What (& When) Is Enrollment?

This is the time for you to make important decisions about your benefits. You can choose new plans, add or drop dependents, or even sign up for a flexible spending account (FSA). Spending time now to review your plans and make careful, informed choices can help you get the most from your benefits.

Enrollment

All new or newly eligible associates have 30 days from their initial benefits eligibility date to enroll or waive their benefits online.

Effective Date

Your benefits begin the first of the month following or coinciding with your hire or status change date. This is your waiting period. For example, if your first day of employment is Feb. 3, your benefits begin March 1. If your first day of employment is Feb. 1, your benefits begin Feb. 1. Your benefits remain in effect until Dec. 31 of each year and you may not make a change mid-year unless you have a qualified life event.

For Example

Sabrina started at Nemours on Feb. 1. A couple of days later (on Feb. 3), Sabrina went to see her doctor, but Sabrina hadn’t completed enrollment until her 15th day on the job. (Things were very busy in Sabrina’s department.)

Once Sabrina’s enrollment in a medical plan was complete, it retroactively went into effect from her first day on the job, and she was able to submit a claim to her new coverage provider for her Feb. 3 doctor visit. (The “effective date” of her new coverage was her start date, Feb. 1.)

If Sabrina had also seen the doctor sometime in January, before her Feb. 1 start date, that visit would NOT be covered by her new medical plan, as Sabrina’s coverage was not yet effective.

Who is eligible for benefits?   |   How do you enroll in benefits?   |   Coverage Effective Date Calculator

Annual Enrollment Period

Each year, Nemours hosts an annual enrollment period, which usually begins mid-fall (October/November) and is available for three to four weeks. This is your opportunity to review your benefits, to make changes or confirm your current benefits are right for you and your family. After the annual enrollment period closes, you will NOT have an opportunity to adjust your benefits until the next annual enrollment period UNLESS you have a status change or qualified life event during the year.

Status Changes and Qualified Life Events

If you experience a change in employment or a qualified life event (QLE), you may be able to make changes to your benefits elections mid-year. Examples of QLEs include marriage, divorce, birth of a child, adoption, loss of coverage and other specific events. You have 60 days from the date of the event to make changes online. Log on and go to “My Profile” or click on “My Benefits” to start a QLE change. Some events — like marriage, divorce, loss of coverage — may be initiated in advance of the event date. You will be required to upload supporting documentation for all events. Any changes will be pended until the submitted documentation can be reviewed and approved. Once approved, benefits will begin on the first of the month following your election.

For Example

Sabrina had a baby boy. After a few long days (and nights), she logged on to https://nemoursbenefits.bswift.com and declared the birth event. She then went through and chose the benefits he needed, based on a pediatrician’s recommendations. She knew her son’s needs would change over time and she can opt to add coverages during annual enrollment for future plan years.

Dependent Verification

Who is eligible for benefits?

Eligibility Definition

Associates:
Full-time associates working 30 – 40 hours a week or 0.75 – 1.00 full-time equivalent (FTE); part-time benefits-eligible associates working 20 – 29 hours a week or 0.50 – 0.749 FTE. Benefits are available after you have satisfied your new hire waiting period.

Spouse:
Your legal spouse.

Dependent Children:
Dependent children may be covered to the last day in the month in which the child turns 26. To be covered beyond the age of 26, a child must be certified as disabled prior to the age of 26 AND must be primarily supported by the associate.

The following children are eligible to be covered under the Nemours benefits plans, regardless of residence or financial dependency:

  • An associate’s biological or adopted child
  • An associate’s step-child (defined as the child of your legal spouse)
  • An associate’s legal ward
  • An associate’s foster child (to age 18 only, letter of placement required)
  • A child for whom an associate has a Qualified Medical Child Support Order (QMCSO)

According to the above requirements, the following dependents would NOT be eligible for coverage under Nemours benefits plans:

  • Opposite-sex and same-sex domestic partner
  • Common law spouse
  • Divorced or legally-separated spouse (where permitted by law)
  • Children who live in the associate’s home and are financially dependent but who are not legal wards of the associate (for example, grandchild or child of opposite-sex or same-sex domestic partner)

Dependent Verification

Any dependents added to the Nemours benefits plans—spouses and children — are subject to an eligibility verification process. If you elect dependent coverage, you will be asked to provide documentation (e.g., birth or marriage certificate, tax return, etc.) to verify your dependents’ eligibility. Please note, your dependents will not be enrolled for benefits until you have provided the required documentation and their eligibility has been verified. Dependent verification for new hires and those who experience a status change, must be completed within 30 days of their date of hire or status change date. For QLEs, documentation must be provided within 60 days of the date of the qualifying life event.

Spousal Surcharge

If your spouse is eligible for medical insurance through his/her/their employer but you elect to cover him/her/them on the Nemours medical plan, you will pay an additional $300 per month ($150 semi-monthly) in payroll contributions for this coverage. The surcharge is not applicable if your spouse does not have coverage available through his/her/their employer; your spouse does not work; your spouse works at Nemours; or your spouse is self-employed.

For Example

When Sabrina signed up for her benefits, she opted to cover her spouse, as well. Adding her spouse to Sabrina’s plan increased the total premium cost — not just for Sabrina, but also for Nemours. The premium cost that Sabrina is responsible for is what’s left after Nemours has paid its contribution, plus a spousal surcharge as Sabrina’s spouse is also offered coverage through a different employer. Sabrina must also submit documentation verifying that her spouse is an eligible dependent, in order for her spouse to have coverage on Sabrina’s benefits plan.

What (& When) Is Enrollment?   |   How Do You Enroll?

How do you enroll in benefits?

SINGLE SIGN-ON

If you are signed on to the Nemours network at work or at home through VPN, you can access https://nemoursbenefits.bswift.com without entering a username or password. The enrollment link can be found through Harmony. From the Nemours Net homepage:

  • Click on the Harmony tile on the right side of the page
  • Click on the Navigator on the top-left corner of the Harmony home page
  • Click on “Show More”
  • Under Nemours Applications, clink on Health and Insurance Benefits

HOW TO LOG ON – OUTSIDE THE NEMOURS NETWORK

First-Time Users

  1. Go to https://nemoursbenefits.bswift.com
  2. Enter your username and password:
    • Your username is your Nemours network username.
    • Your password is the last four digits of your Social Security number.
  3. Click on the “Log In” button.
  4. Next, you will be asked to change your password.

Returning Users

  1. Go to https://nemoursbenefits.bswift.com
  2. Enter your username and password and then click on the “Log In” button.
  3. If you have forgotten your password, click on the “Forgot Password” link.

First-Time Enrollment Information or Employment Status Change

You have 30 days from your date of hire or status change (QLE) to enroll.

Once you’re ready to enroll, have the following information available:

  • Dependent names, birthdates and Social Security numbers
  • Documents to substantiate dependent eligibility

You may login and update your benefits elections as many times as needed to in order to complete your enrollment within your 30-day election period.

Site Summary

“Home” provides links to frequently used documents and enrollment alerts.

“My Benefits” tab provides an overview of the benefits for which you are currently enrolled and the cost per pay period. You can start a QLE here, too.

“My Profile” tab contains a summary of your demographic information; allows you to verify and update beneficiary information; add a log-in security question; start a QLE; upload documents for dependent verification and QLE processing; and print an enrollment confirmation form.

“Library” contains the most recent plan booklets and forms.

“Help” has educational videos on several insurance-related topics.

Mobile Benefits Portal

With the bswift mobile benefits portal, you can enroll on-the-go. Visit the Nemours benefits site on a wide range of browsers and devices including iPhones, iPads, Android phones and other mobile devices, via the web at https://nemoursbenefits.bswift.com

What (& When) Is Enrollment?   |   Who Is Eligible for Benefits?

Key Health Coverage Definitions

Before we run through the plans, let’s make sure we cover all the terminology.

Here is a glossary containing important definitions:

All Inclusive Out-of-Pocket Maximum
The maximum amount associates and their covered dependents will pay in a calendar year. Includes deductibles, coinsurance, and medical and prescription co-pays.

Allowable Charge
The carrier determines if the cost is reasonable for care and/or supplies. Providers that do not participate with the carrier (out-of-network) may ask for full payment of services. Claims may need to be submitted for payment; the carrier will pay the allowable charge to you, less any co-payment or coinsurance after the deductible. This is the same payment that the carrier pays to the participating (in-network) providers. The member is responsible for any balance remaining, after the carrier payment.

