Benefits FAQs Updated 7.17.2023 1 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
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Don't see an answer to your question? Submit an AskHR case or contact People Services at
844.776.6947.
Comprehensive plan documents, including the Employee Benefits Guide, Summaries of Benefits and
Coverage (SBCs) and Summary Plan Documents (SPDs) are available at ssmhealth.com/benefits.
Table of Contents
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BENEFITS ELIGIBILITY & ENROLLMENT ..................................................................................2
GENERAL BENEFITS INFORMATION ........................................................................................5
MEDICAL PLANS .........................................................................................................................6
DISCOUNTED MEDICAL PREMIUMS ....................................................................................... 10
PHARMACY BENEFITS ............................................................................................................. 12
DENTAL PLANS ......................................................................................................................... 13
VISION PLANS ........................................................................................................................... 15
FLEXIBLE SPENDING AND HEALTH SAVINGS ACCOUNTS .................................................. 17
RETIREMENT ............................................................................................................................ 21
SHORT AND LONG-TERM DISABILITY .................................................................................... 24
LIFE INSURANCE ...................................................................................................................... 26
ADDITIONAL LIFESTYLE BENEFITS ........................................................................................ 27
PAID TIME OFF (PTO) ............................................................................................................... 28
TUITION BENEFIT ..................................................................................................................... 32
ADOPTION ASSISTANCE ......................................................................................................... 34
EMPLOYEE ASSISTANCE PROGRAM (EAP) .......................................................................... 35
VOLUNTARY BENEFITS – BENEFITS PLUS ........................................................................... 36
WELLNESS BENEFITS .............................................................................................................. 37
BENEFITS AT SEPARATION OR STATUS CHANGE ............................................................... 38
GLOSSARY OF TERMS ............................................................................................................ 39
2023 Benefits
Frequently Asked Questions
Benefits FAQs Updated 7.17.2023 2 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
BENEFITS ELIGIBILITY & ENROLLMENT
Q. Am I eligible for benefits?
A. You are eligible for benefits if you have an employment status of at least 50% FTE (you are
regularly scheduled to work at least 40 hours per pay period). You are full-time benefits-eligible if
you are regularly scheduled to work 64 or more hours per pay period. You are part-time benefits-
eligible if you are regularly scheduled to work 40 to 63 hours per pay period.
Q. When are benefits effective?
A. Providing you enroll within 31 days, new hires who are benefit-eligible will receive benefits the
first day of the month coinciding with or following the hire date (start date). For example, if your
hire date is June 15, your benefits will be effective on July 1. If your hire date is June 1, your
benefits will be effective on June 1.
If you have a status change and move into a benefit-eligible position from a non-benefit-eligible
position, your benefits will be effective on the date of your status change (unless you have not yet
fulfilled the new-hire waiting period).
Q. When can I enroll in benefits?
A. If you are a new hire who is benefit-eligible, you have 31 days from your date of hire to enroll in
benefits. Benefit enrollment is part of the onboarding process and you will complete your
enrollment in Workday. On your start date, you will receive an additional inbox item to enroll in
Benefits. Use this item to make your selections within the first 31 days.
If you have a status change and move into a benefit-eligible position from a non-benefit-eligible
position, you have 31 days from the date of your status change to enroll in your benefits. Once
your status change is processed, you will receive an inbox item to enroll in Benefits through
Workday.
Q. How do I stop my benefits?
A. Generally speaking, if you do not have a qualifying event, you will need to wait to make benefit
changes for the next plan year during the annual open enrollment period that is held each Fall.
Note: retirement and health savings account contributions may be changed at any time. If you
have a qualifying event during the plan year, you may be allowed to change your benefit
elections. Submit your benefit changes and supporting documentation within 31 days of the
qualifying event through the Benefits app in Workday.
Q. Can I make changes to my benefits?
A. Generally speaking, if you do not have a qualifying event, you will need to wait to make benefit
changes for the next plan year during the annual open enrollment period that is held each Fall.
Note: retirement and health savings account contributions may be changed at any time. If you
have a qualifying event during the plan year, you may be allowed to change your benefit
elections. Submit your benefit changes and supporting documentation within 31 days of the
qualifying event through the Benefits app in Workday.
Q. Are my dependents eligible for benefits?
A. If you are a benefits-eligible employee, you may also choose to cover your eligible dependents.
Eligible dependents include your child(ren) up to the age of 26, your spouse and/or Legally
Domiciled Adult (LDA), and the dependent children of an LDA. If you have a child who is
disabled, you may be eligible to have continued coverage for them – even after they reach age
26. Note: eligible children include your natural child, stepchild, legally adopted child, child placed for
adoption, foster child, or any child for whom you have been appointed as a legal guardian.
Benefits FAQs Updated 7.17.2023 3 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
Q. How do I add my newborn to my benefits?
A. Congratulations on the birth of your child! You may add your child within 31 days of the date of
birth. The date of birth is the qualifying event so coverage will be effective as of the date of birth,
as long as you submit the enrollment within 31 days. To make a benefits election change, click
on the Benefits app in Workday, and select Change Benefits. Check your SSM Health email and
Workday inbox regularly as any requests for additional information will be sent there.
Note: you should not wait until your dependent has a Social Security Number (SSN) or birth
certificate as it may be past the 31-day qualifying event window. In the Benefits App, simply enter
all 1’s or all 9’s when you are asked for the Social Security Number. Once you receive the Social
Security Number, you can go back into Workday and provide that information.
Proof of Birth: You may submit a picture of the bassinet/baby foot print card from the hospital or
hospital discharge papers that list the baby’s name, gender and date of birth as proof of birth.
If you are gaining eligibility for premium assistance under Medicaid/CHIP, you have 60 days to
enroll in the medical plan. Also, in accordance with state law, employees residing in Wisconsin
may add a newborn within 60 days from the date of birth.
Q. My child is over the age of 26 and still needs benefit coverage. What are my options?
A. Coverage for your child will end on the last day of the month in which they turn 26. You will
receive a COBRA packet in the mail that offers your child the opportunity to continue their
coverage. Once your child is 26 or older, you may cover them on your health plans (medical,
dental, and/or vision) as a Legally Domiciled Adult (LDA). To qualify as an LDA, your child must
be residing in the same household as you. Reminder: you may only cover one adult on your
plan(s) at a time. If you are currently covering your Spouse or another LDA, you will not be able
to also cover your child as an LDA.
Q. What is a Legally Domiciled Adult (LDA)?
A. An LDA is an adult who is not a spouse or a child under the age of 26, is a member of your
household (but not your employee) and resides at the same address as you. There are tax
implications if you cover an LDA who is not listed as a dependent on your federal tax return.
Click here for more information about covering an LDA.
Q. When can I enroll a Legally Domiciled Adult (LDA)?
A. If you do not cover a spouse on any of your health plans, you may cover a legally domiciled adult
(LDA). You may add/remove an LDA within 31 days of a qualifying event (for example, the date
the LDA moves in/out of your residence). Click here for more information about covering an LDA.
Q. When can I enroll my dependents?
A. You may enroll your dependents during your new hire enrollment period, the annual open
enrollment period held each Fall or within 31 days of a qualifying event. Submit your enrollment
and supporting documentation within 31 days of the qualifying event through the Benefits app in
Workday.
If your dependent loses coverage under Medicaid or the Children’s Health Insurance Program
(CHIP), you have up to 60 days to enroll them in your benefits.
Q. How do I enroll my dependents?
A. Submit your enrollment and supporting documentation through the Benefits app in Workday.
Benefits FAQs Updated 7.17.2023 4 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
Q. What is a qualifying event?
A. A qualifying event is a change in your situation that makes you eligible to enroll in benefits outside
of the annual open enrollment period. Examples of a qualifying event include: marriage, divorce,
birth, adoption, death, loss or gain of other insurance coverage, or change in employment status
or benefits eligibility. IRS guidelines limit the type of election change that can be made following
each type of qualifying event.
Benefits FAQs Updated 7.17.2023 5 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
GENERAL BENEFITS INFORMATION
Q. How do I receive benefits information? Who do I contact with questions about my benefits?
A. Benefits information is shared through our normal channels including Workday, your SSM Health
email, MyNews, and the ssmhealth.com/benefits site. Please remember to check your SSM
Health email and Workday Inbox often for important information about your benefits and
other human resources policies and programs.
For assistance with your benefit questions, Submit an AskHR case or contact People Services
at 1-844.776.6947.
Q. How are benefit premiums deducted from my pay?
A. Deductions for premiums and other employee contributions are taken each bi-weekly pay period
(26-pay periods per year). For example, if you enroll in a plan with a monthly premium of $100,
your bi-weekly premium will be calculated as follows:
$100 per month = $1,200 per year
$1,200 divided by 26 pay periods = $46.15 deduction per pay period
Q. How much am I paying for benefits?
A. Click on the Benefits App in Workday to view the cost of your current benefit elections. You may
also see your benefit deductions on your pay slip. Benefit costs are also published in the
Employee Benefits Guide (Benefits Booklet).
Q. I have enrolled in my benefits. When will I receive my insurance cards?
A. Enrollment data is uploaded to insurance carriers on a weekly basis. You should receive your
insurance cards within 2 weeks of date you submitted your enrollment. If you have an urgent
issue and need your insurance information immediately, contact People Services at 1-
844.776.6947.
Q. I still haven’t received or lost my new health insurance card. How can I get a new one?
A. You may request replacement insurance cards by contacting the insurance vendor. You are
encouraged to visit each vendor website and set up an online account where you may request
replacement cards and access helpful resources. Contact information for each insurance vendor
is available in the Employee Benefits Guide (Benefits Booklet).
Q. I recently moved. Do I need to change my address with Benefits for my insurance?
A. Enrollment data is uploaded to insurance carriers on a weekly basis. Make sure your address
and contact information is up-to-date in Workday and that information will be automatically
updated with each insurance vendor.
Q. I just had a name change. Do I need to change my name with Benefits for my insurance?
A. Enrollment data is uploaded to insurance carriers on a weekly basis. Make sure your legal name
is up-to-date in Workday and that information will be automatically updated with each insurance
vendor. Contact People Services at 1-844.776.6947 for assistance in updating your legal name.
Benefits FAQs Updated 7.17.2023 6 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
MEDICAL PLANS
Q. Who administers the Medical Plan?
A. The SSM Health Employee Medical Plan is administered by WellFirst Health. You may
reach them by phone at 877.274.4693.
