A WellSpan
Career:

Employer Contributions

Amount of contribution

WellSpan contributes up to a total of 6% of your pay in two ways:

WellSpan will match 50% of what you contribute immediately upon hire. To receive the full match (2% of pay) you must contribute 4% or more.

WellSpan will also contribute a base amount equal to 4% of your pay to the plan after you have worked at WellSpan for one year.*

Vesting of contributions

Employer contributions vest once you work three years for at least 500 hours each year.

Reasons to participate

You will need money to live off of in retirement. The contributions made by WellSpan on your behalf are an important and valuable part of your income.

Pre-Tax Employee Contributions

Amount of contribution

You can make pre-tax contributions up to the annual limit. The annual limit is set by the IRS and changes every year. If you choose to make both pre-tax and after-tax contributions, the total amount you can contribute to both may not exceed the annual limit. Individuals who are age 50 or older by the last day of the year can make additional catch-up contributions.

Vesting of contributions

Your own contributions are 100% vested.

Reasons to participate

You will need money to live off of in retirement. The contributions made by WellSpan on your behalf are an important and valuable part of your income but will not be enough to provide for your needs in retirement. You should probably be saving at least 10% of your income.

Pre-tax contributions reduce your compensation for the year for income tax purposes. When you take a distribution from the plan in retirement, both your contribution and any earnings it has made will be taxable.

After-Tax Employee Contributions - Roth

Amount of contribution

You can make pre-tax contributions up to the annual limit. The annual limit is set by the IRS and changes every year. If you choose to make both pre-tax and after-tax contributions, the total amount you can contribute to both may not exceed the annual limit. Individuals who are age 50 or older by the last day of the year can make additional catch-up contributions.

Vesting of contributions

Your own contributions are 100% vested.

Reasons to participate

You will need money to live off of in retirement. The contributions made by WellSpan on your behalf are an important and valuable part of your income but will not be enough to provide for your needs in retirement. You should probably be saving at least 10% of your income.

Roth contributions do not reduce your current compensation for income tax purposes, but neither your contribution nor its earnings will be taxed when distributed to you in retirement. Your Roth contributions will be worth more to you in retirement than your pre-tax contributions.

Employer Contributions

Amount of contribution

Weekend Option and PRN employees are not eligible for employer contributions.

Pre-Tax Employee Contributions

Amount of contribution

You can make pre-tax contributions up to the annual limit. The annual limit is set by the IRS and changes every year. If you choose to make both pre-tax and after-tax contributions, the total amount you can contribute to both may not exceed the annual limit. Individuals who are age 50 or older by the last day of the year can make additional catch-up contributions.

Vesting of contributions

Your own contributions are 100% vested.

Reasons to participate

You will need money to live off of in retirement. You should probably be saving at least 10% of your income.

Pre-tax contributions reduce your compensation for the year for income tax purposes. When you take a distribution from the plan in retirement, both your contribution and any earnings it has made will be taxable.

After-Tax Employee Contributions - Roth

Amount of contribution

You can make pre-tax contributions up to the annual limit. The annual limit is set by the IRS and changes every year. If you choose to make both pre-tax and after-tax contributions, the total amount you can contribute to both may not exceed the annual limit. Individuals who are age 50 or older by the last day of the year can make additional catch-up contributions.

Vesting of contributions

Your own contributions are 100% vested.

Reasons to participate

You will need money to live off of in retirement. You should probably be saving at least 10% of your income.

After-tax Roth contributions do not reduce your current compensation for income tax purposes, but neither your contribution nor its earnings will be taxed when distributed to you in retirement. Your Roth contributions will be worth more to you in retirement than your pre-tax contributions.

WellSpan Plus

Type of Plan

Point-of-Service/Preferred Provider Organization (POS/PPO)

Premiums for an employee with an hourly pay rate of $72.13 or more receiving the wellness incentive of $15 per pay period.¹

Employee: $37.00
Employee and children: $127.50
Employee and spouse: $157.00
Family: $167.00

Premiums for an employee with an hourly pay rate of $33.67 to $72.12 receiving the wellness incentive of $15 per pay period.¹

Employee: $35.00
Employee and children: $121.50
Employee and spouse: $149.50
Family: $159.00

Premiums for an employee with an hourly pay rate of $16.51 to $33.66 receiving the wellness incentive of $15 per pay period.¹

Employee: $32.50
Employee and children: $115.00
Employee and spouse: $141.50
Family: $150.50

Premiums for an employee with an hourly pay rate of $16.50 or less receiving the wellness incentive of $15 per pay period.¹

Employee: $31.50
Employee and children: $112.00
Employee and spouse: $138.00
Family: $146.50

Annual deductible

Enhanced Network: $200
Core Network: $350 per individual
Out-of-network: $800

Reasons to choose this plan

This plan has highest premiums, but the lowest deductibles and costs when you receive care. Your healthcare costs are more predictable. Most employees choose this plan.

