To view click on 2015 Benefits Plan Summary.

FOR YOUR
BENEFIT
2015 Benefits Guide
CONFEDERATED TRIBES OF GRAND RONDE
WELCOME!
Thank you for joining our community. To continue to grow and succeed, we
need people like you. Like any community, we must help each other through
good times and those that are challenging.
We want to provide you a comprehensive package of benefits that fits the
needs of you and your family.
Each year, we review our benefit package to make sure it keeps up with those
needs. Your wellness matters to us. We are also committed to the personal
growth and well-being of each person while creating an environment of
teamwork and mutual respect.
Be a wise health care consumer.
The benefits presented in this guide play an important part in your overall
health and happiness. We encourage you to take advantage of these programs.
Get in the habit of seeking preventive care. Learn how to manage stress.
Establish a regular exercise plan and stick with it. Learn about nutrition. The
benefit programs are here for you to use. If you have any questions at any time
about these benefits, please contact your Benefits Team.
BENEFITS MISSION STATEMENT
To provide the employees of the Confederated
Tribes of Grand Ronde with a competitive and
comprehensive benefits package that provides
choices and the best value, while sharing costs with
employees and managing costs within the business
plan; which heightens our ability to:
• Attract and retain high quality
employees,
• Enhance employee morale and
productivity, and
• Be positively perceived within the
community and employee population
as an organization concerned about
the well-being of its employees.
TABLE OF CONTENTS
Paying For Your Premiums
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2015 Employee Benefits Summary
Medical and Vision Benefits
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Who is Shasta?
How do I Contact Shasta?
How Will the Plan Work?
What is a PPO Network?
Who is First Choice Health?
How Do I Contact First Choice Health?
Dental Benefits
How Will the Plan Work?
Who is PPO USA?
How Do I Contact PPO USA?
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Pharmacy Benefits
How Does the Drug Card Program Work?
What is Step Therapy?
How Do I Refill My Prescriptions?
Eligibility
Full Time Employees
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Salaried Employees
Part Time Employees
Dependents
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Enrollment
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COBRA
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Other Benefit Plans
Your Life Insurance and AD&D Benefits
Basic Life Insurance
Accidental Death and Dismemberment Insurance
AFLAC Personal Accident Indemnity Plan
AFLAC Voluntary Cancer Insurance
Voluntary Life Insurance Program Voluntary Long Term Disability
Short Term Disability
Voluntary Flexible Spending Accounts (FSA)
Voluntary Employee Assistance Program (EAP)
401(k) Retirement Plan
Paid Time Off (PTO)
Transferring from Spirit Mountain Casino Holidays
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Important Phone Numbers
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Paying for your Premiums
The premiums are automatically deducted from your paycheck on a pre-tax basis. Pre-tax means that you do not pay
Federal, State, Social Security or Medicare taxes on the monies used to pay your premiums - leaving you with more
money in your pocket! Please refer to the chart below for the current medical rates.