Annual Enrollment
A period of time when associates may enroll in or make changes to their health insurance and other benefits plans.

Balance Billing
Amount owed to an out-of-network provider after deductible, coinsurance and co-pays, after the carrier’s payment has been made.

Coinsurance
The percentage of health care costs an individual must pay, once a deductible is met. For example, many plans pay 80% or 70% of the cost of care, and the patient is responsible for the remaining 20% or 30%. Some prescription drug costs limit the amount of coinsurance a covered person must pay.

Coordination of Benefits (Birthday Rule)
If both spouses are working and carry dependent coverage, the responsibility for primary coverage falls to the parent having the earlier birthday in the calendar year, regardless of which parent is older. Coordination of Benefits does not apply to prescription drug coverage.

Co-payment/Co-pays
A specified fee an individual pays for health care services or prescriptions. For example, the patient may pay a $30 co-payment for each primary care doctor visit, or $10 for each generic prescription.

Deductible
The amount an individual must pay for services before a health care plan begins to pay benefits. Most plans have a maximum family deductible that is satisfied by the combined expenses of all covered family members, generally two times the individual amount.

An “aggregate” deductible means that if more than one individual is covered, the full family deductible must be met before expenses are paid. This applies to our Green plan.

Dependent
Additional members of an associate’s household are eligible to be covered by the group’s policy. Generally, these are the spouse and the children of the associate.

Effective Date
The date on which an insurance policy or benefit plan goes into effect and coverage begins.

Eligibility
Conditions to be met in order to receive a benefit or participate in a group benefit plan. Eligibility varies by plan. For associates, it is generally based on the associate’s full-time equivalent (FTE) status. Eligibility for dependents is based on the benefit, age and relationship to the associate.

Elimination period
The amount of time before the benefit payment will begin. Elimination periods typically refer to disability.

Emergency
An emergency is defined as:

  • A condition serious enough to cause a prudent person to seek emergency care
  • A situation where a delay in care might cause permanent damage to one’s health
  • A situation where care is received within 48 hours from the onset of the condition

Note: if you use the emergency room and it is not considered an emergency, the claim will not be covered, and you will be responsible for all charges.

Evidence of Insurability (E of I)
A statement or proof of a person’s physical condition, occupation or other factors affecting his/her/their acceptance for insurance. May be required for life insurance over certain levels or for late enrollment.

Explanation of Benefits (EOB)
A statement from a health plan or insurance company sent to a group member who files a claim giving specific details about how and why benefits payments were or were not made. It summarizes the charges submitted and processed, the amount allowed, the amount paid, and the member balance, if any.

Full-Time Equivalent (FTE)
The benefits eligibility status of an associate based on the number of hours scheduled to work each week.

Guaranteed Issue Amount
The amount of life insurance an insurance company is willing to issue without evidence of insurability (proof of good health).

Health Insurance Portability & Accountability Act (HIPAA)
Federal legislation that improves access to health insurance when changing jobs by restricting certain pre-existing condition limitations. HIPAA also guarantees availability and renewability of health insurance coverage for all employers regardless of claims experience or business size.

Inpatient
A person who occupies a hospital bed, crib or bassinet while under observation, care, diagnosis or treatment for at least 24 hours.

Inventory Information Approval System (IIAS)
An electronic inventory system that identifies items that are eligible for purchase through an FSA or HSA.

Lifetime Maximum
The total amount a dental insurance policy will pay over the course of an individual’s lifetime.

Maximum Allowable Charge (MAC)
MAC is a method of reimbursement for charges. MAC is the discounted amount that is paid to an in-network provider for services rendered. A MAC plan pays an out-of-network provider at the same level as an in-network provider. All amounts above the MAC are the responsibility of the associate.

Medically Necessary
Services that are required to prevent harm to the patient or an adverse effect on the patient’s quality of life, as judged against generally accepted standards of medical practice. The term is most often used to determine whether or not a procedure or service is covered by insurance.

Medicare
Administered by the Social Security Administration, Medicare is the federal government plan for paying certain hospital and medical expenses for those who qualify, primarily those individuals over age 65. Benefits are provided regardless of income level. The program is government-subsidized and government-operated.

Newly Eligible
Refers to individuals that are benefits-eligible for the first time due either to a new hire or status change.

Network
A selected group of physicians, hospitals and other health care providers who participate in a managed care plan and agree to follow the plan’s procedures. Benefits for network care are generally optimized when using services provided by a participating professional.

Plan Year
The calendar or fiscal year on which the records of a benefit plan are kept. Health care plans, deductibles and benefits maximums are reset at the beginning of each plan year. Nemours’ plan year begins January 1.

Portability
The ability to retain benefits coverage when changing jobs. For life insurance, this means changing the life insurance coverage to an individual term life policy that continues as long as the insured person pays the premiums.

Pre-Existing Condition
An injury or illness for which you have been diagnosed, received treatment or incurred expenses prior to the plan effective date. This term applies to disability benefits.

Pre-Tax Contribution
Contributions that are deducted from an associate’s paycheck before federal, most state and local, and Social Security taxes are figured, reducing taxable income.

Primary Coverage
The health coverage most responsible for paying your claims if you have duplicate coverage.

Provider
Carrier-approved professionals or facilities that provide health care services, including physicians, hospitals, nurse practitioners, chiropractors, physical therapists and others.

Providers, In-Network
Health care professionals and facilities that participate in a specific plan’s network. These also are known as participating or in-network providers. After payment of coinsurance or co-payments, the carrier will pay the remaining balance.

Providers, Out-of-Network
Health care professionals and facilities that do not participate in a specific plan’s network. These also are known as non-participating or out-of-network providers. Expenses incurred from these providers may not be covered or may be only partially covered. After payment of coinsurance or co-payments, the carrier will pay the balance equivalent to the amount paid to an in-network provider; any outstanding monies owed after the carrier’s payment will be the member’s responsibility.

Qualified Life Event (Life Status/Family Status Change)
The only time, other than annual enrollment, when an associate may make changes to some of his/her/their benefits coverage. Qualifying life events include (but are not limited to) marriage or divorce, birth or adoption of a child, death of a spouse or dependent, gain or loss of associate or spouse’s employment, or a change in job status that affects benefits coverage. Changes in coverage must be made within 60 days of the date of the qualifying event.

Spouse
Legally married spouses of associates are eligible to participate in the Nemours benefits program.

Summary Plan Description (SPD)
A government requirement for a written description of a benefit plan in an easy-to-read form, including a statement of eligibility, coverage, associate rights and appeal procedure. It is provided to participants, beneficiaries and the Department of Labor upon request.

Underwriting
The process of identifying and classifying the potential degree of risk represented by an associate who enrolls in coverage. Plans that require underwriting may ask associates to provide medical or personal information at the time of enrollment. This mostly applies to life insurance.

Waiting Period
The length of time you must be employed before you become eligible for benefits, (i.e., the first of the month following or coinciding with the date of hire).

Waive
To intentionally decline coverage in a benefits plan; some plans require proof of coverage elsewhere.

Medical and Prescription Plans

Health Care Navigation & Advocacy

Quantum Health is our new “front door” for benefits. This navigation and advocacy partner will assist with communication, support and understanding your benefits all while providing a higher level of customer service. Think of them as a one-stop shop for your health and insurance benefits. This means instead of needing to know the contact information for the medical, dental, vision, prescription and all specific programs offered for diabetes, exercise therapy and surgical centers of excellence, you just need to know the contact information for Quantum Health. Quantum will connect you to all the health programs that Nemours offers that may benefit you at the time of need. Quantum Health is also the advocacy partner (replacing Health Advocate) to answer your detailed plan questions, help you find in-network providers and more.

Quantum Health is provided to all benefits-eligible associates, at no cost to you and regardless of whether you are enrolled in the Nemours benefits plan. This benefit also covers your eligible family members.

Medical Plans

Nemours offers comprehensive medical coverage for associates and their covered dependents. This includes prescription drug coverage.

There are four levels of medical benefits — Red, Blue, White and Green. Contributions are made on a pre-tax basis. Plan types are described below.