Q. How do I get my medical insurance card?
A. WellFirst Health will send your medical/pharmacy card to your home address. Contact WellFirst
Health at 1.877.274.4693 or visit wellfirstbenefits.com/employees if you need additional cards.
Q. What are my Medical Plan options?
A. All SSM Health benefit-eligible employees may choose from three medical plan options:
• WellFirst Plus option ($400 individual deductible)
• WellFirst Base option ($1,000 individual deductible)
• WellFirst Health Savings option ($1,500 individual deductible, works in conjunction with an SSM
Health-funded Health Savings Account)
You may elect one of four coverage tier options:
• Employee Only
• Employee + Spouse/Legally Domiciled Adult (LDA)
• Employee + Child(ren)
• Employee + Family
Q. Is there a limit to the number of children I can add on the employee + child(ren) tier?
A. No, there is no limit to the number of eligible children you may cover.
• Your child(ren) up to age 26: biological, foster, adopted, step or legal guardian
• Disabled child(ren) age 26 or older (documentation required)
• Dependent child(ren) of an LDA up to age 26
Q. How much do I pay for medical coverage?
A. SSM Health reviews the costs of the employee health plans and options each year and is
committed to ensuring affordable health care is available. Medical plan premiums are listed in the
Employee Benefits Guide (Benefits Booklet) posted at ssmhealth.com/benefits.
Q. What is the surcharge for covering my spouse/LDA in the SSM Health Medical Plan? Why is it
charged?
A. The surcharge is $150 per month and deducted in the amount of $69.23 per pay period. This
surcharge helps offset the additional cost to SSM Health for covering an adult on your Medical
Plan, when the adult already has an offer of coverage elsewhere.
You may qualify for a surcharge waiver, if your spouse/LDA is:
• Employed by SSM Health.
• Self-employed or unemployed.
• Retired with no other group medical coverage available.
• Eligible for Medicare, Medicaid or Tri-Care, with no other medical coverage available.
• Employed, but not offered medical coverage or the medical coverage offered does not meet the ACA affordability
standard.
If your spouse/LDA meets any of these criteria, you may waive the surcharge when you enroll.
Benefits FAQs Updated 7.17.2023 7 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
Q. What providers and facilities can I use?
A. Visit wellfirstbenefits.com/employees to view the provider directory. The SSM Health Network
remains the primary provider network for plan members.
In our Mid-Missouri and Oklahoma regions where there are fewer local SSM Health Network
options for care, members may access providers in a Secondary Network; however, higher
deductibles, coinsurance, copays and out-of-pocket maximums may apply.
If you or your dependents live outside the WellFirst Health service area, you may apply to have
your medical services covered through out-of-area coverage and the First Health network.
Q. Can I use a WellFirst Health provider who is not in my region?
A. Yes, you may use a WellFirst Health provider at any of our locations. For example, if you are an
employee in the Mid-Missouri region and you choose to use a WellFirst Health provider in St.
Louis, the benefit is the same as if you use a WellFirst Health provider in Mid-Missouri.
Q. What if my provider or facility is not part of the SSM Health WellFirst Health network?
A. You may contact WellFirst Health Customer Care Center at 877-274-4693 and ask for assistance
in transitioning to a new provider or to work with medical management if you have special
circumstances. Generally speaking, the transition of care needs to be completed within two
weeks of employment. Visit wellfirstbenefits.com/employees to find an in-network provider.
Q. If my region has limited SSM Health providers in the WellFirst Health network, what are my
options?
A. The SSM Health Network remains the primary provider network for plan members. In the Mid-
Missouri and Oklahoma regions where there is limited access to local SSM Health Network
options for care, you may choose to use providers in a Secondary Network, where higher
deductibles, coinsurance, copays and out-of-pocket maximums apply. The Secondary Network in
Oklahoma is available through Health Care Highways. The Secondary Network for Mid-Missouri
is available through HealthLink. Visit wellfirstbenefits.com/employees to view the Secondary
Network provider directory.
Q. How do I decide which Medical Plan option is best for me?
A. Choosing the right Medical Plan option is a personal decision. Think about:
• What kind of ongoing medical care will you and your covered family members need?
• Are you more comfortable paying a higher premium to have the lowest out-of-pocket
expenses when you need care?
• Or, would you prefer to keep your premiums lower, even though your out-of-pocket expenses
could be higher when you need care?
SSM Health provides an online Benefit Enrollment Decision Making Tool to help you compare
the Medical Plan options. Take a few minutes to enter information about your health care needs
and the tool will estimate your total costs (premiums plus out-of-pocket expenses) under each of
the Medical Plan options. It’s completely confidential and available to help you work through this
important decision.
Benefits FAQs Updated 7.17.2023 8 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
Q. What is the Deductible/Coinsurance limit? How is this different than the Annual Out-of-Pocket
Maximum?
A. If you reach the Deductible/Coinsurance Limit, you will not have to pay coinsurance for the rest of
the plan year and will only be responsible for copays until you reach your annual out-of-pocket
maximum. Once you reach the annual out-of-pocket maximum, the plan will pay 100% (including
copays). See the Employee Benefits Guide (Benefits Booklet) for information on the
Deductible/Coinsurance limit and Annual Out-of-Pocket Maximum for each medical plan option.
Q: What can I do to manage the cost of deductibles, copayments and coinsurance?
A. To help manage the cost of deductibles, copayments and coinsurance:
• Use an SSM Health Network provider or pharmacy whenever possible.
• Contribute to a Health Care Flexible Spending Account (FSA) if you choose the WellFirst Plus or
WellFirst Base option. An FSA allows you to use pretax dollars on deductibles and other out-of-pocket
medical expenses. Reminder: FSA funds are “use it or lose it”; important plan timelines apply.
• Consider selecting the WellFirst Health Savings option and contributing to a Health Savings Account
(HSA). An HSA allows you to use pretax dollars on deductibles and other out-of-pocket medical
expenses. SSM Health also contributes directly to your HSA. HSA funds do not expire.
• Focus on maintaining and improving your health through a combination of healthy diet, exercise and
sleep. With the help of your primary care physician, set up a personal plan to maintain and improve
your health. Well-being resources and discounts are available in the Well-being app in Workday.
• If you have a health condition, follow the guidelines to best manage or improve your health by taking
prescribed medications and working with your physician(s).
Q. If my spouse or dependent child lives outside of the SSM Health service area, how will the
Medical Plan cover them?
A. If you or a covered family member is residing outside of the SSM Health service area, you may
apply to have your Medical Plans covered as out-of-area. Any eligible out-of-area member,
regardless of region, has access to the nationwide First Health network. To find out more or
search for providers visit First Health. Visit wellfirstbenefits.com/employees to view eligible zip
codes and to complete the out-of-area certification forms.
Q. Do I have medical coverage when I am traveling?
A. Yes. WellFirst Health members are covered for emergency care worldwide. If you need
emergent care outside the service area and are unable to get to a plan provider, please go to the
nearest emergency center for treatment. Notify WellFirst Health as soon as possible by calling
1.877.274.4693. All follow-up care provided by a non-plan provider requires approval by
WellFirst Health.
Q. Is there a Virtual Visit option?
A. Yes. Online virtual visits are a quick, affordable and convenient way to connect with trusted SSM
Health providers and receive treatment for common, non-urgent medical conditions from the
comfort of your own home. Visit www.ssmhealth.com/virtualvisit for more information. Two
options are available: video visits and e-visits. Note: you will need to set up an SSM Health
MyChart account before scheduling a video visit.
Benefits FAQs Updated 7.17.2023 9 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
Q. What is MyChart?
A. MyChart is your one-stop-shop for all your health care needs. You may access your patient
records and test results, communicate with your doctor, schedule appointments and video visits,
request prescription refills, pay your medical bills and more! Visit www.ssmhealth.com/mychart
for more information and to sign up for MyChart.
Q. Does SSM Health offer a Wellness Program?
A. Yes. SSM Health is establishing a new Wellness Program for all regions and health ministries.
More details will be forthcoming. Well-being resources and discounts are available in the Well-
being app in Workday.
Remember, many preventive and wellness services are available through your Medical Plan at no
cost to you, and as required by the Affordable Care Act (ACA).
Q. What is a 1095-C Form and will I receive one?
A. IRS Form 1095-C, “Employer-Provided Health Insurance Offer and Coverage,” is a document
SSM Health is required to send you each tax season if you were offered employer-based
health insurance coverage during the prior year.
SSM Health also sends Form 1095-C to the IRS. While this form is not required to file your
taxes, you should keep your Form 1095-C with your other important tax documents.
If you have not received your 1095-C by March, contact People Services at 1-844.776.6947.
Q. What if I need to request a duplicate copy of my 1095-C?
A. If you need additional copies of your 1095-C or a copy of a 1095-C from a previous year,
contact People Services at 1-844.776.6947.
Benefits FAQs Updated 7.17.2023 10 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
DISCOUNTED MEDICAL PREMIUMS
Q. What is the Medical Plan Contribution Discount?
A. The Medical Plan Contribution Discount program is offered to improve access to affordable health
care coverage by discounting employee contribution requirements (medical plan premiums) and
the cost of covered prescriptions. The discount is based on family size and household income as
determined by the annual Federal Income Guidelines and as reported on your Federal Income
Tax Return.
Q. How do I know if I am eligible?
A. Refer to the table in the Employee Benefits Guide (Benefits Booklet) to determine the level of
discount for which you may qualify. The discount level is based on your family income and
number (#) of tax dependents (plus yourself and your spouse, if married) as determined by the
annual Federal Income Guidelines and as reported on your Federal Tax Return. For the 2023
plan year, the 2021 Federal Income Tax Return(s) determine your eligibility.
Q. How much is the discount?
A. If you are full-time employee whose family income is less than 400% of Federal Income
Guidelines, you may receive a discount of 25%, 50%, 75% or 100% on your medical plan
premiums. If you are a part-time employee, you will receive the same dollar amount that a full-
time employee receives for the same election/level of discount. The discount applies to all levels
of medical coverage (Employee Only, Employee + Child(ren), Employee + Spouse/LDA or
Employee + Family).
Income as % of
Federal Income Guidelines
Premium Discount
% of Premium
Employee Pays
Less than 100%
100%
0%
100% - 199%
75%
25%
200% - 299%
50%
50%
300% - 399%
25%
75%
Review the Employee Benefits Guide (Benefits Booklet) for current federal income guidelines
and for a helpful worksheet. The worksheet helps you calculate what level of discount for which
you may qualify and the dollar value of that discount.
