Your Guide to the JPMorgan Chase Expatriate Medical and Dental Plan Options

Transcription

1 Your Guide to the JPMorgan Chase Expatriate Medical and Dental Plan Options JPMorgan Chase offers a variety of benefits plan options to expatriate employees. Your eligibility for benefits depends on your expatriate group: If You Are a U.S. Home-Based Expatriate Non-U.S. Home-Based Expatriate Assigned to the United States Non-U.S. Home-Based Expatriate Assigned Outside the United States You Are Eligible for All U.S. benefits Health and Income Protection Plans, except for the U.S. Medical and Dental Plan options, and the Transportation Spending Accounts The Expatriate Medical Plan and Dental Plan options The Vision Plan, Spending Accounts (Health Care, Child/Elder Care, and Transportation), Group Personal Excess Liability Insurance Plan, and Group Legal Services Plan The Expatriate Medical Plan and Dental Plan options The Expatriate Medical Plan and Dental Plan options Questions? Contact the Benefits Call Center through accesshr: JPMChase ( ) Quick Path: Enter your Standard ID or U.S. Social Security number; press 1; enter your PIN; press 1 TDD: If calling from outside the United States: (GDP# ) Service Representatives are available from 8 a.m. to 7 p.m. New York Time, Monday through Friday, except certain U.S. holidays. If you contact the Benefits Call Center after normal business hours, you can leave a message and a Service Representative will return your call within two business days. To Access the Benefits Web Center: From Work: Go to Company Home > My Work > Benefits Web Center From Home: Go to > Benefits Web Center Effective Date 1/1/10 Your Guide to the JPMorgan Chase Expatriate Medical and Dental Plan Options 1

2 Table of Contents Page Important Terms... 4 Participating in the Expatriate Medical and Dental Plan Options Eligibility Coverage Categories Your Eligible Dependents Cost of Coverage When Contributions Begin Cost for Domestic Partner Coverage Smoker Status How to Enroll If You Do Not Enroll When Coverage Begins Qualified Change in Status Medical and Dental Coverage Identification (ID) Cards Hour Customer Service Global Health Management Services e-cleveland Clinic CIGNA Envoy Secure Web Site Service Filing a Claim for Benefits epayment Plus Appealing Claims Expatriate Medical Plan Option How Your Medical Benefits Work Annual Deductible Annual Out-of-Pocket Maximum Maximum Lifetime Benefit If You Need Emergency Care What Is Covered Under the Expatriate Medical Plan Option Inpatient Hospital and Related Services Preventive Care Services Other Covered Services Hospice Care Infertility Treatment Procedures Coverage Limitations What s Not Covered Expatriate Dental Plan Option Annual Deductible Coinsurance Maximum Benefits Orthodontic Covered Services In-Network Care Out-of-Network Care What Is Covered Under the Expatriate Dental Plan Option The JPMorgan Chase U.S. Benefits Program is available to most employees on a U.S. payroll who are regularly scheduled to work 20 hours or more a week and who are employed by JPMorgan Chase & Co. or one of its subsidiaries to the extent that such subsidiary has adopted the JPMorgan Chase U.S. Benefits Program. This information does not include all of the details contained in the applicable insurance contracts, plan documents, and trust agreements. If there is any discrepancy between this information and the governing documents, the governing documents will control. JPMorgan Chase & Co. expressly reserves the right to amend, modify, reduce, change, or terminate its benefits and plans at any time. The JPMorgan Chase U.S. Benefits Program does not create a contract or guarantee of employment between JPMorgan Chase and any individual. JPMorgan Chase or you may terminate the employment relationship at any time. Effective Date 1/1/10 Your Guide to the JPMorgan Chase Expatriate Medical and Dental Plan Options 2

3 Preventive Care Services Basic Restorative Care Services Major Restorative Care Services What s Not Covered Other Limitations If You Are Covered by More Than One Medical and/or Dental Plan Non-Duplication of Benefits Determining Primary Coverage Coordination with Medicare Right of Recovery When Coverage Ends Certificate of Creditable Coverage Prescription Drug Notice of Creditable Coverage Additional Plan Information HIPAA Privacy Rights and Protected Health Information HIPAA Special Enrollment Rights Qualified Medical Child Support Order If Your Situation Changes Right to Amend Effective Date 1/1/10 Your Guide to the JPMorgan Chase Expatriate Medical and Dental Plan Options 3