Way to reduce costs by paying on a pre-tax basis

Participate in the Health Care Flexible Spending Account (FSA)

WellSpan Standard

Type of Plan

Point-of-Service/Preferred Provider Organization (POS/PPO)

Premiums for an employee with an hourly pay rate of $72.13 or more receiving the wellness incentive of $15 per pay period.¹

Employee: $22.50
Employee and children: $91.00
Employee and spouse: $113.00
Family: $123.00

Premiums for an employee with an hourly pay rate of $33.67 to $72.12 receiving the wellness incentive of $15 per pay period.¹

Employee: $20.50
Employee and children: $85.00
Employee and spouse: $106.50
Family: $115.50

Premiums for an employee with an hourly pay rate of $16.51 to $33.66 receiving the wellness incentive of $15 per pay period.¹

Employee: $19.50
Employee and children: $83.00
Employee and spouse: $103.50
Family: $112.50

Premiums for an employee with an hourly pay rate of $16.50 or less receiving the wellness incentive of $15 per pay period.¹

Employee: $19.00
Employee and children: $81.50
Employee and spouse: $102.00
Family: $110.50

Annual deductible

Enhanced Network: $550 individual/$1100 family
Core Network: $1200 individual/$2400 family
Out-of-network: $2050 individual/$4050 family

Reasons to choose this plan

The premiums on this plan are lower than the WellSpan Plus plan, but higher deductibles and costs when you receive care.

Way to reduce costs by paying on a pre-tax basis

Participate in the Health Care Flexible Spending Account (FSA)

WellSpan High Deductible

Type of Plan

High Deductible Health Plan (HDHP)

Premiums for an employee with an hourly pay rate of $72.13 or more receiving the wellness incentive of $15 per pay period.¹

Employee: $16.50
Employee and children: $46.50
Employee and spouse: $82.50
Family: $103.50

Premiums for an employee with an hourly pay rate of $33.67 to $72.12 receiving the wellness incentive of $15 per pay period.¹

Employee: $14.50
Employee and children: $42.50
Employee and spouse: $75.50
Family: $95.00

Premiums for an employee with an hourly pay rate of $16.51 to $33.66 receiving the wellness incentive of $15 per pay period.¹

Employee: $14.00
Employee and children: $42.00
Employee and spouse: $75.00
Family: $94.00

Premiums for an employee with an hourly pay rate of $16.50 or less receiving the wellness incentive of $15 per pay period.¹

Employee: $13.50
Employee and children: $41.00
Employee and spouse: $73.50
Family: $92.50

Annual deductible

Enhanced Network: $1500 individual/$3000 family
Core Network: $1500 individual/$3000 family
Out-of-network: $2800 individual/$5600 family

Reasons to choose this plan

This plan has the lowest premiums of the three but you must first pay all expenses until you have paid an amount equal to your deductible before any services are covered (other than in-network preventive care). WellSpan provides employer contributions to the HS A for employees who choose this plan ($600 individual/$1200 any other coverage).

Way to reduce costs by paying on a pre-tax basis

Participate in the Health Savings Account (HSA)
Participate in the Limited Purpose Flexible Spending Account (FSA)

WellSpan Plus

Type of Plan

Point-of-Service/Preferred Provider Organization (POS/PPO)

Premiums for an employee with an hourly pay rate of $72.13 or more receiving the wellness incentive of $15 per pay period.¹

Employee: $125.50
Employee and children: $291.00
Employee and spouse: $337.00
Family: $362.50

Premiums for an employee with an hourly pay rate of $33.67 to $72.12 receiving the wellness incentive of $15 per pay period.¹

Employee: $123.00
Employee and children: $285.00
Employee and spouse: $330.00
Family: $355.50

Premiums for an employee with an hourly pay rate of $16.51 to $33.66 receiving the wellness incentive of $15 per pay period.¹

Employee: $120.00
Employee and children: $278.50
Employee and spouse: $322.50
Family: $347.00

Premiums for an employee with an hourly pay rate of $16.50 or less receiving the wellness incentive of $15 per pay period.¹

Employee: $119.00
Employee and children: $276.50
Employee and spouse: $320.00
Family: $344.50

Annual deductible

Enhanced Network: $200
Core Network: $350 per individual
Out-of-network: $800

Reasons to choose this plan

This plan has highest premiums, but the lowest deductibles and costs when you receive care. Your healthcare costs are more predictable. Also, premiums are taken from your paycheck on a pre-tax basis. Most employees choose this plan.

