benefits€¦ · the business of merck kgaa, darmstadt germany operates as emd serono,...

BenefitsThe business of Merck KGaA, Darmstadt Germany operates as EMD Serono, MilliporeSigma and EMD Performance Materials in the US and Canada.

Effective January 1, 2020 For employees of EMD Serono, including EMD Digital

Guide

Getting Started

Health Care Plans

Wellness Savings & Financial Protection

BEST Programs

Other Benefits

Enrollment Contacts & Resources

Compliance Information

• Advocacy: Accolade

• Medical • Prescription

Drugs• Dental• Vision

• Incentives• Resources

• Flexible Spending Accounts (FSAs)

• Health Savings Accounts (HSAs)

• Disability• Leaves• Life and

Accident • Transit

Benefits• 401(k)

• ID Protection• Auto &

Home• Pet

Insurance• Discount

Shopping

• Group Accident

• Critical Illness

• Hospital Indemnity

• Group Legal

• Holidays and Time Off

• Adoption/Surrogacy Assistance

• Tuition

• EAP• Backup

and Discount Day Care

• Employee Reimbursement Referral

THIS GUIDE WILL PROVIDE YOU WITH AN OVERVIEW OF THE VARIOUS BENEFITS THE COMPANY PROVIDES. HERE YOU CAN LEARN ABOUT COVERAGE OPTIONS, PLAN FEATURES, AND ELIGIBILITY REQUIREMENTS, AND FIND ENROLLMENT INSTRUCTIONS AND CONTACT INFORMATION.*

How to Use the Guide:

• Jump to specific sections by clicking the links at the bottom of the screen.

• When information spans more than one page, click the Forward button to keep reading or Back button to go back.

• Jump to specific sections or other websites by clicking the Links within the text.

• Review each page by using your scroll bar.

• To print, click on the Print button at the bottom right of all pages. You can print the complete guide or enter a page range to print a specific section.

• If you’re looking for something in particular, click on the Search button at the bottom right of the page.

* Provisions may differ for union employees. Please refer to your collective bargaining agreement.

About This Guide

This guide is an overview of the Benefits4Me Program. It provides a summary of changes to your benefits and is treated as a summary of material modifications under the Employee Retirement Income Security Act (ERISA). In many cases, more details about what’s covered by the company’s plans are provided by plan documents, summary plan descriptions (SPDs), and Summaries of Benefits and Coverage (SBCs), which take precedence over the summary versions provided in this guide. The SPDs and SBCs can be found on the benefits enrollment website, benefits4meenroll.com. In addition, you may have a hard copy mailed to an address of your choosing free of charge by calling the Benefits4Me Program Service Center at 1-844-279-7894.

Every effort has been made to ensure that the information in this guide is accurate. If, however, there is any discrepancy between this guide and the SPDs, plan documents, and/or any company policy, the applicable SPD, plan document, or company policy shall govern. To the extent that there is a discrepancy between a company policy and an SPD or plan document, the SPD or plan document shall govern. If necessary, the SPDs and the policies will be updated to reflect the benefits described in this guide.

The provision of benefits does not guarantee continued employment. The company reserves the right to change, amend, or discontinue benefits at any time.

StartedGetting

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Questions? See the “Contacts & Resources” section to get help finding your answers.

Getting Started

Health Care Plans


BEST Programs

Other Benefits



http://www.benefits4meenroll.com

welcome to Benefits4MeAbout Your BenefitsOur Benefits4Me Program offers a broad range of valuable benefits choices. Our global strategy continues to focus on the following goals to which we are deeply committed:

We encourage you to take advantage of all the benefits available. Remember the big picture: The choices you make are important to the overall well-being of you and your family. Please take the time to review this guide to learn more about the plans and programs available, so that you can choose the coverage options that fit you, your family, and your health.

COMPANY BENEFITSKnowing that comprehensive,

cost-effective coverage is important to all our employees and their families, we provide you with a

range of options and share in the cost of your benefits.

HEALTH & WELL-BEINGWe are committed to promoting the

good health of all our employees and their families. Because of this, we encourage preventive care and programs that benefit your health.

SERVICES FOR LIFEWe support your work-life balance and

provide valuable benefits, such as paid time off, and important

tools and resources to help you balance your working life with

living life to the fullest.

Want more information?

The Accolade personalized health and benefits support service can help with many questions. It’s a great place to start. Call 1-866-852-3410 or visit

member.accolade.com.

For more specific resources, see the “Contacts & Resources” section of this guide.

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Health Care Plans


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http://member.accolade.com

Social Security NumbersYou will not be able to complete the enrollment process until you have filled in the Social Security number field for all covered dependents, due to requirements under

the Affordable Care Act (ACA). The only exception to this requirement is for children up to six months of age: they

will be accepted without a Social Security number. If you need assistance updating a Social Security number,

contact the Benefits4Me Program Service Center.

Who’s eligible for CoverageYou are eligible for the benefits described in this guide if you are an active full-time or part-time employee of the company in the U.S., scheduled to work at least 24 hours per week. In addition to yourself, you can cover eligible dependents under the medical, dental, vision, and group life and AD&D plans.

Eligible Dependents• Your legal spouse or qualifying same- or opposite-sex

domestic partner

• Your child(ren) (biological, step, or adopted) or your domestic partner’s children regardless of student or marital status, up to the end of the month in which they reach age 26

• Your dependent children of any age who are physically or mentally incapable of self-support — you must submit proof of disability to the insurance carrier within 31 days of their 26th birthday to qualify for continued coverage

• Your children who are covered by a Qualified Medical Child Support Order (QMCSO)

See “Documentation Requirements” to the right.

Note: If you cover a domestic partner (or his/her child[ren]), special tax rules apply. See page 61 for information for coverage for your domestic partner and their children.

Documentation Requirements

When adding a new dependent to your coverage, you will be required to provide supporting documentation showing proof of your relationship. Dependents are not added to your coverage until the required documentation is received by our benefits administrator, Businessolver, so it is imperative that you provide documents quickly. Once documentation is received, reviewed, and approved, dependents are added to your coverage retroactive to the coverage start date for which they have been enrolled.

Relationship Documentation

Spouse Marriage certificate (marriage license if certificate is not readily available) ORTax forms showing joint filing or other proof of current marital relationship

Domestic Partner

Signed Affidavit or Certificate of Domestic Partnership or similar proof of state registration AND• Proof of 12-month residency• Lease agreement• Dated document with name(s) and address

Child Birth certificate, hospital “footprint” document, or adoption paperwork OR

Tax forms showing dependent(s), if birth certificates are not readily available

Be sure that you enroll only dependents who meet the plan’s eligibility requirements.

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When benefits begin and endThere are certain times outside the benefits annual enrollment period in which you can make changes to your benefits. Examples of these “Qualifying Life Events” are:

• Marriage or divorce

• Birth or adoption or placement for adoption of a child

• Change in employment status for you or your spouse or domestic partner

• Spouse or domestic partner with different annual enrollment period

• Dependent losing eligibility

• Change in work schedule that impacts your eligibility for benefits, such as a reduction or increase in hours, a switch between part-time and full-time employment, or the start of, or return from, unpaid leave

• Change in residence or work location for you, your spouse, or dependent that affects your benefits (for example, you move out of the Kaiser service area)

• Certain cost, coverage, and/or material changes in the benefit provisions of a non-company plan in which you are enrolled

Important: You have 31 days from the date of the Qualifying Life Event to make changes to your benefits.

If you experience a Qualifying Life Event during the year, you must make the associated changes to your current benefit elections by logging on to benefits4meenroll.com. You will also need to supply necessary supporting documentation within 31 days of the status change. Otherwise, you will have to wait until the next annual enrollment period.

Also, any change in benefits must be consistent with the Qualifying Life Event. For example, if you get married, you may add your spouse (and any eligible dependent children) to your medical plan or cancel your medical coverage to join your spouse’s medical plan.

See other special enrollment rights and a 60-day special enrollment opportunity if you or your dependents become eligible for premium assistance under Medicaid or the Children’s Health Insurance Program (CHIP).

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Getting Started

Health Care Plans


BEST Programs

Other Benefits




Care PlansHealth

IN THIS SECTION:

7 Advocacy: Accolade

8 Benefit Coverage Levels

8 Medical Plan

15 Prescription Drug Coverage

18 Dental Plan

20 Vision Plan

6Getting Started

Health Care Plans


BEST Programs

Other Benefits



AccoladePersonalized Health and Benefits Support

The company wants you to explore and become familiar with all your health care benefits so you can get the most out of them. But we recognize that sometimes, with so many resources available, it can be difficult to know just where to start when you need information or have a question.

Our newest benefits resource, Accolade, makes things easier by giving you and your covered dependents a convenient starting point when you have health or benefits questions. An Accolade Health Assistant will be on hand, dedicated to helping you find the answers you need and get better care. You can reach your Accolade Health Assistant by phone, online, or using a convenient mobile app when you’re on the go.

If you are enrolled in our Core, Buy-Up, or Consumer Choice Plan for medical coverage, administered by Blue Cross Blue Shield (BCBS), once your coverage becomes effective, your Accolade Health Assistant can offer you in-depth, personalized assistance. Note: Even if you’re not enrolled in company-sponsored medical coverage or if you’re enrolled in the Kaiser HMO program, Accolade can help you with general benefits and enrollment questions.

Because Accolade is independent of the company and our benefit plan providers, your Accolade Health Assistant is in the right position to give your family objective, confidential assistance. Working in partnership with a team of clinicians and benefits specialists, your Health Assistant will support you in making the best health care decisions possible.

Accolade’s services are available at no cost to you.

Key Services

Some of the key services that Accolade offers:

Available before and after you enroll

• Answers to annual enrollment questions

• Help comparing benefits options

• Help determining if your existing providers are in-network with our nationwide Blue Cross Blue Shield (BCBS) medical plan administrator

• Help finding BCBS network providers

More personalized assistance available once you’re enrolled and your company medical coverage becomes effective (Core, Buy-Up, and Consumer Choice Plan)

• Assistance with finding out what’s covered

• Help understanding medical bills

• Assistance resolving claim discrepancies

• Help managing a diagnosis, new or chronic

• Consultations with nurses*

* Accolade doesn’t practice medicine or provide patient care. It’s an independent resource to support and assist you as you use the health care system and receive care from your own doctors, nurses, and other health care professionals.

Get Support When and Where You Need It Accolade is at your fingertips with the mobile app! Text 49P9 to 67793 to download the app (message and data charges may apply), or get it from the App Store or Google Play. The best part? You can send secure messages to your Health Assistant on the go!

To reach Accolade:

• Call 1-866-852-3410, Monday through Friday, 8 a.m. to 11 p.m., Eastern Time. (This number will also be on your BCBS medical ID card that you’ll receive after you enroll.)

• Visit member.accolade.com and follow the prompts to register your member account.

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Health Care Plans


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Benefit coverage levelsYou will be able to enroll for medical, dental, and vision coverage at four different coverage levels. This allows you to choose and pay for the level of coverage that best fits your family situation.

When electing your coverage level, you are not required to elect the same level of coverage for all of the benefits in which you enroll. For example, you could enroll in Employee + Spouse coverage for medical and Employee Only coverage for dental.

Benefit Coverage Levels

Coverage Tier Provides Coverage For...

Employee Only Yourself only

Employee + Spouse You and your spouse, or same- or opposite-sex domestic partner* only

Employee + Child(ren) You and your eligible child(ren) only

Family You, your spouse or domestic partner, and eligible child(ren)

* Same-sex domestic partner and opposite-sex domestic partner hereafter will be referred to as “domestic partner.”

Medical PlanThe company provides several medical options that help support your health and well-being and protect you financially when you or a family member is sick or has an accident.

You have these medical options to choose from:

• Core Plan: PPO with an in-network $500 deductible/individual, $1,000 deductible/family

• Buy-Up Plan: PPO with an in-network $200 deductible/individual, $400 deductible/family

• Consumer Choice Plan: High Deductible Health Plan (HDHP) with Health Savings Account (HSA) with an in-network $1,500 deductible/individual, $3,000 deductible/family. The company contributes $500/individual, $1,000/other coverage levels annually to your HSA to pay toward the deductible. This amount is prorated for new hires and employees who enroll in the plan during the year as the result of a Qualifying Life Event.

Meet ALEX Before You Decide

Before deciding which medical plan is best suited for your situation,

be sure to meet ALEX. ALEX is an engaging, easy-to-use online tool that asks a few questions and helps you

make informed decisions about which plan best meets your needs

and preferences.

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Health Care Plans


BEST Programs

Other Benefits



https://www.myalex.com/emd/home/serono#choose-benefits

If you enroll in the Core, Buy-Up, or Consumer Choice Plan, Blue Cross Blue Shield (BCBS) is the administrator and nationwide provider network for your medical plan. The BCBS network has a strong presence in many areas where our employees live and work, making it easy for you to find and use in-network providers to obtain quality health care. To find a BCBS in-network provider, contact Accolade or see the instructions on page 48.

If you live in California, you may also be eligible to enroll in a regional plan: Kaiser HMO.

All of the medical plan options offer comprehensive coverage, including prescription drug coverage, preventive care at no cost to you (when you use in-network providers), and financial protection in the event of a serious illness or injury. However, the way you receive care and pay for coverage varies with each option.

As you decide which medical option best suits your needs, take into consideration how the options differ in their costs:

• The Buy-Up Plan generally offers more coverage in return for higher per paycheck premiums.

• The Core Plan has lower per paycheck premiums than the Buy-Up Plan, but you have a greater out-of-pocket cost responsibility when using the plan.

• The Consumer Choice Plan has the lowest premiums, but you must meet the annual deductible before the plan begins paying benefits for medical and prescription drugs (with the exception of preventive care which is covered at 100% when you use in-network providers). Once you meet the deductible, you pay coinsurance for eligible expenses. To help pay for out-of-pocket expenses, the company makes a contribution to a special tax-advantaged Health Savings Account and you can also contribute to your account on a pre-tax basis. The savings in your account roll over from year-to-year and are yours to use even if you leave the company.

See page 12 for a description of the different ways that the deductible and out-of-pocket maximum work for each plan.

Which option is best for you? The answer will depend on your and your family’s needs and preferences. Review the Medical Plan Comparison Chart for a summary of what’s covered under each plan, and how much you may need to pay out-of-pocket.

