Front Cover.qxp_Layout 1 5/6/16 4:39 PM Page 1

Newspaper Guild of New York - The New York Times Benefits Fund

SUMMARY PLAN DESCRIPTION For Active Employees and Eligible Retirees Younger Than Age 65

Effective January 1, 2016 Title Page.qxp_Layout 1 5/9/16 9:34 AM Page 1

Newspaper Guild of New York - The New York Times Benefits Fund

SUMMARY PLAN DESCRIPTION For Active Employees and Eligible Retirees Younger Than Age 65

Effective January 1, 2016 Project1_Layout 1 8/27/12 4:47 PM Page 1

Newspaper Guild of New York - The New York Times Benefits Fund

TABLE OF CONTENTS

Page

Section I Introduction, Benefits at a Glance, and Contact Information ...... 1 Introduction ...... 2 Benefits at a Glance ...... 4 Contact Information ...... 6

Section II Eligibility and Continuation of Coverage ...... 7 Eligibility for Benefits ...... 8 Enrollment ...... 13 Contributions to the Cost of Coverage...... 15 If You Continue to Work After Age 65 ...... 16 Life Events ...... 17 When Does Your Coverage End? ...... 18 Continuation of Coverage – COBRA ...... 19 Other Ways Your Coverage Can Continue ...... 28 HIPAA Rights ...... 31

Section III Plan Benefits - Medical and Prescription Drug Benefits ...... 32 Summary of Health Plans...... 33 Preferred Provider Organization (PPO) Plan ...... 35 Medical Management Program – PPO Plan ...... 40 Medical Benefits – PPO Plan...... 42 Prescription Drug Benefits – PPO Plan ...... 62 PPO Plan Benefit Exclusions ...... 65 Exclusive Provider Organization (EPO) Plan ...... 70 United Healthcare Oxford ...... 71 Health Maintenance Organization (HMO) Plans ...... 74 HIP Health Plan of New York - EmblemHealth Company ...... 75 Empire HealthChoice HMO ...... 78 Global Health Benefits Plan – Cigna for Expatriates ...... 81

Section IV Additional Benefits – Optical, Dental, and Life Insurance Benefits ...... 88 Summary of Additional Benefits ...... 89 Optical Benefits ...... 90 Dental Benefits ...... 92 Life Insurance Benefits ...... 106

Newspaper Guild of New York - The New York Times Benefits Fund

TABLE OF CONTENTS (continued)

Page

Section V Coordination of Benefits, Subrogation, Claims Procedures & Appeals ...... 112 Coordination of Benefits ...... 113 Subrogation – Reimbursement Agreement ...... 116 Claims Review and Appeal Procedures ...... 118

Section VI ERISA Requirements and Plan Facts ...... 128 Qualified Medical Child Support Orders (QMCSO) ...... 129 Special Rights for Mothers and Newborn Children ...... 130 Women’s Health and Cancer Rights Act ...... 131 Grandfathered Plan Status Statement ...... 132 Primary Care Provider (PCP) Designations and Access to OB/GYN Care ...... 133 HIPAA Privacy Practices for Personal Health Information (PHI) ...... 134 Interpreting the Plan...... 141 If the Plan Ends/Changes in the Plan ...... 142 Misrepresentation and Fraud ...... 143 Plan Facts ...... 144 Your Rights under ERISA ...... 147 Definitions ...... 149

Section I

Introduction, Benefits at a Glance, and Contact Information

Newspaper Guild of New York – The New York Times Benefits Fund Page 1

INTRODUCTION

Newspaper Guild of New York – The New York Times Benefits Fund

Dear Member:

The Board of Trustees of the Newspaper Guild of New York – The New York Times Benefits Fund (Guild- Times Benefits Fund) is pleased to provide you with this revised Summary Plan Description (SPD). This SPD has been written to reflect the changes since the last version was printed. This SPD is for active employees and retired employees younger than age 65. A separate SPD describes the plan of health and welfare benefits for eligible retirees or their dependents who have attained age 65.

As you look through this SPD, you will learn how you become eligible for benefits, what your benefits are and how you claim them. We urge you to read this SPD with care. Since the last SPD was published, a number of changes in benefits have been implemented, particularly changes related to the Affordable Care Act (ACA), which is the health care reform law, and the Mental Health Parity and Addiction Equity Act of 2008. This SPD describes the Plan in effect as of January 1, 2016.

This SPD has been designed to be easy to read and understand and provide you with a summary of your benefits under the Guild-Times Benefits Fund. This SPD was developed to help you understand your benefits and responsibilities under the health plan.

The Trustees may modify or eliminate at any time (without prior notice to you) any benefits and the eligibility requirements for benefits described in this SPD. The Trustees have the authority and discretion to interpret the Plan and make final determinations regarding them. Neither employment nor benefits are guaranteed. Under no circumstances will any Plan benefits become vested or non-forfeitable with respect to active or retired employees or their beneficiaries or dependents.

This SPD summarizes the key features of the Plan. It also constitutes the Plan document. Details of the Plan are also contained in the other official Plan documents, including the Agreement and Declaration of Trust that created the Fund and any insurance contracts relating to benefits provided under the Plan, which legally govern the operation of the Plan. All other official Plan documents are available for your inspection at the Fund Office during normal business hours, and all statements made in this SPD are subject to the provisions and terms of those documents. In case of a conflict or inconsistency between the other official Plan documents and this SPD, the other official documents will govern in all cases.

In addition, this SPD provides the required information about your rights and protection under the law in order to comply with the Employee Retirement Income Security Act of 1974 (ERISA).

We encourage you and your family to read this SPD carefully to make the best choices and use of your benefits offered by the Guild-Times Benefits Fund. If you have any questions concerning your benefits or your eligibility, please feel free to contact the Fund Office at (646) 237-1670.

Sincerely,

The Board of Trustees

Newspaper Guild of New York – The New York Times Benefits Fund Page 2

BOARD OF TRUSTEES

Union Trustees Employer Trustees Grant Glickson Andrew Gutterman Peter Szekely Charlotte Behrendt Anthony Napoli Christopher Biegner Matthew Seaton Terry L. Hayes

CO-COUNSEL Proskauer Rose LLP Meyer, Suozzi, English & Klein, P.C.

ACTUARIAL CONSULTANT Milliman, Inc.

ACCOUNTANT Novak Francella, LLC

FUND ADMINISTRATOR C&R Consulting, Inc.

For claim forms, beneficiary forms, and other benefit information contact:

Newspaper Guild of New York – The New York Times Benefits Fund 1501 Broadway, Suite 1724 New York, NY 10036

Telephone: (646) 237-1670 Fax: (212) 395-9299

To obtain forms and benefit information online, please visit:

guild.candrdirect.com

www.nyguild.org

Newspaper Guild of New York – The New York Times Benefits Fund Page 3

BENEFITS AT A GLANCE

Active Employees and Eligible Retirees Younger Than Age 65

For more information about these benefits plans, please refer to the Summary of Health Plans section.

MEDICAL & PRESCRIPTION DRUG BENEFITS

The Plan offers you a choice of medical and prescription drug benefits program to meet the needs of you and your family.

1. Preferred Provider Organization (PPO) Plan

§ In-Network & Out-of-Network (OON) benefits - In-Network: copays using a participating provider - OON: deductible and coinsurance using a non-participating provider § Provider network through BlueCross BlueShield § Claims administered by C& R Consulting, Inc. § Medical management provided by Alicare Medical Management § Prescription drug plan through Express Scripts, Inc. (ESI)

2. Exclusive Provider Organization (EPO) Plan

§ Provider network through United Healthcare Oxford EPO Plan § In-Network benefit: copays using a participating provider only § No OON coverage § Prescription drug plan through United Healthcare

3. Health Management Organization (HMO) Plans

§ Provider network through HIP Health Plan of New York (EmblemHealth Company) or Empire HMO (Empire BlueCross BlueShield) § In-Network benefit: copays using a participating provider only § No OON coverage § Prescription drug plan through both health insurance companies (EmblemHealth and Empire BlueCross BlueShield)

INTERNATIONAL BENEFITS

The Plan offers you International Health Benefit Plan for expatriates.

§ Medical, dental, optical, prescription drug, medical evacuation and repatriation benefits are provided by Cigna.

Newspaper Guild of New York – The New York Times Benefits Fund Page 4

BENEFITS AT A GLANCE

Active Employees Only

For more information about these benefits, please refer to the Additional Benefits section.

DENTAL BENEFITS

The Plan offers you dental benefits to you and your dependents through Empire Blue Cross Blue Shield (no matter what medical plan you choose).

Dental coverage is not provided to a retiree or dependent of a retiree.

OPTICAL BENEFITS

The Plan offers you optical benefits to you and your dependents (no matter what medical plan you choose).

Optical coverage is not provided to a retiree or dependent of a retiree.

LIFE INSURANCE BENEFITS

The Plan offers life insurance benefits to you through Cigna Life Insurance Company.

Life insurance coverage is not provided to a dependent, retiree or dependent of a retiree.

Newspaper Guild of New York – The New York Times Benefits Fund Page 5

CONTACT INFORMATION

BENEFIT/PLAN TYPE VENDOR/ADDRESS PHONE NUMBER WEBSITE

MEDICAL & PRESCRIPTION DRUGS

PPO Plan Member Services Guild-Times Benefits Fund (646) 237-1670 guild.candrdirect.com 1501 Broadway, Suite 1724 New York, NY 10036

Provider Access BlueCross BlueShield (800) 810-2583 www.anthem.com

Prescription Drugs Express Scripts, Inc. (ESI) (866) 544-2926 www.express-scripts.com Specialty Drugs Accredo (800) 803-2523

EPO Plan Oxford (United Healthcare) (800) 444-6222 www.oxfordhealth.com Prescription Drugs P.O. Box 29135 Hot Springs, AR 71903

HMO Plan HIP Prime (EmblemHealth) (800) 447-8255 www.emblemhealth.com Prescription Drugs 55 Water Street New York, NY 10041-8190

HMO Plan Empire BlueCross BlueShield (800) 453-0113 www.empireblue.com Prescription Drugs One Liberty Plaza New York, NY 10006

OPTICAL Guild-Times Benefits Fund (646) 237-1670 guild.candrdirect.com 1501 Broadway, Suite 1724 New York, NY 10036

DENTAL Empire BlueCross Blue Shield (877) 606-3338 www.empireblue.com Dental Benefits Program PO Box 810 Minneapolis, MN 55440-0810

LIFE INSURANCE Cigna Life Insurance Company (800) 732-1603 www.cigna.com

INTERNATIONAL Cigna Global Health Benefits (302) 797-3150 www.cignaglobalhealth.com PLAN P.O. Box 15050 (800) 243-6998 Wilmington, DE 19850

Newspaper Guild of New York – The New York Times Benefits Fund Page 6

Section II

Eligibility and Continuation of Coverage

Newspaper Guild of New York – The New York Times Benefits Fund Page 7

ELIGIBILITY FOR BENEFITS

EMPLOYEES

You are eligible to join the Plan if you are actively employed (under NewsGuild* of New York, Local 31003 Communications Workers of America jurisdiction) by The New York Times or The Times Center and you are:

§ A full-time employee, scheduled to work at least 30 hours a week, or

§ A part-time employee, scheduled to work at least 20.7 hours a week. If you were hired as a part-time employee before August 1, 1987, and you were a Plan participant on that date, the 20.7 hours-a-week requirement does not apply to you, and you may therefore join the Plan, provided that you are otherwise eligible.

* In 2015, the Newspaper Guild of New York, Local 31003 changed its name to the NewsGuild of New York, Local 31003.

Full Time Employee

If you are a full-time employee who voluntarily reduces your scheduled work time to less than 20.7 hours a week, you will lose your eligibility for the Plan. If such a reduction is involuntary, you may be able to elect continuation coverage. See “Continuation of Coverage – COBRA” in Section II for more details.

Service Employee

If you are classified as a Times Center Service Employee, you are subject to a different eligibility rule. In that case, you must average 20.7 hours or more a week over a six-month period (called a “Qualifying Period”) in order to be eligible for the following six-month period. To maintain eligibility, you must average a minimum of 20.7 hours per week during each subsequent six-month period. The six-month qualifying periods used to determine eligibility are January 1st through June 30th and July 1st through December 31st.

Note that if you work an average of at least 30 hours per week during your first six full calendar months of employment, you will be eligible on the first day of the ninth month of employment. This initial eligibility period will last for six months from the date on which you became eligible, at which time your eligibility will be determined based on the six-month qualifying periods above.

Temporary/Casual Employee

If you are a temporary and/or casual employee who is identified by The New York Times Company as a variable hour employee and you average 30 hours or more a week over a six-month period (called a “Qualifying Period”), you will be eligible for the following six-month period. To maintain eligibility, you must average a minimum of 30 hours per week during each subsequent six-month period. The six-month qualifying periods used to determine eligibility are January 1st through June 30th and July 1st through December 31st.

Newspaper Guild of New York – The New York Times Benefits Fund Page 8

ELIGIBILITY FOR BENEFITS (continued)

Note that if you work an average of at least 30 hours per week during your first six full calendar months of employment, you will be eligible on the first day of the ninth month of employment. This initial eligibility period will last for six months from the date on which you become eligible, at which time your eligibility will be determined based on the six-month qualifying periods above.

If you are a temporary and/or casual employee who is not identified by The New York Times Company as a variable hour employee, you are eligible on the first day of the fourth full calendar month following your date of hire if you are scheduled to work at least 30 hours per week.

Independent Contractors

Individuals who are classified as independent contractors and not as employees at the time of any determination (even if they are later retroactively reclassified as a common-law employee pursuant to applicable law or otherwise) are excluded from being eligible for benefits.

Retired Employee

You are also eligible for medical benefits under the Plan if, immediately after you terminate your employment, you begin collecting your pension under the Guild-Times Pension Plan. In order to receive this retiree coverage, you will be required to make monthly contributions. Please contact the Fund Office for additional information regarding these monthly contributions.

As a retired employee, you are not eligible for HMO coverage or dental, optical, and life insurance benefits under the Plan.

If you are a covered retired employee who reaches age 65 you are covered by a medical plan which supplements Medicare benefits. This plan is described in the Medicare Eligible Retiree Summary Plan Description.

Please keep in mind that, as with all benefits under the Plan, retiree benefits may be modified or terminated by the Trustees at any time, in their discretion. No benefits or rights vest or become non-forfeitable under the Plan.

Newspaper Guild of New York – The New York Times Benefits Fund Page 9

ELIGIBILITY FOR BENEFITS (continued)

DEPENDENTS

The Plan offers medical, prescription drug, dental, and optical benefits for your eligible dependents. Your eligible dependents are your:

§ Spouse or domestic partner

§ Child, until the end of the month in which the child turns 26, regardless of student status, employment status or financial dependency on you. “Child” is defined as: your biological children, your stepchildren, your legally adopted children, domestic partner’s children, and any children placed with you for adoption.

Notwithstanding the limit on dependents’ age above, unmarried children of any age who are unable to do any work to support themselves because of mental illness, developmental disability, or physical handicap are covered provided that, before reaching the age of 26, they (1) satisfied this condition and (2) are covered by the Fund. In order for a dependent age 26 or older to be classified as disabled under the Plan, you must supply the Fund Office with proof of your dependent’s disability and a copy of your dependent’s Supplemental Security Income (SSI) Award.

NOTE: If a child is married, coverage is not available for the child’s spouse or children.

Dependent Documentation

Before coverage for a dependent becomes effective, you must supply the Fund Office with a copy of your marriage certificate, dependent’s birth certificate, adoption decree or other appropriate documentation that demonstrates your relationship to your dependent. You may also be required to provide documentation at other times, as determined by the Plan Administrator in its discretion.

Dependents of Retired Employees

If you are a retired employee, for a dependent to be covered under the health care benefits described in this SPD, your dependent must not be eligible for Medicare.

Retired employee dependents receive medical coverage only. No dental, optical or life insurance benefits are provided to dependents of retired employees.

Newspaper Guild of New York – The New York Times Benefits Fund Page 10

ELIGIBILITY FOR BENEFITS (continued)

Domestic Partner

The Plan also offers medical, dental and optical benefit protection for a domestic partner of the same or opposite gender provided you submit the proof of domestic partnership required by the Plan.

The Plan considers a person to be your domestic partner when:

§ the relationship with you is exclusive and one of mutual support, caring and commitment; § the intent is for the relationship to be permanent; § you and your domestic partner live together in the same permanent residence and are jointly responsible for common expenses; § you and your domestic partner are not married to anyone else; § you and your domestic partner are not related by blood closer than would bar marriage under the law; and § you and your domestic partner are 18 years of age or older and are mentally competent to contract.

No benefit coverage is provided to domestic partners of retired employees.

Taxes Related to Domestic Partner Coverage

Under federal tax law, the tax treatment of your Plan coverage provided to a domestic partner, or a child (under age 26) of any such individual who is not also your child will depend on whether the enrolled individual qualifies as your tax dependent for health coverage purposes. If the enrolled individual does not qualify as your tax dependent for health coverage purposes, the value of the coverage provided, less the amount you pay for the coverage on an after-tax basis, will be included in your gross income, subject to federal income tax withholding and employment taxes, and will be reported on your Form W-2.

Generally, states follow federal law with respect to the taxation of a domestic partner, or their child's health care benefits. However, there are exceptions to this rule. Some states exclude health benefits provided to such individuals from gross income for state income tax purposes, even if such person is not a tax dependent for health coverage purposes under federal law.

If you cover a domestic partner or either of their children, you must advise the Fund if that individual is a dependent for health coverage purposes under federal and/or state tax law. If you don't do so, it will be assumed that the individual is not your dependent.

This information is only a summary of the tax provisions governing the tax status of these individuals for health coverage purposes, and is not intended nor should it be relied upon as legal or tax advice. Due to the complexity of these tax rules and the potential impact of any imputed income you may incur, you should seek advice from a competent tax professional before certifying as to the tax status of any enrolled individual.

Newspaper Guild of New York – The New York Times Benefits Fund Page 11

ELIGIBILITY FOR BENEFITS (continued)

WHEN DOES COVERAGE BEGIN?

If you fulfill the active benefit eligibility requirements, your coverage begins on the first day of the month coinciding with your date of employment. See above for the start date for Service Employees and Temporary and Casual Employees.

Coverage for an eligible dependent begins on the same date as yours, or if later, on the date the dependent first becomes eligible.

NO DUPLICATE COVERAGE

You may not be enrolled in the Plan as a dependent if you are enrolled in the Plan as an employee. You may also not be enrolled as a dependent of a Plan participant and as a participant in any retiree medical plan offered by the Fund to retired employees.

Your dependents may not be enrolled in the Plan as a dependent of both you and your spouse or domestic partner. For example, if you and your spouse or domestic partner are both covered under the Plan, your dependents may not be enrolled as your dependent and as your spouse’s or domestic partner’s dependent.

Newspaper Guild of New York – The New York Times Benefits Fund Page 12

ENROLLMENT

Active Employee

The Plan requires that you complete the following forms in order to provide benefits for you and/or your family:

1. Enrollment form (includes choice of coverage); 2. Flexible Benefits Plan enrollment form; 3. Benefits deduction form; 4. Life insurance enrollment form; 5. Designated beneficiary form; 6. Enrollment form for domestic partnership (if applicable) 7. Switch coverage enrollment form (if applicable); and 8. Supply the following information where applicable: § birth certificate for yourself § birth certificates for your family § a certificate of marriage § proof of dependency § an affidavit of domestic partnership § certification of eligibility for the child(ren) of your domestic partner and proof of cohabitation § any other documentation requested by the Plan Administrator

You may contact the Fund Office for these benefit forms or go online at guild.candrdirect.com. Please submit forms as soon as possible. If you do not enroll, you and your family will not be eligible for the benefits available under the Plan.

You may change your coverage each year during the open enrollment period:

Enrollment Period: February 15th through March 15th Effective Period: April 1st through March 31st

If you are eligible for dependent coverage during the open enrollment period and you elect individual coverage, generally, you may not add any current dependents until the next open enrollment period.

However, there are a few exceptions to this rule.

1. If you get married or acquire a new child during the waiting period (whether through pregnancy, adoption or placement for adoption), you may elect dependent coverage in order to cover that new spouse or child provided that you notify the Fund Office within 30 days of the marriage or birth/adoption and pay the required premium on time. The coverage will begin on the date you provided notice, in the case of marriage, or on the date of the birth/adoption.

2. If you decline to enroll and then get married or acquire a new child, you have the opportunity to cover the new dependent(s) (and yourself, if applicable) provided that you notify the Fund Office within 30 days of the marriage or birth/adoption and pay the required premium on time. The coverage will begin on the date you provided notice, in the case of marriage, or on the date of the birth/adoption.

Newspaper Guild of New York – The New York Times Benefits Fund Page 13

ENROLLMENT (continued)

3. If you elect not to pay the premium (or if you are an eligible active employee, enroll on behalf of yourself) at the beginning of your eligibility period because you, your spouse or dependents had coverage under another plan, but you (or your dependents) then lose that coverage because employer contributions cease or because of a loss of eligibility resulting from a change in family status (i.e., legal separation, divorce), termination of employment, reduction in hours, exhaustion of COBRA, children’s aging out of coverage, or moving out of an HMO service area other than a failure to pay Member premiums or termination of coverage for cause (such as fraud).

In this event, you will be given the opportunity to purchase coverage for them and you (and/or enroll on behalf of yourself if you are an eligible active employee) provided that you notify the Fund Office in writing within 30 days of the change in family status, termination of employment, reduction in hours, exhaustion of COBRA, children’s aging out of coverage, or moving out of an HMO service area. If you both provide this notice and pay the required premium on time, the coverage will begin on the date you notified the Fund of the change.

If the other coverage was COBRA coverage, this exception only applies after the COBRA coverage is exhausted (other than for non-payment of premiums).

A participant who is transferred by the New York Times Company outside the tri-state area, can elect to have their dependents enrolled in the Plan at the time of transfer.

4. If you or your dependents are eligible but not enrolled in the Plan and lose coverage under Medicaid or a State’s Children’s Health Insurance Program (CHIP), or you and your dependents become eligible for a State’s premium assistance under Medicaid or CHIP.

In these instances, you and your eligible dependents will have a special right to enroll in the Plan. You must do so in accordance with the procedures established by the Plan within 60 days after such loss of coverage or such gain of eligibility. If your enrollment election is received by the Plan in accordance with its procedures within this time period, the coverage will be effective on the first day of the first calendar month beginning on or after the date the Plan receives your election.

Newspaper Guild of New York – The New York Times Benefits Fund Page 14

CONTRIBUTIONS TO THE COST OF COVERAGE

Eligible Active Employee

If you are an eligible active employee, you must make weekly contributions in order to receive Plan coverage. The weekly contributions are split into two parts:

1. Weekly contributions based solely upon your pay group; and

2. Additional weekly contribution amount required based on your choice of coverage (single, employee plus one eligible dependent, or employee plus more than one eligible spouse or dependent).

Please contact the Fund Office for the most current weekly contribution rates per pay group chart and the additional weekly contribution amount required based on your coverage. You are required to pay your total weekly contribution rate in order to receive coverage.

Generally an employee’s weekly contributions will be made on a pre-tax basis through his or her employer’s cafeteria plan.

Additional Contributions for Active Employees Enrolled in the EPO or in HMOs

Employees who are enrolled in the EPO or any of the HMOs available through the Plan are required to pay additional contributions if their EPO or HMO charges a higher premium than the cost of the PPO coverage as determined by the Trustees. You will be advised during each annual open enrollment period of the additional EPO or HMO contribution rates for the following plan year.

Please contact the Fund Office for the current additional EPO or HMO premium contributions required.

Eligible Retired Employee

You are required to make a monthly contribution (due on the first of the month) equal to 30% of the cost of premiums for benefit coverage for yourself, as annually determined by the Trustees.

Please note if you are under age 55 at the time of retirement, you will be required to pay 100% of the medical premium until the age of 60. Thereafter, you are required to make a monthly contribution equal to 30% of the cost of premiums for benefit coverage for yourself, as annually determined by the Trustees.

You also will be required to make a contribution of 100% of the cost of premiums for benefit coverage for any dependents you cover, as determined annually by the Trustees.

Please contact the Fund Office for the current premiums for benefit coverage that apply to you and your dependents.

If a retiree or a retiree’s dependent elects not to participate in the Plan, he or she will not be permitted to enroll in the Plan in the future – as either a pre-Medicare or Medicare participant.

A dependent of a deceased employee, who was covered under the Plan immediately prior to the employee’s death, will continue to be covered for the 24-month period following death at no cost to the dependent, and in certain cases, may be eligible to elect an additional twelve months of continuation coverage.

Newspaper Guild of New York – The New York Times Benefits Fund Page 15

IF YOU CONTINUE TO WORK AFTER AGE 65

If you continue to work after age 65 (when you become eligible for Medicare), you, your spouse and your eligible dependents are entitled to the same hospital, medical, prescription drug, dental, and optical coverage as if you were under age 65; and you continue to be eligible for life insurance coverage.

Even though your primary coverage through the Fund continues, you may still apply for Medicare. When you apply for Social Security benefits, you automatically become eligible for Medicare Part A hospital coverage. Part A coverage is free. Medicare Part B coverage, for which you pay premiums, is voluntary so consider whether Part B really makes sense for you. While you remain actively employed, your benefits without Part B are as complete as those of employees under 65 who are not yet eligible for Medicare.

