St. Bernards Human Resources
Current and New employees can 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 are eligible for benefits the first of the month following enrollment date with up to 90 days from the hire date to enroll.
Example: If your hire date is March 4th and you enroll in benefits on March 15th, benefits will start April 1st. If you enroll in benefits on April 1st, your benefit start date is May 1st. You have 90 days from your hire date to enroll in benefits.
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.
Jane Thompson SSN: 987-65-4321
Dependent documents are required. Documents should be submitted to Human Resources at the end of open enrollment. You can submit your documents by emailing 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
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.
The link below is only to enroll in benefits or to view your individual benefits for the current year. This link will not provide information about that benefit. Before enrolling in your benefits, we encourage you to explore your benefithub. Each benefit we offer at St. Bernards will have an individual page where you will find benefit summaries, plan documents, links to providers in-network and other important information on that benefit. Simply, return to the home page of this site and click on the benefit to view details.
* 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
Ad Pro, Inc.
1205 Falls St.
15% off all services
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
2838 Race St.
Jonesboro, AR. 72401
20% Discount off purchase
*Must present badge ID for discount
Cash Discount Furniture
705 W Johnson Ave
Jonesboro, AR. 72401
Phone: 870) 935-2100
Fax: 870) 935-2100
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
1 % off of standard rate for collecting
450 Southwest Dr.
10% off Awards on orders over $50
Discount excludes engraving & promotional products
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
$119 per night, must present employee ID
Fairfield Inn & Suites
3408 Access Rd.
Phone: (870) 934-1600
10% off Regular Rate
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.
2900 Phillips Dr
Phone (870) 974-9500
$90.00 plus tax rate for standard rooms (just ask for SBMC rate)
1320 Red Wolf Blvd.
Jonesboro, AR 72401
10% off purchase
HiJinx: Game Night Reinvented
3102 Shelby Dr.
10% discount at snack bar (Must show Employee Badge)
Holiday Inn (Jonesboro Location Only)
2908 Gilmore Dr.
Discounted Rate of $129 Monday-Thursday and $119 Friday-Saturday by clicking here.
P.O. Box 741
5% off 1 year membership
Layton Eye Clinic, P.A.
2706 Phillips Dr.
15% off discount on a complete pair of glasses with valid prescription
Discount not applicable with any insurance or other discount
320 S. Church St.
10% off of complete pair with no other insurance or discounts
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
Master Print Group
5115 E Highland Dr
Jonesboro, AR. 72401
Phone: 870) 932-4491
Fax: 870) 932-8080
15% Discount on new customers on initial order
The Moving Company
Phone: 870) 882-2842
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)
NEA Massage Therapy
$10 off a 60 minute massage—normally $70
$15 off a 90 minute massage—normally $100
Call to book at 870-219-9633
Must show Employee Badge for discount
2935 Parkwood Rd.
10% off purchase. Must present Employee ID at purchase.
Parkey & Davis
906 Enterprise Dr.
50%off Zoom Whitening or take home bleaching trays
http://rittercommunications.com/residential/communities (to view locations served)
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 & Password are case sensitive. Log onto the link below to purchase:
Save $27 off per ticket
Sleep Cheap Mattresses
1700 E Johnson Ave
Phone: 870) 253-6600
$100 off any size Mattress Set originally priced $299.99 or higher
Soo's Drug Store
2905 E. Nettleton Ave.
10% off gift purchases
3212 E Nettleton Ave
Jonesboro, AR. 72401
Phone: 870) 935-7799
Fax: 870) 935-7771
Discount:10% off Tints
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!
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
18% off monthly access fees
Please select the icons below to view discount and instructions
Online Self Study Modules
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:
Guide to Enroll Online
Payroll Deduction Link
St Bernards Medical Center (your “employer”) is making saving for retirement under our 403(b) Retirement Plan (the “Plan”) even easier. We are offering an Automatic Enrollment feature, and will make employer matching contributions. NOTE: This is only for those employees who are eligible for the employer match and are contributing less than 2%. If you are already contributing 2% or more, this will not affect your elections.
You are receiving this notice to inform you of the option to change the amount of the contributions coming out of your salary and how such contributions will continue to be invested if you do not provide complete investment instructions. Please disregard this notice if you have already completed and submitted a Salary Deferral Agreement and/or provided complete investment instructions.
