Same-Sex Domestic Partner Benefits

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1 Same-Sex Domestic Partner Benefits UPS Health and Welfare Package UPS Health and Welfare Package for Retired Employees UPS Health and Welfare Package Select UPS Health and Welfare Package Select for Retired Employees UPS Health and Welfare Package Select Hawaii UPS Health and Welfare Package Select for Retired Employees Hawaii UPS National Health Plan for Part-Time Employees The terms of this UPS Same-Sex Domestic Partner Benefits brochure are incorporated into and become part of your Plan s Summary Plan Description. This document governs with respect to eligibility and certain coverage for same-sex domestic partners and their eligible children. Your Plan s Summary Plan Description will govern for all other issues regarding coverage.

2 Benefits for a Diverse World... and Workforce UPS is pleased to offer eligible employees and retirees the opportunity to cover same-sex domestic partners (and their eligible dependents) when dependent coverage is available under the terms of your Plan. This extension of coverage is consistent with UPS s commitment to offer competitive benefit programs, and supports UPS s culture of diversity and inclusion. This document provides general information about same-sex domestic partner benefits; including who is eligible, what coverage is available, enrollment details, financial and tax implications related to these benefits, and guidance about changes during the year. A Word About Confidentiality At UPS, all benefit elections and the identities of covered dependents are treated with the highest degree of confidentiality and sensitivity. Information about employee and retiree elections regarding same-sex domestic partner benefits are subject to the same processes and protocols in place for all employee or retiree data. Who is Eligible If you participate in one of the following UPS-administered health care plans, you may be eligible to elect certain benefits for your same-sex domestic partner and his or her dependent children: UPS Health and Welfare Package UPS Health and Welfare Package for Retired Employees UPS Health and Welfare Package Select UPS Health and Welfare Package Select for Retired Employees UPS Health and Welfare Package Select Hawai i UPS Health and Welfare Package Select for Retired Employees Hawai i UPS National Health Plan for Part-Time Employees However, there are many legal and tax implications to consider. Before you make this election, you should understand the definitions of certain terms used in this document. Same-Sex Domestic Partner Eligibility In addition to meeting the same Plan requirements (for example, verifying dependent eligibility and providing a Social Security number) as any other dependent to be eligible for coverage, you and your same-sex domestic partner must: Have been in an exclusive and committed relationship of mutual caring and support for at least the past 12 months, and intend to remain in the partnership permanently; Be jointly responsible for each other s living expenses and/or common welfare; Not be legally married to or legally separated from anyone else, nor have had another domestic partner within the past 12 months; Both be at least 18 years of age and mentally competent to consent to a contract; Have lived together in the same principal residence for at least the past 12 months and intend to do so indefinitely; Not be related by blood, or to the degree of closeness that would otherwise prohibit legal marriage in the state in which you and your partner legally reside; Not be in the relationship solely for the purpose of obtaining benefits coverage. You will be required to sign an affidavit certifying that the above conditions have been satisfied, and to provide additional documentation as evidence of your relationship. 1

