TIME WARNER GROUP HEALTH PLAN 2013 SUMMARY PLAN DESCRIPTION

Transcription

1 TIME WARNER GROUP HEALTH PLAN 2013 SUMMARY PLAN DESCRIPTION

2 Welcome Summary Plan Description for: Medical Prescription Drug Mental Health and Substance Use Disorder Treatment Autism Advocate PROGRAM This is the Summary Plan Description (SPD) for the medical, prescription drug, mental health and substance use disorder treatment and autism support coverages (the Program ) provided for eligible employees. The Program is part of the Time Warner Group Health Plan (the Plan ). This SPD describes the major provisions of the Program as in effect on January 1, 2013 (except as otherwise noted), and provides information participants are legally entitled to know. Generally, the terms you and your as used in this SPD refer to a Time Warner EMPLOYEE (and, with respect to benefits and limitations described in this SPD, an employee s dependent) who meets all the eligibility and participation requirements under the Program and the Plan. Receipt of this SPD does not guarantee that the recipient is a PARTICIPANT under the Program or the Plan and/or otherwise eligible for benefits under the Plan or the Program. 2 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

3 TABLE OF CONTENTS ABOUT THIS SPD... 6 PLAN OPTIONS... 6 WHO S ELIGIBLE Employees Dependents ENROLLMENT Active Enrollment Open Enrollment Qualified Change in Status PAYING FOR COVERAGE WHEN COVERAGE BEGINS MEDICAL COVERAGE PRE-NOTIFICATION HOW THE MEDICAL PLAN OPTIONS WORK PREFERRED PROVIDER ORGANIZATIONS (PPOs) UnitedHealthcare and Blue Cross Blue Shield PPOs PPOs at a Glance Health Savings Account (HSA) OUT-OF-AREA (OOA) Option Out-of-Area at a Glance HEALTH MAINTENANCE ORGANIZATIONS (HMOs) ELIGIBLE MEDICAL EXPENSES What s Not Covered PRESCRIPTION DRUG COVERAGE HOW PRESCRIPTION DRUG COVERAGE WORKS Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 3

4 PREFERRED PROVIDER ORGANIZATIONS (PPOs) PPOs at a Glance Out-of-Area at a Glance PRESCRIPTION DRUG COVERAGE AND MEDICARE PART D ELIGIBLE PRESCRIPTION DRUG EXPENSES What s Not Covered OTHER BENEFITS UNDER THE MEDICAL PLAN OPTIONS MENTAL HEALTH and SUBSTANCE USE DISORDER TREATMENT Arranging for Benefits Eligible Mental Health and Substance Use Disorder Expenses What s Not Covered AUTISM ADVOCATE PROGRAM Arranging for Benefits Autism Advocate Program Eligible Expenses Pre-Authorization What s Not Covered HEALTHY RESOURCES PROGRAM EMPLOYEE ASSISTANCE PROGRAM (EAP) FILING CLAIMS How to File a Claim Appeals Claims Fraud WHAT HAPPENS IF You Become Disabled You Take a Leave of Absence You Receive Notice and Severance You Retire You Become Medicare-Eligible WHEN COVERAGE ENDS Continuing Coverage Under COBRA Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

5 OTHER INFORMATION If You Have Other Coverage Qualified Medical Child Support Orders (QMCSOs) Benefits Lost or Delayed Ownership of Benefits Laws and Regulations Affecting the Plan Plan Administration Plan Facts Your Rights Under ERISA KEY TERMS & DEFINITIONS Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 5

6 ABOUT THIS SPD The information in this Summary Plan Description applies to eligible employees of Turner. This summary tries to explain Plan and PROGRAM provisions in everyday language, but you will come across linked words and phrases that have specific meanings within the context of the Program. Click the links for the definitions of these terms, which are also available in KEY TERMS & DEFINITIONS on page 111. Also, be sure to read OTHER INFORMATION on page 100 and Your Rights Under ERISA on page 108 for important administrative guidelines and facts about your rights under applicable law, the Plan and the Program. If there s any discrepancy between this Summary Plan Description and the official Plan documents, the Plan documents take precedence. You can get a copy of the Plan documents by writing to the PLAN ADMINISTRATOR. Time Warner Inc. or any successor reserves the right to amend, modify, suspend or terminate the Plan, the Program or any coverage option offered under the Plan, in whole or in part, at any time and for any reason, by action of Time Warner Inc. In addition, the BENEFITS OFFICER may amend the Plan on behalf of Time Warner Inc. for changes that do not result in a significant cost to any EMPLOYING COMPANY or have a material effect on benefits. Please note that the Plan does not create an employment contract between you and your Employing COMPANY, and does not give you any right, expressed or implied, of continued employment with your Employing Company. PLAN OPTIONS When you enroll in the PROGRAM, you are offered a choice of medical coverage options. You may elect coverage for yourself and your eligible DEPENDENTS. Your medical coverage options depend on where you live. You may choose between two Preferred PROVIDER Organization (PPO) networks for your medical coverage. If you elect medical coverage under one of the two PPO options, you automatically receive PRESCRIPTION DRUG COVERAGE, MENTAL HEALTH and SUBSTANCE USE DISORDER TREATMENT and autism support coverage. You can also choose a Health Maintenance Organization (HMO) if available in your area. If you choose an HMO, your prescription drug and mental health/substance use disorder coverage will be offered through the HMO. If you choose an HMO, the HMO will provide materials that describe your medical, prescription drug, and mental health/substance use disorder coverages, and most of the later sections of this Summary Plan Description will not apply to you. The Autism Advocate Program benefits are not available to individuals enrolled in an HMO. See the section called HEALTH MAINTENANCE ORGANIZATIONS (HMOs) on page 35 for provisions relating to HMOs. 6 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

