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

26 The following expenses are not applied toward the in-network and out-of-network annual deductibles: Your out-of-pocket expenses for in-network services do not apply to the out-of-network deductible, and your outof-pocket expenses for out-of-network services do not apply to the in-network deductible, Your out-of-pocket expenses for covered prescription drugs unless you participate in the Health Savings PPO, Covered out-of-network expenses that are over the reasonable and customary charge, Amounts that you pay because you do not pre-notify a HOSPITAL stay, procedure or other benefit or meet any other similar requirements, and Charges excluded or limited by the Program. Coinsurance Once the annual deductibles are met, the Program pays a percentage of the negotiated charge for eligible in-network expenses and a percentage of the reasonable and customary charge for eligible out-of-network expenses. You pay the remaining percentage, which is your coinsurance, plus anything over what UHC or BCBS determines is the reasonable and customary charge for out-of-network expenses. Keep in mind that there is no coverage for any service or supply that is not considered medically necessary or that is otherwise specifically excluded under the Program. Annual Out-of-Pocket Maximum The annual out-of-pocket maximum puts a cap on what each participant has to pay toward eligible in-network or outof-network expenses in a given calendar year. Your share of the in-network and out-of-network coinsurance plus amounts paid to satisfy the annual deductibles are applied toward the annual out-of-pocket maximum. Your annual out-of-pocket maximum 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). There are separate in-network and out-of-network out-of-pocket maximums; however, expenses for either in-network or out-of-network coverage are counted towards both the in- and out-of-network out-of-pocket limits. The annual out-of-pocket maximum applies to each enrolled person. If you have individual coverage, your out-ofpocket maximum is satisfied once you meet the individual limit. If you have family coverage and are enrolled in the Health Savings PPO, the annual out-of-pocket maximum for any family member is met only once your family s combined eligible expenses reach the family limit. If you have family coverage and are enrolled in the PPO, the outof-pocket maximum is satisfied for a family member once the member reaches the individual limit. Once your family collectively satisfies the family out-of-pocket maximum, the limit is considered reached for all family members. 26 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

27 Any eligible medical expenses submitted for reimbursement after the annual out-of-pocket maximum is reached are paid at 100% for in-network charges and 100% of the reasonable and customary charge for out-of-network charges. The following expenses are not applied toward the out-of-pocket limit: Your out-of-pocket expenses for covered prescription drugs unless you participate in the Health Savings PPO, Covered out-of-network expenses that are over the reasonable and customary charge, Amounts that you pay because you do not pre-notify a hospital stay, procedure or other benefit or meet any other similar requirements, and Charges excluded or limited by the Program. 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 out-of-pocket maximum. If you are enrolled in the Health Savings PPO, your eligible out-of-pocket prescription drug expenses also count toward your annual out-of-pocket maximum. PPOs at a Glance The following PPO and Health Savings PPO charts show the specific deductibles you pay, coverage percentages the PROGRAM pays for care, cost-sharing requirements, out-of-pocket maximums and limits for in-network and out-ofnetwork care for each of the PPO options available to you. UHC PPO and BCBS PPO PROGRAM PROVISION IN-NETWORK COVERAGE OUT-OF-NETWORK COVERAGE Annual Deductible (based on base pay as of January 1, 2013) Individual Family Individual Family Less than $50,000 $400 $800 $800 $1600 $50,000 but less than $100,000 $450 $900 $900 $1,800 $100,000 but less than $150,000 $550 $1,100 $1,100 $2,200 $150,000 but less than $250,000 $650 $1,300 $1,300 $2,600 $250,000 but less than $350,000 $800 $1,600 $1,600 $3,200 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 27

28 UHC PPO and BCBS PPO PROGRAM PROVISION IN-NETWORK COVERAGE OUT-OF-NETWORK COVERAGE $350,000 or more $1000 $2,000 $2,000 $4,000 Annual Out-of-Pocket Maximum (based on base pay as of January 1, 2013) Less than $50,000 $1,500 $3,000 $3,000 $6,000 $50,000 but less than $100,000 $2,000 $4,000 $4,000 $8,000 $100,000 but less than $150,000 $2,500 $5,000 $5,000 $10,000 $150,000 but less than $250,000 $3,500 $7,000 $7,000 $14,000 $250,000 but less than $350,000 $4,500 $9,000 $9,000 $18,000 $350,000 or more $5,500 $11,000 $11,000 $22,000 Basis for Reimbursement Negotiated rate REASONABLE AND CUSTOMARY charge Preventive Care (routine physicals/screenings, routine OB/GYN (including Pap tests), well-child visits and immunizations, mammograms) Office Visits (primary care physician, SPECIALIST, X-ray and lab tests) 100%; no deductible 60% after deductible 80% after deductible 60% after deductible Maternity Care (initial prenatal office visit, HOSPITAL and other prenatal and postpartum care services) 80% after deductible (maternity preventive care is covered at 100% with no deductible) 60% after deductible Hospital Care (inpatient or outpatient) Mental Health/Substance Use Disorder Emergency Room Care 80% after deductible 60% after deductible 80% after deductible 60% after deductible Emergencies covered at 80% after deductible 28 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

29 UHC PPO and BCBS PPO PROGRAM PROVISION IN-NETWORK COVERAGE OUT-OF-NETWORK COVERAGE Infertility Treatment (office visits, facility services, assisted reproductive technology procedures) $25,000 lifetime cap*, including pharmacy benefits, for INFERTILITY treatments and services incurred on or after January 1, % after deductible 60% after deductible * $25,000 lifetime maximum limit applies to all COMPANY active medical plan and retiree medical plan options combined. UHC Health Savings PPO and BCBS Health Savings PPO PROGRAM PROVISION IN-NETWORK COVERAGE OUT-OF-NETWORK COVERAGE Annual Deductible (based on base pay as of January 1, 2013) Individual Family Individual Family Less than $50,000 $50,000 but less than $100,000 $100,000 but less than $150,000 $1,500 $3,000 $3,000 $6,000 $150,000 but less than $250,000 $250,000 but less than $350,000 $350,000 or more $2,500 $5,000 $5,000 $10,000 Annual Out-of-Pocket Maximum (based on base pay as of January 1, 2013) Less than $50,000 $2,500 $5,000 $5,000 $10,000 $50,000 but less than $100,000 $3,000 $6,000 $6,000 $12,000 $100,000 but less than $150,000 $3,500 $7,000 $7,000 $14,000 $150,000 but less than $250,000 $4,500 $9,000 $9,000 $18,000 $250,000 but less than $350,000 $5,950 $11,900 $11,900 $23,800 $350,000 or more $5,950 $11,900 $11,900 $23,800 Basis for Reimbursement Negotiated rate Reasonable and customary charge Preventive Care (routine physicals/screenings, routine OB/GYN, well-child visits, immunizations, mammograms) 100%; no deductible 60% after deductible Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 29

30 UHC Health Savings PPO and BCBS Health Savings PPO PROGRAM PROVISION IN-NETWORK COVERAGE OUT-OF-NETWORK COVERAGE Office Visits (primary care physician, specialist, X-ray and lab tests) 80% after deductible 60% after deductible Maternity Care (initial prenatal office visit, hospital and other prenatal and postpartum care services) 80% after deductible (maternity preventive care is covered at 100% with no deductible) 60% after deductible Hospital Care (inpatient or outpatient) Mental Health/Substance Use Disorder Emergency Room Care Infertility Treatment (office visits, facility services, assisted reproductive technology procedures) 80% after deductible 60% after deductible 80% after deductible 60% after deductible Emergencies covered at 80% after deductible $25,000 lifetime cap*, including pharmacy benefits for infertility treatments and services incurred on or after January 1, % after deductible 60% after deductible * $25,000 lifetime maximum limit applies to all Company active medical plan and retiree medical plan options combined. Health Savings Account (HSA) If you are eligible and you enroll in the Health Savings PPO option, you can set up a HSA with Fidelity and make pretax contributions to your account through regular payroll deductions. The COMPANY will contribute up to $750 if you enroll in individual coverage, or up to $1,250 if you enroll in family coverage, to your HSA, even if you decide not to contribute any of your own money. You can use the funds in your account to pay for eligible health care expenses, including medical and prescription drug expenses, as well as dental and vision expenses. You are eligible to set up a HSA and make and receive HSA contributions through the Flexible Spending Account Plan during any month in which you: Are enrolled in the Health Savings PPO as of the first day of the month, Are not enrolled in MEDICARE, 30 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

31 Do not have low-deductible health plan coverage, such as through an OPPOSITE-SEX SPOUSE, SAME-SEX SPOUSE or DOMESTIC PARTNER (including coverage under an opposite-sex spouse, same-sex spouse s or domestic partner s health care flexible spending account or health reimbursement account), and Cannot be claimed as a dependent on someone else s federal tax return. You are responsible for the tax consequences associated with the contributions to and withdrawals from your Health Savings Account. More information about HSAs is included in the Flexible Spending Accounts Summary Plan Description. You may also wish to review IRS Publication 969, available at or contact Fidelity at if you have any questions or to learn more about HSAs. OUT-OF-AREA (OOA) OPTION The OUT-OF-AREA (OOA) coverage option is available only to employees who live in an area where there is no PPO NETWORK available. UHC is the CLAIMS ADMINISTRATOR for the OOA coverage option. OOA coverage is a traditional, fee-for-service medical coverage option. Reimbursements are based on the REASONABLE AND CUSTOMARY charge for eligible expenses. There is no deductible or coinsurance for covered preventive care. For all other expenses, benefits are payable after you satisfy an annual deductible. You are responsible for the coinsurance after you satisfy the deductible, subject to the out-of-pocket maximum. Depending on your geographic area, you may have access to PPO network providers. These providers have agreed to discount their charges for members covered under the UHC OOA coverage option. If you receive services from a network PROVIDER, your coinsurance level will remain the same. However, the amount that you owe may be less than if you received services from an out-of-network provider because of the negotiated discount. OOA Member Services Contact Member Services at the phone number or through the website shown on your ID card to: Ask questions about your benefits Resolve claim or bill payment problems Request new ID cards Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 31

32 Your ID card tells you how to reach Member Services by phone ( ) or via the Internet at Those who need to contact Member Services from a TDD (Telecommunications Device for the Deaf) telephone may call How Benefits Are Payable You share in the cost by paying applicable deductibles and coinsurance amounts. Reimbursements are based on the reasonable and customary charge. Amounts above reasonable and customary charges are not eligible for reimbursement and are your responsibility to pay, in addition to any deductibles and/or required coinsurance. See Out-of-Area at a Glance on page 34 for the specific deductibles, coverage percentages, cost-sharing requirements, coverage limits and out-of-pocket maximums under the OOA coverage option. More detailed information is included in later sections of this SPD. Annual Deductible Each PARTICIPANT must satisfy the annual deductible before benefits become payable for treatments and services other than preventive care. If you have individual coverage, you must satisfy the individual annual deductible. If you have family coverage, 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. There is no deductible requirement for covered preventive care services. 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. The following expenses are not applied toward the annual deductible: Your out-of-pocket expenses for covered prescription drugs, Covered expenses that are over the reasonable and customary charge, Amounts that you pay because you do not pre-notify a HOSPITAL stay, procedure or other benefit or meet any other similar requirements, and Charges excluded or limited by the PROGRAM. 32 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

33 Coinsurance Once the annual deductible is met, the Program pays 80% of the reasonable and customary charge for eligible expenses. You pay the remaining 20%, which is your coinsurance, plus anything over what the Claims Administrator determines is the reasonable and customary charge. Keep in mind that there is no coverage for any service or supply that is not considered medically necessary or is specifically excluded under the Program. There is no coinsurance requirement (the Program pays 100% of the reasonable and customary charge) for preventive care. Annual Out-of-Pocket Maximum The annual out-of-pocket maximum puts a cap on what each participant has to pay toward eligible medical expenses in a given calendar year. Your share of the coinsurance plus the annual deductible are applied toward the annual out-of-pocket maximum. The annual out-of-pocket maximum applies to each enrolled person. If you have individual coverage, your out-of-pocket maximum is satisfied once you meet the individual limit. If you have family coverage, the annual out-of-pocket maximum for any family member is met once the member reaches the individual limit. Once your family collectively satisfies the family out-of-pocket maximum, the limit is considered reached for all family members. Any eligible medical expenses submitted for reimbursement after the annual out-of-pocket maximum is reached are paid at 100% of the reasonable and customary charge. The following expenses are not applied toward the out-of-pocket limit: Your out-of-pocket expenses for covered prescription drugs, Covered expenses that are over the reasonable and customary charge, Amounts that you pay because you do not pre-notify a hospital stay, procedure or other benefit or meet any other similar requirements, and Charges excluded or limited by the Program. 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 out-of-pocket maximum. Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 33

34 Out-of-Area at a Glance UHC Out-of-Area Coverage Option PROGRAM PROVISION Annual Deductible Annual Out-of-Pocket Maximum Basis for Reimbursement Preventive Care (routine physicals/screenings, routine OB/GYN, well-child visits, immunizations, mammograms) Office Visits (primary care physician, SPECIALIST, X-ray and lab tests) Maternity Care (prenatal and postpartum care, HOSPITAL services) Outpatient Care (office visit, outpatient SURGERY, X-rays and lab tests) Inpatient Hospital Care (surgical services, semi-private room and board, X-rays and lab tests) Mental Health/Substance Use Disorder Emergency Room Care Infertility Treatment (office visits, facility services, assisted reproductive technology procedures) COVERAGE $400 Individual/$800 Family $1,500 Individual/$3,000 Family REASONABLE AND CUSTOMARY charge 100%, no deductible 80% after the deductible 80% after the deductible (maternity preventive care is covered at 100% with no deductible) 80% after the deductible 80% after the deductible 80% after the deductible 80% after the deductible 80% after the deductible $25,000 lifetime cap*, including pharmacy benefits, for INFERTILITY treatment and services incurred on or after January 1, 2012 * $25,000 lifetime maximum limit applies to all COMPANY active medical plan and retiree medical plan options combined. 34 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

35 HEALTH MAINTENANCE ORGANIZATIONS (HMOS) Health Maintenance Organizations (HMOs) provide an alternative source of health coverage for you and your eligible DEPENDENTS. If you enroll in an HMO, you may be required to select a Primary Care Physician (PCP) from the HMO s PROVIDER NETWORK. If you enroll your dependents for coverage, each PARTICIPANT may choose his or her own PCP. Keep in mind that in most cases, HMOs pay no benefits for care that is not provided or actively managed by your PCP. In addition, prescription drug and mental health and substance use disorder services will be administered or coordinated by the HMO. IMPORTANT NOTICES ABOUT HMO COVERAGE If your HMO requires or allows the designation of a PCP, you have the right to designate any PCP who participates in the HMO s network and who is available to accept you or your family members. For children, you may designate a pediatrician as the PCP. Until you make a PCP designation, the HMO may designate one for you. For information on how to select a PCP, and for a list of the participating primary care providers, contact your HMO provider. You do not need prior authorization from your HMO, your EMPLOYING COMPANY or from any other person (including your PCP) in order to obtain access to obstetrical or gynecological care from a health care professional in the HMO network who specializes in obstetrics or gynecology. The health care professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan, or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, contact your HMO provider. For information on the HMOs, if any, available to you, refer to your Employing COMPANY s intranet site or contact the Time Warner Benefits Service Center at Eligibility rules for dependents (including whether coverage is available for SAME-SEX SPOUSEs and DOMESTIC PARTNERs, deadlines for enrolling new children and limiting ages for dependent children) may vary depending on the HMO. Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 35

36 All benefits, limitations and exclusions for the HMO coverage options are listed in their member brochures, certificates of coverage or membership booklets and contracts. The HMO brochures, certificates of coverage or membership booklets and contracts, together with this document, constitute the Summary Plan Description for HMO benefits under the PROGRAM. Early each year or upon request, the HMO will supply you with written materials about: The nature of services provided to members, Conditions pertaining to eligibility to receive such services (other than general conditions pertaining to eligibility for participation in the Program) and circumstances under which services may be denied, and The procedures to be followed in obtaining such services, and the procedures available for the review of claims for services that are denied in whole or in part. Requests for these materials may be made to your HMO provider or to the PLAN ADMINISTRATOR. ELIGIBLE MEDICAL EXPENSES This section describes the expenses that are eligible for reimbursement under the UHC and BCBS coverage options (including the Out-of-Area coverage option). If you are enrolled in a Health Maintenance Organization (HMO), refer to your HMO s own materials for a description of eligible medical expenses. Please note that for maximum benefits to be payable, certain of the eligible expenses listed below must be pre-notified. Eligible medical expenses under UHC and BCBS include the following: Acupuncture therapy is limited to 30 visits per calendar year when performed by an M.D., D.D.S, D.O. or Certified Licensed Acupuncturist. Any visits beyond 30 will require written approval from a medical doctor (e.g., a letter/prescription) stating that treatment is medically necessary. Massage therapy and herbal medicine are not covered medical services under the PROGRAM, even if recommended by a medical doctor. Allergy testing and injections when prescribed by a physician. 36 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

37 Ambulance Services to or from the nearest HOSPITAL that can provide the necessary care. (If MEDICALLY NECESSARY, airline, railroad or air ambulance travel is also covered to the nearest medical facility qualified to give the required treatment.) Use of ambulance services must not be for routine transportation to receive inpatient or outpatient services. AMBULATORY SURGICAL CENTER for related services provided within 72 hours before or after a surgical procedure. The ambulatory surgical center must meet state licensing or other specified requirements. Amniocentesis when prescribed by a physician. Anesthesia and its administration in connection with a covered surgical, obstetrical or medical procedure. BIRTH CENTERs for delivery of children following a normal uncomplicated pregnancy, as long as care is provided by a licensed facility. Blood banking of a patient s, relative s or friend s blood, provided SURGERY is scheduled to take place and the units of blood do not exceed the amount reasonably expected to be needed for surgery. Storage can be for up to six months preceding surgery. Blood transfusions and any related equipment or supplies. Chemotherapy, including a physician s charges to administer U.S. Food and Drug Administration (FDA)-approved chemotherapy drugs; experimental or research chemotherapy is not covered. Chiropractic care/spinal manipulation is limited to 30 visits per calendar year, whether in-network or out-ofnetwork. Any visits beyond 30 will require written approval from a medical doctor (e.g., a letter/prescription) stating that treatment is medically necessary. Benefits for spinal treatment include chiropractic and osteopathic manipulative therapy, when performed in the PROVIDER s office. Benefits include diagnosis and related services and are limited to one visit and treatment per day. Cochlear implants if clinical guidelines are met (contact PPO Member Services for information about clinical guidelines). Contact lenses for an initial prescription (including examinations and fittings) following cataract removal. Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 37

38 Dental-related care: When treatment is necessary because of accidental damage to a sound, natural tooth; dental damage that results from normal activities of daily living or extraordinary use of the teeth is not covered. The initial contact with a physician or dentist must occur within 72 hours of the accident; and dental services must be received from a Doctor of Dental Surgery or a Doctor of Medical Dentistry. Dental services for final treatment to repair the damage must be started within three months of the accident and completed within 12 months of the accident. Pre-notification is recommended for treatment of dental injuries that result from an accident. HOSPITAL and general anesthesia for dental treatment when there is an underlying medical condition. Initiation of immunosuppressive medication (used to reduce inflammation and suppress the immune system), and direct treatment of cancer or cleft palate is also covered. Diabetic supplies, as follows: Insulin pumps are covered as DURABLE MEDICAL AND SURGICAL EQUIPMENT. For other diabetic supplies, see ELIGIBLE PRESCRIPTION DRUG EXPENSES on page 61. Diagnostic X-ray and lab tests, including professional fees. Disposable medical supplies that are prescribed by a covered provider. Examples include: elastic stockings, ace bandages, colostomy bags and related supplies and tubing. Contact PPO Member Services for more information about disposable medical supplies. Durable medical and surgical equipment (e.g., wheelchairs and hospital beds), including their purchase, rental, repair and replacement. The equipment must be prescribed by a physician and be considered medical necessary for outpatient use to treat an illness or injury or to restore the use of a dysfunctional body part. The Program will cover the cost of buying the equipment when the purchase price is expected to be less costly than long-term rental, or when the item is not available on a rental basis. No benefits are payable for routine maintenance of rented equipment. If more than one piece of durable medical equipment can meet the patient s functional needs, benefits are available only for the most cost-effective piece of equipment (i.e., the least expensive equipment that performs the necessary function). Pre-notification is recommended for durable medical equipment over $1,000. EMERGENCY care, including physicians charges to treat an emergency condition. Care provided for urgent medical situations is not considered emergency care. An urgent medical situation is one that is not life-threatening or serious, yet calls for immediate medical attention. If you use an out-of-network provider for an urgent medical situation, it will be considered for benefits at the out-of-network level. You may contact PPO Member Services for information on obtaining in-network care. Pre-notification is recommended for emergency care that results in an inpatient stay at a hospital or other facility. 38 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

