EFFECTIVE 01/01/2026 2026 Benefits Catalog
Dear Colleague: We appreciate your dedication to establishing Scripps Health as the leading healthcare provider in San Diego County. Your commitment to enhancing the well-being of others is why you chose Scripps, and in turn, we are dedicated to supporting you so that you can thrive both professionally and personally. Our extensive total rewards program is crafted to empower you, featuring: • Competitive compensation and incentive plans • Robust health and wellness initiatives • A variety of special and distinct benefits • Work-life balance activities and discounts • Professional development and educational resources • Opportunities for rewards and recognition My Scripps Benefits is tailored to foster your growth, career progression, and personal wellness. Our benefits portfolio not only includes standard health and wellness offerings but also encompasses services aimed at providing financial stability, legal support, and family protection. Being part of Scripps means enjoying more than just your salary; it encompasses the full spectrum of your compensation, benefits, work-life enrichment, retirement contributions, and beyond. Understanding that our workforce spans five generations, Scripps is committed to being an employer of choice and recognizes the uniqueness of each individual. We provide a benefits program that is adaptable, offering a range of options to match your current and future lifestyle needs. Sincerely, Eric R. Cole Corporate Senior Vice President Human Resources
i TABLE OF CONTENTS Introduction.....................1 My Scripps Benefits About Your Benefits . . . . . . . . . . . . . . 4 Eligibility, Enrollment, Your Cost for Coverage, Mid-year Enrollment Changes, When Coverage Ends, Identification Cards Health and Wellness . . . . . . . . . . . . . 20 Medical, Telehealth, Vision, Dental, Scripps Wellness Program, Retiree Health Insurance Options Financial Wellness . . . . . . . . . . . . . . . 42 Flexible Spending Accounts (FSAs), Disability Coverage, Life and Accidental Death & Dismemberment (AD&D), Whole Life Insurance, Group Critical Illness, Group Hospital Indemnity Insurance, Group Accident Insurance, Group Legal Plan, Identity Theft Protection, Pet Insurance, Auto & Home Insurance, Savings Bonds, Scholarshare College Savings Plan, Fidelity Student Loan Resources Retirement Savings . . . . . . . . . . . . . . 66 Scripps Health 401(a) Retirement Savings Plan, Retiree 401(h) Healthcare Savings Account, Scripps Health 403(b) Plan TimeOff.......................74 Paid Time Off (PTO), Paid Short-term Disability (PSD), Jury Duty, Bereavement Leave, Other Types of Leave Work-Life . . . . . . . . . . . . . . . . . . . . . . 78 Employee Assistance Program, Medicare Resources for Employees, On-site Child Care, Transportation Discount Benefit, Passport Discount Program Careers and Learning . . . . . . . . . . . . . 82 Center for Learning & Innovation, Talent Development Services, Career Development Resources, Tuition Reimbursement, Educational Scholarships Table of Contents My Scripps Benefits Easy Online Enrollment When you’re ready to enroll in My Scripps Benefits, see page 7 for enrollment information. You will follow different steps depending on the benefit, as shown below. Enroll for the following voluntary benefits by visiting the carrier websites below: • Pet Insurance - Nationwide https://benefits.petinsurance.com/scripps • Auto and Home Insurance - Farmers www.myautohome.farmers.com This catalog summarizes some of the benefits under the My Scripps Benefits Program, but it is not a contract. It does not include all plan rules and details and is not considered a certificate of coverage. The terms of your benefits are governed by legal plan documents, including insurance contracts. If there are any differences between this catalog and the legal plan documents and insurance contracts, the legal plan documents and insurance contracts are the final authority. Scripps Health reserves the right to change, discontinue or terminate the benefit plans at any time. Enroll for the following benefits at https://benefits.scripps.org: • Medical • Vision • Dental • Flexible Spending Accounts (FSAs) • Long-term Disability • Supplemental Employee Life and AD&D* Insurance • Dependent Life and AD&D* Insurance *Accidental Death & Dismemberment Enroll for the following voluntary benefits through Benefit Communications, Inc. (BCI) at www.electbenefits.com/scripps: • Individual Short-term Disability • Whole Life Insurance • Group Critical Illness Insurance • Group Hospital Indemnity Insurance • Group Accident Insurance • Group Legal Plan • Identity Protection
INTRODUCTION Everyone has different needs. Whether you are just out of school or established in your career, single or married, with children or without — no two people are exactly the same. A dynamic benefits program should reflect that. As a career destination employer, Scripps recognizes your individuality and provides a flexible benefits program with choices to fit your lifestyle. Scripps offers a comprehensive benefits package that includes health and wellness, financial wellness, retirement savings, time off, learning and development and work-life resources, all designed to help you accomplish your individual goals at work and at home. Total Rewards Program Your Scripps total rewards program is designed to compensate and motivate you throughout your career. It includes a broad range of plans and programs including market competitive pay and performance incentives, health and wellness benefits, financial wellness benefits, work-life resources, learning and development opportunities, and rewards and recognition. What kind of medical coverage is right for you? Do you pay for daycare for your children or have out-of-pocket health care expenses? Does contributing to a Scripps retirement savings plan fit into your long-term financial plan? Because everyone’s situation is different, Scripps provides the basics that you need with a range of choices for the extras that you want. Our special and unique benefits package is highly rated by employees and is one of the reasons we are repeatedly named one of FORTUNE's 100 Best Companies to Work For®. 1
