HAP Insurance Booklet 2018

MY CHOICE REWARDS 2018
MY CHOICE REWARDS
Enrollment Workbook
Inside this Workbook
Important Contact Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Introduction/How My Choice Rewards Works. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Dependent Eligibility/Documentation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
New for 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
2018 Medical Plan Changes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Employee contributions for other benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Health Engagement is being replaced by Reward Your Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
New Voluntary Benefit Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Integrative medicine program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Health Care Coverage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Consumer Driven Health Plans. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Health Savings Accounts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Health Engagement/Reward Your Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Medical/Vision Comparison Charts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Special Medical Credit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Sponsored Dependents/Spouse Surcharge. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Dental Plans/Dental Plan Comparison Chart. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Flexible Spending Accounts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Income Replacement and Survivor Benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Employee Term Life/Dependent Term Life (after tax). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Accidental Death and Dismemberment (AD&D). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Long-Term Disability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Web Enrollment Instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Additional Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Choose Henry Ford. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Employee Wellness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Important Federal Notices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Events Permitting Mid-Year Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Important Terms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Every effort has been made to ensure the accuracy and completeness of the benefit descriptions
contained within this workbook. However, in the event of any interpretation, discrepancy, application and/
or decision in specific circumstances, the official text or terms of the plan document will govern. This
workbook is not intended to create or to be construed as a contract between Henry Ford Health System
(HFHS) and its employees for any matter, including for the provision of benefits described.
1 2018 MY CHOICE REWARDS

Important Contact Information
Employee Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 855-874-7100
1 Ford Place - 4E, Detroit, MI 48202 employeeservices@hfhs.org
Health Alliance Plan / Alliance Health and Life. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 866-766-4709

(Medical/Vision) hap.org
2850 W. Grand Blvd., Detroit, MI 48202
Blue Cross/Blue Shield of Michigan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 877-790-2583

(Medical/Vision) bcbsm.com
600 E. Lafayette, Detroit, MI 48226
Delta Dental Plan of Michigan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-524-0149

(Point-of-Service Dental) deltadentalmi.com
27500 Stansbury St., Farmington Hills, MI 48334-3811
Manulife. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-268-3763
(Medical/Vision) coverme.com
557 Southdale Road East, Suite 205, London, Ontario, Canada N6E 1A2
(Canadian residents only)
CIGNA Group Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-238-2125

(Life Insurance) cigna.com
1600 W. Carson St., Suite 300, Pittsburgh, PA 15219
CIGNA Disability Management Solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-362-4462

(Long-Term Disability Insurance) cigna.com
P.O. Box 22325, Pittsburgh, PA 15222-0325
CIGNA Group Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-238-2125

(AD&D Insurance) cigna.com
P.O. Box 22328, Pittsburgh, PA 15222-0328
Health Equity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 866-346-5800

(Flexible Spending Accounts/Health Savings Accounts) healthequity.com
10 W. Scenic Pointe DR., Suite 100, Draper, UT 84020
If you have questions about your enrollment, contact Employee Services or your local Human
Resources department.
2018 MY CHOICE REWARDS 2

Introduction The benefits offered under My Choice Rewards are
_______________________________________________________________________________ designed to conform to Section 125 of the Internal
Revenue Code, and as such may provide significant
My Choice Rewards continues to give you more choices. tax advantages to you as well as Henry Ford Health
Whether it’s enhancing new medical options, helping System. To maintain its tax-qualified status, the My
you make healthier lifestyle choices or making the Choice Rewards plan must adhere to the regulations
employee enrollment selection experience easier, it’s established by the IRS. These requirements will
all about choice. Open enrollment for 2018 My Choice be summarized in the appropriate sections of this
Rewards will take place Monday, Nov. 6 – Monday, Nov. workbook. This workbook is intended to summarize the
20, 2017. Benefit selections will be effective Jan. 1, 2018. key features of each benefit offered under My Choice
Annually, you have the opportunity to re-examine your Rewards. You are encouraged to consult with your
benefit needs and make any changes you choose. Once financial planner or tax advisor before making your
open enrollment begins, click here. benefit selections. HFHS reserves the right to modify or
discontinue any of its benefits at any time.
Employees who are new hires or rehires during 2018 will
receive an email notification to enroll in their benefits
YOUR MY CHOICE REWARDS SELECTIONS
and will have 10 days from receipt of that email to make Eligible employees may purchase benefits from the
their benefit elections. Employees who experience a following categories:
qualified life event (see chart on pages 38-40) have 30 • Medical/vision
days from the date of the life event to make benefit • Dental
changes. Internal Revenue Service (IRS) regulations • Standalone vision
allow changes to benefits during an annual open • Employee term life insurance
enrollment or if an employee experiences a qualified • Dependent term life insurance
life event. • Accidental death and dismemberment (AD&D)
• Long-term disability
• Health savings account (HSA)
How My Choice Rewards Works • Health care flexible spending account (FSA)
_______________________________________________________________________________ • Dependent care flexible spending account (FSA)
• Critical illness insurance
My Choice Rewards offers a variety of options under • Accident insurance
each benefit category. Each option has a different cost, • Group legal insurance
corresponding to the degree of coverage provided. You • Identity theft insurance
can select a particular benefit category, depending on
your changing needs. My Choice Rewards provides all TAX IMPLICATIONS
full-time employees with credits to assist in purchasing The Social Security benefit you will be eligible to
their benefit selections. Part time employees do not receive is based in part on the amount of income you
receive credits. Once you’ve made all of your selections, have that is subject to Social Security tax. By enrolling
simply add up the costs of each option and subtract in My Choice Rewards, you will have less income subject
them from your total credits. If you’ve chosen to to Social Security taxes. Consequently, the benefits you
purchase more benefits than you have credits for, the or your family may receive from Social Security may
difference will be subtracted from your pay in equal be reduced based on the amount of the reduction in
amounts per pay period. Most benefits can be purchased your pay as a result of your pretax contributions for My
on a pre-tax basis, with the exception of dependent life Choice Rewards.
insurance and voluntary benefits.

• You may also cover certain sponsored dependents.
ALL BENEFITS-ELIGIBLE EMPLOYEES, INCLUDING Sponsored dependents are age 20 or older, related to
THOSE WHO HAVE NO CHANGES TO THEIR BENEFITS, you by blood or marriage and residing in your
household, and claimed as dependents on your most
ARE ENCOURAGED TO REVIEW THEIR BENEFITS
recent tax return.
ONLINE.
Ineligible dependents:
You must go online and enroll: • Your spouse becomes ineligible when he or she is no
 If you want to choose a different plan or option. longer legally married to you.
 If you want to update your dependents.
 If you participate in a flexible spending account, • Your child becomes ineligible at the end of the month
he or she reaches age 26.
you must re-enroll in that account.

 If you participate in a health savings account, • Your sponsored dependent when he or she no longer
you must re-enroll in that account. resides with you or is no longer claimed on your
 If you cover your spouse on a Henry Ford medical income tax return.
plan. You must complete an online Spouse
Verification Form every year or you will be Acceptable forms of documentation are:
assessed a surcharge. Spouse
• Proof of spousal relationship from any one of the
following documents:
Dependent Eligibility/ - Copy of marriage license that includes date of
marriage.
Documentation
__________________________________________________________________________ - Copy of legal, presently valid marriage certificate.
- Copy of the first page of the most recently filed
federal income tax return that indicates
Documentation for newly-added dependents is required.
“married filing jointly.” Financial amounts may be
It is your responsibility to ensure that only people who
blocked out.
are eligible for dependent coverage are covered by
your HFHS benefits. This helps keep benefits costs at
federal income tax return that indicates
reasonable levels for everyone.
“married filing separately.” Your spouse’s name
must appear on the tax form on the line provided
Use the following guidelines to determine if your
after the “married filing separately” status.
enrolled dependents meet eligibility requirements:
Financial amounts may be blocked out.
- Canadian employees who do not claim dependents
Eligible dependents:
on their U.S. federal income tax must submit their
• Your spouse.
Canadian income tax form listing eligible
• Young adult children may remain on your benefits dependents. If an identification number is used in
plan through the end of the month they turn 26. place of a dependent name, documentation such
They do not have to be your IRS dependent, full-time as the social insurance number card must be
student, or live with you. They can also be married. submitted that links the dependent’s name to the
identification number.
• Any unmarried disabled child regardless of age who
depends primarily on you for support, provided the Unmarried, natural and legally adopted children, and
physical or mental disability occurred before age 19. step-children (until the end of the month they reach
age 26)
• “Child” is defined as natural children, legally adopted • Proof of parent/child relationship from any one of the
children (including children placed for adoption for following documents:
whom legal adoption proceedings have started), - Copy of legal birth certificate (employee must be
step-children, and alternate recipients under qualified
listed as a parent), Canadian employees must
medical child support orders (QMCSO), and any other
provide the long form birth certificate.
child for whom you have obtained legal guardianship
and who is in a regular parent-child relationship. - Copy of hospital certificate (employee must
be listed as parent and must include date of birth).

- Affidavit of Parentage that is certified and filed
with the state. HEALTH PLANS FOR THOSE TURNING 26
federal income tax return showing the child HAP Personal Alliance provides coverage for
listed as a dependent and indicating that child
individuals turning 26 and aging off their
lived with you. Financial amounts may be blocked
parents’ health plan. This is a life event that
out).
qualifies the individual to sign up by the end of the
- Canadian employees who do not claim dependents
on their U.S. federal income tax must submit their month the individual turns 26. During the special
Canadian income tax form listing eligible enrollment period, you or your dependent can obtain
dependents. If an Identification Number is used in coverage under a separate contract/policy. Visit
place of a dependent name, documentation such hap.org for more information on the policies designed
as the social insurance Number card must be for young adults.
submitted that links the dependent’s name to the
identification number.
- Copy of qualified medical child support order
(QMCSO).
• Documentation from Social Security or physician
certification of total and permanent disability incurred
before age 19.
Sponsored dependent:
• Copy of the first page of the most recently filed
federal income tax return showing the individual
listed as a dependent and indication that they lived
with you. Financial amounts may be blocked out.
• If your sponsored dependent is Medicare eligible,

provide a copy of their Medicare card parts A and B
AND a copy of the first page of the most recently filed
federal income tax return as noted above.
MIDYEAR LIFE EVENTS

Employees have 30 days to make changes to
certain benefits when they experience a qualified
midyear life event. For a list of life events and
eligible changes see the midyear life event chart on
pages 38-40.

NEW FOR 2018: The former HFHS Preferred Network
and the Full HAP Network HMO are combined into a single plan
____________________________________________________________________________________________________________________________________
Medical plan designs for 2018 are intended to encourage Tier 2 has a broader network of HAP providers and
employees and their families to receive their care from facilities but also comes with significantly higher
Henry Ford providers using HAP insurance products. The deductibles and co-pays.
benefit to employees is lower out-of-pocket costs and high
quality, coordinated care through Henry Ford providers. This new plan encourages employees to use
Henry Ford providers and facilities but does provide
The HFHS Preferred Network and the Full HAP Network HMO flexibility for those who may want or need to go
options have been combined into one new medical option outside Henry Ford for care without changing plans.
called the HFHS Advantage Tiered Access plan. The plan has Instead of choosing one plan over another at open
two “in-network” tiers. enrollment, the two-tier system allows employees
to determine the network they want to use at the
Tier 1 has a network of HFHS and other providers and offers time service is required. For example, if your PCP
lower deductibles and co-pays. Employees may choose is in Tier 1 but you want to see a specialist in Tier
physicians from the Henry Ford Physician Network (HFPN), 2, you can do that within this new, single-plan
the Jackson Health Network and the Genesys Network. option. However, employees who use both tiers are
As a reminder, the HFPN includes the Henry Ford Medical required to meet the deductible maximums of both.
Group, hospital-employed physicians and some private
practice physicians on staff at Henry Ford facilities. Tier 1
also includes all Henry Ford facilities, as well as Genesys
Regional Medical Center.
2018 MEDICAL PLAN CHANGES
FORMER HFHS FORMER FULL

PREFERRED NETWORK HAP OPTION
THE TWO PLANS ARE NOW ONE PLAN...
NEW HFHS
ADVANTAGE PLAN
...WITH TWO TIERS.
TIER 1 TIER 2
$$ $$$$
Henry Ford Non Henry Ford
Providers/Facilities Providers/Facilities
Lower Deductibles & Co-pays Higher Deductibles & Co-pays