Way to reduce costs by paying on a pre-tax basis

Participate in the Health Care Flexible Spending Account (FSA)

WellSpan Standard

Type of Plan

Point-of-Service/Preferred Provider Organization (POS/PPO)

Premiums for an employee with an hourly pay rate of $72.13 or more receiving the wellness incentive of $15 per pay period.¹

Employee: $95.50
Employee and children: $222.50
Employee and spouse: $255.00
Family: $274.50

Premiums for an employee with an hourly pay rate of $33.67 to $72.12 receiving the wellness incentive of $15 per pay period.¹

Employee: $94.50
Employee and children: $220.00
Employee and spouse: $252.00
Family: $271.50

Premiums for an employee with an hourly pay rate of $16.51 to $33.66 receiving the wellness incentive of $15 per pay period.¹

Employee: $93.00
Employee and children: $216.50
Employee and spouse: $248.50
Family: $267.50

Premiums for an employee with an hourly pay rate of $16.50 or less receiving the wellness incentive of $15 per pay period.¹

Employee: $92.50
Employee and children: $215.50
Employee and spouse: $247.00
Family: $266.00

Annual deductible

Enhanced Network: $550 individual/$1100 family
Core Network: $1200 individual/$2400 family
Out-of-network: $2050 individual/$4050 family

Reasons to choose this plan

The premiums on this plan are lower than the WellSpan Plus plan, but higher deductibles and costs when you receive care.

Way to reduce costs by paying on a pre-tax basis

Participate in the Health Care Flexible Spending Account (FSA)

WellSpan High Deductible

Type of Plan

High Deductible Health Plan (HDHP)

Premiums for an employee with an hourly pay rate of $72.13 or more receiving the wellness incentive of $15 per pay period.¹

Employee: $65.50
Employee and children: $159.00
Employee and spouse: $194.00
Family: $232.50

Premiums for an employee with an hourly pay rate of $33.67 to $72.12 receiving the wellness incentive of $15 per pay period.¹

Employee: $65.00
Employee and children: $157.00
Employee and spouse: $192.00
Family: $230.00

Premiums for an employee with an hourly pay rate of $16.51 to $33.66 receiving the wellness incentive of $15 per pay period.¹

Employee: $64.50
Employee and children: $156.50
Employee and spouse: $191.00
Family: $228.50

Premiums for an employee with an hourly pay rate of $16.50 or less receiving the wellness incentive of $15 per pay period.¹

Employee: $64.00
Employee and children: $155.50
Employee and spouse: $190.00
Family: $227.50

Annual deductible

Enhanced Network: $1500 individual/$3000 family
Core Network: $1500 individual/$3000 family
Out-of-network: $2800 individual/$5600 family

Reasons to choose this plan

This plan has the lowest premiums of the three but you must first pay all expenses until you have paid an amount equal to your deductible before any services are covered (other than in-network preventive care). WellSpan provides employer contributions to the HS A for employees who choose this plan ($600 individual/$1200 any other coverage).

Way to reduce costs by paying on a pre-tax basis

Participate in the Health Savings Account (HSA)
Participate in the Limited Purpose Flexible Spending Account (FSA)

WellSpan Plus

Type of Plan

Point-of-Service/Preferred Provider Organization (POS/PPO)

Premiums for an employee with an hourly pay rate of $72.13 or more receiving the wellness incentive of $15 per pay period.¹

Employee: $320.50
Employee and children: $690.50
Employee and spouse: $784.50
Family: $845.00

Premiums for an employee with an hourly pay rate of $33.67 to $72.12 receiving the wellness incentive of $15 per pay period.¹

Employee: $314.00
Employee and children: $677.00
Employee and spouse: $769.50
Family: $828.50

Premiums for an employee with an hourly pay rate of $16.51 to $33.66 receiving the wellness incentive of $15 per pay period.¹

Employee: $306.50
Employee and children: $661.50
Employee and spouse: $752.00
Family: $809.50

Premiums for an employee with an hourly pay rate of $16.50 or less receiving the wellness incentive of $15 per pay period.¹

Employee: $304.50
Employee and children: $657.00
Employee and spouse: $746.50
Family: $804.00

Annual deductible

Enhanced Network: $200
Core Network: $350 per individual
Out-of-network: $800

Reasons to choose this plan

This plan has highest premiums, but the lowest deductibles and costs when you receive care. Your healthcare costs are more predictable. Also, premiums are taken from your paycheck on a pre-tax basis. Most employees choose this plan.

Way to reduce costs by paying on a pre-tax basis

Participate in the Health Care Flexible Spending Account (FSA)

WellSpan Standard

Type of Plan

Point-of-Service/Preferred Provider Organization (POS/PPO)

Premiums for an employee with an hourly pay rate of $72.13 or more receiving the wellness incentive of $15 per pay period.¹

Employee: $228.50
Employee and children: $530.00
Employee and spouse: $601.00
Family: $647.00

Premiums for an employee with an hourly pay rate of $33.67 to $72.12 receiving the wellness incentive of $15 per pay period.¹

Employee: $226.00
Employee and children: $524.50
Employee and spouse: $595.00
Family: $640.50

Premiums for an employee with an hourly pay rate of $16.51 to $33.66 receiving the wellness incentive of $15 per pay period.¹

Employee: $222.50
Employee and children: $516.50
Employee and spouse: $586.00
Family: $630.50

Premiums for an employee with an hourly pay rate of $16.50 or less receiving the wellness incentive of $15 per pay period.¹

Employee: $221.50
Employee and children: $514.00
Employee and spouse: $583.00
Family: $627.50

Annual deductible

Enhanced Network: $550 individual/$1100 family
Core Network: $1200 individual/$2400 family
Out-of-network: $2050 individual/$4050 family

Reasons to choose this plan

The premiums on this plan are lower than the WellSpan Plus plan, but higher deductibles and costs when you receive care.