4 Important Terms As you read this summary of the JPMorgan Chase Expatriate Medical and Dental Plan options, you ll come across some important terms related to each plan. To help you better understand the plans, many of those important terms are defined here. Term Before-Tax Contributions Bitewing Bridge Claims Administrator Coinsurance Consolidated Omnibus Budget Reconciliation Act of 1985 as Amended (COBRA) Definition U.S. home-based expatriate employees, or expatriate employees who are assigned to the United States, pay for coverage with before-tax dollars contributions that are taken from your pay before U.S. federal (and, in most cases, state and local) taxes are withheld. Before-tax dollars are also generally taken from your pay before U.S. Social Security taxes are withheld. This lowers your U.S. taxable income and your U.S. income tax liability. This reduction to taxable income will not affect any other pay-related benefits, such as basic life insurance, long-term disability insurance, and your Retirement Plan benefits. So, your other benefits will continue to be based on your full, unreduced benefits pay. Keep in mind that before-tax contributions do not count as earnings for U.S. Social Security purposes. Therefore, your future U.S. Social Security benefit could be slightly reduced if your total earnings for the year are less than the Social Security wage base ($106,800 for 2010). However, this reduction is nominal and may be outweighed by the immediate tax savings resulting from using before-tax dollars to pay for your benefits. Dental X-ray showing approximately the coronal (crown) halves of the upper and lower teeth. A prosthesis restoring the continuity of the dental arch by replacing on or more artificial teeth suspended between and attached to abutments that provide support and stability. The company that provides certain claims administration services for the Medical and Dental Plan. The way you share costs for certain covered services after you meet the annual deductible. The Medical and Dental Plan options pay a percentage of reasonable and customary (R&C) charges or a percentage of in-network negotiated fees for covered services, and you pay the remainder. The actual percentage depends on the type of covered service. A United States federal law that allows you and/or your covered dependents to continue Medical and/or Dental Plan coverage on an after-tax basis (under certain circumstances) when coverage would otherwise have ended. See the Plan Administration section of Your Guide to Benefits at JPMorgan Chase. Non-U.S. home-based expatriate employees assigned outside the United States and their dependents are not eligible for medical and/or dental continuation coverage. Effective Date 1/1/10 Your Guide to the JPMorgan Chase Expatriate Medical and Dental Plan Options 4

5 Term Coordination of Benefits Copay or Copayment Covered Expenses Covered Services Custodial Care Deductible Denture Definition The rules that determine how benefits are paid when a patient is covered by more than one group plan. Rules include: Which plan assumes primary liability; The obligations of the secondary claims administrator or claims payer; and How the two plans ensure that the patient is not reimbursed for more than the actual charges incurred. In general, the following coordination of benefits rules apply: As a JPMorgan Chase employee, your JPMorgan Chase coverage is considered primary for you. For your spouse/domestic partner, or dependent child covered as an active employee of another employer, that employer s coverage is considered primary for him or her. For children covered as dependents under two plans, the primary plan is the plan of the parent whose birthday falls earlier in the year (based on month and day only, not year). Specific rules may vary, depending on whether the patient is an employee in active status (or the dependent of an employee) or covered by Medicare. These rules do not apply to any private insurance you may have. The amount you pay toward certain health care services under the Expatriate Medical and Dental Plan options. For example, the Expatriate Medical Plan Option requires a $10 copayment for X-rays and labs (for in-network care received in the U.S. or care received outside the U.S.). The reasonable and customary (R&C) charges for medically necessary covered services or supplies that qualify for full or partial reimbursement under the Medical and/or Dental Plans. Medical or dental procedures that are generally reimbursable by the Expatriate Medical and/or Dental Plans when they are medically necessary. While the plans provide coverage for numerous services and supplies, there are limitations on what s covered. For example, experimental treatments, most cosmetic surgery expenses, and inpatient and outpatient private duty nursing are not covered under the Medical Plan. So, while a service or supply may be medically necessary, it may not be covered under the plans. Medical or non-medical services that do not seek to cure, are provided during periods when the medical condition of the patient is not changing, or do not require continued administration by medical personnel. An example of custodial care is assistance in the activities of daily living. The amount you pay in a calendar year for covered expenses before the Medical or Dental Plans begin to pay benefits. Amounts in excess of reasonable and customary (R&C) charges or ineligible charges do not count toward the deductible. Artificial teeth replacing missing natural teeth. Effective Date 1/1/10 Your Guide to the JPMorgan Chase Expatriate Medical and Dental Plan Options 5

6 Term Domestic Partner Eligible Dependents Definition You may cover a domestic partner as an eligible dependent under the Medical and/or Dental Plans if you re not currently covering a spouse. You and your domestic partner must: Be age 18 or older; Have lived together for at least six months and have a serious, committed relationship; Be financially interdependent; Not be related to each other in a way that would prohibit legal marriage; and Not be legally married to, or the domestic partner of, anyone else. OR Have registered as domestic partners pursuant to a domestic partnership ordinance or law of a state or local government, or under the laws of a foreign jurisdiction. You must certify that your domestic partner meets the eligibility rules as defined under the plans before coverage can begin. You may also be asked to certify that your domestic partner and/or your domestic partner s children qualify as a tax dependent as determined by the United States Internal Revenue Code to avoid any applicable imputed income. Please see the Domestic Partner Coverage Guide for additional information on covering a domestic partner. The Guide is available via the Key Resources box on the Expatriate Benefits page on HR & Personal, or contact the Benefits Call Center for more information on domestic partner coverage. Under the Medical and Dental Plans, your eligible dependents can include your spouse or domestic partner, and your dependent children. Please see Your Eligible Dependents on page 13 for more information. Effective Date 1/1/10 Your Guide to the JPMorgan Chase Expatriate Medical and Dental Plan Options 6