39 Family planning services/infertility treatments, including the following: Tests, counseling, corrective procedures and drug therapy for medical conditions resulting in infertility, Genetic testing, including pre-implantation screening of embryos when medically necessary, Voluntary sterilization by vasectomy or tubal ligation (reversals are not covered), Gynecological exams to prescribe or administer a contraceptive drug or device, Injectable and implanted contraceptives, and Artificial insemination and in vitro fertilization procedures (including donor cycles but excluding donor compensation), subject to the lifetime benefit limit, whether in-network or out-of-network. All attempts must meet clinical criteria established by the American College of Obstetrics and Gynecology as appropriate for the treatment of infertility. Donor cycle includes medications, testing and the retrieval of eggs. All infertility treatments (including pharmacy benefits) are subject to a lifetime limit of $25,000 lifetime cap for services and supplies (in-network and out-of-network combined) incurred on or after January 1, This lifetime cap applies collectively to all family members and across all COMPANY active and retiree medical coverage options. Gender reassignment surgery for patients who are at least age 18 and who have been diagnosed with Gender Identity Disorder, if the applicable CLAIMS ADMINISTRATOR s (UHC or BCBS) clinical guidelines are met. Patients interested in this coverage should contact PPO Member Services for additional information. Pre-notification is recommended. Cosmetic surgeries used to improve the gender specific appearance of a patient who has undergone or is planning to undergo gender reassignment surgery are not covered under the Program. Hearing aid devices. Benefits are available only for the most cost-effective piece of equipment (i.e., the least expensive hearing aid device that performs the necessary function), up to $1,000 every five (5) years. This limit applies across all Company active and retiree medical coverage options. Hemodialysis, including equipment and other professional services recommended in connection with approved outpatient treatment, including use of dialysis equipment in the home when treatment is furnished and/or prescribed by a physician. Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 39

40 Home healthcare for part-time or periodic medical services in a patient s home, as long as the care is not considered custodial care, is provided by a licensed home healthcare agency and is prescribed by, or part of a home healthcare program established and approved by, the attending physician. Pre-notification is recommended. The Claims Administrator s medical management staff will decide if home healthcare is needed by reviewing both the skilled nature of the service and the need for physician-directed medical services. Services must be provided by or supervised by a registered nurse in the patient s home. Any combination of network and out-of-network benefits is limited to 40 visits per covered person per calendar year. One visit equals four hours of care. HOSPICE care for counseling, pain relief and incidental medical services for terminally ill patients. Pre-notification is recommended. Hospice care is an integrated program recommended by a physician who provides comfort and support services for the terminally ill. Hospice care can be provided on an inpatient or outpatient basis and includes physician, psychological and social care for the terminally ill person, and short-term grief counseling for immediate family members. Benefits are available only when hospice care is received from a licensed hospice agency. Hospital care in a semiprivate room or an INTENSIVE CARE UNIT. Eligible hospital expenses include general nursing care, drugs, medications, diagnostic testing and use of equipment when administered by hospital employees. If you request a private room when it s not medically necessary for you to have one, reimbursement will be limited to the average charge for a semi-private room and any balance will be the patient s financial responsibility. Prenotification is recommended. Human organ transplants, including hospitalization and charges for immunosuppressive medications, organ procurement costs and donor s medical costs. Donor expenses will be reduced by the amount payable under any other plan. To be considered an eligible expense, the applicable Claims Administrator must determine that the transplant is medically necessary, appropriate and not experimental. Pre-notification is recommended. If the procedure is coordinated by medical management staff and performed at an approved facility located more than 50 miles from the patient s home, per diem travel (e.g. airplane fare, gas, and mileage from your own car, or car rental and related mileage) reimbursements may be payable for the patient and a companion. The search for bone marrow/stem cells from a donor who is not biologically related to the patient is a covered charge. The Program has specific guidelines regarding transplant services. Contact PPO Member Services for information about these guidelines. Infertility treatment (see family planning services under the ELIGIBLE MEDICAL EXPENSES section on page 36). Inpatient medical rehabilitation, limited to 120 days per calendar year, combined with the limit for SKILLED NURSING FACILITY services. 40 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

41 Mastectomy (see Predetermination for Surgical Procedures or Services on page 22). Maternity care including a physician s charges for pre-natal care, the services of a certified nurse/midwife and circumcision of newborns. (Conditions of the newborn are covered only if the child is enrolled for coverage during the applicable enrollment period.) Under federal law, group health plans and health insurance issuers (including this Program) generally may not restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother s or newborn s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not under federal law require that a provider obtain authorization from the plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours as applicable). Pre-notification is recommended for maternity stays expected to exceed 48 hours following a vaginal delivery or 96 hours following delivery via cesarean section. Mental health treatment (see MENTAL HEALTH and SUBSTANCE USE DISORDER TREATMENT on page 64). Morbid obesity surgery, if the applicable Claims Administrator s (UHC or BCBS) clinical guidelines are met. Patients who are at least age 21 will be considered for coverage of morbid obesity surgery provided his/her body mass index (BMI) is a minimum of 40 or is between 35 and 39.9 with documented life-threatening conditions, such as (but not limited to) cardiomyopathy, severe diabetes mellitus, cardiovascular disease or hypertension. Patients interested in this coverage should contact PPO Member Services for additional information. Prenotification is required for out-of-network morbid obesity surgery (and is recommended for in-network 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% (instead of 40%), even if all clinical guidelines are met. Nutritional counseling by a physician or registered dietician is covered up to four visits per calendar year. Occupational therapy (see outpatient short-term rehabilitation below). Outpatient private duty nursing when the care is prescribed by a physician and requires the education, training and technical skills of an Registered Nurse (R.N.) or Licensed Practical Nurse (L.P.N.). Reimbursement is generally limited to 40 visits per calendar year (in-network and out-of-network combined). One visit equals eight hours of care. Pre-notification is recommended. If you are enrolled in a UHC coverage option, all private duty nurse benefits are considered out-of-network benefits unless provided as part of an in-network home healthcare agency benefit. Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 41

42 Outpatient short-term rehabilitation, which includes physical, occupational and non-developmental-disabilityrelated speech therapy that is expected to improve or restore a bodily function that has been lost or impaired due to an injury, disease or congenital defect. Benefits are payable only for outpatient treatment by a physician or a licensed or certified therapist working under the direct supervision of a physician. Covered benefits include treatments and services for diagnoses of autism up to age 9, and diagnoses of developmental delays up to age 10. Reimbursement is generally limited to 30 visits (in-network and out-of-network combined) per calendar year for each of physical therapy, occupational therapy and speech therapy. Coverage for short-term rehabilitation is provided, as medically necessary, as long as there is improvement. Benefits are not provided once a maintenance level of functioning is achieved as then therapy is no longer considered medically necessary. Parent education, assistance and training in breast or bottle feeding, including comprehensive lactation support and counseling with each birth (covered as preventive care). Physical therapy (see outpatient short-term rehabilitation above). Physicians services received at home, in the hospital or in a physician s office to treat a specific illness or injury. Pregnancy termination, both elective and non-elective. Prescription drugs and medications (see PRESCRIPTION DRUG COVERAGE on page 55). Preventive care, limited to the following: Routine adult and pediatric physicals, including X-rays, laboratory or other tests given in connection with the exam, subject to these limits: Exams are covered both in- and out-of-network. There is no coinsurance or deductible requirement for innetwork preventive care. Routine pediatric care (including immunizations). The following frequency guidelines are suggested: Under 1 year of age 7 visits 1-4 years old 6 visits 5-11 years old 7 visits years old 6 visits th birthday 2 visits In- and out-of-network visit maximums are combined. 42 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

43 Routine gynecological exams (including a Pap smear and related lab fees); benefits for routine exams are payable for up to two exams a year. HPV testing as part of cervical cancer screenings for women over 30 Annual domestic violence screening and counseling Annual counseling for sexually transmitted infections Routine mammography (including office visits and lab bills), in accordance with established age and frequency guidelines. Routine prostate exams. Routine hearing examinations, limited to one exam per calendar year. Routine eye exam and refractive error testing, limited to one exam per calendar year. Standard adult and pediatric immunizations recommended by the Centers for Disease Control and Prevention. Routine prenatal care. Food and Drug Administration-approved contraceptive methods and counseling. Breastfeeding support, supplies, and counseling, including rental or purchase of a breast pump (the pump must be obtained from an in-network durable medical equipment provider to be covered under the program - contact Member Services for additional information). Any other preventive care services required under the federal Patient Protection and Affordable Care Act, to the extent applicable. Contact the applicable Claims Administrator s (UHC or BCBS) for information on covered preventive care benefits. Professional fees for surgical and medical services are professional fees for surgical procedures and other medical care received from a physician in a hospital, skilled nursing facility, inpatient rehabilitation facility, outpatient surgery facility, birthing center or any other covered facility. Prosthetic devices are appliances that replace a limb or body part, or help an impaired limb or body part work. Examples include, but are not limited to artificial limbs, artificial eyes and breast prosthesis following mastectomy as required by the Women s Health and Cancer Rights Act of 1998, including mastectomy bras and lymphedema stockings for the arm. Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 43

44 If more than one prosthetic device can meet your functional needs, benefits are available only for the most costeffective prosthetic device (i.e., the least expensive equipment that performs the necessary function). The device must be ordered or provided either by a physician, or under a physician s direction. Radiological therapy (such as X-ray, radium and radioactive isotope therapy), including a physician s charges, when prescribed by a physician to treat a covered illness or injury. Shoe orthotics prescribed by a physician. Skilled nursing facility expenses are payable for confinements necessary to recover from a disease or injury. Covered expenses include room and board, use of special treatment rooms, X-ray and lab work, physical, occupational or speech therapy and other medical supplies and services usually given by a convalescent or extended care facility. Pre-notification is recommended. Coverage is limited to 120 days (in-network and out-ofnetwork combined) per calendar year. Days spent in inpatient rehabilitation also count toward the 120 day limit. Benefits are also available for treatment of a sickness or injury that would have otherwise required an inpatient stay in a hospital. The patient is expected to improve to a predictable level of recovery. Custodial care is not covered. Speech therapy services, up to a limit of 30 visits (in-network and out-of-network combined) per calendar year. Additional visits may be authorized based on medical necessity. Speech therapy services include diagnosis of autism up to age 9. Coverage for speech therapy services are limited as follows: Services must be provided by a qualified speech therapist to do any of the following: Restore speech loss or impairment after a previous ability to speak. Develop or improve speech after surgery to correct a birth defect that impairs, or would have impaired, the ability to speak (if the condition cannot be surgically corrected, benefits will be paid even if surgery has not been performed. For children up to age 10 only, develop or improve speech impaired or delayed due to developmental disabilities that are directly related to an illness that caused the impairment or delay. Developmental disabilities relate to conditions for which an individual s growth and development fail to progress along accepted norms because of genetic, physical or psychological factors. They include, but are not limited to, attention deficit disorders, hyperactivity, expressive language disorder, dyslexia, growth delay, speech delay, stuttering and articulation disorder. 44 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

45 Speech-language pathology (SLP) coverage provides for the identification, assessment and treatment of speech, language and swallowing disorders in children and adults. Benefits are provided for therapy which facilitates the development and/or rehabilitation of functional communication and/or swallowing when provided by speech therapists, audiologists or medical doctors. Speech therapy services do no not include charges for educational therapy or developmental services not directly related to the therapy necessary to assist in the development of speech. Substance use disorder treatment (see MENTAL HEALTH and SUBSTANCE USE DISORDER TREATMENT on page 64). Surgical procedures on both an inpatient and outpatient basis, including pre- and post-operative care. This includes expenses incurred in a hospital, free-standing surgical facility or doctor s office. Reconstructive surgery is covered when the procedure is to correct conditions, functional problems or deformities that result from accidental injuries, disease or congenital anomalies. Surgery necessary to correct deformities due to malignancy is also covered. Pre-notification is recommended for all reconstructive procedures. Participants or beneficiaries who receive medical and surgical benefits in connection with a mastectomy, and who elect breast reconstruction in connection with such mastectomy, will be provided with coverage in a manner determined in consultation with the patient and attending physician for reconstruction of the breast on which the mastectomy was performed, surgery and reconstruction of the other breast to produce a symmetrical appearance, and prostheses and treatment of physical complications at all stages of the mastectomy, including lymphedemas. This applies to both in-network and out-of-network services. Covered surgical charges include: The surgeon s and ASSISTANT SURGEON s charges for surgery (an assistant surgeon s charges are reimbursed as a percentage of the surgeon s charge) Equipment and supplies for administering anesthesia Anesthesiologist s charges Drugs administered for consumption on the premises Blood transfusions Lab tests Medical and surgical supplies Charges for second opinions before elective surgery Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 45

46 When multiple procedures are performed by the same individual physician or other healthcare professional on the same date of service, benefits will be subject to the multiple procedure reduction policy. The Program will consider benefits based on the following: 100% of the NEGOTIATED CHARGE/REASONABLE AND CUSTOMARY charge for the primary/major procedure 50% of the negotiated charge/reasonable and customary charge for all subsequent procedures Temporomandibular joint (TMJ) disease, diagnostic services and treatment directed exclusively at the temporomandibular joint are covered. Coverage includes necessary treatment required as a result of accident, trauma, a CONGENITAL ANOMALY, developmental defect or pathology. Benefits are not available under the medical coverage options for charges for services that are dental in nature. Refer to the Dental Program Summary Plan Description for more information about TMJ treatment under the Dental Program. Vision care for routine eye exams and refractive error testing to detect vision impairment, limited to one exam per calendar year. For other vision benefits, see the Vision Program Summary Plan Description. Wigs are covered when the hair loss is due to treatment of malignancy or Alopecia Areata, or when permanent hair loss is caused by an accident. Wigs are covered as durable medical equipment up to 2 wigs per calendar year. The deductible does not apply, and there is no coinsurance requirement. X-ray and lab services directly related and necessary to a diagnosis, including pathology services. Benefits are also payable for outpatient pre-admission testing. Emergency Care Emergency care for life-threatening or severe medical conditions is always covered, 24 hours a day, seven days a week, no matter where you are. An emergency is a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson (including the parent of a minor child or the guardian of a disabled individual) who possesses an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in placing the health of the individual (or with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy; serious impairment to bodily function; or serious dysfunction of any bodily organ or part. See information on mental health/substance use disorder emergencies under In an Emergency on page 68. Care provided for urgent medical situations is not considered emergency care. 46 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

47 Benefits for Emergency Care If you have an emergency, immediately go to the nearest hospital emergency room or urgent care center, whether or not it is a network facility. The in-network level of benefits will be paid for an emergency admission to an out-of-network hospital. If you continue your stay in an out-of-network hospital after the date your physician determines that it is medically appropriate to transfer you to an in-network hospital, out-of-network benefits will apply. Benefits for Emergency Care Under the Out-of-Area Medical Coverage Option If you have an emergency, immediately go to the nearest hospital emergency room or urgent care center. Since there is no provider network in the Out-of-Area coverage option, the same benefits are payable for all eligible emergency care facilities (that is, in-network or out-of-network is not a consideration). Special Situations Moving to a Different Network Area Both UHC and BCBS offer national networks, so if you are planning to move within the U.S., you will likely be able to continue with the same medical program. If you are enrolled in an HMO, you will have to change your coverage option if you move out of the HMO coverage area. Contact the Time Warner Benefits Service Center at for more information about available medical coverage options in your new location if you are planning to move. Traveling Outside the U.S. If you need medical or mental health or substance use disorder care while traveling outside the U.S., get the appropriate services. If the provider will not seek reimbursement on your behalf, pay for the services, and then get a dated, itemized receipt from the provider to file the claim. Generally, covered services received while traveling outside of the U.S. are paid as out-of-network services. However, emergency care is paid at the in-network level of benefits. Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 47

48 What s Not Covered The following expenses are not covered under the medical coverage options administered by UHC and BCBS. If you are enrolled in a local Health Maintenance Organization (HMO), refer to your HMO s own materials for a description of ineligible expenses: Acupressure and other forms of alternative treatment as defined by the National Center for Complimentary and Alternative Medicine of the National Institutes of Health, Adoption or surrogate s expenses, Ambulance services, when used as routine transportation to receive inpatient or outpatient services, Any loss, illness or injury sustained while in the armed forces or caused or contributed to by an act of war, declared or undeclared, Any type of therapy, service or supply including, but not limited to spinal manipulations by a chiropractor or other doctor for the treatment of a condition which ceases to be therapeutic treatment and is instead administered to maintain a level of functioning or to prevent a medical problem from occurring or reoccurring, Artificial reproductive treatments done for genetic or eugenic (selective breeding) purposes, Autopsies and other coroner services and transportation services for a corpse, Charges by a PROVIDER sanctioned under a federal PROGRAM for reason of fraud, abuse or medical competency, and charges prohibited by federal anti-kickback or self-referral statutes, Charges for preparing medical reports, itemized bills or claim forms; mailing, shipping or handling expenses; charges for broken appointments or telephone calls or for any sales or other tax, Charges for room or facility reservations; completion of claim forms; record processing; or services, supplies or equipment that are advertised by the provider as free, For out-of-network services, charges that exceed the REASONABLE AND CUSTOMARY amount, Charges that would not have been made if you didn t have this coverage, Charges you are not legally required to pay, Chelation therapy, except to treat heavy metal poisoning, 48 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

49 Convalescent care, except as described under SKILLED NURSING FACILITY (this includes living arrangements designed to meet the needs of people who cannot live independently but do not require skilled nursing facility services) (see MENTAL HEALTH and SUBSTANCE USE DISORDER TREATMENT on page 64 for coverage for drug addiction and alcoholism), COSMETIC SURGERY for the purpose of changing the appearance of any part of the body to alter appearance or self-esteem, including any further medical expenditures arising from such cosmetic SURGERY, is not covered, whether or not for psychological or emotional reasons. However, the following are covered: reconstructive surgery to correct the results of an injury; surgery to improve the function of a part of the body (except a tooth or structure that supports the teeth) that is malformed as the result of a congenital defect, disease or a prior surgery performed to treat a disease or injury; surgery to reconstruct a breast after a mastectomy; and breast reduction and breast implant removal after a mastectomy, Custodial and/or maintenance care, Dental expenses, except as specified as eligible dental-related care and temporomandibular joint (TMJ) diseases, Devices used specifically as safety items or to affect performance in sports-related activities, Donor costs for organ or tissue transplantation to another person (these costs may be payable through the recipient s benefit plan), Drugs or methods of treatment not approved by the Food and Drug Administration (FDA), the American Medical Association (AMA) or the appropriate medical specialty society, or considered to be experimental or investigational in nature, Education, training, and bed and board while confined to an institution that is mainly a school or other institution for training, a place of rest, a place for the aged or a nursing home, Educational services or supplies. Educational means that the primary purpose of the service is to provide training in activities of daily living (beyond the training directly related to restoration of function lost because of a specific illness or injury), instruction in scholastic skills, treatment for learning disabilities or job training, Enteral feedings and other nutritional and electrolyte formulas, including infant formula and donor breast milk, unless because of a diagnosed medical condition, it is the sole source of nutrition, Expenses for ecological or environmental medicine, diagnosis or treatment or for herbal medicine, holistic or homeopathic care, including drugs, Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 49

50 Expenses for or related to aromatherapy, hypnotism, massage therapy, primal therapy, Rolfing, psychodrama, megavitamin therapy, nutrition-based therapy, bioenergetic therapy, vision perception training or carbon dioxide therapy, Expenses in excess of Plan or Program limits, Expenses incurred before you or your dependent become covered, or after coverage ends, including health services for medical conditions which began before the date your coverage ends, Expenses payable under any other COMPANY-sponsored plan or program, Expenses resulting from your involvement in a felony or other criminal act, Growth hormone therapy, Hearing expenses, except as specified as eligible hearing aid devices and for routine hearing exams considered preventive care, INFERTILITY testing, counseling, treatments and procedures after voluntary sterilization procedures such as tubal ligation or vasectomy, Liposuction, Marriage, family, child, career, social adjustment, pastoral or financial counseling, Mechanical or animal organ transplants, except services related to the implant or removal of a circulatory assist device (a device that supports the heart while the patient waits for a suitable donor heart to become available), Medical and surgical treatment of snoring, except when provided as a part of treatment for documented obstructive sleep apnea. Appliances for snoring are always excluded, Membership costs for health clubs or smoking cessation programs, Non-surgical treatment of obesity, even if there is a diagnosis of morbid obesity, Nutritional counseling, weight loss clinics or similar programs (except when part of a treatment program for eating disorders or obesity), or costs of special foods, food supplements, liquid diets, diet plans or any related products, Nutritional, dietary or electrolyte supplements, food of any kind (diabetic, low fat, cholesterol), oral vitamins and oral minerals, except to the extent covered as preventive care, 50 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

