BENEFITS SUMMARY

*This information is intended only as a benefits summary. You should refer back to your individual summary plan document (SPD) for detailed information. You can request a new SPD by contacting Human Resources or the benefit provider.

Click here to obtain a copy of the HH Health System HIPAA Notice of Privacy Practices for the health plans and the Flexible Spending Account.

Click here to obtain a copy of the Heart Center, Inc. HIPAA Notice of Privacy Practices for the health plans and the Flexible Spending Account.

RETIREMENT PLAN

PLANS: Huntsville Hospital offers three types of retirement plans, a 401(k)plan, a 457(b) plan, and a Roth 401(k) plan.

401(k):

• Eligibility: You are eligible to participate in the plan on the first of the month following your hire date. You will receive quarterly Matching Contributions from the hospital if you are classified as regular full-time or part-time, been employed for twelve months and have 1,000 hours of paid time. In addition, if approved by the Hospital Board, you will receive a discretionary Basic Contribution. Employees classified as RN Plus are not eligible to receive the Hospital Matching and Basic contributions.

• Vesting Schedule: You are 40% vested after 4 years of vested service. You are 100% vested after 5 years of vested service. A vested year of service is any calendar year in which you are paid for 1,000 hours.
• Heart Center, Inc. employees have a different vesting schedule. Please contact Human Resources for more details.

• Hospital Matching Contributions: If you were hired before January 1, 2013, the hospital will contribute an amount equal to 100% of the first 5% of your voluntary contributions if you meet all the eligibility requirements.

  If you were hired after January 1, 2013, the hospital will contribute an amount equal to 50% of the first 5% of your voluntary contributions if you meet all the eligibility requirements.

• Hospital Basic Contributions: At the end of each fiscal year, June 30, the Hospital Board will review the hospital financials and decide whether or not this contribution will be given and the amount of the contribution. It is not guaranteed to be paid every year.

• Voluntary Contributions: You can contribute up to the lesser of 100% of gross pay or the dollar limit in effect for the year.

• Age 50 Catch Up Plan : If you make the maximum contribution to your plan account, and you are 50 years of age or older during the calendar year, you can make an additional "catch-up" contribution above the IRS limit for that year. The IRS also has a limit on these contributions and they are not matched by the hospital.

457(b):

• Eligibility: You are eligible to participate in the plan on the 1^st of the month following your hire date. This plan is funded completely by your contributions. The hospital will not make contributions to your account.
• Heart Center, Inc. employees are not eligible to participate in this plan.

• Voluntary Contributions: You can contribute up to the lesser of 100% of gross pay or the dollar limit in effect for the year

• Age 50 Catch Up Plan : If you make the maximum contribution to your plan account, and you are 50 years of age or older during the calendar year, you can make an additional "catch-up" contribution above the IRS limit for that year. The IRS also has a limit on these contributions and they are not matched by the hospital.

Roth 401(k): This plan is a "after tax" benefit.:

• Eligibility: You are eligible to participate in the plan on the first of the month following your hire date. You will receive quarterly Matching Contributions from the hospital if you are full-time or part-time, been employed for twelve months and have 1,000 hours of paid time. In addition, if approved by the Hospital Board, you will receive a discretionary Basic Contribution. The Hospital Matching and potential Basic Contributions will be deposited into the pre-tax 401(k) plan, not the Roth 401(k). Employees classified as RN Plus are not eligible to receive either of these contributions.

• Voluntary Contributions: You can contribute up to the lesser of 100% of gross pay or the dollar limit in effect for the year

For questions, to request distributions from your account or to make changes in your deferral percent or investment elections, call 1-800-343-0860 or visit the Fidelity Investments web-site by clicking on the link below.

• Fidelity Investments

To see The Heart Center Inc. plan booklet click here.

To obtain a copy of the Heart Center, Inc. 401(k) Summary Plan Document, please contact Human Resources.

For more information on the HH Health System Retirement Plan 22303 for employees hired on or after January 1, 2013, click here.

For more information on the Healthcare Authority Retirement Plan 57816 for employees hired before January 1, 2013, click here.

ANNUAL REQUIRED FEDERAL NOTICES

As required by the Affordable Care Act and federal government, you may view the following required notices online on Employee Self Service located on Pulse, the hospital's intranet site or you may request a copy from Human Resources at any time.

If you have questions or need assistance, contact Human Resources at (256)256-7715.

