2020 Benefits Annual Enrollment Guide

2020 Benefits Annual Enrollment Guide

Enrollment Period October 10th ? October 23, 2020

Active Salaried Employees

Annual Enrollment is your once-a-year opportunity to review your benefit options for the coming year and select the coverages that will work best for you and your family. Use this brochure to learn what's changing for 2020 and what you need to do.

Annual Enrollment 2020 October 10 ? 23, 2019

Benefits selected during this enrollment period will be effective January 1, 2020.

Please review this Guide in its entirety. It is your source of information for what's changing in 2020. Consider all of your benefit options and your financial and health care needs during Annual Enrollment. You will not need to actively enroll in most benefits for 2020 if you do not wish to make changes, with the exception of the following elections that do not carry over from year to year:

? Health Care or Limited Flexible Spending Account elections

? Dependent Care Flexible Spending Account elections

? Employee tax-favored Health Savings Account contributions

We listened to your feedback and are excited to highlight some of the enhancements to our plans for 2020. Details start on page 2.

? No Medical, Dental (PPO) or Vision Contribution Increases ? No Medical Deductible or Out-Of-Pocket Maximum Increases ? Fidelity Investments? will be the new HSA recordkeeper ? Aetna Customer Care Management Unit ? health advocate nurse

to assist with ongoing conditions or hospitalization ? PPO Dental Care Enhancement

If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, a Federal law gives you more choices about your prescription drug coverage. Please see page 22 for more details.

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Click on a topic below to go directly to the information you need.

What's New for 2020 Medical Plan Comparison

Important Reminders Helpful Links & Tools

to Take Control of Your Health

Legal Reminders Important Contacts

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What's New for 2020

Avaya knows how important health and insurance plans are for you and your family. The following pages include a summary of what's changing for the year ahead. Additional details are available in later sections of this Guide and at . If you have questions or need assistance, contact the Avaya Health & Benefits Decision Center at 1-800-526-8056 option 1 (TDD 1-800-952-0450) or via e-mail at avayaservicecenter@.

Attend a What's New Webinar to learn about 2020 benefits October 11 at 11 a.m. ET October 16 at 4 p.m. ET See the Annual Enrollment email for details.

Benefits Genius Bar

Call in with your annual enrollment benefit questions. Open daily through Annual Enrollment from 3 ? 4p.m. ET. See the Annual Enrollment email for details.

Aetna Enhancements

In 2020, there will be no increase in the individual and family deductibles and out-of-pocket (OOP) maximums! The Medical and Prescription Drug Plans have been enhanced:

The list of Preventive Medications where members pay zero cost has expanded and now includes preventive medication for asthma, Chronic Obstructive Pulmonary Disease, diabetes, heart disease and stroke and high blood pressure among other categories. See for the Preventive Medication List.

If you are enrolled with Aetna through the Avaya Medical Plan (and are not enrolled in Medicare), you will have access to the Aetna Customer Care Management Unit (CCMU) ? based on having an ongoing medical condition or hospitalization, a dedicated nurse will contact you and your family to provide support and coordination of services.

Coverage of habilitative physical, occupational and speech therapy prescribed by a physician for other Developmental Delays in addition to Autism.

Dermatology services are being added to Teladoc.

Please review the Medical Comparison Chart for Active Salaried

Employees on page 8 of this Guide for more details.

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The maximum visit for routine physical exams was changed to one per calendar year (was one visit per 12 months).

Vision and Dependent Life Change

We have simplified the eligibility for your covered child(ren), so your child can be covered up to December 31 of the year in which your child reaches age 26 for Vision and Dependent Life. This is now consistent with Medical and Dental coverage eligibility.

Health Savings Account Update

On January 1, 2020, the Avaya Health Savings Account (HSA) vendor will be Fidelity.

You will be able to see your 401(k) and HSA balance on the same website:

Fidelity has no minimum for investing so any savings that is not needed for current qualified expenses can be invested. You can pay for qualified medical expenses through a variety of options to access your funds, including using an HSA checkbook, online bill paying service, or direct debit.

The HSA is only available if you enroll in the Aetna Healthy Direction CDHP with HSA Medical Plan.

Here are the steps to take to open your new Fidelity HSA and transfer existing funds from your current HSA:

From October 10, 2019 ? October 23, 2019, make your new HSA election at and agree to Fidelity's terms & conditions.