Rates for 2015
$750 Deductible
Total
Premium
SMC Pays
Per Month
Your Monthly
Contribution
Your per Pay
Period Contribution
Employee
$729.17
$709.17
$20.00
$10.00
Employee + Spouse
$1,298.75
$1,041.55
$257.20
$128.60
Employee + Child(ren)
$1,216.28
$1,020.08
$196.20
$98.10
Employee + Family
$2,152.26
$1,816.00
$336.26
$168.13
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2015 Employee Benefits Summary
Plan Feature
PPO
Non-PPO
Annual Deductible -- Per Individual
$750
$1,500
Annual Deductible -- Per Family
$2,250
None
Annual Out-of-Pocket Maximum
-- Per Individual
$5,000
Includes co-pays & deductibles
None
Annual Out-of-Pocket Maximum
-- Per Family
$10,000
Includes co-pays & deductibles
None
Provider Services
Physician Office Visit
100% of PPO rate after $25 co-pay
50% of UCR; subject to deductible
Office Visit--Lab & X-Ray
(excludes MRI, Cat Scans,
Pet Scans and sleep studies)
100% of PPO rate
(See Lab Program on page 7)
50% of UCR; subject to deductible
(See Lab Program on page 7)
Chiropractic Care, Naturopathic
Care or Acupuncture Services,
Massage Therapy
100% of PPO rate after $25
co-pay, subject to $1,000 annual
maximum
100% of PPO rate after $25 co-pay,
subject to $1,000 annual maximum
Routine Exam — Adult
100% of PPO rate after $25 co-pay
50% of UCR ; subject to deductible
Well Child Care, Prostate Exam,
GYN Exam (subject to limits)
100% of PPO rate after $25 co-pay
50% of UCR subject to deductible
and maximum
Allergy Care
100% of PPO rate after $5 co-pay
50% of UCR after $5 co-pay subject to deductible
Routine Mammogram, Pap Test,
Lipid Profile, Hemoccult (subject
to limits)
100% of PPO rate
50% of UCR subject to deductible
Mental Health Office Visit
(Outpatient Services)
100% of PPO rate after $25
co-pay, subject to maximum of 29
visits per 24 months
50% of UCR, subject to deductible and maximum of 29 visits per
24 months
Substance Abuse Office Visit
(Outpatient Services)
100% of PPO rate after $25
co-pay, subject to maximum of 36
visits per 24 months
50% of UCR, subject to deductible and maximum of 36 visits per
24 months
Urgent Care Center
100% of PPO rate after $25 co-pay
50% of UCR; subject to deductible
Outpatient Physical Therapy, Occupational Therapy, Speech Therapy,
and Pulmonary Rehabilitation
80% of PPO rate, subject to deductible
and combined 30-visit annual maximum (or 60 visits following head or
spinal cord injury or stroke)
50% of UCR, subject to deductible
and combined 30-visit annual maximum (or 60 visits following head
or spinal cord injury or stroke)
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Plan Feature
PPO
Non-PPO
Inpatient and Outpatient Hospital Services
Inpatient and Outpatient Hospital
Services
80% of PPO rate, subject to deductible
50% of UCR, subject to deductible
I/P and O/P Hospital Lab & X-ray
80% of PPO rate, subject to deductible
50% of UCR, subject to deductible
Extended Skilled Nursing Facility
80% of PPO rate, subject to deductible and 60-day annual maximum
50% of UCR, subject to deductible
and 60-day annual maximum
Inpatient and Residential Mental
Health Care
80% of PPO rate, subject to deductible
50% of UCR, subject to deductible
Inpatient and Residential Substance
Abuse Care
80% of PPO rate, subject to deductible
50% of UCR, subject to deductible
Emergency Room Visit for Accident
or Illness — Facility
100% of PPO rate after $100 co-pay
(co-pay waived if admitted)
Non-Emergency Use for Illness: No
Coverage
100% of UCR; after $100 co-pay (copay waived if admitted)
Non-Emergency Use for Illness:
No Coverage
Emergency Room Visit for Accident
— Physician
100% of PPO rate
Non-Emengency Use: No Coverage
100% of UCR after$100 co-pay (co-pay
waived if admitted) Non-Emergency Use:
No Coverage
Emergency Room Visit for Illness —
Physician
100% of PPO rate
Non-Emergency Use: No Coverage
50% of UCR; subject to deductible
Non-Emergency Use: No Coverage
Other Services
Air Ambulance
80% of PPO rate, subject to deductible
80% of UCR, subject to deductible
Ground Ambulance
80% of PPO rate, subject to deductible
80% of UCR, subject to deductible
Biofeedback (for migraine headaches
or urinary incontinence)
80% of PPO rate, subject to deductible
and 10-visit lifetime maximum
50% of UCR, subject to deductible and
10-visit lifetime maximum
Cardiac Rehabilitation (Phase I and
Phase II)
80% of PPO rate, subject to deductible
50% of UCR, subject to deductible
Foot Orthotics and Prosthetics
80% of PPO rate, subject to deductible
50% of UCR, subject to deductible
Durable Medical Equipment
80% of PPO rate, subject to deductible and maximums for various types of
durable medical equipment
50% of UCR, subject to deductible and
maximums for various types of durable
medical equipment
Pediatric Dental Care — Facility
(services requiring general anesthesia)
80% of PPO rate, subject to deductible
50% of UCR, subject to deductible
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Plan Feature
PPO
Non-PPO
Prescription Medications (RX)
Prescription Drug Card – Retail
Generic $10 co-pay; Formulary Brand Name $15 co-pay; Non-Formulary Brand
Name $35 co-pay; 30-day supply.