7 Term Experimental, Investigational, or Unproven Services Explanation of Benefits (EOB) Full-Time Student Home Health Care Definition Medical, surgical, diagnostic, psychiatric, substance abuse, or other health care services, technologies, supplies, treatments, procedures, drug therapies, or devices that, at the time the claims administrator makes a determination regarding coverage in a particular case, are determined to be: Not approved by the U.S. Food and Drug Administration (FDA) to be lawfully marketed for the proposed use and not identified in the American Hospital Formulary Service or the United States Pharmacopoeia Dispensing Information as appropriate for the proposed use; or Subject to review and approval by any institutional review board for the proposed use; or The subject of an ongoing clinical trial that meets the definition of a Phase 1, 2, or 3 clinical trial set forth in the FDA regulations regardless of whether the trial is actually subject to FDA oversight; or Not demonstrated through prevailing peer-reviewed medical literature to be safe and effective for treating or diagnosing the condition or illness for which its use is proposed. The claims administrator, in its judgment, may determine an experimental, investigational, or unproven service to be covered under the Medical Plan for treating a life-threatening sickness or condition if the claims administrator determines that a service: Is safe with promising effectiveness; and Is provided in a clinically controlled research setting; and Uses a specific research protocol that meets standards equivalent to those defined by the National Institutes of Health. Please Note: For the purpose of this definition, the term life-threatening is used to describe sicknesses or conditions which are more likely than not to cause death within one year of the date of the request for treatment. If services are denied because they are deemed to be experimental, investigational, or unproven, and the service is approved by the claims administrator within six months of the date of service, you may resubmit your claim for payments. A statement that the claims administrator prepares, which documents your claim and provides a description of benefits paid and not paid under the Medical and/or Dental Plans. Generally, a full-time student is defined as a dependent enrolled in an educational institution on a full-time basis at the time services are received. An educational institution is defined as a school maintaining a regular faculty, an established curriculum, and having an organized student body in attendance. It includes high schools, colleges, technical schools, and similar institutions but not on-the-job training. JPMorgan Chase will use the educational institution s definition of a full-time student. During the summer term, when few students are enrolled, coverage will be based on enrollment during the previous term, unless the student has completed his or her full course of studies. Dependents who are taking classes part-time in their last semester to complete their degree will continue to meet the definition of full-time student. An alternative to inpatient hospitalization during a patient s recovery period. If the attending physician believes that part-time care will suffice in treating the sickness or injury, the physician can prescribe a schedule of services to be provided by a licensed home health care agency. This schedule may include administration of medication, a regimen of physical therapy, suctioning or cleansing of a surgical incision, or the supervision of intravenous therapy. Effective Date 1/1/10 Your Guide to the JPMorgan Chase Expatriate Medical and Dental Plan Options 7

8 Term Hospice Care Program Hospital In-Network/ Out-of-Network Maximum Annual Benefit Maximum Lifetime Orthodontia Benefit Maximum Lifetime Benefit Definition A program that tends to the needs of a terminally ill patient as an alternative to traditional health care, while meeting medically necessary and acceptable standards of quality and sound principles of health care administration. The program must be a written plan of hospice care for a covered person, and it must be approved by the appropriate claims administrator. An institution legally licensed as a hospital other than a facility owned or operated by the United States Government that s engaged primarily in providing bed patients with diagnosis and treatment under the supervision of licensed physicians. The hospital must have 24-hour-a-day registered graduate nursing services and facilities for major surgery. Institutions that don t meet this definition don t qualify as hospitals. Terms referring to whether a covered service is performed by a provider who is part of the networks associated with the Medical and Dental Plan options or by a provider who is not part of the networks ( out-of-network ). When a service is performed in-network, benefits are generally paid at a higher level than they are when a service is performed out-of-network. The most the Dental Plan will pay for covered dental services for each participant in a year. The most the Dental Plan will pay for covered orthodontia services for each participant s lifetime. Any benefits that have been applied to a maximum provision under a U.S. domestic Dental Option will also be applied to the lifetime maximum for the Expatriate Dental Plan Option. The most the Medical or Dental Plan options will pay for covered services in each participant s lifetime. Effective Date 1/1/10 Your Guide to the JPMorgan Chase Expatriate Medical and Dental Plan Options 8

