested 3 years, but less than 4 . . . . . . . . . . . . 60% vested 1 year, but less than 2 . . . . . . . . . . . . . 20% vested 4 years, but less than 5 . . . . . . . . . . . . 80% vested 2 years, but less than 3 . . . . . . . . . . . . 40% vested 5 years . . . . . . . . . . . . . . . . . . . . . . . . 100% vested

Participants will receive quarterly statements online by accessing your personal account information through Fidelity’s website atwww.fidelity.com/atwork. To request paper statements call 1-800-343-0860.

At any time after you leave Texas Children’s:n You may take 100% of your voluntary contributions.nIf you are 100% vested, you may also take 100% of the match dollars contributed by Texas Children’snIf you have been employed less than five years, you may take the VESTED PORTION of the match dollars

contributed by Texas Children’s.nTax implications may apply with distributions.

n Changes are allowed at any time during the year and do not require a qualifying life event to modify.n Fidelity is the official record keeper of beneficiary designations.n Participant employees should go online to www.fidelity.com/atwork to designate or update beneficiary information.n Employees are encouraged to keep beneficiary information up to date, and beneficiary designations may be changed at any time during the year.

NOTE: If you participate in the 403(b) plan and you are married, you must designate your spouse as beneficiary to 100% of your benefit. Your spouse is entitled to 100% of your retirement account upon your death, unless your spouse has provided written consent otherwise.


employeeHealtHandWellnesstexasChildren’siscommittedtoprovidingavarietyofwellness

optionstosupportoptimumhealth,throughhealthychoices.

‘WELLnESS In THE WORkPLACE’ InITIATIVES FOR EMPLOYEESn HandHygieneinitiative(Hy5)

n immunizations(flushots/tBskinteststhroughemployeeHealth)

n preventiveCareBenefitsthroughBlueCrossBlueshield

n HealthandWellnessfairsforemployees(withno-costemployee

Healthscreeningsformedicalplanmembers)

n diseasemanagementthroughfocusedHealthsolutions

n on-sitemobilemammographyofferings

n fitnessClub-membershipdiscounts

InTERnAL EMPLOYEE ASSISTAnCE PROgRAM (EAP) PROVIDES VALUABLE SUPPORTtexasChildren’svaluesyou,bothasanindividualandasan

employee.thedemandsofourworkandpersonallivescan

sometimesconflictwitheachothermakingitdifficulttofeel

successfulateitherone.theeapcanhelpyoumanagelife’s

challenges.

theonsitetrainingsandeducationalopportunitieslistedbelow

provideindividuals,departmentsandleaderswithongoingaccess

tosupporttobettermanagesituationsandcircumstancesthatcan

causedisruption.

n Work&personalstress n family&maritalissues

n Communication&anger n Caregiverstress

n mentalHealthissues n Work-relatedissues

n personal&familyaddictions n Grief&loss

n legal&financialissues

theeapcoversfullandpart-timeemployeesandeligible

dependents,includingyourspouseandchildrenundertheageof

19whodependonyouforsupport(unmarriedchildrenbetweenthe

agesof19and26).

eapservicesarefreeandconfidential.ifit’saconcerntoyou,the

eapcanhelp.tocontactortoscheduleanappointmentwitha

memberoftheeapteam,call832-824-eeap(3327)oremail

[email protected].

foralmostadecadetexasChildren’shasbeen

recognizedasoneofHouston’sBestWorkplaces

forCommutersbytheu.s.environmentalprotection

agency(epa).inadditiontothisgreataccomplishment,

texasChildren’swasdesignatedaCleanairChampion

bytheHouston–GalvestonareaCouncil(H-GaC).

OUTSTAnDIng COMMUTER BEnEFITS FOR TCH-PAID EMPLOYEESn metrobuspasses

n Vanpoolvouchers

n Woodlandsexpresstickets

n offcampusparking

n GuaranteedrideHomeprogram

n availabilityofcoveredbikeracks

n optiontowaiveacommuterelection;(employees

inthemedicalCenterorGreenwayplazawhowaive

theircommuterelectionoptionreceiveamonthlycar

poolallowanceof$20.)eachemployeecanholdonly

oneelectionatatime.

FLEXIBILITY TO CHAngE YOUR COMMUTER ELECTIOn MOnTH-TO-MOnTHemployeesmayaccessthetransportationChange

formonlineorstopbyanHrlocationtocompleteor

turninaform.thenewelectionwillbecomeeffectivethe

firstdayofthefollowingmonth.

Options To Submit a Transportation Change

Request Form to HR:n HrserviceCenter-abercrombieBuilding,1stfloor,

suitea-130

n meyerBuilding–Benefits,3rdfloor

n faxtoHrBenefits:832-825-2829

pleasereadandreviewspecificdetailsofallyourtCH

commutersbenefitsasoutlinedonConneCtandthen

callthetotalrewardsmainlineat832-824-2421,

(options1forBenefits)shouldyouhavequestions.

onceatmCparkingcardhasbeenissued,please

contacttexasmedicalCenter(tmC)Customerservice

lineat713-791-6161withcard-relatedissues.

CommuterBenefits

COM

MUT

ER B

ENEF

ITS


BalanCinGWorK,Homeandfamily

TIME-OFF BEnEFITSagenerouspaidtime-off(pto)programprovideseligiblefull

andpart-timeemployeeswithtimeofffromworkforpersonalor

familyneedsandrewardsemployeesforcomingtoworkandfor

schedulingtimeoffinadvance.

additionally,after2daysoffworkforillnessorinjury,eligible

employeesmaythenaccesstheiraccruedextendedillnessBank

(eiB)whichalsoprovidesasourceofearnedhourswithpay.

Payout of PTO balances occur when:n youterminateemployment,or

n yourclassificationchangestoaperdiemstatus

refertoHrpolicy#Hr201whereyoucanalsoviewyourpto

accrualschedule(basedonyourtexasChildren’sentityandyears

ofservice).

OTHER TYPES OF TIME-OFF AnD THEIR CORRESPOnDIng HR POLICIESn Catastrophictimeoff(Cto)-#Hr202

n Holidays/myday-#Hr203

n Bereavement-#Hr204

n military-#Hr205

n Juryduty-#Hr206

n timeofftoVote-#Hr207

n otherleavesofabsence-#Hr208

n familymedicalleave(fml)-#Hr214

PTO SELL PROgRAM - #HR201

Whileemployeesarenotdiscouragedfromtakingearnedtimeoff,

employeeswithatleast120hoursofaccruedptomayelectto

sellablockofhoursbacktotexasChildren’sandbepaidforthe

valueofthosehours.atotalof80hoursmaybesoldatonetime

or40hoursofptomaybesoldtwicepercalendaryearprovided

theeligibilityrequirementismet.processandsubmityourrequest

online,atanytime,throughyourtotalrewardse-statement.

EVERYOnE’S A RECRUITER nOW -- E.A.R.n. PROgRAMthisreferralrewardprogramofferspotentialdollarstoeligible

employeesforqualifiedapplicantswhoarehiredandbegin

employment.Certainrequirementsapply.forquestions,callHr

recruitmentat832-824-2020.

PERSOnAL AnD FAMILY FOCUSED InITIATIVESADOPTIOn ASSISTAnCE PROgRAM

texasChildren’sadoptionassistancebenefitprovides

reimbursementofeligibleadoptionexpensestofulland

part-timeemployeeswhomeetthefollowingcriteria:

n havecompletedthreemonthsof‘continuous’service,

and

n theadoptedchildisnotyourbiologicalchildor

stepchild

REIMBURSABLE ADOPTIOn EXPEnSES

upto$3,000maybereimbursedoncetheadoptionis

finalandforonlyexpensesincurredafteryoubecome

eligibleforadoptionbenefits.

someeligibleexpensesinclude:

n legalfeesandCourtCosts

n placementfees

n travelexpensesincurred(foroneoftheadopting

parentsoraguardian)toescortthechild

awrittenrequestforreimbursementmustbesubmitted

toHrBenefitswhileyouremainanactive,eligibletexas

Children’semployee.

BERTnER CAFETERIA DISCOUnT ST. LUkE’S HOSPITAL – ABERCROMBIE BASEMEnT

employeesreceiveadiscountonfoodpurchasesby

presentingatCHbadgeattimeofpurchase.

TICkET & EVEnT DISCOUnTSemployeescanenjoysavingsonsuchthingsasmovie

tickets,seasonalevents,cellphonemembershipsand

more.neworenhanceddiscountsarecommunicated

throughthemonthlyonlineHrdialogue!ordialogue

newsflashasneeded.alldiscountinformation(prices,

codes,linksandmore)isdetailedundertheemployee

discountdirectoryviatheConnectHrwebpage.simply

gotoanHrlocation(abercrombie7a-4pormeyer

7:30a-4:30p)tocompleteapayrolldeductionform.

note:tCpaandHealthCenteremployeesshould

faxformstoHrat832-825-2829bynoonofeach

Wednesday.

