SSM Health Employee Benefits Guide

2021 Employee Benefts Guide
MyBene fits
Caring for our
exceptional employees
Table of contents
What’s New in 2021 ........................................2
Important Beneft Contacts ......................... 4
We value and appreciate

you as a member of our Eligibility ................................................................ 5
exceptional team at
SSM Health. Thank you for
being a healing presence to
Medical Plans....................................................... 6
our patients, their families,
each other and all those we Pharmacy Benefts ......................................... 10
serve. You are SSM Health!
At SSM Health, we are Discounted Medical Premiums .................. 12

committed to ofering a just
and fair benefts package that
you can personalize to ft Dental Plans ....................................................... 14
your needs and those of your
family. You may choose the
benefts that are best for you. Vision Plans .........................................................15
To understand the beneft

Pre-Tax Savings .................................................16
options completely, including
benefts that may be ofered
at no cost, it is important Retirement ........................................................... 17
that you read the materials
outlined in this guide.
Paid Time Of......................................................18
Once again, thank you
for your commitment and
dedication to our Mission and Life Insurance ................................................... 20
for providing an exceptional
experience for our patients
and those we serve.
Additional Benefts.......................................... 21
Glossary of Health Coverage and

Medical Terms ...................................................23
Informational Beneft Videos available at

ssmhealth.com/BeneftVideos
This informational booklet provides key features of the personal benefts ofered at SSM Health and 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.
2021 Employee Benefts Guide | SSM Health | November 2020 | 1

What’s New for 2021 & Important Beneft Announcements
No rate changes!
We are pleased to announce that 2020 premiums will carry over to 2021. If you are not making changes to your
level of coverage, your per pay period deductions will be the same in 2021 as they were in 2020.
Benefts Plus
You may purchase additional benefts through the convenience of payroll deduction, including:
• Accident, Critical Illness and/or Hospital Indemnity Insurance
• Pre-Paid Legal Services
• Identity Theft Protection
• Auto and Home Insurance
As part of the Benefts Plus relationship, you will also enjoy FREE access to an extensive discount program and
valuable Financial Planning Resources (through FinFit). See page 21 for additional information the voluntary
benefts.
The Voluntary Benefts highlighted below indicate whether you can enroll during the annual Benefts Open
Enrollment period or if you can make enrollment elections at any time. The Benefts Plus Portal contains
comprehensive beneft information and access to the discounts and fnancial planning resources. See the
Voluntary Benefts section of this booklet for additional information about these oferings.
Enrollment or Changes only available during

Programs available any time
Open Enrollment or with a qualifying
via Benefts Plus Portal
Work/Life Event via Workday
Accident Insurance Identity Theft Protection
Critical Illness Auto and Home Insurance
Hospital Indemnity Discount Program (Free)
Prepaid Legal Services Financial Planning Resources (Free)
Defned Beneft (DB) Pension Plan

Efective January 1, 2021: All employees who were grandparented into the Defned Beneft (DB) Pension Plan will
move to the higher match and basic contribution plan available through the Defned Contribution (DC) Plan. The
Defned Beneft plan freezes on December 31, 2020. All accrued, vested benefts remain available to employees
and may be accessed based on plan provisions. Statements refecting fnal, accrued benefts in the DB Plan will be
provided in early 2021.
Paid Parental Leave

Efective January 1, 2021: One week paid parental leave will be available to both parents.
• 40 hours of paid leave is pro-rated based on FTE
• Includes adoptions
• Covers bonding time
• Compliments maternity leave for the birth parent
New Leave Administrator

SSM Health is continuously reviewing its vendor relationships to ensure that service delivery levels are meeting
expectations. We are pleased to announce that efective January 1, 2021, two new leave administrators will begin
providing short and long-term disability support to covered employees. Sedgwick will manage leave of absence
and short-term disability; CIGNA will manage long-term disability claims. Employees will continue to have support
from the SSM Health Leave of Absence team.

What’s New for 2021 & Important Beneft Announcements
Updated Leave Policies and Resources
Comprehensive leave resources are available at ssmhealth.com/benefts. Due to low utilization and to improve the
leave administration process, efective January 1, 2021, PTO will continue to be used for the 7 - day elimination/
waiting period but will no longer be used to supplement short-term disability pay. Employees may use PTO once
short-term disability pay ends.
Pharmacy Beneft Upgrades – Vaccination Benefts
Efective August 1, 2020: Certain vaccines are now covered under the Pharmacy Beneft and may be obtained directly at
the pharmacy for $0 cost.
• Visit wellfrstbenefts.com/employees to view the Pharmacy Directory
• SSM Health Pharmacies in Wisconsin and Mid-Missouri also provide the vaccination service
• Employees may use the pharmacy vaccination service for their annual SSM Health-required fu shot
• The following vaccinations are included in this beneft program:
- Infuenza - Tetanus - Pneumonia - MMR - Hepatitis
- Varicella - Shingles - Meningitis - HPV
Pharmacy Beneft Upgrades
Efective January 1, 2021: Two pharmacy beneft updates will provide savings to employees covered under WellFirst
Health.
• A maintenance medication program will be implemented; employees and covered dependents will have a 90-day
fll requirement which will ensure they take advantage of the reduced copay beneft.
• Employees and covered dependents who utilize specialty medications may see savings on their medications
through a new co-pay max program. Note: This does not apply to employees enrolled in the WellFirst Health
Savings Plan.
Dental Benefts Expanded
Efective January 1, 2021: The former non-duplication provision is being replaced by Standard Coordination of
Benefts. This means if you carry additional dental insurance through another provider or carrier, you may receive up
to the maximum plan allowance from a combination of both the primary and secondary plans.
Health Savings Account Limits Increased

Efective January 1, 2021: Employees may contribute an additional $100 per year to their Health Savings Account
(HSA). Employees who have elected the WellFirst Health Savings Plan are eligible to participate in the HSA. Explore
the benefts of the WellFirst Health Savings Plan and the SSM Health-funded Health Savings Account by visiting the
SSM Health Benefts Video Library.
Health Care Flexible Spending Account (HCFSA) Limits Increased

Efective January 1, 2021: Employees who elect to fund a Healthcare Flexible Spending Account (HCFSA) may
contribute up to $2,750 pre-tax. Please review the HCFSA section in this booklet to understand important program
guidelines and timelines. Dependent Day Care Flexible Spending Account limits remain unchanged for 2021 – you
may contribute up to $5,000 pre-tax.
Hospital Discount Program Revised
Efective January 1, 2021, copays are not part of the Hospital Discount program. This includes emergency room
copays. All other current employee discounts and practices remain in place. Note: per state law, Wisconsin is not
allowed to ofer hospital discounts.
MyChart.
Employees are encouraged to enroll in MyChart. A mobile app is also available. MyChart gives you 24/7 access to
your health record and also enables you to:
• Schedule appointments online • Keep track of your health history
• Keep an updated list of medications • Review test results
• Communicate with your physician • Pay your physician ofce or hospital bill
Beneft/HR Contact Information
We are here to help you!
Comprehensive Beneft Information
Access informational videos, helpful tools and comprehensive plan documents by visiting:
HR ON-DEMAND Outside SSM Health