9 Term Medically Necessary or Medical Necessity Medicare Multiple Surgical Procedure Reduction Policy Definition Health care services and supplies that are determined by the claims administrator to be medically appropriate and: Necessary to meet the basic health needs of the covered person; Provided in the most cost-efficient manner and type of setting appropriate for the delivery of the service or supply; Consistent in type, frequency, and duration of treatment with scientifically based guidelines of national medical, research, or health care coverage organizations or governmental agencies that are accepted by the claims administrator; Consistent with the diagnosis of the condition; Required for reasons other than the convenience of the covered person or her or his physician; and Demonstrated through prevailing peer-reviewed medical literature to be either: Safe and effective for treating or diagnosing the condition or sickness for which their use is proposed; or Safe with promising effectiveness: - For treating a life-threatening sickness or condition; - In a clinically controlled research setting; and - Using a specific research protocol that meets standards equivalent to those defined by the National Institutes of Health. Please Note: For the purpose of this definition, the term life-threatening is used to describe sicknesses or conditions that are more likely than not to cause death within one year of the date of the request for treatment. The fact that a physician has performed or prescribed a procedure or treatment or the fact that it may be the only treatment for a particular injury, sickness, or condition does not mean that it is a medically necessary service or supply as defined above. The definition of medically necessary used here relates only to coverage and may differ from the way in which a physician engaged in the practice of medicine may define medically necessary. Finally, to be considered necessary, a service or supply cannot be educational or experimental in nature in terms of generally accepted medical standards. Medicare is the Health Insurance for the Aged and Disabled provisions of Title XVIII of the Social Security Act of the United States, as enacted or later amended. Coverage is available to most U.S. residents age 65 and above, those with a disability for at least 29 months, and those with end-stage renal disease (ESRD). Generally, Medicare is the primary coverage for those individuals who are age 65 and above, unless these individuals are actively working. Surgical procedures that are performed on the same date of service are subject to the multiple surgical procedure reduction policy. Of the reasonable and customary (R&C) charges, 100% are reimbursable for the primary/major procedure, 50% of R&C charges are reimbursable for the secondary procedure, and 50% of R&C charges are reimbursable for all subsequent procedures. Participants undergoing surgery are urged to discuss this policy with their health care provider. Effective Date 1/1/10 Your Guide to the JPMorgan Chase Expatriate Medical and Dental Plan Options 9

10 Term Necessary Services Non-Duplication of Benefits Out-of-Pocket Maximum Palliative Periodontal Disease Pre-Determination Primary Plan Definition Services or supplies that are accepted and used by the dental community as appropriate for the condition being treated or diagnosed. The services or supplies also must be prescribed by a dentist for the diagnosis or treatment of the condition to be considered necessary. Some prescribed services may not be considered necessary and may not be covered under the Expatriate Dental Plan option. CIGNA International will determine whether a service or supply is necessary. Finally, to be considered necessary, a service or supply cannot be cosmetic, educational or experimental in nature in terms of generally accepted dental standards. The Medical and/or Dental Plans do not allow for duplication of benefits. If you and your eligible dependents are covered under more than one group plan, the primary plan (the one responsible for paying benefits first) needs to be determined. You are entitled to receive benefits up to what you would have received under the Medical or Dental Plan if it were your only source of coverage, but not in excess of that amount. If you have other coverage that is primary to the Medical or Dental Plan, the claims administrator will reduce the amount of coverage that you would otherwise receive under these plans by any amount you receive from your primary coverage. Please see the definition of Coordination of Benefits in this section. The most you would need to pay in a calendar year for medically necessary covered services under the Medical Plan. Once the out-of-pocket maximum is reached, the Medical Plan will pay 100% of reasonable and customary (R&C) charges for medically necessary covered services for the rest of the year. However, amounts that you pay toward your deductible, copayments, and amounts above R&C charges, do not count toward your out-of-pocket maximum. A service or treatment that reduces the harmful effects of a condition usually an acute (emergency) situation. A condition that weakens and destroys the gum, bone, and membrane which surround and support the teeth, such as pyorrhea, gingivitis, or Vincent s disease. An itemization of the proposed course of treatment (including recent pre-treatment x-rays), which you should submit before work is begun, if you anticipate that charges will be more than $300. A dental consultant will review the proposed treatment before work begins and CIGNA International will inform you and your dentist of the amount of covered charges. That way, you ll understand the benefits that will be paid before treatment begins. Benefits will be paid according to the plan provisions in effect when the services are actually rendered. The amount may change if the treatment changes from that which was predetermined or if frequency limits apply. Except in the case of an emergency, you may not want to begin the course of treatment until you know what amount the Expatriate Dental Plan option will pay. The plan that provides initial coverage to the participant. If the participant is covered under both the JPMorgan Chase Expatriate Medical Plan and/or Dental Plan options and another plan, the rules of the primary plan govern when determining the coordination of benefits between the two plans. Specific rules may vary, depending on whether the patient is an active employee (or the dependent of an employee) or covered by Medicare. These rules do not apply to any private insurance you may have. Effective Date 1/1/10 Your Guide to the JPMorgan Chase Expatriate Medical and Dental Plan Options 10