DISABILITY 2 Financial Wellness • Life and AD&D, Group Critical Illness, Group Accident Insurance, Group Hospital Indemnity Insurance, Short-term and Long-term Disability Insurance • Flexible Spending Accounts • Group Legal Plan and Identity Theft Protection • ScholarShare College Savings Plan and Savings Bonds • Pet, Auto and Home Insurance • F idelity Student Loan Resources Work-Life Resources • F lexible Work Schedules and Benefits for Full-time and Part-time Benefiteligible Positions • E mployee Assistance Program (EAP), Individual/Family Counseling and Mental Health Programs • P assport Discount Program and Entertainment Events • C hildcare Services, Discounts, Resources and Referrals • H OPE Fund for Crisis Support Careers & Learning • P rofessional Development & Continuing Education Offerings • Academic and Specialty Training Programs • S cholarships and Tuition Reimbursement • Leadership Development Programs INTRODUCTION Pay & Time Off • Market Competitive Base Pay and PerformanceBased Merit Increases • Paid Time Off (PTO-Core, PTO-Sick), Paid Short-term Disability, Bereavement Leave and Jury Duty Retirement • 401(a) Retirement Plan with Matching and Annual Contributions • 401(h) Healthcare Savings Account • 403(b) Plan for Additional Retirement Savings • 457(b) Plan for Additional Pre-tax Savings for Directors and Above H ealth & Wellness • Medical, Vision, and Dental Coverage • Telehealth • Scripps Wellness Program • On-site Employee Care Centers • Scripps HealthExpress Awards & Recognition • Excel Together Recognition Program • Values in Action/Values in Leadership Awards • Employees of the Year THIS IS YOUR LIFE @ SCRIPPS PAY & TIME OFF HEALTH & WELLNESS WORK-LIFE RESOURCES RETIREMENT CAREERS & LEARNING FINANCIAL WELLNESS AWARDS & RECOGNITION
ENROLLMENT 3 ABOUT YOUR BENEFITS Our Mission Scripps strives to provide superior health services in a caring environment and to make a positive, measurable difference in the health of individuals in the communities we serve. We devote our resources to delivering quality, safe, cost-effective, socially responsible health care services. We advance clinical research, community health education, education of physicians and health care professionals and sponsor graduate medical education. We collaborate with others to deliver the continuum of care that improves the health of our community.
4 ABOUT YOUR BENEFITS About Your Benefits Eligibility Enrollment Your Cost for Coverage Mid-year Enrollment Changes When Coverage Ends Identification Cards
5 ABOUT YOUR BENEFITS by your benefit effective date. If your verification documents are not received by the deadline, your dependents will not have coverage and you will have to wait until the next annual Open Enrollment to add your dependents. When submitting dependent verification documentation, please ensure the entire document is legible and complete. We are unable to accept supporting documentation with missing or unreadable information. Eligible dependents include your: • Spouse: Husband or wife as defined by California state law. • Children: A child under age 26; or a disabled, dependent child incapable of self-support due to mental or physical disability, if the child becomes disabled prior to reaching age 26. Social Security documentation is required for disability verification. • Registered Domestic Partner: A same sex partner or opposite sex partner, as declared on a Declaration of Domestic Partnership filed with the California Secretary of State. Eligible Children Your eligible children under age 26 include: 1. Natural born child 2. Stepchild, legally adopted child or child for whom you have been appointed legal guardianship by a court of law 3. Child for whom the Plan has received a Qualified Medical Child Support Order 4. Child of a covered spouse or covered registered domestic partner (as defined in 1-3 above). Only you, your dependent children, and one other adult dependent (either your spouse or a registered domestic partner) can be covered under the Plan. To update existing dependent address and phone number, visit https://benefits.scripps.org and select View. From the Benefits Summary under Active Dependents, select the dependent you wish to update and add the address and/or phone number. Remember to return to the Benefits Summary and submit your changes. Eligibility The more you know, the more you can maximize your benefits to your advantage Eligible Employees As a Scripps employee, you are eligible to participate if you meet one of the following conditions: • You are a full-time benefit-eligible employee regularly scheduled to work at least 60 hours per pay period. • You are a part-time benefit-eligible employee regularly scheduled to work at least 40 hours per pay period for 8-hour and 10-hour shift employees or 36 hours per pay period for 12-hour shift employees. • You are a qualified employee under staged retirement, as defined by Scripps policies Employee Status S-FWHR-0220 and Benefits Eligibility S-FW-HR-0300. • You are a qualified employee under Affordable Care Act (ACA) regulations. Per ACA regulations, any Scripps employee that worked an average of 30 hours per week between November 3, 2024 and November 1, 2025 will qualify for full-time medical insurance in the next calendar year. Employees hired after November 1, 2025 will be assessed based on hire date. Eligible Dependents If you are eligible for coverage as an employee, you may also elect coverage for eligible dependents. Documentation to verify eligibility for each dependent must be emailed to HR@scrippshealth.org or faxed to 858-678-6959
6 Allowable Documents to Verify Dependent Eligibility Spouse • Copy of your marriage certificate Child • Copy of the birth certificate that shows the names of both the parent and the child • Final adoption papers • Legal documentation (e.g. court order) substantiating placement for adoption or legal guardianship with financial dependency • Copy of Qualified Medical Child Support Order requiring employee to provide support and health coverage, signed by the child support officer or judge Registered Domestic Partner • Copy of your State of California Certificate of Registration of Domestic Partnership. ABOUT YOUR BENEFITS If You and an Eligible Dependent Both Work for Scripps If both you and your spouse, registered domestic partner or child(ren) are employees of any Scripps business unit, you may not be covered as both a dependent and an employee under the Scripps Medical, Vision, Dental, and Life Insurance plans. Employees may cover one qualifying adult and dependent children, but no dependent(s) may be covered by more than one employee under the Plans. Spousal/Registered Domestic Partner (RDP) Surcharge Scripps believes that all employers have a responsibility for providing medical coverage for their employees, just as we do. Employees with a spouse or registered domestic partner who is eligible for medical coverage with his or her own employer and is covered on the Scripps Medical Plans will pay a $15 per pay period surcharge. If both you and your spouse or registered domestic partner are employees of any Scripps business unit, the spousal/RDP surcharge will not apply. Pre-tax and After-tax Deductions If the adult you cover is not your legal spouse, the cost per pay period for all dependents is taxable (or after-tax). For example, if you cover a registered domestic partner and your legal children, the portion of the premium attributable to the adult and the children will be taxable. In this example, the portion related to your coverage will be deducted before taxes are calculated (or “pre-tax”). Your paycheck stub will show two deductions — a pre-tax deduction for your coverage and an after-tax deduction for your dependent coverage.