Powered by Workday ssmhealth.com/benefts
Technical Assistance
For technical assistance with Workday, Symantec VIP or general login support,
call the Technology Service Center (TSC) at 1-866-776-4357.
Benefts and Workday Support
Via phone:
IMPORTANT NOTICE:
Call People Services at 1-844-776-6947
At SSM Health, we send
during business hours, Monday – Friday, 7 am – 5 pm
benefts reminders and
Via the SSM Health intranet: notifcations via email and
Submit a ticket through AskHR 24/7 Workday. Remember to
Via Workday Help: check your SSM Health
Comprehensive user guide available through the work email and Workday
Workday inbox on a regular basis.
Beneft Vendors/Administrators - 2021 Plan Year

Vendor Name Beneft Administered Website Phone
WellFirst Health Medical Plan wellfrstbenefts.com/employees 877-274-4693
Navitus Prescription Plan navitus.com 866-333-2757
Delta Dental of Missouri Dental Plan deltadentalmo.com 800-335-8266
VSP Vision Plan vsp.com 800-877-7195
Connect Your Care (CYC) HSA and FSA Accounts connectyourcare.com 844-881-0124
Empower Retirement 403(b)/401(k)/457(b) Plans empowermyretirement.com 855-728-7526
Securian Financial Life Insurance securian.com 833-810-8262
Leave of Absence and

Sedgwick Mysedgwick.com/ssmhealth 855-253-0820
Short-Term Disability
CIGNA Long-Term Disability Mycigna.com 800-362-4462
Corestream Benefts Plus (Voluntary Benefts) www.ssmhealth.corestream.com 855-925-5700
Personal Assistance paseap.com

Employee Assistance Program 800-356-0845
Services company code SSM
Employees at Greater
Fond du Lac ministries
Agnesian.com/services/eap-
(Agnesian Health Care) Employee Assistance Program 800-922-3400
employee-assistance-program
will continue to use their
internal EAP
Eligibility
To be benefts-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 fle with Human Resources as having a 0.5 full-time equivalent (FTE)
or higher status. For example, a 0.4 FTE working extra hours does not qualify as “regularly scheduled.” Benefts are
efective on the frst day of the month coinciding with or following hire date.
Full-time Part-time
Benefts-Eligible Status Benefts-Eligible Status
64+ hours pp (.80 - 1.00 FTE) 40 – 63 hours pp (.50 - .79 FTE)
If you are a benefts-eligible employee, you may also choose to cover your eligible dependents. Eligible
dependents include:
• An eligible child up to age 26 (your child(ren): biological, foster, adopted, step or legal guardian)
• Disabled child(ren) age 26 and older may be eligible for benefts
• Your spouse
• A Legally Domiciled Adult (LDA)
- Note: Only ONE adult (Spouse or LDA) may be covered on all plans (applies to medical, dental and vision only)
• The dependent child(ren) of an LDA
Legally Domiciled Adult

If you are not covering a spouse on your plan(s), you have an opportunity to cover another adult on your plan(s) through
the Legally Domiciled Adult (LDA) option.
An LDA could be an adult child who no longer meets the defnition of eligible child, a parent, relative or another adult.
The LDA must reside in the same household as you. The LDA’s dependent child(ren), even if the child(ren) reside in
another household, can also be covered.
There are important tax implications and requirements that apply to the LDA option. If you are interested in covering an
LDA on your beneft plan(s), please click here to view an informational presentation.
Important Notice: Making Changes to Your Benefts

Qualifed Change in Status
If you have a qualifed change in status during the plan year, you may be allowed to change your level of coverage
before December 31. IRS guidelines limit the type of election change that can be made following each type of change
in status. Report ANY qualifed changes in status to through your Workday Benefts App within 31 days of the event if
you want to change your beneft election(s) to refect the change.
Eligible changes in status include, but are not limited to:
• Family changes such as marriage, divorce, legal separation, annulment, death of your spouse or dependent, birth, adoption
or placement for adoption of your child, your dependent child ceases to satisfy the plan’s eligibility requirements.
• Changes in employment status by you or your family member such as termination or commencement of
employment, strike or lockout, commencement of or return from an unpaid leave of absence, change in worksite, or
a switch from full-time to part-time or from salaried to hourly employment (or vice versa) that causes you or your
family member to lose or gain eligibility for coverage.
Loss of Medicaid or Children’s Health Insurance Program (CHIP) Eligibility

Notifcation to Human Resources must be within 60 days after the Medicaid or CHIP coverage terminates.
Open Enrollment
The other opportunity to make changes to your benefts is during the benefts open enrollment period. This gives you
a chance to re-evaluate your beneft needs and make changes. You will receive open enrollment materials in October
for elections to be efective on Jan. 1.

Medical Plans
At SSM Health, the needs of the patient come frst – and that includes you and your family. That’s why all SSM Health Plan
options cover the same services. There is no need to compare your medical plan options based on services. Instead, review
the cost-sharing amounts – the premiums, deductibles, copayments and out-of-pocket maximums – to determine what
meets your preferences or needs. If you would like help choosing the plan best for you and your dependents, click here.
SSM Health has an online Beneft Enrollment Decision Support Tool to help you compare your medical plan options.
All SSM Health employees will be able to choose from the same three
medical plan options:
• WellFirst Plus option ($400 individual deductible) IMPORTANT NOTICE:
• WellFirst Base option ($1,000 individual deductible) You will only be issued a new
medical card for Plan Year 2021
• WellFirst Health Savings option ($1,500 individual deductible;
if you are changing your medical
paired with an SSM Health funded Health Savings Account)
plan or level of coverage or if
Employees will select one of four coverage tiers: you are enrolled in the WellFirst
• Employee Only • Employee + Spouse/LDA Health Savings Plan.
• Employee + Child(ren) • Employee + Family
The SSM Health Network is the primary provider network for plan members. Visit wellfrstbenefts.com/employees
to view the Provider Directory.
Cost-sharing WellFirst Plus WellFirst Base WellFirst Health

Amounts Option Option Savings Option
$400 per person $1,000 per person $1,500 per person
Annual Deductible
$800 per family $2,000 per family $3,000 per family
Coinsurance 15% 15% 15%
Deductible/ $2,500 per person $5,000 per person $3,000 per person
Co-Insurance Limit
*The total amount you pay in $5,000 per family $10,000 per family $6,000 per family
Deductibles + Co-Insurance
Annual Out-of-Pocket $4,000 per person $6,500 per person $4,500 per person
Maximum $8,000 per family $13,000 per family $9,000 per family
Many preventive services are covered at no cost to you. For additional information
Preventive Services
on these services, click here.
Primary Care Visit $20 $25 $20 copay after deductible
Specialist Ofce Visit $30 $40 15% after deductible
Urgent Care $40 $40 $40 after deductible
Emergency Services $200 copay $200 copay $200 copay after deductible
Prescription Drug $5/$15/$30 copay

$5/$15/$30 copay $5/$15/$30 copay
(SSM Health Pharmacy) after deductible
Prescription Drug
$12/$35/$70 copay
(Other In-Network $12/$35/$70 copay $12/$35/$70 copay
after deductible
Retail Pharmacies)
Prescription copays are waived for

Medical Plan Prescription copays are waived for employees who
employees who have been approved for
Contribution Discount have been approved for the Medical Plan
the Medical Plan Contribution Discount
pharmacy beneft Contribution Discount.
once the deductible has been met.