Mandatory to use Grand Ronde Pharmacy on Maintenance drugs after 2 fills.
Step Therapy in place on targeted therapy classes; see Pharmacy Benefits for classes.
Prescription Drug – Grand Ronde
Pharmacy
Generic $10 co-pay; Formulary Brand Name $15 co-pay; Non-Formulary Brand
Name $35 co-pay; 90-day supply
Rx out of pocket maximum: $1,600 Individual; $3,200 Family
Routine Vision Services
Vision Care
100% after $10 copay for one eye exam per calendar year; Lenses (per calendar year)
up to $62 for single, $95 for bifocals, $122 for trifocals, $236 for lenticular, $122 for
progressive, or $137 for contacts; Frames (per every two calendar years) up to $75
Dental Services
Annual Dental Deductibles
$50 per individual, $150 per family
Annual Dental Maximum
$2,000 per individual
Preventative and Diagnostic Services
(Exams, Cleaning, X-Rays)
100% of PPO rate
100% of UCR
Basic and Restorative Services
(Fillings, Simple extractions)
80% of PPO rate, subject to deductible
80% of UCR, subject to deductible
Major Restorations
(Crowns, bridges, dentures)
50% of PPO rate, subject to deductible
50% of UCR, subject to deductible
Orthodontic Services
50% of PPO rate, subject to $1,500
lifetime maximum
50% of UCR, subject to $1,500
lifetime maximum
*For all Non-PPO services, providers may balance bill members any charges over the Usual, Customary and Reasonable (UCR). Any balances providers bill over UCR are member responsibility.
Should you have any questions regarding your benefits and/or claims, please contact Shasta at 1-800-441-4518.
LAB PROGRAM
It’s a voluntary program that allows you to obtain 100% coverage for outpatient laboratory testing. When your doctor
requires laboratory testing, you can avoid co-pays and/or deductibles by using a Quest facility. You may continue to have
the lab work performed at another laboratory or without using the Lab program; however, your normal benefits will apply - you will be responsible for a $10 co-pay.
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Medical and Vision Benefits
The Confederated Tribes of Grand Ronde is pleased to announce the selection of Shasta as the administrator
for our health benefits program! This change will affect where you submit claims, where you call with questions
about your benefits, and, possibly, which physicians, hospitals, and other health care providers you use. To find
out more about how your plan will work, please read on.
Who Is Shasta?
Shasta is a third-party administrator headquartered in Redmond, Oregon. Shasta processes your health care
claims, answers questions related to your benefits, and provides you with information to assist you in making informed health care decisions. A team of Shasta associates is dedicated specifically to our account. The members
of the team are knowledgeable about our benefit plan and are always willing to assist you and answer your health
care questions.
How Do I Contact Shasta?
By Phone – You may call Shasta at 1-800-441-4518 if you have any questions about claims, benefits, or predeterminations.
By Mail – If you need to submit a claim or send a letter, you can mail it to Shasta at:
P.O. Box 1747,
Redmond, Oregon 97756.
Please include the member’s ID number on all correspondence.
Online – Visit Shasta’s Web site at www.shastatpa.com
How Will the Plan Work?
The Confederated Tribes of Grand Ronde Employee Plan provides you with health care choices to help you reduce the high cost of health care. Under the Plan, you have the option of selecting a physician, hospital, or other
health care provider from a preferred provider organization (PPO) network who has agreed to offer health care
services at discounted rates. You may also use health care providers who are not a part of the PPO network.
As the claims administrator, Shasta will process your claims, answer your benefit questions, and handle
pre-certifications, which may be required for special services covered under the Plan. Your PPO network gives
you access to health care services at negotiated, discounted rates.
What Is a PPO Network?