Enrollment Take action... online and on time ABOUT YOUR BENEFITS Who Needs to Enroll? Newly Hired Employees If you are a new employee, you must elect or waive coverage within 60 days from your date of hire. New employees are eligible for benefits the first day of the month coinciding with or following 60 days of employment in a benefit-eligible position. Learn about the different plan options and carefully evaluate your personal situation by viewing the Benefits Orientation eCourse on ScrippsConnect.org. If you plan to enroll dependents under your coverage, have your dependents' birth dates and Social Security numbers during your online enrollment. Documentation for each dependent verifying eligibility for coverage must be emailed to HR@scrippshealth.org or faxed to 858-678-6959 prior to your benefits effective date. See pages 5 and 6 for a list of requirements and allowable documents. Newly appointed or hired department directors and above, fellows, and residents are eligible for benefits from their date of hire and must elect or waive coverage within 31 days from date of hire. 2026 Enrollment Steps With the benefits web enrollment system, enrolling for Medical, Vision, Dental, Flexible Spending Accounts (FSAs), Long-term Disability, Supplemental Employee Life and AD&D* Insurance and Dependent Life and AD&D* Insurance is fast, easy and convenient. You will be able to make decisions, enroll online and get immediate confirmation of your selections. To enroll in these benefits: 1. READ through this catalog. 2. COMPLETE the Benefits Orientation eCourse on ScrippsConnect.org. 3. THINK about what your needs are in relation to benefits. 4. DECIDE which benefits and options are right for you and your family. 5. GO to https://benefits.scripps.org (see page 9 for details) 6. SUBMIT your elections before your enrollment deadline. *Accidental Death & Dismemberment To Enroll in Voluntary Benefits To enroll in voluntary benefits, go to www.electbenefits.com/scripps. Enter your employee ID number and your passcode, which is the month and day of your date of birth (MMDD format). If you have questions about the voluntary benefits or need assistance accessing the enrollment website, contact Benefit Communications, Inc. (BCI) at 888-659-2573 M-F 6am to 3pm PST. IMPORTANT REMINDER If you are adding dependents to your coverage, you must provide proper verification BEFORE your benefits effective date. If proper documentation is not received in time, your dependents will NOT be covered. See pages 5 and 6 for a list of requirements and allowable documents. 7
DISABILITY 8 Current Employees During Open Enrollment Open Enrollment is your annual opportunity to enroll or make changes to your benefits unless you have a Qualifying Life Event during the year. These benefits include: medical, vision, dental, health care spending account, dependent care spending account, employee and dependent life and accidental death and dismemberment (AD&D), and longterm disability. Employees currently enrolled in these benefits who do not make changes during Open Enrollment will default to their current plan elections, with the following exception: if you wish to participate in flexible spending accounts, you must enroll each year per IRS rules. You only need to enroll if you: • Wish to change an existing plan election • Wish to add, drop or change information about your eligible dependents whom you cover under one or more plans • Have an adult on your medical plan and have not completed or updated the adult surcharge questionnaire. If you do not complete the adult surcharge questionnaire, you will be automatically charged the $15 per pay period surcharge for the adult covered on your medical plan • Want to participate in flexible spending accounts for the upcoming calendar year. According to IRS rules, you must enroll each year in the health care spending account and/or dependent care spending account. ABOUT YOUR BENEFITS My Scripps Benefits Default Coverage If you do not actively elect or waive coverage, the chart below shows the default benefits you will receive. Benefit Default Coverage That Applies NEWLY HIRED ELIGIBLE EMPLOYEES CURRENT ELIGIBLE EMPLOYEES Medical HMO Employee Only Current plan election* Vision No coverage Current plan election* Dental No coverage Current plan election* Flexible Spending Accounts No contributions No contributions* Long-term Disability No coverage Current plan election* Basic Employee Life and AD&D One times annual base pay One times annual base pay* Supplemental Employee Life and AD&D No coverage Current plan election* Spouse & Child Life and AD&D No coverage Current plan election* *Following Open Enrollment. All other benefits and options that you have will continue throughout the next calendar year if you do not make changes before the Open Enrollment deadline. Newly Eligible Employees If you are newly eligible for coverage due to a Qualifying Life Event (such as non-benefited position to benefit-eligible), you must enroll or waive coverage within 31 days from the date of the status change. Benefits are effective the first day of the following month, provided you have already met the 60-day employment requirement. Call the HR Service Center at 858-678-MyHR (6947) or email hr@scrippshealth.org to report your status change and obtain access to the benefits web enrollment system. You Must Actively Enroll or Waive Coverage If you are a new hire or a newly eligible employee (due to a status change), and do not actively elect or waive coverage, you will be defaulted into the HMO medical plan with Employee Only coverage and will be responsible for paying the associated premiums. You will still receive life insurance equal to 1 times your annual salary, but you will not be enrolled in dental or vision. You will not have the option to make changes until the next Open Enrollment period, or within 31 days of a Qualifying Life Event (QLE). See the chart below for details.