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Medical Plan Comparison Chart

Core Plan Buy-Up Plan Consumer Choice PlanFeature In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network

You Pay

Employer HSA funding

N/A N/A N/A N/A $500 Employee Only $1,000 all other coverage levels

Individual deductible1

$500 $1,000 $200 $600 $1,500 $3,000

Family deductible1

$1,000 $2,000 $400 $1,200 $3,000 $6,000

Coinsurance (what employees pay)

20% 30% 10% 30% 10% 30%

Annual out-of-pocket maximum (individual)2

$2,400 $4,800 $2,000 $4,000 $3,000 $6,000

Annual out-of-pocket maximum (family)2

$4,800 $9,600 $4,000 $8,000 $6,000 $12,000

Preventive services

Covered in full Deductible, then 30%



Emergency room (waived if admitted)

$150 $150 $150 $150 Deductible, then 10%

Deductible, then 10%

Urgent care $20 $20 $20 $20 Deductible, then 10%


Primary care physician office visit

$20 Deductible, then 30%




Telehealth consultation

$10 Not covered $10 Not covered Deductible, then 10%

Not covered

Specialist office visit





1 For the Consumer Choice Plan, both medical and prescription drug claims will apply towards the medical deductible.2 Out-of-pocket maximum includes the deductible, coinsurance, and all copays.

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Medical Plan Comparison Chart (continued)


You Pay

Inpatient admission







Outpatient surgery







Diagnostic X-rays, lab tests, and other tests at an independent lab or outpatient facility 1







Allergy injections





Hearing aid (once every 3 years)







Vision exam (one routine exam per member per calendar year)




Short-term rehabilitation therapy visit





Chiropractic services





Speech, hearing, language disorder treatment





Durable medical equipment







1 Diagnostic X-ray/lab/tests that are performed in physician’s office are covered in full after office visit copay.

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Medical Plan Comparison Chart (continued)


You Pay

Prosthetic devices Deductible, then 20%






Home health care and hospice care







Inpatient skilled nursing facility (100 days)







Inpatient mental health and substance abuse







Outpatient mental health and substance abuse

$20 at physician’s office; 20% for

other O/P services


$20 at physician’s office; 10% for

other O/P services




The annual deductible for both the Core and Buy-Up Plans is an embedded deductible. An embedded deductible has two components: the individual deductibles for each family member and the family deductible. When you or a covered dependent meets the individual deductible, the plan will begin paying according to your plan’s coinsurance. If only one person meets an individual deductible, the rest of your family still has to pay for services until meeting their deductibles. Any out-of-pocket expenses used to meet an individual deductible are also counted toward meeting the family deductible. Once the family deductible is met, all family members will have medical expenses paid according to the plan’s coinsurance, even if they have not met their own individual deductibles.

Coinsurance only applies until the out-of-pocket maximum, which is also embedded for the Core and Buy-Up Plans, is met; then the plan will cover services at 100%. Once one

person meets an individual out-of-pocket maximum, the plan pays 100% of that person’s eligible expenses for the rest of the calendar year. If only one person meets an individual out-of-pocket maximum, the rest of the family still has to pay their deductible and coinsurance until meeting their out-of-pocket maximum or until the family out-of-pocket maximum is met.

The Consumer Choice Plan requires that you meet the family deductible (if you are covering dependents) before the plan pays. The Consumer Choice Plan also requires that you meet the family out-of-pocket maximum before the plan will cover eligible expenses at 100% for the rest of the calendar year.

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Health Care Plans


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Other Benefits



Medical Plan Chart — Kaiser HMO

If you participate in the Kaiser HMO, available to those who live in California, the chart below details your medical plan benefits.

Kaiser HMO Plan (California only)

Feature In-Network Out-of-Network

You Pay

Employer account funding

N/A N/A

Individual deductible $0 N/A

Family deductible $0 N/A

Coinsurance (what employees pay)

$0 N/A

Annual out-of-pocket maximum (individual)

$1,500

Annual out-of-pocket maximum (family)

$3,000

Preventive services Covered in full Not covered

Emergency room (waived if admitted)

$75 $75

Urgent care $20 $20

Primary care physician office visit

$20 Not covered

Specialist office visit $20 Not covered

Inpatient admission $250 Not covered

Outpatient surgery copay $20 Not covered

Diagnostic X-rays, lab tests, and other tests at an independent lab or outpatient facility

Covered in full Not covered


Feature In-Network Out-of-Network

You Pay

Vision exam (one routine exam per member per calendar year)


Short-term rehabilitation therapy visit

$20 Not covered

Chiropractic services

$15 Not covered

Speech, hearing, language disorder treatment

$20 Not covered

Durable medical equipment


Home health care and hospice care


Inpatient skilled nursing facility (100 days)


Inpatient mental health and substance abuse

$250 per admission

Not covered

Outpatient mental health and substance abuse

$20 Not covered

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Medical Plan ContributionsThe rates below show the cost of medical and prescription drug coverage per bi-weekly pay period.

Core Plan Buy-Up Plan Consumer Choice Plan


Employee Only $55.09 $62.42 $36.84 $47.92

Employee + Spouse $110.46 $125.16 $80.46 $105.41

Employee + Child(ren) $90.37 $102.40 $63.91 $86.24

Employee + Family $164.71 $186.64 $107.52 $143.74

Wellness

You can earn up to $500 in wellness incentives, even if you’re not enrolled in a company medical plan. Any incentive amounts are added to your paycheck quarterly, and paid to you on an after-tax basis. For more information, see the Wellness section of this guide and visit www.healthadvocate.com/benefits4me.

Well Connection: Fast, Convenient Telehealth Care

If you enroll in the Core, Buy-Up or Consumer Choice Plan, you and your covered dependents have access to Well Connection, a convenient telehealth service provided through BCBS. It’s a great option for obtaining care quickly if your regular doctor isn’t available or you are traveling. (It might also save you from having to make an expensive, inconvenient visit to an emergency room as your only source of treatment when your situation isn’t an actual medical emergency.) It’s the next best thing to having a doctor make a house call at your convenience!

With Well Connection, you can:

• Have live video visits with doctors and other health care providers using your smartphone, tablet, or computer.

• See providers almost anytime, anywhere. (Visits for behavioral health require an appointment.)

• Have medical and behavioral health visits that are secure and confidential.

How to use the service:

• Download the Well Connection app, or visit wellconnection.com.

• Create an account and log in.

• Choose the type of service you need: medical or behavioral.

• Pick an available provider.

Examples of covered services and conditions:

Medical: Available 24/7

Behavioral Health: By Appointment

• Urgent care• Cold and flu• Bronchitis• Sinus and respiratory infections• Sore throat• Diarrhea• Gout• Strep throat• Urinary tract infections• Pink eye/conjunctivitis • Hypertension• Migraines• Pneumonia

• Depression and anxiety• Sleep disorders• Substance use disorder• Trauma• Child behavior• Bereavement• Couples therapy• Stress• Divorce

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http://www.healthadvocate.com/benefits4me

http://wellconnection.com

In addition to being fast and convenient, Well Connection is very affordable. If you are covered under the Core or Buy-Up Plan, your cost is a $10 copay per visit, or 10% coinsurance after the medical plan deductible if you are covered under the Consumer Choice Plan. (Note: Telehealth video consulting visits with other in-network providers are covered in the same way.)

Once you enroll in one of these medical plans, you can find more information about Well Connection at myblue.bluecrossma.com/health-plan/well-connection.

Prescription Drug Coverage Express Scripts for the Core, Buy-Up, and Consumer Choice Plans*If you enroll in the Core, Buy-Up, or Consumer Choice Plan for medical coverage, you will automatically receive prescription drug coverage through Express Scripts. Express Scripts offers services through a retail network of pharmacies, convenient home delivery, and a specialty pharmacy.

You can purchase up to a 30-day supply from a network pharmacy. Many of the retail pharmacy and grocery store chains are part of the Express Scripts network.

Maintenance MedicationYou can save time and money by filling your recurring, long-term maintenance prescriptions through home delivery or using Smart90 Walgreens to pick up in-store. Home delivery medication is ordered in a 90-day supply at a discounted cost. If you choose not to use the home delivery option for your maintenance drugs, you will pay a higher copay for a 30-day supply at a network pharmacy.

Cost of MedicationUnder the Core Plan and Buy-Up Plan, you pay a copay for each prescription. Under the Consumer Choice Plan, you pay for

* Kaiser pharmacy benefits are provided by Kaiser.

Other Great Medical BenefitsIn partnership with BCBS, the company makes these benefits available under the Core, Buy-Up, and Consumer Choice Plans to enhance the overall wellbeing of you and your family:

• You can receive reimbursements for participating in these qualified programs:

— Fitness program. The reimbursement pays for fees for memberships and fitness classes, up to $150 per family per year.

— Weight-loss program such as Weight Watchers, Meetings Online Plus, iDiet Engage, and Jenny Craig, up to $150 per family per year.

— Childbirth class. The plans reimburse up to $90 for first-time mothers and up to $45 for a refresher class.

• Acupuncture is covered as a specialist office visit, for up to 12 visits per calendar year.

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http://myblue.bluecrossma.com/health-plan/well-connection

your prescriptions in full until you reach the medical deductible, after which coinsurance applies until you reach your annual out-of-pocket maximum. Under all plans, preventive drugs — such as aspirin, folic acid, smoking-cessation drugs, vaccines, and certain others — are covered at 100% with no coinsurance or copay required. They must be prescribed by a physician and in accordance with Express Scripts guidelines.

The cost of prescription drugs depends on whether you purchase generic, brand name, or non-preferred brand name drugs. Each year, Express Scripts updates its Preferred Prescription formulary and medications may be added or removed. To view the formulary:

• Before you are enrolled: Visit Express-Scripts.com/benefits4me.

• After you are enrolled: Register at Express-Scripts.com to create an account where you may view benefit information.

Specialty MedicationIf your doctor prescribes a specialty medication for a serious medical condition, such as Multiple Sclerosis, Rheumatoid Arthritis, or Hepatitis C, your prescriptions will be filled through Accredo, the Express Scripts specialty pharmacy. Specialty medications not filled by Accredo will not be covered; however,

two fills at a retail network pharmacy will be permitted for specialty medications that are of an urgent nature and must be started immediately. If you have an urgent specialty prescription filled at a retail network pharmacy, you will receive a letter from Express Scripts about how to get started with Accredo. Save With EMD Serono Drugs!

EMD Serono drugs marketed in the U.S. are covered at 100%. (For the Core and Buy-Up Plans, this means there is no copay. For the Consumer Choice Plan, this

means there will be no coinsurance after the applicable deductible has been met.)

This is an exciting way for employees in the U.S. to proudly share in the advantages of being associated with

the companies of Merck KGaA, Darmstadt, Germany.

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http://Express-Scripts.com/benefits4me

http://Express-Scripts.com/benefits4me

http://Express-Scripts.com

Prescription Drug Coverage

Core Plan Buy-Up Plan Consumer Choice Plan

Kaiser HMO (California only)

Preventive Prescription Drugs 1 $0 $0 $0 $0

Prescription Drugs: Retail (30-day supply)

Generic $12 copay $12 copay Deductible, then 10% $10 copay

Brand-Name $30 copay $30 copay Deductible, then 10% $20 copay

Non-Preferred Brand Name $50 copay $50 copay Deductible, then 10% $20 copay

Prescription Drugs: Mail Order 2 (90-day supply)

Generic $30 copay $30 copay Deductible, then 10% $20 copay

Brand-Name $70 copay $70 copay Deductible, then 10% $40 copay

Non-Preferred Brand Name $125 copay $125 copay Deductible, then 10% $40 copay

1 Preventive prescription drugs that are prescribed by a physician in accordance with Express Scripts guidelines, or Kaiser HMO guidelines if you are covered under that plan, such as aspirin, folic acid, smoking-cessation drugs, vaccines, and certain others, are covered at 100% with no copay or coinsurance required.

2 For added convenience, you can also fill a 90-day prescription through your neighborhood Walgreens in-store pick up.

Note: Employees who enroll in the Core or Buy-Up Plan may receive EMD Serono drugs marketed in the U.S. at no cost. Employees who enroll in the Consumer Choice Plan may receive EMD Serono drugs marketed in the U.S. at no cost, after the deductible.

Express Scripts Customer ServiceLocate network pharmacies, check the plan formulary, order and check mail order refills, and much more!

1-800-396-2256Express-Scripts.com

The Express Scripts Mobile AppPharmacy That Goes FartherSM

The Express Scripts Mobile App helps you stay on track with instant access to your personal medication information anytime, anywhere.

Download the Express Scripts Mobile App today for free.

Smart90 WalgreensFilling a 90-day prescription is a convenient, cost-effective, and hassle-free way to get a three-month supply. This program allows you to pick up a 90-day prescription at your neighborhood Walgreens. Note that you still have the option to get your prescription through the mail. See the Benefits Information site at benefits4meinfo.com.

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http://www.express-scripts.com

http://Farther.SM

http://benefits4meinfo.com

Dental PlanThe dental plan, administered by Delta Dental® of Massachusetts, is designed to help you with the expenses involved in maintaining good dental health. There are two dental plans to choose from:

• The Dental Core Plan covers exams, cleanings, and X-rays. Preventive care is 100% covered under the plan up to the calendar-year maximum. The plan also covers services such as fillings, root canals, bridges, and orthodontia (for adults and children).

• The Dental Consumer Choice Plan also covers exams, cleanings, and X-rays, but the annual maximums are lower and basic restorative coverage is at a lesser amount.

Both options give you access to the Delta Dental PPO and Delta Dental Premier Networks. You may receive dental care from any dentist you choose. However, dentists who participate in the Delta Dental networks will generally charge you less for covered services. You can locate a preferred network dentist by visiting www.deltadentalma.com. Go to “Find a a Dentist” (see the top of the page) and select “Delta Dental PPO Plus Premier” as your plan/network.

Out-of-Network ProvidersWhen you choose an out-of-network provider, you will pay more in out-of-pocket costs. In some cases, the provider may submit a claim directly on your behalf, and then send you a bill for the balance (“balance billing”) that may not be fully reimbursed by the plan.

Dental Plan Coverage The chart below shows the portion of services, except the deductible, covered by Delta Dental.

Dental Core Plan Dental Consumer Choice Plan

Annual Deductible

Individual $50 $50

Family $150 $150

Calendar-Year Maximum $2,000 $1,000

Diagnostic/Preventive: Routine Exam, X-rays, Cleanings, Sealants, etc.

100% 100%

Basic Restorative: Amalgam Fillings, Composite Fillings, Extractions, etc.

80% 50%

Major Restorative: Inlays, Crowns, Dentures, Bridges, Implants, Oral Surgery, etc.

50% 50%

Orthodontics 50% up to $2,000 per person/lifetime maximum

50% up to $1,000 per person/lifetime maximum

Services provided by a non-network provider are subject to reasonable and customary limits; employee responsible for additional cost.Deductibles met in the fourth quarter will be carried forward into the next calendar year.This plan is eligible for “Rollover Max.” See the next page.

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http://www.deltadentalma.com

Get More with “Rollover Max”*

Rollover Max rewards good dental habits with a potentially higher calendar-year maximum benefit. Here’s how it works for the Core Plan: If the annual cost of your claims doesn’t exceed $800, up to $600 will be automatically rolled over to the calendar-year maximum benefit for the following year. Therefore, the following year’s calendar-year maximum benefit would be $2,600 ($2,000 + $600).