  RED BLUE WHITE GREEN
Plan Type PPO EPO PPO HDHP with HSA
 
  • Preferred Provider Organization (PPO): Offers you the freedom to seek care from any provider that you wish. If you seek care from an in-network (participating) provider, you will either pay a co-pay or deductible and coinsurance, and you will not be balance billed. Out-of-network charges will be paid at a lower level, and you will be responsible for any charges over the plan’s recognized charge. You may be balance billed for services performed by an out-of-network (non-participating) provider.
  • Exclusive Provider Organization (EPO): An EPO shares essentially the same network as the PPO, but there are no out-of-network benefits associated with the EPO. In that respect, it is similar to an HMO. Emergency services and services that you are unable to choose (such as anesthesiology, ambulance and emergency room) will be paid at the in-network level.
  • High-Deductible Health Plan (HDHP) with Health Savings Account (HSA): Provides both in- and out-of-network benefits through the same PPO; pairs with an HSA.

ID Cards

Digital medical ID cards are available within the Quantum Health app. Physical cards will be mailed to your home. All family members will have the same unique identifier. ID cards are not re-issued every year, so please keep your cards. If additional ID cards are necessary, please contact Quantum Health directly.

Participating Providers

The Nemours medical plans use the national Aetna network, so no matter where you live or work, there are in-network providers near you.

To locate participating providers, go to the “Find a Doctor” tool at www.Aetna.com. For the plan name, select Choice POS II (Red, White or Green plans) or Aetna Select (Blue plan).

Transparency in Coverage Machine-Readable Files

The Transparency in Coverage Final Rules require our group medical plans to provide information regarding in-network rates for covered items and services, out-of-network allowed amounts and billed charges for covered items and services. You can find those files here.*

In addition to the Aetna network, the following providers are available at no additional cost to you if you are enrolled in one of our Nemours medical plans.

  • 2nd.MD is a virtual expert medical consultation and navigation service. Specialists can help with diseases, cancer or chronic conditions; surgeries or procedures; or medication and treatment plans. We connect you with a board-certified, elite specialist for a virtual expert medical consultation via phone or video from the comfort of home.
  • Bright Horizons offers eligible associates access to a network of high quality child care centers and in-home care providers for family members of all ages to fill occasional needs when associates’ usual care providers are unavailable.
  • Brightline offers families nationwide mental health providers with virtual therapy, psychiatry and coaching for kids and teens under the age of 18. After creating an account and answering a few questions about your child(ren), you will be matched with a mental health provider to assist with depression, anxiety, ADHD, managing emotions and many more.  You pay nothing up front.  Your claim will be sent to Aetna and you will receive an invoice for your share of the cost. 
  • Carrum Health provides access to surgical Centers of Excellence that can help connect you with the country’s top surgeons and guide you throughout your surgical journey. More than 100 procedures are covered including hip, knee, shoulder, spine and weight loss surgery. Most, if not all surgery costs are often covered.*
  • Cleo Baby provides expert guidance at critical moments during pregnancy through your baby’s first birthday. You are matched with a Cleo Guide who stays with you through your entire journey. Contact your dedicated expert during family planning and fertility support, when you are expecting your baby, and up to your child’s first birthday to receive emotional support, lactation and sleep training, career counseling/return to work advice and more.
  • Gennev is here to assist women to prepare and get through menopause. All the providers are in-network and can assist with sleep and mental health, weight and body changes, heart and temperature changes, hair and skin changes, joint pain and more. Take a free assessment online to find out where you are on your menopause journey and receive customized recommendations and support. Providers are board-certified OB-GYNs with years of experience supporting patients through menopause and midlife. Online articles are available to help with boosting brain health, metabolic health and alternative treatments for those who are unable to receive hormone therapy. 
  • Hinge Health offers virtual exercise therapy to help you take control of back, knee, hip, neck, shoulder or other joint pain. There is also a benefit for women’s pelvic health. Work with a physical therapist and health coach anywhere, at your convenience. Best of all, there is no co-pay.
  • Progyny is designed for fertility assistance and allows you and your provider to pursue the most effective treatment and provides coverage for two cycles including services and tests. It also includes unlimited clinical and emotional support from a dedicated patient care advocate. This is only available to associates and spouses enrolled in one of the Nemours medical plans and is subject to your deductible and coinsurance.
  • SimpliFed provides virtual breastfeeding and baby feeding support. Get help with breastfeeding, latching and positioning, low supply or oversupply, formula feeding, bottle prep, pace feeding and transitions with prenatal baby feeding plan, returning to work and combo feeding.
  • Twin Health helps reverse Type 2 diabetes through a personalized program including easy-to-use devices (included) that track your health daily, and a dedicated care team that includes a provider, nurse and health coach. There is no cost to you for this benefit. 

* Eligible associates enrolled in the Green plan using Carrum Health: Individuals enrolled in our high-deductible plan must first meet IRS minimum required deductibles (for 2024, the minimum deductible for individual coverage is $1,600 and for family coverage is $3,200), but co-pays and coinsurance will be waived. Per IRS rules, a portion of any covered travel expenses will be reported as taxable income.

Choosing the Right Medical Plan

Benefits are an important part of your total compensation at Nemours. Each associate is responsible for reviewing the information provided by Nemours, so that you can make an informed decision about your benefits. To help you choose the right benefits for you and your family, Nemours offers “Ask Emma” — an interactive decision support tool and so much more! She can help you make an informed and personalized decision across the range of Nemours benefits offerings.

  • Take the guesswork out of benefits enrollment
  • Explore Emma’s FAQs and cost calculator to find the plans that best fit you and your family
  • Personalized cost comparisons by health needs
  • Model future health scenarios for the whole family
  • Translate insurance jargon into easy-to-understand explanations

Benefits Summary — Red, Blue and White Plans

View the latest summary chart for Red, Blue and White plans.

For services that require coinsurance, this applies after the deductible, with the exception of prescription drugs. 

Benefits Summary — Green Plan

The Green plan is a high deductible health plan (HDHP) with a health savings account (HSA). You may enroll yourself, your spouse and your dependents in this plan.

The Green plan is a PPO, with both in- and out-of-network medical benefits. It uses the same Aetna network of participating providers as the other Nemours plans. Coverage includes office visits, diagnostic X-ray and laboratory, hospital, surgical, urgent and emergency care, mental health and many other services. In-network preventive care, including routine mammograms, is covered at 100%. Unlike the other Nemours medical plans, you pay 100% of non-preventive medical services until you meet the plan’s annual deductible.

The Nemours prescription drug benefits are administered by Express Scripts. In the Green plan, most prescriptions are covered at 80% after your deductible; however, the plan also covers certain generic preventive medications (on the Standard Plus list) for a $10 co-pay. These are preventive medications not already covered at 100% and include medications for many chronic conditions including asthma and diabetes.

View the latest summary chart for the Green plan.

Health Savings Account

The Green plan also includes an HSA to which you and Nemours may contribute. The HSA is administered by HealthEquity. The Nemours contribution is up to $250 for an individual or $500 for a family. The Nemours contribution is made semi-monthly. You may also make pre-tax contributions to the plan through payroll deductions or contribute tax-deductible amounts directly into your account. Requested reimbursements cannot exceed your account balance.

The total contribution allowed in 2024, including both Nemours and associate contributions, is $4,150 (individual) or $8,300 (family). If you are age 55 or older, you may contribute an additional $1,000 to the account annually. Additionally, if your spouse is age 55 or older in 2024, you may contribute an additional $1,000 to a separate HSA account. Please contact HealthyEquity at 866.346.5800 or visit their website.

You are eligible to contribute to the HSA if:

  • You are enrolled in a qualified high-deductible health plan

You are NOT eligible to contribute to the HSA if:

  • You are covered by your spouse or have retiree coverage at another employer;
  • You are covered under a parent’s plan;
  • You are claimed as a dependent on another person’s tax return (except for your spouse);
  • You are enrolled in an employer or spouse’s general purpose FSA;
  • You are enrolled in Medicaid, Medicare or TRICARE; or
  • You are enrolled in an individual or Marketplace plan.

Unlike traditional FSAs which are ‘use-it-or-lose-it,’ unused funds contributed to the HSA may be rolled over from year to year and are available to you even if you are no longer employed by Nemours or if you move to another one of the medical plans. Associates who enroll in the Green plan may also sign up for a limited purpose FSA which is only for dental and vision expenses and follow the same rules as the traditional FSA, such as “use it or lose it.”

Medicare Transition Services

Medicare Transition Services offers an easier way to make sense of Medicare. They can help guide you through the decision-making process. Whether you are continuing to work beyond age 65 or if you are retiring, this is a free resource. Enrollment in one of the Nemours medical plans is not required to use this service. More information available here.

Prescription Drug

Prescription drug benefits are administered by Express Scripts and are included in each of the Nemours medical plans.

ID Cards

Beginning Jan. 1, 2024, you will no longer need a separate ID card for prescription coverage. You will use your Quantum Health ID card for all medical and prescription expenses.