7 If you live outside the PPO NETWORK areas, coverage is available under the OUT-OF-AREA (OOA) coverage option. Two PPO Options You may choose between two PPO (Preferred Provider Organization) options. Both PPO options are offered using the Blue Cross Blue Shield and UnitedHealthcare provider networks (where available). CVS Caremark administers prescription drug benefits and Optum administers mental health/substance use disorder benefits for both PPO options, regardless of which carrier you select. Covered services are generally the same under both carriers. Both PPO coverage options cover substantially the same wide range of eligible expenses. For example, both PPOs offer: Comprehensive medical and HOSPITAL benefits after the annual deductible is met. There are separate deductibles for in-network and out-of-network coverage. (You pay a percentage of your eligible medical expenses, called coinsurance. ) In-network preventive care covered at 100% with no deductible. The option to go in- or out-of-network when you need care. (You will pay less if you stay in-network, but you may receive coverage if you go out-of-network.) SPECIALIST care with no referral. Coverage at 100% of eligible medical expenses after reaching the annual out-of-pocket maximum. However, the PPO options differ in several important ways, as highlighted in the comparison chart below. PPO Option Preventive Care Health Savings PPO Option In-network preventive care is covered at 100% with no deductible under both options Deductible You pay 100% of your covered health care costs (except for in-network medical preventive care) until you meet your annual deductible The PPO has a lower deductible than the Health Savings PPO Each family member must meet his or her individual deductible, subject to the family maximum, before coinsurance is available for that member The Health Savings PPO has a higher deductible than the PPO The family unit as a whole must meet the family deductible before coinsurance is available for any family member Coinsurance Once you meet the applicable deductible, both options pay 80% of in-network and 60% of out-of-network costs Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 7

8 PPO Option Health Savings PPO Option Protection from Catastrophic Costs Both options have an out-of-pocket maximum, which protects you from catastrophic health care expenses. Once you meet your annual out-of-pocket maximums, both options cover you at 100% Each family member must meet the individual out-ofpocket maximum, subject to the family maximum, before 100% in-network coverage or REASONABLE AND CUSTOMARY coverage applies to that member The family unit as a whole must meet the family out-ofpocket maximum before 100% in-network coverage or out-of-network reasonable and customary coverage applies for any family member Prescription Drugs Prescription drug coverage for both options is provided through CVS Caremark. You may fill your prescriptions using a local retail pharmacy or the mail order pharmacy Prescription drug costs are not subject to the deductible and do not count toward the out-of-pocket maximum You pay coinsurance for prescription drugs obtained through a retail pharmacy, subject to minimum and maximum amounts You are responsible for a copay for prescription drugs obtained through the mail order pharmacy You may use non-network retail pharmacies, but your benefit will be based on the cost of the drug at a network retail pharmacy, so your out of pocket costs will likely be higher You are responsible for an increased portion of BRAND- NAME DRUG expenses when a generic equivalent is available and your doctor has not written Dispense as Written ( DAW ) on your prescription You will be responsible for significantly increased coinsurance after three fills of the same medication at a retail pharmacy (other than a CVS pharmacy) if the medication can legally be filled through mail order Prescription drug costs apply to both the overall Health Savings PPO deductible and out-of-pocket maximum. You ll pay CVS Caremark s full discounted rate until you meet your integrated medical and prescription drug deductible After you satisfy the deductible, you ll pay 20% coinsurance at a network retail or mail order pharmacy until you reach the out-of-pocket maximum You may use non-network retail pharmacies, but your benefit will be based on the cost of the drug at a network retail pharmacy, so your out of pocket costs will likely be higher The coinsurance rate for maintenance medications does not change if you continue to use a network retail pharmacy, but mail order generally provides deeper discounts 8 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

