benefits TABLE OF CONTENTS benefits program

Transcription

1 beefits TABLE OF CONTENTS beefits program Brookhave Sciece Associates, LLC (BSA) believes that employee beefits are a importat ad meaigful part of the compesatio received by every employee. BSA has provided its employees with a broad beefits program, which icludes the followig: MEDICAL PLAN DENTAL PLAN LIFE INSURANCE PLAN LONG TERM DISABILITY PLAN TRAVEL ACCIDENT INSURANCE PLAN RETIREMENT PLAN 401(K) PLAN FLEXIBLE SPENDING ACCOUNTS PLAN TUITION REFUND PROGRAM SEVERANCE PAY PLAN LONG TERM CARE PLAN VACATION BUY PLAN ADOPTION ASSISTANCE PROGRAM TRANSIT COMMUTER BENEFIT PLAN The iformatio i this booklet is iteded to provide oly a summary of BSA s beefits program. Nothig cotaied i ay sectio of this booklet should be costrued as a promise of employmet or cotiued employmet, or to costitute cotractual obligatios. If questios arise, official pla documets ad isurace agreemets are cotrollig ad gover fial determiatio of beefits cosistet with applicable laws ad regulatios. BSA maitais the right to modify, susped, or termiate beefit plas i whole or i part at ay time. BROOKHAVEN NATIONAL L ABOR ATORY 1

2 beefits TABLE OF CONTENTS 2 BROOKHAVEN NATIONAL L ABOR ATORY

3 beefits TABLE OF CONTENTS cotets MEDICAL PLAN part 1 WHO IS ELIGIBLE FOR THE MEDICAL PLAN?... 1 Active Employees... 1 Eligible Depedets... 1 Depedets of Deceased Participats... 1 Retirees... 2 ENROLLMENT... 3 MEDICAL PROGRAMS AVAILABLE... 3 Medical Programs Available... 3 THE OPEN ACCESS PLUS (OAP) ADMINISTERED BY CIGNA... 4 THE PREFERRED PROVIDER ORGANIZATION (PPO) ADMINISTERED BY VYTRA... 4 HEALTH MAINTENANCE ORGANIZATIONS (HMOS)... 4 Authorizatio... 5 Prevetive Services... 5 PHONE NUMBERS... 5 PROVIDER DIRECTORY... 5 COORDINATION OF BENEFITS... 5 Coverage Uder Other Employers Plas... 5 Dual Coverage... 5 Medicare... 5 CLAIMS... 5 How to File a Claim... 5 Questios About Claims... 6 How to Appeal a Claim... 6 EXCLUSIONS... 7 NEWBORNS AND MOTHERS HEALTH PROTECTION ACT... 8 WOMEN S BREAST CANCER... 8 EMPLOYEE PREMIUMS... 8 RETIREE PREMIUMS... 9 DISPLACED WORKERS HEALTH BENEFITS PROTECTION ACT (DWHBP) PREMIUMS... 9 OPEN ENROLLMENT PERIOD... 9 QUALIFYING EVENT... 9 MISCELLANEOUS Base Salary Cotiuous Service Deductible Geeral Iformatio Hospital Preadmissio Certificatio Leave of Absece Lifetime Maximum Medical Beefits Out-Of-Pocket Maximum Participats Receivig Log Term Disability Pla Beefits Qualified Medical Child Support Order Reasoable ad Customary (R&C) Secod Surgical Opiio Termiatio of Coverage BROOKHAVEN NATIONAL L ABOR ATORY 3

4 beefits TABLE OF CONTENTS COBRA What is COBRA Cotiuatio Coverage? Whe is COBRA Coverage Available? Notificatio Requiremets How is COBRA Coverage Provided? COBRA Premium Requiremets Termiatio of Coverage Uder COBRA CONVERSION ERISA EMPLOYEE PREMIUMS RETIREE PREMIUMS For Participats who were ot i the IBEW Uio For Participats who were i the IBEW Uio DWHBP PREMIUMS COBRA PREMIUMS MEDICAL PLAN COMPARISON CHARTS (A) MEDICAL PROGRAMS All Employees No-Medicare-Eligible Retirees No-Medicare-Eligible Participats o LTD (B) MEDICAL PROGRAMS Medicare-Eligible Retirees Medicare- Eligible Participats o LTD DENTAL PLAN part 2 WHO IS ELIGIBLE FOR THE DENTAL PLAN?... 1 Active Employees... 1 Eligible Depedets... 1 ENROLLMENT... 2 DENTAL PROGRAMS AVAILABLE... 3 DELTA DENTAL INDEMNITY PLAN... 3 Beefits Provided... 3 Schedule of Maximum Allowable Covered Detal Expeses... 3 Coordiatio of Beefits... 3 Coverage Uder Other Employers Plas... 3 Claims... 3 How to File a Claim... 3 Questios About Claims... 4 How to Appeal a Claim... 4 Phoe Number... 4 DELTA DENTAL DMO (DELTACARE USA) PLAN... 4 Beefits Provided... 4 Emergecy Services... 4 Specialty Referrals... 4 Coordiatio of Beefits... 5 How to File a Claim... 5 Questios About Claims... 5 How to Appeal a Claim... 5 Phoe Number... 5 Provider Directory BROOKHAVEN NATIONAL L ABOR ATORY

5 beefits TABLE OF CONTENTS DELTA DENTAL PPO PLAN... 5 Beefits Provided... 5 Coordiatio of Beefits... 5 Coverage Uder Other Employers Plas... 5 Claims... 6 How to File a Claim... 6 Questios About Claims... 6 How to Appeal a Claim... 6 Phoe Number... 6 Provider Directory... 6 DUAL COVERAGE... 6 EXCLUSIONS... 6 EMPLOYEE PREMIUMS... 7 OPEN ENROLLMENT PERIOD... 7 QUALIFYING EVENT... 7 MISCELLANEOUS... 8 Geeral Iformatio... 8 Leave of Absece... 9 Participats Receivig Log Term Disability Beefits... 9 Reasoable ad Customary (R&C)... 9 Termiatio of Coverage... 9 COBRA... 9 What is COBRA Cotiuatio Coverage?... 9 Whe is COBRA Coverage Available? Notificatio Requiremets How is COBRA Coverage Provided? COBRA Premium Requiremets Termiatio of Coverage Uder COBRA ERISA EMPLOYEE PREMIUMS COBRA PREMIUMS DENTAL PLAN COMPARISON CHARTS LIFE INSURANCE PLAN part 3 WHO IS ELIGIBLE FOR THE LIFE INSURANCE PLAN?... 1 Active Employees... 1 ENROLLMENT... 1 LIFE INSURANCE PLAN COVERAGE EMPLOYEES UNDER AGE Basic Life Isurace Beefits Provided... 1 Supplemetal Life Isurace Beefits Provided... 1 LIFE INSURANCE PLAN COVERAGE EMPLOYEES AGE 65 OR OVER... 2 Basic Life Isurace Beefits Provided... 2 Supplemetal Life Isurace Beefits Provided... 2 MAXIMUM LIFE INSURANCE PLAN COVERAGE... 3 OPTION TO ACCELERATE PAYMENT OF DEATH BENEFITS... 3 ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE... 3 Beefits Provided... 3 Exclusios... 4 Additioal Beefits... 4 BROOKHAVEN NATIONAL L ABOR ATORY 5

6 beefits TABLE OF CONTENTS CLAIMS How to File a Claim... 4 Questios About Claims... 4 How to Appeal a Claim... 4 EMPLOYEE PREMIUMS... 5 MISCELLANEOUS... 5 Aual Base Salary... 5 Assigmet of Your Life Isurace ad AD&D Beefits... 5 Beeficiary... 5 Chages i the Amout of Life ad AD&D Isurace... 5 Evidece of Isurability... 6 Geeral Iformatio... 6 Isurace Compay... 6 Leave of Absece... 6 Participats Receivig Log Term Disability Beefits... 6 Termiatio of Coverage... 6 CONVERSION... 7 LONG TERM DISABILITY PLAN part 4 WHO IS ELIGIBLE FOR THE LONG TERM DISABILITY PLAN?... 1 Active Employees... 1 ENROLLMENT... 1 LONG TERM DISABILITY PLAN COVERAGE... 1 Icome Beefits Provided... 1 Cotributios to the Retiremet Pla... 3 Portable Adaptive Equipmet... 3 Rehabilitatio... 3 CLAIMS... 3 How to File a Claim... 3 Questios About Claims... 3 How to Appeal a Claim... 4 EMPLOYEE PREMIUMS... 4 OTHER INSURANCE COVERAGES WHILE ON LTD... 4 Medical Coverage... 4 Life Isurace Coverage... 4 Detal Coverage... 4 MISCELLANEOUS... 4 Base Salary... 4 Chages i the Amout of LTD Coverage... 5 Cotiuous Service... 5 Disabilities Not Covered... 5 Employmet Status While Receivig LTD Beefits... 5 Evidece of Isurability... 5 Geeral Iformatio... 5 Isurace Compay... 5 Leave of Absece... 6 Overpaymet... 6 Reductio i Beefits Due to Earigs... 6 Social Security Beefits... 6 Successive Periods of Disability BROOKHAVEN NATIONAL L ABOR ATORY

7 beefits TABLE OF CONTENTS Termiatio of Coverage...6 Totally Disabled...7 TRAVEL ACCIDENT INSURANCE PLAN part 5 WHO IS ELIGIBLE FOR THE TRAVEL ACCIDENT INSURANCE PLAN?... 1 ENROLLMENT... 1 TRAVEL ACCIDENT INSURANCE PLAN COVERAGE... 1 Beefits Provided... 1 Exclusios... 2 Accidetal Bur ad Disfiguremet Beefit... 2 Airbag Beefit... 3 Bomb Scare ad/or Explosio Coverage: O premises... 3 Carjackig Beefit... 3 Coma Beefit Coverage... 3 Cotiuatio of Isurace Expese Beefit... 4 Emergecy Medical Evacuatio... 4 Exteded Terrorism Coverage... 4 Feloious Assault Coverage: O Premises... 5 Hijackig/Skyjackig Coverage... 5 Kidap ad Extortio Beefit... 5 O Premises Emergecy Fire/Disaster Team Coverage... 5 Persoal Deviatio Provisio... 5 Reasoable Accommodatio at Worksite Beefit... 5 Rehabilitatio Beefit... 6 Repatriatio of Remais... 6 Seat Belt Beefit... 6 Special Adaptatio Beefit... 6 Special Couselig Beefit... 7 Travel Assistace Services... 7 Travel Assistace Services Compay... 7 War Risk Coverage... 7 CLAIMS... 7 How to File a Claim... 7 Questios About Claims... 7 How to Appeal a Claim... 8 PREMIUMS... 8 MISCELLANEOUS... 8 Accidet... 8 Accidet Medical Expese... 8 Aual Salary... 8 Assigmet of Your Travel Accidet Isurace Policy... 8 Authorized Busiess Travel... 8 Automobile... 8 Beeficiary... 9 Carjackig... 9 Coma... 9 Depedet Child(re)... 9 Disfiguremet/Disfigured... 9 Emergecy Medical Beefit... 9 Geeral Iformatio... 9 BROOKHAVEN NATIONAL L ABOR ATORY 7

8 beefits TABLE OF CONTENTS Guest Leave of Absece Loss Presumptive Disability Rehabilitatio Termiatio of Coverage Vehicle RETIREMENT PLAN part 6 WHO IS ELIGIBLE FOR THE RETIREMENT PLAN?... 1 Active Employees... 1 ENROLLMENT... 1 RETIREMENT PLAN COVERAGE... 1 Beefits Provided... 1 Pla Ivestmets... 2 Allocatig Cotributios... 2 Trasferrig Betwee Fuds... 2 Desigatig a Beeficiary... 3 Rollover Cotributios... 3 Vestig... 3 Effect of Termiatio ad Re-employmet... 3 Loas... 4 Withdrawals... 4 Statemets... 4 RETIREMENT OPTIONS... 4 Cash Withdrawal... 4 Retiremet Trasitio Beefit... 4 Oe-Life Auity Optio... 5 Two-Life Auity Optio... 5 Fixed Period Auity Optio... 5 Iterest Paymet Retiremet Optio (IPRO)... 6 Miimum Distributio Optio... 6 Rollover Distributios... 6 REPURCHASE OF BENEFITS... 6 PRE-RETIREMENT DEATH BENEFITS... 6 INVESTMENT COMPANY CONTACT INFORMATION... 7 QUESTIONS ABOUT THE PLAN... 7 MISCELLANEOUS... 7 Base Salary... 7 Break i Service... 7 Cotiuous Service... 7 Discotiuatio of Cotributios... 7 Employer... 7 Geeral Iformatio... 7 Hour of Service... 7 Leave of Absece... 8 No-Alieatio of Beefits... 8 Participats Receivig Log Term Disability Beefits... 8 Pla Admiistrator... 8 Qualified Domestic Relatios Order BROOKHAVEN NATIONAL L ABOR ATORY

9 beefits TABLE OF CONTENTS Type of Pla... 8 Amedmet or Termiatio of the Pla... 8 Brookhave Sciece Associates Fuds Available for Ivestmet (k) PLAN part 7 WHO IS ELIGIBLE FOR THE 401(K) PLAN?... 1 Active Employees... 1 ENROLLMENT (K) PLAN COVERAGE... 1 Beefits Provided... 1 Catch Up Cotributios... 2 Pla Ivestmets... 2 Allocatig Cotributios... 2 Desigatig a Beeficiary... 2 Chagig the Amout Beig Cotributed... 3 Trasferrig Betwee Fuds... 3 Rollover Cotributios... 3 Vestig... 3 Loas... 3 Withdrawals... 4 Statemets... 4 RETIREMENT OPTIONS... 4 Cash Withdrawal... 5 Oe-Life Auity Optio... 5 Two-Life Auity Optio... 5 Fixed Period Auity Optio... 6 Miimum Distributio Optio... 6 Rollover Distributios... 6 REPURCHASE OF BENEFITS... 6 PRE-RETIREMENT DEATH BENEFITS... 6 INVESTMENT COMPANY CONTACT INFORMATION... 6 QUESTIONS ABOUT THE PLAN... 7 MISCELLANEOUS... 7 Base Salary... 7 Discotiuatio of Cotributios... 7 Fiscal Officer... 7 Geeral Iformatio... 7 Leave of Absece... 7 No-Alieatio of Beefits... 7 Participats Receivig Log Term Disability Beefits... 7 Pla Admiistrator... 8 Qualified Domestic Relatios Order... 8 Type of Pla... 8 Amedmet or Termiatio of the Pla... 8 Brookhave Sciece Associates Fuds Available for Ivestmet... 9 BROOKHAVEN NATIONAL L ABOR ATORY 9

10 beefits TABLE OF CONTENTS FLEXIBLE SPENDING ACCOUNTS PLAN part 8 WHO IS ELIGIBLE FOR THE FLEXIBLE SPENDING ACCOUNTS PLAN?... 1 Active Employees... 1 ENROLLMENT... 1 HEALTH CARE REIMBURSEMENT ACCOUNT... 1 Beefits Provided... 1 What Health Care Expeses are Reimbursed?... 2 How Much May You Cotribute Each Year to the Health Care Reimbursemet Accout?... 2 DEPENDENT DAY CARE REIMBURSEMENT ACCOUNT... 2 Beefits Provided... 2 What Depedet Day Care Expeses are Reimbursed?... 2 Who are Eligible Depedets?... 3 How Much May You Cotribute Each Year to the Depedet Day Care Reimbursemet Accout?... 3 Depedet Day Care Reimbursemet Accout or Tax Credit... 3 Does the Use of Before-Tax Cotributios to the Flexible Spedig Accouts Pla Affect Ay Other Beefits?... 3 CLAIMS... 4 How to File a Claim... 4 How Log Do You Have to Submit Claims for Reimbursemet?... 4 Questios About Claims... 4 How to Appeal a Claim... 4 CHANGES IN CONTRIBUTION AMOUNTS... 5 OPEN ENROLLMENT PERIOD... 5 QUALIFYING EVENT... 5 MISCELLANEOUS... 6 Geeral Iformatio... 6 Leave of Absece... 6 Restrictios... 6 Termiatio of Coverage... 7 COBRA... 7 What is COBRA Cotiuatio Coverage?... 7 Whe is COBRA Coverage Available?... 8 Notificatio Requiremets... 8 How is COBRA Coverage Provided?... 8 COBRA Premium Requiremets... 9 Termiatio of Coverage Uder COBRA... 9 TUITION ASSISTANCE PROGRAM part 9 WHO IS ELIGIBLE FOR THE TUITION ASSISTANCE PROGRAM?... 1 Active Employees... 1 ENROLLMENT... 1 TUITION ASSISTANCE PROGRAM COVERAGE... 1 Beefits Provided... 1 Allowable Courses... 1 Exclusios... 2 Approvals... 2 How to Request Reimbursemet BROOKHAVEN NATIONAL L ABOR ATORY

11 beefits TABLE OF CONTENTS Questios About the Program... 2 MISCELLANEOUS... 2 Course Schedules... 2 Geeral Iformatio... 2 Leave of Absece... 3 Log Term Disability Beefits... 3 Termiatio of Coverage... 3 SEVERANCE PAY PLAN part 10 WHO IS ELIGIBLE FOR THE SEVERANCE PAY PLAN?... 1 Active Employees... 1 ENROLLMENT... 1 SEVERANCE PAY PLAN COVERAGE... 1 Beefits Provided... 1 Maximum Beefits... 1 Paymet of Beefits... 2 Recall to Work... 2 Exclusios... 2 Questios About the Pla... 3 MISCELLANEOUS... 3 Base Pay... 3 Cotiuous Service... 3 Geeral Iformatio... 3 Part-Time Employees... 3 Termiatio of Coverage... 3 LONG TERM CARE PLAN part 11 WHO IS ELIGIBLE FOR THE LONG TERM CARE PLAN?... 1 Active Employees... 1 Eligible Depedets... 1 Retirees... 1 APPLYING FOR COVERAGE... 1 LONG TERM CARE PLAN COVERAGE... 1 Beefits Provided... 1 Beefit Eligibility Criteria... 2 Preexistig Coditios Limitatio... 2 Lifetime Maximum Beefit... 2 EXCLUSIONS... 2 CLAIMS... 2 How to File a Claim... 2 Questios About Claims... 3 How to Appeal a Claim... 3 EMPLOYEE PREMIUMS... 3 ELIGIBLE DEPENDENT PREMIUMS... 3 RETIREE PREMIUMS... 3 RETURN OF PREMIUMS... 3 BROOKHAVEN NATIONAL L ABOR ATORY 11

12 beefits TABLE OF CONTENTS WAIVER OF PREMIUMS... 3 MISCELLANEOUS... 3 Beefit Period... 3 Chages i the Amout of LTC Coverage... 3 Daily Beefit Amout... 4 Geeral Iformatio... 4 Home Care Uit... 4 Hospital... 4 Leave of Absece... 4 Loss of Fuctioal Capacity... 4 Nursig Care Facility... 5 Termiatio of Coverage... 5 Waitig Period... 5 CONTINUATION COVERAGE... 5 VACATION BUY PLAN part 12 WHO IS ELIGIBLE FOR THE VACATION BUY PLAN?... 1 Active Employees... 1 ENROLLMENT... 1 VACATION BUY PLAN COVERAGE... 1 Beefits Provided... 1 Use of Vacatio Buy Time... 1 Determiig the Cost of Purchased Vacatio Time... 1 Uused Purchased Vacatio Time... 2 OPEN ENROLLMENT PERIOD... 2 MISCELLANEOUS... 2 Base Salary... 2 Geeral Iformatio... 2 Leave of Absece... 2 Termiatio of Employmet... 2 ADOPTION ASSISTANCE PROGRAM part 13 WHO IS ELIGIBLE FOR THE ADOPTION ASSISTANCE PROGRAM?... 1 Active Employees... 1 ENROLLMENT... 1 ADOPTION ASSISTANCE PROGRAM COVERAGE... 1 Beefits Provided... 1 What Adoptio-Related Expeses are Reimbursable?... 1 How to Request Reimbursemet... 1 MISCELLANEOUS... 2 Geeral Iformatio... 2 Termiatio of Employmet BROOKHAVEN NATIONAL L ABOR ATORY

13 beefits TABLE OF CONTENTS TRANSIT COMMUTER BENEFIT PLAN part 14 WHO IS ELIGIBLE FOR THE TRANSIT COMMUTER BENEFIT PLAN?...1 Active Employees...1 ENROLLMENT...1 TRANSIT COMMUTER BENEFIT PLAN COVERAGE...1 Beefits Provided...1 How Much May You Cotribute Each Year to the Trasit Commuter Beefit Pla?...1 Does the Use of Before-Tax Cotributios to the Trasit Commuter Beefit Pla Affect Ay Other Beefits?...1 CLAIMS/PAYMENT OF EXPENSES...2 How to File a Claim or Pay for Expeses...2 How Log Do You Have to Submit Claims for Reimbursemet?...2 Questios About Claims...2 How to Appeal a Claim...2 CHANGES IN CONTRIBUTION AMOUNTS...2 MISCELLANEOUS...3 Claims Admiistrator...3 Eligible Trasportatio Expeses...3 Geeral Iformatio... 3 Leave of Absece... 3 Participats Receivig Log Term Disability Pla Beefits...3 Restrictios... 3 Termiatio of Coverage...4 GENERAL INFORMATION Pla Idetificatio Numbers...1 Pla Year...1 Pla Fudig...1 Type of Pla...1 Normal Retiremet Age...1 Pla Sposor...1 Pla Admiistrator...2 Aget for Legal Process...2 Trustees...2 Filig Claims for Beefits...2 Claims Appeal Procedure...2 Privacy of Iformatio...2 Your Rights Uder ERISA...3 Receive Iformatio About Your Plas ad Beefits...3 Cotiue Group Health Pla Coverage...3 Prudet Actios by Pla Fiduciaries...3 Eforce Your Rights...4 Assistace With Your Questios...4 BROOKHAVEN NATIONAL L ABOR ATORY 13

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15 beefits: part 1 MEDICAL PLAN part 1 MEDICAL PLAN The Medical Pla provides beefits for medical coverage. Erollmet i the Medical Pla is optioal. WHO IS ELIGIBLE FOR THE MEDICAL PLAN? Active Employees All regular employees who work at least 20 hours per week are eligible to participate i the group Medical Pla o the first day of active employmet. Eligible Depedets The followig members of your family are also eligible for Medical Pla coverage: Your spouse, defied as the perso of the opposite sex to whom you are legally married. Your eligible same-sex domestic parter ad that parter s eligible child(re). To be eligible, you must provide a copy of your marriage certificate, domestic parter registry or proof of fiacial iterdepedece. Additioal iformatio is available at Beefits/DomesticParters.asp Childre of your eligible domestic parter must meet the criteria for childre idicated below. Your child(re) up to his or her 26th birthday, icludig adopted childre ad stepchildre. Coverage may be cotiued for your eligible depedets who are or over age 26 ad who are or become metally or physically icapable of earig their ow livig while covered as a eligible depedet, by submittig proof of the child s icapacity withi 31 days after they become icapacitated. If a depedet is o loger eligible for coverage ad you do ot remove that depedet from your coverage withi the applicable period idicated i the Qualifyig Evet sectio, your depedet will be removed from your coverage as of the date the Beefits Office is otified. Depedets of Deceased Participats If you are participatig i the Medical Pla ad die while receivig Log Term Disability (LTD) Pla beefits, ad are ot eligible for retiree medical coverage or are i active service ad die, your covered depedets may cotiue i the pla, for oe year followig the date of your death, by payig the required employee premiums. After the first year: If you had less tha 3 years of Cotiuous Service, your covered depedets may cotiue i the pla uder the COBRA provisios by payig the COBRA cost of the pla. If you were ot i the caledar year of your 58th birthday or later ad do ot meet the eligibility requiremets for retiree medical coverage (see below) ad you had at least 3 but less tha 15 years of Cotiuous Service, your covered depedets may cotiue i the pla by payig the COBRA cost of the pla. If you were ot i the caledar year of your 58th birthday or later ad you had at least 15 or more years of Cotiuous Service, your covered depedets may cotiue i the pla BROOKHAVEN NATIONAL L ABOR ATORY 1

16 beefits: part 1 MEDICAL PLAN by payig the required retiree premiums. If you were i the caledar year of your 58th birthday or later ad had at least 3 years of Cotiuous Service, your covered depedets may cotiue i the pla by payig the required retiree premiums. If you meet the eligibility requiremets for the retiree medical coverage (see below), your covered depedets may cotiue i the pla by payig the required retiree premiums. If you are participatig i the Medical Pla ad die while receivig Log Term Disability (LTD) Pla beefits, ad are eligible for retiree medical coverage or die while o retiree medical coverage, your covered depedets may cotiue i the pla by payig the required retiree premiums. These provisios will ot apply to covered depedets if eligible for coverage uder aother group medical isurace pla. Coverage will termiate whe they o loger qualify as eligible depedets. Coverage will also termiate for covered depedets o the date the survivig spouse remarries. Retirees All employees who are participatig i the Medical Pla ad who termiate employmet after attaiig age 55 ad have a combiatio of age ad years of Cotiuous Service immediately prior to retiremet (10 years miimum, or for employees hired prior to Jauary 1, 2001, 5 years miimum) that total 70 years or more may participate i the Medical Pla with their covered depedets by payig the required retiree premiums. For example: A employee age 55 would be eligible for retiree medical coverage after 15 years of Cotiuous Service. A 62 year old employee would be eligible after 10 years of Cotiuous Service, if hired o or after Jauary 1, A 62 year old employee would be eligible after 8 years of Cotiuous Service, if hired before Jauary 1, I determiig eligibility for retiree medical coverage, employees who are hired by the Laboratory i coectio with the Natioal Sychrotro Light Source II ( NSLSII ) project may receive credit for their service with their prior employer i calculatig their years of Cotiuous Service. This prior service credit applies to (a) employees permaetly hired by the Laboratory o or after October 1, 2005 to work o the NSLSII project, or (b) spouses of employees permaetly hired by the Laboratory o or after October 1, 2005 to work o the NSLSII project, if the spouse is permaetly hired by the Laboratory o or after October 1, 2005, eve if the spouse is ot hired to work o the NSLSII project. The prior service credit applies oly to service with a laboratory operated uder a cotract with the Departmet of Eergy, ad oly if the employee or spouse was employed by that laboratory immediately before he or she was hired by the Laboratory. For example, if a employee is hired by the Laboratory to work o the NSLSII project o Jauary 1, 2006, ad before beig hired by the Laboratory was employed with aother laboratory operated by a etity uder a cotract with the Departmet of Eergy sice Jauary 1, 2000, the employee will have six years of Cotiuous Service whe he or she begis at the Laboratory. Also, employees who are participatig i the Medical Pla ad who termiate employmet after completig 35 years of Cotiuous Service may participate i the Medical Pla with their covered depedets by payig the required retiree premiums. I additio, whe Log Term Disability (LTD) Pla beefits cease for a participat who was receivig such beefits, the followig criteria apply i determiig retiree medical beefits eligibility, if participatig i the Medical Pla. Use Cotiuous Service prior to commecemet of LTD Pla beefits ad age at the time the LTD Pla beefits cease. Retirees otherwise eligible who are subsequetly employed elsewhere or have coverage available through their spouse s employer may susped their retiree medical coverage through the Laboratory. It may oly be reistated durig a Ope Erollmet Period (effective Jauary 1 of the followig caledar year) or whe a Qualifyig Evet occurs. As of Jauary 1, 2007, eligible employees i the positios idicated below who are participatig i the Medical Pla ad who termiate employmet after attaiig age 50 ad have 25 years or more of Cotiuous Service may participate i the Medical Pla with their covered depedets by payig the required retiree premiums. If Cotiuous Service is at least 20 years but less tha 25 years ad all other criteria idicated above are met, such eligible employees may participate i the Medical Pla by payig the COBRA cost of the pla util their age plus Cotiuous Service immediately prior to 2 BROOKHAVEN NATIONAL L ABOR ATORY

17 beefits: part 1 MEDICAL PLAN retiremet plus their age total 75 years or more (at which time they ca cotiue coverage by payig the required retiree premium). For the purpose of this paragraph, positios eligible for such coverage iclude Fire Chief, Deputy Fire Chief, Fire Captai, Police Chief, Police Captai, Police Lieuteat ad Police Security Traiig Istructor. If you die while your beefits are i a suspeded status, your eligible depedets may also reistate coverage durig a Ope Erollmet Period or whe a Qualifyig Evet occurs. ENROLLMENT Eligible employees may eroll i oe of the medical programs withi 30 days of their date of hire. Oce you eroll, you must cotiue participatio i the program util the ed of the caledar year or your termiatio date of employmet, if earlier. If you do ot eroll for coverage withi 30 days of your date of hire, you will be required to wait util the ext Ope Erollmet Period or whe you have a Qualifyig Evet to elect coverage. To eroll, you must complete a erollmet form ad list all depedets you wat covered. Erollmet forms are available through the Beefits Office. By completig the form, you will authorize the ecessary payroll premiums for the coverage you select. The coverages available are: Employee oly. Employee ad oe depedet. Employee ad two or more depedets. You caot eroll your eligible depedets without also erollig yourself for medical coverage. Employees caot eroll their depedets i a differet medical program tha the oe they select for themselves. Coverage begis o your date of hire if you complete all erollmet forms ad submit them to the Beefits Office withi 30 days of your date of hire. MEDICAL PROGRAMS AVAILABLE Eligible employees ad their depedets may eroll i oe of the o-medicare medical programs. No-Medicare-eligible retirees, o-medicare-eligible participats receivig LTD Pla beefits, ad o-medicare eligible depedets of retirees ad participats receivig LTD Pla beefits may eroll i oe of the o-medicare medical programs. Medicare-eligible retirees, Medicare-eligible participats receivig LTD Pla beefits, ad Medicareeligible depedets of retirees ad participats receivig LTD Pla beefits may eroll i oe of the Medicare medical programs. A brief summary of the beefits provided uder each program is at the ed of the Medical Pla sectio. Medical Programs Available No-Medicare-Eligible Participats Medicare-Eligible Participats Aeta HMO CIGNA Ope Access Plus CIGNA Ope Access Plus HIP VIP HMO HIP HMO Vytra PPO If you ad your spouse are ot eligible for Medicare, you may both participate i a o- Medicare pla but must both elect the same pla. If you ad your spouse are eligible for Medicare, you may both participate i a Medicare pla but must both elect the same pla. BROOKHAVEN NATIONAL L ABOR ATORY 3

18 beefits: part 1 MEDICAL PLAN If you are ot eligible for Medicare but your spouse is eligible for Medicare (or vice versa), the Medicare-eligible participat may participate i ay of the Medicare plas. The o- Medicare-eligible participat may participate i ay of the o-medicare plas. THE OPEN ACCESS PLUS (OAP) ADMINISTERED BY CIGNA Uder the CIGNA OAP program, services are provided through a etwork of physicias ad facilities, but beefits are also provided for use of providers who are ot i the etwork. If services are received from a i-etwork provider, there is o claim filig. Most i-etwork services are covered i full after a small co-paymet. If services are received from a provider who is ot i the CIGNA OAP etwork (thus is out-ofetwork), you have a deductible, must file claim forms, ad most services are covered at a percetage of the Reasoable ad Customary (R&C) amout. The CIGNA OAP program provides beefits to cover i-hospital ad out-of-hospital expeses. Uder this program, you use the physicia of your choice for medical care for you ad your covered depedets. For expeses to be covered by the program, they must be for ecessary ad essetial care ad treatmet of a ijury, illess, or pregacy. Certai facilities ad care providers may ot be covered by this program. Additioal iformatio o beefits, exclusios, ad limitatios is provided i your CIGNA Isurace Certificate which is available at o charge i the Beefits Office. THE PREFERRED PROVIDER ORGANIZATION (PPO) ADMINISTERED BY VYTRA Uder the Vytra PPO program, services are provided through a etwork of physicias ad facilities, but beefits are also provided for use of providers who are ot i the etwork. If services are received from a i-etwork provider, there is o claim filig. Most i-etwork services are covered i full after a small co-paymet. If services are received from a provider who is ot i the Vytra PPO etwork (thus is out-of-etwork), you have a deductible, must file claim forms, ad most services are covered at a percetage of the Reasoable ad Customary (R&C) amout. The Vytra PPO program provides beefits to cover i-hospital ad out-of-hospital expeses. Uder this program, you use the physicia of your choice for medical care for you ad your covered depedets. For expeses to be covered by the program, they must be for ecessary ad essetial care ad treatmet of a ijury, illess, or pregacy. Certai facilities ad care providers may ot be covered by this program. Prescriptio drug coverage for Vytra participats is provided through CIGNA. Additioal iformatio o beefits, exclusios, ad limitatios is provided i your Vytra Isurace Certificate which is available at o charge i the Beefits Office. HEALTH MAINTENANCE ORGANIZATIONS (HMOs) HMO programs are available for medical coverage. Curretly, o-medicare HMOs are provided through Aeta ad HIP ad a Medicare HMO is provided through HIP. Iformatio o the beefits provided through the HMOs is cotaied i literature available at o charge i the Beefits Office. Uder the HMOs, services are provided through a etwork of participatig physicias ad facilities. Coverage is ot provided for providers who are ot i the HMO s etwork. To chage providers i your HMO, you must cotact the HMO. If you require the care of a medical specialist, your participatig physicia must give you a referral to a specialist i that HMO s etwork. May of the services are provided for a small co-paymet. There are o deductibles or claim forms to file. Please ote that coverage uder the HMOs is subject to chage by the HMO ad is based o provisios at the time the service is provided. May prevetive services, such as a aual physical, are provided by the HMOs. If you have ay questios about your HMO, cotact the HMO. 4 BROOKHAVEN NATIONAL L ABOR ATORY

19 beefits: part 1 MEDICAL PLAN Authorizatio If your primary care physicia believes you eed to see a specialist, he or she will provide you with a referral. Prevetive Services I case of a emergecy, you do ot require prior approval or authorizatio by your primary care physicia or isurace compay. However, you must otify your primary care physicia ad your isurace compay of your visit to the emergecy room as soo as reasoably possible. Services such as well child care, routie physicals, ad routie gyecological examiatios are provided. For a list of such services, refer to your member hadbook. PHONE NUMBERS PROVIDER DIRECTORY* AETNA (800) CIGNA (800) HIP (800) VYTRA (631) *Provider directories are available olie at the websites idicated above. COORDINATION OF BENEFITS Coverage Uder Other Employers Plas If you ad your covered depedets are eligible to receive beefits uder aother group medical pla, coordiatio of beefits is based o the terms of those plas. I may cases the HMOs do ot provide additioal reimbursemet whe coordiated with aother group medical pla. I the case of depedet childre who are covered by more tha oe group pla, the isurace pla of the paret whose birthday occurs earlier i the caledar year will be the primary isurace pla for the childre. To obtai all the beefits available, you ad your family members must file claims uder each pla. Dual Coverage Prior to Jauary 1, 2006, dual coverage allowed both spouses to participate i the CIGNA programs where they could elect to cover each other ad their eligible depedets i such programs provided they paid the required premiums. Dual coverage was elimiated as of Jauary 1, Dual coverage was also elimiated for members of the IBEW uio as of Jauary 1, Medicare For retired employees, participats who are receivig LTD Pla beefits ad their depedets who are eligible for Medicare, the medical programs will ot pay for ay medical expeses that are eligible for reimbursemet uder Medicare. Retired employees, participats who are receivig LTD Pla beefits ad their depedets who are eligible for Medicare must eroll for both Parts A ad B of Medicare. If the participat does ot eroll for Medicare Parts A ad B, (a) the participat is ot eligible to eroll i a Medicare HMO ad (b) the OAP program, admiistered by CIGNA, will reduce beefits as if Medicare coverage is i place. CLAIMS How to File a Claim To file a claim uder the out-of-etwork portio of the OAP or PPO programs you must complete a claim form that is available i the Beefits Office or through the Beefits Office website at: BROOKHAVEN NATIONAL L ABOR ATORY 5

