2013 Beefits Guide
Teva is proud to offer our employees a highly competitive ad comprehesive beefits program. This guide will help you avigate ad uderstad what s available. Use it to help you make iformed decisios for you ad your family.
You ad your family have access to: 4 HEALTHCARE Medical (icludes visio) Prescriptio Drug Detal Flexible Spedig Accouts (FSAs) Retiree Health Access 12 LIFE AND DISABILITY INSURANCE Basic Term Life Isurace Accidetal Death ad Dismembermet (AD&D) Isurace Optioal Life Isurace Optioal Employee Term Life Isurace Optioal Spouse Term Life Isurace Optioal Depedet Childre Term Life Isurace Short- ad Log-Term Disability 16 WEALTH MANAGEMENT Erst & Youg Fiacial Plaer Lie Erst & Youg Fiacial Plaig Ceter Website Erst & Youg Survivor Couselig Service Employee Stock Purchase Pla (ESPP) Fidelity 401(k) Pla Fidelity College Savigs Pla (529 Pla) 18 LIVING HEALTHIER Aeta Discout Programs Aeta s Iformed Health Lie Aeta WorkLife Resources/ Employee Assistace Program (EAP) Alere Wellbeig Tobacco Cessatio Program Tobacco Cessatio Icetive Baby Steps Best Doctors Cliical ad Elder Advocacy Fitess Ceter Discouts Health Coachig through OptumHealth Kow Your Numbers Program Weight Watchers 22 LIFESTYLE Adoptio Fiacial Assistace Program KiderCare Day Care Programs MetLife Auto & Home Program Discout Persoal Travel Assistace Veteriary Pet Isurace Also icluded i this guide: 2 Eligibility 3 Beefit Cost Sharig 24 Erollmet 28 Legal Notices 37 Providers/Beefits Cotact Iformatio O the followig pages you ll fid iformatio about your Teva beefits for 2013. Keep this guide hady to serve as a referece throughout the year.
Eligibility Employees To be eligible for coverage uder Teva s beefits program, you must be a Teva employee who is regularly scheduled to work 30 hours or more each week. Depedets Eligible depedets, as defied below, may also be covered uder the medical ad detal plas: Importat If your spouse/domestic parter is offered subsidized group health coverage through his/her employer (or former employer), you will be required to pay a added surcharge of $100 a moth to cover him/her. Legal spouse Domestic parter: Two adults of the same or opposite sex who have bee i a relatioship of mutual carig for at least six moths, reside together ad share a mutual obligatio for basic livig expeses. To eroll, you must complete a Affidavit of Domestic Partership Erollmet Form ad submit the completed form to the Teva Beefits Service Ceter. The form is available o www.my efits.com. If your covered beeficiaries are ot defied as tax depedets by the Iteral Reveue Service (IRS), Teva must calculate the estimated fair market value of your health beefits ad charge that to you as imputed icome. Depedet childre up to age 26 Umarried, disabled childre of ay age; you must provide proof of disability withi 31 days of your child s 26th birthday ID Cards Every year Aeta updates your ID card. This card ca be prited olie via the Aeta website. Be sure to show your ID cards to your doctor, pharmacist ad/or detist, so they ca update their billig records. Also, whe you eroll i Aeta medical coverage, you will automatically receive a prescriptio drug ID card from CVS Caremark. If you eed to request ew ID cards, cotact Aeta at (800) 458-3843 or CVS Caremark at (877) 318-5134, or log o to www.aeta.com ad/or www.caremark.com. 2 Teva 2013 Beefits
Beefit Costs Some we share, but may we cover at 100%. As a Teva employee you have access to may beefits where Teva covers all or most of the cost. Here s a quick breakdow of beefits with shared cotributios, those that are paid by the employee with rates egotiated by Teva, ad those that are 100% Teva-paid. Healthcare Life Isurace Disability Isurace Wealth Maagemet Livig Healthier Lifestyle Beefit Teva-Paid Employee-Paid Medical (icludes Visio) Prescriptio Drug Detal Retiree Health Access Flexible Spedig Accouts (FSAs) Basic Term Life Isurace Accidetal Death ad Dismembermet (AD&D) Optioal Employee Term Life Isurace Optioal Spouse Term Life Isurace Optioal Depedet Childre Term Life Isurace Short-Term Disability Log-Term Disability Fiacial Plaer Lie Fiacial Plaer Website Survivor Couselig Service Teva-egotiated rates for our employees Employee Stock Purchase Pla (ESPP) 401(k) Pla College Savigs Pla (529 Pla) Aeta Discout Programs Iformed Health Lie Employee Assistace Program (EAP) Alere Wellbeig Tobacco Cessatio Program Tobacco Cessatio Icetive Baby Steps Best Doctors Cliical ad Elder Advocacy Fitess Ceter Discouts Health Coachig through OptumHealth Weight Watchers Adoptio ad Fiacial Assistace KiderCare Day Care Programs MetLife Auto & Home Program Discout Persoal Travel Assistace Veteriary Pet Isurace Teva-egotiated rates for our employees 3 Teva 2013 Beefits
Healthcare Medical Teva offers three optios for medical coverage: Aeta Core Pla Aeta Premier Pla Aeta Value Pla with Health Savigs Accout (HSA) You ca fid more iformatio, icludig pla costs, at www.mytevabeefits.com. Aeta Core Pla This is a pla you should cosider if you wat the flexibility of i- ad out-of-etwork care with the peace of mid to kow that you will have lower out-of-pocket expeses for your care. If you have a medical coditio or eed frequet care, this pla will protect you from payig higher out-of-pocket costs tha the Value Pla; however, this pla does have a higher aual deductible ad copay tha the Premier Pla. Aeta Premier Pla You will pay more for this pla, but it gives you maximum protectio by limitig the amout you pay out of your pocket for healthcare expeses. This pla is ideal for those with chroic illesses or large families who expect to make multiple doctor ad specialist visits throughout the year. This pla also allows you to use i- ad out-of-etwork providers. Fid a Aeta Network Provider You ca see if your doctor participates i ay of the Aeta etworks for our three medical plas. Simply go to www.aeta.com ad click Fid a Doctor. To search the etwork Teva uses for our medical plas, choose Aeta Choice POS II (Ope Access). Compare the Cost of Your Optios Use the Medical Expese Estimator to see how much you might pay for healthcare uder the differet medical optios. Just go to www.mytevabeefits.com ad click Estimate Your Medical Expeses. Choose the plas you wat to compare ad the depedets that you wat to cover uder the plas. Click Get Results to see a estimate of your medical expeses uder each pla. 4 Teva 2013 Beefits
