We all have different needs that influence the choices we make every day. Devereux embraces these differences, providing you with the freedom to select quality benefit options that work best for your personal situation. You now have the opportunity to choose a medical plan and/or a dental plan. Medical plans include prescription drug and vision coverage. For this interim Open Enrollment (OE) your benefits will be effective 7/1/2026. You will be able to select new coverage that will be effective 1/1/2027 during our regularly scheduled OE in October.
INSIDE THIS GUIDE
Eligibility & Enrollment
Medical Plans At-a-Glance
Prescription Benefits
NEW! Enhanced Copay Card
Surgical Benefit
Telemedicine
Vision Benefits
Dental Benefits
NEW! Dental Benefit Enhancement
Additional Dental Benefit Resources
Per-Pay Contributions
403(b) Retirement Plan
ScholarShare 529 College Savings Plan
Free-to-you Financial Assistance
ASCEND Career Accelerator Program
Wellbeing Resources
NEW! Surgery Recovery Program
Benefits MAC & Key Definitions
BenePortal
Value-Added Services
Carrier Contacts
Legal Notices
ELIGIBILITY & ENROLLMENT
WHO IS ELIGIBLE?
If you’re a full-time employee at Devereux (scheduled to work 30+ hours per week), you are eligible to enroll in benefits*.
* To be eligible for full-time employer-paid benefits (Basic Life, Long-Term Disability, Health Management Leave, and Time Off), you must work 37.5+ hours/week.
In addition, the following family members are eligible for coverage:
Your legally married spouse/domestic partner
Your dependent child(ren) up to age 26 QUESTIONS?
Reach out to People Operations at your Center or CSB’s Member Advocacy Center.
HOW TO ENROLL
For this interim open enrollment, benefit elections will be made by clicking the Enrollment Form on SharePoint.
QUALIFYING LIFE EVENTS (QLE)
Unless you experience a Qualifying Life Event, you cannot make changes to your benefits until the next Open Enrollment period. QLE’s include:
Marriage (30 days)
Divorce, legal separation, or ending a domestic partnership (60 days)
Birth or adoption of a child (60 days)
Change in child’s dependent status (30 days)
Death of a spouse, child or other qualified dependent (60 days)
Change in employment status or a change in coverage under another employer-sponsored plan (30 days)
NOTE: You must notify People Operations when experiencing a Qualifying Live Event within the number of days specified above.
Independence Blue Cross MEDICAL PLANS AT-A-GLANCE
The following medical plan options are administered by Independence Blue Cross (IBX). Full-time employees (working 30+ hours per week) may enroll in the
Independence Blue Cross PRESCRIPTION BENEFITS
If you enroll in one of the Independence Blue Cross medical plans you are automatically enrolled in corresponding prescription coverage, outlined below.
IBXPRESCRIPTIONPLANFORTIEREDMEDICALPLANS(PPO)
INCLUDED WITH TIERED MEDICAL PLAN ELECTION
Prescription drug accumulates to a separate out-of-pocket maximum:
IBXPRESCRIPTIONPLANFORTHEHIGHDEDUCTIBLEHEALTHPLAN
MANDATORY MAIL ORDER OR CVS
PHARMACY 90-DAY FILLS (FOR TIERED MEDICAL PLANS ONLY)
All covered medications will be provided through our convenient mail order service, which allows you to order up to a 90-day supply (if enrolled in a tiered medical PPO plan).
Independence Blue Cross
NEW! ENHANCED COPAY CARD
The Copay Assistance Program may substantially reduce or even fully cover your costs for certain high-cost specialty medications.
HOW DOES THE COPAY ASSISTANCE PROGRAM WORK?
Many drug manufacturers offer coupons or copay cards for specialty medications. Through the Copay Assistance Program, you can take full advantage of these savings on eligible prescriptions. The program is supported by a team of Care Team Coordinators pharmacy professionals who are highly trained in specialty pharmacy coupons and copay cards.
