2021 Benefits Guide

2021 Benefits Guide

for Active Employees

Your 2021 Benefits

Designed with You in Mind

Table of Contents

Welcome to Your 2021 BNY Mellon Benefits................................................................................................................... 5 Your path to a successful Enrollment ......................................................................................................................... 6 Be Informed ........................................................................................................................................................... 6 Review and Compare Health Plans ....................................................................................................................... 6 Enroll on MyBenefit Solutions by the Deadline...................................................................................................... 6 If You Don't Enroll ....................................................................................................................................................... 6 Who's Eligible?............................................................................................................................................................ 9 Qualified Domestic Partner Definition .................................................................................................................. 10 When Coverage Begins and Ends ............................................................................................................................ 10 Changing Coverage During the Year ........................................................................................................................ 11 Paying for Coverage ................................................................................................................................................. 11 Your Per-Pay Period Cost.................................................................................................................................... 12 When You Have Other Medical Coverage ................................................................................................................ 12 Coordination of Medicare and BNY Mellon Medical Coverage ........................................................................... 12

Accolade......................................................................................................................................................................... 13 How to Enroll .................................................................................................................................................................. 15

Use the Tools to Help You Choose........................................................................................................................... 15 Your 2021 Benefits Options at a Glance ........................................................................................................................ 16 Medical and Prescription Drug ....................................................................................................................................... 18

About Anthem ........................................................................................................................................................... 18 About the Higher Deductible and Lower Deductible HSA Plans............................................................................... 18 About the Copay Plan ............................................................................................................................................... 19 How the Medical Plans Compare.............................................................................................................................. 20 Things to Consider When Choosing Your Medical Plan Option ............................................................................... 23 Specialty Care with Anthem Blue Distinction and Blue Distinction+ Centers of Excellence..................................... 24 2021 Medical Premiums............................................................................................................................................ 25 Prescription Drug Benefits ........................................................................................................................................ 27

CVS Caremark Value Formulary ......................................................................................................................... 28 Step Therapy ....................................................................................................................................................... 28 CVS Caremark Opioid Management Program .................................................................................................... 28 Dispense as Written (DAW) Provision ................................................................................................................. 29 Compound Prescriptions...................................................................................................................................... 29 Preventive Therapy Drugs ................................................................................................................................... 29 Special Programs Available Through Your CVS Prescription Drug Benefit ........................................................ 29 CVS Caremark Resources and Savings.............................................................................................................. 32 Get Care Fast with a CVS Health MinuteClinic?.................................................................................................. 32 Additional Health Programs............................................................................................................................................ 33

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Teladoc Medical Experts: Help with Important Medical Decisions ........................................................................... 33 LiveHealth Online: for Telehealth services ............................................................................................................... 33 Sleepio ...................................................................................................................................................................... 34 Ayco Financial Planning and Education Resources ................................................................................................. 34 Health Savings Account (HSA) ...................................................................................................................................... 35 HSA Eligibility ............................................................................................................................................................ 36 HSA Contributions..................................................................................................................................................... 37 How the HSA Works ................................................................................................................................................. 38 Making Your HSA Contributions ............................................................................................................................... 38

Calculating Your Personal HSA Contribution Limit.............................................................................................. 39 Medicare, Social Security, and Your HSA ................................................................................................................ 40 Flexible Spending Accounts (FSAs)............................................................................................................................... 41 How FSAs Work ........................................................................................................................................................ 42

Paying for Eligible Expenses ............................................................................................................................... 42 Using Your FSA Debit Card for Eligible Healthcare Expenses............................................................................ 42 Eligible FSA Expenses .............................................................................................................................................. 43 Healthcare FSA.................................................................................................................................................... 43 Limited Purpose FSA ........................................................................................................................................... 43 Dependent Care FSA........................................................................................................................................... 44 Important FSA Rules ................................................................................................................................................. 44 How the Healthcare Accounts Compare ................................................................................................................... 45 Dental and Vision ........................................................................................................................................................... 47 Dental Benefits .......................................................................................................................................................... 47 MetLife Dental Options ........................................................................................................................................ 47 Aetna DMO .......................................................................................................................................................... 47 Things to Consider ............................................................................................................................................... 48 Dental Coverage Summary.................................................................................................................................. 48 2021 Dental Premiums ........................................................................................................................................ 49 Vision Benefits .......................................................................................................................................................... 49 Vision Coverage Summary .................................................................................................................................. 50 Paying for Vision Services ................................................................................................................................... 51 2021 Vision Premiums ......................................................................................................................................... 51 Wellbeing Points Program Through Virgin Pulse ........................................................................................................... 52 How Much You Can Earn.......................................................................................................................................... 52 How the Program Works ........................................................................................................................................... 52 Life and Disability Insurance .......................................................................................................................................... 55 Life and Accident Coverage ...................................................................................................................................... 55 Things to Consider ............................................................................................................................................... 55 Employee Coverage ............................................................................................................................................ 55

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Dependent Coverage........................................................................................................................................... 56 Life and Accident Coverage at a Glance ............................................................................................................. 57 Cost of Coverage ................................................................................................................................................. 58 Disability Coverage ................................................................................................................................................... 58 Short-term Disability (STD) .................................................................................................................................. 58 Long-term Disability (LTD) ................................................................................................................................... 58 Flex Vacation Purchase ................................................................................................................................................. 59 How Flex Vacation Purchase Works......................................................................................................................... 59 Your Cost .................................................................................................................................................................. 59 Voluntary Benefits .......................................................................................................................................................... 60 Terms You Should Know................................................................................................................................................ 61 Contact Information ........................................................................................................................................................ 65

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Welcome to Your 2021 BNY Mellon Benefits

BNY Mellon helps create a strong foundation for your health and wellbeing through our flexible benefits program. During your enrollment period as a newly benefits-eligible employee, take some time to evaluate your anticipated needs and choose the benefits that will best meet those needs. Please use this 2021 Benefits Guide to find the information you need to make informed decisions and take action to learn about your 2021 benefits under The Bank of New York Mellon Health and Welfare Plan (the "Plan" or the "BNY Mellon Plan") as well as other benefits available to eligible BNY Mellon employees and their eligible dependents.

If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, federal law gives you more choices about your prescription drug coverage. Please see "Medicare Prescription Drug Notice" in the "Legal Notices" brochure for more details. Also, note that Medicare eligibility may impact your medical plan choices for 2021. Carefully review this document to ensure that you make the best decisions for 2021.

The information set forth in this Benefits Guide is in summary form. This Benefits Guide is intended to provide important information about BNY Mellon's benefit plans for the plan year beginning on January 1, 2021. It is not intended to, and does not, provide tax, legal or investment advice and is not a guarantee of employment or benefits of any nature. In the event of any discrepancy between this Benefits Guide and the applicable plan documents and evidence of coverage booklets, the terms of the applicable documents control. BNY Mellon reserves the right to change or eliminate any of its benefit plans at any time for any reason, subject to applicable law. If you have questions about how to enroll, call the BNY Mellon Benefit Solutions Service Center directly at 1-855-354-6940 Monday through Friday, between 8:30 a.m. and 8 p.m. ET. If you have questions about general healthcare benefits, Anthem ID cards, Anthem claim issues, etc., call your Accolade Health Assistant at 1-833-640-0427, Monday through Friday, between 8 a.m. and 11 p.m. ET.

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