Way to reduce costs by paying on a pre-tax basis

Participate in the Health Care Flexible Spending Account (FSA)

WellSpan High Deductible

Type of Plan

High Deductible Health Plan (HDHP)

Premiums for an employee with an hourly pay rate of $72.13 or more receiving the wellness incentive of $15 per pay period.¹

Employee: $153.00
Employee and children: $367.00
Employee and spouse: $437.50
Family: $469.50

Premiums for an employee with an hourly pay rate of $33.67 to $72.12 receiving the wellness incentive of $15 per pay period.¹

Employee: $151.00
Employee and children: $363.00
Employee and spouse: $433.00
Family: $465.00

Premiums for an employee with an hourly pay rate of $16.51 to $33.66 receiving the wellness incentive of $15 per pay period.¹

Employee: $150.50
Employee and children: $361.50
Employee and spouse: $430.50
Family: $462.50

Premiums for an employee with an hourly pay rate of $16.50 or less receiving the wellness incentive of $15 per pay period.¹

Employee: $149.50
Employee and children: $359.50
Employee and spouse: $428.50
Family: $460.00

Annual deductible

Enhanced Network: $1500 individual/$3000 family
Core Network: $1500 individual/$3000 family
Out-of-network: $2800 individual/$5600 family

Reasons to choose this plan

This plan has the lowest premiums of the three but you must first pay all expenses until you have paid an amount equal to your deductible before any services are covered (other than in-network preventive care). WellSpan provides employer contributions to the HS A for employees who choose this plan ($600 individual/$1200 any other coverage).

Way to reduce costs by paying on a pre-tax basis

Participate in the Health Savings Account (HSA)
Participate in the Limited Purpose Flexible Spending Account (FSA)

Delta Dental

Premiums¹

Employee: $3.36
Family: $10.16

Annual deductible

None

Network

You can choose a dentist who participates in the Delta Dental network or not. You will pay less when you receive care from a Delta Dental provider. If your dentist participates in the Delta Dental network, your claim will be automatically submitted for you. If not, you will have to pay for services at the time you receive them, keep your receipt, and submit a claim for reimbursement. You may also be responsible for charges that exceed the Delta Dental plan allowance.

Annual maximum

The maximum amount the plan will pay is $1500 per plan year for each covered individual.

Reasons to choose this plan

This plan has lower premiums and no deductible. If your dentist participates in the Delta Dental network, you will also benefit from reduced charges. Administration is easier for you because claims will be automatically processed.

Population Health Dental

Premiums¹

Employee: $4.19
Family: $12.79

Annual deductible

Per Person: $50
Family: $150

Network

There is no network for the Population Health dental plan, so your level of benefits will not depend on which provider you choose. Your dentist may or may not automatically submit your claim for you. If not, you will have to pay for services at the time you receive them, keep your receipt, and submit a claim for reimbursement. You may also be responsible for charges that exceed the Population Health Dental Plan allowance.

Annual maximum

The maximum amount the plan will pay is $1500 per plan year for each covered individual.

Reasons to choose this plan

This plan may be desirable if your dentist does not participate in Delta Dental and your dentist’s charges are lower than you can obtain elsewhere.

Delta Dental

Premiums¹

Employee: $8.37
Family: $21.02

Annual deductible

None

Network

You can choose a dentist who participates in the Delta Dental network or not. You will pay less when you receive care from a Delta Dental provider. If your dentist participates in the Delta Dental network, your claim will be automatically submitted for you. If not, you will have to pay for services at the time you receive them, keep your receipt, and submit a claim for reimbursement. You may also be responsible for charges that exceed the Delta Dental plan allowance.

Annual maximum

The maximum amount the plan will pay is $1500 per plan year for each covered individual.

Reasons to choose this plan

This plan has lower premiums and no deductible. If your dentist participates in the Delta Dental network, you will also benefit from reduced charges. Administration is easier for you because claims will be automatically processed.

Population Health Dental

Premiums¹

Employee: $12.57
Family: $21.79

Annual deductible

Per Person: $50
Family: $150

Network

There is no network for the Population Health dental plan, so your level of benefits will not depend on which provider you choose. Your dentist may or may not automatically submit your claim for you. If not, you will have to pay for services at the time you receive them, keep your receipt, and submit a claim for reimbursement. You may also be responsible for charges that exceed the Population Health Dental Plan allowance.

Annual maximum

The maximum amount the plan will pay is $1500 per plan year for each covered individual.

Reasons to choose this plan

This plan may be desirable if your dentist does not participate in Delta Dental and your dentist’s charges are lower than you can obtain elsewhere.