3 Eligible Children of Your Same-Sex Domestic Partner In addition to children eligible for coverage as your dependents (as described in your Plan s Summary Plan Description), you may enroll your domestic partner s children for medical, dental, vision and legal coverage if the child otherwise meets the definition of an eligible dependent child under the Plan. For active employees eligible for spending accounts, eligible dependents are defined differently for purposes of health care and child/elder care spending accounts. Although the spending accounts are available to all eligible employees, the Internal Revenue Service does not permit before-tax reimbursement of health care or child/elder care expenses for same-sex domestic partners or their children, unless they are your dependents for federal income tax purposes (see Paying for Coverage, An Exception to the Rule in this document). Social Security Required In addition to the other requirements for your dependents to be eligible for coverage under the Plan, you must provide a Social Security number for each dependent you wish to cover under the Plan. Coverage for spouses, same-sex domestic partners or civil union partners will not begin until a Social Security number has been provided to the UPS Benefits Service Center during enrollment. Coverage for dependent children will begin, but will be terminated retroactively to the date their coverage began if the Social Security number is not received by the date indicated on the enrollment form. Eligibility for Insured Benefits May Differ To elect same-sex domestic partner benefits through UPS, you and your partner must meet UPS s definition of a same-sex domestic partnership. However, certain insured benefits available through the Plan may have different requirements for determining same-sex domestic partner status and may require documentation or proof of a same-sex domestic partnership. Before enrolling a same-sex domestic partner (and/or his or her eligible dependent children) in any HMO (as available) or other insured benefit, be sure to: Confirm that you meet both UPS s and the insurance company s eligibility requirements; and Provide proof or documentation, as required. For more details, contact the insurer directly. If You Both Work at UPS If both you and your same-sex domestic partner work or worked for UPS, the same rules apply for you and your partner (or his or her child) that apply for spouses and children with respect to the elections you and your partner may make and coordination of coverage between two plans. Refer to your Plan s Summary Plan Description for details. Continuation of Coverage If You Die If you die while an active employee, your covered same-sex domestic partner and/or his or her covered children are eligible for the same continuation of coverage provisions described in the Life Events section of your Plan s Summary Plan Description. If you die while a retiree and your same-sex domestic partner and/or his or her children are covered by a UPS-administered retiree health care plan, your same-sex domestic partner and any covered dependent(s) may be eligible to continue coverage under the Plan. For detailed information, refer to Life Events section of your Plan s Summary Plan Description or by calling the Benefits Service Center at UPS

4 What Coverage is Available Employees If you are an employee participating in a UPS-administered health care plan, you may elect medical, dental, vision and/or other coverage under the Plan for your same-sex domestic partner (and his or her eligible dependent children). Refer to your Plan enrollment materials or contact the UPS Benefits Service Center at UPS-1508 for more information. Retirees If you are a retiree participating in one of the aforementioned UPS-administered health care plan, you may elect medical, dental, vision and any other applicable coverage under the Plan for your same-sex domestic partner (and his or her eligible dependent children). See your Enrollment Worksheet or contact the UPS Benefits Service Center at1-800-ups-1508 for more information. Insurance Beneficiary Designation Because life and AD&D insurance are provided through insurance contracts and may be subject to state regulations, a same-sex domestic partner is not automatically considered the beneficiary of your life insurance. If you want your same-sex domestic partner to be the beneficiary of your life and/or AD&D benefit(s), you must name him or her as your beneficiary. Call UPS-1508 to speak to a UPS Benefits Service Center representative. Enrollment When to Enroll You may enroll your same-sex domestic partner and his or her eligible dependent(s): When enrolling in your Plan for the first time; Each fall during the annual enrollment period; and/or During the calendar year based on the rules governing permitted Plan changes (see the Life Events section of your Plan s Summary Plan Description). How to Enroll In order to enroll a domestic partner in coverage under your Plan, you and your domestic partner must submit the documentation listed below, within the time period indicated in When Documentation is Due, later in this section. Affidavit of Domestic Partnership (Attachment A) - Required. Upon enrollment, an employee in a domestic partnership and his or her domestic partner are required to complete and sign this form certifying that the relationship exists. Affidavit of Tax Dependency (Attachment B) - Optional. If your domestic partner and his or her children are your tax dependents for federal income tax purposes, you may complete and return this form so that imputed income is not calculated on your benefits (see Paying for Coverage, An Exception to the Rule in this document). Dependent verification documentation - Required. You must provide one form of the following types of documentation supporting your relationship to your domestic partner and/or child of domestic partner. 1. If you live in a state or municipality that offers a registry for domestic partners, attach a copy of your Domestic Partner Registry with a local jurisdiction. 3