11 Term Prophylaxis Prosthesis Qualified Change in Status Reasonable and Customary (R&C) Charges Self-Insured Skilled Nursing Facility Spouse Visit Definition Prevention of disease by removal of tartar, stains, and other extraneous materials from the teeth, or the cleaning of the teeth by a dentist or by a dental hygienist. In general, something that replaces a missing part of the body. The dental specialty dealing with replacement of teeth is called prosthodontics. The JPMorgan Chase benefits you elect during each annual benefits enrollment period will generally stay in effect throughout the plan year, unless you elect otherwise due to a qualified change in status (such as marriage, divorce, the birth or adoption of a child, etc. within 31 days of the qualifying event). Please Note: Any changes you make during the year must be consistent with your qualified change in status. Please see Qualified Change in Status on page 19 for more information. The actual charges that are considered for payment when you receive medically necessary care for covered services under the Medical and/or Dental Plans. R&C means the prevailing charge for most providers in the same or a similar geographic area for the same or similar service or supply. These charges are subject to change at any time without notice. Reimbursement is based on the lower of this amount and the provider s actual charge. If your provider charges more than the R&C charges considered under the plans, you ll have to pay the difference. Amounts that you pay in excess of the R&C charge are not considered eligible expenses. Therefore, they don t count toward your deductible, benefit limits, or maximums. JPMorgan Chase pays for claims under the Expatriate Medical and Dental Plan options. An institution that primarily provides skilled nursing care and related services for people who require medical or nursing care and that rehabilitates injured, disabled, or sick people. Refers to any person to whom you are legally married as recognized by U.S. federal law. Even if you are legally married under state law (e.g., in Massachusetts and California), or non-u.s. law (e.g., Canada, Spain, etc.) to a person of the same sex, your same-sex spouse is considered to be your domestic partner for purposes of the administration of the JPMorgan Chase benefits plans, including the U.S. federal tax consequences for covering your domestic partner under your benefits (i.e., imputed income) and the benefits that may not be available to that person (e.g., the Health Care Spending Account). A visit is an encounter with a provider which involves direct patient contact. Some benefit provisions limit the number of covered visits. Unless a visit is defined for a particular benefit provision (such as home health care), each procedure code billed counts as a visit toward the limit. The length of a visit may vary by procedure code. Effective Date 1/1/10 Your Guide to the JPMorgan Chase Expatriate Medical and Dental Plan Options 11

12 Participating in the Expatriate Medical and Dental Plan Options The general guidelines for participating in the JPMorgan Chase Expatriate Medical and Dental Plan options are described in this section. Eligibility Your participation in the JPMorgan Chase Expatriate Medical and Dental Plan options is optional. In general, you are eligible to participate if you are: An expatriate employee who receives salary or is eligible to receive draws, commissions, incentives or overrides ( salaried employee ); Regularly scheduled to work 20 or more hours per week; and Employed by JPMorgan Chase & Co or one of its subsidiaries to the extent that such subsidiary has adopted the plans. Please Note: An individual classified or employed in a work status other than as a common law salaried employee by his/her employer, such as an Independent contractor/agent (or its employee), Hourly-paid employee, Intern, and/or Occasional/seasonal, leased, or temporary employee is not eligible to participate in the plans regardless of whether an administrative or judicial proceeding subsequently determines this individual to have instead been a common law salaried employee. Coverage Categories JPMorgan Chase provides a range of coverage levels. When you enroll in the Expatriate Medical and/or Dental Plan Options, your coverage level is based on the number of dependents you enroll and includes the following coverage categories: Employee Only; Employee Plus One Adult; Employee Plus Child(ren); or Employee Plus One Adult Plus Child(ren). You can enroll yourself and your eligible dependents in the Expatriate Medical Plan option and/or the Expatriate Dental Plan option. You can also elect No Coverage for one or both of these options. Effective Date 1/1/10 Your Guide to the JPMorgan Chase Expatriate Medical and Dental Plan Options 12

13 Important Note on Dependent Eligibility You are responsible for understanding the dependent eligibility rules and abiding by them. Each year during annual benefits enrollment, you must review your covered dependents and confirm that they continue to meet the eligibility requirements. JPMorgan Chase reserves the right to conduct dependent eligibility audits at any time. Such audits help ensure that dependents who have been certified for coverage during the annual enrollment process continue to meet plan rules for eligibility. As a result, you may be asked to provide documentation of eligibility for your covered dependents at any time. It is important that you review both the dependent eligibility rules and the status of your dependents on file, and make any necessary adjustments during your designated enrollment period or within 31 days of a qualified change in status (e.g., birth of a child, gain or loss of other coverage, etc.) Failure to either respond to a request for documentation or provide adequate proof of eligibility may result in termination of dependent coverage, repayment of the cost of that coverage, and/or disciplinary action up to and including termination of employment. For a listing of acceptable documentation, please see the Dependent Eligibility Requirements on HR & Personal > Benefits. Your Eligible Dependents In addition to covering yourself under the Medical and/or Dental Plans, you can also cover your eligible dependents, but only under the same options you choose for yourself. Your eligible dependents under the Medical and Dental Plan and if you re a U.S. home-based expatriate or an expatriate assigned to the U.S., under certain other plans as referenced in those plan sections of Your Guide to Benefits at JPMorgan Chase include: Your spouse* to whom you re legally married or your domestic partner (please see the definition of domestic partner in Important Terms beginning on page 4 for more information); * The term spouse refers to any person to whom you are legally married as recognized by U.S. federal law. Even if you are legally married under state law (e.g., in Massachusetts and California), or non-u.s. law (e.g., Canada, Spain, etc.) to a person of the same sex, your same-sex spouse is considered to be your domestic partner for purposes of the administration of the JPMorgan Chase U.S. benefits plans, including the U.S. federal tax consequences for covering your domestic partner under your benefits (i.e., imputed income) and the benefits that may not be available to that person (e.g., the Health Care Spending Account). For more information regarding domestic partner coverage and the various federal and state consequences, please refer to the 2010 Domestic Partner Coverage Guide on available online via the Key Resources box on the Expatriate Benefits page on HR & Personal. Your unmarried dependent children up to the end of the month in which they reach: age 19; or age 23 if they are a full-time student (this includes dependent children of a domestic partner, whether or not they are legally adopted by you, as long as your domestic partner is also enrolled). Please see the definition of full-time student in Important Terms beginning on page 4. Effective Date 1/1/10 Your Guide to the JPMorgan Chase Expatriate Medical and Dental Plan Options 13

