SPD Summary Plan Description
The
benefits plan
Flexible
Y
OURH
EALTHC
AREA
DVANTAGETable of
Contents
Overview of the Plan . . . 1
Eligibility . . . 4
Enrollment . . . 8
Life Events . . . 9
Medical . . . 17
Dental . . . 60
Vision . . . 74
Life Insurance and AD&D . . . 77
Spending Accounts . . . 84
Signature LegalCare . . . 91
Adoption Assistance. . . 93
LifeWorks . . . 95
Personal Lines Insurance. . . 96
Long-Term Care Insurance. . . 98
Cancer Expense Insurance . . . 101
Income Protection Plan . . . 103
If a Claim Is Denied . . . 114
Continuation of Coverage Under COBRA . . . 116
Plan Administration and ERISA Information . . . 119
Who To Call . . . Back Cover
Concern for the security and well being of you and your family is the cornerstone of our benefits philosophy. We regard our benefits expenditures as an investment in your health and security. The Flexible Benefits Plan (the Plan) is designed to ensure that you receive value for the benefit dollars spent. The Plan is part of your total compensation package.
The Plan offers you a variety of benefit opportunities, allowing you to customize your benefits package to meet your own unique needs. Because your needs will change over time, you can select new benefits annually.
WHAT BENEFITS ARE INCLUDED IN THE PLAN?
The following benefits are part of the Flexible Benefits Plan and are described in this summary plan description booklet:
• medical, including prescription drug coverage and mental health/substance abuse treatment
• dental
• vision
• employee, spouse’s and children’s basic life insurance*
• employee, spouse’s and children’s supplemental life insurance*
• employee basic accidental death and dismemberment (AD&D) insurance
• employee and family supplemental AD&D insurance
• health care spending account (HCSA)
• child/elder care spending account (C/ECSA)
• cancer expense insurance*
• legal*
• adoption assistance*
• personal lines insurance*
• long-term care*
Additional important information about your coverage is described in your Insert. Keep your Insert with this booklet for reference.
*Although these benefits are described in this booklet and are part of the Flexible Benefits Plan, they are not intended to be nor should they be construed to be part of the pre-tax cafeteria plan.
HOW THE PLAN WORKS
Each year, the Company will decide how much it will contribute toward your benefit costs. This dollar amount is provided as Flex Credits and is shown on your Enroll- ment Worksheet.
You may use your Flex Credits to buy the benefits you want. The prices for each of the options are shown on your Enrollment Worksheet. If your choices cost less than your Flex Credits, you get the excess credits back as additional taxable income in each paycheck, prorated throughout the year.
If your choices cost more than your Flex Credits, you pay the extra through payroll deductions.
You can change your benefit choices each year during the annual enrollment period.
The benefits you select at that time will
Overview of the Plan
The only time that you can change your benefit selections during the year is if you have a change in status, such as marriage, birth of a baby or adoption, or a significant change in your work hours that affects benefits eligibility of you, your spouse, or your dependents. See the Life Events section on page 9 for more information on changes in status.
LEVELS OF COVERAGE Medical, Dental and Vision
If you enroll for medical, dental or vision coverage, you’ll be asked to choose one of the following levels of coverage:
• you only
• you plus spouse
• you plus children
• you plus family
You may also choose to waive coverage altogether. In order to receive credits, if applicable, you must certify that you have coverage elsewhere.
Cancer Expense Insurance and Legal If you enroll for legal coverage or cancer expense insurance, you can choose coverage for:
• you only
• you plus family
• single parent—for you and your children (for cancer expense insurance only)
TAXES AND YOUR BENEFITS One of the advantages of the Plan is that you can pay for many benefits on a before- tax basis. You’re able to do this because the Plan falls under Section 125 of the Internal Revenue Code, which states that employees do not pay tax on the amount they pay for certain benefits. (The tax advantages for the child/elder care spending account are similar, but based on Section 129 of the Code.)
The following chart shows which benefits are paid for before-tax and after-tax:
Before-Tax After-Tax
Medical Supplemental employee life insurance
Dental Supplemental spouse’s life insurance
Vision Supplemental children’s life insurance
Spending accounts Signature LegalCare
AD&D Personal lines
Cancer expense insurance* Long-term care
Long-term disability*
*Cancer expense insurance benefits may be taxable. See page 102 for more information and consult your tax advisor for details. Long-term disability benefits are taxable. See page 113 for more information on LTD and taxes.
PAYING FOR BENEFITS
Using your Flex Credits from the Company, you can purchase the level of benefits cover- age that best meets your needs. Credits are first used to purchase before-tax benefits—
medical, dental, vision, AD&D, spending accounts, cancer expense insurance and LTD. Leftover credits (if any) are then taxed, and you can use them to buy after-tax benefits or receive them as income.
There are two types of Flex Credits:
• Base Credits
• Wellness Pledge Credits
Base Credits
Base Credits represent the Company’s contribution to the cost of benefits. These amounts may change from year to year (as determined by the Company) and are shown on your Enrollment Worksheet.
The Base Credits available to you depend on the level of coverage you select for medical coverage (i.e., you only, you plus spouse, you plus children, or you plus family).
Wellness Pledge Credits
Wellness Pledge Credits are added to your Base Credits if you pledge that you will maintain a healthy lifestyle. See your Enrollment Worksheet for details.
You’re eligible to participate in the Flexible Benefits Plan if you meet the eligibility require- ments stated in the Insert under Eligibility.
ELIGIBLE DEPENDENTS It’s important that you know exactly what “dependent” means for each type of coverage.
