Do you need FMLA?

FMLA entitles eligible employees to take unpaid, job-protected leave for specified family and medical reasons with continuation of group health insurance coverage under the same terms and conditions as if the employee had not taken leave. The below video explains the type of leaves offered through St. Bernards Medical Center.

Ready to request FMLA?

Before you get started, it is important to know that it is the employee's responsibility to request the leave and follow up on all paperwork with FMLASource, USAble Life and Human Resources. Read the FMLA Instructions carefully along with the information on this page.

If you are NOT eligible for FMLA, you could be eligible for NonFMLA. This is a two tier leave with 30 days on each tier up to a max of 60 days. Both tiers require approval through FMLASource. You will use the same instructions as FMLA. Apply through FMLASource below. FMLASource will then deny the FMLA leave request. If you are eligible for NonFMLA, they will send you a packet within 24 hours to start the NonFMLA process.

Use the FMLASource.com link below to start your leave. If you have never used the FMLASource site before, you will need to register first by providing your Lawson ID. Employees can also call FMLASource at 877-GO2-FMLA. Keep in mind typical long waiting periods like Mondays or during the lunch hour.

FMLASource Website Link

How to manage your FMLA after requested?

For your convenience, we have created a short PDF and video on how to manage the FMLA process. Click on either one to learn more!

Managing FMLA PDF Link

Important FMLA Information

Do I have to use PTO? Yes. PTO runs concurrent with FMLA. PTO is always used when you are not working on your scheduled day to work.

What if I have Short Term Disability, can I save my PTO? No. Not everyone has Short Term. This is a benefit that you elected and pay for with each pay period. If you complete the Short Term Disability forms, you will be paid through USAble Life for the amount you elected during open enrollment.

Who signs the FMLASource forms and where do they go?

The Medical Certification is completed by the employee and the physician who can verify the leave. You have 15 days from the leave request date to submit the forms back to FMLASource to approve or deny the leave request. Contact information on where to send is listed at the top of the certification form.
The Short Term, Hospital, Accident and Critical Care forms are completed by the employee and the physician that can verify the leave and sent back to USAble Life. Contact information on where to send is listed at the top of each form. Short Term Disability will start after missing 7 days of work.
Benefits add/change/payments while out on leave are sent to Human Resources. You can email to HR@sbrmc.org, fax to 870-207-0555 or drop by the office.
Fit for Duty is required to return to work. This tells the manager that you are released to work and if you have restrictions. Your physician will complete the form and send back to Human Resources prior to the leave ending. If submitting prior is not possible, you must take a paper copy to your manager on the day you are released to work and then send to Human Resource.
IMPORTANT! The decision on the Medical Certification is not required to return to work. Only the Fitness for Duty is required to return to work regardless if a decision on the leave has been made or not.
We encourage you to read through the FMLA Instructions for each leave.
Additional FAQs Click Here

Maintaining Benefits on FMLA

If you have the benefit below and the benefit applies to the leave, simply complete the employee section, have your PCP complete the physician statement and send to the contact information at the top of each form.

Note: if you have a leave request through FMLASource, you do not need the employer statement. The employer information will automatically be sent to USABLE from FMLASource once the leave is submitted.

Insurance Change & Payment Form - send to Human Resources
Short Term Disability Form - send to USAble Life
Accident Care Form - send to USAble Life
Critical Care Form - send to USAble Life
Hospital Care Form - send to USAble Life. If you plan to add the baby to your Hospital Care benefit, complete one claim form for you and a separate claim form for the baby. For the baby, the Hospital Attending Physician’s Statement should be emailed to Brittney Martin at bdgoad1@sbrmc.org. Brittney will return the completed statement back to you so you can submit to USAble along with your Attending Physician Statement as well as the Employee Statement.

Submitting Online Forms To USAble LIFE

You can submit your EMPLOYEE ONLY forms online by going to usablelife.com. Click on Individuals and Families link and then click on "How to Start a Claim." Physician Statement forms can be submitted separately by the Physician's office. For Short Term Disability, you must notify Human Resources by sending an email to HR@sbrmc.org with your name and employee ID or SSN. Online option is for submitting only. There is not an online option to check the status of the claim. Group Number for St. Bernards Medical is 50002015. Please note, it is the employee's responsibility to follow up on all forms.

Need to Add Dependents?

You can add dependents if they qualify as a Life Change Event. For more information on Life Change Events, go to the BenefitHUB Home Screen by clicking the St. Bernards logo at the top left hand corner of this page. Then select Life Change Event tab and the event that applies to you. From here you can either make the changes to your benefits from the enrollment portal or use the benefit change form and submit to Human Resources.

FMLA Forms

Contact Information

FMLA for Employee Medical Certification Forms

Phone: 877-GO2-FMLA

Email: fmlacenter@fmlasource.com

Website: FMLASource.com

USAble for Short Term, Accident, Critical and Hospital Care

Phone: (800) 370-5856

Email: claims@usablelife.com

Website: https://www.usablelife.com/

St. Bernards Human Resources for Fit for Duty Form & Benefit Changes/Payments

Phone: 870-207-1605

Email: HR@sbrmc.org

Fax: 870-207-0555

My Benefits

Who can use the enrollment portal?

Current and New employees can use the enrollment portal.

When do you use the enrollment portal?

Current Employees - will use the portal to view all of their benefit elections for the current year. The portal will show what benefit you are in currently, how much the benefit costs per pay period and the effective dates of each benefit. Simply click on My Benefits from the enrollment portal link below.

NOTE: if there is not a My Benefit link in the left hand navigation, this means you have a benefit that is waiting for an election. Hit next through the prompts and either accept or waive the benefit. Click the orange button at the end to save.

New Employees - will use the enrollment portal below to sign up for benefits. New employees must sign up for benefits BEFORE the first of the month following 59 days of employment.

Example: If your hire date is March 4th, your benefits will not start until June 1st.

How do you log into the enrollment portal?

Username: First 6 characters of last name + first initial of first name + last four digits of your Social Security Number.

Password: Full Social Security Number (SSN) no dashes for new employees. Current employees use the same password you set up during open enrollment. If you do not remember, use the forgot password option.

You will be prompted to change your password upon your initial login.

Example:
Jane Thompson SSN: 987-65-4321
Username: thompsj4321
Password: 987654321

What Dependent Documents are Required?