Other important points to consider: credit of $2.31 have already been reduced from the
• Employees who choose this option – whether they employee contributions and will no longer appear in
were in the HFHS Preferred or Full HAP option the online enrollment process or on the paycheck.
previously – will have the same per-pay contribution • For employee medical contributions see pages 12
because it is now a single plan. and 21.
• Employees previously enrolled in the HFHS Preferred • For employee vision and dental contributions see
Network (HMO) option who choose the new option pages 23 and 26.
will see their per pay contribution increase by $3.57 • The deductibles for the CDHP Comprehensive HFHS
for employee only coverage and $21.52 for family Preferred and CDHP Comprehensive Full HAP options
coverage. are increasing slightly. For employee only, the
• Employees in the current Full HAP option will deductible is $1,350 and for family coverage (two or
see a per-pay decrease ranging from $39.67 for more individuals) it is $2,700.
employee only coverage to $90.56 less for family • The maximum limit employees may contribute to
coverage. Although this is a significant reduction their HSA (including employer contributions) are
for employees currently enrolled in the Full HAP increasing to $3,450 for an individual and $6,900 for
option, it is important to think about the higher out family (two or more).
of pocket costs associated with providers/services • The maximum limit for the health care flexible
in Tier 2. Do not just focus on the reduced medical spending account is increasing to $2,650.
deduction taken from each pay.
• Due to increased deductibles, co-pays and co- Health Engagement is being replaced by Reward
insurance in Tier 2, employees currently enrolled Your Health
in the Full HAP Network option should review all • The Health Engagement program has been
medical plans - including the Consumer Driven redesigned and is taking wellness to a new level.
Health Plans (CDHP) – and select the one that best Reward Your Health is the new wellness program for
meets their needs. See page 8 for details. HFHS employees and their spouses enrolled in a HAP
plan.
Employee contributions for other benefits • Annual deductibles and co-pays will no longer be
Medical and dental premiums and contributions do affected. Instead, employees and covered spouses
change annually, however, this year an increase is who meet the requirements, will pay a lower
being passed on to employees in the majority of plans. employee contribution to their medical coverage
Effective Jan. 1: each pay and/or receive funding to a health savings
• Employees in the CDHP Basic Full HAP option will see account for those employees enrolled in one of the
a slight increase for employee only coverage at $2.19 three CDHP options.
per pay and $12.26 per pay for family coverage. • For 2018, all employees enrolled in a HAP plan will
• Employees in the CDHP Comprehensive HFHS receive the reduced employee contribution and/or
Preferred option will see a slight increase of $1.13 for funding to their HSA.
employee only coverage and $10.41 per pay for family • To keep receiving this reward in 2019, employees and
coverage. their covered spouse must meet the Reward Your
• Employees in the CDHP Comprehensive Full HAP Health wellness program requirements between Jan.
option will have an increase of $9.93 per pay for 1 and July 31, 2018. Rewards are adjusted annually
employee only coverage and $40.56 per pay for and communicated during open enrollment.
family coverage. • Reward Your Health has five requirements that
• Employees in the Community Blue (PPO) option must be completed by employees and their covered
will have a significant increase of $55.77 per pay spouse by July 31, 2018.
for employee only coverage and $134.71 per pay for 1. Know your numbers (BMI, blood pressure,
family coverage. cholesterol, fasting blood glucose)
• Employees enrolled in the Dental options, Long Term 2. Take your online health assessment
Disability and the Standalone Vision options will 3. Be tobacco free
have a slight decrease in their per pay contributions. 4. Complete a wellness activity
• To simplify employee contributions for 2018, the 5. Commit to complete all recommended preventive
medical credit of $25.38 per pay and the dental screenings. Health Fairs will be conducted in the
first quarter of 2018.
New Voluntary Benefit Options A $20 co-pay per visit will be applied to massage therapy
HFHS is offering accident insurance, critical illness and acupuncture benefits. There is no co-pay for yoga.
insurance and identity theft protection insurance. These For more information about the pilot program, contact
are new, voluntary benefits, which means there is a HAP.
cost associated with them.
• Accident insurance pays you benefits for specific
injuries and events resulting from a covered Employees and their family members who do not
accident that you or a family member may have meet the requirements to participate in the program
on or after your coverage effective date. Critical can still receive 20% off at the Henry Ford Center
illness insurance pays a lump-sum benefit if you are for Integrative Medicine in Novi, Grosse Pointe,
diagnosed with a covered illness or condition on or the QuickCare Clinic in Detroit and Vita in West
after your coverage effective date. Identity Theft Bloomfield. Wellspring in Macomb provides discounts
coverage provides identity, financial and privacy for certain services as well. To make an appointment,
protection. call the Center for Integrative Medicine at 248-380-
• As part of the online enrollment process, employees 6201 or Vita at 248-325-3870.
will now be able to enroll in any of the three new
voluntary benefits options, as well as group legal.
Employees no longer have to contact ARAG directly
to enroll in the group legal plan. Health Care Coverage
__________________________________________________________________________
• HFHS continues to offer auto/home insurance,
pet insurance and Purchasing Power, a premium
For most of us, health care coverage is the first thing that
purchasing program offering brand name products
comes to mind when we hear the word “benefits.”
through payroll deduction.
Satisfying our family’s health care needs is a significant
• To find out more go to HFHSVB.com or call concern for many of us. HFHS understands this and
313-879-0755. continues to offer medical/vision and dental options
to meet these needs. You can enhance your health
Integrative medicine program care coverage by carefully reviewing every option and
In 2017, Integrative medicine was launched as a pilot considering how each will work with the other plans in
program. It will continue to be offered in 2018. Research the My Choice Rewards program or other coverage you
shows that integrative medicine can help cancer may have. For example, if you choose a medical/vision
patients with potential treatment side-effects. It also plan option with co-pays, you may want to put pretax
can reduce fatigue and stress, while improving physical dollars in a Health Care FSA to cover the total co-pays you
function and sleep. With these quality of life outcomes expect to incur during the year.
in mind, massage therapy, acupuncture and yoga will
be covered benefits for employees and their family Consumer Driven Health Plans (CDHP)
members with a cancer diagnosis within the past three HFHS offers three CDHP Plans.
years. Eligibility for the program is limited and requires
employees and their family members be enrolled in the CDHP Basic Full HAP – This plan provides catastrophic care
CDHP Comprehensive HFHS Preferred or the new HFHS only. This plan protects you from worst-case scenarios
Advantage Tiered Access options (Tier 1 only). Services like serious accidents or illnesses. While the employee
can be received at the following locations: contribution is low, the deductible is $4,500 for an
• Center for Athletic Medicine – Detroit individual and $9,000 for family (two or more individuals).
• Henry Ford Medical Center – Cottage Employees must pay the full cost of their medical services,
• Henry Ford Medical Center – Novi including prescription drugs, until the deductible has
• Henry Ford West Bloomfield – Vita been reached. Preventive care is covered at 100% and the
• Henry Ford Macomb – Wellspring deductible does not apply. This option allows members to
• Quick Care Clinic – Detroit choose from a broader network of HAP affiliated providers.

CDHP Comprehensive Full HAP – Employees who IZI
NG YOUR BEN
choose this option will pay more than the CDHP Basic
IM
HEALTH SAVINGS ACCOUNT
EF
OPT
ITS
Full HAP option depending on their level of coverage
(single, two-person or family.) Employees choosing this If you plan to contribute to an
option may choose any provider within the broader HSA in 2018 and you currently are
HAP network. Employees must pay the full cost of their enrolled in the health care FSA for
medical services, including prescription drugs, until the 2017, be sure that the balance of your
deductible has been reached. The deductible is $1,350
health care FSA is $0.00 on Dec. 15, 2017 in order
for an individual and $2,700 for family (two or more
for you to contribute and receive the employer
individuals). Preventive care is covered at 100% and the
deductible does not apply. funding to your HSA on Jan. 3, 2018. If your
health care FSA balance is $0.00 on Dec. 31, you
CDHP Comprehensive HFHS Preferred Network – can expect to receive your contributions and
Employees choosing this option are required to use the employer funding on Jan. 12. If your health
CDHP HFHS Preferred Network providers. Employees care FSA balance is not $0.00 on Dec. 31, your
must pay the full cost of their medical services, including
contributions and the employer funded portion
prescription drugs, until the deductible has been
will be deposited on payday Friday, April 6, 2018.
reached. The deductible is $1,350 for an individual and
$2,700 for family (two or more individuals). Preventive Claims must be paid and reimbursed by Dec. 31
care is covered at 100% and the deductible does not not incurred or in a review status.
apply.
By selecting the CDHP Comprehensive HFHS Preferred

HMO, employees and their dependents will receive costs in retirement. In addition to saving for retirement,
services from providers and facilities comprised of HFPN, there are opportunities to invest your HSA contributions.
Jackson Health Network and Genesys PHO. Enrollees
must select a JHN, HFPN or Genesys PHO primary care • If you participate in one of the CDHPs with an HSA
physician and can see any specialist within the preferred you cannot enroll in the health care flexible spending
network. Enrollees will have access to all of the pediatric account (FSA). You are still eligible for the dependent
care FSA.
(dependents 18 & under) and OB/GYN providers who are in a
HAP affiliated network.
• There are eligibility requirements to participate in the
HSA. For example, if you have Medicare or are eligible for
Health Saving Accounts Canadian Health Care, you are not eligible. For these and
All CDHP plans offer a Henry Ford-funded health savings other HSA details, visit http://healthequity.com.
account (HSA). HSAs offer flexibility when it comes to
planning for medical costs now and in the future. • HealthEquity is the vendor used for the HSA and FSA
programs.
• For employees who enroll in any of the CDHP options,
Henry Ford will contribute $500 (single), $750 (two • New hires, benefit status changes and mid-year events
people) or $1,000 (family) to the HSA by after Jan. 1 will have the employer contribution prorated.
Jan. 3, 2018, which can be used toward the deductible.
Additional Medical Options
• Employees also may contribute to their HSA using pre- In addition to the CDHP options, My Choice Rewards is
tax dollars. The annual limit combining the Henry Ford offering the HFHS Advantage Tiered Access plan (see
and employee contributions is $3,450 for an individual
page 17) and continues to offer Community Blue PPO and
or $6,900 for a family (two or more individuals).
Manulife.
Employees over age 55 may contribute an additional
$1,000 over the maximum amounts listed above.
Community Blue PPO allows employees to choose from
• HSA funds roll over from year to year and the benefit is the broadest network of providers at the highest employee
portable between employers and even into retirement. contribution level. For a Community Blue PPO directory go
This makes it a good way to save for future medical to bcbsm.com.

Manulife is offered to Canadian residents only. The plan What are the requirements?
is designed to subsidize Canada’s OHIP insurance and is Reward Your Health has five requirements that must be
not intended to provide a full range of services. For more completed by the employee and their covered spouse by
information click here. July 31, 2018.
1. Know your numbers (BMI, blood pressure, cholesterol,

Health Engagement Achieve fasting blood glucose)
is being replaced with Reward 2. Take your online health assessment
3. Be tobacco free
Your Health
__________________________________________________________________________
4. Complete a wellness activity
5. Commit to complete all recommended preventive
screenings.
The Health Engagement program has been redesigned
and is taking wellness to a new level. Reward Your
Health Fairs will be conducted in the first quarter
Health is the new wellness program for HFHS employees
of 2018.
and their spouses enrolled in a HAP plan.
For additional details about Reward Your Health,
Annual deductibles and co-pays will no longer be
click here.
affected. Instead, employees and covered spouses
who meet the requirements, will pay a lower employee
NG YOUR BEN
contribution to their medical coverage each pay and/or IZI
You and your dependents can
IM
EF
OPT
receive funding to a health savings account for those
ITS
change your PCP and remain
employees enrolled in one of the three CDHP options.
part of the CDHP HFHS Preferred
Network option, as long as the
For 2018, all employees enrolled in a HAP plan will
new PCP is part of the CDHP HFHS
receive the reduced employee contribution and/or
Preferred Network. Changing your PCP
funding to their HSA.
will not affect your contribution for medical
coverage. Changing your network assignment
To keep receiving this reward in 2019, you and your
will affect your medical contribution. If you need
covered spouse must meet the Reward Your Health
to change from the CDHP Henry Ford Preferred
wellness program requirements between Jan. 1 and
Network option to the CDHP Basic or Full HAP
July 31, 2018. Rewards are adjusted annually and
option, you will continue to have a pre-tax
communicated during open enrollment.
deduction up to the cost of the CDHP Henry Ford
Preferred Medical option. The added contribution
Who’s eligible?
will be an after-tax deduction.
• All employees enrolled in a HAP health plan. If you
have a covered spouse, both you and your spouse
For example, if you have single coverage under
must complete all requirements.
the CDHP Henry Ford Preferred option at $33.89
• All new hires and employees new to a HAP health
per pay pre-tax, and you change your network
plan from Jan. 1 to March 31, 2018.
selection to the CDHP Full HAP Network option,
which is $77.47 per pay pre-tax, your pre-tax
When do I participate?
contribution will be $33.89 and your after-
• Jan. 1 through July 31, 2018.
tax contribution will be $43.58 per pay for the
• All requirements must be completed and submitted
remainder of the year.
by July 31, 2018. You’re encouraged to start early so
you can meet the requirements by July 31.
What do I earn?
A reduction in the contribution you pay for medical
coverage for plan year 2019 based on your benefit plan
and/or a health savings account contribution.

Henry Ford MyChart Patient Portal
This online tool offers patients a convenient way to manage their health care. MyChart is secure, free and
available 24 hours per day. MyChart can be viewed on the internet or on various smartphone applications.
Some of the key features include:
• Message with your Henry Ford physician’s office

• Review most lab and x-ray results
when they become available
• Have an e-visit (a non-urgent
electronic visit) with your Henry Ford
primary care physician for select
conditions
• Schedule return visit appointments
with primary care and certain other
physicians
• View your upcoming appointment
schedule and cancel appointments
• Request prescription renewals
and receive a message when the
prescription has been sent to the
pharmacy
• Review key medical record
information including current health
issues, allergies, medications and
summaries from office visits or
hospital admissions
• Enter home monitoring information
like home blood pressure, weight or
glucose readings
• View and pay your HFHS patient
account.
With a MyChart Proxy Account, you can access all of the above information for your minor children. (A Parent
or Legal Guardian of a minor may be granted permission to view the child’s record up to age 18 upon which
permission will be revoked. Children between the ages 0-13, the parent/guardian has full functionality to
view and act on behalf of the child within MyChart. In line with HIPAA regulations, children ages 14 to 17,
the parent/guardian may only ‘Request an Appointment’ and view billing information on behalf of the
child. They will not be able to view any medical information in the child’s record.) Seniors and others
who may want help managing their health care can give proxy access to another adult.

Choose Wisely
Don’t base your medical plan decision solely on the per pay contribution. Selecting the least costly
plan could actually cost you more. For example, the Consumer Driven Basic Full HAP option per pay
contribution is $25.90 for employee only coverage. However, you are required to pay $4,500 out of pocket
for all your medical care including prescription drugs. Only preventive care is covered at 100% without
having to meet the deductible.
2018 CDHPEmployee
2018 CDHP EMPLOYEE CONTRIBUTIONS
Contributions (per pay) (PER PAY)
CDHP Comprehensive CDHP Comprehensive

CDHP BASIC Full HAP Preferrred Network Full HAP Network
Medical Plan Network (EPA)* (HMO)** (EPA)**
Status Coverage Levels Vision Included Vision Included Vision Included
Single $25.90 $33.89 $77.47
Full Time*
Two Person $73.81 $65.36 $174.30
Family $90.21 $79.89 $213.04
Single $51.79 $70.20 $113.78
Part Time Two Person $132.08 $147.07 $256.01
Family $161.43 $179.75 $312.90
Highly Single $41.44 $54.23 $123.95
Compensated Two Person $118.09 $104.58 $278.88
($270,000+) Family $144.34 $127.82 $340.88
Sponsored With Medicare N/A N/A N/A
Dependent Cost Without Medicare $225.99 $315.25 $319.98
* Plan has deductibles of $4,500 / $9,000 that must be paid by you before benefits are paid by the plan (including
prescription drugs).
** Plans have deductibles of $1,350 / $2,700 that must be paid by you before benefits are paid by the plan (including
prescription drugs).
Save time and hassles. Go paperless with HAP.
Did you know that HAP offers secure electronic delivery of Explanation of Benefits (EOB) to its
members? You currently can view your EOBs online, but now you have the option to stop receiving
paper copies altogether.
To enroll, log in at hap.org and follow the prompts. If you sign up, you’ll be notified by email each time
an EOB is posted on the HAP secure member portal. This hassle-free method of EOB delivery is fast,
safe and convenient – good for the environment and a great way for HAP and HFHS to save costs. For
questions or more information, call 866-766-4709.