Once you enroll, manufacturer copay assistance will be automatically applied at checkout to lower your out-of-pocket costs, sometimes to as little as $0. Eligible prescriptions may be processed with a 30% coinsurance, but the manufacturer’s cost-share assistance will be applied to further reduce what you owe. You will never pay more than your normal cost-share.
ENROLLMENT AND SUPPORT
If you take an eligible prescription, a Care Team Coordinator will contact you to:
Explain how the Copay Assistance Program works
Estimate your new out-of-pocket costs for filling your prescription
Help you enroll in the drug manufacturer’s copay assistance program
Coordinate with your pharmacy to ensure they have the updated costs on file
Answer any questions you have about the program
Care Team Coordinators provide ongoing support and monitor your out-of-pocket costs to make sure you get the maximum assistance available. You are not required to enroll for copay assistance, but you must enroll to receive the savings. If you choose not to enroll when contacted by a Care Team Coordinator, you will be responsible for your normal cost-share.
IMPORTANT NOTE
Only the cost-sharing you pay out-of-pocket will count toward your deductible and/or out-of-pocket maximum. The portion paid by the Copay Assistance Program will not count toward either one.
QUESTIONS?
If you are eligible for the Copay Assistance Program, a Care Team Coordinator will call to help you enroll. You can also reach them directly at 215-967-2501
Accarent Health & Blue Distinction Programs
SAVE ON YOUR SURGIAL PROCEDURE!
ACCARENT HEALTH
If you participate in one of Devereux’s medical plans, you can choose to have $0 out-of-pocket for surgical procedures at top-rated hospitals by using Accarent.
With Accarent, you have access to a network of select academic medical centers and top-rated hospitals established in conjunction with Johns Hopkins Hospital.
All initial treatment and any complication or concurrent related illness, outpatient follow-up during the post-surgical period, personalized nurse case management, and concierge and travel assistance are covered under the program.
NEED TO TRAVEL FOR SURGERY?
Devereux will reimburse you and a caregiver for your travel expenses, including a hotel stay, for the day prior to surgery and aftercare based on the Accarent post-operative schedule.
GETTING STARTED WITH ACCARENT
Contact Accarent at 866.771.0697 for immediate assistance or visit www.accarenthealth.com to see the schedule of services and how it works!
Teladoc TELEMEDICINE
TELADOC TELEMEDICINE
Teladoc is a national network of U.S. board-certified doctors available 24/7/365 to diagnose, treat and prescribe medication when necessary for many common medical issues. Teladoc uses digital devices such as computers, smartphones, and video conferencing.
Using telemedicine is a convenient option when it’s not possible to visit your doctor’s office for nonemergency medical conditions such as:
Allergies
Asthma
Acne
Pink eye
Ear infections
Sinus issues
Respiratory infections
Urinary tract infections
Cold and flu symptoms
Behavioral health
TELADOC DERMATOLOGY
Teladoc Dermatology gives you access to boardcertified dermatologists anywhere you are. Whether you have a question about a recent skin change or need help managing a chronic skin condition like acne, rosacea, or psoriasis, Teladoc Dermatology can help.
TELADOC TELEPSYCHIATRY
Members have access to high-quality virtual care for a wide variety of behavioral issues, without the obstacles of conventional in-office options. Members can speak with board-certified psychiatrists, psychologists and therapists from wherever they feel most comfortable.
GETTING STARTED
Why wait for the care you need? Contact Teladoc and feel better now!
Download the Teladoc App from the App Store or Google Play
Visit www.teladochealth.com
Call 1.800.835.2362
COST FOR A TELADOC VISIT
Teladoc will have a $0 copay for the Tiered Medical PPO and HDHP.
Independence Blue Cross VISION BENEFITS
You must be enrolled in one of the medical plans to receive this benefit.
PLEASENOTE:Annual eye exam must be at least one calendar year after your last visit.