How to Use the Program

Retail Prescriptions: Take your prescription(s) to any participating Express Scripts network pharmacy. Present your Quantum Health ID card. You may purchase up to a 34-day supply of retail prescription drugs. If your doctor authorizes a refill, the same supply limitation will apply when your prescription is refilled. There may be prior authorizations, quantity limitations or step therapy required on certain prescription drugs. Drugs purchased from non-participating pharmacies will not be covered. Contact Quantum Health for a list of participating pharmacies or search online for a participating pharmacy.

The cost of prescriptions will vary, depending on whether you receive a generic drug, a preferred-brand drug or a non-preferred brand name drug. Express Scripts updates their formulary throughout the year. We encourage you to review the latest Express Scripts formulary lists and other information linked below.

Definitions

Generic

Generic drugs have been approved by the U.S. Food and Drug Administration (FDA) for quality and safety and are absorbed in the same way as a brand name drug.

  • Chemically Equivalent: have the same active ingredients, in the same quantities, as a brand name drug. The only differences are fillers and dyes.
  • Therapeutically Equivalent: treat the same conditions as brand name drugs, but do not contain the same active ingredients.

Preferred Brand

Preferred brand name drugs are drugs still protected by patents (meaning no chemically equivalent generic is available). The FDA has approved these higher-cost drugs after trials show they are safe and effective. When a generic drug is introduced for a preferred brand name drug, the brand name will automatically move from Preferred Brand to Non- Preferred Brand. Check our carrier links regularly for updates.

Non-Preferred Brand

Associates will pay the most for non-preferred brand name drugs (which are listed in this tier for a variety of reasons). These drugs are non-preferred because there are other, lower-cost brand name drug(s) that are just as effective.

Generic Preferred Program

If you have a prescription for a brand name drug, and a chemically equivalent generic drug is available, you will have the option of choosing either the generic equivalent or the brand name drug. If you choose the brand name drug, you will pay the brand coinsurance or co-pay plus the difference in cost between the generic and the brand name drug.

Maintenance Medications – Smart90

Maintenance medications are ongoing, long-term prescriptions for conditions such as high blood pressure, high cholesterol and diabetes. Smart90 is a program managed by Express Scripts that gives you two ways to get a 90-day supply of your maintenance medications. You can conveniently fill these prescriptions either through home delivery (mail order) from the Express Scripts Pharmacy or from Walgreens, the Smart90 network pharmacy for our plan. Your physician must write the prescription for a 90-day supply.

You are allowed two fills of maintenance medications from other retail pharmacies before you must switch to Walgreens or home delivery. If you continue to use 30-day supplies or fill at a pharmacy that is not part of the Smart90 network, you will pay 100% of the cost of your maintenance medication. Please note that you may fill 90-day prescriptions for maintenance medications without penalty at a Nemours outpatient pharmacy.

For more information regarding the Smart90 program, please contact Express Scripts directly, via their website or toll-free number listed in Contacts.

Cholesterol Care Value Program

Specialty drugs for high cholesterol – called PCSK9 inhibitors – are managed through Express Scripts Cholesterol Care Value Program. These drugs require prior authorization to be covered and, if approved, must be filled through Accredo, the Express Scripts specialty pharmacy (see Nemours Outpatient Pharmacies section below).

Accredo Program

Specialty medications (usually high cost or injectable drugs) must be filled through Accredo, a leading specialty pharmacy, and may require prior authorization. Through the Accredo program, you will have access to:

  • A patient care coordinator who serves as your personal advocate and point of contact
  • Delivery of your specialty medications directly to you or your doctor
  • Supplies to administer your medications — at no additional cost
  • Care management programs to help you get the most from your medications

If you are taking a specialty medication, your first prescription fill may be at your normal retail pharmacy. You will then receive correspondence from Express Scripts on how to transfer your prescription to Accredo.

SaveOn SP Program

A specialty pharmacy co-payment assistance program (also referred to as the SaveOn SP Program) is administered by Express Scripts. Please note that while participation in the SaveOn SP Program is voluntary, and must be affirmatively elected by a participant — certain specialty prescription drugs will be considered non-essential health benefits under the plan. If you participate in the SaveOn SP Program, the cost of these specialty drugs to you will be $0. If you do not elect to participate in the SaveOn SP Program, you will be responsible for the copayments of the specialty drugs, which may be significantly increased. Regardless of whether you participate in the SaveOn SP Program, the cost of such specialty prescription drugs will not be supplied toward satisfying your maximum out-of-pocket limit under the plan’s medical options.

Additional information regarding the SaveOn SP Program will be made available to you by Express Scripts.

Nemours Outpatient Pharmacies

Associates may also fill prescriptions for themselves and their families at the Nemours Children Hospital, Delaware or at Nemours Children’s Health, Jacksonville. A 90-day supply of maintenance medication can be filled at these Nemours outpatient pharmacies for only two times the applicable co-pay or coinsurance. While the 90-day supply will be the most cost-effective option, in most cases, there are some exceptions due to certain retail pharmacy pricing arrangements.

Dental

Nemours provides dental benefits through Delta Dental. There are three levels of dental coverage: Red, Blue and White. Contributions are taken on a pre-tax basis.  Preventive services on the dental plans do not count toward your annual maximum paid by Delta Dental.

Passive PPO Network

A passive PPO allows you to choose any dentist. Although the reimbursement percentages are the same for in- or out-of-network coverage, you will save on out-of-pocket expenses by receiving services from an in-network dentist as out-of-network providers can balance bill. The Nemours plan uses both the Delta Premier and PPO networks.

You can go online to find an in-network provider in your area or use the information located in the Contacts section. Definitions of “Reasonable & Customary” and “Maximum Allowable Charge” are available in the Key Health Coverage Definitions section of this online guide. Please note that changes in network status can occur at any time. Check with your provider prior to your next appointment.

ID Cards

ID cards and a welcome letter that lists all covered dependents will be mailed to your home. Each enrolled associate will receive two ID cards. Dependent ID cards will not be provided. View the latest summary chart for dental plans.

Frequency Schedule

The following procedures have limitations on the frequency with which the procedures can be performed, as follows:

*See Summary Plan Description for details regarding preventive exam benefits.

Voluntary Vision Plan

Nemours offers a voluntary vision program through Vision Service Plan (VSP) on a pre-tax basis. There are two levels: the Base option and the Premium option.

Benefits Standard Premium
Eye Exam (1/year) $10 co-pay $10 co-pay
Single Vision, Lined Bi-focal, Lined Tri-focal and Lenticular Lenses $25 co-pay $25 co-pay
Progressive Lenses $0 – $175 co-pay, depending on type of lenses $0 – $175 co-pay, depending on type of lenses
Frame (Base: every 24 mo. Premium: every 12 mo.) $130 – $150 allowance, 20% discount on balance, ($70 Costco & Walmart/Sam’s Club allowance) $180 – $200 allowance, 20% discount on balance, ($100 Costco & Walmart/Sam’s Club allowance)
Contact Lens Services (exam & fitting) Up to $60 co-pay Up to $60 co-pay
Contacts (instead of glasses) $120 allowance $150 allowance
Out-of-Network Benefits
Exam — up to $40 Lined Bifocal Lenses — up to $50 Progressive Lenses — up to $50
Frame — up to $70 Lined Trifocal Lenses — up to $65 Contacts — up to $105
Single Vision Lenses — up to $30    

To Utilize Your VSP Benefits:

  1. Consult your VSP booklet for coverage details.
  2. Find a VSP provider online or by phone 24-hours-a-day. You may also contact Quantum Health.
  3. Make an appointment with a VSP provider and identify yourself as a VSP member.

There is no ID card, so be sure to identify that you are a VSP member. Your provider will take care of the rest.

NOTE: Our medical plan covers one eye exam every 12 months. Your medical and VSP discounts cannot be combined.

Basic Term Life and Accidental Death & Dismemberment

Nemours offers a basic term life and accidental death & dismemberment (AD&D) benefit of one times your base annual salary to a maximum of $500,000. Term life insurance does not accrue a cash value and terminates when you leave employment. This benefit reduces by 50% at age 70. This benefit is Nemours-paid for all full-time and part-time benefits-eligible associates. Note that the IRS requires Nemours to tax you on the value of this benefit that exceeds $50,000.

Voluntary Term Life

Associates may elect voluntary term life insurance through Reliance Matrix (formerly Reliance Standard). Contributions are taken on a post-tax basis. Voluntary term life insurance is portable but not permanent. Term life insurance does not accrue a cash value and the benefit reduces by 50% at age 70.