2018 Medical Plan Options
2018The following
Medical pages provide comparisons between the level of benefits offered in the various medical options available to
Options
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provide Review thisbetween
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this pocket
coverage, but more importantly what the plan will pay and what your out-of-pocket costs will be. The least costly plan
costs will be. The least costly plan based on a deduction from your paycheck, could turn out to be the most costly based on a deduction
from your paycheck, could turn out to be the most costly plan for you and your family when you factor in what you pay out-of-pocket when you
plan for you and your family when you factor in what you pay out-of-pocket when you see your provider.
see your provider.
Health Care Services CONSUMER DRIVEN HEALTH PLAN (CDHP)

Benefit Period and Annual Deductible CDHP COMPREHENSIVE HFHS CDHP COMPREHENSIVE FULL
LIMITATIONS*
Maximums PREFERRED HMO HAP EPA
Benefit Period Calendar Year
$1,350 Self Only, $2,700 Family Deductible does not include copays or
If more than one person is covered under this plan, all family members must coinsurance. Deductible applies to the
Annual Deductible collectively meet the family coverage amounts. annual Out-of-Pocket Maximum
Co-Insurance (amount member pays) None
These values do not accumulate:
Premiums, balance-billed charges and
$6,550 Self Only; $13,100 Family health care this plan doesn't cover. All
Annual Out of Pocket Maximums Not to exceed $6,550 for any one person other cost sharing accumulates
Preventive Services
Covered. Deductible does not apply Covered. Deductible does not apply
Preventive Office Visit
Related Laboratory and Radiology
Services
Pap Smears, mammograms and Tubal
Ligation
Immunizations
Outpatient and Physician Services
Personal Care Office Visit $20 Copay after the deductible $20 Copay after the deductible
Must be performed by Plan's
$20 Copay after the deductible $20 Copay after the deductible
Telehealth Visit contracted telehealth services provider
Speciality Physician Office Visit $40 Copay after the deductible $40 Copay after the deductible
Gynecology Office Visit $20 Copay after the deductible $20 Copay after the deductible
Audiology Office Visit $40 Copay after the deductible $40 Copay after the deductible
One routine eye exam per benefit
$40 Copay after the deductible $40 Copay after the deductible
Eye Exam Office Visit period at no cost share
Allergy Treatment and Injections Covered after Deductible Covered after Deductible
Laboratory and Pathology Covered after Deductible Covered after Deductible
Imaging MRI's, CT & PET Scans Covered after Deductible Covered after Deductible
Radiology (Xray) Covered after Deductible Covered after Deductible
Radiation Therapy & Chemotherapy Covered after Deductible Covered after Deductible
Dialysis Covered after Deductible Covered after Deductible
Outpatient Surgery $100 Copay after Deductible $100 Copay after Deductible
Chiropractic Not Covered Not Covered
Emergency/Urgent Care
Emergency Room Services $150.00 Copay after the deductible Copay waived if admitted
Urgent Care $50 Copay after the deductible
Emergency Medical Transportation Covered after the deductible Emergency transport only
Inpatient Hospital Services
Facility Fee $100 Co-pay per Admission
Physician Services, Surgery, Therapy,
Laboratory, Radiology, Hospital Services Covered after Deductible
and Supplies
Bariatric Surgery & Related Services $500 Copay after Deductible $500 Copay after Deductible Limited to one procedure per lifetime.
Maternity Services
Prenatal Office Visit Covered. Deductible does not apply
Postnatal Office Visits Covered. Deductible does not apply
Labor, Deliver and Newborn Care See Inpatient Services

2018 Medical Plan Options (continued)
Benefit Period and Annual Deductible CDHP COMPREHENSIVE HFHS CDHP COMPREHENSIVE FULL
LIMITATIONS*
Maximums PREFERRED HMO HAP EPA
Mental Health & Substance Use
Disorder
Inpatient Services See Inpatient Services
Outpatient Services $20 Co-pay after the deductible
Other Services:
Home Health Care Covered after deductible Unlimited
Hospice Care Covered after deductible 210 days per lifetime
Covered for authorized services. Up to
Covered after deductible 730 days renewable after 60 days of
Skilled Nursing Care nonconfinement
Coverage provided for
Durable Medical Equipment, Covered after deductible approved equipment based on
Prosthetics & Orthotics AHLIC's* guidelines
Hearing Aid Hardware Covered after deductible Covered for conventional hearing aid
Rehabilitation Services, Physical, Speech May be rendered at home. 80
Covered after deductible
and Occupational Therapy combined visits per benefit period
Limited to Applied Behavioral Analysis

(ABA) and Physical, Speech and
Occupational Therapy services
Covered after deductible associated with the treatment of Autism
Spectrum Disorders through age 18.
Covered for authorized services only.
See Outpatient Mental Health for ABA
Habilitation Services cost share amount.
Voluntary Sterilizations $100 Copay after Deductible Limited to Vasectomy
Services for diagnosis, counseling and
treatment of anatomical disorders
Covered after deductible causing infertility in accordance with
AHLIC's benefit referral and practice
Infertility Services policies
One attempt of artifical insemination
Covered after deductible
Assisted Reproductive Technologies per lifetime
HFHS Preferred Pharmacy Any Other Contracted Pharmacy
Pharmacy
30 day supply: 30 day supply:
$4 / $27 / $45 copay after deductible $15 / $40 / $60 copay after
A 90-day supply of non-Maintenance
deductible
Generic/ Preferred Brand/ Non-Preferred drugs must be filled at AHLIC's
90 day supply:
Brand designated mail order pharmacy. Other
$12 / $67 / $105 copay after 90 day supply:
exclusions and Limitiations may apply
deductible $30 / $90 / $120 copay after
deductible
*Alliance Health and Life Insurance Company

*Hospital admissions require that AHLIC be notified within 48 hours of admission. Failure to notify AHLIC within 48 hours could result in a reduction of benefits,
or non-payment.
*Students away at school are covered for acute illness and injury related services according to AHLIC criteria.
*In cases of conflict between this summary and your Self-Funded Benefit Guide, the terms and conditions of the Self-Funded Benefit Guide govern.
Some services require prior authorization. Failure to obtain prior authorization before services are received could result in a denial of benefits.
NG YOUR BEN
IZI
IM
CHECK OUT ALEX

EF
OPT
ITS
An interactive decision-making tool called “Alex” allows you to compare benefit choices and
helps you decide on the best choices for you and your family. Athough “Alex” will provide
recommendations, you will make the decision about what’s best for you and your family.
“Alex” is available on Employee Self Service.

Benefit Period and Annual Deductible
CDHP Basic Full HAP EPA LIMITATIONS*
Maximums
Deductible does not include copays or
$4,500 Self Only; $9,000 Family coinsurance. Deductible applies to the
Annual Deductible Not to exceed $6,550 for any one person annual Out-of-Pocket Maximum
Co-Insurance (amount member pays) 20%
These values do not accumulate:
Premiums, balance-billed charges and
$6,550 Self Only; $13,100 Family health care this plan doesn't cover. All other
Annual Out of Pocket Maximums Not to exceed $6,550 for any one person cost sharing accumulates
Preventive Services
Preventive Office Visit Covered. Deductible does not apply
Services Covered. Deductible does not apply
Ligation Covered. Deductible does not apply
Immunizations Covered. Deductible does not apply
Personal Care Office Visit $20 Copay after the deductible
Must be performed by Plan's contracted
Telehealth Visit $20 Copay after the deductible telehealth services provider
Speciality Physician Office Visit $40 Copay after the deductible
Gynecology Office Visit $20 Copay after the deductible
Audiology Office Visit $40 Copay after the deductible
One routine eye exam per benefit period at
Eye Exam Office Visit $40 Copay after the deductible no cost share
Allergy Treatment and Injections Covered after Deductible
Laboratory and Pathology Covered after Deductible
Imaging MRI's, CT & PET Scans Covered after Deductible
Radiology (Xray) Covered after Deductible
Radiation Therapy & Chemotherapy Covered after Deductible
Dialysis Covered after Deductible
Outpatient Surgery $100 Copay after Deductible
Chiropractic Not Covered
Emergency Room Services $150.00 Copay after the deductible Copay waived if admitted
Urgent Care $50 Copay after the deductible
Emergency Medical Transportation Covered after the deductible Emergency transport only
$100 Co-pay per Admission
Facility Fee after deductible
Laboratory, Radiology, Hospital Services
and Supplies Covered after Deductible
Bariatric Surgery & Related Services $500 Copay after Deductible Limited to one procedure per lifetime.
Maternity Services
Prenatal Office Visit Covered. Deductible does not apply
Postnatal Office Visits Covered. Deductible does not apply
Labor, Deliver and Newborn Care See Inpatient Services


CDHP Basic Full HAP EPA LIMITATIONS*
Maximums
Disorder
Inpatient Services See Inpatient Services
Outpatient Services $20 Co-pay after the deductible
Other Services:
Home Health Care Covered after deductible Unlimited
Hospice Care Covered after deductible 210 days per lifetime
Covered for authorized services. Up to 730
days renewable after 60 days of
Skilled Nursing Care Covered after deductible nonconfinement
Durable Medical Equipment, Coverage provided for approved equipment
Prosthetics & Orthotics Covered after deductible based on AHLIC's guidelines
Hearing Aid Hardware Covered after deductible Covered for conventional hearing aid
Rehabilitation Services, Physical, Speech May be rendered at home. 80 combined
and Occupational Therapy Covered after deductible visits per benefit period

Occupational Therapy services associated
with the treatment of Autism Spectrum
Disorders through age18. Covered for
authorized services only. See Outpatient
Habilitation Services Covered after deductible Mental Health for ABA cost share amount.
Voluntary Sterilizations $100 Copay after Deductible Limited to Vasectomy
treatment of anatomical disorders causing
infertility in accordance with AHLIC's benefit
Infertility Services Covered after deductible referral and practice policies
One attempt of artifical insemination per
Assisted Reproductive Technologies Covered after deductible lifetime
Pharmacy
30 day supply:
20% Coinsurance after the deductible A 90-day supply of non-Maintenance drugs
Generic/ Preferred Brand/ Non-Preferred must be filled at AHLIC's designated mail
Brand/Specialty Drug Co-Pay 90 day supply: order pharmacy. Other exclusions and
20% Coinsurance after the deductible Limitiations may apply
*Hospital admissions require that AHLIC be notified within 48 hours of admission. Failure to notify AHLIC within 48 hours could result in
a reduction of benefits, or non-payment.
Option Annual Deductible Annual Out of Pocket Limit How the Family Deductible Works
(Individual/Family) (OOP) (Individual/Famly)
CDHP Basic Full $4,500 / $9,000 $6,550 / $13,100 For family coverage, all family Network members work
HAP together to meet the family deductible. However, the
most any one person in the family will pay toward the
deductible is $6,550 (the individual OOP limit). Once a
family member meets this amount, HAP pays the entire
amount of his/her covered services for the rest of the
benefit period.

Once the family collectively meets the $9,000 deductible,
all family members are considered to have met the
deductible.
CDHP Comprehensive $1,350 / $2,700 $6,550 / $13,100 For family coverage, all family members work together
HFHS Preferred to meet the family deductible amount. When one person
in the family or all members of the family collectively meet
the $2,700 deductible, all family members are considered
to have met the deductible.

Health Care Services HFHS ADVANTAGE TIERED ACCESS PLAN
TIER 1 TIER 2 LIMITATIONS*
Maximums
$250 Individual; $1,250 Individual; Deductible does not include copays or
Annual Deductible $500 Family (2 or more) $2,500 Family (2 or more) coinsurance.
None 30% Deductible applies to the annual Out-of-

Co-Insurance (amount member pays) Pocket Maximum
These values do not accumulate.