If you choose not to enroll in Medicare Part B at the time you reach age 65, you should, however, be sure to consider purchasing coverage immediately when you retire or lose coverage as an active employee. Failure to enroll within 7 months of termination of employment may result in delayed eligibility or premium penalties. At the time your coverage is no longer based on current employment status, Medicare becomes your primary health coverage, while this Plan becomes secondary if you are entitled to retiree coverage.

If you are age 65 or over when you retire, the Plan offers eligible retirees the opportunity to participate in a medical program whose benefits are supplementary to Medicare benefits. Details are provided in the SPD for retirees and their dependents, which you may obtain by contacting the Fund Office.

Newspaper Guild of New York – The New York Times Benefits Fund Page 16

LIFE EVENTS

You should notify the Fund Office as soon as possible if you experience a life event that may affect your coverage.

CHANGES IN PERSONAL STATUS

It is important that you notify the Fund Office promptly if:

§ You retire from employment § You want to change your designated beneficiary § You change your address § You change your telephone number § Taking family medical leave § Entering active military service § Becoming disabled § Becoming eligible for Medicare

CHANGES IN FAMILY STATUS

You must notify the Fund Office as soon as possible, but not more than 30 days after a change in family status.

A change in family status includes:

§ You get married, divorced, or legally separated § An eligible dependent dies § You have a new dependent child (through birth or adoption)

Your child is automatically covered under the Plan for the first 30 days if you have family coverage. However, you will need to add your baby to your coverage. If you do not have family coverage, call the Fund Office within 30 days to add your child as a dependent. In this case, the child’s coverage will be effective as of his or her birth or adoption.

If you have any questions about whether a change in family status requires a new election, please call the Fund Office at (646) 237-1670 as soon as possible.

Newspaper Guild of New York – The New York Times Benefits Fund Page 17

WHEN DOES YOUR COVERAGE END?

Your hospital, medical, prescription drug, dental, optical and life insurance coverage generally ends on the last day of the month in which the earliest of the following events occurs:

Employee

§ You cease to be employed as a regular full-time scheduled to work at least 30 hours per week or as a part-time employee scheduled to work 20.7 hours per week; § for Service Employees and Temporary or Casual Employees identified as variable hour, when your 6- month coverage period ends, if you did not meet the hours requirement for the following coverage period; § You no longer meet the Plan’s eligibility requirements; § You fail to pay any required premium for your coverage; § You cancel your coverage; § You die; or § The Plan terminates.

Note that medical coverage may continue for an eligible retired employee until you reach age 65, at which point you may become eligible for a medical program under the Plan which supplements Medicare benefits. The SPD for retired employees age 65 or over explaining this Medicare supplemental program is available from the Fund Office.

Dependents

Hospital, medical, prescription drug, dental and optical coverage for your dependents ends on the last day of the month in which earliest of the following events occurs:

§ Your coverage ends; § Your dependent is no longer eligible; § You fail to pay any required dependent premium; § Your dependent dies; or § The Plan no longer covers dependents.

If you become disabled, or if you are on an approved leave of absence, benefits may continue for certain periods of time. Please refer to the Continuation of Coverage – COBRA.

If you go on an approved leave of absence in connection with the adoption of a child, coverage continues for up to six (6) months during an approved adoption leave of absence.

Newspaper Guild of New York – The New York Times Benefits Fund Page 18

CONTINUATION OF COVERAGE – COBRA

Under certain circumstances, you, your dependents, or your survivors can continue coverage after eligibility ends, but you (or your dependents or survivor) will have to pay for the cost of this coverage. Read this section carefully. You may contact the Fund Office for further details.

Continuation Coverage Rights Under COBRA

This section contains important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This section generally explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect the right to receive it. When you become eligible for COBRA, you may also become eligible for other coverage options that may cost less than COBRA continuation coverage.

The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). If you are an active employee, you and your covered dependents have the right, under COBRA, to continue group hospital, medical, dental and optical coverage for a limited period if this coverage ends for certain reasons called qualifying events. If you are a retired employee, your covered dependents have the right, under COBRA, to continue group hospital, medical, dental and optical coverage for a limited period if this coverage would otherwise end for certain reasons called qualifying events. For additional information about your rights and obligations under the Plan and under federal law, please contact the Fund Office at (646) 237-1670.

You may have other options available to you when you lose group health coverage. For example you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees. Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov.

What is COBRA Continuation Coverage?

COBRA continuation coverage is a continuation of Plan coverage when coverage would otherwise end because of a life event known as a “qualifying event.” Specific qualifying events are listed later in this section. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage.

If you are an active employee, you will become a qualified beneficiary if you lose your coverage under the Plan because either one of the following qualifying events happens:

§ Your hours of employment are reduced; or § Your employment ends for any reason other than your gross misconduct.

Newspaper Guild of New York – The New York Times Benefits Fund Page 19

CONTINUATION OF COVERAGE – COBRA (continued)

If you are the spouse of an active employee, you will become a qualified beneficiary if you lose your coverage under the Plan because any of the following qualifying events happens:

§ Your spouse dies; § Your spouse’s hours of employment are reduced; § Your spouse’s employment ends for any reason other than his or her gross misconduct; § Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or § You become divorced or legally separated from your spouse.

If you are the spouse of a retired employee, you will become a qualified beneficiary if you lose your coverage under the Plan because any of the following qualifying events happens:

§ Your spouse dies; § Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or § You become divorced or legally separated from your spouse.

If you are an active employee, your dependent children will become qualified beneficiaries if they lose coverage under the Plan because any of the following qualifying events happens:

§ The parent-employee dies; § The parent-employee’s hours of employment are reduced; § The parent-employee’s employment ends for any reason other than his or her gross misconduct; § The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both); § The parents become divorced or legally separated; or § The child stops being eligible for coverage under the Plan as a “dependent child.”

If you are a retired employee, your dependent children will become qualified beneficiaries if they lose coverage under the Plan because any of the following qualifying events happens:

§ The parent-employee dies; § The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both); § The parents become divorced or legally separated; or § The child stops being eligible for coverage under the Plan as a “dependent child.”

Children who are born to or placed for adoption with a covered employee during the period of the employee’s continuation coverage also are qualified beneficiaries entitled to COBRA continuation coverage. Once the newborn or adopted child is enrolled in continuation coverage pursuant to the Plan’s rules, the child will be treated like all other qualified beneficiaries with respect to the same qualifying event. The maximum coverage period for such a child is measured from the same date as for other qualified beneficiaries with respect to the same qualifying event (and not from the date of the child’s birth or adoption). Furthermore, if you get married while receiving COBRA, you may add your spouse to your coverage. If COBRA coverage ceases for you, your spouse or your dependent child(ren) before the end of the maximum 18-, 29- or 36-month COBRA period, COBRA coverage will also end for the newly added dependents.

Newspaper Guild of New York – The New York Times Benefits Fund Page 20

CONTINUATION OF COVERAGE – COBRA (continued)

Loss of Other Group Health Plan Coverage

If, while you (the active employee) are enrolled for COBRA continuation coverage your spouse or dependent loses coverage under another group health plan, you may enroll the spouse or dependent for coverage for the balance of the period of COBRA continuation coverage. The spouse or dependent must have been eligible but not enrolled in coverage under the terms of the pre-COBRA plan and, when enrollment was previously offered under the pre-COBRA plan and declined, the spouse or dependent must have been covered under another group health plan or had other health insurance coverage.

The loss of coverage must be due to exhaustion of COBRA continuation coverage under another plan, termination as a result of loss of eligibility for the coverage, or termination as a result of employer contributions toward the other coverage being terminated. Loss of eligibility does not include a loss due to failure of the individual or Member to pay premiums on a timely basis or termination of coverage for cause. You must enroll the spouse or dependent within 31 days after the termination of the other coverage. Adding a spouse or dependent child may require that you switch from individual to family coverage and may cause an increase in the amount you must pay for COBRA continuation coverage. Sometimes, filing a proceeding in bankruptcy under Title 11 of the United States Code can be a qualifying event for retired employees covered under the Plan, and their covered dependents. If a proceeding in bankruptcy is filed with respect to your former employer, and that bankruptcy results in the loss of coverage of any retired employee covered under the Plan, the retired employee will become a qualified beneficiary with respect to the bankruptcy. The retired employee’s spouse, surviving spouse, and dependent children will also become qualified beneficiaries if bankruptcy results in the loss of their coverage under the Plan. For this purpose, a “loss of coverage” includes a substantial elimination of coverage within one year before or after the date of commencement of the bankruptcy proceedings.

When Is COBRA Coverage Available?

The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. When the qualifying event is the end of employment or reduction of hours of employment, death of the employee/retiree, commencement of a proceeding in bankruptcy with respect to the employer, or the employee’s/retiree’s becoming entitled to Medicare benefits (under Part A, Part B, or both), the employer must notify the Fund Office of the qualifying event.

You Must Give Notice of Some Qualifying Events

For all other qualifying events (divorce or legal separation of the employee/retiree and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you (or your family member) must notify the Fund Office within 60 days after the occurrence of the qualifying event or the date coverage would be lost because of the qualifying event, whichever is later.

You (or your family member) must provide this notice to:

Newspaper Guild of New York - The New York Times Benefits Fund 1501 Broadway, Suite 1724 New York, NY 10036

Newspaper Guild of New York – The New York Times Benefits Fund Page 21

CONTINUATION OF COVERAGE – COBRA (continued)

How is COBRA Continuation Coverage Provided?

After the Fund Office receives notice that a qualifying event has occurred, the Fund Office will offer COBRA continuation coverage to each of the qualified beneficiaries and will send the materials necessary to make their proper election. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children.

To elect continuation coverage, you must complete the election form and furnish it according to the directions on the form. Each qualified beneficiary has a separate right to elect continuation coverage. For example, your spouse may elect continuation coverage even if you do not. Continuation coverage may be elected for only one, several, or for all dependent children who are qualified beneficiaries. A parent may elect to continue coverage on behalf of any dependent children. You or your spouse can elect continuation coverage on behalf of all of the qualified beneficiaries.

The Fund Office must receive a completed election form from the qualified beneficiary within 63 days of the mailing or 60 days of the date the qualifying event occurred, whichever is later.

How Long Does COBRA Continuation Coverage Last?

COBRA continuation coverage is a temporary continuation of coverage. When the qualifying event is the death of the employee/retiree, the employee’s/retiree’s becoming entitled to Medicare benefits (under Part A, Part B, or both), your divorce or legal separation, or a dependent child’s losing eligibility as a dependent child, COBRA continuation coverage lasts for up to a total of 36 months. When the qualifying event is the end of employment or reduction of the employee’s hours of employment, COBRA continuation coverage generally lasts for only up to a total of 18 months. However, when the qualifying event is the end of employment or reduction of the employee’s hours of employment, and the employee became entitled to Medicare benefits less than 18 months before the qualifying event, COBRA continuation coverage for qualified beneficiaries other than the employee lasts until 36 months after the date of Medicare entitlement.

For example, if a covered employee becomes entitled to Medicare 8 months before the date on which his employment terminates, COBRA continuation coverage for his spouse and children can last up to 36 months after the date of Medicare entitlement, which is equal to 28 months after the date of the qualifying event (36 months minus 8 months).

There are two ways in which an 18-month period of COBRA continuation coverage can be extended.

Disability extension of 18-month period of continuation coverage

If you or anyone in your family covered under the Plan is determined by the Social Security Administration to be disabled and you notify the Fund Office in a timely fashion in writing on an authorized form which you can obtain from the Fund Office, you and your entire family may be entitled to receive up to an additional 11 months of COBRA continuation coverage, for a total maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of continuation coverage. You must give the Fund Office notice of a disability by the end of the initial 18-month period of continuation coverage. Call the Fund Office in order to receive the appropriate form.

Newspaper Guild of New York – The New York Times Benefits Fund Page 22

CONTINUATION OF COVERAGE – COBRA (continued)

Second qualifying event extension of 18-month period of continuation coverage

If your family experiences another qualifying event while receiving 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if notice of the second qualifying event is properly given to the Plan. This extension may be available to the spouse and any dependent children receiving continuation coverage if the employee or former employee dies, gets divorced or legally separated, or becomes entitled to Medicare, or if the dependent child stops being eligible under the Plan as a dependent child, but only if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred.

Newspaper Guild of New York – The New York Times Benefits Fund Page 23

Qualifying Event Qualified Beneficiary Eligibility Notification Requirements

Employee terminated for Employee, 18 months Employer must notify Fund other than gross spouse/domestic partner, Office of qualifying event. misconduct and/or dependent children

Employee reduction in Employee, 18 months Employer must notify Fund hours worked (making spouse/domestic partner, Office of qualifying event. employee ineligible for and/or dependent children coverage under the plan)

Employee becomes Spouse/domestic partner, 36 months Employer must notify Fund entitled to Medicare and/or dependent children Office of qualifying event.

Death of Employee Spouse/domestic partner, 36 months Employer must notify Fund and/or dependent children Office of qualifying event.

Employee is divorced or Spouse/domestic partner, 36 months minus Employee or Spouse/Domestic legally separated from and/or dependent children the number of Partner must notify the Fund spouse/domestic partner months covered Office. since the divorce

Child ceases to be eligible Dependent child 36 months Employee must notify the as defined by the Plan Fund Office.

COBRA Continuation Qualified Beneficiary Eligibility Notification Requirements

Employee becomes Employee, 11 months in Employee must notify the eligible for disability spouse/domestic partner, addition to the 18 Fund Office. through Social Security and/or dependent children months (max. 29 months)

Second Qualifying Event COBRA beneficiary 18 months in Employee must notify the (death, divorce/legal addition to the 18 Fund Office. separation from months spouse/domestic partner, (max. 36 months) employee becomes entitled to Medicare, or child ceases to be eligible as defined by the Plan

Newspaper Guild of New York – The New York Times Benefits Fund Page 24

CONTINUATION OF COVERAGE – COBRA (continued)

Early Termination of COBRA Continuation Coverage

The law provides that continuation coverage may be cut short prior to the expiration of the applicable 18, 29, or 36 month period for any of the following five reasons:

1. The group health coverage provided to you is terminated (and the Plan is not required by COBRA to provide you with other group health coverage that it maintains, if any);

2. The premium for COBRA continuation coverage is not timely paid in full (within the applicable grace period);

3. The qualified beneficiary first becomes, after electing COBRA continuation coverage, covered under another group health plan (as an employee or otherwise) that does not contain any preexisting condition exclusion or limitation applicable to the qualified beneficiary;

4. The qualified beneficiary becomes entitled to Medicare (under Part A, Part B, or both) after electing COBRA coverage; or

5. Coverage has been extended for up to 29 months due to disability and there has been a final determination by the Social Security Administration that the qualified beneficiary is no longer disabled. In this case, coverage will end as of the month that begins more than 30 days after the date of such final determination. You are required to notify the Fund Office within 30 days of such final determination.

Continuation coverage may also be terminated for any reason the Plan would terminate coverage of a Member or beneficiary not receiving continuation coverage (such as misrepresentation or fraud).

Leave of Absence (LOA) and COBRA

If an employee is offered alternative health care coverage while on a LOA, and this alternate coverage is not identical in cost (there is an increase in premium), or benefits to the coverage in effect on the day before the LOA, then such alternate coverage does not meet the COBRA requirement, and is considered to be a loss in coverage requiring COBRA to be offered. If you reject the COBRA coverage, the alternative plan is considered to be a different group health plan and, as such, after expiration of the LOA, no COBRA offering is required under this Plan.

Note that if you elected alternative health care coverage while on a LOA, and your spouse or dependents later experienced a qualifying event (divorce, your death, etc.) before the LOA expired, your dependents would be able to elect COBRA.

How Much Does COBRA Continuation Coverage Cost?

Generally, each qualified beneficiary may be required to pay the entire cost of COBRA continuation coverage. The amount a qualified beneficiary may be required to pay may not exceed 102% (or, in the case of an extension of continuation coverage due to a disability, 150%) of the cost to the group health plan (including both employer and employee contributions) for coverage of a similarly situated plan participant or beneficiary who is not receiving continuation coverage.

Newspaper Guild of New York – The New York Times Benefits Fund Page 25

CONTINUATION OF COVERAGE – COBRA (continued)

When and How Must Payment For COBRA Continuation Coverage Be Made?

§ First payment for COBRA continuation coverage

If you elect COBRA continuation coverage, you do not have to send any payment with the election form. However, you must make your first payment for continuation coverage not later than 45 days after the date of your election. (The date your election form is postmarked will be used, if you decide to mail payment.) If you do not make your first payment for continuation coverage in full not later than 45 days after the date of your election, you will lose all COBRA continuation coverage rights under the Plan. You are responsible for making sure that the amount of your first payment is correct. You may contact the Fund Office for this information.

Newspaper Guild of New York – The New York Times Benefits Fund 1501 Broadway, Suite 1724 New York, NY 10036 (646) 237-1670

§ Periodic payments for COBRA continuation coverage

After you make your first payment for COBRA continuation coverage, you will be required to make periodic payments for each subsequent coverage period. Information about the amount due for each coverage period for each qualified beneficiary can be obtained from the Fund Office. The periodic payments can be made on a monthly basis. Under the Plan, each of these periodic payments for continuation coverage is due on the first day of the calendar month for that coverage period. If you make a periodic payment on or before the first day of the coverage period to which it applies, your coverage under the Plan will continue for that coverage period without any break. The Plan will not send periodic notices of payments due for these coverage periods.

§ Grace periods for periodic payments

Although periodic payments are due on the dates shown above, you will be given a grace period of 30 days after the first day of the coverage period to make each periodic payment. Your COBRA continuation coverage will be provided for each coverage period as long as payment for that coverage period is made before the end of the grace period. However, if you pay a periodic payment later than the first day of the coverage period to which it applies, but before the end of the grace period for the coverage period, your coverage under the Plan will be suspended as of the first day of the coverage period and then retroactively reinstated (going back to the first day of the coverage period) when the periodic payment is received. This means that any claim you submit for benefits while your coverage is suspended may be denied and may have to be resubmitted once your coverage is reinstated.

If you fail to make a period payment before the end of the grace period for that coverage period, your COBRA continuation coverage will be terminated and you will lose all rights to COBRA continuation coverage under the Plan.

Newspaper Guild of New York – The New York Times Benefits Fund Page 26

CONTINUATION OF COVERAGE – COBRA (continued)

Your first payment and all periodic payments for COBRA continuation coverage should be sent to:

Newspaper Guild of New York – The New York Times Benefits Fund 1501 Broadway, Suite 1724 New York, NY 10036

Other Coverage Options Besides COBRA Continuation Coverage

There may also be alternative health insurance coverage options for you and your family other than purchasing COBRA coverage from this Plan. When key parts of the health care law took effect in 2014, you became entitled to buy coverage through the Health Insurance Marketplace. The Marketplace is designed to help people without employer-sponsored coverage find health insurance that meets their needs and fits their budget. More information about the Health Insurance Marketplace generally is available at: www.HealthCare.gov.

In considering whether coverage through the Marketplace is better for you than COBRA coverage, you could be eligible for a new kind of tax credit that lowers your monthly premiums right away. Information about the Marketplace can help you see what your premium, deductibles, and out-of-pocket costs will be before you make a decision to enroll. Being eligible for COBRA does not limit your eligibility for coverage for a tax credit through the Marketplace.

In addition to the options available from the Marketplace, you may qualify for a special enrollment opportunity to obtain coverage from another group health plan for which you are eligible (such as a spouse’s plan). Even if the other plan generally does not accept late enrollees, you may still qualify if you request enrollment within 30 days through what is called a “special enrollment period.” This option may cost less than COBRA continuation coverage.

You should compare your other coverage options with COBRA continuation coverage and choose the coverage that is best for you. For example, if you move to other coverage you may pay more out-of-pocket than you would under COBRA continuation coverage because the new coverage may impose a new deductible.

If you would like more information regarding the Marketplace, you should contact the Health Benefit Exchange Marketplace in your state of residence. For example, in New York State, the website for the Marketplace is: www.healthbenefitexchange.ny.gov.

For more information about your rights under ERISA, including COBRA, the Health Insurance Portability and Accountability Act (HIPAA), and other laws affecting group health plans, contact the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit the EBSA website @ www.dol.gov/ebsa (addresses and telephone number of regional and district EBSA offices are available through EBSA’s website).

Newspaper Guild of New York – The New York Times Benefits Fund Page 27

OTHER WAYS YOUR COVERAGE CAN CONTINUE

Special rules apply in the following cases.

1. Death If you should die in active status while eligible for benefits, your eligible dependents will continue to be covered for hospital, medical, prescription drug, dental and optical benefits for two years after your death. This two-year (24-month) period is subtracted from the 36-month maximum continuation under COBRA.

After the two-year period of coverage continuation under the Plan ends, your dependents may apply for up to one year of continuation of coverage under COBRA.

2. Voluntary Separation Package (Separation Plan) If you are accepted into the Voluntary Separation Package and the employer continues contributions on your behalf, your benefits will continue for four months at no cost to you if you have 11 years or less of service. If you have more than 11 years of service, the continuation period is eight months. The four- or eight-month continuation period is subtracted from the 18-month employee maximum continuation under COBRA.

If during your period of non-COBRA continued coverage, you retire and are immediately eligible for a pension from the Newspaper Guild of New York-The New York Times Pension Plan, your benefits as an active employee will stop at that time. Please refer to the Retiree SPD (available from the Fund Office) to determine if you are eligible for health coverage as a retiree 65 years or older.

Leave of Absence (LOA) and COBRA

If an employee is offered alternative health care coverage while on a LOA, and this alternate coverage is not identical in cost (there is an increase in premium), or benefits to the coverage in effect on the day before the LOA, then such alternate coverage does not meet the COBRA requirement, and is considered to be a loss in coverage requiring COBRA to be offered. If you reject the COBRA coverage, the alternative plan is considered to be a different group health plan and, as such, after expiration of the LOA, no COBRA offering is required under this Plan.

Note that if you elected alternative health care coverage while on a LOA, and your spouse or dependents later experienced a qualifying event (divorce, your death, etc.) before the LOA expired, your dependents would be able to elect COBRA.

If you are on an authorized leave of absence, coverage continues as follows:

§ Pregnancy/Adoption leave. Benefits will continue during a six-month approved leave of absence for pregnancy/adoption. They will stop at the end of the six months. You should contact the Fund Office immediately after you return to work. If you do not return to work, you must pay premiums equal to the cost of coverage for the period during which you were on leave.

§ Union leave. If you are an employee who is selected to hold full-time office either in the NewsGuild- Communications Workers of America or the NewsGuild of New York, Local 31033, Communications Workers of America, and you are granted a leave of absence from The New York Times under Section 1, Subsections (b) and (c) of the Collective Bargaining Agreement between the NewsGuild of New York, Local 31003 Communications Workers of America and The New York Times, benefits provided by the Plan (or equivalent benefits) will continue during the approved leave of absence. Employees on such a leave of absence will also be eligible for any new benefits provided to active employees. Medical benefits provided by the Fund are secondary to the existing benefits provided to any employee of the union. See “Coordination of Benefits” in Section V.

Newspaper Guild of New York – The New York Times Benefits Fund Page 28

OTHER WAYS YOUR COVERAGE CAN CONTINUE (continued)

§ Military leave. Under the federal Uniformed Services Employment and Reemployment Rights Act (“USERRA”) of 1994, employers must grant unpaid military leave and continue to subsidize health care coverage for up to 31 days. If you go into active military service you can continue your medical and dental coverage during that period up to 31 days. If your active military service extends beyond 31 days, you may be able to continue your coverage at your own expense for up to 24 months (similar to COBRA continuation coverage). In addition, your dependent(s) may be eligible for health care coverage under the Civilian Health & Medical Program of the Uniformed Services (“CHAMPUS”). This Plan will coordinate coverage with CHAMPUS.

To the extent provided by law, when you are discharged (not less than honorably) from active military duty, and you have served no more than 5 years in the military while employed by your employer, your full eligibility will be reinstated on the day you return to work with a participating employer, provided you return to work within:

1. 90 days from the date of discharge if the period of service was more than 180 days; or

2. 14 days from the date of discharge if the period of service was 31 days or more but less than 180 days; or

3. at the beginning of the first full regularly scheduled working period on the first calendar day following discharge (plus travel time and an additional eight hours if the period of service was less than 31 days.

If you are hospitalized or convalescing from an injury caused by active military duty, these time limits are extended for up to 2 years.

Questions regarding your entitlement to this leave should be referred to your employer.

Questions regarding the continuation coverage during leave should be referred to the Fund Office.

Reinstatement of Coverage After a Leave of Absence

If your coverage ends while you are on an approved pregnancy/adoption leave or USERRA military service and your cumulative periods of military service while employed do not last longer than five years, your coverage will be reinstated on the day you return to active employment (see the Military Leave section above for more details).

§ Other leaves If you are on an unpaid approved leave of absence for any other reason than those referred to above, your eligibility will continue for three (3) months. Your eligibility may continue on a direct payment basis (you will be billed by the Fund at the COBRA cost minus the 2% administrative charge) for no longer than two years. If you are still on approved unpaid leave at the end of the two (2) year period, you may become eligible for COBRA coverage at that time.

Newspaper Guild of New York – The New York Times Benefits Fund Page 29

OTHER WAYS YOUR COVERAGE CAN CONTINUE (continued)

§ Disability If you should become disabled, all hospital and major medical benefits will continue for 24 months while you are on an approved leave of absence for disability (which coverage runs concurrently with COBRA). After the first 24 months of disability, your COBRA coverage extends benefits for another five months (assuming you make a timely election and pay the required premium). These benefits will stop 29 months from the onset of your disability or the date your employer stops making contributions into the Fund on your behalf, whichever occurs later. This continuation of coverage rule also applies if you are receiving Workers’ Compensation benefits, except that the 29 months will be measured from the onset of your Workers’ Compensation benefits.