Aeta Value Pla with Health Savigs Accout (HSA) Not oly is this pla a low-cost optio, but it also gives you the opportuity to save ad ivest moey i a HSA tax-free to pay for future healthcare expeses. The Aeta Value Pla has a higher deductible tha the other Teva plas: $2,000 if you cover yourself oly $4,000 if you cover eligible depedets This pla allows you to use i- ad out-of-etwork providers. Ad, you do t eed a referral to see a specialist. Routie physicals ad other prevetive care services are free whe you go to i-etwork doctors, regardless of whether you ve met the deductible. For other services, such as doctor or specialist office visits for a illess, lab tests, emergecy room visits or X-rays you ll pay the full cost util the deductible has bee met. Save Moey with I-Network Care Although all plas offer the flexibility of i- ad out-of-etwork care, you ca maximize your beefits ad reduce your healthcare costs by usig i-etwork providers. Use the provider search tool o www.aeta.com to see if your doctors, specialists ad hospitals are i or out of the etwork. To search the etwork Teva uses for our medical plas, click Fid a Doctor, ad choose Aeta Choice POS II (Ope Access). If you pla to go out-of-etwork, cosider usig a pre-tax Health Care FSA to save moey o your medical expeses. Make your moey go further. Use a Health Care FSA to set moey aside pre-tax to cover expeses durig the year that are ot covered uder your medical or detal pla. If you re goig to sped the moey ayway, you might as well avoid payig taxes o it. See page 11 for more iformatio. 5 Teva 2013 Beefits
Aeta HealthFud HSA Whe you eroll i the Aeta Value Pla, you automatically have the opportuity to save for healthcare expeses i a HSA. You ca cotribute to your HSA through payroll deductios up to the IRS limit. This moey is ot taxable, ad you ca save ad ivest it for future healthcare expeses. The Teva HSA gives you a triple tax advatage. You will ot pay taxes o: Moey you cotribute via a payroll deductio Iterest the moey ears i the HSA Moey you sped o eligible healthcare services I additio, depedig o how much you cotribute ad your idividual tax circumstaces, you might also lower your taxable icome for the year. How much ca I cotribute? You ca cotribute up to the IRS limit: If you are betwee the ages of 55 ad 64, you ca cotribute a additioal catch-up cotributio over the IRS limit $1,000 i 2013. You also have the optio to make deposits directly ito your accout with JPMorga Chase. If you do this, you will be cotributig after-tax moey ad ca take the tax deductio whe you file your taxes at the ed of the year. How ca I use the moey i my HSA? The IRS determies what expeses HSAs ca be used for. Expeses iclude: Medical pla deductibles ad coisurace Diagostic services covered by your pla Retiree medical coverage premium COBRA premium You ca see a complete list of eligible expeses at www.aeta.com. You ca get a copy of the IRS Publicatio 502 by callig (800) 829-3676. You ca also visit the IRS website at www.irs.gov ad click Forms ad Publicatios. Usig your HSA Whe you eroll i the Aeta Value Pla, you ll receive a HSA welcome kit i the mail from JPMorga Chase/Aeta. You ca order checks to make withdrawals, ad you automatically receive a Aeta Visa Debit Card. With the Aeta Value Pla, you ca have your healthcare expeses deducted directly from your HSA. This is called Aeta AutoDebit. To eroll i AutoDebit: Go to www.aeta.com Log o to Aeta Navigator Click Health Savigs Accout AutoDebit Click Eroll or Cacel Click Submit IRS 2013 Aual Limit for Employee Cotributio Employee Oly $3,250 Employee + 1 (or more) $6,450 The HSA is a tax-free accout for healthcare expeses. With a HSA: You wo t pay taxes o the moey you cotribute via payroll deductio. You wo t pay taxes o the iterest your accout ears. You wo t pay taxes o the moey you sped o eligible healthcare expeses. Your accout balace rolls over each year; there is o use it or lose it rule. You ca take the accout with you whe you retire or leave Teva for ay reaso. Remember: You re goig to pay tax o moey you sped o healthcare if you re ot erolled i the HSA or Flexible Spedig Accout (FSA). With a HSA, eve if you re ot spedig the moey ow, chaces are that you ll eed moey for healthcare whe you retire. Why ot take advatage of the tax-free savigs ad spedig. Wat some help decidig what to do? For questios about how much you should cotribute to a HSA, cotact a Erst & Youg fiacial plaer at (888) 374 5334. For additioal iformatio about the Aeta HealthFud HSA, you ca view olie videos ad calculators at www.aeta.com. 6 Teva 2013 Beefits
Medical, Visio ad Hearig Beefit Details Aeta Core Pla Aeta Premier Pla Aeta Value Pla with HSA Coisurace Aual Deductible Copay Aual Out-of-Pocket Maximum* Aual Lifetime Maximum PCP Office Visit Specialty Care Emergecy Room Ipatiet Hospital Outpatiet Surgery I-Network Out-of-Network I-Network Out-of-Network I-Network Out-of-Network 80% after deductible $600 sigle $1,200 Employee + 1 $20 PCP/$30 Specialist $2,000 sigle $4,000 Employee + 1 $20 copay 60% of R&C covered $1,200 sigle $2,400 Employee + 1 60% of R&C covered $4,000 sigle $8,000 Employee + 1 60% of R&C covered 60% of R&C covered $30 copay 80% covered 50% covered for o-emergecy 80% covered 80% covered 60% of R&C covered 60% of R&C covered 90% after deductible $300 sigle $600 Employee + 1 $20 PCP/$30 Specialist $1,000 sigle $2,000 Employee + 1 $20 copay Ulimited 70% of R&C covered $600 sigle $1,200 Employee + 1 70% of R&C covered $2,000 sigle $4,000 Employee + 1 70% of R&C covered 70% of R&C covered $30 copay 90% covered 50% covered for o-emergecy 90% covered after deductible 90% covered 70% of R&C covered 70% of R&C covered 80% after deductible 80% after deductible 80% covered 80% covered $2,000 sigle $4,000 Employee + 1 $4,000 sigle $8,000 Employee + 1 60% of R&C covered 60% of R&C covered 60% of R&C covered 60% of R&C covered 80% covered 50% covered for o-emergecy 80% covered after deductible 80% covered after deductible 60% of R&C covered 60% of R&C covered Diagostic Labs/X-rays 80% covered 60% of R&C covered 90% covered 70% of R&C covered 80% covered after deductible 60% of R&C covered Hearig Evaluatio (oe test per caledar year) 100% covered, o deductible 80% of R&C covered 100% covered, o deductible 80% of R&C covered 80% covered 60% of R&C covered Hearig Aids 80% covered,, for bilateral aids every five years; max. of $5,000 80% covered,, for bilateral aids every five years; max.of $5,000 80% covered,, for bilateral aids every five years; max. of $5,000 Routie Eye Exam 100% covered, o deductible 80% of R&C covered 100% covered, o deductible 80% of R&C covered 100% covered, o deductible 80% of R&C covered Leses ad Frames $200/year max. for leses, frames ad/or cotacts combied *Out-of-pocket maximum icludes deductible i all optios. 7 Teva 2013 Beefits