Medical, Dental, Vision,
Life Insurance and Legal Coverage You may enroll your dependents for coverage if the dependent is:
• your legal spouse*
• an unmarried child who is:
1. a natural child; an adopted child (or a child placed for adoption);
a stepchild living with you at least half of the time; a stepchild who is a full-time student away from home, provided that the stepchild lived with you at least one half of the time in the year immediately prior to the year the stepchild became a full-time student away from home; or a child for whom you are the court- appointed custodian or guardian, and 2. under age 19 and financially dependent
on you, or up to age 25 if a full-time student and still financially dependent on you, or an incapacitated child (see below).
*If your spouse is your legal spouse under the common law of the state in which you reside, you will be required to provide evidence of the state’s law on common law marriages and evidence that you meet such legal requirements.
For the Flexible Benefits Plan, “placed for adoption” means that you have become legally obligated to support the soon-to-be- adopted child as a result of beginning the adoption process.
A student is considered full time if he or she meets the requirements of full-time status for the school he or she attends.
Your children’s (and eligible stepchildren’s) eligibility for coverage ends on December 31 of the calendar year in which they have their 19th birthday (or 25th birthday if full-time students). If your child graduates from or leaves school before the age limit is reached, coverage continues through December 31 of the year in which he or she graduates or leaves, or until he or she becomes covered through another plan, if earlier.
If your dependent loses eligibility for any other reason, for example marriage, coverage ends on the date of the event.
Incapacitated Children
A child who becomes incapacitated before age 19 (or before age 25 if a full-time student) and becomes covered by the Plan prior to age 19 (or before age 25 if a full-time student) is eligible to continue dependent coverage as long as the incapacity exists.
This continuing coverage is available as long as the child is unmarried and depends primarily on you for support and maintenance.
Eligibility
The child must have a mental or physical incapacity that renders the child unable to care for herself/himself, as determined by the network manager or claims admin- istrator. For this purpose, the incapacity needs to be verified before coverage can be continued. In addition, periodic medical documentation of the continuing incapacity is required as determined by the network manager or claims administrator.
Health Care Spending Account A dependent is a relative or anyone else whose primary residence is your home and who is a member of your household, as long as you provide more than one-half of the person’s support.
Child/Elder Care Spending Account A dependent includes any of the following if they reside with you:
• your children age 12 and under
• your spouse, if disabled
• any disabled relatives or household members who are dependent on you or your spouse for more than half of their support
When Spouses Are UPSers
If you and your spouse both work for the Company (or an affiliate) and are both eligible for the Flexible Benefits Plan, the following conditions apply:
• Each of you may select employee coverage under the medical, dental and vision options.
Only one of you may elect coverage for your eligible children.
• Each of you can be covered only once;
• If you select coverage for your spouse as your dependent, and your spouse elects no medical coverage, he or she will not receive any Flex Credits.
• You and your spouse may each elect employee life insurance as an employee.
Only one of you may select life insurance coverage for your eligible children.
If you are eligible for the Flexible Benefits Plan and your spouse is covered by a UPS- sponsored or UPS-affiliate plan other than the Flexible Benefits Plan, or a multi-employer health care plan to which UPS contributes:
• You may select any available level of coverage (you only, you plus spouse, you plus children, or you plus family).
• If you decide not to participate in the medical, dental and vision care options, your coverage may be provided by your spouse’s plan, based on that plan’s eligi- bility rules. If you do not select medical coverage, you will not receive any Flex Credits. However, you may select partic- ipation in the other Plan coverages: dental, vision, life insurance, AD&D, legal, spending accounts and personal lines insurance.
• If you enroll your spouse in the Flexible Benefits Plan, your spouse may also continue coverage through the UPS- sponsored plan.
QUALIFIED MEDICAL CHILD SUPPORT ORDERS (QMCSO) Medical, dental and vision coverage will comply with the terms of a Qualified Medical Child Support Order. A QMCSO is a judgment, decree or order (including
an administrative process established under state law which has the force and effect of law or a judgment from a state court directing a plan administrator to cover a child by a company’s group health plans.
Federal law requires that a QMCSO must meet certain form and content require- ments in order to be valid. When an order is received, each affected participant and each child covered by the order will be notified of the implementation procedure to determine if the order is valid. If you have any questions or would like to receive a copy of the UPS written procedure for determining whether a QMCSO is valid, please contact your Human Resources department.
WHEN COVERAGE STARTS
If you’re hired (or rehired in a new calendar year) or transferred into an eligible position, coverage based on the options you select begins on the first day of the first full pay period following 30 days from the date you’re:
• hired or rehired, or
• transferred to an eligible position.
Spending account coverage is effective on the latter of the date you enroll or the date your elected coverage begins.
If you’re rehired in the same calendar year in which you left the Company, the coverage you had prior to leaving the Company will automatically be reinstated effective on your return date.
For information about the special rules that govern the effective date of life insurance and AD&D coverage, see the Life Insurance and AD&D section on page 77.
TRANSITION COVERAGE
If you’re a newly hired full-time employee or a current employee moving to or from a Flex-eligible position, the Plan will provide you and your family with transition coverage while you’re making your selections or until you become eligible under another plan.
Newly Hired
If you’re a newly hired full-time employee, your transition coverage includes:
• Medical Option 3 (non-network)—for you plus family
• Vision Option 0—for you plus family
• basic life insurance—for you and your family
• basic AD&D—for you only
Aetna is the administrator of the transition medical benefits, including prescriptions.
Mail order prescription service is not available. Vision Service Plan administers vision services.
Current Employees
If you’re a current employee who is new to a position that is eligible for the Flexible Benefits Plan, your transition coverage includes:
• Medical Option 2 (non-network)—for you plus family
• Dental Option I—for you plus family
• Vision Option 0—for you plus family
• basic life insurance—for you and your family
• basic AD&D—for you only
Aetna is the administrator of these transition medical benefits, including prescriptions. Mail order prescription service is not available.
Vision Service Plan and Aetna administer vision and dental services, respectively.