Optical, dental and life insurance benefits stop six months after contributions are no longer being made on your behalf. Life insurance benefits may be extended by the insurance company under certain circumstances. See the Life Insurance section of this document.

However, if you or a family member is totally disabled on the day your eligibility for health care insurance ends, the Plan will continue to pay hospital and major medical expenses resulting from the condition causing the disability until the earliest of the following:

§ The day you or a dependent becomes eligible for benefits under another group plan; § The day the disability ends; or § December 31 of the calendar year following the date on which your coverage ends.

Newspaper Guild of New York – The New York Times Benefits Fund Page 30

HIPAA RIGHTS

Right to get special enrollment in another plan

Under HIPAA, if you lose your group health plan coverage, you may be able to get into another group health plan for which you are eligible (such as a spouse’s plan), even if the plan generally does not accept late enrollees, if you request enrollment within 30 days. (Additional special enrollment rights are triggered by marriage, birth, adoption, and placement for adoption.)

§ Therefore, once your coverage ends, if you are eligible for coverage in another plan (such as a spouse’s plan), you should request special enrollment as soon as possible.

Prohibition against discrimination based on a health factor

Under HIPAA, a group health plan may not keep you (or your dependents) out of the plan based on anything related to your health. Also, a group health plan may not charge you (or your dependent) more for coverage, based on health, than the amount charged a similarly situated individual.

State Flexibility

This section describes minimum HIPAA protections under federal law. States may require insurers and HMOs to provide additional protections to individuals in that state.

For More Information

If you have questions about your HIPAA rights, you may contact your state insurance department or the U.S. Department of Labor, Employee Benefits Security Administration (“EBSA”) toll-free at 1-866-444- 3272 (for free HIPAA publications ask for publications concerning HPAA). You may also contact the CMS publication hotline at 1-800-633-4227 (ask for “Protecting Your Health Insurance Coverage”). These publications and other useful information are also available at this website: www.dol.gov/ebsa/consumer_info_health.html.

Newspaper Guild of New York – The New York Times Benefits Fund Page 31

Section III

PLAN BENEFITS

Medical and Prescription Drug Benefits

Newspaper Guild of New York – The New York Times Benefits Fund Page 32

SUMMARY OF HEALTH PLANS

I. Preferred Provider Organization (PPO) Plan

II. Exclusive Provider (EPO) Plan

III. Health Maintenance Organization (HMO) Plans

IV. International Health Benefit Plan – Expatriate / Foreign Affairs

The health plan summary descriptions and comparison charts contained in this SPD are for informational purposes only and are subject to change. The benefits are subject to the terms, conditions, and limitations of the applicable contracts and laws. The types of health plans and vendors are subject to change.

CHOOSING A PLAN

To select a health plan that best meets your needs, you should consider the following information:

§ Coverage The services covered by the plans differ. For example, some plans provide alternative medicine, discounts on health related products and services.

§ Choice of Doctor Some plans provide partial reimbursement when non-participating providers are used. Other plans only pay for, or allow the use of participating providers.

§ Convenience of Access Certain plans require precertification or referrals. Certain plans may have participating providers or centers that are more convenient to your home or workplace. You should consider the location of physician’s offices and hospital affiliations.

§ Cost Some plans require copays for each routine office visit while others require no charge. Some plans require you to pay a yearly deductible and coinsurance and incur out-of-pocket costs. Additional premiums may be required by the Fund depending on the plan chosen.

Newspaper Guild of New York – The New York Times Benefits Fund Page 33

PREFERRED PROVIDER ORGANIZATION (PPO) PLAN

Members have the freedom to choose providers in and out of network. Using the PPO provides savings and convenience to you, your family and the Fund. You share the cost of your healthcare with the Fund. If you use in-network providers your cost is less, either a copay or sometimes no charge at all. If you use out-of-network providers your cost is more because you must satisfy a deductible and pay coinsurance. There is no need to choose a primary care physician and no referrals are necessary to see a specialist.

The following PPO Plan is offered by the Guild-Times Benefits Fund:

Health Plan Contact Information PPO Plan

In-Network: BlueCross BlueShield Member Services (C&R Consulting) 212-395-9339 Precertification ( (Alicare Medical Management) 1-800-848-9200 Find a Doctor (BlueCross BlueShield) 1-800-810-2583 (BLUE) Website www.anthem.com Enter Prefix: GFZ Out-of-Network: Member Services (C&R Consulting) 212-395-9339 Website guild.candrdirect.com

Prescription Drug Benefit In-Network Only: Express Scripts, Inc. (ESI) Find a Participating Pharmacy (ESI) 1-866-544-2926 TDD: 1-800-899-2114 Website www.express-scripts.com

You will receive medical and prescription drug ID cards for this plan which contains the above information. Please present your ID card at the time of service.

The chart that follows highlights the benefits of the Newspaper Guild of New York – The New York Times Benefits Fund. For more detailed information, contact the Fund Office.

Newspaper Guild of New York – The New York Times Benefits Fund Page 34

PREFERRED PROVIDER ORGANIZATION (PPO) PLAN For Active and Retired Employees Less than Age 65

SCHEDULE OF MEDICAL BENEFITS

A chart summarizing the PPO Plan’s benefits appears on the next page. Each of the PPO Plan’s medical benefits is summarized in the first column of the chart. Specific differences in the benefits and the out-of- pocket expenses payable by you when the benefits are provided in-network (when you use participating providers) and out-of-network (when you use non-participating providers) are shown in the last two columns of the chart.

Explanations and limitations for those benefits are shown on the pages following the chart.

BENEFITS SUMMARY

When you see the icon ( or the phrase “precertification necessary”, your provider will need to precertify these services with Alicare's Medical Management Program at 1-800-848-9200. It is your responsibility to follow up with the provider to ensure this is done. If you do not comply with Medical Management requirements, benefits may be reduced by 50% up to $5,000 for each admission, treatment, or procedure.

Newspaper Guild of New York – The New York Times Benefits Fund Page 35

PREFERRED PROVIDER ORGANIZATION (PPO) PLAN For Active and Retired Employees Less than Age 65

BENEFIT IN-NETWORK OUT-OF-NETWORK (Through Participating Providers) (Through Non-Participating Providers) Annual Deductible Not Applicable $500 per Individual $1,000 per Family (Services are covered as noted below after satisfaction of the annual deductible). Coinsurance Individual Not Applicable 35% of Allowable Charges1 Plan Not Applicable 65% of Allowable Charges Out-of-Pocket Maximum Individual Not Applicable $5,000 Family Not Applicable $10,000 Annual Maximum Not Applicable Hospital Inpatient( No Charge 35% of Allowable Charges1 Hospital Outpatient No Charge 35% of Allowable Charges1 Cardiac Rehabilitation $20 Copay 35% of Allowable Charges1 Physician/Clinic Visits $20 Copay 35% of Allowable Charges1 Specialist Visits $20 Copay 35% of Allowable Charges1 Physician Hospital Visits (Medical/Surgical) No Charge 35% of Allowable Charges1 Surgical Second Opinion (optional) $20 Copay 35% of Allowable Charges1 Diagnostic Procedures( MRIs/MRAs PET/CAT/SPECT scans No Charge 35% of Allowable Charges1 (x-rays, lab tests) Outpatient Surgery,(2 (surgery, pre-surgical testing, anesthesia) No Charge 35% of Allowable Charges1 Inpatient Surgery (2 (surgery, pre-surgical testing, anesthesia) No Charge 35% of Allowable Charges1 Chemotherapy, Radiation No Charge 35% of Allowable Charges1 Kidney Dialysis No Charge 35% of Allowable Charges1 Transplants( No Charge 35% of Allowable Charges1 Preventive Healthcare Services Routine Pediatric Care Visits & Immunizations No Charge 35% of Allowable Charges1 Routine Adult Physical Exams No Charge 35% of Allowable Charges1 Cholesterol No Charge 35% of Allowable Charges1 Diabetes No Charge 35% of Allowable Charges1 Colorectal Cancer No Charge 35% of Allowable Charges1 Prostate Specific Antigen No Charge 35% of Allowable Charges1

( Precertification required. If you do not comply with Medical Management requirements, benefits may be reduced by 50% up to $5,000 for each admission, treatment, or procedure.

1 You pay this percentage of allowable charges plus any expenses in excess of allowable charges. These expenses are not covered by the Plan. 2 For a second procedure performed during an authorized surgery through the same incision, Plan pays for the procedure with the highest allowable amount. For a second procedure done through a separate incision, the Plan will pay the allowable amount for the procedure with the highest allowance and up to 50% of the allowable amount for the other procedure.

Newspaper Guild of New York – The New York Times Benefits Fund Page 36

PREFERRED PROVIDER ORGANIZATION (PPO) PLAN For Active and Retired Employees Less than Age 65

BENEFIT IN-NETWORK OUT-OF-NETWORK (Through Participating Providers) (Through Non-Participating Providers) Preventive Healthcare Services (cont.) Routine Gynecological Visits No Charge 35% of Allowable Charges1 Pap Smear No Charge 35% of Allowable Charges1 Bone Density Testing & Treating No Charge 35% of Allowable Charges1 Mammogram No Charge 35% of Allowable Charges1 Maternity Physician Services No Charge 35% of Allowable Charges1 Hospital( No Charge 35% of Allowable Charges1 Nursery Care(3 No Charge 35% of Allowable Charges1 Diagnostic Procedures No Charge 35% of Allowable Charges1 Ambulance Air or Ground No Charge 35% of Allowable Charges1 Emergency Room $50 Copay4 35% of Allowable Charges1 Mental Health Inpatient( No Charge 35% of Allowable Charges1 Outpatient Office Visits $20 Copay 35% of Allowable Charges1 Facility No Charge 35% of Allowable Charges1 Substance Abuse Inpatient( No Charge 35% of Allowable Charges1 Outpatient Office Visits $20 Copay 35% of Allowable Charges1 Facility No Charge 35% of Allowable Charges1 Home Health Care5 No Charge 35% of Allowable Charges1 Hospice(6 No Charge 35% of Allowable Charges1 Home Infusion Therapy( No Charge 35% of Allowable Charges1 Durable Medical Equipment( No Charge 35% of Allowable Charges1 Prosthetic Devices( No Charge 35% of Allowable Charges1 Orthotics No Charge 35% of Allowable Charges1 Medical Supplies No Charge 35% of Allowable Charges1 Chiropractic Benefit7 $20 Copay 35% of Allowable Charges1 Acupuncture No Charge 35% of Allowable Charges1 Skilled Nursing Facility(8 No Charge Not Covered

( Precertification required. If you do not comply with Medical Management requirements, benefits may be reduced by 50% up to $5,000 for each admission, treatment, or procedure.

1 You pay this percentage of allowable charges plus any expenses in excess of allowable charges. These expenses are not covered by the Plan. 3 Precertification required if baby stays longer than mother. 4 Waived if admitted to same hospital within 24 hours. 5 Maximum of 200 visits per calendar year. 6 210 days lifetime maximum. Must have a doctor’s statement indicating life expectancy of 6 months or less. 7 $500 annual maximum. 8 Maximum of 60 days per calendar year combined for skilled nursing facility, inpatient physical therapy, and inpatient rehabilitation. Must be ordered by a physician. Custodial/Long Term Care is not covered.

Newspaper Guild of New York – The New York Times Benefits Fund Page 37

PREFERRED PROVIDER ORGANIZATION (PPO) PLAN For Active and Retired Employees Less than Age 65

BENEFIT IN-NETWORK OUT-OF-NETWORK (Through Participating Providers) (Through Non-Participating Providers) Physical Therapy and Rehabilitation Inpatient(8 No Charge Not Covered Outpatient9 $20 Copay 35% of Allowable Charges1 Occupational Therapy9 $20 Copay 35% of Allowable Charges1 Vision Therapy9 $20 Copay 35% of Allowable Charges1 Speech Therapy9 $20 Copay 35% of Allowable Charges1 Infertility Treatment10 (ages 21-44) No Charge Not Covered

( Precertification required. If you do not comply with Medical Management requirements, benefits may be reduced by 50% up to $5,000 for each admission, treatment, or procedure.

1 You pay this percentage of allowable charges plus any expenses in excess of allowable charges. These expenses are not covered by the Plan. 8 Maximum of 60 days per calendar year combined for skilled nursing facility, inpatient physical therapy, and inpatient rehabilitation. Must be ordered by a physician. Custodial/Long Term Care is not covered. 9 Maximum of 30 visits per calendar year combined home, office or outpatient facility for physical therapy, occupational therapy, vision therapy and speech therapy. 10 Up to a $15,000 lifetime maximum for infertility treatment charges covered under the medical program and up to a $5,000 lifetime prescription drug maximum that applies to all infertility treatment charges covered under the prescription drug program. Benefits are defined by the number of procedures and/or by financial caps. Once the maximum Plan benefit has been reached, there is no extension of service, even if ovulation induction has been initiated.

Newspaper Guild of New York – The New York Times Benefits Fund Page 38

PREFERRED PROVIDER ORGANIZATION (PPO) PLAN For Active and Retired Employees Less than Age 65

BENEFIT COVERAGE11

Prescription Drug Benefits

Retail (up to a 30-day supply) Deductible $50 Generic Greater of $10 copay or 25% of drug cost Formulary Brand12 Greater of $15 copay or 25% of drug cost Non-Formulary Brand12 Greater of $40 copay or 40% of drug cost

Mail Order (90-day supply)13 Generic $20 copay Formulary Brand12 $40 copay Non-Formulary Brand12 $60 copay

Specialty Drug14 Greater of $15 copay or 25% of drug cost

11 Coverage is provided only through participating pharmacies. 12 If a generic drug is available, you must pay 25% of the cost of the generic drug plus the difference between the cost of the brand and generic drug. 13 The mail order program is mandatory after two refills of maintenance drug. Thus, after the two refills, maintenance drugs are not covered at retail. Retail co-pay applied to mail order specialty medications. 14 Must use Accredo Specialty Pharmacy. Mail Order not available.

Newspaper Guild of New York – The New York Times Benefits Fund Page 39

MEDICAL MANAGEMENT PROGRAM – PPO PLAN For Active and Retired Employees Less than Age 65

To ensure that your health expenditures are only for appropriate care, your Plan manages medical benefits for you and your covered family members through Alicare Medical Management. You must comply with this program in order to receive the maximum benefits. Alicare's Medical Management Program staff will work with both you and your provider to confirm the necessity of the services you receive and to help you make sound health care decisions and maximize your coverage.

A. How the Medical Management Program Helps You and Your Family

When you call the Medical Management Program at 1-800-848-9200, a team of managed benefits professionals can help you to:

§ Learn more about your health care options. § Choose the most appropriate health care setting or service (i.e., hospital or ambulatory surgery unit). § Avoid unnecessary hospitalization and the associated risks, whenever possible. § Arrange for any required (and covered) discharge services.

B. When Calling the Medical Management Program

When you or someone on your behalf calls the Medical Management Program, you should be prepared to provide the following information:

1. Patient’s name, birth date, and sex. 2. Patient’s address and telephone number. 3. Patient’s identification card number. 4. Name and address of the hospital/facility. 5. Date of patient’s proposed admission to the hospital or facility. 6. Name and telephone number of the admitting doctor. 7. Reason for admission and nature of the services to be performed.

When your provider is required to call the Medical Management Program for precertification, be sure they know about the precertification requirement and that they have the Medical Management telephone number (1-800-848-9200).

C. Examples of Medical Management Services

§ Planned and emergency hospital admission review. § Ongoing hospitalization review. § Review inpatient and same day surgery. § Review high risk pregnancies. § Perform individual case management. § Review of routine maternity admissions. § Precertification of benefits.

Newspaper Guild of New York – The New York Times Benefits Fund Page 40

MEDICAL MANAGEMENT PROGRAM – PPO PLAN For Active and Retired Employees Less than Age 65 (continued)

Precertification (

D. When to Notify the Medical Management Program

In order for you to precertify hospital admissions and certain services and receive the maximum available benefits, you or someone on your behalf must call the Medical Management Program at 1- 800-848-9200 in the following instances:

§ At least two weeks before any planned surgery or hospital admission. This applies to ambulatory surgery as well as inpatient surgery. § Within 48 hours of an emergency hospital admission. (You do not have to call if the emergency room sends you home). § For a hospital admission relating to illness or injury to newborns. § Within the first three months of a pregnancy and no more than one business day after the actual delivery.

For more information on when you must precertify, call the Medical Management Program at 1-800- 848-9200. Please note the ( icon in the PPO Plan benefit chart in the prior pages and in the following Medical Benefits – PPO Plan section.

E. Penalties If Services Are Not Precertified

If you do not comply with Medical Management requirements, benefits may be reduced by 50% up to $5,000 for each admission, treatment or procedure. This benefit reduction also applies to certain same- day surgery and professional services rendered during an inpatient admission. If the admission or procedure is not precertified and it is subsequently determined that it is not medically necessary, no benefits will be paid.

Newspaper Guild of New York – The New York Times Benefits Fund Page 41

MEDICAL BENEFITS - PPO PLAN For Active and Retired Employees Less than Age 65

Plan participants may obtain health care services from in-network or out-of-network healthcare providers. Your out-of-pocket expenses will generally be lower if you choose in-network providers.

IN-NETWORK

In-network services are healthcare services provided by a doctor, hospital or healthcare facility that have fee agreements with your health plan. When a Plan participant uses the services of an in-network healthcare provider, the Plan participant is responsible for paying only the applicable copayment for any medically necessary services or supplies. The in-network healthcare provider generally deals with the Plan directly for any additional amount due.

Copayment

Copayment (or “copay”) is a set dollar amount you are responsible for paying when you incur an eligible medical expense. The Plan pays the balance. When copayments apply, there are no deductibles or coinsurance, unless the Plan specifically provides otherwise.

OUT-OF-NETWORK

Out-of-network services are healthcare services provided by a doctor, hospital or healthcare facility that does not have fee agreements with your health plan. The Plan will reimburse the Plan participant based on allowable charges (usual and customary charge determined by the Plan pursuant to standards it selects) for any medically necessary services or supplies, subject to the Plan’s deductibles, coinsurance, copayments, limitations and exclusions. Plan participants must submit proof of claim before any such reimbursement will be made, and out-of-network healthcare providers may bill the Plan participant for any balance that may be due in addition to the amount payable by the Plan.

Deductibles

A. Individual and Family Deductibles

Each year, you are responsible for paying all of your eligible medical expenses until you satisfy the annual deductible. At such time, the Plan begins to pay benefits. There are different types of deductibles.

1. The individual deductible is the maximum amount one covered individual has to pay before Plan medical benefits begin. 2. The family deductible is the maximum amount that a family of two or more is responsible for paying before Plan medical benefits begin.

B. Coinsurance

Once you have met your annual deductible, the Plan generally pays a percentage of the eligible medical expenses, and you are responsible for paying the rest. The part you pay is called the coinsurance.

Newspaper Guild of New York – The New York Times Benefits Fund Page 42

MEDICAL BENEFITS – PPO PLAN For Active and Retired Employees Less than Age 65 (continued)

C. Coinsurance When You Don’t Comply with the Medical Management Program

If you fail to follow the Medical Management Program, you may be required to pay a greater percentage of your eligible medical expenses. Please refer to the Medical Management Program section of this SPD for more information.

IN-AND OUT-OF-NETWORK

Out-of-Pocket Expenses

You are always responsible for paying for certain expenses for medical services and supplies. Under the Plan, each year you will be responsible for paying the following expenses out of your own pocket:

1. Your individual or family deductible (out-of-network) 2. Any applicable copayment (in-network) 3. All expenses for medical services or supplies that are not covered by the Plan. 4. All charges in excess of the usual and customary charge determined by the Plan (out-of-network). 5. Any additional other amounts you have to pay because you failed to comply with the Medical Management Program.

Newspaper Guild of New York – The New York Times Benefits Fund Page 43

MEDICAL BENEFITS – PPO PLAN For Active and Retired Employees Less than Age 65 (continued)

Doctor’s Services

Tips for Visiting Your Doctor

§ When you make your appointment, confirm that the doctor is an in-network provider and that he/she is accepting new patients. § Arrange ahead of time to have pertinent medical records and test results sent to the doctor. § If the doctor sends you to an outside lab or radiologist for tests or x-rays, call the member services number on the back of your ID card to confirm that the supplier is an in-network participating provider. This will ensure that you receive maximum benefits.

Ask about a second opinion any time that you are unsure about surgery or a cancer diagnosis. To confirm a cancer diagnosis or course of treatment, second or third opinions are paid at the in-network level, even if you use an out-of-network specialist, as long as your participating (i.e. in-network) doctor provides a written referral to a non-participating (i.e. out-of-network) specialist.

What’s Covered

The following are covered services and limitations:

§ Consultation requested by the attending physician for advice on an illness or injury § Diabetes supplies prescribed by an authorized provider § Blood glucose monitors, including monitors for the legally blind § Testing strips § Foot care and orthotics associated with disease affecting the lower limbs, such as severe diabetes, which requires care from a podiatrist or physician § Chiropractic care

What’s Not Covered

The following medical services are not covered:

§ Routine foot care, including care of corns, bunions, calluses, toenails, flat feet, fallen arches, weak feet and chronic foot strain § Symptomatic complaints of the feet except capsular or bone surgery related to bunions and hammertoes § Orthotics for treatment of routine foot care § Routine hearing exams § Hearing aids and the examination for their fitting § Services such as laboratory, x-ray and imaging, and pharmacy services as required by law from a facility in which the referring physician or his/her immediate family member has a financial interest or relationship § Services given by an unlicensed provider or performed outside the scope of the provider’s license

Newspaper Guild of New York – The New York Times Benefits Fund Page 44

MEDICAL BENEFITS – PPO PLAN For Active and Retired Employees Less than Age 65 (continued)

Preventive Care

Preventive care is an important and valuable part of your healthcare. Regular physical checkups and appropriate screenings can help you and your doctor detect illness early. When you treat an illness or condition early, you minimize the risk of a serious health problem and reduce the risk of incurring greater costs. Many preventive care services are available at no cost or only a small copayment when you use in- network providers.

Tips for Using Preventive Care

§ Visit your doctor once a year for a checkup. Take the screening tests appropriate for your gender and age to help identify illness or the risk of serious illness. § Women with no prior or family history of breast cancer, get a baseline mammogram between ages 35¬39, and for ages 40 and over, an annual mammogram. Women who have a family history of breast cancer will be covered for a routine mammogram at any age and as often as their physician recommends one. § Keep your children healthy by getting routine checkups and preventive care, including certain immunizations.

What’s Covered

The following are covered services and limitations:

− Well woman care visits to a gynecologist/obstetrician − Bone density testing and treatment. Standards for determining appropriate coverage include the criteria of the federal Medicare program and the criteria of the National Institutes of Health for the Detection of Osteoporosis. Bone mineral density measurements or tests, drugs and devices include those covered under Medicare and in accordance with the criteria of the National Institutes of Health, including, as consistent with such criteria, dual energy x-ray absorptiometry. Coverage shall be available for individuals meeting the criteria of those programs, including one or more of the following: - Previously diagnosed with or having a family history of osteoporosis - Symptoms or conditions indicative of the presence or significant risk of osteoporosis - Prescribed drug regimen posing a significant risk of osteoporosis - Lifestyle factors to such a degree posing a significant risk of osteoporosis - Age, gender and/or other physiological characteristics that pose a significant risk of osteoporosis - Well child care visits to a pediatrician, nurse or licensed nurse practitioner, including a physical examination, medical history, developmental assessment, and guidance on normal childhood development and laboratory tests. The tests may be performed in the office or a laboratory. Covered services and the number of visits covered per year are based on the prevailing clinical standards of the American Academy of Pediatrics (AAP) and will be determined by your child’s age.

Newspaper Guild of New York – The New York Times Benefits Fund Page 45

MEDICAL BENEFITS – PPO PLAN For Active and Retired Employees Less than Age 65 (continued)

Preventive Care – What’s Covered (continued)

− Well child care immunizations as listed: - DPT (diphtheria, pertussis and tetanus) - Polio - MMR (measles, mumps and rubella) - Varicella (chicken pox) - Hepatitis B - Hemophilus - Tetanus-diphtheria - Pneumococcal - Meningococcal Tetramune − Other immunizations as determined by the Superintendent of Insurance and the Commissioner of Health in New York State or the state where your child lives

What’s Not Covered

These preventive care services are not covered:

§ Screening tests done at your place of work at no cost to you § Free screening services offered by a government health department § Tests done by a mobile screening unit, unless a doctor not affiliated with the mobile unit prescribes the tests

Emergency Care

Emergency care is covered in the hospital emergency room. To be covered as emergency care, the condition must be one in which a prudent layperson, who has an average knowledge of medicine and health, could reasonably expect that without emergency care, the condition would:

§ Place your health in serious jeopardy § Cause serious problems with your body functions, organs or parts § Cause serious disfigurement § In the case of behavioral health, place others or oneself in serious jeopardy

Sometimes you have a need for medical care that is not an emergency (i.e. bronchitis, high fever, sprained ankle), but can’t wait for a regular appointment. This is not covered in a hospital emergency room. If you need urgent care, call your physician.

Newspaper Guild of New York – The New York Times Benefits Fund Page 46

MEDICAL BENEFITS – PPO PLAN For Active and Retired Employees Less than Age 65 (continued)

Emergency Assistance 911

In an emergency, call 911 for an ambulance or go directly to the nearest emergency room. If possible, go to the emergency room of an in-network hospital.