Delta Dental

Premiums¹

Employee: $15.73
Family: $40.09

Annual deductible

None

Network

You can choose a dentist who participates in the Delta Dental network or not. You will pay less when you receive care from a Delta Dental provider. If your dentist participates in the Delta Dental network, your claim will be automatically submitted for you. If not, you will have to pay for services at the time you receive them, keep your receipt, and submit a claim for reimbursement. You may also be responsible for charges that exceed the Delta Dental plan allowance.

Annual maximum

The maximum amount the plan will pay is $1500 per plan year for each covered individual.

Reasons to choose this plan

This plan has lower premiums and no deductible. If your dentist participates in the Delta Dental network, you will also benefit from reduced charges. Administration is easier for you because claims will be automatically processed.

Population Health Dental

Premiums¹

Employee: $24.36
Family: $51.26

Annual deductible

Per Person: $50
Family: $150

Network

There is no network for the Population Health dental plan, so your level of benefits will not depend on which provider you choose. Your dentist may or may not automatically submit your claim for you. If not, you will have to pay for services at the time you receive them, keep your receipt, and submit a claim for reimbursement. You may also be responsible for charges that exceed the Population Health Dental Plan allowance.

Annual maximum

The maximum amount the plan will pay is $1500 per plan year for each covered individual.

Reasons to choose this plan

This plan may be desirable if your dentist does not participate in Delta Dental and your dentist’s charges are lower than you can obtain elsewhere.

Vision Benefits of America (VBA)

Premiums³

Employee: $1.19
Family: $2.82

Network coverage

You may choose to see either a VBA provider or a provider that is not a member of the VBA network. You will receive a higher level of benefits if you see a VBA network provider. If not, you will have to pay for services at the time you receive them, keep your receipt, and submit a claim for reimbursement.

Eye Exam coverage per person (every 12 months)

VBA Network: Plan pays 100% after $10 copay
Out-of-Network: Plan pays $35, you pay the remainder

Eyeglass Frames per person (every 24 months)
Subject to program limits

VBA Network: Plan pays 100% after $10 copay¹ for materials up to the $60 wholesale allowance (approximately $150 - $180 retail)
Out-of-Network: Plan pays $40, you pay the remainder

Eyeglass Lenses per person (every 12 months)

VBA Network: Plan pays 100% after $10 copay¹ for materials. Includes solid and gradient tints, UV and scratch resistant protective coatings, and polycarbonate lens material for children under age 19.
Out-of-Network:

• Single vision: Plan pays $30, you pay the remainder
• Bifocal: Plan pays $40, you pay the remainder
• Trifocal: Plan pays $60, you pay the remainder
• Lenticular: Plan pays $80, you pay the remainder

Contact Lenses per person (every 12 months)²

VBA Network: Plan pays $100, you pay the remainder
Out-of-Network: Plan pays $100, you pay the remainder

Reasons to choose this plan

You may want to choose coverage if, in addition to an annual eye exam, you replace your eyewear on a regular basis and your provider is a member of the VBA network.

Way to reduce costs by paying on a pre-tax basis

Participate in the Healthcare FSA, the Limited Purpose Flexible Spending Account, or the Health Savings Account.

Vision Benefits of America (VBA)

Premiums³

Employee: $1.88
Family: $4.38

Network coverage

You may choose to see either a VBA provider or a provider that is not a member of the VBA network. You will receive a higher level of benefits if you see a VBA network provider. If not, you will have to pay for services at the time you receive them, keep your receipt, and submit a claim for reimbursement.

Eye Exam coverage per person (every 12 months)

VBA Network: Plan pays 100% after $10 copay
Out-of-Network: Plan pays $35, you pay the remainder

Eyeglass Frames per person (every 24 months)
Subject to program limits

VBA Network: Plan pays 100% after $10 copay¹ for materials up to the $60 wholesale allowance (approximately $150 - $180 retail)
Out-of-Network: Plan pays $40, you pay the remainder

Eyeglass Lenses per person (every 12 months)

VBA Network: Plan pays 100% after $10 copay¹ for materials. Includes solid and gradient tints, UV and scratch resistant protective coatings, and polycarbonate lens material for children under age 19.
Out-of-Network:

• Single vision: Plan pays $30, you pay the remainder
• Bifocal: Plan pays $40, you pay the remainder
• Trifocal: Plan pays $60, you pay the remainder
• Lenticular: Plan pays $80, you pay the remainder

Contact Lenses per person (every 12 months)²

VBA Network: Plan pays $100, you pay the remainder
Out-of-Network: Plan pays $100, you pay the remainder

Reasons to choose this plan

You may want to choose coverage if, in addition to an annual eye exam, you replace your eyewear on a regular basis and your provider is a member of the VBA network.

Way to reduce costs by paying on a pre-tax basis

Participate in the Healthcare FSA, the Limited Purpose Flexible Spending Account, or the Health Savings Account.