2018 ADA Notice of HealthWorks Wellness Program

Children's Health Insurance Program Notice

Medicare Part D Creditable Coverage Notice

Notice of HIPAA Special Enrollment Rights

Notice of Patient Protections

Notice of Privacy Practices

Women's Health Act Notice

HEALTH AND DENTAL PLAN

To view a comparison of our Blue Cross Blue Shield PPO and HDHP health plans, click here.

For a partial listing of what is covered under your HH Health System dental plan, click here.

For the bi-monthly PPO health premium deduction, click here.

For the bi-monthly HDHP premium deduction, click here.

For a list of the drugs on the HSA Preventive Drug list, click here.

To view the Summary of Benefits and Coverage for the PPO plan, click here.

To view the Summary of Benefits and Coverage for the HDHP plan, click here.

Plan: Huntsville Hospital offers a self-insured health plan through Blue Cross Blue Shield. For a listing of providers by specialty in these networks, click here.

The hospital offers an insured dental plan through Ameritas. To find in-network providers, click here.

Eligibility: You are eligible to participate in these plans on the 1^st of the month following your hire date provided you are authorized to work 24 hours or more per week and enroll in the benefits. Eligible dependents include your spouse and dependent children up to age 26.

Enrollment: You have 30 days from your hire date to enroll through self-service for your benefits. During the open enrollment period, you may change your coverage in the health or dental plan. You can enroll in the health plan during an open enrollment period; however, you generally cannot enroll in the dental plan without a waiting period. While open enrollment is the only time that coverages may be changed, it is possible to adjust your plans during the year to reflect changes in your employment or family status (marriage, divorce, birth, adoption, death, or a change in spouse’s employment). Contact Human Resources within 30 days of a qualifying event to take advantage of a change in your employment or family status for your benefits enrollment.

For questions regarding your health plan or to request an ID card, please contact Blue Cross Blue Shield 800-321-4398, or visit their website at www.AlabamaBlue.com by clicking here.

For questions regarding your dental plan, please contact Ameritas at 1-800-487-5553.

Claim Forms: For dental claim forms, click here.

For health claim forms, click here.

VISION PLAN

The Vision plan is a voluntary, separate plan that is not connected to the health insurance plan.

To view what is covered on the vision plan, click here.

Eligibility: You are eligible to participate in this plan on the 1^st of the month following your hire date provided you are authorized to work 24 hours or more per week and enroll in the benefits. Eligible dependents include your spouse and dependent children up to age 26.

Enrollment: You have 30 days from your hire date to enroll online through self-service for your benefits. You can enroll in or make changes to the plan during an open enrollment period. While open enrollment is the only time that the coverage may be changed, it is possible to adjust your plan during the year to reflect changes in your employment or family status (marriage, divorce, birth, adoption, death, or a change in spouse’s employment). Contact Human Resources within 30 days of a qualifying event to take advantage of a change in your employment or family status for your benefits enrollment. For questions regarding your vision coverage or to find a network provider, please contact VSP Vision Care at 800-877-7195, or visit their website at vsp.com. Just let the provider know you have VSP Vision Care and no ID card is necessary.

LIFE INSURANCE PLAN

Plan:

Mutual of Omaha administers our life insurance plan.

Eligibility: You are eligible to participate in the plan on the 1^st of the month following your hire date provided you are authorized to work full-time 32 hours or more per week. You may purchase coverage for your dependents, which include your spouse and unmarried dependent children up to age 26. Employees classified as RN Plus are not eligible for this benefit.

Hospital Coverage: The hospital purchases coverage in the amount of 1x your annual base salary with a minimum benefit of $20,000. Coverage includes an accidental death and dismemberment benefit. Should you die as the result of an accident, the benefit would double.

Voluntary Coverage: You may purchase coverage for yourself up to 3x your annual base salary at a cost of $.165 per $1,000, which includes an accidental death and dismemberment benefit. You may also purchase life insurance policies on your eligible spouse and children for very minimal costs. Effective July 1, 2015: You must purchase optional life insurance in order to be eligible to purchase spouse life. To be eligible, your spouse cannot be disabled and cannot be a HH Health System full-time employee. Please contact Human Resources for details about these policies.

If the hospital-provided basic term life insurance benefit for you is greater than $750,000 or if you have purchased optional coverage greater than $300,000, you will need to complete a medical questionnaire in order for your coverage to exceed those amounts.

Beneficiary: You may elect anyone to be the beneficiary of your life benefit.

Filing a Claim: In the event of death, a certified copy of the death certificate should be sent to Human Resources. They will assist you in filing a claim with the insurance company.

SHORT TERM DISABILITY

Plan: Short-Term Disability (STD) plans are designed to protect you with income protection in the event of a short-term illness or injury. Our plan is administered through Mutual of Omaha. You are eligible to receive benefits after 30 days of disability.