Dental Plan Bi-Weekly Contributions

Dental Core Plan

Dental Consumer Choice Plan

Employee Only $8.70 $1.29

Employee + Spouse $19.14 $2.84

Employee + Child(ren) $15.66 $2.33

Employee + Family $26.10 $3.87

* To qualify, you must have had at least one cleaning or oral exam within the past year. Also, you must be enrolled in dental coverage before the fourth quarter of the calendar year. Rollover Max dollars do not apply to orthodontic services. The accumulated Rollover Max is capped at $1,500 (total calendar-year maximum benefit is capped at $3,500 for the Core Plan and $2,500 for the Consumer Choice Plan).

Delta Dental Mobile AppAvailable for mobile devices using iOS (Apple®) or AndroidTM,

Delta Dental’s free mobile app gives you easy access to dental plan information any time, anywhere.

To download, visit your app store and search for Delta Dental.

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Vision PlanYour vision benefit is administered by EyeMed Vision Care®.

You may receive vision care from any vision provider you choose. However, providers and retail outlets who participate in the EyeMed network (including LensCrafters®, Pearle Vision®, Target Optical®, and Sears Optical®) will generally charge you less for covered services. Providers in the EyeMed network will also prepare and submit claims for you.

Vision Plan Coverage

In-Network Out-of-Network Maximum Reimbursement

Eye Exam (every 12 months)

$10 copay $64

Contact Lenses*

Conventional $0 copay, $130 allowance, 15% discount on balance

$130

Disposable $0 copay, $130 allowance $130

Medically Necessary

$0 copay, paid in full $210

Eyeglass Frames (every 24 months)

$0 copay, $130 allowance, 20% discount on balance

$100

Eyeglass Lenses

Single $25 copay $84

Bifocal $25 copay $116

Trifocal $25 copay $130

Lenticular $25 copay $130

Standard Progressive

$90 copay $140

* You can choose contact lenses or eyeglass lenses every 12 months.

Services you receive from EyeMed providers will typically cost less than those you receive from out-of-network providers. If you choose to receive services from an out-of-network provider, you are responsible for paying the provider directly for all charges and submitting a claim to EyeMed for reimbursement.

For more information, including a complete list of providers and retail outlets, log on to eyemed.com.

Vision Care Contributions

Your cost for EyeMed Vision Care is based on who you elect to cover, as shown on the right.

Other EyeMed BenefitsWhen you enroll in the vision plan, you will have access to these additional benefits and features from EyeMed:

• Use the EyeMed mobile app, available from the App Store™ or Google Play™ Store, to review your vision plan benefits or find a provider anytime, any place. Log in using the same information required for the full member website. (Not all features require a login.)

• Shop for and buy frames, contacts and sunglasses online from your computer, smartphone or tablet — with hundreds of brand-name frames and contacts to choose from — and apply your in-network benefits at checkout. Register on eyemed.com or download the member app.

• Get international travel support if you have an eyewear emergency while traveling.

• Get special lenses and lens coatings that filter out potentially harmful blue light.

• Get discounts on hearing exams and hearing aids as part of your vision plan benefits! Find out more on eyemed.com or through the member app. Call 1-844-526-5432 to find a hearing care provider near you and schedule a hearing exam.

Vision Plan Bi-Weekly Rates

Employee Only $2.03

Employee + Spouse $3.84

Employee + Child(ren) $4.66

Employee + Family $5.72

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http://eyemed.com

http://eyemed.com

http://eyemed.com

Wellness

IN THIS SECTION:

22 Wellness Incentive Program

23 Medical Plan Wellness Resources

21Getting Started

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BEST Programs

Other Benefits



Wellness Incentive ProgramIf you are a US-based benefits-eligible employee, you are eligible to take part in our wellness incentive program and earn up to $500 a year in wellness incentives even if you’re not enrolled in the company medical plan. You earn incentives by completing activities designed to help you stay healthy. Each activity is assigned a point value and each point equals one dollar. Collect points each quarter and the value of those points will be paid to you (as taxable income).

Wellness ActivitiesThere are many activities you can undertake in order to earn wellness incentives.

For example, you can earn $300 for completing a biometric screening and another $100 for getting a flu shot. In addition to getting screenings and/or flu shots, you can earn incentives by completing activities such as:

• Participating in a company-sponsored challenge

• Tracking healthy activity and meeting certain goals

• Completing online workshops

• Participating in community wellness activities

Visit the Health Advocate website to learn more.

Deadline: For the 2020 wellness program, you have until September 30, 2020, to complete your wellness activities and submit any necessary forms to Health Advocate, our wellness incentive program partner. (After September 30, look for more opportunities to earn incentives for healthy behaviors into 2021.)

Health Advocate Wellness Program Website

For more information and to get started, visit www.healthadvocate.com/benefits4me and register. After you log in, click the wellness icon to access the site. This is your one-stop source to find out everything you need to learn about the program and meet your health goals.

The resources you will find on the website include:

• A Personal Health Profile to assess your health risks

• Self-guided wellness workshops and programs

• Health trackers compatible with a wide range of fitness devices and apps

• Wellness challenges and annual campaigns

• Monthly newsletters full of healthy tips

• Secure web messaging system to communicate with a personal Wellness Coach

If you need help or have any questions about the wellness incentive program, you may also call Health Advocate at 1-855-737-8585.

Spouses/domestic partners of US-based benefits-eligible employees may take part in activities for the sake of improving their wellness but are not eligible to earn incentives.

Expatriates and Puerto Rico employees are not eligible for the program.

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Medical plan wellness resourcesThe medical plan in which you enroll may also offer various other wellness resources to help you maintain and improve your health. For more information, visit the online wellness resources of your medical plan administrator:

• BCBS: ahealthyme, the BCBS wellness portal, and this collection of useful links and forms

• Kaiser: kp.org/healthylifestyles

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http://www.ahealthyme.com/

https://myblue.bluecrossma.com/tools-resources/forms-brochures/wellness

http://kp.org/healthylifestyles

IN THIS SECTION:

25 Flexible Spending Accounts (FSAs)

27 Health Savings Accounts (HSAs)

28 Disability Insurance

29 Paid and Unpaid Leaves

31 Life and Accident Insurance

33 Transit Benefits

34 401(k) Savings and Investment Plan

Savings and Financial

Protection

24Getting Started

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BEST Programs

Other Benefits



Flexible Spending Accounts (FSAs)Looking for an easy way to save? Try an FSA. As long as you use your FSA for eligible expenses, you are never taxed on the money you contribute.

The company offers three types of FSAs, which are all administered by Businessolver:

All claims are administered by Businessolver. You can access your Businessolver account directly through benefits4meenroll.com.

For 2020 elections, all expenses must be incurred between January 1, 2020, and December 31, 2020.

Health Care FSA $500 RolloverAs an active employee, at the end of the year you can roll over up to $500 of an unused Health Care FSA balance to the next year. Any balance above $500 does not carry over and is subject to the “use it or lose it” rule, so plan carefully.

Please note that per IRS rules, this applies only to the Health Care FSA and does not apply to the Dependent Care FSA.

If you newly enroll in the Consumer Choice Plan with HSA and have an unused balance in your Health Care FSA eligible for

rollover, we will roll that amount into the Limited Purpose FSA on your behalf after the end of the run-out period.

Your 2020 FSA Annual Contribution Limits

Health Care FSA $2,750*

Limited Purpose FSA $2,750*

Dependent Care FSA $5,000

Minimum contribution for all plans is $100 annually. For information about eligible Health Care, Limited Purpose Health Care, and Dependent Care expenses, go to irs.gov.

* These limits may be subject to annual increases. To check the latest FSA contribution limits, see the FSA information on benefits4meenroll.com.

HEALTH CARE FSA (not available to those enrolled in the

medical Consumer Choice Plan)

You can use the Health Care FSA for eligible health care expenses —

medical, pharmacy, dental, vision, hearing, over-the-counter drugs, and menstrual products —

not covered by a health plan.

LIMITED PURPOSE HEALTH CARE FSA

(only for those enrolled in the medical Consumer Choice Plan)

You can use the Limited Purpose Health Care FSA for eligible dental and vision expenses.

This plan is in addition to any money you contribute to a Health

Savings Account.

DEPENDENT CARE FSAYou can use the Dependent Care FSA for eligible child care (up to age 13) and elder care expenses that you incur because you and

your spouse work.

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http://benefits4meenroll.com

http://www.irs.gov


How Do FSAs Work?• You decide how much to contribute on a pre-tax basis annually.

• When you have an eligible expense, mail or fax your claim form along with an itemized bill or proof of the expense. You can also upload your claim through benefits4meenroll.com. You will be reimbursed with tax-free dollars through your choice of a mailed check or direct deposit. For faster reimbursement use your debit card.

• The total amount you choose to set aside for the Health Care FSA and the Limited Purpose FSA is available to cover eligible expenses beginning January 1.

• Your claims for dependent care expenses will be reimbursed only if there’s enough money in your Dependent Care FSA to cover the expense. You can submit claims incurred during the entire plan year regardless of employment status.

• For the Health Care FSAs, if your employment with the company ends, you may only submit claims for expenses that were incurred before the end of your employment. If you need to submit claims for expenses incurred after your employment ends, you are required to elect COBRA coverage.

• You must use all of the money you contribute to the FSAs for expenses incurred between January 1 and December 31, or you will lose the money. Note that all claims for reimbursement must be submitted by March 31, 2021.

• Remember that, if you are actively employed, you can roll over $500 of your unused 2020 Health Care FSA balance to the next year. This provides you with greater flexibility so you don’t have to rush to spend down your balance at the end of the year. Claims for 2020 expenses must still be submitted by March 31, 2021.

FSA Debit CardIf you enroll in an FSA, you will automatically receive a debit card to pay for eligible expenses. The card allows you to pay for out-of-pocket expenses directly from your FSA and may be used at providers accepting Visa (as long as the providers have a

system in place to identify card-purchased items as FSA-eligible). Just present the card at the time you pay for eligible expenses. You pay no money up front and don’t have to wait to be reimbursed.

Important: With the debit card, you don’t the need to submit a claim in order to receive reimbursement. The amount is deducted from your balance automatically. There may be times, however, when you will be asked to submit substantiation for a claim. If an expense cannot be auto-substantiated, the IRS requires submission of supporting documentation. In addition, if the provider’s system for identifying card-purchased items as FSA-eligible doesn’t recognize an item you are buying, instead of using your debit card you will have to submit a claim for later reimbursement. (For example, you may need to file a claim for over-the-counter drugs or menstrual products.) Remember to keep all receipts for claims submitted through this program, even those automatically reimbursed with your debit card.

For recurring expenses, such as monthly orthodontic payments or other medical, dental, or vision expenses, you may use your debit card, but you will need to submit documentation that the expense is eligible when you first submit a claim for this expense to Businessolver.

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Health Savings Accounts (HSAs)The Consumer Choice Plan uses an HSA. When you first enroll in that plan, you must open an HSA with Fidelity. (Fidelity will send you information about opening a Fidelity HSA after you enroll. You can easily open your account at netbenefits.com or call a Fidelity representative at 1-800-835-5095 for assistance.)

Company Contributions to Your HSA• If you elect Employee Only coverage, you will receive the

company contribution of $500 in January 2020.

• If you elect any other coverage level, you will receive the company contribution of $1,000 in January 2020.

How Does the HSA Work for New Hires?The amount the company contributes to your HSA depends on your coverage level and the month you begin work. See below for 2020 contribution amounts.

If you are hired:• January – March: $500 individual / $1,000 all other coverage levels• April – June: $375 individual / $750 all other coverage levels• July – September: $250 individual / $500 all other coverage levels• October: $125 individual / $250 all other coverage levels

If You Experience a Qualifying Life EventIt may happen that you make a change after the plan year begins because you experience a Qualifying Life Event — for example, you might enroll in the Consumer Choice Plan and open an HSA for the first time, or add dependent coverage to your existing Consumer Choice Plan individual coverage. In this case, the additional company contribution to your HSA will be prorated based on when you processed your Qualifying Life Event.

2020 Limits on HSA ContributionsEmployees can contribute to an HSA up to the annual HSA limit associated with their coverage level. The combined amount that both you and the company contribute cannot exceed these 2020 IRS limits:

• Employee Only coverage: Up to $3,550 per year

• Any other coverage level: Up to $7,100 per year

• Individuals age 55 and older who enroll in the Consumer Choice Plan with HSA may make an additional catch-up contribution of up to $1,000 each year until they enroll in Medicare.

5

Advantages of Enrolling in the Consumer Choice Plan with HSA

1

2

3

4

HSAs have triple tax savings: You can contribute pre-tax, earn tax-free interest, and make tax-free withdrawals for qualified health care costs.

The company makes contributions, and you can, too. You can start and stop contributing at any time, up to the combined IRS annual limits.

No “Use It or Lose It” rule. Unused funds roll over from year to year, and the account is yours to keep even if you leave the company.

You can invest your account balance. The funds roll over and are eligible to earn interest and be saved over time, so that you may use the funds for future eligible health care expenses and medical plan premiums in retirement.

Because you can use the HSA to save and invest for these expenses after retirement, it’s a lot like having a 401(k) plan for retirement — but even better, because you can also use your HSA right now.

Designate a Beneficiary for Your HSALog on to netbenefits.com to designate a beneficiary who will receive your HSA balance in the event of your death.

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Disability insuranceDisability benefits* protect you and your family by continuing all or part of your salary if illness, disease, or disability prevents you from working. To file a disability claim, contact the disability program administrator, Sun Life Financial, at 1-833-812-5184 or sunlife-ams.com.

Short Term Disability (STD)STD provides for continuation of your base pay for up to 26 weeks (inclusive of the elimination period) from the date that you become disabled due to eligible illness or injury or if you are having a baby. See the chart below for details. The company pays the full cost of this benefit, and you are automatically enrolled upon your date of hire.

Duration of Benefit Benefit Amount

Up to 13 weeks (includes 7-day elimination period**)

Continuation of 100% of base pay (benefits begin after elimination period)

Next 13 weeks Continuation of 70% of base pay

** During the elimination period you continue to receive pay from the company. (This is considered “incidental pay.”) You do not need to use your Time Off Allowance (TOA, see page 40) during this period. Restrictions may apply — for details, see the STD policy posted on HR4You.

Long Term Disability (LTD)

LTD is paid leave that provides benefits extending beyond 26 weeks. Benefits may be payable up to your normal Social Security retirement age or until you are no longer deemed disabled.

Employer-Paid LTD Coverage

You are automatically enrolled in basic LTD coverage, which provides for continuation of up to 60% of your annual benefits base pay up to a maximum monthly benefit of $15,000. The company pays the premium for basic LTD. The cost of this benefit will be added to your income and you will be taxed on it

(referred to as imputed income). If any future benefits are paid to you, they will be non-taxable as you have already paid taxes on the premiums.