A preferred provider organization, commonly known as a PPO, features doctors, hospitals, and other health care
providers who have agreed to charge a lower amount for their services. When you use these “in-network” providers, the Plan will reimburse medical expenses at a higher level so that you pay less for medical care. Also, coverage
is based on a percentage of a negotiated, discounted amount.
Out-of-network, or non-network, providers are not members of the PPO and do not offer special rates. You may
choose to have services rendered by an out-of-network provider. Most of these services are reimbursed at a lower
level, and are based on the usual, customary, and reasonable allowance after the deductible has been met for
services covered under the Plan. You would be responsible for amounts over the usual, customary, and reasonable allowance.
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Who Is First Choice Health?
First Choice Health (FCH) is a Seattle-based, physician and hospital owned company that has served Washington and the
Northwest since 1985. FCH’s PPO Network is recognized as the leading independent PPO Network in Washington State
and has a growing regional presence in Oregon, Idaho, Alaska and Montana. First Choice Health purchased Oregon-based
Healthcare Direct (HCD) in June 2006, and has a combined company, has more than 900,000 members.
How Do I Contact First Choice Health?
By Phone – Call toll-free 877-287-2922 if you need help finding an in-network provider near you or verifying the network
status of a provider. Representatives are available to assist you Monday through Friday.
Online – You can access the names of providers, including their addresses, areas of specialty, language abilities, and even
customized maps by visiting First Choice Health’s consumer website. Go to www.fchn.com and click on the Find a Doctor
or Hospital link on the left-hand side of the page.
Dental Benefits
How Will the Plan Work?
The Confederated Tribes of Grand Ronde Employee Plan provides you with dental care choices to help you reduce the high
cost of dental care. Under the Plan, you have the option of selecting a dental care provider from a preferred provider organization (PPO) network who has agreed to offer dental care services at discounted rates. You may also use dental care providers
who are not a part of the PPO network.
As the claims administrator, Shasta will process your claims, answer your benefit questions, and handle pre-determinations,
which may be recommended for special services covered under the Plan. Your PPO network, PPO USA, gives you access to
dental care services at negotiated, discounted rates.
Who Is PPO USA?
PPO USA is one of the largest dental networks in the country, offering access to dental services from providers that meet
their high standards. PPO USA has negotiated discounted rates with more than 27,000 dentists practicing in over 36,000
office locations nationwide. Through PPO USA, Plan members can reduce their dental care costs by using in-network providers. You can call PPO USA’s toll-free number or visit their Web site if you need help finding an in-network provider near
you, or if you need to verify a provider’s in-network status.
How Do I Contact PPO USA?
By Phone – You may call PPO USA toll-free at 1-877-277-6872 if you need help finding an in-network provider near you or
verifying the network status of a provider. Representatives are available to assist you Monday through Friday.
Online – PPO USA has a Web site at www.ppousa.com where you can search for a specific dentist in the network, find innetwork providers near you, or nominate a dentist for participation in the network.
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Pharmacy Benefits
How Does the Drug Card Program Work?
The amount you pay for each prescription depends upon whether the drug is a generic, preferred brand, or nonpreferred brand medication and whether it is purchased at an in-network pharmacy or through mail service. This
3-tier co-payment arrangement makes certain that drugs are available to you at more attractive co-payments while
allowing you access to brand name drugs at a higher co-payment. You may choose to use a non-preferred medication, but you will share more of the cost.
What is Step Therapy?
Step Therapy is in place on any new prescriptions that fall into a targeted therapy class. This will require that a
generic medication be filled before the use of a brand name medication. The following are the therapy classes
affected: Heart disease, high blood pressure, depression, arthritis/pain, cholesterol, allergy, stomach ulcer and
dermatitis/psoriasis medications.
How Do I Refill My Prescriptions?
Maintenance drugs can only be filled by the Grand Ronde Wellness Center Pharmacy after 2 fills. For all refill
prescriptions, you will need to contact your physician to have a new prescription written, or call Grand Ronde
Wellness Center at (503) 879-2342 to have your current prescription transferred.
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Eligibility
Full Time Salaried and Hourly Employees
Full time employees (Exempt and Non-Exempt) of the Confederated Tribes of Grand Ronde who are paid at least 30 hours
on a regular basis per week are eligible. Coverage begins on the first day of the month following 30 days from the date of hire
or employee status change to a full time position.
