Healthcare, pharmacist and woman at counter with medicine or prescription drugs in hands at drug store. Health, wellness and medical insurance, man and customer at pharmacy for advice and pills.

Medical & Prescription Plan

Medical	Domestic (Member Pays)	In-Network Only (Member Pays)
Deductible (Single/Family)	$0/$0	$1,000/$2,000
Out of Pocket Maximum (Single/Family)	N/A	$6,500/$13,000 (per covered individual for EPO providers only)
	Medical Coinsurance
Coinsurance	0%	20% after the deductible is met
Calendar Year Maximum	No Limit	No Limit
Preventative Care	0%	20% after $25 copayment. Deductible is waived at Oak Valley Health Clinics
Inpatient Care	0%	20% after $800 copay
Emergency Room Care	0%	20% after $150 copay
	Prescription Drug Plan
Prescription Drug	Retail (Up to 30-Day Supply)	Mail (Up to 90-Day Supply)
Generic	$20	$40
Brand Name	$45	$90
Brand Non-Formulary	$75	$175
Specialty	20% max $1,000	20% max $1,000

An EPO, or exclusive provider network, covered the costs of medical care provided only by in-network providers (except in a medical emergency). Please note that all Sutter hospitals and providers are out-of-network and not covered under the medical plan, including in an emergency

ALL Sutter hospitals and providers — such as Memorial Hospital — may appear on the list, but ARE NOT covered by the medical plan! No Sutter providers are covered by the medical plan.

Look up Domestic Partner Providers

Look up in-network Providers

Dental Care Plan

	In-Network	Out of Network
Annual Program Deductible (Per person/per family)	$50/$150	$50/$150 Excludes Orthodontics
Annual Program Maximum	$1,500	$1,000 Excludes Orthodontics
Lifetime Orthodontic Maximum	$1,000	Not Covered
	Benefits
Diagnostic/Preventive Services	100%	80%
Basic Services	90%	80%
Major Services	60%	50%
Temporomandibular Joint (TMJ)	50%	50%
Orthodontics	50%	Not Covered

The dental plan provides the insured with access to any United Concordia-contracted dentists for dental services. The plan features a low-dollar deductible, preventive care benefits, and Orthodontic coverage (in-network).

Look up in-network Dentists

Eye care, glasses choice and black woman with optometrist at clinic, vision and healthcare with wellness. Prescription lens, frame with help or advice, designer eyewear or spectacles with smile

Vision Service Plan

Vision Care	In-Network
Well Vision Exam	Covered in full after co-pay
Contact Lens Exam	Covered in full after copay, not to exceed $60
Standard & Premium	Covered in full after copay, not to exceed $39
Routine Retinal Scanning	$120 Contact Lens Allowance
Frames	In-Network
Frames	Covered in full after copay, up to a frame allowance of $250 20% off any amount above the allowance Extra $20 allowance on Featured Frame Brands
Lenses	In-Network
Elective	Covered in full, up to Contact Lens Allowance
Necessary	Covered in full after copay
Additional Benefits	In-Network
Essential Medical Eye Care (Supplemental coverage beyond routine care to treat urgent issues/monitor ongoing conditions)	Covered in full after copay, not to exceed $20
Low Vision (Supplemental testing and coverage for approved low vision aids)	Up to $1,000 every two years Covers 100% supplemental testing and 75% of approved low vision aid.
VSP Laser Vision Care Program (Discounted access for laser vision correction services)	Average savings of 15%-20% off retail price or 5% off promotional price.
Additional Pairs of Glasses	30% off unlimited additional pairs of prescription glasses and/or non-prescription sunglasses.
Sunglasses (Use of frame allowance for no-prescription sunglasses for members who have had laser surgery)	Covered in full after copay, up to frame allowance.
Supplemental Benefits	In-Network
VSP LightCare (Non-prescription blue light filtering glasses or sunglasses)	Covered in full after copay, up to frame allowance.

Frequency	CoPay & Allowance
Exam – Every 12 months	$25 total copay
Lenses every 12 months	$250 Frame Allowance
Frame every 24. months	$120 Contact Lens Allowance
Contact Lenses every 12 months (Instead of lenses and frames)	$120 Contact Lens Allowance

Telecom Primary 360

Teladoc Primary360 Virtual Care is available for all members

Primary360 gives you easy access to a primary care provider and care team by phone or video. Teladoc will help you stay healthy, manage conditions, and create a personalized care plan.

Before your visit: Choose a provider, answer a few questions, and get a free blood pressure monitor.

Schedule your $0 checkup: TeladocHealth.com/PrimaryCare or download the Teladoc Health app

During your visit: Discuss health goals, concerns, and next steps — all from home.