Q. What tax documentation is required?
A. The tax form required for verification is the Federal Tax Return filed with the IRS. Handwritten
forms, W-2s and State tax returns cannot be accepted as verification of income.
Important note: If married filing separately, you must also submit your spouse’s Federal Tax
Return for the application to be complete. If you are having difficulty obtaining your tax return(s),
you may request an official Tax Return Transcript from the IRS. Transcripts can be requested
by visiting: https://www.irs.gov/individuals/get-transcript.
Q. How do I apply for the discount?
A. Submit your application through Workday. Use the request app to complete the electronic
application and upload the appropriate tax form.
Benefits FAQs Updated 7.17.2023 11 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
Q. When can I apply for the discount?
A. You may apply for the discount within 31 days of becoming newly eligible for SSM Health
medical benefits (such as a when you are a new hire or experience a qualifying event) and
during the annual open enrollment held each Fall. Submit your application each year during
Open Enrollment to be considered for the Medical Plan Contribution Discount for the next plan
year; the discount does not automatically roll over and you must reapply for the discount each
year.
Q. How and when is the discount reflected on my check?
A. Your paycheck will reflect the full medical premium deduction. You will see a credit in the amount
of the discount in the earnings section of your pay slip. Note: The discount is only applied for pay
periods in which you also have a medical contribution (premium) deducted from your pay.
Q. If my household income or family size changes during the year, can I apply for an increased
Medical Plan Contribution Discount?
A. No. Medical Plan Contribution Discount applications are only accepted during open enrollment,
or when an employee becomes newly eligible for medical benefits. Changes in your household
income or family size will be reflected in your next year’s discount application.
Q. How does the medical plan contribution discount reduce my prescription coverage cost?
A. If you qualify for the medical discount and have elected the WellFirst Plus or WellFirst Base plan,
your prescription drug copayments for covered prescriptions filled at in-network pharmacies are
waived. If you elect the WellFirst Health Savings Option (HDHP), you will see your prescription
copays waived once you meet your deductible(s). Dependents you cover on your medical plan
also qualify for the copay waiver.
Q. How does the in-network pharmacy know that I do not have a copay?
A. The card you receive from WellFirst Health will indicate what medical plan you are in and if a
prescription copay applies to you and/or your covered dependents.
Benefits FAQs Updated 7.17.2023 12 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
PHARMACY BENEFITS
Q. Who administers the Pharmacy Benefits Plan?
A. The Plan administrator for the Pharmacy Benefits Plan is Navitus. Customer Care is provided
by Navitus at navitus.com/members or by telephone at 866.333.2757.
Q. What is my Pharmacy Benefit?
A. All WellFirst Health medical plan options include pharmacy benefits. Covered prescriptions filled
at in-network pharmacies are subject to a copay based on their “Tier”.
Q. How do I know what my drug will cost?
A. Visit navitus.com/members to view the Formulary. The Formulary shows what drugs are
covered and their “Tier”. Your copay will be based on the drug’s “Tier”. The Employee Benefits
Guide (Benefits Booklet) provides detailed information about prescription drug Tiers and
copays.
Q. What pharmacy can I use?
A. Pharmacy benefits are accessible at SSM Health Pharmacies and nationwide at most major
*pharmacies. Visit navitus.com/members for a complete list of other In-Network Retail
Pharmacies.
If you are using a small, locally-owned pharmacy, check navitus.com/members to ensure they
are an in-network pharmacy.
*NOTE: CVS, including CVS-owned Target and Schnuck’s locations, Kmart and Meijer, and
Mercy-owned Dierberg’s pharmacies are NOT In-Network.
Q. Can I use an SSM Health Pharmacy?
A. Absolutely! SSM Health Pharmacy locations offer lower copays and you are encouraged to use
their services whenever possible. A complete listing of SSM Health Pharmacies, by location, is
available in the Employee Benefits Guide (Benefits Booklet).
Q. Is there a mail-order option?
A. Yes. Mail order can be a convenience if you take a maintenance medication. You can receive up
to a 90-day supply from an SSM Health pharmacy or through your mail order provider, Costco.
Contact your local SSM Health pharmacy or start the process online at pharmacy.costco.com.
Note: you do not need to be a member of Costco in order to use the mail order pharmacy.
Q. How can I save money on prescription drug costs?
A. There are several cost-savings options.
• Use an SSM Health Network pharmacy to take advantage of lower copays
• Fill your maintenance medications for one 90-day supply instead of three 30-day supplies; you will save
one-half of a copay by doing so. See the Employee Benefits Guide (Benefits Booklet) for details on
30-day versus 90-day copays.
• Apply for the Medical Plan Contribution Discount during annual open enrollment. If you meet the
eligibility guidelines and your application is approved, your pharmacy copays will be waived.
Note: If you qualify for the medical discount and have elected the WellFirst Plus or WellFirst Base plan,
your prescription drug copayments for covered prescriptions filled at in-network pharmacies are waived. If
you elect the WellFirst Health Savings Option (HDHP), you will see your prescription copays waived once
you meet your deductible(s). Dependents you cover on your medical plan also qualify for the copay waiver.
Benefits FAQs Updated 7.17.2023 13 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
DENTAL PLANS
Q. Who administers the Dental Plan?
A. The Plan Administrator is Delta Dental of Missouri. You may reach them at 1.800.335.8266 or
visit www.deltadentalmo.com.
Q. What are my Dental Plan options?
A. All SSM Health benefit-eligible employees may choose from two dental plan options:
• Dental Plus option ($50 individual deductible/$2,000 annual maximum benefit per person)
• Dental Base option ($100 individual deductible/$1,000 annual maximum benefit per person)
You may elect one of four coverage tier options:
• Employee Only
• Employee + Spouse/Legally Domiciled Adult (LDA)
• Employee + Child(ren)
• Employee + Family
Q. Is there a limit to the number of children I can add on the employee + child(ren) tier?
A. No, there is no limit to the number of eligible children you may cover.
Q. How much do I pay for dental coverage?
A. Dental Plan premiums are listed in the Employee Benefits Guide (Benefits Booklet).
Q. Is there a surcharge for covering my spouse/LDA on the dental plan?
A. No. The surcharge only applies to covering an adult on your Medical Plan.
Q. What Dentist can I use?
A. You may choose any dentist, however the out-of-pocket costs of choosing a Delta Dental PPO
or Premier Network Provider will likely be lower than choosing a dentist outside of the Delta
Dental Network.
Q. If my spouse or dependent child does not live with me, how will the Dental Plan cover them?
A. Delta Dental of Missouri has a nationwide network of providers. Visit www.deltadentalmo.com
to view the provider directory.
Q. How do I get my dental insurance card?
A. Delta Dental of Missouri will send your dental card to your home address. Contact Delta Dental
of Missouri at 1.800.335.8266 or visit www.deltadentalmo.com if you need additional cards.
Benefits FAQs Updated 7.17.2023 14 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
Q. How do I decide which Dental Plan option is best for me?
A. Choosing the right Dental Plan option is a personal decision. Think about:
• What kind of ongoing dental care will you and your covered family members need?
• Are you more comfortable paying a higher premium to have the lowest out-of-pocket expenses when
you need care?
• Or, would you prefer to keep your premiums lower, even though your out-of-pocket expenses could be
higher when you need care?
• Do you want to have orthodontia coverage? If you do, you will want to choose the Dental Plus plan;
the Dental Base plan does not provide orthodontia coverage.
SSM Health provides an online Benefit Enrollment Decision Making Tool to help you compare
the Dental Plan options. Take a few minutes to enter information about your dental needs and the
tool will estimate your total costs (premiums plus out-of-pocket expenses) under each of the
Dental Plan options. It’s completely confidential and available to help you work through this
important decision.
Q: What can I do to manage the cost of dental care?
A. To help manage the cost of deductibles and coinsurance consider using a Delta Dental PPO
Network or Delta Dental Premier Network Dentist. You will pay less out of your pocket at a PPO
dentist and your benefits dollars stretch farther. See a helpful cost savings example located
here.
Q: How does the Dental Plan coordinate with other dental benefits I may have?
A. If you have other dental coverage, benefits under the SSM Health Dental Plan are coordinated
with that plan to avoid duplication of payment. If you have specific questions about how your
other dental plan, including orthodontia coverage, may coordinate with the SSM Health Dental
Plan, please contact Delta Dental of Missouri customer service at 1.800.335.8266.
Benefits FAQs Updated 7.17.2023 15 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
VISION PLANS
Q. Who administers the Vision Plan?
A. The Plan administrator is VSP. You may reach them at 1.800.877.7195 or visit
www.vsp.com.
Q. What are my Vision Plan options?
A. All SSM Health benefit-eligible employees may choose from two vision plan options:
• Exam Only option
• Exam + Materials option
You may elect one of four coverage tier options:
• Employee Only
• Employee + Spouse/Legally Domiciled Adult (LDA)
• Employee + Child(ren)
• Employee + Family
NOTE: If you are electing the Medical Plan, these plans will cover an annual eye exam. However, the
copay is higher, and the network of providers is limited.
Q. Is there a limit to the number of children I can add on the employee + child(ren) tier?
A. No, there is no limit to the number of eligible children you may cover.
Q. How much do I pay for vision coverage?
A. Vision Plan premiums are listed in the Employee Benefits Guide (Benefits Booklet).
Q. Is there a surcharge for covering my spouse/LDA on the vision plan?
A. No. The surcharge only applies to covering an adult on your Medical Plan.
Q. What providers can I use?
A. You may choose any provider, however the out-of-pocket costs of choosing a VSP Network
Provider will likely be lower than choosing a provider outside of the VSP Network.
Q. If my spouse or dependent child does not live with me, how will the Vision Plan cover them?
A. VSP has a nationwide network of providers. Visit www.vsp.com to view the provider directory.
Q. How do I get my Vision insurance card?
A. VSP does not send out insurance cards. You may print one from www.vsp.com or simply
provide your information to your provider at the time of service and they can verify your VSP
coverage.
Benefits FAQs Updated 7.17.2023 16 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
Q: What can I do to manage the cost of vision care?
A. To help manage the cost of deductibles and coinsurance, consider using a VSP Network
provider.
Q. How do I decide which Vision Plan option is best for me?
A. Choosing the right Vision Plan option is a personal decision. Think about:
• What kind of ongoing vision care will you and your covered family members need?
• Do you want to have coverage for lenses and frames? If you do, you will want to choose the Exam +
Materials option; the Exam Only plan does not include coverage for lenses and frames.