20 beefits: part 1 MEDICAL PLAN If you are retired, o log term disability or a depedet ad covered by Medicare, you should submit your bills to Medicare first. For items ot covered i full by Medicare, submit the explaatio of beefits from Medicare, copies of the bills, ad a completed claim form to CIGNA (for the OAP program). Completed CIGNA program claim forms ad copies of your bills should be submitted to the address o the back of your idetificatio card. Vytra claims should be submitted to the address o the claim form. There are o claim forms to file uder the HMOs. The providers will bill the HMO for you. Questios About Claims If you have a questio about your CIGNA OAP program claim, you should cotact CIGNA. If you have a questio about your Vytra PPO claim, you should cotact Vytra. If you participate i the Vytra PPO ad have a questio about your prescriptio drugs, you should cotact CIGNA (ot Vytra) at (800) Whe discussig your claim, please refer to the explaatio of beefits, the claim form, ad ay other correspodece that you may have received. You ca cotact the CIGNA claims admiistrator at (800) or the Vytra claims admiistrator at (631) How to Appeal a Claim Uder the CIGNA OAP program, you may request a review of the deied claim i writig to the isurace compay withi 365 days of the receipt of the otice of deial. You should state the reasos why your claim should ot have bee deied, icludig ay additioal documets which you believe support your claim. I ormal cases, the isurace compay will reder a decisio withi 30 days of the date your request for review is received. Uder the Vytra PPO, your explaatio of beefits will idetify if a claim is deied ad the reaso for the deial. You may request a review of the deied claim i writig to the isurace compay withi 180 days of the receipt of the otice of deial. You should state the reasos why your claim should ot have bee deied, icludig ay additioal documets which you believe support your claim. You will the receive a writte ackowledgmet withi 15 busiess days of receipt of your request. I ormal cases, the isurace compay will provide resolutio of your appeal withi 30 caledar days of receivig all ecessary iformatio. Uder the Aeta program, you may request a review of the deied claim by cotactig the isurace compay at (800) You will the receive a writte ackowledgemet that you must sig ad retur to the isurace compay. Withi 15 days of receipt, the isurace compay will request additioal iformatio. You should provide ay additioal iformatio to assist them i reviewig the claim. I ormal cases, the isurace compay will reder a decisio withi 30 days of the date your request for review is received. Uder the HIP program, you may request a review of the deied claim withi 180 days of the receipt of a adverse determiatio otice by cotactig the isurace compay at (800) , or submit your request i writig to HIP Grievace ad Appeal Departmet, JAF Statio, P.O. Box 2844, New York, N.Y or submit your request i perso to the Customer Service Walk-I Uit, 55 Water Street Lobby, New York, N.Y If the isurace compay requests additioal iformatio you should provide such iformatio to assist them i reviewig the claim. I ormal cases the isurace compay will reder a decisio withi 30 busiess days of the date your request for review is received. 6 BROOKHAVEN NATIONAL L ABOR ATORY

21 beefits: part 1 MEDICAL PLAN EXCLUSIONS The OAP program, admiistered by CIGNA, will ot provide paymet for: Expeses that are covered by Workers Compesatio, o-fault automobile isurace, or uisured motorist isurace law. Charges for uecessary services or charges which you would ot be legally required to pay or which would ot have bee made if there was o isurace. Charges for supplies, care, treatmet or surgery which are ot cosidered essetial for the care ad treatmet of a ijury or sickess. Charges i excess of reasoable ad customary limits or program maximums. Charges for private duty ursig while cofied as a ipatiet. Charges for or i coectio with custodial services, educatio or traiig. Expeses for or i coectio with experimetal procedures, treatmet methods, drugs or substaces ot approved by the America Medical Associatio, the Food ad Drug Admiistratio, or the appropriate medical society. Charges for or i coectio with routie refractios, eye exercises, surgical treatmet of a refractive error, or purchase or replacemet of cotact leses or eyeglasses. Charges for or i coectio with speech therapy if (a) used to improve speech skills that have ot fully developed, (b) cosidered custodial or educatioal, or (c) iteded to maitai speech commuicatio. Charges made by a provider who is a member of your or your depedet s family. Charges covered by Medicare. Detal x-rays ad examiatios, ad detal work uless made ecessary by accidetal ijury to soud atural teeth. Additioal exclusios may apply. Refer to your CIGNA Isurace Certificate for additioal iformatio. The Vytra PPO program will ot provide coverage for: Cosmetic, plastic or recostructive surgery, except as specified i your Certificate of Coverage. Disabilities coected to military service. Examiatios required for employmet, school, licesig, isurace, etc.. Trasportatio, except i the case of a emergecy. Detal care, except as specified i your Certificate of Coverage. Custodial care, except as may be covered through Hospice Care or by a Skilled Nursig Facility. Persoal or comfort items, subject to your rights to a appeal, ad exteral review. Additioal exclusios may apply. Cotact Vytra for iformatio o such exclusios. The Aeta ad HIP HMO programs will ot provide coverage for: Expeses that are covered by Workers Compesatio, o-fault automobile isurace, or uisured motorist isurace law. Charges for or i coectio with custodial services, educatio or traiig. Expeses for or i coectio with experimetal procedures, treatmet methods, drugs or substaces ot approved by the America Medical Associatio, the Food ad Drug Admiistratio, or the appropriate medical society. BROOKHAVEN NATIONAL L ABOR ATORY 7

22 beefits: part 1 MEDICAL PLAN Charges for cosmetic surgery except whe such service is icidetal to or follows surgery for trauma, ifectio or other diseases of the part of the body ivolved. For a covered child, coverage is provided for recostructive surgery to treat cogeital disease or aomaly which results i a fuctioal defect. Hearig aids. Certai expeses for ifertility services. Charges made by a provider who is a member of your or your depedet s family. Charges covered by Medicare. Detal x-rays ad examiatios, ad detal work uless made ecessary by accidetal ijury to soud atural teeth (Aeta). Additioal exclusios may apply. For a list of such exclusios refer to your HMO s member hadbook. NEWBORNS AND MOTHERS HEALTH PROTECTION ACT Group health plas ad health isurace issuers geerally may ot, uder Federal law, restrict beefits for ay hospital legth of stay i coectio with childbirth for the mother or ewbor child to less tha 48 hours followig a vagial delivery, or less tha 96 hours followig a cesarea sectio. However, Federal law geerally does ot prohibit the mother s or ewbor s attedig provider, after cosultig with the mother, from dischargig the mother or her ewbor earlier tha 48 hours (or 96 hours as applicable). I ay case, plas ad isurace issuers may ot, uder Federal law, require that a provider obtai authorizatio from the pla or the isurace issuer for prescribig a legth of stay ot i excess of 48 hours (or 96 hours as applicable). WOMEN S BREAST CANCER Federal law requires group health plas to provide coverage for the followig services to a idividual receivig pla beefits i coectio with a mastectomy: Recostructio of the breast o which the mastectomy has bee performed. Surgery ad recostructio of the other breast to produce a symmetrical appearace. The group health pla must determie the maer of coverage i cosultatio with the attedig physicia ad patiet. Coverage for breast recostructio ad related services are subject to deductibles, co-isurace ad co-paymet amouts that are cosistet with those that apply to other beefits uder the pla. EMPLOYEE PREMIUMS Employees who elect to participate i the Medical Pla must pay the required premiums. Your premiums are based o your Base Salary, the cost of the pla you elect, ad whether you elect to cover (a) yourself oly, (b) yourself ad oe depedet or (c) yourself ad two or more depedets. You may pay your premiums with before-tax or after-tax dollars. Before-tax premiums are deducted from your pay before state ad federal icome taxes ad Social Security taxes are withheld, resultig i a lower actual cost to you. After-tax premiums are deducted from your pay after taxes are withheld ad result i o tax savigs to you. Employee premiums are idicated at the ed of the Medical Pla sectio. If your aual salary is below the Social Security wage base ad you pay your premiums with before-tax dollars, your future Social Security beefits may be reduced. 8 BROOKHAVEN NATIONAL L ABOR ATORY

23 beefits: part 1 MEDICAL PLAN RETIREE PREMIUMS Retiree premiums are affected by both your eligibility for Medicare ad the Medicare eligibility of your covered depedets. If a participat lives outside of the Uited States ad is ieligible for Medicare, the premium for that participat for Medical Pla coverage will be the Medicare Part B premium i additio to ay other required Medical Pla premium. Retiree premiums are idicated at the ed of the Medical Pla sectio, ad are subject to chage. DISPLACED WORKERS HEALTH BENEFITS PROTECTION ACT (DWHBP) PREMIUMS Employees who are termiated from employmet as part of a reductio-i-force may cotiue their medical coverage by payig the required premiums. Premiums durig the first year after termiatio of employmet will be the active employee premium based o your Base Salary o the day immediately precedig termiatio of employmet. Durig the secod year, premiums will be oe-half of the applicable COBRA premium. After the secod year, such participats may cotiue coverage uder COBRA for up to 18 moths. Premiums are idicated at the ed of the Medical Pla sectio. Such DWHBP beefits as described i this sectio are ot available to participats, their spouse or their depedet child if eligible for Medicare, retiree medical coverage, or for coverage uder aother employer s group health pla. If a participat is ieligible for DWHBP beefits, they may be eligible to cotiue coverage for up to 18 moths uder COBRA. OPEN ENROLLMENT PERIOD Ope erollmet is held oce a year. Durig a Ope Erollmet Period, you may chage medical programs, drop coverage ad/or add or drop depedets from your coverage. Employees who did ot previously elect medical coverage may elect it durig the Ope Erollmet Period. Participats receivig LTD Pla beefits, retirees, ad their depedets who did ot previously elect medical coverage, may ot elect it durig the Ope Erollmet Period. Chages you elect durig the Ope Erollmet Period will be effective Jauary 1 of the followig caledar year. Your electios will be i effect for the remaider of the caledar year uless you otify the Beefits Office of a Qualifyig Evet withi 31 days of the evet. QUALIFYING EVENT A Qualifyig Evet is a chage i your family status ad icludes: (a) Chage i legal marital status 1. marriage 2. death of spouse 3. divorce 4. legal separatio 5. aulmet (b) Chage i the umber of depedets 1. birth 2. adoptio 3. placemet for adoptio 4. death of a depedet (c) Chage i employmet status 1. termiatio or commecemet of employmet of the employee, spouse or depedet (other tha for miscoduct) BROOKHAVEN NATIONAL L ABOR ATORY 9

24 beefits: part 1 MEDICAL PLAN (d) Chages i work schedule 1. a icrease or decrease i the umber of hours of employmet by the employee, spouse or depedet 2. a switch betwee full-time ad part-time status 3. a strike or lockout 4. commecemet or retur from a upaid leave of absece (e) The depedet satisfies or ceases to satisfy the requiremets for depedets 1. attaimet of age (f) A chage i the place of residece or work site of the employee, spouse or depedet I additio, based o the provisios of the Childre s Health Isurace Reauthorizatio Act of 2009 (CHIPRA), employees ad depedets that are eligible but ot erolled for BSA health isurace pla coverage may eroll for coverage if oe the followig coditios is met: The employee or depedet loses eligibility ad is termiated from Medicaid or CHIP* coverage or The employee or depedet becomes eligible for a premium assistace subsidy uder Medicaid or CHIP*. *CHIP (Childre s Health Isurace Program) is a state program desiged to provide health care coverage for uisured childre ad some adults. You have 31 days from the date of a Qualifyig Evet to make chages to your medical coverage for all items idicated above except (a)(3), (a)(4), ad (e)(1). You have 60 days from the date of a Qualifyig Evet to make chages to your medical coverage for items (a)(3), (a)(4), (e)(1), ad chages related to CHIPRA. The chage requested must relate to the chage that affects eligibility for medical coverage. Chages are made by completig a erollmet form, available i the Beefits Office. The completed form must be submitted, with proof of the Qualifyig Evet, to the Beefits Office. Your premiums will the be chaged for the remaider of the caledar year. Coverage will become effective as of the date of the evet. If you do ot make a chage to your medical coverage withi the applicable period idicated above, you must wait util the ext Ope Erollmet Period. If a depedet is o loger eligible for coverage ad you do ot remove that depedet from your coverage withi the applicable period idicated above, your depedet will be removed from your coverage as of the date the Beefits Office is otified. MISCELLANEOUS Base Salary Base Salary for the purpose of the medical programs meas your basic rate of pay, before ay salary reductios. It does ot iclude overtime, bouses, or ay other compesatio. For part-time employees, Base Salary is based o the full-time equivalet basic rate of pay. For uio employees, Base Salary is based o the terms of the uio cotract. Cotiuous Service Cotiuous Service meas service from your most recet hire date. Service performed prior to a break i employmet is ot icluded i Cotiuous Service. Cotiuous Service will be reduced by periods o approved Leave of Absece ad will ot iclude periods whe the employee is ot eligible for medical beefits. Cotiuous Service shall iclude Cotiuous Service, if ay, with Associated Uiversities, Ic., Battelle Memorial Istitute, Research Foudatio of the State Uiversity of New York or the State Uiversity of New York at Stoy Brook immediately prior to a trasfer of employmet to Brookhave Sciece Associates, LLC. 10 BROOKHAVEN NATIONAL L ABOR ATORY

25 beefits: part 1 MEDICAL PLAN Deductible Uder the out-of-etwork portio of the OAP ad the PPO programs, the Deductible is the amout you pay out of your pocket before you receive reimbursemet for covered medical expeses. The Deductible does ot iclude expeses that exceed the Reasoable ad Customary charges. For all participats: The aual Deductible for the OAP program, admiistered by CIGNA, is $500 per idividual ($1500 per family) per caledar year. The aual Deductible for the Vytra PPO program is $2,000 per idividual ($4,000 per family) per caledar year. I geeral: I-etwork OAP ad PPO medical expeses do ot have a Deductible or do they cout toward the Deductible. If three or more members of a family icur total out-of-pocket expeses, durig the caledar year, i excess of the Family Deductible, o further Deductible amouts are required for the etire family durig the remaider of that year. The deductibles idicated above do ot apply to the HMOs. I additio to the above, there is a separate $100 per idividual ($300 per family) aual prescriptio deductible for the OAP ad PPO programs. This applies, i total, to both the retail pharmacy ad mail order portios of the program. Geeral Iformatio Iformatio regardig the pla idetificatio umber, pla year, pla fudig, type of pla, pla sposor, pla admiistrator, aget for legal process, your rights uder ERISA, prudet actios by pla fiduciaries, modificatio, suspesio, or termiatio of the pla, ad privacy of iformatio ca be foud i the Geeral Iformatio sectio of this booklet. Hospital Preadmissio Certificatio Uder the OAP ad PPO programs, all covered participats must obtai Hospital Preadmissio Certificatio. This certificatio is madatory for a hospital stay of oe or more ights. If you are retired or disabled ad covered by Medicare, you are ot required to pre-certify your hospital admissio. If Hospital Preadmissio Certificatio is ot obtaied, a $250 pealty will be applied to the OAP ad PPO programs. I additio, uder the OAP ad PPO programs, beefits for ay days ot approved by the isurace compay will be reduced by 50% of the amout otherwise payable. The expeses that you icur because of these beefit limitatios will ot apply to your Out-Of-Pocket Maximum. For Hospital Preadmissio Certificatio, call the toll free phoe umber provided o your medical idetificatio card before admissio to the hospital or withi 48 hours of a emergecy admissio. Uder the HMOs, you must call the telephoe umber show o your medical idetificatio card to obtai approval for hospital care or the applicable claims will be deied. Leave of Absece If you are o a approved Leave of Absece, icludig for military duty, you may cotiue your medical coverage durig the term of the approved leave from the startig date of your leave by payig the required employee premiums. This coverage will cease whe the employee is o loger o the approved Leave of Absece. Participats o approved military leave may drop medical coverage for themselves while cotiuig to cover their depedets. Cotiuatio of isurace is ot allowed while o leave for other employmet whe (1) the other employer offers coverage or (2) the other employer is a agecy or prime cotractor of the federal govermet that will cover you uder its isurace program. BROOKHAVEN NATIONAL L ABOR ATORY 11

26 beefits: part 1 MEDICAL PLAN If you drop medical coverage while o a approved Leave of Absece, you may eroll agai upo your retur to work i a eligible status. Lifetime Maximum Medical Beefits There is o lifetime maximum amout of medical beefits uder the medical programs. Out-Of-Pocket Maximum Uder the out-of-etwork portio of the OAP ad PPO programs, whe a participat icurs the amout of covered out-of-pocket medical expeses idicated below, i additio to the Idividual Deductible, medical expeses for that perso will be reimbursed at 100% of the R&C amout for the remaider of the caledar year. I-etwork OAP ad PPO expeses do ot cout toward the out-of-pocket maximum. CIGNA OAP Vytra PPO Aual Caledar Year Out-Of-Pocket Maximum Idividual Family $2500 $7500 $5000 $10000 Aeta HMO $1500 $3000 HIP HMO Not Applicable Not Applicable Participats Receivig Log Term Disability Pla Beefits Participats who are receivig BSA LTD Pla beefits may cotiue medical coverage for themselves ad their eligible depedet(s) by payig the required premiums. Curretly, for participats whose eligibility date to receive LTD Pla beefits was prior to Jauary 1, 2009, o premium is required to cotiue this coverage. For participats who were ot members of the IBEW uio whose eligibility date to receive LTD Pla beefits was after December 31, 2008, coverage may be cotiued by payig the active employee premium. This coverage will cease whe the employee is o loger eligible to receive LTD Pla beefits. If the participat is the eligible for retiree medical beefits, the participat may cotiue medical coverage by payig the required retiree premiums. For participats who were members of the IBEW uio whose eligibility date to receive LTD pla beefits was after December 31, 2008, o premium is required to cotiue this coverage. Qualified Medical Child Support Order Iformatio o the admiistratio of a qualified medical child support order ca be obtaied at o charge from the Beefits Office. Reasoable ad Customary (R&C) Uder the OAP ad PPO programs, a charge is cosidered Reasoable ad Customary if it is the ormal charge made by the provider for a similar service or supply ad it does ot exceed the ormal charge made by most providers of such service or supply i the geographic area where the service is received, as determied by the isurace compay. Secod Surgical Opiio Secod surgical opiios are based o the terms of each program. You must call the telephoe umber show o your medical idetificatio card to obtai the procedures for a secod surgical opiio. 12 BROOKHAVEN NATIONAL L ABOR ATORY

27 beefits: part 1 MEDICAL PLAN Termiatio of Coverage Medical coverage for active employees, ad their depedets uder the Medical Pla will cease o the earlier of the date your employmet termiates, the date you elect to drop such coverage, the date you are o loger eligible for coverage, or whe you fail to pay the required premiums. Coverage for termiated employees, who cotiue beefits uder COBRA, will cease o the earlier of the date you elect to drop such coverage, the date you are o loger eligible for coverage, or whe you fail to pay the required premiums. Medical coverage for retirees ad their depedets ad participats receivig LTD Pla beefits will cease o the earlier of the date you elect to drop such coverage, the date you are o loger eligible for coverage, or whe you fail to pay the required premiums. Depedet coverage will also cease whe the depedet becomes ieligible. Coverage for your spouse also ceases due to divorce or legal separatio from you. Coverage for your depedet childre also ceases whe the child o loger meets the eligibility requiremets of this pla. COBRA The right to COBRA cotiuatio coverage was created by a federal law, the Cosolidated Omibus Budget Recociliatio Act of 1985 (COBRA). COBRA cotiuatio coverage ca become available to you whe you would otherwise lose your group health coverage. It ca also become available to other members of your family who are covered uder the Pla whe they would otherwise lose their group health coverage. What is COBRA Cotiuatio Coverage? COBRA cotiuatio coverage is a cotiuatio of Pla coverage whe coverage would otherwise ed because of a life evet kow as a qualifyig evet. Specific qualifyig evets are listed previously i this otice. After a qualifyig evet, COBRA cotiuatio coverage must be offered to each perso who is a qualified beeficiary. You, your spouse, ad your depedet childre could become qualified beeficiaries if coverage uder the Pla is lost because of the qualifyig evet. Uder the Pla, qualified beeficiaries who elect COBRA cotiuatio coverage must pay for COBRA cotiuatio coverage. If you are a employee, you will become a qualified beeficiary if you lose your coverage uder the Pla because either oe of the followig qualifyig evets happes: Your hours of employmet are reduced, or Your employmet eds for ay reaso other tha your gross miscoduct. If you are the spouse of a employee, you will become a qualified beeficiary if you lose your coverage uder the Pla because ay of the followig qualifyig evets happes: Your spouse dies; Your spouse s hours of employmet are reduced; Your spouse s employmet eds for ay reaso other tha his or her gross miscoduct; Your spouse becomes etitled to Medicare beefits (uder Part A, Part B, or both); or You become divorced or legally separated from your spouse. Your depedet childre will become qualified beeficiaries if they lose coverage uder the Pla because ay of the followig qualifyig evets happes: The paret-employee dies; The paret-employee s hours of employmet are reduced; The paret-employee s employmet eds for ay reaso other tha his or her gross miscoduct; The paret-employee becomes etitled to Medicare beefits (Part A, Part B, or both); The parets become divorced or legally separated; or The child stops beig eligible for coverage uder the pla as a depedet child. BROOKHAVEN NATIONAL L ABOR ATORY 13

28 beefits: part 1 MEDICAL PLAN Whe is COBRA Coverage Available? The Pla will offer COBRA cotiuatio coverage to qualified beeficiaries oly after the Beefits Office has bee otified that a qualifyig evet has occurred. Whe the qualifyig evet is the ed of employmet or reductio of hours of employmet, death of the employee, commecemet of a proceedig i bakruptcy with respect to the employer, or the employee s becomig etitled to Medicare beefits (uder Part A, Part B, or both), the employer must otify the Beefits Office of the qualifyig evet. Notificatio Requiremets For the other qualifyig evets (divorce or legal separatio of the employee ad spouse or a depedet child s losig eligibility for coverage as a depedet child), you must otify the Beefits Office i writig withi 60 days after the qualifyig evet occurs ad provide documetatio of the evet. Whe the Beefits Office has bee otified that oe of these evets has occurred, they will i tur otify you ad your depedets of the right to elect cotiuatio coverage. If you do ot elect cotiuatio coverage withi 60 days from the date of the otice from the Beefits Office or the date of the qualifyig evet, whichever is later. Your group medical isurace coverage will ed retroactively to the date of the evet that caused the loss of coverage. If you elect cotiuatio coverage, you will have the same medical coverage you had before the evet, although it may be modified if coverage chages for similarly situated participats. How is COBRA Coverage Provided? Oce the Beefits Office receives otice that a qualifyig evet has occurred, COBRA cotiuatio coverage will be offered to each of the qualified beeficiaries. Each qualified beeficiary will have a idepedet right to elect COBRA cotiuatio coverage. Covered employees may elect COBRA cotiuatio coverage o behalf of their spouses, ad parets may elect COBRA cotiuatio coverage o behalf of their childre. COBRA cotiuatio coverage is a temporary cotiuatio of coverage. Whe the qualifyig evet is the death of the employee, the employee s becomig etitled to Medicare beefits (uder Part A, Part B, or both), your divorce or legal separatio, or a depedet child s losig eligibility as a depedet child, COBRA cotiuatio coverage lasts for up to a total of 36 moths. Whe the qualifyig evet is the ed of employmet or reductio of the employee s hours of employmet, ad the employee became etitled to Medicare beefits less tha 18 moths before the qualifyig evet, COBRA cotiuatio coverage for qualified beeficiaries other tha the employee lasts util 36 moths after the date of Medicare etitlemet. For example, if a covered employee becomes etitled to Medicare 8 moths before the date o which his employmet termiates, COBRA cotiuatio coverage for his spouse ad childre ca last up to 36 moths after the date of Medicare etitlemet, which is equal to 28 moths after the date of the qualifyig evet (36 moths mius 8 moths). Otherwise, whe the qualifyig evet is the ed of employmet or reductio of the employee s hours of employmet, COBRA cotiuatio coverage geerally lasts for oly up to a total of 18 moths. There are two ways i which this 18-moth period of COBRA cotiuatio coverage ca be exteded. Disability extesio of 18-moth period of cotiuatio coverage If you or ayoe i your family covered uder the Pla is determied by the Social Security Admiistratio to be disabled ad you otify the Beefits Office i a timely maer, you ad your etire family may be etitled to receive up to a additioal 11 moths of COBRA cotiuatio coverage, for a total maximum of 29 moths. The disability would have to have started at some time before the 60th day of COBRA cotiuatio coverage ad must last at least util the ed of the 18-moth period of cotiuatio coverage. You must otify the Beefits Office withi 60 days after the qualifyig evet occurs ad provide documetatio of the evet. 14 BROOKHAVEN NATIONAL L ABOR ATORY

29 beefits: part 1 MEDICAL PLAN Secod qualifyig evet extesio of 18-moth period of cotiuatio coverage If your family experieces aother qualifyig evet while receivig 18 moths of COBRA cotiuatio coverage, the spouse ad depedet childre i your family ca get up to 18 additioal moths of COBRA cotiuatio coverage, for a maximum of 36 moths, if otice of the secod qualifyig evet is properly give to the Pla. This extesio may be available to the spouse ad ay depedet childre receivig cotiuatio coverage if the employee or former employee dies, becomes etitled to Medicare beefits (uder Part A, Part B, or both), or gets divorced or legally separated, or if the depedet child stops beig eligible uder the Pla as a depedet child, but oly if the evet would have caused the spouse or depedet child to lose coverage uder the Pla had the first qualifyig evet ot occurred. COBRA Premium Requiremets You, or your depedets, will be required to pay 102% of the full cost of the cotiuatio coverage uder the provisios of COBRA. You will be billed for the required premium o a regular basis. COBRA premiums are idicated at the ed of the Medical Pla sectio. Termiatio of Coverage Uder COBRA Cotiuatio coverage will ed whe ay of the followig evets occur: The Beefits Office is otified by you or your depedet to discotiue coverage. 18 moths after cotiuatio coverage begis (if coverage was cotiued due to termiatio or resigatio of the employee). 29 moths after cotiuatio coverage begis (if coverage was cotiued due to disability). 36 moths after cotiuatio coverage begis (if coverage was cotiued because of death of the employee, divorce, legal separatio or loss of depedet status). The idividual becomes eligible for Medicare after the date of the COBRA electio. A idividual becomes covered uder aother group pla, uless a pre-existig coditio prevets you or your depedet from beig covered by the other pla. For a spouse or depedet child: If the Beefits Office is ot otified withi 31 days of the date of divorce or legal separatio. For a depedet child: If the Beefits Office is ot otified withi 31 days of the date the depedet status eds. Paymet for cotiuatio coverage is ot paid o time. The group health care pla is termiated for active employees. CONVERSION You or your depedets may be etitled to covert your medical coverage to a idividual policy if (a) you were isured uder the OAP program, for the three moths immediately prior to whe coverage ceased, (b) coverage ceased because you were o loger i active employmet or o loger eligible for Medicare, or (c) coverage ceased due to ieligibility. You are ot eligible for a coverted policy if isurace uder this pla is replaced by similar coverage withi 45 days. If you qualify for coversio, o medical examiatio will be required, but you must apply i writig ad pay the premium for the coverage to the isurace compay withi 45 days from the date your group medical isurace coverage ceased. The ecessary applicatio forms are available directly from the isurace compay. ERISA Refer to the Geeral Iformatio sectio of this booklet for iformatio regardig your rights uder the Employee Retiremet Icome Security Act of 1974 (ERISA). BROOKHAVEN NATIONAL L ABOR ATORY 15

30 beefits: part 1 MEDICAL PLAN For mothly paid employees: EMPLOYEE PREMIUMS (JANUARY 1, 2011) Mothly Cotributio Coverage Aual Base Salary* Medical Pla Employee Oly Employee + 1 Depedet Employee + 2 or More Depedets $0 - $39, $40,000 - $69, $70,000 - $99, $100,000 ad over Aeta $73.33 $ $ CIGNA $74.72 $ $ HIP $54.80 $ $ Vytra $51.17 $ $ Aeta $ $ $ CIGNA $ $ $ HIP $82.20 $ $ Vytra $76.75 $ $ Aeta $ $ $ CIGNA $ $ $ HIP $ $ $ Vytra $97.22 $ $ Aeta $ $ $ CIGNA $ $ $ HIP $ $ $ Vytra $ $ $ For weekly paid employees: Aual Base Salary* $0 - $39, $40,000 - $69, $70,000 - $99, $100,000 ad over Medical Pla Weekly Cotributio Coverage Employee Oly Employee + 1 Depedet Employee + 2 or More Depedets Aeta $16.92 $40.31 $55.72 CIGNA $17.24 $36.38 $49.94 HIP $12.65 $23.14 $36.76 Vytra $11.81 $24.01 $34.13 Aeta $25.38 $60.47 $83.58 CIGNA $25.86 $54.56 $74.92 HIP $18.97 $34.71 $55.14 Vytra $17.71 $36.01 $51.20 Aeta $32.15 $76.59 $ CIGNA $32.76 $69.11 $94.90 HIP $24.03 $43.97 $69.84 Vytra $22.44 $45.61 $64.85 Aeta $40.61 $96.74 $ CIGNA $41.38 $87.30 $ HIP $30.35 $55.54 $88.22 Vytra $28.34 $57.61 $81.92 For medical pla participats who are ot members of the IBEW uio ad whose eligibility date to receive BSA Log Term Disability Pla beefits was after December 31, 2008: Premium: Employee Premium idicated above For medical pla participats whose eligibilty date to receive BSA Log Term Disability Pla beefits was prior to Jauary 1, 2009 or for participats who were members of the IBEW uio: Premium: $0.00 *The Base Salary category for eligible part-time employees is based o their full-time equivalet salary. These premiums are subject to chage. 16 BROOKHAVEN NATIONAL L ABOR ATORY

31 beefits: part 1 MEDICAL PLAN Retiremet Date RETIREE PREMIUMS FOR PARTICIPANTS WHO WERE NOT IN THE IBEW UNION (Jauary 1, 2011) Mothly Premium Medicare- Eligible Medical Pla(s) Aual Base Salary* Coverage Oe Perso 2 People 3 or More People Prior to 10/1/95 N/A Aeta CIGNA HIP N/A $0.00 $0.00 $0.00 HIP VIP Vytra Aeta Less tha $30,000 $10.29 $15.71 $ /1/95-9/30/96 No CIGNA $30,000 - $39, $14.63 $21.67 $29.25 HIP $40,000 - $59, $18.96 $28.17 $37.92 Vytra $60,000 ad over $24.97 $37.48 $ /1/95 12/31/01 Yes CIGNA HIP VIP N/A $0.00 $0.00 $0.00 Aeta Less tha $30,000 $20.58 $31.42 $ /1/96 12/31/01 No CIGNA $30,000 - $39, $29.25 $43.33 $58.50 HIP $40,000 - $59, $37.92 $56.33 $75.83 Vytra $60,000 ad over $49.93 $74.95 $ /1/02 or later Yes CIGNA N/A $83.12 $ $ HIP VIP (Suffolk) N/A $85.01 $ Aeta N/A $ $ $ /1/02 or later No CIGNA N/A $ $ $ HIP N/A $ $ $ Vytra N/A $ $ $ *The Base Salary category is based o your full-time equivalet salary o the day immediately precedig your retiremet. If you retired from log term disability status, the Base Salary category is based o your full-time equivalet salary o the day immediately precedig your termiatio of employmet. Your retiremet date is determied to be the date LTD Pla beefits cease. These premiums are subject to chage. BROOKHAVEN NATIONAL L ABOR ATORY 17

32 beefits: part 1 MEDICAL PLAN Retiremet Date RETIREE PREMIUMS FOR PARTICIPANTS WHO WERE IN THE IBEW UNION (Jauary 1, 2011) Mothly Premium Medicare- Eligible Medical Pla(s) Aual Base Salary* Coverage Oe Perso 2 People 3 or More People Prior to 10/1/95 N/A Aeta CIGNA HIP HIP VIP Vytra N/A $0.00 $0.00 $0.00 Aeta Less tha $30,000 $10.29 $15.71 $ /1/95-9/30/96 No CIGNA $30,000 - $39, $14.63 $21.67 $29.25 HIP $40,000 - $59, $18.96 $28.17 $37.92 Vytra $60,000 ad over $24.97 $37.48 $ /1/95 7/31/06 Yes CIGNA HIP VIP N/A $0.00 $0.00 $0.00 Aeta Less tha $30,000 $20.58 $31.42 $ /1/96 7/31/00 No CIGNA $30,000 - $39, $29.25 $43.33 $58.50 HIP $40,000 - $59, $37.92 $56.33 $75.83 Vytra $60,000 ad over $49.93 $74.95 $99.94 Aeta Less tha $30,000 $22.64 $34.56 $ /1/00 12/31/03 No CIGNA $30,000 - $39, $32.18 $47.66 $64.35 HIP $40,000 - $59, $41.71 $61.96 $83.41 Vytra $60,000 ad over $54.92 $82.45 $ /1/04 7/31/06 No Aeta CIGNA HIP Vytra Actual Mothly Base Salary* 3% of Mothly Base Salary* 3.5% of Mothly Base Salary* 4% of Mothly Base Salary* 8/1/06 or later Yes CIGNA $83.12 $ $ N/A HIP VIP (Suffolk) $85.01 $ Aeta $ $ $ /1/06 or later No CIGNA $ $ $ N/A HIP $ $ $ Vytra $ $ $ *The Base Salary category is based o your full-time equivalet salary o the day immediately precedig your retiremet. If you retired from log term disability status, the Base Salary category is based o your full-time equivalet salary o the day immediately precedig your termiatio of employmet. Your retiremet date is determied to be the date LTD Pla beefits cease. These premiums are subject to chage. 18 BROOKHAVEN NATIONAL L ABOR ATORY

33 beefits: part 1 MEDICAL PLAN DWHBP PREMIUMS Durig 1st year followig termiatio of employmet Durig 2d year followig termiatio of employmet see Employee Premiums oe-half of COBRA Premiums These premiums are subject to chage. COBRA PREMIUMS (Jauary 1, 2011) Mothly Premium Coverage Medical Pla Oe Perso 2 People 3 or More People Aeta $ $1, $2, CIGNA $ $1, $2, CIGNA for Medicare-Eligible Participats $ $ HIP $ $ $1, HIP VIP (Suffolk) for Medicare-Eligible Participats $ $ Vytra $ $ $1, These premiums are subject to chage. BROOKHAVEN NATIONAL L ABOR ATORY 19

34 beefits: part 1 MEDICAL PLAN All Employees No-Medicare-Eligible Retirees No-Medicare-Eligible Participats o LTD For Employees Medical Care Provider Participatig physicia/facility CIGNA Aeta Vytra HIP I-Network Out-of-Network I-Network Oly I-Network Out-of-Network I-Network Oly Ay physicia/facility Participatig physicia/facility Participatig physicia/facility Ay physicia/facility Participatig physicia/facility Paymet of Beefits No claim forms Submit claim forms No claim forms No claim forms Submit claim forms No claim forms Age Limit for Depedet Childre Up to 26th birthday Up to 26th birthday Up to 26th birthday Up to 26th birthday Aual Deductible (Idividual/Family) N/A $500/$1500 N/A N/A $2000/$4000 N/A Aual Out-of-Pocket Maximum N/A $2500/$7500 $1500/$3000 N/A $5000/$10000 N/A (Idiv/Family) (Excl. Deductible) Lifetime Maximum Beefit Ulimited Ulimited Ulimited Ulimited Pre-Existig Coditio Limitatio N/A N/A N/A N/A Office Visits Covered i full after 80% of R&C after deductible Covered i full after Covered i full after 70% of R&C after Covered i full after deductible Emergecy Room (Accidet/Illess) Ipatiet Hospital (Semi-Private Room, Board, Services, Supplies) No-emergecy: 80% of R&C after deductible Covered i full after $50 copay $20 co-pay PCP $20 co-pay PCP $20 co-pay PCP $20 co-pay PCP $30 co-pay Specialist $25 co-pay Specialist $30 co-pay Specialist $30 co-pay Specialist Covered i full Emergecy: Covered i full Covered i full after $50 copay (waived if admitted) (waived if admitted) Covered i full Covered i full 70% of R&C after deductible (Physicia/Surgeo) Covered i full 80% of R&C after deductible Covered i full Covered i full 70% of R&C after deductible Secod Surgical Opiio (Office Visit) Covered i full 100% of R&C Covered i full after $25 copay Laboratory/X-Ray Covered i full 80% of R&C after deductible Lab: Covered i full Covered i full X-ray: Covered i full after $25 co-pay Materity (Iitial Visit To Determie Pregacy) Covered i full after $20 co-pay 80% of R&C after deductible Covered i full after $20 copay Covered i full Covered i full Covered i full 100% of R&C Covered i full Covered i full after $20 co-pay 70% of R&C after deductible (Subsequet Visits/Delivery) Covered i full 80% of R&C after deductible Covered i full Covered i full 70% of R&C after deductible Covered i full after $20 copay Covered i full Prescriptio Medicatio $10 geeric Use i-etwork beefit $10 geeric Admiistered by Ciga $15 geeric $20 brad ame formulary $30 brad ame formulary (Retail) $25 brad ame formulary (Mail Order) $40 brad ame oformularformularformulary $40 brad ame o- $50 brad ame o- (up to 30-day supply) (up to 30-day supply) (up to 30-day supply) after deductible* $20 geeric Use i-etwork beefit $20 geeric Admiistered by Ciga $22.50 geeric $40 brad ame formulary $45 brad ame formulary $50 brad ame formulary Covered i full Pre-admissio certificatio required or $250 pealty plus 50% reductio i beefits o ay days ot approved. $80 brad ame oformulary (up to 90-day supply) after deductible* * after meetig a $100 per perso/$300 per family aual drug deductible MEDICAL PROGRAMS Emergecy: Covered i full after $50 co-pay (waived if admitted) No-emergecy: oly covered out of etwork: 70% of R&C after deductible Pre-admissio certificatio required or $250 pealty plus 50% reductio i beefits o ay days ot approved. 70% of R&C after deductible (see CIGNA colum for prescriptio drug beefits coverage) (see CIGNA colum for prescriptio drug beefits coverage) $80 brad ame oformularformulary $150 brad ame o- (31 to 90-day supply) (up to 90-day supply) PCP = Primary Care Physicia R&C = Reasoable & Customary 36 Covered i full after $20 copay 20 BROOKHAVEN NATIONAL L ABOR ATORY

