Your 2014 Health Care choices Retiree Annual Enrollment Guide
Your 2014 Retiree Annual Enrollment Guide Contact Information This enrollment guide provides highlights of your 2014 SunTrust Benefit Plans. If you have questions that are not answered in this guide, use these online resources and telephone numbers to get answers. For questions about Go online to Or call my HR Enrolling for benefits www.myhrsuntrust.com 800.818.2363 (TDD: 800.811.8565) Anthem BlueCross BlueShield www.anthem.com 877.331.4654 Medical Cigna Dental www.mycigna.com 800.769.2116 Employee Assistance Program (EAP) Express Scripts prescription drug benefits (all plans except Kaiser Permanente plans) www.guidanceresources.com (use ID SunTrustCares ) www.express-scripts.com or www.express-scripts.com/ suntrustbank (Express Preview for general information prior to January 1, 2014) 877.369.1785 Health Savings Account www.connectyourcare.com 866.442.1313 Kaiser Permanente Georgia Kaiser Permanente DC/ Baltimore For both locations: http://my.kp.org/suntrust Sparkfly Available from my HR online 800.687.2359 SunTrust s Medicare supplement plans UnitedHealthcare Medical https://member-fhs.umr.com 800.430.4308 www.myuhc.com or http://welcometouhc.com/ suntrust (if not currently enrolled and you want to learn more) 877.242.1128 (general information) 800.824.0898 (pharmacy help desk) 800.803.2523 (Accredo, formerly named CuraScript) 404.365.4110 (Georgia) 800.777.7902 (DC/Baltimore) 877.885.8454 UnitedHealthcare Vision plan www.myuhcvision.com 800.638.3120 (member services) 800.839.3242 (for in-network providers)
Welcome to Your 2014 Annual Enrollment Guide Annual Enrollment is your opportunity to review your health coverage and make choices that work best for you and your family. For 2014, there are important changes to your medical options if you are not yet eligible for Medicare. For an overview of what s new, see page 2. There are no changes for the Medicare supplement options. Review this guide to learn more and go online or call to enroll. See the enclosed personalized worksheet for the coverage you will have in 2014 if you don t contact my HR and make changes. 2014 Annual Enrollment is October 17 to November 1, 2013. my HR online and representatives will not be available until October 17th*. * This package is being sent early to comply with Creditable Coverage Notice delivery requirements. In This Guide What s New for 2014 for Those Not Eligible for Medicare...2 Annual Enrollment for 2014...3 What Happens if You Don t Enroll...3 How to Enroll...4 Taking Part in SunTrust Benefits...5 Medical Coverage If You Are Not Yet Eligible for Medicare... 10 Medical Plan Comparison (for those not eligible for Medicare)... 11 Medicare Supplement Plans... 14 Dental Coverage... 16 Vision Coverage... 17 Employee Assistance Program (EAP)... 18 Legal Notices... 19 Note: If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, a federal law gives you more choices about your prescription drug coverage. Please see pages 19-20 for the notice that verifies that prescription drug coverage under all of the SunTrust medical options is considered creditable coverage for your eligibility for Medicare Part D coverage. This guide is only an overview of SunTrust benefits as of January 1, 2014. The information provided in this guide is subject to the official plan documents, which will control in the event of any conflict, difference, or error. The Company reserves the right to amend or terminate any of its benefit plans in the future. October 2013 1
Your 2014 Retiree Annual Enrollment Guide What s New for Those Not Eligible for Medicare HMO Participants: The HMOs will no longer be offered in 2014. If you want coverage through SunTrust, you must make another choice during annual enrollment. Updated Medical Choices For 2014, those not eligible for Medicare will have the following medical plan choices: The High Deductible Health Plan (HDHP) The Preferred Provider Organization Plan (PPO) For the PPO Plan, there will be new fixed copays for office visits. At the same time, there will be higher deductibles and out-of-pocket maximums for all other services. For both plans in 2014: Health plan carriers will be consolidated to: Anthem Blue Cross Blue Shield UnitedHealthcare Kaiser Permanente (in Georgia and the DC/Baltimore area) See page 10 for more information. New prescription drug formulary a list of generic and brand-name drugs covered by the plans. See page 12 for more information. 2
Annual Enrollment for 2014 Annual Enrollment for 2014 begins Thursday, October 17 and ends Friday, November 1, 2013. You can enroll through my HR online 24/7. The enclosed personalized worksheet shows all your current benefit elections your coverage tier (for instance, retiree and spouse), the plans in which you are currently enrolled, and your 2014 options and premiums for coverage based on your current coverage tier. You must actively enroll during Annual Enrollment if: You are not yet eligible for Medicare and are currently enrolled in an HMO you need to select medical coverage or you will be enrolled automatically in the High Deductible Health Plan (HDHP) You wish to enroll in, change or drop medical, dental, and/or vision coverage You want to add or drop covered dependents and change your coverage tier If you have dropped SunTrust medical, dental, or vision coverage in the past and want to enroll in that coverage for 2014, you must call my HR and speak to a representative. The representative can provide you with information on coverage costs and take your election. You must provide documentation showing continuous, comprehensive coverage before your 2014 coverage will take effect. How to Enroll You can enroll online through my HR online SunTrust s benefits website. See page 4 for more details on how to enroll. What Happens if You Don t Enroll? Refer to the enclosed worksheet to see Your 2014 Automatic Benefits section and view the coverages and premiums that will be in place if you don t make any changes. Please remember that elections you make during Annual Enrollment generally cannot be changed during the year unless you experience a qualified life event that allows a change to your current coverage. There are a few exceptions: If you enroll in the HDHP and set up a Health Savings Account (HSA) with the financial institution of your choice, you can deposit contributions any time during the year. You will claim your tax credit when you file your tax return. Retirees over the age of 65 are not eligible for an HSA. Note: Expenses eligible for reimbursement have to be incurred on or after the date the HSA was opened. You may also drop medical, dental, and/or vision coverage at any time, effective the first day of the following month. Make an Active Choice If you re not yet eligible for Medicare and currently in an HMO, we re asking you to make an active choice during annual enrollment for 2014 coverage. If you don t choose another plan, you will be enrolled automatically in the HDHP (for Kaiser Permanente participants, the High Deductible plan). 3
Your 2014 Retiree Annual Enrollment Guide How to Enroll You can enroll online or by phone from October 17 to November 1, 2013. To enroll via my HR online Visit my HR online https://www.myhrsuntrust.com To enroll by phone Representatives are available weekdays from 8:30 a.m. to 6:30 p.m. (ET) during Annual Enrollment. Dial 800.818.2363 to speak to a representative. You can access my HR with the following information: The first time you access my HR online, you will need to enter your Social Security number and PIN (4 digits) and will then be asked to generate your own unique user ID and password which will be used for future access When calling, you will need to enter your Social Security number and 4-digit PIN. Need a PIN Reminder? If you are logging into my HR for the first time and have forgotten your PIN, you can do one of the following: Online From the my HR online sign-on page, select Forgot Your PIN? then you can either: Enter your Social Security number and Answer Challenge Questions if you have previously registered for this feature, or Enter your Social Security number and then click Request your PIN if you have not set up challenge questions By phone Call my HR, then enter your Social Security number and wait to be prompted for a PIN reminder. If you have to request a PIN to be sent to you, this will be mailed to your home address within two business days of your request. 4
Taking Part in SunTrust Benefits Your Eligible Dependents Your eligible dependents include: Your spouse Your domestic partner* Your children and stepchildren, up to the end of the year they turn 26 (must be no older than age 25 on December 31, 2013) Your children age 26 or older who are permanently and totally disabled and who were disabled prior to age 26, or who became disabled while covered under a SunTrust plan as your eligible dependent For more details on dependent eligibility, see Frequently Asked Questions on page 6. * To cover your domestic partner, you can now provide certification of your domestic partner s eligibility via my HR online with electronic signature. You can also find more information on the criteria and tax implications for domestic partner coverage. If you do not certify online, you and your domestic partner must complete an Affidavit, which my HR must then approve. Proof of Continuous, Comprehensive Coverage If you and any eligible dependents are not currently enrolled in SunTrust benefits and wish to enroll for 2014, you must be able to prove that you are currently and have been continuously covered under another health plan that provides comprehensive coverage (for example, prescription drugs, hospitalization, and office visits). Your elections will not be approved until you ve submitted proof. To elect: Medical coverage, you and your eligible dependents must show proof of continuous, comprehensive medical coverage from a group or individual plan, a Medicare Supplement, Medicare Advantage, or TriCare for Life Dental coverage, you must have been covered under a comparable dental plan Vision coverage, you must have been covered under a plan that offered coverage for eye examinations (note that a medical necessity to the eye, glaucoma for example, is covered under the medical plan). After you enroll, my HR will send you a package with documents that can be used to prove continuous, comprehensive coverage. As long as you elect coverage for yourself, you also will be able to enroll any eligible dependents with proof of their continuous, comprehensive coverage. If you are enrolling a dependent for the first time, other than within 31 days of the date that person becomes your dependent, you must provide proof of continuous, comprehensive coverage for that dependent. This includes a domestic partner unless enrolled within 31 days of the date your domestic partner was eligible. 5
