Page 2 - SIH 2022 Re-Enrollment Guide
P. 2
TABLE OF CONTENTS
2022 Beneits . . . . . . . . . . . . . . . . . . . . . . . . . .4 Durable Medical Equipment (DME) . . . . . . .27
Medical Pricing . . . . . . . . . . . . . . . . . . . . . . . . .5 Prescription Drugs . . . . . . . . . . . . . . . . . . . . .28
Medical Plan Design . . . . . . . . . . . . . . . . . . . . .6 Preventive Care . . . . . . . . . . . . . . . . . . . . . . . .31
Dental and Vision Pricing . . . . . . . . . . . . . . . . . 8 SIH WorkWell Employee
Wellness Program . . . . . . . . . . . . . . . . . . . . .32
Dental Plan Design . . . . . . . . . . . . . . . . . . . . .8
Dental Options . . . . . . . . . . . . . . . . . . . . . . . .33
Vision Plan Design . . . . . . . . . . . . . . . . . . . . . .9
Vision Coverage . . . . . . . . . . . . . . . . . . . . . . .34
Short Term Disability and
Family Medical Leave . . . . . . . . . . . . . . . . . . .10 Healthcare Flexible Spending
Account (FSA) . . . . . . . . . . . . . . . . . . . . . . . . . . 35
SIH Beneit Partner Contact Information . .11
Dependent Care Flexible Spending
Options to Re-Enroll in Beneits . . . . . . . . . .12 Account (FSA) . . . . . . . . . . . . . . . . . . . . . . . . .36
Enrolling Family Members . . . . . . . . . . . . . . .13 Basic Life and Accidental Death
Beneit Eligibility . . . . . . . . . . . . . . . . . . . . . . .14 and Dismemberment (AD&D) . . . . . . . . . . . .38
Working Spouse Contribution . . . . . . . . . . .16 Imputing Taxable Income
For Group Term Life Insurance . . . . . . . . . .39
Frequently Asked Questions
About the Working Spouse Contribution . .17 Supplemental Employee Life Insurance . . .40
Life Events–Qualiied Status Voluntary Child Life . . . . . . . . . . . . . . . . . . . .41
Changes During the Year . . . . . . . . . . . . . . . .18 Voluntary Spouse Life . . . . . . . . . . . . . . . . . .41
When Coverage Begins . . . . . . . . . . . . . . . . .19 AD&D Options . . . . . . . . . . . . . . . . . . . . . . . . .42
When Coverage Ends . . . . . . . . . . . . . . . . . . .19 Short Term Disability . . . . . . . . . . . . . . . . . . .43
Changes Allowed Due to Long Term Disability and Buy-Up . . . . . . . . .43
Change in Family Status Event . . . . . . . . . . .20
Voluntary Beneits through
Employment Status Changes and Allstate Beneits . . . . . . . . . . . . . . . . . . . . . . .44
Impact to Beneits . . . . . . . . . . . . . . . . . . . . .21
PAS (Personal Assistance Services) . . . . . . .47
Health and Welfare Beneits . . . . . . . . . . . . .21
Retirement Savings Plan . . . . . . . . . . . . . . . .49
Network Provider Descriptions . . . . . . . . . .22
Additional Beneits . . . . . . . . . . . . . . . . . . . . .52
Listing of Facilities . . . . . . . . . . . . . . . . . . . . .23
Glossary of Health Coverage and
Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 Medical Terms . . . . . . . . . . . . . . . . . . . . . . . . .54
Medical Plan Design . . . . . . . . . . . . . . . . . . . .26 Federally Required Notices . . . . . . . . . . . . . .58
Please read this guide before you make your beneit selections. SIH beneit plans are governed by plan documents and Summary Plan
Descriptions (SPDs). If there is any discrepancy between this guide and any of the plan documents, the plan documents will govern.
This guide and the SPDs are also available via Infolink on the Lawson Dashboards and at beneits.sih.net.
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2022 Beneits . . . . . . . . . . . . . . . . . . . . . . . . . .4 Durable Medical Equipment (DME) . . . . . . .27
Medical Pricing . . . . . . . . . . . . . . . . . . . . . . . . .5 Prescription Drugs . . . . . . . . . . . . . . . . . . . . .28
Medical Plan Design . . . . . . . . . . . . . . . . . . . . .6 Preventive Care . . . . . . . . . . . . . . . . . . . . . . . .31
Dental and Vision Pricing . . . . . . . . . . . . . . . . . 8 SIH WorkWell Employee
Wellness Program . . . . . . . . . . . . . . . . . . . . .32
Dental Plan Design . . . . . . . . . . . . . . . . . . . . .8
Dental Options . . . . . . . . . . . . . . . . . . . . . . . .33
Vision Plan Design . . . . . . . . . . . . . . . . . . . . . .9
Vision Coverage . . . . . . . . . . . . . . . . . . . . . . .34
Short Term Disability and
Family Medical Leave . . . . . . . . . . . . . . . . . . .10 Healthcare Flexible Spending
Account (FSA) . . . . . . . . . . . . . . . . . . . . . . . . . . 35
SIH Beneit Partner Contact Information . .11
Dependent Care Flexible Spending
Options to Re-Enroll in Beneits . . . . . . . . . .12 Account (FSA) . . . . . . . . . . . . . . . . . . . . . . . . .36
Enrolling Family Members . . . . . . . . . . . . . . .13 Basic Life and Accidental Death
Beneit Eligibility . . . . . . . . . . . . . . . . . . . . . . .14 and Dismemberment (AD&D) . . . . . . . . . . . .38
Working Spouse Contribution . . . . . . . . . . .16 Imputing Taxable Income
For Group Term Life Insurance . . . . . . . . . .39
Frequently Asked Questions
About the Working Spouse Contribution . .17 Supplemental Employee Life Insurance . . .40
Life Events–Qualiied Status Voluntary Child Life . . . . . . . . . . . . . . . . . . . .41
Changes During the Year . . . . . . . . . . . . . . . .18 Voluntary Spouse Life . . . . . . . . . . . . . . . . . .41
When Coverage Begins . . . . . . . . . . . . . . . . .19 AD&D Options . . . . . . . . . . . . . . . . . . . . . . . . .42
When Coverage Ends . . . . . . . . . . . . . . . . . . .19 Short Term Disability . . . . . . . . . . . . . . . . . . .43
Changes Allowed Due to Long Term Disability and Buy-Up . . . . . . . . .43
Change in Family Status Event . . . . . . . . . . .20
Voluntary Beneits through
Employment Status Changes and Allstate Beneits . . . . . . . . . . . . . . . . . . . . . . .44
Impact to Beneits . . . . . . . . . . . . . . . . . . . . .21
PAS (Personal Assistance Services) . . . . . . .47
Health and Welfare Beneits . . . . . . . . . . . . .21
Retirement Savings Plan . . . . . . . . . . . . . . . .49
Network Provider Descriptions . . . . . . . . . .22
Additional Beneits . . . . . . . . . . . . . . . . . . . . .52
Listing of Facilities . . . . . . . . . . . . . . . . . . . . .23
Glossary of Health Coverage and
Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 Medical Terms . . . . . . . . . . . . . . . . . . . . . . . . .54
Medical Plan Design . . . . . . . . . . . . . . . . . . . .26 Federally Required Notices . . . . . . . . . . . . . .58
Please read this guide before you make your beneit selections. SIH beneit plans are governed by plan documents and Summary Plan
Descriptions (SPDs). If there is any discrepancy between this guide and any of the plan documents, the plan documents will govern.
This guide and the SPDs are also available via Infolink on the Lawson Dashboards and at beneits.sih.net.
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