9 PPO Option Health Care FSA Available You may set aside pre-tax money in a Health Care Flexible Spending Account (FSA) to pay for eligible health care expenses, including your deductible and coinsurance Health Care FSA contributions are 100% EMPLOYEE funded All eligible expenses must be incurred by December 31 of the plan year and submitted by April 15 of the following year unused amounts are forfeited See the Summary Plan Description for Flexible Spending Accounts for more information Health Savings PPO Option HSA and Limited Purpose FSA Available If you are eligible, you may open a health savings account (HSA) to set aside pre-tax money to pay for eligible health care expenses, including your deductible and coinsurance The COMPANY will contribute up to $250 for individual coverage or up to $1,250 for family coverage to your HSA if you enroll and are eligible (please note that the Company contribution will be prorated depending on your HSA eligibility date) Any unused HSA balance will roll over to the next plan year and is yours to keep even if you leave your EMPLOYING COMPANY You ll also be able to enroll in a Limited Purpose FSA to cover eligible dental and vision expenses only contributions are 100% employee funded with pre-tax money All eligible dental and vision expenses must be incurred by December 31 of the plan year and submitted to your Limited Purpose FSA by April 15 of the following year unused amounts are forfeited See the Summary Plan Description for Flexible Spending Accounts for more information Refer to your Employing Company s intranet site or contact the Time Warner Benefits Service Center at for more information about your medical coverage options and employee contribution requirements. Information About Other Health Coverage Dental coverage is described in the Dental Program and vision coverage is described in the Vision Program Summary Plan Description. Retiree medical coverage is offered to eligible retired employees of Employing Companies and is described in the applicable retiree medical summary plan descriptions. Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 9

10 WHO S ELIGIBLE Employees You may participate in the Program if you are a regular full-time salaried employee or a regular part-time salaried employee working at least 312 hours per quarter. However, if your schedule is reduced below 312 hours per quarter after enrollment, you will lose eligibility. Dependents As an eligible EMPLOYEE, you may extend coverage to your OPPOSITE-SEX SPOUSE, SAME-SEX SPOUSE or DOMESTIC PARTNER, and your dependent children as long as you enroll for medical coverage under the PROGRAM. When you enroll your eligible DEPENDENTS for coverage, you will be required to certify that each person meets the definition of an eligible dependent opposite- or same-sex spouse, domestic partner or child as described below. Enrolling individuals who do not qualify for dependent coverage under the Program is considered fraudulent and may result in retroactive cancellation of coverage and disciplinary actions up to and including termination of employment. If you are unsure about whether a family member meets the definition of an eligible dependent under the Program, contact the Time Warner Benefits Service Center at Opposite-sex spouse means your lawful spouse (including your common-law spouse in states where that is recognized) under federal law. Same-sex spouse means the person of the same sex to whom you were legally married under the laws of the state in which you marriage was performed. If you were legally married in one state, your partner in marriage will not lose status as your same-sex spouse for the purposes of this program solely because you move to a state in which you marriage is not recognized..domestic partner means: Your same-sex or opposite-sex partner with whom you have entered into a legal civil union under applicable state law. 10 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

11 A domestic partner also means an adult of the same or opposite sex with whom you have been in an exclusive and committed relationship that is intended to be permanent. You and your partner must be responsible for each other s welfare on a continuing basis. You must have been in the relationship for at least six months. You and your partner must both be at least 18 years old and may not be related by blood to a degree of closeness that would prohibit marriage under applicable state law as an opposite-sex couple. Neither of you may be legally married to or in a legal civil union with another person. You may have to have an Affidavit of Domestic Partnership on file with the Company for a domestic partner who is not your legal civil union partner to be eligible for coverage. You may be asked to submit a Declaration of Tax Status when you enroll your domestic partner or same-sex spouse in Program coverage. Dependent Children Your dependent children are eligible for coverage until the end of the calendar year in which they turn age 26, regardless of student status and whether or not they can be claimed as dependents on your federal income tax return. This means that even if your child is married, financially independent, or no longer in school, he or she will be eligible for coverage under the Program through the end of the calendar year in which he or she reaches age 26. Dependent children includes your or your opposite-sex spouse s biological children, stepchildren, foster children, legally adopted children, children for whom adoption procedures have been started, children whom you have been ordered to cover through a Qualified Medical Child Support Order and other children who live with you and for whom you are the appointed legal guardian. Your same-sex spouse s or domestic partner s children are also eligible for coverage as long as they meet all other criteria for coverage of dependent children described above. Your dependent child s opposite-sex spouse, same-sex spouse, or domestic partner and your child s dependent children are not eligible for coverage under the Program. Same-Sex Spouses, Domestic Partners and Non-Tax Dependents To the extent permitted under applicable law, same-sex spouses and domestic partners are generally treated in the same way as opposite-sex spouses for purposes of Program benefits. If you elect to cover a domestic partner, samesex spouse and/or child who does not qualify for non-taxable medical benefits as a dependent under federal tax rules, the full amount of the Company s contribution toward this coverage generally is treated as imputed income to you (the employee). This means that the amount that the EMPLOYING COMPANY pays for coverage for your non-taxdependent domestic partner, same-sex spouse or child will be shown on the your IRS Form W-2 and will be taxable income for federal and, in most cases, state tax purposes. Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 11