WORK / LIFE BALANCE

BriGHtHoriZonsBaCK-upCareadVantaGe®proGram

thissubsidizedbenefitcanbeutilizedbyemployeeswhen

regularchildorfamilycareneedsandarrangementsare

disrupted.examplesmightinclude:

n primarycare-giverisonvacation,becomesillor

experiencesafamilyemergency

n schoolvacationdays

n infanttransitionasaparentreturnstowork

n travelorrelocationtoacitywhereyoudonotyetknow

anyone

Well Established and Safety-Focused

thisnationalprovidernetworkrequiresbackgroundchecks

andCprtrainingforstaffmembers.

n 3,000+Center-basedChildCareCenters:available

closetoworkorclosetohome

n 2,000+in-HomeCareandnannyagencyresources:

availablecare:days,nightsandweekends

thispro-activeemployeebenefitallowsyoutobeatwork

whenyoumightnototherwisebeableto.thekeyisto

pre-registerfortheBack-upCareadvantage®program

andbereadyforthoseunexpectedsurprises.note:Care

extendstolovedoneswhodonotliveinyourhome.

tCHemployeeshave80hoursavailablepercalendaryear.

Hoursbeyondtheallotted80willbesubjecttoavailability

andtheemployeewillberesponsibleforthefullcost.

n Employee Cost for Center-Based Care:

$2co-pay/perhour/perchild

n Employee Cost for In-home nanny Services:

$4co-pay/perhour/perchildorfamilymember(infant

toelderly)

yourCreditCardnumbermayberequestedto

holdyourreservation;however,paymentwilloccur

viapayrolldeductionandwillbereflectedonyour

paycheckapproximately30-60daysaftercareservices.

Reservations made, must be cancelled timely to

avoid being charged for unused services.review

detailsaboutalloftheresourcesavailableontheBright

Horizonswebsite,including‘Growinglifelongreaders’,

employeewebinars,andtheir‘Win~Winreferralprogram’.

Pre-register, Learn More or to Schedule Care:n Byphone:1-877-242-2737

n www.backup.brighthorizons.com

username:texasChildrenspassword:backup1

SERVICE RECOgnITIOn AnD EMPLOYEE CELEBRATIOnStexasChildren’svaluespeopleandtheircontributions,dedicationand

commitmenttoourpatients,andtooneanother.

Belowareseveraloftheemployeeprogramsthathavebeenimplemented

toconveythanksandgratitudetostaff.

n newemployeereceptions(sponsoredbyrecruitment)

n servicepinsbasedonemploymentservice:1,5,10,15,20,25,30

years,etc.(Benefits)

n superstarandservicewithHeart:personalrecognitionoftCH

employeeswhoexemplifyexceptionalcustomerservice&workethic

(administeredthroughHrandserviceambassadors)

n 25+platinumClub-employeeswith25ormoreyearsoftexas

Children’semploymentservice(Benefits)

n stressBustevents&more(sponsoredbyHr&serviceambassadors)

n employeerecognitionCelebration(erC),anannualeventorganizedby

Hrtotalrewards(Benefits)


TEAM SPORTS SUBSIDYFor Employees Fitness and Fun!

foremployeeswhowishtoplayaleague

sponsoredsportandstartuptheirowntexas

Children’steam,registrationfees(upto$600

perfiscalyear)canbepaidtotheleague

providedatleasthalfoftheplayersonthe

teamareactive,benefitseligibleemployees.

Whatbetterwaytogettoknowyour

co-workers,enjoysomefriendlycompetition

andshowteamspirit?application&Waiver

(consent)formscanbefoundontheHr

webpageofConneCt.


employeeeduCationanddeVelopmentopportunities

employeesseekingpathwaystoenhancetheircareergoalsthrougheducationcantapintovariousavenuesofsupport.

THE LEARnIng ACADEMY OFFERS InTERnAL EMPLOYEE TRAInIng AnD DEVELOPMEnT CLASSESforinformationaboutstaff,clinicalandleadershiptrainings,

visitthelearningacademyConneCtwebsiteoremail:

[email protected].

TEXAS CHILDREn’S (COLLEgE) TUITIOn ASSISTAnCE PROgRAM (TAP) – ADMInISTERED BY EDLInk®

fullandpart-timeemployeescanutilizethisbenefittosubsidizethecostof

collegecreditcoursesatanaccrediteduniversityandforacourseofstudy

thatwouldbeofbenefitinyourcurrentroleattexasChildren’s.forallthe

detailsandanswersneededtomaximizethisdegree-focusedemployee

benefit,employeesshouldreadthefrequentlyaskedQuestionsonthe

Connectoredlinkwebsitespriortoregistrationorcompletinganonline

application.

Annual Allowable Monetary Support (Cap Limit based on Employee’s TCH Status)n $2,500/calendaryearforfull-timeemployees

n $1,500/calendaryearforpart-timeemployees

unusedannualdollarsdonotcarryoverfromyeartoyear.Covered

expenses(tuition,feesandrequiredbooks)willbecountedtowardthe

annualcaplimitbasedintheyearinwhichthecourseBeGins.

Expenses not Covered Include:

Continuingeducationunits(Ceu’s),certifications(prep,testingor

renewals),deferredpaymentfees,evaluation(priorlearningassessment),

financecharges,Gmat,Gre,sat,latefees,parkingfees,graduation

feesandalumnifees.note:tappayments(includingthosepreviously

approvedwithanloCwillbereducedbytheamountofotherfinancial

assistancereceived.(ex:anawardedpellGrant)

Online Enrollment Steps For Success!

step 1:Completeanonlinetuitionapplication.(1-3courseswithsimilar

startandenddatesonthesameapplication)

n tuitionpre-payapplication

(submit3-5weekspriortocoursestart-date)

n tuitionreimBursementapplication

(submitafterpaymentforcourses,yetwithin6-weeksfrom

courseend-date)

step 2:uponapprovalofyourtuitionapplication,clickontothe

applicationnumberforwhichyouwishtosubmitaBook

reimbursementrequest.alwayssubmitacopyofyourcourse

syllabusalongwithyourbookstorereceiptstoedlink.30 Texas Children’s hospiTal2011BenefitsandWellnessGuide

Important TAP Tipsn submitproofofcoursecompletion(grades)to

edlinkWitHin6weeksofcourseenddateto

remaineligible.

n notifyedlinkimmediatelyatTCh@edlinktuition.

comifyouchangeordropaclasssincetheprogram

allowspaymentforeachcourseonlyonce.

Process and Contact Informationn tocompleteanapplication:

http://tamsonline.org/TCh

n toemailaquestion/inquiry:

[email protected]

n tofaxrequireddocumentation(receipts,course

syllabusandgrades):1-866-284-0859

n tospeakwithaCustomerservicerepresentative:

1-888-797-2235

OnLInE CLInICAL PROgRAM…

U.T. ARLIngTOn IS OnE OPTIOn

(Partnership Code: AP1016)

formoredetails(dates,prices,links,etc.)relatedtothis

rntoBsnfast-trackoption,employeesmay:

1.visit www.stateu.com/uta

2.callstateudirectlyat1-866-489-2810,or

3.calltexasChildren’sClinicaltraining&development

at832-824-2460.

participantsofthisprogrammayalsoutilizethetexas

Children’stuitionassistanceprogram;however,uta

studentswillneedtofaxloC’stostateuat:

1-877-647-8560.


BenefiteleCtionCHanGes

BENE

FIT

ELEC

TION

CH

ANGE

S

RULE TO ADD DEPEnDEnTS anychangeinfamilystatus,whichresultsinadding/deletingcoverageforyourselforadependentmustbesubmittedtotheBenefits

departmentwithin31daysfromthedateofthequalifyingevent;evenifyoucurrentlyhaveemployee+Childrenoremployee+family

coverageandyouareaddingcoverageforanotherchild(includingaddingcoverageforanewborn).thetCH

Benefitenrollment/ChangeformislocatedonConnect/Hr/Benefits/Benefitforms.

theeffectivedateofyourbenefitchangewillbetheeffectivedateofthequalifiedchangeinfamilystatus.

evenifyouhavenotreceivedallsupportingdocumentation(ex.officialbirthcertificate)untilafterthe31

or60dayelectionperiod,youwillstillneedtosubmityourBenefitChangeformwithinthe31or60

daydeadlineandlaterforwardthesupportingdocumentationuponreceipt.duetoirsregulations

regardingchangestopre-taxplans,Hrwillbeunabletoprocessyourchangeuntilthesupporting

documentationisreceived.

LOSS OF COVERAgE DUE TO MEDICARE OR CHIP PROgRAManemployeewhosedependentlosesinsurancecoverageunderthemedicareorCHipprogramasaresult

oflossofeligibilitymayenrollthedependentintexasChildren’smedical,dentalorvisionplanswithin60

daysfromthedatecoveragewaslost.You must submit a Benefit Change Form to the Benefits

Department within 60 days of losing coverage.

it’simportanttomakeenrollmentchoicescarefullybecausetheywillremainineffectuntildecember31stofthatplanyear.the

internalrevenueserviceimposesstrictlimitationsonwhencoveragecanbeelectedorchangedbecauseyourbenefitcontributions

arepre-taxforsomeplanoptions.You can make limited changes at times other than open enrollment only as a result of

a significant change in family or job status.