51 Parenting, pre-natal or birthing classes, or services provided by a doula (labor aide), except as specified under parent education, assistance and training, Personal comfort items (such as a television or telephone while hospitalized), Pharmacological regimens, nutritional procedures or treatments, Physical conditioning programs such as athletic training, bodybuilding, exercise, fitness, flexibility and diversion or general motivation, Physical or occupational therapy or chiropractic care that is maintenance in nature and not for treatment of sickness or injury (for example, visits to a chiropractor for routine adjustments are not covered), Physicians services in connection with corns, calluses or toenails, unless the charges are for the partial or complete removal of nail roots or for services prescribed by a physician who is treating the patient for a metabolic or peripheral vascular disease, Physicians services in connection with weak, strained or flat feet, any instability or imbalance of the foot, or any metatarsalgia or bunion, unless the charges are for an open cutting operation, Preventive dental care; diagnosis or treatment of the teeth or gums, such as extractions and restoration and replacement of teeth; dental implants and braces; or treatment of congenitally missing, malpositioned or supernumerary (extra) teeth, even if part of a CONGENITAL ANOMALY, Private duty nursing while confined in a HOSPITAL or other facility, Procedures or surgery to remove fatty tissue such as panniculectomy, abdominoplasty, thighplasty, brachioplasty or mastopexy, Replacement of an existing intact breast implant if the earlier breast implant was performed as a cosmetic surgery (other than following a mastectomy), Rest cures or respite care for caregivers of terminally ill patients, Reversal of a voluntary sterilization procedure, Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 51

52 Routine physical exams, except as described in preventive care. In addition, the following are not covered under the medical coverage options administered by UHC and BCBS (however, see MENTAL HEALTH and SUBSTANCE USE DISORDER TREATMENT on page 64 for benefits that may be available under the coverage administered by Optum): Behavioral health examinations, Psychiatric, Psychological, Personality or emotional exams or testing (including for employment, licensing, insurance, school, career, education, marriage, incarceration, camp, sports or adoption), Examination or treatment ordered by a court in connection with legal proceedings, and Exams conducted for purposes of medical research or exams given while the patient is in a hospital or other medical facility. Services and supplies furnished mainly to provide a surrounding free from exposure that can worsen the person s disease or injury, Services for hygienic and preventive maintenance foot care or treatment of subluxation (joint or bone dislocation) of the foot, Services for the evaluation and treatment of temporomandibular joint syndrome (TMJ) when the services are considered dental in nature, including oral appliances. Services that are considered medical in nature may be covered and are described under temporomandibular joint (TMJ) disease, Services furnished for or by the U.S. government, or any other government, that results in no charge for the treatment provided, Services of a resident physician or intern billed apart from hospital services, Services ordered or delivered by a Christian Science practitioner or mohel, Services or supplies that do not require the technical skills of a medical professional, Services provided at a diagnostic facility (hospital or otherwise) without a written order from a provider, or ordered by a provider affiliated with a diagnostic facility (hospital or otherwise), when that provider is not actively involved in your medical care (either before or after the service, other than mammography, is ordered), 52 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

53 Services provided at no cost or when received as a result of legal action or settlement, Services provided by a personal care assistant, Services rendered by an unlicensed provider, a provider acting outside the scope of his or her license or a provider who has your same legal residence, Services rendered by any provider who is a family member OPPOSITE-SEX SPOUSE, SAME-SEX SPOUSE, DOMESTIC PARTNER, parents, grandparents, child and siblings of the EMPLOYEE or dependent or by a volunteer who would not normally charge for services, Services, supplies and treatment considered by UHC or BCBS to be experimental or investigative, unproven or provided primarily for research, Services, supplies and treatment that are not medically necessary, except specified preventive care, Services, supplies and treatment that are not prescribed by a physician, Services, supplies or treatment furnished solely because of the setting if the service, supply or treatment could safely and adequately be furnished in a physician s or dentist s office or other less costly setting, Services, supplies or treatment furnished solely because the person is an inpatient on any day on which the person s disease or injury could safely and adequately be diagnosed or treated while not confined, Spinal treatment to treat a condition unrelated to alignment of the vertebral column, such as asthma or allergies, Storage of blood, umbilical cord or other material for use in a covered health service, except if needed for an imminent surgery, Supplies, equipment and similar incidentals for personal comfort. Examples include: air conditioners, beauty/barber service, air purifiers and filters, batteries and battery chargers, dehumidifiers and humidifiers, nonhospital beds and comfort beds, devices and computers to assist in communication and speech, home remodeling to accommodate a health need, Surgery and other related treatment that is intended to correct nearsightedness, farsightedness, presbyopia and astigmatism including, but not limited to, procedures such as laser and other refractive eye surgery and radial keratotomy, Surgical treatment of obesity unless there is a diagnosis of morbid obesity with a body mass index of 35 to 39.9 with comorbidities or at least 40 without comorbidities and the patient is at least 21 years old, Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 53

54 Tattoo or scar removal or revision procedures (such as salabrasion, chemosurgery and other such skin abrasion procedures), Telephone consultations, The following HOSPICE care expenses: funeral arrangements; religious counseling; financial or legal counseling (including estate planning or the drafting of a will); or homemaker or caretaker services, Transplants (organ or tissue) that are determined by medical management not to be proven procedures for the involved diagnoses, or not consistent with the diagnosis of the condition, Travel or transportation expenses, even if ordered by a physician, except for covered ambulance services or travel or transportation as may be provided when using a specialty care facility, Treatment (except initial diagnosis) in connection with pervasive development disorders, chronic organic brain syndrome or learning disability, Treatment of benign gynecomastia (abnormal breast enlargement in males), Treatment of hyperhidrosis (excessive sweating), Treatment resulting from an occupational accident or illness that is covered by Worker s Compensation or similar legislation or programs if you could elect it or could have it elected for you, Treatment, services and supplies (including prescription drugs) that are unlawful where the person resides when the expenses are incurred, Treatments for hair loss, Use of whole body CT scanning, including conventional CT scanning, helical CT scanning, electron-beam CT (EBCT) and multislice CT (MSCT), is considered investigational when used for whole body imaging for general screening (i.e., in patients without signs and symptoms of disease), Varicose vein treatment of the lower extremities, when it is considered cosmetic surgery, Vision expenses, other than routine eye exams as described in preventive care (see the Vision Program Summary Plan Description for coverage available through EyeMed), Weight reduction or control treatment (other than morbid obesity surgery), and Wigs or hairpieces (except as described under wigs in ELIGIBLE MEDICAL EXPENSES on page 36), hair transplants, hair weaving or any drugs used to treat or prevent baldness. This list is not an all-inclusive list. If you have any questions about whether an expense is covered, please contact the appropriate CLAIMS ADMINISTRATOR. 54 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

55 PRESCRIPTION DRUG COVERAGE CVS Caremark Health Solutions, Inc. (CVS Caremark) is the CLAIMS ADMINISTRATOR for prescription drugs for participants who are not enrolled in HMO coverage options. CVS Caremark has established a NETWORK of participating pharmacies separate and apart from the medical PROVIDER network established by UHC and BCBS and has its own procedures for you to follow to maximize benefits. If you are enrolled in a Health Maintenance Organization (HMO), refer to your HMO s own materials for a description of eligible prescription drug expenses. HOW PRESCRIPTION DRUG COVERAGE WORKS There are two ways to fill prescriptions: at a retail pharmacy or through the mail order pharmacy. Benefits for prescription drugs depend on whether you use a NETWORK pharmacy (as described below), not whether an innetwork or out-of-network PROVIDER issues the prescription. If you enroll in a UHC or BCBS coverage option, you will receive a CVS Caremark prescription ID card to access prescription drug benefits. PREFERRED PROVIDER ORGANIZATIONS (PPOs) Using a Network Retail Pharmacy To receive in-network benefits at a network retail pharmacy, present your ID card when you have your prescription filled. You pay your share of the cost at the time of purchase; there are no claims to file. If you are enrolled in the PPO, and you request a BRAND-NAME DRUG when a generic equivalent is available and your doctor has not written Dispense As Written or DAW on your prescription, you are responsible for your share of the cost of the generic equivalent drug, plus 100% of the cost difference between the brand-name drug and the GENERIC DRUG equivalent. Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 55

56 You can get up to a 30-day supply per prescription filled at a retail pharmacy. (You may obtain up to a 90-day supply of a maintenance medication filled at a CVS pharmacy.) You can renew a prescription no earlier than the 10-day period before you use up your 30-day supply. If you have a maintenance medication or other medication that you fill regularly, you should consider using CVS Caremark s mail order drug service or a local CVS pharmacy. If you are enrolled in the PPO and you don t switch to mail order or a CVS pharmacy and instead continue to fill your prescription at a network retail pharmacy (other than a CVS pharmacy), you will be charged 75% of the cost of the medication after three fills of the same medication. This increased cost only applies to medication that can legally be filled through mail order. If you are enrolled in the Health Savings PPO, 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 for maintenance medications. Network pharmacies are listed on CVS Caremark s website at Using an Out-of-Network (Non-Network) Retail Pharmacy If you have your prescriptions filled at a pharmacy that is not in the CVS Caremark network, you will have to pay 100% of the cost of your medications when you have your prescription filled. You will be reimbursed 60% of the amount the covered drug would have cost at an in-network retail pharmacy, minus the amount you would have paid as coinsurance at an in-network retail pharmacy. Prescription Drug Benefits as an Inpatient If you are an inpatient at a HOSPITAL or residential facility, prescriptions are reimbursed by your medical CLAIMS ADMINISTRATOR on the same basis as any other eligible inpatient expense. Similarly, OptumHealth will handle reimbursement of prescriptions while you re under inpatient care for treatment of mental health and substance use disorder. Using the Mail Order Pharmacy CVS Caremark s mail order drug service is designed for those who take maintenance drugs (medication taken on a regular basis for chronic conditions such as high blood pressure, arthritis, diabetes and asthma). Here s how to fill your prescription by mail: When your doctor prescribes a maintenance drug, ask to have the prescription written for up to a 90-day supply with up to three refills. If you need the medicine right away, ask your doctor to write two prescriptions one for 30 days for you to fill immediately at your local network retail pharmacy, and a second, for 90 days with up to three refills, to send to the mail order pharmacy for a long-term supply. 56 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

57 For your first order, fill out the mail service PROGRAM order form. These forms are available from the Time Warner Benefits Service Center at Complete the CVS Caremark mail order form for each new prescription. Either send a check payable to CVS Caremark or provide your credit card information on the form. Please do not send cash through the mail. Enclose your maintenance drug prescription, the order form and your payment in the pre-addressed mail service envelope. Your medications are delivered to you at home postage-paid. Allow days after the prescription is filled for delivery of your medicine. Overnight delivery is available for an additional charge. A new order form and envelope will be sent to you with each delivery. These forms are also available on and You can also order refills by phone (call ) or through the CVS Caremark website ( Please have your prescription number and credit card ready when you call or log on. Refills may be ordered no sooner than 20 days before the prior supply runs out. You should receive them within 7 10 days. Prescription requests for medicines not available through the mail (such as narcotics) will be returned to you. In addition to the mail-order program, you have the option to receive your 90-day supply of maintenance medications at a retail CVS pharmacy. As described above, you pay your share of the cost when you submit your mail order prescription; there are no claims to file. If you are enrolled in the PPO and you request a brand-name drug when a generic equivalent is available and your doctor has not written Dispense As Written ( DAW ) on your prescription, you are responsible for your share of the generic copay/coinsurance plus 100% of the cost difference between the brand-name and the generic drug. If Network Pharmacies Cannot Fill Your Prescription In almost all cases, prescriptions are available through a network pharmacy and by mail order. If your local network pharmacy cannot assist you, contact CVS Caremark to make other arrangements. Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 57

58 PPOs at a Glance PPO Prescription Drug Coverage Administered by CVS Caremark PROGRAM PROVISION Network Retail Pharmacy* 30-Day Supply Mail Order/CVS Pharmacy 90-Day Supply Deductible None None Short-Term Medications Generic You pay 10% coinsurance PROGRAM pays 90% $10 minimum/prescription $40 maximum/prescription Brand Name** You pay 20% coinsurance Program pays 80% $20 minimum/prescription $60 maximum/prescription You pay 10% coinsurance Program pays 90% $25 minimum/prescription $100 maximum/prescription You pay 20% coinsurance Program pays 80% $65 minimum/prescription $150 maximum/prescription Maintenance Medication (After three fills)*** Generic You pay 75% coinsurance Program pays 25% $10 minimum/prescription $100 maximum/prescription Brand Name** You pay 75% coinsurance Program pays 25% $20 minimum/prescription $100 maximum/prescription You pay 10% coinsurance Program pays 90% $25 minimum/prescription $100 maximum/prescription You pay 20% coinsurance Program pays 80% $65 minimum/prescription $150 maximum/prescription * If you use a non-network retail pharmacy, you will be reimbursed 60% of the amount the drug would have cost at a network retail pharmacy minus your retail coinsurance payment. ** If you request a BRAND-NAME DRUG when a generic equivalent is available and your doctor has not written Dispense as Written ( DAW ) on your prescription, you are responsible for the generic copay/coinsurance amount plus the cost difference between the brand-name and GENERIC DRUG. *** After three fills of the same medication at a retail pharmacy (other than a CVS pharmacy), coinsurance increases to 75% and the higher maximum applies. These increased costs only apply to medication that can legally be filled through mail order. Contact CVS Caremark for information on converting your prescription to mail order or transferring your prescription to a CVS pharmacy. 58 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

59 Health Savings PPO Prescription Drug Coverage Administered by CVS Caremark PROGRAM PROVISION Deductible*** Out-of-Pocket Maximum*** Generic Brand Name Network Retail Pharmacy* 30-Day Supply See Health Savings PPO deductible See Health Savings PPO maximum 20% after deductible, no minimum or maximum Mail Order/CVS Pharmacy** 90-Day Supply See Health Savings PPO deductible See Health Savings PPO maximum 20% after deductible, no minimum or maximum * If you use a non-network retail pharmacy, you will be reimbursed based on the cost at a network retail pharmacy minus your retail coinsurance payment. ** Mail order generally provides deeper discounts for maintenance medications. *** There is no separate deductible for prescription drug coverage. You are responsible for paying 100% of covered prescription drug expenses until the integrated medical and prescription drug deductible is met. Prescription drug coverage applies to the overall Health Savings PPO deductible and out-of-pocket maximum. Out-of-Area at a Glance Out-of-Area Prescription Drug Coverage Administered by CVS Caremark PROGRAM PROVISION Network Retail Pharmacy * 30-Day Supply Mail Order/CVS Pharmacy 90-Day Supply Deductible None None Short-Term Medications Generic You pay 10% coinsurance PROGRAM pays 90% $10 minimum/prescription $40 maximum/prescription Brand Name** You pay 20% coinsurance Program pays 80% $20 minimum/prescription $60 maximum/prescription $25 copay $65 copay Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 59

60 Out-of-Area Prescription Drug Coverage Administered by CVS Caremark PROGRAM PROVISION Network Retail Pharmacy * 30-Day Supply Mail Order/CVS Pharmacy 90-Day Supply Maintenance Medication (After three fills)*** Generic You pay 75% coinsurance Program pays 25% $10 minimum/prescription $100 maximum/prescription Brand Name** You pay 75% coinsurance Program pays 25% $20 minimum/prescription $100 maximum/prescription $25 copay $65 copay * If you use a non-network retail pharmacy, you will be reimbursed 60% of the amount the drug would have cost at a network retail pharmacy minus your retail coinsurance payment. ** If you request a BRAND-NAME DRUG when a generic equivalent is available and your doctor has not written Dispense as Written ( DAW ) on your prescription, you are responsible for the generic copay/coinsurance amount plus the cost difference between the brand-name and GENERIC DRUGs. *** After three fills of the same medication at a retail pharmacy (other than a CVS pharmacy), coinsurance increases to 75% and the higher maximum applies. These increased costs only apply to medication that can legally be filled through mail order. Contact CVS Caremark for information on converting your prescription to mail order or transferring your prescription to a CVS pharmacy. PRESCRIPTION DRUG COVERAGE AND MEDICARE PART D MEDICARE prescription drug coverage is available to everyone eligible for Medicare through Medicare Part D prescription drug plans. The COMPANY has determined that the prescription drug coverage under the PPO and OOA coverage options under this PROGRAM is, on average for all participants, expected to pay as much or more than the standard Medicare prescription drug benefit. Therefore, because your existing drug coverage is on average at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay a late penalty if you do not enroll in Medicare prescription drug coverage upon first becoming eligible for Medicare Part D. If you decide to enroll in a Medicare Part D prescription drug plan, you will still have prescription drug coverage under this Program for long as you have medical coverage under the Program. Participants eligible for Medicare receive an annual creditable coverage notice that includes more information. For a copy of the notice, contact the PLAN ADMINISTRATOR. 60 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

61 ELIGIBLE PRESCRIPTION DRUG EXPENSES Prescription drugs and medications are covered when prescribed to treat an injury or illness and dispensed by a pharmacist acting within the scope of his or her license. The following drugs and supplies are covered: Drugs or compounded prescriptions which may be dispensed only by prescription and must be labeled Caution: federal law prohibits dispensing without prescription (called legend drugs), Insulin and other supplies for treatment of diabetes, such as blood glucose monitors and diabetic testing strips, Needles and syringes, INFERTILITY medications, subject to the $25,000 lifetime maximum (see family planning services/infertility treatments under ELIGIBLE MEDICAL EXPENSES on page 36), Food and Drug Administration-approved contraceptives (GENERIC DRUGs and brand names with no generic equivalent are covered as preventive care at 100% with no deductible) with a prescription, Legend vitamins (except pediatric fluoride if age 17 or older), and Drugs to treat impotency. In addition, to the extent required under the federal Patient Protection and Affordable Care Act, certain preventive care over-the-counter medications and supplies are eligible for coverage with a prescription. For example, aspirin may be covered as a preventive care expense (with a prescription) if your physician determines that the potential benefit due to a reduction in the risk of heart attack outweighs the potential harm. Contact CVS Caremark for information on benefits available for over-the-counter preventive care drugs and supplies. See What s Not Covered on page 62 under ELIGIBLE PRESCRIPTION DRUG EXPENSES on page 61 for those expenses that are specifically excluded from reimbursement. Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 61

62 What s Not Covered The following prescription drug services or supplies are not covered under the prescription drug coverage administered by CVS Caremark: Any prescription drug that is not a federal legend drug, The administration or injecting of drugs or insulin, Therapeutic devices or appliances of any type (however, see the benefits for DURABLE MEDICAL AND SURGICAL EQUIPMENT available through the medical coverage administered by UHC and BCBS), Anti-wrinkle agents (e.g., Renova), Minoxidil (Rogaine) for the treatment of alopecia all drugs that promote or stimulate hair growth are excluded, Investigational agents or experimental drugs, or any drug labeled Caution limited by federal law to investigational use, Medication to be taken by or administered to an individual, in whole or in part, while the individual is an inpatient at any medical facility, A quantity of drugs in excess of the amounts normally prescribed, Over-the-counter drugs or supplies (except insulin when a state does not require a prescription for it, and eligible preventive care over-the-counter drugs and supplies prescribed by a physician) Any refill of a drug if it is more than the number of refills specified by the prescribing physician, Any refill of a drug dispensed more than one year after the latest prescription for it or dispensed later than legally allowed where the drug is dispensed, Cosmetic drugs, Legend drugs with over-the-counter equivalents, Nutritional or food supplements, Homeopathic drugs, Allergy sera, 62 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

63 Biologicals, Immunization agents or vaccines (coverage for preventive care immunizations or vaccines is available through the medical coverage administered by UHC and BCBS), Blood or blood plasma products, IUDs (coverage for IUDs is available through the medical coverage administered by UHC and BCBS),and Mifeprex. However, note that some of these excluded prescription drug services or supplies may be covered under the PROGRAM as part of the medical benefits administered by UHC, BCBS or Optum. Botox Coverage Botulinum toxin type A (Botox) will be covered for use in the exclusive treatment of the following conditions: Cervical dystonia (spasmodic toricollis), Strabismus and blepharospasm associated with dystonia, Spasmodic dystonia (laryngeal dystonia), Hand dystonia (writer s, musician s or typist s cramp), Torsion dystonia, Tongue dystonia, Hand tremor, Migraine, Voice tremor, Cerebral palsy associated spasticity, Stroke-associated spasticity, Multiple sclerosis-associated spasticity, Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 63

