The Flexible benefits plan YOUR HEALTH CARE ADVANTAGE SPD Summary Plan Description
Table of Contents Overview of the Plan................................................ 1 Eligibility........................................................... 4 Enrollment......................................................... 8 Life Events......................................................... 9 Medical........................................................... 17 Dental............................................................ 60 Vision............................................................. 74 Life Insurance and AD&D........................................... 77 Spending Accounts................................................. 84 Signature LegalCare............................................... 91 Adoption Assistance................................................ 93 LifeWorks......................................................... 95 Personal Lines Insurance............................................ 96 Long-Term Care Insurance.......................................... 98 Cancer Expense Insurance......................................... 101 Income Protection Plan........................................... 103 If a Claim Is Denied............................................... 114 Continuation of Coverage Under COBRA........................... 116 Plan Administration and ERISA Information......................... 119 Who To Call.............................................. Back Cover
Overview of the Plan Concern for the security and well being of you and your family is the cornerstone of our benefits philosophy. We regard our benefits expenditures as an investment in your health and security. The Flexible Benefits Plan (the Plan) is designed to ensure that you receive value for the benefit dollars spent. The Plan is part of your total compensation package. The Plan offers you a variety of benefit opportunities, allowing you to customize your benefits package to meet your own unique needs. Because your needs will change over time, you can select new benefits annually. WHAT BENEFITS ARE INCLUDED IN THE PLAN? The following benefits are part of the Flexible Benefits Plan and are described in this summary plan description booklet: medical, including prescription drug coverage and mental health/substance abuse treatment dental vision employee, spouse s and children s basic life insurance* employee, spouse s and children s supplemental life insurance* employee basic accidental death and dismemberment (AD&D) insurance employee and family supplemental AD&D insurance short-term disability income long-term disability income health care spending account (HCSA) child/elder care spending account (C/ECSA) cancer expense insurance* legal* adoption assistance* personal lines insurance* long-term care* Additional important information about your coverage is described in your Insert. Keep your Insert with this booklet for reference. *Although these benefits are described in this booklet and are part of the Flexible Benefits Plan, they are not intended to be nor should they be construed to be part of the pre-tax cafeteria plan. HOW THE PLAN WORKS Each year, the Company will decide how much it will contribute toward your benefit costs. This dollar amount is provided as Flex Credits and is shown on your Enrollment Worksheet. You may use your Flex Credits to buy the benefits you want. The prices for each of the options are shown on your Enrollment Worksheet. If your choices cost less than your Flex Credits, you get the excess credits back as additional taxable income in each paycheck, prorated throughout the year. If your choices cost more than your Flex Credits, you pay the extra through payroll deductions. You can change your benefit choices each year during the annual enrollment period. The benefits you select at that time will be effective for the following calendar year, with certain exceptions for dental and vision. Overview of the Plan 1
The only time that you can change your benefit selections during the year is if you have a change in status, such as marriage, birth of a baby or adoption, or a significant change in your work hours that affects benefits eligibility of you, your spouse, or your dependents. See the Life Events section on page 9 for more information on changes in status. LEVELS OF COVERAGE Medical, Dental and Vision If you enroll for medical, dental or vision coverage, you ll be asked to choose one of the following levels of coverage: you only you plus spouse you plus children you plus family Cancer Expense Insurance and Legal If you enroll for legal coverage or cancer expense insurance, you can choose coverage for: you only you plus family single parent for you and your children (for cancer expense insurance only) TAXES AND YOUR BENEFITS One of the advantages of the Plan is that you can pay for many benefits on a beforetax basis. You re able to do this because the Plan falls under Section 125 of the Internal Revenue Code, which states that employees do not pay tax on the amount they pay for certain benefits. (The tax advantages for the child/elder care spending account are similar, but based on Section 129 of the Code.) You may also choose to waive coverage altogether. In order to receive credits, if applicable, you must certify that you have coverage elsewhere. The following chart shows which benefits are paid for before-tax and after-tax: Before-Tax After-Tax Medical Dental Vision Spending accounts AD&D Cancer expense insurance* Long-term disability* Supplemental employee life insurance Supplemental spouse s life insurance Supplemental children s life insurance Signature LegalCare Personal lines Long-term care *Cancer expense insurance benefits may be taxable. See page 102 for more information and consult your tax advisor for details. Long-term disability benefits are taxable. See page 113 for more information on LTD and taxes. 2 Overview of the Plan