SUCH EVEnTS (CALLED FAMILY STATUS CHAngES) InCLUDE, BUT ARE nOT LIMITED TO:n marriage,divorce,legalseparation,orannulment

n death

n Birth,adoption,orplacementforadoptionofachild

n Childbecomesorceasestobeaneligibledependent

n Changeinyourspouse’semploymentand/orother

insurancecoveragethatcausesyouand/oryour

dependentstoloseorgaincoverage

n youand/oryourdependentnolongerresideorworkin

anepo’sserviceareaanddonothaveaccesstoother

benefitoptions

n entitlementorlossofmedicareeligibility

n Changingfromanineligiblestatustoaneligiblestatus,

e.g.perdiemtopart-timeorfull-timestatus

n Changingfromaneligibletoanineligiblestatus,e.g.,

part-timeorfull-timestatustoaperdiemstatus

n Changingfrompart-timestatustofull-timestatus

n Changingfromfull-timestatustopart-timestatus

n Courtorderthatrequiresyoutocoveradependent

n significantchangeincostofbenefitcoverage

n Commencementorreturnfromleaveunderfmlaoran

unpaidleavethataffectseligibilityforcoverage.

n ChangeinmedicaidChildren’sHealthinsurance

program(CHip).


ALABAMA–medicaidWebsite:http://www.medicaid.alabama.

govphone:1-800-362-1504

ALASkA–medicaidWebsite:http://health.hss.state.ak.us/

dpa/programs/medicaid/phone(outsideofanchorage):1-888-

318-8890phone(anchorage):907-269-6529

ARIzOnA–CHipWebsite:http://www.azahcccs.gov/

applicants/default.aspxphone:1-877-764-5437

ARkAnSAS–CHipWebsite:http://www.arkidsfirst.com/phone:1-888-474-8275

CALIFORnIA–medicaidWebsite:http://www.dhcs.ca.gov/

services/pages/tplrd_Cau_cont.aspxphone:1-866-298-8443

COLORADO–medicaidandCHipmedicaidWebsite:http://www.colorado.

gov/medicaidphone:1-800-866-3513CHipWebsite:http://www.CHpplus.orgCHipphone:303-866-3243

FLORIDA –medicaidWebsite:http://www.fdhc.state.fl.us/

medicaid/index.shtmlphone:1-866-762-2237

gEORgIA–medicaidWebsite:http://dch.georgia.gov/Clickonprograms,thenmedicaidphone:1-800-869-1150

IDAHO–medicaidandCHipmedicaidWebsite:www.

accesstohealthinsurance.idaho.govmedicaidphone:1-800-926-2588CHipWebsite:www.medicaid.idaho.govCHipphone:1-800-926-2588

InDIAnA–medicaidWebsite:http://www.in.gov/fssa/2408.

htmphone:1-877-438-4479

IOWA–medicaidWebsite:www.dhs.state.ia.us/hipp/phone:1-888-346-9562

kAnSAS–medicaidWebsite:https://www.khpa.ks.govphone:800-766-9012

kEnTUCkY–medicaidWebsite:http://chfs.ky.gov/dms/default.

htmphone:1-800-635-2570

LOUISIAnA–medicaidWebsite:http://www.la.hipp.dhh.

louisiana.govphone:1-888-342-6207

MAInE–medicaidWebsite:http://www.maine.gov/dhhs/

oms/phone:1-800-321-5557

MASSACHUSETTS–medicaidandCHip

medicaid&CHipWebsite:http://www.mass.gov/massHealth

medicaid&CHipphone:1-800-462-1120

MEDICAID AnD THE CHILDREn’S HEALTH InSURAnCE PROgRAM (CHIP) OFFER FREE OR LOW-COST HEALTH COVERAgE TO CHILDREn AnD FAMILIES

ifyouareeligibleforhealthcoveragefromyouremployer,

butareunabletoaffordthepremiums,somestateshave

premiumassistanceprogramsthatcanhelppayforcoverage.

thesestatesusefundsfromtheirmedicaidorCHipprograms

tohelppeoplewhoareeligibleforemployer-sponsored

healthcoverage,butneedassistanceinpayingtheirhealth

premiums.

ifyouoryourdependentsarealreadyenrolledinmedicaidor

CHipandyouliveinastatelistedbelow,youcancontactyour

statemedicaidorCHipofficetofindoutifpremiumassistance

isavailable.

ifyouoryourdependentsarenotcurrentlyenrolled

inmedicaidorCHip,andyouthinkyouoranyofyour

dependentsmightbeeligibleforeitheroftheseprograms,you

cancontactyourstatemedicaidorCHipofficeordial1-877-

KidsnoWorwww.insurekidsnow.govtofindouthowto

apply.ifyouqualify,youcanaskthestateifithasaprogram

thatmighthelpyoupaythepremiumsforanemployer-

sponsoredplan.

onceitisdeterminedthatyouoryourdependentsare

eligibleforpremiumassistanceundermedicaidorCHip,

youremployer’shealthplanisrequiredtopermityouand

yourdependentstoenrollintheplan–aslongasyouand

yourdependentsareeligible,butnotalreadyenrolledin

theemployer’splan.thisiscalleda“specialenrollment”

opportunity,andyoumustrequestcoveragewithin60daysof

beingdeterminedeligibleforpremiumassistance.

ifyouliveinoneofthefollowingstates,youmaybeeligiblefor

assistancepayingyouremployerhealthplanpremiums.

thefollowinglistofstatesiscurrentasofapril16,2010.you

shouldcontactyourstateforfurtherinformationoneligibility.


MInnESOTA–medicaidWebsite:http://www.dhs.state.mn.us/ClickonHealthCare,thenmedical

assistancephone:800-657-3739

MISSOURI –medicaidWebsite:http://www.dss.mo.gov/mhd/

index.htmphone:573-751-6944

MOnTAnA–medicaidWebsite:http://medicaidprovider.hhs.

mt.gov/clientpages/clientindex.shtmltelephone:1-800-694-3084

nEBRASkA–medicaidWebsite:http://www.dhhs.ne.gov/med/

medindex.htmphone:1-877-255-3092

nEVADA–medicaidandCHipmedicaidWebsite:http://dwss.nv.gov/medicaidphone:1-800-992-0900CHipWebsite:http://www.

nevadacheckup.nv.org/CHipphone:1-877-543-7669

nEW HAMPSHIRE–medicaidWebsite:http://www.dhhs.state.nh.us/

dHHs/mediCaidproGram/default.htmphone:1-800-852-3345x5254

nEW JERSEY–medicaidandCHipmedicaidWebsite:http://www.state.

nj.us/humanservices/dmahs/clients/medicaid/medicaidphone:1-800-356-1561CHipWebsite:http://www.njfamilycare.

org/index.htmlCHipphone:1-800-701-0710

nEW MEXICO–medicaidandCHipmedicaidWebsite:http://www.hsd.

state.nm.us/mad/index.htmlmedicaidphone:1-888-997-2583CHipWebsite:http://www.hsd.state.nm.us/mad/index.

htmlClickoninsurenewmexicoCHipphone:1-888-997-2583

nEW YORk–medicaidWebsite:http://www.nyhealth.gov/

health_care/medicaid/phone:1-800-541-2831

nORTH CAROLInA –medicaidWebsite:http://www.nc.govphone:919-855-4100

nORTH DAkOTA–medicaidWebsite:http://www.nd.gov/dhs/

services/medicalserv/medicaid/phone:1-800-755-2604

OkLAHOMA–medicaidWebsite:http://www.insureoklahoma.

orgphone:1-888-365-3742

OREgOn–medicaidandCHipmedicaid&CHipWebsite:http://www.oregonhealthykids.govmedicaid&CHipphone:1-877-314-5678

PEnnSYLVAnIA–medicaidWebsite:http://www.dpw.state.pa.us/

partnersproviders/medicalassistance/doingbusiness/003670053.htm

phone:1-800-644-7730

RHODE ISLAnD–medicaidWebsite:www.dhs.ri.govphone:401-462-5300

SOUTH CAROLInA–medicaidWebsite:http://www.scdhhs.govphone:1-888-549-0820

TEXAS–medicaidWebsite:https://www.gethipptexas.

com/phone:1-800-440-0493

UTAH –medicaidWebsite:http://health.utah.gov/

medicaid/phone:1-866-435-7414

VERMOnT–medicaidWebsite:http://ovha.vermont.gov/telephone:1-800-250-8427

VIRgInIA–medicaidandCHipmedicaidWebsite:http://www.dmas.

virginia.gov/rcp-Hipp.htmmedicaidphone:1-800-432-5924CHipWebsite:http://www.famis.org/CHipphone:1-866-873-2647

WASHIngTOn–medicaidWebsite:http://hrsa.dshs.wa.gov/

premiumpymt/apply.shtmphone:1-877-543-7669

WEST VIRgInIA–medicaidWebsite:http://www.wvrecovery.com/

hipp.htmphone:304-342-1604

WISCOnSIn–medicaidWebsite:http://dhs.wisconsin.gov/

medicaid/publications/p-10095.htmphone:1-800-362-3002

WYOMIng–medicaidWebsite:http://www.health.wyo.gov/

healthcarefin/index.htmltelephone:307-777-7531

To see if any more states have added a premium assistance program since April 16, 2010, or for more

information on special enrollment rights, you can contact either:

u.s.departmentoflabor u.s.departmentofHealthandHumanservices

employeeBenefitssecurityadministration Centersformedicare&medicaidservices

www.dol.gov/ebsa www.cms.hhs.gov

1-866-444-eBsa(3272) 1-877-267-2323,ext.61565



SPECIAL EnROLLMEnT RIgHTS nOTICEifyouaredecliningenrollmentforyourselforyourdependents

(includingyourspouse)becauseofotherhealthinsurance

orgrouphealthplancoverage,youmaybeabletoenroll

yourselfandyourdependentsinthisplanifyouoryour

dependentsloseeligibilityforthatothercoverage(orifthe

employerstopscontributingtowardyouroryourdependents’

othercoverage).