Your 2014 Retiree Annual Enrollment Guide Dependent Eligibility: Frequently Asked Questions If I divorce, how long can I continue coverage for my ex-spouse? Coverage for your dependent ends on the actual date of the divorce. Reporting the divorce as a qualifying event is required so that COBRA coverage can be offered to the ex-spouse who is no longer your dependent. COBRA information will not be sent automatically; you must call my HR. My divorce decree requires that I provide coverage for my ex-spouse. Can I continue to cover that person under the SunTrust plan? No. Since the person would no longer be considered an eligible dependent under the terms of the plan, you would either need to provide coverage through COBRA or find coverage through another source for your ex-spouse. When do dependent children become ineligible? Children are no longer considered to be eligible under the SunTrust medical, dental, and vision coverages as of December 31 in the year in which the child reaches age 26. I have a Qualified Medical Child Support Order (QMCSO) for my child. How does this affect his/her eligibility for coverage? In accordance with federal law, health coverage will be provided to certain dependent children (called alternate recipients) if the plan is required to do so by a QMCSO. The order should be submitted to the QMCSO Processing Group at my HR for approval. Their address and number are: P. O. Box 199749 Dallas, TX 75219-9640 800.722.0387, ext. 39289 How do I know if my disabled child meets the requirements for continuing coverage? If your dependent child becomes permanently and totally disabled while covered as a dependent under the SunTrust Retiree Health Plan (or another employer-sponsored group health plan) prior to age 26, you may continue coverage for the child until he/she is no longer disabled. The insurance carrier may require you to submit certification that the child continues to be disabled. What if I enroll my dependents when they are actually not eligible? Enrolling and covering ineligible dependents is a violation of the SunTrust Code of Business Conduct and Ethics. If you are found to have enrolled ineligible dependents, you may be dropped from coverage and permanently ineligible from enrolling yourself or eligible dependents in the SunTrust benefit plans. 6
About Medicare Eligible Benefits The SunTrust retiree medical and prescription drug benefits available to you and any covered dependents depend on age and/or eligibility for Medicare. Anyone enrolling for coverage you and/or any dependents under age 65 and not otherwise eligible for Medicare will choose medical and prescription drug coverage from the available pre-65 options. Anyone enrolling for coverage who is age 65 or older or otherwise eligible for Medicare will be eligible for the Medicare supplement plans, which automatically include prescription drug coverage. The same options for dental and vision coverage are available to all eligible retirees and covered dependents regardless of age or Medicare eligibility. When You or Your Spouse Turn 65 About three months before you or your spouse will turn age 65, you will receive information about enrolling in one of the two SunTrust Medicare supplement plans: the Medicare Plus Plan or the Medicare Basic Plan. You will receive information on your premiums and an explanation of how the plans coordinate with Medicare. See page 14 for details on how the plans work. If you do not enroll during the enrollment period, you or your spouse will automatically move to the Medicare Plus Plan the first day of the month in which you or your spouse celebrate your 65th birthday. If you or your spouse turn 65 on the first day of the month, Medicare and Medicare supplement plan coverage take effect the first day of the previous month. For example, if you turn 65 on March 1, you will be eligible for Medicare and be enrolled in the Medicare Plus Plan unless you elect the Medicare Basic Plan on February 1. If, on the other hand, you turn 65 on March 2, you become eligible for Medicare and the Medicare Supplement plans on March 1. Because the Medicare supplement plans are administered as if you are also enrolled in Medicare Benefits, you should enroll in Medicare Parts A and B to ensure that you are receiving the maximum benefits allowed under your plan. See page 19 for information about Medicare Part D and prescription drug coverage. Request from Benefit Advocates, Inc. SunTrust occasionally asks Benefit Advocates, Inc., an alliance partner, to work with my HR to assist retirees with health care eligibility, coverage and coordination with Medicare benefits. Please comply if you are asked to verify any personal information such as your date of birth, or eligibility for Medicare. All information will be kept confidential and only shared with appropriate SunTrust and my HR personnel. Call my HR for additional information. 7
Your 2014 Retiree Annual Enrollment Guide Paying for Your Benefits You pay for retiree health coverage with after-tax dollars through direct debit from your bank account or by mailing a personal check each month. Your 2014 premiums for any plans in which you are currently enrolled are shown on your personalized enrollment worksheet. If you wish to change any of your current plan elections, you can find 2014 premium information for other plan options on your enrollment worksheet. If you need premiums for other coverage tiers or for a benefit you are not currently enrolled in, go to my HR online or call my HR and speak to a representative. If you wish to enroll yourself or any eligible dependents in SunTrust coverage which you don t currently have, you will be required to show proof of continuous, comprehensive coverage and your premiums for 2014 will be consistent with those of SunTrust employees retiring during 2014. If You Drop Coverage and Later Re-enroll If you drop coverage at any time and later wish to re-enroll for SunTrust benefits, you may pay different premiums than you would if you had continuous coverage with SunTrust. For current premiums, see the personalized worksheet in your package. You can call my HR at 800.818.2363 if you have questions about premiums. 8
Making Benefit Changes During the Year In general, the benefits you choose during Annual Enrollment will stay in effect through December 31. You are not allowed to make changes to your medical, dental, or vision coverage selections other than dropping coverage during the year. If you have a qualified life event, such as those listed below, you can make benefit changes provided that the change is consistent with the event. For example, if you divorce and your ex-spouse is therefore no longer eligible for coverage, you can change your coverage tier from retiree and spouse to retiree only. Any changes to your benefits choices must be made within 31 days of the date of the event. Qualified life events include: An addition to your family through marriage, birth, or adoption A change in dependent status through divorce, death, or loss of eligibility for benefits A change in your spouse s benefits because of a new job, job loss, significant change in cost or coverage, or discontinuation of benefits To notify SunTrust of any qualifying events and to make changes during the year, contact my HR at 800.818.2363 and follow the prompts to speak with a representative between 8:30 a.m. and 5:30 p.m. (ET) Monday through Friday. If you drop coverage for yourself and/or your dependents at any time during the year, you cannot re-enroll for coverage unless you can demonstrate continuous, comprehensive coverage under another health care plan. In addition, your premiums may change when you re-enter the plan. Coordination of Medical and Dental Benefits When you or a family member is covered under two or more plans, one is primary and all other plans are secondary plans. It s important to understand that having coverage under two plans does not necessarily mean you will receive higher benefits, because the SunTrust plans and most other plans take into account amounts paid by other coverage when determining benefits. If You Lose Medicaid or CHIP Coverage Retirees and dependents who are eligible for but not enrolled in the SunTrust plan may enroll if they lose Medicaid or CHIP coverage because they are no longer eligible, or they become eligible for a state s premium assistance program. You have 60 days from the date of the Medicaid/ CHIP event to request enrollment under the plan. If you request this change, coverage will be effective the first of the month following your request for enrollment. Specific restrictions may apply, depending on federal and state law. See Legal Notices for more about Medicaid and CHIP coverage. 9
Your 2014 Retiree Annual Enrollment Guide Medical Coverage If You Are Not Yet Eligible for Medicare It s important to carefully consider your options this year. Premiums are changing and the HMO will no longer be offered. SunTrust will offer two plans in 2014. Choices for 2014 High Deductible Health Plan (HDHP) with optional Health Savings Account (HSA) Preferred Provider Organization Plan (PPO) To find an in-network provider, visit the website for the medical plan carrier in your area. See page 33 for instructions. Updated Provider Networks For 2014, SunTrust has consolidated health plan carriers to Anthem Blue Cross Blue Shield, UnitedHealthcare and Kaiser Permanente (in some locations). You can confirm which carrier is offered in your location on your personalized worksheet and at my HR online. With these changes, it s important to confirm whether your doctor participates in the new carrier s network. Over 9 out of 10 doctors in the current carrier s network participate in the new carrier s network. Visit the website for the carrier in your area to find in-network providers (see page 33 for instructions). A Note About Kaiser Permanente Networks In Georgia and the DC/Baltimore area, there is currently a Kaiser Permanente HMO available. Although the HMO will no longer be offered in 2014, there will continue to be two options available from Kaiser Permanente in those areas: Kaiser High Deductible and Kaiser Low Deductible. This will give current Kaiser Permanente HMO participants the opportunity to keep their current doctor under a SunTrust plan. Note that you must use the Kaiser Permanente network or care will not be covered, except in a true emergency. 10 Preventive Care Covered by All Plans All plans cover in-network preventive care at 100% with no deductible. Eligible tests and screenings are considered preventive care if performed as part of a routine examination and considered appropriate based on evidence qualified protocols. Any test or screenings to diagnose disease based on symptoms will be covered as treatment if eligible. For a list of recommended immunizations and screenings based on your age, go to my HR online and click on Documents & Forms under the Resources section of my Health and Other Benefits to locate the document titled Preventive Services. Compare Health Plans Go to my HR online and hover over my Benefits, then select my Health & Other Benefits. Under Tools, select Compare Health Plans. This tool lets you compare plan features side-by-side and estimate how much each plan would cost in 2014 based on premiums plus your out-of-pocket cost for the medical care you anticipate.