9 ABOUT YOUR BENEFITS Enrolling Online Step-by-Step Go to https://benefits.scripps.org Click on New Hire Enrollment, Qualifying Life Events, or View Benefits. Enter your user ID which is your six-digit Scripps Corporate/Employee ID. Enter your eight-digit password. Your default password is set to your eight-digit birth date when you first log in. For example, if your birthday is June 10, 1965, your password is 06101965. Click on the Sign In button. You will be asked to create a personal password to use for accessing the system. Voluntary Benefits Enrollment Enroll for most voluntary benefits through Benefit Communications, Inc. (BCI); see page 7 for details. Change Your Mind? If you are a new hire or making changes to your benefits due to a Qualifying Life Event, you can adjust your elections as often as needed until you have clicked SUBMIT on the Benefits Summary Page to finalize your elections. If you wish to make changes after you have submitted your elections, but BEFORE your effective date, please contact the HR Service Center at HR@scrippshealth.org. During Open Enrollment you can log in to the benefits web enrollment system and adjust your elections as often as you need as long as your elections are submitted by midnight of the last day of the Open Enrollment period. IMPORTANT Ensure your enrollment or benefit changes are completed by your enrollment deadline by returning to the Benefits Summary page and clicking SUBMIT for your elections to be processed and made effective.
ABOUT YOUR BENEFITS Your Cost for Coverage Your benefit options and cost for coverage are displayed when you log in to enroll or make changes to your benefits. After reviewing your options and making your elections, your total per pay period contribution will be displayed. Your medical contribution reflects your earned wellness incentive. The total per pay period employee contribution for your benefits will be deducted from each paycheck over 24 pay periods. When a month has three paychecks, regular benefit premiums will not be deducted from the third paycheck. Pre-tax or After-tax Contributions Pre-tax means that your share of the benefit cost is deducted from your paycheck before taxes are applied and deducted. When you pay for benefits on a pre-tax basis you pay less federal income and Social Security taxes, so you save money. Pre-tax benefits include contributions for medical, vision, dental, long-term disability, health care and dependent care spending accounts. After-tax benefits include medical, dental, vision, and life and accidental death and dismemberment (AD&D) premiums associated to cover a registered domestic partner, premiums for employee life and AD&D benefits greater than one times pay, spouse and child life and AD&D, and voluntary benefits elected. Contributions for a Registered Domestic Partner If you cover a registered domestic partner, the cost per pay period for medical, vision, and dental coverage for ALL dependents is taxable. Your paycheck will show two deductions. One will be pre-tax, equal to the cost for ‘employee only’ coverage; the other will be after-tax, equal to the additional cost of the adult plus any child coverage. To qualify for pre-tax contributions for medical, vision, and dental coverage for your registered domestic partner, you must notify the HR Service Center in writing that your registered domestic partner qualifies as a "dependent" under Section 152 of the Internal Revenue Code. Please provide a copy of the notice and other appropriate forms to the HR Service Center. For questions, call 858-678-MyHR (6947) or email hr@scrippshealth.org. 10 Enhanced Financial Support for Lower Wage Earners Scripps subsidizes the cost of dependent medical premiums at a higher rate for lower wage earners. If you earn $26.93 per hour or less, you will qualify for subsidized dependent medical premiums in 2026. If Your Hourly Rate is: Subsidy Eligibility $26.94 and above No $26.93 and below Yes Subsidy level eligibility for 2026 is determined by your hourly rate on September 12, 2025 and will not be impacted by FY26 annual merit or market adjustments.