Associates may purchase voluntary term life insurance in increments of $10,000 up to the lesser of $1,000,000 or five times your base annual salary. Guaranteed issue coverage is available for newly eligible associates up to $500,000. Amounts over the guaranteed issue for newly eligible associates are subject to evidence of insurability (E of I). All elections for late enrollees are subject to E of I. During annual enrollment, associates currently enrolled in the plan may increase their election by one level ($10,000) without E of I, up to the guaranteed issue amount of $500,000. Any additional amounts elected over the guaranteed issue level will be subject to E of I.

Associates may purchase term life insurance for their spouse in increments of $10,000 to a maximum of $380,000. Coverage amounts for spouses are limited to 100% of the associate’s combined coverage amount (basic life and voluntary associate term life). Guaranteed issue coverage is available for newly eligible spouses in the amount of $100,000. All late enrollee elections are subject to E of I.

Associates may purchase term life insurance for their child(ren) in units of $2,500 to a maximum of $10,000. All amounts are guaranteed issue for newly eligible children. Premiums for child life are per unit, which means that the payroll deductions will remain the same regardless of the number of children covered by the plan. Dependent children may be covered until the end of the month during which they turn 26, but must be unmarried and financially dependent on the associate for support.

Voluntary Accidental Death & Dismemberment (AD&D)

Associates may elect voluntary term AD&D insurance through Reliance Matrix. Contributions are on a post-tax basis.

Associates may purchase additional AD&D for themselves, in increments of $10,000, up to the lesser of $500,000, or 10 times earnings for elections over $150,000 (i.e., if you earn $10,000 a year, you may still elect $150,000). This benefit reduces by 50% at age 75 and then to 25% of the original amount at age 80.

Coverage may also be purchased on a family basis, which covers you, your spouse and/or your dependent children as follows:

  • A spouse with no dependent children is insured for 100% of the associate’s AD&D benefit. A spouse with dependent child(ren) is covered for 60% of the associate’s AD&D benefit, while each dependent child is covered individually at 10% of the associate’s AD&D benefit.
  • If there is no spouse, each dependent child is insured for 15% of the associate’s AD&D benefit.

Voluntary Long-Term Care

Nemours offers long-term care (LTC) coverage through the convenience of post-tax payroll deductions for both associates and their spouses. Direct billed coverage is also available to the parents and grandparents of associates and their spouses. Coverage for LTC insurance is fully portable.

LTC coverage provides an allowance for custodial assistance to individuals who are unable to perform two of six Activities of Daily Living (ADL) due to a disability. ADLs include bathing, dressing, eating, toileting (grooming), continence (using the bathroom without help) and transferring (moving from the bed to a chair, or vice versa). LTC is also payable if the subscriber has a cognitive impairment.

Custodial assistance may be provided by any of the following: a skilled nursing facility, a home health care agency (called professional home care), an assisted living facility, or a member of the community (total home care, including your family members).

Newly eligible associates may elect LTC coverage without providing evidence of insurability (E of I) within 30 days of their eligibility effective date. All elections for late enrollees are subject to E of I determination; all elections made by eligible dependents are also subject to E of I.

Provision Options 3-Year Benefit Duration 6-Year Benefit Duration
Monthly Facility Benefit Amount Options $1,000 to $4,000 $1,000 to $4,000
Skilled Nursing Facility* 100% 100%
Assisted Living Facility* 60% 60%
Total/Professional Home Care 50% 50%

*LTC pays a percent of the total monthly facility benefit amount, based on where services are received. For example, if a facility monthly benefit amount of $1,000 was elected, and services were received at a skilled nursing facility, the benefit amount received would be 100% of $1,000; equaling $1,000 of benefit per month. However, if a facility benefit monthly benefit amount of $1,000 was elected, and services were rendered at an assisted living facility, the benefit amount received would be 60% of $1,000; equaling $600 of benefit per month.

**The lifetime maximum does not change based on where you receive services. If the facility benefit amount elected is $1,000 for a three-year benefit duration, the lifetime maximum is $36,000. For example, if the subscriber is confined to a nursing home, he/she/they would receive the benefit for a duration of three years; assuming the same election, but if services are received at home, the benefit would be pro-rated accordingly, and $500 would be the benefit received for a maximum duration of six years.

Short-Term Disability (STD)

Full and part-time associates are automatically covered by our STD plan that offers income protection for disabilities caused by illness, accident or injury that are not work-related. Coverage is 60% of the associate’s base weekly pay with no maximum weekly benefit amount. The benefit period is a maximum of 13 weeks, inclusive of a seven-day elimination period. Premiums are paid 100% by Nemours. E of I is not required and there are no pre-existing condition limitations. Please note that if you work in a state that has a state-provided disability benefit (e.g., New Jersey), our benefit payments will be reduced by any disability benefits received from the state. Information regarding STD is available via Alight or by contacting the HR Solutions Call Center.

Voluntary Long-Term Disability (LTD)

Nemours offers LTD insurance to associates through NY Life. Contributions are taken on a post-tax basis. LTD insurance offers income protection for disabilities caused by illness, accident or injury. All LTD plans include a pre-existing condition limitation. Newly elected changes will be subject to a pre-existing condition limitation.

Provisions LTD Plan 1 LTD Plan 2 LTD Plan 3
Eligibility All Benefits-Eligible Associates All Benefits-Eligible Associates All Benefits-Eligible Associates
Elimination Period 90 Days
Benefit Duration Up to Social Security Normal Retirement Age. If you become disabled after this age, there is a reduced benefit.
Benefit Percentage 50% 60% 60%
Monthly Maximum $10,000 $12,000 $15,000
Own Occupation Duration 24 Months Own Occupation 24 Months Own Occupation Own Occupation to Social Security Normal Retirement Age

Voluntary Accident, Critical Illness and Hospital Indemnity Insurance

Voluntary Accident

Nemours offers Aetna Accident Insurance through convenient post-tax payroll deductions for associates, spouses and dependents. Accident insurance provides you and your eligible family members with payment for a covered accident. It also pays if you undergo testing, receive medical services, treatment or care for any one of more than 150 covered events as defined in your group certificate. This includes hospitalization resulting from an accident and accidental death or dismemberment.

There are two options – high and low – that vary in the amount of payment for each covered accident. Payments are made directly to you to use as you see fit. They can be used to help pay for medical plan deductibles and co-pays, out-of-network treatments, your family’s everyday living expenses, or whatever else you need while recuperating from an accident.

Your accident coverage is guaranteed, regardless of your health. You just need to be actively at work for your coverage to be effective. There are no medical exams to take and no health questions to answer.

Voluntary Critical Illness

Nemours offers Aetna Critical Illness Insurance through convenient post-tax payroll deductions for associates, spouses and dependents. Critical illness coverage provides you with a lump-sum payment if you or your covered family members are diagnosed with a serious medical condition. Critical illness insurance covers more than 20 illnesses or conditions including cancer, heart attack, stroke, coronary artery bypass, kidney failure, major organ transplant and Alzheimer’s disease.

This insurance pays cash benefits directly to associates and their family members diagnosed with any of the covered conditions and in addition to any benefits paid through the health plan. It is designed to help offset the deductibles, co-pays and indirect costs associated with a serious illness.

You have a choice of three benefit levels – a payment of $10,000, $15,000 or $30,000 upon initial diagnosis. Your spouse is covered for 100% of the associate amount and children are covered for 50% of the associate amount. Included in the coverage is an annual $50 health screening benefit for each covered family member.

Coverage is guaranteed (no health questions asked) and there is no pre-existing condition limitation; however, you must be actively at work for your coverage to be effective. Premiums are based on the associate’s age and tobacco use.

Voluntary Hospital Indemnity

Nemours offers Aetna Hospital Indemnity Insurance through convenient post-tax payroll deductions for associates, spouses and dependents. Hospital indemnity insurance provides you and your eligible family members with payments when you are admitted or confined to a hospital due to an accident or illness. Typically, a flat amount is paid for admission and a daily amount is paid for each day of a hospital stay. It also pays extra benefits for admission to or confinement in an intensive care unit (ICU), and for other benefits and services. This coverage also includes a lump-sum benefit after the birth of your newborn. This will not pay for an outpatient birth.

There are two options – high and low. Payments are made directly to you to use as you see fit and independent of any benefits paid through the health plan. They can be used to help pay for medical plan deductibles and co-pays, for out-of-network stays, for your family’s everyday living expenses, or for whatever else you need while recuperating from an illness or accident.