If you’re a current employee transferring from the Flexible Benefits Plan to another plan sponsored or contributed to by the Company or its affiliates, certain coverages will be continued at no cost to you during the waiting period until you gain eligibility under the new plan. If there is a waiting period before benefits begin under the new plan, the following changes occur at the end of the payroll period in which the job change notification is received at the Benefits Service Center:
• your current medical, dental and vision options and family status levels continue
• basic employee life insurance and AD&D continue
• basic spouse’s and children’s life insurance continues
• all other coverage stops
• payroll deductions and/or credits stop
Transition coverage continues only during the waiting period. Transition coverage ends:
• for you, when you become eligible under the new plan
• for your dependents, when they become eligible under the new plan, unless there is no dependent coverage available under your new plan. Then your dependents’
coverage ends when you become eligible under the new plan (see page 116 for
information about COBRA coverage for your dependents)
• for you and your dependents if you termi- nate employment during the waiting period.
In some cases, you may have a longer waiting period for certain coverages, for instance dental or vision. As an example, if you or your dependents gain eligibility under the medical plan, but not the dental plan, your transition coverage for dental will continue until your new dental coverage begins. Once eligibility under your new dental plan is reached, however, dental coverage under transition coverage ends, even if a particular dental benefit, for instance orthodontia, is not available under the new dental plan or is available at a later eligibility date.
HOW LONG COVERAGE LASTS
In general, your Flexible Benefits Plan coverage continues as long as you meet the Plan’s eligibility requirements and make any required contributions. Your dependents’
coverage will continue as long as you remain eligible for the Plan and your dependents meet the eligibility requirements and make any required contributions. Please see the Life Events section on page 9 for additional details.
Enrollment occurs when you first become eligible for the Flexible Benefits Plan at any time during the year, and again each fall to allow you to make annual changes to your selections.
IF YOU DO NOT ENROLL
If you do not enroll for Plan coverage within your initial 45-day enrollment period, you’re automatically assigned the following default coverages:
• Medical—If “you plus family” credits are greater than “you plus family” Medical Option 3, you will be assigned Option 3.
If not, “No Coverage” is assigned. Excess credits are waived.
• Dental—no coverage
• Vision Option 0—exam only for you and your family
• basic life insurance—for you and your family
• basic AD&D—for you only
If you fail to enroll, no credits, if applicable, are payable.
At future annual enrollments, if you do not make new benefits selections you’ll receive the same coverage for you and your depend- ents that you had in the prior year, except in the following situations:
• You wish to continue participation in the spending accounts. You must annually elect participation in the spending accounts.
• Your dependent child is a full-time student age 19 or older. You must certify full- time students annually to maintain their coverage. If you do not certify student status, coverage will end on December 31 of that Plan year.
Opting Into the Network
If you live outside the network area (non- network) but feel the network is convenient to you, you may elect to participate in the network. This is called overriding into the network. You may override into the network at any time during the year by calling the Benefits Service Center at 1-800-353-9877.
However, you will be required to remain in the network for the rest of that Plan year.
You will automatically remain in the network from year to year unless you call at annual enrollment to change back to your non- network coverage.
Enrollment
Flexible benefit plans are regulated by the Internal Revenue Code, and changes during the year are restricted. However, the IRS realizes that certain life events do occur during the year that create the need for you to change your benefit choices.
You’re allowed to change certain benefit selections during the year depending on the type of change in status that occurs—as long as the change in selection is consistent with the change in status. As a general rule, you will only be allowed to make coverage changes if the event results in you, your spouse, or your dependents gaining or losing coverage eligibility under an employer- sponsored plan. For example, if you have a baby, you can change your level of medical coverage from you plus spouse to you plus family, but you may not decrease your life insurance.
60-DAY TIME LIMIT
You must call the Benefits Service Center (1-800-353-9877) within 60 days of the date of the event to request a change in coverage. You’re not allowed to change coverage after the 60-day period—until the next annual enrollment period.
EFFECTIVE DATE
OF REVISED COVERAGE
Revised coverage is effective retroactive to the date of the event, with the following exceptions:
• life insurance*
—For life insurance requiring evidence of insurability, the requested level of coverage is effective when approved.
Until then, the highest level of coverage (up to the level requested) not requiring evidence of insurability is effective.
—If you decrease your coverage for the cash accumulation fund, the effective date of that coverage change will be the first day of the next full pay period.
• spending accounts
—If you change your contribution to the spending accounts, the effective date of that coverage change is the date you notify the Benefits Service Center.
*In certain circumstances, you or your dependents’ coverage could be delayed. Please see page 77 for further details.
Life Events
SPENDING ACCOUNT CONTRIBUTIONS AND COVERAGE CHANGES
If you change your contribution amount (HCSA or C/ECSA) because of a status change, for instance a marriage or birth of a child, the following occurs:
• If you increase your account balance, the amount of the increase is prorated throughout the remaining calendar year.
For instance, if you increased your account from $1,200 to $1,500, then the additional
$300 would be prorated over the remain- ing pay periods and added to your current per-pay-period contribution amount.
• If you decrease your account balance, your new per-pay-period contribution is calculated by taking any contributions already deducted from your paycheck and subtracting those from your new annual amount, and dividing that difference by the remaining pay periods in the year.
For example, assume your original annual contribution was $1,200, and in May you decreased your annual contribution amount to $600. You would have paid for four months at $100 per month.
Subtract the $400 you have already paid from your new annual contribution amount of $600. Then divide the remaining
$200 by the number of remaining pay periods in the year. That would be your new per-pay-period contribution amount.
You may not decrease your account to an amount that is less than what you have already contributed. In the example above, for instance, you could not decrease your account to less than $400, because you have already contributed $400.
(Some changes in status, however, allow you to stop your account altogether.)