ABOUT YOUR BENEFITS Plan Cost of Coverage HEALTH AND WELLNESS Medical, Vision, Dental You and Scripps share the cost. Your contribution is paid with pre-tax dollars. If you elect coverage for a registered domestic partner, your contribution for the registered domestic partner and all other covered dependents is paid with after-tax dollars. You can reduce your medical contribution by participating in the Scripps Wellness program. Scripps Wellness Program Scripps pays the full cost of the program. Your incentive eligibility depends on your participation. FINANCIAL WELLNESS Flexible Spending Accounts You contribute pre-tax dollars. Short-term Disability You pay the full cost with after-tax dollars. Long-term Disability You pay the full cost with pre-tax dollars. Basic Employee Life and Accidental Death & Dismemberment (AD&D) Scripps pays the full cost. Supplemental Life and AD&D You pay the full cost with after-tax dollars. Dependent Life and AD&D You pay the full cost with after-tax dollars. Whole Life You pay the full cost with after-tax dollars. Group Critical Illness You pay the full cost with after-tax dollars. Group Hospital Indemnity Insurance You pay the full cost with after-tax dollars. Group Accident Insurance You pay the full cost with after-tax dollars. Group Legal Plan You pay the full cost with after-tax dollars. Identity Theft Protection You pay the full cost with after-tax dollars. Pet Insurance You pay the full cost with after-tax dollars. Auto & Home Insurance You pay the full cost with after-tax dollars. RETIREMENT SAVINGS Scripps Health 401(a) Retirement Savings Plan You can make after-tax contributions and receive Scripps matching and annual contributions. Retiree 401(h) Healthcare Savings Account You can allocate a portion of your 401(a) contributions to pay for post-retirement healthcare expenses. Scripps Health 403(b) Plan You can make pre-tax or designated Roth after-tax contributions. TIME OFF Paid Time Off (PTO): PTO-Core & PTO-Sick Scripps pays the full cost. Paid Short-term Disability (PSD) Scripps pays the full cost. Jury Duty & Bereavement Leave Scripps pays the full cost. WORK-LIFE Employee Assistance Program Scripps pays the full cost. Care.com Resources and Referrals Scripps pays the full cost. 11 Who Pays
Mid-year Enrollment Changes The one thing you can always count on in life is change. You get married or have a baby. Your spouse gets a new job. Whatever the events in your life, certain changes can affect your benefits. This section and the charts on the following pages provide information on Qualifying Life Events (QLEs) and the associated benefit changes allowed. After your initial enrollment, you may not make changes or add/remove dependents until the next Open Enrollment or Qualifying Life Event. Documentation of a Qualifying Life Event will be required in order for you to make allowable changes to your benefits. Examples of QLEs include, but are not limited to: • Marriage or divorce • Termination of a registered domestic partnership • Birth, adoption, or legal custody change of a child • Death of a spouse, registered domestic partner, or dependent • Change in your eligibility status; i.e., full-time to part-time status or non-benefited to benefit-eligible • Change in your spouse/RDP's employment status that affects benefit coverage • Involuntary loss of other group health coverage • Move primary residence outside of the service area • Qualified Medical Child Support Order (QMCSO) Report Eligibility Changes to Medicaid (Medi-Cal) or Children's Health Insurance Program (CHIP) within 60 days Call the Scripps HR Service Center at 858-678-MyHR (6947) or email hr@scrippshealth.org to report all Qualifying Life Events (including newborns) which affect your benefit elections 60 days after the loss of coverage or determination of eligibility for premium assistance under a state Children's Health Insurance Program (CHIP) or Medicaid (MediCal). If you miss the deadline, you must wait until the next Open Enrollment period to make any changes to your coverage. ABOUT YOUR BENEFITS Any coverage changes must be made within 31 days of the QLE. To report your QLE and request access to the benefits web enrollment system to make benefit changes, call the HR Service Center at 858-678-MyHR (6947) or email hr@scrippshealth.org. Changes will be made effective the first day of the month following the date of your QLE except for medical coverage for newborns or newly adopted children which begins on the date of birth or adoption. 12
13 ABOUT YOUR BENEFITS Qualifying Life Events and Status Changes During the year, you may have an opportunity to elect, reduce or increase coverage on certain plans as a result of Qualifying Life Events (QLEs) and status changes. QLEs and the allowable changes are listed below. For information on termination and rehire, please call the Scripps HR Service Center at 858-678-MyHR (6947) or email hr@scrippshealth.org. Gain of spouse (Marriage) Benefit Plan Description Medical, Vision, and/or Dental May add new or existing dependents. May revoke or decrease only when spouse’s benefit becomes effective or increased under spouse’s plan. Long-term Disability Employee may enroll if evidence of insurability is met or stop coverage. Employee Life & AD&D* Employee may increase or decrease coverage. Must maintain a minimum of 1x pay. Spouse Life Insurance Eligible to apply for coverage for new spouse if spouse meets evidence of insurability. Child Life Insurance Eligible to add for new dependents. Health Care Spending Account (HCSA) Employee may increase election for newly eligible spouse or dependents or decrease election if employee or dependents become eligible under new spouse’s health plan. Dependent Care Spending Account (DCSA) Employee may enroll or increase to accommodate newly acquired dependents or decrease or stop coverage if new spouse is not employed or makes DCSA election. Loss of spouse/RDP** (Divorce, Legal Separation, Annulment, Death) Benefit Plan Description Medical, Vision, and/or Dental May stop coverage for spouse only. May elect coverage for self or dependents who lose coverage under spouse plan if result of divorce, legal separation, annulment, or death. Long-term Disability Employee may enroll if evidence of insurability is met or stop coverage even when eligibility is not impacted. Employee Life & AD&D* Employee may increase, decrease, or stop coverage even when eligibility is not impacted. Scripps provides 1x pay at no cost to employee. Spouse Life Insurance Must stop spouse coverage. Health Care Spending Account (HCSA) May decrease for former spouse who loses eligibility. Dependent Care Spending Account (DCSA) May enroll, increase, decrease, or cancel consistent with the change in status. Gain dependent (Birth, Placement or Adoption, Legal Guardianship) Benefit Plan Description Medical, Vision, and/or Dental May elect or add coverage for dependents not previously covered. Child Life Insurance Eligible to add coverage. Health Care Spending Account (HCSA) May elect or increase election. Dependent Care Spending Account (DCSA) May elect or increase election. *Accidental Death & Dismemberment **Registered Domestic Partner, must provide documentation of RDP status effective prior to the date of Qualifying Life Event.