Your hospital indemnity coverage is guaranteed. You just need to be actively at work for your coverage to be effective. There are no medical exams to take and no health questions to answer.

Voluntary Identity Theft Protection

Nemours offers identity theft protection through Allstate, an industry leader in digital identity and financial wellness protection. This plan provides a monitoring solution that protects you from the hassles of identity theft. Allstate’s Identity Theft Protection benefit includes the following services:

  • Identity and tri-bureau credit monitoring
  • Annual credit report and monthly credit score tracking
  • Social media reputation monitoring
  • Threshold monitoring
  • Digital wallet storage and monitoring
  • Full-service remediation
  • $1 million identity theft insurance policy
  • Deceased family member coverage
  • Credit freeze assistance
  • Tax fraud refund advance
  • 403(b) and HSA reimbursement

Coverage is available for you and your family, at an affordable rate. Identity theft protection will cover members of your household for whom you are financially responsible, “Under roof, under wallet.”

Pre-Paid Legal Plan

Nemours offers a pre-paid legal plan through MetLife Legal Plan®. Contributions are taken post-tax. The MetLife Legal Plan is a simple, affordable way to access the most frequently needed personal legal services such as wills, powers of attorney and identity theft defense. Divorce is not covered. Some of the covered services include:

  • Family and personal law such as adoption, guardianship and garnishment defense
  • Money matters such as identity theft defense, debt collection defense and personal bankruptcy
  • Vehicle and driving law such as driving privileges restoration and license suspension
  • Home and real estate law such as foreclosure, eviction defense and title disputes
  • Civil lawsuits such as small claims assistance and disputes over consumer goods
  • Estate law such as simple wills, powers of attorney and health care proxies
  • Elder care law related to your parents

MetLife Legal Plan gives participants access to a network of more than 11,000 attorneys. Attorneys in the network meet stringent criteria and are regularly reviewed to ensure they continue to meet plan standards.

Once you are enrolled, you will need to remain enrolled in this plan until the next annual enrollment.

Wellness Program

Associate Wellness seeks to create a culture of wellness, setting you up for success with resources that support your goals. Nemours takes a holistic approach by supporting the physical, emotional, financial and social dimensions of wellness.

Wellness benefits include:

  • Free fitness center membership at Nemours Children’s Hospital, Delaware, Nemours Children’s Hospital, Florida and the Home Office
  • Access to group fitness classes and personal training (at select locations), at an additional cost
  • Reduced cost fitness center membership to more than 18,000 gyms nationwide through Active&Fit Direct program
  • Gym/fitness app reimbursement for benefits-eligible associates
  • Free health coaching for benefits-eligible associates, spouses and dependents over age 18
  • Wellness challenges
  • Reduced cost membership to WeightWatchers for benefits-eligible associates, spouses and dependents over 18
  • Resources for meditation and stress management
  • Rewards for participating in healthy activities

All of the Nemours Wellness program resources and benefits are housed on Wellness-Connect, a user-friendly, robust wellness portal. Wellness-Connect is also available as an app so that you can reach your wellness goals on the go! Log on to Wellness-Connect by clicking the Associate Wellness tile on Nemours Net or visit Wellness-Connect.net.

Wellness Incentive

Nemours wants to reward you for engaging in healthy activities. That is why you can earn 20% off your medical insurance premiums with the Wellness Incentive Program! Save hundreds of dollars on your medical insurance premiums by completing the activities. Complete the activities by Nov. 30, 2024, to earn the discounted insurance premium rate for the 2025 plan year. Learn more about the incentive program and track your progress on Wellness-Connect.

NOTE: When you access your benefits record during annual enrollment, you will see the “With Wellness” medical contribution rates. This will change to the “Without Wellness” medical rate in January if you fail to complete the Wellness Incentive Program activities by the deadline of Nov. 30, 2024.

New to Nemours? Associates hired on or after Sept. 1, 2024, will receive the “With Wellness” rate through the remainder of 2024 and throughout 2025.

Flexible Spending Accounts

Flexible Spending Accounts (FSAs)

FSAs are available to associates through convenient payroll deductions on a pre-tax basis to help cover the cost of eligible expenses (as defined by the IRS). There are several FSAs available. These accounts have been established to cover different needs, as follows:

  • Health care spending account: Covers expenses not covered or partially covered by health, dental, prescription drug and vision programs such as co-pays and deductibles for you and your eligible dependents.
  • Limited purpose spending account: This is a special health care spending account available only if you enroll in the high-deductible health plan (our Green plan). It follows the same rules as the health care FSA but is only for dental and vision expenses.
  • Dependent care spending account: Covers expenses for day care or similar care to eligible dependents as defined by the IRS.
  • Mass transit spending account: Covers expenses for public transportation related to the commute to and from work.
  • Parking spending account: Covers expenses for public parking related to the commute to and from work.

Associates may elect to participate in one or more of these accounts in any combination. Health care, limited purpose and dependent care spending account elections are based on an ANNUAL election amount; you will need to calculate how much you want to set aside for the plan year of Jan. 1 – Dec. 31 in a lump sum. Mass transit and parking spending account elections are based on a MONTHLY election amount. This monthly election will remain in place throughout the plan year unless you change it.

Deductions will be taken semi-monthly on a pre-tax basis. Only those associates who elect these accounts will be enrolled. After you’ve enrolled, as you incur eligible expenses (as defined by the IRS) throughout the plan year, you pay yourself back with the pre-tax money in your FSA account.

If you terminate employment, or if you become ineligible for the plan, please refer to the Termination of Benefit Summary chart available online for information about how long you may incur additional claims and deadlines for submitting those claims for reimbursement. These time periods vary by account.

Tax Effect
Contributions to FSAs reduce the amount of taxable income. This results in savings of FICM, FICA, federal and state income taxes.

Health Care Flexible Spending Account

Health care flexible spending accounts (FSAs) help pay for expenses that are either partially covered or not covered by medical/prescription drug, dental or vision insurance. You may contribute up to $3,200 in 2024 in the account. You may participate in this account even if you have not enrolled in a Nemours medical plan and are not covered by another HSA-eligible plan.

Examples of Health Care Expenses Not Covered by Insurance:   • Deductibles   • Co-payments   • Coinsurance

For extensive details on qualified medical expenses, visit HealthEquity. In general, you may use a health care FSA to pay most health care expenses that qualify as a medical deduction for federal income tax purposes (as described in the IRS Publication 502) for yourself or your tax dependents. Health care expenses reimbursed through the FSA account cannot be claimed as deductions for federal income tax purposes.

Other Considerations

  • Amounts not claimed over the IRS allowed rollover ($640 for 2024) are forfeited under the “use it or lose it” federal requirement.
  • Eligible charges must be incurred during the plan year or run-out period. You will have 120 days after the end of the plan year to file eligible claims under the health care FSA.

Additional Claim Information
If you submit a claim for an amount higher than what you have contributed year-to-date to your FSA, you will be reimbursed up to the amount of your plan year election. Reimbursement consideration is based on when the service is rendered or a purchase is made, not when payment is submitted.

  • You may use your debit card at an authorized vendor to avoid out-of-pocket costs for eligible expenses. (See FSA debit card section for more information on this option.) Alternatively, you may submit a claim via the HealthEquity mobile app, the HealthEquity member portal or fax.
  • You may be required to provide an itemized receipt for your transaction. The IRS defines a valid receipt as a receipt that includes the vendor’s name, a description of the purchase, the amount of the purchase and the purchase date.

Worksheet to Calculate Health Care Contributions
Use the worksheet below to list the out-of-pocket expenses you expect to incur during the plan year (beginning with the coverage effective date). This worksheet will assist you in estimating the total amount to deposit into the health care FSA.

Health Care Expenses Worksheet
(for you and your tax dependents)
Estimated Costs:
Deductibles
Note, if you usually do not meet the deductible, include only the amount you anticipate incurring.
Co-payments
Dental co-pays or costs not covered under the dental plan
Vision exams, glasses or contact lenses, if not covered or only partially covered under insurance
Medical out-of-pocket costs not covered by insurance
Other allowable medical expenses
Total
  • Amounts not claimed are forfeited under the “use it or lose it” federal requirement.
  • Eligible charges must be incurred during the plan year or run-out period. You will have 120 days after the end of the plan year to file eligible claims under the Health Care FSA (until April 30).