However,youmustrequestenrollmentwithin31daysafter

youroryourdependents’othercoverageends(orafterthe

employerstopscontributingtowardtheothercoverage).in

addition,ifyouhaveanewdependentasaresultofmarriage,

birth,adoption,orplacementforadoption,youmaybeable

toenrollyourselfandyoureligibledependents;however,you

mustrequestenrollmentwithin31daysafterthemarriage,

birth,adoption,orplacementforadoption.

ALLOWABLE CHAngESMedical, Dental

youmaychangeyourcoveragelevel,butnotyourplan

option(e.g.,youcanchangefromtheppoplanemployee

onlytotheppoplanemployeeandfamily,butnottothe

epoplan).

LTD, Life and AD&D

youmayincreaseordecreaseyourcoveragelevelelection.

n Changingfrompart-timetofull-time,yougainltdBasic

planBenefitandtheoptiontopurchasetheltdbuy-up

plan.foroptionallifeinsuranceandad&dyouareeligible

topurchaseupto4Xyourannualbasesalarysubjectto

planprovisions.

n Changingfromfull-timetopart-time,youroptionallife

insuranceandad&dreducesto1Xyourannualbase

salary.

Health Care FSA

youmaychangeyourelectionstotheHealthCareand

dependentCarefsasifyouexperienceachangeinfamily

orjobstatus;however,intheeventofadeficitbalanceinan

fsa,youmaynotstopordecreaseyourfsacontribution.

ifyouresignyouremploymentandthenreturntotexas

Children’sinthesamecalendaryear,orifyouchangefrom

aneligiblestatustoanineligiblestatusandbackagain,you

willretaintheoptionsthatyouhadpreviously(unlessyou

incurafamilystatuschange).

Dependent Care FSA

youcannotstop,increaseordecreaseyourcontribution

untilthenextannualenrollmentperiodunlessyouhavea

familystatusorJobstatusChangeasstatedpreviouslyin

thisguide.ifyouresignyouremploymentandthenreturnto

texasChildren’sinthesamecalendaryear,orifyouchange

fromaneligiblestatustoanineligiblestatusandbackagain,

youwillretaintheoptionsthatyouhadpreviouslyunlessyou

haveafamilystatusChange.

Enrollment Change Form Checklist

Benefitelectionsorchangesthatarenotmadewhenyouare

firsteligibleorduringopenenrollmentmustbesubmittedon

aBenefitsChangeform.thisformandallotherbenefitforms

arelocatedonlineonthetexasChildren’sConnectwebsite:

Humanresources/Benefits/Benefitforms.youmayalso

obtainformsfromyourHrBenefitsdepartmentintheservice

Center/abercrombiea-130oratthemeyerBuilding3rdfloor

benefitsdesk.

n ifyouareenrollinganewdependent,additional

documentationisrequiredsuchas,marriagelicense,birth

certificate/birthfacts,adoptionpapers,courtdocuments

n dependentssocialsecuritynumbers

n ifyouhavenotreceivedyourdocumentationinatimely

manner,youwillstillneedtosubmityourBenefitsChange

formwithinthedeadlineandforwardthesupporting

documentationonceitisreceived.duetoirsregulations

regardingchangestopre-taxplans,wewillnotbeableto

processyourchangeuntilthesupportingdocumentationis

received.

n remember,31daystoaddadependentor60daysto

dropadependent

Termination or Change of Status

yourcoverageforyourselfandyourdependentswillendon

thelastdayofthepayperiodcontainingthelastdayworked

oryourtransferdatetoanineligiblestatusforbenefitsorthe

dayadependentbecomesineligibleforcoverage.However,

undercertaincircumstances,youand/oryourdependents

maybeeligibletocontinuemedical,dental,eap,andvision,

andHealthCarefsaparticipationthroughCoBra.



ContinuationCoVeraGeriGHtsunderCoBraunderfederallaw,texasChildren’sisrequiredtooffer

coveredemployeesandcoveredfamilymembersthe

opportunityforatemporaryextensionofhealthcoverage

(called“ContinuationCoverage”)atgrouprateswhen

coverageunderthehealthplanwouldotherwiseenddue

tocertainqualifyingevents.thisnoticeisintendedtoinform

allplanparticipants,inasummaryfashion,ofyourpotential

futureoptionsandobligationsunderthecontinuation

coverageprovisionsoffederallaw.shouldanactual

qualifyingeventoccurinthefuture,theplanadministratorwill

sendyouadditionalinformationandtheappropriateelection

noticeatthattime.

WHAT IS COBRA COVERAgE?ConsolidatedomnibusBudgetreconciliationact(CoBra)

coverageisacontinuationofplancoveragewhencoverage

wouldotherwiseendbecauseofalifeeventknownas

a“qualifyingevent.”specificqualifyingeventsarelisted

laterinthisnotice.afteraqualifyingeventoccursandany

requirednoticeofthateventisproperlyprovidedtotexas

Children’s,CoBracoveragemustbeofferedtoeachperson

losingplancoveragewhoisa“qualifiedbeneficiary.”you,

yourspouse,andyourdependentchildrencouldbecome

qualifiedbeneficiariesandwouldbeentitledtoelectCoBra

ifcoverageundertheplanislostbecauseofthequalifying

event.(Certainnewborns,newlyadoptedchildren,and

alternaterecipientsunderQualifiedmedicalsupportorders

mayalsobequalifiedbeneficiaries.thisisdiscussedin

moredetailinseparateparagraphsbelow.)undertheplan,

qualifiedbeneficiarieswhoelectCoBramustpayfor

CoBracoverage.

WHO IS EnTITLED TO ELECT COBRA?ifyouareanemployee,youwillbeentitledtoelectCoBraif

youloseyourgrouphealthcoverageundertheplanbecause

eitheroneofthefollowingqualifyingeventshappens:

n yourhoursofemploymentarereduced,or

n youremploymentendsforanyreason,otherthanforgross

misconduct(onyourpart).

ifyouarethespouseofanemployee,youwillbeentitledto

electCoBraifyouloseyourgrouphealthcoverageunder

theplanbecauseanyofthefollowingqualifyingevents

happens:

n yourspousedies;

n yourspouse’shoursofemploymentarereduced;

n yourspouse’semploymentendsforanyreasonotherthan

hisorhergrossmisconduct;

n youbecomedivorcedorlegallyseparatedfromyour

spouse. also, if your spouse (the employee) reduces or

eliminates your group health coverage in anticipation

of a divorce or legal separation, and a divorce or legal

separation later occurs, then the divorce or legal

separation may be considered a qualifying event for you

even though your coveragewasreducedoreliminated

beforethedivorceorseparation.

apersonenrolledastheemployee’sdependentchildwill

beentitledtoelectCoBraifheorshelosesgrouphealth

coverageundertheplanbecauseanyofthefollowing

qualifyingeventshappens:

n theparent-employeedies;

n theparent-employee’shoursofemploymentarereduced;

n theparent-employee’semploymentendsforanyreason

otherthanhisorhergrossmisconduct;

n theparentsbecomedivorcedorlegallyseparated;or

n thechildstopsbeingeligibleforcoverageundertheplan

asa“dependentchild.”

WHEn IS COBRA COVERAgE AVAILABLE?Whenthequalifyingeventistheendofemploymentor

reductionofhoursofemploymentordeathoftheemployee,

theplanwillofferCoBracoveragetoqualifiedbeneficiaries.

COBR

A


YOU MUST gIVE nOTICE OF SOME qUALIFYIng EVEnTSforotherqualifyingevents(divorceorlegalseparationofthe

employeeandspouseoradependentchild’slosing

eligibilityforcoverageasadependentchild),aCoBra

electionwillbeavailabletoyouonlyifyounotifytexas

Children’sinwritingwithin60daysafterthelaterof:(1)the

dateofthequalifyingevent;and(2)thedateonwhichthe

qualifiedbeneficiaryloses(orwouldlose)coverageunder

thetermsoftheplanasaresultofthequalifyingevent.in

providingthisnotice,youmustusetheplan’sformentitled

“ChangesinCoverage”fromtexasChildren’sBenefits

department.iftheformisnotprovidedtotexasChildren’s

Benefitsdepartmentduringthe60-daynoticeperiod,thenall

qualifiedbeneficiarieswilllosetheirrighttoelectCoBra.oral

notice,includingnoticebytelephone,isnotacceptable.

IMPORTAnT: no exceptions can be made.