Benefits for treatment in a hospital emergency room are limited to the initial visit for an emergency condition. A participating provider must provide all follow-up care in order to receive maximum benefits.

You will need to show your I.D. card when you arrive at the emergency room.

( If you are admitted to the hospital, you or someone on your behalf must call the Medical Management Program before services are rendered or within 48 hours after you are admitted to or treated at the hospital, or as soon as reasonably possible. If you do not obtain authorization from the Medical Management Program within the required time, a penalty of 50% of benefits will apply.

Tips for Getting Emergency Care

§ If time permits, speak to your physician to direct you to the best place for treatment. § If you have an emergency while outside the network’s service area, follow the same steps described above, show your ID card at the emergency room, and if you are admitted (, notify the Medical Management Program within 48 hours of admission. If the hospital is a non-participating facility, you will need to file a claim.

What’s Not Covered

These emergency services are not covered:

§ Use of the Emergency Room: - To treat routine ailments - Because you have no regular physician - Because it is late at night (and the need for treatment is not sudden and serious) - Ambulette

Air Ambulance

Air ambulance is provided to transport you to the nearest acute care hospital in connection with an emergency room or emergency inpatient admission or emergency outpatient care when the following conditions are met:

§ Your medical condition requires immediate and rapid ambulance transportation and services cannot be provided by land ambulance due to great distances, and the use of land transportation would pose an immediate threat to your health.

Newspaper Guild of New York – The New York Times Benefits Fund Page 47

MEDICAL BENEFITS – PPO PLAN For Active and Retired Employees Less than Age 65 (continued)

Emergency Care – Air Ambulance (continued)

§ Services are covered to transport you from one acute care hospital to another, only if the transferring hospital does not have adequate facilities to provide the medically necessary services needed for your treatment, and use of land ambulance would pose an immediate threat to your health.

If it is determined that the condition for coverage for air ambulance services have not been met but your condition did require transportation by land ambulance to the nearest acute care hospital, the Plan will only pay up to the amount that would be paid for land ambulance to that hospital.

Land Ambulance

Coverage is provided for land ambulance transportation to the nearest acute care hospital, in connection with emergency room care or emergency inpatient admission, provided by an ambulance service, when a prudent layperson, possessing an average knowledge of medicine and health, could reasonably expect the absence of such transportation to result in:

§ Placing the member’s health afflicted with a condition in serious jeopardy, or for behavioral condition, place the health of a member or others in serious jeopardy § Serious impairment to a person’s bodily functions § Serious dysfunction of any bodily organ or part of a person § Serious disfigurement to the member

Benefits are not available for transfers between healthcare facilities.

Newspaper Guild of New York – The New York Times Benefits Fund Page 48

MEDICAL BENEFITS – PPO PLAN For Active and Retired Employees Less than Age 65 (continued)

Hospital Services

The Plan covers your medically necessary care when you stay at a hospital for surgery or treatment of illness or injury.

You are also covered for same-day (outpatient or ambulatory) hospital services, such as chemotherapy, radiation therapy, cardiac rehabilitation and kidney dialysis. Same-day surgical services or invasive diagnostic procedures are covered when they:

§ Are performed in a same-day or hospital outpatient surgical facility § Require the use of both surgical operating and postoperative recovery rooms § May require either local or general anesthesia § Do not require inpatient hospital admission because it is not appropriate or medically necessary § Would justify an inpatient hospital admission in the absence of a same-day surgery program

( Remember to call the Medical Management Program at 1-800-848-9200 at least two weeks prior to any planned surgery or hospital admission. For an emergency admission or emergency surgical procedure, call the Medical Management Program within 48 hours or as soon as reasonably possible. Otherwise your benefits may be reduced by 50% up to $5,000 for each hospital admission or surgery that is not precertified. Benefit reductions will also apply to all care related to the admission, including physician services.

The medical necessity and length of any hospital stay are subject to the Medical Management Program guidelines. If Medical Management determines that the admission or surgery is not medically necessary, no benefits will be paid. See the Medical Management section for additional information.

Tips for Getting Hospital Care

§ If your doctor prescribes pre-surgical testing (unlimited visits), have your tests done within seven days prior to surgery at the hospital where surgery will be performed. For pre-surgical testing to be covered, you need to have a reservation for both a hospital bed and an operating room.

§ If you are having same-day surgery, often the hospital or outpatient facility requires that someone meet you after the surgery to take you home. Ask about their policy and make arrangements for transportation before you go in for surgery.

Newspaper Guild of New York – The New York Times Benefits Fund Page 49

MEDICAL BENEFITS – PPO PLAN For Active and Retired Employees Less than Age 65 (continued)

Inpatient and Outpatient Hospital Care

What’s Covered

The following are covered services and limitations for both inpatient and outpatient (same-day) care:

§ Diagnostic x-rays and lab tests, and other diagnostic tests such as EKG’s, EEG’s or endoscopies § Oxygen and other inhalation therapeutic services and supplies and anesthesia (including equipment for administration) § Anesthesiologist, including one consultation before surgery and services during and after surgery § Blood and blood derivatives for emergency care, same-day surgery, or medically necessary conditions, such as treatment for hemophilia § MRIs/MRAs(, when pre-approved by the Medical Management Program (your provider must call to precertify these services)

Inpatient Hospital Care (

What’s Covered

The following are covered services for inpatient care:

§ Semi-private room and board when: - The patient is under the care of a physician and a hospital stay is medically necessary § Coverage is for unlimited days, subject to the Medical Management Program review, unless otherwise specified § Operating and recovery rooms § Special diet and nutritional services while in the hospital § Cardiac care unit § Services of a licensed physician or surgeon employed by the hospital § Care related to surgery § Breast cancer surgery (lumpectomy, mastectomy), including: - Reconstruction following surgery - Surgery on the other breast to produce a symmetrical appearance - Prostheses § Treatment of physical complications at any stage of a mastectomy, including lymphedemas. The patient has the right to decide, in consultation with the physician, the length of hospital stay following mastectomy surgery. § Use of cardiographic equipment § Drugs, dressings and other medically necessary supplies § Social, psychological, and pastoral services § Reconstructive surgery associated with injuries unrelated to cosmetic surgery § Reconstructive surgery for a functional defect which is present from birth § Physical, occupational, speech and vision therapy including facilities, services, supplies and equipment § Facilities, services, supplies and equipment related to medically necessary medical care

Newspaper Guild of New York – The New York Times Benefits Fund Page 50

MEDICAL BENEFITS – PPO PLAN For Active and Retired Employees Less than Age 65 (continued)

Inpatient Hospital Care ( (continued)

What’s Not Covered

These inpatient services are not covered:

§ Private duty nursing § Private room. If you use a private room, you must pay the difference between the cost for the private room and the hospital’s average charge for a semiprivate room. § Diagnostic inpatient stays, unless connected with specific symptoms that if not treated on an inpatient basis could result in serious bodily harm or risk to life § Services performed in the following: - Nursing or convalescent homes - Institutions primarily for rest or for the aged - Rehabilitation facilities (except for physical therapy) - Spas - Sanitariums - Infirmaries at schools, colleges or camps § Any part of a hospital stay that is primarily custodial § Elective cosmetic surgery or any related complications § Hospital services received in clinic settings that do not meet definition of a hospital or other covered facility.

Outpatient Hospital Care

What’s Covered

The following are covered services for same-day care:

§ Outpatient surgery( § Same-day and hospital outpatient surgical facilities( § Surgeons § Surgical assistant if: - None is available in the hospital or facility where the surgery is performed, and - The surgical assistant is not a hospital employee § Chemotherapy and radiation therapy, including medications, in a hospital outpatient department, doctor’s office or facility. Medications that are part of outpatient hospital treatment are covered if they are prescribed by the hospital and filled by the hospital pharmacy. § Kidney dialysis treatment (including hemodialysis and peritoneal dialysis) is covered in the following settings until the patient becomes eligible for end stage renal disease dialysis benefits under Medicare: - At home, when provided, supervised and arranged by a physician and the patient has registered with an approved kidney disease treatment center (professional assistance to perform dialysis and any furniture, electrical, plumbing or other fixtures needed in the home to permit home dialysis treatment are not covered) - In a hospital-based or free-standing facility.

Newspaper Guild of New York – The New York Times Benefits Fund Page 51

MEDICAL BENEFITS – PPO PLAN For Active and Retired Employees Less than Age 65 (continued)

Outpatient Hospital Care (continued)

What’s Not Covered

These outpatient services are not covered:

§ Same-day surgery not precertified as medically necessary by the Medical Management Program § Routine medical care including but not limited to: - Inoculation or vaccination - Drug administration or injection, excluding chemotherapy - Collection or storage of your own blood, blood products, semen or bone marrow

Newspaper Guild of New York – The New York Times Benefits Fund Page 52

MEDICAL BENEFITS – PPO PLAN For Active and Retired Employees Less than Age 65 (continued)

Maternity Care/Newborn Children

Group health plans generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a caesarean section. However, Federal law generally does not prohibit the mother’s or newborn’s attending physician, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, health plans may not, under Federal law, require that a provider obtain authorization from the Plan for prescribing a length of stay not in excess of 48 hours (or 96 hours).

If You Are Having a Baby

Your baby is automatically covered under the Plan for the first 30 days if you have family coverage. However, you will need to add the baby’s name as a covered dependent. If you do not have family coverage, call the Fund Office within 30 days to add your newborn as a dependent.

Obstetrical care in the hospital or an in-network birthing center is covered up to 48 hours after a normal vaginal birth and 96 hours after a Cesarean section.

What’s Covered

The following are covered services and limitations:

§ One home care visit if the mother leaves earlier than the 48 hour (or 96 hour) limit. The mother must request the visit from the hospital or a home health care agency within this timeframe (precertification is not required). The visit will take place within 24 hours after either the discharge or the time of the request, whichever is later. § Services of a certified nurse-midwife affiliated with a licensed facility. The nurse-midwife’s services must be provided under the direction of a physician. § Circumcision of newborn males § Special care for the baby if the baby stays in the hospital longer than the mother. Call the Medical Management Program to precertify the hospital stay(. § Semi-private room

What’s Not Covered

These maternity care services are not covered:

§ Days in hospital that are not medically necessary (beyond the 48 hour/96 hour limits) § Services that are not medically necessary § Private room § Out-of-network birthing center facilities § Private duty nursing

Newspaper Guild of New York – The New York Times Benefits Fund Page 53

MEDICAL BENEFITS – PPO PLAN For Active and Retired Employees Less than Age 65 (continued)

Infertility Treatment

The Plan offers in-network treatment for infertility benefits as follows:

Eligibility:

In order to be eligible for infertility benefit coverage the covered individual must meet infertility, age, coverage and prior procedure criteria listed below:

1. Infertility Criteria (must meet one): § Failure to achieve pregnancy after 12 months or more of regular unprotected heterosexual intercourse; or § Women aged 35 and older who are unable to achieve pregnancy after 6 months of regular unprotected heterosexual intercourse; or § Women with documented FSH levels less than or equal to 19 mIU/ml on day 3 of the menstrual cycle; or § Women who have not met time criteria for failure to conceive, but who have a documented anatomic variant resulting in the inability to achieve pregnancy (e.g. severe pelvic inflammatory disease, endometriosis, or ectopic pregnancy requiring surgical removal of both fallopian tubes); or § Males with anatomical variants such as aspermia or varicocele resulting in an inability to reproduce.

2. Age Criteria – applies to covered individual being treated (male or female) (must meet both): § Minimum age is 21 years; and § Maximum age is 44 years (covered individual meets the age criteria until the date of his/her 45th birthday).

Exception: § If a covered individual has initiated a cycle of treatment and, by virtue of having a birthday, exceeds the maximum eligible age prior to completion of the cycle, the treatment will be covered to the nearest logical endpoint: – For artificial insemination – Ovulation induction initiated prior to birthday; ovulation induction in progress and subsequent insemination will be covered. – Other advanced procedure – IVF, GIFT, ZIFT, etc. – Ovulation induction initiated prior to birthday; ovulation induction in progress, subsequent ovum retrieval, fertilization, culture and embryo transfer will be covered (unless the benefit has been exceeded).

Newspaper Guild of New York – The New York Times Benefits Fund Page 54

MEDICAL BENEFITS – PPO PLAN For Active and Retired Employees Less than Age 65 (continued)

Infertility Treatment (continued)

3. Coverage Criteria/Maximum Benefit: § The Plan pays up to a $15,000 lifetime maximum for infertility treatment charges covered under the medical program and up to a $5,000 lifetime prescription drug maximum that applies to all infertility treatment charges covered under the prescription drug program. Benefits are defined by the number of procedures and/or by financial caps. Once the maximum Plan benefit has been reached, there is no extension of service, even if ovulation induction has been initiated.

4. Prior Procedure Criteria: § Female covered individuals requesting In vitro fertilization (IVF), Gamete intrafallopian transfer (GIFT), or Zygote intrafallopian transfer (ZIFT) must have used all reasonable, less expensive and medically appropriate treatments and have not been able to become pregnant or carry a pregnancy.

Covered Procedures:

Assisted reproductive services include comprehensive (mid-level) fertility enhancing techniques (from Ovulation Induction up to and including Artificial Insemination) and the more technologically complex Advanced Infertility Services (InVitro services).

Comprehensive level (also referred to as mid-level) techniques: § Ovulation induction with oral or injectable medications § Artificial insemination § Sperm washing § Sperm isolation, simple prep (e.g. sperm wash and swim up) § Sperm isolation, complex prep (e.g. Percoll gradient, albumin gradient) § Sperm evaluation; hamster penetration test § Advanced Infertility Services require Precertification § In vitro fertilization (IVF) § Gamete intrafallopian transfer (GIFT) § Zygote intrafallopian transfer (ZIFT) § Thawing of cryopreserved embryo § Microscopic Epididymal Sperm Aspiration (MESA) § Testicular Sperm Aspiration (TESA) § Percutaneous epididymal sperm aspiration (PESA) § Culture and fertilization of oocyte(s)/embryo(s) § Assisted oocyte fertilizations, microtechnique § Assisted embryo hatching, microtechniques § Oocyte identification from follicular fluid § Preparation of embryo for transfer (any method) § Sperm identification from aspiration (other than seminal fluid) § Ultrasonic guidance for aspiration of ova, imaging and supervision § Intracytoplasmic sperm injection (ICSI)

Newspaper Guild of New York – The New York Times Benefits Fund Page 55

MEDICAL BENEFITS – PPO PLAN For Active and Retired Employees Less than Age 65 (continued)

Infertility Treatment (continued)

Non Covered Services

Treatments not covered as follows: § Cost of donor sperm or an ovum donor when oocyte retrieved from someone other than recipient § Sperm, embryo(s), reproductive tissue, testicular/ovarian, oocyte storage costs § Cryopreservation of embryos, oocytes (eggs), sperm or other reproductive tissue § Ovulation predictor kits § Reversal of permanent sterilization procedures § Cloning § Any infertility services if the covered individual (or partner) has undergone a voluntary sterilization procedure (tubal ligation, fulguration, vasectomy, Essure® insertion) § Services for partner and spouses, and the maternity expenses of gestational carriers not covered by the Plan are excluded. § Experimental procedures and treatments (as defined by the American College of Obstetrics and Gynecologists, the American Society of Reproductive Medicine, or the State of New York). § Any costs associated with surrogate motherhood.

Newspaper Guild of New York – The New York Times Benefits Fund Page 56

MEDICAL BENEFITS – PPO PLAN For Active and Retired Employees Less than Age 65 (continued)

Durable Equipment or Medical Supplies

The Plan covers medically necessary prosthetics, orthotics and durable medical equipment and medical supplies.

In order to receive maximum benefits, please call 1¬800¬848¬9200 to precertify durable medical equipment( or medical supplies( with the Medical Management Program.

What’s Covered

The following are covered services and limitations:

§ Prosthetics( and durable medical equipment(, when prescribed by a doctor and approved by the Medical Management Program, including: - Artificial arms, legs, eyes, ears, nose, larynx and external breast prostheses - Supportive devices essential to the use of an artificial limb - Corrective braces - Wheelchairs - Hospital-type beds - Oxygen equipment - Sleep apnea monitors § Orthotics § Rental (or purchase when more economical) of medically necessary durable medical equipment § Replacement of covered medical equipment because of wear, damage or change in patient’s need, when ordered by a physician § Reasonable cost of repairs and maintenance for covered medical equipment § Disposable medical supplies such as syringes § Enteral formulas with a written order from a physician or other licensed health care provider. The order must state that: - The formula is medically necessary and effective, and - Without the formula, the patient would become malnourished, suffer from serious physical disorders or die. § Modified solid food products for the treatment of certain inherited diseases. A physician or other licensed healthcare provider must provide a written order. § Humidifiers or dehumidifiers

What’s Not Covered

Expenses for the following equipment are not covered:

§ Air conditioners or purifiers § Exercise equipment § Swimming pools § False teeth § Hearing aids

Newspaper Guild of New York – The New York Times Benefits Fund Page 57

MEDICAL BENEFITS – PPO PLAN For Active and Retired Employees Less than Age 65 (continued)

Skilled Nursing and Hospice Care (

In order to receive maximum benefits, please call 1¬800¬848¬9200 to precertify skilled nursing and Hospice care with the Medical Management Program.

Skilled Nursing (

What’s Covered

You are covered for inpatient care in a skilled nursing facility if you need medical care, nursing care or rehabilitation services. The number of covered days is listed in the PPO Plan benefit chart. Prior hospitalization is not required in order to be eligible for benefits. Services are covered if the doctor provides:

§ A referral and written treatment plan § A projected length of stay § An explanation of the services the patient needs § The intended benefits of care § Care is under the direct supervision of a physician, registered nurse (RN), physical therapist, or other healthcare professional.

What’s Not Covered

The following skilled nursing care services are not covered:

§ Skilled nursing facility care that primarily gives assistance with daily living activities, is for rest or for the aged, or treats drug addiction or alcoholism § Convalescent care § Sanitarium-type care § Rest cures

Hospice Care (

The Plan covers up to 210 days of hospice care once in a covered individual’s lifetime. Hospices provide medical and supportive care to patients who have been certified by their physician as having a life expectancy of six months or less. Hospice care can be provided in a hospice, in the hospice area of a hospital, or at home, as long as it is provided by a hospice agency.

What’s Covered

The following are covered services and limitations: Hospice care services, including:

§ Up to 12 hours of intermittent care each day by a registered nurse (RN) or licensed practical nurse (LPN) § Medical care given by the hospice doctor

Newspaper Guild of New York – The New York Times Benefits Fund Page 58

MEDICAL BENEFITS – PPO PLAN For Active and Retired Employees Less than Age 65 (continued)

Hospice Care ( – What’s Covered (continued)

§ Drugs and medications prescribed by the patient’s doctor that are not experimental and are approved for use by the most recent Physicians’ Desk Reference § Physical, occupational, speech and respiratory therapy when required for control of symptoms § Laboratory tests, x-rays, chemotherapy and radiation therapy § Transportation between home and hospital or hospice when medically necessary § Medical supplies and rental of durable medical equipment § Up to 14 hours of respite care in any week

Home Health Care

Home health care can be an alternative to an extended stay in a hospital or a stay in a skilled nursing facility. Benefits and plan maximums are shown in the PPO Plan benefit chart.

Home infusion therapy(, which is a service sometimes provided during home health care visits, must be precertified by the Medical Management Program.

What’s Covered

The following are covered services and limitations:

§ Up to 200 home health care visits per year. A visit is defined as up to four hours of care. Care can be given for up to 12 hours a day (three visits). Your physician must certify home health care as medically necessary and approve a written treatment plan. § Home health care services include: - Part-time services by a registered nurse (RN) or licensed practical nurse (LPN) - Part-time home health aide services (skilled nursing care) - Physical, speech or occupational therapy, if restorative - Medications, medical equipment and supplies prescribed by a doctor - Laboratory tests

What’s Not Covered

The following home health care services are not covered:

§ Custodial services, including bathing, feeding, changing or other services that do not require skilled care

Newspaper Guild of New York – The New York Times Benefits Fund Page 59

MEDICAL BENEFITS – PPO PLAN For Active and Retired Employees Less than Age 65 (continued)

Physical, Occupational, Speech or Vision Therapy

What’s Covered

The following are covered services and limitations:

§ Physical therapy, physical medicine or rehabilitation services, or any combination of these on an inpatient( or outpatient basis up to the Plan maximums if: - Prescribed by a physician - Designed to improve or restore physical functioning within a reasonable period of time - Precertified by the Medical Management Program (inpatient services( only) § Outpatient care must be given at home, in a therapist’s office or in an outpatient facility. Inpatient therapy( must be short-term. § Occupational, speech or vision therapy, or any combination of these on an outpatient basis up to the Plan maximums if: - Prescribed by a physician or in conjunction with a physician’s services - Given by skilled medical personnel at home, in a therapist’s office or in an outpatient facility - Performed by a licensed speech/language pathologist or audiologist

What’s Not Covered

The following therapy services are not covered:

§ Therapy to maintain or prevent deterioration of the patient’s current physical abilities § Tests, evaluations or diagnoses received within the 12 months prior to the doctor’s referral or order for occupational, speech or vision therapy

Behavioral Healthcare

Your behavioral healthcare benefits cover inpatient and outpatient mental health care, inpatient detoxification, inpatient alcohol and substance abuse rehabilitation, and outpatient treatment for alcohol or substance abuse.

To help ensure that you receive appropriate care, you need to precertify inpatient behavioral healthcare services in advance. When you call the Medical Management Program at 1-800-848-9200 to precertify in- network services(, a counselor will refer you to an appropriate hospital, facility or provider and send written confirmation of the authorized services.

If you do not call to precertify inpatient behavioral healthcare, or if you call but do not follow their recommended treatment plan, covered benefits may be denied or reduced as follows:

§ 50% up to $5,000 per inpatient admission for mental health or alcohol/substance abuse detoxification § 50% for each professional mental health care visit made during an inpatient stay

Newspaper Guild of New York – The New York Times Benefits Fund Page 60

MEDICAL BENEFITS – PPO PLAN For Active and Retired Employees Less than Age 65 (continued)

Behavioral Healthcare (continued)

When you are admitted( in an emergency to a hospital or other inpatient facility for behavioral health problems, you or someone on your behalf must call the Medical Management Program at 1-800-848-9200 within 48 hours or as soon as is reasonably possible.

Mental Health Care

What’s Covered

The following are covered services and limitations:

§ Inpatient care( § Electroconvulsive therapy for treatment of mental or behavioral disorders. § Care from psychiatrists, psychologists or licensed clinical social workers, providing psychiatric or psychological services within the scope of their practice, including the diagnosis and treatment of mental and behavioral disorders. Social workers must be licensed by the New York State Education Department or a comparable organization in another state, and have three years of post-degree supervised experience in psychotherapy and an additional three years of post-licensure supervised experience in psychotherapy. § Treatment in a comprehensive care center for eating disorders.

Treatment for Alcohol or Substance Abuse

What’s Covered

The following are covered services and limitations:

§ Inpatient care( § Family counseling services for alcohol or substance abuse at an outpatient treatment facility. These can take place before the patient’s treatment begins. Any family member covered by the Plan may receive one counseling visit per day.

What’s Not Covered

Care that is not medically necessary.

Newspaper Guild of New York – The New York Times Benefits Fund Page 61

PRESCRIPTION DRUG BENEFITS – PPO PLAN For Active and Retired Employees Less than Age 65 (continued)

The Plan offers a prescription drug plan administered by Express Scripts, Inc. (ESI) to you and your covered dependents.

You may contact ESI at 1-866-544-2926 (toll free) or TDD: (800) 899-2114.

Call ESI to: • identify network pharmacies • learn which drugs are currently on the Express Scripts formulary or excluded entirely • find out a prescription drug’s copay before you purchase it • view claims • order ID cards • check the status of a home delivery service order • learn about enrollment in the home delivery service

Visit www.express-scripts.com to: • find participating pharmacies in your area (Select Pharmacy Locator) • order home delivery service prescriptions and refills • transfer a prescription to home delivery service • check the status of your order • search the formulary • check drug cost • find information about drugs and health conditions

You may also access detailed information about your prescription drug plan by creating a secure account at www.express-scripts.com.

There are no claim forms, but you are responsible for a copay or coinsurance amount and a per person annual deductible for retail prescription drug coverage as shown in the PPO Plan benefit chart.

Newspaper Guild of New York – The New York Times Benefits Fund Page 62

PRESCRIPTION DRUG BENEFITS – PPO PLAN For Active and Retired Employees Less than Age 65 (continued)

RETAIL

Deductible

The retail prescription drug plan has a $50 deductible. The deductible is the amount of charges you have to pay for any covered retail prescription drug, before any retail prescription drug is available to you. The retail prescription drug deductible is not integrated with the medical deductible. It does not count towards the out-of-pocket maximum.

Mandatory Generic Policy

The Plan requires mandatory dispensing of generic drugs when available. If you elect to fill a brand name prescription and there is a generic alternative, you will be responsible for a greater share of the cost. You must pay the difference in price between the generic and brand name drug, plus 25% of the drug cost.

For example, let’s say you purchase a brand-name drug not on the formulary with a cost of $125 that has a generic equivalent that costs $45. Please see the chart below that illustrates the costs associated with a mandatory generic policy.

Mandatory Generic Example Brand Name Chosen Generic Chosen Brand Name Drug Cost (not on formulary) $125.00 Generic Equivalent Available Cost -$45.00 $45.00 Difference $80.00 n/a

25% of drug cost $31.25 $11.25

Explanation of Cost Difference + Greater of $10 copay or 25% of cost 25% of cost Your Cost: $111.25 $11.25

MAIL ORDER

The Plan also offers a mail order prescription drug plan through ESI. Through this plan, a prescription can be filled up to a 90-day supply. Drugs categorized as maintenance drugs may only be filled twice at a pharmacy. Thereafter, all maintenance drugs must be filled through ESI’s mail order plan.

