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Table of Contents
Dental Plans
Life Insurance
10
Other Benefits
11
Note: Some of the detailed information in this document does not pertain to unions as stated: The retirement savings plans (including 403(b)/401(k)
and pension) do not apply to Albert Lea SEIU (general and maintenance), Austin USW-Service, Franklin Heating Station, Mankato MNA, Red
Wing SEIU. The Mayo Pension Plan and employer match in the Mayo 403(b) Plan do not apply to the Rochester SEIU unions. The Paid Time Off
benefits do not apply to Albert Lea SEIU (general and maintenance), Mankato MNA, Red Wing SEIU, Red Wing MNA, Gold Cross Mankato, Gold
Cross Duluth. The Short-Term Disability benefits do not apply to Albert Lea SEIU (general and maintenance), Mankato MNA, Red Wing SEIU, and
Red Wing MNA. The Long-Term Disability benefits do not apply to Mankato MNA. The Identity Management Services, Professional Development
Assistance Plan, and Mayo Clinic Dependent Scholarship do not apply to Albert Lea SEIU (general and maintenance), Albert Lea MNA, Mankato
MNA, Red Wing MNA, Red Wing SEIU.
Medical Plans
At Mayo Clinic, the needs of the patient come first and that includes you and your family. Thats why all
Mayo Medical Plan options cover the same services. No need to compare your medical plan options based on
services. Instead, look at the cost-sharing amounts the premiums, deductibles, copayments, and out-of-pocket
maximums to determine what meets your preferences or needs.
Mayo Premier
Mayo Select
Mayo Basic
Cost-sharing
Amounts
Tier 1
In-Network
Tier 2
Expanded
In-Network
Tier 3
Out-ofNetwork
Tier 1
In-Network
Tier 2
Expanded
In-Network
Tier 3
Out-ofNetwork
Tier 1
In-Network
Tier 2
Expanded
In-Network
Tier 3
Out-of-Network
Annual
Deductible
$300
per
person;
$450
per
person;
$900
per
person;
$800
per
person;
$1,200
per
person;
$1,600
per
person;
$600
per
family
$900
per
family
$1,800
per
family
$1,600
per
family
$2,400
per
family
$3,200
per
family
Employee:
$1,700
E+Child(ren):
$3,400
E+Spouse:
$3,400
Family: $3,400
Employee:
$1,900
E+Child(ren):
$3,800
E+Spouse:
$3,800
Family: $3,800
Employee:
$2,100
E+Child(ren):
$4,200
E+Spouse:
$4,200
Family: $4,200
$2,000
per
person;
$3,000
per
person;
$4,000
per
person;
$3,500
per
person;
$4,500
per
person;
$5,500
per
person;
$4,000
per
family
$5,000
per
family
$6,000
per
family
$7,000
per
family
$8,000
per
family
$9,000
per
family
$5,000
per
person;
$10,000
per
family
$6,000
per
person;
$11,000
per
family
$7,000
per
person;
$12,000
per
family
Annual Outof-Pocket
Maximum
Mayo Premier
Tier 1
In-Network
Tier 2
Expanded
In-Network
a. $0
a. $0
b. Specialty care
b. 20%
Mayo Select
Tier 3
Out-ofNetwork
Tier 1
In-Network
Tier 2
Expanded
In-Network
a. 40%
a. $0
a. $0
b. 20%
b. 40%
b. 20%
$0
$0
NC
20%
20%
a. $0
b. D
elivery, inpatient services
b. 20%
