BNY Actoe 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 ? Health and Welfare Benefits ........................................................................................87

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