The deductible does not apply to the mail order plan.

Newspaper Guild of New York – The New York Times Benefits Fund Page 63

PRESCRIPTION DRUG BENEFITS – PPO PLAN For Active and Retired Employees Less than Age 65 (continued)

SPECIALTY DRUGS

Drugs determined by Express Scripts to be specialty drugs are available only through ESI’s specialty pharmacy Accredo. Pre-certification is required. You may call Accredo at (877) 680-4880 or (800) 803- 2523.

If you need specialty medications, you must order them through Accredo or, per your Plan, you will be required to pay the entire cost at retail.

Specialty medications are generally drugs that are used to treat complex conditions, such as cancer, growth hormone deficiency, hemophilia, hepatitis C, immune deficiency, multiple sclerosis, and rheumatoid arthritis. Whether they’re administered by a healthcare professional, self-injected, or taken by mouth, specialty medications generally require an enhanced level of service.

Conditions and therapies for which specialty medications are typically used include:

Age-related macular degeneration, Hemophilia, Noninfectious uveitis, Alpha-1 antitrypsin deficiency, Hepatitis C, Osteoarthritis, Anemia, Hereditary tyrosinemia, Osteoporosis, Asthma, Homocystinuria, Parkinson’s disease, Cancer, Immune deficiency, Psoriasis, Crohn’s disease, Infertility, Pulmonary arterial hypertension, Cystic fibrosis, Iron chelation therapy, Respiratory syncytial virus, Deep vein thrombosis, Lysosomal storage disorders, Rheumatoid arthritis, End stage renal disease, Multiple sclerosis, Thrombocytopenia, Growth hormone deficiency, and Neutropenia.

Newspaper Guild of New York – The New York Times Benefits Fund Page 64

PPO PLAN BENEFIT EXCLUSIONS

In addition to any exclusions and limitations described in other sections of this SPD:

1. Medical expenses incurred because of any work-related injury for any occupation or employment for wage or profit, or any work-related disease with benefits payable by Workers’ Compensation or similar law (except life insurance, accidental death/dismemberment, and disability benefits).

2. Charges not specifically listed as covered medical services under this Plan.

3. Charges you or your dependents incurred before the date you each become eligible for coverage or after the date your coverage terminated.

4. Services that are not recommended or approved by a physician.

5. Expenses for any treatment, services, supplies, hospitalization, or any hospital charges that are not medically necessary and/or not ordered by a physician practicing within the scope of the physician’s license.

6. Cosmetic surgery unless it is: (a) necessary because of an accidental injury; (b) reconstructive surgery that is incidental to or after surgery because of trauma, infection, or other diseases of the involved part; or (c) reconstructive surgery because of a congenital disease or anomaly of a covered dependent child which resulted in a functional defect.

7. Charges for which some other third party is responsible unless you sign this Fund’s Subrogation Agreement and other required documentation.

8. Charges billed by providers other than hospitals, physicians, and other medical providers, including services provided by your immediate family members.

9. Alternative or complementary health services, products, remedies, treatments and therapies including, but not limited to biofeedback (except for treatment of tension and migraine headaches, which are considered medically necessary), massage therapy, hypnosis and hypnotherapy, naturopathy, homeopathy, primal therapy, chelation therapy, carbon dioxide therapy, rolfing, psychodrama, megavitamin therapy, purging, bioenergetic therapy, aroma therapy, hair analysis, thermograms and thermography, yoga, meditation, and recreational therapy and any related diagnostic testing.

10. Charges for the storage and destruction of blood. The Plan will provide benefits for autologous blood donations when they are medically necessary.

11. Charges for services for which benefits are available to you under any federal, state, or local government program, except Medicaid, but including Medicare to the extent it is your primary payer. This exclusion applies even if you fail to enroll, do not make a proper or timely claim, fail to pay the charges for the program, fail to appear at any hearing, or otherwise do not claim the benefits available to you.

Newspaper Guild of New York – The New York Times Benefits Fund Page 65

PPO PLAN BENEFIT EXCLUSIONS (continued)

12. Charges for services you receive in a hospital, facility or institution that is owned, operated or maintained by the Veteran’s Administration, the federal government, or any state or local government, or the United States Armed Forces. However, the Plan will provide benefits for otherwise covered emergency services in such hospital, facility or institution if your condition is an emergency medical condition. The Plan will also provide benefits for otherwise covered services provided to a veteran for non-service connected disability.

13. Autopsy: Expenses for an autopsy and any related expenses, except as required by the Plan.

14. Costs of reports, bills, etc.: Expenses for preparing medical reports, bills or claim forms; mailing, shipping or handling expenses; and charges for broken appointments, telephone calls and/or photocopying fees.

15. Drugs, Medicine and Nutrition: Expenses for § Pharmaceuticals requiring a prescription that: - have not been approved by the U.S. Food and Drug Administration (FDA); or - are not approved by the FDA for the condition, dose, routine and frequency for which they are prescribed; or - are experimental and/or investigational, as defined below. § Nonprescription (or non-legend or over-the-counter) drugs or medicines, except insulin. § Foods and nutritional supplements including, but not limited to, home meals, formulas, foods, diets, vitamins and minerals (whether they can be purchased over-the-counter or require a prescription), except for those nutritional supplements noted elsewhere in this Summary Plan Description, and except for prenatal vitamins or minerals requiring a prescription. § Prescription drugs or medicines that are related to, or approved by the FDA for use in connection with, any procedure, treatment, condition, etc. that is not covered by the Plan.

16. Educational Services: Expenses for educational services, supplies or equipment, including, but not limited to computers, software, printers, books, tutoring, etc., even if they are required because of an injury, illness or disability of a covered individual.

17. Employer-Provided Services: Expenses for services rendered through a medical department, clinic or similar facility provided or maintained by a contributing employer or if benefits are otherwise provided under this Plan or any other plan that a contributing employer contributes to or otherwise sponsors, such as HMOs.

18. Expenses Exceeding Maximum Plan Benefits: Expenses that exceed any Plan Benefit limitation, annual maximum Plan benefits, or limited maximum Plan benefits.

19. Expenses Exceeding Usual and Customary Charges: Any portion of the expenses for covered medical services or supplies that are determined by the Plan to exceed the usual and customary charge as defined by the Plan.

20. Expenses Incurred Before or After Coverage: Expenses for services rendered or supplies provided: § before the patient became covered under the Plan; or § after the date the patient’s coverage ends, except under those conditions described in this Summary Plan Description.

Newspaper Guild of New York – The New York Times Benefits Fund Page 66

PPO PLAN BENEFIT EXCLUSIONS (continued)

21. Experimental and/or Investigational Services: Expenses for § Technology, treatments, procedures, drugs, biological products or medical devices that in the judgment of the Plan are: - Experimental or investigative - Obsolete or ineffective § Any hospitalization in connection with experimental or investigational treatments. “Experimental” or “investigative” means that for the particular diagnosis or treatment of the covered person’s condition, the treatment is: - Not of proven benefit, not generally recognized by the medical community (as reflected in published medical literature). Government approval of a specific technology or treatment does not necessarily prove that it is appropriate or effective for a particular diagnosis or treatment of a covered person’s condition. The Plan may require that any or all of the following criteria be met to determine whether a technology, treatment, procedure, biological product, medical device or drug is experimental, investigative, obsolete or ineffective. - There is final market approval by the U.S. Food and Drug Administration (FDA) for the patient’s particular diagnosis or condition, except for certain drugs prescribed for the treatment of cancer. Once the FDA approves use of a medical device, drug or biological product for a particular diagnosis or condition, use for another diagnosis or condition may require that additional criteria be met. - Published peer review medical literature must conclude that the technology has a definite positive effect on health outcomes. - Published evidence must show that over time the treatment improves health outcomes (i.e., the beneficial effects outweigh any harmful effects). - Published proof must show that the treatment at the least improves health outcomes or that it can be used in appropriate medical situations where the established treatment cannot be used.

22. Failure to Follow Medical Advice: § Expenses incurred by any covered individual who fails to comply with medically appropriate treatment, as determined by the Plan; § Expenses incurred by any covered individual who leaves the hospital/facility against the medical advice of the attending physician within 72 hours after admission; § Expenses incurred by any covered individual during travel if a physician or other health care provider has specifically advised against such travel because of the health condition of the covered individual.

23. Hair Replacement Procedures, Medications, and Devices (Wigs): Expenses for hair transplantation and other procedures to replace lost hair or to promote the growth of hair, for the use of Minoxidil, Propecia, Rogaine, or other prescription drugs or medicines used to promote the growth of hair, or for hair replacement devices including, but not limited to, wigs, toupees and/or hairpieces, except that the Plan will provide benefits for a single wig, toupee or hairpiece if it is required to replace hair lost as a result of chemotherapy.

Newspaper Guild of New York – The New York Times Benefits Fund Page 67

PPO PLAN BENEFIT EXCLUSIONS (continued)

24. Illegal Act: Expenses incurred by any covered individual for injuries resulting from or sustained as a result of the commission or attempted commission, by the covered individual, of an illegal act that the Plan determines, on the advice of legal counsel, involves violence or the threat of violence to another person or in which a firearm, explosive or other weapon likely to cause physical harm or death is used by the covered individual. The Plan’s discretionary determination that this exclusion applies shall not be affected by any subsequent official action or determination with respect to prosecution of the covered individual (including, without limitation, acquittal or failure to prosecute) in connection with the acts involved.

25. Expenses for custodial/long term care.

26. Modifications of Homes or Vehicles: Expenses for construction or modification to a home, residence or vehicle required as a result of an injury, illness or disability of a covered individual.

27. No-Cost Services: Expenses for services rendered or supplies provided for which a covered individual is not required to pay or which are obtained without cost, or for which there would be no charge if the person receiving the treatment were not covered under this Plan.

28. No-Fault Automobile Insurance: Expenses for any services or supplies that are covered by mandatory automobile no-fault insurance.

29. Personal Comfort Items: Expenses for patient convenience, including, but not limited to, care of family members while the covered individual is confined to a hospital or other facility or to bed at home, guest meals, television, DVD, telephone, barber or beautician services, house cleaning or maintenance, shopping, birth announcements, photographs of new babies, etc.

30. Physical Examinations, Tests for Employment, School, etc.: Expenses for physical examinations and testing required for employment, government or regulatory purposes, insurance, school, camp, recreation, sports, or by any third party.

31. Services Provided Outside the United States: Expenses for medical services or supplies rendered or provided outside the United States, except for treatment for emergency care.

32. Services at Home: Expenses for services performed at home, except for those services specifically noted elsewhere in this Summary Plan Description as available either at home or as an emergency.

33. Smoking Cessation or Tobacco Withdrawal: Expenses for nicotine gum or patches, or other products, services or programs intended to assist an individual to stop smoking.

34. Telephone Calls: Any and all telephone calls for any purpose whatsoever.

Newspaper Guild of New York – The New York Times Benefits Fund Page 68

PPO PLAN BENEFIT EXCLUSIONS (continued)

35. Transplantation (Organ and Tissue): Expenses relating to: § Human organ and/or tissue transplants that are experimental and/or investigational, including, but not limited to, donor screening, acquisition and selection, organ or tissue removal, transportation, transplantation, post-operative services and drugs or medicine. § Non-human (Xenografted) organ and/or tissue transplants or implants, except heart valves. § Insertion and maintenance of an artificial heart or other organ or related device, except heart valves and kidney dialysis. § Services provided to the person who donates the organ or tissue, unless the person who receives the transplant is a person covered by this Plan.

36. Travel and Related Expenses: Expenses for and related to non-emergency travel or transportation (including lodging, meals and related expenses) of a healthcare provider, covered individual, or family member of a covered individual.

37. War or Similar Event: Expenses incurred for injury or illness received as a result of war, either declared or undeclared, except as required by law.

38. Weight Management and Physical Fitness: Expenses for: § Medical or surgical treatment of obesity including, but not limited to, gastric restrictive procedures, intestinal bypass and reversal procedures, bariatric surgery, weight loss programs, dietary instructions, and any complications thereof, except as provided by the Plan regarding morbid obesity (a weight of at least 100 pounds more than normal body weight for the patient’s age, sex, height and body frame based on weight tables generally used by Physicians to determine normal body weight). § Medical or surgical treatment of severe underweight, including, but not limited to, high calorie and/or high protein food supplements or other food or nutritional supplements, except in conjunction with medically necessary treatment of anorexia, bulimia or acute starvation. Severe underweight means a weight more than 25 percent under normal body weight for the patient’s age, sex, height and body frame based on weight tables generally used by physicians to determine normal body weight. § Memberships in or visits to health clubs, exercise programs, gymnasiums, and/or any other facility for physical fitness programs.

Newspaper Guild of New York – The New York Times Benefits Fund Page 69

EXCLUSIVE PROVIDER ORGANIZATION (EPO) PLAN

Members covered by the EPO benefit can see any provider in the EPO network, which contains family and general practitioners as well as specialists in all areas of medicine. There is no need to choose a primary care physician and no referrals are necessary to see a specialist. There are no claim forms to file and members will never have to pay more than the copay of covered services. There is no out-of-network coverage.

The following Exclusive Provider Organization (EPO) Plan is offered by the Guild-Times Benefits Fund:

Health Plan Contact Information

United Healthcare Oxford EPO Plan

Member Services (800) 444-6222

Address Oxford Health Plans P.O. Box 29135 Hot Springs, AR 71903

Web Address www.oxfordhealth.com

You will receive an ID card for this plan which contains the above information. Please present this ID card at the time of service.

The following charts are summaries of coverage. Please refer to your contract or certificate of coverage for complete details of your benefits, limits, and exclusions.

Newspaper Guild of New York – The New York Times Benefits Fund Page 70

EPO PLAN United Healthcare Oxford For Active Employees

BENEFIT IN-NETWORK (Through Participating Providers) Annual Deductible None Coinsurance None Out-of-Pocket Maximum Single $2,500 Family $5,000 Hospital Care Physician’s and Surgeon’s Services* No Charge Semi-Private Room and Board* No Charge All drugs and Medication No Charge Outpatient Care Primary Care Physician Office Visits $15 Copay Specialist Office Visits $15 Copay Outpatient Facility Surgery* No Charge Laboratory Services*1 No Charge MRIs, MRAs, PET Scan, CT Scan, Ultrasound* No Charge Radiology Services* No Charge Preventive Care Adult Preventive Care No Charge Infant and Pediatric Preventive Care No Charge Maternity Routine Prenatal and Post-Natal Care* No Charge Hospital Services for Mother and Child* No Charge Emergency Care Ambulance Service When Medically Necessary*2 No Charge At Hospital Emergency Room3 $25 Copay Emergency Care in Urgi-Center $15 Copay Mental Health Care Inpatient** No Charge Outpatient $15 Copay Office Visits $15 Copay Substance Use Disorder Services Inpatient Rehabilitation** No Charge Outpatient Rehabilitation $15 Copay Office Visits $15 Copay

1 Participating laboratories only. 2 When medically necessary. Notification is required if admitted to the hospital. 3 Waived if admitted.

* These services require precertification through Oxford. Members must call Oxford at 1-800-444-6222 at least 14 days in advance of treatment to request precertification. ** Mental health care and substance use disorder services can be pre-certified through Oxford’s Behavioral Health Department at 1-800-201-6991.

Newspaper Guild of New York – The New York Times Benefits Fund Page 71

EPO PLAN United Healthcare Oxford For Active Employees

BENEFIT IN-NETWORK (Through Participating Providers) Home Health Care*4 $15 Copay Physician House Calls* $15 Copay Hospice Inpatient Care* No Charge Home Hospice* $15 Copay Skilled Nursing Facility*5 No Charge Durable Medical Equipment*6 No Charge Medical Supplies*7 No Charge Short Term Rehab & Habilitative Services Inpatient*8 No Charge Outpatient*9 $15 Copay Allergy Care – Testing and Treatment* $15 Copay Chiropractic Care* $15 Copay Hearing Aids10 No Charge Advanced Infertility Treatment11 Specialist Office Visits* $15 Copay Inpatient Facility Services* No Charge Outpatient Facility Services* No Charge Exercise Facility (reimbursement per 6 month period) Employee $200 Spouse $100

4 Maximum of 60 visits per calendar year. 5 Maximum of 30 days per calendar year. 6 Precertification required for items over $500. 7 When medically necessary. 8 Maximum of 60 days per calendar year. 9 Maximum of 90 combined outpatient visits per calendar year. 10 Limited to a single purchase (including repair/replacement) every 3 years. 11 $10,000 lifetime maximum.

* These services require precertification through Oxford. Members must call Oxford at 1-800-444-6222 at least 14 days in advance of treatment to request precertification.

Newspaper Guild of New York – The New York Times Benefits Fund Page 72

EPO PLAN United Healthcare Oxford For Active Employees

BENEFIT IN-NETWORK (Through Participating Providers)

Prescription Drug Benefits*

Retail (up to a 31 day supply) Tier 1** $10 Copay Tier 2 $20 Copay Tier 3 $35 Copay

Mail Order (up to a 90-day supply) Tier 1** $25 Copay Tier 2 $50 Copay Tier 3 $87.50 Copay

* Certain drugs may have a prior authorization requirement or may result in a higher cost. ** Tier 1 Contraceptives covered at no charge.

Newspaper Guild of New York – The New York Times Benefits Fund Page 73

HEALTH MAINTENANCE ORGANIZATION (HMO) PLANS

A Health Maintenance Organization (HMO) is a system of healthcare that provides managed, pre-paid hospital and medical services to its members. An HMO member chooses a Primary Care Physician (PCP) from within the HMO network, and the PCP manages all medical services, provides referrals, and is responsible for non-emergency admissions. Members can receive healthcare at little or no out-of-pocket cost, provided they use the HMO’s doctors and facilities. The HMO provides all necessary services, there are usually no deductibles to meet or claim forms to file. There is no out-of-network coverage.

The following Health Maintenance Organization (HMO) Plans are offered by the Guild-Times Benefits Fund:

Health Plan Contact Information

HIP (EmblemHealth) HMO

Member Services (800) 447-8255

Address EmblemHealth 55 Water Street New York, NY 10041

Web Address www.emblemhealth.com

Health Plan Contact Information

Empire HMO Plan

Member Service (212) 476-1000 or back of ID card

Address Empire BlueCross BlueShield One Liberty Plaza New York, NY 10006

Web Address www.empireblue.com

You will receive an ID card for these plans which contains the above information. Please present this ID card at the time of service.

The following charts are summaries of coverage. Please refer to your contract or certificate of coverage for complete details of your benefits, limits, and exclusions.

Newspaper Guild of New York – The New York Times Benefits Fund Page 74

HEALTH MAINTENANCE ORGANIZATION (HMO) PLAN HIP Health Plan of New York - EmblemHealth Company For Active Employees

BENEFIT IN-NETWORK (Through Participating Providers) Annual Deductible None Coinsurance None Out-of-Pocket Maximum Effective 7/1/15 – 6/30/16 $6,600 Individual/$13,200 Family Inpatient Hospital Services Hospital Admission No charge Hospital and Physician Services No charge Semi-Private Room and Board No charge Operating Room and recovery room, intensive and special No charge care units, general nursing care, prescribed drugs, anesthesia, X-rays and lab tests Short-term speech, physical, occupational, and respiratory No charge therapy (when part of an acute admission) Speech, physical, occupational, and respiratory therapy No charge (when part of a rehabilitation admission) 1 Radiation therapy and chemotherapy No charge Pre-admission Testing No charge Human organ transplants No charge Outpatient Medical Care Ambulatory surgery No charge Second medical and surgical opinion No charge Outpatient Speech, physical, occupational and respiratory therapy2 Subject to Specialist office visit copay Preventive Care Physical exams, ear exams, health education and counseling, No charge pap smear, mammography and immunizations Prenatal, postnatal care in physician’s office No charge Well-child care No charge Diagnostic services including X-ray, lab tests, EKGs Included in PCP office visit copay PCP Office Visit $15 copay Specialist Office Visit $15 copay Emergency and Urgent Care Hospital Emergency Room No charge Urgent Care Facility Subject to PCP office visit copay Physician’s Office Subject to PCP office visit copay Ambulance service to the hospital No charge

1 Maximum of 90 days per calendar year. 2 Maximum of 90 visits per calendar year.

Except for emergency care, the above benefits and services are covered only when provided or referred by a HIP Primary Care Physician and/or approved in advance by the HIP Care Management Program.

Newspaper Guild of New York – The New York Times Benefits Fund Page 75

HEALTH MAINTENANCE ORGANIZATION (HMO) PLAN HIP Health Plan of New York - EmblemHealth Company For Active Employees

BENEFIT IN-NETWORK Mental Health Care Inpatient No charge Outpatient No charge Substance Use Disorder Inpatient Detoxification No charge Rehabilitation No charge Outpatient Rehabilitation $15 copay Home Health Care3 No charge Hospice Care4 No charge Skilled Nursing Facility Care No charge Dialysis Treatment $15 copay Diabetes equipment, supplies, and education $15 copay per month Family planning services Covered Infertility Diagnosis and Treatment Subject to applicable copays In-Vitro Fertilization Not covered Routine foot care Not covered Chiropractic services Subject to Specialist office visit copay Dental Care General dental care Covered at a reduced member fee schedule Preventive dental care Oral exam (every 6 months) $5 copay Cleaning (every 6 months) $10 copay Fluoride applications (1 every 6 months) Children age 16 and under $5 copay Children age 17 and over Copay determined by zip code Durable Medical Equipment No charge Private Duty Nursing No charge Hearing Aids Not covered; cochlear implants covered Optical Care Refractive Eye Exams No charge Eyeglasses $45 for a complete pair every 24 months

3 Maximum of 200 visits per calendar year. 4 Maximum of 210 days.

Except for emergency care, the above benefits and services are covered only when provided or referred by a HIP Primary Care Physician and/or approved in advance by the HIP Care Management Program.

Newspaper Guild of New York – The New York Times Benefits Fund Page 76

HEALTH MAINTENANCE ORGANIZATION (HMO) PLAN HIP Health Plan of New York - EmblemHealth Company For Active Employees

BENEFIT IN-NETWORK Prescription Drug5

Generic Retail (30 day supply) $10 copay Mail Order (90 day supply) $15 copay Specialty (30 day supply) $10 copay

Preferred Brand Retail (30 day supply) $20 copay Mail Order (90 day supply) $30 copay Specialty (30 day supply) $20 copay

Non-Preferred Brand Not Covered

5 Must be dispensed by a participating pharmacy. Specialty drugs require a written referral and must be dispensed by a specialty pharmacy.

Newspaper Guild of New York – The New York Times Benefits Fund Page 77

HEALTH MAINTENANCE ORGANIZATION (HMO) PLAN Empire HealthChoice HMO For Active Employees

BENEFIT IN-NETWORK1 (Through Participating Providers) Annual Deductible None Coinsurance None Out-of-Pocket Maximum Not Applicable Hospital Care Inpatient2 No Charge Surgery No Charge Inpatient Physical Therapy, Physical Medicine or Rehabilitation3 No Charge Ambulatory/Outpatient Facility Surgery4 No Charge Preadmission Testing No Charge Anesthesia No Charge Second Surgical Opinion $15 Copay Cardiac Rehabilitation No Charge Chemotherapy No Charge Ambulance Service (ground, water, or air4 ambulance) No Charge Non-Emergency Ambulance Service (in between facilities) No Charge Emergency Room/Facility (initial visit per occurrence)6 $35 Copay Office Visits Primary Care Physician (PCP) Office Visits $15 Copay Specialist Office Visits $15 Copay Urgent Care Center $15 Copay Office Surgery $15 Copay Telemedicine Program5 $15 Copay Laboratory Tests No Charge X-Rays, MRIs4, MRAs4, PET Scan4, CAT Scan4, Nuclear Technology Services4 $15 Copay Diagnostic Testing4 $15 Copay Preventive Care Adult Preventive Care No Charge Annual Physical Exam No Charge Well-Child Care (to age 19, including immunizations) No Charge Well-Woman Care (no PCP referral required) No Charge

1 A network provider must deliver all care with a PCP referral. 2 As many days as medically necessary; semi-private room and board. 3 Maximum of 30 inpatient days per calendar year. 4 Empire’s network providers must pre-certify in-network services or services may be denied. Empire’s network providers cannot bill members beyond in-network copay (if applicable) for covered services. For ambulatory surgery, preapproval is required for cosmetic/reconstructive procedures, outpatient transplants and ophthalmological or eye-related procedures. 5 A webVisit enables you to receive a covered medical consultation for a non-urgent matter from a participating provider who has agreed to provide webVisits to Empire members online. Confirm your provider’s participation by contacting your provider or his/her staff. Visit www.empireblue.com for more details. 6 Waived if admitted within 24 hours.