$6,850 Individual; Premiums, balance-billed charges and
$13,700 Family (more than 2) health care this plan doesn't cover. All
Annual Out of Pocket Maximums other cost sharing accumulates
Preventive Services
Preventive Office Visit
Services
Ligation
Immunizations
$40 Copay.
$20 Copay. Deductible does not apply
Personal Care Office Visit Deductible does not apply
Must be performed by Plan's
$20 Copay. Deductible does not apply Not Covered
Telehealth Visit contracted telehealth services provider
$80 Copay.
Speciality Physician Office Visit Deductible does not apply
$40 Copay.
Gynecology Office Visit Deductible does not apply
$80 Copay.
Audiology Office Visit Deductible does not apply
$80 Copay. One routine eye exam per benefit
Eye Exam Office Visit Deductible does not apply period at no cost share
Allergy Treatment and Injections Covered after Deductible 30% Coinsurance after Deductible
Laboratory and Pathology Covered after Deductible 30% Coinsurance after Deductible
Imaging MRI's, CT & PET Scans Covered after Deductible 30% Coinsurance after Deductible
Radiology (Xray) Covered after Deductible 30% Coinsurance after Deductible
Radiation Therapy & Chemotherapy Covered after Deductible 30% Coinsurance after Deductible
Dialysis Covered after Deductible 30% Coinsurance after Deductible
Outpatient Surgery $100 Copay after Deductible 30% Coinsurance after Deductible
Chiropractic Not Covered Not Covered
Emergency Room Services $200 Copay. Deductible does not apply Copay waived if admitted
Urgent Care $50 Copay. Deductible does not apply
Emergency Medical Transportation Covered after Tier 1 Deductible Emergency transport only
$100 Co-pay per Admission
30% Coinsurance after Deductible
Facility Fee after deductible
Laboratory, Radiology, Hospital Services Covered after Deductible 30% Coinsurance after Deductible
and Supplies
Limited to one procedure per lifetime.
$500 Copay after Deductible Not Covered Must be performed at a Henry Ford
Bariatric Surgery & Related Services Facility
Maternity Services
Prenatal Office Visit
Postnatal Office Visits
Labor, Deliver and Newborn Care See Inpatient Services 30% Coinsurance after Deductible

Health Care Services HFHS ADVANTAGE TIERED ACCESS PLAN
TIER 1 TIER 2 LIMITATIONS*
Maximums
Disorder
Inpatient Services See Inpatient Services 30% Coinsurance after Deductible
$20 Co-pay. Deductible does not $20 Copay.
Outpatient Services apply Deductible does not apply
Other Services:
Home Health Care Covered after deductible 30% Coinsurance after Deductible Unlimited
210 days per lifetime (Combined in
Covered after deductible 30% Coinsurance after Deductible
Hospice Care Tiers 1 & 2)
Covered for authorized services. Up to
730 days renewable after 60 days of
nonconfinement (Combined Tiers 1 &
Skilled Nursing Care 2)
Coverage provided for approved
Durable Medical Equipment, Covered after deductible 30% Coinsurance after Deductible equipment based on AHLIC's
Prosthetics & Orthotics guidelines
Hearing Aid Hardware Covered after deductible Not Covered Covered for conventional hearing aid
May be rendered at home. 80
Rehabilitation Services, Physical, Speech Covered after deductible 30% Coinsurance after Deductible combined visits per benefit period
and Occupational Therapy (Combined in Tiers 1 & 2)

Occupational Therapy services
Covered after deductible 30% Coinsurance after Deductible associated with the treatment of Autism
Spectrum Disorders through age 18.
Covered for authorized services only.
See Outpatient Mental Health for ABA
Habilitation Services cost share amount.
Voluntary Sterilizations $100 Copay after Deductible 30% Coinsurance after Deductible Limited to Vasectomy
treatment of anatomical disorders
Covered after deductible 30% Coinsurance after Deductible causing infertility in accordance with
AHLIC's benefit referral and practice
Infertility Services policies
One attempt of artifical insemination
Assisted Reproductive Technologies per lifetime
Limited to non-invasive reversible
Covered after Deductible 30% Coinsurance after Deductible
Temporomandibular Joint (TMJ) Disorder procedures only
HFHS Preferred Pharmacy Any Other Contracted Pharmacy
Pharmacy
A 90-day supply of non-Maintenance
30 day supply: 30 day supply:
drugs must be filled at AHLIC's
$4 / $27 / $45 / $100 co-pay $20 / $40 / $80 / $100 co-pay designated mail order pharmacy. Other
Generic/ Preferred Brand/ Non-Preferred exclusions and Limitiations may apply
Brand/Specialty Drug Co-Pay 90 day supply: 90 day supply:
$12 / $67 / $105 / $100 co-pay $40 / $80 / $160 / $100 co-pay
*Hospital admissions require that AHLIC be notified within 48 hours of admission. Failure to notify AHLIC within 48 hours could result in a reduction of benefits,
or non-payment.
*Students away at school are covered for acute illness and injury related services according to AHLIC criteria.
*In cases of conflict between this summary and your Self-Funded Benefit Guide, the terms and conditions of the Self-Funded Benefit Guide gover.
Some services reuire prior authorization. Failure to obtain prior authorization before services are received could result in a denial of benefits.

Health Care Services BCBSM Community Blue PPO

In Network Out of Network
Maximums:
$250 Individual; $500 Family
(Waived if service is performed in a $250 Individual; $500 Family
physician's office and for covered inpatient Out of network deductible amounts also
and outpatient facility services provided at apply toward the in network deductible
Annual Deductible HFHS facilities)
Co-Insurance (amount member pays) None
$6,850 Individual; $6,850 Individual;

$13,700 Family (2 or more) $13,700 Family (2 or more)
Out of Pocket Maximums
Preventive Services:
Covered; One per member
Not Covered
Preventive Office Visit per calendar year
Not Covered
Well Baby/Child Exam per calendar year
Immunization Covered Not Covered
Related Laboratory and Radiology Services Covered Not Covered
Pap Smear Not Covered; Mammogram 60%
Pap Smear covered; Mammogram covered;
after deductible
One per member per year
Pap Smears and mammograms One per member per year
Outpatient and Physician Services:
Covered 60% after deductible; must be
$15 Co-Pay
Primary Care Office Visit medically necessary
Specialty Physician Office Visit $15 Co-Pay Covered 60% after deductible
Not Covered
Gynecology per calendar year
Audiology Examinations Covered; One every 36 months Not Covered
Covered; one eye exam in any period of 12 Up to a maximum payment of $25 per exam
Eye Examinations consecutive months (member responsible for difference)
Allergy Treatment and Injections Covered Covered 60% after deductible
Laboratory and Radiology Services Covered 80% after deductible Covered 60% after deductible
Dialysis Covered 80% after deductible Covered 60% after deductible
Chemotherapy Covered 80% after deductible Covered 60% after deductible
Radiation Covered 80% after deductible Covered 60% after deductible
Outpatient/Office Surgery & Related Services Covered 80% after deductible Covered 60% after deductible
Covered 60% after deductible; Limited to a
$15 Co-pay per visit (up to a maximum of 24
combined maximum of 24 visits per member
visits per member per calendar year)
Chiropractic per calendar year
Emergency/Urgent Care:
$125 Co-pay
Co-pay waived if admitted or for an accidental injury
Emergency Room Services
Covered at 60% after deductible;
$50 Co-pay
Urgent Care Facility Services Must be medically necessary
Covered 60% after deductible or
Covered 80% after deductible in States
Covered 80% after deductible
(like Michigan) where there is no provider
Emergency Ambulance Services network.
Inpatient Hospital Services:
Hospital Inpatient stay in semi-private room,

specialty units as medically necessary, Covered 80% after deductible Covered 60% after deductible
physician services, surgery, therapy, laboratory,
radiology, hospital services and supplies
Covered 80% after deductible; Covered 60% after deductible;
Bariatric Surgery & Related Services must meet specific criteria must meet specific criteria
Maternity Services:
Initial Office Visit to Confirm Pregnancy Covered
Subsequent Prenatal and Postnatal Office Visits Covered Covered 60% after deductible
Covered 80% after deductible; includes Covered; 60% after deductible;
delivery by a certified nurse midwife Includes delivery by a certified nurse midwife
Labor, Deliver and Newborn Care

Health Care Services BCBSM Community Blue PPO

In Network Out of Network
Maximums:
Mental Health:
Inpatient Services Covered 80% after deductible Covered 60% after deductible
Covered 80% after deductible in participating
facilities only;
Covered 80% after deductible
Covered 60% after deductible in physician's
Outpatient Services office
Chemical Dependency:
Inpatient Services Covered 80% after deductible Covered 60% after deductible
Covered 80% after deductible in approved facilities only
Outpatient Services
Other Services:
Home Health Care Covered 80% after deductible Covered 60% after deductible
Covered; provided through a participating hospice program only; limited to dollar maximum
that is reviewed and adjusted periodically
Hospice Care
Covered; 80% after deductible;
up to 120 days per member per calendar year
Skilled Nursing Care
Durable Medical Equipment;
Covered 80% after deductible Covered 60% after deductible
Prosthetics & Orthotics
Hearing Aid (Hardware) Covered Not Covered
Covered 80% after deductible; Covered 60% after deductible;
Limited to a combined maxiumum of 60 visits Limited to a combined maxiumum of 60 visits
Physical, Speech and Occupational Therapy per member per calendar year per member per calendar year
Voluntary Sterilizations Covered 80% after deductible Covered 60% after deductible
Infertility testing covered 80% after Infertility testing covered 60% after
deductible; Infertility treatements are not deductible; Infertility treatements are not
Infertility Services covered. covered.
Voluntary Termination of Pregnancy Not Covered
Assisted Reproductive Technologies Not Covered
Pharmacy:
30 day supply:
30 day supply:
$4 / $17 / $35 co-pay at System Pharmacy
$4 / $17 / $35 co-pay at System Pharmacy
$15 / $30 / $50 co-pay plus 25% of BCBSM
Generic/ Preferred Brand/ Non-Preferred $15 / $30 / $50 co-pay at Non-System
approved amount for the drug at a Non-
Brand/Specialty Drug Co-Pay Pharmacy
System Pharmacy
90 day supply is not available
90 day supply is not available
In case of discrepancies between this summary and the medical plan Contract, the terms and conditions of the Contract govern.

2018 EPA/PPO
2018 EPA/PPO EMPLOYEE
Employee CONTRIBUTIONS
HFHS Advantage
Tiered Access Plan Community Blue Manulife
Status Medical Plan (EPA) BCBSM (PPO) (Canadian)
Coverage Levels Vision Included Vision Included Vision Included
Single $53.79 $312.02 $25.66
Full Time
Two Person $121.02 $746.86 $62.18
Family $147.92 $936.06 $70.66
Single $94.13 $378.88 $38.33
Part Time Two Person $211.79 $909.30 $101.50
Family $258.86 $1,136.64 $122.95
Highly Single $86.06 $445.74
Compensated Two Person $193.64 $1,069.76
($270,000+) Family $236.67 $1,337.22
Sponsored With Medicare $247.32 N/A N/A
Dependent Cost Without Medicare $337.74 $453.39 N/A
All medical plans offered through My Choice Rewards are self-funded plans with the exception of Manulife. To find out if
your physician accepts any of the HAP medical options, review the information below:
1. Log onto www.hap.org

2. Select Doctors
3. Under Type of Plan click on Change Plan
4. Click the Provider Look Up Name below based on the plan you elect
IF YOU ENROLL IN THIS PLAN. . . . . . . . . . . . . . . . . . . . . . . . Use this Provider Look Up Name
HFHS ADVANTAGE TIERED ACCESS PLAN. . . . . . . . . . . . . . . . . HFHS Employee Advantage Tiered Access EPA
CDHP COMPREHENSIVE HFHS PREFERRED. . . . . . . . . . . . . . HFHS Employee CDHP Comprehensive Preferred HMO
CDHP COMPREHENSIVE FULL HAP. . . . . . . . . . . . . . . . . . . . . . HFHS Employee CDHP EPA
CDHP BASIC FULL HAP EPA. . . . . . . . . . . . . . . . . . . . . . . . . . . . HFHS Employee CDHP EPA
5. Enter the information you want to search on to determine if your provider is in the network that accepts your plan.
Final Oct. 09, 2017

Vision Care
The vision coverage below is based on the medical option you selected.
CDHP Comprehensive
HFHS Preferred Network
CDHP Basic Full BCBSM Community Blue
and CDHP HFHS Advantage Tiered Access
HAP PPO
Comprehensive Full
HAP Network
Coverage Tier 1 Tier 2
Services In and Out of Network
$40 co-pay; after
deductible, unlimited $40 co-pay; unlimited $60 co-pay; unlimited
exams (waived for exams (waived for exams (waived for Annual exam covered in full
Eye Exam Covered in full preventive care) preventive care) preventive care) up to approved charges
Covered up to $40; Covered up to $40;

one pair every Covered up to $40 after Covered up to $40; one pair every
consecutive 12 decutible; one pair every one pair every consecutive 12 Covered up to $40; one pair
Frames months 12 consecutive months consecutive 12 months months every 24 months
Covered in full up to
$40; one pair every Covered in full up to
12 months with Covered in full up to the Covered in full up to the approved charges;
prescription change; approved charges; one the approved charges; one pair every Covered in full up to the
otherwise one pair pair every consecutive 12 one pair every consecutive 12 approved charges; one pair
Lenses every 24 months months consecutive 12 months months every 12 months
Covered in full up to Covered in full up to Covered in full up to
$80 in lieu of eye Covered in full up to $80 $80 in lieu of eye $80 in lieu of eye
glassess; contact in lieu of eye glassess; glassess; contact lens glassess; contact lens Covered in full up to the
lens fitting exams contact lens fitting exams fitting exams are not fitting exams are not approved charges in lieu of
Contact Lenses are not covered are not covered covered covered eye glasses
In case of discrepancies between this summary and the vision plan Contract, the terms and conditions of the Contract govern.
In addition to the vision plan you choose, additional Discounts may not be combined with other discounts,
savings on out-of-pocket expenses are available to you coupons or promotions. Sale price merchandise is not
through Henry Ford OptimEyes. After applying insurance included in the discount program.
benefits, the following discounts will apply to your
balance: These benefits are available to you and your immediate
family members (spouse and dependents). To take
• An additional 20% on frame (after current frame advantage of these discounts, simply present your
promotion) Henry Ford identification badge and indicate that you
• 20% on all lenses and upgrades are a System employee at the time the eligible service is
• 20% on all contacts (based on regular retail pricing) provided.
• 20% on accessories
• 25% on all non-prescription sunglasses For a Henry Ford OptimEyes location near you, go online
to henryfordoptimeyes.com or call 800-EYE-CARE.
Discounts are not available on:
• Professional fees
• Co-pays
• Warranty replacements
• Industrial safety glasses
• Exams

Single $2.09 $13.97
Full Time Two Person $4.18 $29.84
Family $7.73 $55.21
HAP Standalone Vision Plan
Employees who opt out of medical/vision
Single coverage may$9.95
purchase vision coverage
$19.13only. Services and benefits are
available throughPart
HenryTime Two Person
Ford OptimEyes and HAP. $19.90 $38.26
Family $36.80 $70.87
v
2018 Vision2018 VISION

Employee
Services Coverage
EMPLOYEE CONTRIBUTIONS
Eye Exam Covered one per benefit period when performed
by a Henry Ford OptimEyes Optometrist Stand Alone Vision
Frames Covered up to $40; One pair every 12 consecutive Plan Coverage HAP Vision
months Levels
Lenses Covered in full up to the approved charges; one Single $4.10
pair every 12 consecutive months
Two Person $9.42
Contact Covered up to $80 in lieu of eyeglasses; Contact
Family $10.65
Lenses lens fitting exams are not included.
Our Commitment to Affordability

_____________________________________ SPECIAL MEDICAL CREDIT
INCOME GUIDELINES
Did you know there are additional benefits available to
you that can reduce your out-of-pocket expenses and Family Size* 1040 Earnings**
make your health care more affordable? Read further
to see how the Special Medical Credit, Flexible Spending 1 $24,120
Account and Health Savings Account may help you save 2 $32,480
money. 3 $40,840
4 $49,200
SPECIAL MEDICAL CREDIT 5 $57,560
The Special Medical Credit is available for single- 6 $65,920
person, two-person and family households in 2018: 7 $74,280
• For employee only coverage, the credit is $32.30 per 8+ $82,640
pay ($70 per month).
* Based on the number of exemptions (you, spouse, dependents)
• For two-person coverage, the credit is 64.62 per pay reported on your most recent federal tax return under “family size.”
($140 per month). ** Based on the total family income amount indicated on your federal
income tax Form 1040 or form 1040EZ.
• For family coverage, the credit is $85.85 per pay
($186 per month).
Final Oct. 09, 2017

The credit is available for full-time employees who
enroll in the HFHS Advantage Tiered Access Plan.
Eligibility for the credit is based on the total family
income as indicated on the most recently filed 1040
tax return and the number of dependents indicated on
that tax return(s). A new online application must be
completed each year. Please refer to chart.