Medical Payroll Deductios Coverage Level Cost Per Pay Period Cost Per Moth Employee Oly $20.62 $44.68 Aeta Core Pla Employee + Spouse* $45.37 $98.30 Employee + Child(re) $37.12 $80.43 Employee + Family* $61.87 $134.05 Employee Oly $38.67 $83.79 Aeta Premier Pla Employee + Spouse* $85.08 $184.34 Employee + Child(re) $69.61 $150.82 Employee + Family* $116.02 $251.37 Employee Oly $29.63 $64.20 Aeta Value Pla with HSA Employee + Spouse* $65.19 $141.24 Employee + Child(re) $53.33 $115.56 Employee + Family* $88.89 $192.60 *Importat If your spouse/domestic parter is offered subsidized group health coverage through his/her employer, you will be required to pay a added surcharge of $100 per moth to cover him/her. Prevetive Care For all of Teva s medical pla optios, i-etwork prevetive care is covered at 100%. Routie Physical Exams Routie OB/GYN Well-Child Visits Aeta Core Pla Aeta Premier Pla Aeta Value Pla with HSA I-Network Out-of-Network I-Network Out-of-Network I-Network Out-of-Network 100% covered, o deductible 80% of R&C covered, o deductible 100% covered, o deductible 80% of R&C covered, o deductible 100% covered, o deductible 80% of R&C covered, o deductible 8 Teva 2013 Beefits
CVS Caremark Prescriptio Drug Coverage Whe you elect Teva medical coverage, you ll automatically have prescriptio drug coverage with CVS Caremark. You ll receive materials from CVS Caremark with iformatio about all of the tools ad resources available to you as a CVS Caremark member. Retail (up to a 30-day supply) Aeta Core Pla Aeta Premier Pla Aeta Value Pla with HSA Teva Geeric & Brad $0 $0 $0 * Geeric $5 $5 $5 * Brad Preferred** $25 $25 $25 * Brad No-preferred** $40 $40 $40 * Mail ad Retail Maiteace Program (up to a 90-day supply) Teva Geeric & Brad $0 $0 $0 * Geeric $10 $10 $10 * Brad Preferred** $62.50 $62.50 $62.50 * Brad No-preferred** $100 $100 $100 * * Deductible waived for prevetive Rx ad preatal vitamis. Go to www.caremark.com or cotact Caremark at (877)-318-5134 for a list of prevetive prescriptios. **Go to www.caremark.com to see which brad-ame prescriptios are preferred; ew hires ca go to www.caremark.com/teva. Keep i mid If you re fillig your prescriptio through the mail order service, just write Please fill with a Teva drug o your prescriptio. Do t forget that you caot be reimbursed from your Health Care FSA for over-the-couter drugs, except isuli, without a prescriptio from your doctor. 9 Teva 2013 Beefits
Detal Teva provides detal coverage through Aeta: Detal PPO Detal PPO Aual Deductible Aual Maximum for Classes I, II, III Class I: Prevetive Oral exams, routie cleaigs, fluoride treatmets, sealats, full-mouth X-rays, bitewig X-rays, space maitaiers Class II: Basic Restorative Filligs, root caal therapy, stailess steel crows, gigivectomy, simple extractios, scalig ad root plaig, full ad partial boy impacts Class III: Major Restorative Crows, detures, bridges, ilays, olays, osseous surgery, repairs to crows ad ilays Class IV: Orthodotia Lifetime Maximum for Orthodotia I-Network Out-of-Network Employee Oly: $50 Employee + 1: $100 Employee + Family: $150 $2,000 per covered member 100% covered, o deductible 100% covered 60% covered 100% of R&C covered, o deductible 80% of R&C covered 50% of R&C covered Childre ad adults: 50% covered, o deductible $2,000 per covered member Employee Cotributio Rate Cost Per Pay Cost Per Moth Employee Oly $3.93 $8.51 Employee + Spouse $9.55 $20.69 Employee + Child(re) $7.85 $17.01 Employee + Family $13.48 $29.20 Keep i mid... To see if your detist participates i the Aeta etwork, go to www.aeta.com ad click Fid a Doctor. The pla is i the Detal PPO/PDN/EEP/HealthFud with PPO PDN etwork. You ca go to ay detal care provider you choose. You do t eed to select a Primary Care Detist (PCD), or do you eed a referral to see a specialist. If you use a out-of-etwork detist, you will be resposible for the aual deductible, coisurace ad ay amouts above the reasoable ad customary (R&C) charges for your area. 10 Teva 2013 Beefits
Retiree Health Access from Aeta Teva offers access to pre- ad post-65 Medicare plas for employees who are age 55 or older with at least five years of service. Go to www.mytevabeefits.com for more iformatio. To see what plas are offered, log o to the Retiree Health Access (RHA) website as a guest. Go to http://rhagroup.et/home.aspx Userame: Tevaguest Password: Tevaguest1 Click Logi Eter zip code Click Logi as Guest Flexible Spedig Accouts (FSAs) Are you usig after-tax moey to pay for healthcare ad daycare? If you are, you re payig more i taxes tha you should be. Health Care FSA A Health Care FSA lets you set moey aside pre-tax to cover expeses that are ot covered uder your medical or detal pla. You ca set aside betwee $120 ad $2,500 to pay toward: Your deductible Coisurace Copays for office visits or prescriptio drugs LASIK surgery, eyeglasses, cotact leses, solutios ad supplies Detal treatmet ad orthodotia, e.g., filligs, X-rays, braces ad caps Over-the-couter medicie (as log as you get a prescriptio from your doctor*) Limited Expese Health Care FSA If you re erolled i a HSA, you ca cotribute to a Limited Expese Health Care FSA; it works alog with your HSA to cover eligible expeses. Depedet Care FSA A Depedet Care FSA lets you set moey aside pre-tax to cover certai depedet care expeses, such as daycare, elder daycare ad summer camp. You ca set aside betwee $120 ad $5,000. (The Depedet Care FSA is ot for medical, healthcare or detal care expeses for your depedets.) Note: The day your child reaches age 13, daycare expeses are o loger eligible. This does ot qualify as a life-chage evet; therefore, you caot chage your electios midyear. Be sure to pla accordigly. Questios about Retiree Health Access? If you have ay questios after you have looked at the plas, cotact the Retiree Service Ceter ad Pla Admiistrator at (866) 643-8742. Medical Expese Estimator The tool ca also help you estimate how much moey you should cotribute to a Health Care Flexible Spedig Accout (FSA). FSA debit card Whe you eroll i a Health Care FSA, you ll receive a debit card from Aeta that you ca use to pay eligible prescriptio ad over-thecouter expeses oly. Use pre-tax savigs for eligible expeses. A full list of eligible FSA expeses ca be foud at www.aeta.com. Remember: The FSA pla year rus from Jauary 1 through December 31. You have util March 31 to submit claims for the pla year edig December 31. These are use it or lose it accouts uused fuds will ot be refuded. So, carefully pla how much to cotribute to each accout usig the tools o www.aeta.com. *Provisio of 2010 healthcare reform. 11 Teva 2013 Beefits