64 Chronic anal fissures, Achalasia, Hyperhidrosis (Frey s Syndrome), Piriformis syndrome, Hemifacial spasm (seventh cranial nerve disorders), Sialorrhea, Detrusor-sphincter dyssynergia, and Oromandibular dystonia. Botox will not be covered for any cosmetic treatments. OTHER BENEFITS UNDER THE MEDICAL PLAN OPTIONS MENTAL HEALTH AND SUBSTANCE USE DISORDER TREATMENT Optum is the CLAIMS ADMINISTRATOR for the treatment of mental health and substance use disorders for participants who are not enrolled in an HMO coverage option. Optum has its own PROVIDER NETWORK separate and apart from the medical provider network established by UHC and BCBS and its own procedures for you to follow to maximize benefits. You can reach Optum 24 hours a day by calling their Customer Service Center; you do not have to contact your primary care physician first. If you are enrolled in a Health Maintenance Organization (HMO), refer to your HMO s own materials for a description of eligible mental health and substance use disorder treatment expenses. 64 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

65 Benefits are paid only for treatment of mental health and substance use disorder services that Optum determines are clinically necessary. Submission of claims for mental health and substance use disorder treatments does not guarantee payment of benefits. The amount the PROGRAM will pay depends on whether you go in-network or out-ofnetwork for your care. For a list of network providers in your area, log on to (access code: TW) or call Optum at Arranging for Benefits In-Network Coverage To go in-network for treatment of mental health and substance use disorder, call Optum at at any time 24 hours a day, seven days a week. A trained clinician, called an Intake Counselor, will discuss your needs with you and refer you to one or more appropriate network providers. As long as you comply with in-network guidelines, maximum benefits will be payable, and there are no claim forms for you to complete. IMPORTANT If you elect to have treatment provided by a non-contracted, out-of-network clinician and/or facility, you are responsible for any amounts not paid by the PROGRAM because the treatment is not medically necessary, is not being provided by an appropriate, licensed PROVIDER, or is otherwise not eligible for coverage. To avoid unexpected costs, it is recommended that you precall Optum at to pre-authorize all inpatient, residential, and partial hospitalizations, and certain outpatient treatments (see list of outpatient treatments for which preauthorization is recommended in Outpatient Care on page 66. You are responsible for filing outof-network claims. Out-of-Network Coverage If you go out-of-network, you may use any licensed provider qualified to render mental health and substance use disorder treatment. The Program will only pay for clinically necessary treatments from a licensed provider. If you receive treatment from an in-network provider and coordinate your care through Optum, then your Care Manager will direct you to an appropriate, licensed provider. If you choose to seek out-of-network care, it is your responsibility to ensure that your provider is licensed and qualified. You or your provider may wish to request a predetermination of benefits and a periodic review of your treatment plan by Optum to confirm the clinical need for proposed out-ofnetwork treatment in order to limit your financial risk. Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 65

66 The Program generally covers eligible out-of-network expenses at 60% of the REASONABLE AND CUSTOMARY charge less than when you go in-network and benefits are payable only after you satisfy the combined medical and mental health/substance use disorder annual deductible. Separate annual deductibles for in-network and out-ofnetwork services apply. Therefore, if you have satisfied your in-network deductible and then decide to see an out-ofnetwork provider, you must also satisfy the full out-of-network deductible before the Program will pay for out-ofnetwork services. In addition to the 40% coinsurance and out-of-network deductible, you are solely responsible for any amount over what the CLAIMS ADMINISTRATOR determines is the reasonable and customary charge. Finally, when you go out-of-network, you are responsible for pre-authorization of all inpatient care and of certain outpatient treatments and for filing claims. Annual Deductible and Out-of-Pocket Maximum Covered mental health and substance use disorder services are subject to the combined medical and mental health/substance use disorder annual deductible. Your share of the in-network and out-of-network coinsurance plus the annual deductibles (if any) are applied toward the combined medical and mental health/substance use disorder annual out-of-pocket maximum. See the PREFERRED PROVIDER ORGANIZATIONS (PPOS) on page 22 and OUT-OF-AREA (OOA) Option on page 31, as applicable, for information about how the annual deductible and outof-pocket maximum are applied. Outpatient Care In-Network Care To receive outpatient mental health or substance use disorder care benefits at the lowest cost for you and the Program, you should start by calling Optum for assistance. When you call Optum, your Intake Counselor will work with you to help assess your needs and then give you the names and telephone numbers of one or more network providers. The network consists only of licensed professionals such as psychiatrists, psychologists, clinical social workers and marriage/family/child counselors, and also includes treatment programs, hospitals and other clinical providers. Please let your Intake Counselor know if you have a preference for a male or female practitioner, or for a provider who speaks a language other than English. Once you have received a network provider s name, call as soon as possible to schedule an appointment. For the most part, appointments are available within 72 hours of your call. After you have made your appointment, call Optum to let them know so that they may process any recommended authorizations. Pre-authorization permits you to receive an advance confirmation that a proposed non-routine treatment or service is medically necessary. If you do not make an initial appointment with your provider within 30 days of calling Optum, you should call an Intake Counselor for a new authorization, if pre-authorization is recommended. 66 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

67 At your first visit (known as your assessment visit ), the provider will discuss your concerns with you, make a diagnosis and recommend a treatment plan. Then, the network provider will contact an Optum Care Manager and coordinate the treatment plan. During your treatment, the Care Manager will work with your mental health provider to ensure that the treatment plan is being followed and remains appropriate for your needs. This limits your exposure to unnecessary medical and financial risk by confirming the need for proposed treatments. By coordinating your care through Optum, your Intake Counselor and Care Manager will direct you to appropriate care providers and will assist you in creating a treatment plan that satisfies in-network guidelines so that you receive the maximum Program benefits. If you want to change a provider, call Optum. An Intake Counselor will recommend different network providers. If you cannot keep an appointment, contact the provider at least 24 hours in advance (or within the period specified in the provider s cancellation policy, if other than 24 hours). If you don t, you may be charged the full per-visit cost or some portion of it. The Program will not pay any benefits in-network or out-of-network for cancelled appointments unless the cancellation is due to an EMERGENCY. Going Out-of-Network for Outpatient Care You may choose to use a provider outside of the Optum network for your outpatient care. It is your responsibility to ensure that your provider is licensed and qualified. All outpatient mental health or substance use disorder care is subject to review by Optum for clinical necessity, whether in-network or out-of-network. Pre-Authorization Recommended To confirm that your treatment will be determined to be clinically necessary, and to avoid unexpected costs, it is recommended that you contact Optum by calling for pre-authorization/pre-notification for the following non-routine outpatient services: Intensive outpatient program treatment Outpatient electro-convulsive treatment Psychological testing Methadone maintenance Extended outpatient treatment visits beyond minutes in duration with or without medication management Applied behavioral analysis (ABA) for the treatment of autism Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 67

68 Inpatient Care In-Network Care To ensure that you receive mental health or substance use disorder treatment benefits for inpatient care at the lowest cost for you and the Program, you should work with your Optum network provider, in conjunction with the Care Manager, to arrange the admission to a network HOSPITAL or rehabilitative residential treatment facility. Going Out-of-Network for Inpatient Care If you bypass the network for inpatient care, you should notify Optum in advance and follow Optum guidelines to receive maximum coverage. When you call to notify Optum about out-of-network hospitalization, Optum may recommend alternative services or hospitalization in a network facility. If you stay in the out-of-network facility, you or your provider may request a predetermination of benefits and a periodic review of your treatment plan by Optum. Predetermination limits your exposure to unnecessary medical and financial risk by confirming the clinical need for the proposed treatment and the appropriate licensure of your out-of-network provider. If benefits at the out-of-network facility are not predetermined by Optum or concurrently reviewed, the providers and services will be reviewed retrospectively (after services are provided and charges are incurred) for clinical necessity and appropriate licensure. Depending on Optum s assessment, benefits could be denied, and you could be responsible for the full cost of your treatment. All inpatient mental health or substance use disorder care is subject to review by Optum for clinical necessity, whether in-network or out-of-network. In an Emergency Optum defines an emergency as an unforeseen BEHAVIORAL DISORDER, substance abuse emergency or psychological problem that requires immediate clinical attention. That is, without treatment, one could reasonably be expected to suffer serious physical or psychological impairment or death, or be a danger to oneself or others. If you or a covered dependent experience an acute behavioral disorder or substance use disorder emergency, go immediately to a hospital emergency room. Benefits for emergency care are payable at the in-network level, even if you receive care from an out-of-network provider. If emergency care results in an inpatient admission, Optum should be notified as soon as possible within two business days to ensure that your treatment is covered at the maximum benefit level under the Program. (Notification is not required, but failure to notify Optum means that you run the risk of incurring expenses for services and treatments that may not be covered services under the Program.) If you continue your stay in an out-of-network hospital after the date your treating physician determines that it is medically appropriate to transfer you to an in-network hospital, out-of-network benefits will apply. All emergency care is subject to review by Optum for clinical necessity, whether in-network or out-of-network. 68 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

69 If you are traveling and need care, call Optum for a referral to the provider or facility that will best meet your needs. Eligible Mental Health and Substance Use Disorder Expenses The PROGRAM covers services and supplies provided for the purpose of preventing, diagnosing or treating a BEHAVIORAL DISORDER, psychological injury or SUBSTANCE USE DISORDER OR CHEMICAL DEPENDENCY, which meet the following guidelines: The services are provided by a physician, psychologist, licensed counselor, HOSPITAL, treatment center or social worker. Providers must be licensed for the field in which they are practicing, and the services provided must be within the scope of their license. Services and supplies are not automatically covered because they were prescribed by a PROVIDER. Covered services include, but are not limited to, assessment; diagnosis; treatment planning; medication management; and individual, family and group psychotherapy. The services are for any sickness which is identified in the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), including a psychological and/or physiological dependence or addiction to alcohol or psychoactive drugs or medications, regardless of any underlying physical or organic cause, or any sickness where the treatment is primarily the use of psychotherapy or other psychotherapeutic methods. All inpatient services, including room and board, given by a mental health facility or area of a hospital which provides mental health or substance use disorder treatment for a sickness identified in the DSM, are covered, except in the case of multiple diagnoses. If there are multiple diagnoses, only the treatment for the sickness which is identified in the DSM is covered. What s Not Covered In addition to the general exclusions described in What s Not Covered on page 48 under ELIGIBLE MEDICAL EXPENSES on page 36, the following expenses are not covered under the Mental Health and Substance Use Disorder coverage administered by Optum: Alternative treatments, including herbal medicine; holistic or homeopathic care; and ecological or environmental medicine, diagnosis or treatment, Charges for missed appointments, record processing or failure to complete forms, Charges in excess of specified PROGRAM limitations, Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 69

70 Custodial care, except for the acute stabilization and return back to the normal baseline of individual functioning, Detoxification services given prior to and independent of a course of psychotherapy or substance use disorder treatment, Education, training, and room and board while confined in an institution that is mainly a school or other institution for training, a place of rest, a place for the aged or a nursing home, Examination or treatment solely for purposes of career, education, sports or camp, travel, employment, insurance, marriage or adoption, court order (except as required by law), medical research, or the obtaining or maintaining of a license of any type, Examinations or treatments ordered by a court in connection with legal proceedings unless otherwise qualified as covered services, Light boxes and other durable medical equipment, Neuropsychological testing for the diagnosis of attention deficit disorder, Nutritional counseling, Personal convenience or comfort items, Prescription drugs (but see PRESCRIPTION DRUG COVERAGE on page 55 for Program coverage information), Private duty nursing services while confined in a facility, Sensitivity training, educational training therapy or treatment for an education requirement, Services for which you have no legal responsibility to pay, or for which a charge would not ordinarily be made in the absence of coverage under the Program, Services given by volunteers or persons who do not normally charge for their services, Services or supplies that are not clinically necessary, Services or supplies that are unproven, investigational or experimental, meaning they do not meet generally accepted standards of medical practice in the United States, 70 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

71 Services or supplies that, in the reasonable judgment of Optum, are any of the following: Not consistent with the symptoms and signs of diagnosis and treatment of the BEHAVIORAL DISORDER, psychological injury or substance use disorder, Not consistent with prevailing professional research demonstrating that the services or supplies will have a measurable and beneficial health outcome, Typically do not result in outcomes demonstrably better than other available treatment alternatives that are less intensive or more cost effective, and Not consistent with Optum s Level of Care Guidelines or best practices, as modified from time to time. Services or treatment rendered by unlicensed providers, including pastoral counselors (except as required by law), or which are outside the scope of the PROVIDER s licensure, Services performed in connection with conditions not classified in the current edition of the DSM, Services performed by a family member or a provider with the same legal residence, Stand-by services of a physician, Surgical procedures, including but not limited to sex transformation operations (but see gender reassignment SURGERY in ELIGIBLE MEDICAL EXPENSES on page 36 for coverage information under the medical benefits administered by UHC and BCBS), Telephone consultations, Travel or transportation services unless Optum has requested and arranged for transfer by ambulance from one facility to another, Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 71

72 Treatment or services, except for initial diagnoses, for a primary diagnosis of mental retardation; learning, motor and communication disorders; pervasive developmental disorder; conduct disorder; dementia; sexual paraphilia and gender identity disorders; and personality disorders; as well as other mental illnesses that will not substantially improve beyond the current level of functioning, or that are not subject to modification or management according to prevailing national standards of clinical practice, as reasonably determined by Optum, and Weight reduction or control programs (unless there is a diagnosis of morbid obesity and the program is under medical supervision), special foods, food supplements, liquid diets, diet plans or any related products or supplies (but counseling on losing weight, eating healthfully, and reducing alcohol use may be covered by preventive care). AUTISM ADVOCATE PROGRAM If you are enrolled in a PPO or OOA coverage option, you are eligible for benefits under the Autism Advocate PROGRAM. OptumHealth is the CLAIMS ADMINISTRATOR. Benefits under the Autism Advocate Program are available to all participants and covered DEPENDENTS who have been diagnosed with autism or an autism spectrum disorder (ASD) and who are not enrolled in an HMO option. With this Autism Advocate Program, covered employees and their dependents have access to a dedicated autism SPECIALIST who can act as an advocate and advisor on treatment and resources. The Autism Advocate Program provides coverage for intensive behavior therapy and applied behavior analysis (ABA) for covered children with autism or an ASD up to age nine. The Autism Advocate Program has its own NETWORK of eligible providers and its own procedures for requesting and receiving benefits. In order to maximize your benefits, you should work with your Autism Advocate Program advocate to create a treatment plan that is predetermined to be covered under the Program. Following your authorized treatment plan and using an in-network autism specialist limits your exposure to unnecessary medical and financial risk by confirming the need for proposed treatment and will allow you to avoid delay in obtaining benefits. Covered autism care received from an eligible PROVIDER qualified to render autism and ASD treatments but who is not a network provider will be paid at the out-of-network rate. All autism and ASD treatments are subject to review for clinical necessity. 72 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

73 The following chart shows the benefits currently payable for treatment of autism and ASD under the Autism Advocate Program. Autism Advocate Program Administered by OptumHealth Covered age Up to age 9 In-Network Coinsurance Out-of-Network Coinsurance Annual Maximum Lifetime Maximum 80% of REASONABLE AND CUSTOMARY charge 60% of reasonable and customary charge None None The autism benefit is a special supplemental coverage benefit that is offered in addition to the current medical and mental health/substance use disorder coverage and is not a part of the medical or mental health/substance use disorder coverage under the Program. The Autism Advocate Program provides benefits for autism- or ASD-related treatments and services that are not considered covered medical expenses under the regular medical or mental health/substance use disorder portions of the Program. However, your eligible out-of-pocket expenses under the Autism Advocate Program apply to the medical coverage deductible and out-of-pocket maximum. Any autism or ASD-related treatment that is eligible for coverage as a medical or mental health/substance use disorder expense under the Program will be paid as described in the medical and/or mental health/substance use disorder sections of this Summary Plan Description. Arranging for Benefits To begin accessing benefits, please call OptumHealth at at any time for an autism advocate referral. An autism advocate will consult with you and discuss treatment, provide information, share resources and make recommendations to improve the efficacy, safety, quality and effectiveness of care. The advocate will provide referrals to centers of excellence or other qualified in-network treatment professionals and authorize treatment, as appropriate. If your child has not been diagnosed with autism or an ASD, then an initial diagnosis will need to be completed before enrollment into this Autism Advocate PROGRAM. This initial evaluation for autism is a covered medical expense under your Mental Health and Substance Use Disorder benefit. Please see MENTAL HEALTH and SUBSTANCE USE DISORDER TREATMENT on page 64 of this Summary Plan Description for benefits. Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 73

74 Autism Advocate Program Benefits The autism benefit provides coverage for acute services, therapy and related interventions for covered children up to age nine with autism and ASD which meet the following diagnosis: Autistic Disorder Childhood Disintegrative Disorder Asperger s Disorder Rett s Disorder Pervasive Developmental Disorder not otherwise specified/atypical autism Pervasive Developmental Disorder Benefits for autism or ASD therapies and services are not offered after the child s ninth birthday; however, the care advocate is available to all covered individuals with autism or an ASD (of any age) and their families to assist with dissemination of information, coordination of care, evaluation of treatment plans, and accessing community and school resources. Autism Advocate Program Eligible Expenses Covered services must match the findings from the PROVIDER s assessment and must be determined to be clinically necessary and appropriate. In order to maximize your benefits, you should work with your Autism Advocate PROGRAM advocate to create a treatment plan that is predetermined to be covered under the Program. Following your authorized treatment plan limits your exposure to unnecessary medical and financial risk by confirming the need for proposed treatment and helps to ensure that you receive the highest level of benefits. A treatment plan may include the following services: Intensive behavior therapy/applied behavior analysis Physical therapy Occupational therapy Speech therapy Skills training (e.g., activities of daily living, social and coping) 74 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

75 Traditional outpatient therapy (e.g., family, group, individual) Feeding programs (as a medical service) This Autism Advocate Program is offered in addition to the current medical coverage for physical, occupation and speech therapy visits for development delay and mental health coverage offered under the Program. Please see ELIGIBLE MEDICAL EXPENSES on page 36 and Eligible Mental Health and Substance Use Disorder Expenses on page 69 of this Summary Plan Description. Pre-Authorization Claims for autism and ASD treatments and services will be denied if they are not part of a treatment PROGRAM approved by an autism advocate. Authorization by an autism advocate includes PROVIDER eligibility verification and treatment plan review. You and your provider should call the OptumHealth customer service number on your medical plan ID card to start the approval process and get an explanation of benefits covered. Clinical management by the Autism Advocate Program is strongly recommended prior to the start of services. Preauthorization limits your exposure to unnecessary financial risk by confirming the need for and appropriateness of the proposed treatment prior to incurring any expenses. Each case will be reviewed, diagnosis validated, and treatment plan evaluated for appropriateness, applying OptumHealth s coverage determination guidelines for autism spectrum disorders and intensive behavior therapy, in determining whether to approve or deny services. When you use a NETWORK provider, the provider is responsible for obtaining pre-authorization from the autism advocate for you; however, you should confirm that your autism care is pre-authorized because you may be responsible to pay for treatments and services that are determined not to be clinically appropriate or otherwise ineligible for coverage under the Autism Advocate Program. When you use an out-of-network provider, preauthorization is your responsibility, so it is important that you ask your provider to work with the autism advocate to create a treatment plan for pre-approval before receiving services. What s Not Covered The following expenses are not covered under the Autism Advocate PROGRAM coverage administered by OptumHealth: Vitamin therapy Education services offered in school systems Respite care (unless under state mandate or requested by customer) Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 75

76 Nutrition therapy Alternative/complementary-based treatment or protocol, such as by a DAN doctor Supplies or equipment associated with treatment Hippo therapy Equine therapy Dolphin therapy Chelation therapy Tuition for school-based programs Relationship Development Intervention (RDI) DIR/Floortime Summer camps Any services provided by non-eligible PROVIDER All treatment plans are regularly reviewed for appropriateness and best practices in accordance with Optum s guidelines for autism spectrum disorders and intensive behavioral therapy. Only treatments and services that are determined to be clinically necessary and appropriate will be covered under the Program. Eligible Providers Eligible providers include: Providers who have met established qualifications of a Board Certified Behavior Analyst (BCBA or BCBA-D), Clinically licensed mental health clinicians with a Doctorate or Master s degree that are trained to treat autism spectrum disorders, and Providers who perform services under the direct supervision of an eligible provider as defined above (e.g., therapy assistants). 76 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

