2019 Benefits Guide for Active Employees

2019 Benefits Guide for Active Employees

Make Informed Choices When You Enroll

Revised July 2019

WELCOME TO BNY MELLON .............................................................................. 5

ELIGIBILITY AND ENROLLMENT ....................................................................... 6

Benefits Eligibility.....................................................................................................................................................6

- Qualified Domestic Partner Definition ......................................................................................................6

Benefit Options at a Glance.....................................................................................................................................7 Enrollment .................................................................................................................................................................8

- How to Enroll ............................................................................................................................................8 - Your Path to a Successful Enrollment......................................................................................................9 - Choosing Your Health Plan ......................................................................................................................9 - Enrollment Reminders ..............................................................................................................................9 - If You Do Not Enroll by the Enrollment Deadline ...................................................................................10 - When Coverage Becomes Effective and Terminates ............................................................................10

Paying for Coverage...............................................................................................................................................10

- Your Per-Pay Cost..................................................................................................................................11 - Pricing Structure for Medical Coverage..................................................................................................11

When You Have Other Medical Coverage Available ...........................................................................................11

- Coordination of Medicare and BNY Mellon Medical Coverage ..............................................................12

If You Leave BNY Mellon........................................................................................................................................13

CHANGING COVERAGE .................................................................................... 14

What Is a Qualified Life Event? .............................................................................................................................14 How to Report a Qualified Life Event Change .....................................................................................................14 What You Can Change ...........................................................................................................................................15 Special Health Coverage Enrollment....................................................................................................................18

MEDICAL AND PRESCRIPTION DRUG ............................................................. 19

Prescription Drug Benefits ....................................................................................................................................22

- Find the Right Help for Complex or Chronic Health Conditions .............................................................26

2019 Medical Premiums .........................................................................................................................................27 About the HSA Plans ..............................................................................................................................................29

- Choosing a Carrier ................................................................................................................................29 - Precertification ........................................................................................................................................30 - Healthy Pregnancy Programs ................................................................................................................30 - Infertility Services ...................................................................................................................................32 - Autism Spectrum Disorder Services.......................................................................................................32 - Applied Behavior Analysis (ABA) Therapy .............................................................................................32 - UnitedHealthcare Spine and Joint Solution............................................................................................32 - Aetna Spine and Joint Institutes of Quality ............................................................................................33

The Health Savings Account .................................................................................................................................33

- Health Savings Account Contributions ...................................................................................................34 - How the Health Savings Account (HSA) Works.....................................................................................35 - Medicare and Your Health Savings Account..........................................................................................37 - How the Health Accounts Compare .......................................................................................................39

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Using Your HSA Plan During the Year ................................................................................................................. 41

- Meet Your Deductible............................................................................................................................. 41 - Know When Your Deductible Applies .................................................................................................... 41 - Understand Your Out-of-Pocket Maximum ............................................................................................ 42 - Prepare for Your Doctor Visit ................................................................................................................. 42 - Know What to Ask Your Doctor ............................................................................................................. 43 - Know What to Do After Your Visit .......................................................................................................... 44 - Obtain 100 Percent-Paid Preventive Care............................................................................................. 44 - Castlight: Make Informed Health Care Choices..................................................................................... 46 - Best Doctors: Get Help with Important Medical Decisions .................................................................... 46

FLEXIBLE SPENDING ACCOUNTS ................................................................... 47

How FSAs Work...................................................................................................................................................... 47 Health Care FSA Eligible Expenses ..................................................................................................................... 50 Dependent Care FSA Eligible Expenses.............................................................................................................. 50 Health Care FSA During a Leave of Absence...................................................................................................... 51 Dependent Care FSA During a Leave of Absence .............................................................................................. 51 Important FSA Rules.............................................................................................................................................. 51 Should You Use the Dependent Care FSA or the Dependent Care Tax Credit?.............................................. 51 Limited Purpose FSA ............................................................................................................................................. 51

DENTAL AND VISION ....................................................................................... 52

Dental Benefits ....................................................................................................................................................... 52

- MetLife Dental Options........................................................................................................................... 52 - Aetna DMO ............................................................................................................................................ 54 - 2019 Dental Premiums........................................................................................................................... 56 - Things to Consider ................................................................................................................................. 56

Vision Benefits ....................................................................................................................................................... 56

- How the Plan Works............................................................................................................................... 57 - 2019 Vision Premiums ........................................................................................................................... 59

HEALTH AND WELLBEING ............................................................................... 60

- Improve Your Wellbeing and Earn Rewards Along the Way ................................................................. 60 - Special Information if You Are Covered by the Kaiser, HMSA Hawaii or Aetna International

Health Plan............................................................................................................................................. 61

- Alternative Means to Earning Incentives................................................................................................ 61 - 2019 IRS Limits Impacting Health Savings Account Incentives ............................................................ 61

FINANCIAL PROTECTION BENEFITS .............................................................. 62

Disability Coverage ................................................................................................................................................ 62

- Short-term Disability (STD) .................................................................................................................... 62 - Long-term Disability (LTD) ..................................................................................................................... 62

Life and Accident Coverage .................................................................................................................................. 62

- Coverage Amounts ................................................................................................................................ 63 - Life and Accident Coverage at a Glance ............................................................................................... 63 - Cost of Coverage ................................................................................................................................... 64 - Evidence of Insurability .......................................................................................................................... 64 - Employee Coverage............................................................................................................................... 65 - Dependent Coverage ............................................................................................................................. 65

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AYCO FINANCIAL PLANNING .......................................................................... 67

Financial Planning and Education Resources.....................................................................................................67

TIME OFF AND PERSONAL............................................................................... 68

Flex Vacation Purchase .........................................................................................................................................68

- How Flex Vacation Works ......................................................................................................................68 LEGAL NOTICES ............................................................................................... 69

Women's Health and Cancer Rights Act of 1998 (WHCRA) Notice ...................................................................69 Newborns' and Mothers' Notice ............................................................................................................................69 Mental Health Parity and Addiction Equity Act ...................................................................................................69 Military Leave Under the Uniformed Services Employment and Reemployment Rights Act (USERRA) ................................................................................................................................................................70 Qualified Medical Child Support Orders ..............................................................................................................70 Premium Assistance Under Medicaid and the Children's Health Insurance Program (CHIP)........................70 Health Insurance Marketplace Coverage Options and Your Health Coverage ................................................72

- Key Things to Know About the Affordable Care Act (ACA)....................................................................72

Health Insurance Marketplace Coverage Options...............................................................................................73

- PART A: General Information.................................................................................................................73 - PART B: Information About Employer-Provided Health Coverage ........................................................74

Medicare Prescription Drug Notice.......................................................................................................................75

- BNY Mellon Creditable Coverage Plans ................................................................................................75

HIPAA Notice...........................................................................................................................................................78 COBRA Rights Notice?Health and Welfare Benefits ..........................................................................................83

PRIVACY NOTICE FOR WELLBEING PROGRAM .............................................. 88 TERMS YOU SHOULD KNOW ........................................................................... 89 CONTACT INFORMATION ................................................................................ 92 VALUE FORMULARY QUICK REFERENCE LIST .............................................. 97 PREVENTIVE THERAPY DRUG LIST ................................................................ 98

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