Life ad Disability Isurace Basic Term Life Isurace As a Teva employee, you are automatically covered uder Teva s Basic Term Life Isurace pla the day you are hired. The pla will pay your beeficiary two times your aual salary (rouded up to the ext $1,000), up to a maximum of $1,000,000. Accidetal Death ad Dismembermet (AD&D) Isurace As a Teva employee, you are automatically covered uder Teva s AD&D Isurace pla the day you are hired. If your death is a result of a covered accidet, the pla will pay your beeficiary two times your aual salary (rouded up to the ext $1,000), up to a maximum of $1,000,000. I the evet of dismembermet i relatio to a covered accidet, you will receive a beefit based o a established schedule of beefits. Optioal Life Isurace Need additioal protectio? You may wat to purchase additioal life isurace for yourself, your spouse ad/or your childre. You are resposible for premiums. They will be deducted from your paycheck o a after-tax basis. If you wat your spouse to be covered, you must eroll i Optioal Life Isurace. Optioal Employee Term Life Isurace You ca purchase additioal Optioal Employee Term Life Isurace i the followig amouts, ot to exceed five times your aual salary or $1,000,000, whichever is less. I additio, your Basic Life Isurace ad Optioal Life Isurace are subject to a combied maximum of $2,000,000. Optio 1: $50,000 Optio 2: $100,000 Optio 3: $200,000 Optio 4: $300,000 Optio 5: $400,000 Optio 6: $500,000 Optio 7: $600,000 Optio 8: $700,000 Optio 9: $800,000 Optio 10: $900,000 Optio 11: $1,000,000 Evidece of Isurability (EOI) Curret employees who wat to purchase Optioal Employee/ Spouse or Depedet Term Life Isurace for the first time, or icrease Optioal Term Life Isurace amouts i amouts over $50,000 (Optios 3, 4, 5, 6 ad 7) durig Ope Erollmet, must complete a EOI Form. This form ca be foud at www.mytevabeefits.com. New hires are eligible to purchase Optioal Employee Term Life Isurace up to $300,000 or five times aual salary, whichever is less. This is called Guarateed Issue (GI). If you wish to purchase more tha the GI, you must complete a EOI Form. This form ca be foud at www.mytevabeefits.com. Also, the amout you elect is subject to the $50,000 roudig rule. Uder this rule, amouts edig i $50,000 or less are rouded dow, ad amouts edig greater tha $50,000 are rouded up. For example: Example 1 (Salary) $30,000 5 = $150,000 You may elect up to optio 2, or $100,000 Example 2 (Salary) $55,000 5 = $275,000 You may elect up to optio 4, or $300,000 12 Teva 2013 Beefits
Optioal Spouse Term Life Isurace If you buy Optioal Term Life Isurace for yourself, you may purchase it for your spouse/domestic parter. Optioal Life Isurace for your spouse/domestic parter ca t be more tha 50% of your life isurace amout Optio 1: $25,000 Optio 2: $50,000 Optio 3: $100,000 Optio 4: $150,000 Optio 5: $200,000 Optioal Depedet Childre Term Life Isurace Optio 6: $250,000 Optio 7: $300,000 You must buy Optioal Term Life Isurace for yourself i order to purchase life isurace for your childre. You may purchase Optioal Life Isurace for your childre i the followig amouts: Optio 1: $5,000 per child Optio 2: $10,000 per child All of your childre betwee the ages of 14 days ad 22 years are covered at the amout you select. Childre who are full-time studets are eligible for coverage util age 25. Note: Childre of domestic parters are ot eligible to participate i Teva s Optioal Life Isurace beefit. 13 Teva 2013 Beefits
Optioal Term Life Isurace Rates Optioal Employee-Paid Term Life Isurace for Employees ad Spouses/Parters (Biweekly Rates for Employees ad Spouses/Parters) $25,000 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 Uder 30 $0.62 $1.25 $2.49 $3.74 $4.98 $6.23 $7.48 30 34 $0.83 $1.66 $3.32 $4.98 $6.65 $8.31 $9.97 35 39 $0.93 $1.87 $3.74 $5.61 $7.48 $9.35 $11.22 40 44 $1.25 $2.49 $4.98 $7.48 $9.97 $12.46 $14.95 45 49 $1.87 $3.74 $7.48 $11.22 $14.95 $18.69 $22.43 50 54 $2.80 $5.61 $11.22 $16.82 $22.43 $28.04 $33.65 55 59 $4.47 $8.93 $17.86 $26.79 $35.72 $44.65 $53.58 60 64 $6.85 $13.71 $27.42 $41.12 $54.83 $68.54 $82.25 65 69 Beefit $16,250 $32,500 $65,000 $97,500 $130,000 $162,500 $195,000 65 69 Bi-Weekly $8.57 $17.15 $34.29 $51.44 $68.58 $85.73 $102.87 70-74 Beefit $10,000 $20,000 $40,000 $60,000 $80,000 $100,000 $120,000 65 69 Bi-Weekly $8.56 $17.11 $34.23 $51.34 $68.46 $85.57 $102.68 Over 74 Beefit $6,250 $12,500 $25,000 $37,500 $50,000 $62,500 $75,000 65 69 Bi-Weekly $5.35 $10.70 $21.39 $32.09 $42.78 $53.48 $64.18 $400,000 $500,000 $600,000 $700,000 $800,000 $900,000 $1,000,000 Uder 30 $9.97 $12.46 $14.95 $17.45 $19.94 $22.43 $24.92 30 34 $13.29 $16.62 $19.94 $23.26 $26.58 $29.91 $33.23 35 39 $14.95 $18.69 $22.43 $26.17 $29.91 $33.65 $37.38 40 44 $19.94 $24.92 $29.91 $34.89 $39.88 $44.86 $49.85 45 49 $29.91 $37.38 $44.86 $52.34 $59.82 $67.29 $74.77 50 54 $44.86 $56.08 $67.29 $78.51 $89.72 $100.94 $112.15 55 59 $71.45 $89.31 $107.17 $125.03 $142.89 $160.75 $178.62 60 64 $109.66 $137.08 $164.49 $191.91 $219.32 $246.74 $274.15 65 69 Beefit $260,000 $325,000 $390,000 $455,000 $520,000 $585,000 $650,000 65 69 Bi-Weekly $137.16 $171.45 $205.74 $240.03 $274.32 $308.61 $342.90 70-74 Beefit $160,000 $200,000 $240,000 $280,000 $320,000 $360,000 $400,000 65 69 Bi-Weekly $136.91 $171.14 $205.37 $239.59 $273.82 $308.05 $342.28 Over 74 Beefit $100,000 $125,000 $150,000 $175,000 $200,000 $225,000 $250,000 65 69 Bi-Weekly $85.57 $106.96 $128.35 $149.75 $171.14 $192.53 $213.92 Optioal Employee-Paid Term Life Isurace for Childre (Biweekly Rates) $5,000 $10,000 $0.23 $0.46 14 Teva 2013 Beefits
Short-Term Disability (STD) Isurace Teva STD coverage protects your icome i the evet of o-work-related ijury or illess. The pla pays 100% of your weekly salary up to eight weeks after a seve-day waitig period at o cost to you. After the waitig period, days eight through 90 will be maaged by our vedor parter, Matrix Absece Maagemet (Matrix). Durig weeks 10 through 13, the pla pays 66.67% of your weekly salary if you are uable to perform the duties of your ow occupatio solely because of a ijury or illess. Certai states where Teva employees are located (i.e., New York, New Jersey, Hawaii, Rhode Islad ad Califoria) have special beefit rules that apply. Note: All disability claims must be certified i writig by a specialist physicia ad be supported by objective diagostic testig ad appropriate treatmet plas. Log-Term Disability (LTD) Isurace Teva LTD beefits begi at the ed of the STD coverage. If you qualify for LTD beefits, the pla pays 60% of your gross base earigs, up to a maximum mothly beefit of $25,000. The LTD pla is isured by Reliace Stadard. Forty-five to 60 days ito your STD claim, Matrix will automatically sed you the forms to begi the process of filig with Reliace Stadard for LTD beefits. To file a STD claim: Cotact Matrix at (877) 202-0055 or visit www.matrixeservices.com. 15 Teva 2013 Beefits