77 All autism or ASD care must be received from an eligible provider in order to be covered under the Autism Advocate Program. If treatment or services are received from an eligible provider who is not a NETWORK provider for the Autism Advocate Program, benefits will be paid at the out-of-network rate. HEALTHY RESOURCES PROGRAM If you are enrolled in a PPO or OOA coverage option, you and your covered DEPENDENTS are eligible for additional health management and support programs administered by OptumHealth: 24/7 NurseLine When you or someone in your family is sick or injured, it s sometimes hard to know what to do. The 24/7 NurseLine will connect you with an experienced registered nurse on hand to answer your questions. For the 24/7 NurseLine, call Cancer Support PROGRAM This new program offers guidance and support if you or a covered family member is diagnosed with cancer. An experienced cancer care nurse, as well as a clinical team that includes board certified medical oncologists, will be available to work with you and your doctor to help you understand your diagnosis, coordinate your care and quickly begin the treatment option that is right for you. For the Cancer Support Program, call Maternity Support Program This program pairs you with a personal obstetrics nurse who can offer support through the various stages of pregnancy and answer both clinical and practical questions about pregnancy, childbirth and childcare. For the Maternity Support, call Personal Health Support This program provides you with a personal nurse who can offer valuable support and guidance if you re dealing with a major health issue; managing a chronic condition, such as coronary artery disease or diabetes; or if you have been, or plan to be, admitted to the HOSPITAL. For Personal Health Support, call These programs are free and voluntary and are designed to provide you with additional support, help you coordinate care and enable you to obtain quality resources. For more information, contact OptumHealth at Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 77

78 EMPLOYEE ASSISTANCE PROGRAM (EAP) If your EMPLOYING COMPANY has an EMPLOYEE Assistance PROGRAM, you may also call the EAP instead of OptumHealth for mental health or substance use disorder problems. See the Employee Assistance Program summary plan description or contact your Human Resources department if you need more information about the availability of an EAP. Please note that EAP services are not part of the Time Warner Group Health Plan. Some problems may not require referral for additional counseling and may be handled solely through the EAP. However, if a referral is required, the EAP counselor may contact OptumHealth or may refer you directly to OptumHealth to receive coverage under the Program, at which point benefits depend on whether you go in-network or out-of-network for your care (as described above). Confidentiality OptumHealth and the EAP are committed to protecting your privacy, and all contact with them and all services provided by them are strictly confidential in accordance with federal and state laws and professional standards of confidentiality. Generally, if anyone else requests information, your approval must be obtained to release it. Among the situations where the PROVIDER is required by law to notify authorities are instances of child abuse, elder abuse or a professional determination that the patient is a threat to personal safety. FILING CLAIMS In order to receive the benefits for which you may be eligible under the PROGRAM described in this Summary Plan Description, you or your beneficiary may first be required to file a claim. The law allows a reasonable amount of time for: The applicable CLAIMS ADMINISTRATOR to evaluate a claim directly related to determining whether you have incurred a covered expense for which benefits are payable under the Program and determining the amount of, and administering the payment of, any such benefits based on the information contained in the written claim, or The PLAN ADMINISTRATOR to evaluate a claim related to your eligibility to participate in the Program and to evaluate a claim, other than directly related to determining whether you have incurred a covered expense for which benefits are payable under the Program, based on the information contained in the written claim. 78 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

79 Routine requests for information regarding your benefits under the Program will not be considered benefit claims subject to the Program s claims and appeals procedures. If you wish to make a claim for benefits in accordance with your rights under ERISA, you must do so in writing as described in How to File a Claim on page 80. All claims should be directed to the applicable administrator (either the appropriate Claims Administrator or the Plan Administrator), and the entire claim procedure and appeal process, as set forth below, will be handled through that administrator. If you have any questions as to which administrator you should direct your claim, please contact the Time Warner Benefits Service Center at Claims Filed with the Plan Administrator All claims that must be directed to the Plan Administrator must be filed within one year after the date of service. Claims Filed with the Claims Administrator All out-of-network claims that must be directed to a medical, mental health/substance use disorder, or Autism Advocate Program Claims Administrator, as applicable, must be filed within one year after the date of service or the date of discharge after hospitalization. Prescription drug claims must be filed with CVS Caremark within 365 days from the date your prescription is filled. Claims Procedure The time within which your medical claim must be approved or denied will depend on the type of claim you file. For claims involving urgent care (as defined below), you will be notified of the approval or denial (in whole or in part) of your claim not later than 72 hours after your claim is received. If your claim did not include enough information to determine whether your claim should be approved or denied, you will be notified within 24 hours of the specific information that is necessary, and you will be afforded at least 48 hours to provide the specified information. Urgent care, for purposes of these claims and appeals procedures, means medical care or treatment which requires pre-notification/pre-authorization approval and that must be provided without delay in order to avoid seriously jeopardizing life, health or the ability to regain maximum function, or that must, in the opinion of a physician, be provided without delay in order to adequately manage severe pain. For care involving an ongoing course of treatment to be provided over a period of time or through a number of treatments (called concurrent care decisions ), you will be notified in advance of any decision by the Claims Administrator to reduce or terminate the course of treatment that would be covered, so that you will have enough time to appeal the decision. If you wish to extend the course of treatment and the treatment involves urgent care (as defined above), you will be notified within 24 hours after your claim is received, as long as you make your claim at least 24 hours before the approved course of treatment is scheduled to end. Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 79

80 For medical care which requires pre-certification (pre-notification/pre-authorization) approval to get the full benefit under the Program (called a pre-service claim ), you will be notified of the decision to deny coverage not later than 15 days after your claim is received, unless special circumstances require a longer period of time for reaching a decision. If a longer period of time is required, you will be notified within the initial 15-day period and a single extension of up to 15 days may be utilized. If your claim did not include enough information to reach a decision, you will be notified and afforded at least 45 days to provide the specified information. For all other care, you will be notified of the denial (in whole or in part) of your claim not later than 30 days after your claim is received, unless special circumstances require a longer period of time for reaching a decision. If a longer period of time is required, you will be notified within the original 30-day period and a single extension of up to 15 days may be utilized. If your claim did not include enough information to make a decision, you will be notified and afforded at least 45 days to provide the specified information. How to File a Claim Medical Claims There are no claim forms for most in-network services. When you visit an in-network PROVIDER, you do not pay anything to the in-network provider at the time of service. Once your claim is processed and the PROGRAM determines the amount of your covered benefit, you will be billed for the balance of the cost (your coinsurance amount, subject to deductible requirements and the out-of-pocket maximum, plus any amounts for services not covered under the Program) by your provider. You pay these amounts directly to the provider. If you receive a bill for in-network services other than for the appropriate balance, do not pay it. Immediately report the error to your CLAIMS ADMINISTRATOR s Member Services. Your in-network and, in most cases, your out-of-network HOSPITAL bills are submitted directly to your Claims Administrator. After your Claims Administrator pays the hospital at the appropriate in-network or out-of-network level, the hospital will bill you for any remaining amounts. When you are treated in an out-of-network EMERGENCY room, the hospital in most cases will bill your Claims Administrator first and later bill you for the applicable emergency room charges for which you are responsible. Other out-of-network hospitals will request your share of the applicable emergency room charges (coinsurance) at the time services are rendered. If you go out-of-network for medical services or are in the Out-of-Area coverage option, you will likely need to submit claim forms to your Claims Administrator in order to be reimbursed by the Program. Claim forms are available from the Time Warner Benefits Service Center at You should submit your claim within 90 days of your date of service or as soon as reasonably possible. You have 12 months from the date of service or the date of discharge after hospitalization to file your claim for out-of-network benefits. 80 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

81 Submit claims to your Claims Administrator, as follows: UnitedHealthcare Claims P.O. Box Atlanta, GA Blue Cross Blue Shield P.O. Box 5072 Middletown, NY Mental Health and Substance Use Disorder Claims You are not generally required to file claim forms when you go in-network for mental health and substance use disorder treatments, but you must generally file a claim for benefits when you go out-of-network. Claim forms are available from Optum or the Time Warner Benefits Service Center at Submit mental health and substance use disorder claims to: Optum P.O. Box Salt Lake City, UT Prescription Drug Claims Generally, when you have your prescription filled at a CVS Caremark network pharmacy, there are no claims to file. However, if you fill or attempt to fill your prescription at a CVS Caremark network pharmacy and are required to pay more than the network coinsurance amount, you should file a formal claim for benefits with CVS Caremark. If you have your prescription filled at a pharmacy that is not in the CVS Caremark network, you must pay for the prescription and file a claim with CVS Caremark for reimbursement at the out-of-network level. Claim forms are available from CVS Caremark or the Time Warner Benefits Service Center at Submit prescription drug claims to: CVS Caremark Health Solutions, Inc East Shea Boulevard, MC 128 Scottsdale, AZ Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 81

82 Autism Advocate Program Claims You or your clinician may submit claims under the Autism Advocate Program. If the clinician submits the claim on your behalf, the clinician can submit a standard CMS 1500 (a.k.a. HCFA 1500) to OptumHealth s dedicated autism fax line at You can submit an autism claim using the standard form available from OptumHealth or the Time Warner Benefits Service Center at Claims that are submitted without an approved treatment plan from an autism advocate will be denied. Information about the authorization process is available in the Autism Advocate Program section above. You are encouraged to seek authorization prior to the start of any autism or autism spectrum disorder (ASD) treatments or services. It is recommended that you send the completed claims form and the invoice to your autism care advocate for review. If you do this, the autism care advocate will review the claim documents to ensure the invoice and form has all the required data elements (e.g., diagnosis codes, units/hours, etc.) and will then forward your claim to OptumHealth for processing. However, you have the option to send the claim form along with the clinician s invoice directly to: OptumHealth P.O. Box Salt Lake City, UT Assignment of Benefits (UHC or BCBS Coverage Options Only) You may have your out-of-network or Out-of-Area claims paid to you or assigned to your doctor. If benefits are assigned to your doctor, you must submit a claim form for each bill. You are responsible for any expenses charged by your doctor that are not fully reimbursed by the assigned payment. Denied Claims If benefits are denied for any reason, you have the right to appeal the denial, see Appeals on page 82 for more information. Appeals If you receive notice that your claim has been denied, either in full or in part, the notice will explain the reasons for the denial, including references to pertinent Plan or PROGRAM provisions on which the denial was based. You may request the specific diagnosis and/or treatment code(s) relating to your claim by contacting the appropriate CLAIMS ADMINISTRATOR. If your claim was denied because you did not furnish complete information or documentation, the notice will state the additional materials needed to support your claim. The notice will also tell you how to request a review of the denied claim, based on the established rules for the Program. 82 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

83 If the Claims Administrator relied on an internal rule, guideline, protocol or other similar criterion in denying your claim, you will be notified of the reason and provided with a summary of the guideline, protocol or other criterion. A copy of the full rule, guideline, protocol or other criterion will be provided to you free of charge upon request. If the denial is based on medical necessity, experimental treatment or a similar exclusion or limit, an explanation of the scientific or clinical judgment for the determination, applying the terms of the Plan or the Program to your medical circumstances, will be provided, and a copy of the scientific or clinical guidelines used in making the determination will be available free of charge upon request. As part of the review procedure, you or your authorized representative may ask the Claims Administrator or PLAN ADMINISTRATOR (as applicable) for pertinent documents that affect your claim. You may appeal the denial in writing within 180 days after the claim is denied. Appeals should be mailed to the Plan Administrator (for Program eligibilityrelated appeals) or to the applicable Claims Administrator (for all other types of appeals), as follows: For medical claim appeals (other than mental health, substance use disorder, Autism Advocate Program or prescription drug appeals): UnitedHealthcare Appeals P.O. Box Salt Lake City, UT Blue Cross Blue Shield P.O. Box 5072 Middletown, NY For mental health and substance use disorder claim appeals: Optum P.O. Box Salt Lake City, UT For Autism Advocate Program claim appeals: Autism Advocate Program 9009 Corporate Lake Drive Tampa, FL Fax: (Attn: Autism Appeals) Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 83

84 For prescription drug claim appeals: CVS Caremark Appeals Department, MC 109 PO Box Phoenix, AZ Fax: External review by an independent third party may be available if your claim is denied. For urgent care claims and other claims for which the timeframe for completing an internal appeal under the Program s procedures would seriously jeopardize the your life or health or jeopardize the your ability to regain maximum function, you may request an expedited external review without filing an internal appeal or while simultaneously pursuing an appeal through the Program s internal appeal process. You or your authorized representative may request external review orally or in writing. To request an expedited external review of a claim, you or your authorized representative should contact the appropriate Claims Administrator. Effective for new claims submitted on or after January 1, 2012, the Program has two levels of appeal except for urgent care claims. If you request review of a denied claim, the Claims Administrator or the Plan Administrator (as applicable) will review and decide on the appeal within the following time limits: For urgent care claims, 72 hours (there is only one level of appeal for urgent care claims) For pre-service claims, 15 days For all other claims, 30 days Once a decision is reached on first appeal, the Claims Administrator or the Plan Administrator (as applicable) will notify you in writing of the outcome. For urgent care claims, you may be notified of the decision orally, followed by written notification. However, if you receive no response within the applicable period, you may consider your claim denied. Your Claim Is Denied on First Appeal For urgent care claims, the decision is final and no other internal appeals are available. For all other types of claims, if you request review of a denied claim and your appeal is denied on the first level of appeal, you may request a second level of appeal. You may request a second appeal in writing within 60 days after receipt of denial of your first appeal. Second appeals should be mailed to the appropriate Claims Administrator or to the Plan Administrator (for Program eligibility-related appeals only) at the address listed above. On review of the second level of appeal, the Claims Administrator or Plan Administrator will take into account all comments, documents, records and other 84 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

85 information you submitted, without regard to whether such information was considered in the initial determination or the first appeal. If you request a second review of a denied claim, the Claims Administrator or the Plan Administrator (as applicable) will review and decide on the second appeal within the following time limits: For pre-service claims, 15 days For all other claims (other than urgent care claims), 30 days Once a decision is reached on second appeal, the Claims Administrator or the Plan Administrator (as applicable) will notify you in writing of the outcome. However, if you receive no response within the applicable period, you may consider your appeal denied. Notice of Decision on Appeal If your claim is denied on first or second level appeal, the denial notice will give the reasons for the decision and include references to pertinent Plan and Program provisions. You may request the specific diagnosis and/or treatment code relating to your claim by contacting the applicable Claims Administrator. If the Claims Administrator relied on an internal rule, guideline, protocol or other similar criterion in denying your appeal, you will be notified of the reason and provided with a summary of the guideline, protocol or other criterion. A copy of the full rule, guideline, protocol or other criterion will be provided to you free of charge upon request. If the denial is based on medical necessity, experimental treatment or a similar exclusion or limit, an explanation of the scientific or clinical judgment for the determination, applying the terms of the Plan or the Program to your medical circumstances, will be provided, and a copy of the scientific or clinical guidelines used in making the determination will be available free of charge upon request. The notice will also tell you about any other appeal or external review rights, based on the established rules for the Program. Your Claim Is Denied on Second Appeal If the Claims Administrator or Plan Administrator denies your claim on second appeal, you may be able to request external review of your claim by an independent third party, who will review the denial and issue a final decision. External review is only available if your claim is denied or partially denied based on: Clinical reasons or medical judgment, such as a determination that a service or supply is not medically necessary, Experimental or investigational services exclusions or unproven services exclusions, Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 85

86 Rescission of coverage (coverage that was cancelled or discontinued retroactively for reasons other than failure to pay your share of the premium cost), or As otherwise required by applicable law. If you are eligible, external review of your claim by an independent third party is available at no charge to you. You must request external review within four (4) months of the date you receive the denial or partial denial from the Claims Administrator. More information about the external review process will be provided with your notice of denial on second appeal. Information about external review is also available at from your Claims Administrator. You must use and complete the Program s administrative claims and appeals procedure, including external review (if available), before bringing an action at law or in equity to recover under the Plan. If the Claims Administrator or the Plan Administrator denies your appeal on final review, and if your claim is denied on external review (if available) by the independent third party reviewer, you may bring a suit for benefits. If you choose to pursue any judicial or administrative proceeding relating to your claim, the evidence that can be presented will be strictly limited to the documents, information and other evidence timely provided to the Claims Administrator or the Plan Administrator and to the external reviewer (if applicable) in connection with the Program s claims and appeals procedures, as described above. No legal actions may be brought on a claim more than 90 days after the Claims Administrator or Plan Administrator issues its final decision on the claim. This time limit will be suspended while you are pursuing external review, if you choose to do so. If you are eligible for and decide to pursue external review, the deadline for filing a lawsuit or initiating any other legal proceeding is 90 days after the independent third party reviewer makes a decision on external review. Special Claims Procedures for HMO Coverage Options If you are enrolled in an HMO coverage option, the HMO PROVIDER is the Claims Administrator. The HMO provider will require that you follow certain internal claims and appeals procedures (sometimes called grievance procedures) when you request medical treatment or referral to a SPECIALIST for medical treatment and your request is denied by the HMO provider. You must follow the HMO s internal procedures in order to receive a fair hearing from the HMO provider. However, all claims and appeals requirements established by your HMO provider must meet minimum standards under ERISA. Once you exhaust the HMO s internal claims procedures, some HMO providers might have additional appeal rules that require binding arbitration or that limit your rights to go to court. These appeal rules do not always comply with ERISA. The following is a list of HMO provider appeal rules that do not comply with ERISA. If you have reached a level of appeal that requires you to do one of the following, you should know that your ERISA rights as described in Your Rights Under ERISA on page 108 will override the HMO provider requirements. 86 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

87 No HMO provider may require you to submit to binding arbitration or to binding mediation. If your HMO certificate of coverage advises that you must submit to binding arbitration or binding mediation after you exhaust the HMO provider s internal claims and appeals procedure, you should know this rule does not comply with ERISA. If you voluntarily agree to binding arbitration or binding mediation, you may be giving up the right you have under ERISA to sue the HMO provider in federal court. If you have a serious claim, you should check with legal counsel before you submit to binding arbitration or binding mediation with the HMO provider. No HMO provider can make the statement that, by virtue of becoming covered under an HMO coverage option, you have agreed to give up any rights you have to sue, including any constitutional rights or any ERISA rights. Generally, no HMO provider may require you to pay for any internal grievance or appeal procedure. If the HMO certificate of coverage tells you that you must pay for part or all of a grievance procedure, arbitration, mediation or any legal fees, you should know that ERISA generally does not allow this type of charge. However, under Health Care Reform requirements, the HMO provider may be permitted to charge a minimal filing fee of not more than $25 per claim (limited to $75 per year) if the claim is sent for external review after exhaustion of the HMO s internal grievance procedure. This amount must be refunded if the decision is reversed on external review and can be waived in the event of financial hardship. No HMO provider may require you to undergo more than two levels of appeal following the initial denial of your claim for benefits. If your HMO provider has additional levels of appeals, you may choose to follow those optional appeal procedures rather than to sue the HMO provider in federal court under ERISA. However, by submitting to these additional appeals procedures, you may negatively affect your ability to sue the HMO provider under ERISA (for example, if the HMO provider is required under state law to provide additional levels of review, then the statute of limitations on your claim may continue to run while you pursue your appeal with the HMO provider). If you have a serious claim, you should check with legal counsel before you choose to pursue optional HMO provider appeals rather than taking your case directly to external review or to federal court. No HMO provider may require that you accept the decision of an independent reviewer on a benefit denial appeal. The HMO provider may be required to submit your claim to an independent external reviewer under state or federal law, and you can agree to abide by the independent reviewer s decision if you want to do so. However, before you agree ahead of time to accept the decision of an independent reviewer, make certain you first read the procedures described in the claims and appeals procedures above (applicable to the UHC and BCBS coverage options) and Your Rights Under ERISA on page 108 because you may be giving up your right to sue for the benefit under ERISA. Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 87

88 If you find that you want to exercise your rights as described in Your Rights Under ERISA on page 108, you should not wait too long after the HMO provider gives you its final decision when you go through the grievance procedure. This is because, under the Plan, you have 90 days following your receipt of a final decision after completing the mandatory HMO grievance process to take legal action, as described in Your Rights Under ERISA on page 108. This time limit will be suspended while you are pursuing external review, if you choose to do so. All HMO providers are subject to state regulation. If you have a complaint about an HMO provider, you can contact the state insurance department listed in your HMO certificate of coverage. Remember, even when you contact the state insurance department with a complaint, you still have ERISA rights as explained in Your Rights Under ERISA on page 108. Claims Fraud The CLAIMS ADMINISTRATORs regularly evaluate claims to detect fraud or false statements and will notify the COMPANY regarding these matters. The Claims Administrators must be advised of any discounts or price adjustments made to you by any PROVIDER. A provider who waives or refunds amounts that are your responsibility under the Plan (such as your coinsurance amount) is entering into a discount arrangement with you. The Claims Administrators calculates the benefit payment based on the amount actually charged, less any discounts, rebates, waivers or refunds of coinsurance amounts or deductibles you receive. Failure to notify the applicable Claims Administrator or the PLAN ADMINISTRATOR of such price adjustments may result in an overpayment of benefits and constitutes a serious violation of the provisions of the Plan. If a claim has been submitted for payment or paid by the Plan as a result of fraudulent representations, the Claims Administrator or the Plan Administrator may seek reimbursement and may elect to pursue the matter by pressing criminal charges. WHAT HAPPENS IF You Become Disabled In general, if you are approved for benefits under your EMPLOYING COMPANY s salary continuation policy (short-term disability), your PROGRAM coverage will continue as long as you pay your share of the cost of medical coverage. 88 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