Dependent documents are required. Documents should be submitted to Human Resources at the end of open enrollment. You can submit your documents by uploading to the enrollment portal, emailing a screen shot to HR@sbrmc.org or bring a copy to Human Resources.

NOTE: if documents are not received, dependents will be dropped from the coverage. For a complete list of documents, refer to the dependent link below.

Dependent Document List

How do you Upload Documents?

Once you completed your enrollment, it is now time to submit dependent documents. From the enrollment portal home page, click on Life Events and then Enrollment Doc Upload, enter the date, upload or drop in documents and then click save.

When can I make changes to My Benefits?

If your enrollment period has past, you are able to make changes to your benefits either by a Life Changing Event or during the next open enrollment period. Open enrollment is usually in November each year but could vary. To view a Qualified Life Event, go to the Home page of the BenefitHUB and click on Life Events.

Click Here to go to the Enrollment Portal

St. Bernards Billing Office Discounts

As a St. Bernards Full-Time Employee, you have the option to apply discounts to your medical center bills. Payroll deduction options are also available.

Discounts

Payroll Deduction Form

* Those listed with asterisk do not require use of keytag. Individuals may be required to present St. Bernards employee name badge.

Ace of Blade Barbershop
2306 E Matthews Ave
Jonesboro, AR. 72401
$1.00 off any service
870-268-1221

Ad Pro, Inc.
1205 Falls St.
(870) 932-6000
15% off all services

*AT&T
Jonesboro, AR.
(800) 331-0500
24% discount (Mention Discount Code: FAN2397671 and employee id badge)
Click Here for a detailed instruction sheet to get discount.
To sign up online, visit att.com/wireless/sbrmc
Or visit your local AT&T store at: 3006 E Highland, Jonesboro, AR 72401

ATA Martial Arts
1420 S. Caraway Rd.
Jonesboro, AR. 72401
20% Discount on Monthly Tuition
*Must present badge ID for discount
870-972-8811

Battery Outfitters
2838 Race St.
Jonesboro, AR. 72401
20% Discount off purchase
*Must present badge ID for discount
870-930-2838

Cash Discount Furniture
705 W Johnson Ave
Jonesboro, AR. 72401
Phone: 870) 935-2100
Fax: 870) 935-2100
Discount:25% off

Candlewood Suites
Jonesboro, AR
Phone: 870) 336-6500
Fax: 870) 336-6501
Discount Nightly Rates: $85.99 (1 -3 Nights); $79.99 (4 - 7 Nights); $75.99 (8 or more)

Credit Bureau of Jonesboro, Inc.
109 E. Jackson
(870) 932-6681
1 % off of standard rate for collecting

Crown Trophy
450 Southwest Dr.
(870) 268-0901
10% off Awards on orders over $50
Discount excludes engraving & promotional products
www.crowntrophy.com

Daycare Discounts
To find a list of all daycare providers in our area please click here.
Below are the local day cares that provide discounts to St. Bernards employees:

· Ana's Angels
2614 East Matthews Ave.
10% off by presenting St. Bernards ID Badge

· Kids Kingdom Daycare
1507 E. Matthews Ave.
Jonesboro, AR 72401
Phone (870) 932-2543
5% off Discount

Embassy Suites Jonesboro
223 Red Wolf Blvd.
Jonesboro, AR 72401
870-619-4482
$119 per night, must present employee ID

Fairfield Inn & Suites
3408 Access Rd.
Phone: (870) 934-1600
www.fairfieldjonesboro.com
10% off Regular Rate

Gearhead Outfitters
231 S. Main St. & The Mall at Turtle Creek
Phone: (870) 910-5569
20% off select footwear, inserts and socks. Free shipping for orders over $49.99.
Shop online at https://www.gearheadoutfitters.com/thank-you#hcw.

Hampton Inn
2900 Phillips Dr
Phone (870) 974-9500
$90.00 plus tax rate for standard rooms (just ask for SBMC rate)

HealthWear inc.
1320 Red Wolf Blvd.
Jonesboro, AR 72401
(870) 336-3046
10% off purchase

HiJinx: Game Night Reinvented
3102 Shelby Dr.
(870) 972-5270
10% discount at snack bar (Must show Employee Badge)

Holiday Inn (Jonesboro Location Only)
2908 Gilmore Dr.
(870) 333-5100
Discounted Rate of $129 Monday-Thursday and $119 Friday-Saturday by clicking here.

Jonesboro Jaycees
P.O. Box 741
(870) 275-1975
5% off 1 year membership

Layton Eye Clinic, P.A.
2706 Phillips Dr.
(870) 932-9800
15% off discount on a complete pair of glasses with valid prescription
Discount not applicable with any insurance or other discount

LensMasters
320 S. Church St.
(870) 972-1818
10% off of complete pair with no other insurance or discounts
www.rxlensmasters.com

Magic Springs Water & Theme Park
1701 E. Grand Ave.
Hot Springs, AR, 71901
Click Here to view available discounts. Save up to 60% off one-day tickets.
Purchase tickets at www.tiny.cc/saintbernard
501-624-0100

Master Print Group
5115 E Highland Dr
Jonesboro, AR. 72401
Phone: 870) 932-4491
Fax: 870) 932-8080
www.masterprintgroup.com
15% Discount on new customers on initial order

The Moving Company
Jonesboro, AR
Phone: 870) 882-2842
10% Discount

NEA Credit Union
2704 Fair Prk Blvd.
Jonesboro, AR 72401
NEAFCU members have access to thousands of surcharge free ATMs nearby and around the world (see attached information)

Qdoba
2935 Parkwood Rd.
(870) 336-2172
10% off purchase. Must present Employee ID at purchase.

Parkey & Davis
906 Enterprise Dr.
(870) 932-0330
50%off Zoom Whitening or take home bleaching trays
www.smiles4jonesboro.com

Ritter Communications
http://rittercommunications.com/residential/communities (to view locations served)
888-336-4466
Free internet upgrades for a year for St. Bernards Employees
(*Only Applies to New Accounts Created)

Silver Dollar City
Log on to http://store.silverdollarcity.com to purchase your disounted tickets. Use promo code 25607.