Event
Marriage
Divorce; Legal Separation;
Annulment
Birth;
Adoption or Placement for Adoption;
Child Gains Eligibility
Death of Spouse
Death of Child; Loss of Child’s Eligibility;
Termination of Adoption Proceedings
Dependent Loses Eligibility for Spending
Medical or Cancer Expense Insurance
If covered, change family status. If opted out, start coverage.
If now have outside coverage, can opt out.
If covered, change family status. If opted out, start coverage if lost under spouse’s plan.
If covered, increase family status. If opted out, start coverage
If covered, change family status. If opted out, start coverage if lost under spouse’s plan.
Decrease family status
No changes
Dental
Increase family status
If covered, change family status.
If opted out, start coverage if lost under spouse’s plan.
Increase family status
If covered, change family status.
If opted out, start coverage if lost under spouse’s plan.
Decrease family status
No changes
Vision
Increase family status
Change family status.
Increase coverage if lost under spouse’s plan.
Increase family status
Change family status.
Increase coverage if lost under spouse’s plan
Decrease family status
No changes
AD&D
Change family status
Change family status
Increase family status
Change family status
Decrease family status
No changes
Employee Life*
Increase coverage
Increase or decrease coverage
Increase coverage
Increase or decrease coverage
No changes
No changes
Spouse’s Life*
Add coverage
Drop coverage
Add coverage
Drop coverage
No changes
No changes
Children’s Life*
Add coverage
No changes
Add or increase coverage
No changes
Drop coverage
No changes
Legal
Start coverage;
change family status
Start or drop coverage;
change family status
Start coverage;
change family status
Start or drop coverage;
change family status
No changes
No changes
LTD
Start, stop or change coverage
Start, stop or change coverage
No changes
Start, stop or change coverage
No changes
No changes
Health Care
Start or increase contributions
No changes
Start or increase contributions
Stop or decrease contributions
Stop or decrease contributions
Stop or decrease contributions
Child/
Elder Care
Start, stop or change contributions
Start, stop or change contributions
Start, or increase contributions
Start, stop or change contributions
Stop or decrease contributions
Stop or decrease contributions
ALLOWABLE COVERAGE CHANGES MATRIX (Only the changes that are listed are allowed.)
Spending Accounts
Event
Loss of Outside Medical Coverage Eligibility with Other Employment
Change in Spouse’s Employment or Coverage;
Open Enrollment Period Differs from Employee’s
Loss of DMO access
Reduction in earnings due to leave of absence**
Change Full-time to Part-time
Change in Child/Elder Care Provider or Cost
Court- Ordered Coverage Change
Medical or Cancer Expense Insurance
If opted out, start coverage.
Increase family status if dependent lost coverage elsewhere
If covered, change family status.
If opted out, start coverage.
If now have outside coverage, can opt out.
No changes
No changes
No changes
No changes
As dictated by court order
Dental
If opted out, start coverage if lost elsewhere.
Increase family status if dependent lost coverage elsewhere
If covered, change family status.
If opted out, start coverage.
Change to Option 1 or 2
No changes
No changes
No changes
As dictated by court order
Vision
No changes
Change family status
No changes
No changes
No changes
No changes
As dictated by court order
AD&D
No changes
Change family status
No changes
No changes
No changes
No changes
As dictated by court order
Employee Life*
No changes
No changes
No changes
Decrease coverage
Decrease coverage
No changes
As dictated by court order
Spouse’s Life*
No changes
Add or increase coverage
No changes
Stop or decrease coverage
Stop or decrease coverage
No changes
As dictated by court order
Children’s Life*
No changes
No changes
No changes
Stop or decrease coverage
Stop or decrease coverage
No changes
As dictated by court order
Legal
No changes
Start, stop or change
No changes
Start or drop coverage;
change family status
Start or drop coverage;
change family status
No changes
As dictated by court order
LTD
No changes
Start, stop or change coverage
No changes
No changes
No changes
No changes
No changes
Health Care
Start or increase contributions if health coverage is lost due to employment change
Start or increase contributions (Employment)
No changes (Annual Enrollment, Coverage)
No changes
No changes
No changes
No changes
As dictated by court order
Child/
Elder Care
No changes
Start, stop or change contributions
No changes
Stop or decrease coverage
Stop or decrease coverage
Start, stop, or change contributions (limited to four changes per year)
As dictated by court order
ALLOWABLE COVERAGE CHANGES MATRIX (continued) (Only the changes that are listed are allowed.)
Spending Accounts
Note: You may start, stop, or change your contributions to the Cash Accumulation Fund at any time.
**See the Life Insurance section on page 77 for details about coverage maximums and evidence of insurability requirements.
**Except military leave.
What If…
If your employment status with the Company changes, that may affect Plan coverage for you and your eligible dependents. Additionally, your credits or deductions could be affected.
This section answers the question “What if…?” for the following circumstances.
…YOU LEAVE THE COMPANY?
If you leave the Company, coverage for you and your eligible dependents ends:
• for an employee paid weekly, on the last day of the pay period following the pay period in which you became ineligible.
• for an employee paid monthly or bi-monthly, on the last day of the pay period in which you became ineligible.
Under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), you and your eligible dependents can continue health coverage from the Flexible Benefits Plan for a period of time after your termi- nation date. (Please see the COBRA section on page 116 for more information.) Also, you may convert your, your spouse’s and your children’s life insurance to individual policies. You cannot convert AD&D coverage to an individual policy.
…YOU RETIRE?
If you retire from the Company and are eligible for retiree health coverage, your active coverage ends on the last day of the month following 30 days from your
retirement date. If you do not retire from the Company, coverage ends as indicated under
“If you leave the Company…”.