Newspaper Guild of New York – The New York Times Benefits Fund Page 78

HEALTH MAINTENANCE ORGANIZATION (HMO) PLAN Empire HealthChoice HMO For Active Employees

BENEFIT IN-NETWORK1 (Through Participating Providers) Maternity Care Inpatient Hospital Services4 No Charge Prenatal Care, Physician Services, Postnatal Care No Charge Mental Health4 Inpatient Care2 No Charge Outpatient Office Visits $15 Copay Facility No Charge Alcohol/Substance Abuse4 Inpatient Detoxification2 No Charge Inpatient Rehabilitation No Charge Outpatient Office Visits $15 Copay Facility No Charge Home Health Care7 No Charge Hospice Care8 No Charge Infusion Therapy (Home9, Office, Outpatient Hospital) No Charge Skilled Nursing Facility10 No Charge Medical Supplies11 $15 Copay Durable Medical Equipment and Braces4,11 20% Coinsurance Prosthetics and Orthotics4 20% Coinsurance Chemotherapy, Radiation Therapy No Charge Cardiac and Pulmonary Rehabilitation No Charge Diagnostic Radiology Service4 $15 Copay Therapeutic Radiology Services No Charge Physical Therapy4,12 $15 Copay Occupational and Speech Therapies4,13 $15 Copay Kidney Dialysis No Charge Allergy Testing and Treatment No Charge Chiropractic Care4 $15 Copay Acupuncture No Charge

1 A network provider must deliver all care with a PCP referral. 2 As many days as medically necessary; semi-private room and board. 4 Empire’s network providers must pre-certify in-network services or services may be denied. Empire’s network providers cannot bill members beyond in-network copay (if applicable) for covered services. For ambulatory surgery, preapproval is required for cosmetic/reconstructive procedures, outpatient transplants and ophthalmological or eye-related procedures. 7 Maximum of 200 visits per calendar year. 8 Maximum of 210 days per lifetime. 9 Counts towards home health care limit of 200 visits per calendar year. 10 Maximum of 60 days per calendar year. 11 Diabetic durable medical equipment, medical supplies, education, insulin, and oral agents are subject to an office visit copay for the first 52 items (combined), then covered at 100% when covered under medical benefit. 12 Maximum of 30 visits per calendar year combined in home, office, or outpatient facility. 13 Maximum of 60 visits per calendar year combined in home, office, or outpatient facility.

Newspaper Guild of New York – The New York Times Benefits Fund Page 79

HEALTH MAINTENANCE ORGANIZATION (HMO) PLAN Empire HealthChoice HMO For Active Employees

BENEFIT IN-NETWORK (Through Participating Providers)

Prescription Drug Benefits Retail Tier 1 $10 Copay Tier 2 $20 Copay Tier 3 $40 Copay

Mail Order Tier 1 $20 Copay Tier 2 $40 Copay Tier 3 $80 Copay

Newspaper Guild of New York – The New York Times Benefits Fund Page 80

GLOBAL HEALTH BENEFITS PLAN Cigna For Expatriates

The following Global Health Benefits Plan is offered to employees on international assignment by the Guild-Times Benefits Fund:

Health Plan Contact Information

Cigna Global Health Benefits Plan

Member Services (800) 441-2668

Address Cigna P.O. Box 15050 Wilmington, DE 19850

Web Address www.cignaglobalhealth.com

Cigna provides access to broad worldwide networks of doctors and hospitals in many countries and jurisdictions.

Cigna Global Health Benefits is a comprehensive international healthcare program allowing members to access healthcare anywhere in the world. The benefits are for employees on international assignment.

Cigna Global Health Benefits include:

§ Medical § Dental § Vision § Pharmacy § Medical Evacuation § Repatriation

The following charts are summaries of coverage. Please refer to your contract or certificate of coverage for complete details of your benefits, limits, and exclusions.

Newspaper Guild of New York – The New York Times Benefits Fund Page 81

GLOBAL HEALTH BENEFITS PLAN Cigna For Expatriates

BENEFIT INTERNATIONAL IN-NETWORK OUT-OF-NETWORK U.S. U.S. (Through Participating (Through Non-Participating U.S. Providers) U.S. Providers) Annual Deductible Individual $0 $0 $300 Family $0 $0 $900 Coinsurance Individual 0% 10% 30% after deductible Plan 100% 90% 70% after deductible Out-of-Pocket Maximum Individual $0 $1,000 $2,000 Family $0 $2,000 $4,000 Deductible/Out-of-Pocket Accumulation Cross applies between International, In-Network and Out-of-Network U.S. Lifetime Maximum Unlimited Inpatient Hospital Services Facility 100% 90% 70% after deductible Physician 100% 90% 70% after deductible Outpatient Facility Services 100% 90% 70% after deductible Maternity Care Services 100% 90% 70% after deductible Infertility1 100% 90% 70% after deductible Family Planning2 100% 90% 70% after deductible Lab and Radiology Facility 100% 100% 70% after deductible Short Term Rehabilitation3 100% 100% after $20 copay 70% after deductible Physician Visit 100% 100% after $20 copay 70% after deductible Prescription Drug 100% See schedule below See schedule below Mental Illness and Substance Abuse Inpatient 100% 90% 70% after deductible Outpatient 100% 90% 70% after deductible Skilled Nursing Facility4 100% 90% 70% after deductible

1 Procedures directly related to diagnosis are covered. Treatment, prescription drugs, and/or other method to bypass, i.e. in-vitro are not covered. 2 Includes contraceptive devices and surgical sterilization. Reversals are not covered. 3 Maximum of 60 days per calendar year for all therapies combined. Includes cardiac rehabilitation, physical therapy, speech therapy, occupational therapy, pulmonary rehabilitation, and cognitive therapy. 4 Maximum of 120 days per calendar year.

Newspaper Guild of New York – The New York Times Benefits Fund Page 82

GLOBAL HEALTH BENEFITS PLAN Cigna For Expatriates

BENEFIT INTERNATIONAL IN-NETWORK OUT-OF-NETWORK U.S. U.S. (Through Participating (Through Non-Participating U.S. U.S. Providers) Providers) Home Health Care4 100% 90% 70% after deductible Chiropractic Services5 100% 100% after $20 copay 70% after deductible Hospice 100% 90% 70% after deductible TMJ6 100% 90% 70% after deductible Mammograms7 100% 100% 100%; not subject to deductible Papanicolaou Screening Test8 100% 100% 100%; not subject to deductible Prostate Cancer Screening9 100% 100% 100%; not subject to deductible Lead Poisoning Screening10 100% 100% 100%; not subject to deductible Colorectal Cancer Screening11 100% 100% 100%; not subject to deductible Well Child Care 100% 100% 100%; not subject to deductible Immunizations12 100% 100% 100%; not subject to deductible Adult Preventive Care 100% 100% 100%; not subject to deductible Diabetes, Equipment & Supplies13 100% 90% 70% after deductible External Prosthetic Appliances 100% 90% 70% after deductible Durable Medical Equipment 100% 90% 70% after deductible Dental Accident14 100% 90% 70% after deductible Hearing Exam15 100% 90% 70% after deductible Routine Eye Exam16 100% 100% after $20 copay 70%; not subject to deductible

4 Maximum of 120 days per calendar year. 5 Maximum of 20 days per calendar year. 6 Maximum of $1,000 per lifetime. 7 1 baseline mammogram for asymptomatic women ages 35-39; 1 every 2 years for asymptomatic women ages 40-49; 1 annually for women age 50+ and whenever prescribed. 8 1 test per calendar year for females over age 18. 9 1 test per calendar year for males over age 50. 10 For children at or around 12 months and children under age 6 who are considered to be high risk. 11 Age 50 and older or any person deemed as high risk of colon cancer. 12 For children birth to age 18. Includes diphtheria, hepatitis A, hepatitis B, measles, mumps, pertussis, polio, rubella, tetanus, varicella, haemophilus influenza B. 13 Prescribed and recommended in writing by a physician. Equipment included are: insulin pumps, blood glucose meters and strips, urine testing strips, insulin, syringes, lancets, alcohol swabs, and pharmacological agents for controlling blood sugar. 14 Limited to a continuous course of treatment started within 6 months of accidental injury to sound natural teeth. 15 1 exam every 24 months; $150 maximum. 16 Exam: 1 every 12 months.

Newspaper Guild of New York – The New York Times Benefits Fund Page 83

GLOBAL HEALTH BENEFITS PLAN Cigna For Expatriates

Pharmacy Benefit

NON-PARTICIPATING PRESCRIPTION DRUGS PARTICPATING PHARMACY PHARMACY

RETAIL (per 30 day script or refill)

Generic 100% after $10 copay 70% after deductible

Brand Name Non-Preferred 100% after $20 copay 70% after deductible Preferred 100% after $40 copay 70% after deductible

MAIL ORDER (per 90 day script refill)

Generic 100% after $30 copay In-Network coverage only

Brand Name Non-Preferred 100% after $60 copay In-Network coverage only Preferred 100% after $120 copay In-Network coverage only

Newspaper Guild of New York – The New York Times Benefits Fund Page 84

GLOBAL HEALTH BENEFITS PLAN Cigna For Expatriates

EAP/Emergency Medical Evacuation/Repatriation Benefits

INTERNATIONAL EMPLOYEE ASSISTANCE PROGRAM

Level 2 Direct dial 24/7 immediate access to confidential services for behavioral International EAP Assist issues. Services include telephonic triage for emergent and urgent referrals, crises intervention and referrals to community resources. Referrals for 5 face to face sessions with licensed behavioral professionals (currently in 160 countries)

EMERGENCY MEDICAL EVACUATION/REPATRIATION

Emergency Evacuation 100% coverage not subject to the deductible for services approved by International SOS

Family Travel Economy round trip airfare to the place of hospitalization for one family Arrangements member for hospitalizations in excess of 7 days

Return of Dependent One way economy airfare to return dependent children to their country of Children residence

Repatriation of Mortal 100% coverage not subject to the deductible Remains

Return of Traveling In the event of hospitalization or evacuation, and a traveling companion’s air Companion ticket is no longer usable, one way economy airfare will be provided to the original point of departure.

Newspaper Guild of New York – The New York Times Benefits Fund Page 85

GLOBAL HEALTH BENEFITS PLAN Cigna For Expatriates

Dental Benefit

INTERNATIONAL DENTAL PLAN

Calendar Year Maximum (for Class I, II, and III) $2,000

Lifetime Maximum (for Class IV) $2,500

Class I Preventive Services Diagnostic – General 100% Preventive 100%

Class II Basic Services Restorative (Basic) 80% Endodontics 80% Periodontics 80% Prosthodontics – Removable1 80% Prosthodontics – Fixed Bridge1 80% Oral Surgery 80%

Class III Major Services Restorative (Major) 50% Prosthodontics – Removable2 50% Prosthodontics – Fixed Bridge2 50% Class IV Orthodontia 50% For dependent children under age 19

1 Maintenance 2 Installation

Newspaper Guild of New York – The New York Times Benefits Fund Page 86

GLOBAL HEALTH BENEFITS PLAN Cigna For Expatriates Cigna Global Health Benefits

Life Insurance & AD&D Benefits

GROUP TERM LIFE INSURANCE Classification Amount of Insurance Each Eligible Employee Flat Benefit Amount of $25,000

GROUP ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE Classification Principal Amount Each Eligible Employee Flat Benefit Amount of $25,000

If the insured is 65 or older, but under age 70, life and AD&D amounts are reduced to 65% of the scheduled amount. These amounts are reduced to 50% for insureds age 70 and older.

An employee’s amount of insurance reduced by 35% upon attainment of age 65 and further reduced to 50% upon attainment of age 70. Insurance terminates at retirement.

Newspaper Guild of New York – The New York Times Benefits Fund Page 87

Section IV

ADDITIONAL BENEFITS

Optical, Dental, and Life Insurance Benefits

Newspaper Guild of New York – The New York Times Benefits Fund Page 88

SUMMARY OF ADDITIONAL BENEFITS ACTIVE EMPLOYEES

BENEFIT COVERAGE

Optical Benefits Annual Maximum Per Member $100

Dental Benefits Annual Maximum Per Member $2,500

Orthodontia Benefits Lifetime Maximum Per Member $1,500

Life Insurance Benefits (Employee Only)

Amount of Insurance $10,000

Continuation Options:

For Temporary Leave of Absence Maximum Benefit Period 3 months Extended Death Benefit with Waiver of Premium Waiver Waiting Period 9 months Maximum Benefit Period To age 65

Terminal Illness Benefit $5,000

Regardless of which medical plan you choose, optical, dental and life insurance benefits are available.

Newspaper Guild of New York – The New York Times Benefits Fund Page 89

OPTICAL BENEFITS

If you are an active employee enrolled in the Plan, the Plan provides optical benefits for you and your covered dependents. Optical benefits are administered by C&R and do not require a separate enrollment.

Optical benefits are not available to retired employees or their dependents.

Panel vs. Non-Panel

You may choose between using a panel or non-panel optical center, optician, or optometrist. If you use an optician on the panel of opticians, you will receive services at virtually no cost to you and your family. If you use a non-panel optical center, optician, or optometrist, it may be more costly for you and you will be required to submit an optical expense claim form for reimbursement.

Panel Optical Center, Optician, or Optometrist

The Fund Office has a list of panel optical centers, private opticians and optometrists who have agreed to provide you with an eye examination (by an optometrist) and a basic pair of glasses. There is a charge for anything above a basic pair of glasses (i.e. contact lenses, tinted lenses, or brand name frames).

1. Find a panel optical center, private optician, and/or optometrist (see the chart below – you may search online or call). 2. Make an appointment with a panel provider. 3. Obtain a voucher from the Fund Office. 4. Visit your panel optician and provide them with the voucher.

Website Phone Number Fund Office guild.candrdirect.com (646) 237-1670 GVS General Vision (Benefits # 6910) www.generalvision.com (855) 653-0586 Vision Screening www.visionscreeninginc.com (800) 652-0063

The above websites allow you to view benefits, search for panel opticians, and set up appointments online. In addition, discounts are available for additional optical benefits through these panel providers. Please contact Fund Office for more information.

Non-Panel Optical Center, Optician, or Optometrist

If you use a non-panel provider you must complete an optical expense claim form to receive reimbursement. These forms are available at the Fund Office or you may download them from the website, guild.candrdirect.com.

Please complete the optical expense claim form and send it to:

Newspaper Guild of New York – The New York Times Benefits Fund 1501 Broadway, Suite 1724 New York, NY 10036

Newspaper Guild of New York – The New York Times Benefits Fund Page 90

OPTICAL BENEFITS (continued)

New Jersey Optical Services

Optical benefits are limited to eyeglasses only in New Jersey because the law prohibits private opticians and optometrists from providing eye examinations, for services in New Jersey.

Annual Maximum Benefit

There is a separate annual maximum optical benefit for you and for each of your covered dependents. For example, if the Plan covers you, your spouse, and dependents, each covered person is subject to a maximum optical benefit per calendar year. The maximum optical benefit applies to any covered optical benefits. This benefit does not accumulate if you do not use it.

NOTE: The annual benefit maximum does not apply to children under age 19 for optical benefits that are considered essential benefits as defined in the Affordable Care Act.

Covered Optical Expenses

The following are eligible expenses:

§ Eye examination by an optometrist or an ophthalmologist § Replacement or repair of broken frames § Purchase of prescription eyeglasses, including prescription sunglasses and contact lenses

Optical Expenses Not Covered

The following services are not covered:

§ Optical expenses for covered services resulting from an on-the-job injury or from a disease for which benefits are payable under the Workers’ Compensation Act or a similar law; § Optical expenses for covered services in a hospital operated by the Federal government or for which you or your family would not be charged a fee; or § Any doctor’s fees for treating an eye illness or injury. These expenses may be covered under your medical plan.

Newspaper Guild of New York – The New York Times Benefits Fund Page 91

DENTAL BENEFITS

Summary of Dental Benefits In-Network Out-of-Network

Calendar Year Maximum § Per member $2,500 § Annual Maximum Carryover None

Lifetime Orthodontia Maximum § Per member $1,500

Out-of-Network Reimbursement n/a Maximum Allowable Cost (MAC)

Calendar Year Deductible $0 $0

Diagnostic & Preventive Services 100% 100%

Basic Services 100% 100%

Major Services 100% 100%

Orthodontia 50% 50%

Please note limitations and exclusions on these dental services listed on the following pages.

Newspaper Guild of New York – The New York Times Benefits Fund Page 92

DENTAL BENEFITS (continued)

If you are an active employee, the Plan provides dental care benefits for you and your covered dependents. The dental benefit plan is administered by Empire BlueCross Blue Shield. Dental benefits do not require a separate enrollment.

Dental benefits are not available to retired employees or their dependents.

You will receive an Empire dental ID card which you should present to your dental provider each time you require dental services. On the back of your dental ID care you will find the dental claims address and dental customer service phone number.

In-Network vs. Out-of-Network Dentists

If you use an in-network dentist, there are no claim forms and you receive discounted services. If you use an out-of-network dentist, you may reach your maximum sooner because the services will be more expensive. You will also be required to submit your out-of-network dental claim forms for reimbursement.

In-network dentists have agreed to payment rates for various services and cannot charge you more. Out- of-network dentists don’t have a contract and are able to bill you for the difference between the total amount Empire allows to be paid for a service – called the “maximum allowable cost (MAC)” – and the amount they usually charge for a service. When they bill you the difference, it is called “balance billing”.

Example: Your plan offers 100% coinsurance for either in-network or out-of-network services. You choose to get a crown from an out-of-network dentist who charges $1,200 for the service and bills Empire for that amount. If Empire’s MAC for this dental service is $800, this means there will be a $400 difference and the out-of-network dentist can bill you for that amount. If you went to an in-network dentist, your cost would be $0 because you would not have been “balanced billed” the $400 difference.

In-Network Dentist

How to locate a participating dental provider:

1. Go to www.empireblue.com 2. Located in the right column under “Useful Tools”, click on “Find a Doctor” 3. Select the state – New York, New Jersey, etc. 4. Select the plan – Dental Prime 5. Click on “Select and continue” 6. Select the specialty, or location either by zip code or address, or name to locate your participating provider. 7. Click on “Search” 8. You may refine your search depending on specialty, gender, or additional options on the left hand column.

Newspaper Guild of New York – The New York Times Benefits Fund Page 93

DENTAL BENEFITS (continued)

In-Network Dentist (continued)

How to setup your member login:

1. Go to www.empireblue.com 2. Located on the right of the menu bar select “Customer Support” 3. Click on “My Dental Benefits” 4. Click on the link provided 5. Click on “Create a Username and Password” 6. Enter Subscriber Registration information: First Name, Last Name, Subscriber’s ID, and Date of Birth 7. Create a username, password, and challenge question/answer 8. Registration is complete – you may now access coverage, claims, and eligibility information, and order replacement ID cards.

Out-of-Network Dentist

If you use an out-of-network dentist, you will have to submit your dental claims to receive reimbursement. All out-of-network dental claim forms must be sent to:

Empire BlueCross BlueShield Dental Benefits Program P.O. Box 810 Minneapolis, MN 55440-0810

If you have any questions, please contact Empire Blue Cross Blue Shield directly at (877) 606-3338.

Annual Maximum Benefit

There is a separate maximum dental benefit per year for you and for each covered dependent. For example, if the Plan covers you, your spouse and dependents, each covered person is subject to the maximum dental benefit per calendar year. The maximum dental benefit applies to any covered dental benefits whether an in-network or out-of-network dentist is utilized.

NOTE: The annual benefit maximum does not apply to children under age 19 for dental benefits that are considered essential benefits as defined in the Affordable Care Act.

Orthodontic Lifetime Maximum

Your orthodontic benefits are subject to the Orthodontic Services Lifetime Maximum. The Plan will not pay any orthodontic benefits in excess of that amount during a member’s lifetime.

Newspaper Guild of New York – The New York Times Benefits Fund Page 94

DENTAL BENEFITS (continued)

Pretreatment Estimate (Estimate of Benefits)

It is recommended, but not required, that a pretreatment estimate be submitted to Empire prior to treatment to estimate the maximum allowed cost if your dental treatment involves major restorative, periodontics, prosthetics or orthodontic care. The pretreatment estimate is a valuable tool for both the dentist and you. Submitting a pretreatment estimate allows the dentist and you to know what reimbursement is available to you before beginning treatment. The pretreatment estimate will outline your responsibility to the dentist with regard to coinsurance and non-covered services. This will allow the dentist and you to make any necessary financial arrangements before treatment begins. This process does not determine whether the treatment is necessary for you. This is not a guarantee of benefits.

Newspaper Guild of New York – The New York Times Benefits Fund Page 95

DENTAL BENEFITS (continued)

DIAGNOSTIC & PREVENTIVE SERVICES

Oral Evaluations

§ Evaluation (checkup or exam) is covered 2 times per calendar year.

NOTE: Comprehensive oral evaluations will be allowed 1 time per dental office, subject to the 2 times per calendar year limitation. Any additional comprehensive oral evaluations performed by the same dental office will be considered a periodic oral evaluation and will be subject to the 2 times per calendar year limitation.

Radiographs (X-rays)

§ Bitewings - Covered at 2 series of bitewings per 12-month period. § Full Mouth (Complete Series) or Panoramic - Covered 1 time per 36-month period. § Periapical(s) - 4 single x-rays are covered per 12-month period. § Occlusal - Covered at 2 series per 24-month period.

Dental Cleaning

§ Prophylaxis - Any combination of this procedure or periodontal maintenance (see Periodontics section) is covered 2 times per calendar year.

NOTE: Child Prophylaxis - Under the age of 14 Adult Prophylaxis - Age 14 or older

Fluoride Treatment

§ Topical application of fluoride – Covered 1 time per 12-month period for dependent children through the age of 18.

Sealants or Preventive Resin Restorations

§ Any combination of these procedures is covered 1 time per 24-month period for permanent first and second molars of eligible dependent children through the age of 15.

Newspaper Guild of New York – The New York Times Benefits Fund Page 96

DENTAL BENEFITS (continued)

BASIC RESTORATIVE SERVICES

Emergency Treatment

§ Emergency (palliative) treatment for the temporary relief of pain or infection.

Permanent Basic Restorations

§ Covered when there has been loss of tooth structure due to decay or fracture of a permanent or primary tooth. Coverage for amalgam or composite restorations is available for 1 surface per 24-month period. § Amalgam (silver) Restorations § Composite (white) Resin Restorations

Space Maintainers

§ Covered 1 time per lifetime on eligible dependent children through the age of 16 for extracted primary posterior (back) teeth. - The repair or replacement of a lost/broken appliance is not a covered service

Basic Tooth Extractions

§ Removal of coronal remnants (retained pieces of the crown portion of the tooth) on primary teeth § Extraction of erupted tooth or exposed root

Restorative cast post and core build-up, including pins and posts

See the benefit coverage description under Complex or Major Restorative Services.

ENDODONTIC SERVICES (NERVE OR PULP TREATMENT)

Completed Endodontic Therapy on Primary Teeth

§ Covered 1 time per tooth per lifetime - Pulpal Therapy - Therapeutic Pulpotomy

Completed Endodontic Therapy on Permanent Teeth

§ Covered 1 time per tooth per lifetime - Root Canal Therapy

Newspaper Guild of New York – The New York Times Benefits Fund Page 97

DENTAL BENEFITS (continued)

PERIODONTAL SERVICES (GUM & BONE TREATMENT)

Periodontal Maintenance

§ A procedure that includes removal of bacteria from the gum pocket areas, scaling and polishing of the teeth, periodontal evaluation and gum pocket measurements for patients who have completed periodontal treatment.

Any combination of this procedure and dental cleanings (see Diagnostic and Preventive section) is covered 2 times per calendar year.

Basic Non-Surgical Periodontal Care

§ Treatment of diseases of the gingival (gums) and bone supporting the teeth. - Periodontal scaling & root planning - Covered 1 time per 36 months if the tooth has a pocket depth of 4 millimeters or greater - Full mouth debridement - Covered 1 time per lifetime

Complex Surgical Periodontal Care

§ Surgical treatment of diseases of the gingival (gums) and bone supporting the teeth. The following services are considered complex surgical periodontal services under this plan. - Gingivectomy/gingivoplasty - Gingival flap - Apically positioned flap - Osseous surgery - Bone replacement graft - Pedicle soft tissue graft - Free soft tissue graft - Subepithelial connective tissue graft - Soft tissue allograft - Combined connective tissue and double pedicle graft - Distal/proximal wedge - LIMITATION: Covered on natural teeth only

One complex surgical periodontal benefit is covered per 36-month period per single tooth or multiple teeth in the same quadrant if the pocket depth of the tooth is 5 millimeters or greater.

Newspaper Guild of New York – The New York Times Benefits Fund Page 98

DENTAL BENEFITS (continued)

ORAL SURGERY SERVICES (TOOTH, TISSUE, OR BONE REMOVAL)

Complex Surgical Extractions

§ Surgical removal of erupted tooth § Surgical removal of impacted tooth § Surgical removal of residual tooth roots

Surgical removal of 3rd molars is covered if the removal is associated with symptoms or oral pathology.

Surgical Reduction of Fibrous Tuberosity

§ Covered 1 time per 6-month period.

Intravenous Conscious Sedation, IV Sedation and General Anesthesia

§ Covered when performed in conjunction with complex surgical service.

Temporomandibular Joint Disorder (TMJ)

§ Dental treatment that is considered surgical and nonsurgical treatment of temporomandibular joint disorder (TMJ) and craniomandibular disorder, including splints.

MAJOR RESTORATIVE SERVICES (CROWNS, INLAYS AND ONLAYS) Services performed to restore lost tooth structure as a result of decay or fracture

Gold foil restorations

§ Benefits are available at the same level that applies to amalgams (silver fillings) and are subject to the same surface limitations and allowances. The member is responsible for any difference in cost between the maximum allowed amount for the amalgam (silver filling) and the maximum allowed amount for the gold foil restoration.

Inlays

§ Benefits are available at the same level that applies to amalgams (silver fillings) and are subject to the same surface limitations and allowances. The member is responsible for any difference in cost between the maximum allowed amount for the amalgam (silver filling) and the maximum allowed amount for the inlay.