Medical Plans - Southern Illinois, Mid-Missouri, Oklahoma
The SSM Health Network remains the primary provider network for plan members. In the Southern Illinois, Mid-Missouri,
and Oklahoma regions where employees have local limited access to SSM Health Network options for care, they may
choose to use providers in a Secondary Network, where higher deductibles, coinsurance, copays and out-of-pocket
maximums apply. Secondary Networks in Oklahoma are available through Health Care Highways. Secondary Networks
for Mid-Missouri and Southern Illinois are available through HealthLink.
Cost Sharing
Amounts –
WellFirst Health
Secondary Network WellFirst Plus Option WellFirst Base Option
Savings Option
(Southern Illinois, Secondary Network Secondary Network
Secondary Network
Mid-Missouri and
Oklahoma only)
$600 per person $1,500 per person $2,000 per person
Annual Deductible
$1,200 per family $3,000 per family $4,000 per family
Coinsurance 30% 30% 30%
Deductible/ $4,500 per person $6,500 per person $4,500 per person
Coinsurance Limit
*The total amount you pay in $9,000 per family $13,000 per family $9,000 per family
Deductibles + Co-Insurance
Annual Out-of-Pocket $6,000 per person $8,000 per person $6,000 per person
Maximum $12,000 per family $16,000 per family $12,000 per family
Many preventive services are covered at no cost to you.

Preventive Services
For additional information on these services, click here.
Primary Care Visit $20 $25 $20 after deductible
Specialist Ofce Visit $35 $45 $35 after deductible
Urgent Care $40 $40 $40 after deductible
Emergency Services $200 copay $200 copay $200 copay after deductible
Prescription Drug $5/$15/$30 copay

$5/$15/$30 copay $5/$15/$30 copay
(SSM Health Pharmacy) after deductible
Prescription Drug
$12/$35/$70 copay
(Other In-Network $12/$35/$70 copay $12/$35/$70 copay
after deductible
Retail Pharmacies)
Prescription copays are

waived for employees who
Medical Plan Prescription copays are waived for employees who
have been approved for the
Contribution Discount have been approved for the Medical Plan
Medical Plan Contribution
pharmacy beneft Contribution Discount.
Discount once the
deductible has been met.

Medical Plans
Important Announcement!
The WellFirst Health Savings Option is paired with a Health Savings Account (HSA).
SSM Health will provide HSA contributions to employees who elect the WellFirst Health
Savings Option. For more information on the HSA, please refer to page 16 or click here
for information on how the WellFirst Health Savings Option election and HSA accounts
work together.
WellFirst Health Savings Option HSA Contribution Provided by SSM Health
Coverage Tier Full-Time Employees Part-Time Employees
Per Pay Per Pay

Annually Annually
Period Period
Employee Only $19.23 Up to $500 $9.62 Up to $250
Employee + Child(ren) $38.46 Up to $1000 $19.23 Up to $500
Employee + Spouse/LDA $38.46 Up to $1000 $19.23 Up to $500
Family $38.46 Up to $1000 $19.23 Up to $500
Employees may contribute additional pre-tax dollars to the HSA account. HSA funds are deposited on a pay period basis
and the annual HSA contribution is pro-rated based on the date an employee becomes beneft eligible. HSA funds may
be used as they become available. Employees may change their own HSA contributions at any time. See page 16 for
information on maximum employee contribution amounts.
Out-of-Area Coverage
If you or a covered family member is residing outside of the SSM Health service area, you may apply to have your
medical claims covered as out-of-area. Any eligible Out-of-Area member, regardless of region, has access to both
Multiplan and PCHS networks. To search for a provider, visit multiplan.com. To determine eligibility, visit
https://wellfrstbenefts.com/employees/Coverage-for-out-of-area-dependents-and-family and review the list of SSM
Employee Health Plan network zip codes to determine if you or your covered dependents qualify as out of area. If your
home zip code is not listed, complete the Out-of-Area form. You will need to complete and submit the Out-of-Area form
so your claims are covered. Please wait until WellFirst Health has approved your out of area status before you or your
covered dependents begin using the multiplan network.
Your Annual Total Cost for Health Care

Because your health care needs are personal to you and there are many factors to consider, here’s a link to the
Beneft Enrollment Decision Support Tool. The tool includes 2020 medical and pharmacy claim information and allows
you to enter basic information about yourself and your anticipated health care expenses. It will provide you information
about your total anticipated costs under each of the SSM Health Medical Plan options - including the premiums you
would pay out of your paycheck - and your estimated out-of-pocket cost-sharing expenses. This tool is completely
confdential and is designed to assist you with your beneft enrollment decisions.
Note: the tool does not enroll you in your beneft elections. Visit the enrollment system in in Workday, to enroll in your
benefts.

Medical Plan Premiums for 2021
SSM Health reviews the costs of the employee health plans and options each year and is committed to ensuring
afordable health care is available. Medical premiums are outlined in the table below with both pre-tax monthly and
per pay period amounts. We are pleased to announce that there are NO increases to the medical premiums in 2021; the
2020 medical premiums will remain the same in 2021.
IMPORTANT! You may qualify for a Medical Plan Contribution

Discount which provides up to a 25% - 100% reduction in your
medical premiums. To see if you qualify for this discount, please
refer to page 12 or click here to view an informational video.
WellFirst WellFirst WellFirst Health

Plus Option Base Option Savings Option
Average Per Pay Average Per Pay Average Per Pay
Monthly Period Monthly Period Monthly Period
Cost Cost Cost Cost Cost Cost
Full-Time Employee Premiums (64 – 80 hours per pay period)
Employee $105 $48.46 $70 $32.31 $70 $32.31
Employee + Child(ren) $210 $96.92 $140 $64.62 $140 $64.62
Employee + Spouse/LDA $275 $126.92 $180 $83.08 $180 $83.08
Family $380 $175.38 $250 $115.38 $250 $115.38
Part-Time Employee Premiums (40 - 63 hours per pay period)
Employee $180 $83.08 $120 $55.38 $120 $55.38
Employee + Child(ren) $350 $161.54 $240 $110.77 $240 $110.77
Employee + Spouse/LDA $450 $207.69 $290 $133.85 $290 $133.85
Family $650 $300.00 $460 $212.31 $460 $212.31
Note: The premium is taken out of each pay period, so the amount shown per pay period is taken out of your paycheck
26 times per year. The amount shown does not include the $69.23 per pay period Spouse/LDA surcharge (if applicable).
The surcharge may be waived if you qualify; see more information below.
Spouse/LDA Surcharge
A $69.23 pre-tax per pay period surcharge will be added to the medical plan for employees who are covering a spouse
or LDA on their medical plan, if that spouse/LDA is eligible for group medical coverage through his/her employer. You are
eligible to waive this surcharge and must submit a waiver each year if your spouse/LDA is:
• also employed by SSM Health For more
• self-employed or unemployed information about
the Spouse/LDA
• retired with no other group health coverage available
surcharge and
• eligible for Medicare/Medicaid/Tricare with no other group health coverage available instructions on
• employed but not eligible for employer-provided medical coverage or how to WAIVE
the surcharge,
• medical coverage provided by employer does not meet ACA afordability standards.
click here.
Your spouse/LDA may contact their employer’s human resources department to verify
whether or not the coverage provided meets the ACA afordability standard.