If you take early or normal retirement based on the provisions of the UPS Retirement Plan, you and your eligible dependents may be eligible for medical, dental and vision coverage from the Retired Employees’ Health Care Plan if you meet the eligibility rules of that Plan. You’ll receive a separate summary plan description of your retiree health coverage when you retire.
Under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), you and your eligible dependents can continue health coverage from the Flexible Benefits Plan for a period of time after your termina- tion or retirement date. (Please see the COBRA section on page 116 for more infor- mation.) Also, you may convert your, your spouse’s and your children’s life insurance to individual policies. You cannot convert AD&D coverage to an individual policy.
Life Insurance
Because your life insurance can be continued without evidence of insurability, you may wish to evaluate your coverage during the last annual enrollment prior to your retirement date. At the time of retirement, you are not allowed to increase your life insurance coverage.
It’s a good idea to review the Life Insurance and AD&D section in detail, paying particular attention to the section entitled “If You Leave…”.
…YOU DIE?
If you die while you’re covered by the Flexible Benefits Plan as an active employee, the Company will continue your eligible depend- ents’ coverage at no cost to your dependents through the last day of the 13th calendar month following the date of your death.
(For instance, if your death occurs on February 2, dependent coverage continues through March 31 of the following year.) Your covered dependents are automatically enrolled for this 13-month coverage period.
When this Company-paid coverage ends, your dependents may extend health care coverage in accordance with COBRA provisions for up to an additional 23 months, for a total of 36 months of coverage. The full cost of this coverage will be billed to your dependents according to the COBRA provisions of this Plan.
(Please see the COBRA section on page 116 for more information.) Spouse’s and children’s life insurance may be converted to individual policies.
Your dependents are only eligible for this 13-month extension of coverage if you and your dependents were covered by the Flexible Benefits Plan at the time of your death. For example, if you are on military leave, or if you opted out of medical coverage for you or your dependents, your dependents would not be eligible.
…YOU’RE LAID OFF?
If you’re laid off, your Flexible Benefits Plan coverage will continue until the last day of the month following the month in which your layoff begins. In addition, you can then
continue your medical, dental, vision and health care spending account coverage through COBRA. (Please see the COBRA section on page 116 for more information.)
You may convert your, your spouse’s and your children’s life insurance to individual policies.
…YOU HAVE JURY DUTY?
If you have jury duty, your coverage continues.
You will make contributions as if you were at work.
…YOU TAKE AN APPROVED LEAVE OF ABSENCE?
FMLA Leave
If you’re on an approved leave of absence as provided by the Family and Medical Leave Act of 1993 or Company policy, full Plan coverage for you and your dependents will continue for up to 12 weeks. You are responsible for your share of the costs and may be billed if your leave extends beyond 20 days. If you fail to make timely payment of this bill, your coverage will be terminated.
If you are billed, you must pay the billed amount; it will not be deducted from your paycheck when you return to work. If you do not receive a bill, deductions and credits will be applied to your first paycheck upon returning to work.
If your leave is approved for extension beyond 12 weeks, your coverage from the Plan will continue provided you pay the full cost of coverage (see “Personal Leave”
on page 15). You’ll need to notify the Company in writing that you want to extend your leave.
Military Leave
Except for military leaves of less than 31 days (or as otherwise required by federal law), benefits cease and therefore deductions and/or credits also cease. Refer to page 116 for details about continuing coverage under COBRA.
Personal Leave
You are responsible for the full cost of coverage during a personal leave, and may be billed if your leave extends beyond 20 days. If you fail to make timely payment of this bill, your coverage will be terminated.
If you are billed, you must pay the billed amount; it will not be deducted from your paycheck when you return to work.
Deductions/Credits While on Leave (except military leave of more than 31 days)
As long as you are receiving a paycheck from the Company, deductions or credits will continue to be applied to your paycheck while you are on leave. However, if you are not receiving a paycheck, deductions or credits that accumulate while you are on leave will be applied to your first paycheck when you return to work. If your leave extends beyond 20 days, you may be billed.
If you fail to make timely payment of this bill, your coverage will be terminated. If you are billed, you must pay the billed amount; it will not be deducted from your paycheck when you return to work.
To avoid an accumulation of deductions during your leave, you may request to be billed during your leave. Call the Benefits
Credits will not be issued during a leave, but will accumulate and be applied to your first paycheck upon return to work.
Spending Accounts and Leaves
• C/ECSA
Your C/ECSA contributions will stop during your leave until you return to work.
Upon return to work, your per-pay-period contribution amount will automatically be reinstated. Only eligible expenses incurred prior to your date of leave and after your return to work will be eligible for reimbursement.
• HCSA
During a leave, contributions to your HCSA may be continued on an after-tax basis (assuming you are on leave long enough to be billed for your share of the expenses), or stopped.
—If you choose to continue your contributions on an after-tax basis during your leave, any eligible expenses incurred during your leave will be eligible for reimbursement.
—If you stop your contributions during your leave, only expenses incurred prior to your leave or upon your return to work will be eligible. Expenses incurred during your leave will not be eligible for reimbursement. Upon return to work, your per-pay-period contribution amount will automatically be reinstated, (except for FMLA leaves, in which case you must notify the Benefits Service Center at 1-800-353-9877 to start your account again). Your annual contribution amount will be reduced by the amount not contributed during your leave.
For instance, if your annual contribution amount is $1,200, and you are on leave for three months and do not continue your contributions on an after-tax basis during your leave, your revised annual contribution amount will be reduced to $900 (reduced by $300—the amount you didn’t pay while on leave).
…YOU MOVE
If you change your address, call eHR at 1-800-UPS-1508. Your call will be transferred to the Employee Service Center and you will be prompted to update your new address.
…YOU BECOME DISABLED?
You and your dependents still have protection if you become disabled. A full description of your short-term and long-term disability coverage, including health care coverage, begins on page 103, Income Protection Plan.
