A. H. Belo Health Care & Welfare Benefit Plan Summary Plan Description
A. H. Belo
Health Care & Welfare
Benefit Plan
Summary Plan Description
Effective January 1, 2020
Your Summary Plan Description
This document presents information about the health and welfare benefit programs provided by
A. H. Belo Corporation (sometimes referred to as A. H. Belo or the ¡°company¡± in this document) for its
eligible employees. Eligible employees of A. H. Belo and its participating subsidiaries and their family
members and beneficiaries are covered by these A. H. Belo plans.
This document is intended to provide easy-to-understand descriptions (Summary Plan Descriptions, or SPDs) of each benefit program provided by the
A. H. Belo health and welfare benefit plans. Neither these SPDs nor updated materials are contracts or assurances of compensation, continued
employment or benefits of any kind. If any summary of benefits differs from the official plan documents in any way, the official plan documents will
govern.
A. H. Belo reserves the right to modify or terminate any of its plans or programs described in the SPDs or booklets at its discretion. Only A. H. Belo is
authorized to change its respective plans. From time to time, you will receive updated information concerning plan changes.
The information contained here can also be accessed at . Citations within this text referring readers to the benefits Web site are directing
you to .
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Table of Contents
Benefits Overview ................................................................................................................................................................. 5
Your Benefits .......................................................................................................................................................................................... 5
Eligibility and Participation .................................................................................................................................................. 6
Eligibility Summary ................................................................................................................................................................................. 6
Who Is Eligible ........................................................................................................................................................................................ 6
Eligible Dependents ................................................................................................................................................................................ 7
Summary of Benefit Plans .................................................................................................................................................... 8
Enrolling for Benefits ............................................................................................................................................................ 9
Coverage Categories .............................................................................................................................................................................. 9
Your Initial Enrollment ........................................................................................................................................................................... 10
Annual Open Enrollment ....................................................................................................................................................................... 10
Paying for Your Benefits .................................................................................................................................................... 10
How Paying Before- or After-Tax Can Affect Changes ......................................................................................................................... 10
Changing Your Coverage ................................................................................................................................................... 11
Changes in Status ................................................................................................................................................................................ 11
Special Enrollment Rights ..................................................................................................................................................................... 12
Summary of Allowable Status Changes ................................................................................................................................................ 12
Mid-Year Enrollment and Re-Enrollment .............................................................................................................................................. 13
Changing Supplemental Coverages ..................................................................................................................................................... 13
Benefits While on Leave of Absence ................................................................................................................................ 15
Summary of Benefits While on Leave of Absence ................................................................................................................................ 15
Family and Medical Leave .................................................................................................................................................................... 15
Military Leave ........................................................................................................................................................................................ 16
Extended Medical Leave....................................................................................................................................................................... 17
Personal Leave ..................................................................................................................................................................................... 17
Medical ................................................................................................................................................................................. 19
When Coverage Begins and Ends ........................................................................................................................................................ 19
Dental ................................................................................................................................................................................... 19
When Coverage Begins and Ends ........................................................................................................................................................ 19
Vision .................................................................................................................................................................................... 20
When Coverage Begins and Ends ........................................................................................................................................................ 20
How the Vision Plan Works................................................................................................................................................................... 20
Benefits at a Glance.............................................................................................................................................................................. 21
Health Savings Account (HSA) .......................................................................................................................................... 21
Benefits at a Glance.............................................................................................................................................................................. 21
When Coverage Begins and Ends ........................................................................................................................................................ 22
How the HSA Works ............................................................................................................................................................................. 22
Flexible Spending Accounts .............................................................................................................................................. 23
Your FSA Options ................................................................................................................................................................................. 23
When Coverage Begins and Ends ........................................................................................................................................................ 23
How the Accounts Work........................................................................................................................................................................ 24
Health Care FSA ................................................................................................................................................................................... 25
Dependent Care FSA............................................................................................................................................................................ 27
Employee Assistance Program (EAP) .............................................................................................................................. 29
Participation .......................................................................................................................................................................................... 29
How the EAP Can Help......................................................................................................................................................................... 29
Additional EAP Services ....................................................................................................................................................................... 30
Continuation of Coverage .................................................................................................................................................. 30
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Overview ............................................................................................................................................................................................... 30
Your Eligibility for COBRA .................................................................................................................................................................... 30
Dependents¡¯ Eligibility for COBRA ........................................................................................................................................................ 31
Enrolling for COBRA ............................................................................................................................................................................. 31
Paying for Coverage ............................................................................................................................................................................. 32
Making Changes to COBRA Coverage ................................................................................................................................................. 32
When COBRA Coverage Ends ............................................................................................................................................................. 32
Questions?............................................................................................................................................................................................ 33
Filing Health Care Claims ................................................................................................................................................... 33
Medical and Dental Claims ................................................................................................................................................................... 33
Vision Claims ........................................................................................................................................................................................ 33
Flexible Spending Account Claims ....................................................................................................................................................... 33
Eligibility Claims .................................................................................................................................................................................... 34
Denied Claims ...................................................................................................................................................................................... 34