 

Dependent Care Flexible Spending Account (DCFSA)
DCFSAs allow you to set aside pre-tax dollars to provide care for your eligible dependents, so you (and your spouse) can work. This is for daycare expenses, not health care expenses for dependents.

Eligible dependents include anyone under age 13, your disabled spouse or other disabled person (including a parent or child), whom you can claim as a dependent for federal income tax purposes.

Costs for “activities” while a dependent is in a daycare are not eligible for reimbursement through the DCFSA. Examples of costs not eligible are: art, dance, piano and singing lessons. Only the cost for the actual daycare is eligible for reimbursement.

Examples of Eligible Dependent Care Expenses:   • Child Daycare   • Adult Daycare

You may contribute up to $5,000 ($2,500 if you are married filing separately) per plan year into a DCFSA. You may be reimbursed for the cost of care given inside or outside your home by a professional caregiver. Participants must provide the provider’s EIN or Social Security number for reimbursement. Please note that the provider must report the monies paid as income and pay taxes on that income.

If you earned more than $150,000 in 2023, your DCFSA election will be limited to a maximum of $1,700 in 2024.

To enroll in a dependent care account you must meet at least one of the following qualifications:

  • You are a single parent who works full-time
  • You and your spouse both work, and your spouse’s annual income is greater than the amount you are claiming for dependent care
  • Your spouse is enrolled full-time at a college or university for at least five months of the year
  • Your spouse is medically disabled and cannot care for himself/herself/themself or your dependents

Note: If your spouse is a full-time student at least five months a year, or disabled, federal law limits the maximum pre-tax amount you may contribute. Contributions from highly compensated individuals may also be limited or amended as a result of federally required non-discrimination testing.

Worksheet to Calculate Dependent Care Contributions
Use the worksheet below to list the out-of-pocket expenses you expect to incur during the plan year (beginning with the coverage effective date). This worksheet will assist you in estimating the total amount to deposit into the DCFSA.

Dependent Care Expenses Worksheet Estimated Costs:
Wages or Salary Paid to Caregiver
FICA and other taxes you pay on behalf of caregiver, if applicable
Payment to a licensed dependent care facility
Eligible expenses for care before and/or after your child goes to school
Eligible expenses for a housekeeper who provides care for a qualified dependent
  • Amounts not claimed are forfeited under the “use it or lose it” federal requirement.
  • You may not be reimbursed for an amount in excess of the deposits you have made to date.
  • Eligible charges must be incurred during the plan year (Jan. 1 – Dec. 31). You will have 120 days after the end of the plan year to file eligible claims under the DCFSA (until April 30).

 

Transportation Accounts
Transportation FSAs allow you to set aside pre-tax dollars to cover mass transit or parking expenses related to your commute to and from work. There are two types of accounts, mass transit and parking. You may elect to participate in one or both of these accounts. The maximum monthly election is $315 for the mass transit account and $315 for the parking account.

Mass Transit Accounts
Mass transit eligible expenses include a transit pass, token, farecard, voucher or similar item (tolls are not reimbursable) entitling a person to transportation to and from work on a mass transit system. Some examples of mass transit include:

  • Trains
  • Subways
  • Trolleys
  • Buses

Expenses related to a commuter highway vehicle may also be eligible, ONLY if all of the following requirements are met:

  • Must have seating capacity of six or more adults (not including the driver)
  • At least 80% of the mileage use can reasonably be expected to be for purposes of transportation of employees between work and residences
  • The number of employees carried is at least one-half of the adult seating capacity of such vehicle (not including the driver)

Accessing your mass transit account funds: The debit card is the only method to access your available mass transit funds.

Your debit card will be accepted only at merchants coded as a mass transit facility in the VISA transaction system such as a SEPTA or NJ transit station. A convenience store that sells bus passes would NOT be recognized.

Parking Account
Eligible parking expenses include the cost of parking your car at a facility at or near your office location (e.g., parking garage or lot), or the cost of parking at a facility located at or near a location from which you commute to work (e.g., Metro parking lot, train station parking lot).

Accessing your parking account funds: The debit card is the only method to access your available parking funds. Your debit card will be accepted only at merchants coded as a parking facility in the VISA transaction system such as the Metro parking lot or train station parking lot.

  • Amounts not claimed at the end of the plan year will roll into the next plan year.
  • You may change your election once per month, WITHOUT a Qualified Life Event.
  • You may not be reimbursed for an amount in excess of the deposits you have made to date.

Debit Card

All associates who participate in any of the HSA, HCFSA, LPFSA or transportation account benefits will receive a benefit-specific debit card to pay for qualified health, mass transit or parking expenses. The debit cards look like a regular MasterCard or VISA, but are only accepted at specific types of merchants or provider locations.

Once you’ve enrolled, be on the lookout for your card.
Debit cards will be mailed to your home in a plain unmarked white envelope. Please read the cardholder agreement that is included with the card. Additional (up to three) or replacement cards may be requested through the member site at no extra cost.

Activation is easy…
Your new debit cards will arrive with a sticker on the front of the cards, and you must either activate the card at the member portal or call the number listed to activate them.

Where can I use the card?
You may use your debit card at the following locations:

  • Any doctors’ or dentists’ office, or any hospital or clinic setting
  • A pharmacy, grocery store or discount store with an approved Inventory Information Approval System (IIAS)
  • A merchant coded as a mass transit or parking facility

If you use your card at an unqualified merchant, the transaction will be declined. You can download a list of merchants that have an IIAS system installed by entering the following web address in your browser: http://apps.sig-is.org/SIGISPublicRpts/IIASMerchantList.aspx.

What debit card transactions must be substantiated?
Certain debit card transactions will require you to submit physical documentation of the expense. Examples of such expenses include:

  • Any transaction that is processed at a merchant that does not have an IIAS (including doctors’ and dentists’ offices) IF the amount is not a standard Nemours co-pay amount
  • Any transaction other than a Nemours co-pay amount that is not recurring

How do I substantiate a debit card transaction?
If documentation is needed, you will be notified of the item(s) that require substantiation. Sufficient substantiation must include: date the expense was incurred, the amount of the expense, a description of the service provided or item purchased, the name of the recipient (you, your spouse or dependent) and the name of the facility or provider. Examples of sufficient documentation include a detailed pharmacy receipt or an insurance Explanation of Benefits statement.

What happens if I do not submit documentation for my debit card transaction?
If documentation is not submitted, IRS regulations require that card access for that participant be temporarily suspended until you provide the applicable receipts or repay the plan. You will be responsible for reimbursing the plan — by check or through payroll deductions — for any unsubstantiated amounts. If recovery is not possible, you will be taxed on the value of the unsubstantiated expenses.

How long can you use your card?
Your debit cards will be valid for three years. You will automatically receive new cards by mail during the month in which your card expires.

Other Information

Please remember you can get more information about these benefits online as well as access your HSA, FSA and transportation account. You may view detailed information such as your account balance, claim status and payment information. This information will be available to you 24 hours a day, seven days a week. If you have any questions regarding your account, please call HealthEquity Member Services at 866.346.5800.

To access your account, follow the simple steps below:

  • Go to my.healthequity.com
  • Log on using your benefits username and password
  • Click on the appropriate benefit to access detailed information

You will be automatically and securely transferred to the member portal. Here you can:

  • Check your HSA, FSA, transit or parking plan balances
  • Input or update your direct deposit information
  • Check the approval and payment status of the claims you have submitted
  • Submit new claims for reimbursement (NOTE: substantiation for debit card claims should be uploaded through the portal or the mobile app)

Income-Based Health Reimbursement Arrangement

This benefit is used to help eligible associates and their dependents to pay for co-pays, deductibles, coinsurance and prescriptions. Nemours will fund up to $1,000 for single and $2,000 for family coverages. Since this is funded by Nemours, associate contributions are not permitted and unused funds do not roll over year to year. This arrangement is available for associates who meet household income limits (see eligibility chart) and are enrolled in either the Red, Blue or White plans. Associates enrolled in the Green plan and SAVI are not eligible for this benefit.

Participation in this benefit is voluntary and requires completion of a one-page application along with your prior year tax return.