In addition to the information in the Income Protection Plan section, please refer to “Deductions/Credits While on Leave” and “Spending Accounts and Leaves”
in this section, both of which also apply to a disability leave.
Depending on your move, several situations could then occur to your elected medical and/or dental coverage:
If you:
Stay in the same network area
Move to a new network (from another network or from a non-network area)
Move from a new network area to a non-network area
Move out of your HMO network area
Move into an HMO network area
Move outside the DMO area
Move into the DMO area
Then…
No changes will occur to your coverage. If necessary, you may call the network manager to change your PCP.
You will receive a letter from the Benefits Service Center asking you to select a PCP for each family member, and to select a coverage effective date (within 30 days of the date of the letter) for your new network. If you do not notify the Benefits Service Center within 30 days, you will automatically be moved to the new network without a PCP.
You will receive a letter from the Benefits Service Center asking you to select a coverage effective date (within 30 days of the date of the letter) for your non-network coverage. If you do not notify the Benefits Service Center within 30 days, you will automatically be moved to non-network coverage.
You will receive a letter from the Benefits Service Center asking you to make a new medical election (Option 1, 2, or 3, or a new HMO option if available).
You will receive a letter from the Benefits Service Center allowing you to elect coverage for the HMO. If you do not elect the HMO, you must keep your current medical option.
You will receive a letter from the Benefits Service Center asking you to elect a new dental option.
You will receive a letter from the Benefits Service Center allowing you to elect the DMO. If you do not elect the DMO, you must keep your current dental option.
In all cases, you are not allowed to change your coverage level (you only, you plus spouse, etc.) when you move.
If you are a shareowner, you will also want to notify First Union National Bank in Philadelphia of your new address (1-888-663-8325).
If you move out of the network area…
until the effective date of your new coverage at your new address, you must continue to coordinate your care through your old network PCP or you will receive out-of- network benefits.
Choice is a central part of the medical care provided through the Flexible Benefits Plan.
The choices you have are based on your home ZIP code. If you live:
• in a network area, you may elect a point of service (POS) option. With POS, you select a Primary Care Physician (PCP) who coordinates your medical care.
The costs to you are less when your services are provided and coordinated through your PCP.
• outside a network area (non-network), you have indemnity options to choose from. With an indemnity option, covered services and supplies may be provided by any doctor or health care provider you select.
• in an HMO network area, you may elect HMO coverage
You can also choose not to have medical coverage.
If you live outside the network area (non-network) but feel the network is convenient to you, you may elect to participate in the network. See page 8 for details.
In describing the medical benefits provided by the Flexible Benefits Plan, this section explains:
• how the POS options work
• how the indemnity options work
• your expenses
• expenses covered by the Plan
• prescription drug benefits
• Solutions—for mental health and substance abuse treatment
• how the HMO options work
A GUIDE TO POINT OF SERVICE BENEFITS What Is Point of Service (POS)?
In a point of service plan, in-network care is provided by Primary Care Physicians who provide or coordinate all of your care.
However, you also have benefits if you choose to use a non-network physician.
You can choose whether to go to a network provider or go outside the network each time you seek care; in other words, you choose the coverage you want at the point of service.
The network managers for the POS options are Aetna U.S. Healthcare, Blue Cross/Blue Shield, CIGNA or United HealthCare, depending on where you live.
Medical
What Is a Network?
A network is a group of doctors, hospitals and other health care providers who have agreed to provide their services to partici- pants at contracted rates. When services are provided in-network:
• coverage is provided at a higher level for most eligible charges
• preventive care is covered
• no annual deductible must be met
• in-network care is always within reasonable and customary limits
• your care is coordinated through your Primary Care Physician
• you usually don’t have to file claim forms
If you go out-of-network for care:
• you pay a higher percentage of eligible charges
• you pay an annual deductible
• you are responsible for precertifying all hospitalizations
• preventive care is not usually covered
• you file claim forms
• you are responsible for charges above reasonable and customary limits
• you are responsible for ensuring that care is medically necessary
YOUR PRIMARY CARE PHYSICIAN (PCP)
When you use the network your Primary Care Physician will provide most of your care, refer you to a specialist when neces- sary and coordinate any hospital services you need.
PCPs are general or family practitioners, internists and pediatricians. You must choose a PCP for each covered family member, but you can choose a different PCP for each.
You must use your PCP to receive in-network benefits. If you go to a net- work doctor or hospital without your PCP’s referral, your expenses will be paid on an out-of-network basis.
There are five exceptions:
• Women do not need a referral from the PCP to visit a network obstetrician or gynecologist for OB/GYN-related care.
• Students away at school may receive non-preventive care without a referral from their PCP (see “Special Situations”
on page 20).
• Solutions can be contacted directly by you or your covered dependents.
• Emergency care as described in
“Emergency Treatment” on page 25.
• Selected network specialists in certain locations. Contact Member Services for details.
Selecting Your PCP
You select your PCP from your network manager’s provider directory when you first enroll. A provider directory is included with your enrollment materials. Or you can call Member Services to learn more about a particular PCP.
Network manager means the company that establishes and maintains the network for the managed care options.
The network manager is also responsible for processing claims for in- and out-of-network treatment.
A PCP must meet strict eligibility standards—
established and maintained by the network manager—before admission to the network.
For example, a PCP generally:
• has an appropriate professional degree and current, unrestricted state license
• is board certified or board eligible
• has adequate malpractice insurance
• has 24-hour office coverage
• has sufficient office hours to meet patient demand
• has admitting privileges to at least one network hospital
Other providers in the network—like hospitals, labs and X-ray facilities—are also selected by the network manager based on reputation in the community, geographic location, efficiency in providing medical service, the quality of those services, and willingness to adhere to the network manager’s guidelines and to provide appropriate, affordable care.