Vision Benefits of America (VBA)

Premiums³

Employee: $3.16
Family: $7.43

Network coverage

You may choose to see either a VBA provider or a provider that is not a member of the VBA network. You will receive a higher level of benefits if you see a VBA network provider. If not, you will have to pay for services at the time you receive them, keep your receipt, and submit a claim for reimbursement.

Eye Exam coverage per person (every 12 months)

VBA Network: Plan pays 100% after $10 copay
Out-of-Network: Plan pays $35, you pay the remainder

Eyeglass Frames per person (every 24 months)
Subject to program limits

VBA Network: Plan pays 100% after $10 copay¹ for materials up to the $60 wholesale allowance (approximately $150 - $180 retail)
Out-of-Network: Plan pays $40, you pay the remainder

Eyeglass Lenses per person (every 12 months)

VBA Network: Plan pays 100% after $10 copay¹ for materials. Includes solid and gradient tints, UV and scratch resistant protective coatings, and polycarbonate lens material for children under age 19.
Out-of-Network:

• Single vision: Plan pays $30, you pay the remainder
• Bifocal: Plan pays $40, you pay the remainder
• Trifocal: Plan pays $60, you pay the remainder
• Lenticular: Plan pays $80, you pay the remainder

Contact Lenses per person (every 12 months)²

VBA Network: Plan pays $100, you pay the remainder
Out-of-Network: Plan pays $100, you pay the remainder

Reasons to choose this plan

You may want to choose coverage if, in addition to an annual eye exam, you replace your eyewear on a regular basis and your provider is a member of the VBA network.

Way to reduce costs by paying on a pre-tax basis

Participate in the Healthcare FSA, the Limited Purpose Flexible Spending Account, or the Health Savings Account.

Basic Employee Life

Coverage amount

For hourly employees, your beneficiaries will receive an amount equal to your annual pay in the event of your death. For salaried employees and supervisors, the benefit is equal to one and one-half times your annual pay.

Certain leadership and clinical jobs are covered in an amount equal to two or two and one-half times pay.

Maximum benefit

The benefit is limited to $500,000.

Premium¹

None, your employer provides this benefit to you at no cost.

Tax impact

Life insurance received by your beneficiaries in the event of your death is not taxable. However, the value of the coverage you receive (to the extent your pay exceeds $50,000 annually) is taxable each year. To avoid the additional tax liability, you may waive coverage of the benefit over $50,000.

Do you need to get a physical before being covered or otherwise demonstrate evidence of insurability (EOI)?

No EOI required.

Reasons to choose coverage

N/A, your employer automatically provides this benefit. You may want to waive coverage of the benefit over $50,000 if you do not have beneficiaries who depend on your income and you do not wish to pay taxes on the value of the benefit.

Basic Employee Accidental Death and Dismemberment (AD&D)

Coverage amount

For hourly employees, your beneficiaries will receive an amount equal to your annual pay in the event of your accidental death. For salaried employees and supervisors, the benefit is equal to one and one-half times your annual pay. Certain leadership and clinical jobs are covered in an amount equal to two or two and one-half times pay.

In addition, your beneficiaries will receive a variety of additional benefits depending on the circumstances. Additional benefits may include a sum of money for your dependents’ education, training or child care.

Dismemberment benefits will be paid to you if you lose functionality of some part of your body such as loss of sight, hearing, hands, feet or similar.

Maximum benefit

The benefit is limited to $500,000.

Premium¹

None, your employer provides this benefit to you at no cost.

Tax impact

Life insurance or AD&D benefits received by you or your beneficiaries is not taxable. However, the value of the coverage you receive (to the extent your pay exceeds $50,000 annually) is taxable each year. To avoid the additional tax liability, you may waive coverage of the benefit over $50,000.

Do you need to get a physical before being covered or otherwise demonstrate evidence of insurability (EOI)?

No EOI required.

Reasons to choose coverage

N/A, your employer automatically provides this benefit.

Supplemental Employee Life

Coverage amount

You may choose up to five times your annual pay in addition to your Basic Life coverage. Coverage is provided in increments of your annual pay.

Maximum benefit

This benefit is limited to $1,000,000.

Premium¹

Per $1000 of coverage (rounded)
Your Age	Rate
Under 25	$0.03
25-29	$0.03
30-34	$0.04
35-39	$0.05
40-44	$0.05
45-49	$0.08
50-54	$0.12
55-59	$0.22
60-64	$0.33
65-69	$0.64
70 and older	$1.03

Tax impact

Life insurance received by your beneficiaries in the event of your death is not taxable. The value of the coverage is not taxable either because it is paid for by the employee.

Do you need to get a physical before being covered or otherwise demonstrate evidence of insurability (EOI)?

If you enroll for this coverage within 31 days of hire, no EOI is required for coverage up to $500,000.

Reasons to choose coverage

You would choose supplemental insurance if you would like to provide more than the basic life insurance amount to your beneficiaries. This is particularly important if your family depends on your income to pay bills and if your beneficiaries will not be well situated to replace your income or otherwise take care of expenses in the event of your death.