IBX VISION PLAN
Davis Vision Collection Fashion or Designer Frames
Davis Vision Collection Premier Frames
Non-Davis Vision Collection Frames
Visionworks Frames Option
LENSES Single
Bifocal
CONTACT LENSES & EVALUATION (in lieu of eyeglasses)
Davis Vision Collection – Standard, Specialty, or Disposable Contact Lenses Evaluation at a Davis Vision Participating Provider
Non-Davis Vision Collection Contact Lenses
Non-Davis Vision Evaluation
* Participating Davis provider
ADDITIONAL VISION DISCOUNTS
The following discounts are also available to you under the IBX vision plan.
Additional Eyewear Discount: Members selecting noncovered materials (i.e., second pair of eyeglasses, sunglasses, etc.) will receive up to a 20% courtesy discount and up to a 10% discount on disposable contacts at most participating providers
Replacement Contact Lenses: Through Lens 123, a free mail order program, member may receive replacement contact lenses offered at guaranteed, discounted prices.
Discount on Laser Vision Correction Services at Davis Vision Participating Providers: Up to 25% off the participating provider’s usual and customary fees or 5% off any participating provider’s advertised specials, whichever is less.
Cigna DENTAL BENEFITS
Benefit-eligible employees may enroll in one of the three Cigna dental plans below a choice of two DPPOs or the DHMO –which include 100% coverage for preventive services such as routine dental exams, cleanings and X-rays.
PREVENTIVE & DIAGNOSTIC SERVICES
Exams, Cleanings, Bitewing X-rays (each twice in a calendar year)
Fluoride Treatment (once in a calendar year, children to age 19)
Crowns, Gold Restorations, Bridgework, Full and Partial Dentures
19)
(ADULTS)
The DPPO plans offer the convenience and flexibility of visiting any licensed dentist, anywhere. Covered services are paid based on a percentage if, for example, fillings are covered at 80%, you pay the remaining 20%. Under the DHMO plan, members have their choice of skilled primary care dentists from the Cigna network. Select a primary care dentist who will then coordinate any needed referrals to a specialist. There are no maximums or deductibles.
To search for participating dental providers near you, visit www.mycigna.com and enter your address, city, or ZIP code. Dental ID cards are also available at www.mycigna.com.
Special Health Needs Program
NEW! DENTAL BENEFIT ENHANCEMENT
The SHCN Dental Program supports employees and dependents with physical, developmental, mental, sensory, behavioral, cognitive, or emotional conditions requiring specialized dental care. The program improves access, outcomes, and satisfaction through tailored benefits.
ELIGIBILITY
Employees and dependents with special healthcare needs, as defined by the American Academy of Pediatric Dentistry (AAPD), may enroll.
HOW TO ENROLL
Request and complete a Special Healthcare Needs
Enrollment Form from HR or Cigna Healthcare Dental. Once enrolled, you’ll receive a welcome letter and can begin using enhanced benefits.
REIMBURSEDPROCEDURES
Registered participants are eligible for reimbursement for:
One additional cleaning per benefit year (D1110, D1120, D4346, D4910)
One additional exam per benefit year (D0120, D0145, D0150, D0180)
One additional fluoride treatment per benefit year, any age (D1206, D1208)
General anesthesia or IV sedation with a covered service (D9222, D9223, D9239, D9243)
Dental case management up to four times per year (D9997)
Usual deductibles, copayments, or coinsurance apply. Reimbursements are mailed directly after claims are processed for in-network visits.
Virtual Care & SmartScan
ADDITIONAL DENTAL BENEFIT RESOURCES
CIGNA HEALTHCARE DENTAL VIRTUAL CARE
Cigna Healthcare Dental Virtual Care provides access to licensed dental professionals from home, 24 hours a day, seven days a week, all year round. If you have an urgent dental issue such as a toothache, chipped tooth, or oral infection and cannot reach your regular provider, you can consult with a dentist through a secure video call by logging into your myCigna.com account.
HOW IT WORKS
During your virtual visit, the dentist will assess your condition, offer guidance, prescribe medication if needed, and refer you to a local Cigna Healthcare dentist for inperson care when appropriate. Records from your virtual consultation are shared with your local provider to ensure continuity of care.
COST AND COVERAGE
Virtual consults are processed as in-network claims under your dental plan, with no copay or coinsurance required. These visits count toward your plan’s frequency limits and annual maximums.