Pharmacy Benefts
Pharmacy benefts are included in your medical plan and are accessible nationwide at most major pharmacies with
the exception of CVS (Target/Schnucks), Kmart and Meijer. See next page for a list of SSM Health Pharmacies. Visit
wellfrstbenefts.com/employees for a complete list of other In-Network Retail Pharmacies.
WellFirst Plus and WellFirst Health

WellFirst Base Option Savings Option
Other
SSM Health In-Network
Other
Pharmacy Retail
SSM Health In-Network
Pharmacy
Pharmacy Retail
Pharmacy
30-day 90-day 30-day 90-day
supply supply supply supply
Tier 1
$5 $12.50 $12 $30
Formulary generic and Copays after Deductible
copay copay copay copay
preferred drug
Tier 2
$15 $37.50 $35 $87.50
Formulary brands and Copays after Deductible
high cost generics
Tier 3
$30 $75 $70 $175
Non-Formulary brands Copays after Deductible
and generics*
Mail order can be a convenience for members who take maintenance

medications. You can receive up to a 90-day supply from an SSM Health
Mail Order Service
pharmacy or through your mail order provider, Costco. Contact your local
SSM Health pharmacy or start the process online at pharmacy.costco.com.
*Certain specialty prescriptions are covered under the plan only when flled by the Navitus Specialty Pharmacy, Lumicera
or by an SSM Health pharmacy. This program is part of your pharmacy beneft and is mandatory. Mandatory means your
specialty medication must be obtained via a Lumicera or SSM Health pharmacy. Employees and covered dependents
who utilize specialty medications may see savings on their medications through a new co-pay max program. Note: this
program does not apply to employees who are enrolled in the WellFirst Health Savings Plan.
Efective 1/1/2021, maintenance medication must be flled as a 90-day supply. You may need to contact your provider/
prescriber for a 90-day prescription.
Filling your maintenance medication as a 90-day supply helps you:

• avoid missing doses of your medication
• minimize trips to the pharmacy
• save money (as you will only need to pay 2.5 times your regular copay for a 90-day supply)
Note: This requirement does not apply to specialty medications.
If you have any questions about whether or not you have a maintenance medication that is subject to this requirement, call
Navitus Customer Care at 1.866.333.2757
SSM Health Pharmacy Locations
Mid-Missouri Wisconsin
SSM Health St. Mary’s Hospital SSM Health Pharmacy Agnesian Pharmacy Main
2505 Mission Dr. 1821 S. Stoughton Rd. Suite 300 145 N. Main St.
Jeferson City, MO 65109 Madison, WI 53716 Fond du Lac, WI 54935
573-681-3740 608-260-6500 920-926-4660
SSM Health Pharmacy Agnesian Pharmacy West

Oklahoma 1313 Fish Hatchery Rd. Suite 300, 912 S. Hickory Rd.
SSM Health St. Anthony Hospital
Madison, WI 53715 Fond du Lac, WI 54935
608 N.W. Ninth St. Third Floor
608-252-8044 920-929-7480
Oklahoma City, OK 73102
405-815-5655 SSM Health Prescription Center Agnesian Pharmacy Markesan
3200 E. Racine St. Suite 300 730 N Margaret St.
Southern Illinois Janesville, WI 53546 Markesan, WI 53946
SSM Health Good Samaritan Hospital 608-371-8100 920-398-3261
2 Good Samaritan Way #120
SSM Health Prescription Center Agnesian Pharmacy Waupun
Mt. Vernon, IL 62864
752 N. High Point Rd. Suite 300, 904 W. Main St.
618-899-4999
Madison, WI 53717 Waupun, WI 53963
608-824-4500 920-324-3010
St. Louis
SSM Health St. Mary’s Hospital SSM Health Prescription Center Agnesian Pharmacy Plus
1035 Bellevue Ave. 700 S Park St., Suite 300 420 E. Division St.
St. Louis, MO 63117 Madison, WI 53715 Fond du Lac, WI 54935
314-768-8870 608-256-6465 920-926-8585
SSM Health Depaul Hospital SSM Health Prescription Center Agnesian Prescription Center -
12266 DePaul Dr. Suite 105 753 N Main St. Suite 300 Health Plaza, 421 Camelot Dr.
Bridgeton, MO 63044 Oregon, WI 53575 Fond du Lac, WI 54935
314-344-7300 608-835-7175 920-926-5455
SSM Health Outpatient Center SSM Health Prescription Center Monroe Clinic Pharmacy
711 Veterans Memorial Parkway 2825 Hunters Trail 515 22nd Ave.
Suite 102 Portage, WI 53901 Monroe, WI 53566
St. Charles, MO 63303 608-745-3001 608-325-3111
636-669-2223
SSM Health Prescription Center
SSM Health Cardinal Glennon 10 Tower Dr. Suite 300
Outpatient Pharmacy Sun Prairie, WI 53590
1465 S Grand Blvd 608-825-3690
St. Louis MO 63104
314 - 577-5677 SSM Health Prescription Center
740 Reena Ave., Suite 300
SSM Health Pharmacy at Saint Louis Fort Atkinson, WI 53538
University Hospital 920-568-3515
1225 South Grand Blvd
Saint Louis, MO 63104
314-257-3450

Discounted Medical Premiums
At SSM Health, we believe care must not only address the physical needs of our employees, it must also address the
spiritual, social and emotional needs by ensuring peace of mind and access to quality health care. To help us achieve this
vision for optimum employee health, we ofer a medical plan contribution discount program for employees. This program
is ofered to improve access to afordable health care coverage by discounting employee contribution requirements based
on family size and household income as determined by the annual Federal Income Guidelines and as reported on your
2019 Federal Tax Return. The current federal income guidelines can always be accessed here and are also shown below.
# in Household (A) (B) (C) (D)

(# of tax dependents 100% of the 200% of the 300% of the 400% of the
including yourself Federal Income Federal Income Federal Income Federal Income
and your spouse, if Guidelines Guidelines Guidelines Guidelines
married)
1 $12,760 $25,520 $38,280 $51,040
2 $17,240 $34,480 $51,720 $68,960
3 $21,720 $43,440 $65,160 $86,880
4 $26,200 $52,400 $78,600 $104,800
5 $30,680 $61,360 $92,040 $122,720
6 $35,160 $70,320 $105,480 $140,640
7 $39,640 $79,280 $118,920 $158,560
8 $44,120 $88,240 $132,360 $176,480

Based on your 2019 family income (total income as reported on line 7b of your Federal Income Tax Return) and number
(#) of dependents, if you are a full-time employee, you will be eligible for a 25 – 100% discount on your medical plan
contributions (premiums). Part-time employees will receive the same dollar amount 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). The discount does not apply to any other benefts. The table below illustrates how the discount applies.
Full-Time Employee Discount (64 – 80 hours per pay period)
(A) Household Income less than 100% of the Federal

100% discount
Income Guidelines
(B) Household Income >100% but <200% of the Federal

75% discount
Income Guidelines
(C) Household Income >200% but <300% of the Federal

50% discount
Income Guidelines
(D) Household Income >300% but <400% of the Federal

25% discount
Income Guidelines
Receive the actual dollar amount in discount that a full-time employee receives for that election.