89 If your employment ends because you are determined to be disabled and are approved for benefits under your Employing COMPANY s disability income program (long-term disability), you and your enrolled DEPENDENTS may be eligible for continued coverage under the Program. Coverage as a disabled PARTICIPANT will continue until your eligibility for long-term disability benefits ends, as long as you pay your share of the cost of medical coverage. If you are a disabled participant eligible for benefits under the long-term disability program, you cannot add any new dependents, other than a new OPPOSITE-SEX SPOUSE or SAME-SEX SPOUSE via marriage, a new DOMESTIC PARTNER as a result of a new domestic partnership, or a child who becomes your dependent child via birth or adoption. Contribution rates will initially be the same as they were just before you became disabled; however, your contributions will be made on an after-tax basis (subject to annual changes). If you are offered and accept a lumpsum disability payment from the long-term disability insurance carrier managing your case, in place of regular periodic income benefits, you will no longer qualify for continued coverage under the Program. The Company has designated MEDICARE as the primary payer of benefits for disabled participants, as permitted under federal law. This means that Medicare will become your primary source of coverage and the Program may supplement coverage after benefits from Medicare have been determined. If you are a disabled Medicare-eligible participant, you are required to enroll in both Medicare Part A and Part B. If you are eligible for Medicare, the Program will pay benefits as the secondary payer whether or not you enroll in Medicare. See You Become Medicare-Eligible on page 91 for more information. You Take a Leave of Absence Coverage continues while you are on an approved paid or unpaid leave of absence (including illness leave and/or a leave that qualifies under the Family and Medical Leave Act (FMLA)) of not more than three months (or a longer period if required by law) if you continue to pay your share of the cost of the coverage. Also see You Become Disabled on page 88 if your leave is due to disability. Military Leave Coverage generally continues while you are on National Guard or Reserve Corps duty, fulfilling routine, periodic service obligations. If you are called into active military service, you may continue coverage for yourself and your DEPENDENTS for the duration of a qualified military leave, as defined by the Uniformed Services Employment and Reemployment Rights Act (USERRA). Refer to your EMPLOYING COMPANY s intranet site or contact the Time Warner Benefits Service Center at for more information about your options during a qualified military leave. Family and Medical Leave Your Employing COMPANY complies with, and in some cases exceeds the obligations of, the Family and Medical Leave Act (FMLA) and similar state and local laws. If you have been employed by your Employing Company for at Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 89

90 least 12 months and have worked 1,250 hours or more within a 12-month period, you remain eligible to participate in the Plan if you go on leave which is designated as FMLA leave during any 12-month period as a result of your own serious medical condition; to care for a new child (including a newly-adopted or newly-placed foster care child); to care for an immediate family member who has a serious health condition; for certain covered activities if your OPPOSITE-SEX SPOUSE, SAME-SEX SPOUSE, DOMESTIC PARTNER, son, daughter or parent is on active duty (or has been notified of a call or order to active duty) in the U.S. Armed Forces and is deployed to a foreign country; or for other reasons designated by the FMLA. In addition, you remain eligible to participate in the Plan if you go on an unpaid leave for up to 26 weeks during a 12- month period in order to care for your opposite-sex spouse, same-sex spouse, domestic partner, son, daughter, parent or next of kin who is a covered service member of the U.S. Armed Forces who is injured in the line of active duty (or a veteran who was a member of the U.S. Armed Forces at any time during the five-year period preceding the date on which the veteran undergoes medical treatment, recuperation or therapy for an injury incurred in the line of active duty). During FMLA leave or leave under similar applicable state or local family and medical leave laws, the Employing Company will continue to pay its share of the cost of coverage, and you will continue to be responsible for your share. Paying for Coverage During Leave You must continue to pay for your share of the cost of coverage during your approved leave of absence. If you are on a paid leave, your regular contributions will be taken out of your pay. If you are on an unpaid leave, you will be sent a booklet of coupons that you should use to submit payment for your health plan premiums for each month of your leave. (Please call the Time Warner Benefits Service Center if you do not receive the coupon booklet within 2 to 3 weeks after the start of your leave.) Payments are due on the first day of each month. If you do not make timely payments within 60 days of the due date, your coverage under the PROGRAM will end. You will receive more details about your payment obligations when you begin your leave. Please contact the Time Warner Benefits Service Center at for more information about your Program coverage during a leave of absence. You Receive Notice and Severance Coverage continues during a period of paid Notice and Severance. Coverage ends on the last day of the month in which your Notice and Severance ends. If you receive a lump-sum payment, coverage ends on the last day of the month in which you receive the lump-sum payment. Following termination of your period of Notice and Severance, coverage can be extended through COBRA. 90 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

91 You Retire What happens to your coverage when you retire depends on your age and service. If you are at least age 55 but less than age 65 with 10 to less than 20 years of vesting service, you and your eligible DEPENDENTS under age 65 are eligible for Access 55 Medical Coverage. You pay the entire cost of coverage. This coverage terminates on the first of the month in which you or your eligible dependents turn age 65. If you do not qualify for Access 55 Medical Coverage, you and/or your covered dependents may be eligible for COBRA continuation coverage (see Continuing Coverage Under COBRA on page 93). Vesting service means your periods or years of service recognized for vesting under an EMPLOYING COMPANY pension or retirement savings plan. Retiree medical benefits are described in more detail in separate retiree medical PROGRAM summary plan descriptions. You may also contact the Time Warner Benefits Service Center at for more information. You Become Medicare-Eligible If you re still an active EMPLOYING COMPANY EMPLOYEE when you reach age 65, the PROGRAM will generally continue to be your primary coverage, with MEDICARE secondary. If you have an enrolled dependent who is eligible for Medicare, the Program generally is primary. In cases where the Program is your primary coverage, you or your enrolled dependent(s) will be entitled to the same benefits under this Program as those persons who do not have Medicare. If you become entitled to Medicare due to end-stage renal disease, the Program will continue to be the primary payer for your health benefits for the first 30 months of Medicare entitlement. After 30 months, Medicare becomes primary and the Program provides secondary coverage. If your employment terminates because you are determined to be disabled and you become entitled to Medicare due to your disability, Medicare will be the primary payer and the Program will be the secondary payer for your health benefits while you remain covered under the Program as a disabled PARTICIPANT. If your employment has been terminated and you are entitled to Medicare due to disability, you must enroll in Medicare Part A and Part B as soon as you are eligible. If you are eligible and do not enroll in Medicare, the Program will pay benefits as though you are enrolled in Medicare, resulting in increased out-of-pocket medical expenses. (See You Become Disabled on page 88.) If your dependent becomes entitled to Medicare due to disability, the Program will pay primary as long as you are enrolled in the Program as an active Employing COMPANY employee. Rules governing the coordination of Medicare are complex, and this is only a brief summary. As you or your OPPOSITE-SEX SPOUSE, SAME-SEX SPOUSE or DOMESTIC PARTNER approach age 65 (or older), or are considering your Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 91

92 retirement options, you should make an appointment with your local Social Security office to discuss Medicare coverage options, enrollment procedures and effective dates for you, your opposite-sex spouse, same-sex spouse or domestic partner, and any covered DEPENDENTS. You also can contact the Time Warner Benefits Service Center at for more information. For more details about Medicare, call MEDICARE ( ) or visit their website: WHEN COVERAGE ENDS For You Your coverage under the PROGRAM ends on the last day of the month in which the earliest of the following events take place unless coverage is continued as described in You Become Disabled on page 88, Continuing Coverage Under COBRA on page 93 or You Retire on page 91: You elect to discontinue coverage (subject to QUALIFIED CHANGE IN STATUS rules). You are no longer an eligible EMPLOYEE of an EMPLOYING COMPANY. You stop making required contributions. The Plan or Program is terminated or amended so that coverage is no longer available to you. Three months (or a longer period if required by law) after the first day of an approved, unpaid leave of absence. Twelve months after the first day you meet the Short-Term Disability Policy s definition of disability. Your Notice and Severance ends, or if you receive a lump-sum severance payment, upon your receipt of the lump-sum payment. Your participation in the Plan ends when your coverage under all Plan benefit programs ends or when the Plan is terminated. For Your Dependents Dependent coverage generally ends when your coverage ends, or the last day of the month in which the earliest of any of the following happens: You elect to discontinue dependent coverage (subject to qualified change in status rules), 92 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

93 Your dependent is no longer considered an eligible dependent, You stop making any required contributions for dependent coverage, or The Program or your Employing COMPANY stops offering dependent coverage. Your dependent s participation in the Plan ends when coverage under all Plan benefit programs ends or when the Plan is terminated. Certificate of Creditable Coverage If you lose or any covered dependent loses medical coverage, your CLAIMS ADMINISTRATOR will issue you a Certificate of Creditable Coverage showing how long you were covered under the Program. This certificate enables you to receive credit toward any pre-existing condition exclusion under a new policy of individual or group coverage. You will automatically receive this certificate when you lose coverage or become entitled to COBRA continuation coverage or other continuation coverage, and when your COBRA continuation coverage period or other continued coverage period is exhausted. You can also ask for a certificate either before you lose coverage, or within 24 months of losing coverage, by contacting the Time Warner Benefits Service Center at Continuing Coverage Under COBRA Under the Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA), PROGRAM coverage under the Time Warner Group Health Plan for you and your eligible DEPENDENTS may continue past the date it would normally end. (The Program also provides COBRA-like continuation coverage for DOMESTIC PARTNERs and SAME-SEX SPOUSEs and their children who are not your Internal Revenue Code dependents, even though it s not required under COBRA.) HMO participants should review the continuation coverage provisions in the HMO s materials, such as the certificate of coverage. Notice of COBRA Continuation Rights This notice contains important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Program. This notice generally explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect the right to receive it. The right to COBRA continuation coverage was created by a federal law. COBRA continuation coverage can become available to you when you would otherwise lose your group health coverage. It can also become available to other members of your family who are covered under the Program when they would otherwise lose their group health coverage. For additional information about your rights and obligations under the Program and under federal law, you Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 93

94 should review this Summary Plan Description or contact the Time Warner Benefits Service Center at The COMPANY has voluntarily elected to provide continuation coverage similar to that required by COBRA to domestic partners and same-sex spouses and their children who are not dependents of the EMPLOYEE as defined under the Internal Revenue Code. This notice describes both the federally-mandated COBRA continuation coverage and the COBRA-like continuation coverage offered to domestic partners, same-sex spouses and children who are not required to be offered continuation coverage under federal law (both referred to as COBRA continuation coverage in this notice). COBRA Continuation Coverage COBRA continuation coverage is a continuation of Program coverage when coverage would otherwise end because of a life event known as a qualifying event. Specific qualifying events are listed later in this section. After a qualifying event, COBRA continuation coverage must be offered to each person who is a qualified beneficiary. You, your OPPOSITE-SEX SPOUSE, same-sex spouse or domestic partner and your dependent children could become qualified beneficiaries if coverage under the Program is lost because of the qualifying event. Under the Program, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage. If you are an employee, you will become a qualified beneficiary if you lose your coverage under the Program because either one of the following qualifying events happen: Your hours of employment are reduced, or Your employment ends for any reason other than your gross misconduct. If you are the opposite-sex spouse, same-sex spouse or domestic partner of an employee, you will become a qualified beneficiary if you lose your coverage under the Program because any of the following qualifying events happen: Your opposite-sex spouse, same-sex spouse or domestic partner (the employee) dies. Your opposite-sex spouse, same-sex spouse s or domestic partner s (the employee s) hours of employment are reduced. Your opposite-sex spouse, same-sex spouse s or domestic partner s (the employee s) employment ends for any reason other than his or her gross misconduct. Your opposite-sex spouse, same-sex spouse or domestic partner (the employee) becomes entitled to MEDICARE benefits (under Part A, Part B or both). 94 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

95 You become divorced or legally separated from your employee-spouse (or you dissolve your domestic partnership with the employee). Your dependent children will become qualified beneficiaries if they lose coverage under the Program because any of the following qualifying events happens: The parent-employee dies. The parent-employee s hours of employment are reduced. The parent-employee s employment ends for any reason other than his or her gross misconduct. The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both). The parents become divorced or legally separated (or dissolve their domestic partnership). The child stops being eligible for coverage under the Program as a dependent child. When COBRA Coverage Is Available The Program will offer COBRA continuation coverage to qualified beneficiaries only after the COBRA Administrator has been notified that a qualifying event has occurred. When the qualifying event is the end of employment or reduction of hours of employment, death of the employee or the employee s becoming entitled to Medicare benefits (under Part A, Part B, or both), your EMPLOYING COMPANY must notify the COBRA Administrator of the qualifying event. Notice of Some Qualifying Events For other qualifying events (divorce, legal separation of the employee and opposite-sex spouse or same-sex spouse, the dissolution of a domestic partnership or a dependent child s losing eligibility for coverage as a dependent child), you must notify the COBRA Administrator in writing within 60 days after the qualifying event occurs. How COBRA Coverage Is Provided Once the COBRA Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage under your Program option (e.g., the UHC PPO option) at the time of the qualifying event will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation on behalf of their opposite-sex spouses, same-sex spouses or domestic partners, and parents may elect COBRA continuation coverage on behalf of their dependent children. Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 95

96 COBRA continuation coverage is a temporary continuation of coverage. When the qualifying event is the death of the employee, the employee becoming entitled to Medicare benefits (under Part A, Part B, or both), divorce or legal separation, dissolution of a domestic partnership, or a dependent child s losing eligibility as a dependent child under the Program, COBRA continuation coverage lasts for up to a total of 36 months. When the qualifying event is the end of employment or reduction of the employee s hours of employment, and the employee became entitled to Medicare benefits less than 18 months before the qualifying event, COBRA continuation coverage for qualified beneficiaries other than the employee lasts until 36 months after the date of Medicare entitlement. For example, if a covered employee becomes entitled to Medicare eight months before the date on which his employment terminates, COBRA continuation coverage for his opposite-sex spouse, same-sex spouse or domestic partner and dependent children can last up to 36 months after the date of Medicare entitlement, which is equal to 28 months after the date of the qualifying event (36 months 8 months). Otherwise, when the qualifying event is the end of employment or reduction of the employee s hours of employment, COBRA continuation coverage generally lasts for only up to a total of 18 months. There are two ways in which this 18-month period of COBRA continuation coverage can be extended. Disability extension of 18-month period of continuation coverage. If you or anyone in your family covered under the Program is determined by the Social Security Administration to be disabled and you notify the COBRA Administrator in writing in a timely fashion, you and your entire family may be entitled to receive up to an additional 11 months of COBRA continuation coverage, for a total maximum of 29 months. The disability would have to have started at some time before the 60 th day of COBRA continuation coverage and must last beyond the end of the 18-month period of continuation coverage. This notice must be in writing and sent to the COBRA Administrator within 60 days after the Social Security determination of disability is issued. Second qualifying event extension of 18-month period of continuation coverage. If your family experiences another qualifying event while receiving 18 months of COBRA continuation coverage, your opposite-sex spouse, same-sex spouse or domestic partner and the/or dependent children in your family, as applicable, can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if notice of the second qualifying event is properly given in writing to the COBRA Administrator within 60 days of the second qualifying event. This extension may be available to the opposite-sex spouse, same-sex spouse or domestic partner and any dependent children receiving continuation coverage if the employee or former employee dies, becomes entitled to Medicare benefits (under Part A, Part B, or both), or gets divorced or legally separated, or if the dependent child stops being eligible under the Program as a dependent child, but only if the event would have caused the opposite-sex spouse, same-sex spouse or domestic partner and/or dependent children to lose 96 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

97 Conversion Rights for HMO Participants HMO participants may be able to convert their coverage to an individual policy when COBRA coverage ends. Contact your HMO PROVIDER for information. Conversion to an individual policy is not available under the PPO and Out-of-Area coverage options. Questions About COBRA Continuation Coverage Questions concerning the Program or your COBRA continuation coverage rights should be addressed to the Time Warner Benefits Service Center at or to the COBRA Administrator identified below. For more information about your rights under the Employee Retirement Income Security Act (ERISA), including COBRA, the Health Insurance Portability and Accountability Act (HIPAA) and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor s Employee Benefits Security Administration (EBSA) in your area or visit the EBSA website at (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA s website.) Inform the Plan of Address Changes In order to protect your family s rights, you should keep the PLAN ADMINISTRATOR informed of any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator or COBRA Administrator. Plan Contact for Additional COBRA Information You can obtain further information about COBRA continuation coverage from the Time Warner Benefits Service Center at COBRA Administrator The COBRA Administrator is: Time Warner Benefits Service Center Attn: COBRA Department 2300 Renaissance Blvd King of Prussia, PA Electing COBRA Continuation Coverage When a qualifying event occurs, you or your dependent(s) who are qualified beneficiaries must request continued coverage. The COBRA Administrator will give you and your dependent(s) all of the details about continued coverage, Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 97

98 including the cost, and will provide you and/or your dependent(s) with an election form. To continue coverage, the completed election form must be sent to the address shown on the form within 60 days after the latest of the date: You or your dependent were provided the election form, or Program coverage ends. You and each of your eligible dependents who is a qualified beneficiary have an independent election right for COBRA coverage. If you or your dependents elect to continue coverage, either you or they must pay 102% (or, in the case of an extension of continuation coverage due to a disability, 150% during the disability extension period) of the total cost of the coverage elected (including the portion previously paid by your Employing Company). Coverage costs may change from year to year. In considering whether to elect continuation coverage, you should take into account that a failure to continue your group health coverage will affect your future rights under federal law. First, you can lose the right to avoid having preexisting condition exclusions applied to you by other group health plans if you have more than a 63-day gap in health coverage, and election of continuation coverage may help you not have such a gap. Second, you will lose the guaranteed right to purchase individual health insurance policies that do not impose such pre-existing condition exclusions if you do not get continuation coverage for the maximum time available to you. Finally, you should take into account that you have special enrollment rights under federal law. You have the right to request special enrollment in another group health plan for which you are otherwise eligible (such as a plan sponsored by your spouse s employer) within 30 days after your group health coverage ends because of the qualifying event listed above. You will also have the same special enrollment right at the end of continuation coverage if you get continuation coverage for the maximum time available to you. Payment for COBRA Continuation Coverage If you elect to continue coverage, you must make required payments for the cost of coverage as described in this COBRA election notice. The Company will determine the cost of COBRA coverage in accordance with applicable law. You must make your initial premium payment no later than 45 days following the date of your election to purchase COBRA continuation coverage. This payment will cover the period of coverage from the date of the COBRA election retroactive to the date of the qualifying event. Future COBRA contributions are due in advance of the period for which coverage is to be provided. If the required COBRA premiums are not paid when due, your COBRA coverage will terminate. Subsequent COBRA payments will be considered timely only if made no later than 30 days following the due date. 98 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

99 Early Termination of COBRA Continuation Coverage COBRA continuation coverage will stop before the end of the maximum period under any of the following circumstances: The required contributions are not made on a timely basis. Recovery from disability, if the individual is eligible for extended continuation coverage due to disability, but not before 18 months of continuation coverage. The Plan and any other group health plans provided by the Company terminate. After electing COBRA continuation coverage, a qualified beneficiary becomes entitled to Medicare (under Part A, Part B or both) or another group plan that does not have a pre-existing condition restriction. COBRA continuation coverage may also be terminated for any reason the Program would terminate coverage of a PARTICIPANT who is not receiving continuation coverage (such as fraud). Notify COBRA Administrator of Change in Disability Status If you have already received 18 months of COBRA continuation coverage, you are receiving extended COBRA continuation coverage due to your or a family member s disability, and the qualified beneficiary is determined by the Social Security Administration to no longer be disabled, you are required to notify the COBRA Administrator of that fact within 30 days after the Social Security Administration s determination. Notification of COBRA Ineligibility If you provide notice to the COBRA Administrator as described in this Summary Plan Description and you are determined to be ineligible for COBRA continuation coverage or for a disability or second qualifying event extension, you will be notified in writing. Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 99