35 beefits: part 1 MEDICAL PLAN Medicare-Eligible Retirees Medicare-Eligible Participats o LTD MEDICAL PROGRAMS Prevetive Care Metal Health Care (Ipatiet) Same as ipatiet hospital Covered i full Same as ipatiet hospital Covered i full (Outpatiet) Covered i full after $20 co-pay 80% of R&C after deductible Covered i full after $20 copay Covered i full after $30 co-pay 70% of R&C after deductible Substace Abuse Treatmet (Ipatiet Detox) Same as ipatiet hospital Covered i full Same as ipatiet hospital Covered i full (Outpatiet Rehab) Covered i full after $20 co-pay The Patiet Protectio ad Affordable Care Act requires that certai, but ot all, prevetive care services be covered at 100% with o deductible, coisurace or copay. Such prevetive services will be defied by agecies ad committees idetified by the govermet ad may be subject to chage. Not all prevetive care services are icluded i this madate. 80% of R&C after deductible Covered i full after $20 copay Covered i full after $30 co-pay 70% of R&C after deductible Covered i full after $25 copay Covered i full after $25 copay Alterate Care (Home Health Care) Covered i full 80% of R&C after Covered i full after $20 Covered i full 70% of R&C after Covered i full deductible co-pay deductible (Max: 40 visits/year combied i ad out of etwork) (Max: 3 itermittet (Max: 40 visits/year combied i ad out of (Max: 200 visits/year) visits/day) etwork) (Skilled Nursig Facility No-Custodial) Same as ipatiet hospital Covered i full Same as ipatiet hospital Covered i full (Max: 60 days/year combied i ad out of etwork) (Max: 45 days/year combied i ad out of etwork) (Outpatiet Short-Term Rehab: Physical Therapy) Covered i full after $30 co-pay 80% of R&C after deductible Covered i full after $25 copay (Max: 60 cosecutive days/ijury/lifetime) Covered i full after $30 co-pay 70% of R&C after deductible Durable Medical Equipmet Covered i full 80% of R&C after deductible Covered i full Covered i full 70% of R&C after deductible Exteral Prosthetic Devices Covered i full 80% of R&C after deductible Covered i full for iitial device oly Covered i full 70% of R&C after deductible Visio Care** (Routie Eye Exam) Not covered Covered i full Covered i full after $30 co-pay (age/frequecy schedule may apply) (Hardware) 1 pair of glasses followig cataract surgery Coverage available. Based o fee schedule. (Max: 60 cosecutive days/ijury/ lifetime combied i ad out of etwork) Covered i full after $30 copay (Max: 90 visits/year) Covered i full Covered i full Not covered Covered i full for optometrist i discout program (1 exam per year) (1 exam every 24 moths) Coverage available. Based o fee schedule. Not covered Coverage available. Based o fee schedule. Hearig Aids Covered i full 80% of R&C after deductible Not covered Not covered Not covered Not covered (Max: $2000/ 1095 days) ** Also available to all employees is a visio discout program through Natioal Visio, Ic located at the Walmart i Middle Islad, NY. PCP = Primary Care Physicia R&C = Reasoable & Customary 37 BROOKHAVEN NATIONAL L ABOR ATORY 21

36 beefits: part 1 MEDICAL PLAN For Medicare-eligible retirees For Medicare-eligible participats o log term disability CIGNA HIP VIP I-Network Out-of-Network I-Network Oly Medical Care Provider Participatig physicia/facility Ay physicia/facility Participatig physicia/facility Paymet of Beefits No claim forms Submit claim forms No claim forms Age Limit for Depedet Childre Up to 26th birthday Up to 26th birthday Aual Deductible (Idividual/Family) N/A $500/$1500 N/A Aual Out-of-Pocket Maximum (Idiv/Family) (Excl. N/A $2500/$7500 N/A Deductible) Lifetime Maximum Beefit Ulimited Ulimited Pre-Existig Coditio Limitatio N/A N/A Office Visits Covered i full after 80% of R&C after deductible Covered i full for PCP Emergecy Room (Accidet/Illess) MEDICAL PROGRAMS $20 co-pay PCP $10 co-pay Specialist $30 co-pay Specialist Covered i full Emergecy: Covered i full Covered i full after $50 co-pay (waived if admitted) Ipatiet Hospital (Semi-Private Room, Board, Services, Supplies) Covered i full No-emergecy: 80% of R&C after deductible Pre-admissio certificatio required or $250 pealty plus 50% reductio i beefits o ay days ot approved. (Doctors/Specialits: $10 co-pay) Covered i full (Physicia/Surgeo) Covered i full 80% of R&C after deductible Covered i full Secod Surgical Opiio (Office Visit) Covered i full 100% of R&C Covered i full Laboratory/X-Ray Covered i full 80% of R&C after deductible Covered i full after $20 co-pay Prescriptio Medicatio $10 geeric Use i-etwork beefit $5 formulary (Retail) $25 brad ame formulary $45 o-formulary $40 brad ame o-formulary (up to 30-day supply) (up to 30-day supply) after deductible* (Mail Order) $20 geeric Use i-etwork beefit $7.50 formulary $50 brad ame formulary $135 o-formulary $80 brad ame o-formulary (up to 90-day supply) (up to 90-day supply) after deductible* * after meetig a $100 per perso/$300 per family aual drug deductible BROOKHAVEN NATIONAL L ABOR ATORY

37 beefits: part 2 DENTAL PLAN part 2 DENTAL PLAN The Detal Pla provides beefits for prevetive, diagostic, restorative, ad orthodotic detal services. Erollmet i the Detal Pla is optioal. WHO IS ELIGIBLE FOR THE DENTAL PLAN? Active Employees All regular employees who work at least 20 hours per week are eligible to participate i the group Detal Pla o the first day of active employmet. Eligible Depedets The followig members of your family are also eligible for Medical Pla coverage: Your spouse, defied as the perso of the opposite sex to whom you are legally married. Your eligible same-sex domestic parter ad that parter s eligible child(re). To be eligible, you must provide a copy of your marriage certificate, domestic parter registry or proof of fiacial iterdepedece. Additioal iformatio is available at Beefits/DomesticParters.asp Childre of your eligible domestic parter must meet the criteria for childre idicated below. Your umarried childre up to 19 years of age, icludig adopted childre ad stepchildre who are depedet upo you for support. Stepchildre must reside with you to be eligible for coverage. A umarried child is cosidered to be eligible for depedet coverage up to his or her 19th birthday. Your umarried childre who are metally or physically icapable of earig their ow livig may be cotiued beyod age 19 if, withi 31 days after they have reached age 19, you submit proof of the child s icapacity. Coverage may be cotiued for depedets who are over age 19 ad who become metally or physically icapable of earig their ow livig while covered as a eligible depedet, by submittig proof of the child s icapacity withi 31 days after they become icapacitated. Your umarried childre age 19 ad over who meet the followig criteria: The depedet child must be the taxpayer s child, icludig adopted child or stepchild. The depedet child must have the same pricipal residece as the taxpayer for more tha oe-half of the tax year. Childre who are away at school will ot be excluded by this criterio as log as whe they re ot at school, they are livig with you. Childre of parets who are divorced will ot be excluded as log as they are livig with oe of the parets for at least oe-half of the tax year. Please ote that stepchildre must reside with you to be eligible. The depedet child must ot provide more tha oe-half of his or her ow support. For a depedet child who is age 19 or over to be eligible for coverage, he or she must atted a accredited college or uiversity o a full-time basis ad also meet the criteria idicated above.you must provide proof of full-time studet status withi 31 days of the begiig of each school sememster. BROOKHAVEN NATIONAL L ABOR ATORY 1

38 beefits: part 2 DENTAL PLAN Coverage for such umarried childre will ed o the earlier of (a) the ed of the year of attaimet of age 23 or (b) whe they o loger meet the criteria idicated above. If they are o loger eligible for coverage because they are o loger attedig a accredited college or uiversity o a full-time basis, coverage will ed as follows: Depedet coverage eds as of the ed of the moth i which he or she is o loger a full-time studet. Based o the provisios of Michelle s Law, a depedet child who is covered uder a group health isurace pla who (1) is erolled i a post-secodary educatioal istitutio ad (2) eeds to take a medically ecessary leave of absece o accout of a serious illess or ijury from which the child is sufferig may be eligible to retai his/her health care coverage while o the medically ecessary leave of absece. To qualify for the extesio of coverage: the child must be erolled as a eligible depedet uder a BSA health care pla, the child must be a full-time studet at a accredited college or uiversity immediately before the first day of the medically ecessary leave of absece, proof of the leave from the educatioal istitutio must be provided to the Beefits Office, ad the child s treatig physicia must provide certificatio that the child is sufferig from a serious illess or ijury that ecessitates the leave of absece. Such coverage ca cotiue util the earlier of: oe year from the start of the medically ecessary leave of absece or the date o which such coverage would otherwise be termiated uder the terms of the health pla. I order to be eligible for such beefits, provide proof of the leave from the educatioal istitutio ad proof of the serious illess from the child s physicia to the Beefits Office, Bldg. 400B, withi 31 days of the begiig of the medically ecessary leave. If a depedet is o loger eligible for coverage ad you do ot remove that depedet from your coverage withi the applicable period idicated i the Qualifyig Evet sectio, your depedet will be removed from your coverage as of the date the Beefits Office is otified. ENROLLMENT Eligible employees may eroll i oe of the detal programs withi 30 days of their date of hire. Oce you eroll, you must cotiue participatio i the program util the ed of the caledar year or your termiatio date of employmet, if earlier. If you do ot eroll for coverage withi 30 days of your date of hire, you will be required to wait util the ext Ope Erollmet Period or whe you have a Qualifyig Evet to elect coverage. To eroll, you must complete a erollmet form ad list all depedets you wat covered. Erollmet forms are available through the Beefits Office. By completig the form, you will authorize the ecessary payroll premiums for the coverage you select. The coverages available are: Employee oly. Employee ad oe depedet. Employee ad two or more depedets. You caot eroll your eligible depedets without also erollig yourself for detal coverage or ca you eroll them i a differet detal program tha the oe you select for yourself. Coverage begis o your date of hire if you complete all erollmet forms ad submit them to the Beefits Office withi 30 days of your date of hire. 2 BROOKHAVEN NATIONAL L ABOR ATORY

39 beefits: part 2 DENTAL PLAN DENTAL PROGRAMS AVAILABLE Eligible employees ad their depedets may eroll i the Delta Detal Idemity Pla, the Delta Detal DMO Pla (DeltaCare USA), or the Delta Detal PPO Pla. DELTA DENTAL INDEMNITY PLAN The Delta Detal Idemity Pla allows you to use ay detist to care for you ad your family. It is a fee-for-service pla ad provides reimbursemet for a portio of the cost of covered detal services based o a schedule. Beefits Provided The Delta Detal Idemity Pla pays a combied maximum of $1,000 i beefits per caledar year for each covered idividual for prevetive ad diagostic services plus basic ad major detal services. The maximum lifetime beefit for covered orthodotic services is $1,000 per eligible child. Schedule of Maximum Allowable Covered Detal Expeses The maximum allowable amouts specified i the followig schedule are ot iteded to represet what your detist s charges will be or should be. These are the maximum reimbursemet amouts for specified detal services. The claims admiistrator will pay beefits for detal services that are covered by the pla but ot listed below. The claims admiistrator will determie beefits o the basis of the complexity ad severity of the type of service i a amout cosistet with the maximum allowace specified for other detal services. Limitatios may apply. The schedule of beefits is at the ed of the Detal sectio. Coverage iformatio idicated is ot all iclusive. Coordiatio of Beefits Coverage Uder Other Employers Plas If you or your covered depedets are eligible to receive beefits uder aother group detal pla, the beefits from that pla will be coordiated with the beefits from the Delta Detal Idemity Pla so that up to 100% of the allowable expeses icurred durig a caledar year will be paid joitly by the plas. A allowable expese is ay ecessary, reasoable, ad customary expese covered i full or i part uder ay oe of the group plas ivolved. I the case of depedet childre who are covered by more tha oe group pla, the isurace pla of the paret whose birthday occurs earlier i the caledar year will be the primary isurace pla for the childre. To obtai all the beefits available, you ad your family members must file claims uder each pla. Claims How to File a Claim You have the followig optios to file a claim uder the Delta Detal Idemity Pla. Your detist ca submit the claim electroically or Sed a claim form to: Delta Detal of New York, Ic. P.O. Box 2105 Mechaicsburg, PA Claim forms are available i the Beefits Office or o the Web at: likablefiles/deltaclmfrm.pdf. BROOKHAVEN NATIONAL L ABOR ATORY 3

40 beefits: part 2 DENTAL PLAN Questios About Claims If you have a questio about your Delta Detal Idemity Pla claim, you should cotact the claims admiistrator at Delta Detal at (800) Whe discussig your claim, please refer to the explaatio of beefits, the claim form, ad ay other correspodece that you may have received. How to Appeal a Claim Your explaatio of beefits will idetify if a claim is deied ad the reaso for the deial. You may request a review of the deied claim i writig to Delta Detal at Oe Delta Drive, Mechaicsburg, PA withi 180 days of the date of the otice of deial. You should state the reasos why you feel your claim should ot have bee deied, icludig ay additioal documets which you believe support your claim. I ormal cases, a decisio will be redered withi 30 days of the date your request for review is received. Phoe Number Delta Detal: (800) DELTA DENTAL DMO PLAN (DELTACARE USA) The Delta Detal DMO Pla (DeltaCare USA) provides services through a etwork of participatig detists. It is a detal maiteace orgaizatio, DMO, ad services are based o a fee schedule. If you choose to participate i this pla, you must select a participatig detist. You may select differet participatig detists for you ad your depedets. By cotactig Delta Detal, you may chage participatig detists as of the first day of the moth after you request the chage provided the request is made by the 21st of the moth. Coverage is ot provided for providers who are ot i the Delta Detal DMO (DeltaCare USA) etwork. If you require the care of a detal specialist, your participatig detist must give you a referral to a specialist i Delta Detal s DMO (DeltaCare USA) etwork. Beefits Provided The Delta Detal DMO Pla (DeltaCare USA) provides coverage for prevetive, basic ad restorative detal services, ad orthodotia for both adults ad childre. The schedule of beefits is at the ed of the Detal Sectio. Please ote that the cost of detal services is subject to chage ad is based o provisios of the Delta Detal DMO Pla (DeltaCare USA) at the time the service is provided. The cost of other detal services covered by the Delta Detal DMO Pla (DeltaCare USA) are icluded i the Delta Detal Care patiet charge schedule which ca be obtaied at o cost through the Beefits Office or directly from Delta. Emergecy Services Delta Detal will pay for up to $100 i detal expeses for each emergecy if (1) the eed for treatmet occurs at least 35 miles from the participat s cotracted detist s facility or (2) the participat is uable to cotact the desigated participatig detist. You are resposible for the copaymet(s) as well as ay charges over the $100. Emergecy is limited to palliative treatmet for the elimiatio of detal pai. Further treatmet must be obtaied from the assiged cotract detist. Specialty Referrals Whe specialized detal care services are required, your desigated participatig detist must iitiate the referral process ad refer you to a specialist i Delta Detal s DMO (DeltaCare) etwork. 4 BROOKHAVEN NATIONAL L ABOR ATORY

41 beefits: part 2 DENTAL PLAN Coordiatio of Beefits If you or ay of your covered depedets are eligible to receive beefits uder aother group detal pla, beefits from that pla will be coordiated with the beefits from the Delta Detal DMO Pla (DeltaCare USA). How to File a Claim There are o claim forms to file uder the Delta Detal DMO Pla (DeltaCare USA). You just pay the detist the scheduled fee. Questios About Claims If you have ay questios about costs or procedures uder the Delta Detal DMO Pla (DeltaCare USA), you should cotact Delta Detal at (800) How to Appeal a Claim You may request a review of the deied claim i writig to DeltaCare, Quality Maagemet Dept., P. O. Box 6050, Artesia, CA or by telephoe to the Delta Detal DMO Pla (DeltaCare USA). You should state the reasos why you feel your claim should ot have bee deied. I ormal cases, the isurace compay will reder a decisio withi 30 days of the date your request for review is received. Phoe Number Delta Detal DMO Pla (DeltaCare USA): (800) Provider Directory Provider directories are available o the Web at: DELTA DENTAL PPO PLAN Uder the Delta Detal PPO Pla, services are provided through a etwork of participatig detists, but beefits are also provided for use of providers who are ot i the etwork. You do ot eed to eroll with a specific detist to receive coverage uder this pla. I-etwork beefits are provided if you use a provider i Delta s detal PPO or Premier etwork. Out-of-etwork beefits are provided if you use a provider who is ot i Delta s detal PPO or Premier etwork. The pla is a preferred provider orgaizatio, PPO, ad provides reimbursemet for a portio of the cost of covered detal services based o a schedule. To receive reimbursemet of covered expeses you or your provider must submit a claim. Beefits Provided The Delta Detal PPO Pla pays a combied maximum of $1,000 i beefits per caledar year for each covered idividual for prevetive ad diagostic services plus basic ad major detal services. The maximum lifetime beefit for covered orthodotic services is $1,000 per eligible child. Coordiatio of Beefits Coverage Uder Other Employers Plas If you or your covered depedets are eligible to receive beefits uder aother group detal pla, the beefits from that pla will be coordiated with the beefits from the Delta Detal PPO Pla so that up to 100% of the allowable expeses icurred durig a caledar year will be paid joitly by the plas. A allowable expese is ay ecessary, reasoable, ad customary expese covered i full or i part uder ay oe of the group plas ivolved. I the case of depedet childre who are covered by more tha oe group pla, the isurace pla BROOKHAVEN NATIONAL L ABOR ATORY 5

42 beefits: part 2 DENTAL PLAN of the paret whose birthday occurs earlier i the caledar year will be the primary isurace pla for the childre. To obtai all the beefits available, you ad your family members must file claims uder each pla. Claims How to File a Claim You have the followig optios to file a claim uder the Delta Detal PPO Pla. Claim forms are available i the Beefits Office or o the Web at: DeltaClmFrm.pdf. Your detist ca submit the claim electroically or Sed a claim form to: Delta Detal of New York, Ic. P.O. Box 2105 Mechaicsburg, PA Questios About Claims If you have a questio about your Delta Detal PPO Pla claim, you should cotact Delta Detal at (800) Whe discussig your claim, please refer to the explaatio of beefits, the claim form, ad ay other correspodece that you may have received. How to Appeal a Claim Your explaatio of beefits will idetify if a claim is deied. You may request a review of the deied claim i writig to the isurace compay withi 365 days of the receipt of the otice of deial. You should state the reasos why your claim should ot have bee deied, icludig ay additioal documets which you believe support your claim. I ormal cases, the isurace compay will reder a decisio withi 30 days of the date your request for review is received. Phoe Number Delta Detal PPO Pla: (800) Provider Directory Provider directories are available o the Web at: DUAL COVERAGE Prior to Jauary 1, 2006, dual coverage allowed both spouses to participate i the detal program where they could elect to cover each other ad their eligible depedets provided they paid the required premiums. Dual coverage was elimiated as of Jauary 1, Dual coverage was also elimiated for all members of the IBEW uio as of Jauary 1, EXCLUSIONS The followig detal expeses are ot covered by the Delta Detal Idemity Pla, the Delta Detal Care Pla (DeltaCare USA), or the Delta Detal PPO Pla: Cosmetic treatmet, experimetal treatmet, dietary plaig, plaque cotrol, oral hygiee istructios, treatmet for the correctio of ay cogeital or developmetal malformatio. Replacemet of a lost or stole appliace, extra appliaces, or a detally acceptable bridge, cap, crow, or deture. 6 BROOKHAVEN NATIONAL L ABOR ATORY

43 beefits: part 2 DENTAL PLAN Replacemet of a bridge, deture, cap, crow, etc. withi five years of its origial istallatio uless this is ecessary owig to istallatio of a origial opposig full deture, the extractio of atural teeth, or irreparable damage as a result of a accidet while the deture is i place. Replacemet of a fixed or removable prosthodotic or orthodotic appliace that has bee made useless due to patiet abuse, misuse, or eglect, or has bee lost, stole, or damaged. Appliaces or restoratios to alter vertical dimesios, stabilize teeth, restore occlusio, or diagose or treat coditios or dysfuctio of the temporomadibular joit. Istallatio of a iitial appliace replacig teeth that were already missig whe you or a depedet became isured. Ay procedure or service associated with the placemet or prosthodotic restoratio of a detal implat. (Delta Detal DMO oly) Services related to a ijury or illess paid uder Workers Compesatio, o-fault automobile or uisured motorist isurace law, govermet laws, regulatios, public programs, or similar laws. Charges i excess of Reasoable ad Customary limits. Charges for uecessary services or charges which would ot have bee made had o beefit existed or which you would ot be legally required to pay. Services covered by a group medical pla. Prescriptio drugs. Charges for broke appoitmets or for completio of claim forms. Additioal exclusios may apply. Cotact the Beefits Office at (631) or (631) for additioal iformatio, icludig a copy of the detal schedules. EMPLOYEE PREMIUMS Employees who elect to participate i the Detal Pla must pay the required premiums. Your premiums are based o the Pla you elect ad whether you elect to cover (a) yourself oly, (b) yourself ad oe depedet or (c) yourself ad two or more depedets. You may pay your premiums with beforetax or after-tax dollars. Before-tax premiums are deducted from your pay before state ad federal icome taxes ad Social Security taxes are withheld, resultig i a lower actual cost to you. After-tax premiums are deducted from your pay after taxes are withheld ad result i o tax savigs to you. If your aual salary is below the Social Security wage base ad you pay your premiums with before-tax dollars, your future Social Security beefits may be reduced. Employee premiums are idicated at the ed of the Detal Pla sectio. OPEN ENROLLMENT PERIOD Ope erollmet is held oce a year. Durig a Ope Erollmet Period, you may chage detal programs, drop coverage ad/or add or drop depedets from your coverage. Employees who did ot previously elect detal coverage may elect it durig the Ope Erollmet Period. Chages you elect durig the Ope Erollmet Period will be effective Jauary 1 of the followig caledar year. Your electios will be i effect for the remaider of the caledar year uless you otify the Beefits Office of a Qualifyig Evet withi a limited period of time from the date of the evet. QUALIFYING EVENT A Qualifyig Evet is a chage i your family status ad icludes: (a) Chage i legal marital status 1. marriage 2. death of spouse 3. divorce BROOKHAVEN NATIONAL L ABOR ATORY 7

44 beefits: part 2 DENTAL PLAN 4. legal separatio 5. aulmet (b) Chage i the umber of depedets 1. birth 2. adoptio 3. placemet for adoptio 4. death of a depedet (c) Chage i employmet status 1. termiatio or commecemet of employmet of the employee, spouse or depedet (other tha for miscoduct) (d) Chages i work schedule 1. a icrease or decrease i the umber of hours of employmet by the employee, spouse or depedet 2. a switch betwee full-time ad part-time status 3. a strike or lockout 4. commecemet or retur from a upaid leave of absece (e) The depedet satisfies or ceases to satisfy the requiremets for umarried depedets 1. attaimet of age 2. studet status (f) A chage i the place of residece or work site of the employee, spouse or depedet I additio, based o the provisios of the Childre s Health Isurace Reauthorizatio Act of 2009 (CHIPRA), employees ad depedets that are eligible but ot erolled for BSA health isurace pla coverage may eroll for coverage if oe the followig coditios is met: The employee or depedet loses eligibility ad is termiated from Medicaid or CHIP* coverage or The employee or depedet becomes eligible for a premium assistace subsidy uder Medicaid or CHIP*. *CHIP (Childre s Health Isurace Program) is a state program desiged to provide health care coverage for uisured childre ad some adults. You have 31 days from the date of a Qualifyig Evet to make chages to your detal coverage for all items idicated above except (a)(3), (a)(4) ad (e)(1). You have 60 days from the date of a Qualifyig Evet to make chages to your detal coverage for items (a)(3), (a)(4), (e)(1) ad chages related to CHIPRA. The chage requested must relate to the chage i your family status that affects eligibility for detal coverage. Chages are made by completig a erollmet form, available i the Beefits Office. The completed form must be submitted, with proof of the Qualifyig Evet, to the Beefits Office. Your premiums will the be chaged for the remaider of the caledar year. Coverage will become effective as of the date of the evet. If you do ot make a chage to your detal coverage withi the applicable period idicated above, you must wait util the ext Ope Erollmet Period. If a depedet is o loger eligible for coverage ad you do ot remove that depedet from your coverage withi the applicable period idicated above, your depedet will be removed from your coverage as of the date the Beefits Office is otified. MISCELLANEOUS Geeral Iformatio Iformatio regardig the pla idetificatio umber, pla year, pla fudig, type of pla, pla sposor, pla admiistrator, aget for legal process, your rights uder ERISA, prudet actios by pla fiduciaries, modificatio, suspesio, or termiatio of the pla, ad privacy of iformatio ca be foud 8 BROOKHAVEN NATIONAL L ABOR ATORY

45 beefits: part 2 DENTAL PLAN i the Geeral Iformatio sectio of this booklet. Leave of Absece If you are o a approved Leave of Absece, icludig for military duty, you may cotiue your detal coverage durig the term of the approved leave from the startig date of your leave by payig the required active employee premiums. This coverage will cease whe the employee is o loger o the approved Leave of Absece. Participats o approved military leave may drop detal coverage for themselves while cotiuig to cover their depedets. Cotiuatio of isurace is ot allowed while o leave for other employmet whe (1) the other employer offers coverage or (2) the other employer is a agecy or prime cotractor of the federal govermet that will cover you uder its isurace program. If you drop detal coverage while o a approved Leave of Absece, you may eroll agai upo your retur to work i a eligible status. Participats Receivig Log Term Disability Beefits Employees who qualify for Log Term Disability (LTD) Pla beefits may cotiue detal coverage for themselves ad their eligible depedet(s) by paymet of the required active employee premiums. This coverage will cease whe the employee is o loger eligible to receive LTD Pla beefits. Reasoable ad Customary (R&C) Uder the Delta Detal PPO Pla, a charge is cosidered Reasoable ad Customary if it is the ormal charge made by the provider for a similar service or supply ad it does ot exceed the ormal charge made by most providers of such service or supply i the geographic area where the service is received, as determied by Delta Detal. Termiatio of Coverage Detal coverage for active employees, participats receivig LTD Pla beefits, ad their depedets uder the Detal Pla will cease o the earlier of the date your employmet termiates, the date you elect to drop such coverage, the date you are o loger eligible for coverage, or whe you fail to pay the required premiums. Coverage for termiated employees, who cotiue beefits uder COBRA, will cease o the earlier of the date you elect to drop such coverage, the date you are o loger eligible for coverage, or whe you fail to pay the required premiums. Idividual depedet coverage will also cease whe the depedet becomes ieligible. Coverage for your spouse also ceases due to divorce or legal separatio from you. Coverage for your depedet childre also ceases whe the child o loger meets the eligibility requiremets of this pla. COBRA The right to COBRA cotiuatio coverage was created by a federal law, the Cosolidated Omibus Budget Recociliatio Act of 1985 (COBRA). COBRA cotiuatio coverage ca become available to you whe you would otherwise lose your group health coverage. It ca also become available to other members of your family who are covered uder the Pla whe they would otherwise lose their group health coverage. What is COBRA Cotiuatio Coverage? COBRA cotiuatio coverage is a cotiuatio of Pla coverage whe coverage would otherwise ed because of a life evet kow as a qualifyig evet. Specific qualifyig evets are listed previously i this otice. After a qualifyig evet, COBRA cotiuatio coverage must be offered to each perso who is a qualified beeficiary. You, your spouse, ad your depedet childre could become qualified beeficiaries if coverage uder the Pla is lost because of the qualifyig evet. Uder the Pla, qualified beeficiaries who elect COBRA cotiuatio coverage must pay for COBRA cotiuatio coverage. BROOKHAVEN NATIONAL L ABOR ATORY 9

46 beefits: part 2 DENTAL PLAN If you are a employee, you will become a qualified beeficiary if you lose your coverage uder the Pla because either oe of the followig qualifyig evets happes: Your hours of employmet are reduced, or Your employmet eds for ay reaso other tha your gross miscoduct. If you are the spouse of a employee, you will become a qualified beeficiary if you lose your coverage uder the Pla because ay of the followig qualifyig evets happes: Your spouse dies; Your spouse s hours of employmet are reduced; Your spouse s employmet eds for ay reaso other tha his or her gross miscoduct; Your spouse becomes etitled to Medicare beefits (uder Part A, Part B, or both); or You become divorced or legally separated from your spouse. Your depedet childre will become qualified beeficiaries if they lose coverage uder the Pla because ay of the followig qualifyig evets happes: The paret-employee dies; The paret-employee s hours of employmet are reduced; The paret-employee s employmet eds for ay reaso other tha his or her gross miscoduct; The paret-employee becomes etitled to Medicare beefits (Part A, Part B, or both); The parets become divorced or legally separated; or The child stops beig eligible for coverage uder the pla as a depedet child. Whe is COBRA Coverage Available? The Pla will offer COBRA cotiuatio coverage to qualified beeficiaries oly after the Beefits Office has bee otified that a qualifyig evet has occurred. Whe the qualifyig evet is the ed of employmet or reductio of hours of employmet, death of the employee, commecemet of a proceedig i bakruptcy with respect to the employer, or the employee s becomig etitled to Medicare beefits (uder Part A, Part B, or both), the employer must otify the Beefits Office of the qualifyig evet. Notificatio Requiremets For the other qualifyig evets (divorce or legal separatio of the employee ad spouse or a depedet child s losig eligibility for coverage as a depedet child), you must otify the Beefits Office i writig withi 60 days after the qualifyig evet occurs ad provide documetatio of the evet. Whe the Beefits Office has bee otified that oe of these evets has occurred, they will i tur otify you ad your depedets of the right to elect cotiuatio coverage. If you do ot elect cotiuatio coverage withi 60 days from the date of loss of coverage due to oe of the evets described above, your group detal isurace coverage will ed retroactively to the date of the evet that caused the loss of coverage. If you elect cotiuatio coverage, you will have the same detal coverage you had before the evet, although it may be modified if coverage chages for similarly situated participats. How is COBRA Coverage Provided? Oce the Beefits Office receives otice that a qualifyig evet has occurred, COBRA cotiuatio coverage will be offered to each of the qualified beeficiaries. Each qualified beeficiary will have a idepedet right to elect COBRA cotiuatio coverage. Covered employees may elect COBRA cotiuatio coverage o behalf of their spouses, ad parets may elect COBRA cotiuatio coverage o behalf of their childre. COBRA cotiuatio coverage is a temporary cotiuatio of coverage. Whe the qualifyig evet is the death of the employee, the employee s becomig etitled to Medicare beefits (uder Part A, Part 10 BROOKHAVEN NATIONAL L ABOR ATORY

47 beefits: part 2 DENTAL PLAN B, or both), your divorce or legal separatio, or a depedet child s losig eligibility as a depedet child, COBRA cotiuatio coverage lasts for up to a total of 36 moths. Whe the qualifyig evet is the ed of employmet or reductio of the employee s hours of employmet, ad the employee became etitled to Medicare beefits less tha 18 moths before the qualifyig evet, COBRA cotiuatio coverage for qualified beeficiaries other tha the employee lasts util 36 moths after the date of Medicare etitlemet. For example, if a covered employee becomes etitled to Medicare 8 moths before the date o which his employmet termiates, COBRA cotiuatio coverage for his spouse ad childre ca last up to 36 moths after the date of Medicare etitlemet, which is equal to 28 moths after the date of the qualifyig evet (36 moths mius 8 moths). Otherwise, whe the qualifyig evet is the ed of employmet or reductio of the employee s hours of employmet, COBRA cotiuatio coverage geerally lasts for oly up to a total of 18 moths. There are two ways i which this 18-moth period of COBRA cotiuatio coverage ca be exteded. Disability extesio of 18-moth period of cotiuatio coverage If you or ayoe i your family covered uder the Pla is determied by the Social Security Admiistratio to be disabled ad you otify the Beefits Office i a timely fashio, you ad your etire family may be etitled to receive up to a additioal 11 moths of COBRA cotiuatio coverage, for a total maximum of 29 moths. The disability would have to have started at some time before the 60th day of COBRA cotiuatio coverage ad must last at least util the ed of the 18-moth period of cotiuatio coverage. You must otify the Beefits Office withi 60 days after the qualifyig evet occurs ad provide documetatio of the evet. Secod qualifyig evet extesio of 18-moth period of cotiuatio coverage If your family experieces aother qualifyig evet while receivig 18 moths of COBRA cotiuatio coverage, the spouse ad depedet childre i your family ca get up to 18 additioal moths of COBRA cotiuatio coverage, for a maximum of 36 moths, if otice of the secod qualifyig evet is properly give to the Pla. This extesio may be available to the spouse ad ay depedet childre receivig cotiuatio coverage if the employee or former employee dies, becomes etitled to Medicare beefits (uder Part A, Part B, or both), or gets divorced or legally separated, or if the depedet child stops beig eligible uder the Pla as a depedet child, but oly if the evet would have caused the spouse or depedet child to lose coverage uder the Pla had the first qualifyig evet ot occurred. COBRA Premium Requiremets You, or your depedets, will be required to pay 102% of the full cost of the cotiuatio coverage uder the provisios of COBRA. You will be billed for the required premium o a regular basis. COBRA premiums are idicated at the ed of the Detal Pla sectio. Termiatio of Coverage Uder COBRA Cotiuatio coverage will ed whe ay of the followig evets occur: The Beefits Office is otified by you or your depedet to discotiue coverage. 18 moths after cotiuatio coverage begis (if coverage was cotiued due to termiatio or resigatio of the employee). 29 moths after cotiuatio coverage begis (if coverage was cotiued due to disability). 36 moths after cotiuatio coverage begis (if coverage was cotiued because of death of the employee, divorce, legal separatio or loss of depedet status). The idividual becomes eligible for Medicare after the date of the COBRA electio. A idividual becomes covered uder aother group pla, uless a pre-existig coditio prevets you or your depedet from beig covered by the other pla. For a spouse or depedet child: If the Beefits Office is ot otified withi 31 days of the date of divorce or legal separatio. For a depedet child: If the Beefits Office is ot otified withi 31 days of the date the depedet status eds. BROOKHAVEN NATIONAL L ABOR ATORY 11