Buy-Up LTD Coverage

You may increase your LTD coverage to 66 2/3 % of your annual benefits base pay by purchasing this coverage. You pay for the benefit on an after-tax basis, making the benefits themselves non-taxable.

Buy-Up coverage is not available to employees earning over $300,000 annually, because your maximum monthly LTD benefit may not exceed $15,000. If this maximum is already provided by your employer-paid basic LTD, it cannot be increased by the purchase of Buy-Up coverage.

For duration information, please refer to the appropriate Certificate of Coverage.

You can view the cost of Buy-Up LTD coverage on benefits4meenroll.com.

Benefits Base PayThis is your annual base pay plus prior 12 months’ commission. (For new hires: Your annual base pay

plus target commission.)

* Note: Union employees — Please refer to your union contract for specifics on this benefit.

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http://sunlife-ams.com


The company offers reimbursement of eligible expenses for adoption or surrogacy and another two weeks of adoption/surrogacy leave. See page 41 for details.

Paid and Unpaid LeavesThe company offers a variety of paid and unpaid leave programs*. These include paid maternity and parental leave, as well as unpaid time off to attend to other family and personal matters. To request any form of leave, contact the leave administrator, Sun Life Financial, at 1-833-812-5184 or sunlife-ams.com.

Maternity Leave for Birth MothersBirth mothers are eligible for STD salary continuation of base salary for up to eight weeks, as well as additional time off described below:

Duration of Benefit

Maternity STD** Up to 8 weeks salary continuation of 100% base salary (may not be deferred to a later date); the 8 weeks include the 7-day elimination period for STD

Parental Leave Up to an additional 5 weeks of salary continuation of 100% of base pay

Additional Leave Unpaid or may use any accrued but unused vacation. It is important to discuss your leave plans with your supervisor.

** Pay may continue under Short Term Disability Plan if you remain disabled more than eight weeks.

While on maternity leave, if you meet the eligibility criteria, your job is protected for up to 12 weeks under the Family and Medical Leave Act (FMLA) to the same extent as if you were an active employee, unless a greater benefit is provided under applicable state law.

Note: Many states have leave laws that coordinate with the programs here. Contact the leave administrator for more information on how your leave will be managed in your state.

Parental LeaveFive weeks of paid Parental Leave are provided at 100% of base pay for birth mothers, fathers, partners, and adoptive parents. For birth mothers, this is in addition to any STD pay you may receive, which is a minimum of eight weeks of salary continuation. Paid Parental Leave runs concurrent with any state or federal leaves such as FMLA leave.

Unpaid Leaves of Absence

Personal Leave of Absence

If you have completed at least six months of continuous employment, you may, at the discretion of the company, be granted an unpaid leave of absence. A personal leave would allow you to attend to personal matters if the company determines an extended period of time away from your job to be in the best interest of you and the company.

Family Medical Leave (FMLA)

Provided in accordance with the FMLA, this is unpaid leave providing up to 12 weeks of job protection to eligible employees


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Thinking about taking a leave of absence? ALEX can help you learn more.

for reasons such as the birth of a child, a serious health condition of an immediate family member, or the employee’s own serious health condition. See the policy posted on HR4You for full details of your entitlement to FMLA leave.

If you are out of work due to a qualified family leave and you are eligible for protected leave, your job may be protected for up to 12 weeks in any continuous 12-month period, to the same extent as if you were an active employee. FMLA leave may run concurrent with other leaves, including Short Term Disability.

Sabbatical Leave of Absence

A sabbatical leave provides an employee with unpaid time off to take a break and/or pursue personal interests, with a guarantee of the same job upon return to work as if no leave had been taken. Approval is at the company’s discretion and is based on your business unit, length of service, job performance, and the ability to reassign work.

If you are a regular employee scheduled to work at least 24 hours a week, you may apply for a sabbatical leave of up to 12 weeks after five years of continuous service. After each subsequent five-year period (10, 15, 20, etc., years of service), you may apply for up to 12 weeks of leave. Sabbatical leaves must be at least five years apart, regardless of the amount of time taken, and cannot be taken in conjunction with any other leave.

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https://loa.myalex.com/emd

Life and Accident InsuranceLife and Accident Insurance offers you and your family financial protection if you or a covered family member dies.

Basic Life and Accidental Death & Dismemberment (AD&D) InsuranceThis employer-paid benefit is administered by Sun Life Financial.

You are automatically enrolled in Basic Life and AD&D insurance coverage equal to two times your benefit pay. (Benefit pay is base pay as of September plus 12 months prior commissions.) The company pays the full cost of these benefits.

According to IRS guidelines, the value of any insurance amounts over $50,000 is taxable to you as imputed income. For that reason, you can choose reduced Basic Life and AD&D insurance coverage in the amount of $50,000.

You may also purchase supplemental coverage.

Employee Supplemental Life InsuranceYou may purchase one to eight times your benefits base pay up to a $2,000,000 combined maximum (Basic and Supplemental Life Insurance) via after-tax payroll deductions.

Note: If you choose to reduce your Basic Life coverage amount to $50,000, you may not enroll in Employee Supplemental Life Insurance.

Evidence of Insurability (EOI)

New hires may select Supplemental Life Insurance coverage of up to three times benefits base pay with a combined maximum of $2,000,000 without Evidence of Insurability (EOI) or proof of good health.

Any increase in coverage after your initial new hire enrollment window requires EOI. If you make an election where EOI is required, you will need to submit forms to Sun Life Financial for approval before supplemental coverage will take effect.

Note:• Life insurance coverage is rounded to the nearest $1,000.

• Your coverage amount will be reduced 50% on the January 1st following your 70th birthday.

• If you become totally disabled prior to age 60 and your disability is approved by the insurance company, your premiums for supplemental coverage may be waived for the period of your disability up to age 65.

Take Time to Make Your Beneficiary Designations

Make sure your life insurance beneficiary designations are up to date. To review your life insurance designations, log

on to benefits4meenroll.com.

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Dependent Life Insurance You may purchase life insurance for your spouse or domestic partner, as well as for your child(ren), in the amounts shown below.

The amount of your spouse life insurance cannot exceed the amount of your employee life insurance (basic plus supplemental).

Note: For each eligible dependent, you must provide proof of dependency.

Available Coverage Amounts

Spouse $10,000

$25,000

$50,000

$100,000

$150,000

$200,000

$250,000

Child $5,000

$10,000

Evidence of Insurability (EOI)

For your spouse/domestic partner, you will need to provide proof of good health (by completing the Evidence of Insurability process) for all increases in life insurance. As a new hire, or when your spouse is newly eligible within 31 days of marriage, you may select spouse/domestic partner life insurance coverage up to $50,000 without proof of good health. EOI or proof of good health is not required for your child(ren).

Supplemental AD&D

Supplemental AD&D coverage is available for you and your family through after-tax payroll deductions in increments of $10,000, up to a total of eight times your benefits base pay or $2,000,000, whichever is less. You may also enroll your spouse and child(ren) for Supplemental AD&D coverage.

EOI or proof of good health is not required for AD&D coverage.

Note: Be sure to visit benefits4meenroll.com to designate a beneficiary for all Life and AD&D insurance benefits.

Rates

You can see your personalized rates for Supplemental Employee Life Insurance, Dependent Life Insurance, and

Supplemental AD&D by visiting benefits4meenroll.com.

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Transit BenefitsThe Transit Benefits program through Businessolver allows you to save money on transportation to and from work while you are actively employed by the company. You can make purchases such as subway, bus, or train tickets and parking garage permits with pre-tax dollars taken as a convenient payroll deduction.

When you elect the Transit Benefits program, you have access to your account through benefits4meenroll.com. Online, you can:

• Order a transit and/or parking pass mailed directly to your home

• Renew a transit and/or parking pass automatically (monthly)

• Track your order history

• Maintain personal account information

Eligible forms of transportation for the Transit Benefit include:

• Train

• Light rail

• Commuter rail

• Parking

• Shuttle bus

• Vanpool

• Bus

• Ferry and boat

Note: Mileage, tolls, fuel, carpooling, and business travel are not eligible expenses for the commuter program.

You can make changes to your orders at any point throughout the year to meet your changing commuting needs. For more information or to sign up, see the Transit Benefits information on benefits4meenroll.com.

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401(k) SavIngs and InvesTmenT PLanUnder most circumstances, if you are a U.S. employee*, you are eligible to participate in the 401(k) Savings and Investment Plan after your date of hire. There are three different types of contributions to the Savings and Investment Plan: your contributions, company matching contributions, and Retirement Account Contributions.

Your Contributions You can save from 1% to 75% of your 401(k) eligible compensation (in whole percentages) up to the annual maximum dollar amount set by the IRS, which is $19,500 for 2020. You can contribute on a pre-tax or post-tax (Roth 401(k)) basis. If you are age 50 or older, you may also make additional “catch up” contributions up to an annual limit set by the IRS, which is $6,500 for 2020.

Company Match To help you reach your financial goals for retirement, the company matches your contributions dollar for dollar, up to the first 6% of your 401(k) eligible compensation (subject to IRS limits). You are always 100% vested in your own contributions as well as company matching contributions.

How to Get the Full Company Match

Because the company matches the first 6% of 401(k) eligible compensation that you save in the 401(k) plan, contribute at least this amount to maximize your match. See example below.

You Earn

Your Annual Contribution

The Company’s Annual Match

Total Contributions

$50,000 $3,000 (6% of your

401(k) eligible compensation)

$3,000 (100% match)

$6,000 (12% of your annual

401(k) eligible compensation)

For more information, refer to your summary plan description (SPD), available on benefits4meenroll.com.

True-Up Feature

Company matching contributions are made each pay period. However, the true-up feature ensures you receive the maximum company match based on the total contribution you made over the entire year (up to IRS limits). If you contributed to your 401(k) during the year, you may be eligible for a true-up matching contribution to maximize what you receive. The true-up matching contribution is determined after the end of the Plan Year.

Retirement Account Contribution You may be eligible for a discretionary Retirement Account Contribution (RAC) subject to annual Board approval. For years in which a RAC is made, all U.S. employees who are eligible to participate in the Plan and who are employed on the last day of the Plan Year will receive a RAC equal to 3% of 401(k) eligible compensation above and beyond the current company match. Any RAC will generally be made during the first quarter of the following Plan Year — for example, Q1 2021 for 2020 RAC.

401(k) Eligible Compensation This generally includes base pay, annual incentive and

sales incentive bonus payments, overtime, shift differential, and commission. See the plan document for details; visit netbenefits.com or call Fidelity at 1-800-835-5095.


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The portion of your account attributable to Retirement Account Contributions (if any) will become vested over time, with 20% for each year of service, and will be 100% vested after five years of service. If you have five or more years of service, any RAC will be immediately 100% vested.

RothRoth contributions provide a tax advantage for your retirement savings different from traditional 401(k) before-tax contributions. Roth contributions are salary deferrals that are made after taxes are taken from your pay. These contributions are subject to the same income tax withholding as your salary. However, Roth contributions accumulate tax-free — your contributions and earnings on your contributions are tax-free when you take a qualified distribution from the Plan. Although the company matches your Roth contributions up to 6% of your 401(k) eligible compensation (combined total of 6% for 401(k) and Roth), the company’s contribution will go into your account as before-tax money, which will be taxed upon distribution.

Designate a Beneficiary for Your Account

Be sure to designate a beneficiary for your 401(k) Savings and Investment Plan, and keep your beneficiary

information up to date. Visit netbenefits.com.

Summary of Key Contribution Features

Contribution Annual Amount (% of 401(k) Eligible Compensation)

Vesting

Your contributions

1% to 75% (up to IRS limits)

100% immediately

Company matching contributions

Dollar-for-dollar up to 6% 100% immediately

Retirement Account Contribution (RAC)

3% (with Board approval) 20% for each year of service

(100% immediately with 5+ years of service)

Auto-EnrollmentTo encourage savings, all new hires will be

automatically enrolled at 6% of their 401(k) eligible compensation if they do not elect to participate after 45 days from their date of hire. You can change your

election at any time.

Auto-Escalation of ContributionsThe Plan includes an auto-escalation feature.

If you actively choose to participate in this feature, your contribution will be automatically increased by 1% of your 401(k) eligible compensation each year until your annual contribution reaches 10% of your

401(k) eligible compensation.Even if you do not actively choose to participate,

each year you will have the opportunity to have your contribution increased by 1% of your 401(k) eligible

compensation unless you opt out. This does not apply if you are already contributing at least 10% of

your 401(k) eligible compensation.

Managing Your AccountThe plan administrator is Fidelity Investments. You can access information and manage your account at any time (not just annual enrollment). Log on

to the Net Benefits website at netbenefits.com or call Fidelity Investments at 1-800-835-5095.

You must choose among the various funds in the Plan to invest your savings. The Plan offers a number of investment funds to suit a variety of

investment styles.

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http://www.netbenefits.com

BEST

IN THIS SECTION:

37 Identity Protection

37 Auto and Home Insurance

37 Pet Health Insurance

37 Discount Shopping

38 Group Voluntary Accident Insurance

38 Critical Illness Insurance

38 Hospital Indemnity Insurance

38 Group Legal Services Plan

Programs

36Getting Started

Health Care Plans


BEST Programs

Other Benefits



Benefits4Me BEST Voluntary BenefitsThe company offers you access to the Benefits4Me BEST (Benefits Extras & Shopping Tool) program, provided by Corestream. The Benefits4Me BEST program includes low-cost insurance protection and discounts. Unlike the other benefits described in this guide, these are not company-sponsored plans, but the company gives you access to enroll in them at reasonable rates.

Programs You May Enroll in at Any TimeYou may enroll in the programs described on this page at any time by visiting Benefits4MeBest.com.

Identity Protection (from InfoArmor)PrivacyArmor® from InfoArmor is a proactive monitoring service that alerts you at the first sign of fraud. It will send you alerts for credit score changes, accounts opened in your name, compromised credentials, financial transactions, and more. Enrolling your family extends that protection to anyone in your household. In the event of fraud, dedicated Privacy Advocates® fully manage and restore your identity, and a $1 million identity theft insurance policy covers any fees for identity restoration.

Auto and Home Insurance The Auto and Home Insurance program offers you protection with special employee savings. After you complete one online form, you can instantly compare real-time, side by side auto insurance quotes from leading national carriers. You can also apply for additional coverage for your home, condo, vacation property, boats, recreational vehicles and more — and by bundling your insurance, you could save even more when you insure with the same carrier. You can take advantage of convenient payment options, including automatic payroll deduction and through an escrow account for home insurance. Coverage can begin as early as the day after you apply.