• Employees may also apply for the Special Medical SPOUSE SURCHARGE
Credit throughout the year due to life events, status Employees who elect to cover a spouse on an HFHS
changes and new hire eligibility. medical plan who is eligible for health insurance
• An online application can be found on Employee Self with their own non-HFHS employer will be assessed
Service. Employees have until Dec. 8 to complete the a surcharge of $46.15 pretax per pay. This surcharge
application in time for the first pay of Jan. is in addition to the employee’s per pay contribution
for medical coverage and is designed to shift the
• After review of the application and tax return responsibility of coverage to a broader spectrum of
information, Employee Services will notify you of the employers.
determination.
• Cancellation of the Special Medical Credit will occur Employees who cover their spouses also are required
if you are no longer a full-time employee enrolled in to complete an online verification form stating the
the HFHS Advantage Tiered Access Plan or you are spouse does not have the opportunity to be covered by
no longer eligible for benefits. their non-HFHS employer. If your spouse is covered on
your medical plan and you do not complete the online
verification form, you will be defaulted to receive
ONLINE SPECIAL MEDICAL CREDIT coverage for your spouse and the surcharge will
APPLICATION apply. If you are defaulted for failure to complete the
Employees can go to Employee Self Service verfication form, you can contact Employee Services to
and complete the online Special Medical Credit complete this form, but no refunds of the prior spouse
application. Completion by Dec. 8, 2017 will surcharge deduction will occur. Random audits will
guarantee credit on the first pay in Jan. 2018. be conducted and ineligible spouses will be removed.
Falsification may result in disciplinary action, which
could include termination.
SPONSORED DEPENDENTS
You may also cover certain sponsored dependents,
HIGHLY COMPENSATED EMPLOYEES
but no credits are given for this coverage. For related Highly compensated employees continue to pay more
information, see pages 4-5. (Sponsored dependents for their medical coverage. A “highly compensated”
are not eligible for dental coverage or HAP Standalone employee earns a base annual salary of $270,000
Vision.) The rates per pay period for sponsored or more. The salary is based on the 2017 Annual
dependent medical coverage are: Compensation Limit as defined by the Internal Revenue
Service and is adjusted annually. A highly compensated
employee’s contribution is 60 percent higher than the
contribution of other employees.
Medical Option Sponsored Sponsored
Dependent Dependent without
with Medicare Medicare
CDHP Basic Full HAP Not Eligible $225.99
Network
CDHP Comprehensive Not Eligible $315.25
Preferred Network
CDHP Comprehensive Not Eligible $319.98
Full HAP Network
HFHS Advantage Tiered $247.32 $337.74
Access Plan
Community Blue PPO Not Eligible $453.39

Dental Plans
______________________________________________________________________________
Henry Ford Health System offers you and your eligible dependents the opportunity to seek quality dental care on a
regular, preventive basis. Changes to your dental option may be made every year. Employees enrolled in the Delta
Basic or Comprehensive options have two networks from which to choose a Delta Dental participating provider. You
will receive the highest level of coverage if you go to a Delta Dental PPO dentist. Although your coverage levels will
be lower for some services when you go to a non-PPO dentist, you may still save money if that dentist participates in
the Delta Dental Premier Network.
Dental Plan Comparison Chart
Delta Basic Delta Comprehensive

Service
Diagnositic & Preventive - Class I PPO Premier PPO Premier
Deductible $25 Single; $50 Family $25 Single; $50 Family

Diagnostic and Preventive Services - Used to
diagnose and/or prevent dental abnormalities or Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100%
disease (includes exams, cleanings and flouride
treatment)
Emergency Palliative Treatment - Used to Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100%
temporarily relieve pain
Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100%
Sealants - to prevent decay of permanent teeth
Brush Biopsy - to detect oral cancer
Radiographs - X-rays Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100%
Basic Services - Class II
Oral Surgery Services - Extractions and dental
surgery, including preoperative and postoperative Plan pays 60% Plan pays 40% Plan pays 85% Plan pays 65%
care
Relines and Repairs - Relines and repairs to bridges
and dentures
Minor Restorative Services - Used to repair teeth
damaged by disease or injury (for example, amalgam Plan pays 60% Plan pays 40% Plan pays 85% Plan pays 65%
[silver] and resin [white] fillings
Major Restorative Services - Used when teeth can't
be restored with another filling materal (for example, Plan pays 60% Plan pays 40% Plan pays 85% Plan pays 65%
crowns)
Peridontic Services - Used to treat diseases of the
gums and supporting structures of the teeth
Endodontic Services - Used to treat teeth with
diseased or damaged nerves (for example, root Plan pays 60% Plan pays 40% Plan pays 85% Plan pays 65%
canals)
Major Services - Class III
Posthodontic Services - Used to replace missing
natural teeth (for example, bridges and dentures)
Orthodontic Services - Class IV
Orthodontic Services - Used to correct malposed No coverage No coverage Plan pays 60% Plan pays 50%
teeth and/or facial bones (for example, braces)
No coverage $1,500 per person
Ortho Lifetime Maximum
Maximum Payment
$750 $1,500
Maximum Payment - Per person per contract year
In cases of discrepancies between this summary and the dental plan Contract, the terms and conditions of the Contract govern.

2018 Employee
2018 Dental Dental
Employee Contributions
Contributions (per pay)(per pay)
Dental Plan Delta Premier

Delta Premier
Status Coverage Comprehen-
Basic (PPO)
Levels sive (PPO)
Single $2.09 $13.97

Full Time Two Person $4.18 $29.84
Family $7.73 $55.21
Single $9.95 $19.13

Part Time Two Person $19.90 $38.26
Family $36.80 $70.87
v
2018 Vision Employee

Dental Plan PPO (Point-of-Service) Questions and Answers
Contributions (per pay)
What are Delta Dental PPOSM and Delta Dental PPO (Point-of-Service) is Delta Dental’s nationalStand Alone
preferred providerVision
organization program that gives you
Delta Dental Premier® Plan Coverage
access to two of the nation’s largest networks of participating dentists: Delta Dental PPO andHAP Vision
Delta Dental Premier.
Although you can go to any licensed dentist anywhere, your out-of-pocket
Levelscosts are likely to be lower if you go to a dentist
who participates in one of these networks.
Single $4.10
How do I find a participating Two Person $9.42
To find out whether your dentist participates in Delta Dental PPO or Delta Dental Premier, you can call his or her office,
dentist? check our website at www.deltadentalmi.com, or call our Customer $10.65
FamilyService department at 800-524-0149.
Do I have to go to a participating No. You can go to any licensed dentist anywhere, regardless of whether he or she participates in Delta Dental PPO or
dentist? Delta Dental Premier. However, your out-of-pocket costs may be higher if you go to a nonparticipating dentist.
Can I change dentists whenever Yes. You can change dentists at any time.
I’d like?
Can each member of my family Yes. Each member of your family may see a different dentist.
choose a different dentist?
Am I covered if I go to a Yes. However, when you seek care from a nonparticipating dentist, you are responsible for all fees charged. We will
nonparticipating dentist? reimburse you up to our nonparticipating dentist fee, which is generally lower than our fee for participating dentists.
Am I covered for Emergency Yes.

Services?
Will I receive dental cards? No. Your dentist can verify your eligibility through the Customer Service department or our online Dental Office Toolkit.
Who do I call if I have If you have questions, please call the Customer Service department at 800-524-0149.
questions?
NG YOUR BEN
IZI
IM
EF
OPT
ITS
FIRST PAY OF 2018

Review your first paycheck of the New Year – Friday, Jan. 12, 2018, to verify elections and
Final Oct. 09, 2017
contributions.
As a new hire, or newly benefits-eligible employee, you should also review your paycheck to
verify elections and contributions are correct.
If you have questions, contact Employee Services at Employeeservices@hfhs.org or 855-874-7100.

DELTA DENTAL PPO DENTIST
Submitted fee: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $100.00
You will receive the highest level of coverage if you go
Maximum Approved Fee: . . . . . . . . . . . . . . . . . . . . . $ 95.00
to a Delta Dental PPO (PPO) dentist. Delta Dental will
Delta Dental pays 80% of $95: . . . . . . . . . . . . . . . . $ 76.00
pay PPO dentists directly based on their submitted fee
You pay: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 19.00
or the amount in their local Delta Dental’s PPO dentist
schedule, whichever is less. If the PPO dentist schedule
amount for a covered service is lower than the dentist’s
submitted fee, the dentist cannot charge you the NON-PARTICIPATING DENTIST
difference. If you go to a non-participating dentist (a dentist
who does not participate in Delta Dental PPO or Delta
For example: If a PPO dentist charges $100 for a service Dental Premier), you will probably have to pay more.
covered at 100 percent, and if the PPO dentist schedule Our payment for covered services will be based on the
amount for that service is $80, we will pay the dentist dentist’s submitted fee or the local Delta Dental’s non-
$80 and you will owe nothing. The dentist cannot charge participating dentist fee, whichever is less.
you the $20 difference between his or her submitted fee
and the PPO dentist schedule amount. Delta Dental will usually send payment directly to you,
and you will be responsible for paying the dentist
whatever he or she charges. In addition, you might have
Submitted fee: . . . . . . . . . . . . . . . . . . . . . . . . . . . . $100.00 to pay the dentist at the time of your appointment.
PPO dentist schedule amount: . . . . . . . . . . . . . . . $ 80.00
Delta Dental pays 100% of $80: . . . . . . . . . . . . . . . $ 80.00 For example: If a non-participating dentist charges $100
You pay: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0.00 for a service that is covered at 80 percent, and if the
non-participating dentist fee for that service is $82, we
will pay you $65.60 (80 percent of $82). You will owe the
dentist the remaining $34.40. You will be responsible for
DELTA DENTAL PREMIER DENTIST paying him or her the full $100.
Although your coverage levels will be lower for some
services when you go to a non-PPO dentist, you may still
save money if that dentist participates in another Delta Submitted fee: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $100.00
Dental program called Delta Dental Premier (Premier). We Non-participating dentist fee: . . . . . . . . . . . . . . . . $ 82.00
pay Premier dentists directly based on their submitted Delta Dental pays 80% of $82: . . . . . . . . . . . . . . . . $ 65.60
fee or their local Delta Dental’s maximum approved fee, You pay: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 34.40
whichever is less. If the maximum approved fee for a
covered service is lower than the dentist’s submitted
fee, the dentist cannot charge you the difference.
For example: If a non-PPO dentist who participates in

Delta Dental Premier charges $100 for a service that is
covered at 80 percent, and if the maximum approved fee
for that service is $95, we will pay the dentist $76 (80
percent of $95). You will owe the dentist the remaining
$19. The dentist cannot charge you the $5 difference
between his or her submitted fee and the maximum
approved fee.

Flexible Spending Accounts • For dependent care claims, save the itemized receipts
____________________________________ from your day care provider and submit a claim
form with your receipt to HealthEquity. For more
Flexible spending accounts (FSAs) allow you to pay for information on eligible expenses click here.
out-of-pocket health care and dependent care expenses • Eligible expenses for a dependent care account
with pre-tax dollars. Your contributions are subtracted include but are not limited to, care for dependents
from your paycheck before federal, state and FICA taxes age 12 or younger, or dependents regardless of age
are calculated on your pay, so you save money on taxes. who are physically or mentally incapable of caring
for themselves and whom you claim as a dependent
There are two types of FSAs. You may participate in on your federal income tax return. You (and your
either or both: spouse if you are married) must maintain a home that
• Health Care FSA – covers eligible health care you live in for more than half of the year with your
expenses for you and your eligible dependents. qualifying child or dependent.
• Dependent Care FSA – covers eligible dependent • If you are married, your spouse must also be at work,
daycare or elder care expenses so you and your school (as a full-time student), searching for a job, or
spouse can work or attend school full-time. mentally or physically disabled and unable to provide
care for a dependent.
How the Accounts Work • For more information on dependent care accounts
click here.
• You decide how much you want to deposit during
the calendar year. The maximum you can contribute Things to consider when enrolling in an FSA
to a health care FSA is $2,650. The maximum for a
dependent care FSA is $5,000. There are some IRS rules you need to know before you
• HealthEquity is the third party administrator for the decide to participate in a health care and/or dependent
FSA program. care FSA. You must enroll each year if you want to
• The annual limit you elect is calculated over 26 participate. FSAs do not carry over from year to year.
pay periods (or for a new hire, over the remaining
pay periods in the year) to determine the per pay Health Care FSA
deduction. • The annual amount you elect for a health care FSA is
available as of Jan. 1, 2018, or the date you become
• When you have an eligible health care FSA expense,
benefit eligible and enroll in the plan.
such as a prescription drug co-pay, save the
itemized receipt. You can pay the expense with your • Your 2018 contributions for a health care FSA must be
HealthEquity health care FSA card at the point of used for eligible expenses you incur between Jan. 1,
purchase. HealthEquity may request a copy of your 2018 and March 15, 2019.
itemized receipts. For a list of eligible expenses • You incur an expense on the date the service is
click here. provided – not when you are billed or when you pay
• For more information on the health care FSA it.
click here. • You cannot submit a claim for services incurred prior
• You should retain receipts for your health care and to becoming eligible for the FSA.
dependent care expenses. To reduce the amount • By law, any money remaining in your health care
of substantiation that may be required, both HAP FSA after April 30, 2019 is forfeited and will not be
and Delta Dental provide medical and dental claims returned to you. This is known as the “use it or lose
data to HealthEquity. HealthEquity is more rigorous it” rule.
in reviewing and processing claims. This is good • If you terminate employment or have a status change
for Henry Ford Health System and you from an IRS mid-year and you are no longer eligible to participate
compliance perspective and any audits that could in a health care FSA, you have 90 days from the date
occur. of your event to submit eligible expenses incurred on
or before your mid-year event.
Dependent Care FSA

• Your 2018 contributions for a dependent care FSA
must be used for eligible expenses you incur between

Jan. 1 and Dec. 31, 2018, or the date you become
eligible and enroll in the plan. Health Care FSA (Flexible Savings Account)
• You can only receive reimbursement up to the and HSA (Health Savings Account)
amount available in your dependent care account. A side-by-side comparison
• You cannot submit a claim for services provided prior Description FSA HSA
to becoming eligible and enrolled in the plan. Use it to pay for medical expenses before you
• By law, any money remaining in your dependent care meet the deductible for your consumer driven 
FSA after Dec. 31, 2018 is forfeited and will not be health plan (CDHP)
returned to you. This is known as the “use it or lose Use it to pay for a variety of eligible health and
it” rule. medical expenses including dental expenses.  
• If you terminate employment or have a status change You must use it by the end of the year or first
mid-year and you are no longer eligible to participate quarter of the new year or forfeit the remaining
in a dependent care FSA, you have 30 days from funds.

the date of your event in which to submit eligible
expenses incurred on or before your mid-year event. Rolls over from year to year. 
• The health care and dependent care FSAs must You can take it with you when you change
maintain separate accounts. Money cannot be employers or retire. 
transferred between the accounts. Health care You can invest the funds in your account. 
services cannot be reimbursed from a dependent care
account or vice versa. Make contributions with pre-tax dollars.  
• See pages 38-40 for qualified mid-year events that Employees can contribute a maximum of $2,650
annually. 
may allow you to change your election to a health
care and/or dependent care FSA. Employee and employer together may contribute
• For more information, contact HealthEquity at 866- $3,450 to $6,900 depending on family status 
346-5800 or click here (individual/family).
Catch-up contributions up to an additional $1,000
for employees age 55+. 
All funds available beginning Jan. 3, 2018. 
Only funds that have already been deposited into
the account are available. 
HFHS contributes funds to the account at the 
beginning of the benefit year for 2018.
Designed to be used with the CDHP plans. 
Can be used with any health plan except CDHPs.