Six Flags St. Louis
Username: SBRMC
Password: SixFlags8
Username & Password are case sensitive. Log onto the link below to purchase:
www.sixflags.com/partnerlogin
Save $27 off per ticket

Sleep Cheap Mattresses
1700 E Johnson Ave
Jonesboro, AR.
Phone: 870) 253-6600
www.mysleepcheap.com
$100 off any size Mattress Set originally priced $299.99 or higher

Soo's Drug Store
2905 E. Nettleton Ave.
(870) 932-6930
10% off gift purchases
www.mygnp.com

Supertints
3212 E Nettleton Ave
Jonesboro, AR. 72401
Phone: 870) 935-7799
Fax: 870) 935-7771
Discount:10% off Tints

TicketsatWork.com
Create an account using Code: SBHC to gain access to discounts to major theme parks, shows, theaters, hotels, car rentals & more!
CLICK HERE FOR MORE DETAILS!

TJ's Burgers
2810 E. Highland Dr.
Jonesboro, AR. 72401
Phone: 870) 938-0008
10% off purchase: Must present employee ID badge when checking out to receive discount

Travel With Us
2718 E Nettleton Ave
Jonesboro, AR. 72401
Phone: 870) 932-7221
Fax: 870) 932-7346
www.travel-with-us.com
Discount:
Waived service fee on all tour packages
Not available for airline tickets

Verizon wireless
verizonwireless.com/discounts
Discount:
18% off monthly access fees
Please select the icons below to view discount and instructions

Paid Time Off

Your new PTO balance starts in the same pay period as your PTO Service Date. If you do not use your PTO balance by the end of the pay period prior to the PTO Service Date, you will lose it.

What is your PTO Service Date?
How do you find your PTO Balance?
Are you eligible for PTO payout upon departure?

Click the PTO Video link below to learn answers to these questions and more!

2020/2021 Pay Period Dates

Holidays

St. Bernards observes the following six (6) paid holidays each year.

New Years Day
Memorial Day
Independence Day
Labor Day
Thanksgiving Day
Christmas Day

You must work the day before and the day after the holiday to get paid unless you have scheduled PTO. If you work the holiday, you will have 90 days to use your paid holiday time off.

St. Bernards Health and Wellness

St. Bernards Health & Wellness is the premier fitness facility of Northeast Arkansas. Our 50,000-square-foot state-of-the-art facility in Jonesboro is equipped with top-notch fitness, cardiovascular and strength training equipment. It features an aquatics center, an indoor track and spacious locker rooms with comprehensive amenities including saunas.

We offer daily group exercise fitness classes, individualized personal training and nutritional sessions, competitive event training, specialized athletic training for adults and children, as well as a wide variety of health and wellness programming. Our supportive team of knowledgeable professionals is dedicated to changing lives by helping others reach their goals.

As an affiliate of St. Bernards Medical Center, we have integrated medical knowledge and services to improve individual health and wellness. These stories include medical fitness programs designed to help members who are living with cancer, arthritis, osteoporosis, fibromyalgia and cardiovascular disease to manage those conditions, Cardiac Rehab, Physical Therapy and an Orthopedic clinic.

To enroll, complete the enrollment form below and return to the Health and Wellness Center. You will be contacted for a tour of the facility. Payroll deduction is only available to those in a FT status.

Health and Wellness Website

Health and Wellness Facebook Page

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Employee Assistance Program

The St. Bernards Counseling Center EAP was designed to help everyone, not just the 15% of those with substance or alcohol abuse problems. These services include:

Anxiety Disorders
Depression
Problems with children/teens
Drug and alcohol abuse
Gambling Addictions
Attention Deficit Disorder
Marriage Counseling
Social Service Referrals
Stress

Grief Counseling
Spousal Abuse
Family Therapy
Sexual Abuse
Child Abuse
Nicotine Addiction
Eating Disorders
Children of divorce

After the initial phone call or referral, an appointment will be scheduled. Individuals in emergency situations will be seen immediately at St. Bernards Behavioral Health.

Assistance is provided by professional therapists trained to provide services for each employee based on their needs as well as workshops and literature to help each employee enhance their quality of life.
And as always, we guarantee confidentiality regarding discussions, problems identified, records maintained and overall treatment.

To request assistance, just call the St. Bernards Counseling Center at 870.930.9090 or toll-free at 1.800.346.0183. Our professionally trained staff will request information about your specific needs so that an assessment can be scheduled for you.

HOW IT WORKS
The St. Bernards Employee Assistance Program (EAP) has been designed to help employees and their families find assistance when dealing with the problems that can occur in everyday life. St. Bernards EAP can help you and your family with a wide range of behavioral health and substance abuse problems.

Your EAP allows you and your family to seek assistance in a simple and confidential manner from a trained professional. Referrals to the EAP can be made by anyone: yourself, family members, supervisors or physicians, etc. Once you utilize the EAP, all discussion and information shared is kept strictly confidential. St. Bernards Counseling Center will release information only to those individuals you desire to share the information with.

PLEASE REMEMBER
It is important to identify yourself as a member of St. Bermards EAP to ensure that your benefits are rendered correctly. Benefit eligible St. Bernard employees are eligible for 9 FREE visits per year.

Air Evac

All of us see the effects of motor vehicle accidents, all-terrain vehicle accidents, and other situations where time is critical and the cost to transport for critical care is tremendous. An average air ambulance flight bill is $25,000. With an Air Evac Lifeteam membership, you and your family are covered!

During annual enrollment, a 1-year membership can be purchased per household. Membership provides coverage for transport by an AirMedCare Network air ambulance provider to the closest appropriate medical facility for injuries or illness that are deemed, by an attending medical professional, as life or limb-threatening or that could lead to permanent disability.

Benefit Details

If new members need more than two Air Evac automobile stickers, please indicate the total number needed on the membership enrollment form. Stickers can also be placed on ATVs, boats, tractors, etc.
Air Evac suggests listing any second home address on the membership application, such as a lake home, where members might have a potential pick-up; please include a note to the membership application for address number two.
Student dependents living out of the home are still covered by the primary household membership.
In order to receive the special contracted pricing listed above: 1) the application form used has to be the SHARP Air Evac membership application form, 2) the check has to be made out to SHARP, Inc.

For more information, contact SHARP at 972.0032 or go by the office located at 105 E Matthews Suite A; Jonesboro, AR 72401.

Air Evac Website

Medic One

Supporting breastfeeding at work
is good for business.

You can receive a reimbursement for $160.00 if you submit a claim on your health insurance. This is also an approved purchase on your Flexible Spending Account card.