ELECTIng COBRAeachqualifiedbeneficiarywillhaveanindependentright

toelectCoBra.Coveredemployeesandspouses(ifthe

spouseisaqualifiedbeneficiary)mayelectCoBraon

behalfofallofthequalifiedbeneficiaries,andparentsmay

electCoBraonbehalfoftheirchildren.Any qualified

beneficiary for whom COBRA is not elected within

the 60-day election period specified in the Plan’s

COBRA election notice will lose his or her right to

elect COBRA.

HOW LOng DOES COBRA COVERAgE LAST?CoBracoverageisatemporarycontinuationofcoverage.

Whenthequalifyingeventisthedeathoftheemployee,

thecoveredemployee’sdivorceorlegalseparation,ora

dependentchild’slosingeligibilityasadependentchild,

CoBracoverageundertheplan’smedical,dentaland

Visioncomponentscanlastforuptoatotalof36months.

Whenthequalifyingeventistheendofemploymentor

reductionoftheemployee’shoursofemployment,andthe

employeebecameentitledtomedicarebenefitslessthan18

monthsbeforethequalifyingevent,CoBracoverageunder

theplan’smedical,dentalandVisioncomponentsfor

qualifiedbeneficiaries(otherthantheemployee)wholose

coverageasaresultofthequalifyingeventcanlastuntil

upto36monthsafterthedateofmedicareentitlement.

forexample,ifacoveredemployeebecomesentitledto

medicare8monthsbeforethedateonwhichhisemployment

terminates,CoBracoverageforhisspouseandchildren

wholostcoverageasaresultofhisterminationcanlastup

to36monthsafterthedateofmedicareentitlement,which

isequalto28monthsafterthedateofthequalifyingevent

(36monthsminus8months).thisCoBracoverageperiod

isavailableonlyifthecoveredemployeebecomesentitled

tomedicarewithin18monthsbeforetheterminationor

reductionofhours.

otherwise,whenthequalifyingeventistheendof

employmentorreductionoftheemployee’shoursof

employment,CoBracoverageundertheplan’smedical,

dental,andVisioncomponentsgenerallycanlastforonlyup

toatotalof18months.

CoBracoverageundertheHealthCarefsacomponent

canlastonlyuntiltheendoftheyearinwhichthequalifying

eventoccurred—seetheparagraphbelowentitled“Health

CarefsaComponent.”

theCoBracoverageperiodsdescribedaboveare

maximumcoverageperiods.CoBracoveragecanend

beforetheendofthemaximumcoverageperiodsdescribed

inthisnoticeforseveralreasons,whicharedescribedinthe

plan’ssummaryplandescription.

There are two ways (described in the following

paragraphs) in which the period of COBRA coverage

resulting from a termination of employment or

reduction of hours can be extended. (The period of

COBRA coverage under the Health Care FSA cannot

be extended under any circumstances.)

DISABILITY EXTEnSIOn OF COBRA COVERAgEifaqualifiedbeneficiaryisdeterminedbythesocialsecurity

administrationtobedisabledandyounotifypayflexinatimely

fashion,allofthequalifiedbeneficiariesinyourfamilymaybe

entitledtoreceiveuptoanadditional11monthsofCoBra

coverage,foratotalmaximumof29months.thisextension

isavailableonlyforqualifiedbeneficiarieswhoarereceiving

CoBracoveragebecauseofaqualifyingeventthatwasthe

coveredemployee’sterminationofemploymentorreduction

ofhours.thedisabilitymusthavestartedatsometimebefore

the61stdayafterthecoveredemployee’sterminationof

employmentorreductionofhoursandmustlastatleastuntil

theendoftheperiodofCoBracoveragethatwouldbe

availablewithoutthedisabilityextension(generally18months,

asdescribedabove).


thedisabilityextensionisavailableonlyifyounotifypayflexin

writingofthesocialsecurityadministration’sdeterminationof

disabilitywithin60daysafterthelatestof:

n thedateofthesocialsecurityadministration’sdisability

determination;

n thedateofthecoveredemployee’sterminationof

employmentorreductionofhours;and

n thedateonwhichthequalifiedbeneficiaryloses(orwould

lose)coverageunderthetermsoftheplanasaresultofthe


ofhours.

youmustalsoprovidethisnoticewithin18monthsafterthe


ofhoursinordertobeentitledtoadisabilityextension.ifthese

proceduresarenotfollowedorifthenoticeisnotprovidedto

payflexduringthe60-daynoticeperiodandwithin18months

afterthecoveredemployee’sterminationofemploymentor

reductionofhours,thentherewillbenodisabilityextensionof

CoBracoverage.

SECOnD qUALIFYIng EVEnT EXTEnSIOn OF COBRA COVERAgEifyourfamilyexperiencesanotherqualifyingeventwhile

receivingCoBracoveragebecauseofthecovered

employee’sterminationofemploymentorreductionofhours

(includingCoBracoverageduringadisabilityextensionperiod

asdescribedabove),thespouseanddependentchildren

receivingCoBracoveragecangetupto18additionalmonths

ofCoBracoverage,foramaximumof36months,ifnoticeof

thesecondqualifyingeventisproperlygiventotheplan.this

extensionmaybeavailabletothespouseandanydependent

childrenreceivingCoBracoverageiftheemployeeorformer

employeediesorgetsdivorcedorlegallyseparated,orif

thedependentchildstopsbeingeligibleundertheplanasa

dependentchild,butonlyiftheeventwouldhavecausedthe

spouseordependentchildtolosecoverageundertheplan

hadthefirstqualifyingeventnotoccurred.(thisextension

isnotavailableundertheplanwhenacoveredemployee

becomesentitledtomedicareafterhisorherterminationof

employmentorreductionofhours.)

theextensionduetoasecondqualifyingeventisavailable

onlyifyounotifypayflexinwritingofthesecondqualifying

eventwithin60daysafterthedateofthesecondqualifying

event.iftheseproceduresarenotfollowedorifthenoticeis

notprovidedtopayflexduringthe60-daynoticeperiod,then

therewillbenoextensionofcobracoverageduetoasecond

qualifyingevent.

forinformationrelatedtoCoBrarightsforfmlaandmilitary

leave,youmayreferencepolicynumbersHr214

andHr205onthetexasChildren’sConnectwebsite.

HEALTH CARE FSA COMPOnEnTCoBracoverageundertheHealthCarefsawillbe

offeredonlytoqualifiedbeneficiarieslosingcoveragewho

haveunderspentaccounts.aqualifiedbeneficiaryhasan

underspentaccountiftheannuallimitelectedbythecovered

employee,reducedbythereimbursableclaimssubmittedup

tothetimeofthequalifyingevent,isequaltoormorethan

theamountofthepremiumsforHealthCarefsaCoBra

coveragethatwillbechargedfortheremainderoftheplan

year.CoBracoveragewillconsistoftheHealthCarefsa

coverageinforceatthetimeofthequalifyingevent(i.e.,the

electedannuallimitreducedbyreimbursableclaimssubmitted

uptothetimeofthequalifyingevent).theuse-it-or-lose-it

rulewillcontinuetoapply,soanyunusedamountswillbe

forfeitedattheendoftheplanyear,andCoBracoverage

willterminateattheendoftheplanyear.unlessotherwise

elected,allqualifiedbeneficiarieswhowerecoveredunderthe

HealthCarefsawillbecoveredtogetherforHealthCarefsa

CoBracoverage.However,eachqualifiedbeneficiarycould

alternativelyelectseparateCoBracoveragetocoverthat

beneficiaryonly,withaseparateHealthCarefsaannuallimit

andaseparatepremium.

MORE InFORMATIOn ABOUT InDIVIDUALS WHO MAY BE qUALIFIED BEnEFICIARIESChildren Born to or Placed for Adoption With the Covered Employee During COBRA Coverage Period

achildbornto,adoptedby,orplacedforadoptionwitha

coveredemployeeduringaperiodofCoBracoverageis

consideredtobeaqualifiedbeneficiaryprovidedthat,ifthe

coveredemployeeisaqualifiedbeneficiary,thecovered

employeehaselectedCoBracoverageforhimselforherself.

thechild’sCoBracoveragebeginswhenthechildisenrolled

intheplan,whetherthroughspecialenrollmentoropen

enrollment,anditlastsforaslongasCoBracoveragelasts

forotherfamilymembersoftheemployee.tobeenrolledin

theplan,thechildmustsatisfytheotherwiseapplicableplan

eligibilityrequirements(forexample,regardingage).

Alternate Recipients Under qMCSOs

achildofthecoveredemployeewhoisreceivingbenefits

undertheplanpursuanttoaqualifiedmedicalchildsupport

order(QmCso)receivedbytexasChildren’sduringthe

coveredemployee’speriodofemploymentwithtexas

Children’sisentitledtothesamerightstoelectCoBraasan

eligibledependentchildofthecoveredemployee.