PAYING FOR BENEFITS Using your Flex Credits from the Company, you can purchase the level of benefits coverage that best meets your needs. Credits are first used to purchase before-tax benefits medical, dental, vision, AD&D, spending accounts, cancer expense insurance and LTD. Leftover credits (if any) are then taxed, and you can use them to buy after-tax benefits or receive them as income. There are two types of Flex Credits: Base Credits Wellness Pledge Credits Base Credits Base Credits represent the Company s contribution to the cost of benefits. These amounts may change from year to year (as determined by the Company) and are shown on your Enrollment Worksheet. The Base Credits available to you depend on the level of coverage you select for medical coverage (i.e., you only, you plus spouse, you plus children, or you plus family). Wellness Pledge Credits Wellness Pledge Credits are added to your Base Credits if you pledge that you will maintain a healthy lifestyle. See your Enrollment Worksheet for details. Overview of the Plan 3
Eligibility You re eligible to participate in the Flexible Benefits Plan if you meet the eligibility requirements stated in the Insert under Eligibility. ELIGIBLE DEPENDENTS It s important that you know exactly what dependent means for each type of coverage. Medical, Dental, Vision, Life Insurance and Legal Coverage You may enroll your dependents for coverage if the dependent is: your legal spouse* an unmarried child who is: 1. a natural child; an adopted child (or a child placed for adoption); a stepchild living with you at least half of the time; a stepchild who is a full-time student away from home, provided that the stepchild lived with you at least one half of the time in the year immediately prior to the year the stepchild became a full-time student away from home; or a child for whom you are the courtappointed custodian or guardian, and 2. under age 19 and financially dependent on you, or up to age 25 if a full-time student and still financially dependent on you, or an incapacitated child (see below). *If your spouse is your legal spouse under the common law of the state in which you reside, you will be required to provide evidence of the state s law on common law marriages and evidence that you meet such legal requirements. For the Flexible Benefits Plan, placed for adoption means that you have become legally obligated to support the soon-to-beadopted child as a result of beginning the adoption process. A student is considered full time if he or she meets the requirements of full-time status for the school he or she attends. Your children s (and eligible stepchildren s) eligibility for coverage ends on December 31 of the calendar year in which they have their 19th birthday (or 25th birthday if full-time students). If your child graduates from or leaves school before the age limit is reached, coverage continues through December 31 of the year in which he or she graduates or leaves, or until he or she becomes covered through another plan, if earlier. If your dependent loses eligibility for any other reason, for example marriage, coverage ends on the date of the event. Incapacitated Children A child who becomes incapacitated before age 19 (or before age 25 if a full-time student) and becomes covered by the Plan prior to age 19 (or before age 25 if a full-time student) is eligible to continue dependent coverage as long as the incapacity exists. This continuing coverage is available as long as the child is unmarried and depends primarily on you for support and maintenance. 4 Eligibility
The child must have a mental or physical incapacity that renders the child unable to care for herself/himself, as determined by the network manager or claims administrator. For this purpose, the incapacity needs to be verified before coverage can be continued. In addition, periodic medical documentation of the continuing incapacity is required as determined by the network manager or claims administrator. Health Care Spending Account A dependent is a relative or anyone else whose primary residence is your home and who is a member of your household, as long as you provide more than one-half of the person s support. Child/Elder Care Spending Account A dependent includes any of the following if they reside with you: your children age 12 and under your spouse, if disabled any disabled relatives or household members who are dependent on you or your spouse for more than half of their support When Spouses Are UPSers If you and your spouse both work for the Company (or an affiliate) and are both eligible for the Flexible Benefits Plan, the following conditions apply: Each of you may select employee coverage under the medical, dental and vision options. Only one of you may elect coverage for your eligible children. Each of you can be covered only once; you may not be covered as both a spouse and as an employee. If you select coverage for your spouse as your dependent, and your spouse elects no medical coverage, he or she will not receive any Flex Credits. You and your spouse may each elect employee life insurance as an employee. Only one of you may select life insurance coverage for your eligible children. If you are eligible for the Flexible Benefits Plan and your spouse is covered by a UPSsponsored or UPS-affiliate plan other than the Flexible Benefits Plan, or a multi-employer health care plan to which UPS contributes: You may select any available level of coverage (you only, you plus spouse, you plus children, or you plus family). If you decide not to participate in the medical, dental and vision care options, your coverage may be provided by your spouse s plan, based on that plan s eligibility rules. If you do not select medical coverage, you will not receive any Flex Credits. However, you may select participation in the other Plan coverages: dental, vision, life insurance, AD&D, legal, spending accounts and personal lines insurance. If you enroll your spouse in the Flexible Benefits Plan, your spouse may also continue coverage through the UPSsponsored plan. QUALIFIED MEDICAL CHILD SUPPORT ORDERS (QMCSO) Medical, dental and vision coverage will comply with the terms of a Qualified Medical Child Support Order. A QMCSO is a judgment, decree or order (including approval of settlement agreement) issued by a court of competent jurisdiction or Eligibility 5