Comparing How the Plans Pay Benefits In-network annual deductible In-network annual out-of-pocket maximum In-network preventive care Office visits PCP/Physician Specialist Hospital care Inpatient services Outpatient surgery Emergency care** Urgent care Lab and X-ray Mental health/substance abuse Inpatient Outpatient Pharmacy/drug benefit HDHP $1,500 one person $3,000 more than one person PPO $1,000/individual $2,000/family The deductible for out-of-network care is two times the in-network deductible $5,500 one person $11,000 more than one person $4,500/individual $9,000/family The maximum for out-of-network care is two times the in-network maximum What the plan pays* In-network: Plan pays 100%, no deductible Out-of-Network: Plan pays 70% of R&C allowance after deductible* In-network: Plan pays 90% after deductible Out-of-network: Plan pays 70% of R&C allowance after deductible (out-of-network emergency care covered at in-network benefit level)* Once the deductible is met, plan pays 90% 100% after: $25 copay $35 copay In-network: Plan pays 80% after deductible Out-of-network: Plan pays 60% of R&C allowance after deductible (out-of-network emergency care covered at in-network benefit level)* Separate copay * If you enroll in the Kaiser High Deductible or Low Deductible plans, care is covered only if you use in-network doctors and facilities. There is an exception for care provided to treat a life- or limb-threatening emergency. ** Emergency care is covered at the in-network benefit level for a life- or limb-threatening emergency. See Prescription Drug Coverage on page 12 for more information on prescription drug coverage. 11
Your 2014 Retiree Annual Enrollment Guide Note: If you enroll in the HDHP, you must meet the HDHP deductible before the plan begins paying for prescriptions. Prescription Drug Coverage if You Are Not Yet Eligible for Medicare Prescription drug coverage for the HDHP and PPO is provided through Express Scripts. Starting in 2014, prescription coverage will be based on a new formulary, which is a list of covered generic and brand-name medications. The formulary is compiled by an independent group of doctors and pharmacists and includes medications that offer effective treatment and the best value. Drugs that are not on the new formulary will not be covered, except in certain special cases. Drugs not covered do not apply to deductibles or out-of-pocket maximums. If you are currently using a drug that is not on the new formulary, you will have a six-month transition period. You have until July 1, 2014 to work with your doctor to switch to an alternative drug that is on the new formulary. You are required to use home delivery for regular maintenance medications after the third retail order or contact Express Scripts to opt out of mail order. HDHP PPO Retail (30-day supply) Generic on formulary 10%, no maximum* $10 copay Brand-name on 10%, no maximum* 40%, max. $115 formulary Not on formulary Not covered Not covered Home Delivery (90-day supply) Generic on formulary 10%, no maximum* $20 copay Brand-name on 10%, no maximum* 40%, max. $230 formulary Not on formulary Not covered Not covered * Subject to medical/prescription drug out-of-pocket maximum. For the Kaiser Permanente High Deductible and Low Deductible Plans, prescription drug coverage is provided through Kaiser Permanente. See the Kaiser Permanente website for details. Go Online for More About the New Formulary Learn more about the new formulary at www.express-scripts.com/suntrustbank and check to see if your medication is on the list. If it is not, work with your doctor to determine which drug on the new formulary may be effective for you. Because medications for certain conditions are difficult to transition, these drugs are grandfathered for those currently using one of these medications, which means they continue to be covered even though they are not on the new formulary. Express Scripts will mail a notification letter to members taking grandfathered medications later this year. 12
How the Health Savings Account Works If you enroll in the HDHP, the Health Savings Account (HSA) works like this: Money goes in Money comes out Have money left? It rolls over. Any after-tax contributions you make up to: $3,300 for single coverage $6,550 if you enroll your spouse/ domestic partner and/or children An extra $1,000 if you are age 55 or older Your after-tax contributions can be deducted on your 2014 tax return. Setting up a SunTrust HSA Go to www.connectyourcare.com or call 866.442.1313 to set up a SunTrust Health Savings Account. You can also set up an HSA at the financial institution of your choice. You pay the full cost of nonpreventive care, including prescription drugs, until you meet the deductible. You receive discounted rates innetwork. By budgeting now, you can set aside enough money to cover your deductible if you need it. When you have an eligible expense, you can pay it with your HSA debit card, request direct payment from your account to your provider, or reimburse yourself from the account if you pay the expense out of pocket. If there is not enough money in your account to cover the expense, you can pay it and reimburse yourself later. Any money left in your account is yours to pay for health care in the future, even retiree medical premiums.* Any money in your account used for eligible medical expenses is not taxed. *According to IRS Publication 969, you cannot treat insurance premiums as qualified medical expenses unless the premiums are for: 1. Long-term care insurance 2. Health care continuation coverage (such as coverage under COBRA) 3. Health care coverage while receiving unemployment compensation under federal or state law 4. Medicare and other health coverage if you were 65 or older (other than premiums for a Medicare supplement policy, such as Medigap) The premiums for long-term care insurance that you can treat as qualified medical expenses are subject to limits based on age and are adjusted annually. See Limit on long-term care premiums you can deduct in the instructions for Schedule A (Form 1040). Items (2) and (3) can be for your spouse or a dependent meeting the requirement for that type of coverage. For item (4), if you, the account beneficiary, are not 65 or older, Medicare premiums for your spouse or a dependent (who is 65 or older) generally are not qualified medical expenses. Note: You cannot claim the health coverage tax credit for premiums that you pay with a tax-free distribution from your HSA. See Publication 502 for more information on this credit. Health Savings Accounts and Dependent Expenses While the Patient Protection and Affordable Care Act (PPACA) allows parents to add adult children (up to age 26) to their medical plans, the IRS has not changed its definition of a dependent for HSAs. This means that a retiree with a child age 24 or older (19 or older if not a full-time student) covered under the SunTrust HDHP cannot use HSA funds to pay for medical expenses for that child. HSA Cost Calculator The HSA Cost Calculator, available on my HR online, can help you estimate your annual tax savings if you enroll in the HDHP and set up a Health Savings Account (HSA) based on your contribution and tax bracket. 13
Your 2014 Retiree Annual Enrollment Guide Default Coverage If you or your spouse have SunTrust retiree medical coverage and become eligible for Medicare, you automatically will be enrolled in the Medicare Plus Plan if you don t make a choice between the two options during the enrollment period. Medicare Supplement Plans If you are age 65 or older, or otherwise eligible for Medicare, you will be covered by one of the SunTrust Medicare supplement plans the Medicare Plus Plan or the Medicare Basic Plan. Both Medicare supplement plans are administered by UMR. Both plans are intended to coordinate with Medicare benefits to protect you from the out-ofpocket costs of catastrophic illness. The Medicare supplement plans pay benefits as though you are enrolled in Medicare Parts A and B regardless of your actual enrollment. This means that, if you are not enrolled in Medicare Parts A and B, you will not be reimbursed for expenses that would have been paid by Medicare. To ensure that you receive maximum coverage, you must enroll in Medicare Parts A and B. The Medicare supplement plans generally pay the difference between the maximum amount that Medicare authorizes for a medical procedure and what it actually pays. You are responsible for amounts that exceed the Medicare allowable charge if you see a physician who does not accept Medicare s assignment. For the Medicare Plus Plan, you are also responsible for an inpatient hospitalization copay of $200 per Part A deductible applied by Medicare and the