In December, go to to activate your HSA with Fidelity.

In December, after you activate your HSA with Fidelity, transfer any existing HSA funds from PayFlex to Fidelity by clicking on the link on the website and approving the transfer. If you approve the funds to be transferred from PayFlex to Fidelity by January 10, 2020 there will not be a fee to transfer the funds.

If you do not authorize to have your HSA funds transferred from PayFlex to Fidelity by January 10, 2020 PayFlex will charge you a fee to transfer funds after this date and you will also be charged a monthly maintenance fee starting in January 2020 if you have funds remaining in your PayFlex HSA.

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What's New for 2020

Kaiser Plan Changes 2020 carrier-mandated changes:

Plan

Benefit

Kaiser MAS (Maryland)

Contraceptives

Kaiser MAS (Virginia)

Autism Spectrum Disorder

2019 Plan Design

2020 Plan Design

Kaiser will cover and dispense prescription contraceptives once every 6 months

Kaiser will cover and dispense prescription contraceptives once every 12 months

Only covered for members aged 2 to 10

Coverage for all ages ? no age limit

Kaiser CO

Emergency Services

$75 copay for ER visit

$250 copay for ER visit

Kaiser CO Kaiser CO

Allergy Evaluation and Testing

$40 copay

Outpatient Surgery

10% coinsurance

Primary Care: $15 copay Specialty Care: $40 copay

Cost share will depend on where surgery takes place; cost share will be lower at an ambulatory surgery center than at an outpatient hospital department

TRICARE Changes for 2020 Due to low enrollment, the TRICARE Supplemental Plan will no longer be offered in 2020. If you would like to continue your TRICARE Supplement Plan, please contact our third-party administrator, Selman & Co., at 1-855-637-1961. HMSA Medical Plan Changes Please visit to review HMSA's 2019/2020 carrier-mandated changes.

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What's New for 2020

Aetna Dental PPO Changes After you obtain your preventive prophylaxis (cleaning), you will receive an additional $100 toward the annual benefit maximum in the following calendar year. Preventive services will be excluded from the annual benefit maximum.

The following services were moved from a Major to a Basic Care benefit which means a lower cost for you: Endo/Perio(Osseous surgery, Partial Bony Impactions and Full Bony Impactions) and General Anesthesia.

Annual Express Scripts (ESI) Prescription Drug Formulary Changes

The lists below describe some of the ESI carrier-mandated drug list and program changes, effective January 1, 2020. Personalized notifications, reminder communications, and targeted alerts will go out to affected members before January 1. ESI's formulary will continue to ensure that clinically sound, costeffective drugs are available to members and will drive greater savings. ESI's 2020 carrier-mandated drug exclusion list is available at . The 2020 formulary is available at under the Forms & Plan Documents tile. Filter on "M" and click on the "MEDICAL BENEFITS - ESI RX PREFERRED DRUG GUIDE" link.

2020 Preferred-to-Non-Preferred Changes

ABSORICA

ADAGEN

AMITIZA

ARCAPTA NEOHALER

ARZERRA

ATROVENT HFA

BYVALSON

FIRDAPSE

FULPHILA

GRALISE

HEXALEN

LARTRUVO

MOXEZA

RELENZA

SANCUSO

TABLOID

VARUBI VIAL

XOFLUZA

ZONTIVITY

2020 HSA Contribution Maximums

Based on Internal Revenue Service rules, the maximum amount you can contribute to a Health Savings Account (HSA) in 2020 is $3,550 for self-only CDHP medical plan coverage and $7,100 for all other coverage tiers. If you are turning age 55 in 2020 or are already over 55, you can contribute an additional $1,000 in HSA catch-up contributions in 2020. These limits include: the contributions you make via payroll deductions, any contributions you make to your HSA outside of payroll deductions, and the HSA dollars Avaya contributes to your HSA. Remember, the tax-favored HSA is only available if you enroll in Avaya's Healthy Direction CDHP with HSA medical plan.

2020 Health Care or Limited FSA Contribution Maximum

The annual contribution maximum for Health Care or Limited Flexible Spending Account elections in 2020 has increased from $2,650 to $2,700. Please make your new election at . 2019 elections will not carry over to 2020.

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