The network manager regularly reviews all providers to make sure they continue to meet their standards.
Changing your PCP
You can change your PCP by calling Member Services, which will send you a new medical ID card. Certain network managers may have a waiting period for changing your PCP. Call Member Services for details.
If Your PCP Leaves the Network Some doctors will occasionally be added to the network and some doctors will occasionally leave the network. If your PCP leaves the network, your network manager will notify you and ask you to select another PCP. Be sure to call Member Services with your new PCP selection prior to your first visit to the new PCP.
REFERRAL TO A SPECIALIST When your PCP refers you to a network specialist, you receive in-network benefits for covered services. Because you may choose at any time to seek care outside the network, your PCP’s referral to a network specialist notifies the network manager that your visit to the specialist has been authorized, and to pay your eligible claims in-network. Without the referral, your claims will be paid out-of-network, even if the specialist or hospital is a network provider.
Usually, you will receive authorization for a prescribed number of visits to a specialist within a specific time for a specific course of treatment. Make sure you and your specialist know how many visits have been authorized.
Your PCP is responsible for coordinating the care you receive from a network specialist.
The network manager follows the same credentialing process for network specialists as for PCPs. In addition, the specialist must complete an approved residency program and be board certified or board eligible in her/his specialty area.
Provider Directories You should have received a provider directory in your first enrollment kit. If you would like to access the most current list of doctors or dentists, however, log on to Your Benefits Resources and look under Other Sites for a full list of carriers.
If you would like a hard copy mailed to your home free of charge, call 1-800-353-9877.
Web addresses are also listed on the back of this booklet.
Referral to an Out-of-Network Provider In the rare instance that you need to see a specialist who is not in the network, your PCP can request the network manager’s approval of the referral. If the request is approved, in-network benefits will be paid. Except for emergencies, and urgent care when traveling away from your network area, the network manager must approve the use of out-of-network providers and facilities in advance, or out-of-network benefits will apply.
Women Can Self-Refer to Network OB/GYN
Women do not need a PCP referral to visit a network obstetrician or gynecologist for OB/GYN-related care. However, OB/GYN providers may not be selected as primary care physicians.
If you go to a non-network OB/GYN for your routine check-up, only the labo- ratory fees are covered. The office visit itself is not covered.
SPECIAL SITUATIONS
• If you’re traveling and need urgent medical care when you’re away from home, call your PCP to discuss treatment. If your doctor recommends that you be treated where you are, your expenses will be paid at the in-network level provided they are otherwise covered by the Plan. If you can’t contact your PCP, get the treatment you think you need. If you call your PCP within 48 hours, you’ll receive in-network benefits for the covered services. However, because treatment was provided out-of- network, you’ll have to file a claim form.
• If your eligible dependent child attends school away from home, select a PCP for your child in your home network. The PCP will provide and coordinate all care when your child is at home.
When your child is at school, non-preventive care is covered in-network without a referral from the PCP, provided it is other- wise covered by the Plan. It is still a good idea to keep your child’s PCP informed of any care received while away at school, so the PCP has a complete medical history on your child. Preventive care is only covered if provided by your child’s PCP.
• If you have eligible dependent children or an eligible spouse who permanently lives outside your network area (non- resident dependents), their covered expenses will be paid as in-network benefits, even though services are provided out-of-network, provided they are otherwise covered by the Plan.
In this situation, you’re responsible for ensuring that the services are medically necessary; non-medically necessary treatment is not covered. In addition, you’ll have to file claim forms to be reimbursed. You should not select a Primary Care Physician for these non- resident dependents. (See “A Guide to Indemnity Benefits” following.)
To designate your dependent children or eligible spouse as non-resident depend- ents, call the Benefits Service Center at 1-800-353-9877.
MEMBER SERVICES
Member Services is your link to network care. You can call a Member Services representative to:
• ask questions about a network physician’s credentials
• ask questions about your benefits
• change your PCP
• obtain information about a network provider or service
• replace an ID card
Your medical ID card will show a toll-free number for Member Services or you can refer to the back page of this booklet.
A GUIDE TO
INDEMNITY BENEFITS If you live outside the network area, you participate in an option that provides indemnity benefits. Aetna U.S. Healthcare administers all the Flexible Benefits Plan indemnity options.
With an indemnity option, covered services and supplies may be provided by any doctor or health care provider you select. Benefits are paid once the annual deductible is met.
All covered expenses must be:
• medically necessary as determined by the claims administrator,
• not investigational or experimental as deter- mined by the claims administrator, and
• within the reasonable and customary amount as determined by the claims administrator
Choosing a Doctor
In an indemnity option, you don’t choose a primary care physician. However, you may want to consider choosing a primary doctor for yourself and your dependents to work with you in coordinating your care and the selection of any necessary specialists.
By doing so, you’ll have a doctor with full knowledge of your health history.
WHAT MEDICAL EXPENSES YOU HAVE TO PAY UNDER OPTIONS 1, 2 AND 3
Medical Options 1, 2, and 3 pay a significant portion of the medical expenses you and your family may incur each year. You’ll gener- ally also pay a portion of the costs incurred.
Here’s a description of the types of charges for which you’ll be responsible if you elect Option 1, 2, or 3. For information about the amount of these charges, please refer to the
“Summary of Medical Options” at the end of this section.
If you elect an HMO option, your covered expenses could be different. Refer to your HMO kit for details about HMO coverage, or call your HMO’s Member Services.
Copayment
If you participate in a managed care option, you pay a flat dollar amount, called a copay- ment, for each in-network office visit. Your copayment amount will depend on the option you elect. The balance of the covered expense is paid in full by the Plan. The copayment is not included in determining if your costs have reached the out-of- pocket maximum.