Other Legal Information ..................................................................................................................................................... 36
Consistency of Treatment ..................................................................................................................................................................... 36
Coordination of Benefits........................................................................................................................................................................ 37
Medicare or TRICARE and Your Company Plan .................................................................................................................................. 37
Liability for Payment.............................................................................................................................................................................. 38
Recovery of Overpayments .................................................................................................................................................................. 38
Life and Accident ................................................................................................................................................................ 38
When Coverage Begins and Ends ........................................................................................................................................................ 38
Life Insurance for You ........................................................................................................................................................................... 39
Travel Assistance Services ................................................................................................................................................................... 41
Dependent Life Insurance ..................................................................................................................................................................... 42
Voluntary Accidental Death and Disability (VADD) Insurance .............................................................................................................. 42
Long-Term Disability .......................................................................................................................................................... 44
Your Coverage ...................................................................................................................................................................................... 44
When Coverage Begins and Ends ........................................................................................................................................................ 44
Business Travel Accident Insurance ................................................................................................................................ 45
When Coverage Begins and Ends ........................................................................................................................................................ 45
How the Plan Works ............................................................................................................................................................................. 45
How Benefits Are Paid .......................................................................................................................................................................... 46
Accidental Death & Dismemberment Benefit ........................................................................................................................................ 47
Aggregate Benefit Limits ....................................................................................................................................................................... 47
Exclusions............................................................................................................................................................................................. 47
Filing Disability, Life and Accident Claims ....................................................................................................................... 48
Long-Term Disability Claims ................................................................................................................................................................. 48
Life Insurance and Personal Accident Claims ....................................................................................................................................... 48
Business Travel Accident Insurance Claims ......................................................................................................................................... 49
Eligibility Claims .................................................................................................................................................................................... 49
Denied Claims ...................................................................................................................................................................................... 49
Other Legal Information ........................................................................................................................................................................ 51
A. H. Belo Severance Plan.................................................................................................................................................. 52
Who Is Eligible ...................................................................................................................................................................................... 52
How the A. H. Belo Severance Plan Works .......................................................................................................................................... 52
When Are Severance Benefits Paid? .................................................................................................................................................... 53
Duration of the Plan .............................................................................................................................................................................. 54
Filing Severance Claims ....................................................................................................................................................................... 54
Appeals ................................................................................................................................................................................................. 54
Retiree Benefits ................................................................................................................................................................... 55
A. H. Belo Corporate and The Dallas Morning News ............................................................................................................................ 55
The Press-Enterprise Company Retirees ............................................................................................................................................. 55
The Providence Journal Company Retirees ......................................................................................................................................... 56
Group Auto and Home Insurance ...................................................................................................................................... 57
How the Program Works ....................................................................................................................................................................... 57
Applying for Coverage .......................................................................................................................................................................... 57
Paying for Coverage ............................................................................................................................................................................. 57
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If You Leave the Company ................................................................................................................................................................... 57
Group Legal ......................................................................................................................................................................... 58
Your Legal Plan .................................................................................................................................................................................... 58
When Coverage Begins and Ends ........................................................................................................................................................ 58
How the Plan Works ............................................................................................................................................................................. 58
Critical Illness Insurance .................................................................................................................................................... 59
MetLife Critical Illness Plan ................................................................................................................................................................... 59
Who Is Eligible ...................................................................................................................................................................................... 59
When Coverage Begins and Ends ........................................................................................................................................................ 60
HIPAA ................................................................................................................................................................................... 61
Protecting Your Health Information ....................................................................................................................................................... 61
Uses and Disclosures of Protected Health Information ......................................................................................................................... 61
Your Rights ........................................................................................................................................................................................... 63
Changes to This Notice / Effective Date ............................................................................................................................................... 64
Contact Information .............................................................................................................................................................................. 64
Legal and Administrative Information .............................................................................................................................. 65
Legal Information .................................................................................................................................................................................. 65
Your ERISA Rights ............................................................................................................................................................................... 65
Plan Amendments ................................................................................................................................................................................ 66
Discounts and Refunds ......................................................................................................................................................................... 66
If a Third Party Is Liable for Expenses .................................................................................................................................................. 66
Assignment of Benefits if You Divorce .................................................................................................................................................. 67
Misrepresentation or Omission of Information ...................................................................................................................................... 67
No Guarantee of Employment .............................................................................................................................................................. 67
Administrative Information .................................................................................................................................................................... 67
Glossary of Terms ............................................................................................................................................................... 71
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