12 Tax Equalization As described above, because the federal government does not recognize state-sanctioned same-sex marriages or civil unions as the equivalent of opposite-sex marriages, the health care benefits provided to same-sex spouses and domestic partners are subject to federal and, in most cases, state income taxes. To address this less favorable tax treatment and equalize the impact of the benefits that Time Warner provides to gay and lesbian employees, beginning in 2013, the Company provides tax equalization to active U.S. employees in same-sex marriages, civil unions or spousal-equivalent registered domestic partnerships to account for the additional taxes they must pay for a same-sex spouse s or domestic partner s health coverage. To qualify for tax equalization, you must enter into a legally-recognized relationship that provides rights under state law comparable to opposite-sex married couples, if available in your home state. This means: If you live in a state where same-sex marriage is legal (e.g., New York) you must be married in order to receive the tax equalization. If you live in a state where same-sex marriage is not legal, but where domestic partners or civil unions can register with the state and receive comparable recognition (e.g., domestic partners in California) you must enter into that registered domestic partnership or civil union to receive the tax equalization. If you live in a state where same-sex marriage is not legal and/or registered domestic partnerships and civil unions are not allowed or do not receive benefits comparable to marriage (e.g., Georgia) the tax equalization will be provided for all employees with same-sex domestic partners enrolled in the Plan. To receive tax equalization, you must submit a Declaration of Tax Status. For more information about tax equalization, contact the Time Warner Benefits Service Center at Former Spouses or Domestic Partners An ex-spouse or former domestic partner is not considered an eligible dependent, even if you are legally required to provide his or her health insurance. However, if you divorce while your opposite-sex spouse or same-sex spouse is covered by the Program, or if you end your domestic partnership while your domestic partner is covered by the Program, he or she may be able to continue individual coverage for a limited period at his or her own expense. See Continuing Coverage Under COBRA on page 93 for more information. Survivors Surviving opposite-sex spouses, same-sex spouses or domestic partners and/or dependent children of deceased employees are generally eligible to continue Program participation for a limited period following the employee s death (see Continuing Coverage Under COBRA on page 93 for more information). In addition, if the employee would have met the requirements for retiree coverage on the date of his death, the employee s surviving opposite- sex spouse, 12 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

13 same-sex spouse or domestic partner and/or dependent children may be eligible for survivor coverage under Retiree Medical Coverage or Access 55 Medical Coverage. For information about survivor coverage, contact the Time Warner Benefits Service Center at Disabled Children An unmarried DISABLED adult child who is primarily dependent on you for support and who would otherwise not be eligible due to age limitations under the PROGRAM can be enrolled within 60 days of your initial eligibility, subject to verification by the CLAIMS ADMINISTRATOR that the disability occurred before age 26. If you do not enroll this disabled adult child when you first become eligible, you may do so during any subsequent open enrollment period, subject to the same verification. If your unmarried child becomes disabled while covered under the terms of the Program, coverage can continue without regard to age for as long as the child remains disabled and is primarily dependent on you for support. Extended coverage for disabled children is subject to periodic verification by the Claims Administrator. ENROLLMENT Medical coverage options depend on where you live. Eligible EMPLOYEES may choose between two Preferred PROVIDER Organization (PPO) networks offered by UnitedHealthcare (UHC) and Blue Cross Blue Shield (BCBS). Employees who live outside a medical NETWORK area are eligible for the UHC OUT-OF-AREA (OOA) option. Health Maintenance Organizations (HMOs) also are offered in certain areas. Active Enrollment Participation in the PROGRAM is not automatic; you must enroll to have coverage in place. You may enroll yourself and your eligible DEPENDENTS at the following times: Within 60 days of your eligibility date, in which case your participation begins on the day you first become eligible. If you do not enroll yourself or your dependents for coverage during your initial election period, or if you waive coverage and later want to enroll, you must wait until the next open enrollment period unless you have a QUALIFIED CHANGE IN STATUS. You may reject or waive participation in this Program. During the open enrollment period, which is usually held in the fall, in which case your participation begins on the next January 1 and stays in effect throughout the next calendar year. Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 13

14 Within 60 days of a QUALIFIED CHANGE IN STATUS, in which case your participation begins on the date of the qualifying event and stays in effect for the rest of the current calendar year. Choosing a Coverage Level You may elect one of the following coverage levels: EMPLOYEE only Employee plus spouse/domestic PARTNER (considered family coverage ) Employee plus child(ren) (considered family coverage ) Employee plus spouse/domestic partner plus child(ren) (considered family coverage ) You cannot enroll dependents for coverage that you waive for yourself. For example, you cannot choose medical coverage for your dependents if you waive it for yourself. Independent Medical, Dental and Vision Elections You make separate elections for medical, dental and vision coverage. For example, you may elect medical coverage without electing dental and vision coverage. You also may elect different coverage levels for each kind of coverage, but you cannot enroll dependent for coverage that you waive for yourself. For example, you may choose employeeonly medical coverage, employee-plus-two or more dental coverage and employee-plus-one vision coverage, but you cannot choose medical coverage for your family if you waive it for yourself. Enrollment in the Flexible Spending Account Plan You may also wish to enroll in the Flexible Spending Account (FSA) Plan to set aside pre-tax dollars to pay for any unreimbursed eligible health care expenses you anticipate each year. If you are in the PPO, you will be eligible for the Health Care FSA, which allows you use pre-tax dollars for unreimbursed medical, dental, and vision expenses, including your coinsurance amounts and deductibles. If you enroll in the Health Savings PPO option, you may contributed to a Limited Purpose FSA, which allows you to use pre-tax dollars for unreimbursed dental and vision expenses only. (If you are eligible and enrolled in the Health Savings PPO, you may also set up a Health Savings Account with Fidelity, as described in Health Savings Account (HSA) on page 30.) Refer to the Flexible Spending Accounts Summary Plan Description or contact the Time Warner Benefits Service Center at for more information about your eligibility for the FSA Plan. 14 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