48 beefits: part 2 DENTAL PLAN Paymet for cotiuatio coverage is ot paid o time. The group health care pla is termiated for active employees. ERISA Refer to the Geeral Iformatio sectio of this booklet for iformatio regardig your rights uder the Employee Retiremet Icome Security Act of 1974 (ERISA). EMPLOYEE PREMIUMS (Jauary 1, 2011) Delta Detal Idemity Pla (Delta Detal) or Delta DMO Delta PPO Coverage Weekly Mothly Weekly Mothly Employee oly $1.15 $ 5.00 $2.33 $10.11 Employee + 1 depedet $2.31 $10.00 $4.81 $20.86 Employee + 2 or more depedets $4.38 $19.00 $7.90 $34.23 COBRA PREMIUMS (Jauary 1, 2011) Mothly Premium Coverage Delta Detal Idemity Pla Delta Detal DMO (DeltaCare) Delta Detal PPO Employee oly $14.35 $17.90 $31.58 Employee + 1 depedet $30.49 $36.36 $67.07 Employee + 2 or more depedets $42.75 $54.11 $94.06 These premiums are subject to chage. 12 BROOKHAVEN NATIONAL L ABOR ATORY

49 beefits: part 2 DENTAL PLAN DENTAL PROGRAMS DELTA DENTAL PPO Idemity DMO Network PPO ad Premier Networks N/A PPO ad Premier Networks DeltaCare I-Network Out-of-Network I- ad Out-of-Network I-Network Oly Provider Participatig Provider Ay Provider Ay Provider Participatig Provider Pay detist scheduled fee Claim Process Detist will charge you applicable coisurace Must submit claim to Delta Detal Participatig detist will charge you applicable co-pay. Claims must be submitted to Delta Detal for o-participatig detists. Depedet Childre Age Limit To age 19. Ed of year age 23 if full-time studet. To age 19. Ed of year age 23 if full-time studet. $25/$75 (i- ad out-of-etwork combied) $25/$75 N/A Aual Deductible Per Idividual/Family (for basic & major restorative detal services. Does ot apply to prevetive services.) For the family Deductible to apply, at least three family members must reach their idividual Deductible. Caledar Year Maximum Beefit Per Perso (for all services other tha orthodotia.) $1,000 (i- ad out-of-etwork combied) $1,000 N/A To age 19. Ed of year age 23 if full-time studet. Eligibility for Orthodotia Coverage Childre: To age 19. Employee/Spouse: ot eligible. Childre: To age 19. Employee/Spouse: ot eligible. Predetermiatio of Beefits Predetermiatio of Beefits allows you to determie what services will be covered ad what paymets will be made before your detal treatmet is performed. The procedure is as follows: The detist iforms the claims admiistrator of the proposed course of treatmet by itemizig services ad charges. The claims admiistrator the determies the amout the pla will pay ad iforms you ad your detist. You ad your detist should discuss the result before the work is doe. If a Predetermiatio of Beefits is ot requested, the claims admiistrator will pay the claims based o the iformatio provided. If your detist submits a treatmet pla for Predetermiatio of Beefits ad the chages the treatmet pla, the claims admiistrator will adjust the paymets accordigly. If ay major chages i the treatmet pla are made, your detist should sed i a revised Services Provided After Eligibility Ceases course of treatmet to the claims admiistrator. Normally, the plas will ot pay for services or supplies beyod termiatio of your coverage or whe depedet is o loger eligible for coverage, eve if a Predetermiatio of Beefits has bee made before coverage ceases. However, there are three exceptios for which beefits are payable: - A prosthetic device (such as full or partial deture) if the detist took the impressios ad prepared the abutmet teeth while the patiet was covered; - A crow if the detist prepared the tooth for the crow while the patiet was covered by the pla; - Root caal therapy if the detist opeed the tooth while the patiet was covered. Childre: To age 19. Ed of year age 23 if full-time studet. Employee/Spouse: eligible. BROOKHAVEN NATIONAL L ABOR ATORY 13

50 beefits: part 2 DENTAL PLAN PPO Idemity DMO Network PPO ad Premier Networks N/A PPO ad Premier Networks DeltaCare I-Network Out-of-Network I- ad Out-of-Network I-Network Oly Medical The Medical Pla, specifically the OAP medical program, admiistered by Ciga Healthcare, covers a limited umber of specific detal procedures. Whe detal beefits are available uder both the OAP medical program ad the Delta Detal Idemity or PPO plas, the beefits payable uder the Delta Detal Idemity or PPO plas will be coordiated with the beefits payable uder the OAP medical program so that up to 100% of allowable expeses will be paid joitly by the plas. I all such cases, the Delta Detal Idemity or PPO program is cosidered the primary policy to which you must submit claims first. Coverage Based O Reduced Cotracted Fees Reasoable & Customary Fees Reimbursemet Schedule Fee Schedule Amout isurace compay pays Amout isurace compay pays Amout participat pays Diagostic & Prevetive Services Periodic exams (limits apply) (D0120) 80% 70% $22.00 $0.00 Bitewig x-rays/radiographs four films 80% 70% $23.00 $0.00 (limits apply) (D0274) Paoramic film (D0330) 80% 70% $50.00 $0.00 Prophylaxis (cleaig) (limits apply) (D1110) 80% 70% $38.00 $0.00 Restorative Filligs: Amalgam - oe surface (D2140) 60% 45% $26.00 $0.00 Resi-based composite - oe surface, aterior (D2330) Resi-based composite - oe surface, posterior (D2391) Ilay - metallic - oe surface (D2510) Olay - metallic - two surfaces (D2542) Ilay - porcelai/ceramic - oe surface (D2610) Olay - porcelai/ceramic - two surfaces (D2642) Ilay - resi based composite - oe surface (D2650) Olay - resi based composite - two surfaces (D2662) Crows: Resi with high oble metal (D2720) 60% 45% $30.00 $ % 45% Not Covered $ % 35% $ $ % 35% Not Covered $ % 35% Not Covered $ % 35% Not Covered $ % 35% Not Covered $ % 35% Not Covered $ % 35% $ $ BROOKHAVEN NATIONAL L ABOR ATORY

51 beefits: part 2 DENTAL PLAN PPO Idemity DMO Network PPO ad Premier Networks N/A PPO ad Premier Networks DeltaCare I-Network Out-of-Network I- ad Out-of-Network I-Network Oly Implats Surgical placemet of implat body, edosteal 50% 35% $1, Not Covered implat (D6010) Surgical placemet of iterim implat 50% 35% $1, Not Covered body for trasitioal prosthesis: edosteal implat (D6012) Surgical replacemet: edosteal implat 50% 35% $1, Not Covered (D6040) Surgical replacemet: trasosteal implat 50% 35% $1, Not Covered (D6050) Abutmets (D6057) 50% 35% $ Not Covered Edodotics Pulp Cap: direct (excludig fial restoratio) 60% 45% $20.00 $0.00 (D3110) idirect (excludig fial 60% 45% $20.00 $0.00 restoratio) (D3120) Root Caal/edodotic therapy: aterior tooth (excludig fial restoratio) (D3310) bicuspid tooth (excludig fial restoratio) (D3320) molar (excludig fial restoratio) (D3330) Apicoectomy/periradicular surgery: 60% 45% $ $ % 45% $ $ % 45% $ $ aterior (D3410) 60% 45% $ $ bicuspid (first root) (D3421) 60% 45% Not Covered $ molar (first root) (D3425) 60% 45% $75.00 $ Periodotics Gigivectomy or gigivoplasty - four or more cotiguous teeth or tooth bouded spaces per quadrat (D4210) Gigival flap procedure, icludig root plaig - four or more cotiguous teeth or tooth bouded spaces per quadrat (D4240) 60% 45% $ $ % 45% $56.00 $ BROOKHAVEN NATIONAL L ABOR ATORY 15

52 beefits: part 2 DENTAL PLAN PPO Idemity DMO Network PPO ad Premier Networks N/A PPO ad Premier Networks DeltaCare Osseous surgery (icludig flap etry ad closure) - four or more cotiguous teeth or I-Network Out-of-Network I- ad Out-of-Network I-Network Oly 60% 45% $ $ tooth bouded spaces per quadrat (D4260) Periodotal scalig ad root plaig - four or 60% 45% $45.00 $55.00 more teeth per quadrat - limits apply (D4341) Full mouth debridemet to eable comprehesive 60% 45% Not Covered $55.00 evaluatio ad diagosis - limits apply (D4355) Periodotal maiteace - limits apply 60% 45% $38.00 $40.00 (D4910) Additioal periodotal maiteace - limits 60% 45% $38.00 $55.00 apply (D4910) Prosthodotics (Removable) limits apply Complete deture - maxillary (D5110) 50% 35% $ $ Complete deture - madibular (D5120) 50% 35% $ $ Immediate deture - maxillary (D5130) 50% 35% $ $ Immediate deture - madibular (D5140) 50% 35% $ $ Replace missig or broke teeth - complete 50% 35% Not Covered $25.00 deture (each tooth) (D5520) Prosthodotics (Fixed) Potic - cast high oble metal (D6210) 50% 35% $ $ Potic - porcelai fused to high oble metal 50% 35% $ $ (D6240) Potic - resi with high oble metal (D6250) 50% 35% $ $ Ilay - porcelai/ceramic, two surfaces 50% 35% Not Covered $ (D6600) Ilay - cast high oble metal, two surfaces 50% 35% Not Covered $ (D6602) Olay - porcelai/ceramic, two surfaces 50% 35% Not Covered $ (D6608) Olay - cast high oble metal, two surfaces 50% 35% Not Covered $ (D6610) Crow - resi with high oble metal (D6720) 50% 35% Not Covered $ Crow - porcelai/ceramic (D6740) 50% 35% $ $ Crow - porcelai fused to high oble metal 50% 35% $ $ (D6750) 16 BROOKHAVEN NATIONAL L ABOR ATORY

53 beefits: part 2 DENTAL PLAN PPO Idemity DMO Network PPO ad Premier Networks N/A PPO ad Premier Networks DeltaCare I-Network Out-of-Network I- ad Out-of-Network I-Network Oly Oral ad Maxillofacial Surgery Extractio, erupted tooth or exposed root 60% 45% $37.00 $8.00 (elevatio ad/or forceps removal) (D7140) Removal of impacted tooth - soft tissue 60% 45% $ $60.00 (D7220) Removal of impacted tooth - partial boy 60% 45% $ $80.00 (D7230) Removal of impacted tooth - completely 60% 45% $ $ boy (D7240) Biopsy of oral tissue - does ot iclude 60% 45% $95.00 $30.00 pathology laboratory procedures (D7286) Alveoloplasty i cojuctio with extractios 60% 45% Not Covered $ oe to three teeth or tooth spaces, per quadrat (D7311) Alveoloplasty ot i cojuctio with extractios 60% 45% Not Covered $ oe to three teeth or tooth spaces, per quadrat (D7321) Orthodotic Beefits Limited orthodotic treatmet of the 50% 50% $1, $1, adolescet detitio - adolescet to age 19 (D8030) Limited orthodotic treatmet of the adult Not Covered Not Covered Not Covered $1, detitio - adults, icludig covered depedet adult childre (D8040) Iterceptive orthodotic treatmet of the 50% 50% $1, $1, primary detitio (D8050) Iterceptive orthodotic treatmet of the 50% 50% $1, $1, trasitioal detitio (D8060) Comprehesive orthodotic treatmet of the 50% 50% $1, $1, trasitioal detitio - child or adolescet to age 19 (D8070) Comprehesive orthodotic treatmet of the Not Covered Not Covered Not Covered $2, adult detitio - adults, icludig covered depedet adult childre (D8090) Pre-orthodotic treatmet visit (D8660) 50% 50% 50% $25.00 BROOKHAVEN NATIONAL L ABOR ATORY 17

54 beefits: part 2 DENTAL PLAN PPO Idemity DMO Network PPO ad Premier Networks N/A PPO ad Premier Networks DeltaCare Orthodotic retetio (removal of appliaces, costructio ad placemet of removable retaiers) (D8680) Orthodotic Lifetime Maximum Beefit Per Perso I-Network Out-of-Network I- ad Out-of-Network I-Network Oly 50% 50% 50% $ $1,000 (i- ad out-of-etwork combied) $1, N/A Adjuctive Geeral Services Deep sedatio/geeral aesthesia - first 30 miutes (D9220) Deep sedatio/geeral aesthesia - each additioal 15 miutes (D9221) Itraveous coscious sedatio/aalgesia - first 30 miutes (D9241) Itraveous coscious sedatio/aalgesia - each additioal 15 miutes (D9242) 60% 40% Covered with Allowable Oral Surgery Procedures $ % 40% Not Covered $ % 40% $37.00 $ % 40% Not Covered $80.00 This represets oly a portio of the detal schedule. For additioal iformatio, refer to the schedule of beefits for each pla. 18 BROOKHAVEN NATIONAL L ABOR ATORY

55 beefits: part 3 LIFE INSURANCE PLAN part 3 LIFE INSURANCE PLAN The Life Isurace Pla offers Basic ad Supplemetal Life Isurace coverage ad Accidetal Death ad Dismembermet beefits. WHO IS ELIGIBLE FOR THE LIFE INSURANCE PLAN? Active Employees All regular employees who work at least 20 hours per week are eligible for Basic Life Isurace, Supplemetal Life Isurace, ad Accidetal Death ad Dismembermet (AD&D) coverages o the first day of active employmet. ENROLLMENT Eligible employees must eroll for Basic Life Isurace coverage o their date of hire, ad coverage will be effective o their date of hire. Supplemetal Life Isurace coverage is optioal. You will automatically be erolled for Basic AD&D coverage whe you eroll for Basic Life Isurace Coverage. You will automatically be erolled for Supplemetal AD&D coverage whe you eroll for Supplemetal Life Isurace coverage. All such coverages will be delayed if the employee is ot actively at work. It will begi o the first day that eligibility requiremets are met ad the employee is actively at work. To eroll, you must complete a erollmet form ad idicate oe or more Beeficiaries. Erollmet forms are available through the Beefits Office. By completig the form, you will authorize the ecessary payroll premiums for the coverage you select. Eligible employees have 90 days from their date of hire to eroll for Supplemetal Life Isurace coverage, ad coverage will be effective o the date the erollmet form is siged. After 90 days, employees may request erollmet, but must submit evidece of isurability ad be approved by the Isurace Compay before isurace ca become effective. If approved, Supplemetal Life Isurace coverage will become effective o the date of such approval. LIFE INSURANCE PLAN COVERAGE EMPLOYEES UNDER AGE 65 Basic Life Isurace Beefits Provided Basic Life Isurace coverage is provided i a amout equal to the earest multiple of $2,500 that exceeds your Aual Base Salary. For part-time employees, coverage is based o the actual part-time Aual Base Salary. Basic Life Isurace coverage is provided at o cost to eligible employees. Supplemetal Life Isurace Beefits Provided I additio to Basic Life Isurace coverage, two levels of Supplemetal Life Isurace coverage are also available. Supplemetal I Life Isurace coverage ca be purchased i a amout equal to your Basic Life Isurace coverage. Supplemetal II Life Isurace coverage is available i a amout sufficiet to make total Life Isurace coverage equal to approximately three times your Aual Base Salary. The total Life Isurace coverage is rouded to the earest $500. BROOKHAVEN NATIONAL L ABOR ATORY 1

56 beefits: part 3 LIFE INSURANCE PLAN Examples: A employee whose Aual Base Salary is $30,000 per year will have Life Isurace coverage available as follows: Aual Base Salary Basic Isurace Supplemetal I Isurace Supplemetal II Isurace Total Isurace $30,000 $32,500 $32,500 $25,000 $90,000 If a employee works 20 hours per week, which, i this example, is assumed to be fifty percet of the regular work schedule ad has a Aualized Base Salary of $30,000, Life Isurace coverage is available as follows: Aualized Base Salary Actual Base Salary Basic Isurace Supplemetal I Isurace Supplemetal II Isurace Total Isurace $30,000 $15,000 $17,500 $17,500 $10,000 $45,000 The followig schedule outlies the Basic ad Supplemetal coverage available at various Aual Base Salary levels: Aual Base Salary Basic Isurace Supplemetal I Isurace Supplemetal II Isurace $20,000 to $22, $22,500 $22,500 Additioal isurace $22,500 to $24, $25,000 $25,000 to make total coverage from Basic, $25,000 to $27, $27,500 $27,500 Supplemetal I,ad $27,500 to $29, $30,000 $30,000 Supplemetal II equal to three times Aual Base $30,000 to $32, $32,500 $32,500 Salary rouded to the $32,500 to $34, $35,000 $35,000 earest $500. (cotiues i multiples of $2,500) LIFE INSURANCE PLAN COVERAGE EMPLOYEES AGE 65 OR OVER Basic Life Isurace Beefits Provided Basic Life Isurace coverage is provided at o cost to eligible employees ad is i accordace with the followig schedule: Age Basic Life Isurace as Percetage of Aual Base Salary 65 to /3% 70 to 74 45% 75 to 79 30% 80 or over 20% Supplemetal Life Isurace Beefits Provided Supplemetal I ad Supplemetal II coverages are available i amouts equal to the Basic Life Isurace coverage amout idicated above. The amout of Basic Life Isurace coverage available is determied as a fractio of Aual Base Salary rouded to the earest $500. Examples: A 65 year-old employee earig $35,200 per year erolled i Supplemetal I ad II would have the followig Life Isurace coverage: Basic $23,500 Supplemetal I $23,500 Supplemetal II $23,500 Total Life Isurace $70,500 2 BROOKHAVEN NATIONAL L ABOR ATORY

57 beefits: part 3 LIFE INSURANCE PLAN A 70 year-old employee earig $35,200 per year erolled i Supplemetal I ad II would have the followig Life Isurace coverage: Basic $16,000 Supplemetal I $16,000 Supplemetal II $16,000 Total Life Isurace $48,000 MAXIMUM LIFE INSURANCE PLAN COVERAGE The maximum total life isurace coverage, icludig supplemetal life isurace, is $1 millio. The miimum is $5,000. OPTION TO ACCELERATE PAYMENT OF DEATH BENEFITS If you become termially ill while isured uder this Pla, you may elect Termial Illess Proceeds. Termial Illess Proceeds are equal to a miimum of 25% or $50,000 if less ad a max of $500,000 ot to exceed 80% of your total life isurace coverage o the date the Isurace Compay receives proof of your termial illess (but ot to exceed $50,000). Such proceeds may be reduced o accout of age. Such beefits are payable to you. Additioal coditios apply. Oe such coditio is that your life expectacy is 6 moths or less. If you elect this optio, your total life isurace coverage at death will be reduced by the Termial Illess Proceeds. ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE Beefits Provided Accidetal Death ad Dismembermet (AD&D) Isurace coverage is i additio to Life Isurace coverage ad is provided i amouts as follows: Aual Base Salary Basic AD&D Isurace Supplemetal AD&D Isurace* Total AD&D Isurace Less tha $5,000 $ 5,000 $ 5,000 $10,000 $5,000 to $7, $ 7,500 $ 7,500 $15,000 $7,500 to $9, $10,000 $10,000 $30,000 $10,000 or over $12,500 $12,500 $25,000 *Oly provided if you elect Supplemetal Life Isurace coverage. The maximum total AD&D coverage is $25,000. This isurace will be paid, regardless of other isurace, for ay of the followig losses resultig from a accidet occurrig o or off the job while you are isured: Loss AD&D Coverage Amout Life 100% Oe had by severace at or above the wrist 50% Oe foot by severace at or above the akle 50% Sight i oe eye (etire ad irrecoverable) 50% Speech 50% Hearig 50% More tha oe of the above 100% Quadriplegia 100% Paraplegia 75% Hemiplegia 25% Thumb ad idex figer of same had 25% No more tha 100% of the total coverage amout ca be paid. BROOKHAVEN NATIONAL L ABOR ATORY 3

58 beefits: part 3 LIFE INSURANCE PLAN Exclusios AD&D isurace does ot cover a loss occurrig more tha 90 days after the accidet, or a loss if it results from ay of these: 1) Suicide or attempted suicide. 2) Itetioally self-iflicted ijuries, or ay attempt to iflict such ijuries. 3) War, or ay act of war. War meas declared or udeclared war ad icludes resistace to armed aggressio. 4) Ijury sustaied durig service i the armed forces (lad, water, air) of ay coutry or iteratioal authority. 5) Travel or flight i ay vehicle used for aerial avigatio. This icludes gettig i, out, o or off ay such vehicle. This (8) applies oly if: a) the perso is ridig as a passeger i ay aircraft ot iteded or licesed for the trasportatio of passegers; b) the perso is performig as a pilot or a crew member of ay aircraft; or c) you are ridig as a passeger i a aircraft owed, leased or operated by your employer. 6) Commissio of or attempt to commit a feloy. 7) Beig legally itoxicated or uder the ifluece of ay arcotic uless admiistered or cosumed o the advice of a doctor. 8) Participatio i these hazardous sports: bugee jumpig; skydivig; parachutig; hag glidig; or ballooig. Additioal Beefits The additioal amout payable for loss of life as a result of a accidet i a four wheel vehicle while usig a seat belt is the lesser of (a) 10% of the AD&D Coverage amout, ad (b) $10,000. Additioal coditios apply. CLAIMS How to File a Claim To file a claim uder the Life Isurace Pla, you or a family member must otify the Beefits Office. The Hartford will mail the claim form directly to the Beeficiary o file which will eed to be completed ad submitted to The Hartford directly with writte proof of the loss withi 90 days after the date of the loss. The amout of your Life ad/or AD&D Isurace will be paid whe the Isurace Compay receives proof that you died, or were ijured while isured for these beefits, ad approves the claim. Questios About Claims If you have a questio about a Life Isurace Pla claim, you should cotact the Beefits Office at (631) How to Appeal a Claim If your claim is deied, you will receive a writte otice of the deial from the Isurace Compay. The otice will explai the reaso for the deial ad idicate the review procedures. You may request a review of the deied claim. The request must be submitted i writig to the Isurace Compay withi 180 days after you receive the deial otice. Submit your request, icludig your reasos for requestig the review ad ay additioal documets which you believe support your claim. The Isurace Compay will review the claim ad ordiarily otify you withi 45 days of the date your request for review is received. I special cases requirig a delay, the Isurace Compay will reder a decisio 4 BROOKHAVEN NATIONAL L ABOR ATORY

59 beefits: part 3 LIFE INSURANCE PLAN o later tha 90 days after your request for review is received. If your iitial appeal is deied, you may submit a secod appeal withi 180 days of the date such claim was deied. The Isurace Compay has up to 90 days to reder a decisio. EMPLOYEE PREMIUMS Employees who elect Supplemetal I or II Life Isurace coverage must pay the required employee premiums. For uder age 30: $.08 per $1,000 of supplemetal life isurace coverage. For ages 30 to 44: $.20 per $1,000 of supplemetal life isurace coverage. For ages 45 ad over: $.30 per $1,000 of supplemetal life isurace coverage. Ay chage i the amout of your Life Isurace due to a chage i your Aual Base Salary will result i a adjustmet to your employee premiums. Participats who are receivig BSA Log Term Disability (LTD) Pla beefits ad are ot members of the IBEW uio may also cotiue Life Isurace coverage by payig the required premium. Curretly, for participats whose eligibility date to receive LTD Pla beefts was prior to Jauary 1, 2009, o premium is required to cotiue this coverage. Curretly, for participats whose eligibility date to receive LTD Pla beefits, was after December 31, 2008, ad were ot members of the IBEW uio coverage may be cotiued by payig the active employee premium. MISCELLANEOUS Aual Base Salary Aual Base Salary is the isured perso s aual base salary, before exercise of ay salary reductio optio, as of the time of the accidet or death. Overtime pay ad premium pay are ot icluded i Aual Base Salary. Assigmet of Your Life Isurace ad AD&D Beefits Istead of amig a Beeficiary, you may elect to make a assigmet of your Life ad AD&D Isurace beefits to your spouse or aother desigated perso. Whe you assig your beefits to aother perso, you divest yourself of all owership rights or iterests icludig the right to chage Beeficiaries. You may obtai additioal iformatio ad the ecessary assigmet forms from the Beefits Office or olie through PeopleSoft self-service. Beeficiary I the evet of your death, from ay cause, your Life Isurace beefits will be paid to the Beeficiary(ies) you have desigated. You may desigate ayoe you wish as a Beeficiary, ad you may chage your Beeficiary at ay time. You may obtai chage of beeficiary forms from the Beefits Office or olie through PeopleSoft self-service. If there is o Beeficiary at your death, your beefits will be payable to the first of the followig: your (a) survivig spouse; (b) survivig child(re) i equal shares; (c) survivig parets i equal shares; (d) survivig sibligs i equal shares; (e) estate. Ay assigmet you have desigated will apply ad supercedes the above. Chages i the Amout of Life ad AD&D Isurace Ay chage i the amout of your Life ad AD&D Isurace coverages due to a chage i your Aual Base Salary will become effective o the date your Aual Base Salary chages. If you are ot i active employmet o that date, the icrease will become effective after you retur to active employmet for oe full day. BROOKHAVEN NATIONAL L ABOR ATORY 5

60 beefits: part 3 LIFE INSURANCE PLAN You may reduce your Supplemetal Life Isurace coverage at ay time by completig the required form available i the Beefits Office. To icrease Supplemetal Life Isurace coverage, you must complete a erollmet form, submit evidece of isurability ad be approved by the Isurace Compay before the isurace ca become effective. Forms are available i the Beefits Office. If approved, the isurace will become effective o the date of such approval, ad you will be required to pay the appropriate employee premiums. Evidece of Isurability Evidece of isurability is required if: You eroll more tha 90 days after you are first eligible for coverage. You were eligible for ay coverage uder the prior policy, but did ot eroll ad later choose to eroll for that coverage uder The Hartford. Geeral Iformatio Iformatio regardig the pla idetificatio umber, pla year, pla fudig, type of pla, pla sposor, pla admiistrator, aget for legal process, your rights uder ERISA, prudet actios by pla fiduciaries, modificatio, suspesio, or termiatio, ad privacy of iformatio of the pla ca be foud i the Geeral Iformatio sectio of this booklet. Isurace Compay The Isurace Compay is The Hartford. Leave of Absece If you are o a approved Leave of Absece, you may cotiue your Life Isurace coverage durig the term of the approved leave from the startig date of your leave by payig the required active employee premiums. Cotiuatio of isurace is ot allowed while o leave for other employmet whe (1) the other employer offers coverage or (2) the other employer is a agecy or prime cotractor of the federal govermet that will cover the employee uder its isurace program. Participats Receivig Log Term Disability Beefits Life Isurace coverage will be cotiued at o cost for employees who were members of the IBEW uio or employees who qualify for Log Term Disability (LTD) Pla beefits with a effective date prior to No-IBEW members who qualify for LTD pla beefits with a effective date after cotiue by payig the active employee premiums. This coverage will cease whe the employee is o loger eligible for LTD Pla beefits. Termiatio of Coverage Life Isurace coverage will cease o the earlier of the date your employmet termiates, the date you are o loger eligible for coverage, whe you fail to pay the required premiums, or the date the cotract with the Isurace Compay eds. If coverage has ceased ad you die withi 31 days after coverage ceased, the beefit amout will still be paid if the claim is approved. 6 BROOKHAVEN NATIONAL L ABOR ATORY

61 beefits: part 3 LIFE INSURANCE PLAN CONVERSION You are etitled to covert to a idividual policy oly if (a) your isurace ceases because you are o loger i active employmet or o loger eligible for life isurace, (b) your isurace ceases or is reduced because of retiremet or age, (c) your isurace is reduced due to a chage i your class or amedmets of the policy, or (d) the policy is caceled for your class of employees. No medical examiatio will be required, but you must submit a completed applicatio form ad pay the premium for this coverage to the Isurace Compay withi 31 days from the date your employmet termiates. Hartford will mail you the ecessary coversio applicatio form directly. BROOKHAVEN NATIONAL L ABOR ATORY 7

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63 beefits part 4 LONG TERM DISABILITY PLAN part 4 LONG TERM DISABILITY PLAN The Log Term Disability (LTD) Pla provides you with protectio agaist complete loss of icome durig a log period of absece because of a disablig illess or ijury. WHO IS ELIGIBLE FOR THE LONG TERM DISABILITY PLAN? Active Employees All regular employees who work at least 20 hours per week are required to participate i the LTD Pla upo completio of oe year of active service. Service shall iclude Cotiuous Service, if ay, with Associated Uiversities, Ic., Battelle Memorial Istitute, Research Foudatio of the State Uiversity of New York, or the State Uiversity of New York at Stoy Brook immediately prior to a trasfer of employmet to Brookhave Sciece Associates, LLC. ENROLLMENT Employees must eroll for LTD Pla coverage o their date of hire. Your coverage will be effective upo completio of oe year of Cotiuous Service. You must be i active employmet status for coverage to become effective. LONG TERM DISABILITY PLAN COVERAGE Icome Beefits Provided LTD beefits are provided if you are cotiuously Totally Disabled durig the elimiatio period. The elimiatio period is 180 days. If your disability stops less tha oe-half (1/2) the umber of days of your elimiatio period durig the elimiatio period, your disability will be treated as cotiuous. The days you are ot disabled will ot cout toward your elimiatio period. The Isurace Compay will determie if you are eligible for these beefits. If eligible, ad you first became disabled ad etitled to a beefit uder the LTD Pla before Jauary 1, 2005, LTD beefits were based o the pla i existece at that time. If eligible, ad you first become disabled ad etitled to a beefit uder the LTD Pla o or after Jauary 1, 2005, commecig with the seveth cosecutive moth of disability, you will receive mothly icome paymets equal to sixty percet (60%) of your mothly full-time or part-time Base Salary. Your gross mothly icome paymets will be reduced by the followig sources of icome: The amout that you receive as loss of time beefits uder: a workers' compesatio law; a occupatioal disease law; or ay other act or law with similar itet. The amout that you receive or are etitled to receive as loss of time disability icome paymets uder ay: state compulsory beefits act or law. group isurace or self-isured plas where the employer, directly or idirectly, has paid all or part of the cost or made payroll deductios. govermetal retiremet system as the result of your job with your employer. BROOKHAVEN NATIONAL L ABOR ATORY 1

64 beefits part 4 LONG TERM DISABILITY PLAN The gross amout that you receive or are etitled to receive as loss of time disability paymets because of your disability uder: the Uited States Social Security Act; the Railroad Retiremet Act; the Caada Pesio Pla; the Quebec Pesio Pla; ay similar pla or act. The gross amout that you receive as retiremet paymets uder: the Uited States Social Security Act; the Railroad Retiremet Act; the Caada Pesio Pla; the Quebec Pesio Pla; or ay similar pla or act The amout that you: (a) receive as disability paymets uder your employer's retiremet pla; (b) volutarily elect to receive as retiremet or early retiremet paymets uder your employer's retiremet pla. The amout you receive uder the maritime doctrie of maiteace, wages ad cure. This icludes oly the wages part of such beefits. The amout idetified as earigs replacemet or disability icome beefits that you receive, due to your disability, from a third party by judgmet, settlemet or otherwise. The amout of loss of time beefits that you receive or are etitled to receive uder ay salary cotiuatio. The amout of loss of time beefits that you receive or are etitled to receive uder ay accumulated sick leave, to the extet that your total mothly beefits exceed or would exceed 100% of your mothly earigs. The amout that you receive from a partership, proprietorship or ay similar draws. The amout that you receive or are etitled to receive uder ay uemploymet icome act or law due to the ed of employmet with your employer. With the exceptio of retiremet paymets, or amouts that you receive from a partership, proprietorship or ay similar draws, the Isurace Compay will oly subtract deductible sources of icome which are payable as a result of the same disability. However, if you cotiue to be disabled after receivig LTD beefits for 24 moths or after obtaiig age 65, ad you elect to receive Retiremet Pla beefits, this will ot cause a reductio i your LTD beefits. If you become Totally Disabled, you may be eligible to receive mothly beefit paymets for up to 2 years. However, if you cotiue to be Totally Disabled ad if your disability prevets you from egagig i ay occupatio for which you are qualified by traiig, educatio, or experiece, beefit paymets will cotiue beyod the 2-year period util you are o loger Totally Disabled, or as idicated i the followig schedule: 2 BROOKHAVEN NATIONAL L ABOR ATORY

65 beefits part 4 LONG TERM DISABILITY PLAN Maximum Period of Beefits Your Age o Date Disablemet Begis Uder age 61 Age 61 Age 62 Age 63 Age 64 Age 65 Age 66 Age 67 Age 68 Age 69 ad over Your Maximum Beefits Duratio To your NRA*, but ot less tha 60 moths To your NRA*, but ot less tha 48 moths To your NRA*, but ot less tha 42 moths To your NRA*, but ot less tha 36 moths To your NRA*, but ot less tha 30 moths 24 moths 21 moths 18 moths 15 moths 12 moths * Your ormal retiremet age (NRA) is your retiremet age uder the Social Security Act where retiremet age depeds o your year of birth. LTD beefits cease o the date you cease to be Totally Disabled. The maximum mothly beefit is $20,000. Cotributios to the Retiremet Pla If you were a participat i the Retiremet Pla before becomig Totally Disabled, mothly cotributios will be made by the Isurace Compay to the Retiremet Pla as log as you qualify for LTD beefit paymets. The mothly cotributio to the Retiremet Pla will equal oe-twelfth of the total of the followig: 12.5% of your aual Base Salary that is taxable uder the Social Security Act o the day prior to the day you become eligible to receive LTD beefits ad 17.5% of the remaiig amout of your aual Base Salary. Portable Adaptive Equipmet The Isurace Compay may be able to assist you to idetify portable adaptive equipmet that is likely to help you remai at work or retur to work. Additioal details are available from the Isurace Compay. Rehabilitatio The Isurace Compay has a rehabilitatio program available. They will cotact you if, upo review of your iformatio, you qualify to participate. CLAIMS How to File a Claim If you wat to file a claim for LTD Pla beefits, you must cotact the Beefits Office who will provide the applicable forms to you. The completed forms must be submitted to the Isurace Compay withi 90 days after the elimiatio period. Questios About Claims If you have a questio about your LTD claim, you should cotact the Beefits Office at (631) or The Hartford Group Disability Office at (800) BROOKHAVEN NATIONAL L ABOR ATORY 3

66 beefits part 4 LONG TERM DISABILITY PLAN How to Appeal a Claim If your claim is deied, you will receive a writte otice of the deial from the Isurace Compay. The otice will explai the reaso for the deial ad idicate the review procedures. You may request a review of the deied claim. The request must be submitted i writig withi 180 days after you receive the deial otice. Submit your request, icludig your reasos for requestig the review, to The Hartford, 200 Hopmeadow St., Simsbury CT They ca also be reached at (800) The Isurace Compay will review the claim ad ordiarily otify you withi 45 days of the date your request for review is received. I special cases requirig a delay, the Isurace Compay will reder a decisio o later tha 90 days after your request for review is received. EMPLOYEE PREMIUMS Whe participatig i the LTD Pla, employees must pay the required employee premiums ($0.431 per $100 of coverage). OTHER INSURANCE COVERAGES WHILE ON LTD Medical Coverage Curretly, as log as you cotiue to qualify for LTD Pla beefits ad were erolled i the Medical Pla immediately prior to your disability, you ad your eligible depedets will be provided with Medical Pla coverage by payig the required premiums. Curretly, for participats whose eligibility date to receive LTD Pla beefits was prior to Jauary 1, 2009, o premium is required to cotiue this coverage. Curretly, for participats whose eligibility date to receive LTD Pla beefits was after December 31, 2008, ad were ot members of the IBEW uio, coverage may be cotiued by payig the active employee premium. If you qualify for Medicare Health Isurace coverage because of your disability, or if you have reached age 65, you must elect both Parts A ad B of Medicare ad pay the applicable premium. Medicare the becomes your primary medical isurace coverage. Life Isurace Coverage Curretly, as log as you cotiue to qualify for LTD beefits, you may cotiue your Life Isurace Pla coverage by payig the required premiums. Curretly, for participats whose eligibility date to receive LTD Pla beefits was prior to Jauary 1, 2009, o premium is required to cotiue this coverage. Curretly, for participats whose eligibility date to receive LTD Pla beefits was after December 31, 2008, ad were ot members of the IBEW uio, coverage may be cotiued by payig the active employee premium. Life Isurace coverage will be the amout i force o the day immediately precedig your first day of disability. Life Isurace coverage amouts will reduce at age 65 or over i accordace with the provisios of the Life Isurace Pla. Detal Coverage Curretly, if you were erolled i the Detal Pla, you ad your eligible depedets may cotiue detal coverage by payig the required employee premiums. This coverage will cease whe LTD beefits cease. MISCELLANEOUS Base Salary Base Salary meas your actual Base Salary o the day immediately precedig the day you become eligible to receive LTD beefits. It does ot iclude overtime, shift or holiday premium, bous or ay other forms of compesatio. For part-time employees, Base Salary is based o the part-time basic rate of pay. 4 BROOKHAVEN NATIONAL L ABOR ATORY