ELIGIBILITY
All enrolled employees and dependents may use this service. Dependents under age 18 must be accompanied by a parent or guardian during the consultation.
CONTACT INFORMATION
For more information or assistance, please visit myCigna. com or call 1-800-Cigna24. You can also call the number on the back of your ID card.
NEW! SMARTSCAN AT-HOME DENTAL SCREENING
SmartScan is an easy, at-home oral health screening tool available to Cigna Healthcare members. Using your smartphone, you can take guided photos of your teeth and gums and receive a professional assessment from a Cigna Healthcare dentist within minutes. This service is designed for those who may avoid dental visits due to cost, inconvenience, or anxiety.
WHAT SMARTSCAN IS NOT
SmartScan does not replace a full dental exam or x-rays performed in a dental office, which remain essential for comprehensive oral health care.
BENEFITS
SmartScan screenings are provided at no additional cost and take about five minutes to complete. After your photos are submitted, they are analyzed using artificial intelligence and reviewed by network dentists. You will receive a report indicating your oral health status green, yellow, or red along with tips for improvement. If your results indicate a concern, you can schedule a virtual dental appointment or be referred to an in-network provider.
HOWTOGETSTARTED
To use SmartScan, log in or register on myCigna.com, select “Talk to a Doctor,” choose “Dental” virtual care, and then select “Connect” to access SmartScan.
CONTACT INFORMATION
For more information, visit myCigna.com.
2026 Medical & Dental
CONTRIBUTIONS
AllOne Health & Devereux
WELLBEING RESOURCES
ALLONE HEALTH EMPLOYEE ASSISTANCE PROGRAM (EAP)
AllOne Health can help with managing family and personal concerns including childcare, parenting, elder care, money management, education planning, time management, legal resources, relocation and more.
Help is confidential and available 24/7/365 by calling 800-451-1834, visiting allonehealth.com/portal or downloading the AllOne Health EAP app.
Five free, per topic, in-person or virtual counseling services. These can assist you and family members living in your household with emotional concerns such as grief, stress, relationship difficulties, depression, anxiety, substance abuse or other behavioral health challenges.
Discounted shopping and other helpful resources
When accessing services, use code ADC53
RESILIENCY
Learn how to grow, thrive and flourish by taking care of yourself first, so you can take care of others. Fill your pitcher and build your bounce with videos, webinars, mindfulness activities and other resources hosted by Devereux’s DCRC team. Visit devereux.sharepoint.com/pages/devereuxstrong.aspx to enhance your well-being and become DevereuxStrong
Lilly Direct & Utopia WellCare WELLBEING RESOURCES
LILLYDIRECT – OBESITY CARE
LillyDirect offers independent obesity care options with access to FDA-approved obesity medications, if clinically appropriate. Find local in-person obesity care using Lilly’s independent physician search tool.
For those looking for more focused support, a telehealth program through Form Health is available and covered by most insurance plans*. Form provides personalized weight loss guidance based on nutrition, physical activity, and mindset by providers who specialize in obesity medicine. Prescription savings programs are also available to help those who qualify obtain the Lilly medications, like Zepbound, at a lower cost.
Visit lillydirect.com/obesity for more information.
*Member is responsible for any copay or deductible, similar to an office visit.
UTOPIA WELLCARE
What Utopia WellCare is all about – Utopia WellCare’s goal is to help you develop a better overall relationship with your health via comprehensive Functional Nutrition services provided by Board Certified Registered Dietitians.
How it works – Utopia WellCare provides one on one virtual consultations with dietitians at no cost to you. Consultations are covered under preventive care through your insurance carrier and offers 6 FREE visits. Capturing your complete patient history and health status to leverage diet and nutrition counseling to assist with your overall health and wellbeing.
Not only can you take advantage of Utopia WellCare but your dependents can also schedule a visit with one of their Board Certified Registered Dietitians.
Treated Conditions:
Mood Regulation
Stress and Anxiety
Body Composition
Cardiovascular Issues
Endocrine Imbalance
Kidney Imbalances & Cancer
Autoimmunity
Allergies and Environmental exposures
Gastro-Intestinal Disorders
And More!