an administrative process established under state law which has the force and effect of law or a judgment from a state court directing a plan administrator to cover a child by a company s group health plans. Federal law requires that a QMCSO must meet certain form and content requirements in order to be valid. When an order is received, each affected participant and each child covered by the order will be notified of the implementation procedure to determine if the order is valid. If you have any questions or would like to receive a copy of the UPS written procedure for determining whether a QMCSO is valid, please contact your Human Resources department. WHEN COVERAGE STARTS If you re hired (or rehired in a new calendar year) or transferred into an eligible position, coverage based on the options you select begins on the first day of the first full pay period following 30 days from the date you re: hired or rehired, or transferred to an eligible position. Spending account coverage is effective on the latter of the date you enroll or the date your elected coverage begins. If you re rehired in the same calendar year in which you left the Company, the coverage you had prior to leaving the Company will automatically be reinstated effective on your return date. For information about the special rules that govern the effective date of life insurance and AD&D coverage, see the Life Insurance and AD&D section on page 77. TRANSITION COVERAGE If you re a newly hired full-time employee or a current employee moving to or from a Flex-eligible position, the Plan will provide you and your family with transition coverage while you re making your selections or until you become eligible under another plan. Newly Hired If you re a newly hired full-time employee, your transition coverage includes: Medical Option 3 (non-network) for you plus family Vision Option 0 for you plus family basic life insurance for you and your family basic AD&D for you only Aetna is the administrator of the transition medical benefits, including prescriptions. Mail order prescription service is not available.vision Service Plan administers vision services. Current Employees If you re a current employee who is new to a position that is eligible for the Flexible Benefits Plan, your transition coverage includes: Medical Option 2 (non-network) for you plus family Dental Option I for you plus family Vision Option 0 for you plus family basic life insurance for you and your family basic AD&D for you only 6 Eligibility
Aetna is the administrator of these transition medical benefits, including prescriptions. Mail order prescription service is not available. Vision Service Plan and Aetna administer vision and dental services, respectively. If you re a current employee transferring from the Flexible Benefits Plan to another plan sponsored or contributed to by the Company or its affiliates, certain coverages will be continued at no cost to you during the waiting period until you gain eligibility under the new plan. If there is a waiting period before benefits begin under the new plan, the following changes occur at the end of the payroll period in which the job change notification is received at the Benefits Service Center: your current medical, dental and vision options and family status levels continue basic employee life insurance and AD&D continue basic spouse s and children s life insurance continues all other coverage stops payroll deductions and/or credits stop Transition coverage continues only during the waiting period. Transition coverage ends: for you, when you become eligible under the new plan for your dependents, when they become eligible under the new plan, unless there is no dependent coverage available under your new plan. Then your dependents coverage ends when you become eligible under the new plan (see page 116 for information about COBRA coverage for your dependents) for you and your dependents if you terminate employment during the waiting period. In some cases, you may have a longer waiting period for certain coverages, for instance dental or vision. As an example, if you or your dependents gain eligibility under the medical plan, but not the dental plan, your transition coverage for dental will continue until your new dental coverage begins. Once eligibility under your new dental plan is reached, however, dental coverage under transition coverage ends, even if a particular dental benefit, for instance orthodontia, is not available under the new dental plan or is available at a later eligibility date. HOW LONG COVERAGE LASTS In general, your Flexible Benefits Plan coverage continues as long as you meet the Plan s eligibility requirements and make any required contributions. Your dependents coverage will continue as long as you remain eligible for the Plan and your dependents meet the eligibility requirements and make any required contributions. Please see the Life Events section on page 9 for additional details. Eligibility 7
Enrollment Enrollment occurs when you first become eligible for the Flexible Benefits Plan at any time during the year, and again each fall to allow you to make annual changes to your selections. IF YOU DO NOT ENROLL If you do not enroll for Plan coverage within your initial 45-day enrollment period, you re automatically assigned the following default coverages: Medical If you plus family credits are greater than you plus family Medical Option 3, you will be assigned Option 3. If not, No Coverage is assigned. Excess credits are waived. Dental no coverage Vision Option 0 exam only for you and your family basic life insurance for you and your family basic AD&D for you only If you fail to enroll, no credits, if applicable, are payable. At future annual enrollments, if you do not make new benefits selections you ll receive the same coverage for you and your dependents that you had in the prior year, except in the following situations: You wish to continue participation in the spending accounts. You must annually elect participation in the spending accounts. Your dependent child is a full-time student age 19 or older. You must certify fulltime students annually to maintain their coverage. If you do not certify student status, coverage will end on December 31 of that Plan year. Opting Into the Network If you live outside the network area (nonnetwork) but feel the network is convenient to you, you may elect to participate in the network. This is called overriding into the network. You may override into the network at any time during the year by calling the Benefits Service Center at 1-800-353-9877. However, you will be required to remain in the network for the rest of that Plan year. You will automatically remain in the network from year to year unless you call at annual enrollment to change back to your nonnetwork coverage. 8 Enrollment