403(b) Plan

All associates are automatically enrolled* in The Nemours Foundation Section 403(b) Plan with a contribution rate of 4%. This is a tax-deferred savings plan that provides employee payroll contributions and Nemours contributions to eligible associates. Associate contributions begin on the first paycheck following 30 days of employment and are automatically invested in a default investment. Associates may opt out or change their contribution percentage or investment election at any time. Associates may contribute up to the IRS limits. For 2024, the annual contribution limit is $23,000 for associates under 50 years of age. Associates age 50 or older may contribute up to $30,500. Your contributions are always 100% vested. For eligible associates, the plan provides a 50% Nemours matching contribution up to 4% of eligible pay (maximum match of 2% of eligible pay), and a service-based Nemours contribution (ranging from 3% to 8% of eligible pay) made quarterly. Associates who are not scheduled to work at least 1,000 hours in a year must complete at least 1,000 hours of service before being eligible for Nemours contributions.

Associates who are not eligible for Nemours contributions may still make voluntary payroll contributions to the 403(b) plan with traditional pre-tax or Roth after-tax contributions.

*Once you are automatically enrolled, please remember to access your account at Transamerica.com/portal and designate a beneficiary to ensure your financial assets are allocated according to your wishes upon your passing. 

403(b) Summary Plan Description
403(b) Enrollment Booklet

Nemours Matching Contribution

Eligible associates will receive a Nemours match each pay period equal to $0.50 on each dollar you contribute on contributions up to 4% of eligible pay, up to a maximum match of 2% of eligible pay. Effective Jan. 1, 2022, the Nemours matching contributions for new hires are 100% vested after three years of service. Matching contributions for associates hired prior to Jan. 1, 2022, are 100% vested.

Note: Casual and part-time associates will be eligible for Nemours matching and quarterly base contributions after one year of service. A year of service is earned after you work at least 1,000 hours within 12 months of your date of hire or you work at least 1,000 hours in any calendar year beginning after your date of hire.

Note: If your full-time equivalency is .4807 or higher, meaning you are scheduled to work at least 1,000 hours per year, you are immediately eligible for Nemours matching contributions.  If your full-time equivalency is less than .4807, meaning you are scheduled to work less than 1,000 hours per year, you may become eligible for Nemours matching contributions by working at least 1,000 hours of service during an eligibility period.  The first eligibility period is the 12-month period beginning on your date of hire.  Subsequent eligibility periods are based on the calendar year beginning after your date of hire.

Nemours Service-Based Contribution

Once you become eligible for matching contributions as noted above, Nemours provides a quarterly service-based contribution for any quarter that you receive pay for at least 250 hours of work, based on the paycheck dates during the quarter. The quarterly service-based Nemours contributions are calculated by taking your earnings paid during the quarter times a percentage based on your years of service provided in the table below. Quarterly service-based contributions become 100% vested after three years of service.

Years of Service Contribution
0-4 Years 3%
5-9 Years 4%
10-14 Years 5%
15-19 Years 6%
20-24 Years 7%
25+ Years 8%

403(b) Contribution Example

Let’s say you are an eligible associate with two years of service. Your annual compensation is $50,000 and you contribute 4% of your compensation to the 403(b) Plan. The example below shows an annualized calculation of all plan contributions:

4% x $50,000 = $2,000 (Your Contribution)

50% x $2,000 = $1,000 (Nemours Matching Contribution)

3% x $50,000 = $1,500 (Nemours Service-Based Contribution)

Total of Your and Nemours Contributions = $4,500

457(b) Non-Qualified Deferred Compensation Plan

The 457(b) Retirement Savings Plan is a supplemental tax-deferred savings plan available to Nemours associates whose annual base salary is $150,000 or more. This plan offers another way to save for retirement, in addition to saving through the 403(b) plan. Contributions are permitted up to the IRS limits which are indexed and may change from year to year. The 2024 contribution limit is $23,000. If you decide to enroll in this plan, remember to designate a beneficiary for your account.  

457(b) Enrollment Booklet

Resources for Living (Employee Assistance Program)

Resources for Living, the Nemours Employee Assistance Program (EAP), is more than just a counseling service. It is a holistic resource for helping associates balance work and life, not only emotionally but financially and legally as well. There is even a chat and a televideo option called Talkspace for members ages 13 and older that can enhance your coverage options.

Resources for Living provides up to eight free sessions for each covered person for each issue annually. And, if you use the Talkspace option for chat or televideo, each week of either chat or televideo counts as only one session.

Resources for Living is a free, confidential, 24-hour/day, 365 days/year service sponsored by Nemours. This benefit covers all members of your household, including dependent children up to the age of 26. Contact Resources for Living:

• By phone at 855.506.2373
• Online at ResourcesForLiving.com
Username: Nemours
Password: resources4living

When logged on, you can access Talkspace to access a licensed therapist. You can also view the online library of tools. There is even an app that can be downloaded to access content on-the-go with a mobile device.

Family-Forming Benefits

Fertility Assistance

The Nemours benefit design for fertility assistance through Progyny allows you and your provider to pursue the most effective treatment and provides coverage for two cycles including services and tests. It also includes unlimited clinical and emotional support from a dedicated patient care advocate. This is only available to associates and spouses enrolled in one of the Nemours medical plans. To learn more and activate your benefit, call Progyny at 844.930.3289.

Adoption Assistance

Nemours provides adoption assistance benefits to full- and part-time benefits-eligible associates after the completion of the 90-day evaluation period. Nemours will reimburse full-time associates for eligible adoption expenses up to the IRS maximum, with a pro-rated amount for part-time associates. Assistance is limited to three adoptions per family. Most expenses directly related to the adoption are reimbursable. Eligible expenses include application fees, home studies, placement fees and travel expenses.

Paid Parental Leave

If you are in a benefits-eligible role (.50 full-time equivalency or greater), you are eligible for six weeks of paid (100%) parental leave. This is in addition to the short-term disability benefits. Note you must be eligible and employed by Nemours prior to the birth of the child. To learn more, contact Alight online or by calling 866.693.0064.

Maternity Support

Cleo Baby is a personalized, guided virtual care and experience for expecting parents and parents of newborns through their baby’s first birthday. Based on a family’s specific needs, their 1:1 Cleo Guide will provide guidance and oversight on various topics, including but not limited to emotional support, pregnancy and prenatal health, miscarriage and loss, birth prep classes, postpartum support, lactation, infant sleep, child development, and returning to work. This is only available to associates and spouses enrolled in one of the Nemours medical plans.

Back-Up Child/Elder Care

Eligible associates have access to a network of high-quality child care centers and in-home care providers through Bright Horizons Back-Up Care™ which provides care to family members of all ages. Back-up Care is available (15 uses per associate, per year) to fill occasional needs when associates’ usual care providers are unavailable. The cost of this benefit is paid by Nemours with associates responsible only for the following copays:

  • Center-based care copay: $15 per child or $25 per family per day
  • In-home care copay for dependent adults, elders or up to three children: $6 per hour (minimum of 4 hours and maximum of 10 hours per use)

Tuition Reimbursement

All benefits-eligible associates are eligible to participate in the Nemours tuition reimbursement program after successful completion of the 90-day evaluation period. Associates are eligible for up to $5,250 in tuition reimbursement benefits annually, pro-rated for part-time associates. Courses must be approved in advance and completed successfully (minimum grade of “C” or “pass”).

Please note that repayment is required if you terminate or have a change in employment status (e.g., moving from full time to casual) within one year of reimbursement.

The program is administered by Bright Horizons EdAssist Solutions and includes free educational advising and network discounts to help maximize your tuition reimbursement benefits.

Public Service Loan Forgiveness (PSLF)

PSLF is a loan forgiveness program for Federal Direct student loans. It forgives the remaining loan balance of
borrowers who make 120 eligible payments while employed full-time (30 hours per week) by an eligible 501(c)(3)
non-profit employer. Whether you have student loans now or might have them in the future, many associates are
impacted by the financial strains that come with earning a college education. That’s why Nemours has partnered
with Tuition.io to make things easier.

When you sign up for Tuition.io, you’ll have access to knowledge and tools that will help you manage, and over time,
eliminate your student loan debt. If you’re the parent of college-bound children, Tuition.io will help you find ways to
save and pay for their education.

This service comes with technical assistance and one-on-one student loan coaching. You can also use the Strategy
Finder tool to find the best student loan repayment strategy for your goals and calculate any potential savings. The
site also includes information regarding the risks and benefits of refinancing to see if it’s right for you.

Additional information about PSLF, frequently asked questions and links can be found here.

Travel Assistance

Benefits-eligible associates now have round-the-clock access to On Call International’s 24-hour, toll-free travel assistance services through Reliance Matrix. Whether you need help with an illness or injury, lost passport, missing luggage, or even a prescription refill, associates and their dependents have access to a personal travel emergency companion anytime you are more than 100 miles from home or traveling in a foreign country.