Wealth Maagemet Fidelity 401(k) Pla Maximize your savigs. It s the best way for you to save ad ivest for retiremet. You ca cotribute pre-tax betwee 1% ad 75% of your salary up to the Iteral Reveue Service (IRS) limit. Teva will match your cotributio up to 6% AND provide a lump-sum Defied Cotributio of 3% of your salary aually. Remember: You re immediately vested i Teva s Employer Matchig cotributios. If you cotribute 6% or less, Teva will fully (100%) match that percetage. If you cotribute more tha 6%, Teva will match the first 6% of your salary. The 3% Defied Cotributio will be deposited ito your 401(k) accout i oe lump sum. This cotributio is automatic eve if you do t make your ow cotributios to the 401(k) pla. To be eligible for the Defied Cotributio, you must be employed at the ed of the pla year ad have worked at least 1,000 hours that year. You are 100% vested after three years of workig 1,000 hours or more each year. Fidelity Roth 401(k) cotributios. Roth 401(k) accout cotributios are made with moey that you have already paid taxes o. Your earigs grow tax-free, ad you do ot have to pay taxes o them whe you take a qualified distributio.* Speak with a Erst & Youg fiacial plaer at (888) 374-5334 to help you make your 401(k) accout decisios. If you are age 50 or older, you ca make catch-up cotributios up to the IRS aual maximum. To get started, or for questios, go to www.401k.com, or call (866) 747-8382. Employee Stock Purchase Pla (ESPP) Buy Teva stock at a discouted price. The Teva ESPP allows you to ivest up to 10% of your eligible earigs up to $21,250 a year to purchase commo shares of Teva Pharmaceutical Idustries Limited stock at 85% of market value. This moey is coveietly deducted from your paycheck. Questios about your persoal ESPP accout? Cotact Computershare at (877) 600-4505. You ca eroll i this program o a quarterly basis. If you wat to eroll or chage your payroll deductio, log o to www-us.computershare.com/employee ad eter your Social Security umber (SSN) or your user ID ad password. 16 Teva 2013 Beefits
If you wish to eroll or chage your deductio for the ew quarter, you must log o to the website at least a moth prior to the begiig of the quarter. If you wish to stop your deductio durig the quarter, you ca do so by cotactig Computershare. Cotact Computershare by: To Make Chages for: December 20 Jauary 1 to March 31 March 20 April 1 to Jue 30 Jue 20 July 1 to September 30 September 20 October 1 to December 31 Erst & Youg Fiacial Plaer Lie Fiacial plaig ad wealth maagemet. Plaig to sed your kids to college? Need help savig for retiremet? Wat to buy a house? This program provides ulimited ad free access to fiacial plaers who are traied i Teva s beefits programs. These plaers will take a holistic view of your family s health ad wealth eeds ad help you make the most of the beefits ad resources that Teva offers so you ca meet your goals. Call Erst & Youg at (888) 374-5334 to speak cofidetially with a fiacial plaer Moday through Friday betwee 9 a.m. ad 8 p.m., Easter Time. At all other times, leave a message ad a represetative will call you back the ext busiess day. Fiacial Plaig Ceter website. Use calculators ad see istat oscree fiacial projectios to help you better uderstad your log-term fiacial situatio. If you eed help iterpretig what you see, cotact the Fiacial Plaer Lie. This website also icludes a iteractive ewsletter, olie articles, weekly fiacial tips ad liks to state tax agecies. Access the Fiacial Plaig Ceter website at http://teva.eyfpc.com. Compay Code: Teva Compay Program: Welcome1234 Survivor Fiacial Couselig Service. Receive fiacial couselig for you ad/or your spouse/domestic parter durig a termial illess ad followig a death. Cotact a fiacial plaer by callig the Fiacial Couselig Service at (800) 944-9618. Fidelity College Savigs Pla (529 Pla) Save for college. Take advatage of a tax-free college savigs opportuity through a 529 pla. A 529 pla is a smart way to save for college, ad a Fidelity-maaged 529 pla has amog the lowest costs i the idustry, so you get to keep more of what you save. For more iformatio about the College Savigs Pla, visit www.fidelity.com/collegeplaer. * A qualified distributio is tax-free if take at least five years after the year of your first Roth 401(k) cotributio ad you have reached age 59½, if you have become totally disabled, or if you die. If your distributio is ot qualified, ay withdrawal from your accout will be partially taxable. These rules apply to Roth distributios oly from employer-sposored retiremet plas. Additioal pla distributio rules apply. 17 Teva 2013 Beefits
Livig Healthier Aeta Discout Programs Save moey o alterative therapy ad other services. Erolled i a Teva medical pla optio? You ca save moey through www.aetaavigator.com. Just click Beefits ad Health Programs. Aeta Natural Products ad Services Program: Get discouts o services like acupucture, dietetic couselig ad massage therapy. Hearig Program: Get discouts o hearig exams, hearig aids ad hearig aid repairs. Plus follow-up services for oe year. Aeta Visio: Get discouts o eyeglasses, cotacts ad LASIK services. Aeta s Iformed Health Lie Aswers to your health questios are just a phoe call away, 24/7. Is your child up at ight with a cough? Not sure why your stomach hurts? Call Aeta s Iformed Health Lie ad get help from a registered urse. This service is cofidetial ad free for Teva employees. If you re a Aeta member, call the Iformed Health Lie at (800) 556-1555. They re available 24/7. Aeta WorkLife Resources/Employee Assistace Program (EAP) Cofidetial help for just about aythig. You ad your family ca get cofidetial help for a rage of issues, wheever you eed it. Aeta will provide cofidetial olie ad phoe couselig for you ad your family. If you have cocers about your health, your family s health ad/or stressrelated issues icludig persoal fiace problems Aeta ca help you. Just call (866) 513-7249 or visit www.aetaeap.com (compay ID: TevaWLEAP). Aeta ca also help with everyday questios about thigs like: Buyig or retig a home Child ad adult learig programs Trasportatio Paretig Seior care Educatio, icludig payig for college, tutors ad test prep If you re a Aeta member, call the Iformed Health Lie at (800) 556-1555. They re available 24/7. Cotact Aeta WorkLife at (866) 513-7249 or www.aetaeap.com (compay ID: TevaWLEAP). 18 Teva 2013 Beefits
Alere Wellbeig Tobacco Cessatio Program Ready to quit smokig? If you re ready to quit smokig, get some help to make sure you stay smoke-free at o cost to you. The Alere Wellbeig Tobacco Cessatio Program gives you that extra support you eed. The program is backed by 20 years of research ad experiece. So, take advatage of it so you ca be tobacco-free for good. Teva pays the full cost for this program (over $300 per perso), but it s free to you ad your family. Participats must be 18 or older. Here s some of what you ll get to help you: A eight-week supply of icotie replacemet, such as patches or gum A Quit Kit with tips ad tools to help you quit Medicatio recommedatios, if eeded (Teva covers the prescriptio if you are erolled i a Teva medical pla) For more iformatio or to eroll, call (866) QUIT-4-LIFE or (866) 784-8454. Tobacco Cessatio Icetive Complete five scheduled calls with Alere Wellbeig ad ear $300 (subject to taxes). Alere will iform Teva of each participat s completio of the five calls. Six moths icotie-free? Ear a additioal $300 (subject to taxes) whe you reach your six-moth aiversary i the program. I order to ear the $300, you must have the required biochemical blood test by Quest Diagostics ad the result must be egative for icotie. Alere will cotact erolled employees at their six-moth aiversary to verify that they are icotie-free. Oe year icotie-free? Ear aother $300 (subject to taxes) whe you reach your oe-year aiversary i the program. You must call Alere to report that you have bee icotie-free for oe year, ad you ll be required to repeat the biochemical blood test with Quest Diagostics. Icetive for employees oly. Quit smokig for good! Experts agree that social support is key to quittig smokig. Tell your frieds ad family that you pla to quit, ad make them hold you to it. Baby Steps Get help before, durig ad after your baby is bor. Everyoe likes coupos ad free gifts. Baby Steps offers these icetives ad much more. Whe you eroll i the program, you ll receive guidace from experieced obstetric urses, a aalysis of your diet, access to a 24/7 urse help lie ad much more. Plus, it s completely cofidetial. For questios or to eroll, call (877) 973-BABY or (877) 973-2229. 19 Teva 2013 Beefits