Discounted Medical Premiums – Example & Calculator
To see how the Medical Plan Contribution Discount would apply to you, please review the example and use the calculator
shown below.
Eddie Example
Employee Name Your Information Here
Full-Time Employee
2019 Family Size

(# of dependents plus yourself
and your spouse (if applicable)
4
claimed on your 2019 Federal
Tax Return)
2019 Household Income (Total

Income as reported on line 7b
$36,345
of your Federal Tax Return)
Household Income
Federal Income Guidelines
>100% but <200% of the Federal
(see chart on page 11)
Income Guidelines
Family coverage –
Medical Plan Election
WellFirst Plus Option
Medical premium deduction

$175.38
per pay period
% of discount .75
Discount amount credited on

paycheck (multiply the medical
$131.54
premium per pay period cost
by the % of discount)
Actual per pay period premium

cost (subtract the discount
$43.84
amount from the medical
premium per pay period)
Note: If Eddie were a part-time employee, his per pay period discount would be $131.54, the same dollar amount he
would receive as a full-time employee with the same plan election.
The Medical Plan Contribution Discount must be renewed each year during the annual open enrollment period.
Outside of open enrollment, applications may be submitted within 31 days of becoming eligible for and enrolling
in SSM Health medical coverage – either as a new hire or as the result of a status change or other qualifying event.
For more information about this discount, click here to view a program overview and application guide that includes
links to informational videos and step-by-step application instructions.

Dental Plans
Healthy teeth are an important part of wellness. SSM Health provides two dental plans from which to choose. Delta
Dental ofers a cost-sharing plan with a participating provider network. This plan provides fexibility, network savings and
preventive services. To make the most of your dental beneft dollars, you may want to consider using one of the dental
providers in their PPO or Premier Network. You may use any dentist you choose, but your in-network beneft will always
provide the most afordable option and it will enhance the total services that you can receive under the annual maximum
beneft. Visit deltadentalmo.com for information on the provider network. You can choose the Dental Base or Dental
Plus Plan options. Click here to view an informational video about how to make the most of your Dental Plan.
Note: If you are not making a change to your level of coverage for 2021, you may continue to use your current dental
card. If you change your level of coverage for 2021, you will receive a new dental card.
Dental Plus Dental Base
Annual Deductible – you will pay $50 per person/$150 family $100 per person/$300 family
Annual Maximum – plan will pay $2,000 per person $1,000 per person
Preventive Services –
Deductible does not apply 100% 100%
Routine exam, cleaning, X-rays
Basic Services 80% 50%
Major Services 50% 50%
Orthodontic Services (includes adults)

Note: Orthodontic benefts are not available for 50% N/A
services related to “do it yourself” orthodontic kits.
Lifetime Ortho Maximum Plan will pay $2,000 N/A
Dental Plan Premiums

Premiums are taken out of your paycheck 26 times per year. We are pleased to announce that there are NO increases to
the dental premiums in 2021; the 2020 dental premiums will remain the same in 2021.
Dental Plus Dental Base
Average Per Pay Average Per Pay

Monthly Cost Period Cost Monthly Cost Period Cost
Full-Time Employee Premiums (64 – 80 hours per pay period)
Employee $10.25 $4.73 $7.00 $3.23
Employee + Child(ren) $30.75 $14.19 $15.75 $7.27
Employee + Spouse/LDA $25.50 $11.77 $17.50 $8.08
Family $38.50 $17.77 $26.25 $12.12
Employee $17.50 $8.08 $12.00 $5.54
Family $61.25 $28.27 $42.00 $19.38

Vision Plans
The Vision Plan can assist with the cost of eye exams, lenses, frames and contact lenses. The plan is administered
by VSP, a national leading vision plan provider. The plan design includes copays for in-network coverage and
reimbursements (up to plan limits) for out-of-network coverage. Click here to view an informational video about how to
make the most of your Vision Plan.
Exam + Materials
How often you can
Out-of-Network
VSP Provider use services
Provider
per covered member
Comprehensive Vision Examination $10 copay $40 allowance Once every 12 months
$40 - $125
Lenses - Glass or Plastic $25 copay Once every 12 months
allowance
OR
$150 allowance + $105 allowance
evaluation and ftting ($210 allowance
Contact Lenses Once every 12 months
covered + additional if medical
discounts necessity)
$190 allowance; $25

Standard Frames copay if lenses not $45 allowance Once every 24 months
purchased
Exam Only
Note: If you are electing the WellFirst Plus or WellFirst Base Medical Plan in 2021, these plans cover an annual eye exam.
However, the copay is higher and the network of providers is limited. If you elect one of these medical plan options and
do not need lenses or frames, you may want to opt out of the vision plan.
How often you can

Out-of-Network
VSP Provider use services
Provider per covered member
Comprehensive Vision Examination $10 copay $40 allowance Once every 12 months
Vision Plan Premiums

Premiums are taken out of your paycheck 26 times per year. We are pleased to announce that there are NO increases to
the vision premiums in 2021; the 2020 vision premiums will remain the same in 2021.
Average Per Pay Average Per Pay

Monthly Cost Period Cost Monthly Cost Period Cost
Part-Time and Full-Time Employee Premiums (40 – 80 hours per pay period)
Employee $6.50 $3.00 $3.50 $1.62
Family $20.00 $9.23 $12.50 $5.77

Pre-Tax Savings
Health Savings Account
A Health Savings Account (HSA) allows participants to set aside pre-tax dollars today to pay for out-of-pocket medical
expenses in the future. IRS guidelines outline eligibility for participating in an HSA. To participate in the HSA, you must
be enrolled in the WellFirst Health Savings Option. If you elect the WellFirst Health Savings Option, SSM Health will
provide contributions to your HSA account. You may also contribute additional pre-tax funds, up to the annual IRS limit,
to your HSA. Click here to an informational video about the WellFirst Health Savings Option and HSA accounts.
Annual HSA
WellFirst Health Savings Annual HSA Contribution Contribution Limits
Option Coverage Level Provided by SSM Health (amount Employee can add to the HSA
with their own pre-tax contributions)
Full-time Employee Per Pay Period Annually Up to Age 55 *Age 55+
Employee Only $19.23 Up to $500 $3,100 $4,100
Employee + Child(ren) $38.46 Up to $1,000
Employee + Spouse/LDA $38.46 Up to $1,000 $6,200 $7,200
Family $38.46 Up to $1,000
Part-time Employee Per Pay Period Annually
Employee Only $9.62 Up to $250 $3,350 $4,350
Employee + Child(ren) $19.23 Up to $500
Employee + Spouse/LDA $19.23 Up to $500 $6,700 $7,700
Family $19.23 Up to $500
*If you will be at least age 55 during plan year 2021, you may contribute an additional $1,000 to your HSA
HSA funds are deposited on a pay period basis and the annual HSA contribution is pro-rated based on the date an
employee becomes beneft eligible. To pay for an eligible service or purchase, you need to have the available funds
in your account.
Note: You may start, stop, increase or decrease your own HSA contributions at anytime through the Benefts App
in Workday.
Flexible Spending Account – Health Care FSA