Medical Claim Form

Believe it or not, you probably have more room in your budget than you think. But to find that extra money, you need to have a plan.

When you follow the plan, SmartDollar can help take you from living paycheck to paycheck to being able to save, invest and give like no one else. Millions of people just like you have used this seven-step process to save their first emergency fund, eliminate debt, invest wisely, and even pay off their homes. We call this the Millionaire Movement! The average user saves more than $6,127 and pays off $9,405 in the first 12 months.

That’s why we’re now providing you with SmartDollar for FREE—and getting started takes only 5 minutes! Click here or simply text SBRMC to 33789 for your enrollment link!

With SmartDollar, it's completely confidential and you'll get access to these tools:

	A Proven, Step-by-Step Plan
	Learn about the 7 Baby Steps that have helped millions of people get out of debt, invest, build wealth and give generously.
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	Online Tools Accessible 24/7 on Any Device
	Jump start your finances as quickly as possible with the best budgeting tool on the planet, EveryDollar, along with a savings tracker and debt snowball tool.

Create My Free Account

MamaBear Legal Wills

St. Bernard’s Medical Center is partnering with Mama Bear Legal Forms and David Ramsey Solutions to provide Wills to team members. This benefit includes a Living Will, Last Will and Power of Attorney.

To create a Will:

Go to the enrollment portal from the My Benefits link on the Home page of the BenefitHUB.
By going through the enrollment portal, you will receive a cheaper rate than purchasing directly from the website.
The cost is split over 2 payrolls through payroll deduction.
- For a Single Will the deduction is $99
- For a Will for you and a spouse the deduction is $168
- Once the benefit is paid for, the deduction will stop and you will receive an email from MamaBear on how to start the Will process.

Sign & Make It Legal

Sign your documents in front of witnesses and a notary. You can have the document notarized at St. Bernards Human Resources or by a bank. Then file them in a safe place.

Not sure why you need one? Here's why a will is a good idea.

Questions? Email customercare@mamabearlegalforms.com

401k Retirement Plan

As a new hire, employees will receive a retirement packet from Simmons Bank by email. This packet includes the information you need to go online to start your retirement.

For question about this plan or if you do not receive your new hire packet, please contact Rena at Simmons Bank.

Rena Escue
Trust Officer
Direct Link 870-933-3198

401k Website Link

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Entitlement to or loss of eligibility for Medicare or Medicaid

If an employee or the employee's dependent becomes entitled to or loses eligibility for Medicare (Part A or Part B) or Medicaid they may be able to make changes to their benefit plans.

Contact your Human Resources Department to confirm eligibility and determine what can be changed based on your specific situation.
Changes must be reported within 30 days of the eligibility change. You may add or drop medical, dental, or vision coverage for yourself or the applicable family member. You may also elect to change your medical FSA amount. You will need to complete the appropriate forms and provide a copy of the notification letter from Medicare or Medicaid.

Medicare Website

Medicare Helpful Contacts

Create your personal my Social Security account today

With your free, personal my Social Security account, you can receive personalized estimates of future benefits based on your real earnings, see your latest Statement, and review your earnings history. It even makes it easy to request a replacement Social Security Card or check the status of an application, from anywhere!

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What are Worksite Benefits?

Regular expenses, big and small, can add up. Think about your ability to pay for those expenses if you or your family member experience a covered accident, illness, or hospitalization. While your medical insurance will provide some coverage, St Bernards Critical Care Elite, Accident Elite, and Hospital Care plans pay benefits directly to you in the event of a covered accident, illness, or hospitalization, and you decide how to use the benefit. You could even use the benefit to pay for something totally unrelated such as childcare, travel expenses, groceries, everyday bills, or any other expenses you need help covering.

Why do employees request voluntary/worksite benefits?

low-cost coverage
pre-taxed premiums
payroll deducted
quick claims turnaround
portable

Voluntary/worksite benefits options

accident
cancer/critical illness
hospital indemnity

USAble Customer Service

Toll free: (800) 370-5856

Monday - Friday 8 a.m. - 5 p.m. (CST)

https://www.usablelife.com/

Email: claims@usablelife.com

Accident Care

Living an active life is everyone’s expectation. But an accident can change everything in the blink of an eye. The costs of dealing with a life-altering accident can be overwhelming for those who are unprepared. After an accident, bills can mount quickly and linger for years, leaving a lasting effect on everyone in the household.

Because Accidents Happen! Accident Recovery offers an additional layer of financial protection for you and your family. This plan pays YOU directly in the event of a covered accident.

Accident Recovery Based on 24 Payroll Deductions Per Year

USAble Customer Service

Toll free: (800) 370-5856

Monday - Friday 8 a.m. - 5 p.m. (CST)

https://www.usablelife.com/

Email: claims@usablelife.com

Hospital Care

You have the option to purchase Hospital Care coverage through USAble. You have two plan options to choose from and you can elect coverage for yourself, your spouse, and your children. This coverage pays a benefit directly to you when you are admitted to the hospital for a covered stay.

While we have great medical benefits under the health plan, this coverage complements your health insurance to help you pay for the costs associated with a hospital stay. It can also provide funds which can be used to help pay the out-of-pocket expenses your medical plan may not cover, such as coinsurance, copays, and deductibles. Evidence of Insurability (EOI) is never required when enrolling in the Hospital Care plan.

Hospital Claim Form

Life Claim Form

USABLE Website

USAble Customer Service

Toll free: (800) 370-5856

Monday - Friday 8 a.m. - 5 p.m. (CST)

https://www.usablelife.com/

Email: claims@usablelife.com

Critical Care

Every few seconds, an American suffers a heart attack or learns that he or she has cancer. The impact on their family’s finances can be devastating. The copays and the expenses that aren’t covered by major medical insurance eat away at savings as well as the belief that things can get better.

Accident Recovery Based on 24 Payroll Deductions Per Year

USAble Customer Service

Toll free: (800) 370-5856

Monday - Friday 8 a.m. - 5 p.m. (CST)

https://www.usablelife.com/

Email: claims@usablelife.com

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Life and Accidental Death and Dismemberment (AD&D)

Employee Supplemental Life and AD&D—Optional

Newly hired employees are eligible to purchase additional life insurance in increments of $10,000 up to a maximum benefit of 5 times your annual salary or $200,000. At age 65, the original benefit is reduced to 65%. At age 70, the original benefit is reduced to 50%. The same coverage options exist for supplemental AD&D coverage.