SSM Health provides an online Benefit Enrollment Decision Making Tool to help you compare
the Vision Plan options. Take a few minutes to enter information about your vision needs and the
tool will estimate your total costs (premiums plus out-of-pocket expenses) under each of the
Vision Plan options. It’s completely confidential and available to help you work through this
important decision.
Benefits FAQs Updated 7.17.2023 17 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
FLEXIBLE SPENDING AND HEALTH SAVINGS ACCOUNTS
Q. Who administers the Flexible Spending and Health Savings Accounts?
A. The Plan administrator for both the Flexible Spending and Health Savings Accounts is Optum
Financial. You may reach them by phone at 844.881.0124.
Q. What is a Flexible Spending Account (FSA)?
A. Flexible spending accounts give you the ability to use pre‐tax dollars to pay for qualified
medical or dependent care (child care) expenses. You choose how much money to contribute
to your FSA (within limits set by the IRS) and you choose what qualified expenses on which to
spend your FSA funds. There are two types of flexible spending accounts.
• Health Care FSA — may be used for IRS-approved expenses, including deductibles, co-pays,
prescription drugs, select dental and vision care expenses, and many other items for both yourself and
your eligible dependents.
• Dependent Care FSA — may be used to cover the costs of daycare for children or elderly dependents
so you can work.
Q. Can I elect a Health Care Flexible Spending Account (FSA) if I did not elect the medical, vision
and/or dental insurance?
A. Yes. You may elect a Health Care Flexible Spending Account even if you did not elect
medical, vision and/or dental insurance.
Q. How much can I contribute to a Flexible Spending Account (FSA)?
A. FSA funds are subject to IRS guidelines and are “use it or lose it”. Funds not used before the
end of the plan year are forfeited.
• Health Care FSA — in plan year 2023 you may contribute up to $2,850. The limit is per person; each
spouse in the household may contribute up to the limit. You must use your 2023 funds by December
31, 2023 unless you are taking advantage of the carry-over provision. If you enroll in the HCFSA for
the 2024 plan year, you may carry over up to $570 of your 2023 HCFSA funds. The minimum
balance that can be carried over is $25. Carry over funds from the 2023 plan year will be added to
your 2024 HCFSA approximately 7-10 days after the 2023 plan year has finalized on March 31, 2024.
• Dependent Care FSA — in plan year 2023 you may contribute up to $5,000 per year if you are married
and filing a joint return, or if you are a single parent. If you are married and filing separately, you may
contribute up to $2,500 per year per parent. You must use your 2023 funds by December 31, 2023.
• In accordance with non-discrimination testing requirements, highly compensated employees who earn
$135,000 or more on an annual basis are limited to $2,100 per year.
Q. How do I access my Health Care Flexible Spending Account (HCFSA) funds?
A. You will be provided with a Health Care FSA debit card that may be used for eligible health
care expenses or you may submit receipts and request reimbursement through the Optum
Financial website or mobile app.
Q. How do I access my Dependent Care Flexible Spending Account (DCFSA) funds?
A. Dependent care accounts are funded on a per pay period basis. The amount you have
elected to contribute each pay period is sent to Optum after each payday. Once you have
funds in your dependent care account, you may submit your child or elder care receipts for
reimbursement. You may submit receipts and request reimbursement through the Optum
Financial website or mobile app. Remember! You may not dependent care flexible spending
account funds for health-related expenses.
Benefits FAQs Updated 7.17.2023 18 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
Q. What type of child or elder care expenses are eligible for reimbursement from my Dependent
Care Flexible Spending Account (DCFSA) funds?
A. Dependent care accounts are subject to IRS regulations. Dependent children must be under the
age of 13. The following expenses are classified as being eligible for reimbursement:
• Before school or after school care (other than tuition)
• Qualifying custodial care for dependent adults
• Licensed day care centers
• Nursery schools or pre-schools
• Placement fees for a dependent care provider, such as an au pair
• Child care at a day camp, nursery school, or by a private sitter
• Late pick-up fees
• Summer or holiday day camps
For more information, visit the Optum Financial website.
Q. What is a Health Savings Account (HSA)?
A. A health savings account (HSA) is like a 401(k) for health care. They are tax-advantaged
accounts that accumulate interest and can earn investment returns. The funds can be used to
pay for qualified medical expenses today or can be saved for future expenses. You will be
provided with an HSA debit card.
Q. How do I access my Health Savings Account (HSA) funds?
A. You will be provided with a Health Savings Account (HSA) debit card that may be used for
eligible expenses or you may submit receipts and request reimbursement through the Optum
Financial website or mobile app.
Q. Do Health Savings Account (HSA) funds expire?
A. Unspent HSA funds at any point continue to accumulate (tax-free) and can serve as an excellent
source of funding for health care costs during your retirement.
Q. Can I enroll in the Health Savings Account (HSA)?
A. You may enroll in the Health Savings Account (HSA) if you elect the WellFirst Health Savings
Medical Plan option (provided you do not have secondary medical coverage).
Q. How much may I contribute to a Health Savings Account (HSA)?
A. The 2023 contribution limits, including the employer contribution from SSM Health, are:
• Employee only coverage: up to $3,850
• Other coverage tiers: up to $7,750
• If you are over age 55, you may contribute an additional $1,000 to your HSA.
Benefits FAQs Updated 7.17.2023 19 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
Q. How much does SSM Health contribute to my Health Savings Account (HSA)?
A. SSM Health deposits contributions into your HSA account on a per pay period basis. The
contribution is pro-rated based on the date you become benefit eligible:
• Employee only coverage: Up to $500 annually ($19.23 per pay period) if you are a full-time employee
and up to $250 annually ($9.62 per pay period) if you are a part-time employee.
• Other coverage tiers: Up to $1,000 annually ($38.46 per pay period) if you are a full-time employee and
up to $500 annually ($19.23 per pay period) if you are a part-time employee.
Q. How do I decide how much to contribute to my HSA or Health Care FSA?
A. Estimate the eligible out-of-pocket medical expenses that you and your covered dependents
expect to pay during the year. The Benefit Enrollment Decision Making Tool can help you with
this calculation.
If you plan to contribute to an HSA, remember that SSM Health will also contribute to your
account and that unused funds continue to accumulate and are not forfeited. Therefore, you may
find this option helpful as you think about saving for health care costs during retirement.
If you plan to contribute to a Health Care FSA, it is a good idea to be conservative when
estimating eligible expenses. If you contribute too much, you will forfeit the unspent balance.
Q. How does the Health Savings Account (HSA) compare to the Health Care Flexible Spending
Account (FSA)?
Health Savings Account
Health Care Flexible Spending Account
• Must be enrolled in the WellFirst Health Savings
medical plan. You may not have secondary medical
coverage.
• Can be used to pay out-of-pocket medical expenses,
including deductibles, coinsurance, copays and other
IRS-qualified medical expenses not covered by
insurance.
• Total 2023 pre-tax contributions to your account can be
up to $3,850 for individual coverage or $7,750 for
family coverage.
• SSM Health also contributes to your account in the
amount of up to $500 for full-time employee only
coverage (up to $250 for part-time) and up to $1,000
for other full-time coverages (up to $500 for other part-
time).
• Contributions are made on a per pay period basis and
you may access your HSA funds as they become
available.
• You may start, stop, lower or raise your per pay period
contributions at any time.
• Unspent funds in the account continue to accumulate.
• Funds never expire and always belong to you.
• Funds in your HSA account may be invested to grow
over time.
• Can be enrolled in the WellFirst Plus or
WellFirst Base medical plan but do not
have to be enrolled in a medical plan in
order to participate.
• Can be used to pay several types of
medical expenses, including deductibles,
coinsurance, copays and other IRS-
qualified medical expenses not covered by
insurance.
• You make pre-tax contributions to your
account up to the allowable limit ($2,850 in
2022).
• You may only make changes to your FSA
contributions during the annual benefit
open enrollment period or within 31 days
of a qualifying event.
• Unspent funds in the account at the end of
the plan year are forfeited (unless eligible
for the carry over provision).
• Account is 100% funded by you.
• You have immediate access to your
Health Care FSA funds on January 1 of
the plan year or on the date you become
benefit-eligible.
Benefits FAQs Updated 7.17.2023 20 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
Q. If I have existing funds in a Health Savings Account, can I roll them into the SSM Health HSA?
A. Yes. Optum Financial customer service specialists can assist you with this transaction.
You may reach them by phone at 1.844.881.0124.
Q. Can I participate in the Dependent Day Care Flexible Spending Account if I have a Health
Savings Account?
A. Yes. Participating in the HSA does not impact your ability to participate in the Dependent Day
Care Flexible Spending Account.
Q. Where can I learn more about Flexible Spending and Health Savings Accounts?
A. Visit Optum Financial to learn more about these tax-advantaged accounts.
Benefits FAQs Updated 7.17.2023 21 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
RETIREMENT
Q. Who is the Plan Administrator for the Retirement Savings Plans?
A. Defined Contribution Plan: The Plan administrator is Fidelity, and you can reach them at
800.343.0860 or visit the Fidelity site at netbenefits.com.
Defined Benefit Plan/Pension Plan: If you have earned benefits in one of the defined
benefit/pension plans sponsored by SSM Health, contact People Services at 844.776.6947.
Q. What is the Defined Contribution (DC) Plan?
A. SSM Health contributes to the Retirement Savings Plan accounts of all eligible employees.
• Basic/Fixed Contribution: To qualify, you must work a minimum of 1,000 hours in the payroll year and
be actively employed on the last day of the payroll year. You are not required to make employee
contributions in order to receive the basic/fixed contribution. The employer basic/fixed contribution is
3% of your eligible compensation (up to the annual IRS limit) or a minimum of $1,400, whichever is
greater. The $1,400 minimum contribution is pro-rated based on hours worked in the plan year. For
plan year 2023, the annual IRS limit for eligible retirement compensation is capped at $330,000.
• Match Contribution: SSM Health will match $0.50 on the dollar for the first 6% of employee
contributions on a per pay period basis (up to IRS annual limits). You are immediately eligible to
receive Employer Matching Contributions upon your SSM Health employment if the following
requirements are met:
o You are in a benefit-eligible position and are scheduled to work a minimum of 1,000 Hours in
the payroll year (40 hours per pay period)
o You are contributing to the 403(b) or 401(k) Plan.
• If you are not in a benefit-eligible position (your scheduled hours are under 1,000 Hours in a payroll
year) but you complete 1,000 Hours during the payroll year and are actively employed on the last day
of the payroll year, you will receive the Employer Matching Contribution in the first quarter of the
following year after your hours of service have been determined.