Eligibility: You are eligible to participate in the plan on the 1^st of the month following your hire date provided you are authorized to work 24 hours or more per week. Employees classified as RN Plus are not eligible for this benefit.

Hospital Coverage: The hospital provides you a benefit of $125 a week.

Voluntary Coverage: You may purchase additional STD coverage, which will replace 60% of your weekly earnings up to a maximum of $1,000 per week. The premium is calculated based upon your age.

Filing a Claim: If you are not able to return to work within 30 days of your illness or injury, please contact Mutual of Omaha at 1-800-877-5176 as soon as possible to begin the claims process.

LONG TERM DISABILITY

Plan: Long Term Disability (LTD) plans are designed to provide you with income protection in the event of a long-lasting illness or injury. Our plan is administered through Mutual of Omaha. You are eligible to receive benefits after 90 days of disability.

Eligibility: You are eligible to participate in the plan on the 1^st of the month following your hire date provided you are authorized to work 24 hours or more per week. Employees classified as RN Plus are not eligible for this benefit.

Hospital Coverage: The hospital provides you 50% of your base monthly salary up to a $3,000 maximum.

Voluntary Coverage: You may purchase an additional 10% of coverage up to a $7,000 maximum. The cost is $.25 per $100.

Filing a Claim: If you are not able to return to work within 90 days of your illness or injury, please contact Mutual of Omaha at 1-800-877-5176 as soon as possible to begin the claims process. You, your physician and Human Resources will be required to submit documentation to the insurance company.

HEALTH SAVINGS ACCOUNT (HSA)

Plan: The Health Savings Account (HSA) is an individually managed account that allows employees to contribute pre-tax money through payroll deduction to pay for qualified healthcare expenses.

Eligibility: Employees who enroll in the High Deductible Health Plan are eligible to participate in the HSA plan on the 1st of the month following your hire date as long as you meet the regulatory criteria for enrollment including that you are: not enrolled in any other non-HSA qualified health insurance plan (such as a PPO plan), not enrolled in Medicare, Medicaid, or Tricare; not claimed as a dependent on another person's tax return; and not enrolled or eligible to use a medical FSA. You must re-enroll each year.

Hospital Contributions: If you enroll in the HSA and activate your account at Fidelity, the hospital will make a quarterly contribution to your account. The maximum annual contribution by the hospital will be $500 for employees enrolled in individual coverage and $1,000 for employees enrolled in coverage that includes other family members.

2018 Contribution Limits:

Individual HSA        $3,450

Family HSA            $6,900

Over 55 Catch-Up      $1,000

Using Your Funds: You will work directly with Fidelity Investments to manage your account and access the funds that have been contributed by you and the hospital.

Important Notes: It is the employee's responsibility to determine if they are eligible to make contributions to an HSA, and to ensure that they do not exceed the annual limits set by the IRS. All aspects of managing and maintaining the HSA, including any fees associated with the account, are the responsibility of the employee.

To read the Fidelity HSA Documents, please click here.

To read the Electronic Delivery Agreement, please click here.

To read the HSA Terms and Conditions, please click here.

FLEXIBLE SPENDING ACCOUNT

Plan: Allegiance offers two types of Flexible Spending Accounts that you may choose to enroll in: Medical/Dental Spending Account or Dependent Care Plan.

Eligibility: You are eligible to participate in the plan after you have been employed for 30 days provided you are authorized to work 24 hours or more per week. You are required to participate for the entire calendar year and cannot stop deductions without a change in status.

Voluntary Contribution: You may contribute a maximum of $2,550 to the Medical/Dental Spending Account during the year. The maximum contribution to the Dependent Care Plan for any one year is the lesser of your income or your spouse’s income, married filing jointly $5,000 per year, single filers $5,000 per year or married filing separately $2,500 per year. Expenses incurred during the year may be filed up to March 31 of the following year. Unclaimed contributions up to $500 from the previous year may be rolled over to the next plan year. Any contributions exceeding $500 not claimed by March 31^st are required by federal law to be forfeited. Please plan carefully!

To obtain more details about the Flexible Spending Account and view a list of qualified medical expenses, click here.

To view the Summary Plan Description for the Huntsville Hospital Health System plan, click here.

To view the Summary Plan Description for the Heart Center, Inc. plan, click here.

TUITION REIMBURSEMENT

Tuition Reimbursement: Huntsville Hospital provides tuition reimbursement to all eligible employees. For a current tuition application, click here.