annual Medicare Part B deductible for physician services. For the Medicare Basic Plan, you are responsible for the first $2,000 of covered expenses per person, which can include the Part A deductible, the Part B deductible, and 20% of Medicare-approved charges after the Part B deductible. After you pay $2,000 per person, the plan pays Medicare-approved charges not covered by Medicare. The following chart shows what the Medicare supplement plans pay, based on what Medicare pays, for certain expenses. There is no lifetime maximum under the Medicare supplement plans. Medicare Part A Services Inpatient hospital services Medicare Part B Services Physician services Emergency treatment/ Foreign travel Medicare Pays Medicare Plus Plan Pays Medicare Basic Plan Pays All but Part A deductible for up to 150 days 80% of Medicare approved charges after Part B deductible Part A deductible after your $200 copay, plus charge for days beyond 150 if medically necessary 20% of Medicare-approved charges after you pay Part B deductible After you have paid the first $2,000 of covered expenses per person in a year, plus charge for days beyond 150 if medically necessary 20% of Medicare-approved charges after you pay $2,000 in covered expenses per person in a year and any remaining Part B deductible Nothing 100% 100% after you pay $2,000 in covered expenses per person All health benefits shown here are subject to all provisions of the Medicare supplement plans. The plans generally will not cover any charges that Medicare does not cover. 14
Prescription Drug Coverage for Both Medicare Supplement Plans Prescription drug coverage under the Medicare supplement plans is considered to be at least as good as coverage under Medicare Part D. Unless you are eligible for a special subsidy under Medicare Part D, the SunTrust coverage is more comprehensive. More information about the comparison of SunTrust s and Medicare s prescription drug coverage is in the Creditable Coverage Notice on pages 19-20. As long as you are not enrolled in Medicare Part D, prescription drug benefits for either Medicare supplement plan are provided through Express Scripts. If you are enrolled in Medicare Part D, you are not eligible for prescription drug coverage through SunTrust even though your premium will not be reduced. Your prescription drug coverage lets you purchase medications from retail pharmacies or through Express Scripts mail order program. You pay a low, set copayment for generic medications and a coinsurance amount for brand-name medications. There is also a limit on the amount of money you will have to spend out of your pocket during the year for prescription drugs. If You Enroll In Medicare Part D Remember that if you are covered under either Medicare Supplement plan and enroll in Medicare Part D, your coverage will not provide prescription drug benefits even though your premium will not be reduced. What You Pay for Prescription Drugs Annual Out-of-Pocket Maximum $1,500 per person Retail (30-day supply) Generic $5 copay Preferred brand-name 30%, max $95 Non-preferred brand-name 40%, max $125 Home Delivery (90-day supply) Generic $10 copay Preferred brand-name 30%, max $190 Non-preferred brand-name 40%, max $250 15
Your 2014 Retiree Annual Enrollment Guide Dental Coverage Depending on your home zip code, you have a choice of either two or three dental plans for 2014: The Cigna Basic option The Cigna Plus option The Cigna Dental HMO (if you live in a Cigna Dental HMO network area) You may use any dentist you choose under the Basic and Plus options. However, you may pay less if you visit a dentist who participates in Cigna s Radius dental network. The Cigna Dental HMO is available only if you live in a Cigna Dental HMO network area. When you enroll in the Dental HMO, you select an in-network general dentist who provides routine, basic care and refers you to specialty dentists when necessary. Payment for services is based on a predetermined patient charge schedule, available on my HR online. Cigna Basic* Cigna Plus* Cigna Dental HMO Annual deductible $50 per person $50 per person None $150 per family $150 per family Annual maximum benefit $500 per person $1,500 per person Unlimited What the Plan Pays Preventive care (cleanings, diagnostic X-rays) Basic care (fillings, periodontal care, root canals) Major care (crowns, bridges) 100% 100% Costs based on patient charge schedule** 80% after deductible 80% after deductible Not covered 50% after deductible Orthodontia Not covered 50%, no deductible $1,500 lifetime maximum * All claims are subject to R&C allowances unless you visit a dentist who participates in Cigna s Radius network. Using a preferred provider could result in lower out-of-pocket expenses. ** The updated schedule is available at my HR online. 16
Vision Coverage The vision care benefit, offered through UnitedHealthcare Vision, helps you and your family save money on exams, eyeglasses, contacts, and laser eye surgery. UnitedHealthcare Vision has a national network of participating independent doctors and retail chain providers. Whenever you need vision care, you can use any doctor you want. However, you receive a higher level of benefits when you choose a UnitedHealthcare Vision in-network provider. Service In-Network Out-of-Network How Often Covered Routine eye exam 100% after $10 copay Up to $40 allowance Once every calendar year Lenses 100% after $25 copay Allowance: Once every calendar year Single vision: Up to $40 Bifocal: Up to $60 Trifocal: Up to $80 Lenticular: Up to $80 Frames* Allowance: Up to $130 Up to $45 allowance Once every two calendar years Contact lenses** 100% after $25 copay Allowance: Elective: Up to $105 Medically necessary: Up to $210 Once every calendar year * When you use UnitedHealthcare Vision network providers, UnitedHealthcare Vision covers a wide selection of frames, but not all frames are covered in full. ** Contact lenses are covered in lieu of eyeglass lenses and frames. Up to four boxes of disposable contact lenses may be covered, depending on the prescription. Laser eye surgery is also available at discounted rates from any Laser Vision Network of America (LVNA) provider location nationwide. Optional Items Not Covered Certain optional items, such as scratch-guard coating and progressive lenses, are not covered under the plan and are your responsibility to pay. 17
Your 2014 Retiree Annual Enrollment Guide Employee Assistance Program (EAP) The Employee Assistance Program (EAP) is provided free of charge to all SunTrust retirees. The EAP offers free, confidential, short-term counseling, as well as resource information on a variety of life issues such as elder care, child care, and general living support. ComPsych GuidanceResources provides professional and personal assistance for you and your family members for any type of problem. Counseling is given by experienced, licensed counselors and is available 24 hours a day, seven days a week. You can receive five visits per issue in any 12-month period at no cost to you. If you need additional care, services may be covered by your medical plan. It s important to check your medical plan coverage, including provider networks, before you continue care. You can also use ComPsych to find appropriate child care as well as resources to meet the needs of aging parents. This resource and referral service helps you explore options, find background information, and identify resources for choosing day care and/or finding elder care providers. The EAP also offers a resource for getting expert information on a variety of life tasks. Provided through FamilySource, this service can save you time and help minimize the headaches related to: Buying homes, cars, or computers Planning a vacation or obtaining a passport Relocating to a new city Having repairs or construction done on your home Entertaining family and friends The EAP also provides financial and legal resources: Legal support for issues ranging from divorce and family law to criminal and civil actions Financial help with anything from resolving debt issues to retirement planning Go to www.guidanceresources.com (ID SunTrustCares ) or call 877.369.1785. 18