5 2. If a Domestic Partner Registry is not available where you live, submit a copy of one of the following: A deed or other documentation (current within last 12 months) showing you are joint owners of a residence, or Your current lease showing you are joint tenants on the lease. 3. If neither item listed above is available or applicable, submit a current copy of two items from the following list: A joint bank statement or credit card bill from within last 12 months. A loan note or payment coupon showing you are joint obligators on a loan. Utility or telephone bills showing interdependence from within the last 12 months showing you have common household and shared household expenses. The title or registration of a motor vehicle showing you are joint owners. An executed will naming each other as executor and/or beneficiary. Documentation granting each other durable powers of attorney. Documentation conferring upon each other authority to make health care decisions under a health care power of attorney. Documentation designating each of you (or one of you) as a beneficiary under the other s retirement benefits plan or account. Where to Send Documentation Send the required forms with copies of your supporting documentation to: UPS Benefits Service Center 100 Half Day Road Lincolnshire, IL When Documentation is Due If you add a same-sex domestic partner and/or his or her dependent(s), you must provide the required affidavits and verification documentation within the time period shown below: At initial enrollment: Within your initial 45-day enrollment period At annual enrollment: Early the following year If you do not submit the appropriate documentation in a timely fashion, coverage for your dependent(s) will be terminated retroactive to the date their coverage began, and you may be required to reimburse the Plan for any claims paid on behalf of your otherwise ineligible dependent(s). Paying for Coverage You and UPS share the cost of covering a same-sex domestic partner and/or his or her eligible dependent children, just as if you were covering a spouse and your own eligible dependent children. However, there are additional financial and tax implications to consider. Domestic partners are not considered spouses under the Internal Revenue Code. Accordingly, they may not receive tax-free benefits from employer benefit plans. Any benefits received by a domestic partner and/or children of a domestic partner must be taxed. Additionally, IRS regulations do not allow reimbursement from a flexible spending account for otherwise eligible expenses incurred by or on behalf of a domestic partner and/or children of a domestic partner. (However, if the domestic partner and/or his or her children are the employee s dependents for federal income tax purposes, then these restrictions may not apply; you should consult your tax advisor with any questions. See Paying for Coverage, An Exception to the Rule in this section.) 4

6 As a result, the full cost of medical, dental and vision coverage for your same-sex domestic partner and his or her eligible dependent children will be added to your income and subject to federal, state and local taxes as well as applicable employment and payroll taxes if you are an employee. These additions known as imputed income are based on the price of the coverage you select. After-tax benefits, such as legal coverage, are not added as imputed income. Any applicable payroll deductions for coverage for you and your same-sex domestic partner and/or his or her eligible dependent children will appear on your pay stub just as it would for any employee covering eligible dependents. However, the full value (the price tag) of domestic partner benefits will be taxed and shown as imputed income in your gross wages on your paycheck and your year-end W-2 statement. A separate line-item, DOMPARTBEN, will appear on your pay stub. The full value of the benefits will be offset prior to imputing income by any after-tax dollars you pay toward coverage. If you are a retiree, you will be sent a Form 1099 each year showing the value of your same-sex domestic partner benefits as imputed income. The full value of the benefits will be offset prior to imputing income by any after-tax dollars you pay toward retiree coverage. The price tag is based on the medical, dental and vision coverage you elect. The imputed income is based on the dependent(s) you cover. The table that follows indicates what is considered imputed income based on your coverage level (meaning whom you elect to cover) for medical, dental and vision coverage. If you elect: You + Spouse (domestic partner) You + Children (and at least one of the children is a child of your domestic partner) You + Family (domestic partner and at least one of the children is a child of the domestic partner) Then your imputed income* is the: You Only price tag for the cost of your partner s coverage. You Only price tag for the cost of your partner s children s coverage (keep in mind that the number of children covered is not a factor in the cost of children s coverage). You + Children price tag for the cost of your partner s coverage and your partner s children s coverage. *See An Exception to the Rule section below if your domestic partner and/or his or her children qualify as dependents for federal income tax purposes. An Exception to the Rule If your same-sex domestic partner and his or her eligible dependent children qualify as your dependents for federal income tax purposes, the costs for their medical, dental and vision benefits are not considered taxable income to you. In addition, you may request reimbursement from a flexible spending account for eligible expenses incurred by or on behalf of your domestic partner and/or children of your domestic partner. According to the Internal Revenue Code, your same-sex domestic partner and/or his or her children can be claimed as dependents for federal income tax purposes (on your tax return) for any calendar year in which they are: Citizens, nationals or residents of the United States; Living with you during the entire year, and members of your household; In a relationship with you that does not violate local laws; and Receiving over half their financial support for the year from you. To determine whether your same-sex domestic partner and his or her children are your dependents for federal income tax purposes, you may wish to consult a tax advisor. 5