67 beefits part 4 LONG TERM DISABILITY PLAN A icrease i Base Salary will ot be recogized uder this LTD Pla if it occurs betwee separate periods of Total Disability which are cosidered oe period of disability for LTD beefits. Chages i the Amout of LTD Coverage Ay chage i the amout of your LTD coverage due to a chage i your Base Salary will become effective o the date your Base Salary chages. Cotiuous Service Cotiuous Service meas service from your most recet hire date. Service performed prior to a break i employmet is ot icluded i Cotiuous Service. Cotiuous Service will be reduced by periods o approved Leave of Absece. Cotiuous Service shall iclude cotiuous service, if ay, with Associated Uiversities, Ic., Battelle Memorial Istitute, Research Foudatio of the State Uiversity of New York or the State Uiversity of New York at Stoy Brook immediately prior to a trasfer of employmet to Brookhave Sciece Associates, LLC. Disabilities Not Covered The LTD Pla does ot cover ay disabilities caused by, cotributed to, or resultig from your: itetioally self-iflicted ijuries; commissio of or attempt to commit a feloy for which you have bee covicted uder state or federal law. disability due to war, declared or udeclared, or ay act of war. Employmet Status While Receivig LTD Beefits If you are a active employee, effective o the date you qualify for LTD beefits (commecig with your seveth cosecutive moth of disability), you will be placed o a leave of absece of up to 12 moths. If, at the ed of this period, you cotiue to qualify for LTD beefits, your employmet will be termiated, but your isurace coverages will cotiue as idicated above. Evidece of Isurability If you retur to work immediately after a approved Leave of Absece, but did ot cotiue your LTD coverage durig the leave ad are age 30 or over with oe year of Cotiuous Service, the Evidece of Isurability is ot required. Geeral Iformatio Iformatio regardig the pla idetificatio umber, pla year, pla fudig, type of pla, pla sposor, pla admiistrator, aget for legal process, your rights uder ERISA, prudet actios by pla fiduciaries, modificatio, suspesio, or termiatio of the pla, ad privacy of iformatio ca be foud i the Geeral Iformatio sectio of this booklet. Isurace Compay The Hartford as of August 1, BROOKHAVEN NATIONAL L ABOR ATORY 5

68 beefits part 4 LONG TERM DISABILITY PLAN Leave of Absece If you are o a approved Leave of Absece, you may cotiue your LTD coverage durig the term of the approved leave from the startig date of your leave by payig the required active employee premiums. Cotiuatio of isurace is ot allowed while o leave for other employmet whe (1) the other employer offers coverage or (2) the other employer is a agecy or prime cotractor of the federal govermet that will cover the employee uder its isurace program. Overpaymet If you are overpaid LTD beefits, you will be required to repay such amouts. The Isurace Compay will determie the method of repaymet. Reductio i Beefits Due to Earigs The mothly LTD beefits for ay moth durig which you are Totally Disabled will be reduced ad will take ito accout the amout you ear through work durig that moth. Social Security Beefits You are required to file for Social Security beefits if you are disabled. If you are covered uder the Federal Social Security Act for disability or Old Age Beefits, you will be assumed to be receivig such beefits. The level of such beefits will be estimated by the Isurace Compay. Your mothly LTD beefits will be reduced by the amout of such estimated beefits uless you have applied ad, if deied for beefits, reapplied ad bee deied. Upo proof of the actual beefit amout, the Isurace Compay will adjust your LTD beefits accordigly. Successive Periods of Disability If, after receivig LTD beefits, you retur to work o a part-time or full-time basis ad agai become Totally Disabled, you will be eligible for the cotiuatio of your previous LTD beefits ad will ot be required to establish a ew 180 day disability elimiatio period, provided that your disability recurs withi three moths after you retur to work ad is due to the same or related cause. This meas that your retur to work must be for less tha six moths to qualify for this provisio. If, however, your disability has a etirely ew ad urelated cause or if you have retured to work o a full-time basis for more tha six moths, you will be required to establish a ew 180 day disability elimiatio period before becomig eligible for LTD beefits. Termiatio of Coverage LTD Pla coverage will cease o the earlier of the date you are o loger receivig LTD beefits ad are o loger employed, the date you are o loger eligible for coverage, whe you fail to pay the required premiums, or the date the group cotract is cacelled. 6 BROOKHAVEN NATIONAL L ABOR ATORY

69 beefits part 4 LONG TERM DISABILITY PLAN Totally Disabled You will be cosidered Totally Disabled if, because of ijury or illess, you are uable to perform oe or more of the Essetial Duties of your regular occupatio durig the elimiatio period ad are uder the regular care of a doctor. After mothly LTD beefits have bee paid for twety four moths, you will be cosidered Totally Disabled if, because of ijury or illess, you are uable to perform the duties of ay gaiful occupatio for which you are reasoably fitted by educatio, traiig or experiece ad are uder the regular care of a doctor. Essetial Duty is defied as: Substatial, ot icidetal Fudametal or iheret to the occupatio ad Caot be reasoably omitted or chaged. Your ability to work the umber of hours i your regularly scheduled work week is a Essetial Duty. BROOKHAVEN NATIONAL L ABOR ATORY 7

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71 beefits: part 5 TRAVEL ACCIDENT INSURANCE PLAN part 5 TRAVEL ACCIDENT INSURANCE PLAN The Travel Accidet Isurace Pla provides 24-hour accidet coverage while o Authorized Busiess Travel. Coverage begis at the actual startig poit of a aticipated trip, whether this is your place of employmet, your home, or some other locatio, whichever occurs last. Coverage termiates upo your retur to home or place of employmet, whichever occurs first. WHO IS ELIGIBLE FOR THE TRAVEL ACCIDENT INSURANCE PLAN? All regular, temporary ad part-time employees, visitig scietists, Guests, ad members of the Board of Directors are eligible for Travel Accidet Isurace coverage. ENROLLMENT If you are eligible for the Travel Accidet Isurace Pla, you do ot eed to eroll. TRAVEL ACCIDENT INSURANCE PLAN COVERAGE Beefits Provided Category (1) All regular, temporary ad part-time employees, visitig scietists ad Guests. (2) All members of the Board of Directors. (3) All maagemet ad patrol officers of the police group (4) Spouses of Category (1), Category (2) ad Category (3) isured persos (5) Depedet Childre of Category (1), Category (2) ad Category (3) isured persos Coverage For Category (1) ad Category (2): For Category (3) For Category (4) ad Category (5): Coverage is for periods while o Authorized Busiess Travel (away from premises of residece or place of regular employmet) icludig sojour ad persoal deviatio, ad icludig while ridig as a passeger i ay regular, special or chartered flight or military aircraft beig used for the trasportatio of passegers, or as a passeger i ay tried, tested ad approved civilia aircraft. Coverage uder this Category applies to busiess oly War Risk Coverage (o ad off premises) icludig acts of war or terrorism. It excludes sojour ad persoal deviatio. Persos covered uder Category (3) are also icluded uder Category (1). I the evet of a loss, coverage uder either Category (1) or Category (3) will apply, but ot both. Oly that coverage which provides the greatest beefit amout shall be payable i the evet of a loss. Coverage is for periods while travelig with or i cojuctio with the Authorized Busiess Travel of the isured perso ad/or i coectio with the relocatio of the isured perso, provided the expeses for such trips are authorized ad paid by BSA. 1/07 1/10 BROOKHAVEN NATIONAL L ABOR ATORY 1

72 beefits: part 5 TRAVEL ACCIDENT INSURANCE PLAN Coverage Amout Travel Accidet Isurace beefits are based o the Pricipal Sum idicated below. Category Pricipal Sum (applicable to Accidetal Death & Dismembermet beefits ad Permaet & Total Disability beefits) (1) Five times Aual Salary. Miimum beefit of $100,000. Maximum beefit of $2,000,000. (2) $500,000 (3) $100,000 (4) $100,000 (5) $ 50,000 Travel Accidet Isurace beefits will be paid as follows for bodily ijuries sustaied withi oe year from the date of a Accidet: For Accidetal Death For Permaet Total Disability For Loss of Both Eyes, Two Limbs, Oe Limb ad Oe Eye, or Speech ad Hearig i Both Ears For Loss of Oe Eye, Oe Limb, Speech, or Hearig i Both Ears For Loss of Thumb ad Idex Figer of Same Had For Quadriplegia For Paraplegia For Hemiplegia 100% of Pricipal Sum. 100% of Pricipal Sum. (ot applicable to Categories, (4) ad (5)) 100% of Pricipal Sum. 50% of Pricipal Sum 25% of Pricipal Sum. 100% of Pricipal Sum. 75% of Pricipal Sum. 50% of Pricipal Sum. I additio, Accidet Medical Expeses, up to a maximum of $10,000, will be paid for medical expeses icurred withi 365 days of the date of the accidet (oly for Category (2) isured persos). A Emergecy Medical Beefit of up to $10,000 is also available to satisfy a medical providers medical expese guaratee or hospital admissio guaratee should a isured perso suffer from a emergecy illess or ijury durig a covered trip. Exclusios The pla does ot provide coverage for commutatio ad vacatio travel, suicide or attempt thereof, sickess or disease, other tha bacterial ifectios which result from a accidetal cut or woud, declared or udeclared war or ay act thereof occurrig i the U.S., or the isured s coutry of permaet residece, service i the armed forces, or ridig as a pilot or crew member i ay aircraft or as a passeger i ay aircraft used for acrobatic or stut flyig, racig or edurace tests, crop dustig, seedig or baer towig, or ay aircraft owed or leased by BSA or ay employee of the BSA, losses resultig from the commissio of a commo law feloy, defied as, but ot limited to, robbery, murder, rape, arso ad kidappig. A aggregate limit of beefits of $23,000,000 is imposed o ay sigle aircraft ad war Accidet causig loss ivolvig more tha oe ijured perso. If the total beefits payable exceed that amout, claimats will share the beefits i proportioal amouts. Accidetal Bur ad Disfiguremet Beefit Coverage is exteded for covered ijuries if a isured perso suffers burs that leave him or her Disfigured. The burs must result directly ad idepedetly of all other causes from a covered Accidet. The Disfiguremet must satisfy all of the coditios below. 1. recostructive or cosmetic surgery is required to restore the isured perso s physical abilities or correct Disfiguremet, ad must be commeced/performed withi twelve moths of the covered Accidet.; 2 BROOKHAVEN NATIONAL L ABOR ATORY 1/08 1/10

73 beefits: part 5 TRAVEL ACCIDENT INSURANCE PLAN 2. the covered Accidet must occur while the isured: a. is o BSA/BNL premises; ad b. egaged i the course of his or her job. 3. a doctor must determie that the bur satisfies all of the followig: 1. ivolves the miimum percetage of body disfiguremet show below; 2. be classified as secod degree burs or worse as show below; ad 3. results i Disfiguremet or loss of physical abilities. Accidetal Bur ad Disfiguremet Beefit Schedule % Body Disfiguremet Lesser of 25% of the Pricipal Sum or $25, % Body Disfiguremet Lesser of 15% of the Pricipal Sum or $25, % Body Disfiguremet Lesser of 5% of the Pricipal Sum or $25,000 Airbag Beefit A additioal beefit of 10% of the isured perso s pricipal sum up to a maximum of $15,000 will be payable if a isured perso s death results from a covered Accidet while positioed i a seat protected by a properly fuctioig ad properly deployed supplemetal restrait system (airbag) while operatig or ridig as a passeger i a Automobile. Bomb Scare ad/or Explosio Coverage: O Premises Coverage is exteded to isured persos for covered ijuries resultig from a bomb scare or explosio while o BNL/BSA premises, subject to a aggregate limit of beefits of $23,000,000 o ay sigle loss ivolvig more tha oe isured perso. Carjackig Beefit A additioal beefit shall be payable if the isured perso suffers a covered Loss resultig directly ad idepedetly of all other causes from a covered Accidet that occurs durig a carjackig of a Automobile that the isured perso was operatig, gettig ito or out of, or ridig as a passeger. Verificatio of the Carjackig must be made part of a official police report withi 24 hours of the carjackig, or as soo as reasoably possible, or be certified i writig by the ivestigatig officer(s) withi 24 hours of the Carjackig, or as soo as reasoably possible. The additioal beefit payable is 10% of the isured perso s pricipal sum subject to a maximum beefit of $10,000. Coma Beefit Coverage Coverage is exteded for covered ijuries resultig i a isured perso lapsig ito a Coma withi 21 days of the Accidet ad cotiues for 3 successive moths. The mothly beefit is equal to 1% of the isured s Pricipal Sum. The mothly beefits will start o the begiig of the 4th cotiuous moth of the Coma ad will cotiue util the earlier of: 1. the date the Coma eds; 2. the date the isured dies; or 3. the ed of a period of 100 cosecutive moths. A prorated beefit will be payable for partial moths. 1/10 BROOKHAVEN NATIONAL L ABOR ATORY 3

74 beefits: part 5 TRAVEL ACCIDENT INSURANCE PLAN Cotiuatio of Isurace Expese Beefit A additioal beefit will be paid if a survivig isured spouse or a survivig isured Depedet Child elects to cotiue group medical ad/or detal isurace provided by BSA/BNL of a isured who died, subject to all of the followig coditios: 1. the isured s death results directly ad idepedetly of all other causes from a covered Accidet; 2. the isured is survived by a isured spouse, isured Depedet Child who are isured uder the policy o the date the isured dies; 3. the isured spouse, isured Depedet Child is also isured uder a medical or detal pla sposored by BSA/BNL at the time of the isured s death; 4. the isured spouse, isured Depedet Child otifies the isurace carrier of his or her electio, withi 60 days of the isured s death, to cotiue his or her existig coverage uder group isurace plas sposored by BSA/BNL as permitted by state or federal cotiuatio law. This beefit, payable aually, equals the premiums required to cotiue the medical ad or detal isurace described above, as log as the total amout of this beefit does ot exceed the lesser of 5% of the Isured perso s pricipal sum or $7, The beefit will be paid at the ed of each year durig which medical ad/or detal isurace is cotiued, if the isurace carrier receives a request for reimbursemet ad proof of the premiums paid durig that year. Beefit paymets will cotiue util the earliest of the followig dates: 1. the date a survivig spouse or survivig Depedet Child is o loger eligible to cotiue medical ad/or detal isurace coverage; 2. the date beefits equal the maximum beefit show above ad 3. the ed of the maximum beefit period. Beefits are payable to the survivig spouse, or the perso who actually paid the premium o the survivig spouse s behalf, if other tha the survivig spouse. lth couselig. Emergecy Medical Evacuatio Coverage is exteded to isured persos while travelig outside 100 miles from his/her home or place of permaet assigmet. Beefits will be payable for covered expeses if ay ijury or illess commecig durig a covered trip results i the emergecy evacuatio of a isured perso. The emergecy evacuatio must be coordiated through the Travel Assistace Services Compay ad be ordered by a legally licesed physicia who certifies that the severity of the isured perso s ijury or illess warrats the emergecy evacuatio of the isured perso. Exteded Terrorism Coverage Coverage is exteded to isured persos for covered ijuries sustaied as idicated herei. The war exclusio does ot apply to acts of terrorism occurrig i the U.S. causig a loss covered by the pla. Acts of terrorism meas a activity that 1) ivolves ay violet act or ay act dagerous to huma life, ad that threates or causes accidetal ijury to persos; ad 2) appears to be i ay way iteded to: a) itimidate or coerce a civilia populatio; or b) disrupt ay segmet of a atio s ecoomy; or c) ifluece the policy of a govermet by itimidatio or coercio; or d) affect the coduct of a govermet by mass destructio, assassiatio, kidappig or hostage-takig; or e) respod to govermetal actio or policy. It icludes the use of ay uclear weapo or device or the emissio, discharge, dispersal, release or escape of ay solid liquid or gaseous, chemical or biological aget. It shall also iclude ay icidet declared to be a act of terrorism by a official, departmet or agecy that has bee specifically authorized by federal statute to make such a determiatio. This icludes, but is ot limited to, murder, kidappig, hijackig, sabotage, or bombigs. 4 BROOKHAVEN NATIONAL L ABOR ATORY 1/10

75 beefits: part 5 TRAVEL ACCIDENT INSURANCE PLAN Exteded terrorism coverage does ot iclude covetioal warfare desiged to result i wholesale loss of life through use of missiles, aerial bombardmet, uclear, chemical or biological warfare, or outright ivasio. With the exceptio of Category (3), as described previously, this coverage does ot apply o premises of BNL/BSA. Feloious Assault Coverage: O Premises Coverage is exteded to isured persos for covered ijuries resultig from ay feloious acts committed by a o-employee who is ot a family member upo the isured perso while o BNL/BSA premises, subject to a aggregate limit of beefits of $23,000,000 o ay sigle loss ivolvig more tha oe isured perso. Hijackig/Skyjackig Coverage Coverage is exteded to isured persos for covered losses sustaied resultig from hijackig or skyjackig of a coveyace while travelig o Authorized Busiess Travel regardless of whether the hijackig/skyjackig is or is ot the result of a act of war. Kidap ad Extortio Beefit A additioal beefit of up to $50,000 shall be payable if the isured perso is a victim of kidap or extortio. O-Premises Emergecy Fire/Disaster Team Coverage Coverage is exteded while actig as a member of a BSA Emergecy Fire/Disaster team. Persoal Deviatio Provisio Coverage is exteded to isured persos for side trips take, which are icidetal to Authorized Busiess Travel, uless idicated otherwise. Reasoable Accommodatio at Worksite Beefit The isurace carrier will reimburse costs, up to the maximum beefit show i the Schedule of Beefits, subject to the followig coditios, whe BSA/BNL icurs costs for ay worksite chage required to eable the isured to retur to work. The isured must have suffered a covered Loss resultig directly ad idepedetly of all other causes from a covered Accidet, ad be returig to work as soo thereafter as permitted by his or her doctor. The beefit payable to BSA/BNL is the reimbursemet costs of ay pre-approved chage made to the worksite for the Isured, up to the maximum amout specified i the Schedule of Beefits. Reimbursemet will be subject to all of the followig coditios: 1. isurace provided uder the policy must be i force for the isured o the date the covered Accidet occurs; 2. chage to the worksite must be made withi 12 moths of the date of the covered Accidet; 3. there is reasoable expectatio that such chage to the worksite will eable the isured to retur to work; 4. the isurace carrier approves ay chage to the worksite i writig before it is made. Beefits will ot be payable if: 1. there is o cost ivolved i makig ay chage to the worksite; or 2. ay chage to the worksite does ot meet the stadards foud i Title I of the Americas with Disabilities Act (ADA). 1/10 BROOKHAVEN NATIONAL L ABOR ATORY 5

76 beefits: part 5 TRAVEL ACCIDENT INSURANCE PLAN The isurace carrier will ot reimburse the cost of ay chage to the worksite for which reimbursemet is made uder more tha oe policy isurig the isured ad issued by the isurace carrier or ay other isurace compay. Chages to the worksite meas: 1. makig existig facilities used by the isured readily accessible ad usable; ad 2. job restructurig, reassigmet to a vacat positio, acquisitio or modificatio of equipmet or devices, appropriate adjustmet or modificatio of examiatios, traiig materials or policies, the provisio of qualified readers or iterpreters, ad other similar accommodatios for idividuals with disabilities resultig from a covered Accidet. Rehabilitatio Beefit Coverage is iteded to reimburse a isured perso for Rehabilitatio Expeses arisig from a covered ijury if: 1. the isured perso is participatig i a Rehabilitatio program due to a ijury that results directly from, ad from o other cause, but a covered accidet; ad 2. a doctor prescribes the Rehabilitatio program. Beefits are payable for: 1. the facility providig the Rehabilitatio program i which the isured is participatig; ad 2. immediate family members who icur expeses for travel to ad from the locatio at which the isured is participatig i a Rehabilitatio program provided actual receipts are submitted with the claim. Beefits will ed whe the first of the followig evets occur: 1. the date the isured completes the Rehabilitatio program; or 2. the date the isured dies. Reimbursemet of covered Rehabilitatio expeses is subject to a maximum beefit of $50,000. Repatriatio of Remais Coverage is exteded to isured persos while outside a 100-mile radius from his/her home or regular place of employmet. Beefits will be payable for the reasoable covered expeses icurred to retur the isured perso s body home to his/her home coutry if he/she dies. The repatriatio of remais must be coordiated through the Travel Assistace Services Compay. Coverage icludes, but is ot limited to expeses for embalmig, crematio, coffi, ad trasportatio. Seat Belt Beefit A isured perso s Pricipal Sum will be icreased by 10% but ot less tha $1,000 to a maximum of $50,000 for covered losses occurrig while ridig i a automobile durig Authorized Busiess Travel provided the isured was usig a seat belt at the time of the loss. Special Adaptatio Beefit Special adaptatio beefits will be paid if a isured perso: 1. suffers a Presumptive Disability from a covered Accidet; ad 2. requires a special housig adaptatio; or 3. a special Vehicle to accommodate the disability. Beefits will ot be payable uless the Isured Perso s doctor certifies them as ecessary. 6 BROOKHAVEN NATIONAL L ABOR ATORY 1/10

77 beefits: part 5 TRAVEL ACCIDENT INSURANCE PLAN Special Couselig Beefit Coverage icludes a special couselig beefit for metal health couselig to assist a isured perso i dealig with a covered loss if he/she: 1. suffers a ijury that results i a Loss for which the Accidetal Death ad Dismembermet Beefit is payable; ad 2. obtais metal health to a maximum of $25,000. Covered expeses are reimbursable at 10% of the isured perso s Pricipal Sum subject Travel Assistace Services Coverage is exteded to isured persos whe travelig o BNL/BSA busiess outside 100 miles from his/her home or place of permaet assigmet. These services iclude: Pre-Departure Services Lost Baggage/Passport Isurace Coordiatio Emergecy Cash Travel Medical Emergecy Services Legal Assistace Evacuatio ad Repatriatio Assistace Services Travel Assistace Services Compay Emergecy Medical Evacuatio ad Repatriatio of Remais are provided while travelig 100 miles or more from your primary home through Worldwide Assistace Services, Ic. They ca be reached at: Toll-free from the U.S Collect from other locatios Please provide the ame Brookhave Sciece Associates ad this Travel Assistace Pla Idetificatio Number: 01AH585 War Risk Coverage Coverage is exteded to isured persos for covered ijuries sustaied as the result of declared or udeclared war, worldwide with the exceptio of the U.S., ad the isured s coutry of permaet residece. CLAIMS How to File a Claim To file a claim uder the Travel Accidet Isurace Pla, you must complete a Travel Accidet claim form that is available i the Beefits Office. The completed claim form must be submitted to the Beefits Office. Questios About Claims If you have a questio about your Travel Accidet Isurace claim, you should cotact the Beefits Office at (631) Whe discussig your claim, please refer to the claim form ad ay correspodece that you may have received. BROOKHAVEN NATIONAL L ABOR ATORY 7

78 beefits: part 5 TRAVEL ACCIDENT INSURANCE PLAN How to Appeal a Claim If your claim is deied i whole or i part, you will receive a writte otice of the deial from the isurace compay. The otice will explai the reaso for the deial ad the review procedures. You may request a review of the deied claim. The request must be submitted i writig withi 60 days after you receive the deial otice. Submit your request, icludig your reasos for requestig the review, to Ace America Isurace Compay, Accidet: Health Claims, P. O. Box 15417, Wilmigto, DE They will have the claim reviewed ad ordiarily otify you of the fial decisio withi 60 days of receipt of your request. If special circumstaces require a extesio of time, you will be otified durig the 60 days followig receipt of your request. PREMIUMS Travel Accidet Isurace is provided to you at o cost. MISCELLANEOUS Accidet A Accidet is a occurrece which occurs while eligible or uder this pla, causes bodily ijury which results i a loss covered by this pla, ad causes a loss directly ad idepedetly of ay other causes ot related to the Accidet. Accidet Medical Expese Reasoable medical expeses caused by a covered Accidet icurred withi 365 days after the date of the Accidet, up to the stated maximum amout payable. Aual Salary Aual Salary from BSA or from the regular employer of the isured perso is the isured perso s aual base salary, before exercise of ay salary reductio optio, as of the time of the Accidet. Overtime pay ad premium pay are ot icluded i Aual Salary. Assigmet of Your Travel Accidet Isurace Policy If you wat to make a outright assigmet of your Travel Accidet Isurace to aother perso istead of amig a Beeficiary, a separate assigmet form is ecessary ad may be obtaied from the Beefits Office. Authorized Busiess Travel Meas a trip take at the directio ad authorizatio of BNL/BSA. Automobile A self-propelled private passeger motor vehicle with four or more wheels, that is of a type both desiged ad required to be licesed for use o the highways of ay state or coutry. Automobile icludes, but is ot limited to, a seda, statio wago, sport utility vehicle, ad a motor vehicle of the pickup, pael, va, camper or motor home type. Automobile does ot iclude a mobile home or ay motor vehicle that is used i mass or public trasit. 8 BROOKHAVEN NATIONAL L ABOR ATORY

79 beefits: part 5 TRAVEL ACCIDENT INSURANCE PLAN Beeficiary I the evet of accidetal death covered by this pla, your Beeficiary will be the perso or persos desigated uder your Basic Life Isurace Pla coverage. I the absece of a desigated Beeficiary, beefits for loss of life will be paid to the followig successor Beeficiaries: Your spouse, if livig; otherwise Your survivig child(re) i equal shares, if ay; otherwise Your paret(s) i equal shares, if livig; otherwise Your brother(s) or sister(s) equally, if ay; otherwise Your estate. All other beefits payable uder this pla are paid to you. Carjackig A perso other tha the isured perso takig ulawful possessio of a Automobile by meas of force or threats agaist the perso(s) the rightfully occupyig such Automobile. Coma A state of profoud ucosciousess from which a isured perso caot be aroused. The isured must be cofied i a hospital or other medical facility ad diagosed as beig i a coma by a licesed physicia. Depedet Child(re) Depedet Child(re) are ay umarried childre of isured persos i Categories (1) or (2), per the isurace cotract, who are uder age 19 or age 25 if i a accredited school or college o a fulltime basis, ad who are wholly depedet o the isured perso for support. A child, for eligibility purposes, icludes a isured s atural child; adopted child, begiig with ay waitig period pedig fializatio of the child s adoptio; or a stepchild who depeds o the isured for fiacial support. Disfiguremet/Disfigured Spoiled or deformed appearace caused by burs that ca be corrected by meas of recostructive or cosmetic surgery. Emergecy Medical Beefit Pays medically ecessary expeses specifically for medical expese guaratee ad hospital admissio guaratee up to the amout stated should a isured perso suffer a medical emergecy while travelig 100 miles or more away from his or her place of permaet residece. Geeral Iformatio Iformatio regardig the pla idetificatio umber, pla year, pla fudig, type of pla, pla sposor, pla admiistrator, aget for legal process, your rights uder ERISA, prudet actios by pla fiduciaries, ad modificatio, suspesio, or termiatio of the pla ca be foud i the Geeral Iformatio sectio of this booklet. BROOKHAVEN NATIONAL L ABOR ATORY 9

80 beefits: part 5 TRAVEL ACCIDENT INSURANCE PLAN Guest A Guest is a perso who travels at the directio or ivitatio of BSA whose travel expeses are paid for or reimbursed by BSA, or those persos who agree to pay oe-half of the airfare while travelig to ad from the BNL/BSA premises at the ivitatio of BSA. Leave of Absece You are ot covered by the Travel Accidet Isurace Pla if you are o a approved Leave of Absece. Loss A Loss of member with respect to a had or foot meas complete severace through or above the wrist or akle joit; with respect to eyes meas the total, permaet loss of sight; with respect to speech, meas total ad permaet loss of audible commuicatio that is irrecoverable by atural, surgical or artificial meas; with respect to hearig meas etire loss of hearig i both ears that is irrecoverable ad caot be corrected by ay meas; with respect to thumb ad idex figer meas complete severace through or above the kuckle joits earest the had. A Loss for disability meas permaet ad total disability resultig from a covered Accidet which causes the isured to be uable to egage i ay occupatio or employmet for which he or she is qualified by reaso of educatio, traiig, or experiece. Beefits are payable after such coditio has lasted 12 moths ad is deemed total, cotiuous, ad permaet at that time. A Loss with regard to quadriplegia meas complete ad irreversible paralysis of both upper ad lower limbs; with regard to paraplegia meas the complete ad irreversible paralysis of both lower limbs; ad with regard to hemiplegia meas the complete ad irreversible paralysis of upper ad lower limbs of oe side of the body. Presumptive Disability Presumes a isured perso is Totally Disabled if he/she suffers the complete ad irrecoverable sight of both eyes, speech, hearig i both ears, or of ay two limbs, hads or feet, provided the loss occurs withi oe year of the Covered Accidet Rehabilitatio Medical services, supplies, or treatmet, or hospital cofiemet (or part of a hospital cofiemet) that satisfies all of the followig coditios: 1. are essetial for physical rehabilitatio required due to the isured s covered loss; 2. meet geerally accepted stadards of medical practice; 3. are performed uder the care, supervisio or order of a doctor; 4. prepare the Isured to retur to his or ay other occupatio. Termiatio of Coverage Travel Accidet Isurace Pla beefits will cease o the day a isured perso is o loger employed or affiliated with BSA i a eligible capacity. Vehicle A private passeger lad motor vehicle. It icludes automobiles, vas, ad four wheel drive vehicles. It does ot iclude a vehicle used for farmig, commercial busiess, racig or ay type of competitive speed evet. 10 BROOKHAVEN NATIONAL L ABOR ATORY 1/10

81 beefits: part 6 RETIREMENT PLAN part 6 RETIREMENT PLAN The Retiremet Pla provides participats with icome at retiremet. The Retiremet Pla is provided at o cost to participats. WHO IS ELIGIBLE FOR THE RETIREMENT PLAN? Active Employees Effective Jauary 1, 2007, ay employee who was ot already a participat i the Pla o December 31, 2006 will become eligible to participate after he or she has either: (a) attaied age 21 ad completed oe Year of Service, or (b) attaied age 30 ad completed six moths of Cotiuous Service, ad is ot a Part-Time or Temporary Employee. A Year of Service is a 12-moth period of cotiuous employmet with the Employer, except that a Part-Time or Temporary Employee must be credited with at least 1,000 Hours of Service durig the twelve moth period begiig o the date you first perform a Hour of Service (or each successive aiversary thereof), to ear a Year of Service. Participatio begis the first day of the pay period followig completio of the age ad service requiremets. Service icludes Cotiuous Service, if ay, with Associated Uiversities, Ic., Battelle Memorial Istitute, Research Foudatio of the State Uiversity of New York, or the State Uiversity of New York at Stoy Brook immediately prior to a trasfer of employmet to Brookhave Sciece Associates, LLC. If you termiate employmet after you have become a participat i the Pla ad are re-employed before icurrig a Five Year Break i Service or if you had a vested iterest i your Pla Accout whe you left, you will be eligible to re-eter the Retiremet Pla o the first pay period begiig after your re-employmet. Otherwise, you must satisfy the eligibility requiremets described above. The followig idividuals are ot eligible to participate i the Pla: (1) ay leased employee, as defied by Iteral Reveue Code Sectio 414(); (2) ay perso holdig solely a Guest or Visitor Appoitmet to Brookhave; (3) ay perso whose terms of employmet are govered by a collective bargaiig agreemet whose retiremet beefits are the subject of good faith bargaiig, uless the collective bargaiig agreemet specifies that such idividual is eligible to participate i the Pla; (4) ay idividuals hired o or after Jauary 1, 1999 who are desigated by the Employer as a research associate, research fellow or studet assistat; or (5) ay perso desigated by the Employer as a idepedet cotractor or who performs services pursuat to a writte agreemet with a third party. ENROLLMENT Eligible employees must eroll for the Retiremet Pla whe first eligible. To eroll, you must complete erollmet forms that are available through the Beefits Office. By completig the forms, you will authorize the fuds i which Retiremet Pla cotributios will be ivested. RETIREMENT PLAN COVERAGE Beefits Provided If you work at least 1,000 Hours of Service durig a Pla Year ad were hired prior to Jauary 1, 2011, Brookhave will cotribute a amout equal to 10% of your Base Salary to your accout i this Pla. If you work at least 1,000 hours of service durig a pla year ad were hired o or after Jauary 1, 2011, Brookhave will cotribute a amout equal to 9% of your Base Salary to your accout i BROOKHAVEN NATIONAL L ABOR ATORY 1

82 beefits: part 6 RETIREMENT PLAN this Pla. (For employees who are members of the IBEW uio, the terms of the collective bargaiig agreemet apply). Federal laws ad regulatios may limit cotributios to this Pla. Cotributios will be made oly with respect to the portio of your Base Salary paid while you are a participat i the Pla. I additio, for each former employee of Brookhave Natioal Laboratory who was a participat i the AUI Retiremet Pla o February 28, 1998, the participat s 401(a) accumulatio i that Pla was trasferred to this Pla o or about March 1, Participats are ot required or allowed to cotribute to this Pla. Pla Ivestmets There are umerous approved TIAA-CREF, Fidelity ad Vaguard fuds i which a participat ca allocate the ivestmet of cotributios. The fuds available for ivestmet are idicated at the ed of the Retiremet Pla sectio. The Pla is iteded to costitute a pla described i Sectio 404(c) of the Employee Retiremet Icome Security Act of 1974 (ERISA), ad Title 29 of the Code of Federal Regulatios Sectio c-1. This meas that the fiduciaries of the Pla may be relieved of liability for ay losses that are the direct ad ecessary results of your ivestmet choices. Uder these regulatios, you have the right to receive additioal iformatio regardig the ivestmet optios provided uder the Pla. The Pla Admiistrator is the Pla fiduciary resposible for providig this iformatio, ad the iformatio may be obtaied from the Beefits Office. The additioal iformatio icludes: A descriptio of the aual operatig expeses of each ivestmet fud which may reduce the rate of retur o the fud, ad the amout of expeses expressed as a percetage of the fud s average et assets. Copies of prospectuses, fiacial statemets ad reports, ad other materials relatig to the ivestmet fuds, to the extet such iformatio is provided to the Pla. A list of fuds, icludig the issuer, term ad rate of retur of all guarateed ivestmet cotracts. Iformatio cocerig the value of shares or uits i each available ivestmet fud, as well as the past ad curret ivestmet performace of such fuds, et of expeses. Iformatio cocerig the value of shares or uits of each fud held i your accout. I additio to this iformatio, each mutual fud whose shares are registered with the U.S. Securities ad Exchage Commissio must periodically publish a documet called a prospectus, which is a descriptio of the fud, its maagemet ad ivestmet philosophy, ad certai risk factors ivolved i ivestig i the fud. The prospectus will also cotai iformatio about the prior ivestmet performace ad maagemet expeses of the fud. Each of the ivestmet fuds curretly available uder the Pla is required to issue a prospectus, ad you should receive ad review the curret prospectus before ivestig ay part of your accout i the fud. If you do ot automatically receive a curret prospectus, you ca request oe from the ivestmet compay. Allocatig Cotributios Whe a participat first erolls i the Pla, he or she will complete a form idicatig how to allocate Pla cotributios amog ivestmet fud optios. The allocatio ca be chaged at ay time. If a participat wats to chage the allocatio withi a ivestmet compay, he or she must cotact the ivestmet compay directly. If the participat wats to chage ivestmet compaies or the allocatio betwee compaies, he or she must complete a allocatio form available i the Beefits Office. Trasferrig Betwee Fuds Participats are permitted to trasfer accumulatios betwee fuds ad ivestmet compaies. To trasfer accumulatios withi a ivestmet compay, the participat must cotact the ivestmet 2 BROOKHAVEN NATIONAL L ABOR ATORY