14 Please Note: You may continue coverage for an unmarried dependent child who is not capable of supporting himself or herself due to a mental or physical disability, if that disability began before the age limits described previously and if he or she is fully dependent on you for financial support. If you have a dependent child who meets these criteria, you should contact the Benefits Call Center to update his or her status to continue coverage. If JPMorgan Chase also employs or employed your spouse/domestic partner or dependent child, he or she can be covered as an employee or as your dependent, but not both. If you want to cover your eligible dependent child(ren), you or your spouse/domestic partner (but not both of you) may elect to provide this coverage. Dependent Children Children include your natural children, stepchildren, children under your legal guardianship, children of your domestic partner, and legally adopted children whom you claim as dependents on your income tax return or for whom you provide at least 50% of support. Children also include children who live with you and for whom adoption proceedings have already begun, who are under age 18, and for whom you have the legal obligation to support (in whole or in part). United States federal law requires that any child of a plan participant who is an alternate recipient under a Qualified Medical Child Support Order (QMCSO) will be considered as having a right to dependent coverage under the Medical and Dental Plans. In general, QMCSOs are state court orders requiring a parent to provide medical support to an eligible child, for example, in the case of a divorce or separation. For a detailed description of the procedures for a QMCSO, free of charge, contact the Benefits Call Center. Please Note: If you are covering the child of a domestic partner who is not a tax dependent, imputed income for that child will be applied. Please see the Domestic Partner Coverage Guide for more information. The Guide is available online via the Key Resources box on the Expatriate Benefits page on HR & Personal. Michelle s Law If your covered dependent child age 19 or older must take a medically necessary leave of absence from school that begins on or after January 1, 2010 and causes him/her to no longer be a full-time student, your dependent may be eligible to continue coverage under the JPMorgan Chase U.S. Benefits Program. The leave of absence from the post-secondary school must be medically necessary, commence while the covered full-time student is suffering from a serious illness or injury, and otherwise cause the dependent to lose coverage (i.e., he or she no longer meets JPMorgan Chase s definition of eligible dependent child). The coverage would continue in the same manner as if the dependent was a full-time student and would end one year after the date of the leave or earlier, if coverage would have otherwise ended (e.g., child turns age 23). If a dependent qualifies under these provisions, you should contact the Benefits Call Center at JPMChase ( ) or (GDP# ) if calling from outside of the United States to update their status so their coverage may continue. Effective Date 1/1/10 Your Guide to the JPMorgan Chase Expatriate Medical and Dental Plan Options 14

15 Domestic Partners In addition to the dependents previously listed, you may also cover a domestic partner as an eligible dependent under the Medical and Dental Plans if you re not currently covering a spouse. You generally must cover your domestic partner under the same options you choose. For purposes of the Medical and Dental Plans, you and your domestic partner must: Be age 18 or older; Have lived together for at least six months and have a serious, committed relationship; Be financially interdependent; Not be related to each other in a way that would prohibit legal marriage; and Not be legally married to, or the domestic partner of, anyone else; OR Have registered as domestic partners pursuant to a domestic partnership ordinance or law of a state or local government, or under the laws of a foreign jurisdiction. In addition, you can enroll children of a domestic partner, as long as they meet the eligibility requirements of being your dependent children under the Medical and Dental Plans as described under Your Eligible Dependents on page 13, and the domestic partner is also enrolled. In the event that you reside in a location that does not recognize legal adoption with respect to a child of a domestic partner, coverage will be available provided that you submit, in writing, that your jurisdiction of residency does not permit adoption with respect to domestic partner relationships, and that if this restriction did not exist, you would otherwise adopt the child. This condition only applies if you do not cover the domestic partner. For more information on covering a domestic partner, please refer to the Domestic Partner Coverage Guide, available online via the Key Resources box on the Expatriate Benefits page on HR & Personal. To have your claim considered for benefits, all claims must be filed by December 31 of the year following the year in which services were provided. If you do not meet this deadline, your claim will be denied. If your claim for reimbursement is denied, either in whole or in part, you can appeal the denial by following the appropriate procedures described in the Plan Administration section of Your Guide to Benefits at JPMorgan Chase, available in the Expatriate Library section of the Expatriate Programs page on HR & Personal. Go to HR & Personal > Expatriate Programs > Expatriate Library. You may also contact the Benefits Call Center to request a copy of the Guide. Cost of Coverage You and JPMorgan Chase share the cost of coverage under the Expatriate Medical and Dental Plan options. During your designated enrollment period, the cost under each of the coverage categories for each option offered will be available on the Benefits Web Center via My Work. Your cost depends on the options you choose and the number and type of eligible dependents you cover. Effective Date 1/1/10 Your Guide to the JPMorgan Chase Expatriate Medical and Dental Plan Options 15