14 ABOUT YOUR BENEFITS Loss of dependent (Death, Loss of Eligibility Due to Divorce or Legal Separation) Benefit Plan Description Medical, Vision, and/or Dental Employee must stop coverage only for the dependent who loses eligibility. Child Life Insurance Must drop coverage for lost dependent. Health Care Spending Account (HCSA) Employee may decrease or stop election. Dependent Care Spending Account (DCSA) Employee may decrease or stop election. Gain or change in employment status of employee (Non-benefited, Casual to PT or FT) Benefit Plan Description Medical, Vision, and/or Dental Employee may add coverage for employee, spouse, or dependents, may change to higher cost medical plan. Long-term Disability Employee may add coverage if evidence of insurability is met. Employee Life & AD&D* Employee may add or increase coverage for employee. Spouse Life Insurance Employee may add or increase coverage for spouse. Child Life Insurance Employee may add or increase coverage for dependents. Health Care Spending Account (HCSA) Employee may add or increase coverage for employee, spouse, and/or dependents. Dependent Care Spending Account (DCSA) Employee may add or increase coverage for employee, spouse, and/or dependents. Gain or change in employment status of employee (FT to PT, PT to FT) Benefit Plan Description Medical, Vision, and/or Dental If FT to PT, may stop coverage, or change to a lower cost plan. If PT to FT, may enroll, or change to a higher cost plan. Dependent Care Spending Account (DCSA) Employee may decrease or stop election. Spouse/RDP**, dependent gain in employment or other change in employment that affects benefit status Benefit Plan Description Medical, Vision, and/or Dental May cancel or decrease election for employee, spouse, or dependent coverage if added to dependent’s coverage. Employee Life & AD&D* May increase or decrease coverage. Spouse Life Insurance Eligible to elect or drop coverage. Child Life Insurance Eligible to elect or drop coverage. Health Care Spending Account (HCSA) May cancel or decrease election for employee, spouse, or dependent coverage if added to dependent’s coverage. Dependent Care Spending Account (DCSA) May elect or increase election if spouse did not previously work. May cancel election if spouse or dependent is added to new spouse or dependent coverage. *Accidental Death & Dismemberment **Registered Domestic Partner, must provide documentation of RDP status effective prior to the date of Qualifying Life Event. Qualifying Life Events and Status Changes (continued) Gain or loss of a registered domestic partnership Benefit Plan Description Medical, Vision, and/or Dental Eligible to add during Open Enrollment only. Benefits stop when registered domestic partnership ends.
15 ABOUT YOUR BENEFITS Termination of employment for spouse/RDP**/dependent Benefit Plan Description Medical, Vision, and/or Dental May enroll any eligible dependent not previously covered. Employee Life & AD&D* May increase or decrease coverage. Spouse Life Insurance Eligible to elect or drop coverage. Child Life Insurance Eligible to elect or drop coverage. Health Care Spending Account (HCSA) May enroll or increase contributions if health coverage is lost for affected dependent. Dependent Care Spending Account (DCSA) May enroll or increase if spouse or dependent loses eligibility for DCSA. May stop participation if spouse’s loss of employment leaves dependents ineligible. Dependent gains eligibility under employer’s plan Benefit Plan Description Medical, Vision, and/or Dental May enroll any eligible dependent not previously covered. Child Life Insurance Eligible to add for new dependent. Health Care Spending Account (HCSA) May enroll or increase contributions to take into account expenses of affected dependent. Dependent Care Spending Account (DCSA) May enroll or increase contributions to take into account expenses of affected dependent. Dependent no longer meets eligibility requirements (attains specified age) Benefit Plan Description Medical, Vision, and/or Dental Employee must stop coverage only for the affected dependent. Child Life Insurance Must cancel coverage for affected dependent. Health Care Spending Account (HCSA) May decrease contributions to take into account expenses of affected dependent. Dependent Care Spending Account (DCSA) May decrease contributions to take into account expenses of affected dependent. Termination of employment for employee Benefit Plan Description Medical, Vision, and/or Dental Coverage continues through the end of the month. Eligible for COBRA continuation. Long-term Disability Coverage continues through the end of the month. May be able to convert policy. Employee Life & AD&D* Coverage continues through the end of the month. May be able to convert policy. Spouse Life Insurance Coverage continues through the end of the month. May be able to convert policy. Child Life Insurance Coverage continues through the end of the month. May be able to convert policy. Health Care Spending Account (HCSA) Coverage continues through the end of the month. Eligible for COBRA continuation. Dependent Care Spending Account (DCSA) Coverage continues through the end of the month. *Accidental Death & Dismemberment **Registered Domestic Partner, must provide documentation of RDP status effective prior to the date of Qualifying Life Event. Qualifying Life Events and Status Changes (continued)
16 ABOUT YOUR BENEFITS When Coverage Ends If you terminate employment or retire, all My Scripps Benefits coverage will end on the last day of the month of your departure from Scripps. See chart below for COBRA continuation options. If you become ineligible for benefits due to a status change, you may be eligible to continue medical coverage based on Affordable Care Act (ACA) regulations. See page 5 for details. All other benefits will end on the last day of the month of your status change. Coverage for your dependent children that turn age 26 will end the last day of the month in which they turn 26 years of age. The opportunity to continue or convert coverage varies by plan. See chart below. If applicable, you have 60 days from the date on your COBRA* election notice or from the loss of coverage date, whichever is later, to select coverage through COBRA. For continuation or conversion options, you have 31 days from termination, status change or retirement to complete conversion forms. For more information about conversion options for employee, spouse and child life, accidental death & dismemberment (AD&D), and long-term disability contact the HR Service Center at 858-678-MyHR (6947). For more information about direct-bill options for whole life, short-term disability, group critical illness, group hospital indemnity insurance, group accident insurance, group legal plan, auto and home insurance, identity theft protection, and pet insurance, contact the appropriate insurance carrier directly. Contact information is provided on the back cover of this catalog. Coverage COBRA* Continuation Other Continuation or Conversion Options Medical/Pharmacy 18 to 36 months No Vision 18 to 36 months No Dental 18 to 36 months No Health Care Spending Account to the end of current plan year No Dependent Care Spending Account No No Employee, Spouse & Child Life and AD&D No Yes Long-term Disability No Yes *COBRA stands for Consolidated Omnibus Budget Reconciliation Act. The length of COBRA continuation depends on the reason for loss of coverage.