Part Time Employees
Employees who are designated as a part time employee are not eligible to participate in the employee benefits package.
Dependents
Your qualified dependents include:
• Your legal spouse
• Dependent children to age 26.
Enrollment
To enroll you must complete the required enrollment forms and return them to the Benefits Team by your deadline. After
your initial enrollment, you may only make changes to your coverage during the open enrollment period, which is held annually from early November to early December, or if you have a qualified family status change (shown below).
Qualified Family Status Changes:
• New marriage or final divorce
• The addition of a dependent child through birth or adoption
• The death of your spouse or a dependent
• The loss of dependent status due to reaching the coverage age limit of 26
• A change in your spouse’s job which results in your gain or loss of insurance coverage
• A change in your status or your spouse’s status from full time to part time employment which results in a gain or loss of insurance coverage
COBRA
If coverage for you or your dependents ends, you or they may be able to continue their coverage under a Federal law called
COBRA. COBRA is an abbreviation for the Consolidated Omnibus Budget Reconciliation Act of 1985. This act allows
former plan participants, at their on expense, to extend their current medical coverage for up to 18 months. In some cases,
former dependent coverage can be extended up to 36 months. The entire coverage premium costs (plus a 2% administrative
fee) must be paid by the enrolled COBRA participant. The COBRA option is available if any one of the below situations
occurs:
• You stop working for reasons other than gross misconduct
• You are no longer eligible for benefits because of a change in work status
• You decide to retire early
• You become legally separated or divorced
• Your dependent child marries or turns 26
• The covered employee dies
Please note that there are other circumstances where COBRA may apply. There are also many extenuating circumstances
and limitations that may affect your COBRA coverage. Please see the Benefits Team for more information.
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Other Benefit Plans
Your Life Insurance and AD&D Benefits
Life Insurance is an important part of any family’s financial plan. It protects your beneficiaries* against financial
hardship in the event of your death. In addition, Accidental Death & Dismemberment (AD&D) Insurance
protects you in the event of a disabling accident. We are proud to provide you with a life and AD&D benefit as
well as an option for additional low-cost voluntary life insurance.
Basic Life Insurance
Confederated Tribes of Grand Ronde provides all eligible employees with a life insurance benefit equal to two
times their annual salary to a maximum of $300,000. Benefits will be reduced once and employee reaches age 70,
and reduces every five years thereafter. If an employee becomes disabled as as defined in the contract before age
60, the life insurance benefit may continue. Basic Life insurance also has the accelerated benefit payment feature.
This allows terminally ill, insured employees to receive up to 50% of their policy prior to death to assist them
with financial, espouses; the maximum amount that can be received is $100,000.
This coverage is underwritten by LifeMap and pays your beneficiaries in the event of your death. All benefits end
with you retire or lose your eligibility.
Accidental Death and Dismemberment Insurance
Accidental Death and Dismemberment Insurance (AD&D) provides your beneficiaries with extra financial
protection if your death is to an accident. It also provides you with financial assistance if you accidentally lose you
sight or a limb. This benefit is equal to two times your Annual Salary to a maximum of $300,000. This AD&D
benefit is also underwritten by LifeMap.
Seat Belt Benefit
Additional benefits are provided if you die as a result of an accident and you were wearing a properly fastened seat belt.
AFLAC (Personal Accident Indemnity Plan)
AFLAC’s Accident plan providers benefits for a covered person’s death, dismemberment, or injury cause by a
covered accident. This policy does not play benefits for sickness. With AFLAC’s Accident Plan, benefits are paid
directly to the covered participant, not to the hospitals, doctors or insurance companies. Please contact your
Benefits Specialist for more details.
AFLAC (Voluntary Cancer Insurance)
Cancer treatment is expensive. Even excellent heath insurance plans will not cover all the medical costs of
cancer, much less the many indirect expenses usually incurred with a serious cancer illness. AFLAC’s Cancer
Policy provides benefits to assist you in meeting the high cost of cancer treatment. With AFLAC’s Cancer Policy,
benefits are paid directly to the covered participant, not the hospitals, doctors or insurance companies. Please
contact your Benefits Specialist for details.