You may select up to $200,000 without submitting evidence of insurability (EOI), also known as proof of good health. If you are a late entrant you may enroll during open enrollment in the amount of $10,000. Currently enrolled employees can increase their coverage option by $10,000 during enrollment up to the guarantee issue amount. Refer to page 13 for more information about EOI.

If you elect over the GI values (200k for Employee, 30k for Spouse) you will be prompted to complete Evidence of Insurability. If proof of good health is not provided, your elected coverage amounts will be denied.

Cost for Employee Supplemental Life and AD&D Coverage

Evidence of Insurability Form

Life Claim Form

Worksite Benefits ( Accident, Critical or Hospital Care Forms)

USAble Customer Service

Toll free: (800) 370-5856

Monday - Friday 8 a.m. - 5 p.m. (CST)

https://www.usablelife.com/

Short term Disability

Short term disability (STD) insurance helps provide financial security while you are on an approved medical leave. You will receive a weekly benefit in $50 increments (minimum of $100) up to $1,000, not to exceed 70% of your pre-disability base pay for up to 25 weeks. There is a 7 calendar-day elimination period and benefits are paid out on the 8th day.

Additional Plan Details—Optional

Contributions are based on the benefit selected amount
Your PTO is concurrent with the STD benefit
Disability must be approved by USAble Life
Pre-existing conditions are waived if enrolling during your initial eligibility period
Benefit reduction and termination:
- At age 65, the original benefit is reduced to 66⅔%
- Terminates at age 70

Short Term Disability Form

If you are completing the Short Term Disability form and do not have an FMLA leave, you must contact Human Resources to complete the Employer Statement. This statement is only completed if there is NOT an FMLA claim.

Online Access
You can also complete the USAble Forms online by going to usablelife.com. Click on Individuals and Families and then click on "How to Start a Claim." For Short Term, Disability, you must notify Human Resources by sending an email to HR@sbrmc.org with your name and employee id or ssn.

Online option is for submitting only. There is not an online option to check the status of the claim.

Group Number for St. Bernards Medical is 50042523

Click Here for Claim Tutorials/Submit Forms Online

USAble Customer Service

Toll free: (800) 370-5856

Monday - Friday 8 a.m. - 5 p.m. (CST)

https://www.usablelife.com/

Email: claims@usablelife.com

Long Term Disability

Long Term Disability (LTD) replaces a portion of your income due to a non-work related disabling illness or accident for an extended recovery period.

Long Term Disability—Optional

You have the option to choose up to 40%, 50% or 60% of your base pay
180-day elimination period
$8,000 maximum per month benefit
Two years for your own occupation; after that, any occupation
Benefits continue to age 65 or later depending upon your age at the date of disability
Pre-existing conditions apply

For example; an employee making $30,000 a year can expect to receive the following income per month by choosing either 40%, 50% or 60% of their salary.

The $30,000 x 40%/12 = $1,000 per month.
The $30,000 x 50%/12 = $1,250 per month.
The $30,000 x 60%/12 = $1,500 per month.

Long Term Disability Form

Claim Tutorial

USAble Customer Service

Toll free: (800) 370-5856

Monday - Friday 8 a.m. - 5 p.m. (CST)

https://www.usablelife.com/

Health Flexible Spending Account

DataPath offers an FSA debit card, which allows you to pay for eligible expenses directly from your account. Expenses include medical, prescription, dental and vision. The advantage of using the FSA for these expenses is that you get all of your money at the begining of each year and is tax free. For 2020, if you choose to participate, you may contribute up to $2,700 per year on a pre-tax basis. Money is loaded to your card on 1/1 and you spilt up the contributions through out the year pre-tax. For other eligible expenses, use the link below.

Eligible Expenses

Eligible Expenses Due to Cares Act

Receipt Rules

The below list shows transactions that do not require you to submit an itemized receipt:

St. Bernard’s Affiliated pharmacies & clinic’s.
- Jonesboro Plastic Surgery & McClurkan Clinic are excluded & require receipts.
Amounts that match the co-pays attached to your health or dental benefits.
Pharmacies with the IIAS certification. This is an inventory system that approves or denies items at the point of sale. Typically larger locations such as Kroger or Wal-Mart have this in place at their pharmacy counters.

ALL OTHER LOCATIONS OR OUTSIDE THE COPAYS WILL REQUIRE A RECEIPT. This is NOT a debit card receipt.

Per IRS guidelines, if you use your card outside of the set paramaters you are required to submit an itemized receipt to substanitate the transaction. All transactions are subject to review. Failure to do so will result in the funds being owed back to the plan.

Itemized Recipts must contain:
- Date of Service
- Service Performed
- Patient Name
- Amount

If you are uncertain if an item is covered you can contact customer service for further asssitance at 1-877-685-0655.

FSA Funds Notice

FSA is a use it or lose it program.

All transactions must be for the dates of the service year from 1/1 to 12/31.
- This is not when you receive a bill but when the service date was compelted.
All 2020 FSA claims must be submitted to DataPath on or before 3/31/2021 for dates of service 1/1/20-12/31/20.
Any funds left after your run out period will be forfeited.

Account Setup

You will receive in the mail a series of plan white envelops with your FSA account setup. These are sent separately for your protection.

To activate your card by phone, use the TPA number 10.

To register online, use the Employer ID 10306 and the Participant ID that came in the mail with your card. If you do not know your Participant ID contact Human Resources or call DataPath Customer Service.

DataPath Login Instructions

Enrollment Guide

Claim & Reimbursement Form

Direct Deposit Form

When you go to the DataPath site below, keep in mind that all of the DataPath educational materials and forms are listed on the front page of the site. The login is only to view your individual account information. You do not have to login to get the reimbursement forms as shown below under Commonly Used Forms.

DataPath Website Link

Customer Service 1-877-685-0655
Email: St.bernards@datapathadmin.com

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Dependent Flexible Spending Account

DataPath offers an FSA debit card, which allows you to pay for dependent expenses directly from your account. The advantage of using the FSA for these expenses is that you get all of your money at the begining of each year and is tax free. For 2020, if you choose to participate, you may contribute up to $5,000 per year on a pre-tax basis ($2.500 maximum if married and filling separate tax returns.)