• Match Contribution True-Up: If you make uneven contributions to the plan during the W-2 year
and/or max out your contributions early in the W-2 year, the match true-up feature ensures that you are
able to still maximize the match. To be eligible for the true up, you must:
o Work at least 1,000 hours in the payroll year
o Be actively employed on the last day of the payroll year
You might also be eligible for a match true-up if you are on track to complete 1,000 hours, but your employment ends
prior to the end of the W-2 year due to death, disability, severance or on or after reaching age 65.
Q. What does it mean to be vested in the retirement plan?
A. When your retirement account is 100% vested, this means you own 100% of your account. You
are always 100% vested in any contributions you make to your retirement savings. You are
100% vested in the contributions SSM Health makes to your retirement savings account once you
have three years of credited service. You receive one year of credited service for any year in
which you work at least 1,000 hours.
Q. I have frozen benefits in the Defined Benefit (Pension) Plan. Will those benefits be available to
me when I retire?
A. Yes. Participants in this plan will keep all benefits earned through the date the plan was frozen.
Your benefits will still be available to you based on plan provisions, assuming you meet the
vesting requirements.
Benefits FAQs Updated 7.17.2023 22 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
Q. Does SSM Health offer a 401(k)?
A. SSM Health sponsors both a 401(k) and 403(b) plan. Both plans are retirement savings accounts
that you may contribute to through payroll deduction on either a pre-tax or post-tax basis. You
may contribute to the 401(k) if you work for an SSM Health for-profit ministry. You may contribute
to the 403(b) if you work for an SSM Health not-for-profit ministry. Visit the Fidelity site at
netbenefits.com for more information or to set up your contribution.
Q. Does SSM Health offer a 403(b)?
A. SSM Health sponsors both a 401(k) and 403(b) plan. Both plans are retirement savings accounts
that you may contribute to through payroll deduction on either a pre-tax or post-tax basis. You
may contribute to the 401(k) if you work for an SSM Health for-profit ministry. You may contribute
to the 403(b) if you work for an SSM Health not-for-profit ministry. Visit the Fidelity site at
netbenefits.com for more information or to set up your contribution.
Q. Does SSM Health offer a 457(b)?
A. Eligible employees may also contribute to the 457(b) up to the annual IRS limit. Due to IRS
regulations, this plan may only be offered to eligible employees of non-profit ministries. You may
enroll in this plan at netbenefits.com. Eligible employees include physicians and those at or
above the manager level. New contribution elections or changes to your existing contribution
election will be effective of the first day of the following month.
Q. How do I enroll in the 401(k)/403(b)?
A. Visit netbenefits.com to access the Fidelity website. You may enroll in or make changes to your
401(k)/403(b) contribution, update your beneficiary information and select your investment
options. To be processed in time for the next pay period, changes must be submitted by 8:00 pm
CT on the last day of the current pay period. Contact Fidelity at 800.343.0860 if you do not have
internet access or if you need assistance.
Q. How do I enroll in the 457(b)?
A. You may enroll in this plan at netbenefits.com. New contribution elections or changes to your
existing contribution election will be effective of the first day of the following month.
Q. How do I schedule an appointment with a Retirement Education Counselor?
A. Contact Fidelity at 800.343.0860 to schedule an appointment with a retirement education
counselor.
Q. How can Fidelity help me manage my retirement savings account?
A. Fidelity offers a range of services and investment options to help you make the most of the funds
in your retirement savings accounts. Fidelity provides complimentary one-on-one retirement
consultations and can provide many account services (including rolling funds into the plan).
Q. Can I only make changes to my retirement contributions during open enrollment?
A. You may change your 403(b)/401(k) retirement contributions at any time. You may start, stop,
increase or decrease your contributions by visiting netbenefits.com. To be processed in time for
the next pay period, changes must be submitted by 8:00 pm CT on the last day of the current pay
period. Contact Fidelity at 800.343.0860 if you do not have internet access or if you need
assistance.
Benefits FAQs Updated 7.17.2023 23 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
Q. I have retirement savings accounts from a former employer. Can I roll those into my SSM
Health Retirement Savings account?
A. Contact Fidelity at 800.343.0860 or visit netbenefits.com to access the Fidelity website. A
representative will assist you with the rollover process.
Q. How do I apply for a 403(b) or 401(k) loan?
A. Contact Fidelity at 800.343.0860 or visit netbenefits.com to access the Fidelity website. A
representative will assist you with the loan process.
Q. How do I get a defined benefit pension calculation?
A. If you are grand parented as a participant in the Defined Benefit (DB) pension plan, please refer
to your annual benefits statement for retirement calculations. If you will be starting your pension
within the next 12 months, contact People Services at 844.776.6947.
Q. I am planning on retiring. What steps should I take?
A. A helpful retirement checklist is available at ssmhealth.com/benefits.
Benefits FAQs Updated 7.17.2023 24 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
SHORT AND LONG-TERM DISABILITY
Q. When do I request a leave of absence?
A. Any time you have a life event such as a personal health condition that results in your being
unable to work for more than three consecutive full calendar days (not shifts), you are required to
request a leave of absence. You should submit a leave of absence request within seven calendar
days from your first date of absence to avoid a delay or potential denial of your leave or disability
claim.
Q. Does SSM Health offer Maternity Leave?
A. Yes. If you are in a benefit-eligible position and are accessing Short-Term Disability due to
maternity leave, 100% of your income will be replaced for up to six weeks for a routine delivery or
up to eight weeks for a c-section. The first week (seven calendar days) elimination period still
applies. You must use available PTO to replace your income for the first week of your maternity
leave, unless you are covered by Wisconsin FMLA, then you may take it unpaid. The 100%
maternity leave coverage is provided by SSM Health with no premium cost to you.
• If maternity leave begins prior to the date of delivery for medical reasons or is extended for
medical reasons, the regular Short-Term Disability benefit will apply at 60% or 75% of your
base weekly salary
• If taking bonding time following a 6 or 8-week maternity leave, you must use PTO up to your
full FTE unless covered by Wisconsin FMLA, then you may take it unpaid. G
ran
Q. Does SSM Health offer Paid Parental Leave?
A. Yes. One week paid parental leave is available to you if you are in a benefit eligible position and
have completed at least 90 days of employment with SSM Health. The leave, which is intended to
cover bonding time, provides 40 hours of paid leave (pro-rated based on FTE), includes
adoptions, and compliments maternity leave for the birth parent. Parental leave is paid at the
base rate of pay for the primary job held by the employee and applied to the first seven calendar
days of an approved continuous bonding leave. The pay benefit is not available to be utilized
intermittently. Paid Parental Leave is not available for adoption of relatives, unless the adoption of
a relative is due to the death of the child’s biological parent(s). View the PTO Guidelines for
additional information.
Q. What Short-Term Disability Benefits are offered?
A. As a benefit eligible employee, you are covered by a Short-Term Disability (STD) plan that
replaces 60% of your income when you are medically unable to work due to a serious health
condition. The first week (seven calendar days) of disability is an elimination period during which
disability benefits are not paid. You must use PTO to satisfy the elimination period while you are
medically unable to work before STD benefits begin (unless taking unpaid WI FMLA).
Following the elimination period, you may be eligible to receive a benefit. The 60% Short-Term
Disability coverage is provided by SSM Health at no premium cost to you (with minimum weekly
benefits).
You have the option to “buy up” to a 75% STD plan. You will see the cost of the buy-up option
when you go through the enrollment process. You may enroll in the buy-up option during the
annual open enrollment period or within 31 days of becoming benefit eligible either as a new hire
or through a qualifying work/life event.
Benefits FAQs Updated 7.17.2023 25 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
Benefits continue until the earliest of your recovery or the end of the maximum benefit period,
which is 90 days after your first date of disability. Disability payments are paid via normal SSM
Health payroll cycle. Short-Term Disability benefit pay is taxable income.
Q. What Long-Term Disability Benefits are offered?
A. After 90 days of being medically unable to work, you are eligible to apply to receive a Long-Term
Disability benefit of 60% of your salary up to a maximum of $10,000 per month. The 60% Long-
Term Disability coverage is provided by SSM Health with no premium cost to you. Executives and
physicians should refer to the applicable benefit booklet for LTD information. Note, you must
exhaust all PTO before LTD payments begin.
LTD benefits are taxable income. LTD benefits are paid directly to you by the SSM Health LTD
vendor. LTD benefits are not paid via SSM Health normal payroll cycle.
Q. Where can I get more information about disability benefits or taking a leave of absence?
A. For more information about the Short and Long-Term Disability plans, including Maternity
Benefits and Paid Parental Leave, review the Leave of Absence Resource Guide.
Benefits FAQs Updated 7.17.2023 26 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
LIFE INSURANCE
Q. Who administers the Life Insurance policies?
A. The insurer and Plan Administrator is Securian Financial; you may reach them by phone at
833.810.8262 or by visiting www.securian.com.
Q. What is Life Insurance?
A. Life insurance is an important financial safety net that provides an income tax-free death
benefit to beneficiaries upon your death. Your beneficiaries can use the money to help with
their everyday living expenses – such as mortgage payments or medical bills, education
expenses, your funeral costs and more.
Q. What is the Life Insurance benefit?
A. SSM Health provides employer-paid basic term life and accidental death and dismemberment
(AD&D) insurance. If you are in a staff position, your insurance coverage is equal to 1X (one
times) your annual base salary up to $500,000, for each plan. If you are in a management
position, your insurance coverage is equal to 2X (two times) your annual base salary up to $1M,
for each plan. Per industry standards, life insurance benefits are subject to age reduction once
you reach age 65.
Q. What is the difference between Life Insurance and AD&D (Accidental Death & Dismemberment)?
A. Life insurance provides financial protection for your family in most cases of death and will pay out
if you die by accident or illness. Accidental death and dismemberment (AD&D) insurance only
pays out in certain instances of death by accident, but not for natural causes or illness. It also
provides benefits for some non-death accidents.
Q. Can I buy additional life insurance for myself?
A. If you are eligible for life insurance, you may purchase supplemental life insurance (both term life
and/or accidental death and dismemberment) coverage for yourself in multiples of your base
salary – up to 8X your base salary (capped at $2M for term life and capped at $1M for AD&D).