Pet Health Insurance (from Nationwide)You can get up to 90% back on veterinarian bills with the My Pet Protection® plan, which gives your pet superior protection at an unbeatable price. You can visit any vet, anywhere, and you’ll have access to a 24/7 vet helpline. Policies cover common illnesses, including ear infections, vomiting, and diarrhea, as well as serious or chronic illnesses such as cancer, diabetes, hereditary and congenital conditions and more. If you sign up multiple pets you’ll receive a discount for even more savings. And it’s not just for cats and dogs — the plan includes coverage options for birds and exotic pets, too.

Discount Shopping Online Find great deals on computers, apparel, cars, electronics, live entertainment, gifts, travel, and more, from an extensive network of local and national vendors. Connect at home or on the go! Sign up for a monthly newsletter to be informed of the latest offers.

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http://Benefits4MeBest.com

Programs You May Enroll in During Annual Enrollment or Other Specified TimesYou may choose to enroll in these only during the following times by visiting benefits4meenroll.com:

• When you are newly hired.

• During our benefits annual enrollment period, held in the fall of each year.

• If you experience a Qualifying Life Event.

Group Voluntary Accident Insurance (from Allstate)No one plans to have an accident, but it can happen at any time. Group Voluntary Accident Insurance pays a lump sum benefit if you should die or suffer certain injuries due to a covered accident, on or off the job. It also provides benefits to help pay costs associated with the treatment of an accidental injury. Because this accident insurance is supplemental, it pays in addition to other coverage. The coverage can be used on its own or to fill a gap left by other coverage, and the benefits are paid directly to you unless you assign them elsewhere. The coverage pays a benefit up to a specified amount for accidental death, dismemberment, dislocation/fracture, initial hospitalization confinement, hospitalization confinement, intensive care, ambulance service, medical expenses and more.

Critical Illness Insurance (from Allstate)The signs pointing to a critical illness are not always clear and may not be preventable, but Group Voluntary Critical Illness Insurance can help provide financial protection if you are diagnosed. This insurance pays benefits that can be used for non-medical expenses that your regular health insurance might not cover. You select the benefit coverage amount that you want based on your individual need and your budget. If you have covered family members, the plan also provides cash benefits for them. If diagnosed with a covered critical illness — such as heart attack, cancer or stroke — you will receive a cash benefit based on the percentage payable for the condition.

Hospital Indemnity Insurance (from Allstate)Expenses associated with a hospital stay can be burdensome if money is tight and you are not prepared. Hospital Indemnity insurance can help you worry less. This coverage pays a lump-sum benefit if you or a covered member of your family is hospitalized. Payments are made directly to you, to help you pay for out-of-pocket costs, such as health insurance deductibles and copayments — or for anything that you see fit.

LegalGUARD Group Legal Services Plan (from LegalEASE)When you must deal with legal matters, LegalGUARD helps provide peace of mind by protecting you from the high cost of legal fees. This plan connects you to an attorney for most common personal legal matters and pays for the attorney fees. LegalGUARD has a national network of highly experienced attorneys who can be matched to meet your specific legal needs. In addition to providing you with paid-in-full coverage on most legal matters, the plan offers personal guidance and coaching. You may use either in-network or out-of-network attorneys. Note: The cost of coverage is $16.38 per month. Your cost per pay period may vary based on the number of pay periods in any given month.

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Other

IN THIS SECTION:

40 Holidays and Paid Time Off

41 Adoption/Surrogacy Assistance Program

41 Tuition Reimbursement Program

41 Employee Assistance Program

42 Backup and Discount Day Care

42 Employee Referral Program

Benefits

39Getting Started

Health Care Plans


BEST Programs

Other Benefits



Holidays and Paid Time Off2020 Company HolidaysHere is a list of fixed and floating holidays for 2020, as outlined below. Keep in mind that the number of fixed company holidays depends on your location and business unit. Check with your management for more information. If you transfer to a different legal entity or work location, you will be subject to the scheduled holidays at that site.

Holiday Calendar

New Year’s Day Wednesday, January 1

Martin Luther King Day Monday, January 20

Presidents’ Day Monday, February 17

Memorial Day Monday, May 25

Independence Day Friday, July 3 (observed)

Labor Day Monday, September 7

Columbus Day Monday, October 12

Thanksgiving Day Thursday, November 26

Day after Thanksgiving Friday, November 27

Christmas Eve Thursday, December 24

Christmas Day Friday, December 25

Year-End Shutdown Monday to Thursday, December 28-31

In addition to the scheduled holidays outlined above, you will be granted one floating holiday.

New employees hired during the year are eligible for one floating holiday if hired on or before June 30.

Paid Time Off Vacation Allowance

Eligible employees accrue vacation based on their years of service.

Years of Service Vacation Semi-Monthly Accrual*

Up to 5 years 120 hours (15 days) 5.00 hours

5-15 years 160 hours (20 days) 6.67 hours

15+ 200 hours (25 days) 8.34 hours

* You accrue vacation on the 1st and 15th of every month, and you must be employed on the date the accrual is posted. You accrue at the higher rate on the next applicable semi-monthly accrual date after your anniversary.

Sick Time Off Allowance

All full-time employees are provided a bank of 64 hours (prorated for part-time employees and new hires) for the purpose of absences due to illness, doctor’s appointments, or caring for a child or immediate family member.Note: • If you exhaust the hours in your time off bank, you may

substitute vacation or floating holiday time, with your manager’s approval.

• Exempt employees must charge time to this bank in increments of one day.

Except where state or local law requires otherwise:• All holidays, vacation, and sick time are prorated for part-time

and new employees. • Any unused floating holidays, vacation, or sick time hours will be

forfeited at the end of each calendar year.• Co-ops, temporary part-time and seasonal employees are not

eligible for any holidays, vacation, or sick time.Note: State and local laws vary. Always refer to HR4U or your local site lead for specific details about policies that apply to you.

This page is an overview of holidays and paid time off. For full details see the articles posted on HR4You.

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Adoption/Surrogacy Assistance ProgramThis program reimburses you up to $5,000 for eligible expenses for the adoption of each child. Surrogacy services are eligible for this assistance as well. For more information, please contact HR4You at 1-855-444-5678 or visit HR4You.

In addition to five weeks of parental leave, employees who are adopting or welcoming a child via surrogacy are eligible for another two weeks of adoption/surrogacy leave. See the policy posted on HR4You for more information.

Tuition Reimbursement ProgramTo encourage you to further your professional development in areas related to your current work assignments or next identified job within the company, we’ll reimburse you for tuition and books for approved, qualified courses up to $10,000 annually. The amount of reimbursement will depend on your grade.

• Grades B– and above will be reimbursed at 100%.

• Grade C will be reimbursed at 50%.

• Grade D or lower is not eligible for reimbursement.

Note: You must be employed for at least one month prior to the date your course starts, for courses that begin after your date of hire. Other terms apply.

For more information, please contact HR4You at 1-844-358-1619 or visit tamsonline.org/HR4You.

Employee Assistance Program (EAP)EAP counselors provide free and confidential assistance for employees and family members. An EAP counselor can identify issues and help you plan strategies for dealing with them. If necessary, your EAP counselor can refer you to a specialist in the area of your concern.

The EAP also provides consultation and referral for child care and elder care assistance, as well as a wide variety of time-saving convenience services like finding home contractors, cleaning

services, pet sitters, movers, and more. In addition, the EAP offers consultation with attorneys and financial counselors.

To contact Comprehensive EAP call 1-800-344-1011, or visit online, compeap.com. (Username: Benefits4Me and Password: Benefits4Me.)

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http://HR4You.merckgroup.com

http://tamsonline.org/HR4You

http://compeap.com

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Backup and Discount Day careOur company’s day care services program can save the day when you need help taking care of a child or adult family member without having to miss work. We have partnered with the KinderCare® Education family of brands and Care.com to offer you a variety of day care benefits through the Care@Work program.

Day care in connection with work-related issues is available for children of any age from newborns to teens, or dependent adult children who need companion care, as well as your spouse/domestic partner, parents, in-laws, and grandparents.

If you enroll for a premium membership by registering at Benefits4Me.care.com, you receive access to the following day care services.

Backup Day Care

Backup day care can help you cover day care gaps in the event of a school closure, sick day(s), when your regular day care is closed, if a regular nanny or caregiver is sick, or whenever you need an extra hand. It also comes in handy when a spouse/domestic partner needs care while recovering from surgery, or a parent needs a ride to doctor appointments.

It isn’t just for emergencies. You can also use backup day care when your regular caregiver is taking a scheduled vacation, or your children are home from school during a regular holiday or break.

You can receive up to 10 days of backup child care and adult care per dependent per year. You pay just a small copay.

Care can be provided in your home, the home of a family member needing care (even if they live in another city), or at one of the child care centers in Care.com’s nationwide network (during center hours Monday through Friday). Care providers are professionally qualified and thoroughly vetted by Care.com.

Note: Any backup care days you use will be subject to imputed income, meaning you will be taxed on the fair market value of the services.

Daycare Tuition Discounts As a Care.com member, you can save 10% on full-time and part-time tuition for children ages six weeks to 12 years at KinderCare, Knowledge Beginnings, participating CCLC centers, and Champions before/after school sites nationwide.

Other Membership BenefitsAt no cost to you, you can also use your Care.com membership to help you find, select, and hire nannies, sitters, caregivers, dog walkers, summer camps, house cleaners, tutors, and much more. To learn more about the Care@Work program, go to Benefits4Me.care.com or call 1-855-781-1303.

Employee Referral ProgramEmployees are an excellent source for talent, and by referring candidates through our Employee Referral Program, everyone wins! For more information on the program and to refer candidates, please contact HR4You at 1-855-444-5678.

http://Benefits4Me.care.com

http://Benefits4Me.care.com


enrollment

IN THIS SECTION:

44 Enrolling for Your Benefits

45 Enrollment Checklist

45 Ready to Enroll?

43Getting Started

Health Care Plans


BEST Programs

Other Benefits



Enrolling for your benefitsTo Enroll, Go to benefits4meenroll.comThis interactive website is your one-stop benefits shop for messages, reminders, personal information, and updates that need your attention.

You will not be able to change your benefits until the annual enrollment period each fall, unless you experience a Qualifying Life Event. That’s why we strongly encourage you to review all the materials provided to you, decide which plan is right for you, and select the coverage that will make the most sense for you and your family.

New Hire Enrollment PeriodAs a new hire, you have 31 days from your hire date to enroll for your new benefits. If you do not enroll during this period, you will not be eligible to enroll for benefits until the next annual enrollment period, unless you experience a Qualifying Life Event.

For more information about the enrollment process, visit benefits4meenroll.com or call the Benefits4Me Program Service Center at 1-844-279-7894.

New Hires: If You Don’t Enroll

If you do not enroll for benefits within 31 days, you may have coverage that does not meet your or your family’s needs.

What you will receive if you do not make an active election

Medical coverage No coverage

Dental coverage No coverage

Vision coverage No coverage

FSAs and HSA No employee contributions

Basic Life and AD&D 2x benefits base pay

Supplemental Life Insurance

No coverage

Spouse and Child Life Insurance

No coverage

Long-Term Disability (LTD)

Employer provided coverage only

benefits4meinfo.comThe Benefits Information Site is available to help you

and your family learn about your benefits. • Read more information about your benefits.

• Access contact information for your current benefit providers.

• Find instructions on the steps to enroll

Have Questions?See the “Contacts & Resources” section of this guide to get help finding your answers.

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Enrollment ChecklistThe Enrollment Checklist below provides important steps to take before you are ready to enroll for your benefits.

You may call your Accolade Health Assistant at 1-866-852-3410 to ask questions about your benefits options. You can also visit member.accolade.com or download the Accolade mobile app.

To review additional benefits information without the need to log in, visit the Benefits Information Site at benefits4meinfo.com.

Use ALEX, our engaging online tool, to help you evaluate your medical plan coverage and other benefits so you can make informed decisions based on your preferences. Visit myalex.com/emd/home/serono.

Make sure you have all the information for your covered dependents, including date of birth and Social Security number — it’s required for IRS reporting. Gather any documents needed to verify the eligibility of any newly added dependents, such as a marriage license or birth certificates. If this documentation is not provided, your dependents will not have coverage.

Review your life, disability, and accident insurance coverage to make sure you have the coverage you need.

This is also a good time to include your beneficiary designations.

• Visit benefits4meenroll.com to designate beneficiaries for life and AD&D insurance.

• To designate a beneficiary for your 401(k) plan, visit netbenefits.com.

• If you enroll in the Consumer Choice Plan for medical coverage, visit netbenefits.com to designate a beneficiary for your HSA.

Consider whether you are interested in any of the BEST benefits. You may enroll in group voluntary accident insurance, critical illness insurance, hospital indemnity insurance and/or group legal insurance as a new hire or each year during a benefits annual enrollment period at benefits4meenroll.com. You may enroll in ID protection, auto and home insurance, pet insurance and/or discount shopping at any time by visiting Benefits4MeBest.com.

READY tO eNROLL?Enroll by visiting benefits4meenroll.com. Remember: As a new hire, you have 31 days to enroll.

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https://www.myalex.com/emd/home/benefits4me#choose-benefits





http://Benefits4MeBest.com


IN THIS SECTION:

47 Start Here: Where to Go for More Information

48 Benefits and Provider Contact Information

51 Health Glossary

Contacts and

Resources

46Getting Started

Health Care Plans


BEST Programs

Other Benefits



Start Here: Where to Go for More Information1. If you have general questions about your benefits and

your enrollment decisions at any time throughout the year, you can connect with your Accolade Health Assistant for answers:

• Call 1-866-852-3410, Monday through Friday, 8 a.m. to 11 p.m., Eastern Time.

• Visit member.accolade.com and follow the prompts to register your member account, or download the Accolade mobile app and use it to send secure messages to your Health Assistant. Text 49P9 to 67793 to download the app (message and data charges may apply), or get it from the App Store or Google Play.

2. After you’re enrolled and your coverage becomes effective, your dedicated Accolade Health Assistant will also be able to provide more personalized help with your health, benefits, and health care claim questions.

3. If you have questions about the enrollment process or about using the enrollment website benefits4meenroll.com, call the Benefits4Me Program Service Center at 1-844-279-7894.

4. If you’re looking for benefits information without the need to log in, visit the Benefits Information Site at benefits4meinfo.com.

5. If you want help finding an in-network BCBS medical care provider, or finding out whether your current provider is in-network, you may contact Accolade, or you may use the BCBS website by following the instructions on the next page.

6. If you have a specific question about a benefit and would prefer to contact the benefit provider directly without assistance from Accolade, please see the contact information on the following pages.

Businessolver Benefits AppAfter you’re enrolled, you can use the MyChoiceSM app from Businessolver to access all kinds of benefits information on your mobile device. At your fingertips you’ll have:

• Current benefits coverage

• Current designated beneficiaries

• The ability to send and receive messages and reminders, including copies of documentation such as dependent verification

• Digital copies of your medical and other benefit ID cards

• Contact information for quick questions about benefits, enrollment, or documentation

Download the app from the App Store or Google Play, then log into benefits4meenroll.com to get your access code.