Supplemental Employee AD&D

Coverage amount

You may choose an additional amount not to exceed five times your annual pay in addition to your Basic Employee AD&D coverage. Coverage is provided in increments of $10,000.

Maximum benefit

This benefit is limited to $500,000.

Premium¹

$0.011 per $1000 of coverage.

Tax impact

Life insurance or AD&D benefits received by you or your beneficiaries is not taxable. The value of the coverage is not taxable either because it is paid for by the employee.

Do you need to get a physical before being covered or otherwise demonstrate evidence of insurability (EOI)?

No EOI required.

Reasons to choose coverage

You would choose supplemental AD&D insurance if you would like to provide more than the basic life insurance and AD&D amounts to your beneficiaries in the event of your accidental death or if you are particularly concerned about the loss of functionality of part of your body as the result of an accident. In addition, AD&D insurance has lower premiums than life insurance (because it only pays out in the event of an accident) and may be a more affordable alternative for you.

Spouse Life

Eligibility

Full and part-time employees are eligible. If your spouse is employed by WellSpan, they are not eligible for this coverage as your dependent.

Do your dependents need to get a physical before being covered or otherwise demonstrate evidence of insurability?

If you enroll for this coverage within 31 days of hire, no EOI is required for coverage up to $30,000.

Coverage

You may choose an amount up to the lesser of:

1. $500,000 or
2. five times your annual pay

in increments of $10,000.

Premiums¹

Per $1,000 of coverage (rounded)
Spouse’s Age	Rate
Under 25	$0.03
25-29	$0.04
30-34	$0.05
35-39	$0.05
40-44	$0.06
45-49	$0.09
50-54	$0.13
55-59	$0.25
60-64	$0.38
65-69	$0.73
70 and older	$1.19

Reasons to choose coverage

You depend on your spouse’s income to pay bills and your spouse does not have insurance coverage or other savings that you will receive upon death.

Spouse Accidental Death and Dismemberment (AD&D)

Eligibility

Full and part-time employees are eligible. If your spouse is employed by WellSpan, they are not eligible for this coverage as your dependent.

Do your dependents need to get a physical before being covered or otherwise demonstrate evidence of insurability?

No EOI required.

Coverage

You may choose an amount up to the least of:

1. $500,000 or
2. five times your annual pay or
3. your own AD&D coverage

in increments of $10,000.

Premiums¹

$0.0125 per $1000 of coverage.

Reasons to choose coverage

You would choose Spouse AD&D insurance if you would like more than the basic life insurance amount for you and your family in the event of your spouse’s accidental death or if you are particularly concerned about the loss of functionality of part of your spouse’s body as the result of an accident. In addition, AD&D insurance has lower premiums than life insurance (because it only pays out in the event of an accident) and may be a more affordable alternative for you.

Child Life

Eligibility

Full and part-time employees are eligible. For unmarried children from the age of 14 days to 26 years. The coverage is for each of your children, regardless of how many you have. If your child is employed by WellSpan, they are not eligible for this coverage as your dependent.

Do your dependents need to get a physical before being covered or otherwise demonstrate evidence of insurability?

No EOI required.

Coverage

You may choose from coverage equal to $2,500, $5,000 or $10,000.

Premiums¹

Coverage	Rate
$2,500	$0.20
$5,000	$0.40
$10,000	$0.80

Reasons to choose coverage

You probably don’t need life insurance for your children unless your circumstances are unusual.

Child Accidental Death and Dismemberment (AD&D)

Eligibility

Full and part-time employees are eligible. For unmarried children from the age of 14 days to 26 years. The coverage is for each of your children, regardless of how many you have. If your child is employed by WellSpan, they are not eligible for this coverage as your dependent.

Do your dependents need to get a physical before being covered or otherwise demonstrate evidence of insurability?

No EOI required.

Coverage

You may choose from coverage equal to $2,000, $4,000, $6,000, $8,000, or $10,000.

Premiums¹

$0.0125 per $1,000 of coverage.

Reasons to choose coverage

You probably don’t need AD&D insurance for your children unless your circumstances are unusual.

Health Care Flexible Spending Account (FSA)

Eligibility to participate

You must not be enrolled in a health savings account. You must work full, part-time 1 or Weekend Option.

Eligible expenses

Medical, prescription, dental, orthodontia, vision expenses and more incurred during the plan year for you or your dependents. Expenses do not need to be associated with a WellSpan-sponsored plan.

Timeframe for reimbursement

Must be submitted by March 31 of the following calendar year.

Other rules for reimbursement

You may use the debit card which is provided. Remember to keep receipts as transactions may be subject to review.

Annual contribution limits

Minimum: $120
Maximum: $2850

Rollover of funds from year to year

You can carry over up to $570 of unused funds into the following plan year.

Portability from one employer to the next

None

Limited Purpose Flexible Spending Account (FSA)

Eligibility to participate

You must be enrolled in a health savings account to participate. You must work full, part-time 1 or Weekend Option.

Eligible expenses

Eligible dental, orthodontia and vision expenses incurred during the plan year.