a. Emergency transportation
to nearest qualified facility
(includes air ambulance when
authorized)
Mayo Basic
Tier 3
Out-ofNetwork
Tier 1
In-Network
Tier 2
Expanded
In-Network
Tier 3
Out-ofNetwork
a. 40%
a. 20%
a. 20%
a. 40%
b. 20%
b. 40%
b. 20%
b. 20%
b. 40%
$0
$0
NC
$0
$0
NC
40%
20%
20%
40%
20%
20%
40%
a. $0
a. 40%
a. $0
a. $0
a. 40%
a. 20%
a. 20%
a. 40%
b. 20%
b. 40%
b. 20%
b. 20%
b. 40%
b. 20%
b. 20%
b. 40%
a. $0
a. $0
a. $0
a. $0
a. $0
a. $0
a. $0
a. $0
a. $0
b. E
mergency room facility
copayment
b. $75
b. $75
b. $75
b. $75
b. $75
b. $75
b. 20%
b. 20%
b. 20%
c. P
rofessional services,
diagnostic tests, and labs
c. 20%
c. 20%
c. 40%
c. 20%
c. 20%
c. 40%
c. 20%
c. 20%
c. 20%
Physician Visits
Emergency Services
NC = Not covered
2016 Benefit Highlights - Mayo Clinic - Allied Health | 2
Mayo Premier
Mayo Select
Tier 1
In-Network
Tier 2
Expanded
In-Network
20%
20%
20%
a. P
hysical therapy (PT),
Occupational therapy,
Speech therapy
a. 20%
b. C
hiropractic care
b. 20%
b. 20%
b. 40%
b. 20%
b. 20%
b. 40%
b. 20%
b. 20%
b. 40%
c. 20%
c. NC
c. NC
c. 20%
c. NC
c. NC
c. 20%
c. NC
c. NC
a. 20%
a. 20%
a. 40%
a. 20%
a. 20%
a. 40%
a. 20%
a. 20%
a. 40%
b. 20%
b. 20%
b. 40%
b. 20%
b. 20%
b. 40%
b. 20%
b. 20%
b. 40%
c. Hospice care
c. 20%
c. 20%
c. 40%
c. 20%
c. 20%
c. 40%
c. 20%
c. 20%
c. 40%
d. S
killed nursing care facility
d. 20%
d. 20%
d. 40%
d. 20%
d. 20%
d. 40%
d. 20%
d. 20%
d. 40%
50% for
eligible
services
50% for
eligible
services
NC
50% for
eligible
services
50% for
eligible
services
NC
50% for
eligible
services
50% for
eligible
services
NC
a. $0
a. $0
a. 40%
a. $0
a. $0
a. 40%
a. 20%
a. 20%
a. 40%
b. Inpatient/outpatient
b. 20%
b. 20%
b. 40%
b. 20%
b. 20%
b. 40%
b. 20%
b. 20%
b. 40%
c. Non-Residential Structured
Treatment Program
c. 20%
c. 20%
c. 40%
c. 20%
c. 20%
c. 40%
c. 20%
c. 20%
c. 40%
d. R
esidential Structured
Treatment Program
d. 20%
d. 20%
d. 40%
d. 20%
d. 20%
d. 40%
d. 20%
d. 20%
d. 40%
a. Chemotherapy/radiation
therapy
a. 20%
a. 20%
a. 40%
a. 20%
a. 20%
a. 40%
a. 20%
a. 20%
a. 40%
b. Disposable supplies
b. 20%
b. 20%
b. 40%
b. 20%
b. 20%
b. 40%
b. 20%
b. 20%
b. 40%
c. D
urable, non-durable medical
equipment
c. 20%
c. 20%
c. 40%
c. 20%
c. 20%
c. 40%
c. 20%
c. 20%
c. 40%
d. O
rthotics and prosthetics
d. 20%
d. 20%
d. 40%
d. 20%
d. 20%
d. 40%
d. 20%
d. 20%
d. 40%
e. Tobacco cessation
e. $0
e. $0
e. NC
e. $0
e. $0
e. NC
e. $0
e. $0
e. NC
f. $0
f. $0
f. NC
f. $0
f. $0
f. NC
f. $0
f. $0
f. NC
Tier 3
Out-ofNetwork
Tier 1
In-Network
Tier 2
Expanded
In-Network
40%
20%
20%
20%
40%
20%
a. 20%
a. 40%;
a. 20%
Mayo Basic
Tier 3
Out-ofNetwork
Tier 1
In-Network
Tier 2
Expanded
In-Network
Tier 3
Out-ofNetwork
40%
20%
20%
40%
20%
40%
20%
20%
40%
a. 20%
a. 40%;
a. 20%
a. 20%
a. 40%;
c. Acupuncture
Limit of 20 visits per year
20-visit limit
for PT
20-visit limit
for PT
20-visit limit
for PT
Continued Care
Note: Custodial care not covered.