7 Affidavit of Tax Dependency If you claim your domestic partner and his or her children (if any) as dependents for federal income tax purposes, you must complete the Affidavit of Tax Dependency (Attachment B) so that imputed income is not included in your paycheck or year-end W-2 statement, or Form 1099 if retired. If you do not complete this form and submit it to the UPS Benefits Service Center at the time of initial enrollment, and later determine that you are eligible to report your domestic partner and his or her children as tax dependents, you may submit the Affidavit of Tax Dependency at that time. However, imputed income will not be reprocessed for the time period prior to receipt of the affidavit by the Benefits Service Center. Once submitted, the affidavit will remain in effect until you otherwise notify the Benefits Service Center in writing. You may submit the Affidavit of Tax Dependency only if your domestic partner and his or her children, if any, are your dependents for federal income tax purposes. Because of administrative restrictions, your domestic partner s family coverage may not be split to avoid imputed income on some of the dependents and not others. State Laws Some states have legislation exempting the taxation of domestic partner benefits. UPS is unable to make exemptions for these states, and state income tax will be deducted on your imputed income. You are responsible for determining whether you must adjust your state income tax filing to receive a refund. You may wish to consult a tax advisor with any questions. If You Take a Leave of Absence For active employees, if you are on a leave of absence from work and are directly billed for your benefits, your payments are not included in domestic partner benefits imputed income (even if they are normally pre-tax benefits), since these payments are made on an after-tax basis. Termination of a Domestic Partnership Upon termination of a domestic partnership, you must submit a signed Affidavit of Termination of Domestic Partnership form (Attachment C) to the UPS Benefits Service Center within 60 days of the termination of the domestic partnership. Termination of the covered dependent(s) is considered a life event and must be reported to the Benefits Service Center using the same procedures as for any other dependent, as described in your Plan s Summary Plan Description. Coverage for the domestic partner and his or her dependent(s) will cease on the date the relationship ended, as specified on the Affidavit form. Your domestic partner and his or her dependent(s) may be eligible for continuation of health benefits in certain circumstances. See the COBRA-Like Coverage section below. Waiting Period for New Partners An employee or retiree who wishes to add coverage for a new same-sex domestic partner following the end of a previous partnership must wait 12 months from the date the previous domestic partnership was terminated, and must submit the Affidavit of Termination of Domestic Partnership form to the Benefits Service Center within 60 days of the termination of partnership. Additionally, you must meet the Plan s standard eligibility rules for adding dependents. COBRA-Like Coverage for Same-Sex Domestic Partners In certain circumstances, health care coverage for domestic partners and their dependent(s) (if they are considered qualified beneficiaries ) can continue beyond the date it would otherwise end. Although domestic partners and their children are not considered qualified beneficiaries by COBRA, UPS will provide the same coverage continuation provisions to them if they otherwise meet the qualifications. To 6

8 be eligible for domestic partner COBRA coverage, the eligible domestic partner and/or his or her dependent(s) must have been covered by your Plan immediately preceding a COBRA qualifying event. Please refer to your Plan s Summary Plan Description for a full explanation of COBRA coverage. Ineligibility for HIPAA Protection Your Summary Plan Description explains the right provided under the Health Insurance Portability and Accountability Act (HIPAA) for eligible individuals to obtain coverage in the individual market. However, domestic partners and/or their dependent(s) are not considered by the Act to be eligible, and are not protected by this law. Effect on Other Benefits The extension of same-sex domestic partner benefits under your health care plan has no effect on benefits outside the scope of your health care plan. For More information If you need additional guidance or have questions about these benefits contact the UPS Benefits Service Center by calling UPS