17 ABOUT YOUR BENEFITS ID Cards You will receive identification cards when you enroll for the benefits listed below. HMO participants will receive medical ID cards from Scripps Health Plan Services. Additional/replacement cards can be requested by calling Scripps Health Plan Customer Service at 844-337-3700. ID cards for vision and/or dental will be sent from Personify Health. EPO participants will receive ID cards for medical, dental and/or vision from Personify Health. Digital ID Cards for Dental, Vision and EPO Medical Coverage can be downloaded by visiting HCOnline. Please see instructions below for how to create your HCOnline account. Additional/replacement cards from Personify can also be requested by calling Member Services at 877-552-7247. Plan ID Cards Medical, Dental, Vision If you enroll in the HMO Medical Plan, you will receive one identification card for you and each covered dependent. If you also enroll in the Vision Plan or the Dental Plan, you will receive a separate ID card for vision and/or dental for you and each covered dependent. If you enroll in the EPO Medical Plan and also enroll in the Vision Plan and Dental Plan, your ID card will include EPO, Vision and Dental information. If you enroll in the Vision Plan and the Dental Plan but not the Medical Plan, you will receive one identification card for yourself and each covered dependent with only Vision and Dental Plan information. If you enroll in only the Vision Plan or the Dental Plan you will receive one identification card for yourself and each covered dependent with information on the Plan in which you have enrolled. Health Care Spending Account If you enroll in the health care spending account, you may elect to receive a payment card that can be used to pay for qualified expenses. Personify Health Online (HCOnline) Personify Health is the administrator for the EPO Medical Plan, Dental, Vision and Flexible Spending Accounts. Personify Health processes claims and provides customer service for Scripps Health employees. HCOnline is Personify Health's online benefits portal with convenient, self-service access to view coverage information, access claims and Explanation of Benefits (EOBs), print digital ID cards, find forms and more. To register for online access, follow these steps: • Visit HCOnline and click on Sign up for online access. • For What type of access do you need, select Member. • Complete the information requested and click the Submit button.
18 ABOUT YOUR BENEFITS
HEALTH AND WELLNESS 19 Our Vision Scripps Health will continue to be the leading health care delivery system in the greater San Diego community, as evidenced by the highest clinical quality, patient safety, and patient, physician and employee satisfaction. This will be achieved through unending focus on patient-centered and compassionate care, cost-effective operations, research, advanced technology and innovation.
Health and Wellness Medical Telehealth Vision Dental Scripps Wellness Program Retiree Health Insurance Options HEALTH AND WELLNESS 20
Health and Wellness Benefits Choice, flexibility and room to grow My Scripps Benefits offers several important types of health and wellness coverage: • Medical, vision, and dental coverage to protect you and your family from the expenses of illness or injury • Scripps Wellness program to help you stay healthy and fit, and manage health conditions • Retiree health insurance options to continue medical, vision, and/or dental coverage after your employment with Scripps ends if you meet the age and years of service requirements HEALTH AND WELLNESS 21 Who Pays for Coverage? As an eligible employee, you and Scripps share the cost of health coverage. Scripps EPO medical, vision, and dental plans are self-funded which means that you and Scripps (not an insurance company) pay the cost of claims and administrative expenses. Scripps contracts with Personify Health to provide plan administration, customer service, and claims processing for the EPO medical option. Scripps contracts with Scripps Health Plan Services to provide plan administration, customer service, and claims processing for the fully insured HMO medical option. Scripps contracts with Anthem to provide administration, customer service, and claims processing for the dental plan. Scripps contracts with EyeMed to provide administration, customer service, and claims processing for the vision plan. Women’s Health and Cancer Rights Act All of Scripps medical options provide benefits for mastectomy-related services including reconstruction and surgery to achieve symmetry between breasts, prostheses, and complications resulting from a mastectomy (including lymphedema). The same deductibles, copayments and coinsurance amounts apply to these procedures as any other covered illnesses. If you have questions, please call: • 844-337-3700 (HMO option) • 877-552-7247 (EPO option)
Health Maintenance Organization (HMO) Option The Scripps Health Plan HMO provides a wide range of quality health care services through a network of Scripps providers within San Diego County. All routine care (office visits and annual screenings) must be provided by your elected Primary Care Physician (PCP). Your PCP is responsible for coordinating referrals to specialists within the same medical group. If you are outside of your medical group's service area or San Diego County, only services that are urgent or emergent will be covered. If you are living outside of San Diego County and cannot reasonably return for routine care, you cannot choose the HMO plan. PCPs and their medical groups coordinate and assume responsibility for your care. You must designate a PCP for yourself and each covered family member when you enroll. When choosing a new PCP, make sure you are selecting a provider who is accepting new patients. Your PCP coordinates your health care, maintains your medical records, provides routine care, and refers you to specialists and other services when medically necessary. You can select your PCP from the following Plan Medical Groups (PMGs) that participate in the HMO plan option: • Mercy Physicians Medical Group • Optum Care Network - North County SD • Rady Children's Health Network • Scripps Clinic Medical Group • Scripps Coastal Medical Center • Optum Care Network SDPMG You have access to hospitals, specialty care, and urgent care centers from the providers affiliated with your PMG. Visit