Life Events Flexible benefit plans are regulated by the Internal Revenue Code, and changes during the year are restricted. However, the IRS realizes that certain life events do occur during the year that create the need for you to change your benefit choices. You re allowed to change certain benefit selections during the year depending on the type of change in status that occurs as long as the change in selection is consistent with the change in status. As a general rule, you will only be allowed to make coverage changes if the event results in you, your spouse, or your dependents gaining or losing coverage eligibility under an employersponsored plan. For example, if you have a baby, you can change your level of medical coverage from you plus spouse to you plus family, but you may not decrease your life insurance. 60-DAY TIME LIMIT You must call the Benefits Service Center (1-800-353-9877) within 60 days of the date of the event to request a change in coverage. You re not allowed to change coverage after the 60-day period until the next annual enrollment period. EFFECTIVE DATE OF REVISED COVERAGE Revised coverage is effective retroactive to the date of the event, with the following exceptions: life insurance* For life insurance requiring evidence of insurability, the requested level of coverage is effective when approved. Until then, the highest level of coverage (up to the level requested) not requiring evidence of insurability is effective. If you decrease your coverage for the cash accumulation fund, the effective date of that coverage change will be the first day of the next full pay period. spending accounts If you change your contribution to the spending accounts, the effective date of that coverage change is the date you notify the Benefits Service Center. *In certain circumstances, you or your dependents coverage could be delayed. Please see page 77 for further details. Life Events 9
SPENDING ACCOUNT CONTRIBUTIONS AND COVERAGE CHANGES If you change your contribution amount (HCSA or C/ECSA) because of a status change, for instance a marriage or birth of a child, the following occurs: If you increase your account balance, the amount of the increase is prorated throughout the remaining calendar year. For instance, if you increased your account from $1,200 to $1,500, then the additional $300 would be prorated over the remaining pay periods and added to your current per-pay-period contribution amount. If you decrease your account balance, your new per-pay-period contribution is calculated by taking any contributions already deducted from your paycheck and subtracting those from your new annual amount, and dividing that difference by the remaining pay periods in the year. For example, assume your original annual contribution was $1,200, and in May you decreased your annual contribution amount to $600. You would have paid for four months at $100 per month. Subtract the $400 you have already paid from your new annual contribution amount of $600. Then divide the remaining $200 by the number of remaining pay periods in the year. That would be your new per-pay-period contribution amount. You may not decrease your account to an amount that is less than what you have already contributed. In the example above, for instance, you could not decrease your account to less than $400, because you have already contributed $400. (Some changes in status, however, allow you to stop your account altogether.) 10 Life Events
ALLOWABLE COVERAGE CHANGES MATRIX (Only the changes that are listed are allowed.) Spending Accounts Event Medical or Cancer Expense Insurance Dental Vision AD&D Employee Life* Spouse s Life* Children s Life* Legal LTD Health Care Child/ Elder Care Marriage If covered, change family status. If opted out, start coverage. If now have outside coverage, can opt out. Increase family status Increase family status Change family status Increase coverage Add coverage Add coverage Start coverage; change family status Start, stop or change coverage Start or increase contributions Start, stop or change contributions Divorce; Legal Separation; Annulment If covered, change family status. If opted out, start coverage if lost under spouse s plan. If covered, change family status. If opted out, start coverage if lost under spouse s plan. Change family status. Increase coverage if lost under spouse s plan. Change family status Increase or decrease coverage Drop coverage No changes Start or drop coverage; change family status Start, stop or change coverage No changes Start, stop or change contributions Birth; Adoption or Placement for Adoption; Child Gains Eligibility If covered, increase family status. If opted out, start coverage Increase family status Increase family status Increase family status Increase coverage Add coverage Add or increase coverage Start coverage; change family status No changes Start or increase contributions Start, or increase contributions Death of Spouse If covered, change family status. If opted out, start coverage if lost under spouse s plan. If covered, change family status. If opted out, start coverage if lost under spouse s plan. Change family status. Increase coverage if lost under spouse s plan Change family status Increase or decrease coverage Drop coverage No changes Start or drop coverage; change family status Start, stop or change coverage Stop or decrease contributions Start, stop or change contributions Death of Child; Loss of Child s Eligibility; Termination of Adoption Proceedings Decrease family status Decrease family status Decrease family status Decrease family status No changes No changes Drop coverage No changes No changes Stop or decrease contributions Stop or decrease contributions Dependent Loses Eligibility for Spending Accounts No changes No changes No changes No changes No changes No changes No changes No changes No changes Stop or decrease contributions Stop or decrease contributions (continued on page13) Life Events 11