15 How to Enroll Log on to or call Please call between 8 a.m. and 10 p.m. ET with any questions about the enrollment process. Open Enrollment Your EMPLOYING COMPANY holds an open enrollment, usually during the fall, during which you can: Enroll in coverage for the following year, Change your coverage option election, Cancel your own and/or your covered DEPENDENTS coverage, and Add (an) eligible dependent(s). Whatever elections you make during open enrollment take effect on the next January 1 and stay in effect for the full calendar year unless you experience a QUALIFIED CHANGE IN STATUS and file an amended election within the 60-day election period. Generally, if you don t make a change to your PROGRAM elections during open enrollment, your elections for the prior year remain in effect. Qualified Change in Status Your elections generally must stay in effect until the end of the current calendar year. Once made, you can t change your elections during the calendar year unless you have a QUALIFIED CHANGE IN STATUS. A qualified change in status includes the following: Your legal marital status changes (i.e., marriage, divorce, legal separation or annulment) or you enter into or dissolve a DOMESTIC PARTNERship. The number of your eligible DEPENDENTS changes (such as when a child becomes your dependent through birth or adoption, a person s status as an eligible dependent under the PROGRAM changes, or a dependent dies). Your covered dependent no longer satisfies the requirements for coverage under the Program because he or she reaches the limiting age or any similar circumstance. Eligibility for employer-sponsored health coverage is affected because you or your eligible dependent becomes employed or unemployed (and is not rehired within 30 days). Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 15

16 Eligibility for employer-sponsored health coverage is affected because you or your eligible dependent takes or returns from an unpaid work-related leave of absence. Eligibility for employer-sponsored health coverage is affected because your or your eligible dependent s employment status changes from full-time to part-time (or vice versa). Eligibility for employer-sponsored health coverage is affected because you go or your eligible dependent goes on strike or you are or your eligible dependent is locked out, or you return or your eligible dependent returns from a strike or lockout. The coverage options available to you change because you change residences or worksites. You previously waived participation in the Program for yourself or your eligible dependent(s) because you or your dependents were covered under another group health plan and you or your dependents subsequently lose coverage under that plan due to loss of eligibility (including for reasons of attainment of the maximum age for dependent coverage or because an HMO or other similar arrangement ceases to provide coverage to individuals who no longer reside, live or work in a service area and no other coverage option is available under the other group health plan) or because employer contributions for the other group health coverage were terminated. Your eligible dependent s employer-sponsored plan has a different open enrollment period and a different plan year, and you would like to make a change to correspond with an election change under your eligible dependent s plan. You either become eligible for or lose eligibility for, or your eligible dependent either becomes eligible for or loses eligibility for, MEDICARE or Medicaid coverage (to the extent permitted by law). You lose or an eligible dependent loses coverage under Medicaid or a state Children s Health Insurance Program (CHIP) because you are or your eligible dependent is no longer eligible for coverage. You are or an eligible dependent is determined to be eligible for assistance with the cost of Program coverage under Medicaid or a state CHIP. COBRA coverage under another plan is exhausted. There is a significant change in the employer-sponsored health coverage you have or your eligible dependent has (as determined in accordance with Internal Revenue Service guidelines). A judgment, decree or other order resulting from a divorce, legal separation, annulment or change in legal custody, such as Qualified Medical Child Support Orders (QMCSOs), requires health coverage for your child or dependent foster child. 16 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

17 If you have a qualified change in status, you have until the end of the 60-day election period to change your coverage elections. The change in your elections must be due to and consistent with the qualified change in status and is subject to Internal Revenue Code requirements. Once a coverage change has been approved, it generally becomes effective as of the date of the qualified change in status event. Documentation verifying a qualified change in status must be provided to the PLAN ADMINISTRATOR upon request. Failure to comply will result in the amended election request being denied. Your ability to change coverage during a calendar year is restricted under Internal Revenue Code rules because contributions for coverage (other than coverage for domestic partners, SAME-SEX SPOUSEs and children who are not eligible for non-taxable medical benefits as a dependent under federal tax law) are made on a before-tax basis. You may enroll in any of the medical coverage options that are available to similarly-situated new employees if you or your eligible dependent experiences a qualified change in status because: You gain a new dependent by marriage, birth, adoption or placement for adoption, You or your eligible dependent previously waived participation in the Program due to coverage under another group health plan and you subsequently lose coverage under that plan because of loss of eligibility for the other coverage, termination of employer contributions for the other coverage, or exhaustion of COBRA continuation coverage, You lose or your eligible dependent loses coverage under Medicaid or a state CHIP because of loss of eligibility for coverage, or You or your eligible dependent is determined to be eligible for assistance with the cost of Program coverage under Medicaid or a state CHIP. If the qualified change in status occurred because you or your eligible dependent lost other group health plan coverage, the other coverage must have ended either because COBRA continuation coverage was exhausted, because the prior coverage was terminated as a result of loss of eligibility for the coverage (including as a result of legal separation, divorce, death, termination of employment or reduction in the number of hours of employment) or because employer contributions towards such prior coverage were terminated. Transfers If you transfer from a nonparticipating division of Time Warner Inc. to an EMPLOYING COMPANY, you have until the end of the 60-day election period to enroll. The effective date of your election will be the date of your transfer. If you transfer from one Employing COMPANY to another and already participate in the Program, your election will carry over to your new Employing Company, if possible; otherwise, you must choose one of the medical coverage options your Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 17