MyScrippsHealthPlan.com to find the affiliated hospitals and urgent care facilities for each PMG. Scripps Medical Plans With My Scripps Benefits you can choose between two medical plans. Scripps offers two medical plan options: HMO and EPO. The differences between the medical plan options are: • Your payroll contribution • What you pay when you receive medical services • Provider networks • Out-of-pocket maximums • Referral requirements Refer to the table on page 25 for a side-by-side summary of your options. HEALTH AND WELLNESS Quick Facts ELIGIBILITY/ENROLLMENT • F ull-time and part-time benefit-eligible employees are eligible the first of the month following 60 days of employment; must enroll within 60 days of hire • D epartment Directors and above, Fellows and Residents are eligible the first day of employment; must enroll within 31 days of hire OPTIONS • HMO • EPO COVERAGE TIERS • Employee only • Employee plus adult • Employee plus child(ren) • Employee plus adult & child(ren) OPEN ENROLLMENT/MID-YEAR CHANGES • Current employees can make changes during the Open Enrollment period or within 31 days of a Qualifying Life Event • Enroll or make changes online using the benefits web enrollment system RESOURCES • HMO Customer Service – 844-337-3700: benefits, eligibility, claims, and pre-authorization • EPO Member Services – 877-552-7247: eligibility, claims, and pre-authorization • MyScrippsHealthPlan.com: plan documents, provider network information • Scripps HR Service Center – 858-678-MyHR (6947): to report a Qualifying Life Event during the year, general questions 22
HEALTH AND WELLNESS 23 You can choose a different PCP and/or PMG for each covered family member. Information about whether the provider is accepting new patients is displayed when making PCP elections. A provider who is not accepting new patients appears as "not accepting new patients." If you are an existing patient of this provider, you may elect the provider as your PCP even if their panel status is "not accepting new patients." You can change your PCP at any time by calling Scripps Health Plan Customer Service at 844-337-3700. If you are a continuing HMO member, please call Customer Service to make any PCP changes rather than making the change during Open Enrollment. Your PCP change will be effective the first of the month following your call or sooner depending on certain criteria. Your PCP will provide the appropriate services or referrals to other plan providers within your PMG. If you need to see a specialist, you will need a referral from your PCP for the services to be covered. You will have direct access to certain services such as annual mammogram screenings, OBGYN care within your PMG, and other routine services that may not require a referral from your PCP. In the rare circumstance where you require specialty care that is unavailable through your PMG, authorization would be required for services to be provided outside of the PMG. With the HMO option you have no calendar year deductible, no claims to file, and pay a fixed copay for most covered services. Exclusive Provider Organization (EPO) Option The EPO option provides quality care through the Scripps Custom Network. All medical care must be provided by a Scripps Custom Network provider except in the case of an emergency. You must designate a primary care physician (PCP) for yourself and each covered family member when you enroll to ensure the lowest office visit copay ($30 copay vs. $40 copay). You may change your PCP at any time at https://benefits.scripps.org. Care can be coordinated by your PCP or you may self-refer to any provider within the Scripps Custom Network. Visit MyScrippsHealthPlan.com to find a PCP and other network providers. Eligible employees who live and work outside of San Diego County and eligible covered dependent(s) living outside of San Diego County may be eligible to enroll in the Outof-Area Plan. Care must be provided by the contracted national provider network to receive benefits under the EPO option. Eligibility for each covered member will be determined at time of enrollment based on the address submitted online at https://benefits.scripps.org. If any of your covered members move during the year, it is your responsibility to submit the updated address in the benefits web enrollment system for placement on the Out-of-Area Plan. If an address is not provided, claims for providers outside of the Scripps Custom Network will not be covered.
HEALTH AND WELLNESS Urgently Needed Care and Emergency Care Under Both Medical Options Urgently needed care is medical treatment for conditions that require prompt medical attention, but are not life threatening emergencies. Examples include but are not limited to minor sprains, fractures, pain, heat exhaustion, and breathing difficulties. Even if it’s after office hours, always contact your physician to schedule an appointment each time you need to be treated by a medical professional. If your doctor feels you need to be seen immediately, your doctor will refer you to the appropriate medical facility. Make sure you verify network status. See the chart on page 25 for additional information. Emergency care is a covered service due to the sudden and unexpected onset of a condition or injury that you believe endangers your life or could result in serious injury or disability and that requires immediate medical or surgical care. If you believe your condition is an emergency, dial 911 for immediate medical assistance or go to the nearest Emergency Center. After the medical emergency has been resolved, contact your physician for appropriate follow-up. Scripps Medical Plans pay benefits according to how your medical need is classified. Benefits for “emergency care” are different from those provided for “urgently needed care.” 24 Prior Authorization Required for Both Medical Plan Options Both medical plan options have prior authorization requirements for certain services. Prior authorization procedures are managed by your Plan Medical Group for the HMO option and by Personify Health for the EPO option. If you do not receive prior authorization when required, benefits may be denied, reduced, and/or a penalty applied. Please refer to the appropriate plan document online at MyScrippsHealthPlan.com for a detailed explanation of prior authorization and when it is required.
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