If you have not completed and submitted a Salary Deferral Agreement, you will be automatically enrolled in the Plan starting with your first paycheck on or after July 1, 2021. This means that amounts will be taken from your pay and contributed to the Plan. These automatic contributions will be 2% of your eligible pay each pay period. But, you can choose a different amount. You can choose to contribute more, less, or even nothing.
This notice gives you important information about the Plan’s rules, including the Plan’s automatic enrollment feature and employer matching contributions. The notice covers these points:
Distributions from 403(b) plans before age 59 ½, severance from employment, death, or disability may be prohibited, limited, and/or subject to substantial tax penalties. Different restrictions may apply to other types of plans.
You can find out more about the Plan in the Summary Plan Description (SPD), which is available from Human Resources at the address shown at the end of this notice.
The Plan’s Automatic Enrollment feature does not apply to you if you already elected (completed and submitted a Salary Deferral Agreement to Human Resources to make contributions to the Plan or to not contribute. If you made an election of how much you want to contribute, your contribution level will remain the same. You can always change your contribution level by completing and submitting a new Salary Deferral Agreement to Human Resources at the address shown at the end of this notice.
If you have not elected a contribution rate, you will be enrolled in the Plan starting with your first paycheck on or after July 1, 2021. This means money will be automatically taken from your salary and contributed to your account. If you do not want to be enrolled, you need to obtain a salary reduction form from Human Resources at the address shown at the end of this notice, and then submit the completed form to Human Resources indicating your election not to participate.
If you do not turn in a completed Salary Deferral Agreement by July 1, 2021, 2% of your Gross salary amount for each pay period will continue to be taken from your salary and contributed to the Plan. To learn more about the Plan’s definition of eligible salary, you can review the Plan’s SPD.
Your contributions to the Plan will be taken out of your salary and are not subject to federal income tax at that time. Instead, they will be contributed to your plan Account and may grow over time with earnings. Your plan account balance will be subject to federal income tax only when amounts are withdrawn. This helpful tax rule is a reason to save for retirement through Plan contributions.
Contributions will be taken out of your salary if you do nothing. But you are in charge of the amount that you contribute. You may decide to do nothing and become automatically enrolled, or you may choose to contribute an amount that better meets your needs. For example, you may want to get the full amount of your employer’s matching contributions by contributing at least 6% of your eligible pay. You can change your contributions by completing and submitting a new Salary Deferral Agreement to Human Resources at the address listed at the end of this notice.
If you want to contribute more to your plan account than the Automatic Enrollment percentage, there are limits on the maximum amount. These limits are described in the Plan’s summary plan description “SPD,” which is available from Human Resources at the address listed at the end of this notice.
St. Bernards Medical Center is making contributions to the Plan on your behalf. However these contributions are subject to vesting rules, so they will become entirely yours (will be vested) according to the following schedule:
Years of Service Vested Percentage
Less than 2 0%
6 or more 100%
Remember, you can always change the amount you contribute to the Plan by completing and submitting a new Salary Deferral Agreement to Human Resources at the address shown at the end of this notice.
TIAA-CREF has been selected by St. Bernards Medical Center as the investment provider for the Automatic Enrollment contributions. The Plan lets you invest the contributions in a number of different investment choices. Unless you choose a different investment option or options, the Auto Enroll contributions will be invested in the default investment option for the Plan, which is the Vanguard Wellington Fund. If the default investment option changes at any time in the future, you will be notified.
The enclosed Fact Sheet for the Vanguard Wellington Fund provide additional information, including the investment objectives and strategy, fund/account performance, risk and return characteristics, and fees and expenses. You can obtain updated information on fee expenses and a more detailed explanation of the Vanguard Wellington Fund at www.tiaa-cref.org/stbernards or by contacting TIAA-CREF at 800 842-2252.
To learn more about the Plan’s investment choices, you can review the Plan’s SPD. Also, you can contact Human Resources using the contact information at the end of this notice.
The Plan allows you to choose from a diverse set of investment options. A list of the Plan's available investment options and a copy of the prospectus or information statement for each investment option may be obtained from TIAA-CREF at 800 842-2252 or at www.tiaa-cref.org/stbernards.