Infertility Services
Office visits and outpatient or
hospital procedures
Up to $15,000 lifetime maximum
Special Services
NC = Not covered
2016 Benefit Highlights - Mayo Clinic - Allied Health | 3
Mayo Premier
Monthly
Mayo Select
Mayo Basic
Monthly
Monthly
Employee
$86
$43
$48
$24
$12
$6
Employee + Child(ren)
$171
$85.50
$95
$47.50
$23
$11.50
Employee + Spouse
$154
$77
$86
$43
$21
$10.50
Family
$257
$128.50
$143
$71.50
$35
$17.50
Employee
$129
$64.50
$72
$36
$18
$9
Employee + Child(ren)
$257
$128.50
$143
$71.50
$35
$17.50
Employee + Spouse
$231
$115.50
$129
$64.50
$32
$16
Family
$386
$193
$215
$107.50
$53
$26.50
Spousal Surcharge: A $50 pre-tax monthly surcharge will be added to the medical plan for employees covering a spouse who is offered medical
coverage through his/her employer, does not elect that coverage, and is instead covered under the Mayo Medical Plan.
Note: The premium is taken out of the first two pay periods per month, so the amount shown per pay period is taken out of your paycheck
24 times per year.
Mayo Mail
Service
(up to 100-day
supply)
Mayo
Outpatient
Pharmacy
(up to 100-day
supply except
where indicated)
$10
maximum
OptumRx
Pharmacy
Mayo Mail
Service
(up to 34-day
supply)
(up to 100-day
supply)
$10
maximum
5%
10%
25%
25%
30%
40%
40%
40%
50%
50%
50%
60%
$10
maximum
Formulary Brand or
injectable drug (Tier II)
25%
30%
40%
($10 minimum)
($10 minimum)
($15 minimum)
Formulary non-preferred
drug (Tier III)
40%
40%
50%
($10 minimum)
($10 minimum)
($15 minimum)
Non-formulary drug
(Tier IV)**
50%
50%
60%
($10 minimum)
($10 minimum)
($15 minimum)
Deductible
Annual out-of-pocket
maximum
up to 34-day supply
None
Mayo Basic*
Mayo
Outpatient
Pharmacy
(up to 100-day
supply)
OptumRx
Pharmacy
(up to 34-day
supply)
* Specialty prescriptions are covered under the Mayo Medical Plan when purchased at the Mayo Specialty Pharmacy as well as any participating
Mayo Clinic or Mayo Clinic Health System outpatient pharmacy.
** Non-formulary (Tier IV) prescriptions do not apply to the Mayo Premier or Mayo Select plans out-of-pocket maximums.
Dental Plans
Healthy teeth are a part of wellness. Mayo Clinic provides two dental options for all benefits-eligible employees to choose from.
Delta Dental
Delta Dental
Deductible
Mayo Reimbursement
Account*
N/A
$0
$0**
Basic Services
20%
$0**
50%
$0**
N/A
$0**
Month of
Enrollment
MRA Proration
Amount
Month of
Enrollment
MRA Proration
Amount
Month of
Enrollment
MRA Proration
Amount
January
$1,150
May
$766.66
September
$383.33
February
$1,054.17
June
$670.83
October
$287.50
March
$958.33
July
$574.99
November
$191.67
April
$862.50
August
$479.16
December
$95.83
Delta Dental
Monthly
Monthly
$9.10
$4.55
$4
$2
Employee + Child(ren)
$18.20
$9.10
$4
$2
Employee + Spouse
$31.50
$15.75
$4
$2
$36
$18
$4
$2
Employee
Family
Employee
$9.10
$4.55
$4
$2
Employee + Child(ren)
$27.30
$13.65
$4
$2
Employee + Spouse
$41.20
$20.60
$4
$2
Family
$49.50
$24.75
$4
$2
Note: The premium is taken out of the first two pay periods per month, so the amount shown per pay period is taken out of your
paycheck 24 times per year.