Best Doctors Have a questio or eed aother opiio? Be oe of the millios to receive clear aswers ad guidace from world-reowed doctors at o cost to you or members of your household. Best Doctors is a free ad cofidetial service that gives you access to 40,000 doctors who will work with you to make sure your diagosis ad treatmet pla are o target. Call Best Doctors at (866) 904-0910. Ope to ayoe i your household. Cliical ad Elder Advocacy Get someoe o your side eve for help with Medicare. Advocacy provides help for you ad your family members eve your exteded family for all of your healthcare eeds at o cost to you. This icludes resolvig billig issues, gettig help fidig the right treatmet, doctor or prescriptio drugs, ad eve help resolvig Medicare claims issues. Here are some ways Cliical ad Elder Advocacy ca help you ad your family members: Advocacy meas you ad your family have someoe o your side to help you avigate through the ofte challegig healthcare maze. Refer you to the right Teva beefit program for your situatio Resolve complex healthcare billig ad isurace claim issues Explai paperwork you receive i the mail Provide iformatio ad guidace about treatmet optios, specialists ad prescriptio drugs Locate etwork doctors Help you get secod opiios Provide iformatio ad guidace about additioal coverage optios, such as Medicare Help with Medicare claims ad issues Help with home healthcare ad adult daycare Help you to fid a ursig home Help fid elder support groups ad activities To get started, call Cliical ad Elder Advocacy at (888) 622-1200. 20 Teva 2013 Beefits
Fitess Ceter Discouts LA Fitess Teva will cover the erollmet fee for your membership up to $149. Email occ.health@tevapharm.com to get your erollmet coupo. GlobalFit Teva provides employees access to GlobalFit, a atioally recogized fitess provider with a etwork of thousads of chais ad local clubs. Visit www.globalfit.com for more iformatio. Health Coachig through OptumHealth Available to you ad your depedets eve if you are ot erolled i the Teva medical plas. Teva s health coachig programs help you ad your depedets set persoal goals ad strategies at o cost to you. This program offers you a persoal health coach who will work with you by phoe or olie to help you set your health goals ad stay o track to achieve them. To participate, just call (800) 478-1057 or log o to the OptumHealth website through www.myteva.com ad click Olie Health Coach to participate i ay of the programs Teva offers aytime. Note: Whe you participate i the Kow Your Numbers program, Quest Diagostics will forward your HRQ resposes ad your biometric results to OptumHealth who may cotact you. At o poit will Teva receive this iformatio. Weight Watchers Take cotrol of your weight ad your life. Teva parters with Weight Watchers to provide fudig ad access to four programs: Local meetigs, At-Work meetigs, Olie or At-Home. As log as you meet the program requiremets, you will be reimbursed for 100% of the program fees. Call (866) 933-2458 to get started. Whe you call, be sure to have your employee file umber hady. It s located at the top of your pay stub ad o your employee badge. 21 Teva 2013 Beefits
Lifestyle Adoptio Fiacial Assistace Program Plaig to adopt a child? Teva will reimburse you for eligible adoptio expeses up to $10,000 per child. Eligible expeses iclude legal fees ad travel costs. It s importat to ote, this is a taxable beefit. Teva is pleased to provide Adoptio Leave (ADOPT) to adoptive parets immediately followig the placemet for adoptio of a child. Leave is paid at 100%. Female employees will receive 8 weeks of leave ad male employees will receive 1 week for a domestic adoptio ad 2 cosecutive weeks for iteratioal adoptio. If both adoptive parets are Teva employees, up to 8 weeks of leave ca be split betwee them. Aeta offers additioal support for adoptive parets, icludig: Cosultatio with a experieced adoptio couselor. Referrals to adoptio agecies ad adoptio support orgaizatios. For more iformatio, cotact Aeta at (866) 513-7249 or visit www.aetaeap.com (compay ID: TevaWLEAP). KiderCare Daycare Programs Ifat ad Toddler Priority Use. Teva has partered with KiderCare to provide Priority Access i all classrooms across the coutry. This meas that if there is a waitig list at your commuity-based KiderCare ceter, your child will move to the top. KiderCare Tuitio Discout (for pre-school to school-aged childre). Every Teva employee will be eligible to receive a discout o stadard weekly child care tuitio rates at all commuity-based KiderCare ceters atioally. The program will provide a 10% discout o pre-school through school-aged weekly tuitio rates, whether it is o a full-time basis or part-time basis. Visit KiderCare s website at www.kidercare.com, call (888) 525-2780, or email klcdiscouts@klcorp.com. 22 Teva 2013 Beefits
MetLife Auto & Home Program Discout Need home or auto isurace? Get special group rates, hassle-free paymet optios ad persoalized service whe you apply to purchase auto, home ad other property ad liability isurace through MetLife. For quick, free quotes, call (800) 438-6388. Veteriary Pet Isurace Medical coverage for your four-legged family members. Protect your pets with medical isurace that works similar to your ow medical coverage. Aeta also provides referral services for a rage of other pet-care eeds. For more iformatio, cotact Aeta at (866) 513-7249. Persoal Travel Assistace O Call Iteratioal (O Call) is a 24-hour, toll-free service that gives you access to iformatio, referral service, coordiatio ad arragemet services desiged to respod to most medical care situatios ad other emergecies whe you travel. To be eligible, you must be travelig i a foreig coutry or more tha 100 miles from home. This service does ot replace your health isurace. O Call also offers pre-trip assistace, icludig passport/visa requiremets, foreig currecy ad weather iformatio. Call (800) 456-3893 (i the Uited States) or (603) 328-1966 (worldwide, collect). O Call is available 24 hours a day, 365 days a year. Get more iformatio about O Call at www.myteva.com. 23 Teva 2013 Beefits