ALLOWABLE COVERAGE CHANGES MATRIX (continued) (Only the changes that are listed are allowed.) Spending Accounts Event Medical or Cancer Expense Insurance Dental Vision AD&D Employee Life* Spouse s Life* Children s Life* Legal LTD Health Care Child/ Elder Care Loss of Outside Medical Coverage Eligibility with Other Employment If opted out, start coverage. Increase family status if dependent lost coverage elsewhere If opted out, start coverage if lost elsewhere. Increase family status if dependent lost coverage elsewhere No changes No changes No changes No changes No changes No changes No changes Start or increase contributions if health coverage is lost due to employment change No changes Change in Spouse s Employment or Coverage; Open Enrollment Period Differs from Employee s If covered, change family status. If opted out, start coverage. If now have outside coverage, can opt out. If covered, change family status. If opted out, start coverage. Change family status Change family status No changes Add or increase coverage No changes Start, stop or change Start, stop or change coverage Start or increase contributions (Employment) No changes (Annual Enrollment, Coverage) Start, stop or change contributions Loss of DMO access No changes Change to Option 1 or 2 No changes No changes No changes No changes No changes No changes No changes No changes No changes Reduction in earnings due to leave of absence** No changes No changes No changes No changes Decrease coverage Stop or decrease coverage Stop or decrease coverage Start or drop coverage; change family status No changes No changes Stop or decrease coverage Change Full-time to Part-time No changes No changes No changes No changes Decrease coverage Stop or decrease coverage Stop or decrease coverage Start or drop coverage; change family status No changes No changes Stop or decrease coverage Change in Child/Elder Care Provider or Cost No changes No changes No changes No changes No changes No changes No changes No changes No changes No changes Start, stop, or change contributions (limited to four changes per year) Court- Ordered Coverage Change As dictated by court order As dictated by court order As dictated by court order As dictated by court order As dictated by court order As dictated by court order As dictated by court order As dictated by court order No changes As dictated by court order As dictated by court order Note: You may start, stop, or change your contributions to the Cash Accumulation Fund at any time. **See the Life Insurance section on page 77 for details about coverage maximums and evidence of insurability requirements. **Except military leave. 12 Life Events
What If If your employment status with the Company changes, that may affect Plan coverage for you and your eligible dependents. Additionally, your credits or deductions could be affected. This section answers the question What if? for the following circumstances. YOU LEAVE THE COMPANY? If you leave the Company, coverage for you and your eligible dependents ends: for an employee paid weekly, on the last day of the pay period following the pay period in which you became ineligible. for an employee paid monthly or bi-monthly, on the last day of the pay period in which you became ineligible. Under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), you and your eligible dependents can continue health coverage from the Flexible Benefits Plan for a period of time after your termination date. (Please see the COBRA section on page 116 for more information.) Also, you may convert your, your spouse s and your children s life insurance to individual policies. You cannot convert AD&D coverage to an individual policy. YOU RETIRE? If you retire from the Company and are eligible for retiree health coverage, your active coverage ends on the last day of the month following 30 days from your retirement date. If you do not retire from the Company, coverage ends as indicated under If you leave the Company. If you take early or normal retirement based on the provisions of the UPS Retirement Plan, you and your eligible dependents may be eligible for medical, dental and vision coverage from the Retired Employees Health Care Plan if you meet the eligibility rules of that Plan. You ll receive a separate summary plan description of your retiree health coverage when you retire. Under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), you and your eligible dependents can continue health coverage from the Flexible Benefits Plan for a period of time after your termination or retirement date. (Please see the COBRA section on page 116 for more information.) Also, you may convert your, your spouse s and your children s life insurance to individual policies. You cannot convert AD&D coverage to an individual policy. Life Insurance Because your life insurance can be continued without evidence of insurability, you may wish to evaluate your coverage during the last annual enrollment prior to your retirement date. At the time of retirement, you are not allowed to increase your life insurance coverage. It s a good idea to review the Life Insurance and AD&D section in detail, paying particular attention to the section entitled If You Leave. Life Events 13
YOU DIE? If you die while you re covered by the Flexible Benefits Plan as an active employee, the Company will continue your eligible dependents coverage at no cost to your dependents through the last day of the 13th calendar month following the date of your death. (For instance, if your death occurs on February 2, dependent coverage continues through March 31 of the following year.) Your covered dependents are automatically enrolled for this 13-month coverage period. When this Company-paid coverage ends, your dependents may extend health care coverage in accordance with COBRA provisions for up to an additional 23 months, for a total of 36 months of coverage. The full cost of this coverage will be billed to your dependents according to the COBRA provisions of this Plan. (Please see the COBRA section on page 116 for more information.) Spouse s and children s life insurance may be converted to individual policies. Your dependents are only eligible for this 13-month extension of coverage if you and your dependents were covered by the Flexible Benefits Plan at the time of your death. For example, if you are on military leave, or if you opted out of medical coverage for you or your dependents, your dependents would not be eligible. YOU RE LAID OFF? If you re laid off, your Flexible Benefits Plan coverage will continue until the last day of the month following the month in which your layoff begins. In addition, you can then continue your medical, dental, vision and health care spending account coverage through COBRA. (Please see the COBRA section on page 116 for more information.) You may convert your, your spouse s and your children s life insurance to individual policies. YOU HAVE JURY DUTY? If you have jury duty, your coverage continues. You will make contributions as if you were at work. YOU TAKE AN APPROVED LEAVE OF ABSENCE? FMLA Leave If you re on an approved leave of absence as provided by the Family and Medical Leave Act of 1993 or Company policy, full Plan coverage for you and your dependents will continue for up to 12 weeks. You are responsible for your share of the costs and may be billed if your leave extends beyond 20 days. If you fail to make timely payment of this bill, your coverage will be terminated. If you are billed, you must pay the billed amount; it will not be deducted from your paycheck when you return to work. If you do not receive a bill, deductions and credits will be applied to your first paycheck upon returning to work. If your leave is approved for extension beyond 12 weeks, your coverage from the Plan will continue provided you pay the full cost of coverage (see Personal Leave on page 15). You ll need to notify the Company in writing that you want to extend your leave. 14 Life Events