Legal Notices Notice About Prescription Drugs and Medicare SunTrust Banks, Inc. Retiree Health Plan and SunTrust Banks, Inc. Employee Benefit Plan - All Medical Options Revised September 2013 for 2014 Plan Year Your Prescription Drug Coverage and Medicare Important Notice from SunTrust Banks, Inc. If you or one of your covered dependents is eligible for Medicare benefits, please read this notice carefully and keep it where you can find it. At the end of this notice is information about where you can get help to make decisions about your prescription drug coverage. 1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare through Medicare prescription drug plans and Medicare Advantage Plans that offer prescription drug coverage. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. 2. SunTrust has determined that the prescription drug coverage included as part of medical coverage under either the Retiree Health Plan or the Employee Benefit Plan is, on average for each plan s participants, expected to pay out at least as much as the standard Medicare prescription drug coverage will pay. Therefore, the SunTrust prescription drug benefits under all medical options are considered Creditable Coverage. Because the prescription drug coverage through all SunTrust medical plans in 2013 and in 2014 is on average at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay extra if you later decide to enroll in Medicare prescription drug coverage. Individuals can enroll in a Medicare prescription drug plan when they first become eligible for Medicare and each year from October 15 through December 31. Beneficiaries leaving employer/union coverage may be eligible for a Special Enrollment Period to sign up for a Medicare prescription drug plan. You should compare your current coverage, including which drugs are covered, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. A description of SunTrust s prescription drug coverage is included in the SunTrust Retiree Summary Plan Descriptions and the SunTrust Benefits Summary Plan Descriptions. It is also described in this SunTrust Annual Enrollment Guide. A representative at my HR can tell you how to get a copy. SunTrust s coverage pays for other health expenses, in addition to prescription drugs. Unless you are in active SunTrust employment, if you choose to enroll in a Medicare prescription drug plan, prescription drug benefits generally will not be paid under the SunTrust coverage, but other covered health expenses will be paid according to the plan document. Even if the SunTrust coverage does not pay for prescription drug benefits because you have Medicare prescription coverage, your SunTrust premium will not be reduced. You should also know that, once Medicare-eligible, if you drop or lose your SunTrust medical coverage (because of failure to pay premiums) and don t enroll in Medicare prescription drug coverage soon after your SunTrust coverage ends, you may pay more (a penalty) to enroll in Medicare prescription drug coverage later. Specifically, if you go 63 days or longer without prescription drug coverage that s at least as good as Medicare s prescription drug coverage, your Medicare Part D monthly premium will go up at least 1% per month for every month that you were eligible but did not have that coverage. For example, if you go 19 months without coverage, your premium will always be at least 19% higher than what most other people pay. You ll have to pay this higher premium as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the next October to enroll. 19
Your 2014 Retiree Annual Enrollment Guide More detailed information about Medicare plans that offer prescription drug coverage is in the Medicare &You handbook. A new version of this handbook is mailed every year to Medicare beneficiaries directly from Medicare. You may also be contacted directly by Medicare prescription drug plans. For more information about Medicare prescription drug plans: Visit www.medicare.gov Call your State Health Insurance Assistance Program (see your copy of the Medicare & You handbook for their telephone number) for personalized help Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. For people with limited income and resources, extra help paying for Medicare prescription drug coverage is available. Information about this extra help is available from the Social Security Administration (SSA) online at www.socialsecurity.gov, or you may call them at 1-800-772-1213 (TTY 1-800-325-0778). Remember: Keep this notice if you are eligible for Medicare or will become eligible within the next 12 months. If you enroll in one of the plans approved by Medicare which offer prescription drug coverage, you may be required to provide a copy of this notice when you join to show that you are not required to pay a higher premium amount. For more information about this notice or your current prescription drug coverage Contact my HR online (www.myhrsuntrust.com) or at 800.818.2363. NOTE: You may receive this notice at other times in the future such as before the next period you can enroll in Medicare prescription drug coverage, and if this coverage changes. You also may request a copy of this notice at any time. Privacy Notice SunTrust protects the privacy of your protected health information. SunTrust Human Resources complies with all HIPAA privacy rules. These policies have been revised to reflect recent changes in the law which 1) expand and clarify the circumstances under which the plan needs your written authorization to use protected health information and 2) require a description of your rights to be notified if we discover a breach of your unsecured protected health information. The SunTrust and ComPsych (EAP) Privacy Policies are available at my HR online. Take a moment to read how these privacy rules restrict how and when protected health information can be used and disclosed. These policies are posted on my HR online in the Library. You can also call my HR and request that a copy be sent to you. Breast Reconstruction Following a Mastectomy If you have to have a mastectomy, all SunTrust medical plans provide the following benefits: Reconstruction of the breast on which the mastectomy has been performed Surgery and reconstruction of the other breast to produce a symmetrical appearance Prostheses and treatment of physical complications at all stages of mastectomy, including lymphedemas 20
Medicaid and the Children s Health Insurance Program (CHIP) Offer Free or Low-Cost Health Coverage to Children and Families If you or your children are eligible for Medicaid or CHIP and you are eligible for health coverage from your employer, your State may have a premium assistance program that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for these programs, but also have access to health insurance through their employer. If you or your children are not eligible for Medicaid or CHIP, you will not be eligible for these premium assistance programs. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, you can contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan. Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must permit you to enroll in your employer plan if you are not already enrolled. This is called a special enrollment opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, you can contact the Department of Labor electronically at www.askebsa.dol.gov or by calling toll-free 1-866-444-EBSA (3272). If you live in one of the following States, you may be eligible for assistance paying your employer health plan premiums. The following list of States is current as of July 31, 2013. You should contact your State for further information on eligibility. ALABAMA Medicaid Website: http://www.medicaid.alabama.gov Phone: 1-855-692-5447 ALASKA Medicaid Website: http://health.hss.state.ak.us/dpa/ programs/medicaid/ Phone (Outside of Anchorage): 1-888-318-8890 Phone (Anchorage): 907-269-6529 ARIZONA CHIP Website: http://www.azahcccs.gov/applicants Phone (Outside of Maricopa County): 1-877-764-5437 Phone (Maricopa County): 602-417-5437 COLORADO Medicaid Medicaid Website: http://www.colorado.gov/ Medicaid Phone (In state): 1-800-866-3513 Medicaid Phone (Out of state): 1-800-221-3943 FLORIDA Medicaid Website: https://www.flmedicaidtplrecovery.com/ Phone: 1-877-357-3268 GEORGIA Medicaid Website: http://dch.georgia.gov/ Click on Programs, then Medicaid, then Health Insurance Premium Payment (HIPP) Phone: 1-800-869-1150 IDAHO Medicaid and CHIP Medicaid Website: www.accesstohealthinsurance.idaho. gov Medicaid Phone: 1-800-926-2588 CHIP Website: www.medicaid.idaho.gov CHIP Phone: 1-800-926-2588 INDIANA Medicaid Website: http://www.in.gov/fssa Phone: 1-800-889-9949 21