* Beneficiary/Beneficiaries - The person or persons who receive the financial benefit in the event of the insured’s death,
disability or injury.
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Voluntary Life Insurance Program
Additional life insurance can make the difference between a comfortable life and a struggle for those left behind. You and
your family may need life insurance protection over and above the basic policy that the company provides. With VIP Plus,
underwritten by LifeMap, you and/or your spouse may be eligible for coverage. Each can select insurance amount increments
of $10,000, up to a maximum of $300,000. The premiums are based on age and are conveniently deducted from your
paycheck. Please contact your Benefits Specialist for more information.
Short Term Disability (STD)
Short-term disability insurance covers an employee when they must be away from work for more than 14 days due to illness
or injury. The Tribe provided this coverage at no cost to the employee. Benefits are cal to 60% of their basic weekly earnings
up to a maximum of $1,500 per week. Benefits are payable for up to 11 weeks.
Long Term Disability
Long term disability coverage begins when an employee is unable to return to work after 90 days of continues illness or
disability. This benefit is also at no cost tot he employee. Benefits are equal to 60% of their basic monthly earnings up to a
maximum of $7,000 per month. Benefits are payable as long as they remain disabled up to age 65.
Benefits are payable for the first 24 consecutive months if they are unable to perform the duties of their regular occupation.
After 24 consecutive monist, benefits are payable if they are unable to perform the duties of any other suitable occupation
based on their education, training and experience.
Flexible Spending Accounts (FSA)
Employees may elect to participate in a Flexible Spending Account (FSA) which is pre-tax money that you set aside each
pay period to cover qualifying individual and family expenses that occur during the plan year. The company provides two
different types of Flexible Spending Accounts for your benefit. The Health FSA is used to pay out of pocket medical, dental
and vision expenses, including, co-payments, co-insurance, deductibles and other qualified medical expenses which are not
typically covered by your group health plan. The Dependant Care FSA allows you to set aside a portion of your income to
pay for work related dependant care costs. The money deducted from your paycheck is pre-tax, which reduces your total
Federal, State and Social Security and Medicare tax liability. Please contact your Benefits Team for more information.
Employee Assistance Program (EAP)
The Employee Assistance Program (EAP) is available to all full and part time employees and their family members. This
completely confidential service can help you with personal issues such as alcohol and drug abuse, relationships, parenting
concerns, depression, financial worries or other problems.
You and your family members can receive up to seven (4) confidential counseling sessions per year at no cost to you. Your
counselor can refer you for additional counseling if necessary. Your medical plan may cover a portion of the additional
counseling costs. Please contact your Benefits Specialist for more information.
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401(k) Retirement Plan
For most of us, retirement seems as though it is a long way off. But it is never too early or too late to start saving for your
retirement. People are living longer which means you could spend up to one-third of your life retired. Your retirement
income may need to last 20 years or more!
The 401(k) Plan is a great way for you to save for your retirement and manage your tax burden. Here are a few reasons why
you may choose to participate:
• It’s easy! Contributions are automatically deducted from your paycheck and deposited into the investment
options of your choice.
• You can elect to contribute to the plan on a pre-tax basis or an after-tax basis (Roth); or both.
• Pre-tax contributions reduce your current taxable income and lower your current taxes; earnings on these
contributions grow tax-free; when you retire and/or receive the money in your account, you pay taxes on
those funds.
• After-tax Roth contributions are taxed currently; the account and all earnings on these contributions can
be distributed tax-free when you retire.
• You control how your account is invested choosing from a wide range of investment options.
• The plan is a Safe Harbor 401(k) Plan with matching contribution features.
• 401(k) loans are available.
• Retirement plan accounts from prior employers may be rolled into this plan.
Your Contributions
You will be eligible to participate in the plan when you are 18 years old and have completed 1 Year of Service, meaning
that you worked 1,000 hours in the 12-month period starting with your date of hire. Once you have met the eligibility
requirements you may join the plan at the beginning of the next month. You can contribute up to $18,000 of your pay
into the plan in 2015. If you are 50 or older by December 31, 2015, you can contribute an additional $5,500 to the plan.