83 beefits: part 6 RETIREMENT PLAN compay directly. To trasfer accumulatios from oe ivestmet compay to aother, forms are available i the Beefits Office. Limitatios apply whe trasferrig accumulatios out of TIAA. Trasfers out of the TIAA Traditioal Auity ca oly be made over a te-year period, where the amout to be trasferred must first be moved to a TIAA trasfer payout auity. Desigatig a Beeficiary Whe a participat erolls i the Pla, he or she will idicate oe or more beeficiaries o the erollmet forms. For married participats, the spouse must be the beeficiary for at least 50% of the accumulatio uless the spouse cosets to the desigatio of someoe else. The spouse s coset must be i writig ad witessed by a Pla represetative or a otary public. I the evet of a participat s death, retiremet beefits will be paid to the desigated beeficiary(ies). A beeficiary desigatio may be chaged at ay time, prior to begiig retiremet beefits, by cotactig the Beefits Office or the ivestmet compaies directly. If you do ot desigate a beeficiary ad are ot married at the time of your death, ay remaiig beefits will be paid i a lump sum to your estate. If you are married at the time of your death ad have ot desigated a beeficiary, ay remaiig beefits will be paid to your spouse i the form of a auity (although your spouse may elect a differet form of beefit that is available uder the Pla). Remember to review your desigatio if you get married or divorced or have aother major life evet. If you have desigated a beeficiary ad the get married, remember that your desigatio will ot be effective uless your survivig spouse cosets to the desigatio. Rollover Cotributios This Pla does ot accept rollover cotributios. Vestig Vestig is the process by which a participat ears the right to the value of the cotributios i his or her accout. Employees who were participats i the Pla before Jauary 1, 2007 are 100% vested i their accouts uder the Pla. For employees who become participats o or after Jauary 1, 2007, accouts will vest accordig to your Years of Service uder the followig schedule: Years of Service Less tha 2 0% 2 but less tha 3 25% 3 but less tha 4 50% 4 but less tha 5 75% 5 or more 100% Percetage Vested For vestig purposes, a Year of Service is a 12 cosecutive moth period begiig o the date you begi workig for the Employer (ad each successive aiversary) i which you are credited with at least 1,000 Hours of Service. Effect of Termiatio ad Re-employmet If you were a participat before Jauary 1, 2007, termiate employmet, ad are re-hired you will cotiue to be 100% vested i cotributios made to your accout after your retur. If you became a Participat o or after Jauary 1, 2007, ad leave employmet before you are 100% vested, ay o-vested portio of your beefit will be forfeited oce you (a) take a distributio of the vested portio of your beefit from the Pla, or (b) icur a Five Year Break i Service. If you are BROOKHAVEN NATIONAL L ABOR ATORY 3

84 beefits: part 6 RETIREMENT PLAN re-employed before icurrig a Five Year Break i Service you ca agai ear Years of Service toward vestig your accout. If you had take a distributio of the vested portio of your beefit, the amout you forfeited will be restored oly if you repay that distributio withi five years of your re-employmet. Lost earigs will ot be restored. If you are re-employed after icurrig a Five Year Break i Service, your forfeited beefit will ot be restored. Your prior service will cout i determiig your vested iterest i ay ew cotributios to your accout oly if (a) you had a vested iterest i your accout before you left, or (b) your pre-break Years of Service exceed your years of Break i Service. Loas Loas are ot permitted or provided for uder this Pla. Withdrawals Withdrawals are ot permitted from this Pla while a participat is eligible for cotributios to be made to his or her accout. See the RETIREMENT OPTIONS ad REPURCHASE OF BENEFITS sectios for iformatio o withdrawals ad the receipt of retiremet icome after termiatio of employmet. Statemets Participats will receive quarterly accout statemets from each of the ivestmet compaies i which they have ivested Pla cotributios. The statemets will idicate the amout of accumulatios i each of the fuds i which the participat has ivested. RETIREMENT OPTIONS If a participat has termiated employmet, he or she may begi receivig retiremet beefits. Participats have the beefit optios idicated below for the paymet of beefits. Paymet of retiremet beefits, other tha the Cash Withdrawal or Rollover optios, must be made through TIAA-CREF. This meas that i order to establish the paymet of beefits other tha through the Cash Withdrawal or Rollover optios, the participat must trasfer accumulatios, if ay, i Fidelity Ivestmet Services to TIAA-CREF before beefit paymets ca begi. Other tha for the purpose of the Cash Withdrawal Rollover ad Retiremet Trasitio Beefit optios idicated below, retiremet beefits will be provided i the form of a auity. A auity, for the purpose of this Pla, is a series of regular paymets. I ay case where spousal coset is required to elect a form of beefit, the coset form must be siged before a Pla represetative or a otary public. To apply for beefits, call (800) for TIAA-CREF ad/or Vaguard fuds or (800) for Fidelity fuds. Cash Withdrawal If a participat has termiated employmet ad is age 55 or older, he or she may request to receive up to 100% of his or her total accumulatio i the Retiremet Pla through cash withdrawals. Cash withdrawals are permitted from TIAA; however, limitatios apply. Based o federal law, married participats who request a cash withdrawal must provide their spouse s writte coset for such withdrawal, uless the distributio is $5000 or less. Retiremet Trasitio Beefit Whe a participat begis the process to establish a retiremet auity, he or she may request that 10% of his or her total accumulatio be provided as a sigle sum paymet. This is called a retiremet trasitio beefit. Based o federal law, married participats who request a retiremet trasitio beefit must provide their spouse s writte coset for such beefit. 4 BROOKHAVEN NATIONAL L ABOR ATORY

85 beefits: part 6 RETIREMENT PLAN Oe-Life Auity Optio The most basic auity form is the oe-life auity. This is the ormal form of beefits for participats who are ot married whe distributios begi. It pays icome to the participat for his or her lifetime, ad the icome ceases at death. A participat may elect a guarateed period of either 10, 15, or 20 years to be added to this optio, but restrictios may apply. If the participat dies durig the period, the desigated beeficiary will cotiue to receive the full paymets util the guarateed period eds. Based o Federal law, married participats who request a oe-life auity optio must provide their spouse s writte coset for such beefit. Two-Life Auity Optio A two-life auity provides a icome for life for two people. This is the ormal form of beefits for participats who are married whe distributios begi. Neither the participat or his or her desigated secod auitat ca outlive the icome. The amout cotiuig to the survivor after the participat s death depeds o the optio selected. A participat may elect a guarateed period of either 10, 15, or 20 years to be added to ay of the two-life auity optios idicated below, but restrictios may apply. Whe a guarateed period is added to a two-life auity, the guaratee provides that the beefit will cotiue to a desigated beeficiary util the ed of such period if both the participat ad the secod auitat die withi the guarateed period. Based o federal law, married participats who request a two-life auity optio must provide their spouse s writte coset for such beefit, if the desigated secod auitat is ot the spouse. A two-life auity with full beefit to survivor meas that there is o beefit reductio after the death of either the participat or the secod auitat. If a guarateed period is added to this optio ad both the participat ad the secod auitat die durig the period, the desigated beeficiary will cotiue to receive the full beefit util the guarateed period eds. A two-life auity with half beefit to secod auitat meas that if the participat dies first, the beefit to the secod auitat will cotiue at half of the amout it would otherwise be. If the secod auitat dies first, the icome to the participat does ot chage. If a guarateed period is added to this optio ad both the participat ad the secod auitat die durig the period, the desigated beeficiary will receive half of the beefit util the guarateed period eds. A two-life auity with three-quarters beefit to secod auitat meas that if the participat dies first, the beefit to the secod auitat will cotiue at three-quarters of the amout it would otherwise be. If the secod auitat dies first, the icome to the participat does ot chage. If a guarateed period is added to this optio ad both the participat ad the secod auitat die durig the period, the desigated beeficiary will receive three-quarters of the beefit util the guarateed period eds. A two-life auity with two-thirds beefit to survivor meas that whe either the participat or the secod auitat dies, the beefit is reduced to two-thirds of the amout it would otherwise be for the survivor. This is the oly optio where the beefit of the participat reduces if the secod auitat dies first. If a guarateed period is added to this optio ad both the participat ad the secod auitat die durig the period, the desigated beeficiary will receive the two-thirds beefit util the guarateed period eds. Fixed Period Auity Optio For ay vested accumulatio that a participat has i CREF, he or she may elect the fixed period auity optio that provides retiremet beefits over a umber of years based o the participat s electio. The umber of years available for beefits is betwee 15 ad 30 ad depeds o the participat s age. Durig that period, all of the participat s accumulatio will be retured to him or her. Whe the fixed period is over, beefits cease. If a participat dies durig the period, the desigated beeficiary may elect to cotiue receivig the remaider of the beefit paymets or a lump sum paymet. Based o Federal law, married participats who request a fixed period auity optio must provide their spouse s writte coset for such beefit. BROOKHAVEN NATIONAL L ABOR ATORY 5

86 beefits: part 6 RETIREMENT PLAN Iterest Paymet Retiremet Optio (IPRO) For ay vested accumulatio that a participat has i TIAA, he or she may elect the IPRO that provides for paymets cosistig oly of curret iterest o the TIAA accumulatio. The miimum amout that may be desigated for a IPRO is $10,000. The accumulatio remais uchaged durig the period that the IPRO icome is provided. This optio is available to participats betwee ages 55 ad approximately 69½. If a participat elects this optio, it must evetually be coverted to a auity or MDO. Based o federal law, married participats who request a IPRO optio must provide their spouse s writte coset for such beefit. Miimum Distributio Optio For participats who have termiated employmet, have ot yet begu receivig retiremet beefits, ad who are age 70½, Federal laws require that a miimum retiremet distributio must begi by April 1 of the year after reachig age 70½. Uder this optio, paymets are set at the miimum level required by law ad ca cotiue util (a) the total accumulatio has bee fully paid out to the participat or if he or she dies before paymets are completed, to a desigated beeficiary or (b) such time that the participat decides to begi a auity paymet optio. Rollover Distributios You may also elect to have your accout balaces directly rolled over to a idividual retiremet accout or aother qualified retiremet pla, icludig a Sectio 403(b) auity or govermetal Sectio 457 Pla. To receive a rollover distributio, you must be eligible to receive a cash withdrawal from the Pla. Therefore, to receive a rollover of a cash withdrawal, you must have termiated employmet ad reached age 55. However, some types of distributios, such as auity paymets, caot be rolled over. To iitiate a rollover distributio, cotact the Trustee where your accouts are ivested. REPURCHASE OF BENEFITS Participats who have termiated employmet before the fifth aiversary of becomig a participat will receive the vested balace of their total accumulatio (if the total value of your Retiremet Pla, TIAA-CREF, Fidelity ad Vaguard fuds is less tha $5,000) i a lump sum paymet. Spousal coset is ot required for lump sum paymets of $5,000 or less. A lump sum paymet from TIAA-CREF will be based o the terms of such auity cotract. You must request a repurchase of your beefits through the Trustee. If you repurchase beefits before age 55, Federal early distributio pealties may apply. PRE-RETIREMENT DEATH BENEFITS If a participat dies before establishig a auity optio, the value of his or her total vested accumulatio will be paid to the desigated beeficiary. The beeficiary may elect to receive either a lump sum paymet or oe of the auity optios idicated above. The participat s spouse is automatically the beeficiary for 50% of the total accumulatio uless the spouse has coseted to a waiver of such beefit. The pre-retiremet death beefit may be waived by the participat ad his or her spouse begiig o the first day of the Pla year durig which the participat attais age 35 ad edig o the earlier of (a) the date of the participat s death or (b) the date auity beefits begi. A waiver may be revoked durig that period oly if the participat also revokes his or electio. A waiver is ot available for participats uder age 35, uless the participat termiates employmet. 6 BROOKHAVEN NATIONAL L ABOR ATORY

87 beefits: part 6 RETIREMENT PLAN INVESTMENT COMPANY CONTACT INFORMATION Ivestmet Fuds Telephoe Numbers Website TIAA-CREF ad Vaguard (800) Fidelity (800) QUESTIONS ABOUT THE PLAN Questios or cocers about the Retiremet Pla may be directed to the Beefits Office at (631) or the ivestmet compaies directly. MISCELLANEOUS Base Salary Base Salary is the participat s base salary that is reflected o the participat s W-2 statemet, before exercise of ay salary reductio optio. Overtime paymets, shift premiums, termiatio paymets, severace pay, ad ay other forms of compesatio are ot icluded i Base Salary. For uio employees, Base Salary is based o the terms of the uio cotract. Break i Service A Break i Service is a 12 cosecutive moth period (measured from your date of hire ad aiversaries of such date) i which you are credited with less tha 501 Hours of Service. A Five Year Break i Service meas five cosecutive Breaks i Service. Cotiuous Service Cotiuous Service meas service from a participat s most recet hire date. Service performed prior to a break i employmet is ot icluded i Cotiuous Service. Cotiuous Service will be reduced by periods o a approved Leave of Absece. Discotiuatio of Cotributios Cotributios to a participat s accumulatio will cease o the earlier of the date he or she termiates employmet or is o loger eligible for coverage. Employer Brookhave Sciece Associates, LLC. Geeral Iformatio Iformatio regardig the Pla idetificatio umber, Pla year, Pla fudig, type of Pla, Pla sposor, Pla admiistrator, aget for legal process, your rights uder ERISA, prudet actios by Pla fiduciaries, ad modificatio, suspesio, or termiatio of the Pla ca be foud i the Geeral Iformatio sectio of this booklet. Hour of Service A Hour of Service is each hour for which you are etitled to be paid for the performace of duties, or for which you are etitled to be paid for vacatio, holiday, illess, icapacity, layoff, jury duty, military duty or leave of absece. No more tha 501 Hours of Service will be credited for ay sigle cotiuous period durig which you perform o duties, except i the case of certai abseces due to military service. BROOKHAVEN NATIONAL L ABOR ATORY 7

88 beefits: part 6 RETIREMENT PLAN Leave of Absece Cotributios will ot be made to the Retiremet Pla durig a approved Leave of Absece. If, however, you retur to work withi the time required by law, from a approved Leave of Absece for military duty, a amout equal to 10%, 9%, if hired 1/ or later ad were ot a member of the IBEW uio, of your Base Salary will be made for ay period for which you would have bee otherwise eligible for cotributios had you ot bee o a Leave of Absece. No-Alieatio of Beefits Beefits uder this Pla may ot be subject to alieatio, ecumbrace, the claims of creditors, or legal process. Beefits may ot be trasferred, assiged, or alieated. The Pla will, however, comply with ay judgmet, decree, or order which established the rights of aother perso to all or a portio of a participat s beefits uder this Pla to the extet that it is a Qualified Domestic Relatios Order uder Iteral Reveue Code sectio 414(p). Participats Receivig Log Term Disability Beefits For the purpose of this Pla, Base salary for participats who qualify for beefits uder the Log Term Disability Pla (LTD) will be based o Base Salary at the rate i effect prior to the day you become eligible to receive LTD beefits. Pla cotributios will cotiue util the earliest of (1) the ed of the participat s maximum LTD period of beefits, (2) the date the participat elects to retire, (3) the participat s death, or (4) the ed of the participat s disability. Durig the period while the participat is receivig LTD beefits, Retiremet Pla cotributios will be made to the participat s accout at a rate of 12½% of Base Salary ot i excess of the social security wage base ad 17½% of Base Salary i excess of the social security wage base. Pla Admiistrator The Pla admiistrator is the Retiremet Committee ad ca be reached at (631) ad at the address of the Pla Sposor listed i the Geeral Iformatio sectio. Qualified Domestic Relatios Order Iformatio o the admiistratio of a Qualified Domestic Relatios Order ca be obtaied at o charge from the Beefits Office. Type of Pla This Pla is a moey purchase defied cotributio Pla. The amout of beefits that you receive is based o the vested balace of your accouts i the Pla. Because the Pla is a idividual accout Pla, the beefits provided by the Pla are ot isured by the Pesio Beefit Guaraty Corporatio. Amedmet or Termiatio of the Pla BSA reserves the right to amed or termiate this Pla at ay time ad for ay reaso. If the Pla is termiated for ay reaso, the assets i the Pla will be used for the exclusive beefit of Pla participats ad their beeficiaries. If you are affected by a termiatio of the Pla, you will become 100% vested i your accout balaces. 8 BROOKHAVEN NATIONAL L ABOR ATORY

89 beefits: part 6 RETIREMENT PLAN Brookhave Sciece Associates Fuds, LLC. Available for Ivestmet TIAA-CREF TIAA Traditioal Auity TIAA Real Estate Accout CREF Moey Market Accout CREF Bod Market Accout CREF Iflatio-Liked Bod Accout CREF Social Choice Accout CREF Equity Idex Accout CREF Global Equities Accout CREF Growth Accout CREF Stock Accout TIAA-CREF Real Estate Securities TIAA-CREF Growth & Icome TIAA-CREF S&P 500 Idex TIAA-CREF Social Choice Equity TIAA-CREF Large-Cap Value TIAA-CREF Mid-Cap Value TIAA-CREF Mid-Cap Growth TIAA-CREF Small-Cap Equity TIAA-CREF Iteratioal Equity TIAA-CREF Lifecycle Fud 2010* TIAA-CREF Lifecycle Fud 2015* TIAA-CREF Lifecycle Fud 2020* TIAA-CREF Lifecycle Fud 2025* TIAA-CREF Lifecycle Fud 2030* TIAA-CREF Lifecycle Fud 2035* TIAA-CREF Lifecycle Fud 2040* TIAA-CREF Lifecycle Fud 2045* TIAA-CREF Lifecycle Fud 2050* Fidelity Retiremet Gov t Moey Market Retiremet Moey Market Itermediate Bod Fud Purita Fud Equity-Icome Fud Magella Fud Diversified Iteratioal Fud Overseas Fud Freedom Icome Fud Freedom 2000 Fud* Freedom 2005 Fud* Freedom 2010 Fud* Freedom 2015 Fud* Freedom 2020 Fud* Freedom 2025 Fud* Freedom 2030 Fud* Freedom 2035 Fud* Freedom 2040 Fud* Freedom 2045 Fud* Freedom 2050 Fud* Vaguard Prime Moey Market Fud Federal Moey Market Fud** Welligto Fud Wellesley Icome Fud 500 Idex Fud Widsor Fud Explorer Fud Total Iteratioal Stock Idex Fud Iteratioal Growth Fud *Qualified Default Ivestmet Alterative (QDIA). (TIAA-CREF ad Vaguard fuds are admiistered by TIAA-CREF, so the QDIA for TIAA-CREF ad Vaguard fuds is the same.) ** Closed to ew ivestors BROOKHAVEN NATIONAL L ABOR ATORY 9

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91 beefits: part 7 401(k) PLAN part 7 401(k) PLAN The 401(k) Pla provides participats with the opportuity to supplemet icome at retiremet. Erollmet i the 401(k) Pla is optioal. WHO IS ELIGIBLE FOR THE 401(k) PLAN? Active Employees Each employee of Brookhave Sciece Associates, LLC who was a participat i the Pla o December 31, 2001 remaied eligible to participate i this Pla o Jauary 1, I additio, all full-time employees are eligible to participate i the 401(k) Pla o the first day of active employmet. Employees who work o a part-time, temporary or irregular basis may participate o the earlier of Jauary 1 or July 1 followig completio of 1,000 Hours of Service durig the 12 cosecutive caledar moth period begiig with the first day of active employmet (or each successive aiversary thereof). A Hour of Service is each hour for which you are etitled to be paid for the performace of duties, or for which you are etitled to be paid for vacatio, holiday, illess, icapacity, layoff, jury duty, military duty or leave of absece. No more tha 501 Hours of Service will be credited for ay sigle cotiuous period durig which you perform o duties, except i the case of certai abseces due to military service. Service shall iclude Cotiuous Service, if ay, with Associated Uiversities, Ic., Battelle Memorial Istitute, Research Foudatio of the State Uiversity of New York or the State Uiversity of New York at Stoy Brook immediately prior to a trasfer of employmet to Brookhave Sciece Associates, LLC. The followig idividuals are ot eligible to participate i the Pla: (1) ay leased employee, as defied by Iteral Reveue Code Sectio 414(); (2) ay perso holdig solely a guest or visitor appoitmet to Brookhave; (3) ay perso whose terms of employmet are govered by a collective bargaiig agreemet whose retiremet beefits are the subject of good faith bargaiig, uless the collective bargaiig agreemet specifies that such idividual is eligible to participate i the Pla; or (4) ay perso desigated by the Employer as a idepedet cotractor or who performs services pursuat to a writte agreemet with a third party. ENROLLMENT To eroll, you must complete erollmet forms which are available through the Beefits Office. By completig the forms, you will authorize cotributios, as a percet of Base Salary, from your paycheck ad the fuds i which 401(k) Pla cotributios will be ivested. 401(k) PLAN COVERAGE Beefits Provided Participats may make cotributios to the Pla through regular payroll reductios. Cotributios are draw from a participat s salary before taxes are calculated. This reduces taxable icome, so a participat pays less i taxes ow. This arragemet is called salary reductio. Icome o cotributios is tax-deferred util withdraw i the future. The maximum cotributio a participat ca make to the Pla is 25% of Base Salary. Federal laws ad regulatios may further limit a participat s ability to cotribute to this Pla. The limits are subject to chage based o chages i the laws. 1/10 BROOKHAVEN NATIONAL L ABOR ATORY 1

92 beefits: part 7 401(k) PLAN Catch Up Cotributios The Pla allows catch up cotributios (as provided uder the Iteral Reveue Code) for participats who are or will become age 50 or over durig the caledar year. Federal laws ad regulatios limit such cotributios ad are subject to chage. Participats must complete a erollmet form to elect this catch up provisio or i PeopleSoft self-service. The dollar amout elected will remai i effect uless a participat completes aother erollmet form idicatig otherwise. Pla Ivestmets There are umerous approved TIAA- Cref, Fidelity ad Vaguard fuds i which a participat ca allocate the ivestmet of his or her cotributios. The fuds available for ivestmet are idicated at the ed of the 401(k) Pla sectio. The Pla is iteded to costitute a pla described i Sectio 404(c) of the Employee Retiremet Icome Security Act of 1974 (ERISA), ad Title 29 of the Code of Federal Regulatios Sectio c-1. This meas that the fiduciaries of the Pla may be relieved of liability for ay losses that are the direct ad ecessary results of your ivestmet choices. Uder these regulatios, you have the right to receive additioal iformatio regardig the ivestmet optios provided uder the Pla. The Pla Admiistrator is the Pla fiduciary resposible for providig this iformatio, ad the iformatio may be obtaied from the Beefits Office. The additioal iformatio icludes: A descriptio of the aual operatig expeses of each ivestmet fud which may reduce the rate of retur o the fud, ad the amout of expeses expressed as a percetage of the fud s average et assets. Copies of prospectuses, fiacial statemets ad reports, ad other materials relatig to the ivestmet fuds, to the extet such iformatio is provided to the Pla. A list of fuds, icludig the issuer, term ad rate of retur of all guarateed ivestmet cotracts. Iformatio cocerig the value of shares or uits i each available ivestmet fud, as well as the past ad curret ivestmet performace of such fuds, et of expeses. Iformatio cocerig the value of shares or uits of each fud held i your accout. I additio to this iformatio, each mutual fud whose shares are registered with the US Securities ad Exchage Commissio must periodically publish a documet called a prospectus, which is a descriptio of the fud, its maagemet ad ivestmet philosophy, ad certai risk factors ivolved i ivestig i the fud. The prospectus will also cotai iformatio about the prior ivestmet performace ad maagemet expeses of the fud. Each of the ivestmet fuds curretly available uder the Pla is required to issue a prospectus, ad you should receive ad review the curret prospectus before ivestig ay part of your accout i the fud. If you do ot automatically receive a curret prospectus, you ca request oe from the Beefits Office. Allocatig Cotributios Whe a participat first erolls i the Pla, he or she will complete a form idicatig how to allocate Pla cotributios. The allocatio ca be chaged at ay time. If a participat wats to chage the allocatio withi a ivestmet compay, he or she must cotact the ivestmet compay directly. If the participat wats to chage ivestmet compaies or the allocatio betwee compaies, he or she must complete forms available i the Beefits Office or i PeopleSoft self-service. Desigatig a Beeficiary Whe a participat erolls i the Pla, he or she will idicate oe or more beeficiaries o the erollmet forms. For married participats, the spouse must be the beeficiary for at least 50% of the accumulatio uless the spouse cosets to the desigatio of someoe else. The spouse s coset must 2 BROOKHAVEN NATIONAL L ABOR ATORY

93 beefits: part 7 401(k) PLAN be i writig ad witessed by a Pla represetative or a otary public. I the evet of a participat s death, retiremet beefits will be paid to the desigated beeficiary(ies). A beeficiary desigatio may be chaged at ay time, prior to begiig retiremet beefits, by cotactig the ivestmet compaies directly or the Beefits Office. Chagig the Amout Beig Cotributed A participat may chage the percetage he or she is cotributig to this Pla oce each caledar moth. This icludes a chage from o cotributios to startig cotributios ad vice versa. A participat ca, however, cease cotributios at ay time. To make a chage to the amout beig cotributed, a participat must complete a form available olie through the Beefits Office website at hr/beefits/ ad retur it to Payroll or i PeopleSoft self-service. Trasferrig Betwee Fuds Participats are permitted to trasfer accumulatios betwee fuds ad ivestmet compaies. To trasfer accumulatios withi a ivestmet compay, the participat must cotact the ivestmet compay directly. To trasfer accumulatios from oe ivestmet compay to aother, forms are available by cotactig the ivestmet compaies directly or the Beefits Office. Rollover Cotributios A employee who is eligible to participate i the 401(k) Pla (icludig employees who have ot yet satisfied the Pla s service requiremets for eligibility) may cotribute to the Pla as a rollover ay qualified rollover distributio payable to the employee from ay other qualified pla, 403(a) or 403(b) Pla, 457 Pla or idividual retiremet accout. However, the rollover amout caot cotai ay after-tax cotributios, eve if the employee s prior pla allowed for after-tax cotributios. Vestig Vestig is the process by which a participat ears the right to the value of the cotributios i his or her accout. Uder the 401(k) Pla, participats are immediately vested i the Pla beefits. Loas Loas are permitted from a participat s TIAA-CREF accumulatio i this Pla. Whe a participat begis a loa, a portio of his or her accumulatio will be set aside as security for the loa but will cotiue to ear icome while the loa is beig repaid. The miimum loa amout available is $1,000. The maximum amout is the least of the followig: $50,000 or 45% of the participat s TIAA-CREF accumulatio or 90% of the participat s TIAA accumulatio. If a participat has Pla accumulatios i CREF, Fidelity or Vaguard fuds, he or she may trasfer all or part of the accumulatio to TIAA to icrease the available loa amout. A participat may have more tha oe outstadig loa. If a participat applies for a secod loa, the amout available may be effected by the outstadig loa. Loa repaymets may be made over a period of oe to five years with paymets due mothly or quarterly. A te year repaymet optio is available if the loa is beig used to purchase a pricipal residece. Participats who wat to pursue a loa must cotact TIAA-CREF directly for a loa applicatio ad additioal iformatio o loa provisios icludig the iterest rate, billig, ad default. Based o Federal law, married participats who request a loa must provide their spouse s writte coset for such beefit. Both active employees ad termiated employees are eligible to apply for a loa. BROOKHAVEN NATIONAL L ABOR ATORY 3

94 beefits: part 7 401(k) PLAN Withdrawals Withdrawals durig employmet are permitted from this Pla if ay of the followig evets occur: The participat wishes to withdraw ay rollover cotributios that he or she made to the Pla; The participat attais age 59½; or The participat icurs a fiacial hardship. For a participat to icur a fiacial hardship, the participat must have a immediate ad heavy fiacial eed that meets oe of the followig hardship criteria: Purchase of the participat s pricipal residece. Prevetio of foreclosure o or evictio from the participat s pricipal residece. Paymet of medical expeses which are ot reimbursed through isurace for the participat or his or her spouse or depedets. Paymet of tuitio, related educatioal expeses, ad/or room ad board for post-secodary educatio for the participat or his or her spouse or depedets for the ext twelve moths. Paymet of fueral expeses for a member of the participat s family. Expeses for the repair of damage to the participat s pricipal residece that would qualify for a casualty deductio uder Code Sectio 165. A withdrawal for hardship reasos is oly available if the fiacial eed caot be reasoably relieved through other sources. The hardship withdrawal caot exceed the amout required to satisfy the immediate hardship ad may oly iclude the participat s Pla cotributios, ot icome eared. A participat who receives a withdrawal for hardship reasos will be required to discotiue Pla cotributios for six moths. To apply for a hardship withdrawal, participats must cotact the Fiscal Officer. I additio, a withdrawal of rollover cotributios may be made at ay time. If a participat withdraws rollover cotributios before age 59½, Federal early distributio pealties may apply. Based o Federal law, married participats who request a withdrawal must provide their spouse s writte coset for such beefit. For iformatio o withdrawals, other tha for fiacial hardship, ad the receipt of retiremet icome see the RETIREMENT OPTIONS sectio. Statemets Participats will receive quarterly accout statemets from each of the ivestmet compaies i which they have ivested Pla cotributios. The statemets will idicate the amout of accumulatios i each of the fuds i which the participat has ivested. RETIREMENT OPTIONS If a participat retires, termiates employmet, becomes disabled ad termiates employmet, or attais age 59½, he or she may begi receivig retiremet beefits. Participats have the beefit optios idicated below for the paymet of beefits. Paymet of retiremet beefits, other tha the Cash Withdrawal or Rollover optios, must be made through TIAA-CREF. This meas that i order to establish the paymet of beefits other tha through the Cash Withdrawal or Rollover optios, the participat must trasfer accumulatios, if ay, i Fidelity Ivestmet Services to TIAA-CREF before beefit paymets ca begi. Other tha for the purpose of the Cash Withdrawal, Rollover, ad Retiremet Trasitio Beefit optios idicated below, retiremet beefits will be provided i the form of a auity. A auity, for the purpose of this Pla, is a series of regular paymets. 4 BROOKHAVEN NATIONAL L ABOR ATORY

95 beefits: part 7 401(k) PLAN I ay case where spousal coset is required to elect a form of beefit, the coset form must be siged before a Pla represetative or a otary public. To apply for beefits, call (800) for TIAA-CREF ad/or Vaguard fuds or (800) for Fidelity fuds. Cash Withdrawal A participat may elect, as a retiremet beefit, a cash withdrawal of up to 100% of his or her total accumulatio i the 401(k) Pla. Based o Federal law, participats who request a cash withdrawal must provide their spouse s writte coset for such withdrawal, uless the withdrawal is $5,000 or less. Oe-Life Auity Optio The most basic auity form is the oe-life auity. This is the ormal form of beefits for participats who are ot married whe distributios begi. It pays icome to the participat for his or her lifetime, ad the icome ceases at death. A participat may elect a guarateed period of either 10, 15, or 20 years to be added to this optio, but restrictios may apply. If the participat dies durig the period, the desigated beeficiary will cotiue to receive the full paymets util the guarateed period eds. Based o Federal law, married participats who request a oe-life auity optio must provide their spouse s writte coset for such beefit. Two-Life Auity Optio A two-life auity provides a icome for life for two people. This is the ormal form of beefits for participats who are married whe distributios begi. Neither the participat or his or her desigated secod auitat ca outlive the icome. The amout cotiuig to the survivor after the participat s death depeds o the optio selected. A participat may elect a guarateed period of either 10, 15, or 20 years to be added to ay of the two-life auity optios idicated below, but restrictios may apply. Whe a guarateed period is added to a two-life auity, the guaratee provides that the beefit will cotiue to a desigated beeficiary util the ed of such period if both the participat ad the secod auitat die withi the guarateed period. Based o Federal law, married participats who request a two-life auity optio must provide their spouse s writte coset for such beefit, if the desigated secod auitat is ot the spouse. A two-life auity with full beefit to survivor meas that there is o beefit reductio after the death of either the participat or the secod auitat. If a guarateed period is added to this optio ad both the participat ad the secod auitat die durig the period, the desigated beeficiary will cotiue to receive the full beefit util the guarateed period eds. A two-life auity with half beefit to secod auitat meas that if the participat dies first, the beefit to the secod auitat will cotiue at half of the amout it would otherwise be. If the secod auitat dies first, the icome to the participat does ot chage. If a guarateed period is added to this optio ad both the participat ad the secod auitat die durig the period, the desigated beeficiary will receive half of the beefit util the guarateed period eds. A two-life auity with two-thirds beefit to survivor meas that whe either the participat or the secod auitat dies, the beefit is reduced to two-thirds of the amout it would otherwise be for the survivor. This is the oly optio where the beefit of the participat reduces if the secod auitat dies first. If a guarateed period is added to this optio ad both the participat ad the secod auitat die durig the period, the desigated beeficiary will receive the two-thirds beefit util the guarateed period eds. A two-life auity with three-quarters beefit to secod auitat meas that if the participat dies first, the beefit to the secod auitat will cotiue at three-quarters of the amout it would otherwise be. If the secod auitat dies first, the icome to the participat does ot chage. If a guarateed period is added to this optio ad both the participat ad the secod auitat die durig the period, the desigated beeficiary will receive three-quarters of the beefit util the guarateed period eds. 1/10 BROOKHAVEN NATIONAL L ABOR ATORY 5

96 beefits: part 7 401(k) PLAN Fixed Period Auity Optio For ay accumulatio that a participat has i TIAA-CREF, he or she may elect the fixed period auity optio which provides retiremet beefits over a umber of years based o the participat s electio. The umber of years available for beefits is betwee 2 ad 30 ad depeds o the participat s age. Durig that period, all of the participat s accumulatio will be retured to him or her. Whe the fixed period is over, beefits cease. If a participat dies durig the period, the desigated beeficiary may elect to cotiue receivig the remaider of the beefit paymets or a lump sum paymet. Based o Federal law, married participats who request a fixed period auity optio must provide their spouse s writte coset for such beefit. Miimum Distributio Optio For participats who have termiated employmet, have ot yet begu receivig retiremet beefits, ad who are age 70½, Federal laws require that a miimum retiremet distributio must begi by April 1 of the year after reachig age 70½. Uder this optio, paymets are set at the miimum level required by law ad ca cotiue util (a) the total accumulatio has bee fully paid out to the participat or if he or she dies before paymets are completed, to a desigated beeficiary or (b) such time that the participat decides to begi a auity paymet optio. Rollover Distributios Whe you termiate your employmet, you may also elect to have your accout balaces directly rolled over to a idividual retiremet accout or aother qualified retiremet Pla, icludig a Sectio 403(b) auity or govermetal Sectio 457 pla. To iitiate a rollover distributio, cotact the Trustee where your accouts are ivested or cotact the Beefits Office. REPURCHASE OF BENEFITS Participats who have termiated employmet before the fifth aiversary of becomig a participat will receive the balace of their total accumulatio (if the total value of your 401(k) Pla TIAA-CREF, Fidelity ad Vaguard fuds is less tha $5,000) i a lump sum paymet. Spousal coset is ot required for lump sum paymets of $5,000 or less. A lump sum paymet from TIAA-CREF will be based o the terms of such auity cotract. You must request a repurchase of your beefits through the Trustee or the Beefits Office. If you repurchase beefits before age 55, Federal early distributio pealties may apply. PRE-RETIREMENT DEATH BENEFITS If a participat dies before establishig a auity optio, the value of his or her total accumulatio will be paid to the desigated beeficiary. The beeficiary may elect to receive either a lump sum paymet or oe of the auity optios idicated above. The participat s spouse is automatically the beeficiary for 50% of the total accumulatio uless the spouse has coseted to a waiver of such beefit. The pre-retiremet death beefit may be waived by the participat ad his or her spouse begiig o the first day of the Pla Year durig which the participat attais age 35 ad edig o the earlier of (a) the date of the participat s death or (b) the date auity beefits begi. A waiver may be revoked durig that period oly if the participat also revokes his or her electio. A waiver is ot available for participats uder age 35, uless the participat termiates employmet. INVESTMENT COMPANY CONTACT INFORMATION Ivestmet Fuds Telephoe Numbers Website TIAA-CREF ad Vaguard (800) Fidelity (800) BROOKHAVEN NATIONAL L ABOR ATORY