IF YOU HAVE qUESTIOnSQuestionsconcerningyourplanoryourCoBrarightsshould

beaddressedtothecontactorcontactsidentified

below.formoreinformationaboutyourrightsundererisa,

includingCoBra,theHealthinsuranceportabilityand

accountabilityact(Hipaa)andotherlawsaffectinggrouphealth

plans,contactthenearestregionalordistrictoffice

oftheu.s.departmentoflabor’semployeeBenefitssecurity

administration(eBsa)inyourareaorvisittheeBsa

websiteatwww.dol.gov/ebsa.(addressesandphone

numbersofregionalanddistricteBsaofficesareavailable

througheBsa’swebsite.)

kEEP YOUR PLAn InFORMED OF ADDRESS CHAngESinordertoprotectyourfamily’srights,youshouldkeeptexas

Children’sinformedofanychangesintheaddressesof

familymembers.youshouldalsokeepacopy,foryourrecords,

ofanynoticesyousendordelivertotexasChildren’s.

PLAn COnTACT InFORMATIOnyoumayobtaininformationabouttheplanandCoBra

coverageuponrequestfrom:texasChildren’sHospital,Human

resources,suite1301,1919s.Braeswood,HoustontX

77030,832-824-2421,option1.thiscontactinformation

fortheplanmaychangefromtimetotime.themostrecent

informationwillbeincludedintheplan’smostrecentsummary

plandescription(ifyoudonothaveacopy,youmayrequest

onefromtexasChildren’s).

WOMEn’S HEALTH AnD CAnCERtheWomen’sHealthandCancerrightsactof1998(WHCra)

requiresthatourplanprovidethefollowingmedicaland

surgicalbenefitsaftermastectomiesinamannerdeterminedin

consultationwiththeattendingphysicianandthepatientfor:

n allstagesofreconstructionofthebreastonwhichthe

mastectomyhasbeenperformed

n surgeryandreconstructionoftheotherbreasttoproducea

symmetricalappearance

n prosthesesandphysicalcomplicationsofallstagesof

mastectomies,includinglymphedemas.thesebenefitsare

subjecttothesamedeductiblesandcoinsuranceapplicable

toothermedicalandsurgicalbenefitsprovidedunder

ourplan.pleasefollowtheplanproceduresforobtaining

precertification.

MEnTAL HEALTHtheplancomplieswiththementalHealthparityact,which

generallyrequiresparitybetweenmentalhealthbenefitsand

medical/surgicalbenefits.theplanappliesthesameannual

dollarlimitsandaggregatelifetimelimitsformentalhealth

benefitsandmedical/surgicalbenefits.

MOTHERS AnD nEWBORnSincompliancewithfederallaw,tCHselectplansdonot:(1)

restrictbenefitsforanyhospitallengthofstayinconnection

withchildbirthforthemotherornewbornchildtofewerthan48

hoursfollowinganormalvaginaldelivery,orfewerthan96hours

followingaCesareansection,or(2)requirethataproviderobtain

authorizationfromtheinsurancecarrierforprescribingalengthof

staynotinexcessoftheaboveperiods.

CERTIFICATE OF CREDITABLE COVERAgEyouwillbeprovidedacertificateofcreditablecoveragein

writing,freeofcharge,fromBlueCrossBlueshieldoftexasfor

healthplancoverage:

n Whenyoulosecoverageunderthehealthplan;

n WhenyoubecomeentitledtoelectCoBra;

n WhenyourCoBracoverageends;youmayrequest

acertificateofcreditablecoveragebycallingthetoll-

freenumberonyourmedicalidcard.youmayrequest

acertificateofcreditablecoveragefromanothergroup

healthplan,oryoumayreceiveareductionoreliminationof

exclusionaryperiodsofcoverageforpreexistingconditions

underyourgrouphealthplan.Withoutevidenceofcreditable

coverage,planbenefitsforthetreatmentofapre-existing

conditionmaybeexcludedfor12months(18monthsforlate

enrollees)afteryourenrollmentdateinyourcoverage.

yourriGHts

YOU

R R

IGH

TS


qUALIFIED MEDICAL CHILD SUPPORT ORDER (qMCSO)federallawrequiresthetCHselectplan,undercertain

circumstances,toprovidehealthcarecoverageforyourchildren

whenyoudivorce,separate,orareevennevermarried,when

orderedtodosobystateauthorities.theprocessbeginswhen

texasChildren’sHospitalreceivesamedicalchildsupportorder.

thismeansanyjudgment,decree,ororder,includingapprovalof

asettlementagreement,which:

n isissuedfromacourtofcompetentjurisdictionorthroughan

administrativeprocessestablishedunderstatelawandhas

theforceandeffectofanorderunderstatelawpursuanttoa

state’sdomesticrelationslaw;

n requiresyoutoprovidegrouphealthcoverageforyour

childreneventhoughyounolongerhavecustody;

n Clearlyspecifiesthenameofourplan,yournameandyourlast

knownmailingaddressandthenameandaddressesofachild

coveredbytheorder.thenameandmailingaddressofastate

orlocalofficialmaybesubstitutedfortheaddressofthechild;

n areasonabledescriptionofthecoveragetobeprovided;and

n theperiodofcoveragetowhichtheorderapplies.

theplanadministratorwillprovidewrittennotificationtoyouand

eachidentifiedchildforwhichithasreceivedanorderrequiring

coverage.Withinareasonabletimeafterthereceiptoftheorder,

theplanadministratorwilldeterminewhethertheorderisa

QualifiedmedicalChildsupportorder(QmCso)andnotifyyou

andthechild’slegalrepresentativeofthedetermination.this

noticewillincludeanyrequiredenrollmentmaterial,adescription

oftheprocedurestobefollowed,andaformfordesignating

thechild’scustodialparentorlegalguardianashisorher

representativeforallbenefitplanpurposes.planbenefitsthat

havenotbeenassignedwillbeusedtoreimbursechargesfor

coveredexpensesincurredbyanidentifiedchild.

iftexasChildren’sHospitalreceivesaQmCso,itmustpermit

immediateenrollment.thismeansthechildrenidentifiedwillbe

includedforcoverageasyoureligibledependentandyouwill

paytherequiredpremiums.thechild’scustodialparent,legal

guardian,orastateagencycanmakeanapplicationforthe

child’scoverage,evenifyoudonot.

“MICHELLE’S LAW” (H.R. 2851)michelle’slawprovidescontinuedcoverageundergrouphealth

plansforyourdependentchildwhoiscoveredunderthetexas

Children’splanasastudentbutmightlosetheirstudentstatus

becausetheytakeamedicallynecessaryleaveofabsence

fromschoolorbeginachangeinschoolenrollmentthatwould

otherwiseresultinacancellationofcoverageunderourplan.

youmaycontinueforupto12monthsfromthebeginningof

theabsenceaslongasyourchildwascoveredbytheplanand

enrolledinacollegeoruniversity.

ifyoubelieveyourchildiseligibleforthiscontinuedcoverage,

thechild’sphysicianmustprovideawrittencertificationstating

thatyourchildissufferingfromaseriousillnessorinjurythat

necessitatestheleaveorchangeinenrollmentstatus.

attheendofthe12monthsofcoverageundermichelle’slaw,

CoBracoveragewillbeavailableifyourchildisstilltooillto

attendschool.

PRESCRIPTIOn DRUg COVERAgE AnD MEDICARE OPTIOnSpleasereadthisnoticecarefullyandkeepitwhereyoucanfindit.

thisnoticehasinformationaboutyourcurrentprescriptiondrug

coveragewithtexasChildren’sHospitalandaboutyouroptions

undermedicare’sprescriptiondrugcoverage.thisinformation

canhelpyoudecidewhetherornotyouwanttojoinamedicare

drugplan.ifyouareconsideringjoining,youshouldcompareyour

currentcoverage(includingwhichdrugsarecoveredatwhat

cost)withthecoverageandcostsoftheplansofferingmedicare

prescriptiondrugcoverageinyourarea.informationaboutwhere

youcangethelptomakedecisionsaboutyourprescriptiondrug

coverageisattheendofthisnotice.

therearetwoimportantthingsyouneedtoknowaboutyour

currentcoverageandmedicare’sprescriptiondrugcoverage:

1.medicareprescriptiondrugcoveragebecameavailablein

2006toeveryonewithmedicare.youcangetthiscoverageif

youjoinamedicareprescriptiondrugplanorjoinamedicare

advantageplan(likeanHmoorppo)thatoffersprescription

drugcoverage.allmedicaredrugplansprovideatleasta

standardlevelofcoveragesetbymedicare.someplansmay

alsooffermorecoverageforahighermonthlypremium.

2.texasChildren’sHospitalhasdeterminedthattheprescription

drugcoverageofferedbythetCHselectplanis,onaverage

forallplanparticipants,expectedtopayoutasmuchas

standardmedicareprescriptiondrugcoveragepaysandis

thereforeconsideredCreditableCoverage.Becauseyour

existingcoverageisCreditableCoverage,youcankeepthis

coverageandnotpayahigherpremium(apenalty)ifyoulater

decidetojoinamedicaredrugplan.


When Can You Join A Medicare Drug Plan?

youcanjoinamedicaredrugplanwhenyoufirstbecome

eligibleformedicareandeachyearfromnovember15ththrough

december31st;however,ifyouloseyourcurrentcreditable

prescriptiondrugcoverage,throughnofaultofyourown,you

willalsobeeligibleforatwo(2)monthspecialenrollmentperiod

(sep)tojoinamedicaredrugplan.