Income Replacement and COVERAGE AFTER AGE 65
If you continue to work after age 65, the amount of your
Survivor Benefits
____________________________________ life insurance will decrease on Jan. 1 following your 65th
birthday as follows:
Protecting our family’s income in the event of a serious
injury or death is a concern that many of us have.
• Age 65-69 . . . . . . . . . . . . . . . . . . . 65% of elected option
Financial security can be achieved through personal
• Age 70-74 . . . . . . . . . . . . . . . . . . . . 50% of elected option
financial planning, including employer-sponsored
• Age 75+ . . . . . . . . . . . . . . . . . . . . . 20% of elected option
voluntary life and disability insurance.
Dependent Term Life Insurance coverage does not
EMPLOYEE TERM LIFE INSURANCE
My Choice Rewards provides you with a variety of life decrease if you continue working past age 65.
insurance options. You may choose either more or less
coverage, in the increments shown below, based on IMPUTED INCOME
your projected needs. Coverage can be purchased with When you purchase insurance in excess of $50,000, you
pretax dollars. The maximum protection you can receive are subject to the IRS imputed income rules. Imputed
from this benefit is $1 million. Income is the value of your life insurance in excess of
$50,000. You are required to pay federal and state
Coverage Maximum Benefit income taxes as well as Social Security tax on this
• 1 x Your Base Pay . . . . . . . . . . . . . . . . . . . . . . $250,000 “excess” amount. The amount of tax you pay is based
• 2 x Your Base Pay. . . . . . . . . . . . . . . . . . . . . . $500,000 on your age. The value of the life insurance in excess of
• 3 x Your Base Pay . . . . . . . . . . . . . . . . . . . . . $750,000 $50,000 will be reported on your W-2.
• 4 x Your Base Pay. . . . . . . . . . . . . . . . . . . . . . $1 million
• $10,000* TERMINAL ILLNESS BENEFIT
• $25,000* Enrollees who are diagnosed with a terminal illness (life
• $50,000*
expectancy of 12 months or less) may apply to have up
• Opt out*
to 50 percent of their Employee Life Insurance paid out
*Options available to part time employees. to them in advance. Information is available from
Employee Services.
Life insurance deductions are based on an employee’s
age and salary. Deductions change based on the DEPENDENT TERM LIFE INSURANCE
following age groups: My Choice Rewards also provides dependent term life
Insurance options on an after-tax basis. Because of IRS
Age Rate per $1,000 of coverage regulations, no pretax dollars or credits may be used
29 and less $0.023 for this coverage. Your dependent term life Insurance
options are:
30 to 34 $0.035
35 to 39 $0.052
Spouse Coverage Child(ren) Coverage
40 to 44 $0.076
$50,000 $15,000 each child
45 to 49 $0.116
$25,000 $10,000 each child
50 to 54 $0.192
$10,000 $5,000 each child
55 to 59 $0.343
60 to 64 $0.471
65 to 69 $0.954 If you choose to enroll, you must designate who will
70 and older $2.188 be covered by the dependent term life Insurance. You
may choose spouse-only coverage or, child(ren)-only
coverage. For dependent eligibility requirements, see
If you move up more than one coverage level, or you pages 4-5 of this workbook. You are the beneficiary for
are electing coverage when you previously waived
coverage, you must furnish evidence of insurability
(EOI).

your spouse or dependent’s life insurance. If you are COVERAGE AT AGE 75 AND OLDER
electing dependent coverage when you have previously When you or your spouse reach age 75, the coverage
waived coverage, you must furnish evidence of amount is reduced on Jan. 1 following the 75th birthday
insurability (EOI) for your spouse; children do not require as follows :
EOI. Any dependents you cover must live with you.
• Age 75-79. . . . . 57.5% of the elected coverage amounts
• Age 80-84. . . . . 37.5% of the elected coverage amounts
ACCIDENTAL DEATH AND DISMEMBERMENT • Age 85+. . . . . . . . 20% of the elected coverage amounts
(AD&D)
This reduction also applies to any dependents you have
AD&D insurance provides protection against financial chosen to cover.
hardship when you or a covered dependent suffer an
accidental death, loss of limb, paralysis or loss of sight. LONG-TERM DISABILITY (LTD)
Your AD&D coverage options are indicated in the above Long-term disability Insurance or LTD provides a source
chart. of income for you if you are unable to work due to a
serious illness or injury. If you have previously waived
If you choose to enroll in AD&D coverage, you must LTD and would now like to elect coverage, or you are
designate who will be covered. You may choose either increasing more than one level of coverage, you
employee-only coverage or employee and dependents will have to furnish evidence of insurability (EOI).
coverage. For dependent eligibility requirements, see If you are initially enrolling in or increasing your
pages 4-5 of this workbook. Any dependents you cover LTD coverage during open enrollment, you will not
must live with you. be eligible for the higher coverage amount for any
disability resulting from a pre-existing condition that
begins three months before the coverage effective
Coverage level and maximum benefits. date and in the first 12 months after the effective
date of coverage. Since your LTD benefit is paid for on a
5 x base annual salary for employee ($1.25 million) pretax basis or by the company, any long term disability
2.5 x employee’s base annual salary for spouse ($500,000) benefit you receive will be subject to income taxes. Your
0.1 x employee’s base annual salary for each child ($50,000) LTD options are as follows:
4 x base annual salary for employee ($1 million)
2 x employee’s base annual salary for spouse ($500,000) 50% of base annual salary:
0.1 x employee’s base annual salary for each child ($50,000) maximum monthly benefit of $10,700*
3 x base annual salary for employee ($750,000)
60% of base annual salary:
1.5 x employee’s base annual salary for spouse ($375,000)
maximum monthly benefit of $12,850
0.1 x employee’s base annual salary for each child ($50,000)
$100,000 employee 70% of base annual salary:
$50,000 spouse maximum monthly benefit of $15,000
$10,000 each child
$50,000 employee* *Option available to part time employees.
$25,000 spouse
$5,000 each child
$20,000 employee*
$10,000 spouse
$5,000 each child
*Options available to part time employees.

My Choice Rewards Enrollment STEP 8 Review the confirmation statement for
Instructions
____________________________________ accuracy and keep it as proof of your
enrollment for 2018.
During Open Enrollment, all benefits-eligible employees
must log on to https://workforceconnect.hfhs.org if STEP 9 A final confirmation statement will be
they are making changes to their benefits. If you available for you to print beginning the
need help enrolling or have questions about benefits week of Dec. 11, 2017. Go to Employee Self
choices after reviewing this workbook, call Service/Benefits Home and print the final
Employee Services at 855-874-7100 or email your confirmation statement.
question to openenrollment@hfhs.org.
DEFAULT PLAN – NEW HIRES
HOW TO ENROLL • Flexible Spending Accounts or Health Savings
Accounts default to non-participation unless you
STEP 1 Go to https://workforceconnect.hfhs.org from enroll each year.
any computer that has access to the web
starting Monday, Nov. 6. • For new hires and rehires as of Jan. 1, 2018, the
default package for full and part time employees is no
STEP 2 Enter your corporate ID and password. If coverage. If you are enrolled in the default package,
you don’t remember your password, click you will have no coverage for the rest of the plan
on Forgot your Password. (Your Employee year. Also, if you experience a life event, you may not
Self Service log on is your Corporate ID and be able to make a change to your benefits until the
password.) next open enrollment period.
STEP 3 Access your Personal Enrollment Summary.

Receiving a confirmation number does not
STEP 4 Make your benefits selections for 2018. mean your benefit elections are correct. It
only means the information you entered was
STEP 5 Update your dependent information. recorded. You must thoroughly review the
If you add new dependents, upload birth confirmation statement provided to you at
certificates and/or marriage certificates the end of the enrollment process to ensure
while online. Include your employee ID on all you made the right choices and that your
documents. dependents have coverage. Your covered
dependents must have a “Y” in the medical and
STEP 6 After completing your benefit selections, if or dental columns if they are to have coverage
you are satisfied with your choices, proceed
in 2018.
to receive your confirmation number. Record
this number. You must obtain a confirmation
number, as this completes your enrollment
and confirms your benefit selections have
been recorded and submitted. This does not
mean your elections are correct. It only
means the information you entered was
recorded.
STEP 7 Your temporary confirmation statement

will be emailed to you. Confirmation
statements will not be mailed home.

Making Choices... the Enrollment LEAVE OF ABSENCE
If you are on a leave of absence during open enrollment,
Experience
_____________________________________ changes made to your medical/vision or dental plans
will be effective Jan. 1. All other benefit changes made
Henry Ford continues to provide information about your during open enrollment will not be in effect until you
benefits: have returned to work in the new plan year.
• Web Page
Visit https://mychoicerewards.hfhs.org. This is the TERMINATION OF BENEFITS
hub for My Choice Rewards information during open Benefit coverage for you and your family will terminate
enrollment. Materials are organized and housed on the last day of the month in which you terminate
together on an easy-to-navigate web page. your employment or are in an ineligible benefit status.
Long-term disability coverage ends on the date of
• Alex
termination. If you become ineligible for coverage, you
An interactive decision-making tool called “Alex” will
and your eligible dependents may have continuation
allow you to compare benefits options and help you
rights for medical/vision, dental and health care flexible
decide on the best choices for you and your family.
spending account benefits under the federal law known
Although Alex will provide recommendations, you
as COBRA. If you terminate your employment or are in an
will make the decisions about what’s best for you
ineligible benefit status, you will be notified about your
and your family. You’ll be able to use Alex as you
continuation rights.
prepare to enroll for benefits.
PHONE OR EMAIL HAP Personal Alliance Coverage

As always, after reading the key messages and for Gaps
_____________________________________
enrollment workbook, if you still have questions,
call Employee Services at 855-874-7100 or email Employees who are leaving the System or are no
openenrollment@hfhs.org, longer eligible for coverage because of a life event will
experience a discontinuation of coverage.
Additional Information For these gaps in coverage, HAP offers health plans
____________________________________ for individuals and families that may be a lower-cost
COVERAGE FOR HFHS COUPLES alternative to COBRA. If your loss of coverage is due to
If both a husband and wife are HFHS employees, they a qualifying life event, you can sign up during a special
cannot be “double covered” under My Choice Rewards. enrollment period (SEP). The loss of previous coverage is
A person covered as an employee cannot be an eligible considered a qualifying event. Call HAP Personal Alliance
dependent. However, one spouse could opt out of at (855) WITH-HAP, or visit hap.org for information about
health care coverage and be covered as a dependent special enrollment period qualifying events.
by the other spouse under two-person or family
coverage. Eligible dependents of a couple employed by
HFHS can be double covered under My Choice Rewards. Health Plans for Those
Keep in mind that coordination of benefits rules apply Turning 26
for health care coverage, so that not more than 100 _____________________________________
percent of eligible expenses can be paid. Similarly, HAP provides coverage for individuals turning 26 and
an employee cannot be covered as a dependent on a
aging off their parents’ health plan. This is a life event
spouse’s life insurance contract. However, an eligible
that qualifies the individual to sign up by the end of the
dependent may be covered under both spouse’s
month the individual turns 26. During the SEP, you or
dependent life insurance contracts. If that dependent
your dependent can obtain coverage under a separate
dies, both spouses could collect on the dependent
contract/policy. Visit hap.org for more information about
life coverage in which they were enrolled. An eligible
the policies designed for young adults.
expense may only be reimbursed once, even if both
spouses participate in flexible spending accounts.