The Health Care FSA allows participants to set aside pre-tax income (up to $2,750 maximum annual contribution per
employee) to pay for eligible health care expenses incurred by you or your dependents, but not covered by, other plans.
Click here for more information and to see if a Health Care FSA is right for you.
Important Note: Plan elections will be reviewed and audited each year to ensure the plan meets the IRS Nondisrimination
Testing requirements. You will be notifed if any changes need to be made to the amount you elected for the 2021 plan
year based on the results of this audit.
Important Note: Per IRS Regulations, the Health Care FSA beneft is not available to participants in the WellFirst Health
Savings Option who have an HSA. If you have funds from your 2020 FSA account as of 1/1/2021, you have to wait until
4/1/2021 to begin participation in the HSA.
Flexible Spending Account – Dependent Day Care FSA

The Dependent Day Care FSA allows participants to set aside pre-tax income (up to $5,000 maximum annual
contribution per household) to pay for eligible child or other Dependent Day Care expenses. Click here for more
information and to see if a Dependent Day Care FSA is right for you. You may participate in a Dependent Day Care FSA
and the HSA. Participating in the HSA does not impact your ability to participate in the Dependent Day Care FSA.
Important Note: FSA funds are subject to IRS guidelines and are “use it or lose it”. Information about important timelines
and planning tools that can help you determine how much you may want to set aside in a Flexible Spending Account are
available at connectyourcare.com.

Retirement
SSM Health provides a market-competitive retirement program that is consistent with our Mission and Values
and is designed to assist you in achieving fnancial security for your retirement. To learn more about the retirement
savings program, click here to view an informational video or visit the Empower Retirement website
at empowermyretirement.com. Click here to schedule a one-on-one appointment with Empower.
Note: Physicians should refer to their Benefts Booklet for Retirement Savings information.
Fixed Contribution
SSM Health provides an annual basic/fxed contribution for employees who qualify. To qualify, employees must be 18
years of age, work a minimum of 1,000 hours in the plan year and be actively employed on the last day of the plan year.
The employer basic/fxed contribution is 3% of employee salary (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.
Match Contribution
Employees who are 18 years of age and who work a minimum of 1,000 hours per year are eligible for the Employer
Match. SSM Health will match $0.50 on the dollar for the frst 6% of employee contributions on a per pay period basis
(up to IRS annual limits). The match is provided on a per pay period basis and you must make a contribution to your
403(b)/401(k) plan in order to be eligible for the match. Plan your contributions accordingly.
Employees are vested in both the basic/fxed and match contributions after three years of eligible service. Eligible
compensation is defned by the IRS on an annual basis. For 2021, it is capped at $290,000 annually or $11,153.85 per pay
period.
Retirement Savings Plans: 403(b) and 401(k)

The voluntary 403(b) or 401(k) plans allow eligible employees to contribute pre-tax or post-tax (Roth) dollars to an
investment plan administered by Empower Retirement. There are many investment options from which to choose.
Currently, you may contribute up to $19,500. If you are going to be age 50 or older in the 2021 plan year, you may also
contribute up to an additional $6,500 under the catch-up provision. You may defer up to the annual IRS limit.
Deferred Compensation: 457(b)

Eligible employees who are on track to contribute the maximum amount to the 403(b) may also contribute to the 457(b)
up to the annual IRS limit. Currently, up to $19,500 may be contributed. Due to IRS regulations, this plan may only be
ofered to employees of non-proft ministries.
Comprehensive retirement information, including Summary Plan Descriptions (SPDs) are available here.
Defned Beneft (DB) Pension Plan

Efective January 1, 2021, all employees who were grandparented into the Defned Beneft (DB) Pension Plan will move
to the higher match and basic contribution plan available through the Defned Contribution (DC) Plan. The Defned
Beneft plan freezes on December 31, 2020. All accrued, vested benefts remain available to employees and may be
accessed based on plan provisions. Statements refecting fnal, accrued benefts in the DB Plan will be provided in early
2021.

Paid Time Of
Paid Time Off (PTO) includes vacation time, holidays, sick days, personal time and the elimination period for short-term
disability benefits. PTO is accrued each pay period based on the actual number of hours that an employee is paid and
on eligible low census hours (up to a maximum of 80 hours per pay period). Hours paid by Short-Term Disability are not
eligible for PTO accrual. To be eligible to accrue PTO, 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.
Unused PTO time carries over from year to year but the maximum amount of PTO that you have in your accrual bank is
1.5 times your annual accrual amount. If you reach your maximum PTO hours, you will need to utilize PTO time in order
to accrue additional hours. Click here to view the comprehensive PTO guidelines.
Note: Market-specific PTO programs apply to employees working a 7 on/7 off schedule. These schedules do not apply to executives, directors and
physicians. Physicians and Executives should refer to the applicable Benefits Booklet for information about Paid Time Off. Directors: At SSM Health, we
utilize an informal time off model for director-level positions. Under this approach, time off is taken as needed. There is no need to record the time away
within the timekeeping system or monitor a PTO bank. It is expected that directors will be prudent under this approach, focusing appropriate attention to
their role and leadership responsibilities. As a general guideline, it is expected that total time taken will not exceed six weeks per year, including holidays.
Director-level PTO does not have cash value, is not eligible for the PTO Sell or PTO Donation programs and does not payout upon separation of
employment.B
Annual Annual Overall Overall
Accrual Rate Max Max (days) Max Max (days)
*based on *based on
(hours) 8 hour days (hours) 8 hour days
Staf PTO Schedule

Fewer than 5 years of service .0923 per hour paid 192 24 288 36
More than 5 but fewer than 10 years of service .1077 per hour paid 224 28 336 42
More than 10 but fewer than 15 years of service .1192 per hour paid 248 31 372 46.5
More than 20 years of service .1385 per hour paid 288 36 432 54
Management PTO Schedule
Fewer than 5 years of service .1192 per hour paid 248 31 372 46.5
More than 10 years of service .1385 per hour paid 288 36 432 54
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 frontloaded hours.
PTO Sell
During open enrollment each year, employees may elect to “sell” up to 80 hours of unused PTO. The number of hours
that may be sold will be limited such that the employee’s PTO balance is at least 40 hours after the hours are sold.
The PTO hours sold will be paid at 85% of the employee’s base rate for the primary job held and will be taxed at the
supplemental rate. Payment will be made on the paycheck for the pay period in which the PTO Sell request was made.
Employees may elect the number of hours to sell through the Workday Absence App.
PTO Donation/PTO Emergency