Non-network area means those ZIP codes which do not have network access. If your home ZIP code is in a non-network area, your medical benefits are provided through one of the indemnity options, unless you contact the Benefits Service Center and request inclusion in a network option.
Claims administrator means the company that administers the indemnity options and is responsible for claims processing for those options.
A copayment also applies to network care for mental health or substance abuse treatment provided through Solutions, to prescription drugs purchased through your prescription benefits and to emergency room services.
Deductible
The deductible is the amount you must pay before certain benefits begin each year if you participate in:
• a POS option and receive out-of-network care, or
• an indemnity option
The amount of the deductible varies with the option you select. The individual deductible applies separately to each covered family member. However, if two or more family members’ expenses combine to reach the family deductible, then the deductible for each family member is considered to be met. This is true even if no single member reached the individual deductible.
Expenses credited toward the deductible are also credited toward the out-of-pocket maximum that applies each year. The deductible must be met each year—there is no carryover provision.
The following chart shows several examples of how a family deductible might be met.
Family Member Example 1 Example 2 Example 3
#1 $250 $250 $300
#2 $250 $125 $ 50
#3 — $125 $ 50
#4 — — $100
Family deductible $500 $500 $500
If you elect an HMO option, your covered expenses could be different. Refer to your HMO kit for details about HMO coverage, or call your HMO’s Member Services.
Coinsurance
Coinsurance is the percentage of covered expenses paid by the medical option you select. The remaining percentage you pay is credited toward your out-of-pocket maximum for that year.
Hospital Admission Fee
The hospital admission fee is the amount that you pay each time you’re admitted as a hospital inpatient. The hospital admis- sion fee applies to all options, but does not apply to treatment as an outpatient. If you are readmitted to a hospital for the same or a related condition within 30 days after your stay as an inpatient ends, you will not have to pay another hospital admission fee.
An additional hospital admission fee of $250 applies if a hospital admission is:
• not coordinated by your PCP, or
• not precertified by the network manager if care is provided out-of-network, or
• not precertified by the claims administrator if you participate in an indemnity option.
Out-of-Pocket Maximum
Each option limits the out-of-pocket expenses you pay. After you meet the out- of-pocket maximum for the option you select, 100 percent of most covered charges are paid for the rest of the calendar year.
This provision assures you that your annual out-of-pocket expenses for most covered charges will never be more than a certain amount. This feature can be particularly valuable if you or a dependent has a catastrophic illness or injury.
In calculating your out-of-pocket expenses, the dollar amounts included are the deductible, coinsurance amount (except mental health/substance abuse expenses) and the hospital admission fee.
If you are confined in the hospital from one calendar year to the next, your hospital charges for that stay will count toward the out-of-pocket maximum for the year that you are admitted, not the year you are discharged. This means that you do not have to start a new out-of-pocket maximum during your hospital stay. Physician and other charges related to the hospital stay begin a new out-of-pocket calculation on January 1.
Dollar amounts not included in determining the out-of-pocket maximum are copay- ments, prescription drug expenses, mental health/substance abuse treatment expenses, the additional hospital admission fee (for failure to precertify), any amounts over reasonable and customary and expenses that are not covered expenses by the Plan.
Lifetime Maximum Benefits
Up to $1 million in lifetime medical benefits can be paid for each person covered by the Plan. The maximum is a combined amount that is the total of benefits paid even if you switch from one option to another from year to year. The lifetime maximum includes benefits payable through the medical option you select, including benefits you receive from Solutions. However, benefits from PAID Prescriptions or the Mail Order Prescription Program do not count toward the $1 million lifetime maximum.
If you were a participant in the UPS Insurance Plan on March 31, 1994, the medical and dental benefits you received from that Plan count toward the $1 million lifetime maximum.
Each January 1, up to $1,000 in individual benefits paid during the preceding year or years will automatically be restored.
PREVENTIVE CARE
Since it’s often less painful and less expensive to keep people healthy than it is to treat them when they’re ill, the medical options cover preventive services. In determining how frequently or at what ages certain preventive care services are covered, the medical options generally follow the guidelines of medical consultants (for adult frequency and protocols), the American Cancer Society (for mammograms) or the American Academy of Pediatrics (for well- baby care).
For information about the preventive care guidelines, refer to the Physical Evaluation Guidelines on page 58. You may also call
Member Services or your claims adminis- trator at the toll-free number on your ID card or on the back page of this booklet.
The preventive benefits listed in the Guidelines represent suggested guidelines for physical evaluations. Actual care is deter- mined by the primary care doctor as patient needs warrant.
If you participate in a POS option, preventive care must be performed by your primary care physician (or a specialist when authorized). Women may see a network OB/GYN for an annual well-woman exam without a referral from the PCP.
INDIVIDUAL CASE MANAGEMENT While none of us likes to think about a complicated, long-term illness or serious accident, sometimes it can happen.
The Individual Case Management (ICM) program can offer you and your dependents help with:
• understanding treatment plans and alter- natives, monitoring claims payments, and
• evaluating alternative treatment facilities and options
Here are some medical conditions that may be appropriate for ICM:
• quadriplegia, paraplegia
• AIDS and certain associated symptoms
• brain injury, including traumatic brain injury
• newborn respiratory distress, newborn apnea
• spinal cord injury
• any complicated, chronic illness Reasonable and
Customary (R&C) All eligible medical expenses received out- of-network or in an indemnity option are subject to reasonable and customary (R&C) limits—charges within the normal range of fees in your geographic area for similar services and similar supplies, as determined by the net- work manager or claims administrator. If your doctor charges more than the R&C limit, you’re required to pay any amounts considered above the R&C limit.
These charges do not count toward your deductible or out-of- pocket maximum.
All benefits provided in-network through a managed care option are considered reason- able and customary.