18 new Employing Company offers. A transfer between Employing Companies does not by itself constitute a qualified change in status; however, you do have a qualified change in status if the coverage options available to you change as a result of your transfer. When Couples Work for an Employing Company If you and your OPPOSITE-SEX SPOUSE, same-sex spouse or domestic partner both work for an Employing Company, you decide how your dependents (if any) are to be enrolled. Each of you can enroll individually, one can enroll as a dependent of the other, or one or both can elect family coverage. If you are covered as both an EMPLOYEE and a dependent under the Program, keep in mind that coordination of benefits will apply. See If You Have Other Coverage on page 100 for Coordination of Benefits (COB) provision. Newborn or Newly-Adopted Children A newborn or newly-adopted child, or a child for whom adoption procedures have begun, will be covered automatically during the 60-day election period. To maintain coverage beyond that initial 60-day period, you must enroll your new child as a dependent before the end of the election period, even if you already had family coverage. PAYING FOR COVERAGE You and your EMPLOYING COMPANY share the cost of PROGRAM coverage for you and your covered DEPENDENTS. Your contributions toward the cost of coverage for a plan year is based on your base pay (or, if you are a part-time EMPLOYEE, your full-time equivalent base pay) as of January 1 of that plan year (or your date of hire, if later). Your contributions for coverage for yourself and any eligible dependent who is permitted to receive non-taxable medical benefits under federal tax law are made through before-tax payroll deductions. If you elect to cover any eligible dependent who does not qualify for non-taxable medical benefits under federal tax rules (such as certain DOMESTIC PARTNERs and SAME-SEX SPOUSEs) you pay for your share of the dependent s coverage through before-tax payroll deductions, and the amount of your contributions for the dependent s coverage and the Employing COMPANY s contributions toward this coverage generally is treated as imputed income to you. The cost of Program coverage and the amount of employee contributions for coverage are subject to change and may be revised each January 1 to reflect changes in the cost of coverage from year to year. Refer to your Employing Company s intranet site or contact the Time Warner Benefits Service Center at for more information about current contribution requirements. 18 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

19 WHEN COVERAGE BEGINS Coverage for you and your family starts on the date you satisfy the eligibility criteria described in WHO S ELIGIBLE on page 10 (your eligibility date), as long as you enroll within 60 days of your eligibility date (your initial election period). If you don t enroll within 60 days of your eligibility date but you decide to enroll during the annual open enrollment period, coverage starts on the following January 1. If you re electing coverage as a result of a QUALIFIED CHANGE IN STATUS, coverage begins on the date of the qualified change in status event as long as you enroll within 60 days of the qualified change in status event (your qualified change in status election period). MEDICAL COVERAGE This section describes PROGRAM features that are the same for all the medical coverage options (PPOs and OOA option) administered by UHC and BCBS, such as the services and supplies covered by the Program and limitations on that coverage. Any exceptions are noted. If you are enrolled in an HMO, see the HMO s materials for a description of the benefits provided under the HMO. Under the Program, the medical services and supplies described under ELIGIBLE MEDICAL EXPENSES on page 36 are eligible for payment or reimbursement. As you read the following sections, you ll see that most HOSPITAL, surgical and medical services are considered covered expenses. But, certain services are not covered (as described under What s Not Covered on page 48 under ELIGIBLE MEDICAL EXPENSES on page 36), or are only partially covered, or are covered only in-network. Medical expenses for a job-related illness or injury are generally covered by Workers Compensation. However, any eligible medical expense that is not covered in full by Workers Compensation may be covered by the Program on the same basis as any other illness or injury. For more information about filing a Workers Compensation claim, contact your EMPLOYEE Benefits/Human Resources department. Necessary Medical Care The Program covers only those expenses determined to be medically necessary or eligible for preventive care, as determined by the appropriate CLAIMS ADMINISTRATOR (UHC or BCBS). In all circumstances, benefit payments will be made only if the appropriate Claims Administrator (UHC or BCBS) determines that the treatment provided meets its specific requirements. In doing so, each Claims Administrator has Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 19