Military Leave Except for military leaves of less than 31 days (or as otherwise required by federal law), benefits cease and therefore deductions and/or credits also cease. Refer to page 116 for details about continuing coverage under COBRA. Personal Leave You are responsible for the full cost of coverage during a personal leave, and may be billed if your leave extends beyond 20 days. If you fail to make timely payment of this bill, your coverage will be terminated. If you are billed, you must pay the billed amount; it will not be deducted from your paycheck when you return to work. Deductions/Credits While on Leave (except military leave of more than 31 days) As long as you are receiving a paycheck from the Company, deductions or credits will continue to be applied to your paycheck while you are on leave. However, if you are not receiving a paycheck, deductions or credits that accumulate while you are on leave will be applied to your first paycheck when you return to work. If your leave extends beyond 20 days, you may be billed. If you fail to make timely payment of this bill, your coverage will be terminated. If you are billed, you must pay the billed amount; it will not be deducted from your paycheck when you return to work. To avoid an accumulation of deductions during your leave, you may request to be billed during your leave. Call the Benefits Service Center at 1-800-353-9877. Credits will not be issued during a leave, but will accumulate and be applied to your first paycheck upon return to work. Spending Accounts and Leaves C/ECSA Your C/ECSA contributions will stop during your leave until you return to work. Upon return to work, your per-pay-period contribution amount will automatically be reinstated. Only eligible expenses incurred prior to your date of leave and after your return to work will be eligible for reimbursement. HCSA During a leave, contributions to your HCSA may be continued on an after-tax basis (assuming you are on leave long enough to be billed for your share of the expenses), or stopped. If you choose to continue your contributions on an after-tax basis during your leave, any eligible expenses incurred during your leave will be eligible for reimbursement. If you stop your contributions during your leave, only expenses incurred prior to your leave or upon your return to work will be eligible. Expenses incurred during your leave will not be eligible for reimbursement. Upon return to work, your per-pay-period contribution amount will automatically be reinstated, (except for FMLA leaves, in which case you must notify the Benefits Service Center at 1-800-353-9877 to start your account again). Your annual contribution amount will be reduced by the amount not contributed during your leave. Life Events 15
If you move out of the network area until the effective date of your new coverage at your new address, you must continue to coordinate your care through your old network PCP or you will receive out-ofnetwork benefits. For instance, if your annual contribution amount is $1,200, and you are on leave for three months and do not continue your contributions on an after-tax basis during your leave, your revised annual contribution amount will be reduced to $900 (reduced by $300 the amount you didn t pay while on leave). YOU MOVE If you change your address, call ehr at 1-800-UPS-1508. Your call will be transferred to the Employee Service Center and you will be prompted to update your new address. YOU BECOME DISABLED? You and your dependents still have protection if you become disabled. A full description of your short-term and long-term disability coverage, including health care coverage, begins on page 103, Income Protection Plan. In addition to the information in the Income Protection Plan section, please refer to Deductions/Credits While on Leave and Spending Accounts and Leaves in this section, both of which also apply to a disability leave. Depending on your move, several situations could then occur to your elected medical and/or dental coverage: If you: Stay in the same network area Move to a new network (from another network or from a non-network area) Move from a new network area to a non-network area Move out of your HMO network area Move into an HMO network area Move outside the DMO area Move into the DMO area Then No changes will occur to your coverage. If necessary, you may call the network manager to change your PCP. You will receive a letter from the Benefits Service Center asking you to select a PCP for each family member, and to select a coverage effective date (within 30 days of the date of the letter) for your new network. If you do not notify the Benefits Service Center within 30 days, you will automatically be moved to the new network without a PCP. You will receive a letter from the Benefits Service Center asking you to select a coverage effective date (within 30 days of the date of the letter) for your non-network coverage. If you do not notify the Benefits Service Center within 30 days, you will automatically be moved to non-network coverage. You will receive a letter from the Benefits Service Center asking you to make a new medical election (Option 1, 2, or 3, or a new HMO option if available). You will receive a letter from the Benefits Service Center allowing you to elect coverage for the HMO. If you do not elect the HMO, you must keep your current medical option. You will receive a letter from the Benefits Service Center asking you to elect a new dental option. You will receive a letter from the Benefits Service Center allowing you to elect the DMO. If you do not elect the DMO, you must keep your current dental option. In all cases, you are not allowed to change your coverage level (you only, you plus spouse, etc.) when you move. If you are a shareowner, you will also want to notify First Union National Bank in Philadelphia of your new address (1-888-663-8325). 16 Life Events