Pre-fabricated or Stainless Steel Crown

§ Covered 1 time per 60-month period for eligible dependent children through the age of 18.

Newspaper Guild of New York – The New York Times Benefits Fund Page 99

DENTAL BENEFITS (continued)

MAJOR RESTORATIVE SERVICES (CROWNS, INLAYS AND ONLAYS) (CONTINUED))

Onlays and/or Permanent Crowns

§ Covered 1 time per 7-year period per tooth for members age 12 and older if the tooth has extensive loss of natural tooth structure due to decay or tooth fracture such that an amalgam or composite restoration cannot be used to restore the tooth.

- Porcelain/ceramic substrate onlays/crowns - Benefits are available up to the maximum allowed amount for a porcelain to noble metal crown. The member is responsible for any difference in cost between the maximum allowed amount for the covered service and the cost of the optional treatment.

Implant Crowns – See Prosthetic Services.

Recement Inlay, Onlay and Crowns

§ Covered 6 months after initial placement.

Crown Repair

§ Covered 1 time per 12-month period per tooth when the submitted narrative from the treating dentist supports the procedure.

Restorative cast post and core build-up, including 1 post per tooth and 1 pin per surface

§ Covered 1 time per 7-year period when necessary to retain an indirectly fabricated restoration due to extensive loss of actual tooth structure due to caries or fracture.

Newspaper Guild of New York – The New York Times Benefits Fund Page 100

DENTAL BENEFITS (continued)

PROSTHODONTIC SERVICES (DENTURES, PARTIALS, AND BRIDGES) The replacement of teeth that were missing prior to becoming a member under this Plan will be covered after the member has been continuously covered under this Plan for 12 months or more

Tissue Conditioning

§ Covered 1 time per 24-month period.

Recement Fixed Prosthetic

§ Covered 1 time per 12-month period.

Reline and Rebase

§ Covered 1 per 24-month period: - when the prosthetic appliance (denture, partial or bridge) is the permanent prosthetic appliance; and - only after 6 months following initial placement of the prosthetic appliance (denture, partial or bridge).

Repairs, Replacement of Broken Artificial Teeth, Replacement of Broken Clasp(s)

§ Covered 1 per 6-month period: - when the prosthetic appliance (denture, partial or bridge) is the permanent prosthetic appliance; - only after 6 months following initial placement of the prosthetic appliance (denture, partial or bridge); and - when the submitted narrative from the treating dentist supports the procedure.

Denture Adjustments

§ Covered 2 times per 12-month period: - when the denture is the permanent prosthetic appliance; and - only after 6 months following initial placement of the denture.

Partial and Bridge Adjustments - Covered 2 times per 24-month period:

§ when the partial or bridge is the permanent prosthetic appliance; and § only after 6 months following initial placement of the partial or bridge.

Newspaper Guild of New York – The New York Times Benefits Fund Page 101

DENTAL BENEFITS (continued)

PROSTHODONTIC SERVICES (DENTURES, PARTIALS, AND BRIDGES) The replacement of teeth that were missing prior to becoming a member under this Plan will be covered after the member has been continuously covered under this Plan for 12 months or more

Completed Removable Prosthetic Services (Dentures and Partials) – Covered 1 time per 7-year period:

§ for members age 16 or older; § for the replacement of extracted (removed) permanent teeth; § if 7 years have elapsed since the last benefited removable prosthetic appliance (denture or partial) and the existing denture or partial needs replacement because it cannot be repaired or adjusted.

Completed Fixed Prosthetic Services (Bridge) – Covered 1 time per 7-year period:

§ for members age 16 or older; § for the replacement of extracted (removed) permanent teeth; § if no more than 3 teeth are missing in the same arch; § a natural, healthy, sound tooth is present to serve as the anterior and posterior retainer; § no other missing teeth in the same arch that have not been replaced with a removable partial denture; § if none of the individual units of the bridge has been benefited previously as a crown or cast restoration in the last 7 years; § if 7 years have elapsed since the last benefited removable prosthetic appliance (bridge) and the existing bridge needs replacement because it cannot be repaired or adjusted.

If there are multiple missing teeth, a removable partial denture is covered if it is the least costly course of treatment. Any additional optional benefits are subject to the contract limitations of those services.

Other Complex Surgical Procedures – Covered when necessary to prepare for dentures.

§ Alveoloplasty § Vestibuloplasty § Removal of exostosis - per site § Surgical reduction of osseous tuberosity

Single Tooth Implant Body, Abutment and Crown – Covered 1 time per 7-year period for members age 16 and over. Coverage includes only the single surgical placement of the implant body, implant abutment and implant/abutment supported crown.

LIMITATION: Some adjunctive implant services may not be covered. It is recommended that a pretreatment estimate be requested to estimate the amount of payment prior to beginning treatment.

Coverage is provided for the least expensive professionally acceptable treatment.

Coverage for congenitally missing teeth is available once the member has been continuously covered under this Plan for 12 months or more.

Newspaper Guild of New York – The New York Times Benefits Fund Page 102

DENTAL BENEFITS (continued)

ORTHODONTICS Treatment necessary for the prevention and correction of malocclusion of teeth and associated dental and facial disharmonies

Limited Treatment – Treatments which are not full treatment cases and are usually done for minor tooth movement.

Interceptive Treatment – A limited (phase I) treatment phase used to prevent or assist in the severity of future treatment.

Comprehensive (complete) Treatment – Full treatment includes all records, appliances and visits.

Removable Appliance Therapy – An appliance that is removable and not cemented or bonded to the teeth.

Fixed Appliance Therapy – A component that is cemented or bonded to the teeth.

Other Complex Surgical Procedures § Surgical exposure of impacted or unerupted tooth for orthodontic reasons § Surgical repositioning of teeth

Treatment in progress (appliances placed prior to eligibility under this Plan) will be benefited on a pro-rated basis.

Coverage is limited to those treatment plans commencing after the member’s 8th birthday.

Orthodontic Exclusions – Coverage is NOT provided for: 1. Monthly treatment visits that are inclusive of treatment cost; 2. Repair or replacement of lost/broken/stolen appliances; 3. Orthodontic retention/retainer as a separate service; and 4. Retreatment and/or services for any treatment due to relapse.

Orthodontic Payments: Because orthodontic treatment normally occurs over a long period of time, benefit payments are made over the course of treatment. The member must have continuous eligibility under the Plan in order to receive ongoing orthodontic benefit payments.

Benefit payments are made in equal amounts: (1) when treatment begins (appliances are installed), and (2) at six month intervals thereafter, until treatment is completed or until the lifetime maximum benefits are exhausted (see Benefit Maximums in the Summary of Dental Benefits).

Before treatment begins, the treating dentist should submit a pretreatment estimate. An Estimate of Benefits form will be sent to you and your dentist indicating the estimated maximum allowed amount, including any amount you may owe. This form serves as a claim form when treatment begins.

When treatment begins, the dentist should submit the Estimate of Benefits form with the date of placement and his/her signature. After benefit and eligibility verification by the Plan, a benefit payment will be issued. A new/revised Estimate of Benefits form will also be issued to you and your dentist. This again will serve as the claim form to be submitted 6 months from the date of appliance placement.

Newspaper Guild of New York – The New York Times Benefits Fund Page 103

DENTAL BENEFITS (continued)

DENTAL EXCLUSIONS

This section indicates items which are excluded and are not considered covered dental services. This information is provided as an aid to identify certain common items which may be misconstrued as covered dental services. This list of exclusions is in no way a limitation upon, or a complete listing of, such items considered to be non-covered services.

Coverage is NOT provided for:

1. Dental services which a member would be entitled to receive for a nominal charge or without charge if this Plan were not in force under any Worker's Compensation Law, Federal Medicare program, or Federal Veteran's Administration program. However, if a member receives a bill or direct charge for dental services under any governmental program, then this exclusion shall not apply. Benefits under this Plan will not be reduced or denied because dental services are rendered to a member or dependent who is eligible for or receiving medical assistance.

2. Dental or health care services or supplies that are medical in nature, including but not limited to, hospital, surgical, treatment facility or emergency room charges, or for services of an anesthesiologist or anesthetist. New, experimental or investigational dental techniques or services may be denied until there is, to the satisfaction of the Plan, an established scientific basis for recommendation.

3. Experimental or investigational treatments are not covered. However, the Plan shall cover an experimental or investigational treatment approved by an external appeal agent. If the external appeal agent approves coverage of an experimental or investigational treatment that is part of a clinical trial, the Plan will only cover the costs of services required to provide treatment to you according to the design of the trial. The Plan shall not be responsible for the costs of investigational drugs or devices, the costs of non-health care services, the costs of managing research, or costs which would not be covered for non-experimental or non-investigational treatments provided in such clinical trial.

4. Analgesia, analgesic agents, nitrous oxide, prescription drug charges, therapeutic drug injections, medicines, or drugs for non-surgical or surgical dental care.

5. Dental services performed for cosmetic purpose, including cosmetic surgery and services or supplies that have the primary purpose of improving the appearance of your teeth. This includes, but is not limited to, tooth whitening agents, tooth bonding and veneer covering of the teeth.

6. Dental services, appliances or restorations that are necessary to alter, restore or maintain occlusion, including but not limited to: increasing vertical dimension, replacing or stabilizing tooth structure lost by attrition, abrasion and abfraction, realignment of teeth, periodontal splinting and gnathologic recordings.

7. Guided tissue regeneration.

8. Case presentations, office visits and consultations.

9. Incomplete treatment (e.g. patient does not return to complete treatment) or interim/temporary services (e.g. temporary restorations and temporary removable/fixed prosthetic appliances).

Newspaper Guild of New York – The New York Times Benefits Fund Page 104

DENTAL BENEFITS (continued)

DENTAL EXCLUSIONS (continued)

10. Corrections of congenital conditions during the first 12 months of continuous coverage under this Plan.

11. Athletic mouth guards, occlusal guards and adjustments, enamel micro abrasion and odontoplasty.

12. Retreatment or additional treatment necessary to correct or relieve the results of treatment previously benefited under the Plan.

13. Crown lengthening.

14. Tests, laboratory and adjunctive charges, including but not limited to, bacteriologic tests, cytology sample collection, pulp vitality tests, diagnostic tests/casts, cone beam images and oral hygiene instructions.

15. Additional, elective or enhanced prosthodontic procedures including but not limited to, connector bar(s), stress breakers and precision attachments.

16. Sedative filling, base or liner used under a restoration.

17. Anatomical crown exposure, surgical exposure of impacted/unerupted teeth or the surgical repositioning of teeth.

18. Complex endodontic services, including intentional reimplantation, apicoectomy, root amputation, apexification, retrograde fillings and hemisection.

19. Procedures used to prepare, repair or place materials in the root canal, including removal of pulpal debridement, pulp cap, resorbable or non-resorbable fillings, root canal obstruction and internal root repair of perforation defects.

20. Brush biopsy.

21. Amalgam or composite restorations placed for preventive or cosmetic purposes.

Optional Treatment Plans

In all cases in which there are alternative treatment plans carrying different costs, the decision as to which course of treatment to be followed shall be solely that of the member and the dentist. However, the benefits payable hereunder will be made for the applicable percentage of the least costly course of treatment, with the balance of the treatment cost remaining the payment responsibility of the member.

Newspaper Guild of New York – The New York Times Benefits Fund Page 105

LIFE INSURANCE BENEFITS

Life insurance benefits are provided through an insurance contract with Cigna Life Insurance Company (“the insurance company”). You may request a certificate from the insurance company for more detailed information on this benefit.

Life insurance is provided for active employees only. This benefit is provided at no cost to you. Retired employees and dependents (of active or retired employees) are not eligible for coverage.

Life Insurance Death Benefit

If you die, the insurance company will pay the life insurance benefit in force on the date of your death.

Notice of Claim

When you die, your beneficiary will be sent a claim form. The completed claim form and a certified copy of your death certificate should be sent to the insurance company at the address shown on the claim form. When the claim is approved by the insurance company, the benefit will be sent to the address specified by the beneficiary.

To Whom Payable

Death benefits for you will be paid to the beneficiary named in the plan records, if any, at the time of payment. If there is no named beneficiary or surviving beneficiary, or if you die while disability benefits are payable to you, the insurance company may, at its option, make direct payment to any of the following:

1. Your spouse; 2. Your child or children; 3. Your parents; 4. Your sisters or brothers; or 5. Your estate.

Newspaper Guild of New York – The New York Times Benefits Fund Page 106

LIFE INSURANCE BENEFITS (continued)

Terminal Illness Benefit

The insurance company will pay a terminal illness benefit to you if you have been determined by the insurance company to be terminally ill. The benefit determination date is the date the insurance company determines that you have a terminal illness.

The terminal illness benefit is 50% of the life insurance benefit in effect on the benefit determination date. The terminal illness is payable only once in your lifetime. Any terminal illness benefit paid will reduce the death benefit payable for life insurance.

Notice/Determination of Terminal Illness

For the purpose of determining the existence of a terminal illness, the insurance company will require you to submit the following proof:

1. A written diagnosis and prognosis by two physicians licensed to practice in the U.S.; and 2. Supportive evidence satisfactory to, including but not limited to radiological, histological, or laboratory reports documenting the terminal illness.

The insurance company may require, at its expense, an examination of you and a review of the documented evidence by a physician of its choice.

“Terminal illness” is defined as a person with a prognosis of 12 months or less to live, as diagnosed by a physician.

To Whom Payable

Terminal illness benefits are payable to you, if living. If you die prior to the payment of an eligible claim for a terminal illness benefit, benefits will be paid in accordance with the provisions applicable to the payment of life insurance benefits, unless you have directed the insurance company otherwise in writing. However, any payment made by the insurance company prior to notice of your death shall discharge the insurance company of any benefit that was paid.

Claim Provisions

Change of Beneficiary

You may change the beneficiary at any time by filling out the life insurance beneficiary card available at the Fund Office and providing it to the Fund Office.

Claim Forms

When the insurance company receives written notice of claim, it will send claim forms for filing proof of loss. If claim forms are not sent within 15 days after notice is received by the insurance company, the proof requirements will be met by submitting, within the time required under the “Proof of Loss” section, written proof or proof by any other electronic or telephonic means authorized by the insurance company, of the nature and extent of the loss.

Newspaper Guild of New York – The New York Times Benefits Fund Page 107

LIFE INSURANCE BENEFITS (continued)

Claim Forms (continued)

Failure to cooperate with the insurance company in the administration of the claim may result in termination of the claim. A claimant will be required to provide any information or documents needed to determine whether benefits are payable or the actual benefit amount due.

Proof of Loss Written proof of loss, or proof by any other electronic or telephonic means authorized by the insurance company, for terminal illness benefits must be furnished as soon as reasonably possible after the date of diagnosis. This proof must describe the occurrence, character, and extent of the diagnosis for which claim is made.

In case of claim for any other loss, written proof or notice by any other electronic or telephonic means authorized by the insurance company, of loss must be given to the insurance company as soon as reasonably possible after the date of the loss for which a claim is made.

Claims will not be denied or reduced if it:

1. Is not reasonably possible to furnish the required proof within that period; and 2. Is shown that such proof of loss was given as soon as was reasonably possible.

Physical Examination and Autopsy

The insurance company, as its own expense, will have the right to examine any person for whom a claim is pending as often as it may reasonably require. The insurance company may, at its own expense, require an autopsy unless prohibited by law. Time of Payment

Any benefits due under the policy for loss, other than a loss for which the policy provides installments, will be paid immediately upon receipt of due written proof of loss by any other electronic or telephonic means authorized by the insurance company.

Legal Actions

No action at law or in equity may be brought to recover benefits under the policy less than 60 days after written proof of loss, or proof by any other electronic or telephonic means authorized by the insurance company, has been furnished as required by the policy. No such action shall be brought more than three (3) years after the time written proof of loss is required to be furnished.

Newspaper Guild of New York – The New York Times Benefits Fund Page 108

LIFE INSURANCE BENEFITS (continued)

Claim Provisions (continued)

Time Limitations

If any time limit stated in the policy for giving notice of claim or proof of loss, or for bringing any action at law or in equity, is less than that permitted by the law of the state in which you live when the policy is issued, then the time limit provided in the policy is extended to agree with the minimum permitted by the law of that state. Termination of Insurance

Your coverage will end on the earliest of: 1. the date your employment ends; 2. the date you retire; 3. the date you are no longer eligible for the Plan; or 4. the date the Fund cancels participation under the policy.

Continuation for Temporary Leave of Absence

If you are on an employer-approved unpaid leave of absence, your life insurance benefits will continue for up to three (3) months.

Newspaper Guild of New York – The New York Times Benefits Fund Page 109

LIFE INSURANCE BENEFITS (continued)

Extended Death Benefit with Waiver of Premium

If you become disabled while insured under this insurance policy and are less than age 60, your life insurance benefit shown in the Summary of Additional Benefits will be extended without premium payment (the Fund normally pays your premium). No waiting period is required. Coverage will be extended until the earlier of:

1. The date you are no longer disabled. 2. The date you fail to qualify for waiver of premium or fail to provide proof of disability.

If you submit satisfactory proof that you have been continuously disabled for nine (9) months (the waiver waiting period), coverage will be extended up to age 65. Such proof must be submitted to the insurance company no later than three (3) months after the date the waiver waiting period ends.

Disability/Disabled means because of injury or sickness you are unable to perform all the material duties of your regular occupation, or are receiving disability benefits under the Plan.

Regular occupation means the occupation you routinely perform at the time the disability begins.

Amount of Insurance

If you die while you are disabled and coverage is extended under this provision, the insurance company will pay a death benefit equal to the amount in effect on the date you became disabled.

Termination of Waiver

Insurance under the waiver of premium provision will end for you on the earliest of:

1. The date you are no longer are disabled. 2. The date you refuse to submit any physical examination required by the insurance company. 3. The last day of the 12-month period of disability during which you fail to submit satisfactory proof of continued disability. 4. The date you turn age 65.

In lieu of continuing coverage under this provision, the Conversion Privilege for Life Insurance is available to you on the date continued insurance ends, or at any time while life insurance benefits are continued under this option. If you convert your coverage prior to satisfying the waiver waiting period and later qualify for the Waiver of Premium Benefit under the policy, you will be covered under the policy provided the conversion policy is surrendered. If the conversion policy is rescinded, premiums paid for that policy will be refunded.

Newspaper Guild of New York – The New York Times Benefits Fund Page 110

LIFE INSURANCE BENEFITS (continued)

Conversion Privilege for Life Insurance

If your coverage ends for any reason, except for non-payment of premium, you may apply for a conversion policy of life insurance (from the insurance company, not from the Fund).

The conversion privilege is not activated when your life insurance benefit is reduced due to payment of a terminal illness benefit.

The conversion insurance may be a type of life insurance currently being offered for conversion by the insurance company at your age and in the amount requested.

If coverage ends because the policy is terminated or amended, or the Fund cancels participation under the policy, and you are or become eligible for coverage under any group policy within 45 days, the maximum amount of coverage you can convert is the $10,000 amount you have under the Fund’s group policy. However, this amount will be reduced by the amount of any other life insurance for which you are eligible through your employer. For example, if you become covered by an $8,000 policy through a new employer, you can convert only $2,000 of the Fund’s group policy.

To apply for conversion insurance, you must submit any application to the insurance company and pay the required premium within 31 days after your insurance company under this Plan ends. Evidence of insurability is not required. Premium for the conversion insurance will be based on your age and class of risk and the type and amount of coverage issued.

Conversion insurance will become effective on the 31st day after the date coverage under this policy ends if your application has been received by the insurance company and the required premium is paid on that date. If you die during the conversion period, the insurance company will pay the amount of your life insurance to your beneficiary.

Newspaper Guild of New York – The New York Times Benefits Fund Page 111

Section V

Coordination of Benefits, Subrogation, Claims Procedures & Appeals

Newspaper Guild of New York – The New York Times Benefits Fund Page 112

COORDINATION OF BENEFITS

This section applies to the PPO Benefit Plan and Additional Benefits (provided by this Plan). If you are covered by an insured plan (underwritten by Cigna, Empire BlueCross and BlueShield, Emblem Health or United Healthcare), please refer to the information provided by your insurance company for their Coordination of Benefits provision.

How Are Benefits Coordinated?

You, your spouse and your other dependents may be covered through your respective employers by more than one group medical, dental or health insurance plan. In that case, benefits are coordinated between the plans so that you may receive up to—but not more than—l00% of the usual, customary and reasonable charges for which you submit claims. In addition, no plan will pay more benefits that it would normally provide without this special coordinating provision.

Here is how it works. One plan is designated the primary plan, the other is secondary. The primary plan pays first. Then, the secondary plan pays a reduced amount that, when added to the benefits paid by the primary plan, may reach up to l00% of the usual, customary and reasonable charge for a covered health care service in your geographical area.

If a primary plan is “closed panel” (that means that you can only get benefits from participating providers) and you obtain benefits from a nonparticipating provider, the secondary plan is treated as a primary plan (except for emergency services or authorized referrals paid or provided by the primary plan).

Note that if the Plan is the secondary plan for you, you will not be covered for expenses which would have been covered by your primary plan but for your failure to follow claims procedures or obtain required precertification. Also, the Plan will be secondary if you fail to obtain a second surgical opinion if the primary plan requires such an opinion. The Plan will not cover the difference between a private and a semi- private room (unless one plan covers a private room). Furthermore, the Plan will not cover amounts beyond those that are usual, customary and reasonable.

NOTE: If you are a person with multiple benefit coverage, when filing a claim with this Plan you must make full disclosure. If you fail to disclose “other plan” information, this may be considered a fraudulent claim with you being disqualified from receiving benefits from this Plan.

Which Plan Pays First For You and Your Spouse?

A plan that does not coordinate with other plans pays before a plan that does coordinate. In plans that do coordinate, the plan that covers you or your spouse as an employee rather than as a dependent always pays first.

If both you and your spouse are covered under this Plan and both are eligible for benefits, the one being billed for health care services should file the claim.

§ For example, John and Carol are both covered as employees under this Plan. Carol has eye surgery, so she submits the claim under her coverage. Additional payment, if applicable, will be based on John’s coverage, but total payments cannot be more than 100% of covered charges.

Newspaper Guild of New York – The New York Times Benefits Fund Page 113

COORDINATION OF BENEFITS (continued)

Which Plan Pays First For Your Children?

If both plans coordinate benefits and, if you and your spouse are legally married, there are two ways of determining order of payment for your dependent children covered under both plans.

The plan of the parent whose birthday falls earlier in the year pays first, regardless of the year in which each parent was born.

§ For example, Jane, a covered employee under this Plan, was born on February 6. Her husband, John, who is covered under another employer’s plan, was born on December 2. Since Jane was born earlier in the year, this Plan pays first when they submit a claim for a dependent child.

If both parents share the same birthday, then the plan covering the parent for the longest time pays first.

§ For example, Fred and Shirley were both born on April 25, but since Fred has been covered under his plan at work for five years, and Shirley has only been covered under her plan for two years, Fred’s plan pays first for their children’s claims.

However, when your spouse’s plan does not have to follow this “birthday rule,” then the order of payment for their children’s claims is father’s plan first and mother’s plan second.

If you and your spouse are legally separated or divorced, different rules govern order of payment of claims for your children.

First, a court decree may specify that one of you is primarily responsible for your children’s health care coverage in which case that person’s plan is primary if it has knowledge of the decree. If no such ruling exists, then the plan of the parent with custody of the child pays first; except when the parent with custody has remarried and the spouse of that parent also covers the child under a group plan, the order of payments by the respective plans is:

1. parent with custody; 2. spouse of parent with custody; 3. parent without custody.

If the cases above do not apply, the plan that has covered the child the longest pays first.

Coordination of Benefits Claim Filing Information

Whether this Plan is primary or secondary, the Fund Office needs all necessary information about other coverage completed on your claim form before payment will be made for any claim involving coordination of benefits.

If this Plan is primary, send the Fund Office your original itemized bills along with your completed claim form.

If this Plan is secondary, send your bills to your primary plan first. After you receive payment or a rejection statement of your claim from the primary plan, send the Fund Office a copy of your bills, the original payment or rejection statement (Explanation of Benefits (EOB)) from the primary plan, and your completed claim form.

Newspaper Guild of New York – The New York Times Benefits Fund Page 114

COORDINATION OF BENEFITS (continued)

How Does No-Fault Insurance Affect Coordination of Benefits?

If you or a dependent is injured in an automobile accident, send the claim first to your auto insurance carrier. Then submit a claim for any remaining amount to the Fund Office.

Benefits normally payable to treat injuries from an automobile accident will be reduced so that these benefits plus no-fault benefits are not more than l00% of the covered expenses for such injuries.

The Plan will treat all members as if they have medical coverage under their automobile insurance policy and will reject primary coverage on these claims. Payments made by the Fund for these claims will be coordinated with your automobile policy even if you have elected not to pay for this medical component.

Newspaper Guild of New York – The New York Times Benefits Fund Page 115

SUBROGATION – Reimbursement Agreement

Occasionally, a third party may be liable for your medical expenses. This may occur when a third party is responsible for causing your illness or injury or is otherwise responsible for your medical bills. The rules in this section govern how this Plan pays benefits in such situations.

These rules have two purposes. First, the rules ensure that your benefits will be paid promptly. Often, where there is a question of third party liability, many months pass before the third party actually pays. These rules permit this Plan to pay your covered expenses until your dispute with the third party is resolved.

Second, the rules protect this Plan from bearing the full expense in situations where a third party is liable. Under these rules, once it is determined that a third party is liable in any way for the injury or illness giving rise to these expenses, this Plan shall have a lien for and must be reimbursed for the relevant benefits it has advanced to you out of any recovery whatsoever that you receive that is in any way related to the event which caused you to incur the medical expenses.