97 beefits: part 7 401(k) PLAN QUESTIONS ABOUT THE PLAN Questios or cocers about the 401(k) Pla may be directed to the Beefits Office at (631) or the ivestmet compaies directly. MISCELLANEOUS Base Salary Base Salary is the participat s Base Salary which is reflected o the participat s W-2 statemet icludig vacatio pay, overtime paymets ad, shift premiums before exercise of ay salary reductio optio. Reimbursemets or other expese allowaces, frige beefits (cash ad ocash), movig expeses, other welfare beefits, ad ay other forms of compesatio are ot icluded i Base Salary. For uio employees, Base Salary is based o the terms of the uio cotract. Discotiuatio of Cotributios Cotributios to a participat s accumulatio will cease o the earlier of the date he or she (a) termiates employmet, (b) begis receivig beefits uder the Log Term Disability Pla, (c) elects to discotiue cotributios, or (d) is o loger eligible for coverage. Fiscal Officer The Fiscal Officer ca be reached at (631) ad at the address of the Pla Sposor listed i the Geeral Iformatio sectio. Geeral Iformatio Iformatio regardig the Pla idetificatio umber, Pla year, Pla fudig, type of Pla, Pla sposor, Pla admiistrator, aget for legal process, your rights uder ERISA ad prudet actios by Pla fiduciaries ca be foud i the Geeral Iformatio sectio of this booklet. Leave of Absece Cotributios caot be made to the 401(k) Pla durig a approved Leave of Absece. If you retur to work from a approved Leave of Absece for military duty, you may cotribute a amout ot greater tha that which you were allowed to cotribute had you ot bee o a Leave of Absece. No-Alieatio of Beefits Beefits uder this Pla may ot be subject to alieatio, ecumbrace, the claims of creditors, or legal process. Beefits may ot be trasferred, assiged, or alieated. The Pla will, however, comply with ay judgmet, decree, or order which established the rights of aother perso to all or a portio of a participat s beefits uder this Pla to the extet that it is a Qualified Domestic Relatios Order uder Iteral Reveue Code sectio 414(p). Participats Receivig Log Term Disability Beefits Cotributios to this Pla cease whe a participat qualifies for Log Term Disability Pla beefits. BROOKHAVEN NATIONAL L ABOR ATORY 7

98 beefits: part 7 401(k) PLAN Pla Admiistrator The Pla admiistrator is the Retiremet Committee ad ca be reached at (631) ad at the address of the Pla Sposor listed i the Geeral Iformatio sectio. Qualified Domestic Relatios Order Iformatio o the admiistratio of a Qualified Domestic Relatios Order ca be obtaied at o charge from the Beefits Office. Type of Pla This Pla is a defied cotributio Pla with a 401(k) deferral feature. The amout of beefits that you receive is based o the balace of your accouts i the Pla. Because the Pla is a idividual accout Pla, the beefits provided by the Pla are ot isured by the Pesio Beefit Guaraty Corporatio. AMENDMENT OR TERMINATION OF THE PLAN BSA reserves the right to amed or termiate this Pla at ay time ad for ay reaso. If the Pla is termiated for ay reaso, the assets i the Pla will be used for the exclusive beefit of Pla participats ad their beeficiaries. If you are affected by a termiatio of the Pla, you will be 100% vested i your accout balaces. 8 BROOKHAVEN NATIONAL L ABOR ATORY 1/10

99 beefits: part 7 401(k) PLAN Brookhave Sciece Associates, LLC. Fuds Available for Ivestmet TIAA-CREF TIAA Traditioal Auity TIAA Real Estate Accout CREF Moey Market Accout CREF Bod Market Accout CREF Iflatio-Liked Bod Accout CREF Social Choice Accout CREF Equity Idex Accout CREF Global Equities Accout CREF Growth Accout CREF Stock Accout TIAA-CREF Real Estate Securities TIAA-CREF Growth & Icome TIAA-CREF S&P 500 Idex TIAA-CREF Social Choice Equity TIAA-CREF Large-Cap Value TIAA-CREF Mid-Cap Value TIAA-CREF Mid-Cap Growth TIAA-CREF Small-Cap Equity TIAA-CREF Iteratioal Equity TIAA-CREF Lifecycle Fud 2010* TIAA-CREF Lifecycle Fud 2015* TIAA-CREF Lifecycle Fud 2020* TIAA-CREF Lifecycle Fud 2025* TIAA-CREF Lifecycle Fud 2030* TIAA-CREF Lifecycle Fud 2035* TIAA-CREF Lifecycle Fud 2040* TIAA-CREF Lifecycle Fud 2045* TIAA-CREF Lifecycle Fud 2050* Fidelity Retiremet Gov t Moey Market Retiremet Moey Market Itermediate Bod Fud Purita Fud Equity-Icome Fud Magella Fud Diversified Iteratioal Fud Overseas Fud Freedom Icome Fud Freedom 2000 Fud* Freedom 2005 Fud* Freedom 2010 Fud* Freedom 2015 Fud* Freedom 2020 Fud* Freedom 2025 Fud* Freedom 2030 Fud* Freedom 2035 Fud* Freedom 2040 Fud* Freedom 2045 Fud* Freedom 2050 Fud* Vaguard Prime Moey Market Fud Federal Moey Market Fud** Welligto Fud Wellesley Icome Fud 500 Idex Fud Widsor Fud Explorer Fud Total Iteratioal Stock Idex Fud Iteratioal Growth Fud *Qualified Default Ivestmet Alterative (QDIA). (TIAA-CREF ad Vaguard fuds are admiistered by TIAA-CREF, so the QDIA for TIAA-CREF ad Vaguard fuds is the same.) ** Closed to ew ivestors BROOKHAVEN NATIONAL L ABOR ATORY 9

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101 beefits: part 8 FLEXIBLE SPENDING ACCOUNTS PLAN part 8 FLEXIBLE SPENDING ACCOUNTS PLAN The Flexible Spedig Accouts Pla cosists of two accouts, the Health Care Reimbursemet Accout ad the Depedet Day Care Reimbursemet Accout, which allow you to pay for a variety of health care ad depedet day care expeses o a before-tax basis. By payig for expeses o a before-tax basis, you reduce your icome for the purpose of state, federal ad Social Security taxes. Erollmet i the Flexible Spedig Accouts Pla is optioal. WHO IS ELIGIBLE FOR THE FLEXIBLE SPENDING ACCOUNTS PLAN? Active Employees All regular employees who work at least 20 hours per week are eligible to participate i the Flexible Spedig Accouts Pla o the first day of active employmet. Participatio i the Depedet Day Care Reimbursemet Accout also requires that you are: a sigle paret ad require depedet day care so you ca work, or look for work or, married ad require day care so you ca work ad your spouse ca work, or look for work (if filig joitly) or be a full-time studet. ENROLLMENT Eligible employees may eroll i the Health Care ad/or Depedet Day Care Reimbursemet Accouts withi 30 days of their date of hire. Oce you eroll, you must cotiue participatio i the pla util the ed of the caledar year. If you do ot eroll for coverage withi 30 days of your date of hire, you will be required to wait util the ext Ope Erollmet Period or whe you have a Qualifyig Evet to elect coverage. To eroll, you must complete a erollmet form ad idicate the amout you wat to cotribute to the Health Care ad/or Depedet Day Care Reimbursemet Accouts. Erollmet forms are available through the Beefits Office. By completig the form, you will authorize a aual salary reductio amout. Your actual cotributios will be made from your paycheck i equal mothly or weekly istallmets depedig o your pay status. Coverage begis o your date of hire if you complete the erollmet form ad submit it to the Beefits Office withi 30 days of your date of hire. Erollmets completed durig a Ope Erollmet Period will be effective o Jauary 1 of the followig caledar year. HEALTH CARE REIMBURSEMENT ACCOUNT Beefits Provided You ca use the pla to set aside moey o a pre-tax basis ito a reimbursemet accout to pay for eligible health care expeses. You determie what types of expeses you expect to have durig the pla year ad fud your Health Care Reimbursemet Accout through automatic salary reductio. BROOKHAVEN NATIONAL L ABOR ATORY 1

102 beefits: part 8 FLEXIBLE SPENDING ACCOUNTS PLAN Throughout the year, you draw moey out of your Accout ad reimburse yourself for the health care expeses as you ad your eligible depedets icur them. Your eligible depedets iclude: Your spouse. Your childre up to age 26. Your umarried childre who are metally or physically icapable of earig their ow livig. What Health Care Expeses are Reimbursed? Expeses that are reimbursable uder the Health Care Reimbursemet Accout are maily those goods ad services curretly allowed by the Iteral Reveue Service (IRS) as a icome tax deductio, but ot all items that qualify for a tax deductio also qualify for the Reimbursemet Accout. However, this does ot iclude premiums paid for isurace coverages. Eligible expeses iclude, but are ot limited to: Deductibles ad co-isurace paymets that are ot reimbursed uder the medical or detal isurace plas. Out-of-pocket expeses. Charges ot reimbursed by the medical or detal isurace plas that are above reasoable ad customary charges. Hearig ad visio care expeses such as exams, eyeglasses, ad cotact leses. Aual physical examiatios. Approved weight-loss ad stop-smokig programs, if prescribed by a physicia to treat a specific coditio. Over-the-couter medicatios used to alleviate or treat persoal illess or ijuries that are deemed medically ecessary ad for which the participat has received a prescriptio. Dietary supplemets to maitai oe s health (such as vitamis) do ot qualify for reimbursemet. How Much May You Cotribute Each Year to the Health Care Reimbursemet Accout? You may cotribute ay amout from a miimum of $300 to a maximum of $4,000 each caledar year. It is extremely importat that you carefully determie the amout you elect to cotribute, if ay, sice uder IRS regulatios, all amouts that you do ot use toward expeses icurred i the caledar year will be forfeited. DEPENDENT DAY CARE REIMBURSEMENT ACCOUNT Beefits Provided You ca use the Depedet Day Care Reimbursemet Accout to reimburse yourself for eligible depedet day care expeses with before-tax dollars. Estimate the amout you will be spedig i the comig year o day care. The, to cover these costs, you cotribute to the Accout through automatic salary reductio. Throughout the year, you draw moey out of your Accout ad reimburse yourself for paymets you have made to your day care provider. What Depedet Day Care Expeses are Reimbursed? Expeses that are reimbursable uder the Depedet Day Care Reimbursemet Accout are maily those curretly allowed by the IRS as a tax credit, but ot all items that qualify for a tax credit also 2 BROOKHAVEN NATIONAL L ABOR ATORY

103 beefits: part 8 FLEXIBLE SPENDING ACCOUNTS PLAN qualify for the Reimbursemet Accout. All day care must be redered by eligible providers. Eligible expeses iclude, but are ot limited to: Care of a depedet i your home by a paid provider. Care of a depedet outside of your home by a licesed ursery or day care ceter. Household services, such as a housekeeper, provided some portio of the service is to a depedet. A relative is cosidered a eligible provider of depedet day care if he or she is ot claimed as your depedet for tax purposes. The provider s ame, address ad Tax Idetificatio Number or Social Security Number must be supplied to receive reimbursemet. Who are Eligible Depedets? Expeses may be claimed for: A child uder age 13 who is claimed as a depedet o your icome tax retur. Ay depedet you claim for icome tax purposes who requires day care because of physical or metal iability. How Much May You Cotribute Each Year to the Depedet Day Care Reimbursemet Accout? You may cotribute ay amout from a miimum of $300 to a maximum of $5,000. However, there are certai guidelies you must follow. If you are sigle or if you are married ad file separate icome tax returs, the maximum amout you may cotribute is $2,500 i a caledar year. Your total cotributio i ay caledar year may ot exceed your aual earigs or, if less, your spouse s aual earigs. It is extremely importat that you carefully determie the amout you elect to cotribute, if ay, sice uder IRS regulatios, all amouts you do ot use toward expeses icurred i the caledar year will be forfeited. Depedet Day Care Reimbursemet Accout or Tax Credit Federal law curretly permits a idividual to take a tax credit agaist federal icome taxes for allowable depedet care expeses. Whe cosiderig cotributios to the Depedet Day Care Reimbursemet Accout, you may wat to cosider if it is better to take the tax credit or to pay for your depedet care expeses through the Flexible Spedig Accout. With the depedet care tax credit, you pay your depedet day care expeses yourself ad claim a credit for them o your federal icome tax retur. You may use oly oe of these methods for ay give dollar of depedet care costs. You caot use the Depedet Day Care Reimbursemet Accout for a particular expese ad also claim a credit for that same expese o your tax retur. You should cosult your tax advisor to determie whether it is better for you to reimburse yourself for day care expeses with the Depedet Day Care Reimbursemet Accout or use the tax credit o your icome tax retur. Does the Use of Before-Tax Cotributios to the Flexible Spedig Accouts Pla Affect Ay Other Beefits? It may. If your aual salary is below the Social Security wage base, your future Social Security beefit may be reduced, but oly miimally. 1/10 BROOKHAVEN NATIONAL L ABOR ATORY 3

104 beefits: part 8 FLEXIBLE SPENDING ACCOUNTS PLAN CLAIMS/PAYMENT OF EXPENSES How to File a Claim or Pay for Expeses You must either: use your PayFlex card (which is similar to a debit card) at the poit of purchase for your eligible expeses where the expeses are debited directly from your Accout, or complete a PayFlex Health/Depedet Care Flexible Spedig Accouts Claim Form, available i the Beefits Office or through the Beefits Office website at or go olie to ad submit your claim electroically. I geeral, whe submittig a claim for reimbursemet, you must submit a receipt alog with your claim form icludig provider ame ad address, date of service, type of service provided, ad dollar amout charged for the service. For Health Care expese claims, you must first submit your medical ad detal claims to the applicable isurace compay. You will receive your Explaatio of Beefits (EOB) from the isurace compay. If you are ot erolled i the medical or detal plas or are erolled i a HMO, you must provide itemized bills. You ca pay for your eligible expeses with the PayFlex card or submit for reimbursemet for up to the amout of fuds i your Accout. If you submit for reimbursemet of your claims, you may either set up a direct deposit optio with PayFlex or receive a check which is mailed to your home. Paymets will be issued daily for eligible expeses. For eligible health care expeses, you ca be reimbursed for up to the total amout you have elected for the caledar year eve though you have ot yet coributed that amout ito your Accout. For eligible depedet care expeses, you ca oly be reimbursed for up to the total amout that is i your Accout at the time of your claims submissio or whe you use your PayFlex card. You caot be reimbursed for expeses icurred prior to your participatio i the pla. How Log Do You Have to Submit Claims for Reimbursemet? You have util March 31 followig the caledar year i which you icurred expeses to submit claims for reimbursemet. So, for example, if you buy eyeglasses i December, you would still have up to March 31 to claim the expese, provided there is moey remaiig i your Health Care Reimbursemet Accout. If you have ay fuds i your Accout at the time you termiate employmet, termiate participatio or cease to be eligible to participate, these fuds will be forfeited if they are ot used for expeses icurred prior to these dates ad you do ot submit them for reimbursemet withi the applicable timeframes. Ay expeses icurred after these dates are ot eligible for reimbursemet. Questios About Claims If you have a questio about your Flexible Spedig Accout claim, you should cotact PayFlex at (800) How to Appeal a Claim If your claim is deied, you will receive a writte otice of the deial from the Claims Admiistrator. The otice will explai the reaso for the deial ad idicate the review procedures. You may request a review of the deied claim. The request must be submitted i writig to the Claims Admiistrator withi 60 days after you receive the deial otice. Submit your request, icludig your reasos for requestig the review ad ay additioal documets which you believe support your claim. The Claims Admiistrator will review the claim ad ordiarily otify you withi 60 days of the date your request for review is received. I special cases requirig a delay, the Claims Admiistrator will reder a decisio o later tha 120 days after your request for review is received. 4 BROOKHAVEN NATIONAL L ABOR ATORY

105 beefits: part 8 FLEXIBLE SPENDING ACCOUNTS PLAN CHANGES IN CONTRIBUTION AMOUNTS The amout of pre-tax dollars you elect to cotribute to your Health Care or Depedet Day Care Reimbursemet Accout is irrevocable ad thus, will remai i effect for the etire caledar year. You may be eligible to chage your cotributio oly if you have a Qualifyig Evet. OPEN ENROLLMENT PERIOD Ope erollmet is held oce a year. Durig a Ope Erollmet Period, you may elect your cotributio amout for the followig caledar year. Your electio durig the Ope Erollmet Period will be effective Jauary 1 of the followig caledar year. Coverage will ot automatically carry forward from year to year. You must elect coverage durig the Ope Erollmet Period for the followig caledar year. Your electios will be i effect for the remaider of the caledar year uless you otify the Beefits Office of a Qualifyig Evet withi 31 days of the evet. QUALIFYING EVENT A Qualifyig Evet is a chage i your family status ad icludes: a) Chage i legal marital status 1. marriage 2. death of spouse 3. divorce 4. legal separatio 5. aulmet b) Chage i the umber of depedets 1. birth 2. adoptio 3. placemet for adoptio 4. death of a depedet c) Chage i employmet status 1. termiatio or commecemet of employmet of the employee, spouse or depedet (other tha for miscoduct) d) Chages i work schedule 1. a icrease or decrease i the umber of hours of employmet by the employee, spouse or depedet 2. a switch betwee full-time ad part-time status 3. a strike or lockout 4. commecemet or retur from a upaid leave of absece e) The depedet satisfies or ceases to satisfy the requiremets for umarried depedets 1. attaimet of age f) A chage i the place of residece or work site of the employee, spouse or depedet You have 31 days from the date of a Qualifyig Evet to make chages to your FSA coverage for all items idicated above except (a)(3), (a)(4), (e)(1) ad (e)(2). You have 60 days from the date of a Qualifyig Evet to make chages to your FSA coverage for items (a)(3), (a)(4), (e)(1) ad (e)(2). The chage requested must relate to the chage i your family status that affects eligibility for Flexible Spedig Accout coverage. Chages are made by completig a erollmet form, available through the Beefits BROOKHAVEN NATIONAL L ABOR ATORY 5

106 beefits: part 8 FLEXIBLE SPENDING ACCOUNTS PLAN Office. The completed form must be submitted, with proof of the Qualifyig Evet, to the Beefits Office. Your cotributios will the be chaged for the remaider of the caledar year. Coverage will become effective as of the date of the evet. If you do ot make a chage to your cotributios withi the applicable period idicated above, you must wait util the ext Ope Erollmet Period. MISCELLANEOUS Claims Admiistrator PayFlex Systems USA, Ic. P.O. Box 3039 Omaha, NE Telephoe:(800) Fax: (402) Geeral Iformatio Iformatio regardig the pla idetificatio umber, pla year, pla fudig, type of pla, pla sposor, pla admiistrator, aget for legal process, your rights uder ERISA, prudet actios by pla fiduciaries, ad modificatio, suspesio, or termiatio of the pla ca be foud i the Geeral Iformatio sectio of this booklet. Leave of Absece If you are o a approved Leave of Absece, you may cotiue your Flexible Spedig Accouts coverage by payig your elected cotributios for the remaider of the caledar year. If you discotiue cotributios, oly expeses icurred prior to the leave will be eligible for reimbursemet. If you discotiued cotributios at the time of your leave, upo retur to work, you may elect to participate for the remaider of the caledar year by completig a erollmet form. Restrictios Flexible Spedig Accouts are allowable uder Sectio 125 of the Iteral Reveue Code, ad certai restrictios apply to them. Determiatio of your aual cotributios to your Flexible Spedig Accout(s) must be made prior to the start of the pla year. To be eligible for reimbursemet, expeses must be icurred i the same year that your salary reductios are credited to the Pla. Health care expeses caot be reimbursed from a Depedet Day Care Reimbursemet Accout, or depedet day care expeses from a Health Care Reimbursemet Accout. All uused Accout balaces remaiig at the ed of a pla year are forfeited. Expeses reimbursed from your Accout(s) caot be claimed as deductios or credits o your federal icome tax retur. Re-erollmet is required each year to have your before-tax cotributios made to the Flexible Spedig Accouts Pla. The IRS cosiders the two Flexible Spedig Accouts totally separate ad thus, does ot allow you to trasfer moey from oe accout to the other. 6 BROOKHAVEN NATIONAL L ABOR ATORY 1/10

107 beefits: part 8 FLEXIBLE SPENDING ACCOUNTS PLAN Termiatio of Coverage Flexible Spedig Accouts Pla beefits will cease o the earlier of the date your employmet termiates or the date you are o loger eligible for coverage. You may ot cotiue your Depedet Day Care Reimbursemet Accout but you may cotiue your Health Care Reimbursemet Accout. Health Care Reimbursemet Accout coverage for termiated employees, who cotiue beefits uder COBRA, will cease o the earlier of the date you elect to drop such coverage, the date you are o loger eligible for coverage, or whe you fail to pay the required premiums. COBRA The right to COBRA cotiuatio coverage was created by a federal law, the Cosolidated Omibus Budget Recociliatio Act of 1985 (COBRA). COBRA cotiuatio coverage ca become available to you whe you would otherwise lose your group health coverage. It ca also become available to other members of your family who are covered uder the Pla whe they would otherwise lose their group health coverage. What is COBRA Cotiuatio Coverage? COBRA cotiuatio coverage is a cotiuatio of Pla coverage whe coverage would otherwise ed because of a life evet kow as a qualifyig evet. Specific qualifyig evets are listed later i this otice. After a qualifyig evet, COBRA cotiuatio coverage must be offered to each perso who is a qualified beeficiary. You, your spouse, ad your depedet childre could become qualified beeficiaries if coverage uder the Pla is lost because of the qualifyig evet. Uder the Pla, qualified beeficiaries who elect COBRA cotiuatio coverage must pay for COBRA cotiuatio coverage. If you are a employee, you will become a qualified beeficiary if you lose your coverage uder the Pla because either oe of the followig qualifyig evets happes: Your hours of employmet are reduced, or Your employmet eds for ay reaso other tha your gross miscoduct. If you are the spouse of a employee, you will become a qualified beeficiary if you lose your coverage uder the Pla because ay of the followig qualifyig evets happes: Your spouse dies; Your spouse s hours of employmet are reduced; Your spouse s employmet eds for ay reaso other tha his or her gross miscoduct; Your spouse becomes etitled to Medicare beefits (uder Part A, Part B, or both); or You become divorced or legally separated from your spouse. Your depedet childre will become qualified beeficiaries if they lose coverage uder the Pla because ay of the followig qualifyig evets happes: The paret-employee dies; The paret-employee s hours of employmet are reduced; The paret-employee s employmet eds for ay reaso other tha his or her gross miscoduct; The paret-employee becomes etitled to Medicare beefits (Part A, Part B, or both); The parets become divorced or legally separated; or The child stops beig eligible for coverage uder the pla as a depedet child. 1/10 BROOKHAVEN NATIONAL L ABOR ATORY 7

108 beefits: part 8 FLEXIBLE SPENDING ACCOUNTS PLAN Whe is COBRA Coverage Available? The Pla will offer COBRA cotiuatio coverage to qualified beeficiaries oly after the Beefits Office has bee otified that a qualifyig evet has occurred. Whe the qualifyig evet is the ed of employmet or reductio of hours of employmet, death of the employee, commecemet of a proceedig i bakruptcy with respect to the employer, or the employee s becomig etitled to Medicare beefits (uder Part A, Part B, or both), the employer must otify the Beefits Office of the qualifyig evet. Notificatio Requiremets For the other qualifyig evets (divorce or legal separatio of the employee ad spouse or a depedet child s losig eligibility for coverage as a depedet child), you must otify the Beefits Office i writig withi 60 days after the qualifyig evet occurs ad provide documetatio of the evet. Whe the Beefits Office has bee otified that oe of these evets has occurred, they will i tur otify you ad your depedets of the right to elect cotiuatio coverage. If you do ot elect cotiuatio coverage withi 60 days from the date of loss of coverage due to oe of the evets described above, your group health isurace coverage will ed retroactively to the date of the evet that caused the loss of coverage. If you elect cotiuatio coverage, you will have the health isurace coverage you had before the evet, although it may be modified if coverage chages for similarly situated participats. How is COBRA Coverage Provided? Oce the Beefits Office receives otice that a qualifyig evet has occurred, COBRA cotiuatio coverage will be offered to each of the qualified beeficiaries. Each qualified beeficiary will have a idepedet right to elect COBRA cotiuatio coverage. Covered employees may elect COBRA cotiuatio coverage o behalf of their spouses, ad parets may elect COBRA cotiuatio coverage o behalf of their childre. COBRA cotiuatio coverage is a temporary cotiuatio of coverage. Whe the qualifyig evet is the death of the employee, the employee s becomig etitled to Medicare beefits (uder Part A, Part B, or both), your divorce or legal separatio, or a depedet child s losig eligibility as a depedet child, COBRA cotiuatio coverage lasts for up to a total of 36 moths. Whe the qualifyig evet is the ed of employmet or reductio of the employee s hours of employmet, ad the employee became etitled to Medicare beefits less tha 18 moths before the qualifyig evet, COBRA cotiuatio coverage for qualified beeficiaries other tha the employee lasts util 36 moths after the date of Medicare etitlemet. For example, if a covered employee becomes etitled to Medicare 8 moths before the date o which his employmet termiates, COBRA cotiuatio coverage for his spouse ad childre ca last up to 36 moths after the date of Medicare etitlemet, which is equal to 28 moths after the date of the qualifyig evet (36 moths mius 8 moths). Otherwise, whe the qualifyig evet is the ed of employmet or reductio of the employee s hours of employmet, COBRA cotiuatio coverage geerally lasts for oly up to a total of 18 moths. There are two ways i which this 18-moth period of COBRA cotiuatio coverage ca be exteded. Disability extesio of 18-moth period of cotiuatio coverage If you or ayoe i your family covered uder the Pla is determied by the Social Security Admiistratio to be disabled ad you otify the Beefits Office i a timely fashio, you ad your etire family may be etitled to receive up to a additioal 11 moths of COBRA cotiuatio coverage, for a total maximum of 29 moths. The disability would have to have started at some time before the 60th day of COBRA cotiuatio coverage ad must last at least util the ed of the 18-moth period of cotiuatio coverage. You must otify the Beefits Office withi 60 days after the qualifyig evet occurs ad provide documetatio of the evet. 8 BROOKHAVEN NATIONAL L ABOR ATORY 1/10

109 beefits: part 8 FLEXIBLE SPENDING ACCOUNTS PLAN Secod qualifyig evet extesio of 18-moth period of cotiuatio coverage If your family experieces aother qualifyig evet while receivig 18 moths of COBRA cotiuatio coverage, the spouse ad depedet childre i your family ca get up to 18 additioal moths of COBRA cotiuatio coverage, for a maximum of 36 moths, if otice of the secod qualifyig evet is properly give to the Pla. This extesio may be available to the spouse ad ay depedet childre receivig cotiuatio coverage if the employee or former employee dies, becomes etitled to Medicare beefits (uder Part A, Part B, or both), or gets divorced or legally separated, or if the depedet child stops beig eligible uder the Pla as a depedet child, but oly if the evet would have caused the spouse or depedet child to lose coverage uder the Pla had the first qualifyig evet ot occurred. COBRA Premium Requiremets You, or your depedets, will be required to pay 102% of the full cost of the cotiuatio coverage uder the provisios of COBRA. You will be billed for the required premium o a regular basis. COBRA premiums are idicated at the ed of the Detal Pla sectio. Termiatio of Coverage Uder COBRA Cotiuatio coverage will ed whe ay of the followig evets occur: The Beefits Office is otified by you or your depedet to discotiue coverage. 18 moths after cotiuatio coverage begis (if coverage was cotiued due to termiatio or resigatio of the employee). 29 moths after cotiuatio coverage begis (if coverage was cotiued due to disability). 36 moths after cotiuatio coverage begis (if coverage was cotiued because of death of the employee, divorce, legal separatio or loss of depedet status). The idividual becomes eligible for Medicare after the date of the COBRA electio. A idividual becomes covered uder aother group pla, uless a pre-existig coditio prevets you or your depedet from beig covered by the other pla. For a spouse or depedet child: If the Beefits Office is ot otified withi 31 days of the date of divorce or legal separatio. For a depedet child: If the Beefits Office is ot otified withi 31 days of the date the depedet status eds. Paymet for cotiuatio coverage is ot paid o time. The group health care pla is termiated for active employees. 1/10 BROOKHAVEN NATIONAL L ABOR ATORY 9

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111 beefits: part 9 TUITION ASSISTANCE PROGRAM part 9 TUITION ASSISTANCE PROGRAM The Tuitio Assistace Program ecourages ad supports the cotiuig educatio ad traiig of employees. The program is desiged to ecourage attedace at credit courses ad degree programs offered by accredited istitutios ad job relevat vocatioal courses. The program provides reimbursemet for pre-approved courses that are iteded to ehace a employee s professioal skills ad/or cotribute to the employee's career growth at the Laboratory. WHO IS ELIGIBLE FOR THE TUITION ASSISTANCE PROGRAM? Active Employees All regular employees who work at least 20 hours per week are eligible to participate i the Tuitio Assistace Program o the first day of active employmet. ENROLLMENT Eligible employees may eroll i the Tuitio Assistace Program by completig a Tuitio Assistace Request form which is available through the Tuitio Office or olie at tuitio.asp TUITION ASSISTANCE PROGRAM COVERAGE Beefits Provided The program provides reimbursemet for all or part of the tuitio fee paid upo successful completio of a formal course of study. Reimbursemet is restricted to out-of-pocket tuitio costs actually icurred by the employee. Regular full-time employees are eligible for 9 credits per semester for three semesters per year. Regular part-time employees are eligible for a maximum of 4 credits per semester for three semesters per year. The maximum reimbursemet provided by the program is $4,000 per semester for full-time employees ad $2,000 per semester for part-time employees. For udergraduate, correspodece or vocatioal level courses, reimbursemet is 75% of the tuitio cost. Upo receipt of a baccalaureate degree, reimbursemet may be made for the 25% differece betwee the previously reimbursed 75% ad 100% of tuitio costs. This reimbursemet is made oly for courses required for the degree ad take withi te years of receipt of the degree. For graduate level courses, reimbursemet is 100% of the tuitio cost. Allowable Courses Courses must (a) be pertiet to the work that the employee is doig or may reasoably be expected to do or (b) be required for a degree i a field of study pertiet to the work of the Laboratory. Courses must begi ad be completed while employed by the Laboratory. BROOKHAVEN NATIONAL L ABOR ATORY 1

112 beefits: part 9 TUITION ASSISTANCE PROGRAM Exclusios The Tuitio Assistace Program does ot provide reimbursemet for: College fees. Registratio charges. Books. Ay items other tha out-of-pocket tuitio costs. Short courses, workshops, or semiars for which cotiuig educatio uits may be eared. Approvals For a course to be eligible for reimbursemet it must be approved, by sigatures, o the Tuitio Assistace Request form. Approvals must iclude (a) the employee s Supervisor, ad (b) the employee s Departmet Chair, Divisio Maager, or desigee. How to Request Reimbursemet To request reimbursemet for a approved course, the employee must satisfactorily complete the course, ormally with a grade of C or equivalet or better. Proof of paymet, bursar s receipt, paid ivoice from the school, or paymet report from the school website ad a copy of the fial grade report from the college or uiversity must be submitted to the Tuitio Office. Request for reimbursemet must be submitted withi 12 moths of course completio. Advace tuitio is also available. If a tuitio advace is requested, it will be cosidered a advace util proof of paymet ad a fial grade report are submitted to the Tuitio Office. The employee must repay the tuitio advace immediately if the employee: Does ot complete the course(s) with a grade C or equivalet or better; or Does ot submit the required documetatio withi 60 days after the completio date of the course(s); or Drops or withdraws from a class; or Termiates employmet with the Laboratory before completig course(s). Advaces must be repaid to the Laboratory prior to their termiatio date. Questios About the Program If you have a questio about the Tuitio Assistace Program, cotact the Tuitio Office. MISCELLANEOUS Course Schedules Course schedules should ot iterfere with the employee s work attedace. Geeral Iformatio Iformatio regardig the pla idetificatio umber, pla year, pla fudig, type of pla, pla sposor, pla admiistrator, aget for legal process, your rights uder ERISA, prudet actios by pla fiduciaries, ad modificatio, suspesio, or termiatio of the pla ca be foud i the Geeral Iformatio sectio of this booklet. 2 BROOKHAVEN NATIONAL L ABOR ATORY

113 beefits: part 9 TUITION ASSISTANCE PROGRAM Leave of Absece Tuitio Assistace Program coverage will cease o the date your approved Leave of Absece takes effect. If the employee is curretly approved for ad attedig a oe-semester course, the employee will be eligible for reimbursemet at the completio of the course or if a advace was grated, the employee will be required to submit a grade ad paid statemet to close out their paperwork at the ed of the semester. Log Term Disability Beefits Employees who are receivig Log Term Disability Pla beefits are ot eligible for the Tuitio Assistace Program. Termiatio of Coverage Tuitio Assistace Program coverage will cease o the earlier of the date your employmet termiates or the date you are o loger eligible for coverage. Tuitio advaces must be repaid prior to a employee s termiatio date uless he or she is part of a layoff. If employmet is termiated due to a layoff ad the employee is approved for ad attedig a oe-semester course, the employee will be eligible for reimbursemet at the completio of the course eve though he or she is o loger employed. Normal refud ad pre-paymet procedures ad requiremets will apply. BROOKHAVEN NATIONAL L ABOR ATORY 3

114 beefits: part 10 SEVERANCE PAY PLAN part 10 SEVERANCE PAY PLAN The Severace Pay Pla is desiged to assist employees whose earigs are uexpectedly caceled by layoff due to a reductio-i-force. Severace Pay Pla provisios for bargaiig uit employees will be i accordace with applicable provisios of the collective bargaiig agreemets. WHO IS ELIGIBLE FOR THE SEVERANCE PAY PLAN? Active Employees All regular employees who work at least 20 hours per week are eligible for the Severace Pay Pla o the first day of active employmet. Employees who are o a temporary appoitmet or a leave of absece are ot eligible for this pla. ENROLLMENT If you are eligible for the Severace Pay Pla, you do ot eed to eroll. SEVERANCE PAY PLAN COVERAGE Beefits Provided For active employees, the pla provides the followig beefits, subject to the Maximum Beefits Provisio, based o Base Pay ad Cotiuous Service for a reductio-i-force. Years of Cotiuous Service First 10 years Severace Beefit 1 week of Base Pay for each year of Cotiuous Service Over 10 years through 15 years 1 1/2 weeks of Base Pay for each year of Cotiuous Service over 10 ad through 15 years Over 15 years 2 weeks of Base Pay for each year of Cotiuous Service over 15 years Maximum Beefits Effective September 1, 2011, for active employees who are ot members of the IBEW or SCSPA uios, the maximum severace beefit provided by the pla is 39 weeks of Base Pay with a cap of $50,000. For active employees who are members of the IBEW or SCSPA uios, the maximum severace beefit provided by the pla will be i accordace with the applicable provisios of their collective bargaiig agreemets. 9/11 BROOKHAVEN NATIONAL L ABOR ATORY 1

115 beefits: part 10 SEVERANCE PAY PLAN Example of Severace Beefit Full-time Regular Employee Aualized Base Pay: $78,000 ($1,500 per week)* Cotiuous Service: 27 years** # of weeks of severace per year of service x service i years x weekly pay rate = severace pay First 10 years of Cotiuous Service Next 5 years of Cotiuous Service Cotiuous years of Service above 15 years 1 10 $1, $15, $1, $11, $1, $36, $62, Total severace pay before applicatio of maximum beefits Weeks of severace pay before applicatio of 39-week maximum Weeks of severace pay after applicatio of 39-week maximum $58, Severace pay after applicatio of 39-week maximum but before $50,000 maximum $50, Total severace pay after applicatio of maximum beefits *Use the 100% full-time equivalet Base Pay i the calculatio eve if it is a part-time employee. (i.e. If a employee is scheduled to work 50% time ad has a actual Base Pay of $25,000, use the 100% full-time equivalet Base Pay rate of $50,000 for the calculatio.) **Cotiuous Service is prorated for part-time employees (i.e. If a employee is scheduled to work 50% time durig a particular year, use 0.50 for that year s service, ot 1.00 for the calculatio.) Paymet of Beefits Severace beefits will be paid i either oe or two lump sum paymets. If paymet of the severace beefit plus compesatio for uused vacatio would cause a employee to receive a amout i excess of oe year s Base Pay durig the caledar year, that portio of vacatio ad/or severace which causes the excess is deferred for paymet durig Jauary of the followig caledar year. 2 BROOKHAVEN NATIONAL L ABOR ATORY 9/11