Your 2014 Retiree Annual Enrollment Guide IOWA Medicaid Website: www.dhs.state.ia.us/hipp/ Phone: 1-888-346-9562 KANSAS Medicaid Website: www.dhs.state.ia.us/hipp/ Phone: 1-888-346-9562 KENTUCKY Medicaid Website: http://chfs.ky.gov/dms/default.htm Phone: 1-800-635-2570 LOUISIANA Medicaid Website: http://www.lahipp.dhh.louisiana.gov Phone: 1-888-695-2447 KENTUCKY Medicaid Website: http://chfs.ky.gov/dms/default.htm Phone: 1-800-635-2570 LOUISIANA Medicaid Website: http://www.lahipp.dhh.louisiana.gov Phone: 1-888-695-2447 MAINE Medicaid Website: http://www.maine.gov/dhhs/ofi/publicassistance/index.html Phone: 1-800-977-6740 TTY 1-800-977-6741 MASSACHUSETTS Medicaid and CHIP Website: http://www.mass.gov/masshealth Phone: 1-800-462-1120 MINNESOTA Medicaid Website: http://www.dhs.state.mn.us/ Click on Health Care, then Medical Assistance Phone: 1-800-657-3629 MISSOURI Medicaid Website: http://www.dss.mo.gov/mhd/participants/ pages/hipp.htm Phone: 573-751-2005 MONTANA Medicaid Website: http://medicaidprovider.hhs.mt.gov/ clientpages/clientindex.shtml Phone: 1-800-694-3084 NEBRASKA Medicaid Website: www.accessnebraska.ne.gov Phone: 1-800-383-4278 NEVADA Medicaid Medicaid Website: http://dwss.nv.gov/ Medicaid Phone: 1-800-992-0900 NEW HAMPSHIRE Medicaid Website: http://www.dhhs.nh.gov/oii/documents/ hippapp.pdf Phone: 603-271-5218 NEW JERSEY Medicaid and CHIP Medicaid Website: http://www.state.nj.us/ humanservices/dmahs/clients/medicaid/ Medicaid Phone: 609-631-2392 CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710 NEW YORK Medicaid Website: http://www.nyhealth.gov/health_care/ medicaid/ Phone: 1-800-541-2831 NORTH CAROLINA Medicaid Website: http://www.ncdhhs.gov/dma Phone: 919-855-4100 NORTH DAKOTA Medicaid Website: http://www.nd.gov/dhs/services/medicalserv/ medicaid/ Phone: 1-800-755-2604 OKLAHOMA Medicaid and CHIP Website: http://www.insureoklahoma.org Phone: 1-888-365-3742 OREGON Medicaid and CHIP Website: http://www.oregonhealthykids.gov http://www.hijossaludablesoregon.gov Phone: 1-800-699-9075 22
PENNSYLVANIA Medicaid Website: http://www.dpw.state.pa.us/hipp Phone: 1-800-692-7462 RHODE ISLAND Medicaid Website: www.ohhs.ri.gov Phone: 401-462-5300 SOUTH CAROLINA Medicaid Website: http://www.scdhhs.gov Phone: 1-888-549-0820 SOUTH DAKOTA - Medicaid Website: http://dss.sd.gov Phone: 1-888-828-0059 TEXAS Medicaid Website: https://www.gethipptexas.com/ Phone: 1-800-440-0493 UTAH Medicaid and CHIP Website: http://health.utah.gov/upp Phone: 1-866-435-7414 VERMONT Medicaid Website: http://www.greenmountaincare.org/ Phone: 1-800-250-8427 VIRGINIA Medicaid and CHIP Medicaid Website: http://www.dmas.virginia.gov/rcp- HIPP.htm Medicaid Phone: 1-800-432-5924 CHIP Website: http://www.famis.org/ CHIP Phone: 1-866-873-2647 WASHINGTON Medicaid Website: http://hrsa.dshs.wa.gov/premiumpymt/apply. shtm Phone: 1-800-562-3022 ext. 15473 WEST VIRGINIA Medicaid Website: www.dhhr.wv.gov/bms/ Phone: 1-877-598-5820, HMS Third Party Liability WISCONSIN Medicaid Website: http://www.badgercareplus.org/pubs/p-10095. htm Phone: 1-800-362-3002 WYOMING Medicaid Website: http://health.wyo.gov/healthcarefin/ equalitycare Phone: 307-777-7531 To see if any more States have added a premium assistance program since July 31, 2013, or for more information on special enrollment rights, you can contact either: U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/ebsa 1-866-444-EBSA (3272) U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Ext. 61565 23
Your 2014 Retiree Annual Enrollment Guide Hipaa Notice of Privacy Practices for Protected Health Information Effective September 5, 2013 This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. SunTrust is providing this Health Information Privacy Notice for the selfinsured group health plans sponsored by SunTrust Banks, Inc. ( SunTrust ) so you understand how we may use your health information and when we need to disclose your health information to others. You have received this Notice because you may be enrolled for coverage in one or more programs listed below, either as an employee, a retiree or a current or former family member eligible for individual coverage: Medical PPOs, HDHP/HSA, HMO coverage Anthem Blue Cross Blue Shield, Aetna, Inc., CIGNA HealthCare, UnitedHealthcare Medical HMO Coverage by Kaiser Permanente Medicare Eligible Participants administered by UMR Prescription Drug Coverage administered by Express Scripts, Inc. Dental HMO and PPO Coverage administered by CIGNA HealthCare Healthcare FSA, HRA, HSA administered by Aetna, Inc. or ConnectYourCare Vision Coverage administered by UnitedHealthCare Vision Each of these programs is a health care component under SunTrust s Employee Benefit Plan or Retiree Health Plan and is referred to in this Notice separately as a Plan and together with other components as the Plans. This Notice applies to all of the Plans listed above, which together are considered an organized health care arrangement under Health Insurance Portability and Accountability Act ( HIPAA ). This Notice is required by HIPAA. SunTrust, as sponsor of the Plans, which are self-insured, must ensure that the Plans comply with HIPAA s privacy rules. You may receive other HIPAA privacy notices for SunTrust s fully insured health plans (e.g., from MetLife for life and long-term care, UnitedHealthCare for vision, Kaiser Permanente for HMO medical coverage, CIGNA for HMO Dental) as well as from your doctors, hospitals or other health care providers. Their notices will be different from this one. This Notice applies only to protected health information obtained and maintained by a Plan. This Notice describes how the Plans protect your Protected Health Information ( PHI ) that they maintain or transmit, regardless of the form (oral, written or electronic). Your PHI includes individually identifiable information which relates to your past, present or future mental or physical health or condition, your health care treatment, and your past, present or future payment for health care services. This Notice also describes your rights with respect to your PHI and how 24
you can exercise those rights. The Plans are required by HIPAA to take reasonable steps to: maintain the privacy of your PHI; provide you this Notice of the Plans legal duties and privacy practices with respect to your PHI; notify affected individuals following a breach of unsecured PHI; and follow the terms of this Notice. Uses And Disclosures of PHI for Treatment, Payment and Health Care Operations We are obligated to use and disclose your PHI to provide information: to you or someone who has the legal right to act for you (e.g., your personal representative) to the U.S. Department of Health and Human Services, if necessary, to protect your privacy when it s required by law We have the right to disclose and use your PHI to pay for your health care and to operate and administer the Plans. The Plans use and disclose your PHI primarily to evaluate and process requests about your coverage and claims for benefits that you may make. These uses and disclosures are generally for treatment, payment and health care operations, as described below. The Plans may disclose PHI to SunTrust as Plan Sponsor for purposes related to treatment, payment and health care operations. The Plan documents provide for this disclosure to SunTrust and to protect your PHI as required by federal law. A Plan may also disclose your PHI to designated service providers that help administer a Plan to another Plan. For example, the PPO Plan may disclose your out-of-pocket co-pays to the Healthcare Flexible Spending Account Plan. These uses and disclosures do not require your authorization or advance notice to you. Some examples of when we may use your protected health information are: For Treatment: The Plans may use or disclose your PHI to facilitate medical treatment or services by your health care providers, such as doctors, nurses, other medical personnel, or pharmacists who are involved in taking care of you. For example, a Plan might give your orthodontist information about your dentist so your orthodontist may request your dental X-rays. For Payment: The Plans may use and disclose PHI to obtain premiums or to make decisions about your Plan coverage and benefits payment. For example, a Plan may tell a doctor whether you are eligible for coverage or what percentage of a bill a Plan will pay. A Plan may also disclose PHI to other health plans to coordinate coverage for a particular claim. A Plan may also use or disclose PHI in connection with other payment-related activities, such as eligibility determination; claims management; review of services 25