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Benefits and Provider Contact Information

Benefit Vendor/Program Contact Information

Personalized Health and Benefits Support Accolade 1-866-852-3410/member.accolade.com

To find a BCBS network provider

myfindadoctor.bluecrossma.com/?ci=Benefits4Me

Click “PPO or EPO” to begin or if you live in any of the following locations, choose the specific local network listed below by clicking the arrow next to “PPO or EPO” before starting your search:• PPO New Hampshire• PPO Missouri/St. Louis• PPO Missouri/Kansas City• PPO Wisconsin

Health Care Plans

Medical Blue Cross Blue Shield (BCBS)

Coverage is through Blue Cross Blue Shield of Massachusetts, available nationwide

Contact Accolade

1-866-852-3410/member.accolade.com

Kaiser (including prescription drugs) 1-800-464-4000/kp.org

Prescription Drug Express Scripts 1-800-396-2256/Express-Scripts.com

Dental Delta Dental® of Massachusetts 1-800-872-0500/deltadentalma.com

Vision EyeMed Vision Care® 1-866-299-1358/eyemed.com

Find hearing care provider or schedule a hearing exam: 1-844-526-5432

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http://myfindadoctor.bluecrossma.com/?ci=Benefits4Me


http://www.kp.org

http://www.Express-Scripts.com

http://deltadentalma.com

http://www.eyemed.com


Wellness Program

Wellness Incentives Health Advocate 1-855-737-8585/www.healthadvocate.com/benefits4me

Health Management & Wellness

ahealthyme BCBS ahealthyme.com

MyBlue Wellness Resources BCBS myblue.bluecrossma.com/tools-resources/ forms-brochures/wellness

Health & Wellness Programs Kaiser 1-800-464-4000/kp.org/healthylifestyles

Savings & Financial Protection

Health Savings Account (HSA) Fidelity Investments 1-800-544-3716/netbenefits.com

Flexible Spending Accounts (FSAs) Businessolver 1-844-279-7894/benefits4meenroll.com

Life and AD&D Insurance Sun Life Financial 1-800-247-6875/benefits4meenroll.comLife insurance portability: 1-866-365-2374

Short Term Disability (STD)

Long Term Disability (LTD)

Unpaid Leaves of Absence (Military, Unpaid Personal Leave, and Sabbatical Leave)

Unpaid Leaves of Absence (FMLA)

Parental Leave

Sun Life Financial 1-833-812-5184/sunlife-ams.com

State Disability and Paid Family Leave for CA Employees

CA EDD 1-800-480-3287 or 1-866-658-8846 (En español)/ edd.ca.gov/Disability/

State Disability and Paid Family Leave for NJ Employees

NJ TDI 1-609-292-7060/myleavebenefits.nj.gov

Transit Benefits Businessolver 1-844-279-7894/benefits4meenroll.com

401(k) Savings and Investment Plan Fidelity Investments 1-800-835-5095/netbenefits.com

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http://ahealthyme.com

http://myblue.bluecrossma.com/tools-resources/forms-brochures/wellness

http://myblue.bluecrossma.com/tools-resources/forms-brochures/wellness

http://www.kp.org/healthylifestyles





http://edd.ca.gov/Disability/

http://myleavebenefits.nj.gov




BEST Benefits

Benefits4Me BEST Voluntary Benefits Corestream 1-855-313-2200/benefits4mebest.com

Other Benefits

Adoption Assistance HR4You 1-855-444-5678/HR4You.merckgroup.com

Tuition Reimbursement Program ED Assist 1-844-358-1619/tamsonline.org/HR4You

Employee Assistance Program Comprehensive EAP 1-800-344-1011/compeap.comUsername: Benefits4MePassword: Benefits4MeEmail: [email protected]

Employee Referral Program EMD Staffing 1-855-444-5678

Backup Day Care Care.com 1-855-781-1303/Benefits4Me.care.com

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http://benefits4mebest.com


http://tamsonline.org/HR4You

http://compeap.com

mailto:info%40compeap.com?subject=

http://care.com

https://benefits4me.care.com/

Health Glossary

CopayA fixed amount you pay for a covered service under a plan, usually when you receive the service. The amount can vary by the type of service.

CoinsuranceYour share of the costs of a covered health care service, calculated as a percentage of the allowed amount for the service. You pay coinsurance plus any deductibles you owe. The health plan pays the rest of the allowed amount.

DeductibleThe amount you owe for covered health care services (other than preventive services) before the plan begins to pay.

Deductible, Embedded A feature of the medical Core and Buy-Up Plans that works like this if you have dependent coverage:

The annual deductible has two components: the individual deductibles for each family member, and the family deductible. Once a person meets the individual deductible, the plan will pay benefits for that family member only, while expenses for all other family members will count toward meeting the overall family deductible. This means:

• Any combination of expenses from all family members will count toward meeting the family deductible. Once this is met, the plan pays benefits for all family members.

• But no person has to meet more than the individual deductible before the plan pays benefits for that person.

Deductible, Non-Embedded The medical Consumer Choice Plan does not have an embedded deductible. (It may be said to have a non-embedded deductible.) If you have dependent coverage, this means:

• Any combination of expenses from all family members will count toward meeting the family deductible. Once this is met, the plan pays benefits for all family members.

• But the plan does not pay benefits for any person until the family deductible is met.

Eligible ExpensesThe services and supplies eligible for reimbursement under your medical plan option. The service or supply must be recommended by a physician and must be essential for the necessary care and treatment of an injury or sickness. Those fees cannot exceed the allowed amount for out-of-network services.

Generic DrugAn alternative form of a brand-name drug that has been shown to be equally effective while also being less costly.

Health Maintenance Organization (HMO)A plan that offers coverage for services received from a specific network of providers associated with the plan. Participants pay for their share of the cost of services in the form of copays, and referrals are required for certain types of care.

Non-Formulary DrugA drug outside of the plan’s formulary (list of covered drugs).

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Out-of-Pocket Maximum (OOP)The maximum amount of deductible and coinsurance you have to pay in a calendar year for certain eligible expenses. The out-of-pocket (OOP) maximum protects you from unbearable financial burdens by capping the total amount you will have to spend on your health care each year.

Out-of-Pocket Maximum, EmbeddedThis feature applies if you have dependent coverage under the medical Core or Buy-Up Plan:

• Any combination of eligible out-of-pocket expenses (deductible and coinsurance) from all family members will count toward meeting the plan’s family out-of-pocket maximum. Once this is met, the plan covers all eligible expenses at 100% for all family members for the rest of the calendar year.

• But no person has to meet more than the individual out-of-pocket maximum before the plan covers all eligible expenses at 100% for that person for the rest of the calendar year.

Out-of-Pocket Maximum, Non-EmbeddedIf you have dependent coverage under the medical Consumer Choice Plan:

• Any combination of eligible out-of-pocket expenses from all family members will count toward meeting the plan’s family out-of-pocket maximum. Once this is met, the plan covers all eligible expenses at 100% for all family members for the rest of the calendar year.

• But the plan does not cover all eligible expenses at 100% for the rest of the calendar year for any person until the family out-of-pocket maximum is met.

Pre-Admission Certification/Prior AuthorizationYou must obtain Pre-Admission Certification and/or Prior Authorization for certain types of care under the medical plan options to avoid a reduction in or denial of benefits for that care. Pre-Admission Certification/Prior Authorization for hospital

admissions and certain outpatient surgical and diagnostic procedures is required. Network providers generally coordinate Pre-Admission Certification/Prior Authorization on your behalf, but it is your responsibility to make sure it is obtained. For more information, contact Accolade at 1-866-852-3410 or member.accolade.com — or, if you are covered by the Kaiser HMO Plan, visit kaiserpermanente.org.

Preferred Provider Organization (PPO) PlanA plan that offers in- and out-of-network coverage to its participants. Members pay for the cost of services through a mix of copays and coinsurance. Referrals are not required.

Preventive CareServices designed to prevent or detect illness before the condition develops or becomes more severe. All of the company’s plans cover preventive care at 100%, according to age and frequency limits.

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http://kaiserpermanente.org

Informationcompliance

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The company is required to provide employees with the following regulatory information annually. Not all of the information may pertain to you at this time or to benefits for which you are eligible. Within this document, you will find information about:

• Your rights and protections regarding our company wellness program

• Your health information and privacy (privacy notice)

• Your special enrollment rights under HIPAA

• Coverage for domestic partners (not a legally required notice, but information included for your convenience)

• Premium assistance under Medicaid and the Children’s Health Insurance Program (CHIP) offered by several states

• Qualified Medical Child Support Orders (QMCSOs)

• Patient protection information about your right to designate or not designate certain care providers and receive access to certain types of care

• An important Creditable Coverage Notice concerning your prescription drug coverage and Medicare

• The Women’s Health and Cancer Rights Act of 1998

• The Newborns’ and Mothers’ Health Protection Act of 1996 (NMHPA)

At any point in time, you may have a paper copy mailed to an address of your choosing free of charge by calling the Benefits4Me Program Service Center at 1-844-279-7894.

Notice Regarding The Wellness ProgramThe company’s wellness program is a voluntary program available to all employees and their spouses. The program is administered according to federal rules permitting employer-sponsored wellness programs that seek to improve employee health or prevent

disease, including the Americans with Disabilities Act of 1990, the Genetic Information Nondiscrimination Act of 2008, and the Health Insurance Portability and Accountability Act, as applicable, among others. If you are a US-based benefits-eligible employee, you will have the opportunity to take part in various wellness activities, such as a biometric screening, and earn a total of up to $500 annually in wellness incentives. You are not required to take part in any of these activities; participation is completely voluntary. However, only eligible employees who choose to take part in the wellness incentive activities will receive the incentive.

If you are unable to participate in the wellness incentive activities, you may be entitled to a reasonable accommodation or an alternative standard. You may request a reasonable accommodation or an alternative standard by contacting the Benefits4Me Program Service Center at [email protected].

If you choose to receive a biometric screening or take part in certain other wellness activities, the results will be used to provide you with information to help you understand your current health and potential risks, and may also be used to offer you services through the wellness program such as health coaching. You also are encouraged to share your results or concerns with your own doctor.

Protections from Disclosure of Medical Information

We are required by law to maintain the privacy and security of your personally identifiable health information. Although the wellness program and the company may use aggregate information it collects to design a program based on identified health risks in the workplace, the company will never disclose any of your personal information, except as necessary to respond to a request from you for a reasonable accommodation needed to participate in the wellness program, or as expressly permitted by law. Medical information that personally identifies you that is provided in connection with the wellness program will not be provided to your supervisors or managers and may never be used to make decisions regarding your employment.

Your health information will not be sold, exchanged, transferred, or otherwise disclosed except to the extent permitted by law to carry

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mailto:[email protected]

out specific activities related to the wellness program, and you will not be asked or required to waive the confidentiality of your health information as a condition of participating in the wellness program or receiving an incentive. Anyone who receives your information for purposes of providing you services as part of the wellness program will abide by the same confidentiality requirements. The only individual(s) who will receive your personally identifiable health information is Health Advocate (our biometric screening vendor) in order to provide you with services under the wellness program.

In addition, all medical information obtained through the wellness program will be maintained separate from your personnel records, information stored electronically will be encrypted, and no information you provide as part of the wellness program will be used in making any employment decision. Appropriate precautions will be taken to avoid any data breach and, in the event a data breach occurs involving information you provide in connection with the wellness program, we will notify you immediately.

You may not be discriminated against in employment because of the medical information you provide as part of participating in the wellness program, nor may you be subjected to retaliation if you choose not to participate.

If you have questions or concerns regarding this notice, or about protections against discrimination and retaliation, please contact the Benefits4Me Program Service Center at [email protected].

Privacy NoticePlease carefully review this notice. It describes how medical information about you may be used and disclosed and how you can get access to this information.

The Health Insurance Portability and Accountability Act of 1996 and the Health Information Technology for Economic and Clinical Health Act and the related regulations (collectively, HIPAA) impose numerous requirements on the use and disclosure of individual health information by employer health plans. This

information, known as protected health information (PHI), includes almost all individually identifiable health information held by a plan — whether received in writing, in an electronic medium, or as an oral communication. This notice describes the privacy practices of these plans: medical, health care flexible spending account, dental, and vision. The plans covered by this notice may share health information with each other to carry out treatment, payment, or health care operations. These plans are collectively referred to as the Plan in this notice, unless specified otherwise.

The Plan’s Duties with Respect to Health Information about YouThe Plan is required by law to maintain the privacy of your health information and to provide you with this notice of the Plan’s legal duties and privacy practices with respect to your health information. If you participate in an insured plan or HMO option, you will receive a notice directly from the Insurer or HMO. It’s important to note that these rules apply to the Plan, not the company as an employer — that’s the way the HIPAA rules work. Different policies may apply to other company programs or to data unrelated to the Plan.

How the Plan May Use or Disclose Your Health InformationThe privacy rules generally allow the use and disclosure of your health information without your permission (known as an authorization) for purposes of health care treatment, payment activities, and health care operations. Here are some examples of what that might entail:• Treatment includes providing, coordinating, or managing

health care by one or more health care providers or doctors. Treatment can also include coordination or management of care between a provider and a third party, and consultation and referrals between providers. For example, the Plan may share your health information with physicians who are treating you.

• Payment includes activities by this Plan, other plans, or providers to obtain premiums, make coverage determinations,

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and provide reimbursement for health care. This can include eligibility determinations, reviewing services for medical necessity or appropriateness, utilization management activities, claims management, and billing, as well as “behind the scenes” plan functions such as risk adjustment, collection, or reinsurance. For example, the Plan may share information about your coverage or the expenses you have incurred with another health plan in order to coordinate payment of benefits.

• Health care operations include activities by this Plan (and in limited circumstances other plans or providers) such as wellness and risk assessment programs, quality assessment and improvement activities, customer service, and internal grievance resolution. Health care operations also include vendor evaluations, credentialing, training, accreditation activities, underwriting, premium rating, arranging for medical review and audit activities, and business planning and development. For example, the Plan may use information about your claims to audit the third parties that approve payment for Plan benefits.

The amount of health information used, disclosed or requested will be limited and, when needed, restricted to the minimum necessary to accomplish the intended purposes, as defined under the HIPAA rules. If the Plan uses or discloses PHI for underwriting purposes, the Plan will not use or disclose PHI that is your genetic information for such purposes. The Plan may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you, as permitted by law.

How the Plan May Share Your Health Information with the CompanyThe Plan, or its health insurer or HMO, may disclose your health information without your written authorization to the company for plan administration purposes. The company may need your health information to administer benefits under the Plan. The company agrees not to use or disclose your health information other than as permitted or required by the Plan documents and by law. Company employees who provide services to the plan are

the only company employees who will have access to your health information for plan administration functions.

