2016 Benefits Guide

2016 Benefits Guide

Make Informed Choices When You Enroll

WELCOME ..........................................................................................................5

WELCOME TO BNY MELLON .............................................................................6

Choosing Your Health Plan .....................................................................................................................................6 How to Enroll.............................................................................................................................................................6 Enrollment Reminders .............................................................................................................................................6 Enrollment 2016........................................................................................................................................................6 Your 2016 Benefits ...................................................................................................................................................7 Medical Option Highlights .......................................................................................................................................8

- Choosing a Carrier ...................................................................................................................................8 - Provider Networks ....................................................................................................................................9 - Health Care Reform .................................................................................................................................9 - Choosing a Health Plan............................................................................................................................9

Dental Option Highlights .......................................................................................................................................10 Flexible Spending Accounts (FSAs) Highlights ..................................................................................................10 Flex Vacation Highlights........................................................................................................................................10 Benefits Eligibility ..................................................................................................................................................10

- Domestic Partner Definition ...................................................................................................................11

How to Enroll...........................................................................................................................................................11 Paying for Coverage...............................................................................................................................................13

- Your Per-Pay Cost .................................................................................................................................14 - Pricing Structure for Medical Coverage .................................................................................................14

Tools to Help You Choose the Right Health Plan ...............................................................................................14 Health and Wellbeing .............................................................................................................................................15

- Live Well .................................................................................................................................................15 - Live Well Incentives................................................................................................................................17 - Special Information if You Are Covered by the Kaiser, HMSA Hawaii or Aetna International

Health Plan.............................................................................................................................................18

- Manage Your Health through Doctor On Demand.................................................................................18 - Get Quality Care Fast with a CVS Health MinuteClinic?.......................................................................18 - 2016 IRS Limits Impacting HSA Incentives............................................................................................18

CHANGING COVERAGE ...................................................................................19

What Is a Qualified Life Event? .............................................................................................................................19 How to Report a Qualified Life Event Change .....................................................................................................19 What You Can Change ...........................................................................................................................................20 Special Health Coverage Enrollment....................................................................................................................22

- When You Have Other Medical Coverage Available .............................................................................22 - Coordination of Medicare and BNY Mellon Medical Coverage..............................................................23

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

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

How the Plans Work ...............................................................................................................................................26 Comparing the Plans..............................................................................................................................................31 2016 Monthly Medical Contributions ....................................................................................................................33 Prescription Drug Benefits ....................................................................................................................................35 Plan HRA (Health Reimbursement Account) .......................................................................................................39

- Plan HRA Details....................................................................................................................................41

Plan HSA (Health Savings Account).....................................................................................................................42

- Plan HSA Details ....................................................................................................................................48

How the Health Accounts Compare......................................................................................................................50 New Health Plan ID Card ........................................................................................................................................52 Best Doctors: Get Help with Important Medical Decisions ................................................................................52 Illustrated Plan Comparisons ................................................................................................................................52

FLEXIBLE SPENDING ACCOUNTS .................................................................. 56

How FSAs Work ......................................................................................................................................................56

- Debit Card Convenience with Health Care FSA ....................................................................................57 - Paying Online .........................................................................................................................................57 - Filing a Claim..........................................................................................................................................58 - When Your Coverage Ends....................................................................................................................58 - Questions ...............................................................................................................................................58

Health Care FSA Eligible Expenses......................................................................................................................58 Dependent Care FSA Eligible Expenses ..............................................................................................................59 Health Care FSA During a Leave of Absence ......................................................................................................59 Dependent Care FSA During a Leave of Absence ..............................................................................................59 Important FSA Rules ..............................................................................................................................................59 Should You Use the Dependent Care FSA or the Dependent Care Tax Credit? ..............................................60 Limited Purpose FSA .............................................................................................................................................60 Things to Think About............................................................................................................................................60

DENTAL AND VISION ...................................................................................... 61

2016 Monthly Dental Contributions ......................................................................................................................61 MetLife Options.......................................................................................................................................................62 Aetna DMO...............................................................................................................................................................63 Things to Think About............................................................................................................................................65 2016 Monthly Vision Contributions ......................................................................................................................66 How the Plan Works ...............................................................................................................................................66

- In-Network Benefits ................................................................................................................................68 - Out-of-Network Benefits .........................................................................................................................68 - Paying for Vision Services......................................................................................................................68

FINANCIAL PROTECTION ............................................................................... 69

- Short-term Disability (STD) ....................................................................................................................69 - Long-term Disability (LTD) .....................................................................................................................69 - Coverage Amounts.................................................................................................................................70 - Life and Accident Coverage at a Glance................................................................................................70 - Cost of Coverage....................................................................................................................................71 - Evidence of Insurability...........................................................................................................................71 - Employee Coverage ...............................................................................................................................72 - Dependent Coverage .............................................................................................................................73

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TIME OFF & PERSONAL ..................................................................................74 - How Flex Vacation Works ......................................................................................................................74

LEGAL NOTICES ..............................................................................................75

Women's Health and Cancer Rights Act of 1998 (WHCRA) Notice ...................................................................75 Newborns' and Mothers' Notice............................................................................................................................76 Premium Assistance Under Medicaid and the Children's Health Insurance Program (CHIP) .......................76 Key Things to Know About the Affordable Care Act (ACA)...............................................................................78 Information Regarding Termination of Health Plan Coverage for Cause .........................................................78 What Self-Insured Really Means ...........................................................................................................................78 Medicare Prescription Drug Notice ......................................................................................................................79 HIPAA Notice...........................................................................................................................................................81

TERMS YOU SHOULD KNOW ..........................................................................87

CONTACT INFORMATION................................................................................90

ADVANCED CONTROL FORMULARY ...............................................................94

BNY MELLON PRESCRIPTION COVERAGE ...................................................106

TRADITIONAL GENERIC STEP THERAPY .....................................................110

PREVENTIVE THERAPY DRUG LIST .............................................................113

COMPREHENSIVE SPECIALTY PHARMACY DRUG LIST...............................118

About this Guide This document is a Summary of Material Modifications to the 2015 version intended to notify you of important changes made to BNY Mellon's benefit plans for the plan year beginning on January 1, 2016. The information set forth in this guide is in summary form. In the event of any discrepancy between this information and the applicable summary plan descriptions (SPDs) or plan documents, the terms of the applicable plan documents control. BNY Mellon reserves the right to change or eliminate any of its benefit plans at any time for any reason, subject to the law. If you have questions, call the BNY Mellon Benefit Solutions Service Center at 1-800-947-HR4U (4748), option 2, Monday through Friday between 8:30 a.m. and 8 p.m. Eastern Time.

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Welcome

To Enroll for 2016 Benefits

? At Work: Go to MySource > MyReward > Log on to MyReward > Proceed to My Personal Total Reward Data > MyBenefit Solutions

? At Home: Go to (If you have not already registered, you will need to create a username and password.)

? For information about the circumstances that allow you to change your elections during the calendar year, see Changing Coverage

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" on page 79 for more details.

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