Your 2014 Retiree Annual Enrollment Guide 26 for medical necessity, appropriateness of care, or justification of charges; utilization review activities (e.g., pre-authorization); or to assist you with inquiries or disputes. For Health Care Operations: The Plans may use and disclose PHI in connection with their health care operations. For example, a Plan may review your PHI to (1) conduct quality assessment and improvement activities and review competence or qualifications of health care professionals; (2) perform underwriting, premium rating, and other activities relating to Plan insurance or coverage; (3) conduct disease management or claims management; (4) conduct or arrange for medical review, legal services and audit functions, including fraud and abuse detection and compliance programs; (5) learn about the successes and failures of the Plan, and about ways to manage costs, including consideration of a merger or consolidation with another group health plan; and (6) manage the business of the Plan and make sure it is administered properly and effectively. For example, a Plan may use information about your claims to project future benefit costs, to audit the accuracy of its claims processing function, to refer you to a disease management program or to contact you or your physician with information about alternative treatments (for example, if you are taking a brand-name drug, to let you know about a generic equivalent). Other Permissible Uses and Disclosures of PHI Not Requiring Your Authorization The Plans may also use or disclose your PHI in the following situations without your authorization or advance notice to you. Where Required By Law: The Plans will disclose your PHI when required to do so by federal, state or local law. For example, a Plan may be required to disclose your PHI at the request of the Secretary of Health and Human Services in connection with an investigation of the Plan s compliance with the HIPAA privacy rules. To Business Associates: The Plans may enter into contracts with entities known as Business Associates that provide services to or perform functions on behalf of the Plan such as to administer claims. The Plans may disclose protected health information to Business Associates once they have agreed in writing to safeguard the protected health information. Business Associates are also required by law to protect protected health information. For Public Health Activities: The Plans may disclose your PHI for public health activities. These may include activities to (1) prevent, control or report disease, injury or disability; (2) report births and deaths or report child abuse or neglect to public health or governmental authorities; (3) conduct public health surveillance, investigations or interventions; (4) report reactions to medications or product defects; (5) notify people of product recalls; and (6) notify a person who may have been exposed to a communicable disease or may be at risk for contracting or spreading a disease or condition. About Victims of Abuse, Neglect or Domestic Violence: The Plans may disclose your PHI, when authorized by law, to notify the appropriate government authority if there is a reasonable belief that you may be
the victim of abuse, neglect or domestic violence, and you agree to the disclosure or the disclosure is required by law. The Plans will notify you of any such disclosure unless there is reason to believe that this information would place you at risk of serious harm. Notice may be given to a minor s parents or representative instead of to the minor unless they are not allowed such access. For Health Oversight Activities: The Plans may disclose your PHI to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations (civil, administrative or criminal), inspections, and licensure or disciplinary actions (e.g., to investigate disciplinary actions against a provider) and other activities necessary for appropriate oversight of government benefit programs (e.g., to investigate Medicare fraud). For Judicial and Administrative Proceedings: The Plans may disclose your PHI in response to a court or administrative order or in response to a subpoena, discovery request, or other lawful process, but only if certain conditions are met. One of those conditions is that the Plan must receive satisfactory assurances that the party seeking the information has made a good faith effort to tell you about the request (so that you could object) or to obtain an order protecting the requested PHI. For Law Enforcement: The Plans may release your PHI for certain law enforcement purposes, including the following: (1) in response to a court order or a subpoena, warrant, summons or similar process; (2) at the request of a law enforcement official, to identify or locate a suspect, fugitive, material witness, or missing person; (3) about the victim of a crime if, under certain limited circumstances, the Plan is unable to obtain the person s agreement; or (4) about a death that appears to be the result of criminal conduct. About Decedents: The Plans may release your PHI to a coroner or medical examiner. This may be necessary, for example, to identify you in the event of your death or to determine the cause of your death. The Plans may also release your PHI to funeral directors as necessary to carry out their duties. For Research: The Plans may use and disclose PHI for certain research provided that your authorization is not required, as certified by a certain type of institutional review or privacy board. For Organ, Eye and Tissue Donation: The Plans may release your PHI to organizations that handle the procurement, banking or transplantation of cadaver organs, eyes or tissues in order to facilitate donation and transplantation. To Avert a Serious Threat to Health or Safety: The Plans may use and disclose your PHI to prevent or lessen a serious threat to the health or safety of you, the public or another person, but only to a person who is able to help prevent the threat. For Special Governmental Functions: If you are a member of the armed forces, the Plans may be required to release your PHI to the appropriate military command authorities. The Plans may also release your PHI to authorized federal officials for intelligence, counterintelligence, and 27
Your 2014 Retiree Annual Enrollment Guide other national security activities authorized by law. If you should become incarcerated or be placed under the custody of a law enforcement official, the Plans may release your PHI so that the institution can provide you with health care or protect the health and safety of you or others, or the safety and security of the correctional institution. For Workers Compensation: The Plans may release your PHI to comply with workers compensation and similar laws. If none of the above reasons apply, then your written authorization is needed to use or disclose your PHI. It is our intent to meet the most stringent requirements of other applicable laws, as necessary, to protect your privacy. Following our receipt of your authorization to release your PHI, we cannot guarantee that the person to whom the PHI is provided will not disclose your information. You have the right to revoke your written authorization unless we have already acted based on your authorization. You may revoke your written authorization by contacting the claims administrator for the Plan in which you are enrolled. Uses and Disclosures of PHI for Which You May Agree or Disagree in Advance A Plan may disclose your PHI to a family member, other relative or close personal friend if the information is directly relevant to the person s involvement with or payment for your health care and you either have agreed to the disclosure or have not objected when given an opportunity to do so or your incapacity or emergency situation prevents your agreement. Similar types of disclosure may be made to certain disaster relief or disaster assistance agencies. Uses and Disclosures of Psychotherapy Notes Your written authorization generally must be obtained before a Plan will use or disclose psychotherapy notes about you from your psychotherapist. Psychotherapy notes are separately filed notes about your conversations with your mental health professional during a counseling session. They do not include summary information about your mental health treatment. A Plan may use and disclose such notes when needed by the Plan to defend against litigation filed by you. 28 Other Uses and Disclosures of PHI Requiring Your Written Authorization Except as otherwise provided in this Notice, the Plans will not use PHI for marketing purposes, to make disclosures that constitute the selling of your PHI or use or disclose your PHI without your written authorization. Marketing purposes do not include refill reminders or other communications about a drug or biologic currently prescribed for you. In addition, certain communications for health care operations are not considered marketing for authorization purposes. These include communications pertaining to your treatment by your health care provider, communications to describe healthrelated products or services provided by the Plan making the communication, communications regarding treatment alternatives, other health-related benefits and services that may be of interest to you, and communications for your case management or care coordination to the extent it s not considered treatment.