What Happens To Your Current Coverage?

ifyoudecidetojoinamedicaredrugplan,yourcurrenttCH

selectplancoveragewillnotbeaffected.

n youmaychoosetoenrollinmedicarepartdinadditionto

theHospitalprovidedmedicalandprescriptiondrugplan.if

youselectthisoption,medicare’sprescriptiondrugplanwill

coordinatecoveragebydeterminingbenefitsasthesecondary

providersaslongasyouremainanactiveemployeeunderthe

Hospitalprovidedplan.

n youmaychoosenottoenrollinthemedicareprescription

drugplanatthistimeandkeepyourmedicalandprescription

drugbenefitsundertheHospitalprovidedplan.ifthisoption

isselected,yourmedicalandprescriptiondrugbenefitswill

continueundertheHospitalprovidedmedicalplanoption

selected.

n ifyoudecidetojoinamedicaredrugplananddropyour

currenttexasChildren’sHospitalcoverage,beawarethatyou

andyourdependentsmaynotbeabletogetthiscoverage

back.

When Will A Higher Premium (Penalty) Be Paid to Join a

Medicare Drug Plan?

ifyoudroporloseyourcurrentcoveragewithtexasChildren’s

Hospitalanddon’tjoinamedicaredrugplanwithin63continuous

daysafteryourcurrentcoverageends,youmaypayahigher

premium(apenalty)tojoinamedicaredrugplanlater.ifyougo

63continuousdaysorlongerwithoutcreditableprescriptiondrug

coverage,yourmonthlypremiummaygoupbyatleast1%ofthe

medicarebasebeneficiarypremiumpermonthforeverymonth

thatyoudidnothavethatcoverage.

forexample,ifyougonineteenmonthswithoutcreditable

coverage,yourpremiummayconsistentlybeatleast19%higher

thanthemedicarebasebeneficiarypremium.youmayhaveto

paythishigherpremium(apenalty)aslongasyouhavemedicare

prescriptiondrugcoverage.inaddition,youmayhavetowaituntil

thefollowingnovembertojoin.

For More Information:n About This Notice or Your Current Prescription Drug Coverage

ContacttheBenefitstotalrewardslineat832-824-2421and

press1forbenefits.you’llgetthisnoticeeachyear.youwill

alsogetitbeforethenextperiodyoucanjoinamedicaredrug

plan,andifthiscoveragethroughtexasChildren’sHospital

changes.youalsomayrequestacopyofthisnoticeatany

time.

n About Your Options under Medicare Prescription Drug

Coverage

moredetailedinformationaboutmedicareplansthatoffer

prescriptiondrugcoverageisinthe“medicare&you”

handbook.employeesaremailedacopyofthehandbook

everyyearfrommedicare.youmayalsobecontacteddirectly

bymedicaredrugplans.

n About Medicare Prescription Drug Coverage

-Visitwww.medicare.gov

-forpersonalizedhelp,callyourstateHealthinsurance

assistanceprogram(seetheinsidebackcoverofyour

copyofthe“medicare&you”handbookfortheirtelephone

number)

-Call1-800-mediCare(1-800-633-4227).ttyusers

shouldcall1-877-486-2048.ifyouhavelimitedincomeand

resources,extrahelppayingformedicareprescriptiondrug

coverageisavailable.forinformationaboutthisextrahelp,

visitsocialsecurityonthewebatwww.socialsecurity.gov,

orcallthemat1-800-772-1213(tty1-800-325-0778).

403(B) PLAn IRS REgULATIOnS RELATED TO 2011 MAXIMUM COnTRIBUTIOn AMOUnTSifbothofthefollowingtwopointsapplytoyou,pleasecontactHr

Benefitssothattheycanworkwithyoutominimizeyourriskof

exceedingthe2011contributionlimit.

1.youcurrentlycontrol(owndirectlyorindirectly)morethana

50%interestofabusiness,and

2.thatbusinessprovidestoyouaQualifieddefinedContribution

retirementplanorasimplifiedemployeepension(“sep”)plan

for2011

duetocertainchangesincomplianceproceduresestablished

bytheinternalrevenueservice(the“irs”),employeeswho

controlmorethana50%interestofabusinessthatprovidesto

youaqualifiedretirementplanorasep,arerequiredbytheirs,

tocombinethecontributionsmadeonyourbehalftoour403(b)

planwiththecontributionsmadeonyourbehalftotheretirement

plan(s)ofthatbusiness(orbusinesses)todetermineifthe

retirementplanannualadditionslimittestisviolated.


therefore,texasChildren’sisobligedtomonitorthemaximum

amountofcontributionsmadeonyourbehalftoour403(b)plan

andanyothertax-qualifieddefinedcontributionplansmaintained

byemployersinwhichyouhaveanownershipinterestofmore

than50%.

in2011,thecurrentknownmaximumcontributionisthelesser

of(i)$49,000or(ii)100percentofeligiblecompensation.to

addressanyquestionsorconcernsrelatedtothisirsregulation,

pleasecontactHrat832.824.2421andselectoption1for

Benefits.

ifthereisaviolationtothisannualadditionslimittest,youwillbe

subjecttocurrentfederalincometaxontheexcesscontributions

andyoumayalsobesubjecttocertainfederaltaxpenalties.

YOUR (ERISA) BEnEFITS RIgHTS asaparticipantinthisplan,youareentitledtocertainrightsand

protectionsundertheemployeeretirementincomesecurityact

of1974(erisa).thisstatementofyourerisarightsisrequired

byfederallawandregulations.inaddition,

erisaprovidesthatyou,asaplanparticipantareentitledto:

n receiveinformationaboutyourplanandbenefits.

n examine,withoutcharge,attheofficeoftheplansupervisor

andatotherspecifiedlocationssuchasworksitesand

unionhalls,allplandocumentsgoverningtheplan,including

insurancecontractsandcollectivebargainingagreements,

andcopiesofalldocumentsfiledbytheplanwiththeu.s.

departmentoflaborandavailableatthepublicdisclosure

roomofthepensionandWelfareBenefitsadministration.

n obtain,uponwrittenrequesttotheplansupervisor,copies

ofdocumentsgoverningtheoperationoftheplan,including

insurancecontractsandcollectivebargainingagreements.the

plansupervisormaymakeareasonablechargeforthecopies.

n receiveasummaryoftheplan’sannualfinancialreport.the

plansupervisorisrequiredbylawtofurnisheachparticipant

withacopyofthissummaryannualreport.

PRUDEnT ACTIOnS BY PLAn FIDUCIARIESinadditiontocreatingrightsforplanparticipants,erisaimposes

dutiesuponthepeoplewhoareresponsiblefortheoperationof

theplan.thepeoplewhooperateyourplan,called“fiduciaries”of

theplan,haveadutytodosoprudentlyandintheinterestofyou

andotherplanparticipantsandbeneficiaries.noone,including

youremployer,yourunion,ifapplicable,oranyotherperson,

mayfireyouorotherwisediscriminateagainstyouinanywayto

preventyoufromobtainingawelfarebenefitorexercisingyour

rightsundererisa.

EnFORCE YOUR RIgHTSifyourclaimforabenefitisdeniedorignoredinwholeorinpart,

youhavearighttoknowwhythiswasdone,toobtaincopiesof

documentsrelatingtothedecisionwithoutchargeandtoappeal

anydenial,allwithincertaintimeschedules.

undererisa,therearestepsyoucantaketoenforceyourrights.

forinstance,ifyourequestacopyoftheplandocumentsorthe

latestannualreportfortheplananddonotreceivethemwithin30

days,youmayfilesuitinafederalcourt.insuchacase,thecourt

mayrequirethefiduciaryCommitteetoprovidethematerialsand

payupto$110adayuntilyoureceivethematerials,unlessthe

materialswerenotsentbecauseofreasonsbeyondthecontrol

ofthefiduciaryCommittee.ifyouhaveaclaimforbenefits,which

isdeniedorignored,inwholeorinpart,youmayfilesuitina

federalcourt.inaddition,ifyoudisagreewiththeplan’sdecision

orlackthereofconcerningthequalifiedstatusofadomestic

relationsorder,youmayfilesuitinfederalcourt.ifitshould

happenthatplanfiduciariesmisusetheplan’smoney,orifyou

arediscriminatedagainstforassertingyourrights,youmayseek

assistancefromtheu.s.departmentoflabor,oryoumayfile

suitinafederalcourt.thecourtwilldecidewhoshouldpaycourt

costsandfees.ifyouaresuccessful,thecourtmayorderthe

personyouhavesuedtopaythesecostsandfees.ifyoulose,

thecourtmayorderyoutopaythesecostsandfees,forexample,

ifitfindsyourclaimisfrivolous.

ASSISTAnCE WITH YOUR qUESTIOnSifyouhavequestionsaboutyourplan,youshouldcontactthe

plansupervisor.ifyouhaveanyquestionsaboutthisstatement

oryourrightsundererisa,orifyouneedassistanceinobtaining

documentsfromtheplansupervisor,youshouldcontactthe

nearestemployeeBenefitsadministration,u.s.department

oflabor,listedinthetelephonedirectory.youmaycall

202.693.8673oraddressrequeststopublicdisclosureroom,

roomn-1513,employeeBenefitssecurityadministration,u.s.

departmentoflabor,200Constitutionave.,n.W.,Washington,

d.C.20210.