Dependent Care Fact Sheet

DataPath Login Instructions

Enrollment Guide

Recurring Expense Form

Direct Deposit Form

Eligible dependent care expenses include:

Before- and after-school care
Extended day programs
Daycare, preschool, or nursery school
Summer day camp
Elder day care

An eligible dependent is:

A child under age 13, who is claimed as a dependent on your income tax
A child age 13 and older, who depends on you for at least half of his/her support;
Regularly spends at least eight hours a day in your household; and
Is physically or mentally unable to care for himself/herself
A disabled spouse
An elderly parent

Note: Dependent Care requires a request reimbursement from you on your Dependent Care Account. Contributions will be reimbursed to you on a per pay period basis. By completing the Recurring Expense Form you will not need to provide continuing documentation.

When you go to the DataPath site below, keep in mind that all of the DataPath educational materials and forms are listed on the front page of the site. The login is only to view your individual account information. You do not have to login to get the reimbursement forms as shown below under Commonly Used Forms.

DataPath Website Link

Customer Service 1-877-685-0655
Email: St.bernards@datapathadmin.com

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Superior Vision by DeltaDental

Our Delta Vision plan is offered through Delta Dental of Arkansas. Register online to search for providers, print claim forms, print ID cards, check claim status, and view covered members.

REGISTER ONLINE

Finding In-Network Providers
Remember to visit in-network providers to receive the deepest level of discount on your services. To find a participating in-network provider in your area go online or call 844.549.2603.

VIEW CERTIFICATE OF COVERAGE

DOWNLOAD VISION CLAIM FORM

Dental by BlueAdvantage

Dental insurance is offered through BlueAdvantage Administrators of Arkansas.

Finding In-Network Providers
Remember to visit in-network dentists to receive the deepest level of discount on your services. To find a participating in-network dentist in your area go online or call 888.223.4999.

Register with My Blue Print
Register with My Blue Print to order replacement cards, check claims status, review EOB’s, check deductibles, and review your personal health record.

REGISTER ONLINE

IN-NETWORK PROVIDER LINK

Clinic Dental Rates Per Pay Period

Employee Only $0.00 (Paid by Company)
Family $30.52

DENTAL CLAIM FORM

Paragould Dental by Delta Dental

Dental insurance is offered through Delta Dental of Arkansas.

Finding In-Network Providers
Remember to visit in-network dentists to receive the deepest level of discount on your services.

Register with My Blue Print
Register to order replacement cards, check claims status, review EOB’s, check deductibles, and review your personal health record.

REGISTER ONLINE

IN-NETWORK PROVIDER LINK

Dental Rates Per Pay Period

Employee Only is $0.00 (Paid by Company)
Family is $31.65

DENTAL CLAIM FORM

DENTAL PLAN DOCUMENT

Medical Plan

St. Bernards is pleased to offer you a Medical and Prescription plan that meets the needs of your family. Having the right health plan is important. It is our objective to provide an employee benefit program with a high level of benefits making it easy for you and your dependents to access the medical care you need.

There may be coverage for out-of-network services in the event of an emergency or when cases are managed by SHARP. See plan documents for specifics.

Some services may require precertification. Contact SHARP at 870.972.0032 to precertify.
There is a $500 penalty for failure to follow precertification guidelines. The penalty is in addition to any other deductible.
No coverage for non-emergency services.
Care and treatment of pregnancy and complications of pregnancy for a dependent daughter is not covered.Medical or Prescription Questions?

USAble is our third party plan adminstrator who provides you with all information as it relates to what your health plan will cover.

Benefit Limits
Claims Processing
Explanation of Benefits (EOBs)

Get access to your individual health plan information through the USAble My Tracker link. If you do not have an account, simply create a new account. You also have access to search covered policies and other useful links related to your medical plan at Arkansas BlueCross. For medical claims call 888.898.8145

Find In-Network Providers

USAble Tracker Link

Procedures Covered by Plan

Dependents for coverage generally include Legal Spouse and Children. All dependents must have the required documents submitted prior to the benefit start date or they will be dropped from your coverage. More information can be found in the Covering Your Family Link Below.

COVERING FAMILY MEMBERS

  Discounts
  Claim Form
  Insurance Change Form
  Insurance Payment Form

  Plan Document
  Summary of Benefits
Medical Center Health Plan Notice
  CHIP Notice

Understanding Your Explanation of Benefits

AVOID A SCARE WITH PREVENTIVE CARE

Care through BlueCross
Care through ACA

Phone: 1-888-872-2531

https://www.arkansasbluecross.com/support

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Prescription Plan

Formulary

St. Bernards uses the Standard with Step Therapy Formulary (list of drugs covered by tier) which follows a step therapy approach. Members are required to purchase a generic drug before a brand-name drug is covered. If a member hasn’t used the generic option in 24 months, or the member’s physician does not submit a request for approval to get brand without having the Step, the member is required to try generic or the name brand drug will be considered a 100% member pay drug. Please keep in mind you have access to the Employee Pharmacy which could save you money.

USABLE DRUG FORMULARY

Immunizations

Medical plan members can utilize pharmacies for vaccinations. Certain vaccinations, as provided by the Affordable Care Act, are 100% covered using the prescription drug benefit. This includes all the preventive routine vaccinations but does not apply to travel related vaccinations. The shingles vaccine is now covered at 100% administered at a pharmacy.

Zero Cost Immunizations

Preventive Serivces

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Network Coverage, Precertifications & Narcotic Review

SHARP (St. Bernards Healthcare Associated Regional Providers, Inc.) is a physician hospital organization (PHO) developed in 1994 by St. Bernards Healthcare and the physicians in Northeast Arkansas. SHARP connects providers, employers, and patients seeking medical services to create the very best healthcare service possible at an affordable rate. With over 4,300 providers and 173 facilities, SHARP is one of only a few PHOs in the country that is licensed to provide services to review the necessity, use, appropriateness, and efficiency of healthcare services. Utilization review is about verifying value for the healthcare consumer. SHARP has the ability to work with any employer at the level needed and SHARP has working relationships with over 35 third-party administrators. SHARP currently has 485,000 covered lives accessing the SHARP network.

SHARP provides St. Bernards Medical Center employees the following services to help reduce healthcare costs.