Pension Plan
Mayo Clinic is one of the few U.S. companies who continue to provide a pension benefit at no cost to their staff. The Mayo Clinic
Pension is a defined benefit plan where contributions are made by your employer. Your final benefit payout can be predicted
because it is determined by a formula rather than by investment results.
Length of pension
benefit service
0-19
20-29
30
Financial Engines
As an added benefit, asset management services are available through Financial Engines, LLC. The first $5,000 is managed at
no charge; otherwise a fee of $3.00 per $1,000 invested is charged up to $100,000. You may opt out of this service at any time.
Exempt (salary)
Years of Service
PTO Days
(Annual)
PTO Hours
(Per Pay Period)
Years of Service
PTO Days
(Annual)
PTO Hours
(Per Pay Period)
Years of Service
PTO Days
(Annual)
PTO Hours
(Per Pay Period)
23
7.08
28
8.62
23
7.08
28
8.62
33
10.15
28
8.62
10
33
10.15
10
35
10.77
33
10.15
15
35
10.77
15
38
11.69
15
35
10.77
20+
38
11.69
20+
38
11.69
Benefit Amount
Nonexempt
0-5
Nonexempt
5+
Exempt
0+
0+
*All non-supervisory RN staff (excluding Arizona, Florida and Waycross) with positions that require all of the following: RN education, active RN license,
and competency to provide direct patient care that impacts patient clinical outcomes. This excludes Directors, Supervisors, Managers, Advanced
Practice RNs, Staff Educators, and those who do not have direct patient care.
Life Insurance
Mayo Clinic offers both employer paid and voluntary life insurance to care for yourself and loved ones and provide
financial security should the unexpected occur.
Employee Cost
Description of Benefit
Voluntary
Universal Life
Insurance
Family Life
Insurance
Varies according to
spouses age
When you elect Voluntary Universal Life Insurance, you also may participate in
Family Term Life Insurance. You can elect a benefit of one or two times your annual
salary. You cannot elect a benefit on your spouse that is larger than your benefit.
You can elect a benefit of $10,000 per child. If you have elected spousal coverage,
you will not pay an additional premium for child coverage. If you are married but
have not elected spousal coverage, you will pay a small premium.
Voluntary
Accidental Death
& Dismemberment
(AD&D) Insurance
You can purchase additional Voluntary AD&D coverage, in addition to the employer
paid AD&D plan, at a rate of $0.15 per $10,000 of coverage. Coverage is available
in $10,000 or $25,000 increments, up to a maximum of $225,000.
Other Benefits
Wellness
Mayo Clinic offers a variety of programs to help employees improve and maintain their health including
an online portal and telephonic coaching. To be eligible for these programs, you must be enrolled in
the Mayo Medical Plan.
IDT911
IDT911 provides fraud specialists 24 hours a day to help with fraud resolution. Additionally, a copy of
your credit report and single bureau credit monitoring is available at no cost and three bureau credit
monitoring is available for $5.25 per month.
Adoption Assistance
The Mayo Clinic Adoption Assistance Plan will reimburse eligible adoption-related expenses up to
$10,000 per adoption. For adoption of a step-child, the maximum benefit is limited to $500.
Notes
This is a high-level summary of certain Mayo Clinic benefits. The summary may or may not be applicable to union
employees. It is intended for general information purposes only and should not be considered legal, investment
or other benefits advice. This guide is not a legal Summary Plan Description or plan document. If there is a
conflict with this information and an official plan document, the official plan document is controlling. Mayo Clinic
reserves the right to terminate or amend the Plans at any time, in whole or in part, for any reason. Any such
amendment or termination may apply to current and future participants, current and future retirees, covered
spouses, beneficiaries and dependents. Please refer to the Summary Plan Description for eligibility requirements
for each plan as certain employment categories may or may not be included in coverage.
MC1090-107rev1215