Q. Can I buy life insurance for my spouse?
A. You may elect to purchase term life insurance for your spouse in increments of $25,000 up to
$250,000. Newly eligible employees may elect up to $50,000 without evidence of insurability
(EOI) requirements. Amounts above $50,000 or any amount of coverage elected during the
annual open enrollment period require evidence of insurability.
You may purchase accidental death and dismemberment (AD&D) insurance for your spouse in
increments of $25,000 up to $100,000. No evidence of insurability is required for AD&D.
Q. Can I buy life insurance for my children?
A. You may elect to purchase term life insurance for your eligible child(ren) in increments of $5,000
up to $25,000. You may purchase accidental death and dismemberment (AD&D) insurance for
your children for either $10,000 or $25,000. No evidence of insurability review is required for
children.
Benefits FAQs Updated 7.17.2023 27 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
Q. What is Evidence of Insurability?
A. Proof of good health, also known as evidence of insurability (EOI), is an application process in
which you provide information on the condition of your health or your dependent’s health to get
certain types of insurance coverage. Securian will contact you directly to initiate the EOI process.
Q. What if I do not want to complete the Evidence of Insurability process or I was not approved.
Does that mean I cannot get additional life insurance?
A. If Securian does not receive the Life EOI application or your EOI is not approved, your coverage
will remain at your current level and will not change. You will not be charged any premiums for
the additional coverage, until your EOI is approved.
Q. How do I file a Life Insurance claim?
A. Visit the Securian Benefit Service Center to report a new claim.
Q. Can I convert the SSM Health Life Insurance to an individual policy when I leave or retire
from SSM Health?
A. Yes, you will have options to continue (“port”) your coverage as annual term insurance or convert
your coverage to permanent insurance. Securian Financial will provide these options to you when
they are notified of your employment separation.
Q. Where can I learn more about Life Insurance?
A. Visit the Securian Benefit Service Center to view helpful beneficiary checklists, legacy planning
resources and general life insurance information.
ADDITIONAL LIFESTYLE BENEFITS
Q. What additional benefits are available through Securian?
A. If you are enrolled in Life Insurance, you are automatically eligible for additional benefits including
travel assistance, and financial and grief resources.
Q. What are the travel assistance benefits?
A. Planning to travel 100 miles or more from home? Access pre-trip planning and emergency
services through RedpointWTP. Learn more at: LifeBenefits.com/travel.
Q. What are the legal, financial and grief resources?
A. Gain access to resources for creating wills and other key legacy documents. Learn more at:
LifeBenefits.com/lfg Use the username: lfg and the password: resources.
Benefits FAQs Updated 7.17.2023 28 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
PAID TIME OFF (PTO)
If you are a Director, Physician or Executive, please refer to the PTO Guidelines or speak with your practice
manager regarding your PTO benefits. PTO Donation, PTO Hardship, and PTO Sell options are only available to
employees accruing PTO at the staff or management level.
Q. What is the Paid Time Off (PTO) benefit?
A. SSM Health offers paid time off to eligible employees for vacations, holidays, sick days, personal
time and the elimination period for Short-Term Disability. PTO accrues with each hour paid and
on eligible low census hours, starting with the first day of employment and up to the maximum
accrual allowed per pay period. Note: PTO does not accrue on disability payments.
Q. Who is eligible for Paid Time Off (PTO) benefits?
A. To be benefits-eligible, employees must be regularly scheduled to work at least 40 hours or more
per pay period. “Regularly scheduled” means the employee is on file with Human Resources as
having a 0.5 full-time equivalent (FTE) or higher status. Employees begin to accrue PTO upon date
of hire. There is no waiting period.
Q. How do Paid Time Off (PTO) hours accrue?
A. If you are in a staff or management position, PTO is accrued each pay period based on the actual
number of hours paid and on any eligible low census hours (up to a maximum of 80 hours per
pay period). Your accrual rate depends on your length of service with SSM Health. Note: hours
paid from Short or Long-Term Disability do not accrue PTO.
Q. How many Paid Time Off (PTO) hours can I accrue? And do my PTO hours carry over?
A. The annual maximum of PTO is based on 2080 paid hours per year (40 hours per week). Paid
hours in excess of 80 hours per pay period will not be used to calculate accrual of PTO. Unused
PTO time carries over from year to year, but the overall maximum of PTO is 1.5 times your
annual accrual amount. If you reach the PTO maximum, you will need to utilize PTO time in order
to accrue additional hours. Click here to view the PTO guidelines or view the PTO accrual
schedule in the Employee Benefits Guide (Benefits Booklet).
Q. I am a new hire. How soon do I being accruing Paid Time Off (PTO)?
A. New Hires will be provided with 8 hours of PTO (pro-rated for FTE) upon hire date in order to
account for holiday time off that might be needed before the PTO time is accrued. As a result,
the accrual rate for the first year of employment will be adjusted down to account for the front-
loaded hours.
Q. How many years of service do I need to move to the next level of PTO accrual?
A. The accrual rate changes in five-year increments, until you reach your maximum annual accrual
rate. The accrual rate will be effective the pay period following your employment anniversary
date.
Q. At what rate of pay is my Paid Time Off (PTO) paid?
A. PTO hours are paid at the base rate of pay for the primary job you hold.
Q. How do I request Paid Time Off (PTO)?
A. Use the Absence app in HR on-Demand, powered by Workday, to request time off. View the
PTO guidelines here for information about how far in advance you should submit your PTO
request.
Benefits FAQs Updated 7.17.2023 29 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
Q. Do I use Paid Time Off (PTO) for Holidays?
A. Yes. SSM Health observes the following holidays: New Year’s Day, Memorial Day,
Independence Day, Labor Day, Thanksgiving Day, Christmas Day. When operations of a
department or facility are closed in recognition of an observed holiday, if you are scheduled to
work that day, you must use PTO. You will want to manage your PTO to ensure you have
enough PTO hours in your PTO bank to cover the observed holidays.
If a holiday falls on a day of the week that you are regularly scheduled to work, you will use PTO
to ensure your meet your hours worked for the week. If the holiday falls on a day of the week that
you are not regularly scheduled to work (i.e. you will meet your hours worked for the week without
using PTO), you will not use PTO for that holiday. You cannot choose to go unpaid for a
holiday. In order to meet your hours requirement (based on your FTE status), you will need to
use PTO. If you work on an observed holiday, you will receive your regular pay for those hours
worked and will not use PTO. The manager of the department would be the best contact in
discussing the individual department’s needs/schedule regarding the holiday.
Q. What happens to my PTO if I leave SSM Health or move to a position that is not eligible for
PTO?
A. If you separate your employment with SSM Health or move to a status that is not eligible for
accrued PTO (PRN, Director, etc.), you will receive payment for any remaining PTO hours at the
base rate of your primary position that was held prior to the date of the status change. This
payment will occur as soon as administratively possible.
Q. May I elect to receive cash in lieu of time off and, if so, how will this be paid?
A. Yes. The PTO Sell option enables you to voluntarily cash out up to 80 hours of PTO every year,
provided you have at least 40 hours in your PTO bank after the payment. You may submit up to
two PTO Sell requests each calendar year through the Absence App in Workday. View the PTO
guidelines here for more information.
Note: Based on IRS regulations, if you voluntarily elect to cash out PTO, through PTO Sell, the
payment will be made at 85% of your hourly rate, and the payment will be taxed at the
supplemental tax rate.
Q. May I cash out my PTO if I have an emergency?
A. Yes. If you are suffering a serious financial hardship, you may request a pay-out from your PTO
bank. The pay-out is limited to the amount of the hardship or half your PTO balance at the time of
the request (whichever is lower) up to a maximum of 80 hours per calendar year. The PTO will
be paid at 85% of full value. PTO hours are paid at the base rate for the primary job held by the
employee. The hardship must meet one of the IRS-eligible reasons. View the PTO guidelines
here to see what qualifies as a hardship.
Q. May I donate my unused PTO to another employee?
A. Yes. You may donate PTO to a medical emergency leave bank and you are not taxed on the
donation. You may donate up to 80 hours each calendar year and you must have at least 40
hours in your PTO bank following the donation. Hours donated to the bank will be converted to
dollars based on your (the donor’s) hourly rate (base rate of pay for the primary job). You may
submit your donation through the Request app in Workday.
Per IRS regulations, you may “recommend” the recipient, but you may not make the donation
contingent on the time going to the desired recipient.
Benefits FAQs Updated 7.17.2023 30 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
Q. May I request PTO from the emergency leave bank?
A. Yes. You may submit your application for Emergency PTO through the Request app in HR On-
Demand, powered by Workday. You will need to meet the IRS criteria for a medical leave
sharing program. Your application will be reviewed by Human Resources and hours will be
awarded based on need. The maximum number of hours that may be provided to you is 160
hours in a calendar year. Any PTO hours given to you will be based on your rate of pay and you
will be taxed on the PTO value when the time is taken.
Q. What qualifies as an emergency?
A. Under the program considered by the IRS, a medical emergency is defined as a medical
condition of the employee (or family member of the employee) that would require the prolonged
absence of the employee from duty and would result in a substantial loss of income to the
employee because the employee would have exhausted all paid leave available.
Q. How many days off do I get for a funeral? How much bereavement leave is provided?
A. If you are a benefit-eligible employee, you are allowed up to five (5) scheduled shifts of
Bereavement Leave with pay following the death of your spouse or child/stepchild. You are
allowed up to three (3) scheduled shifts of bereavement leave with pay following the death of
another family member. Note: per Illinois state law, if you work in Illinois, you are eligible for ten
(10) days of protected time away from work due to the loss of a child. Click here to review the
bereavement leave guidelines.
Q. What is bereavement leave?
A. Bereavement leave provides paid time off after the death of a family member or Legally-
Domiciled Adult (LDA).
Q. Who is eligible for bereavement leave?
A. Benefits-eligible employees are eligible for the Bereavement Leave program and are eligible for
bereavement leave upon date of hire. There is no waiting period.
Q. What family members are covered by bereavement leave?
A. Family members include: spouse, legally-domiciled adult (LDA), child (including medically
documented stillbirths and miscarriages), step or foster child, child for whom the employee is a
legal guardian, children of the LDA, parent or step-parent, sibling or step-sibling, grandparent,
grandchild or step-grandchild, great-grandparent, great-grandchildren or step-great
grandchildren, step-grandparents, brother-in-law, sister-in-law, mother-in-law, father-in-law, son-
in-law, daughter-in-law, grandparent of spouse. A Legally-Domiciled Adult (LDA) is a relative or
another adult who resides with the employee and is currently declared as an LDA. The
relationship status with all family members must be current at the time bereavement leave is
used.