Precertifications
SHARP provides precertification services as required by the plan for all Inpatient Services, Outpatient Surgery (excluding EGD, Colonoscopy, and HC), CT, MRI, PET Scans, insulin pumps (prior authorization), and private duty nursing services.

Prior Authorization—required from the provider for Insulin Pumps prior to purchase
Identifies In Network Providers—contact SHARP for local and surrounding areas in-network providers and facilities
Referrals outside SHARP Network—required from referring physician to SHARP prior to services provided

* Provider must get coverage approval from USAble prior to precertification

SHARP Case Management Services - provide services to improve the overall health and well being of the patient by promoting continuity of care, ensuring cost efficiency, identifying resources, implementing, monitoring, and evaluating a plan of action while continuously communicating with the parties involved; case manages and prioritize cases by high dollar or catastrophic illness or injury, cases of questionable medical necessity, excess or high cost cases, cases involving out of network providers; and coordinating any in home needs from case managed vendors such as: durable medical equipment, infusion services, respiratory care services, home health or wound care needs.

Narcotics Appeals
The prescription drug plan requires reauthorization on usage of a controlled substance for more than 120 tablets or 30 day supply of other dosage in a 12-month period. Information from the prescribing physician must be submitted to SHARP 870.972.0032 for approval of continued plan coverage. The forms to be completed by the prescribing physician are available at SHARP or in the HR Office.

Narcotic Consent Form

Narcotic Appeal Form

What is a Qualifying Life Event?

A qualifying life event (QLE) is an event deemed acceptable by the IRS that may allow participants in section 125 plans to change their benefit elections. You may change your benefit elections during the annual Open Enrollment period or during the year if you experience a Qualifying Life Event. A Life Event change permits employees to make certain mid-year benefit changes consistent with the qualifying event. You must consult your Benefits Administrator within 31 days from the date of the event to make changes.

Qualifying Life Events

Special Enrollment Rights: An event described in the Special Enrollment provisions as shown in the group policy/plan;
Entitlement to or loss of eligibility for Medicare or Medicaid: The employee or the employee's dependent becomes entitled to or loses eligibility for Medicare (Part A or Part B) or Medicaid.
Special Requirements relating to the Family and Medical Leave Act (FMLA): An employee takes leave under FMLA, in which case the employee may revoke an existing election of health plan coverage and make such other election for the remaining portion of the period of coverage as may be provided for under FMLA.
Significant cost or coverage changes: Cost of coverage changes significantly.
A judgment, decree or order: Resulting from a divorce, legal separation, annulment, or change in legal custody (including a qualified child support order) that requires health coverage for an employee's dependent child or for a foster child who is a dependent of the employee.

Changes in status events, which include the following:

Legal marital status: Change in the employee's legal marital status, including marriage, death of spouse, divorce, legal separation and annulment;
Number of dependents: Change in the employee's number of dependents, including birth, death, adoption and placement for adoption.
Employment status: Change in the employment status of the employee or the employee's dependent, including termination or commencement of employment, a strike or lockout, a commencement of or return from an unpaid leave of absence or a change in worksite. This also includes a change in the employee's or the employee's dependent's employment status resulting in the individual becoming or ceasing to be eligible under the group policy/plan;
Eligible dependent status: Change in the eligibility of a dependent due to reaching a limiting age, change in student status or any similar circumstance; and
Residence: Change in the place of residence of the employee or the employee's dependent provided that the change in place of residence affects the eligibility for the employee or the employee's dependent's coverage under the group policy/plan.

Consistency Rule: In all cases, any election change as a result of any change in status must be on account of and correspond with a change in status that affects eligibility for coverage under the plan. For example, if the change in status is the employee's divorce, the death of a spouse, an employee's election to cancel health coverage will apply only to the spouse involved.

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Marriage

Once you are married, you may add your spouse to your existing medical, dental, vision or hospital coverage, enroll in a medical plan, change to another option or drop your coverage to go on your spouse’s plan. You will need to complete the appropriate forms and provide a copy of your certified marriage certificate along with a copy of the spouse driver's license. You should also review your beneficiary designations for life insurance, retirement savings, and pension plans. You must consult the HR Department within 31 days from the date of the event to make changes.

How To Make Benefit Changes Online

Use the Life Event Instruction link below to create a Life Change Event in the enrollment portal to make changes to benefits. Be sure to upload the required documents to make the change.

Eligible changes include:

Medical
Dental
Vision
Hospital Care
Beneficiaries for Life Insurance

Required Documents:

Provide Marriage License
Provide Spouse Driver's License

Review/Change Beneficiaries and Emergency Contact Information:

If you need access to see what benefits you currently have, click on Enrollment Portal link below. Log in the same as you did during open enrollment. If you do not know your password, use the forgot password option. From here, you can change beneficiaries and emergency contact information.

OR Change By Paper Form and send to Human Resources

Paper Enrollment Form

Retirement Beneficiary Changes

This is also a good time to change your beneficiaries in your retirement. If you are currenly in the TIAA retirement plan, use the link below to log into your account to make the beneficiary changes. If you are in the Pension plan, complete the form below and return to Human Resources.

TIAA Retirement Online Beneficiary Change

Pension Beneficiary Change Form

Tax Forms

To change your tax withholdings, complete the forms below and return to Human Resources. Changes are made on the next payroll.

Federal Tax Form

State Tax Form

Name Change

For a name change, complete the change form from the link below. A copy of your Social Security Card with the new name is required. You can either bring it into Human Resources or email to HR@sbrmc.org.

Name Change Link

For the Social Security Administration

If you legally change your name because you get married, you will need to apply for a corrected Social Security card with your changed name. Failure to do so could delay a tax refund coming to you or prevent some of your pay from being credited properly to your Social Security record, which could cause your future Social Security benefits to be less than they should be. You will need to provide a recently issued document, such as your marriage license/certificate, as proof of your legal name change. If the document you provide does not give the Social Security Administration enough information to identify you in its records, you will be asked for an identity document showing your old name and another in your new name providing evidence of your identity. You will need to fill out an Application for a Social Security Card (SS-5) form and submit it to the Social Security Administration. You can download a copy of the SS-5 form and instructions in an electronic format from here and print it out at your leisure. The instructions include details on acceptable evidence of your identity. Also, you can visit the Social Security website or call 1-800-772-1213.

Social Security Card Application Link

Baby/Adoption

This material will provide you with resources that can guide you toward your life goal--to bring your new child into your family and nurture the happiness and well-being of a precious child.