116 beefits: part 10 SEVERANCE PAY PLAN Recall to Work If a employee is recalled to work before the ed of the period for which severace pay was received, the amout of overpaymet will be cosidered a advace of future earigs. Exclusios The Severace Pay Pla does ot provide beefits to employees who volutarily termiate because of resigatio, retiremet, disability, death, or for cause. Questios About the Pla If you have a questio about the Severace Pay Pla, cotact the Huma Resources ad Occupatioal Medicie Divisio. MISCELLANEOUS Base Pay Base Pay for the purpose of the Severace Pay Pla meas your aual full-time equivalet basic rate of pay, before ay salary reductios. This meas that for a part-time employee, such as a perso who is scheduled to work 50% time, the 100% rate is used. It does ot iclude overtime, bouses, or ay other compesatio. Cotiuous Service Cotiuous Service meas service from your most recet hire date. Service performed prior to a break i employmet is ot icluded i Cotiuous Service. Cotiuous service is pro-rated for parttime employees. For the fial year of employmet, service is computed i quarterly, three-moth, icremets with a full quarter s credit give for ay fractio of a quarter attaied. Employees with less tha oe year of Cotiuous Service will be credited with a full year s service for the purpose of this pla. If a employee was previously laid off with severace beefits, service used i the prior calculatio will ot be icluded for the purpose of aother layoff. Cotiuous Service will be reduced by time spet o approved leave of absece or i ay employmet category ieligible for severace beefits, such as part-time employmet of less tha 20 hours per week. Cotiuous Service shall iclude cotiuous service, if ay, with Associated Uiversities, Ic., Battelle Memorial Istitute (ad Battelle-related etities, excludig Departmet of Eergy laboratories maaged by Battelle except as idicated below), Research Foudatio of the State Uiversity of New York or the State Uiversity of New York at Stoy Brook immediately prior to a trasfer of employmet to Brookhave Sciece Associates, LLC. Cotiuous Service for employees hired for the NSLS II project shall iclude cotiuous service, if ay, with other Departmet of Eergy cotractors immediately prior to a trasfer of employmet to Brookhave Sciece Associates, LLC. Geeral Iformatio Iformatio regardig the pla idetificatio umber, pla year, pla fudig, type of pla, pla sposor, pla admiistrator, aget for legal process, your rights uder ERISA, prudet actios by pla fiduciaries, ad modificatio, suspesio, or termiatio of the pla ca be foud i the Geeral Iformatio sectio of this booklet. 9/11 BROOKHAVEN NATIONAL L ABOR ATORY 3

117 beefits: part 10 SEVERANCE PAY PLAN Part-Time Employees Severace beefits for eligible part-time employees, or employees whose Cotiuous Service cotais periods of eligible part-time employmet, will be prorated i accordace with the employee s official work schedule for the period of part-time employmet. Termiatio of Coverage Severace Pay Pla coverage will cease whe a employee is o loger eligible. 4 BROOKHAVEN NATIONAL L ABOR ATORY 9/11

118 beefits: part 11 LONG TERM CARE PLAN part 11 LONG TERM CARE PLAN The Log Term Care (LTC) Pla provides beefits for specific types of medical care ad assistace ot covered by the medical pla. Log term care refers to a wide rage of persoal care, health care, ad social services for people who suffer a chroic disease or log-lastig disability. This type of care is referred to as custodial care ad provides help with ormal activities of daily livig such as bathig, eatig or dressig. Services ca take place i a ursig care facility, a assisted livig facility, a adult day care ceter, or at home. Erollmet i the Log Term Care Pla is optioal. WHO IS ELIGIBLE FOR THE LONG TERM CARE PLAN? Active Employees All regular employees who work at least 20 hours per week are eligible to apply for the LTC Pla o the first day of active employmet. Eligible Depedets The spouse, same-sex domestic parter, parets, parets-i-law, gradparets, gradparets-i-law, survivig spouses, ad adult childre age 18 ad older of a employee are eligible to apply for this pla. Retirees All employees who retire ad their spouses or same-sex domestic parters are eligible to apply for this pla. APPLYING FOR COVERAGE Employees may apply for LTC Pla coverage withi 31 days of their date of hire. Eligible depedets may apply at the same time as the employee but must submit evidece of isurability ad be approved by Prudetial before coverage ca become effective. If a employee applies more tha 31 days after his or her date of hire or if a retiree or eligible depedet applies for coverage, he or she must submit evidece of isurability ad be approved by Prudetial before coverage ca become effective. If a employee is disabled ad away from work o the date coverage would otherwise become effective, the effective date will be delayed util the first of the moth followig the date the employee returs to work as a active employee. LONG TERM CARE PLAN COVERAGE Beefits Provided If a participat suffers a Loss of Fuctioal Capacity ad a Beefit Period commeces while he or she is a participat, the LTC Pla will provide a beefit for each day of the Loss of Fuctioal Capacity after the applicable Waitig Period. The beefit will be based o the Daily Beefit Amout ad the place of cofiemet. 8/08 1/10 BROOKHAVEN NATIONAL L ABOR ATORY 1

119 beefits: part 11 LONG TERM CARE PLAN Beefit Eligibility Criteria I order to receive beefits, you must first be assessed by a assessor ad be cofirmed as havig a Chroic Illess or Disability. A Chroic Illess or Disability is oe i which there is: 1) A loss of the ability to perform, without substatial assistace, at least two Activities of Daily Livig. This loss must be expected to cotiue for 90 days. Activities of Daily Livig are bathig, cotiece, dressig, eatig, toiletig ad trasferrig. Or 2) A severe cogitive impairmet which requires substatial supervisio to protect you from threats to health or safety. Preexistig Coditios Limitatio There is o preexistig coditios limitatio. Lifetime Maximum Beefit A participat may elect either a 3 or 5 year maximum beefit. EXCLUSIONS The followig charges are ot covered: 1) Work-coected Coditios Charge. A charge covered by a workers compesatio law, occupatioal disease law or similar law. 2) Govermet Pla Charge: A charge for a service or supply: a) furished by or for the Uited States govermet or ay other govermet, uless paymet of the charge is required by law. Or b) to the extet that the service or supply, or ay beefit for the charge, is provided by ay law or govermetal pla uder which the patiet is or could be covered. This (b) does ot apply to a state pla uder Medicaid or to ay law or pla whe, by law, its beefits are excess to those of ay private isurace program or other o-govermetal program. Whe this (b) applies to Medicare, the beefits provided by Medicare will be deemed to iclude ay amout that would have bee payable by Medicare i the absece of a deductible or coisurace requiremet uder that program. 3) War, Feloy, Riot or Isurrectio. Charges for a coditio due to war or ay act of war while you are isured or due to your participatio i a act of feloy, riot or isurrectio. War meas declared or udeclared war ad icludes resistace to armed aggressio. Riot meas a wild, violet, public disturbace of the peace. 4) Self-iflicted Ijury or Suicide. Charges arisig from itetioally self-iflicted ijury or attempted suicide. 5) Services ad Supplies Outside the Uited States. Charges for services or supplies outside of the Uited States ad its possessios. 6) Treatmet for Chroic Alcoholism or Chemical Depedecy. Charges i coectio with the treatmet of chroic alcoholism or chemical depedecy. CLAIMS How to File a Claim To file a claim uder the LTC Pla, you must complete a LTC Claim Form which is available through Prudetial. The completed claim form must be submitted to Prudetial withi 90 days of the date of the Loss of Fuctioal Capacity. 2 BROOKHAVEN NATIONAL L ABOR ATORY 8/08

120 beefits: part 11 LONG TERM CARE PLAN Questios About Claims If you have a questio about your LTC claim, you should cotact Prudetial at How to Appeal a Claim If your claim is deied, you have the right to appeal the decisio made about your claim. The explaatio of beefits otice will explai the procedure you should follow if you choose to appeal a claim decisio. Prudetial will sed you a writte ackowledgemet of your appeal. If o additioal iformatio is required ad the appeal is deied, the ackowledgemet will iclude a detailed explaatio of the reasos for the deial. If additioal iformatio is required, Prudetial will explai what iformatio is eeded. Upo receipt ad review of the additioal iformatio, Prudetial will otify you i writig of the results of the review. If you still disagree with the appeal decisio, you ca request i writig withi 60 days of the decisio that the matter be submitted to the claim appeal committee. This committee icludes, but is ot limited to, cliical cosultats, legal cosultats ad product maagemet staff. After a thorough review, the committee will sed you a writte otificatio of its decisio. EMPLOYEE PREMIUMS Whe participatig i the LTC Pla, employees have the optio of after-tax payroll deductios or beig billed directly from Prudetial. ELIGIBLE DEPENDENT PREMIUMS Coverage for eligible spouses must be paid for through the employee s payroll deductios or billed directly from Prudetial. Coverage for all other eligible depedets will be billed directly from Prudetial. RETIREE PREMIUMS Retirees ad spouses of retirees ad same-sex domestic parters of retirees will be billed directly from Prudetial. RETURN OF PREMIUMS If a participat who is erolled i the pla dies while covered uder the pla, a refud or partial refud of premiums may be provided. WAIVER OF PREMIUMS A participat s LTC Pla premiums will be waived if he or she has satisfied the Waitig Period ad is receivig pla beefits. Premiums will agai be required whe the Beefit Period eds. MISCELLANEOUS Beefit Period A Beefit Period is the period of days of a covered Loss of Fuctioal Capacity begiig o the first day of the loss ad edig 90 cosecutive days after which the participat has ot had a Loss of Fuctioal Capacity. It does ot iclude ay day prior to the participat s effective date of coverage. Chages i the Amout of LTC Coverage Every three years you will be offered the opportuity to icrease your beefits to keep up with 8/08 1/10 BROOKHAVEN NATIONAL L ABOR ATORY 3

121 beefits: part 11 LONG TERM CARE PLAN iflatio. If you accept the offer, the amout of the additioal beefit shall be the differece betwee your existig beefits ad those beefits compouded aually at a rate of five percet for the period begiig with the purchase of your existig beefits ad extedig util the year i which the offer is made. Beefits will be rouded to the earest dollar. Your age o the effective date of the icrease will be used to determie the additioal separate premium for the icreased coverage. Therefore, your premium will icrease each time you accept a iflatio protectio offer. You do ot have to provide evidece of isurability to take iflatio icreases. However, if you declie the previous two offerigs made to you, ad the wat to icrease coverage, you will be required to submit satisfactory evidece of isurability the ext time you accept a offer. Daily Beefit Amout The Daily Beefit Amout for a Nursig Care Facility is $100, $150, $200 or $250 ad is based o the participat s coverage electio. The home health care Daily Beefit Amout is 75% of the Daily Beefit Amout the participat elected for a Nursig Care Facility. Geeral Iformatio Iformatio regardig the pla idetificatio umber, pla year, pla fudig, type of pla, pla sposor, pla admiistrator, aget for legal process, your rights uder ERISA, prudet actios by pla fiduciaries, ad modificatio, suspesio, or termiatio of the pla ca be foud i the Geeral Iformatio sectio of this booklet. Home Care Uit A Home Care Uit is ay uit, icludig a private home, that does ot qualify as a Nursig Care Facility or Hospital. Hospital A Hospital is a short-term duly licesed, acute geeral hospital which meets certai requiremets as idicated i the Prudetial Isurace Certificate. Leave of Absece If you are o a approved Leave of Absece, you may cotiue your LTC coverage durig the term of the approved leave by writte request ad paymet of the required premium to Prudetial withi 30 days of the startig date of your leave. Loss of Fuctioal Capacity For tax-qualified Log Term Care cotracts, federal law (HIPAA) establishes a defiitio of a Chroically Ill idividual as ay idividual certified by a licesed health care practitioer as: Beig uable to perform (without substatial assistace from aother perso) at least two Activities of Daily Livig (ADL) for at least 90 days, or Requirig Substatial Supervisio to protect the idividual from harm due to severe cogitive impairmet. As a result, there are two separate beefit triggers ADL deficiecy or severe cogitive impairmet. Geerally, Prudetial measures severe cogitive impairmet i accordace with IRS Notice 97-31: 4 BROOKHAVEN NATIONAL L ABOR ATORY 8/08

122 beefits: part 11 LONG TERM CARE PLAN Severe cogitive impairmet meas a loss or deterioratio i itellectual capacity that is: Comparable to (ad icludes) Alzheimer s disease ad similar forms of irreversible demetia, ad Measured by cliical evidece ad stadardized tests that reliably measure impairmet i the idividual s: Short-term or log-term memory, Orietatio as to people, places, or time, ad Deductive or abstract reasoig. Substatial Supervisio meas cotiual supervisio (which may iclude cuig by verbal promptig, gestures, or other demostratios) by aother perso that is ecessary to protect the severely cogitively impaired idividual from threats to his or her health or safety (such as may result from waderig). Nursig Care Facility A Nursig Care Facility is a istitutio, or distict part of oe, which is duly licesed ad meets certai requiremets as idicated i the Prudetial Isurace Certificate. Termiatio of Coverage LTC Pla coverage will cease o the day you decease, are o loger eligible for coverage, or fail to pay the required premiums. Waitig Period The Waitig Period is 60 days. Beefits will ot be paid from the date of a Loss of Fuctioal Capacity through the Waitig Period. The Waitig Period will ot iclude days prior to pla participatio. CONTINUATION COVERAGE If a participat s coverage ceases due to ieligibility, coverage may be cotiued by writte request ad paymet of the required premium to Prudetial withi 60 days of the date coverage ceased. For additioal iformatio o cotiuatio coverage, cotact Prudetial at BROOKHAVEN NATIONAL L ABOR ATORY 5

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124 beefits: part 12 VACATION BUY PLAN part 12 VACATION BUY PLAN The Vacatio Buy Pla allows you to purchase additioal vacatio time o a pretax basis ad spread the cost of doig so over the caledar year. Erollmet i the Vacatio Buy Pla is optioal. WHO IS ELIGIBLE FOR THE VACATION BUY PLAN? Active Employees All regular employees who work at least 20 hours per week are eligible for the Vacatio Buy Pla o the first day of active employmet. Employees who are o a temporary assigmet or a leave of absece are ot eligible for this pla. ENROLLMENT Eligible employees may eroll i the Vacatio Buy Pla withi 30 days of their date of hire. Oce you eroll, you must cotiue participatio i the pla util the ed of the caledar year. If you do ot eroll withi 30 days of your date of hire, you will be required to wait util the ext Ope Erollmet Period to elect the beefit. VACATION BUY PLAN COVERAGE Beefits Provided You may purchase a miimum of 8 hours (up to a maximum of 40 hours) of vacatio time i 1-hour icremets each caledar year i additio to the vacatio time you are eligible to receive from the Laboratory. Vacatio buy beefits for eligible part-time employees will be prorated accordig to your official work schedule. Additioal vacatio time is paid for through pre-tax payroll deductios take equally from your paychecks throughout the year. The hours of vacatio you purchase become available to you as of your date of employmet. Each year thereafter, if you buy vacatio time, the hours of vacatio you purchase become available to you as of Jauary 1 of the followig year. Use of Vacatio Buy Time The use of all vacatio time requires the approval of your supervisor ad must be i accordace with Laboratory vacatio policies. Whe you record the vacatio buy hours o your timecard, you will use a special vacatio buy code. Vacatio buy hours ca oly be used after your regular accrued vacatio time has bee exhausted. The cutoff date for the use of vacatio buy hours varies from year to year. Cotact the Beefits Office for further iformatio. Determiig the Cost of Purchased Vacatio Time To determie the hourly cost of purchased vacatio time for a full caledar year, divide your fulltime Aual Base Salary by You ca prorate this accordigly for a partial year. 1/09 BROOKHAVEN NATIONAL L ABOR ATORY 1

125 beefits: part 12 VACATION BUY PLAN Uused Purchased Vacatio Time If you do ot use up all of the vacatio time that you have purchased, it will ot be carried over to the ext caledar year. Those extra hours will be paid back to you i your last paycheck i December based o the rate at which they were purchased. The amout you are reimbursed will be taxable i your paycheck. OPEN ENROLLMENT PERIOD Ope erollmet is held oce a year. Durig a Ope Erollmet Period, you may elect your Vacatio Buy beefit for the followig caledar year. Your electio durig the Ope Erollmet Period will be effective Jauary 1 of the followig caledar year. Vacatio Buy beefits do ot automatically carry forward from year to year. You must elect the beefit durig the Ope Erollmet Period for the followig caledar year. MISCELLANEOUS Base Salary Your Base Salary is the amout that will be reflected o your W-2 statemet, before exercise of ay salary reductios. Overtime paymets, shift premiums, termiatio paymets, severace pay, ad other forms of compesatio are ot icluded i Base Salary. For uio employees, Base Salary is based o the terms of their collective bargaiig agreemets. Geeral Iformatio Additioal iformatio is available o the Web at or through the Beefits Office at (631) or (631) Leave of Absece If you are o a approved Leave of Absece, your vacatio buy beefits will be discotiued. Your last paycheck whe you were eligible for the beefit will be adjusted the same as it would upo termiatio of employmet. You may elect the vacatio buy pla beefits upo your retur to work as a eligible employee. Termiatio of Employmet Vacatio Buy Pla beefits will cease o the earlier of the date your employmet termiates or the date you are o loger eligible for coverage. Your fial paycheck will be adjusted for: Hours purchased but ot used. You will be reimbursed for these i your fial paycheck based o the rate at which they were purchased ad the applicable tax. Hours purchased ad used but ot yet paid for. These will be deducted from your fial paycheck based o the rate at which they were purchased. 2 BROOKHAVEN NATIONAL L ABOR ATORY

126 beefits: part 13 ADOPTION ASSISTANCE PROGRAM part 13 ADOPTION ASSISTANCE PROGRAM The Adoptio Assistace Program provides fiacial assistace for certai expeses related to the adoptio of a urelated mior child. WHO IS ELIGIBLE FOR THE ADOPTION ASSISTANCE PROGRAM? Active Employees All regular employees who work at least 20 hours per week ad have completed oe year of cotiuous service are eligible for the Adoptio Assistace Program. Employees who are o a temporary assigmet or a leave of absece are ot eligible for this pla. ENROLLMENT You do ot eed to eroll for this program, but you must otify the Beefits Office i writig withi 30 days of the time a adoptio proceedig has commeced. ADOPTION ASSISTANCE PROGRAM COVERAGE Beefits Provided The adoptio assistace program provides eligible employees fiacial assistace (up to a maximum of $5000 per adopted child) for certai expeses related to the adoptio of a urelated mior child uder the age of eightee (18). BNL spouses or same-sex domestic parters are eligible for a combied maximum reimbursemet of $10,000 per adopted child. The adoptive child may ot be a relative or stepchild. What Adoptio-Related Expeses are Reimbursable? The followig expeses are reimbursable: Licesed adoptio agecy fees (icludig fees for placemet ad paretal couselig). Legal costs (icludig attorey s fees ad court costs). Charges for trasportatio to obtai physical custody of the adoptive child (icludig reasoable ad customary travel expeses for both the adoptive parets ad the adoptive child). How to Request Reimbursemet To request a reimbursemet for eligible expeses, you must submit a request for reimbursemet form, itemized bills, proof of paymet, ad a certified copy of the judicial order of adoptio to the Beefits Office withi 90 days after the adoptio is fial. Fiacial assistace reimbursemet will be made oly after the adoptio is fial. Reimbursemets are made directly to the employee, are cosidered taxable icome, ad are subject to withholdigs at the time of paymet. 1/10 BROOKHAVEN NATIONAL L ABOR ATORY 1

127 beefits: part 13 ADOPTION ASSISTANCE PROGRAM MISCELLANEOUS Geeral Iformatio Additioal iformatio is available through the Beefits Office at (631) Termiatio of Employmet Adoptio Assistace Program beefits will cease o the earlier of the date your employmet termiates or the date you are o loger eligible for coverage. 2 BROOKHAVEN NATIONAL L ABOR ATORY 1/10

128 beefits: part 14 TRANSIT COMMUTER BENEFIT PLAN part 14 TRANSIT COMMUTER BENEFIT PLAN The Trasit Commuter Beefit Pla allows you to use pre-tax dollars to pay for Eligible Trasportatio Expeses o a before-tax basis. By payig for expeses o a before-tax basis, you reduce your icome for the purpose of state, federal ad Social Security taxes. Erollmet i the Trasit Commuter Beefit Pla is optioal. WHO IS ELIGIBLE FOR THE TRANSIT COMMUTER BENEFIT PLAN? Active Employees All regular employees who work at least 20 hours per week are eligible to participate i the Trasit Commuter Beefit Pla o the first day of active employmet. ENROLLMENT Eligible employees may eroll i the Trasit Commuter Beefit Pla at ay time. To eroll, you must complete a erollmet form ad idicate the amout you wat to cotribute to the Trasit Commuter Beefit Pla. Erollmet forms are available through the Beefits Office. By completig the form, you will authorize a aual salary reductio amout. Your actual cotributios will be made from your paycheck i equal mothly or weekly istallmets depedig o your pay status. Coverage begis o the day you elect it o the erollmet form ad submit it to the Beefits Office. TRANSIT COMMUTER BENEFIT PLAN COVERAGE Beefits Provided You ca use the pla to set aside moey o a pre-tax basis ito a reimbursemet accout to pay for qualified commutig expeses such as vapoolig, trais, ad buses to ad from work. It excludes parkig, gasolie ad telecommutig expeses. You determie what types of expeses you expect to have durig the year ad fud your Trasit Commuter Beefit Pla Accout through automatic salary reductio. Throughout the year, you draw moey out of your Accout ad reimburse yourself for the trasit commuter expeses you have paid. How Much May You Cotribute Each Year to the Trasit Commuter Beefit Pla? You may cotribute ay amout from a miimum of $25 to a maximum of $2,760 for caledar year. The maximum mothly cotributio is $240. This amout may chage from year to year based o IRS limits. Does the Use of Before-Tax Cotributios to the Trasit Commuter Beefit Pla Affect Ay Other Beefits? It may. If your aual salary is below the Social Security wage base, your future Social Security beefit may be reduced, but oly miimally. BROOKHAVEN NATIONAL L ABOR ATORY 1

129 beefits: part 14 TRANSIT COMMUTER BENEFIT PLAN CLAIMS/PAYMENT OF EXPENSES How to File a Claim or Pay for Expeses You must either: use your PayFlex card (which is similar to a debit card) at the poit of purchase for your commutig expeses where the expeses are debited directly from your Accout, or complete a PayFlex Trasportatio Claim Form, available i the Beefits Office or through the Beefits Office website at or go olie to ad submit your claim electroically. I geeral, whe submittig a claim for reimbursemet, you must submit a receipt alog with your claim form icludig provider ame ad address, date of service, type of service provided, ad dollar amout charged for the service. You ca pay for your eligible expeses with the PayFlex card or submit for reimbursemet for up to the amout of fuds i your Accout. If you submit for reimbursemet of your claims, you may either set up a direct deposit optio with PayFlex or receive a check which is mailed to your home. Paymets will be issued daily for eligible expeses. You ca oly be reimbursed for up to the total amout that is i your Accout at the time of your claims submissio or whe you use your PayFlex card. You caot be reimbursed for expeses icurred prior to your participatio i the pla. How Log Do You Have to Submit Claims for Reimbursemet? You have util March 31 followig the caledar year i which you icurred expeses to submit claims for reimbursemet. So, for example, if you buy a trai ticket i December, you would still have up to March 31 to claim the expese, provided there is moey remaiig i your Trasit Commuter Beefit Pla Accout. If you have ay fuds i your Accout at the time you termiate employmet, termiate participatio or cease to be eligible to participate, these fuds will be forfeited if they are ot used for expeses icurred prior to these dates ad you do ot submit them for reimbursemet withi the applicable timeframes. Ay expeses icurred after these dates are ot eligible for reimbursemet. Questios About Claims If you have a questio about your Trasit Commuter Beefit Pla claim, you should cotact PayFlex at (800) How to Appeal a Claim If your claim is deied, you will receive a writte otice of the deial from the Claims Admiistrator. The otice will explai the reaso for the deial ad idicate the review procedures. You may request a review of the deied claim. The request must be submitted i writig to the Claims Admiistrator withi 60 days after you receive the deial otice. Submit your request, icludig your reasos for requestig the review ad ay additioal documets which you believe support your claim. The Claims Admiistrator will review the claim ad ordiarily otify you withi 60 days of the date your request for review is received. I special cases requirig a delay, the Claims Admiistrator will reder a decisio o later tha 120 days after your request for review is received. CHANGES IN CONTRIBUTION AMOUNTS The amout of pre-tax dollars you elect to cotribute to your Trasit Commuter Beefit Pla Accout will remai i effect util you make aother electio ad either chage the amout you are cotributig or termiate the Accout. You may do this at ay time for ay future pay period. 2 BROOKHAVEN NATIONAL L ABOR ATORY 1/10

130 beefits: part 14 TRANSIT COMMUTER BENEFIT PLAN MISCELLANEOUS Claims Admiistrator PayFlex Systems USA, Ic. P.O. Box 3039 Omaha, NE Telephoe: (800) Fax: (402) Eligible Trasportatio Expeses Eligible Trasportatio Expeses iclude: Trasit Pass Expeses: expeses icurred for a pass, toke, fare card, voucher, or similar item (a Pass ) for trasportatio O mass trasit facilities, whether or ot publicly owed, or Provided by ay perso i the busiess of trasportig persos for compesatio or hire if such trasportatio is provided i a vehicle with seatig capacity of at least six adults (excludig the driver) Commuter Highway Vehicle (Vapool) Expeses: expeses icurred for trasportatio i a commuter highway vehicle if such trasportatio is i coectio with travel betwee your residece ad place of employmet. A Commuter Highway Vehicle is ay highway vehicle with a seatig capacity of at least six adults (ot icludig the driver), ad for which at least 80% of the mileage is for the purpose of trasportig employees i coectio with travel betwee their residece ad their places of employmet, ad o trips durig which the umber of employees trasported for such purposes is, o average, at least half of the adult seatig capacity of the vehicle (ot icludig the driver). Geeral Iformatio Iformatio regardig the pla idetificatio umber, pla year, pla fudig, type of pla, pla sposor, pla admiistrator, aget for legal process, your rights uder ERISA, prudet actios by pla fiduciaries, ad modificatio, suspesio, or termiatio of the pla ca be foud i the Geeral Iformatio sectio of this booklet. Leave of Absece If you are o a approved Leave of Absece, your cotributios to this pla will cease ad your Accout will be termiated. Oly expeses icurred prior to the leave will be eligible for reimbursemet. Upo retur to work, you may oce agai elect to participate by completig a erollmet form. Participats Receivig Log Term Disability Pla Beefits Cotributios to this pla cease whe a participat qualifies for BSA Log Term Disability Pla beefits. Restrictios Trasit Commuter Beefit Pla Accouts are allowable uder Sectio 132(f) of the Iteral Reveue Code, ad certai restrictios apply to them. All uused Accout balaces remaiig whe you are o loger a participat i the pla are forfeited. 1/10 BROOKHAVEN NATIONAL L ABOR ATORY 3

131 beefits: part 14 TRANSIT COMMUTER BENEFIT PLAN Termiatio of Coverage Trasit Commuter Beefit Pla beefits will cease o the earlier of the date your employmet termiates, the date you cease participatio i the pla, or the date you are o loger eligible for coverage. 4 BROOKHAVEN NATIONAL L ABOR ATORY 1/10

132 beefits: GENERAL INFORMATION GENERAL INFORMATION This booklet cotais oly a summary of the beefit plas. Nothig herei should be deemed to waive or alter ay of the terms or coditios of the Plas. Pla Idetificatio Numbers The followig are the Pla ames ad umbers: Pla Name Pla Number BSA Retiremet Pla 001 BSA 401(k) Pla 002 BSA Comprehesive Welfare Beefits Pla 501 The Employer Idetificatio Number is Pla Year The pla year for each of the Plas idicated above is the caledar year, Jauary 1 through December 31. Pla Fudig The Plas idicated above are paid for by the employer ad, i some cases, also by employee cotributios or premiums. Type of Pla Plas 001 ad 002 idicated above are classified as pesio beefit plas for the purpose of providig retiremet beefits. Pla 501 is classified as a welfare pla for the purpose of providig medical isurace, life isurace, log term disability isurace, travel accidet isurace, detal isurace, reimbursemet accout beefits, severace pay beefits, tuitio refud beefits, log term care isurace ad trasit commuter beefits. Normal Retiremet Age Uder plas 001 ad 002, your ormal retiremet age is 65 years old. Pla Sposor The ame, address, ad phoe umber of the employer who is the Pla Sposor are as follows: Brookhave Sciece Associates, LLC Brookhave Natioal Laboratory P.O. Box 5000 Upto, New York (631) /07 1/10 BROOKHAVEN NATIONAL L ABOR ATORY 1

133 beefits: GENERAL INFORMATION Pla Admiistrator The Pla Admiistrator for Plas 001 ad 002 is the Retiremet Committee ad for Pla 501 is Brookhave Sciece Associates, LLC. The Pla Admiistrator ca be reached at the address ad phoe umber idicated above. Aget for Legal Process The aget for service of legal process is: Geeral Cousel Brookhave Sciece Associates, LLC Brookhave Natioal Laboratory P.O. Box 5000 Upto, New York (631) Service of process may be made upo a pla trustee or pla admiistrator. Trustees You choose to allocate your cotributios i the Retiremet Pla ad the 401(k) Pla to be ivested with TIAA-CREF, Fidelity Ivestmet Services, or Vaguard Group. You may cotact them at the followig addresses ad telephoe umbers: For TIAA-CREF ad/or Vaguard fuds: TIAA-CREF 730 Third Aveue New York, NY (800) For Fidelity fuds: Fidelity Ivestmets P.O. Box Ciciati, OH (800) Filig Claims for Beefits To file a claim for beefits uder the Retiremet Pla or the 401(k) Pla, cotact the Trustee(s) with whom you have ivested your accouts at the telephoe umber listed above. Each Trustee may require you to complete certai forms to process your request for beefits. If you eed assistace, cotact the Beefits Office. To file a claim uder ay other pla, cotact the isurace compay or other provider who admiisters the beefits uder the pla. If you eed assistace, cotact the Beefits Office. Claims Appeal Procedure Whe a claim is deied, you will receive a writte otificatio of the deial. The otificatio will explai the reasos for the deial, the additioal iformatio or material eeded to further review the claim, ad the procedure for requestig a review of the deial. Privacy of Iformatio Your protected health iformatio will ot be disclosed without your writte authorizatio, uless such disclosure is permitted by law. Protected health iformatio is idividually idetifiable iformatio that is maitaied relatig to the provisio of your health care, such as your medical records, claims paymet iformatio, ad health care visit ad treatmet patters. 2 BROOKHAVEN NATIONAL L ABOR ATORY 1/07 1/10

134 beefits: GENERAL INFORMATION Your Rights Uder ERISA As a participat i the Plas, you are etitled to certai rights ad protectios uder the Employee Retiremet Icome Security Act of 1974 (ERISA). ERISA provides that all pla participats shall be etitled to: Receive Iformatio About Your Plas ad Beefits Examie without charge, at the Pla Admiistrator s office, all documets goverig the pla, icludig isurace cotracts, collective bargaiig agreemets, ad copies of the latest aual report (Form 5500 Series) filed by the pla with the U.S. Departmet of Labor ad available at the Public Disclosure Room of the Employee Beefits Security Admiistratio. Obtai, upo writte request to the Pla Admiistrator, copies of documets goverig the operatio of the pla, icludig isurace cotracts ad collective bargaiig agreemets, copies of the latest aual report (Form 5500 Series) ad updated summary pla descriptio. The Pla Admiistrator may make a reasoable charge for the copies. Receive a summary of the pla s aual fiacial report. The Pla Admiistrator is required by law to furish each participat with a copy of this summary aual report. Obtai a statemet tellig you whether you have a right to receive a beefit i the Retiremet ad 401(k) Plas ad if so, what your beefits would be if you stop workig ow. If you do ot have the right to a beefit, the statemet will tell you how may more years you have to work to get the right to a beefit. This statemet must be requested i writig ad is ot required to be give more tha oce every twelve (12) moths. The pla must provide the statemet free of charge. Cotiue Group Health Pla Coverage Cotiue health care coverage for yourself, spouse or depedets if there is a loss of coverage uder the pla as a result of a qualifyig evet. You or your depedets may have to pay for such coverage. Review this summary pla descriptio ad the documets goverig the pla o the rules goverig your COBRA cotiuatio coverage rights. Reductio or elimiatio of exclusioary periods of coverage for pre-existig coditios uder your group health pla, if you have creditable coverage from aother pla. You should be provided a certificate of creditable coverage, free of charge, from your group health pla or health isurace issuer whe you lose coverage uder the pla, whe you become etitled to elect COBRA cotiuatio coverage, whe your COBRA cotiuatio coverage ceases, if you request it before losig coverage, or if you request it up to 24 moths after losig coverage. Without evidece of creditable coverage, you may be subject to a pre-existig coditio exclusio for 12 moths (18 moths for late erollees) after your erollmet date i your coverage. Prudet Actios by Pla Fiduciaries I additio to creatig rights for pla participats, ERISA imposes duties upo the people who are resposible for the operatio of the employee beefit plas. The people who operate your pla, called fiduciaries of the pla, have a duty to do so prudetly ad i the iterest of you ad other pla participats ad beeficiaries. No oe, icludig your employer, your uio, or ay other perso, may fire you or otherwise discrimiate agaist you i ay way to prevet you from obtaiig a beefit or exercisig your right uder ERISA. 1/07 BROOKHAVEN NATIONAL L ABOR ATORY 3

135 beefits: GENERAL INFORMATION Eforce Your Rights If your claim for a beefit is deied or igored, i whole or i part, you have a right to kow why this was doe, to obtai copies of documets relatig to the decisio without charge ad to appeal ay deial, all withi certai time schedules. Uder ERISA, there are steps you ca take to eforce the above rights. For istace, if you request a copy of pla documets or the latest aual report from the pla ad do ot receive them withi 30 days, you may file suit i Federal court. I such a case, the court may require the Pla Admiistrator to provide the materials ad pay you up to $110 a day util you receive the materials, uless the materials were ot set because of reasos beyod the cotrol of the Admiistrator. If you have a claim for beefits which is deied or igored, i whole or i part, you may file suit i a state or Federal court. I additio, if you disagree with the pla s decisio or lack thereof, cocerig the qualified status of a domestic relatios order or medical child support order, you may file suit i Federal court. If it should happe that pla fiduciaries misuse the pla s moey or if you are discrimiated agaist for assertig your rights, you may seek assistace from the U.S. Departmet of Labor, or you may file suit i a Federal court. The court will decide who should pay court costs ad legal fees. If you are successful, the court may order the perso you have sued to pay these costs ad fees. If you lose, the court may order you to pay these costs ad fees, for example, if it fids that your claim is frivolous. Assistace With Your Questios If you have ay questios about your plas, you should cotact the Pla Admiistrator. If you have ay questios about this statemet or about your rights uder ERISA, or if you eed assistace i obtaiig documets from the Pla Admiistrator, you should cotact the earest office of the Employee Beefits Security Admiistratio, U.S. Departmet of Labor, listed i your telephoe directory or the Divisio of Techical Assistace ad Iquiries, Employee Beefits Security Admiistratio, U.S. Departmet of Labor, 200 Costitutio Aveue N.W., Washigto, D.C You may also obtai certai publicatios about your rights ad resposibilities uder ERISA by callig the publicatios hotlie of the Employee Beefits Security Admiistratio. The iformatio i this booklet is iteded to provide oly a summary of BSA s beefits program. Nothig cotaied i ay sectio of this booklet should be costrued as a promise of employmet or cotiued employmet, or to costitute cotractual obligatios. If questios arise, official pla documets ad isurace agreemets are cotrollig ad gover fial determiatio of beefits cosistet with applicable laws ad regulatios. BSA maitais the right to modify, susped, or termiate beefit plas i whole or i part at ay time. 4 BROOKHAVEN NATIONAL L ABOR ATORY 1/07