100 OTHER INFORMATION If You Have Other Coverage When you are or a dependent is covered by more than one group medical plan, the order in which each plan pays benefits is determined by the coordination of benefits (COB) provisions. The PROGRAM has a nonduplication of benefits requirement. COB also limits the combined benefits you may receive from all plans to 100% of covered charges. COB does not apply to personal insurance policies (other than automobile no-fault insurance) Under the COB provisions, the primary plan always pays first. Generally, the COMPANY s Plan is primary for you (the EMPLOYEE); the employer s plan for your working/retired OPPOSITE-SEX SPOUSE, SAME-SEX SPOUSE or DOMESTIC PARTNER is primary for him or her. For dependent children covered by two or more group plans, the primary plan is determined by the birthdays of the parents. The group insurance plan of the parent whose birthday comes first in the year is primary (the birthday rule) and pays first. In situations where your opposite-sex spouse S, same-sex spouse s or domestic partner s coverage does not use the birthday rule, the rule of your same- or 0pposite-sex spouse s or domestic partner s plan will determine the order of benefits. In the event of a divorce or separation, dependent children may be covered under more than one plan. In this case, the plan of the parent with custody will be primary; the other parent s plan will be secondary. In the event the parent with custody has remarried, the plan of the stepparent with custody will be secondary and the plan of the parent without custody will be last. If there is a court decree giving one parent financial responsibility for the medical expenses, then that parent s plan becomes primary. Coordination of benefits (COB) provisions are complex. If you or your DEPENDENTS have other coverage and want more details on how COB may apply to you, contact the Time Warner Benefits Service Center at Subrogation and Reimbursement Obligations The Plan was created to assist you with medical expenses. The Plan is not intended to provide you with benefits greater than your covered medical expenses. The subrogation and reimbursement rights and obligations described below apply to all employees and dependents covered under the Plan and will continue to apply even after your participation in the Plan ends. These obligations and responsibilities also apply to your estate, the personal representative of your estate, and your heirs or beneficiaries after your death, and to your parent, guardian, or legal representative if you are a minor child or are determined to be incapacitated or under a legal disability. If someone else, including your automobile insurance company, makes payments relating to a sickness, illness or injury for which benefits are paid under the Plan, then the Plan is entitled to recover the amount of those benefits (or 100 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

101 if less, the full amount of the third-party payments). The Plan is also subrogated to all of your rights to recovery to the full extent of any payment made under this Plan. This means that the Plan is entitled to stand in your shoes in order to recover payments made to you or on your behalf by the Plan if you have a sickness, illness or injury caused by a third party or for which another party (e.g., an insurance company or another person) has payment responsibility or is obligated to compensate you for your health care expenses. The Plan is also entitled to reimbursement if you make a claim against another person, insurance company (including your own), or other responsible party for sickness, illness or injury. You may be required to sign a reimbursement agreement if you seek payment of medical expenses relating to the sickness, illness or injury under the Plan before you have received the full amount you would recover through a judgment, settlement, insurance payment or other source. In addition, you may be required to sign necessary documents (including a subrogation agreement and assignment). You are required to promptly notify the Plan of the details of relevant legal actions. You must not do anything to prejudice the Plan s rights to subrogation or reimbursement, including accepting any settlement that does not fully reimburse the Plan, without the PLAN ADMINISTRATOR s written approval, and you must do everything necessary to secure such rights, including providing the appropriate CLAIMS ADMINISTRATOR with timely notice of any and all claims you make against third parties for any such sickness, illness or injury. Your failure to cooperate in the Plan s subrogation or reimbursement efforts is considered a breach of contract. If your failure to cooperate prevents the Plan from recovering some or all of the payments made for your medical care, the Plan may take legal action against you and/or set off from any future benefits the value of benefits that have been paid for the sickness, illness or injury. The Plan (including the Plan Administrator and the appropriate Claims Administrators) may disclose your personal health information without your authorization and/or consent to the extent necessary to pursue subrogation against a responsible party. Any and all amounts you recover from a third party (whether by lawsuit, settlement or otherwise) will first be apportioned to the Plan, and the Plan will be reimbursed first to the full extent of its payment of Program benefits, regardless of whether you have been made whole or fully compensated for damages by any responsible third party or whether medical expenses are itemized in a payment or award. The Plan s subrogation and reimbursement rights apply to full and partial settlements, judgments, or other recoveries paid or payable to you, no matter how those proceeds are captioned or characterized. Examples of these types of payments include economic, non-economic, and punitive damages. The Plan s first priority right to payment is superior to any and all claims, debts or liens asserted by any medical providers (including hospitals or EMERGENCY treatment facilities) that assert a right to payment from funds payable from or recovered from an allegedly responsible insurance carrier or other third party. Reimbursement due the Plan will not be subject to or limited by any proration formula that takes into account the relationship between the amount of damages you claimed and the amount of recovery you received and will not be subject to any claim of unjust enrichment or any other equitable defense doctrine that attempts to limit the Plan s recovery, nor will it be subject to or limited by any reduction of any recovery of payment due to your or any third party s fault or negligence. No amount of associated costs, including attorneys fees, may be deducted from the Plan s recovery without the Plan s express written consent. No so-called Fund Doctrine or Common Fund Doctrine or Attorney s Fund Doctrine will defeat the Plan s right to full recovery. Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 101

102 If the Company, the Plan Administrator or the Plan incurs attorney fees in order to pursue the Plan s subrogation or reimbursement interests, you will be obligated to reimburse the Company, the Plan Administrator or the Plan in full out of any amount recovered. The Plan will have an equitable interest in the amount you recover for the entire benefits paid by the Plan for your claims. Any proceeds collected, held or received by you, your legal representative or any other person or entity by virtue of a settlement of, or judgment relating to, any claim against a third party that arises from the same event that caused or resulted in injury, illness or sickness expenses paid by the Plan, are constructively held in trust for the benefit of the Plan and for satisfaction of the Plan s subrogation and reimbursement rights. The Plan may place a lien against any responsible party or other third-party recovery to the extent of the benefits paid by the Plan for the sickness, illness or injury; may bring an action on its own behalf or on your behalf against any responsible party or third party involved in the sickness, illness or injury; may suspend the payment of any benefits under the Plan pending receipt of any acknowledgment, agreement, authorization, or waiver or release that the Plan Administrator or Claims Administrator deems necessary to exercise the Plan s rights and/or privileges under the Plan; or may offset present or future benefits payable under the Plan to or on behalf of you or your dependents, regardless of whether such benefits are related to the subject sickness, illness or injury. The company that contacts you about a possible subrogation claim may be a third-party company under contract with a Claims Administrator. Please note that the Plan Administrator, the Claims Administrator, and any third-party company under contract to administer the terms and conditions of the Plan s subrogation and reimbursement rights have those powers and duties as are necessary to discharge its duties and functions, including the exercise of its discretionary authority to (1) construe, interpret and enforce the terms of the Plan s subrogation and reimbursement rights, and (2) make determinations with respect to the subrogation amounts and reimbursements owed to the Plan. To ensure that you comply with your subrogation and reimbursement obligations, you should notify the applicable Claims Administrator of any accidents involving another person or entity and any other potential legal claim(s) you may have against any third party for acts which caused you to receive medical treatments covered under the Plan. If you have questions about your subrogation or reimbursement obligations, contact the Time Warner Benefits Service Center at or your Claims Administrator s Member Services for more information. Qualified Medical Child Support Orders (QMCSOs) The Plan provides benefits in accordance with the requirements of any Qualified Medical Child Support Order ( QMCSO ) that provides for group health plan coverage for an EMPLOYEE s dependent child. The QMCSO rules permit state courts (or state agencies) to require an employer that provides dependent health coverage to make that coverage available to an employee s child, even though the child is not a legal dependent because of a separation or divorce. 102 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

103 A QMCSO includes a judgment, decree or order (including a settlement agreement or administrative notice) issued either by a domestic relations or other court of competent jurisdiction, or through an administrative process established under state law and that has the force and effect of law under state law. This means that when a state agency issues a medical child support order that satisfies the QMCSO requirements in section 609(a) of ERISA, it must be honored by the Plan. To get a free copy of the procedures the Plan follows in the event a QMCSO is issued, contact Time Warner Benefits Service Center at Benefits Lost or Delayed There are certain situations under which benefits may be forfeited or delayed. Most of these circumstances are spelled out in the previous sections, but benefit payments also may be forfeited or delayed if you: Do not file for benefits properly or on time (see Your Rights Under ERISA on page 108 Do not furnish the information required to complete or verify a claim, and Do not have a current address on file with your EMPLOYING COMPANY or the applicable CLAIMS ADMINISTRATOR. You should also be aware that benefits are not payable for services provided to enrolled DEPENDENTS after they become ineligible (e.g., due to age, divorce or DOMESTIC PARTNERship dissolution). Finally, if the Plan mistakenly pays a greater benefit than you re eligible for, or pays benefits that were not authorized by the Plan, the PLAN ADMINISTRATOR or the Claims Administrator may seek any permissible remedy allowed by law to recover benefits paid in error. Uncashed Checks Any benefit payment or reimbursement made by check must be cashed within one year after it is issued. If any check for a benefit payable under the Plan is not presented for payment within one year of the date of issue, the Plan will have no liability for the benefit payment, the amount of the check will be deemed a forfeiture and no funds will escheat to any state. Therefore, it is important to keep the Plan Administrator informed of your current address and to timely deposit your benefits checks. If you misplace a benefit payment or reimbursement check, you may contact the appropriate Claims Administrator within one year of the original date of issue to request that the check be re-issued. If the one-year period has elapsed, checks cannot be re-issued. Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 103

104 Ownership of Benefits The benefits described in this Summary Plan Description are exclusively for PROGRAM participants or their beneficiaries. Program benefits cannot be sold, transferred or assigned for any reason except as provided by law or as described under Assignment of Benefits (under OTHER INFORMATION on page 100 Laws and Regulations Affecting the Plan Compliance with Federal Law The PROGRAM and the Plan are governed by regulations and rulings of the Internal Revenue Service and the Department of Labor, and applicable current federal laws. The Plan will always be construed to comply with these regulations, rulings and laws. Generally, federal law pre-empts (that is, takes precedence over) state law. States Rights and Participants Who Are Eligible for Medicaid Under Section 609(b) of ERISA, the Plan is subject to any state s right to reimbursement for medical benefits that the state has paid on behalf of a covered PARTICIPANT, if the participant is covered by a state s Medicaid program and if the benefits paid by the state would have been covered by the Plan. In providing benefits or enrolling an EMPLOYEE or dependent, the Plan may not take into account an individual s eligibility for medical assistance under a state s Medicaid program. Collective Bargaining Agreements The Plan and the Program may also be referred to in any collective bargaining agreements entered into by, or applicable to, your EMPLOYING COMPANY. You can ask your Employee Benefits/Human Resources department whether a collective bargaining agreement applies to you. Plan Administration Your benefits as a PARTICIPANT in the PROGRAM are provided under the official Plan documents, the terms of this Summary Plan Description and, for HMOs, the insurance policies and/or contracts, if any, issued to the COMPANY or an EMPLOYING COMPANY. The Program is maintained for the exclusive benefit of Plan and Program participants and their beneficiaries. The PLAN ADMINISTRATOR has exclusive authority and sole and absolute discretion to interpret the Plan and the Program to determine eligibility for Plan and Program coverage, and to make any factual determination, resolve factual disputes, and decide all matters in connection with the interpretation, administration and operation of the Plan and the Program in order to determine eligibility for Plan and Program coverage. 104 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

105 The applicable CLAIMS ADMINISTRATOR has complete authority and sole and absolute discretion to interpret the Plan and the Program, to make any factual determination, to resolve factual disputes, and decide all matters in connection with the interpretation, administration and operation of the Plan and the Program in order to determine whether you have incurred a covered expense for which benefits may be payable under the Plan and the Program and to determine the amount of, and administer the payment of, any such benefits under the Plan and the Program. Benefits will be paid under the Plan and the Program only if the Plan Administrator or the applicable Claims Administrator, as appropriate, determines in its discretion that the claimant is entitled to them. Decisions of the Plan Administrator and the applicable Claims Administrator will be conclusive and binding upon all similarly situated individuals having an interest in the Plan. Please note that no other person or group has any authority to interpret the terms of the Plan and the Program (including the official Plan documents, this Summary Plan Description and any other documents describing the Program) or to make any promises to you about them. Amendment or Termination of the Plan or the Program 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 or the Program, in whole or in part, at any time and for any reason, by action of Time Warner Inc. Time Warner Inc. has delegated authority to execute amendments to the Plan and the Program to the BENEFITS OFFICER. Termination of the Plan or the Program will not affect benefit claims for covered services incurred prior to the termination. Contacts Your contact for Plan and Program information is Time Warner Benefits Service Center at Your contacts for claiming benefits are the applicable Claims Administrator and the Plan Administrator. Also see FILING CLAIMS on page 78. Health Information Privacy The Health Insurance Portability and Accountability Act of 1996 and its applicable regulations (HIPAA) is a federal law that, in part, requires health plans like the Plan (including any HMO coverage options) to protect the privacy and security of your confidential health information. Pursuant to the HIPAA privacy rules, the Plan and the Program (and any HMO) will not use or disclose your protected health information without your authorization, except for purposes of treatment, payment, healthcare operations, Plan administration, or as required or permitted by law. A description of the Plan s uses and disclosures of your protected health information and your rights and protections under the HIPAA privacy rules is set forth in the notice of privacy practices, which has been furnished to you. You can receive another copy of the Plan s notice of privacy practices by contacting the Time Warner Benefits Service Center at If you are an HMO participant, you will also receive the HMO s notice of privacy practices directly from the HMO. Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 105

106 Nondiscrimination The Plan is subject to certain nondiscrimination requirements under the Internal Revenue Code. These nondiscrimination rules prevent the design or operation of the Plan in a way that disproportionately favors highly compensated employees. The Plan Administrator will notify you if you are affected by any of these nondiscrimination limitations. Plan Facts Plan Name Type of Plan Plan Sponsor Time Warner Group Health Plan Welfare benefits plan. This Summary Plan Description describes the active medical, prescription drug, mental health and substance use disorder, and autism support benefits (the PROGRAM ) provided under the Plan Time Warner Inc. One Time Warner Center MC001 New York, NY Employer Identification Number Plan Number 502 Plan Administrator and Named Fiduciary The ADMINISTRATIVE COMMITTEE Time Warner Inc. One Time Warner Center MC001 New York, NY Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

107 Claims Administrators and Claims Fiduciaries Agent for Service of Legal Process The Program is administered pursuant to administrative service contracts with: ] UnitedHealthcare 185 Asylum Street. Hartford, CT Blue Cross Blue Shield P.O. Box 5072 Middletown, NY CVS Caremark Customer Care Correspondence PO Box 6590 Lee s Summit, MO Optum 2000 Powell Street, Suite 1180 Emeryville, CA OptumHealth (Autism Advocate Program) 9009 Corporate Lake Drive Tampa, FL ext HMO benefits are provided under the Program through contracts with HMO providers. The CLAIMS ADMINISTRATOR and Claims Fiduciary for an HMO option is the HMO PROVIDER. Vice President and Chief Litigation Counsel Time Warner Inc. One Time Warner Center MC001 New York, NY Legal Process may also be served on the PLAN ADMINISTRATOR. Plan Year January 1 December 31 Plan Funding Financial Records This is a self-insured, unfunded welfare plan (except for HMOs, which are insured). Employees and the Employing Companies share the cost of coverage. Employees generally contribute on a before-tax basis, to the extent permitted under applicable tax law. Time Warner Inc. maintains all records of the Plan based on a Plan Year that ends as of the date shown above. All financial records are maintained by the COMPANY at the following address: Vice President, Global Benefits Time Warner Inc. One Time Warner Center MC001 New York, NY Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 107

108 Your Rights Under ERISA The benefits provided by the Time Warner Group Health Plan are covered by the EMPLOYEE Retirement Income Security Act of 1974, as amended (ERISA). The law does not require the COMPANY to provide these benefits, but it does set certain standards for any that are offered. Receive Information About Your Plan and Benefits Specifically, ERISA entitles you, as a Plan PARTICIPANT or beneficiary of a Plan participant, to: Examine without charge all Plan documents (including collective bargaining agreements and insurance policies and/or contracts, if any, where applicable) and a copy of the latest annual report (Form 5500 Series) filed by the Plan with the Department of Labor and available at the Public Disclosure Room of the Employee and Benefits Security Administration. Corporate Employee Benefits in New York has these documents available, and you may make an appointment to examine them at any time during business hours. Obtain copies of all Plan documents and other pertinent Plan information, including insurance contracts and collective bargaining agreements, and copies of the latest annual report (Form 5500 series) and updated Summary Plan Description, by requesting these materials in writing. You may obtain copies by writing to the PLAN ADMINISTRATOR. (The Company reserves the right to make a reasonable charge for copying any documents you request.) Annual Financial Summary ERISA entitles Plan participants to receive a summary of the annual financial report of the Plan. You do not need to request the summary annual report; the Company provides this information to all Plan participants once a year. Continuation of Coverage You may continue healthcare coverage for yourself, your OPPOSITE-SEX SPOUSE, or other DEPENDENTS if there is a loss of coverage under the Plan as a result of a qualifying event. In addition, the Plan voluntarily provides continuation coverage for SAME-SEX SPOUSEs, DOMESTIC PARTNERs and their children who lose PROGRAM coverage due to termination of a domestic partnership or divorce. You or your dependents may have to pay for such coverage. Review Your Rights Under ERISA on page 108 of this Summary Plan Description on the rules governing your continuation coverage rights. 108 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

109 Reduction or Elimination of Exclusionary Periods of Coverage for Preexisting Conditions You are entitled to a reduction or elimination of exclusionary periods of coverage for preexisting conditions if you have creditable coverage from another plan. You should be provided a certificate of creditable coverage, free of charge, from your group health plan or health insurance issuer when you lose coverage under the plan, when you become entitled to elect COBRA continuation coverage, when your COBRA continuation coverage ceases, if you request it before losing coverage, or if you request it up to 24 months after losing coverage. Without evidence of creditable coverage, you may be subject to a preexisting condition exclusion for 12 months (18 months for late enrollees) after your enrollment date in your coverage. To request a certificate of creditable coverage from the Plan, contact the Time Warner Benefits Service Center at Obligation of Fiduciaries In addition to creating rights for Plan participants, ERISA imposes obligations on the persons responsible for the operation of an employee benefit plan. These people, referred to as FIDUCIARIES under the law, have an obligation to administer the Plan prudently and to act in the interest of the Plan participants and their beneficiaries. The law provides that fiduciaries who violate ERISA may be removed and required to make good any losses they have caused the Plan. Obligations of Employers Many of the specific obligations ERISA imposes on employers are intended to make certain that all Plan participants are fully informed of their rights to benefits and the nature and extent of those benefits. No one, including your EMPLOYING COMPANY or your union, may discriminate against you in any way to prevent you from receiving benefits or exercising your rights under ERISA. Provisions for Legal Action ERISA specifically provides for circumstances under which you may take legal action as a Plan participant. If your claim for a welfare benefit is denied or ignored, in whole or in part, you have a right to know why this was done, to obtain copies of documents relating to the decision without charge and to appeal any denial, all within certain time schedules. At the completion of that review process, you have a right to file suit in federal or state court. After exhaustion of the Program s claims and appeals procedures described above (including external review, if available), any further legal action taken against the Plan or its fiduciaries must be filed in a court of law no later than 90 days after the CLAIMS ADMINISTRATOR s or Plan Administrator s final decision is rendered on the claim. This 90-day time limit will be suspended while you are pursuing external review, if you choose to do so. If you are eligible for and decide to request external review of your claim, the deadline for filing a lawsuit or initiating any other legal proceeding is 90 days after the independent third party reviewer makes a decision on external review. Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 109

110 If Plan fiduciaries misuse the Plan s funds or if you are discriminated against for asserting your rights, you have a right to seek assistance from the U.S. Department of Labor or to file suit in a federal court. If you submit a written request for copies of any Plan documents or other Plan information to which you are entitled under ERISA, and you do not receive those materials within 30 days of your request, you may file suit in a federal court. If a violation exists, the court may require the Plan Administrator to provide the material and to pay you up to $110 for each day s delay. This provision does not apply, however, if the requested materials were not sent to you because of reasons beyond the control of the Plan Administrator. If you disagree with the Plan s decision or lack thereof concerning the qualified status of a medical child support order, you may file suit in federal court. In these circumstances, the court will decide who should pay court costs and legal fees. In other words, if you are successful, the court may order the party you have sued to pay these costs and fees. But if you lose, the court may order you to pay the costs and fees (for example, if the court finds that your claim is frivolous). If you believe that the Plan Administrator or Claims Administrator (as applicable) has improperly denied you benefits under this Program, please remember that you must complete each step of the claims and appeals procedure in FILING CLAIMS on page 78, within the deadlines, before you can take any legal action. If it should ever become necessary for you or your beneficiary to take legal action to enforce your rights under ERISA or the terms of the Plan, legal process may be served on the Plan Administrator or on the Vice President and Chief Litigation Counsel, Time Warner Inc. Your Rights Your rights can be determined only by referring to the full text of the Plan documents, which are available for your inspection from the Plan Administrator. The Company encourages you to contact the Time Warner Benefits Service Center at if you should have any questions about the foregoing statements or about your rights under ERISA. You may also contact the nearest office of the Employee Benefits Security Administration, U.S. Department of Labor listed in your telephone directory, or the Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue N.W., Washington, D.C , to discuss questions about this statement of rights or about any rights under ERISA, or if you need assistance in obtaining documents from the Plan Administrator. You can also obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the Employee Benefits Security Administration. 110 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