Goldfinch Health
NEW! SURGERY RECOVERY PROGRAM
GOLDFINCH HEALTH
Goldfinch Health is a service designed to support you through every step of your surgery experience. If you or a family member need surgery, Goldfinch Health provides access to nurse navigators who offer personalized guidance before, during, and after your procedure. Their team helps you understand your options, connects you with high-quality surgical facilities, and shares recovery strategies proven to reduce pain, speed healing, and minimize the need for opioids.
With Goldfinch Health, you can feel confident that you have expert support to help you recover safely and return to your daily life as quickly as possible. For more information, visit www.goldfinchhealth.com
Benefits MAC MEMBER ADVOCACY
NEED HELP RESOLVING A BENEFITS ISSUE?
The Benefits Member Advocacy Center (MAC), provided by Conner Strong & Buckelew, allows you to speak to a specially trained Member Advocate who can help you get the most out of your benefits.
You can contact the Benefits MAC for assistance if you:
Believe your claim was not paid properly
Need clarification on information from the insurance company
Have a question regarding a medical bill
Are unclear on how your benefits work
Need information about adding or removing a dependent
Need help resolving a benefits problem
You can contact the Benefits MAC via:
Phone: 800-563-9929*
Web: www.connerstrong.com/memberadvocacy
E-mail: cssteam@connerstrong.com
* Member Advocates are available Monday through Friday, 8:30 am to 5:00 pm (Eastern Time). After hours, you will be able to leave a message with a live representative and receive a response by phone or email during business hours within 24 to 48 hours of your inquiry.
Brush up on your benefits knowledge with these key healthcare definitions!
Copay/Copayment
A fixed dollar amount that you usually pay when you receive services (e.g., office visits, prescriptions, emergency room usage, hospital admissions).
Coinsurance
The percentage of eligible medical or prescription expenses after the deductible amount that you pay.
Deductible
A flat amount you must pay before the plan begins to pay for covered services you use. Review your plan details; you may not have to meet your deductible for specific services before the plan will pay.
Out-of-Pocket Limit (OOP)
The most you could pay during the calendar year for your share of covered services. You have a different OOP for your medical and prescription expenses for Tiered Medical Plans. Your share includes your copays, coinsurance and deductibles. At times, you may see OOP referred to as out-of-pocket maximum, or abbreviated as OOM.
Health Savings Account (HSA)
An account that holds tax-free income in reserve for health-related expenses. HSAs can be funded only when you are enrolled in the High Deductible Health Plan. Contributions are withheld from income before taxes and are not subject to taxes when used for qualifying medical expenses.
Flexible Spending Account (FSA)
A healthcare or dependent care FSA allows you to save tax-free for health or dependent care expenses. This account must be elected each year.
BenePortal ONLINE BENEFITS RESOURCE
YOUR BENEFITS INFORMATION ALL IN ONE PLACE!
At Devereux, employees have access to a full range of valuable employee benefit programs. With BenePortal, you and your dependents can review your current employee benefit plan options online, 24/7!
Use BenePortal to access benefit plan documents, insurance carrier contacts, forms, guides, links and other applicable benefit materials. BenePortal is mobile-optimized, making it easy to view your benefits on-the-go. Simply bookmark the site in your phone’s browser or save it to your home screen for quick access.
BenePortal features include:
Oracle Self-Service Information
Plan summaries
Wellness resources
Carrier contacts
Downloadable forms
And more!
Simply go to www.mydevereuxbenefits.org to access your benefits information today!
Conner Strong & Buckelew
VALUE-ADDED SERVICES
BENEFITPERKS
With CSB Benefit Perks, members gain access to premium discounts on valuable services and items. CSB Benefit Perks is a discount and rewards program provided by Conner Strong & Buckelew (CSB) that is available to all employees at no additional cost.
The program allows employees to receive discounts and cash back for hand-selected shopping online at major retailers. Use the Benefit Perks website to browse through categories such as:
Automotive
Beauty
Computer & Electronics
Gifts & Flowers
Health & Wellness
And much more!