Employees may donate up to 80 hours of PTO to a medical emergency leave bank on an annual basis. The employee
may “recommend” the recipient but may not make the donation contingent on the time going to the desired recipients.
PTO hours may be donated through the Request App in Workday.
Employees who experience an emergency that meets the IRS-defined requirements, may request hours from the medical
emergency leave bank by submitting an application through the Request App in Workday. Up to 160 hours may be
awarded annually.
PTO Hardship
Employees suffering a serious financial hardship may request a pay-out from their PTO bank by submitting an
application through the Request App in Workday. The payout 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. PTO hours are
paid at the base rate for your primary job held and are paid at 85% of full value. The hardship must meet the IRS
eligibility requirements.
2021 Employee Benefits Guide | SSM Health | November 2020 | 18
Paid Time Of
Short-Term Disability
As a benefts-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 frst week (seven calendar days)
of disability is an elimination period during which disability benefts are not paid. You must use PTO to satisfy the
elimination period while you are medically unable to work before STD benefts begin (unless taking unpaid WI FMLA).
Following the elimination period you may be eligible to receive a beneft. The 60% Short-Term Disability coverage is
provided by SSM Health at no premium cost to you (with minimum and maximum weekly benefts). You have the
option to “buy up” to a 75% STD plan.
Note: Once short-term disability payments begin, you may not use PTO. Once short-term disability payments end, you
may begin using your PTO if you need additional time away from work.
Employees who transitioned into the STD beneft from former illness banks or salary continuation received an employer-
paid buy-up to 75% at no cost, based on their former illness bank balance at 2019 year-end.
Balance as of 12/2019 Automatic “buy up” provided through the last payroll occurring in:
25 – 49% of maximum December 2022
50 – 74% of maximum December 2024
75% + of maximum December 2026
You will see the cost of the buy-up option when you go through the enrollment process.
Note: The minimum weekly beneft is $400 (pro-rated based on FTE). If you make less than $13.33 per hour, choosing
the buy-up option will not beneft you.
Maternity Benefts
If you 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 frst week (seven calendar days) elimination period
still applies. The 100% maternity leave coverage is provided by SSM Health with no premium cost to you.
Paid Parental Leave

Efective January 1, 2021, one week paid parental leave will be available to both parents.
• 40 hours of paid leave is pro-rated based on FTE
• Includes adoptions
• Covers bonding time
• Compliments maternity leave for the birth parent
Long-Term Disability
After 90 days of being medically unable to work, you are eligible to apply to receive a Long-Term Disability beneft 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. Employees must exhaust all PTO before LTD payments begin.
Note: This plan does not apply to executives and physicians.
For more information about the Short- and Long-Term Disability plans, please click here

Life Insurance
SSM Health ofers both employer-paid and voluntary life insurance to provide fnancial security should the unexpected
occur. For more information about life insurance, please click here .
Employer-Paid Life Insurance Coverage
Part-Time and Full-Time Employees (40 – 80 hours per pay period)
Staf 1X pay up to $500,000
Manager and Above 2X pay up to $1M
While SSM Health pays for the cost of this basic life policy, per federal regulations, employees must pay tax on the imputed income for the “value” of any
employer-provided life insurance that exceeds $50,000. Click here. to view the IRS guidelines. If you do not want to pay tax on this imputed income, you
may waive the basic life insurance during enrollment. Accidental Death and Dismemberment (AD&D) Insurance is not subject to imputed income tax and
therefore, may not be waived. If you waive your Basic Life and then later choose to enroll in Basic Life, you will be subject to Evidence of Insurability.
Please note: If you choose to opt out of Basic Life and you do not purchase Voluntary Employee Life, you cannot elect Dependent or Spouse Life.
Employer-Paid Accidental Death and Dismemberment Insurance (AD&D)

Part-Time and Full-Time Employees (40 – 80 hours per pay period)
Staf 1X pay up to $500,000
Manager and Above 2X pay up to $1M

Note: per industry standards, employee and spouse life insurance and AD&D are subject to beneft reduction
based on age. The beneft reduces to 65% at age 65 and to 50% at age 70.
Employee-Paid Optional Insurance (Life and AD&D)
Part-Time and Full-Time Employees Guaranteed Issue and Evidence of Insurability
(40 – 80 hours per pay period) (EOI - only applies to Life Insurance)
Multiples of pay up to 8X, Newly eligible: May elect up to the lesser of
Staf
capped at $2M supplemental 3x annual salary or $1M without EOI.
for life insurance; During Open Enrollment: If currently enrolled, may increase
Management Multiples of pay up to 8X, coverage 1x up to the lesser of 3x annual salary or $1M; If not
capped at $1M for AD&D. currently enrolled, any election requires EOI.
Dependent Life Insurance

Part-Time and Full-Time Employees Guaranteed Issue and
(40 – 80 hours per pay period) Evidence of Insurability (EOI)
Increments of $25,000 Newly eligible: May elect up to $50,000 without EOI.
Spouse
up to $250,000 During Open Enrollment: Any increase in coverage requires EOI.
Increments of $5,000
Eligible Child All coverage is guaranteed issue – no EOI required.
up to $25,000
Dependent AD&D
Part-Time and Full-Time Employees Guaranteed Issue and Evidence of Insurability
(40 – 80 hours per pay period) (EOI – only applies to Life Insurance)
Increments of $25,000
Spouse
up to $100,000 All coverage is guaranteed issue – no EOI required.
Eligible Child $10,000 or $25,000
Additional Lifestyle Benefts

Additional services are automatically ofered to those enrolled in Life Insurance; there is no additional cost for these benefts.
Travel Assistance: Planning to travel 100 miles or more from home? Access pre-trip planning and emergency services
through RedpointWTP. Learn more at: LifeBenefts.com/travel
Legal, fnancial and grief resources: access to resources for creating wills and other key legacy documents. Learn more
at LifeBenefts.com/lfg, username: lfg and password: resources.