111 KEY TERMS & DEFINITIONS ADMINISTRATIVE COMMITTEE Administrative Committee is the Plan Administrator for the Time Warner Inc. Group Health Plan. You can write to the Administrative Committee (Time Warner Group Health Plan) c/o Time Warner Inc., One Time Warner Center, MC001, New York, NY AMBULATORY SURGICAL CENTER Ambulatory Surgical Center is a licensed specialized facility which is established, equipped, operated and staffed primarily to perform surgical procedures. If licensing is not required, the facility must meet all the following requirements: The facility must be under the supervision of a licensed physician and must permit a surgical procedure to be done only by a physician qualified to do the same surgery in at least one hospital in the same area. A qualified anesthesiologist must administer the anesthesia (or supervise an anesthetist) and remain present throughout the procedure. It provides the full-time services of a registered nurse (R.N.). It has at least one operating room and one post-anesthesia recovery room. It is equipped to perform diagnostic X-ray and laboratory exams or has an arrangement to obtain these services and has immediate access to a blood bank or blood supplies. It has trained personnel and equipment to handle emergencies. It maintains an adequate medical record for each patient, including the admitting diagnosis, a preoperative examination report, medical history and lab and X-ray results, an operative report and a discharge summary. ASSISTANT SURGEON Assistant surgeon is a licensed physician who actively assists the operating surgeon. Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 111

112 BEHAVIORAL DISORDER Behavioral disorder is a pathological state producing clinically significant psychological symptoms (including, but not limited to, affective, cognitive and behavioral impairments) or physiological symptoms that impair one or more major areas of functioning. BENEFITS OFFICER Benefits Officer acts on behalf of Time Warner Inc. and has certain responsibilities, including the authority to execute Plan amendments. The Benefits Officer performs only non-fiduciary functions and may delegate certain functions at his or her discretion. BIRTH CENTER Birth center is a licensed facility primarily for the delivery of children following an uncomplicated pregnancy. In addition to being operated and equipped according to state law, the facility must also: Operate under the full-time supervision of a licensed physician or registered graduate nurse (R.N.). Be equipped to perform routine diagnostic and laboratory examinations. Be staffed and equipped to handle foreseeable emergencies. Maintain a written agreement with at least one local hospital for immediate acceptance of patients who develop complications. Maintain an adequate medical record for each patient, including prenatal history, prenatal examination, laboratory and diagnostic tests and a postpartum summary. BRAND-NAME DRUG Brand-name drug is a prescription drug that is or was under patent protection. 112 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

113 CLAIMS ADMINISTRATOR Claims Administrator is the applicable company that reviews certain types of claims directly and is responsible for determining whether you have incurred an eligible expense for which benefits may be payable under the Program. The Claims Administrator determines the amount of, and administers the payment of, any such benefits under the Program. (See Plan Facts on page 106 for information on how to contact your applicable Claims Administrator.) CLINICAL NECESSITY OR CLINICALLY NECESSARY Clinical necessity or clinically necessary refers to standards required to identify, assess or treat a mental health or alcoholism/substance use disorder condition in a manner consistent with established mental health practices as determined by Optum and with the expectation of improving the patient s health. Clinically necessary services, supplies, accommodations or other items are those which are consistent with the symptoms and signs of diagnosis and treatment of a behavioral disorder, psychological injury or chemical dependency; consistent in type and amount with regard to the standards of good clinical practice; not solely for the convenience or preference of the patient, or his or her healthcare provider; and the least restrictive and least intrusive appropriate supply or level of service that can be safely provided. Services, supplies, accommodations and other items are not automatically clinically necessary because they are prescribed by a provider. The criteria used for clinical necessity determinations are available upon request by contacting Optum. COBRA COBRA means the Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA). COMPANY Company means Time Warner Inc. or any successor. CONGENITAL ANOMALY Congenital anomaly is a physical developmental defect that is present at birth and is identified within the first 12 months of birth. COPAYMENT OR COPAY Copayment or copay means the fixed-dollar fee that must be paid by a participant to the CVS Caremark mail order pharmacy for covered medications. Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 113

114 COSMETIC SURGERY Cosmetic surgery is a procedure performed primarily for the purpose of changing the appearance of any part of the body to improve or alter appearance or self-esteem, whether or not for psychological or emotional reasons. COVERED CHARGES OR COVERED EXPENSES Covered charges or covered expenses are eligible medical charges or expenses that qualify for reimbursement under the Program. To qualify, the expense must be medically necessary/clinically necessary or for covered preventive care, must not be an ineligible expense under the terms of the Program and must be incurred while you are covered under the Program. CUSTODIAL CARE OR MAINTENANCE CARE Custodial care or maintenance care includes services or supplies that are furnished mainly to train or assist an individual in the activities of daily living, such as assistance in walking, getting in and out of bed, bathing, dressing, feeding, using the toilet, preparation of special diets and supervision of medication that can usually be selfadministered. Custodial care can safely and adequately be provided by persons who do not have the technical skills of a healthcare provider; or is provided without reasonable expectation of measurable improvement in the patient s health. DEPENDENTS Dependents are defined in WHO S ELIGIBLE on page 10. DISABLED OR DISABILITY Disabled or disability means you are under a physician s care and your illness or injury prevents you from performing the material and substantial duties of your occupation. For a dependent child, disabled or disability means the child is under a physician s care and is incapable of permanent self-support due to a physical or mental condition which is permanent. DOMESTIC PARTNER Domestic partner is defined in WHO S ELIGIBLE on page 10. To cover your domestic partner under the Plan, you may be required to file an Affidavit of Domestic Partnership and/or Declaration of Tax Status with your Employing Company. 114 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

115 DURABLE MEDICAL AND SURGICAL EQUIPMENT Durable medical and surgical equipment is equipment that is made to withstand prolonged use, made for and mainly used in the treatment of a disease or injury, suited for use in the home, not normally of use to persons who do not have a disease or injury, not for use in altering air quality or temperature, and not for exercise or training. EFFECTIVE TREATMENT OF SUBSTANCE USE DISORDER OR MENTAL AND NERVOUS DISORDERS Effective treatment of substance use disorder or mental and nervous disorders is a program of alcoholism or drug abuse therapy prescribed and supervised by a physician. It must have a follow-up therapy program directed by a physician on at least a monthly basis or include meetings at least twice a month with organizations devoted to the treatment of alcoholism or drug abuse. Detoxification (treating the after-effects of a specific episode of alcoholism or drug abuse) and maintenance care (providing an environment free of alcohol or drugs) are not considered effective treatment of substance use disorder or mental and nervous disorders by themselves. EMERGENCY Emergency means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson (including the parent of a minor child or the guardian of a disabled individual), who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in placing the health of the individual (or with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy; serious impairment to bodily function; or serious dysfunction of any bodily organ or part. EMPLOYEE Employee for Time Warner Group Health Plan purposes means an individual who is regularly employed full-time or part-time by an Employing Company and is paid on the regular U.S. payroll of an Employing Company. (This U.S. payroll requirement may be waived by written agreement between the Claims Administrator and the Benefits Officer in the limited case of employees working abroad.) Temporary employees, or anyone so classified by the Employing Company, are generally not eligible to participate in any components of the Plan, nor are employees covered by a collective bargaining agreement, unless the collective bargaining agreement and the Plan, as amended, provides for Plan participation with Benefits Officer approval. An individual classified as an independent contractor or a leased employee by an Employing Company, or any individual otherwise not in a covered class who provides services to an Employing Company while being paid by a business other than an Employing Company, will not be considered an employee for purposes of the Plan even if this individual is considered a common law employee of the Employing Company by any entity for any other purpose. Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 115

116 EMPLOYING COMPANY Employing Company means Time Warner Inc. or any successor and the affiliate Time Warner Inc. companies participating in the Plan. For a current listing of Employing Companies, contact the Plan Administrator. Any company that adopts the Plan and that later ceases to be an affiliate of Time Warner Inc. will cease to be an Employing Company. EXPERIMENTAL OR INVESTIGATIVE TREATMENT For UHC coverage options and for all mental health and substance use disorder benefits medical, surgical, diagnostic psychiatric, substance use disorder or other healthcare services, technologies, supplies, treatments, procedures, drug therapies or devices that, at the time UnitedHealthcare makes a determination regarding coverage in a particular case, are determined to be any of the following: 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, 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. If you have a sickness or injury that is likely to cause death within one year of the request for treatment, UnitedHealthcare may, at its discretion, determine that an experimental or investigational treatment is a covered charge for that sickness or injury. For this to take place, UnitedHealthcare must determine that the procedure or treatment is: Proved to be safe and promising, Provided 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. For BCBS coverage options procedures, services, drugs and other supplies that fall into any of the following categories, as determined by BCBS: There are insufficient outcomes data available from controlled clinical trials published in the peer reviewed literature to substantiate its safety and effectiveness for the disease or injury involved, 116 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

117 If required by the FDA, approval has not been granted for marketing, A recognized national medical or dental society or regulatory agency has determined, in writing, that it is experimental, investigational or for research purposes, or The written protocol or protocols used by the treating facility or the protocol or protocols of any other facility studying substantially the same drug, device, procedure or treatment or the written informed consent used by the treating facility or by another facility studying the same drug, device, procedure or treatment states that it is experimental, investigational or for research purposes. The UHC and BCBS coverage options may cover experimental treatments or drugs under the following circumstances: If the Claims Administrator determines that denying treatment will lead to the patient s death within one year, as long as the treatment in question has been demonstrated by scientific data as being effective for that disease. This determination will take into account the results of a review by a selected panel of independent medical professionals who treat the type of diseases involved. Drugs granted treatment investigational new drug (IND) or Group/treatment IND status that are being studied at the Phase III level in a national clinical trial sponsored by the National Cancer Institute or for which available scientific evidence demonstrates that the drug is effective for the disease or shows the promise of being effective as determined, provided they are prescribed and administered during a hospitalization. FIDUCIARIES Fiduciaries are those individuals or entities assigned the responsibility for ensuring that the Plan operates in the best interests of the participants. Fiduciaries have ultimate decision-making authority on Plan-related matters. GENERIC DRUG Generic drug is a prescription drug that is not under patent protection. HEALTH MAINTENANCE ORGANIZATION OR HMO Health Maintenance Organization or HMO is a health-care alternative to the PPO and OOA coverage options. HMOs provide a package of health services to enrolled members through a network of physicians and other health services providers within a particular geographic area. Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 117

118 HOSPICE Hospice care means a program of care that is provided by a hospital, skilled nursing facility, hospice or duly licensed hospice care agency; approved by the Claims Administrator; and focused on palliative rather than curative treatment for a Program participant who has a medical condition and a prognosis of less than six months to live. HOSPITAL Hospital means an institution, operating within the scope of its license, that meets any of these three tests: It is accredited as a hospital by the Joint Commission on Accreditation of Healthcare Organizations. It is legally operated, has 24-hour-a-day supervision by a staff of doctors, has 24-hour-a-day nursing service by registered graduate nurses, and mainly provides general or specialized inpatient and emergency medical care and treatment of sick and injured persons by the use of medical, diagnostic and major surgical facilities under its control or available to it under a written agreement. In connection with the treatment of substance use disorder, when such treatment is prescribed by a doctor, it is licensed as a hospital; is a detoxification facility that is licensed under the laws of the state in which it is located; or is a residential treatment facility that is licensed, certified or approved by the state in which it is located under a program that meets minimum standards of care. Those standards must be equivalent to those prescribed by the Joint Commission on Accreditation of Healthcare Organizations. A hospital does not include a nursing home, hospice or an institution, or part of one, which mainly: is used as a place for convalescence, rest, nursing care or care for the aged; furnishes homelike or custodial care, or training in the routines of daily living; or is a school. INFERTILITY Infertility means the inability to conceive or produce conception after one year of frequent, unprotected heterosexual sexual intercourse. INTENSIVE CARE UNIT Intensive care unit is a section, ward or wing within a hospital which is operated exclusively for critically ill patients and provides special supplies, equipment, and constant observation and care by registered graduate nurses or other highly trained personnel. This excludes, however, any hospital facility maintained for the purpose of providing normal post-operative recovery treatment or service. 118 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

119 MEDICALLY NECESSARY OR MEDICAL NECESSITY Medically necessary or medical necessity refers to services or supplies that are determined by the Claims Administrator to be necessary for the diagnosis or treatment of an injury, illness or pregnancy. This determination is based on and consistent with standards approved by the medical personnel of the Claims Administrator. These standards are developed, in part, with consideration given to whether the service or supply meets the following criteria: For UHC coverage options: Provided for the purpose of preventing, diagnosing or treating physical illness, disease, pregnancy, injury or their symptoms, Included in the section ELIGIBLE MEDICAL EXPENSES on page 36, Provided to an EMPLOYEE or dependent who meets the PROGRAM s eligibility requirements, as described in the WHO S ELIGIBLE on page 10, and Not identified in the section What s Not Covered on page 48 under ELIGIBLE MEDICAL EXPENSES on page 36. For BCBS coverage options: Provided by a physician, exercising prudent clinical judgment, for the purpose of preventing, evaluating, diagnosing or treating an illness, injury, disease or its symptoms, Provided in accordance with generally accepted standards of medical practice, meaning standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, physician specialty society recommendations and the views of physicians practicing in relevant clinical areas, and any other relevant factors, Clinically appropriate, in terms of type, frequency, extent, site and duration, and considered effective for the patient s illness, injury or disease, Not primarily for the convenience of the patient, the physician or other healthcare PROVIDER, and is not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results, Included in the section ELIGIBLE MEDICAL EXPENSES on page 36, Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 119

120 Provided to an employee or dependent who meets the Program s eligibility requirements, as described in WHO S ELIGIBLE on page 10, and Not identified in the section What s Not Covered on page 48 under ELIGIBLE MEDICAL EXPENSES on page 36. A determination that a service or supply is not medically necessary may apply to the entire service or supply or to any part of the service or supply. MEDICARE Medicare is the health insurance program for the aged and disabled as provided under Title XVIII of the Social Security Act. MENTAL HEALTH OR NERVOUS CONDITION OR DISORDER Mental health or nervous condition or disorder means any diagnosed condition listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM, most recent edition, revised), except as specified in What s Not Covered on page 48 under ELIGIBLE MEDICAL EXPENSES on page 36 of this Summary Plan Description, for which treatment is commonly sought from a psychiatrist or mental health provider. The DSM is a clinical diagnostic tool developed by the American Psychiatric Association and used by mental health professionals. Diagnoses described in the DSM will be considered mental/nervous in nature, regardless of the factors causing the condition. NEGOTIATED CHARGE Negotiated charge is the maximum charge an in-network provider has agreed to make for any service or supply for the purpose of benefits under this Program. NETWORK Network is a group of providers assembled by each Claims Administrator to offer services to Program participants for a pre-determined fee. Network provider means a provider that has entered into a contractual agreement with the Claims Administrator to provide services to enrolled Program participants. 120 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

121 NON-OCCUPATIONAL ILLNESS OR DISEASE Non-occupational illness or disease is an illness or disease that does not arise out of (or in the course of) any work for pay or profit, or result in any way from a disease that does. A disease is considered non-occupational regardless of its cause if proof is furnished that the person is covered under any type of Workers Compensation law and is not covered for that disease under such law. NON-OCCUPATIONAL INJURY Non-occupational injury is an accidental bodily injury that does not arise out of (or in the course of) any work for pay or profit or result in any way from an injury that does. OPPOSITE-SEX SPOUSE Opposite-sex spouse is defined in WHO S ELIGIBLE on page 10. OUT-OF-AREA (OOA) Out-of-Area (OOA) coverage option means the UnitedHealthcare Out-of-Area medical coverage option, as described in this Summary Plan Description. PARTICIPANT Participant is an employee or dependent who satisfies the Program s eligibility requirements and enrolls in the Program. PHYSICIAN OR DOCTOR Physician or doctor is a practitioner of the healing arts licensed by a state and acting within the scope of his or her license. This includes, but is not limited to, pediatricians, internists, family practitioners, obstetrician/gynecologists, psychiatrists, chiropractors, chiropodists, podiatrists, doctors of osteopathy and other medical doctors. Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 121

122 PLAN ADMINISTRATOR Plan Administrator for the Time Warner Group Health Plan is the Administrative Committee. You can write to the Administrative Committee (Time Warner Inc. Group Health Plan) c/o Time Warner Inc., One Time Warner Center, MC001, New York, NY PPO PPO means the UHC and BCBS Preferred Provider Organization coverage options, as described in this Summary Plan Description. PROGRAM Program means the medical, prescription drug, mental health and substance use disorder, and autism support coverages provided to eligible employees and their dependents under the Plan. PROVIDER Provider means an eligible licensed or certified healthcare or mental health professional or facility, including doctors, hospitals, skilled nursing facilities, rehabilitation centers, nurse-midwives, chiropractors, podiatrists, surgical centers, outpatient radiology facilities, outpatient laboratories, home healthcare services, medical equipment suppliers and other healthcare professionals. QUALIFIED CHANGE IN STATUS Qualified change in status means any of the qualifying events listed under Qualified Change in Status on page 15. REASONABLE AND CUSTOMARY Reasonable and customary means the maximum eligible charge the Claims Administrator determines it will accept for a service, in a geographic area, based on the Claims Administrator s guidelines. 122 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

123 For UHC coverage options and for all mental health and substance use disorder and Autism Advocate Program benefits reasonable and customary charges are determined by: Selected data resources which, in the judgment of UHC (or one of its vendors, affiliates or subcontractors), represent competitive fees in that geographic area, or Negotiated rates agreed to by an out-of-network provider and either UHC or one of its vendors, affiliates or subcontractors. These provisions do not apply if you receive EMERGENCY services from an out-of-network provider. In that case, REASONABLE AND CUSTOMARY means the amounts billed by the provider, unless UHC negotiates lower rates. For BCBS coverage options reasonable and customary charges are determined by BCBS based on one or more of several sources, including the following: Amounts based on BCBS s network provider fee schedule/rate, Amounts based on the level and/or method of reimbursement used by the Centers for MEDICARE and Medicaid Services, unadjusted for geographic locality, for the same services or supplies (updated no less than annually), Amounts based on charge, cost reimbursement or utilization data, Amounts based on information provided by a third party vendor, which may reflect one or more of the following factors: (i) the complexity or severity of treatment; (ii) level of skill and experience required for the treatment; or (iii) comparable providers fees and costs to deliver care, or An amount negotiated by BCBS or a third party vendor which has been agreed to by the provider. This may include rates for services coordinated through case management. Special rules apply for determining the reasonable and customary amount in emergency care situations. SAME-SEX SPOUSE Same-sex spouse is defined in WHO S ELIGIBLE on page 10. Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 123

124 SEMIPRIVATE RATE Semiprivate rate is the charge for room and board which an institution applies to most beds in its semiprivate rooms with two or more beds. If there are no such rooms, the rate will be the rate most commonly charged by similar institutions in the same geographic area. SKILLED NURSING FACILITY Skilled nursing facility is an institution that is either approved by Medicare or meets all the following tests: Is licensed to provide the following inpatient care to patients convalescing from disease or injury: professional nursing care by an R.N. or L.P.N. directed by a full-time R.N.; administration of medication on the order of a licensed physician; and physical restoration services that help patients restore their ability to care for themselves Provides 24-hour nursing care by licensed nurses directed by a full-time R.N., Is supervised full-time by a physician or R.N., Keeps a complete medical record on each patient, Has a utilization review plan, and Is not mainly a place for rest; for the aged, drug addicts, alcoholics or the mentally retarded; for custodial or educational care; or for care of mental disorders. SPECIALIST Specialist means a physician who provides medical care in any generally accepted medical or surgical specialty or sub-specialty. SUBSTANCE USE DISORDER OR CHEMICAL DEPENDENCY Substance use disorder or chemical dependency is a condition of psychological and/or physiological dependence or addiction to alcohol or psychoactive drugs or medications that results in functional (physical, cognitive, mental, affective, social or behavioral) impairment. 124 Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner

125 SURGERY Surgery refers to cutting, suturing, treatment of burns, correction of fractures, reduction of dislocations, manipulation of joints under general anesthesia, electrocauterization, tapping (paracentesis), application of plaster casts, administration of pneumothorax, endoscopy or injection of sclerosing solution, and other medical procedures defined as surgery by the American Medical Association and based on Current Procedure Terminology (CPT) codes. TERMINAL ILLNESS OR TERMINALLY ILL Terminal illness or terminally ill means an illness of a Program participant which has been diagnosed by a physician and for which the participant has a prognosis of six months or less to live. TIME WARNER GROUP HEALTH PLAN OR PLAN Time Warner Group Health Plan or Plan refers to the Time Warner Group Health Plan, a consolidated welfare benefits plan providing medical, mental health and substance use disorder treatment, vision care, prescription drug, autism support and dental benefits to eligible employees and retired employees and their eligible dependents. Time Warner Group Health Plan Benefits Effective January 1, 2013 Turner 125