Employees can also print coupons to present at local retailers and merchants for in-person savings, including movie theatres and other services.
Start saving today by registering online at connerstrong.corestream.com
HEALTHYLEARN
This resource covers over a thousand health and wellness topics in a simple, straight-forward manner. The HealthyLearn On-Demand Library features all the health information you need to be well and stay well.
Learn more at: www.healthylearn.com/connerstrong
HUSK WELLNESS DISCOUNT PROGRAM
Achieving optimal health and wellness doesn’t have to be complicated or expensive. Access exclusive best-in-class pricing with some of the biggest brands in fitness, nutrition, and wellness with HUSK Marketplace (formerly GlobalFit).
Not a traditional gym goer?
Take advantage of all the benefits of group exercise classes in the comfort of your own home. HUSK’s streaming membership options will take your wellness and workouts to the next level.
Home Equipment and Tech
Whatever your fitness level is, HUSK has exclusive equipment and wearable technology to help support you on your wellness journey. Whether you want to monitor an everyday activity or start a new fitness routine, find the best products and deals here.
Learn more by visiting marketplace.huskwellness.com/connerstrong
GOODRX
Use Good Rx to compare drug prices at local and mailorder pharmacies and discover free coupons and savings tips. Find huge savings on drugs not covered by your insurance plan – you may even find savings versus your typical co-payment!
Start saving on your prescriptions today at connerstrong.goodrx.com.
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Legal Notices & Disclosures
AVAILABILITY OF SUMMARY HEALTH INFORMATION
As an employee, the health benefits available to you represent a significant component of your compensation package. They also provide important protection for you and your family in the case of illness or injury.
Your plan offers a series of health coverage options. Choosing a health coverage option is an important decision. To help you make an informed choice, your plan makes available a Summary of Benefits and Coverage (SBC), which summarizes important information about any health coverage option in a standard format, to help you compare across options.
Contact People Operations for a copy of your SBC.
OPEN
ENROLLMENT MATERIALS
AS AN SMM This open enrollment communication addresses information on changes coming for the new year, and as such this communication constitutes a “Summary of Material Modification” or SMM to the Summary Plan Description (SPD) for the Plan, thereby modifying the information previously presented in the SPD with respect to the Plan. Please keep a copy of this SMM with the SPD previously provided to you.
NEWBORNS’ AND MOTHERS’ HEALTH PROTECTION ACT NOTICE
Group health plans and health insurance issuers generally may not, under federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable).
In any case, plans and issuers may not, under federal law, require that a provider obtain authorization from the plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).
WOMEN’S HEALTH AND CANCER RIGHTS ACT NOTICE If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage willbe provided in a manner determined in consultation with the attending physician and the patient, for:
allstages of reconstruction of the breast on which the mastectomy was performed;
surgeryandreconstructionof theother breast toproducea symmetricalappearance;
prostheses;and
treatment of physical complications of the mastectomy, including lymphedema.
These benefits willbe provided subject to the same deductibles and coinsurance applicable to other medicaland surgicalbenefits
providedunderthisplan. If youwould like more informationon WHCRAbenefits, contact PeopleOperations.
SPECIAL ENROLLMENT NOTICE
Loss of other coverage (excluding Medicaid or a State Children’s Health Insurance Program). If you decline enrollment for yourself or for an eligible dependent (including your spouse) while other health insurance or group health plan coverage (including COBRA coverage) is in effect, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the Company stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 30 days or any longer period that applies under the plan after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage). If you request a change within the applicable timeframe, coverage will be effective the first of the month following your request for enrollment. When the loss of other coverage is COBRA coverage, then the entire COBRA period must be exhausted in order for the individual to have another special enrollment right under the Plan. Generally, exhaustion means that COBRA coverage ends for a reason other than the failure to pay COBRA premiums or for cause (that is, submission of a fraudulent claim). This means that the entire 18-, 29-, or 36-month COBRA period usually must be completed in order to trigger a special enrollment for loss of other coverage.