Primary360: Key Info: Teladoc Health Primary360 gives you virtual primary care for your physical and mental health.

You can:

Before your visit: choose your own provider, answer a few questions, and get a free blood pressure monitor (which is yours to keep) at no cost to you.
Schedule your $0 visit (Mon–Fri 7 a.m.–9 p.m., Sat 8 a.m.–Noon): Online at TeladocHealth.com/Primary360, download the Teladoc Health app, or call 1-800-835-2362.
Access 24/7 non-emergency care

Care Team: Board-certified doctors, nurses, and coordinators guide you every step.

Labs & Imaging: Your provider can order and review results—in-person or at home (if available). If you decide to have labs and imaging done at an OVHD facility, it will be at no cost to you.

Hearing Plan Benefit

Oak Valley Hospital District has partnered with HearUSA to provide Hearing Benefits for all eligible OVHD employees and family members. with hearing loss. Your provider is your partner in the process of what, for many, is the equivalent of learning to hear again. The key to success is to establish realistic goals and to work with your hearing care provider to achieve them.

For further information, call HearUSA at 1-800-442-8231, visit www.hearusa.com, or contact the Human Resources Department employees and family members.

Employee Tuition Reimbursement Benefit

Looking to expand your horizons? Oak Valley Hospital District offers an exciting Tuition Reimbursement Program. Please contact the Human Resources Department for a complete review of the program and qualifications.

Flexible Spending Account

The HC Flex Account allows members to use pre-tax dollars to pay for eligible benefits. You can save 22% or more on your dependent care and health care expenses through the HC Flex Account. Simply choose the Dependent Care FSA and/or Health Care FSA options at Open Enrollment and select how much of your paycheck you’d like to defer to your account tax-free.

Dependent Care Expenses:

Expenses for the care of a dependent child (12 years or under)
Expenses for the care of a dependent elder (if in your home at least 8 hours/day)
Expenses for day camp
Housekeeping fees, if part of the fee is
for child/elder care
Expenses for the care of a physically or mentally disabled dependent

Unreimbursed Health Expenses

Deductibles and Co-payments
Vision expenses
Orthodontia expenses that the IRS considers eligible under Code Section 213

REMINDER- ANNUAL ELECTION IS REQUIRED DURING OPEN ENROLLMENT PERIOD (OR WITHIN 31 DAYS OF BEING ELIGIBLE FOR BENEFITS)

Basic Term Life Insurance

100% Employer-Paid Basic Life Benefit. We are sensitive to your need for financial assistance when there is a crisis that results in death. This is one of the reasons why your Basic Life Benefit through The Hartford is 100% employer-paid. Eligible employees include all active, full-time employees working 30 hours or more. Oak Valley Hospital District provides you with basic Term Life Insurance and basic Accidental Death & Personal Loss (AD&PL) coverage of 5 times your Annual Base Salary to a maximum of $500,000.

Accidental Death & Personal Loss

Coma Benefit

If a covered employee suffers a bodily injury caused by an accident and, as a direct result, becomes comatose, a monthly benefit of 5% will be payable for 11 months after the person has been continually comatose for 30 consecutive days. Full principal sum paid after 12 months of continuous coma.

Passenger Restraint and Airbag Benefit

If the covered loss of life of the employee occurs as a direct result of a motor vehicle accident and the insured is properly using a passenger restraint and (if the driver) is properly licensed, a benefit will be payable. If the airbag is activated as a result of the same accident, an additional benefit will be payable. The benefit provides for $10,000 for the use of a passenger restraint and an additional $5,000 if an airbag is activated. Basic Life Benefit through The Hartford is 100% employer-paid. Eligible employees include all active, full-time employees working 30 hours or more.

Education Benefit

If the covered loss of life of the employee occurs as a direct result of an accident, an education benefit will be payable on behalf of each dependent child and/or surviving spouse for a maximum of 4 years from the date of death, with verification of continued enrollment. The benefit provides 5% of the employee’s principal sum, not to exceed $5,000 per year.

Child Care Benefit

If loss of life of the employee occurs as a direct result of an accident, a benefit will be payable to the guardian of the estate of the child or custodian/care-taker, to cover expenses associated with the dependent child’s enrollment in a legally licensed childcare as of the date of the accident. The benefit provides for 3% of the employee’s principal sum to a maximum of $2,000 per child per year for a maximum of 4 years.

Repatriation of Remains

If a covered loss of life of the employee occurs as a direct result of an accident while he/she is at least 200 miles from home, a benefit of up to $5,000 will be payable for the preparation and transportation of the body to the hometown mortuary.