Timeframe for reimbursement

Must be submitted by March 31 of the following calendar year.

Other rules for reimbursement

You may use the debit card which is provided. Remember to keep receipts as transactions may be subject to review.

Annual contribution limits

Minimum: $120
Maximum: $2850

Rollover of funds from year to year

You can carry over up to $570 of unused funds into the following plan year.

Portability from one employer to the next

None

Dependent Day Care Flexible Spending Account (FSA)

Eligibility to participate

You must work full, part-time 1 or Weekend Option and your spouse must either work full or part-time 1 or attend school full-time.

Eligible expenses

Child care for children under age 13 or day care for a dependent or disabled parent incurred during the plan year.

Timeframe for reimbursement

Must be submitted by March 31 of the following calendar year.

Other rules for reimbursement

You must submit a claim form and evidence of payment either online or through the mobile app. Remember to keep receipts as transactions may be subject to review.

Annual contribution limits

Minimum: $120
Maximum: $5000 combined for both you and your spouse.

Rollover of funds from year to year

None

Portability from one employer to the next

None

Health Savings Account (HSA)

Eligibility to participate

You must be enrolled in a high deductible health plan to participate. If you enroll in Medicare or are automatically enrolled in Medicare Part A, you cannot make contributions; however, you may continue to use any remaining funds in your HSA. You must work full, part-time 1 or Weekend Option.

Eligible expenses

Deductibles, copays and coinsurance; eligible prescriptions; vision care, including LASIK; dental care, including orthodontia.

Timeframe for reimbursement

Because the funds are not tied to a specific plan year, you can use them any time.

Other rules for reimbursement

If you use the PayFlex Card or pay your provider using the online feature, you’ll pay for the expense automatically from your account so no need to be reimbursed. If you pay using cash, check or credit card, you’ll withdraw funds from your HSA to pay yourself back.

Annual contribution limits

WellSpan contributes $600 for employees who elect employee only coverage and $1200 for other coverage prorated by hire date.

Annual contribution limits for the employer contribution and employee contribution combined:
Employee only coverage: $3650
Any other coverage: $7,300

55 and older: $1000 catch-up

Rollover of funds from year to year

Unused funds roll over from year to year.

Portability from one employer to the next

Your HSA is yours to keep even if you leave or retire. You may roll over an account you started with a previous employer.

Short Term Disability (STD)

Eligibility

Full-time employees are eligible after 90 days of employment.

When the benefit begins

The plan will begin paying you after one week of disability.

Premiums

N/A, this benefit is provided by your employer.

Coverage

You will receive 60% of your salary for 90 calendar days after the one-week elimination period.

Reasons to use this plan

This benefit means that you will continue to receive income while you are not working. You can access this benefit instead of using up all of your PTO or going unpaid.

Ways to supplement the plan payments

If you have PTO available, it will be used to supplement your income. In addition, WellSpan offers a supplemental short-term disability plan that will increase the benefits you will receive in the event you are disabled. You have to choose this benefit and pay the premiums before you are disabled.

Long Term Disability (LTD)

Eligibility

Full-time employees are eligible the first of the month after hire date.*

When the benefit begins

The plan will begin paying you after three months of disability.

Premiums

N/A, this benefit is provided by your employer.

Coverage

You will receive 50% of your salary to a maximum of $13,000 per month.

Reasons to use this plan

This benefit means that you will continue to receive income while you are not working.

Ways to supplement the plan payments

There is a buy up benefit available to employees for coverage equal to an additional 10% of your pay.

LTD Buy-Up Option

Eligibility

If you are a full-time employee eligible for Basic LTD at 50% of pay, you may purchase additional coverage by electing the LTD Buy-Up option.

When the benefit begins

The plan will begin paying you after three months of disability.

Premiums

$0.065 per $100 of monthly covered income.

Coverage

You will receive an additional 10% of pay – for a total LTD benefit equal to 60% of pay. The maximum benefit for Basic LTD and the Buy-Up option combined is $13,000 per month.

Reasons to use this plan

You would like to have more than the Basic LTD coverage of 50%.

Short Term Disability (STD)

Eligibility

Part-time employees are eligible after 90 days of employment.

When the benefit begins

The plan will begin paying you after one week of disability.

Premiums

N/A, this benefit is provided by your employer.

Coverage

You will receive 60% of your salary for 90 calendar days after the one-week elimination period.

Reasons to use this plan

This benefit means that you will continue to receive income while you are not working. You can access this benefit instead of using up all of your PTO or going unpaid.

Ways to supplement the plan payments

If you have PTO available, it will be used to supplement your income. In addition, WellSpan offers a supplemental short-term disability plan that will increase the benefits you will receive in the event you are disabled. You have to choose this benefit and pay the premiums before you are disabled.

Long Term Disability (LTD)

Eligibility

Part-time employees are not eligible for this benefit.*

LTD Buy-Up Option

Eligibility

Part-time employees are not eligible for this benefit.