Loss of eligibility for Medicaid or a State Children’s Health Insurance Program. If you decline enrollment for yourself or for an eligible dependent (including your spouse) while Medicaid coverage or coverage under a state children’s health insurance program (CHIP) is in effect, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage. However, you must request enrollment within 60 days after your or your dependents’ coverage ends under Medicaid or CHIP. If you request a change within the applicable timeframe, coverage will be effective the first of the month following your request for enrollment.
New dependent by marriage, birth, adoption, or placement for adoption. If you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your new dependents. However, you must request enrollment within 30 days or any longer period that applies under the plan after the marriage, birth, adoption, or placement for adoption. If you request a change within the applicable timeframe, coverage will be effective the date of birth, adoption or placement for adoption. For a new dependent as a result of marriage, coverage will be effective the first of the month following your request for enrollment.
Eligibility for Medicaid or a State Children’s Health Insurance Program. If you or your dependents (including your spouse) become eligible for a state premium assistance subsidy from Medicaid or through a state children’s health insurance program (CHIP) with respect to coverage under this plan, you may be able to enroll yourself and your dependents in this plan. However, you must
request enrollment within 60 days after your or your dependents’ determination of eligibility for such assistance. If you request a change within the applicable timeframe, coverage will be effective the first of the month following your request for enrollment.
To request special enrollment or obtain more information, contact People Operations.
PREMIUM ASSISTANCE UNDER MEDICAID
AND THE CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP) If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependentsmight be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).
If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of March 17, 2026. Contact your State for more information on eligibility –
To see if any other states have added a premium assistance program since March 17, 2026, or for more information on specialenrollment rights, contact either:
U.S. Department of Labor
Employee Benefits Security Administration
www.dol.gov/agencies/ebsa 1-866-444-EBSA (3272)
U.S. Department of Health and Human Services
Centers for Medicare & Medicaid Services www.cms.hhs.gov
1-877-267-2323, Menu Option 4, Ext. 61565
Legal Notices & Disclosures
PART A: GENERAL INFORMATION
When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace and employment based health coverage offered by your employer.
What is the Health Insurance Marketplace?
The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers “one-stop shopping” to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace begins in October 2013 for coverage starting as early as January 1, 2014.
Can I Save Money on my Health Insurance Premiums in the Marketplace? You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn’t meet certain standards. The savings on your premium that you’re eligible for depends on your household income.
Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?
Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer’s health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage your employer provides does not meet the “minimum value” standard set by the Affordable Care Act, you may be eligible for a tax credit.1
3. Employer Name The Devereux Foundation
5. Employer Address 444 Devereux Drive
7.City Villanova
10. Who can we contact about Teammate health coverage at this job? People Operations
Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution -as well as your employee contribution to employer-offered coverage- is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis.
How Can I Get More Information?
For more information about your coverage offered by your employer, please check your summary plan description or contact the insurance carrier’s customer service number located on your ID card. The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area. To get information about the Marketplace coverage, you can call the government’s 24/7 Help-Line at 1-800-318-2596 or go to https://www. healthcare.gov/marketplace/individual/.
PART B: INFORMATION ABOUT HEALTH COVERAGE OFFERED BY YOUR EMPLOYER
This section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application.
1 An employer-sponsored health plan meets the “minimum value standard” if the plan’s share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs.
4. Employer Identification Number 23-1390618
6. Employer phone number 610-520-3000
8. State PA
11. Phone number (if different from above)
9. Zip Code 19085
12. Email address adelcarl@devereux.org
This benefit guide provides selected highlights of the employee benefits program at Devereux. It is not a legal document and shall not be construed as a guarantee of benefits nor of continued employment at Devereux. All benefit plans are governed by master policies, contracts and plan documents. Any discrepancies between any information provided through this summary and the actual terms of such policies, contracts and plan documents shall be governed by the terms of such policies, contracts and plan documents. Devereux reserves the right to amend, suspend or terminate any benefit plan, in whole or in part, at any time. The authority to make such changes rests with the Plan Administrator.