Q. Will I receive pay while on bereavement leave?
A. While on bereavement leave, you will be paid regular base salary for any time scheduled to work.
No shift differentials, holiday or weekend premiums will apply.
Benefits FAQs Updated 7.17.2023 31 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
Q. May I wait and use bereavement leave at a later date?
A. Bereavement leave must begin and conclude within two (2) weeks of the funeral or memorial
service.
Q. How do I request bereavement leave?
A. Notify your manager as soon as possible when you need bereavement leave. You may request
your bereavement leave in the Absence app in Workday.
Q. Does SSM Health provide time off for Jury Duty?
A. All employees are eligible for time off to serve jury duty upon date of hire. Benefits-eligible
employees will be paid time off for regular scheduled shifts as a result of Jury duty. To be
benefits-eligible, you must be regularly scheduled to work at least 40 hours or more per pay
period. “Regularly scheduled” means you are on file with Human Resources as having a 0.5 full-
time equivalent (FTE) or higher status.
Q. I am a benefits-eligible employee. How will I be paid while serving Jury Duty?
A. You will be paid your regular base salary for Jury Duty served during regularly scheduled work
hours. No shift differentials, holiday or weekend premiums will apply. Jury Duty is not considered
worked time and, therefore, is not considered in overtime calculations.
Q. The Court paid me a small stipend for serving on the jury. What should I do with that?
A. You may keep any payments from the Court for Jury Duty service.
Q. What do I need to submit if I am summoned for Jury Duty?
A. Upon receipt of a summons for Jury Duty, you should present a copy of the summons to your
manager. The summons should indicate the beginning date of service and the anticipated date of
return.
Upon completion of Jury Duty, provide your manager with a statement of attendance from the
court indicating the dates you served.
Benefits FAQs Updated 7.17.2023 32 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
TUITION BENEFIT
Q. What tuition benefits are available?
A. SSM Health provides assistance to eligible employees for certain educational and certificate
programs related to employment opportunities within SSM Health. View the tuition benefit
guidelines for more information.
Q. Who is eligible for tuition benefits?
A. Benefits-eligible employees are eligible for the Tuition Benefit program after completing a
minimum of 90 calendar days of employment.
To be benefits-eligible, you must be regularly scheduled to work at least 40 hours or more per
pay period. “Regularly scheduled” means that you are on file with Human Resources as
having a 0.5 full-time equivalent (FTE) or higher status. The benefit amount is different
depending on whether you are a full-time or part-time employee.
Full-time
Benefits-Eligible Status
Part-time
Benefits-Eligible Status
64+ hours pp (.80 - 1.00 FTE)
40 – 63 hours pp (.50 - .79 FTE)
Q. How much is available in tuition benefits?
A. The traditional Tuition Reimbursement program will reimburse 100% of your out-of-pocket
costs for tuition, books or other eligible fees, up to the following maximums:
Tuition Benefit Program
Maximum Amounts
Full-time
Benefits-eligible employees
Up to $4,200 per year
Part-time
Benefits-eligible employees
Up to $2,100 per year
If you receive grants, scholarships, or other money for your education, SSM will not reimburse for
more than your out-of-pocket costs.
Q. Do I have to wait for tuition reimbursement or is there a pre-paid option?
A. If you qualify for the Medical Plan Contribution Discount, you are eligible to receive Tuition
benefits pre-paid, rather than as a reimbursement.
Q. How do I request pre-payment?
A. To receive pre-payment, submit the reimbursement request form, proof of course enrollment
detailing class, dates, times, place and cost in advance of the course start date.
Q. If I receive tuition benefits, is there an employment commitment I must fulfill?
A. You are expected to remain employed in a benefits-eligible status with SSM for twelve (12)
months after the date of tuition reimbursement. If you leave SSM Health (except for employer-
induced Reduction in Force or permanent disability), you will be expected to repay, in full, the
tuition reimbursement provided during the prior twelve (12) months. Repayment will be deducted
from your unused PTO payout and you will be responsible for any outstanding balance.
Benefits FAQs Updated 7.17.2023 33 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
Q. What courses and programs qualify for tuition benefits?
A. You must be enrolled in coursework in an accredited college/university or Certificate program
to complete a degree or certificate related to your role or an employment opportunity within
SSM Health. Certificate programs must be specifically designated by the regional leadership
in which you work. View the tuition benefit guidelines for more information. Continuing
Education courses are not eligible for reimbursement under this benefit.
Q. Are there grade requirements?
A. To receive tuition benefits, you must successfully complete the course or program with a
grade of C or better for undergraduate degrees or a grade of B or better for graduate degrees.
Q. How do I request tuition benefits?
A. Click on the Requests app in Workday. Submit your request within 31 days after the course
end date. For pre-pay options, submit the information in advance of the course start date. The
Request app outlines the required supporting documentation you must submit.
Q. Is my tuition reimbursement on this check?
A. Tuition Reimbursement may be requested in Workday by using the Request application. The
reimbursement is typically processed within 1 – 2 pay periods from the date of your request
submission. You may view the reimbursement on your payslip.
Q. What is a cohort program?
A. The Cohort Program Option is available to eligible employees who are pursuing specific
degrees at Partner Universities (colleges or universities in which SSM has a contracted
agreement to provide educational opportunities to SSM employees). In addition to the Tuition
Reimbursement Policy, employees who participate in a cohort program are subject to the
terms of the SSM Health Cohort Program Tuition Repayment Agreement. Visit the Learning
app in Workday for information on available cohort programs.
Q. What is the nursing specialty certification?
A. This option allows you to receive reimbursement for the cost of one approved nursing
specialty certification. Reimbursement can be used for either new or renewed certifications.
Certifications for attainment of minimum job requirements do not qualify.
• Nursing specialty certifications are reimbursed up to a maximum of $500 in a three (3) year period
• Cost of the exam is reimbursed; review courses and books are not eligible for reimbursement.
• You must apply within 31 days after you complete the certification program.
• You must meet all the eligibility requirements of the traditional Tuition Reimbursement Program.
Q. What is the “Hard to Recruit” certification program?
A. If you are enrolled in a certificate program designated by your regional leadership as a “hard
to recruit” position, you may receive pre-paid tuition or tuition reimbursement for courses
recognized as part of the designated certificate program. Pre-payment or reimbursement
amount and eligibility requirements are the same as the Traditional Reimbursement Program.
Benefits FAQs Updated 7.17.2023 34 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
ADOPTION ASSISTANCE
Q. What is Adoption Assistance?
A. The Adoption Assistance program can reimburse you for normal agency fees and legal fees
incurred for the adoption of a minor child, up to the maximum amount allowed per adoption.
For more information, view the Adoption Assistance program guidelines here.
Q. Who is eligible for Adoption Assistance?
A. Benefits-eligible employees are eligible for the Adoption Assistance program. To be benefits-
eligible, you must be regularly scheduled to work at least half-time (40 hours) or more per pay
period. “Regularly scheduled” means that you are on file with Human Resources as having a
0.5 full-time equivalent (FTE) or higher status. You must have completed six (6) months of
employment with SSM Health at the time you apply for adoption assistance. To receive
reimbursement, you also must be benefits-eligible when the adoption is successfully
completed.
Note: Physicians who have employment contracts are eligible only if the employment contract
specifically includes adoption assistance.
Q. How much adoption assistance is available?
A. For 2023, the maximum Adoption Assistance benefit is $9,500.
Q. What fees can be reimbursed?
A. Normal agency and legal fees may be reimbursed. There are fees that are not eligible for
reimbursement. These include:
• Fees incurred for foster placements
• Guardianship situations
• Adoptions outside of a licensed agency
• Adoption of relatives; Note: exceptions may be made if the adoption of a relative is due to the death
of the child’s biological parent(s).
Q. When can I submit for reimbursement?
A. Submit your reimbursement request once the adoption has been finalized.
Q. How many times may I request Adoption Assistance?
A. There is no limit to the number of adoptions for which assistance can be requested. However,
if both parents are employed by SSM Health, only one parent can request reimbursement per
child/adoption.
Q. How do I apply for Adoption Assistance?
A. Apply through the Request app in Workday.
Q. What documentation do I need to submit with my application request?
A. Submit your completed application along with the certificate of adoption that verifies the date
of adoption and proof of payment of your agency and/or legal fees.
Benefits FAQs Updated 7.17.2023 35 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
EMPLOYEE ASSISTANCE PROGRAM (EAP)
Q. What is the Employee Assistance Program (EAP)?
A. A free, confidential counseling and referral service designed to assist both you and your
immediate family. The Employee Assistance Program (EAP) can provide resources on health,
finances, retirement planning, childcare planning, family issues and much more.
Q. Who is the Plan administrator for the Employee Assistance Program (EAP)?
A. EAP services are provided by Personal Assistance Services (PAS). You may reach them by
phone at 800.356.0845 or by visiting paseap.com (company code: SSM).
Note: Employees at Greater Fond du Lac ministries (Agnesian HealthCare) will continue to use
their internal EAP. Employees of these ministries may reach them by phone at 1.800.922.3400 or
by visiting the SSM Health at Work site here.
Benefits FAQs Updated 7.17.2023 36 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
VOLUNTARY BENEFITS – BENEFITS PLUS
Q. What is Benefits Plus?
A. Benefits Plus provides exclusive employee rates on a variety of programs. Premiums for these
specially negotiated plans are paid through payroll deduction, making it safe, easy, and
convenient for your budget. Benefits Plus also provides access to free financial planning
resources and retail discount programs. Offerings include:
• Accident, Critical Illness and Hospital
Indemnity Insurance
• Pre-Paid Legal Services
• Identity Theft Protection
• Auto & Home Insurance
• Pet Insurance
Q. What is Accident Insurance?
A. Accident insurance helps you pay for the medical and out-of-pocket costs that you may incur after
an accidental injury. You may enroll in this coverage if you become newly eligible for benefits or
during the annual open enrollment period.
Q. What is Critical Illness Insurance?
A. Critical illness insurance provides additional coverage for medical emergencies like heart attack,
stroke, or cancer. You may enroll in this coverage if you become newly eligible for benefits or
during the annual open enrollment period.
Q. What is Hospital Indemnity Insurance?
A. Hospital indemnity insurance helps offset hospitalization expenses that may not be covered under
your medical plan. You may enroll in this coverage if you become newly eligible for benefits or
during the annual open enrollment period.