You have the right to change the allocation of your investments at any time. If you elect to change the allocation of your account from the Vanguard Wellington Fund, there are no fees or expenses imposed in connection with that transfer. But certain restrictions may apply if multiple transfers are made from any one account. See the fund prospectus at www.tiaa-cref.org/stbernards for more details on restrictions on frequent transfers.
You can change how the contributions are invested among the Plan’s offered investment options, by contacting TIAA-CREF at 800 842-2252 or accessing your account online at www.tiaa-cref.org/stbernards.
You will always be fully vested in your contributions to the Plan. To be fully vested means that the contributions (together with any investment gain or loss) will always belong to you, and you will not lose them when you leave your job. For more information about years of service, you can review the Plan’s SPD, which can be obtained from Human Resources at the address listed at the end of this notice.
Even if you are vested in your Account, there are limits on when you may withdraw your funds. These limits may be important to you in deciding how much, if any, to contribute to the Plan. In general, for 403(b) or 401(k) plans you may only withdraw vested money after you leave your job, reach age 59½, or become disabled. Also, there is a 10% federal tax penalty on distributions before age 59½.
You can change the amount you contribute to the Plan. If you do not want to contribute to the Plan (and you haven’t already elected not to contribute), you will want to turn in a Salary Deferral Agreement electing zero contributions (0%) by July 1, 2021.
If you discontinue automatic contributions, St. Bernards Medical Center will treat you as having chosen to make no further contributions. However, you can always choose to continue or restart your contributions by completing and submitting a new Salary Deferral Agreement to Human Resources.
In addition to reviewing how your contributions are invested, you should also review and update your beneficiary designation(s) if it does not reflect how you would want your assets distributed upon your death. Reviewing and changing your beneficiary designation(s) in accordance with Plan rules can be made by logging into your secure account at www.tiaa-cref.org/stbernards or by contacting TIAA-CREF at 800-842-2252.
If you have any questions about the Plan’s investment choices, how the Plan works or your rights and obligations under the Plan, or if you would like a copy of the Plan’s SPD or other Plan documents, please contact Human Resources.
Opt In Link
Opt Out Link
Paper Form Link
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?
Voluntary/worksite benefits options
USAble Customer Service
Toll free: (800) 370-5856
Monday - Friday 8 a.m. - 5 p.m. (CST)
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.
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.
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.
If you have FMLA, do not use these forms. Go to the Family Medical Leave page from the Home screen for the correct forms.
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
Employee Statement - employee can submit by the form below or online
Autorization for Release of Medical Records - employee will submit form to USAble Life
Fraud Notice - employee will submit to form USAble Life
Physician Statement - employee will take the form below to the physician
Employer Statement - employee will email HR at HR@sbrmc.org once the employee statement and the physician statement have been completed. HR will then complete the employer statement for the leave.
It is the employee's responsibility to make sure all 3 statements are submitted to USAble Life.
You can also complete the USAble Forms online. The 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, this is required to submit a leave online.
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.
Basic Long Term Disability is a Company Paid Benefit
$8,000 maximum per month benefit when combined with Basic LTD
Benefits continue to age 65 or later depending upon your age at the
date of disability
Long Term Disability Paper Form
Long Term Online Form
The below list shows transactions that do not require you to submit an itemized receipt:
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:
If you are uncertain if an item is covered you can contact customer service for further asssitance at 1-877-685-0655.
FSA is a use it or lose it program.
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.
Customer Service 1-877-685-0655
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.
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.
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.
USAble is our third party plan adminstrator who provides you with all information as it relates to what your health plan will cover.
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
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.
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.
If you are on workers compensation, you do not need FMLA. Please refer to the Home page and click on Disability Insurance if you need Short Term Disability.
The Family Medical Leave Act 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.
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.
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. FMLA packets are received within 5 Days.
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, FMLASource will send you a packet within 5 Days to start the NonFMLA process.
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
Will I have to use PTO with my FMLA?
Employees will use PTO for the first 7 days of missed work. If you have Short Term Disability, you are no longer required to use PTO while out on leave unless you choose to use PTO to supplement your Short Term Disability. PTO will stop on the 8th day unless you complete the PTO Continuation Form located below. If you choose to use PTO on the 8th day, then you will only use a portion of PTO not to exceed 100% of base pay when combined with STD.