16 U.S. home-based expatriate employees or expatriate employees who are assigned to the U.S. pay for coverage with before-tax dollars, which means your U.S. federal, state, and local income taxes (if applicable) are reduced. If you are a U.S. home-based expatriate employee and become totally and permanently disabled and are eligible for benefits from the JPMorgan Chase Long-Term Disability (LTD) Plan, you re treated as having benefits eligible status for certain benefits. In the case of the Medical Plan, you ll be eligible to continue coverage while receiving benefits from the LTD Plan. You ll pay for coverage with after-tax dollars on a direct-bill basis. When Contributions Begin Your contributions toward the cost of coverage start when your coverage begins. Your contributions are automatically deducted from your pay in monthly installments (unless retroactive payments are required). If you have coverage but are away from work because of an unpaid leave of absence, you will be billed directly for any required contributions on an after-tax basis. Cost for Domestic Partner Coverage If you re covering a domestic partner as described in Your Eligible Dependents beginning on page 13, there are some cost implications of which you should be aware. Specifically, in many cases a Domestic Partner will not satisfy the definition of Dependent under the U.S. Internal Revenue Code (IRC). As a result, if you are subject to U.S. tax withholding, U.S. federal law requires JPMorgan Chase to report the entire value of the medical coverage for a Domestic Partner to the Internal Revenue Service as taxable income to you. The entire value of this coverage includes the amount that both you and JPMorgan Chase contribute towards the cost of coverage. Please Note: If you are covering the child of a domestic partner who is not a U.S. tax dependent, imputed income for that child will be applied. Favorable Tax Treatment in Certain States Based on the availability of more favorable tax treatment in certain states, employees who certify that their domestic partner and/or domestic partner s children are tax-qualified in the following states (based on the individual state s requirements) are not subject to state imputed income tax related to benefits coverage for their domestic partner and partner s child(ren): California Connecticut Massachusetts New Jersey Oregon Vermont Washington, D.C. Please Note: In order to be eligible for this state income tax treatment, you must contact the Benefits Call Center to certify that your domestic partner and partner s child(ren) (if applicable) qualify for this tax treatment. Enrolling a Domestic Partner For more information on enrolling and the tax consequences of covering a domestic partner, please refer to the Domestic Partner Coverage Guide available via the Key Resources box on the Expatriate Benefits page on HR & Personal. Effective Date 1/1/10 Your Guide to the JPMorgan Chase Expatriate Medical and Dental Plan Options 16

17 Smoker Status When you enroll for coverage, and each year at annual benefits enrollment, you must verify the smoker status of yourself and your covered dependents as a non-smoker or smoker. If you and/or any of your dependents meet the definition of a smoker but fail to declare your smoker status, you will be subject to disciplinary action. Please Note: While you must verify your smoker and/or non-smoker status, your cost of coverage under the Expatriate Medical Plan option will be the lower non-smoker rates, regardless of whether you certify as a smoker or non-smoker. To be considered a non-smoker, you and/or any covered dependents must be a non-smoker for at least 12 months as of January 1 of that plan year, or complete an approved smoking cessation program. Smoking cessation programs are available throughout the year. For more information on smoking cessation programs and requirements, go to the Key Resources box on the Expatriate Benefits page on HR & Personal. You ll receive more information regarding the opportunity to update your smoker status during each annual benefits enrollment period. How Smoker Is Defined Under the JPMorgan Chase U.S. Benefits Program, a person who has smoked any type of tobacco product (e.g., cigarettes, cigars, or a pipe) regardless of the frequency or location (this includes daily, occasionally, socially, at home only, etc.) in the 12 months preceding any January 1 is considered a smoker. This definition does not pertain to users of tobacco products that are not smoked, such as chewing tobacco or snuff. How to Enroll Participation in the Medical Plan is optional. If You: Are an Expatriate Employee What You Need to Do to Enroll: During an annual benefits enrollment period, you can make your elections through the Benefits Web Center via My Work or via the Benefits Call Center. At the beginning of each enrollment period, you ll receive instructions on how to enroll. You ll also receive information about the choices available to you and their costs at that time. You need to review your available choices carefully and enroll in the options that best meet your needs. You can t change your choices during the year unless you have a qualified change in status. Please see Qualified Change in Status on page 19 for more information. Effective Date 1/1/10 Your Guide to the JPMorgan Chase Expatriate Medical and Dental Plan Options 17