YOUR RIGHTS AND RESPONSIBILITIES
You are responsible for notifying Employee Services FREE PRESCRIPTION HOME DELIVERY
at the time a covered dependent no longer remains Have your medications shipped right to your door.
Henry Ford Pharmacy offers free home delivery of
eligible for benefit coverage by going online to
your medications, whether you need a simple refill
Employee Self Service within 30 days of the event to
or even a new prescription. To find out how, call
remove your dependent, 800-456-2112 or ask a Henry Ford pharmacist.
HFHS Rewards
_____________________________________
Henry Ford OptimEyes
As a Henry Ford employee, your benefits extend Additional savings on out-of-pocket vision expenses are
beyond compensation and health insurance coverage. available for employees through Henry Ford Optimeyes.
Rewards are benefits employees receive at no cost To find a location click here.
as valued members of the health system. To find out
more about Rewards, click here. Same Day Appointments
If you need care today, more than 35 Henry Ford
Choose Henry Ford outpatient medical locations in Wayne, Oakland and
_____________________________________ Macomb counties, provide same-day appointments. For
Adding value for employees and aligning more information click here.
the healthcare and insurance sides of our
organization Walk-In Clinic
When it’s not an emergency, but you need to be
Henry Ford employees are also healthcare consumers seen today, Henry Ford Walk-In Clinics treat patients
and we know they are looking for the best value. At of all ages. For more information and to find a location
the same time, HFHS and HAP are working on how click here.
to better align services as part of an overall growth
strategy. Changes in the medical plan options aim to Urgent Care
increase the healthcare value employees receive. We When the unexpected happens and you need
are also encouraging all employees to use Henry Ford medical care quickly, Henry Ford’s certified urgent care
providers and facilities, and be insured by HAP. This is a locations allow you to get in, get out and feel better
win-win because: fast. Urgent care is a convenient option, for all ages,
• Patients (employees), will receive better continuity to treat non-threatening illnesses or injuries. To find a
of care and a broad range of services. location click here.
• HFHS, HAP and by extension, employees, will benefit
from a strong business model. QuickCare Clinic
Located in downtown Detroit, this walk-in health
Henry Ford has an extensive presence in Southeastern boutique clinic caters to busy professionals who live
Michigan and beyond, including: or work in the city. Board certified nurse practitioners
• Five acute care hospitals at the clinic treat minor illnesses and injuries, perform
• 200 care sites basic lab tests, administer vaccinations and much more.
For more information click here.
• More than 20 retail pharmacies
• More than 2,000 physicians
This large geographic footprint makes it easy to access
the following services.
HFHS Pharmacies
Employees and their family members enrolled in any
of the medical plans provided by HFHS will continue to
pay reduced co-pays for their prescriptions filled at a
Henry Ford Pharmacy. To find a pharmacy click here.

ADDITIONAL PERKS The journey is different for everyone and we want to
make sure there are initiatives, programs and series
eVisits that meet your needs. Learn more about wellness
eVisits with a primary care doctor and select programs available to all employees.
specialists conducted through MyChart for non-
emergency care. HFHS Wellness Innovators
Wellness innovators are essential to creating a culture
Inside Connection of wellness at HFHS. They coordinate programming at
Inside Connection is Henry Ford’s employee referral local levels and ensure that System-wide programs have
program for accelerated appointments with Henry Ford high participation rates at each site. Are you interested
specialists for yourself, friends or family. in a session on healthy eating? How about a yoga class?
Stress management techniques? All this and more may
MyCare Advice Line be available through your wellness innovator. Review
Talk to Henry Ford providers who offer free medical the list of wellness innovators arranged by location. If
advice over the phone, 24/7, to established Henry you are interested in becoming a wellness innovator
Ford Medical Group patients regarding nonemergency (and we welcome more than one per site), email
primary care concerns. Avoid a trip to the emergency employeewellness@hfhs.org.
room for minor medical concerns. To learn more,
call 1-844-262-1949.
MyChart WELLNESS PROGRAMS BY THE NUMBERS

MyChart is tthe online health tool that provides
patients with all of their health information in one • Nearly 20,000 employees have participated in or
place for immediate access. been touched by a LiveWell WorkWell program.
• Close to 10,000 apples were handed out to
employees on National Employee Health and
Employee Wellness
_____________________________________ Fitness Day in May.
• 1,500 employees participated in recess events.
Emotional Well-Being • Close to 500 employees attended “lunch and
Managing stress, finding a healthy work/life balance learn” sessions.
and developing conflict resolution and relationship- • The first ever day conference focused on
building skills are all part of wellness. Take advantage wellness for nursing staff was offered to 200
of the many resources available through the Enhance nursing employees.
Program (formerly EAP) that can help you improve • Approximately 200 wellness innovators provided
your emotional well-being. It’s confidential and free to local programs to more than 5,000 employees in
employees. Enhance even offers a six-step program to their departments.
better manage stress. For more information click here.
Henry Ford LiveWell WorkWell

Wellness is at the core of Henry Ford Health System’s
vision statement. “Transforming lives and communities
through health and wellness – one person at a time.”
Employees learning to “live well” is important for a
number of reasons:
• If you feel good, it’s easier for you to feel good about
your work and deliver exceptional service.
• You are role modeling for your patients, your
community and your family – showing what
wellness looks like and how to get there.

Important Federal Notices Newborns’ Mothers’ Health Protection Act
_____________________________________ Group health plans and health plan issuers generally
may not, under federal law, restrict benefits for any
Women’s Health & Cancer Rights Act
hospital length of stay in connection with childbirth
The Women’s Health & Cancer Rights Act requires group
for the mother or newborn child to less than 48 hours
health plans that provide coverage for mastectomy to
following a vaginal delivery, or less than 96 hours
provide coverage for certain reconstructive services.
following a Cesarean section. However, federal law
This law also requires that written notice of the
generally does not prohibit the mother’s or newborn’s
availability of the coverage be delivered to all plan
attending provider, after consulting with the mother,
participants upon enrollment and annually thereafter.
from discharging the mother or her newborn earlier
This language serves to fulfill that requirement for 2018.
than 48 hours (or 96 hours as applicable). In any case,
These services include:
plans and issuers may not, under law, require that
a provider obtain authorization from the plan or the
• Reconstruction of the breast upon which the
issuer for prescribing a length of stay not in excess of
mastectomy has been performed,
48 hours (or 96 hours).
• Surgery/reconstruction of the other breast to produce
a symmetrical appearance,
• Prostheses, and
Summary of Benefits and Coverage (SBC) and
• Treatment for physical complications during all stages
Uniform Glossary
In addition to the detailed Medical Plan Comparison
of mastectomy, including lymphedema.
Chart on pages 13-20, a document called a Summary
of Benefits and Coverage (SBC) is also here. An SBC
In addition, the plan may not:
is a federally mandated document intended to help
• Interfere with a woman’s rights under the plan to
individuals across the nation compare health plans.
avoid these requirements, or
Each health plan is required to issue an SBC for every
• Offer inducements to the health provider, or assess
group health plan it offers. An SBC details deductibles,
penalties against the health provider, in an attempt
co-insurance and out-of-pocket limits for various
to interfere with the requirements of the law.
services in a prescribed format. A Uniform Glossary of
However, the plan may apply deductibles and co-pays
Health Coverage and Medical Terms to accompany the
consistent with other coverage provided by the plan.
SBC is also available. To view a health plan SBC and/or
the Uniform Glossary, log on to HR Connect/Benefits.
HIPAA Rights
HFHS sponsors a group health plan. As such, the
System has access to the individually identifiable health
Special Enrollment Rights
Under the federal Health Insurance Portability and
information of plan participants (1) on behalf of the plan
Accountability Act of 1996 (HIPAA), a special enrollment
itself; or (2) on behalf of the System, for administrative
period for health plan coverage may be available if you
functions of the plan.
lose health care coverage under certain conditions, or
when you acquire new dependents by marriage, birth,
The Health Insurance Portability and Accountability Act
or adoption.
of 1996 (HIPAA) and its regulations restrict the System’s
ability to use and disclose protected health information
If during open enrollment you decline enrollment for
(PHI). Protected health information means any
yourself or your dependents (including your spouse)
information relating to the past, present or future
because you have other health care coverage and later
physical or mental condition of an individual (or payment
you involuntarily lose that coverage, you may be able
thereof) that identifies the individual or can be used to
to enroll yourself or your dependents in health care
identify the individual.
coverage outside the annual open enrollment period,
provided you previously declined enrollment due to
It is Henry Ford Health System’s policy to comply fully
coverage elsewhere and you request enrollment within
with HIPAA requirements. Consequently, if you become
30 days after your other coverage ends.
a covered participant under the group health plan, you
have a right under HIPAA to receive a Notice of Privacy
If you have a new dependent as a result of marriage,
Practices for Protected Health Information.
birth, adoption or placement for adoption, you may be
To request a copy, call 855-874-7100 or email
ask_Ben1@hfhs.org.

able to enroll yourself and your dependents for health how to apply. If you qualify, you can ask the state if it
coverage outside the annual Open Enrollment period, has a program that might help you pay the premiums
provided you previously declined enrollment due to for an employer-sponsored plan.
coverage elsewhere and you request enrollment within
30 days after the marriage, birth, adoption or placement Once it is determined that you or your dependents are
for adoption. eligible for premium assistance under Medicaid or CHIP,
your employer’s health plan is required to permit you
Special Rules for Gain or Loss of Eligibility for and your dependents to enroll in the plan — as long as
Medicaid/CHIPRA you and your dependents are eligible, but not already
When you experience a change that results in a gain or enrolled. As of the date of this publication the State of
loss of eligibility for Medicaid/CHIP*, you may be able to Michigan does not participate in this program.
make certain adjustments to your benefits correlating
to your status change within 60 days.
Effective April 1, 2009, the Children’s Health Insurance

Program Reauthorization Act of 2009 (“CHIPRA”) adds two
new special enrollment events. You or your dependent(s)
will be permitted to enroll or cancel your medical
coverage in either of the following circumstances:
1. You or your dependent’s Medicaid or state Children’s

Health Insurance Program (“CHIP”) coverage is
canceled due to a loss of eligibility. You must go
online to Employee Self Service within sixty (60) days
from the date you or your dependent loses coverage
and make this change.
2. You or your dependent(s) enrolls in Medicaid or

the state CHIP. You may cancel your HFHS provided
medical coverage within 60 days of your or your
dependent’s coverage effective date by going online
to Employee Self Service to make this change.
For further details on Medicaid or Michigan’s CHIP

program, call the Michigan Department of Community
Health at 888-988-6300 toll-free.
*The state Children’s Health Insurance Program in

Michigan is called MIChild.
Medicaid and the Children’s Health Insurance

Program (CHIP)
If you are eligible for health coverage from your
employer, but are unable to afford the premiums, some
states have premium assistance programs that can
help pay for coverage. (For a list of participating states,
visit dol.gov/ebsa/chipmodelnotice.doc) If you or your
dependents are not currently enrolled in Medicaid or
CHIP, and you think you or any of your dependents might
be eligible for either of these programs, you can contact
your state Medicaid or CHIP office, or you may contact
1-877-KIDS NOW or visit insurekidsnow.gov to find out

Events Permitting Mid-Year Election Changes Consistent with Event
IRS Qualifying Event* Explanation of Event Medical/Vision and Dental Health Care/Day Care Life, Accidental Death & Dependent Life
Flexible Spending Dismemberment, Long
Accounts Term Disability
Marriage This event allows you to You may: You may: You may: You may:
add your new spouse within Enroll Enroll Increase coverage Enroll
30 days of your marriage. Add spouse Increase Coverage Decrease coverage Increase coverage
Stepchildren may be added. Change Option Decrease Coverage Opt Out Decrease coverage
Proof is required. Opt Out Opt Out Opt Out
You may not:
Enroll

Divorce, legal This event allows you to You may: You may: You may: You may:
separation/annulment remove your spouse within Remove Spouse and Enroll Increase coverage Enroll
or death of spouse 30 days of the event. Proof is dependents Increase coverage Decrease coverage Increase coverage
required. Enroll Decrease coverage Opt out Decrease coverage
Change Option Opt out Opt Out
You may not:
You may not: Enroll
Opt out

Birth, Adoption, This event allows you to add You may: You may: You may: You may:
Placement for your newborn child or newly Enroll Enroll Increase coverage Enroll
Adoption of a child or adopted child within 30 days Add dependent Increase coverage Decrease coverage
gain stepchild(ren) of the event. Proof is required. Change Option Opt out You may not
You may not: Increase coverage
You may not: Decrease coverage You may not: Decrease coverage
Remove dependents Opt out Enroll Opt Out
Opt out

Death of Dependent This event allows you to You may: You may: You may: You may:
remove your dependent within Remove dependent Decrease coverage Increase coverage Decrease coverage
30 days of the event. Proof is Change Option Opt out Decrease coverage Opt Out
required. Opt out
You may not: You may not: You may not:
Enroll Enroll You may not: Enroll
Add dependents Increase coverage Enroll Increase coverage
Opt Out

Other eligible This event allows you to add a You may: You may: No changes are allowed No changes are
dependents sponsored dependent to your Add your sponsor dependent Enroll allowed
(Aged Parents) existing medical coverage Increase limit
only within 30 days of the You may not:
event. Proof is required. Enroll You may not:
Add other dependents Decrease limit
A sponsored dependent must Remove other dependents Opt Out
be an IRS dependent such as Opt Out
a parent or adult child who Make any changes to dental
lives with you and is claimed coverage
on your Federal Income Tax.

Employee changes This event allows you to enroll Part to Full time: No changes are allowed You may: You may:
status in medical/vision or dental if You may: Increase coverage Increase coverage
your status changes from part Enroll Decrease coverage Decrease coverage
Part time to full time time to full time. You are now
eligible to receive credits. You You may not: You may not: You may not:
have 30 days to make your Opt out Enroll Enroll
elections. Opt Out Opt Out

Full time to part time For status changes from full Please see event for Please see event for Please see event for Please see event
time to part time, please see Significant
Cost Changes Significant Cost Changes Significant Cost Changes for Significant Cost
event for Significant Cost Changes
Changes

Employee now You are no longer eligible for You may: You may: You may: You may:
ineligible for benefits active benefits. All benefits Elect COBRA continuation Elect COBRA continuation Conversion rights are Conversion rights
will be canceled and COBRA Active coverage will be Active coverage will be available are available
or conversion rights will be cancelled cancelled Active coverage will be Active coverage
provided. cancelled will be cancelled
You may not: You may not:
Enroll in active benefits Enroll in active benefits You may not:
Continue COBRA You may not: Enroll in active
coverage for dependent Enroll in active benefits benefits
care FSA
* Changes must be made within 30 days of the life event.