Medical Choice is a central part of the medical care provided through the Flexible Benefits Plan. The choices you have are based on your home ZIP code. If you live: in a network area, you may elect a point of service (POS) option. With POS, you select a Primary Care Physician (PCP) who coordinates your medical care. The costs to you are less when your services are provided and coordinated through your PCP. outside a network area (non-network), you have indemnity options to choose from. With an indemnity option, covered services and supplies may be provided by any doctor or health care provider you select. in an HMO network area, you may elect HMO coverage You can also choose not to have medical coverage. If you live outside the network area (non-network) but feel the network is convenient to you, you may elect to participate in the network. See page 8 for details. In describing the medical benefits provided by the Flexible Benefits Plan, this section explains: how the POS options work how the indemnity options work your expenses expenses covered by the Plan prescription drug benefits Solutions for mental health and substance abuse treatment how the HMO options work A GUIDE TO POINT OF SERVICE BENEFITS What Is Point of Service (POS)? In a point of service plan, in-network care is provided by Primary Care Physicians who provide or coordinate all of your care. However, you also have benefits if you choose to use a non-network physician. You can choose whether to go to a network provider or go outside the network each time you seek care; in other words, you choose the coverage you want at the point of service. The network managers for the POS options are Aetna U.S. Healthcare, Blue Cross/Blue Shield, CIGNA or United HealthCare, depending on where you live. Medical 17
Network manager means the company that establishes and maintains the network for the managed care options. The network manager is also responsible for processing claims for in- and out-of-network treatment. What Is a Network? A network is a group of doctors, hospitals and other health care providers who have agreed to provide their services to participants at contracted rates. When services are provided in-network: coverage is provided at a higher level for most eligible charges preventive care is covered no annual deductible must be met in-network care is always within reasonable and customary limits your care is coordinated through your Primary Care Physician you usually don t have to file claim forms If you go out-of-network for care: you pay a higher percentage of eligible charges you pay an annual deductible you are responsible for precertifying all hospitalizations preventive care is not usually covered you file claim forms you are responsible for charges above reasonable and customary limits you are responsible for ensuring that care is medically necessary YOUR PRIMARY CARE PHYSICIAN (PCP) When you use the network your Primary Care Physician will provide most of your care, refer you to a specialist when necessary and coordinate any hospital services you need. PCPs are general or family practitioners, internists and pediatricians. You must choose a PCP for each covered family member, but you can choose a different PCP for each. You must use your PCP to receive in-network benefits. If you go to a network doctor or hospital without your PCP s referral, your expenses will be paid on an out-of-network basis. There are five exceptions: Women do not need a referral from the PCP to visit a network obstetrician or gynecologist for OB/GYN-related care. Students away at school may receive non-preventive care without a referral from their PCP (see Special Situations on page 20). Solutions can be contacted directly by you or your covered dependents. Emergency care as described in Emergency Treatment on page 25. Selected network specialists in certain locations. Contact Member Services for details. Selecting Your PCP You select your PCP from your network manager s provider directory when you first enroll. A provider directory is included with your enrollment materials. Or you can call Member Services to learn more about a particular PCP. 18 Medical
A PCP must meet strict eligibility standards established and maintained by the network manager before admission to the network. For example, a PCP generally: has an appropriate professional degree and current, unrestricted state license is board certified or board eligible has adequate malpractice insurance has 24-hour office coverage has sufficient office hours to meet patient demand has admitting privileges to at least one network hospital Other providers in the network like hospitals, labs and X-ray facilities are also selected by the network manager based on reputation in the community, geographic location, efficiency in providing medical service, the quality of those services, and willingness to adhere to the network manager s guidelines and to provide appropriate, affordable care. The network manager regularly reviews all providers to make sure they continue to meet their standards. Changing your PCP You can change your PCP by calling Member Services, which will send you a new medical ID card. Certain network managers may have a waiting period for changing your PCP. Call Member Services for details. If Your PCP Leaves the Network Some doctors will occasionally be added to the network and some doctors will occasionally leave the network. If your PCP leaves the network, your network manager will notify you and ask you to select another PCP. Be sure to call Member Services with your new PCP selection prior to your first visit to the new PCP. REFERRAL TO A SPECIALIST When your PCP refers you to a network specialist, you receive in-network benefits for covered services. Because you may choose at any time to seek care outside the network, your PCP s referral to a network specialist notifies the network manager that your visit to the specialist has been authorized, and to pay your eligible claims in-network. Without the referral, your claims will be paid out-of-network, even if the specialist or hospital is a network provider. Usually, you will receive authorization for a prescribed number of visits to a specialist within a specific time for a specific course of treatment. Make sure you and your specialist know how many visits have been authorized. Your PCP is responsible for coordinating the care you receive from a network specialist. The network manager follows the same credentialing process for network specialists as for PCPs. In addition, the specialist must complete an approved residency program and be board certified or board eligible in her/his specialty area. Provider Directories You should have received a provider directory in your first enrollment kit. If you would like to access the most current list of doctors or dentists, however, log on to Your Benefits Resources and look under Other Sites for a full list of carriers. If you would like a hard copy mailed to your home free of charge, call 1-800-353-9877. Web addresses are also listed on the back of this booklet. Medical 19