VENDOR PHONE WEB ADDRESS

Backup Care (Temporary care for infant to elder)

nBright Horizons — to pre-register or schedule care 1-877-242-2737www.backup.brighthorizons.comUn: TexasChildrens PW: backup1

COBRA — new 2011 ProvidernPayFlex 1-800-284-4885(option3) www.HealthHub.com

Disease Management — new 2011 ProvidernFocused Health Solutions 1-888-352-9355 TCH.myfocusedhealth.com

FSA’s (Health Care & Dependent Care) — new 2011 VendornPayFlex 1-800-284-4885(option1) www.HealthHub.com

Life Insurance — new 2011 ProvidernPrudential 1-888-598-5671 www.prudential.com

Long-Term CarenJohn Hancock 1-800-724-3785

http://tch.jhancock.comun: tch PW: mybenefit

Medical / Dental — new 2011 Provider and networknBlueCross BlueShield of texas (BCBStX) 1-877-734-8924 www.bcbstx.com/tch

Pharmacy / Prescriptionsnexpress ScriptsnSelect Home Delivery ProgramnCuraScript (specialty medications)nFreedom Fertility (fertility drugs)

1-800-316-31021-888-772-51881-888-773-73761-800-660-4283

www.express-scripts.comwww.StartHomeDelivery.comwww.curascript.comwww.freedomfertility.com

RetirementnFidelity 403b retirement Savings PlannFidelity 529 College Savings PlannFidelity Spanish information line

1-800-343-08601-800-544-19141-877-297-3017

www.fidelity.com/atworkwww.fidelity.com/unique

Texas Medical CenternFor tmC Parking Card issuesnFor changes to Parking elections

713-791-6161

832-824-2421(option1)

Tuition Assistance Programnedlink – Customer Servicenedlink – For online applicationsnedlink – to Fax Documentation

1-888-797-2235

1-866-284-0859http://tamsonline.org/TCH

VisionnVision Service Plan (VSP) 1-800-877-7195 www.vsp.com/go/tch

HUMAN RESOURCES PHONE WEB ADDRESS

Employee HealthnPersonal and Family medical leave (Fml)nemployee assistance Program (eaP)

832-824-2150832-824-3327

[email protected]

Texas Children’s Benefits Departmentmeyer Building, 3rd Floor, 8a - 5p monday - Friday

Texas Children’s HR Service Centerabercrombie Building (a-130), 7a - 4p monday - Friday

832-824-2421(option1) [email protected]

ContaCtinformationBytypeofserViCe


tCHseleCtdollarsasasupportivewaytohelpemployeesoffsetthecostofbenefitpremiums,additionaldollars(referredto

as“selectdollars”)arepaidbasedonyouryearsof‘benefit’serviceandjobstatus.selectdollarsbeginon

thesamedayyourpremiumdeductionsbeginandwillchangeonyouranniversarydateoronthedateofa

statuschange.(example:part-timetofull-timestatus)Whetheryouenrollorwaivebenefitcoverage,eligibleemployees will

automaticallyreceiveselectdollarsasadditionaltake-homeincome,subjecttoapplicabletaxes.

selectPLUS’dollars,intheamountof$50/monthor$23.08/payperiod,willbeappliedtoemployeeswho

1)participateinatCHmedicalplanand2)whoearnanhourlywageof$14.00orlessasofJanuary1,2011.

Additional Pay to Offset the Cost of Employee Benefit Premiums

FULL-TIME Employees

(Years of benefit service)

Monthly SELECT

DOLLARS

AMOUNT ADDED TO EMPLOYEE PAYCHECK

SELECT DOLLARS

SelectPLUS DollarsMust be in a TCH Medical Plan

AND make an hourly wage of $14 or less.

0-1 year $60 + $ 0 = $ 60 $27.69 / pay period $50.77 / pay period

1-2 years $60 + $ 5 = $ 65 $30.00 / pay period $53.08 / pay period

3-4 years $60 + $10 = $ 70 $32.31 / pay period $55.39 / pay period



11-15 years $60 + $40 = $100 $46.15 / pay period $69.23 / pay period

16-24 years $60 + $50 = $110 $50.77 / pay period $73.85 / pay period

25+ years $60 + $75 = $135 $62.31 / pay period $85.39 / pay period

PART-TIME Employees

(Years of benefit service)

Monthly SELECT

DOLLARS

AMOUNT ADDED TO EMPLOYEE PAYCHECK

SELECT DOLLARS

SelectPLUS DollarsMust be in a TCH Medical Plan

AND make an hourly wage of $14 or less.

0-1 year $25 + $ 0 = $ 25 $11.54 / pay period $34.62 / pay period

1-2 years $25 + $ 5 = $ 30 $13.85 / pay period $36.93 / pay period






25+ years $25 + $75 = $100 $46.15 / pay period $69.23 / pay period

Per Pay Period Examples of Select Dollars In Action!

Examples Reflect: New Employeewith ‘Employee ONLY’ coverage with PPO Medical

FULL-TIME Employee

PART-TIME Employee

FULL-TIME SelectPLUS Employee

PART-TIME SelectPLUS Employee

Per Pay Period PPO Premium $35.22 $35.22 $35.22 $35.22

Offset by per pay period Select Dollars -27.69 -11.54 - 50.77 -34.62

Actual per pay period cost for PPO Medical $ 7.53 $23.58 - $15.55 $0.60

NEWiN 2011

SELE

CT D

OLLA

RS

nEW

nEW


2011tCHseleCtplansemployeeCosts

per paY periodMEDICAL OPTIONS PPO EPO

employeeonly

employee&spouse

employee&Child

employee&Children

employee,spouse&Child

employee&family

$ 35.22

$ 154.67

$ 111.52

$ 164.98

$ 230.66

$ 284.45

$ 63.94

$ 187.08

$ 143.03

$ 196.50

$ 266.08

$ 319.65

DENTAL OPTIONS DPPO-HIGH DPPO-LOW

employeeonly

employee&1dependent

employee&family

$ 16.01

$ 30.45

$ 42.94

$ 9.25

$ 17.58

$ 24.80

VISION PLAN

employeeonly

employee&spouse

employee&Child

employee&Children

employee,spouse&Child

employee&family

$ 3.83

$ 7.66

$ 7.28

$ 7.28

$ 11.49

$ 11.49

EMPLOYEE LIFE INSURANCE

Basiclife

optional life insurancepaidbytexasChildren’spremiumpaidbyemployeebasedonsalary

SPOUSE LIFE INSURANCE

premiumpaidbyemployee(basedonemployee’sage)uptomaximum$100,000.

EMPLOYEE ACCIDENTAL DEATH AND DISMEMBERMENT (AD&D) INSURANCE

Basicad&d

optional aD&D insurancepaidbytexasChildren’spremiumpaidbyemployeebasedonsalary

DEPENDENT LIFE INSURANCE

$ 2,500 $ 5,000$10,000

$ .26$ .51$ 1.02

LONG-TERM DISABILITY

Basicltd

optionalltd

paidbytexasChildren’spremiumpaidbyemployeebasedonageandsalary

FLEXIBLE SPENDING ACCOUNTS

HealthCarefsaannualmaximum

dependentCarefsaannualmaximum

$5,000peryear(minimum$5.00perpayperiod)

$5,000peryear,including$260.00employercontributions

(minimum$5.00perpayperiod)

Remember Your Select Dollars!

PR

EMIU

MS

thisguideisasummaryofmaterialmodificationstoyourbenefitscoverageandcontainschangestoyourbenefitsasdescribedinyour

summaryplandescription.foracompletedescriptionofyourbenefits,seeyoursummaryplandescriptionontheConnectwebsite.

thisreferenceguidedescribesthevariousbenefitplansofferedbytexasChildren’sinsummaryonly.theactualeligibilityrequirements,

benefits,terms,conditions,limitations,andprovisionsthatgoverntheplansarecontainedintheplandocumentsorgroupinsurancecontracts.

if,inoureffortstomaketheplanseasytounderstand,anyoftheplans’provisionshavebeenomittedormisstated;theofficialplandocuments

orinsurancecontractsmustremainthefinalauthority.thelegaldocumentsalsogoverntheadministrationoftheplansandpaymentofbenefits.

inthecaseofanydispute,theinformationintheplandocumentsorcontractswillprevail.

Copiesofthesedocumentsareavailableforyourinspectionduringnormalbusinesshoursormayberequestedinwritingforanominalfeefrom:

texasChildren’sHospital

Humanresourcesdept.,suite1301

1919s.Braeswood,Houston,tX77030

Texas Children’s Hospital is proud to be one of the Houston Business Journal’sBest Places to Work for the fifth consecutive year.Every day, our team of gifted employees, physicians, researchers and volunteers makes the world a healthier place byproviding the finest possible patient care, education and research.Together, we are redefining the future of pediatrichealth care with a comprehensive growth plan including a state-of-the-art maternity center, a suburban hospital inWest Houston and the Jan and Dan Duncan Neurological Research Institute™. Simply stated,Texas Children’s ismaking a world of difference to the world at large.

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