Erollmet Erollig is easy follow these steps 1. Log o to www.myteva.com For curret employees ad ew hires, to eroll i 2013 beefits, log o to www.myteva.com. Eter your user ID, which is your 6-digit employee umber that ca be foud o: Frot of your employee badge Top of your pay stub Withi the profile box i the orgaizatio charts located o the itraet Forgot Your Password? Click Forgot Your Password? Eter your 6-digit employee ID i User ID ad Teva i Orgaizatio Click Reset Password A lik to establish your password will be set to your Teva email address 2. Click mysigle Sig-O 3. Click Eroll i Teva Beefits SSO 24 Teva 2013 Beefits
4. Eroll o mytevabeefits.com Whe you re eligible to eroll i your beefits or make chages i your coverage, the Welcome scree o www.mytevabeefits.com will idicate how much time you have left to eroll or make a chage to your coverage. Whe you re ready to eroll, click Eroll Olie. The website will provide a detailed list of steps to: Review your iformatio Review your beefits Select your beefits Complete your erollmet Whe you ve reviewed the steps ad are ready to eroll, click Start Erollmet. You ll be guided through the process as you go. 5. Review My Iformatio Review your persoal iformatio, icludig your depedet/beeficiary iformatio. If you wat to add additioal depedet iformatio this is the place to do it. Keep i mid that addig depedet iformatio here does ot add those depedets to your beefit plas. That step comes later. Whe you ve fiished, click Cotiue. 25 Teva 2013 Beefits
6. Select Your Beefits Whe you re ready, review ad update your beefit electios. Click Cotiue to be guided through the erollmet process for each beefit. After you ve made your electios for each beefit, click Cotiue to proceed to the ext beefit i the erollmet process. Whe electig medical beefits, you will be asked questios about your spouse s medical coverage with his or her employer. 7. Complete Your Erollmet After you ve fiished makig your beefit electios ad have reviewed your Beefits Summary, click Complete Erollmet i Your Erollmet Checklist. 26 Teva 2013 Beefits
Life Evets If, durig the year, you experiece a life evet, such as marriage or the birth/ adoptio of a child ad you eed to make chages to your beefits, go to www.mytevabeefits.com. It s a very simple process. To get started, click My Accout from the home page, ad the click Add Life Status Evet. Keep i mid: If you add a depedet or multiple depedets as part of your life-chage evet, you ll eed to make sure that you also elect or chage coverage, as eeded. I additio, you ll be asked to provide writte documetatio of your status chage. You ca see details about acceptable documetatio at www.mytevabeefits.com. Need help? Call the Teva Beefits Service Ceter at (800) 979-1733. 27 Teva 2013 Beefits
HIPAA Privacy Notice PLEASE CAREFULLY REVIEW THIS NOTICE. IT DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. The Health Isurace Portability ad Accoutability Act of 1996 (HIPAA) imposes umerous requiremets o the use ad disclosure of idividual health iformatio by Teva Pharmaceuticals USA, Ic. health plas. This iformatio, kow as protected health iformatio, icludes almost all idividually idetifiable health iformatio held by a pla whether received i writig, i a electroic medium, or as a oral commuicatio. This otice describes the privacy practices of this pla: Teva Pharmaceuticals USA, Ic. Omibus Welfare Beefit Pla. The Pla s duties with respect to health iformatio about you The Pla is required by law to maitai the privacy of your health iformatio ad to provide you with this otice of the Pla s legal duties ad privacy practices with respect to your health iformatio. If you participate i a isured pla optio, you will receive a otice directly from the Isurer. It is importat to ote that these rules apply to the Pla, ot Teva Pharmaceuticals USA, Ic. as a employer that is the way the HIPAA rules work. Differet policies may apply to other Teva Pharmaceuticals USA, Ic. programs or to data urelated to the Pla. How the Pla may use or disclose your health iformatio The privacy rules geerally allow the use ad disclosure of your health iformatio without your permissio (kow as a authorizatio) for purposes of healthcare treatmet, paymet activities ad healthcare operatios. Healthcare operatios iclude activities by this Pla (ad i limited circumstaces other plas or providers) such as welless ad risk assessmet programs, quality assessmet ad improvemet activities, customer service, ad iteral grievace resolutio. Healthcare operatios also iclude vedor evaluatios, credetialig, traiig, accreditatio activities, uderwritig, premium ratig, arragig for medical review ad audit activities, ad busiess plaig ad developmet. For example, the Pla may use iformatio about your claims to audit the third parties that approve paymet for Pla beefits. The amout of health iformatio used, disclosed or requested will be limited ad, whe eeded, restricted to the miimum ecessary to accomplish the iteded purposes, as defied uder the HIPAA rules. If the Pla uses or discloses PHI for uderwritig purposes, the Pla will ot use or disclose PHI that is your geetic iformatio for such purposes. The Pla may cotact you to provide appoitmet remiders or iformatio about treatmet alteratives or other health-related beefits ad services that may be of iterest to you, as permitted by law. How the Pla may share your health iformatio with Teva Pharmaceuticals USA, Ic. The Pla, or its health isurer or HMO, may disclose your health iformatio without your writte authorizatio to Teva Pharmaceuticals USA, Ic. for pla admiistratio purposes. Teva Pharmaceuticals USA, Ic. may eed your health iformatio to admiister beefits uder the Pla. Teva Pharmaceuticals USA, Ic. agrees ot to use or disclose your health iformatio other tha as permitted or required by the Pla documets ad by law. The Teva Beefits staff are the oly Teva Pharmaceuticals USA, Ic. employees who will have access to your health iformatio for pla admiistratio fuctios. Here is how additioal iformatio may be shared betwee the Pla ad Teva Pharmaceuticals USA, Ic., as allowed uder the HIPAA rules: The Pla, or its isurer or HMO, may disclose summary health iformatio to Teva Pharmaceuticals USA, Ic., if requested, for purposes of obtaiig premium bids to provide coverage uder the Pla, or for modifyig, amedig, or termiatig the Pla. Summary health iformatio is iformatio that summarizes participats claims iformatio, from which ames ad other idetifyig iformatio have bee removed. The Pla, or its isurer or HMO, may disclose to Teva Pharmaceuticals USA, Ic. iformatio o whether a idividual is participatig i the Pla or has erolled or diserolled i a isurace optio or