Referral to an Out-of-Network Provider In the rare instance that you need to see a specialist who is not in the network, your PCP can request the network manager s approval of the referral. If the request is approved, in-network benefits will be paid. Except for emergencies, and urgent care when traveling away from your network area, the network manager must approve the use of out-of-network providers and facilities in advance, or out-of-network benefits will apply. Women Can Self-Refer to Network OB/GYN Women do not need a PCP referral to visit a network obstetrician or gynecologist for OB/GYN-related care. However, OB/GYN providers may not be selected as primary care physicians. If you go to a non-network OB/GYN for your routine check-up, only the laboratory fees are covered. The office visit itself is not covered. SPECIAL SITUATIONS If you re traveling and need urgent medical care when you re away from home, call your PCP to discuss treatment. If your doctor recommends that you be treated where you are, your expenses will be paid at the in-network level provided they are otherwise covered by the Plan. If you can t contact your PCP, get the treatment you think you need. If you call your PCP within 48 hours, you ll receive in-network benefits for the covered services. However, because treatment was provided out-ofnetwork, you ll have to file a claim form. If your eligible dependent child attends school away from home, select a PCP for your child in your home network. The PCP will provide and coordinate all care when your child is at home. When your child is at school, non-preventive care is covered in-network without a referral from the PCP, provided it is otherwise covered by the Plan. It is still a good idea to keep your child s PCP informed of any care received while away at school, so the PCP has a complete medical history on your child. Preventive care is only covered if provided by your child s PCP. If you have eligible dependent children or an eligible spouse who permanently lives outside your network area (nonresident dependents), their covered expenses will be paid as in-network benefits, even though services are provided out-of-network, provided they are otherwise covered by the Plan. In this situation, you re responsible for ensuring that the services are medically necessary; non-medically necessary treatment is not covered. In addition, you ll have to file claim forms to be reimbursed. You should not select a Primary Care Physician for these nonresident dependents. (See A Guide to Indemnity Benefits following.) To designate your dependent children or eligible spouse as non-resident dependents, call the Benefits Service Center at 1-800-353-9877. 20 Medical
MEMBER SERVICES Member Services is your link to network care. You can call a Member Services representative to: ask questions about a network physician s credentials ask questions about your benefits change your PCP obtain information about a network provider or service replace an ID card Your medical ID card will show a toll-free number for Member Services or you can refer to the back page of this booklet. A GUIDE TO INDEMNITY BENEFITS If you live outside the network area, you participate in an option that provides indemnity benefits. Aetna U.S. Healthcare administers all the Flexible Benefits Plan indemnity options. With an indemnity option, covered services and supplies may be provided by any doctor or health care provider you select. Benefits are paid once the annual deductible is met. All covered expenses must be: medically necessary as determined by the claims administrator, not investigational or experimental as determined by the claims administrator, and within the reasonable and customary amount as determined by the claims administrator Choosing a Doctor In an indemnity option, you don t choose a primary care physician. However, you may want to consider choosing a primary doctor for yourself and your dependents to work with you in coordinating your care and the selection of any necessary specialists. By doing so, you ll have a doctor with full knowledge of your health history. WHAT MEDICAL EXPENSES YOU HAVE TO PAY UNDER OPTIONS 1, 2 AND 3 Medical Options 1, 2, and 3 pay a significant portion of the medical expenses you and your family may incur each year. You ll generally also pay a portion of the costs incurred. Here s a description of the types of charges for which you ll be responsible if you elect Option 1, 2, or 3. For information about the amount of these charges, please refer to the Summary of Medical Options at the end of this section. If you elect an HMO option, your covered expenses could be different. Refer to your HMO kit for details about HMO coverage, or call your HMO s Member Services. Copayment If you participate in a managed care option, you pay a flat dollar amount, called a copayment, for each in-network office visit. Your copayment amount will depend on the option you elect. The balance of the covered expense is paid in full by the Plan. The copayment is not included in determining if your costs have reached the out-ofpocket maximum. Non-network area means those ZIP codes which do not have network access. If your home ZIP code is in a non-network area, your medical benefits are provided through one of the indemnity options, unless you contact the Benefits Service Center and request inclusion in a network option. Claims administrator means the company that administers the indemnity options and is responsible for claims processing for those options. Medical 21