Other Prohibited Uses: The Plans (other than a long-term care plan) are prohibited from using or disclosing an individual s PHI that is genetic information of the individual for underwriting purposes. Your Rights Regarding PHI Maintained By the Plans Your various rights under HIPAA regarding your PHI are described below. Should you have questions about a specific right, please write to the designated service provider of the applicable Plan as follows: PPO, HMO, HDHP, Out-of-Area Medical Coverage for Participants PPO, HMO, HDHP Medical Participants Healthcare Flexible Spending Account (FSA) (Aetna contract end date: 12.31.2013) PPO, HMO, HDHP Medical Participants (CIGNA contract for medical end date: 12.31.2013) Dental PPO, HMO insurance Prescription Drugs Express Scripts, Inc. PPO, HMO, HDHP Medical Participants Blue Cross Blue Shield of Georgia Privacy Office: OH0101-C300 4361 Irwin Simpson Road, Mason, OH 45040 e-mail WellPoint s Privacy Office: Privacy.Office@WellPoint.com Aetna, Inc. Privacy Officer 151 Farmington Avenue Hartford, CT 06156 860-952-8600 CIGNA HealthCare Attention: Privacy Office P.O. Box 5400 Scranton, PA 18503 800-762-9940 Express Scripts, Inc. P.O. Box 66562 St. Louis, MO 63166-6562 Privacy@Express-Scripts.com UnitedHealthcare Customer Service Privacy Unit PO Box 740815 Atlanta, GA 30374-0815 866-633-2446 Vision Care insurance participants HMO Medical Participants Healthcare Flexible Spending Account, Healthcare Savings Account, Healthcare Reimbursement Account UnitedHealthcare Vision Privacy Unit: HIPAA Notice PO Box 25187 Santa Ana, CA 92799-5187 800-638-3895 Kaiser Permanente (GA Region) Attn: Privacy & Security Officer 3495 Piedmont Rd. NE Atlanta, GA 30305-1736 404-261-2590 Kaiser Permanente (MAS Region) Burke Medical Center Health Information Management Service 5999 Burke Commons Road, 1st Floor Burke, VA 22015 1-800-777-7902 ConnectYourCare Attn: Privacy & Security Officer 307 International Circle Suite 200 Hunt Valley, MD 21030 (410) 891-1000 29
Your 2014 Retiree Annual Enrollment Guide 30 Your Individual Rights With Respect to PHI You have certain individual rights with respect to your PHI. Following is a description of how you may exercise these rights: Right to Request Restrictions on Uses and Disclosures of PHI You have the right to request a Plan to restrict or limit the PHI it uses or discloses about you for treatment, payment or health care operations, or that it discloses to a person involved in your care or payment for your care, such as a family member or friend. The Plan is not required to agree to your requested restriction. If the Plan does agree to it, the Plan will comply with your request. To request a restriction, you must submit your request in writing to the applicable designated service provider listed above. A Plan will not agree to restrictions on PHI uses or disclosures that are legally required or necessary to administer the Plan s business. Right to Request Confidential Communications: You have the right to request a Plan to communicate with you about PHI in a certain way or at a certain location if you clearly state that communication in another manner may endanger you. For example, you can ask that the Plan only contact you at work or by mail. To request confidential communications, you must submit your request in writing to the applicable designated service provider listed above and specify how or where you wish to be contacted. The Plans will accommodate reasonable requests. Right to Inspect and Copy Your PHI: In most cases, you have the right to inspect and obtain a copy of the PHI that a Plan maintains about you in its designated record set. A Plan s designated record set includes information about enrollment, payment, billing, claims adjudication and case or management record systems and other information the Plan uses to make decisions about individuals. Certain types of PHI will not be provided, including psychotherapy notes and PHI collected by the Plan in connection with, or in reasonable anticipation of, any claim or legal proceeding, and certain PHI excepted by HIPAA. To inspect and copy your PHI, you must submit your request in writing to the applicable designated service provider listed above. Information will be provided within 30 days unless the Plan provides you with a written statement of the reasons for the delay and the date by which the Plan will complete its action on the request. You may be charged a fee for the costs of summarizing or explaining your PHI or for copying, mailing or other supplies associated with your request. In very limited circumstances a Plan may deny your request without giving you an opportunity to appeal the denial. If there are reviewable grounds for denial, you may request a review of the denial. Right to Amend Your PHI: If you believe that your PHI is incorrect or incomplete, you have the right to ask a Plan to amend your PHI while it is kept by or for the Plan as part of its designated record set. You must submit your request in writing to the applicable designated service provider listed above. The Plan has 60 days to respond, with a 30-day extension allowed. The Plan may deny your request if it is not in writing or does not include a reason that supports the request. The Plan also may deny your request if you ask to amend PHI that:
is accurate and complete; was not created by the Plan, unless the person or entity that created the PHI is no longer available to make the amendment; is not part of the designated record set kept by or for the Plan; or is not part of the PHI which you would be permitted to inspect and copy. You may submit a written statement of disagreement, which you can request to have included with future PHI disclosures. Right to a List of Disclosures: You have the right to request a list of the disclosures that a Plan has made of your PHI during the 6 years prior to your request. This list will not include disclosures made directly to you or pursuant to your authorization, to carry out treatment, payment or health care operations, incident to certain disclosures allowed or required by HIPAA, for national security or intelligence purposes, to law enforcement or corrections personnel or for certain research using de-identified information. To obtain this list, you must submit your request in writing to the applicable designated service provider listed above. The Plan has 60 days to respond, with a 30-day extension allowed. The first list you request within a 12-month period will be free. A Plan may charge you for responding to any additional requests, but will notify you in advance of the cost involved so that you may withdraw or modify your request before any costs are incurred. Right to Receive Paper Copy of Notice: You have the right to obtain a paper copy of this notice from the Plans upon request even if you have previously agreed to receive this notice electronically. You may obtain a paper copy by contacting the Benefits Compliance Coordinator at the number listed above. Right to be Notified of a Breach: You have the right to be notified in the event that we (or one of our Business Associates) discover a breach of your unsecured protected health information. Notice of any such breach will be made in accordance with federal requirements. Right to File a Complaint: If you believe your privacy rights have been violated, you may file a complaint with the Plan or with the Secretary of the Department of Health and Human Services at Hubert H. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201. To file a complaint with a Plan, please contact the Privacy & Security Officer at SunTrust Banks, Inc., Mail Code: GA-Atlanta-802G, 303 Peachtree Street, NE, Suite 400, Atlanta, GA 30308. All complaints must be submitted in writing (not email). You will not be retaliated against for filing a complaint. 31
Your 2014 Retiree Annual Enrollment Guide Additional Information About Personal Representatives: You may exercise your HIPAA rights described above through a personal representative. Your personal representative will be required to produce evidence of authority to act on your behalf before the person is given access to your PHI or allowed to take any action for you. Proof of such authority may take one of the following forms: A power of attorney for health care purposes, notarized by a notary public; A court order of appointment of the person as conservator or guardian of the individual; or An individual who is the parent of a minor child. The Plans retain discretion to deny access to your PHI to a personal representative to provide protection to those vulnerable people who depend on others to exercise their rights under these rules and who may be subject to abuse or neglect. This also applies to personal representatives for minors. Changes to This Notice: The Plans reserve the right to change the terms of this Notice at any time and to apply the changes to PHI that the Plans already have about you, as well as to any PHI the Plans receive in the future. The effective date of this Notice and any revised or changed Notice may be found on the first page of the Notice. SunTrust will send you a copy of any revised Notice within 60 days after it becomes effective, by interoffice delivery or by mail, or it may be posted on the SunTrust intranet site. Further Information: You may have additional rights under other applicable laws. For additional information regarding our HIPAA Privacy Practices, please contact the Privacy & Security Officer at SunTrust Banks, Inc., Mail Code: GA- Atlanta-802G, 303 Peachtree Street, NE, Suite 400, Atlanta, GA 30308. If you have questions relating to your current health coverage, please contact the designated service provider of your coverage listed above. If you received this notice in an electronic format, you may also request a hard copy to be mailed to your home address at no charge to you by calling my HR Service Center at 800.818.2363. Representatives are available from 8:30 a.m. to 5:30 p.m. ET, Monday through Friday (excluding holidays). 32
Finding In-Network Providers To find a provider for... Anthem BlueCross BlueShield medical plans Kaiser Permanente High Deductible and Low Deductible medical plans UnitedHealthcare medical plans Cigna dental plans UnitedHealthcare Vision plan Go online to... www.anthem.com Select Find a Doctor Complete questions 2 and 3 For question 4, What insurance plan would you like to use?, select I am a current member and want to search using my plan. Select this even if you are not currently enrolled. Enter your Alpha prefix: If you live in Florida, your Alpha Prefix is KSY If you live in Georgia, your Alpha Prefix is KST If you live outside of Georgia and Florida, your Alpha Prefix is UDU www.kp.org/medicalstaff Select your region from the dropdown menu and select Go You may narrow your search by one of five parameters: City Name, Zip Code, Provider Name, Specialty or Facility. The provider list will include physician name, address, specialty and network listed as plans. Under each physician, be sure the HMO or EPO is listed after Plans, as this will be in-network for the SunTrust plans. www.myuhc.com Select Find Physician, Laboratory or Facility on the right-hand side Search UnitedHealthcare Choice Plus from the list www.cigna.com Select Find a Doctor at the top Under Find a, select Person by Specialty and under Where? type your zip code, then click Search Click Select a Plan and: For the Dental HMO, choose Cigna Dental Care (HMO) For the Basic and Plus plans, choose Cigna Dental PPO and (from the dropdown menu) choose Radius Network - If you are unable to locate a provider in the Radius Network, select Out-of-Network Dental Network Savings Plan Click Select Click the Dentists tab https://www.myuhcvision.com Select Provider Locator Select current or future member and enter the requested information 33
Your 2014 Retiree Annual Enrollment Guide