Additional Benefts
Benefts Plus
Benefts 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.
Beneft Description How to Enroll
Accident insurance helps you pay for the medical and out-of-
Accident Insurance
pocket costs that you may incur after an accidental injury.
Critical illness insurance provides additional coverage for View coverage options
Critical Illness
medical emergencies like heart attack, stroke, or cancer. and enroll in Workday
during Open Enrollment.
Hospital indemnity insurance helps ofset hospitalization
Hospitalization
expenses that may not be covered under your medical plan.
MetLife Legal Plans provides access to attorneys for many
Legal Services
common legal issues.
Identity Theft LifeLock provides an all-in-one membership for your Cyber
Protection Safety.
Enroll at any time through
Streamline shopping for auto and home insurance; get real-time, the Benefts Plus portal.
Auto & Home
side by side rate quotes so you can fnd the policy that works
Insurance
best for your needs and budget.
FinFit provides you with personalized tools and

Financial Counseling
recommendations to help you identify your fnancial goals,
(FREE!)
manage your fnances and achieve personal success. Access these services
at any time through the
Enjoy curated savings on your favorite products and services.
Discount Shopping Benefts Plus portal.
It's our way of saying, "Thanks for doing a great job!" Find great
(FREE!) deals on electronics, travel, entertainment, clothes, gifts and
more in one convenient location.
Employee Assistance Program

A free, confdential counseling and referral service designed to assist both you and your immediate family. The
Employee Assistance Program (EAP) can provide resources on health, fnances, retirement planning, childcare
planning, family issues and much more. EAP services are provided by Personal Assistance Services (PAS). You
may reach them at: paseap.com (company code: SSM) or 1-800-356-0845.
Note: Employees at Greater Fond du Lac ministries (Agnesian HealthCare) will continue to use their internal EAP.
Employees of these ministries may reach them at: Agnesian.com/services/eap-employee-assistance-program or
1-800-922-3400.
Bereavement Leave
You may take up to three scheduled shifts with pay in the event of the death of a family member; up to fve
scheduled shifts with pay are provided if the loss is a spouse or child/step-child. Click here to view the
bereavement leave guidelines.
Tuition Reimbursement
The tuition reimbursement policy is designed to provide fnancial assistance in support of your professional
development. If you are in good standing, you are eligible once you have been with SSM Health for 90 days. Full-time
employees are eligible for up to $4,200 annually and part-time employees are eligible for up to $2,100 annually to help
cover the cost of tuition towards a job-related degree program at an accredited college or university. Click here to view
comprehensive tuition beneft information.

Additional Benefts
Adoption Reimbursement
You may be reimbursed for normal agency and legal fees incurred to adopt a minor child, up to the maximum beneft,
set at the cost of an uncomplicated childbirth.
Virtual Visits
Online virtual visits are a quick, afordable and convenient way to connect with trusted SSM Health providers and receive
treatment for common, non-urgent medical conditions. The virtual visit guides patients through an adaptive interview,
asking only relevant questions about their symptoms, just like an in-person ofce visit. SSM Health employee health plan
members: $10 Non-members: $25
Wellness Resources
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 and Self-Care app.

Glossary of Health Coverage and Medical Terms
The Summary of Benefts and Coverage (SBC) fnal regulations require group health plans and health insurance issuers
to provide the Uniform Glossary in a common format and use terminology that is understandable by the average plan
enrollee or individual covered under an individual policy.
The Uniform Glossary includes many commonly used health coverage and medical terms, but isn’t a full list. These terms
and defnitions are intended to be educational and may be diferent from the terms and defnitions for a plan. Some of
these terms might not have exactly the same meaning when used in a policy or plan, and in any such case, the policy or
plan governs.
The glossary may not be modifed by plans or issuers. Examples of insurance-related terms to be defned are:
coinsurance, copayment, deductible, excluded services, grievance, appeal, non-preferred provider, out-of-network
copayment, out-of-pocket limit, preferred provider, premium and UCR (usual, customary and reasonable) fees.
Examples of medical terms to be defned are: durable medical equipment, emergency medical transportation,
emergency room care, home health care, hospice services, hospital outpatient care, hospitalization, physician services,
prescription drug coverage, rehabilitation services, and skilled nursing care.
How to Access the Uniform Glossary

The Uniform Glossary may be reviewed and obtained at the following websites:
• The Center for Consumer Information & Insurance Oversight (CCIIO) at cciio.cms.gov
• U.S. Department of Labor at dol.gov/ebsa/healthreform and healthcare.gov
• Paper copies of the Uniform Glossary are also available upon request.
Written Translation of the Uniform Glossary

Plans and issuers are also required to provide notices in a culturally and linguistically appropriate manner. This includes
providing access to written translation of the Uniform Glossary in Spanish, Tagalog, Chinese and Navajo for certain
geographic areas. HHS will provide written translation of the Uniform Glossary in the above listed languages at the
following websites: cciio.cms.gov and dol.gov/ebsa/healthreform

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2021 Employee Benefts Guide

What’s New in 2021 ........................................2

Important Beneft Contacts ......................... 4

We value and appreciate

At SSM Health, we are Discounted Medical Premiums .................. 12

To understand the beneft

Glossary of Health Coverage and

Informational Beneft Videos available at

2021 Employee Benefts Guide | SSM Health | November 2020 | 1

Enrollment or Changes only available during

Accident Insurance Identity Theft Protection

Critical Illness Auto and Home Insurance

Hospital Indemnity Discount Program (Free)

Prepaid Legal Services Financial Planning Resources (Free)

Defned Beneft (DB) Pension Plan

Paid Parental Leave

New Leave Administrator

2021 Employee Benefts Guide | SSM Health | November 2020 | 2

Health Savings Account Limits Increased

Health Care Flexible Spending Account (HCFSA) Limits Increased

HR ON-DEMAND Outside SSM Health

Beneft Vendors/Administrators - 2021 Plan Year

WellFirst Health Medical Plan wellfrstbenefts.com/employees 877-274-4693

Navitus Prescription Plan navitus.com 866-333-2757

Delta Dental of Missouri Dental Plan deltadentalmo.com 800-335-8266

VSP Vision Plan vsp.com 800-877-7195

Empower Retirement 403(b)/401(k)/457(b) Plans empowermyretirement.com 855-728-7526

Securian Financial Life Insurance securian.com 833-810-8262

Leave of Absence and

CIGNA Long-Term Disability Mycigna.com 800-362-4462

Corestream Benefts Plus (Voluntary Benefts) www.ssmhealth.corestream.com 855-925-5700

Personal Assistance paseap.com

64+ hours pp (.80 - 1.00 FTE) 40 – 63 hours pp (.50 - .79 FTE)

Legally Domiciled Adult

Important Notice: Making Changes to Your Benefts

Loss of Medicaid or Children’s Health Insurance Program (CHIP) Eligibility

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Cost-sharing WellFirst Plus WellFirst Base WellFirst Health

Coinsurance 15% 15% 15%

Primary Care Visit $20 $25 $20 copay after deductible

Specialist Ofce Visit $30 $40 15% after deductible

Urgent Care $40 $40 $40 after deductible

Prescription Drug $5/$15/$30 copay

Prescription copays are waived for

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Coinsurance 30% 30% 30%

Many preventive services are covered at no cost to you.

Primary Care Visit $20 $25 $20 after deductible

Specialist Ofce Visit $35 $45 $35 after deductible

Urgent Care $40 $40 $40 after deductible

Prescription Drug $5/$15/$30 copay

Prescription copays are

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WellFirst Health Savings Option HSA Contribution Provided by SSM Health

Coverage Tier Full-Time Employees Part-Time Employees

Per Pay Per Pay

Employee Only $19.23 Up to $500 $9.62 Up to $250

Employee + Child(ren) $38.46 Up to $1000 $19.23 Up to $500

Employee + Spouse/LDA $38.46 Up to $1000 $19.23 Up to $500