Here’s how additional information may be shared between the Plan and the company, as allowed under the HIPAA rules:

• The Plan, or its insurer or HMO, may disclose “summary health information” to the company, if requested, for purposes of obtaining premium bids to provide coverage under the Plan, or for modifying, amending, or terminating the Plan. Summary health information is information that summarizes participants’ claims information, from which names and other identifying information have been removed.

• The Plan, or its insurer or HMO, may disclose to the company information on whether an individual is participating in the Plan or has enrolled or disenrolled in an insurance option or HMO offered by the Plan.

In addition, you should know that the company cannot and will not use health information obtained from the Plan for any employment-related actions. Health information collected by the company from other sources, for example, under the Family and Medical Leave Act, Americans with Disabilities Act, or workers’ compensation, is not protected under HIPAA (although this type of information may be protected under other federal or state laws).

Other Allowable Uses or Disclosures of Your Health InformationIn certain cases, your health information can be disclosed without authorization to a family member, close friend, or other person you identify who is involved in your care or payment for your care. Information about your location, general condition, or death may be provided to a similar person (or to a public or private entity authorized to assist in disaster relief efforts). You’ll generally be given the chance to agree or object to these disclosures (although exceptions may be made — for example, if you’re not present or if you’re incapacitated). In addition, your health information may be disclosed without authorization to your legal representative.

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The Plan also is allowed to use or disclose your health information without your written authorization for the following activities:

Workers’ compensation

Disclosures to workers’ compensation or similar legal programs that provide benefits for work-related injuries or illness without regard to fault, as authorized by and necessary to comply with the laws

Necessary toprevent serious threat to health or safety

Disclosures made in the good-faith belief that releasing your health information is necessary to prevent or lessen a serious and imminent threat to public or personal health or safety, if made to someone reasonably able to prevent or lessen the threat (or to the target of the threat); includes disclosures to help law enforcement officials identify or apprehend an individual who has admitted participation in a violent crime that the Plan reasonably believes may have caused serious physical harm to a victim, or where it appears the individual has escaped from prison or from lawful custody

Public health activities

Disclosures authorized by law to persons who may be at risk of contracting or spreading a disease or condition; disclosures to public health authorities to prevent or control disease or report child abuse or neglect; and disclosures to the Food and Drug Administration to collect or report adverse events or product defects

Victims of abuse, neglect, or domestic violence

Disclosures to government authorities, including social services or protected services agencies authorized by law to receive reports of abuse, neglect, or domestic violence, as required by law or if you agree or the Plan believes that disclosure is necessary to prevent serious harm to you or potential victims (you’ll be notified of the Plan’s disclosure if informing you won’t put you at further risk)

Judicial and administrative proceedings

Disclosures in response to a court or administrative order, subpoena, discovery request, or other lawful process (the Plan may be required to notify you of the request or receive satisfactory assurance from the party seeking your health information that efforts were made to notify you or to obtain a qualified protective order concerning the information)

Law enforcement purposes

Disclosures to law enforcement officials required by law or legal process, or to identify a suspect, fugitive, witness, or missing person; disclosures about a crime victim if you agree or if disclosure is necessary for immediate law enforcement activity; disclosure about a death that may have resulted from criminal conduct; and disclosures to provide evidence of criminal conduct on the Plan’s premises

Decedents Disclosures to a coroner or medical examiner to identify the deceased or determine cause of death; and disclosures to funeral directors to carry out their duties

Organ, eye, or tissue donation

Disclosures to organ procurement organizations or other entities to facilitate organ, eye, or tissue donation and transplantation after death

Research purposes

Disclosures subject to approval by institutional or private privacy review boards, subject to certain assurances and representations by researchers about the necessity of using your health information and the treatment of the information during a research project

Health oversight activities

Disclosures to health agencies for activities authorized by law (audits, inspections, investigations, or licensing actions) for oversight of the health care system, government benefits programs for which health information is relevant to beneficiary eligibility, and compliance with regulatory programs or civil rights laws

Specialized government functions

Disclosures about individuals who are Armed Forces personnel or foreign military personnel under appropriate military command; disclosures to authorized federal officials for national security or intelligence activities; and disclosures to correctional facilities or custodial law enforcement officials about inmates

HHS investigations

Disclosures of your health information to the Department of Health and Human Services to investigate or determine the Plan’s compliance with the HIPAA privacy rule

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Except as described in this notice, other uses and disclosures will be made only with your written authorization. For example, in most cases, the Plan will obtain your authorization before it communicates with you about products or programs if the Plan is being paid to make those communications. If your health record contains psychotherapy notes, the Plan does not receive that information. HIPAA places strict limits on the use and disclosure of mental health records. If the Plan were to receive a request for a record containing psychotherapy notes, it would not disclose the information without first obtaining the written authorization of the participant. The Plan will never sell your health information unless you have authorized us to do so. You may revoke your authorization as allowed under the HIPAA rules. However, you can’t revoke your authorization with respect to disclosures the Plan has already made. You will be notified of any unauthorized access, use or disclosure of your unsecured health information as required by law.

The Plan will notify you if it becomes aware that there has been a loss of your health information in a manner that could compromise the privacy of your health information.

Your Individual RightsYou have the following rights with respect to your health information the Plan maintains. These rights are subject to certain limitations, as discussed below. This section of the notice describes how you may exercise each individual right. For additional information, contact the Benefits4Me Program Service Center, 400 Summit Drive, Burlington, MA 01803 or call 1-844-279-7894.

Right to Request Restrictions on Certain Uses and Disclosures of Your Health Information and the Plan’s Right to Refuse

You have the right to ask the Plan to restrict the use and disclosure of your health information for treatment, payment, or health care operations, except for uses or disclosures required by law. You have the right to ask the Plan to restrict the use and disclosure of your health information to family members, close friends, or other persons you identify as being involved in your

care or payment for your care. You also have the right to ask the Plan to restrict use and disclosure of health information to notify those persons of your location, general condition, or death — or to coordinate those efforts with entities assisting in disaster relief efforts. If you want to exercise this right, your request to the Plan must be in writing.

The Plan is not required to agree to a requested restriction. If the Plan does agree, a restriction may later be terminated by your written request, by agreement between you and the Plan (including an oral agreement), or unilaterally by the Plan for health information created or received after you’re notified that the Plan has removed the restrictions. The Plan may also disclose health information about you if you need emergency treatment, even if the Plan has agreed to a restriction.

An entity covered by these HIPAA rules (such as your health care provider) or its business associate must comply with your request that health information regarding a specific health care item or service not be disclosed to the Plan for purposes of payment or health care operations if you have paid for the item or service, in full out-of-pocket.

Right to Receive Confidential Communications of Your Health Information

If you think that disclosure of your health information by the usual means could endanger you in some way, the Plan will accommodate reasonable requests to receive communications of health information from the Plan by alternative means or at alternative locations.

If you want to exercise this right, your request to the Plan must be in writing and you must include a statement that disclosure of all or part of the information could endanger you.

Right to Inspect and Copy Your Health Information

With certain exceptions, you have the right to inspect or obtain a copy of your health information in a “designated record set.” This may include medical and billing records maintained for a health care provider; enrollment, payment, claims adjudication,

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and case or medical management record systems maintained by a plan; or a group of records the Plan uses to make decisions about individuals. However, you do not have a right to inspect or obtain copies of psychotherapy notes or information compiled for civil, criminal, or administrative proceedings. The Plan may deny your right to access, although in certain circumstances you may request a review of the denial.

If you want to exercise this right, your request to the Plan must be in writing. Within 30 days of receipt of your request (60 days if the health information is not accessible onsite), the Plan will provide you with:

• The access or copies you requested;

• A written denial that explains why your request was denied and any rights you may have to have the denial reviewed or file a complaint; or

• A written statement that the time period for reviewing your request will be extended for no more than 30 more days, along with the reasons for the delay and the date by which the Plan expects to address your request.

You may also request your health information be sent to another entity or person, so long as that request is clear, conspicuous, and specific. The Plan may provide you with a summary or explanation of the information instead of access to or copies of your health information, if you agree in advance and pay any applicable fees. The Plan also may charge reasonable fees for copies or postage.

If the Plan doesn’t maintain the health information but knows where it is maintained, you will be informed of where to direct your request.

You may request an electronic copy of your health information if it is maintained in an electronic health record in a form readily producible by the Plan. You may also request that such electronic health information be sent to another entity or person, so long as that request is clear, conspicuous, and specific. Any charge that is assessed to you for these copies, if any, must be reasonable and based on the Plan’s cost.

Right to Amend Your Health Information That Is Inaccurate or Incomplete

With certain exceptions, you have a right to request that the Plan amend your health information in a designated record set. The Plan may deny your request for a number of reasons. For example, your request may be denied if the health information is accurate and complete, was not created by the Plan (unless the person or entity that created the information is no longer available), is not part of the designated record set, or is not available for inspection (e.g., psychotherapy notes or information compiled for civil, criminal, or administrative proceedings).

If you want to exercise this right, your request to the Plan must be in writing, and you must include a statement to support the requested amendment. Within 60 days of receipt of your request, the Plan will:

• Make the amendment as requested;

• Provide a written denial that explains why your request was denied and any rights you may have to disagree or file a complaint; or

• Provide a written statement that the time period for reviewing your request will be extended for no more than 30 more days, along with the reasons for the delay and the date by which the Plan expects to address your request.

Right to Receive an Accounting of Disclosures of Your Health Information

You have the right to a list of certain disclosures of your health information the Plan has made. This is often referred to as an “accounting of disclosures.” You generally may receive this accounting if the disclosure is required by law, in connection with public health activities, or in similar situations listed in the table earlier in this notice, unless otherwise indicated below.

You may receive information on disclosures of your health information for up to six years before the date of your request. You do not have a right to receive an accounting of any disclosures made:

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• For treatment, payment, or health care operations;

• To you about your own health information;

• Incidental to other permitted or required disclosures;

• Where authorization was provided;

• To family members or friends involved in your care (where disclosure is permitted without authorization);

• For national security or intelligence purposes or to correctional institutions or law enforcement officials in certain circumstances; or

• As part of a “limited data set” (health information that excludes certain identifying information).

In addition, your right to an accounting of disclosures to a health oversight agency or law enforcement official may be suspended at the request of the agency or official.

If you want to exercise this right, your request to the Plan must be in writing. Within 60 days of the request, the Plan will provide you with the list of disclosures or a written statement that the time period for providing this list will be extended for no more than 30 more days, along with the reasons for the delay and the date by which the Plan expects to address your request. You may make one request in any 12-month period at no cost to you, but the Plan may charge a fee for subsequent requests. You’ll be notified of the fee in advance and have the opportunity to change or revoke your request.

Right to Obtain a Paper Copy of This Notice from the Plan Upon Request

You have the right to obtain a paper copy of this privacy notice upon request. Even individuals who agreed to receive this notice electronically may request a paper copy at any time.

Changes to the Information in This Notice

The Plan must abide by the terms of the privacy notice currently in effect. This notice takes effect on September 23, 2013. However, the Plan reserves the right to change the terms of its

privacy policies, as described in this notice, at any time and to make new provisions effective for all health information that the Plan maintains. This includes health information that was previously created or received, not just health information created or received after the policy is changed. If changes are made to the Plan’s privacy policies described in this notice, a revised privacy notice will be posted on HR InTouch by the effective date of the change and either 1) the revised notice, or 2) information about the change and how to obtain the revised notice, will be provided during the next annual enrollment or at the beginning of the plan year if there is no annual enrollment process.

Complaints

If you believe your privacy rights have been violated or your Plan has not followed its legal obligations under HIPAA, you may complain to the Plan and to the Secretary of Health and Human Services. You won’t be retaliated against for filing a complaint. To file a complaint, contact the HIPAA Privacy Officer (see “Contact”).

Contact

For more information on the Plan’s privacy policies or your rights under HIPAA, contact Melissa Donahue at 1-978-715-1852.

Special Enrollment Rights Under HIpAALoss of Other Coverage. If you decline enrollment for yourself or your dependents (including your same-sex spouse or domestic partner) because of other health insurance coverage, you or your dependents may be able to enroll in certain benefit plans without waiting for the next benefits annual enrollment period if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 31 days following the date your or your dependents’ other coverage ends (or after the employer stops contributing toward other coverage).

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New Dependent. In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. You must request enrollment within 31 days following the event.

Medicaid and CHIP Coverage Eligibility. You also have a special enrollment opportunity if you become eligible, or cease to be eligible, for Medicaid or Children’s Health Insurance Program (CHIP) coverage and/or for the Medicaid or CHIP premium assistance program. You must request enrollment within 60 days following the date you become eligible or cease to become eligible for such a program.

Coverage for Domestic PartnersImportant Information about Coverage for Domestic Partners and Their ChildrenBoth you and your partner must sign an Affidavit of Domestic Partnership stating that you meet the criteria shown below, and a notary public must witness your signatures. If you reside in a state that permits domestic partners to register their relationship, a copy of that registration (similar to a marriage certificate) can be used in place of an affidavit.

Qualifying domestic partners must meet the following requirements:

• You are each other’s sole domestic partner and intend to remain so indefinitely.

• Neither of you has a spouse or former domestic partner who is currently utilizing company health insurance benefits (except under COBRA).

• It has been at least 12 months since either of you has filed a statement of termination of a previous Affidavit of Domestic Partnership.

• You are each of legal age and mentally competent to consent to a legal contract.

• You are not related by blood to a degree of closeness that would prohibit legal marriage in the state in which you both legally reside.

• You have resided together in the same residence for at least the last 12 full consecutive months and intend to do so indefinitely.

Eligible dependent children of your domestic partner qualify for coverage if they:

• Are unmarried

• Are primarily dependent on you or your partner for financial support

• Meet the age requirements of the plan, and

• May be claimed by you or your partner as a dependent as defined in IRC Section 152.

Note: If you cover a domestic partner (or his/her child[ren]), see the special tax rules below.

Tax Treatment of Coverage for Domestic PartnersIf you cover your domestic partner (or his/her children), federal law requires the company to treat the value of their benefits differently for tax purposes. This may affect you in three ways:

• You must pay for coverage for a domestic partner with after-tax dollars. You pay for your own coverage and coverage for your tax dependents with before-tax dollars.

• If you enroll in the medical Consumer Choice Plan with Health Savings Account (HSA) or a Flexible Spending Account (FSA), you cannot use your account to pay for expenses for your domestic partner or his/her children, unless they qualify as tax dependents under IRC Section 152.

The contributions the company pays for coverage for your domestic partner and/or your domestic partner’s dependent child(ren) are considered taxable (imputed) income, and you will pay income tax on the company’s contributions toward the cost of coverage for these dependents. You will see this additional amount appear on your pay stub each pay period and on your W-2 at year-end.