18 If You: Are a Newly Hired U.S. Home-Based Expatriate Employee or New to Expatriate Status Have a Change in Work Status or Experience a Qualifying Event What You Need to Do to Enroll: If you ve just joined JPMorgan Chase or are new to expatriate status and are enrolling for the first time, you need to make your choices through the Benefits Web Center via My Work or via the Benefits Call Center, or within 31 days of your date of hire if you are a newly hired full-time employee within 31 days of commencing an expatriate assignment, or within 31 days prior to becoming eligible if you are a newly hired part-time employee. Part-time employees will receive their enrollment materials within 31 days prior to becoming eligible and can enroll at that time. You can access your benefits enrollment materials online via Company Home > HR & Personal > Expatriate Programs > Expatriate Benefits. If you re enrolling during the year because you have a qualified change in status (including birth or adoption of a child, etc.), you ll have 31 days from the date of the change in status to make your new choices through the Benefits Web Center via My Work or by contacting the Benefits Call Center and speaking with a Service Representative. Please see Qualified Change in Status on page 19 for more information. Please see Expatriate Medical Plan Option on page 26 on page for information about the options available under the U.S. benefits plan options available to you. You can find additional information on these plans in Your Guide to Benefits at JPMorgan Chase available via the Key Resources box on the Expatriate Benefits page on HR & Personal. If You Do Not Enroll If You: Are an Expatriate Employee Are a Newly Eligible or Newly Hired Expatriate Employee What Happens If You Do Not Enroll: If you re already participating in the Medical and/or Dental Plan and do not change your elections or cancel coverage during the annual benefits enrollment period, you ll keep the same coverage for the following plan year that you had before the annual benefits enrollment period (if available) or you will be assigned coverage by JPMorgan Chase. However, you ll be subject to any changes in the plan and coverage costs. If you re a new hire or newly eligible employee and do not enroll within the designated 31-day eligibility period, generally you will not have coverage for the remainder of the calendar year and your next opportunity to enroll will be during the next annual benefits enrollment period, unless you experience a qualified change in status. Please see Qualified Change in Status on page 19 for more information. Effective Date 1/1/10 Your Guide to the JPMorgan Chase Expatriate Medical and Dental Plan Options 18

19 If You: Have a Qualified Change in Status What Happens If You Do Not Enroll: If you have a qualified change in status (including the birth or adoption of a child, etc.) that allows you to enroll in the Medical and/or Dental Plan mid-year and you do not enroll within the designated 31-day period. You will not be able to make the change in coverage until the following annual benefits enrollment period. Please see Qualified Change in Status on page 19 for more information. When Coverage Begins If You: Are an Expatriate Employee Are a Newly Eligible or Newly Hired Expatriate Employee Have a Change in Work Status or Experience a Qualifying Event When the Coverage You Elect Begins: The coverage you elect during the annual benefits enrollment period takes effect the beginning of the following plan year (January 1). The coverage you elect as a new expatriate employee becomes effective on the date of your transfer to expatriate status. The coverage you elect as a result of a qualifying event (such as marriage or the birth or adoption of a child) or a work-related event, such as an adjustment to your regularly scheduled work hours that results in a change in eligibility, will take effect the day of the qualifying event, if you enroll within 31 days of the event and if you have already met the plans eligibility requirements. Please Note: The Expatriate Medical Plan option covers pre-existing conditions. So, under this option, your coverage for any pre-existing condition begins as soon as you enroll. Qualified Change in Status The Medical and Dental Plan elections you make during the annual benefits enrollment period will stay in effect through the following plan year (or the current plan year if you enroll during the year as a newly eligible employee). However, you may be permitted to change your elections before the next enrollment period if you have a qualified change in status. Please Note: Any changes you make during the year must be consistent with your qualified change in status. If you miss the 31-day deadline, generally you will not have coverage for the remainder of the calendar year and your next opportunity to enroll will be during the next annual benefits enrollment period. If you have a qualified change in status and want to change your elections, please see the Benefits Status Change Guide available online under the Key Resources box on the Expatriate Benefits page on HR & Personal. This Guide is also available on request through the Benefits Call Center. You need to enroll through the Benefits Web Center via My Work or via the Benefits Call Center within 31 days of the qualifying event. Otherwise, you will not be able to make the change in coverage until the next annual benefits enrollment period. Please Note: Documentation of eligibility isn t always required when you enroll but may be requested at any time by JPMorgan Chase or the claims administrator. Effective Date 1/1/10 Your Guide to the JPMorgan Chase Expatriate Medical and Dental Plan Options 19

20 Qualified changes in status for eligible dependents under the Medical and Dental Plans are listed in the following table. Medical and Dental Plan Changes for Qualified Change in Status Event Medical and/or Dental Plan Changes You get married You enter into a domestic partner relationship or civil union You have, adopt, or obtain legal guardianship of a child You and/or your covered dependents gain other benefits coverage You and/or your eligible dependents lose other benefits coverage You get legally separated or divorced You end a domestic partner relationship or civil union A covered family member dies A dependent child is no longer eligible Add coverage for you, spouse, and/or eligible dependent children Add coverage for you, your domestic partner, and any eligible dependent children Add coverage for you and/or your eligible dependents Cancel coverage for you and/or your covered dependents who have gained other coverage Add coverage for you and/or your eligible dependents who have lost other coverage Cancel coverage for your former spouse and/or dependent children who are no longer eligible Cancel coverage for your domestic partner, and your domestic partner s dependent children who are no longer eligible Cancel coverage for your deceased dependent and any dependent children who are no longer eligible Cancel coverage for your dependent child Please Note: Your deadline to report a qualifying event may be extended to 60 days if your newly eligible dependent dies prior to adding him or her to coverage. Please contact the Benefits Call Center if this situation applies to you. Effective Date 1/1/10 Your Guide to the JPMorgan Chase Expatriate Medical and Dental Plan Options 20