9 Attachment A Affidavit of Domestic Partnership We, and, (Print Name of Employee) (Print Name of Domestic Partner) each certify and declare that we are domestic partners in accordance with all of the following: Our same-sex domestic partnership began on or about / / ; We are each eighteen (18) years of age or older; and mentally competent to consent to this declaration; We have been in an exclusive and committed relationship of mutual caring and support for at least the past 12 months, and intend to remain in the partnership permanently; We are jointly responsible for each other s living expenses and/or common welfare; We are not legally married to or legally separated from anyone else, nor have we had another domestic partner within the past 12 months; We have lived together in the same principal residence for at least the past 12 months and intend to do so indefinitely; We are not related by blood, or to the degree of closeness that would otherwise prohibit legal marriage in the state in which we legally reside; and We are not in the relationship primarily for the purpose of obtaining benefits coverage. Change in Domestic Partnership We, the undersigned domestic partners, understand and agree that we have an obligation to notify the UPS Benefits Service Center if there is any change in our domestic partnership status (as attested to in this Affidavit) that would terminate this Affidavit (for example, due to death of a partner, a change in residence of one partner, or termination of a relationship). If there is a change in our domestic partnership status, we agree to file an Affidavit of Termination of Domestic Partnership notice with the UPS Benefits Service Center within 60 days of any such change. We understand that termination of health coverage (obtained as a result of completion of this Affidavit) will be effective on the date the relationship ends as specified on the Affidavit of Termination of Domestic Partnership, providing coverage has not otherwise been terminated due to standard Plan provisions. Acknowledgements We acknowledge that we have provided the information requested by the Plan on this form and all other information requested by the Plan in conjunction with its domestic partnership benefits program freely and voluntarily for the purpose of determining our eligibility for benefits. We have provided the information in this Affidavit for use by the Plan Administrator for the sole purpose of determining our eligibility for certain domestic partner benefits. We understand and agree that the Plan is not legally required to extend any such benefits and may modify, amend, suspend, or terminate such benefits at any time, for any reason, and without our consent. We understand that the information provided in this Affidavit will be treated as confidential by the Plan but will be subject to disclosure in accordance with applicable law. (Continued on next page) 8

10 Affidavit of Domestic Partnership Page 2 of 2 We understand that this Affidavit may have legal implications relating, for example, to our ownership of property, taxability of benefits provided (imputed income), and support obligations; and that before signing this Affidavit we should obtain competent legal and/or tax advice concerning such matters. / / Name of Employee (Print) Date of Birth Employee ID Signature of Employee Date Name of Domestic Partner (Print) / / Date of Birth Signature of Domestic Partner Date Employee and Domestic Partner Principal Address: Street City State ZIP Code Send the required forms to: UPS Benefits Service Center 100 Half Day Road Lincolnshire, IL

11 Attachment B Affidavit of Tax Dependency I certify that my domestic partner and his or her children, if any, are my tax dependents for federal income tax purposes. I understand that, once submitted, this Affidavit will be in effect until I otherwise notify the UPS Benefits Service Center in writing. I understand that, according to the Internal Revenue Code, my same-sex domestic partner and his or her children can be claimed on my tax return as my dependents for federal income tax purposes for any calendar year in which they are: Citizens, nationals or residents of the United States; Living with me during the entire year, and members of my household; In a relationship with me that does not violate local laws; and Receiving over half their financial support for the year from me. I acknowledge that it is my responsibility to know or seek the appropriate advice regarding these potential tax implications. Name of Employee (Print) Witnessed By (Print name; other than partner) Employee ID / / Signature of Employee Date Signature of Witness Date Send the required forms to: UPS Benefits Service Center 100 Half Day Road Lincolnshire, IL

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13 Attachment C Affidavit of Termination of Domestic Partnership This document must be received by the UPS Benefits Service Center within 60 days of the effective date of the termination of the relationship. I certify and declare that, effective : (date) and (Print Name of Employee) (Print Name of Domestic Partner) are no longer domestic partners in accordance with the terms of eligibility for UPS s same-sex domestic partner benefits program. I understand that coverage for my former domestic partner and his or her children will be retroactively terminated as of the effective date indicated above. Name of Employee (Print) Employee ID Signature of Employee Date Name of Domestic Partner (Print) Signature of Domestic Partner (Not Required) Date Send the required forms to: UPS Benefits Service Center 100 Half Day Road Lincolnshire, IL

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15 Notes 14

16 2010 United Parcel Service of America, Inc. UPS and the UPS brandmark are registered trademarks of United Parcel Service of America, Inc. All rights reserved /10

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