2017 Benefits Guide

2017 Benefits

Guide

Take a Fresh Look at Your Benefits and Enroll

WELCOME TO OPEN ENROLLMENT 2017 ........................................................ 5

How to Enroll............................................................................................................................................................. 5

What¡¯s New for 2017 ................................................................................................................................................. 5

- Introducing Castlight! A Personalized Tool for Finding High-Quality, Affordable and

Convenient Medical Care ......................................................................................................................... 6

- Medical ..................................................................................................................................................... 6

- Flexible Spending Accounts (FSAs) ......................................................................................................... 6

- Wellbeing Program ................................................................................................................................... 6

Benefit Options at a Glance ..................................................................................................................................... 7

Medical Option Highlights ....................................................................................................................................... 8

- Choosing a Carrier ................................................................................................................................... 8

- Provider Networks .................................................................................................................................... 9

- Health Care Reform ................................................................................................................................. 9

- Choosing a Health Plan............................................................................................................................ 9

- Switching Between Plan HRA and Plan HSA ........................................................................................ 10

Dental Option Highlights ....................................................................................................................................... 10

Flexible Spending Accounts (FSAs) Highlights .................................................................................................. 10

Flex Vacation Highlights ........................................................................................................................................ 11

Benefits Eligibility................................................................................................................................................... 11

- Domestic Partner Definition.................................................................................................................... 12

How to Enroll........................................................................................................................................................... 12

- Enrollment Reminders ............................................................................................................................ 12

- If You Miss the Enrollment Deadline ...................................................................................................... 13

Paying for Coverage ............................................................................................................................................... 14

- Your Per-Pay Cost ................................................................................................................................. 15

- Pricing Structure for Medical Coverage ................................................................................................. 15

Tools to Help You Choose the Right Health Plan ............................................................................................... 15

Health and Wellbeing ............................................................................................................................................. 16

- Wellbeing Program ................................................................................................................................. 16

- Wellbeing Incentives .............................................................................................................................. 18

- Special Information if You Are Covered by the Kaiser, HMSA Hawaii or Aetna International

Health Plan ............................................................................................................................................. 19

- Manage Your Health through Doctor On Demand ................................................................................. 19

- Get Quality Care Fast with a CVS Health MinuteClinic? ....................................................................... 19

- 2017 IRS Limits Impacting HSA Incentives............................................................................................ 19

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CHANGING COVERAGE .................................................................................. 20

What Is a Qualified Life Event? ............................................................................................................................. 20

How to Report a Qualified Life Event Change ..................................................................................................... 20

What You Can Change ........................................................................................................................................... 21

Special Health Coverage Enrollment .................................................................................................................... 23

- When You Have Other Medical Coverage Available ............................................................................. 23

- Coordination of Medicare and BNY Mellon Medical Coverage .............................................................. 24

If You Leave BNY Mellon ....................................................................................................................................... 24

MEDICAL AND PRESCRIPTION DRUG ............................................................ 25

How the Plans Work ............................................................................................................................................... 26

- The Health Accounts .............................................................................................................................. 26

- You and BNY Mellon Share Costs ......................................................................................................... 27

- Cost of Coverage ................................................................................................................................... 28

- Precertification ........................................................................................................................................ 28

- Coverage Includes Mastectomy Benefits ............................................................................................... 28

- Healthy Pregnancy Programs ................................................................................................................ 29

- Aetna¡¯s Beginning Right Maternity Program .......................................................................................... 29

- UnitedHealthcare Maternity Support Program ....................................................................................... 29

- Infertility Services ................................................................................................................................... 30

- Autism Spectrum Disorder Services....................................................................................................... 30

- Applied Behavior Analysis Therapy........................................................................................................ 30

Comparing the Plans .............................................................................................................................................. 31

2017 Medical Contributions ................................................................................................................................... 33

Prescription Drug Benefits .................................................................................................................................... 35

- Find the Right Help for Serious or Chronic Health Conditions ............................................................... 37

Plan HRA (Health Reimbursement Account) ....................................................................................................... 38