Q. What are Prepaid Legal Services?
A. MetLife Legal Plans provides access to attorneys for many common legal issues. You may enroll
in this coverage if you become newly eligible for benefits or during the annual open enrollment
period.
Q. What is Identity Theft Protection?
A. LifeLock provides an all-in-one membership for your Cyber Safety. You may enroll in this benefit
at any time through the Benefits Plus portal.
Q. What Auto and Home Insurance Discount are available?
A. Streamline shopping for auto and home insurance; get real-time, side by side rate quotes so you
can find the policy that works best for your needs and budget. You may enroll in this benefit at
any time through the Benefits Plus portal.
Q. What does Pet Insurance offer?
A. There are two plans from which to choose. A traditional insurance plan offered through
Nationwide and a discount program offered through Pet Benefit Solutions. You may enroll in,
change or drop your pet insurance at any time during the year through the Benefits Plus portal.
Benefits FAQs Updated 7.17.2023 37 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
Q. What financial counseling resources are available?
A. FinFit provides you with personalized tools and recommendations to help you identify your
financial goals, manage your finances and achieve personal success. You may access these
resources for free – at any time – through the Benefits Plus portal.
Q. What retail discounts are offered?
A. Enjoy curated savings on your favorite products and services. It's our way of saying, "Thanks for
doing a great job!" Find great deals on electronics, travel, entertainment, clothes, gifts and more
in one convenient location. You may access these discounts for free through the Benefits Plus
portal.
WELLNESS BENEFITS
Q. What Wellness Benefits are available?
A. Comprehensive wellness information and resources to assist you with your own well-being and
work-life concerns are available in Workday through the Well-Being app.
Benefits FAQs Updated 7.17.2023 38 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
BENEFITS AT SEPARATION OR STATUS CHANGE
Q. What happens to my benefits if I leave SSM Health?
A. Click here to view a Summary of Benefit Coverage at Status Change or Separation.
Q. What happens to my benefits if I move to a non-benefits-eligible position?
A. Click here to view a Summary of Benefit Coverage at Status Change or Separation.
Q. What is COBRA?
A. COBRA stands for Consolidated Omnibus Budget Reconciliation Act. It's a federal law that was
created in 1985 that gives individuals who experience a job loss or other qualifying event the option
to continue their current health insurance coverage for a limited amount of time.
Q. Does insurance coverage under COBRA cost the same as I pay now as an active employee?
A. No, you will pay both your portion and the portion that SSM Health paid towards your insurance
while you were an active employee plus a 2% administrative fee.
Q. How much does COBRA cost?
A. Click here to view the current COBRA rates. Refer to the COBRA packet you receive from
Discovery Benefits for complete information.
Q. How do I request coverage through COBRA?
A. In the event that you, your spouse or your children lose SSM Health coverage due to a change in
status or qualifying life event, you will be mailed a COBRA election letter from Discovery Benefits.
If you have not received your COBRA election letter within 14 days, you may contact
WEX/Discovery Benefits at 866.451.3399 or visit wexinc.com/login/benefits-login.
Note: Important timelines apply. If you and/or your qualified dependents wish to continue
coverage, complete and return the COBRA election letter and premium payments to Discovery
Benefits within 60 days (as stated in your election letter).
Q. What happens to my retirement savings if I leave SSM Health?
A. Click here to view a Summary of Benefit Coverage at Status Change or Separation.
Benefits FAQs Updated 7.17.2023 39 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
GLOSSARY OF TERMS
Click here for the Uniform Glossary of Health Coverage and Medical Terms or review the
commonly used benefit terms listed below.
Allowed Amount
This is the maximum payment the plan will pay for a covered health care
service. May also be called "eligible expense", "payment allowance", or
"negotiated rate."
Appeal
A request that your health insurer or plan review a decision that denies a
benefit or payment (either in whole or in part).
Balance Billing
When a provider bills you for the balance remaining on the bill that your
plan doesn't cover. This amount is the difference between the actual billed
amount and the allowed amount. For example, if the provider’s charge is
$200 and the allowed amount is $110, the provider may bill you for the
remaining $90. This happens most often when you see an out-of-network
provider (non-preferred provider). A network provider (preferred provider)
may not bill you for covered services.
Claim
A request for a benefit (including reimbursement of a health care expense)
made by you or your health care provider to your health insurer or plan for
items or services you think are covered.
Coinsurance
Your share of the costs of a covered health care service, calculated as a
percentage (for example, 20%) of the allowed amount for the service. You
generally pay coinsurance plus any deductibles you owe. (For example, if
the health insurance or plan’s allowed amount for an office visit is $100
and you’ve met your deductible, your coinsurance payment of 20% would
be $20. The health insurance or plan pays the rest of the allowed amount.)
See a detailed example.
Copayment
A fixed amount (for example, $25) you pay for a covered health care
service, usually when you receive the service. The amount can vary by the
type of covered health care service.
Cost Sharing
Your share of costs for services that a plan covers that you must pay out of
your own pocket (sometimes called “out-of-pocket costs”). Some examples
of cost sharing are copayments, deductibles, and coinsurance. Family cost
sharing is the share of cost for deductibles and out-of-pocket costs you
and your spouse and/or child(ren) must pay out of your own pocket. Other
costs, including your premiums, penalties you may have to pay, or the cost
of care a plan doesn’t cover usually aren't considered cost sharing.
Benefits FAQs Updated 7.17.2023 40 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
Deductible
An amount you could owe during a coverage period (usually one year) for
covered health care services before your plan begins to pay.
Diagnostic Test
Tests to figure out what your health problem is. For example, an x-ray can
be a diagnostic test to see if you have a broken bone.
Emergency Room Care
/ Emergency Services
Services to check for an emergency medical condition and treat you to
keep an emergency medical condition from getting worse. These services
may be provided in a licensed hospital’s emergency room or other place
that provides care for emergency medical conditions.
Excluded Services
Health care services that your plan doesn’t pay for or cover.
Formulary
A list of drugs your plan covers. A formulary may include how much your
share of the cost is for each drug. Your plan may put drugs in different cost
sharing levels or tiers. For example, a formulary may include generic drug
and brand name drug tiers and different cost sharing amounts will apply to
each tier.
Grievance
A complaint that you communicate to your health insurer or plan.
Health Insurance
A contract that requires a health insurer to pay some or all of your health
care costs in exchange for a premium. A health insurance contract may
also be called a “policy” or “plan”.
Maximum Out-Of-
Pocket Limit
Yearly amount the plan sets as the most each individual or family can be
required to pay in cost sharing during the plan year for covered, in-network
services.
Medically Necessary
Health care services or supplies needed to prevent, diagnose, or treat an
illness, injury, condition, disease, or its symptoms, including habilitation,
and that meet accepted standards of medicine.
Minimum Essential
Coverage
Health coverage that will meet the individual responsibility requirement.
Minimum essential coverage generally includes plans, health insurance
available through the Marketplace or other individual market policies,
Medicare, Medicaid, CHIP, TRICARE, and certain other coverage.
Network
The facilities, providers and suppliers your health insurer or plan has
contracted with to provide health care services.
Network Provider
A provider who has a contract with your health insurer or plan who has
agreed to provide services to members of a plan.
Benefits FAQs Updated 7.17.2023 41 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
Physician Services
Health care services a licensed medical physician, including an M.D.
(Medical Doctor) or D.O. (Doctor of Osteopathic Medicine), provides
or coordinates.
Plan
Health coverage issued to you directly (individual plan) or through an
employer, union or other group sponsor (employer group plan) that
provides coverage for certain health care costs. Also called "health
insurance plan", "policy", "health insurance policy" or "health insurance".
Preauthorization
A decision by your health insurer or plan that a health care service,
treatment plan, prescription drug or durable medical equipment (DME) is
medically necessary. Sometimes called prior authorization, prior approval
or precertification. Your health insurance or plan may require
preauthorization for certain services before you receive them, except in an
emergency. Preauthorization isn’t a promise your health insurance or plan
will cover the cost.
Premium
The amount that must be paid for your health insurance or plan. You
and/or your employer usually pay it monthly, quarterly, or yearly.
Prescription Drug
Coverage
Coverage under a plan that helps pay for prescription drugs. If the plan’s
formulary uses “tiers” (levels), prescription drugs are grouped together by
type or cost. The amount you'll pay in cost sharing will be different for each
"tier" of covered prescription drugs.
Prescription Drugs
Drugs and medications that by law require a prescription.
Preventive Care
(Preventive Service)
Routine health care, including screenings, check-ups, and patient
counseling, to prevent or discover illness, disease, or other health
problems.
Primary Care Physician
A physician, including an M.D. (Medical Doctor) or D.O. (Doctor of
Osteopathic Medicine), who provides or coordinates a range of health care
services for you.
Primary Care Provider
A physician, including an M.D. (Medical Doctor) or D.O. (Doctor of
Osteopathic Medicine), nurse practitioner, clinical nurse specialist, or
physician assistant, as allowed under state law and the terms of the plan,
who provides, coordinates, or helps you access a range of health care
services.
Provider
An individual or facility that provides health care services. Some examples
of a provider include a doctor, nurse, chiropractor, physician assistant,
hospital, surgical center, skilled nursing facility, and rehabilitation center.
The plan may require the provider to be licensed, certified, or accredited as
required by state law.
Benefits FAQs Updated 7.17.2023 42 of 42
The information provided here is for reference purposes only. When there is a discrepancy between this information and information in the Summary Plan Description (SPD), the SPD will prevail.
Referral
A written order from your primary care provider for you to see a specialist
or get certain health care services. In many health maintenance
organizations (HMOs), you need to get a referral before you can get health
care services from anyone except your primary care provider. If you don’t
get a referral first, the plan may not pay for the services.
Screening
A type of preventive care that includes tests or exams to detect the
presence of something, usually performed when you have no symptoms,
signs, or prevailing medical history of a disease or condition.
Specialist
A provider focusing on a specific area of medicine or a group of patients to
diagnose, manage, prevent, or treat certain types of symptoms and
conditions.
Specialty Drug
A type of prescription drug that, in general, requires special handling or
ongoing monitoring and assessment by a health care professional, or is
relatively difficult to dispense. Generally, specialty drugs are the most
expensive drugs on a formulary.
UCR
(Usual, Customary,
& Reasonable)
The amount paid for a medical service in a geographic area based on what
providers in the area usually charge for the same or similar medical
service. The UCR amount sometimes is used to determine the allowed
amount.
Urgent Care
Care for an illness, injury, or condition serious enough that a reasonable
person would seek care right away, but not so severe as to require
emergency room care.