Have you started your FMLA Leave?

What is the Family Medical Leave Act (FMLA)? FMLA is a federal law that entitles employees to 12 weeks of unpaid leave for qualifying medical and family reasons. This time can be used over the course of 12 months for qualifying medical and family reasons. Go online to FMLASource to start a leave case or call 877-GO2-FMLA. This can be done for the mother and/or the father. Be sure to let FMLASource know your return date to work. A Fit for Duty must be submitted to FMLASource 1 week prior to returning. If you are unable to submit in advance, a copy should be given to your manager on your return date.

FMLA Instructions

FMLASource Website

When To Make Benefit Changes

After the birth or adoption (official placement or final decree), or court order, you may add the child to your existing medical, dental, or vision coverage, or drop your coverage to go on your spouse’s plan. You may elect to change your medical FSA amount and start or change a dependent care FSA. You may also elect child life insurance. You will need to complete the appropriate forms and provide a copy of the certified birth certificate, adoption placement order or decree, or court order. You must consult your HR Department within 31 days from the date of the event to make changes.

Note: Medicaid Health Insurance programs are offered during your stay at St. Bernards. These programs will offer assistance to those that qualify based on income and family size. If you complete an application for this program, it does not automatically enroll your child in your employee health insurance. If you have questions or concerns, please contact HR.

How To Make Benefit Changes Online

Use the Life Event Instruction link below to create a Life Change Event in the enrollment portal to make changes to benefits. Be sure to upload the required documents to make the change.

Eligible changes include:

Medical
Dental
Vision
Hospital Care
Beneficiaries for Life Insurance

Required Documents:

Provide birth certificate or birthing letter from the hospital
Provide Social Security Number

Review/Change Beneficiaries and Emergency Contact Information:

If you need access to see what benefits you currently have, click on Enrollment Portal link below. Log in the same as you did during open enrollment. If you do not know your password, use the forgot password option. From here, you can change beneficiaries and emergency contact information.

OR Change By Paper Form and send to Human Resources

Paper Enrollment Form

Retirement Beneficiary Changes

This is also a good time to change your beneficiaries in your retirement. If you are currenly in the TIAA retirement plan, use the link below to log into your account to make the beneficiary changes. If you are in the Pension plan, complete the form below and return to Human Resources.

TIAA Retirement Online Beneficiary Change

Pension Beneficiary Change Form

Insurance Payments

You may be required to pay for your insurance while out on leave. Once your PTO runs out, complete the form below and submit to Human Resources.

Insurance Payment Form

Tax Forms

To change your tax withholdings, complete the forms below and return to Human Resources. Changes are made on the next payroll.

Federal Tax Form

State Tax Form

Need a Pediatrician?

Click Here to find an in-network provider!

Short Term Disability And Other USABLE BENEFITS

For your convenience, Employee Assistance, Short Term Disability, Accident Care, Critical Care and Hospital Care will automatically be sent to you (if you have the benefit) when you create a leave case with FMLASource. It is up to you to decide which benefit applies to your leave.

Short Term Disability You will complete the Employee Statement and the physician will complete the Attending Physician Statement. Submit to USAble using the email, fax or address provided at the top of the claim forms. Payment for this benefit starts on the 8th day after your last day worked.
USAble Accident, Critical or Hospital Care You will complete the Employee Statement and the physician will complete the Attending Physician Statement. Submit to USAble using the email, fax or address provided at the top of the claim forms.
If you plan to add the baby to your Hospital Care benefit, complete a separate claim form for the baby. The Hospital Attending Physician’s Statement should be emailed to Brittney Martin at bdgoad1@sbrmc.org. Brittney will return the complete statement back to you so you can submit to USAble.

HOSPITAL CLAIM FORM LINK

EAP The St. Bernards Employee Assistance Program (EAP) has been designed to help employees and their families ﬁnd assistance when dealing with the problems that can occur in everyday life. To request assistance, just call the St. Bernards Counseling Center at 870.930.9090 or toll-free at 1.800.346.0183.
PTO: PTO is used concurrent while on leave. This means any PTO balance will be used regardless if you have Short Term Disability or not while you are out on leave.
You can get all of the claim forms from your BenefitHUB by choosing the information card for that benefit.

Helpful Tips:

Don’t forget about the employee discounts! You can contact the billing office at 870-207-7222 to have your discount applied to your hospital bills.
Discounts are available on breast pumps at Delta Medical Supplies. The Willow Pump also has a St. Bernards discount code. You will receive a $160.00 reimbursement when you submit a claim form to USAble health insurance.

Willow Breast Pump

Delta Medical Supplies

Medical Reimbursement Form

Do you need FMLA?

Ready to request FMLA?

FMLASource Website Link

How to manage your FMLA after requested?

Important FMLA Information

Maintaining Benefits on FMLA

Submitting Online Forms To USAble LIFE

Need to Add Dependents?

FMLA Forms

Contact Information

My Benefits

Who can use the enrollment portal?

When do you use the enrollment portal?

How do you log into the enrollment portal?

What Dependent Documents are Required?

Dependent Document List

How do you Upload Documents?

When can I make changes to My Benefits?

Click Here to go to the Enrollment Portal

With SmartDollar, it's completely confidential and you'll get access to these tools:

Sign & Make It Legal

Sign your documents in front of witnesses and a notary. You can have the document notarized at St. Bernards Human Resources or by a bank. Then file them in a safe place.

Create your personal my Social Security account today

Mobile

Web-based

Receipt Rules

FSA Funds Notice

Claim & Reimbursement Form

Direct Deposit Form

Recurring Expense Form

Direct Deposit Form

Eligible dependent care expenses include:

An eligible dependent is:

Dependents for coverage generally include Legal Spouse and Children. All dependents must have the required documents submitted prior to the benefit start date or they will be dropped from your coverage. More information can be found in the Covering Your Family Link Below.

Formulary

Immunizations

Qualifying Life Events

Changes in status events, which include the following:

How To Make Benefit Changes Online

Retirement Beneficiary Changes

Tax Forms

Name Change

For the Social Security Administration

When To Make Benefit Changes

How To Make Benefit Changes Online

Retirement Beneficiary Changes

Insurance Payments

Tax Forms

Short Term Disability And Other USABLE BENEFITS

HOSPITAL CLAIM FORM LINK