20 full discretionary authority to rely on its own materials, expertise and procedures, especially in determining issues concerning REASONABLE AND CUSTOMARY charges, medical necessity and other defined terms. Benefit Limits While there is no overall maximum on the dollar amount of benefits you and/or your enrolled DEPENDENTS can receive under the PPO and Out-of-Area coverage options under the Program, there may be dollar or frequency limits that apply to certain covered services. If a limit applies, it will be spelled out where a covered service is explained. Coverage maximums applicable to HMOs are described in the materials provided by your HMO PROVIDER, such as your certificate of coverage or membership booklet. PRE-NOTIFICATION Each CLAIMS ADMINISTRATOR (UHC and BCBS) recommends pre-notification of certain kinds of medical care. Prenotification limits your exposure to unnecessary medical and financial risk by confirming the need for proposed treatment. Pre-notification is required for out-of-network morbid obesity SURGERY in order to receive full coverage under the PROGRAM. Who is Responsible to Pre-Notify When you use a network PROVIDER, the provider may handle the pre-notification for you; however, you should confirm that your medical care is pre-notified because you will be responsible to pay for medical care that is not medically necessary or is not otherwise eligible for coverage under the Program. When you go out-of-network, prenotification is your responsibility. How Pre-Notification Works The Claims Administrator s medical management staff will review the proposed care to certify the length of stay, course of treatment or number of visits (as applicable) and will approve or deny coverage for the proposed care based on medical necessity and other relevant criteria established by the Claims Administrator. In all cases, the proposed care must be MEDICALLY NECESSARY. See the description under Your Rights Under ERISA on page 108 for information about the pre-service claims review procedures (including timeframes within which a Claims Administrator must respond following a request for pre-notification). 20 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

21 If You Don t Pre-Notify Failure to pre-notify may result in delay or denial of a claim. If you obtain morbid obesity surgery from an out-ofnetwork provider and you do not pre-notify the procedure, you will be required to pay an increased coinsurance amount of 50%, and the Program will pay for only 50% of the REASONABLE AND CUSTOMARY amount (if the surgery is pre-notified, the Program will pay 60% for the PPO or Health Savings PPO, and 80% for the Out-of-Area coverage option). When Pre-Notification Is Recommended The following procedures and services should be pre-notified to confirm the need for the proposed treatment: Inpatient admissions (hospitals, skilled nursing facilities, HOSPICE care facilities, etc.), EMERGENCY health services that result in an inpatient stay, Home healthcare services, including private duty nursing and home infusion therapy, Hospice care (inpatient and outpatient), Morbid obesity surgery if the surgery is performed by an out-of-network provider, failure to pre-notify will result in an increased coinsurance amount of 50% (you will be responsible for a greater portion of the reasonable and customary charge), SKILLED NURSING FACILITY care, Durable medical equipment that costs more than $1,000 to buy or rent, Reconstructive procedures, Maternity stays that are expected to exceed 48 hours following a vaginal delivery or 96 hours following delivery via cesarean section, Accidental dental services (treatment of dental injuries that result from an accident), Organ and tissue transplants and evaluations, Bone marrow and stem cell transplants (inpatient and outpatient), Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 21

22 Gender reassignment surgery, and All inpatient mental health/substance use disorder admissions and certain outpatient mental health/substance use disorder services (see MENTAL HEALTH and SUBSTANCE USE DISORDER TREATMENT on page 64). Predetermination for Surgical Procedures or Services You are responsible for a percentage of your covered medical expenses for in-network and out-of-network services (coinsurance). In addition to pre-notifying the Claims Administrator as described above, it is also advisable to contact Member Services to request a predetermination of your expected coinsurance amount for any single surgical procedure or service. This is especially important for out-of-network procedures or services because out-of-network or Out-of-Area reimbursement is based on reasonable and customary charges even if the surgery or service is prenotified, and you are solely responsible for any amount over what the Claims Administrator determines is the reasonable and customary charge. Multiple surgical procedures will not be predetermined. The amount covered under the Program will be determined after the procedures are performed, based on the medical necessity of the multiple procedures and how they are billed by the providers. When two or more surgical procedures are performed at one time, benefits will be limited to the NEGOTIATED CHARGE/reasonable and customary charge for the more expensive procedure plus one-half of the negotiated charge/reasonable and customary charge for all other procedures. HOW THE MEDICAL PLAN OPTIONS WORK PREFERRED PROVIDER ORGANIZATIONS (PPOs) The PROGRAM offers medical coverage options through nationally available Preferred PROVIDER Organizations (PPOs) administered by UnitedHealthcare (UHC) and Anthem Blue Cross Blue Shield (BCBS). Each carrier offers its own NETWORK of participating medical providers. You may search for in-network providers via the Internet or request a free list by contacting PPO Member Services : For UHC, visit and select the link under the UnitedHealthcare Choice Plus plan or call Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