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Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from the company, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed on the following pages, 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, 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, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.

If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under the company’s plan, the company must allow you to enroll in our plan if you aren’t 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 our plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).

If you live in one of the following states, you may be eligible for assistance paying the company’s health plan premiums. The following list of states is current as of January 31, 2020. Contact your State for more information on eligibility.

ALABAMA – Medicaid

Website: http://myalhipp.com/Phone: 1-855-692-5447

ALASKA – Medicaid The AK Health Insurance Premium Payment ProgramWebsite: http://myakhipp.com/ Phone: 1-866-251-4861Email: [email protected] Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx

ARKANSAS – Medicaid

Website: http://myarhipp.com/Phone: 1-855-MyARHIPP (855-692-7447)

CALIFORNIA – Medicaid

Website: https://www.dhcs.ca.gov/services/Pages/TPLRD_CAU_cont.aspx Phone: 1-800-541-5555

COLORADO – Health First Colorado (Colorado’s Medicaid Program) & Child Health Plan Plus (CHP+)

Health First Colorado Website: https://www.healthfirstcolorado.com/ Health First Colorado Member Contact Center: 1-800-221-3943/ State Relay 711CHP+: https://www.colorado.gov/ pacific/hcpf/child-health-plan-plus CHP+ Customer Service: 1-800-359-1991/ State Relay 711

FLORIDA – Medicaid Website: http://flmedicaidtplrecovery.com/hipp/Phone: 1-877-357-3268

GEORGIA – Medicaid Website: https://medicaid.georgia.gov/health-insurance-premium-payment-program-hippPhone: 1-678-564-1162 ext. 2131

INDIANA – Medicaid Healthy Indiana Plan for low-income adults 19-64Website: http://www.in.gov/fssa/hip/Phone: 1-877-438-4479All other MedicaidWebsite: http://www.indianamedicaid.comPhone: 1-800-403-0864

IOWA – Medicaid and CHIP (Hawki)

Medicaid Website: https://dhs.iowa.gov/ime/membersMedicaid Phone: 1-800-338-8366Hawki Website: http://dhs.iowa.gov/Hawki Hawki Phone: 1-800-257-8563

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http://www.healthcare.gov

http://www.insurekidsnow.gov

http://www.askebsa.dol.gov

http://myalhipp.com

http://myakhipp.com


http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx

http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx

http://myarhipp.com

https://www.dhcs.ca.gov/services/Pages/TPLRD_CAU_cont.aspx

https://www.dhcs.ca.gov/services/Pages/TPLRD_CAU_cont.aspx

https://www.healthfirstcolorado.com/

https://www.colorado.gov/pacific/hcpf/child-health-plan-plus

https://www.colorado.gov/pacific/hcpf/child-health-plan-plus

http://flmedicaidtplrecovery.com/hipp

http://flmedicaidtplrecovery.com/hipp

https://medicaid.georgia.gov/health-insurance-premium-payment-program-hipp



http://www.in.gov/fssa/hip/

http://www.indianamedicaid.com

https://dhs.iowa.gov/ime/members

https://dhs.iowa.gov/ime/members

http://dhs.iowa.gov/Hawki

KANSAS – Medicaid Website: http://www.kdheks.gov/hcf/default.htmPhone: 1-800-792-4884

KENTUCKY – Medicaid

Kentucky Integrated Health Insurance Premium Payment Program (KI-HIPP) Website: https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspxPhone: 1-855-459-6328Email: [email protected] Website: https://kidshealth.ky.gov/Pages/index.aspx Phone: 1-877-524-4718Kentucky Medicaid Website: https://chfs.ky.gov

LOUISIANA – Medicaid

Website: www.medicaid.la.gov or www.ldh.la.gov/lahippPhone: 1-888-342-6207 (Medicaid hotline) or 1-855-618-5488 (LaHIPP)

MAINE – Medicaid

Website: http://www.maine.gov/dhhs/ofi/public-assistance/index.htmlPhone: 1-800-442-6003TTY: Maine relay 711

MASSACHUSETTS – Medicaid and CHIP

Website: http://www.mass.gov/eohhs/gov/departments/masshealthPhone: 1-800-862-4840

MINNESOTA – Medicaid

Website: https://mn.gov/dhs/people-we-serve/children-and-families/health-care/health-care-programs/programs-and-services/medical-assistance.jsp (Under ELIGIBILITY tab, see “what if I have other health insurance?”)Phone: 1-800-657-3739

MISSOURI – Medicaid

Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htmPhone: 1-573-751-2005

MONTANA – Medicaid

Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPPPhone: 1-800-694-3084

NEBRASKA – Medicaid

Website: http://www.ACCESSNebraska.ne.gov/ Phone: 1-855-632-7633 Lincoln: 1-402-473-7000Omaha: 1-402-595-1178

NEVADA – Medicaid

Medicaid Website: http://dhcfp.nv.govMedicaid Phone: 1-800-992-0900

NEW HAMPSHIRE – Medicaid

Website: https://www.dhhs.nh.gov/oii/hipp.htm Phone: 1-603-271-5218Toll-free number for the HIPP program: 1-800-852-3345 ext. 5218

NEW JERSEY – Medicaid and CHIP

Medicaid Website: http://www.state.nj.us/humanservices/dmahs/clients/medicaid/Medicaid Phone: 1-609-631-2392CHIP Website: http://www.njfamilycare.org/index.htmlCHIP 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: https://medicaid.ncdhhs.gov/Phone: 1-919-855-4100

NORTH DAKOTA – Medicaid

Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/Phone: 1-844-854-4825

OKLAHOMA – Medicaid and CHIP

Website: http://www.insureoklahoma.orgPhone: 1-888-365-3742

OREGON – Medicaid

Website: http://healthcare.oregon.gov/Pages/index.aspxhttp://www.oregonhealthcare.gov/index-es.htmlPhone: 1-800-699-9075

PENNSYLVANIA – Medicaid

Website: https://www.dhs.pa.gov/providers/Providers/Pages/Medical/HIPP-Program.aspxPhone: 1-800-692-7462

RHODE ISLAND – Medicaid

Website: http://www.eohhs.ri.gov/Phone: 1-855-697-4347, or 1-401-462-0311 (Direct RIte Share Line)

SOUTH CAROLINA – Medicaid

Website: http://www.scdhhs.govPhone: 1-888-549-0820

SOUTH DAKOTA - Medicaid

Website: http://dss.sd.govPhone: 1-888-828-0059

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http://www.kdheks.gov/hcf/default.htm

https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspx



mailto:KIHIPP.PROGRAM%40ky.gov?subject=

https://kidshealth.ky.gov/Pages/index.aspx

https://kidshealth.ky.gov/Pages/index.aspx

https://chfs.ky.gov

http://www.medicaid.la.gov

http://www.ldh.la.gov/lahipp

http://www.maine.gov/dhhs/ofi/public-assistance/index.html

http://www.maine.gov/dhhs/ofi/public-assistance/index.html

http://www.mass.gov/eohhs/gov/departments/masshealth

http://www.mass.gov/eohhs/gov/departments/masshealth

https://mn.gov/dhs/people-we-serve/children-and-families/health-care/health-care-programs/programs-and-services/medical-assistance.jsp




http://www.dss.mo.gov/mhd/participants/pages/hipp.htm

http://www.dss.mo.gov/mhd/participants/pages/hipp.htm

http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP

http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP

http://www.ACCESSNebraska.ne.gov/

http://dhcfp.nv.gov

https://www.dhhs.nh.gov/oii/hipp.htm

https://www.dhhs.nh.gov/oii/hipp.htm

http://www.state.nj.us/humanservices/dmahs/clients/medicaid

http://www.state.nj.us/humanservices/dmahs/clients/medicaid

http://www.njfamilycare.org/index.html

http://www.njfamilycare.org/index.html

http://www.nyhealth.gov/health_care/medicaid

http://www.nyhealth.gov/health_care/medicaid

https://medicaid.ncdhhs.gov/

http://www.nd.gov/dhs/services/medicalserv/medicaid

http://www.nd.gov/dhs/services/medicalserv/medicaid

http://www.insureoklahoma.org

http://healthcare.oregon.gov/Pages/index.aspx

http://www.oregonhealthcare.gov/index-es.html

https://www.dhs.pa.gov/providers/Providers/Pages/Medical/HIPP-Program.aspx

https://www.dhs.pa.gov/providers/Providers/Pages/Medical/HIPP-Program.aspx

http://www.eohhs.ri.gov

http://www.scdhhs.gov

http://dss.sd.gov

TEXAS – Medicaid

Website: http://gethipptexas.com/Phone: 1-800-440-0493

UTAH – Medicaid and CHIP

Medicaid Website:https://medicaid.utah.gov/CHIP Website: http://health.utah.gov/chipPhone: 1-877-543-7669

VERMONT– Medicaid

Website: http://www.greenmountaincare.org/Phone: 1-800-250-8427

VIRGINIA – Medicaid and CHIP

Website: https://www.coverva.org/hipp/Medicaid Phone: 1-800-432-5924CHIP Phone: 1-855-242-8282

WASHINGTON – Medicaid

Website: https://www.hca.wa.gov/Phone: 1-800-562-3022

WEST VIRGINIA – Medicaid

Website: http://mywvhipp.com/Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)

WISCONSIN – Medicaid and CHIP

Website: https://www.dhs.wisconsin.gov/publications/p1/p10095.pdfPhone: 1-800-362-3002

WYOMING – Medicaid

Website: https://wyequalitycare.acs-inc.com/Phone: 1-307-777-7531

To see if any other states have added a premium assistance program since January 31, 2020, or for more information on special enrollment rights, contact either:

U.S. DEPARTMENT OF LABOR – Employee Benefits Security Administration

Website: www.dol.gov/agencies/ebsaPhone: 1-866-444-EBSA (3272)

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES –Centers for Medicare & Medicaid Services

Website: www.cms.hhs.govPhone: 1-877-267-2323, Menu Option 4, Ext. 61565

OMB Control Number 1210-0137

Qualified Medical Child Support Orders (QMCSOs)The company will honor a qualified medical child support order (QMCSO) relating to provisions for child support, alimony payments, or marital property rights that may require you to provide medical coverage to an eligible child. If the company receives such an order, you will be notified of how it will be handled with respect to your benefits.

Patient ProtectionThe company medical plan options generally allow, but do not require, the designation of a primary care provider. You have the right to designate any primary care provider who participates in our network and who is available to accept you or your family members. For information on how to select a primary care provider, and for a list of the participating primary care providers, contact your medical plan administrator.

For children, you may designate a pediatrician as the primary care provider.

You do not need prior authorization under the plan or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in our network who specializes in obstetrics or gynecology. The health care professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan, or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, contact your medical plan administrator.

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http://gethipptexas.com

https://medicaid.utah.gov/

http://health.utah.gov/chip

http://www.greenmountaincare.org

https://www.coverva.org/hipp/

https://www.hca.wa.gov/

http://mywvhipp.com/

https://www.dhs.wisconsin.gov/publications/p1/p10095.pdf

https://www.dhs.wisconsin.gov/publications/p1/p10095.pdf

https://wyequalitycare.acs-inc.com/

http://www.dol.gov/agencies/ebsa

http://www.cms.hhs.gov

Important Notice from the Company About Your Prescription Drug Coverage and Medicare (Creditable Coverage Notice)

Note: The following information about Medicare prescription drug benefits will not apply to most active employees. However, because it is difficult or impossible to determine whether or not you and/or your covered dependents are or soon will be eligible for Medicare prescription drug coverage, we provide this legally required notice to all active employees.

Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with the company and about options for people with Medicare under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.

There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:

1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare 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. The company has determined that the prescription drug coverage offered by the Benefits4Me Program (Core Plan,

Buy-Up Plan, Consumer Choice Plan, Kaiser HMO Plan) is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because the company’s coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.

When Can You Join a Medicare Drug Plan? You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15 to December 7.

However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two-month Special Enrollment Period (SEP) to join a Medicare drug plan.

What Happens to Your Current Coverage If You Decide to Join a Medicare Drug Plan? If you decide to join a Medicare drug plan, your current Benefits4Me coverage may be affected. For more information about how your current prescription drug coverage may be affected (including whether you can enroll in both company Benefits4Me coverage and Medicare coverage, and if so, how the two coverages coordinate with each other), please see the summary plan description (SPD), available from the benefits enrollment website, benefits4meenroll.com.

If you do decide to join a Medicare drug plan and drop your current company coverage, be aware that you and your dependents will be able to get this coverage back during a future benefits annual enrollment period, or if you have a change in status that permits reenrollment during the year. Of course, you also must remain an active employee.

When Will You Pay a Higher Premium (Penalty) to Join a Medicare Drug Plan? You should also know that if you drop or lose your current company coverage and don’t join a Medicare drug plan within

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63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later.

If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.

For More Information About This Notice or Your Current Prescription Drug Coverage… For further information call the Benefits4Me Program Service Center at 1-844-279-7894. Note: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if your coverage through the company changes. You also may request a copy of this notice at any time.

For More Information About Your Options Under Medicare Prescription Drug Coverage… More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans.

For more information about Medicare prescription drug coverage:

• Visit www.medicare.gov.

• Call your State Health Insurance Assistance Program (see the inside back cover of 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.

If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213

(TTY 1-800-325-0778).

Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug

plans, you may be required to provide a copy of this notice when you join to show whether you have maintained creditable coverage and, therefore,

whether you are required to pay a higher premium (a penalty).

Date: January 1 to December 31, 2020

Name of Entity/Sender: EMD Millipore Corporation

Contact—Position/Office: Benefits4Me Program Service Center

Address: Benefits4Me Program Service Center 400 Summit Drive Burlington, MA 01803

Phone Number: 1-844-279-7894

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http://www.medicare.gov

http://www.socialsecurity.gov

The Women’s Health and Cancer Rights Act of 1998The Women’s Health and Cancer Rights Act of 1998 requires that we provide the following information every year. If a participant or beneficiary is receiving benefits under a group health plan in connection with a mastectomy and elects breast reconstruction, coverage under the plan will be provided in a manner determined in consultation with the attending physician and patient for:

• All stages of reconstruction of the breast on which the mastectomy was performed;

• Surgery and reconstruction of the other breast to provide a symmetrical appearance; and

• Prostheses and treatment of physical complications at all stages of the mastectomy, including lymphedemas.

In accordance with the Act, coverage of the breast reconstruction benefits will be subject only to deductibles and coinsurance limits consistent with those established for other benefits under the plan.

Newborns’ and Mothers’ Health Protection Act of 1996 (NMHPA)Group health plans and health insurance issuers generally may not, under the Newborns’ and Mothers’ Health Protection Act (NMHPA), restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a Cesarean section. However, federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours

as applicable). In any case, plans and issuers may not, under federal law, require that a provider obtain authorization from the plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).

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