Short & Long Term Disability

Financial protection for you and your family for unexpected (or expected) illness or injury provides peace of mind. We have worked with The Hartford to provide this peace of mind for you and your family. Premiums for STD and LTD are 100% employer-paid. You are eligible for these plans after your 90-day provisional period.

During your disability, you may be able to receive the following benefits and/or & Long-term resources:

Legal Reference Program
Rehabilitation
Survivor Benefit

Employee Assistance Program (EAP)

The Aetna Employee Assistance Program (EAP) is available for active employees,

members of their households, and their children up to the age of 26. The EAP can

help you balance the demands of work, life, and personal issues. You can access the EAP 24

hours a day, seven days a week, online, by phone, or by Televideo Conferencing.

Benefits Overview

The EAP offers short-term counseling on all aspects of life at no cost to you, including:

Relationship difficulties
Emotional/psychological concerns
Work or family stress and anxiety
Alcohol and drug abuse
Personal and life improvement
Legal or financial topics
Depression
Childcare
Elder care issues
Grief issues
Mind Comparison Self-Care Mental, Well-Being Program

Legal & Financial Services

Typical financial consultation for matters including credit counseling, debt and budgeting assistance, tax planning, and retirement and college planning.
A free on-line will, valid in 49 states
Detailed will and trust preparation
Identity theft consultation
Mediation services
Telephonic tax consultation
Legal and financial library

Confidential assistance is available 24 hours a day, 7 days a week Toll-free:
1-800-342-8111
www.resourcesforliving.com
User name: OVHD
Password: EAP

Retirement

Money Purchase Plan

Oak Valley Hospital District (OVHD) provides a Money Purchase Pension plan at no cost to employees. For more information on this plan, you can contact Empower Retirement at 1-866-467-7756 or online at www.empowermyretirement.com

Optional Tax Shelter Annuities

Oak Valley Hospital District is partnered with a few different optional Tax Sheltered Annuity

companies. For more information, please contact Human Resources at (209) 848-5436.

FOR MORE THAN FOUR DECADES, OAK VALLEY HOSPITAL HAS CONTINUOUSLY EVOLVED TO MEET THE CHANGING HEALTHCARE NEEDS OF OUR RURAL COMMUNITIES. TODAY, WE PROUDLY OFFER A COMPREHENSIVE NETWORK OF MEDICAL SERVICES—DELIVERED LOCALLY AND CONVENIENTLY.

Happy, smiling and mature couple using a laptop together at home. Charming husband assisting wife with online work on the internet. Cheerful Middle aged partners working as a team on social media.

Considering joining Oak Valley Hospital?

Connect with our Human Resources team for support, plan information, and assistance navigating your benefits.

Human Resources Department
209-XXX-XXXX (insert correct number)
HR@ovhd.com
Monday–Friday, 8:00 AM–5:00 PM

Our team is happy to answer your questions and help ensure you have the information you need.

Medical & Prescription Plan

Medical

Domestic

(Member Pays)

In-Network Only

(Member Pays)

Medical Coinsurance

Prescription Drug Plan

An EPO, or exclusive provider network, covered the costs of medical care provided only by in-network providers (except in a medical emergency). Please note that all Sutter hospitals and providers are out-of-network and not covered under the medical plan, including in an emergency

ALL Sutter hospitals and providers — such as Memorial Hospital — may appear on the list, but ARE NOT covered by the medical plan! No Sutter providers are covered by the medical plan.

Dental Care Plan

In-Network

Out of Network

Benefits

The dental plan provides the insured with access to any United Concordia-contracted dentists for dental services. The plan features a low-dollar deductible, preventive care benefits, and Orthodontic coverage (in-network).

Vision Service Plan

Vision Care

In-Network

Frames

In-Network

Additional Benefits

In-Network

Supplemental Benefits

In-Network

Frequency

CoPay & Allowance

Telecom Primary 360

Hearing Plan Benefit

Employee Tuition Reimbursement Benefit

Flexible Spending Account

Dependent Care Expenses:

Unreimbursed Health Expenses

Basic Term Life Insurance

Accidental Death & Personal Loss

Short & Long Term Disability

Employee Assistance Program (EAP)

Retirement

FOR MORE THAN FOUR DECADES, OAK VALLEY HOSPITAL HAS CONTINUOUSLY EVOLVED TO MEET THE CHANGING HEALTHCARE NEEDS OF OUR RURAL COMMUNITIES. TODAY, WE PROUDLY OFFER A COMPREHENSIVE NETWORK OF MEDICAL SERVICES—DELIVERED LOCALLY AND CONVENIENTLY.

Considering joining Oak Valley Hospital?