23 For BCBS, visit or call Both BCBS and UHC offer a PPO and a Health Savings PPO, with different levels of coverage, so you may choose the coverage option best suited to your needs. With the Health Savings PPO, you pay lower premiums but you have a higher annual deductible when you use covered services and are subject to a higher out-of-pocket maximum, as described below. The PPOs give you the flexibility to go in-network or out-of-network each time you need medical care. However, the PPOs pay a greater portion of your eligible expenses if you use in-network providers and a lesser portion for eligible expenses incurred outside the network. UnitedHealthcare and Blue Cross Blue Shield PPOs Each of the UnitedHealthcare (UHC) and Blue Cross Blue Shield (BCBS) Preferred PROVIDER Organizations (PPOs) give you direct access to a NETWORK of doctors and HOSPITALS that charge lower fees for services they provide to eligible participants. PPO benefits depend on whether you go in-network or out-of-network for your care. Using PPO providers Under any of the PPOs, you may seek care from any physician/specialist in the network, in most cases without an authorization referral from a network provider, and you will still qualify for in-network benefits. What To Do When You Visit a PPO Provider When you visit the provider you ve selected, show the provider your UHC or BCBS PPO ID card. When you identify yourself to PPO providers with your ID card, they will file all claims for you, and the CLAIMS ADMINISTRATOR will pay them directly. You will be billed for your coinsurance amount (the portion of the covered expenses not paid by the PROGRAM), plus any non-covered services. To get information on network providers, please contact PPO Member Services (UHC: ; BCBS: ). Both UHC and BCBS offer self-service health and well-being websites which provide direct access to administrative systems in a real-time environment. (To find the appropriate UHC or BCBS web address, please see your ID card.) That means you may log on at any time to order new or replacement ID cards, search for providers, make up-to-theminute inquiries into the status and history of your health claims, view your eligibility information and even view password-protected personal data online. You ll also have access to a wealth of personalized health information, live events and interactive tools such as health quizzes. Once you have your password, you ll have full access to the website for your coverage option. These websites are provided by UHC and BCBS. The COMPANY has no responsibility for these websites. Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 23

24 PPO Member Services Contact your CLAIMS ADMINISTRATOR S Member Services department at the phone number or through the website shown on your ID card to: Get information about network providers (for example, you may find out where and when the physician went to medical school), Ask questions about in-network and out-of-network benefits, Register a complaint about network services, Resolve claim or bill payment problems, and Request new ID cards. Your ID card tells you how to reach Member Services by phone or via the Internet. If you need to contact UHC or BCBS Member Services from a TDD (telephone communications device for the deaf) telephone, you may call: for UHC for BCBS For UHC, visit and select the link under the UnitedHealthcare Choice Plus plan or call For BCBS, visit or call In-Network Benefits In-network benefits apply only to services and supplies that are both covered by the Program and provided (subject to pre-notification requirements, if applicable) by a PPO network provider. Deductibles and coinsurance apply to eligible in-network medical expenses. (There is no coinsurance or deductible requirement for in-network preventive care.) Covered benefits are based on the NEGOTIATED CHARGE. For in-network services, you have lower out-of-pocket expenses. When you see an in-network provider, you pay nothing at the time you receive care. The Program will pay a portion of the cost of covered services. You will be billed by the network provider for the remaining portion. This is called your coinsurance. You will also be billed for the full cost of any services not covered by the Program. See PPOs at a Glance on page 27 for the specific deductibles, coverage percentages, cost-sharing requirements, out-of-pocket maximums and limits for in-network care. More detailed information is included in later sections of this SPD. 24 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

25 Out-of-Network Benefits Eligible out-of-network medical expenses are reimbursable at a lower level, which means you pay more toward those expenses. Out-of-network care is defined as care that is not provided by a PPO network provider. Out-of-network benefits are only provided for services and supplies that are covered by the Program, subject to applicable prenotification requirements. Deductibles and coinsurance apply to eligible out-of-network medical expenses. Reimbursements are based on the REASONABLE AND CUSTOMARY charge. Amounts above the reasonable and customary charge are not eligible for reimbursement and are your responsibility to pay, in addition to any deductibles or required coinsurance. You are responsible for pre-notification, if required (see PRE-NOTIFICATION on page 20 for more information). See PPOs at a Glance on page 27 for the specific deductibles, coverage percentages, cost-sharing requirements, out-of-pocket maximums and limits for out-of-network care. More detailed information is included in later sections of this SPD. Annual Deductible The PPOs have annual deductibles that must be met before the Program begins to pay for your covered healthcare expenses. Your annual deductible is determined based on your base pay (or, if you are a part-time EMPLOYEE, your full-time equivalent base pay) as of the first day of the plan year (or your date of hire, if later). Each PARTICIPANT must satisfy the annual deductible before benefits become payable. If you have individual coverage, you must satisfy the individual annual deductible. If you have family coverage and are enrolled in the Health Savings PPO, the annual deductible obligation for any family member is met only once your family s combined eligible expenses reach the family deductible limit. If you have family coverage and are enrolled in the PPO, benefits for a family member become payable once the member meets the individual deductible. Once enough family members collectively satisfy the family deductible limit, coinsurance is available for all family members, including those who have not satisfied the individual deductible. Separate annual deductibles for in-network and out-of-network services apply. Therefore, if you have satisfied your in-network deductible and then decide to see an out-of-network provider, you must also satisfy the full out-of-network deductible before the Program will pay for out-of-network services. The annual deductible requirement does not apply for in-network preventive care. Your eligible out-of-pocket expenses for mental health and substance use disorder care and for autism support benefits covered under the AUTISM ADVOCATE PROGRAM on page 72 count toward your annual medical deductible. If you are enrolled in the Health Savings PPO, your eligible out-of-pocket prescription drug expenses also count toward your annual medical deductible. Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 25