The combined total of your pre-tax and after-tax Roth contributions are limited to these amounts.
Employer Matching Contributions
• Safe Harbor Matching Contribution: If you contribute to the 401(k) Plan, you will receive a Safe Harbor
Matching Contribution equal to 100% of your contributions, but not more than 4% of your eligible pay.
You are 100% vested in this matching contribution.
• Matching Contribution: If you contribute between 4-6% of your pay to the 401(k) Plan, you will receive an
additional Matching Contribution equal to 100% of those contributions (limited to 2% of your eligible pay).
You are not 100% vested in this additional matching contribution until you have completed 3 years of service.
For more details and a thorough explanation of the features of this plan, please refer to the Confederated Tribes of
Grand Ronde Retirement Plan Summary Plan Description. Should you terminate your employment, you will need to
contact your tax advisor and learn about the possible tax consequences of your individual decision. See your Benefits
Team for more information.
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Paid Time Off (PTO)
CTGR recognizes that employees have varied needs for time off from work. It also recognizes that employees designer
personal choice in how they structure their benefits whenever it is possible for the Tribe to provoke that flexibility. This
program is designed to meet those needs and to encourage self-management of employees by providing for personal choices
in planning and scheduling their pain time off from work and how they use their accrued hours. PTO Balances may be
carried over from one calendar year to the next; not to exceed a maximum PTO accrual of 480 hours.
Full-time
Length of Service
PTO days per year
Hours per year
Bi-weekly Accrual
0 up to 2 years
20
160
6.154 hours
2 up to 5 years
25
200
7.692 hours
5 up to 10 years
30
240
9.231 hours
10 plus years
35
280
10.769 hours
Employees transferring from Spirit Mountain Casino
Employes who transfer from Spirit Mountain Gaming, Inc. or other Tribally owned entities to the Tribal Government
without a break in service may have there prior years of service credited when calculating their rate of Paid Time Off (PTO)
accrual and Retirement 401(k). However, PTO account balances to not transfer from one entity to the other.
Holidays
The Tribe Recognizes the following twelve (12) Holidays
New Year’s Day
Martin Luther King Day
Presidents’/Chief’s Day
Memorial Day
Independence Day
Labor Day
National Indian Day
Veteran’s Day
Restoration Day
Thanksgiving Day
Friday After Thanksgiving
Christmas
January 1
3rd Monday in January
3rd Monday in February
Last Monday in May
July 4
1st Monday in September
4th Friday in September
November 11
November 22
4th Thursday in November
4th Friday in November
December 25
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Important Phone Numbers
For General Information
or Questions
Contact:
Telephone/Website/E-mail:
The Confederated Tribes of Grand Ronde
Benefits Team
9615 Grand Ronde Rd
Grand Ronde, OR 97347
Cindy Mitchell:
(503) 879-2038
[email protected]
Tammy Gould:
(503) 879-2031
[email protected]
Peggy Carpenter:
(503) 879-2221
[email protected]
Medical/Vision/
Dental/Prescription
Shasta
P.O. Box 1747,
Redmond, OR 97756
1-800-441-4518
www.shastatpa.com
Mail Order
Prescription Program
Grand Ronde Health and
Wellness Pharmacy
(503)879-2342
FAX: (503)879-2030
Life/Accident/Critical
Care/Disability Insurance
LifeMap Assurance Company
PO Box 1271 (MS E3A)
Portland, OR 97207
(800) 794-5390
401(k) Retirement Plan
Milliman
(877) 887-2169
www.yourbenefitsite.com
Employee Assistance
Program
Reliant Behavioral Health
(866) 750-1327
24-Hour Nurse hotline
My Nurse Hotline
(800) 970-7138
Note: The information presented in this guide is only a summary of the major features of the plan. It is not intended
to be a complete explanation of your benefits. The plan documents and insurance certificates contain all benefit
information including limits and exclusions. You must refer to them for final determination on coverage. Benefit
programs at The Confederated Tribes of Grand Ronde are not guaranteed and are subject to change at any time
without prior notice. Whenever you see the term “employer” used in this guide, it refers to The Confederated Tribes
of Grand Ronde
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