Events Permitting Mid-Year Election Changes Consistent with Event (continued)
Employee rehires This event allows you to You may: You may: You may: You may:
within 30 days be reinstated in your prior Have your prior elections Have your prior elections Have your prior elections Have your prior
elections within 30 days of reinstated reinstated reinstated elections reinstated
your rehire.
You may not: You may not: You may not: You may not:
Make changes to prior Make changes to prior Make changes to prior Make changes to
elections elections elections prior elections

Employee rehires This event allows you to enroll You may: You may: You may: You may:
after 30 days in all of your benefits as a new Enroll Enroll Enroll Enroll
hire within 60 days of your
rehire.
Spouse/Dependent This event allows you to You may: You may: You may: No changes are
now eligible for their change some of your options Remove
dependents who now Decrease
coverage Increase
coverage allowed
employer’s plan within
30 days of being have other coverage Opt Out Decrease coverage
covered under your spouse/ Opt out if covered by spouse/
dependent employer’s plan. dependent’s plan You may not: You may not:
Proof is required. Enroll Enroll
You may not: Increase limit Opt out
Enroll
Add dependents

Spouse/Dependent or This event allows you to You may: You may: You may: You may:
HFHS employee* lose change some of your options Enroll Enroll Increase coverage Increase coverage
eligibility for their within 30 days, due to your Add dependents who lost Increase limit Decrease coverage Decrease coverage
employer’s plan spouse/dependent losing coverage
coverage through their You may not: You may not: You may not:
employer’s plan. Losing You may not: Decrease limit Enroll Enroll
coverage does not mean Remove dependents Opt Out Opt out Opt out
voluntarily opting out of Opt Out
coverage. Proof is required.

In rare situations, an HFHS
employee may waive
coverage because they are
employed and have full time
benefits elsewhere. If the
employee loses their eligibility
through that employer, they
would be entitled to enroll in
all of the HFHS benefits listed
in this chart. Proof is required

Change in Residence This event allows you to You may: No changes are allowed No changes are allowed No changes are
or Worksite of change your medical/vision Change option allowed
employee, spouse or or dental coverage, within
dependent that causes 30 days, because you or a You may not:
eligibility or loss of dependent moved out of the Enroll
eligibility service area (as defined by Add dependents
the insurance contract.) Remove Dependents
Opt Out

Significant cost This event allows you to You
may: No changes are allowed You may: You may:
changes change certain benefits, Switch to less costly option Decrease coverage Decrease coverage
For HFHS Employee within 30 days, due to your Remove dependents Opt Out Opt Out
status change from full time to
part time. The loss of credits You may not: You may not: You may not:
results in a cost change to Enroll Enroll Enroll
you. Add dependents Increase coverage Increase coverage
Opt Out

Employee begins This event allows you to You
may: You may: You may: You may:
FMLA Leave change certain benefits within Change Option Enroll Enroll Enroll
30 days as a result of your Opt Out Increase limit Increase coverage Increase coverage
FMLA leave. Decrease limit Decrease coverage Decrease coverage
You may not: Opt Out Opt Out Opt Out
Enroll
Add dependents
Remove dependents


Events Permitting Mid-Year Election Changes Consistent with Event (continued)
Employee returns from This event allows you to You may: You may: You may: You may:
FMLA Leave change certain benefits within Enroll if coverage was Enroll if coverage was Enroll if coverage was Enroll if coverage
30 days that were terminated terminated while on FMLA terminated while on FMLA terminated while on FMLA was terminated
as a result of your FMLA leave. Change option while on FMLA
You may not: You may not:
You may not: Enroll if coverage was not Enroll if coverage was not You may not:
Enroll if coverage was not terminated while on FMLA terminated while on FMLA Enroll if coverage
terminated while on FMLA was not terminated
Add dependents while on FMLA
Remove dependents
Opt Out
Special Enrollment This event allows you to enroll You may: No changes are allowed No changes are allowed No changes are

Rights Under HIPAA in medical coverage, within Enroll in medical/vision only allowed
Loss of other coverage 30 days, even though you Add dependent(s)
or acquisition of new previously opted out. Eligibility
dependent to enroll is contingent on You may not:
adding a newborn or adding Enroll in dental
a dependent that recently lost Opt out of dental
coverage. Losing coverage
does not mean voluntarily
opting out of coverage. Proof
is required.

Judgment, Divorce or This event allows you to You may: You may: No changes are allowed No changes are

Medical Child Support enroll your dependent, within Add dependent as a result of Elect if Order requires allowed
Order 30 days, as a result of a the Order Increase limit if Order
Require coverage Judgment, Divorce or Medical requires
for child(ren) under Child Support Order. Proof is You may not:
employee’s plan required. Add dependents not part of You may not:
the Order Decrease limit
Remove dependents Opt Out
Change option
Opt out
Coverage required This event allows you to You may: You may: No changes are allowed No changes are
under spouse’s plan remove your dependent Remove
dependent Decrease limit allowed
within
30 days because your Opt out
dependent is now enrolled You may not:
under your spouse’s plan. Enroll You may not:
Proof is required. Add dependent Enroll
Change option Increase limit
Opt out
Entitlement to This event allows you to You may: You
may: No
changes are allowed No changes are
Medicare/Medicaid remove you or your dependent Remove dependent Decrease limit allowed
that is now eligible for Opt out Opt out
Medicare or Medicaid within
30
days of becoming eligible. You may not: You may not:
Proof is required Enroll Enroll
Add dependent Increase limit
Change option
Loss of Medicare/ This event allows you to enroll You may: You may: No changes are allowed No changes are
Medicaid eligibility your dependent that is no Enroll in medical/vision only Enroll allowed
longer eligible for Medicare Add dependent to medical/ Increase limit
or Medicaid within 30 days vision only
losing eligibility. Proof is
of You may not:
required You may not: Decrease limit
Change option Opt Out
Remove dependents
Opt Out



choose a primary care physician (PCP) from the
Important Terms network of providers who they will see for routine
__________________________________________________________________________
medical care. This physician will ensures that
members receive the most appropriate and efficient
• Comparison Chart – A chart that allows you to care available. There are no out-of-network benefits
compare the medical, vision or dental plans available to available to members except for treatment of
you. emergency medical conditions. However, he network
is much broader.
• Confirmation statement – A statement available online
to confirm the selections you made. • Flexible spending accounts (FSAs) – There are two
types of FSA accounts. The health care FSA allows
• Consumer-driven health plan (CDHP) – A health plan an employee to contribute pretax dollars to pay for
that has higher deductibles and lower employee medical expenses not covered under the plan. The
contributions. The plan requires a member to meet dependent care FSA allows an employee to use pretax
their deductible before any benefits are paid by the dollars to pay for dependent care expenses for a child
plan. Only preventive care is covered before meeting or other dependent. Money not used by a certain date
the deductible. A CDHP is sometimes referred to as is forfeited.
a consumer-directed health plan or a qualified high
deductible health plan. The terms are interchangeable • Full time employee eligibility – Employees regularly
and refer to the same type of plan. scheduled to work 72 to 80 hours every two weeks
may participate in the My Choice Rewards program.
• Coinsurance – The percentage you pay (20%, for Full-time employees receive credits to assist in
example) toward the cost of a health care service. purchasing accidental death and dismemberment
insurance and long-term disability insurance.
• Copayment – The percentage or flat dollar amount of
covered expenses you must pay. • Health assessment (HA) – The health assessment
is one of the requirements to qualify for a reduced
• Credits – A pool of dollars full-time employees receive employee contribution as part of Reward Your Health
to use toward the purchase of accidental death and (formerly Health Engagement). All employees and
dismemberment insurance and long-term disability their spouses enrolled in a HAP medical plan through
insurance. HFHS are required to complete the online health
assessment starting Jan. 1 through July 31.
• Deductible – The expense you incur before the plan or
insurance carrier begins paying your covered expenses. • Health engagement – This program has been
redesigned for 2018 and is now Reward Your Health.
• Effective date – All benefits are effective as of Jan.
1 for employees making their elections during open • Health maintenance organization – A type of health
enrollment. For employees enrolling outside of open insurance plan that usually limits coverage to care
enrollment, benefits are effective first of the month from doctors who work for or contract with the HMO.
following their date of hire or qualifying life event. You are required to select a primary care provider
(PCP) who coordinates the member’s care and refers
• Evidence of insurability (EOI) – This is an application the member to a specialist when medically necessary.
process that you provide information on the condition A HMO generally won’t cover out-of-network care
of your health or your spouse’s health in order to be except in an emergency. A HMO may require you
considered for certain types of employee or dependent to live or work in its service area to be eligible for
life or disability insurance coverage if you did not enroll coverage. HMOs often provide integrated care and
in coverage when first eligible or you want to increase focus on prevention and wellness.
your coverage. The insurance company (not HFHS)
determines your eligibility for this coverage. • Heath savings account (HSA) – An account created
for employees who are covered on a CDHP to save
• Exclusive Provider Arrangement (EPA) - An Exclusive for medical or dental expenses that CDHPs or dental
Provider Arrangement (EPA) is similar to a Health
Maintenance Organization or HMO. Members must

plans do not cover. Contributions (pretax) are made • Price tag – This is the cost to you for the each benefit
by the employee and/or employer and are limited to a and coverage level you select.
maximum amount each year. Contributions carry over
each year and can be invested over time. The HSA is • Primary care provider (PCP) – The doctor you
portable between employers and even into retirement. designate from the EPA or HMO participating network
to coordinate all of your medical needs, including
• In-network – A doctor or facility that participates in referrals to a specialist.
the EPA, HMO or PPO plan and has agreed to a reduced
fee schedule which lowers your out-of-pocket costs. • Qualification period – The period of time from Jan. 1
through July 31 when you and your covered spouse
• Options – The choices you have in each benefit area. enrolled in one of the HAP medical options provided
by HFHS will need to (1) know your numbers (BMI,
• Out-of-network – A doctor or facility not part of the blood pressure, cholesterol, fasting blood glucose), (2)
EPA, HMO or PPO plan network. Generally services are take your online health assessment, (3) be tobacco
either not covered or covered at a lower percentage free, (4) complete a wellness activity and (5) commit
than if your doctor were in network. Using out-of- to complete all recommended preventive screenings.
network physicians or facilities increases your out-of- Completing these requirements will provide you with
pocket costs. lower employee contributions toward the cost of your
HAP medical coverage and/or funding to a HSA in the
• Out-of-pocket maximums – The most you would following year.
pay in a plan year for eligible medical expenses,
excluding deductibles. Once you meet the out-of-pocket • Reward Your Health – A new wellness program that
maximum, the plan pays 100%. was redesigned to replace Health Engagement.
• Part-time employee eligibility – Employees regularly • Spouse surcharge – An additional pretax charge
scheduled to work 40 hours every two weeks may assessed to an HFHS employee who covers their
participate in the My Choice Rewards program. Part spouse who is also eligible for medical cover through
time employees do not receive credits. They have their non-HFHS employer.
the same medical, vision and dental options as full
time employees and may purchase reduced levels of • Wellness reward – The reward you will receive for
accidental death and dismemberment insurance, long- you and your spouse completing the requirements of
term disability and life insurances. Reward Your Health by the qualification deadline of
July 31. Currently the reward is a lower contribution
• Personal enrollment summary – This online form toward the cost of your medical premiums and/or
displays your current coverage, available benefit funding to a HSA.
options, and price tag for each option. The online
summary will guide you through your online benefits
enrollment.
• Plan year – The My Choice Rewards plan year is Jan. 1

through Dec. 31. Each fall, you will make your selections
for the following plan year.
• Preferred provider organization (PPO) – A type of

managed care plan that gives you the choice to obtain
medical services from a network or non-network
provider. You make the decision at the time you need
medical care. In a PPO, the doctors and hospitals have
agreed to provide medical services at a reduced cost.
Generally, you will receive a higher level of coverage if
you receive care in-network.

HAP Insurance Booklet 2018

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HAP Insurance Booklet 2018

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MY CHOICE REWARDS 2018

Important Contact Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

1 2018 MY CHOICE REWARDS

Health Alliance Plan / Alliance Health and Life. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 866-766-4709

Blue Cross/Blue Shield of Michigan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 877-790-2583

Delta Dental Plan of Michigan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-524-0149

CIGNA Group Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-238-2125

CIGNA Disability Management Solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-362-4462

CIGNA Group Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-238-2125

Health Equity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 866-346-5800

2018 MY CHOICE REWARDS 2

3 2018 MY CHOICE REWARDS

2018 MY CHOICE REWARDS 4

• If your sponsored dependent is Medicare eligible,

MIDYEAR LIFE EVENTS

5 2018 MY CHOICE REWARDS

2018 MEDICAL PLAN CHANGES

FORMER HFHS FORMER FULL

THE TWO PLANS ARE NOW ONE PLAN...

2018 MY CHOICE REWARDS 6

2018 MY CHOICE REWARDS 8

By selecting the CDHP Comprehensive HFHS Preferred

9 2018 MY CHOICE REWARDS

1. Know your numbers (BMI, blood pressure, cholesterol,

2018 MY CHOICE REWARDS 10

• Message with your Henry Ford physician’s office

11 2018 MY CHOICE REWARDS

CDHP Comprehensive CDHP Comprehensive

Save time and hassles. Go paperless with HAP.

2018 MY CHOICE REWARDS 12

Health Care Services CONSUMER DRIVEN HEALTH PLAN (CDHP)

13 2018 MY CHOICE REWARDS

Limited to Applied Behavioral Analysis

*Alliance Health and Life Insurance Company

CHECK OUT ALEX

2018 MY CHOICE REWARDS 14

15 2018 MY CHOICE REWARDS

Health Care Services CONSUMER DRIVEN HEALTH PLAN (CDHP)

Limited to Applied Behavioral Analysis

2018 MY CHOICE REWARDS 16

None 30% Deductible applies to the annual Out-of-

These values do not accumulate.

17 2018 MY CHOICE REWARDS

Limited to Applied Behavioral Analysis

2018 MY CHOICE REWARDS 18

Benefit Period and Annual Deductible

$6,850 Individual; $6,850 Individual;

Hospital Inpatient stay in semi-private room,

19 2018 MY CHOICE REWARDS

Benefit Period and Annual Deductible

2018 MY CHOICE REWARDS 20

1. Log onto www.hap.org

Final Oct. 09, 2017

21 2018 MY CHOICE REWARDS

Covered up to $40; Covered up to $40;

2018 MY CHOICE REWARDS 22

2018 Vision2018 VISION

Our Commitment to Affordability

Final Oct. 09, 2017

23 2018 MY CHOICE REWARDS

2018 MY CHOICE REWARDS 24

Dental Plan Comparison Chart

Delta Basic Delta Comprehensive

Deductible $25 Single; $50 Family $25 Single; $50 Family