Employees that do not have Short Term Disability are still required to use PTO for their leave.
Sick bank will work the same. You must use 24 hours of PTO prior to using sick bank.
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. (ONLY USE FORMS SENT FROM FMLASOURCE)
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
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 (ONLY USE FORMS SENT FROM FMLASOURCE)
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 email@example.com. 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.
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.
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.
Call Guide Options
Reporting Intermittent Leave
Leave is Denied? Now What?
Fit for Duty Form
PTO Continuation Form
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.
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.
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.
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.
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:
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.
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.
To change your tax withholdings, complete the forms below and return to Human Resources. Changes are made on the next payroll.
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.
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.
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.
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.
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.
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.
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 firstname.lastname@example.org. Brittney will return the complete statement back to you so you can submit to USAble.
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.
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.
Medical Reimbursement Form
There are a couple of life changing events that qualify as a spouse change. By having a quality support team, it will reduce the stress that couples and families feel during this experience.
Change due to Spouse Benefits
If your spouse has a change in benefits, you may be eligible to update your insurnce plan. You have 31 days from the date of the event to report the change to your employer. Changes can be made to medical, dental, or vision coverage. The following events will allow for a change in benefits.
When the divorce decree is signed, you may elect any medical coverage you are losing under your spouse’s plan. If you currently cover your spouse, you must drop his or her coverage for medical, dental, vision, and group term life, you are able to continue to cover your children. You will need to complete the appropriate forms and provide a copy of the first and last pages of your certified divorce decree. You should also review your beneficiary designations for life insurance, retirement savings, and pension plans. Prior to the final decree, you may not drop a spouse in anticipation of the final decree.
If your spouse is no longer eligible for coverage, you should notify HR to remove him or her from the benefit plans. Any stepchildren who are no longer eligible will also need to be removed from the plans. You may also obtain information on Insurance Continuation for your spouse. Conversely, if you and/or your children were covered by your spouse's plan, you will need to enroll yourself or your child/children in the appropriate plan(s).
Use the Life Event Instructions 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.
Navigating the grieving process can be challenging, but the other changes associated with the loss of a loved one can also be difficult to comprehend and deal with. Getting your loved one's estate and finances in order, for example, can pose obstacles and certainly many questions. You'll need to review your loved one's papers as well as their benefits package.
Family Medical Leave Act
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 including loss of a loved one. To start a leave case go to FMLASource or call 877-GO2- FMLA.
Death Certificate; other documents could be required such as accident reports etc. depending on the requirements from the insurance carriers.
If you had Life Insurance on your dependent, complete the Life Insurance Claim Form below and submit to USAble Life along with a copy of the death certificate.
If you have Accident, Critical Care with Cancer or Hospital Care benefits, we have listed the claim forms below for you. If the benefit applies, complete the claim form and send to the "where to submit" at the top of each form.
For assistance in filing claims for veterans and survivor benefits, counseling or emergency financial assistance, contact: Disabled American Veterans P.O. Box 14301 Cincinnati, OH 45250-0301 (606) 441-6300 For information on military funerals, contact: Veterans of Foreign Wars VFW Memorial Building 200 Maryland Avenue, NE Washington, DC 20002 (202) 543-2239.
Congratulations on your change of position! It is now time to make benefit changes. Follow the steps below by either going online to make changes or use the paper form.
If you are adding dependents you will need to provide a copy of your certified marriage certificate along with a copy of the spouse driver's license for spouse and for children a birth certificate or court order is required. 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.
THIS PAGE DOES NOT APPLY TO REGULAR BENEFIT ELIGIBLE EMPLOYEES
Affordable Care Act
We continuously monitor and track actual hours worked to determine ACA full-time or part-time status under the ACA guidelines for health insurance eligibility for all active employees.
You are receiving this because through our tracking process it was determined you have exceeded an average of 30 hours per week. Therefore, you are eligible for health insurance coverage to start 1/1 of the new year until the end of that calendar year. Ongoing eligibility is not guaranteed and is determined by each measurement period.
Enrollment form and rates are below. Complete the form and return to HR prior to 1/1.
ACA Enrollment Form
RN Affordable Care Act