- HRA Contributions .................................................................................................................................. 38

- How the HRA Works .............................................................................................................................. 39

- Plan HRA Details .................................................................................................................................... 40

Plan HSA (Health Savings Account) ..................................................................................................................... 41

- Health Savings Account (HSA) Contributions ........................................................................................ 41

- How the HSA Works ............................................................................................................................... 42

- Plan HSA Details .................................................................................................................................... 47

How the Health Accounts Compare...................................................................................................................... 49

- New Health Plan ID Card ....................................................................................................................... 51

Castlight: Make Informed Health Care Choices .................................................................................................. 51

Best Doctors: Get Help with Important Medical Decisions ................................................................................ 51

Illustrated Plan Comparisons ................................................................................................................................ 51

FLEXIBLE SPENDING ACCOUNTS .................................................................. 55

How FSAs Work ...................................................................................................................................................... 55

Health Care FSA Eligible Expenses ...................................................................................................................... 57

Dependent Care FSA Eligible Expenses .............................................................................................................. 58

Health Care FSA During a Leave of Absence ...................................................................................................... 58

Dependent Care FSA During a Leave of Absence .............................................................................................. 58

Important FSA Rules .............................................................................................................................................. 58

Should You Use the Dependent Care FSA or the Dependent Care Tax Credit? .............................................. 59

Limited Purpose FSA ............................................................................................................................................. 59

Things to Think About............................................................................................................................................ 59

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DENTAL AND VISION ...................................................................................... 60

Dental Coverage ..................................................................................................................................................... 60

- 2017 Dental Contributions ...................................................................................................................... 60

- MetLife Options ...................................................................................................................................... 60

- Aetna DMO ............................................................................................................................................. 62

- Things to Consider ................................................................................................................................. 64

Vision Coverage...................................................................................................................................................... 64

- 2017 Vision Contributions ...................................................................................................................... 64

- How the Plan Works ............................................................................................................................... 65

FINANCIAL PROTECTION ............................................................................... 67

Disability Coverage ................................................................................................................................................ 67

- Short-term Disability (STD) .................................................................................................................... 67

- Long-term Disability (LTD) ..................................................................................................................... 67

Life and Accident Coverage .................................................................................................................................. 68

- Coverage Amounts ................................................................................................................................. 68

- Life and Accident Coverage at a Glance ................................................................................................ 68

- Cost of Coverage ................................................................................................................................... 69

- Evidence of Insurability .......................................................................................................................... 69

- Employee Coverage ............................................................................................................................... 70

- Dependent Coverage ............................................................................................................................. 71

TIME OFF & PERSONAL .................................................................................. 72

Flex Vacation Purchase ......................................................................................................................................... 72

- How Flex Vacation Works ...................................................................................................................... 72

LEGAL NOTICES ............................................................................................. 73

Women¡¯s Health and Cancer Rights Act of 1998 (WHCRA) Notice ...................................................................73

Newborns¡¯ and Mothers¡¯ Notice ............................................................................................................................ 73

Military Leave Under the Uniformed Services Employment and Reemployment Rights Act

(USERRA) ................................................................................................................................................................ 73

Qualified Medical Child Support Orders .............................................................................................................. 74

Premium Assistance Under Medicaid and the Children¡¯s Health Insurance Program (CHIP) ....................... 74

Key Things to Know About the Affordable Care Act (ACA) ............................................................................... 76

Health Insurance Marketplace Coverage Options............................................................................................... 76

- PART A: General Information................................................................................................................. 76

- PART B: Information About Employer-Provided Health Coverage ........................................................ 77

Information Regarding Termination of Health Plan Coverage for Cause ......................................................... 77

Self-Insured Plans .................................................................................................................................................. 78

Medicare Prescription Drug Notice....................................................................................................................... 78

- BNY Mellon Creditable Coverage Plans ................................................................................................ 78

HIPAA Notice........................................................................................................................................................... 81

COBRA Rights Notice ¨C Health and Welfare Benefits ........................................................................................ 87

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