HMO offered by the Pla. I additio, you should kow that Teva Pharmaceuticals USA, Ic. caot ad will ot use health iformatio obtaied from the Pla for ay employmet-related actios. However, health iformatio collected by Teva Pharmaceuticals USA, Ic. from other sources, for example uder the Family ad Medical Leave Act, Americas with Disabilities Act, or workers compesatio, is ot protected uder HIPAA (although this type of iformatio may be protected uder other federal or state laws). Other allowable uses or disclosures of your health iformatio I certai cases, your health iformatio ca be disclosed without authorizatio to a family member, close fried or other perso you idetify who is ivolved i your care or paymet for your care. Iformatio about your locatio, geeral coditio or death may be provided to a similar perso (or to a public or private etity authorized to assist i disaster relief efforts). You will geerally be give the chace to agree or object to these disclosures (although exceptios may be made for example, if you are ot preset or if you are icapacitated). I additio, your health iformatio may be disclosed without authorizatio to your legal represetative. The Pla also is allowed to use or disclose your health iformatio without your writte authorizatio for the followig activities: Workers compesatio Disclosures to workers compesatio or similar legal programs that provide beefits for work-related ijuries or illess without regard to fault, as authorized by ad ecessary to comply with the laws. 28 Teva 2013 Beefits
Necessary to prevet serious threat to health or safety Disclosures made i the good-faith belief that releasig your health iformatio is ecessary to prevet or lesse a serious ad immiet threat to public or persoal health or safety, if made to someoe reasoably able to prevet or lesse the threat (or to the target of the threat); icludes disclosures to help law eforcemet officials idetify or apprehed a idividual who has admitted participatio i a violet crime that the Pla reasoably believes may have caused serious physical harm to a victim, or where it appears the idividual has escaped from priso or from lawful custody. Public health activities Disclosures authorized by law to persos who may be at risk of cotractig or spreadig a disease or coditio; disclosures to public health authorities to prevet or cotrol disease or report child abuse or eglect ad disclosures to the Food ad Drug Admiistratio to collect or report adverse evets or product defects. Victims of abuse eglect, or domestic violece Disclosures to govermet authorities, icludig social services or protected services agecies authorized by law to receive reports of abuse, eglect or domestic violece, as required by law or if you agree or the Pla believes that disclosure is ecessary to prevet serious harm to you or potetial victims (you ll be otified of the Pla s disclosure if iformig you wo t put you at further risk). Judicial ad admiistrative proceedigs Disclosures i respose to a court or admiistrative order, subpoea, discovery request or other lawful process (the Pla may be required to otify you of the request or receive satisfactory assurace from the party seekig your health iformatio that efforts were made to otify you or to obtai a qualified protective order cocerig the iformatio). Law eforcemet purposes Disclosures to law eforcemet officials required by law or legal process, or to idetify a suspect, fugitive, witess or missig perso; disclosures about a crime victim if you agree or if disclosure is ecessary for immediate law eforcemet activity; disclosures about a death that may have resulted from crimial coduct ad disclosures to provide evidece of crimial coduct o the Pla s premises. Decedets Disclosures to a coroer or medical examier to idetify the deceased or determie cause of death ad to fueral directors to carry out their duties. Orga, eye or tissue doatio Disclosures to orga procuremet orgaizatios or other etities to facilitate orga, eye or tissue doatio ad trasplatatio after death. Research purposes Disclosures subject to approval by istitutioal or private privacy review boards, subject to certai assuraces ad represetatios by researchers about the ecessity of usig your health iformatio ad the treatmet of the iformatio durig a research project. Health oversight activities Disclosures to health agecies for activities authorized by law (audits, ispectios, ivestigatios or licesig actios) for oversight of the healthcare system, govermet beefits programs for which health iformatio is relevat to beeficiary eligibility ad compliace with regulatory programs or civil rights laws. Specialized govermet fuctios Disclosures about idividuals who are Armed Forces persoel or foreig military persoel uder appropriate military commad; disclosures to authorized federal officials for atioal security or itelligece activities ad disclosures to correctioal facilities or custodial law eforcemet officials about imates. HHS ivestigatios Disclosures of your health iformatio to the Departmet of Health ad Huma Services to ivestigate or determie the Pla s compliace with the HIPAA privacy rule. Except as described i this otice, other uses ad disclosures will be made oly with your writte authorizatio. You may revoke your authorizatio as allowed uder the HIPAA rules. However, you caot revoke your authorizatio with respect to disclosures the Pla has already made. You will be otified of ay uauthorized access, use or disclosure of your usecured health iformatio as required by law. Breach of Usecured PHI You must be otified i the evet of a breach of usecured PHI. A breach is the acquisitio, access, use, or disclosure of PHI i a maer that compromises the security or privacy of the PHI. PHI is cosidered compromised whe the breach poses a sigificat risk of fiacial harm, damage to your reputatio, or other harm to you. This does ot iclude good faith or iadvertet disclosures or whe there is o reasoable way to retai the iformatio. You must receive a otice of the breach as soo as possible ad o later tha 60 days after the discovery of the breach. Your idividual rights You have the followig rights with respect to your health iformatio the Pla maitais. These rights are subject to certai limitatios, as discussed below. This sectio of the otice describes how you may exercise each idividual right. Cotact the Beefits staff at mytevabeefits@tevausa.com for iformatio o how to submit requests. Right to request restrictios o certai uses ad disclosures of your health iformatio ad the Pla s right to refuse You have the right to ask the Pla to restrict the use ad disclosure of your health iformatio for treatmet, paymet or healthcare operatios, except for uses or disclosures required by law. You have the right to ask the Pla to restrict the use ad disclosure of your health iformatio to family members, close frieds or other 29 Teva 2013 Beefits