Benefits payable by the Plan for the treatment of an illness or injury shall be limited in the following ways when the illness or injury is the result of an act or omission of another (including a legal entity) and when the member or dependent pursues or has the right to pursue a recovery for such act or omission.

The Plan shall pay benefits for covered expenses related to such illness and injury only to the extent not paid by the third party and only after the member or dependent (and his or her attorneys, if applicable) has entered into a written subrogation and reimbursement agreement with the Plan. Immediately upon paying or providing any benefit under this Plan, the Plan shall be subrogated to all rights of recovery a covered person has against any party potentially responsible for making any payment to a covered person due to a covered person’s injuries or illness, to the full extent of benefits provided or to be provided by the Plan.

Covered person includes, for the purposes of this provision, anyone on whose behalf the Plan pays or provides any benefit, including but not limited to the minor child or dependent of any member or person entitled to receive any benefits from the Plan. It is the duty of the covered person to notify the Fund (and/or group health insurance issuer in the case of the HMO benefit options) within 30 days of the date when any notice is given to any party, including an attorney, of the intention to pursue or investigate a claim to recover damages due to injuries sustained by the covered person. Any and all such funds recovered by the covered person shall remain traceable from the responsible party to the covered person and in the hands of the covered person. A covered person shall not dissipate any such funds received before reimbursing the Plan.

By accepting benefits related to such illness or injury, all covered persons (referred to as “you”) agree:

§ that the Plan has established a lien on any recovery received by you (or your dependent, legal representative or agent);

§ to notify any third party responsible for your illness or injury of the Plan’s right to reimbursement for any claims related to your illness or injury;

§ to hold any reimbursement or recovery received by you (or your dependent, legal representative or agent) in trust on behalf of the Plan to cover all benefits paid by the Plan with respect to such illness or injury and to reimburse the Plan promptly for the benefits paid, even if you are not fully compensated (“made whole”) for your loss;

§ that the Plan has the right of first reimbursement against any recovery or other proceeds of any claim against the other person (whether or not the member or dependent is made whole) and that the Plan’s claim has first priority over all other claims and rights;

Newspaper Guild of New York – The New York Times Benefits Fund Page 116

SUBROGATION – Reimbursement Agreement (continued)

§ to reimburse the Plan in full up to the total amount of all benefits paid or to be paid by the Plan in connection with the illness or injury from any recovery received from a third party, regardless of whether the recovery is specifically identified as a reimbursement of medical expenses, paid and suffering, non-economic damage or otherwise and regardless of whether there is any admission of fault. All recoveries from a third party, whether by lawsuit, settlement, insurance or otherwise, must be turned over to the Plan as reimbursement up to the full amount of the benefits paid;

§ that the Plan’s claim is not subject to reduction for attorneys’ fees or costs under the “common fund” doctrine or otherwise;

§ that, in the event that you elect not to pursue your claim(s) against a third party, the Plan shall be equitably subrogated to your right of recovery and may pursue your claims;

§ to assign, upon the Plan’s request, any right or cause of action to the Plan;

§ not to take or omit to take any action to prejudice the Plan’s ability to recover the benefits paid and to cooperate in doing what is reasonably necessary to assist the Plan in obtaining reimbursement;

§ to cooperate in doing what is necessary to assist the Plan in recovering the benefits paid or in pursuing any recovery;

§ to forward any recovery to the Plan within ten days of disbursement by the third party or to notify the Fund as to why you are unable to do so; and

§ to the entry of judgment against you and, if applicable, your dependent, in any court for the amount of benefits paid on your behalf with respect to the illness or injury to the extent of any recovery or proceeds that were not turned over as required and for the cost of collection, including but not limited to the Plan’s attorneys’ fees and costs.

No benefits will be payable for charges and expenses which are excluded from coverage under any other provision of the Plan. The Plan may enforce its right to reimbursement by filing a lawsuit, recouping the amount owed from a member’s or a covered dependent’s future benefit payments (regardless of whether benefits have been assigned by a member or covered dependent to the doctor, hospital or other provider), or any other remedy available to the Plan.

The Plan may permit you to turn over less than the full amount of benefits paid and recovered as it determines in its sole discretion. Any reduction of the Plan’s claim is subject to prior written approval by the Plan.

§ For example: A member is injured in an accident in a grocery store and the accident was the store’s fault. If the Plan paid $1,000 in benefits to the member due to injuries resulting from the accident and the member was entitled to recover or did recover, due to a legal suit or settlement, any money from the store, the Plan would be entitled to receive up to $1,000 of such money as reimbursement for the benefits which it provided.

Newspaper Guild of New York – The New York Times Benefits Fund Page 117

CLAIMS REVIEW AND APPEAL PROCEDURES

This section applies to the PPO Benefit Plan and Additional Benefits (provided by this Plan). If you are covered by an insured plan (underwritten by Cigna, Empire BlueCross and BlueShield, Emblem Health or United Healthcare), please refer to the information provided by your insurance company for their claims review and appeal procedures.

Filing of Claims

All claims for benefits must be submitted on the claim forms made available by the Fund Office or on standardized claim forms provided by providers. Claims submitted must be accompanied by any information or proof requested as reasonably required to process such claims for benefits.

For purposes of this provision, the terms “you” and “your” refer to all employees and their eligible dependents.

INITIAL DECISIONS

1. Content of Notification of Initial Adverse Benefit Determination

If an initial notification of adverse benefit determination is needed, the notification shall set forth:

a. The specific reasons for the adverse determination;

b. Reference to the specific Plan provisions (including any internal rules, guidelines, protocols, criteria, etc.) on which the determination is based;

c. A description of any additional material or information necessary for you to complete the claim and an explanation of why such material or information is necessary;

d. A description of this Plan’s review procedures and the time limits applicable to such procedures, including a statement of your right to bring a civil action under Section 502 (a) of ERISA following an adverse benefit determination on review;

e. In the case of an adverse determination involving the claim for urgent care, a description of the expedited review process applicable to such claims;

f. If an internal rule, guideline, protocol, or other similar criterion was relied upon in making the adverse benefit determination, the notice will provide either the specific rule, protocol, or other similar criterion that was relied upon in making the adverse benefit determination or a statement that a copy of such rule, guideline, protocol, or other criterion will be provided free of charge upon request; and

g. If the adverse benefit determination is based on medical necessity or experimental treatment, either an explanation of the scientific judgment for the determination, applying this Plan’s terms to your medical circumstances, or a statement that such an explanation will be provided free of charge upon request.

Newspaper Guild of New York – The New York Times Benefits Fund Page 118

CLAIMS REVIEW AND APPEAL PROCEDURES (continued)

2. Time Frames

a. Medical Benefits (including Optical and Dental Benefits)

§ Medical Benefits Not Requiring Pre-Certification: You will be notified of any adverse benefit determination within a reasonable period, but not later than 30 days after receipt of the claim.

The 30-day period may be extended for up to 15 days after receipt of the claim by this Plan. The 15-day period may be extended for up to 15 days for matters beyond this Plan’s control if, before the end of the initial 30-day period, this Plan notifies you of the reasons for the extension and of the date by which this Plan expects to render a decision.

If the extension is needed because you did not submit the information necessary to decide the claim, the notice of extension will describe the required information and give you at least 45 days from receipt of the notice to provide it. This Plan then has 15 days to make a decision.

§ Medical Benefits Requiring Pre-Certification: You will be notified of this Plan’s benefit determination (whether adverse or not) within a reasonable period, but not later than 15 days after receipt of the claim by this Plan.

The 15-day period may be extended for up to 15 days for matters beyond this Plan’s control if, before the end of the initial 15-day period, you are notified of the reasons for the extension and of the date by which this Plan expects to render a decision.

If the extension is needed because you did not submit the information necessary to decide the claim, the notice of extension will describe the required information and give you at least 45 days from receipt of the notice to provide it. If the claim is improperly filed, this Plan will provide notice of the failure within 5 days.

§ Medical Benefit Claims Requiring Pre-Certification that Involve Urgent Care: An urgent care claim is a claim for treatment in which application for making non-urgent care determinations could seriously jeopardize the life or health of the claimant or the ability of the claimant to regain maximum function, or, in the opinion of a physician knowledge of the claimant’s medical condition, would subject the claimant to severe pain that cannot be adequately managed without the care or treatment that is the subject of the claim.

For urgent care predetermination claims, you will be notified by this Plan regarding the benefit determination (whether adverse or not) as soon as possible, but not later than 72 hours after receipt, unless you fail to provide sufficient information to decide the claim.

In the case of a failure to provide sufficient information or to follow filing procedures, you will be notified of the failure as soon as possible, but not later than 24 hours after receipt of the claim, of the specific information needed to complete the claim.

Notification of the decision on that claim will then be provided within 48 hours after the earlier of this Plan’s receipt of the specified information or the end of the additional period afforded you to provide such information. Notification can be made orally if a written or electronic communication is provided with 3 days of the oral notification.

Newspaper Guild of New York – The New York Times Benefits Fund Page 119

CLAIMS REVIEW AND APPEAL PROCEDURES (continued)

With regard to predetermination claims, if this Plan has approved an ongoing course of treatment to be provided over a period of time or number of treatments, any reduction or termination by this Plan of such course of treatment is an adverse benefit determination. You will receive notice of such an adverse determination sufficiently in advance of the reduction or termination to allow you to appeal and obtain a determination on review before the reduction or termination occurs.

Also, for any request to extend an urgent care ongoing course of treatment beyond the initially- prescribed period of time, you will be notified of the determination (whether adverse or not) within 24 hours after receipt of the claim, if the claim is made at least 24 hours before the end of the initially-prescribed period of time or number of treatments.

b. Employee Life Insurance

If your claim for employee life insurance benefits is denied in whole or in part for any reason, then within 90 days after the insurance company receives your claim, the insurance company will send you written notice of its decision, unless special circumstances require an extension, in which case the insurance company will send you written notice of the decision no later than 180 days after the insurance company receives your claim.

If an extension is necessary, you will be given written notice of the circumstances requiring the extension of time and the date by which the insurance company expects to render the benefit determination.

Newspaper Guild of New York – The New York Times Benefits Fund Page 120

The initial decision timeframes required for claims decisions are listed in the following tables:

MEDICAL CLAIMS DEADLINES*

Medical Claims Requiring Medical Claims Requiring Medical Claims Pre-Certification for Pre-Certification Not Requiring Urgent Care Pre-Certification

You must be notified of initial decision within? 72 hours 15 days 30 days from receipt of claim from receipt of claim from receipt of claim

Are there any No Yes, Yes, extensions? one 15-day extension. one 15-day extension. You will be informed of the You will be informed of the extension within the normal extension within the normal deadline. deadline.

What is the deadline if This Plan will notify you If extension is necessary If extension is necessary additional information of need for additional because you failed to because you failed to is needed? information provide necessary provide necessary within 24 hours of information, the notice of information, the notice of receipt of the claim. extension will specify the extension will specify the information needed. information needed.

You will be given at least You will be given at least You will be given at least 48 hours to respond. The 45 days to respond. The 45 days to respond. The normal deadline is normal deadline is normal deadline is suspended for 48 hours or suspended until the end of suspended until the end of until information is this period or until this period or until received. information is received. information is received. This Plan then has 15 days This Plan then has 15 days to make a decision. to make a decision.

OTHER CLAIMS DEADLINES*

You will be notified of initial decision within? 90 days from receipt of claim

Are there any extensions? Yes, one 90-day extension

* The term “days” in the above tables refers to calendar days.

Newspaper Guild of New York – The New York Times Benefits Fund Page 121

CLAIMS REVIEW AND APPEAL PROCEDURES (continued)

APPEALS OF ADVERSE BENEFIT DETERMINATIONS

If you are not satisfied with the reason or reasons why your claim was denied, then you may appeal to the Board of Trustees.

1. Time Frames

§ Medical Claims To appeal an adverse benefit determination of any benefit claim, you must write to the Trustees within 180 days after you receive this Plan’s initial determination.

§ Employee Life Insurance Claims To appeal an adverse benefit determination of any benefit claim, you must write to the insurance company within 60 days (180 days in case of any claim for disability) after you receive this insurance company’s initial determination.

For appeals to the Board of Trustees, your correspondence (or your representative’s correspondence) must include the following statement: “I AM WRITING IN ORDER TO APPEAL YOUR DECISION TO DENY ME BENEFITS. YOUR ADVERSE BENEFIT DETERMINATION WAS DATED ______, 20____.” If this statement is not included, then the Trustees may not understand that you are making an appeal, as opposed to a general inquiry.

If you have chosen someone to represent you in making your appeal, then your letter (or your representative’s letter) must state that you have authorized him or her to represent you with respect to your appeal, and you must sign such statement. Otherwise, the Trustees may not be sure that you have actually authorized someone to represent you, and the Trustees do not want to communicate about your situation to someone unless they are sure he or she is your chosen representative.

In an appeal from an adverse health insurance benefit expense pre-certification involving urgent care, a health care professional with knowledge of your medical condition shall be permitted to act as your authorized representative.

You shall have the opportunity to submit written documents, records, and other information related to the claim for benefits. You shall also be provided, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to your claim for benefits. The review will take into account all comments, documents, records, and other information submitted by the claimant relating to the claim, without regard to whether such information was submitted or considered in the initial benefit determination.

In addition, in regard to all appeals other than those involving employee life insurance benefits: (1) the review will not afford deference to the initial adverse benefit determination and will be conducted by an appropriate named fiduciary of this Plan who is neither the individual who made the adverse benefit determination nor the subordinate of such individual; (2) insofar as the adverse benefit determination is based on medical judgment, the Board will consult with a health care professional who has appropriate training and experience in the field of medicine involved in the medical judgment; (3) such health care professional shall not be the individual, if any, who was consulted in connection with the adverse benefit determination that is the subject of the appeal, nor the subordinate of such individual; and (4) medical or vocational experts whose advice was obtained on behalf of this Plan, without regard to whether the advice was relied upon in making the adverse benefit determination, will be identified.

Newspaper Guild of New York – The New York Times Benefits Fund Page 122

CLAIMS REVIEW AND APPEAL PROCEDURES (continued)

Special Rule Regarding Urgent Care Claims: For urgent care claims, you may request an expedited appeal, either orally or in writing, and all necessary information, including this Plan’s benefit determination on review, shall be transmitted between you and this Plan by telephone, facsimile, or other similarly expeditious method.

DETERMINATIONS ON APPEAL

1. Time Frames

§ Medical Benefit Claims Requiring Pre-certification: You will be notified of the decision within a reasonable period of time appropriate to the medical circumstances, but not later than 30 days after receipt of the request for review.

§ Medical Benefit Claims Requiring Pre-certification Involving Urgent Care: Appeals of adverse determinations must be decided and communicated to you as soon as possible, taking into account medical exigencies, but not later than 72 hours after receipt of the request for review.

§ Employee Life Insurance: The insurance company has 60 days (45 days, in the case of any disability benefit) from the date it receives a request to review the claim and provide its decision. Under special circumstances the insurance company may require more time to review the claim. If this should happen, the insurance company must provide notice, in writing, that its review period has been extended for an additional 60 days (45 days in the case of any disability benefit). Once its review is complete, the insurance company must state, in writing, the results of the review and indicate the Plan provisions upon which it based its decision.

§ All Other Claims: The Trustees at their next quarterly Trustees meeting will make a determination of the appeal. However, if the appeal is received less than 30 days before the meeting, the decision may be made at the second meeting following receipt of the request. If special circumstances require an extension of time for processing, then a decision may be made at the third meeting following the date the appeal is made. Before an extension of time commences, you will receive written notice of the extension, describing the special circumstances requiring the extension and the date by which the determination will be made. This Plan will notify you of the benefit determination not later than 5 days after the determination is made.

Newspaper Guild of New York – The New York Times Benefits Fund Page 123

CLAIMS REVIEW AND APPEAL PROCEDURES (continued)

CONTENT OF ADVERSE BENEFIT DETERMINATION ON REVIEW

This Plan’s written notice of the Board’s decision will include the following:

1. The specific reasons for the adverse benefit determination;

2. Reference to specific Plan provisions on which the determination is based;

3. A statement that the claimant is entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to your claim for benefits;

4. A statement describing any voluntary appeal procedures offered by this Plan and a statement of your right to bring a civil action under Section 502(a) of the Employee Retirement Income Security Act (ERISA);

5. If an internal rule, guideline, protocol, or other similar criterion was relied upon in making the adverse benefit determination, the notice will provide either the specific rule, protocol, or other similar criterion that was relied upon in making the adverse benefit determination or a statement that a copy of such rule, guideline, protocol, or other criterion will be provided free of charge upon request; and

6. If the adverse benefit determination is based on medical necessity or experimental treatment, the written notice shall contain an explanation of the scientific or clinical judgment for the determination, applying the terms of this Plan to the claimant’s medical circumstances, or a statement that such explanation will be provided upon request.

Newspaper Guild of New York – The New York Times Benefits Fund Page 124

The appeals decision time frames required for claims decisions are listed in the following tables:

MEDICAL CLAIMS APPEALS TIME FRAMES*

Pre-Certification Medical Claims Medical Claims Concurrent Claims for Urgent Care Requiring Not Requiring Claims Pre-Certification Pre-Certification

How long do you At least 180 days At least 180 days At least 180 days You will be given the have to appeal? following receipt of following receipt of following receipt of a opportunity to appeal the a notification of a notification of notification of concurrent review adverse benefit adverse benefit adverse benefit decision sufficiently in determination determination determination advance to allow an appeal and determination on the appeal before termination of the benefit.

Are there any No No No No extensions?

You must be 72 hours 30 days At the next regularly Prior to termination of the notified of the from receipt of the from receipt of the scheduled Trustee benefit decision within? appeal appeal meeting. If appeal is received less than 30 days prior to the meeting, the appeal can be reviewed at the following meeting.

You will be notified within 5 days of the decision on the appeal.

* The term “days” in the above table refers to calendar days.

Newspaper Guild of New York – The New York Times Benefits Fund Page 125

The appeals decision time frames required for claims decisions are listed in the following tables:

OTHER CLAIMS DEADLINES*

How long do you have to appeal? At least 60 days following receipt of a notification of adverse benefit determination

Are there any extensions? Yes, one 60-day extension

You will be notified of initial decision within? 60 days from receipt of the appeal

* The term “days” in the above tables refers to calendar days.

The Trustees’ Decision is Final and Binding

The Trustees’ (or their designee’s) final decision with respect to their review of any appeal will be final and binding upon you because the Trustees have exclusive authority and discretion to determine all questions of eligibility and entitlement under this Plan.

Limitation on Lawsuits

This means that you may not bring any legal or equitable action for benefits under the Plan, to enforce your rights under the Plan, or to clarify your right to future benefits under the Plan unless and until you have followed and exhausted the claims and appeal procedures that are described above and the benefits you requested have been denied in whole or in part, or there is any other adverse benefit determination.

In addition, no legal or equitable action for benefits under the Plan, to enforce your rights under the Plan, to clarify your right to future benefits under the Plan, or against the Plan, the Trustees, the Administrator or any other Plan fiduciary or representative may be brought more than 180 days following the earlier of: (i) the date that the statute of limitations period would commence under applicable law, (ii) the date upon which you knew or should have known that you did not receive an amount due under the Plan, or (iii) the date on which you fully exhausted the Plan’s administrative remedies.

Newspaper Guild of New York – The New York Times Benefits Fund Page 126

CLAIMS REVIEW AND APPEAL PROCEDURES (continued)

How to File an Appeal with the Board of Trustees

You may file an appeal with the Board of Trustees at the following address:

Board of Trustees Newspaper Guild of New York – The New York Times Benefits Fund 1501 Broadway, Suite 1724 New York, NY 10036

Delayed Benefits

If benefit payments are delayed for any reason whatsoever, please be advised that you will not be entitled to interest on these payments as a result of the delay.

Newspaper Guild of New York – The New York Times Benefits Fund Page 127

Section VI

ERISA Requirements and Plan Facts

Newspaper Guild of New York – The New York Times Benefits Fund Page 128

QUALIFIED MEDICAL CHILD SUPPORT ORDERS (QMCSO)

Generally you may not assign your benefits to which you are entitled to any other person, creditor, or other third party. However, federal law requires group health plans to honor Qualified Medical Child Support Orders (“QMCSOs”). In general, QMCSOs are orders issued by a state court or state administrative agency requiring that medical coverage be provided under a plan for a child or children.

A QMCSO may require the Fund to make coverage available to your child even though, for income tax or Fund purposes, the child is not your dependent due to divorce or legal separation. In order to qualify as a QMCSO, the medical child support order must be a judgment, decree or order (including approval of a settlement agreement) issued by a court of competent jurisdiction or by an administrative agency, which does the following:

§ specifies your name and last known address, and the child’s name and last known address; § provides a reasonable description of the type of coverage to be provided by the Fund, or the manner in which the type of coverage is to be determined; § states the period to which it applies; and § specifies each Plan to which it applies.

The QMCSO may not require the Fund to provide coverage for any type or form of benefit, or any option, not otherwise provided under the terms of the Plan.

Upon approval of a QMCSO, the Fund is required to pay benefits directly to the child, or to the child’s custodial parent or legal guardian, pursuant to the terms of the order to the extent it is consistent with the terms of the Plan.

You and the affected child will be notified if an order is received and will be provided with a copy of the Fund’s QMCSO procedures. A child covered under the Fund pursuant to a QMCSO will be treated as an eligible dependent under the Fund.

If you have any questions about this process, or if you would like a free copy of the procedures, please contact the Fund Office.

Newspaper Guild of New York – The New York Times Benefits Fund Page 129

SPECIAL RIGHTS FOR MOTHERS AND NEWBORN CHILDREN

For the mother or newborn child, the Plan will not restrict benefits for any hospital length of stay in connection with childbirth to less than 48 hours following a vaginal delivery, or 96 hours following a Cesarean section. However, the mother’s or newborn’s attending provider, after consulting with the mother, may discharge the mother or her newborn earlier than 48 hours (or 96 hours, as applicable) after the delivery. In any case, no authorization is required from the Plan or an insurance company for a length of stay that does not exceed 48 hours (or 96 hours).

Newspaper Guild of New York – The New York Times Benefits Fund Page 130

WOMEN’S HEALTH AND CANCER RIGHTS ACT

The Plan will provide certain coverage for benefits received in connection with a mastectomy, including reconstructive surgery following a mastectomy. This benefit applies to any covered employee or dependent, including you, your spouse, and your children.

If the covered person receives benefits under the Plan in connection with a mastectomy and elects breast reconstruction, the coverage will be provided in a manner determined in consultation with the attending physician and the covered person. Coverage may apply to:

§ Reconstruction of the breast on which the mastectomy was performed; § Surgery and reconstruction of the other breast to produce a symmetrical appearance; § Prostheses; and § Treatment of physical complications at all stages of the mastectomy, including lymphedemas.

Benefits for breast reconstruction are subject to annual Plan deductibles and coinsurance provisions that apply to other medical and surgical benefits covered under the Plan.

Newspaper Guild of New York – The New York Times Benefits Fund Page 131

GRANDFATHERED PLAN STATUS STATEMENT

The Board of Trustees believes that the Plan’s PPO Plan and the Empire Health Maintenance Organization (“HMO”) are “Grandfathered Health Plans” under the Patient Protection and Affordable Care Act of 2010 (the “Affordable Care Act”). The HIP (EmblemHealth) HMO and United Healthcare Oxford EPO are “Non-Grandfathered Health Plans”.

As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that your medical plan may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections under the Affordable Care Act, for example, the elimination of lifetime limits on benefits.

Questions regarding which protections apply and which protections do not apply to a Grandfathered Health Plan and what might cause a plan to change from grandfathered health plan status can be directed to the Fund Office at (646) 237-1670. You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at (866) 444-3272 or www.dol.gov/ebsa/healthreform. This website has a table summarizing which protections do and do not apply to grandfathered health plans.

Newspaper Guild of New York – The New York Times Benefits Fund Page 132

PRIMARY CARE PROVIDER (PCP) DESIGNATIONS AND ACCESS TO OB/GYN CARE

The HIP (EmblemHealth) HMO and United Healthcare Oxford EPO provided under this plan generally require the designation of a primary care provider (PCP). With respect to those options (and any other option that is not grandfathered under the Affordable Care Act and requires you or your dependents to designate a PCP), you have the right to designate any participating primary care provider who is available to accept you or your family members (for children, you may designate a pediatrician as a primary provider). Until you make this decision, the Oxford EPO will designate one for you (the HIP HMO will not). For information on how to select a primary care provider and for a list of participating primary care providers, please contact your HMO.

You do not need prior authorization from the HMO, EPO, or any other person, including your primary care provider, in order to obtain access to obstetrical and gynecological care from a health care professional; however, you may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a preapproved treatment plan, or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, please contact your HMO or EPO.

Newspaper Guild of New York – The New York Times Benefits Fund Page 133

HIPAA PRIVACY PRACTICES FOR PERSONAL HEALTH INFORMATION (PHI)

This notice describes how medical information about you may be used and disclosed and how you can get access to this information.

PLEASE REVIEW IT CAREFULLY.

Introduction

During the course of providing you with the health coverage, the Fund will have access to information about you that has been deemed to be “protected health information” by the Health Insurance Portability and Accountability Act of 1996, commonly known as “HIPAA”. This Notice describes the medical information privacy practices of the Fund, and explains the Fund’s obligations and your rights regarding the use and disclosure of your protected health information. From time to time the Fund contracts with individuals or companies to perform various functions on your behalf. HIPAA refers to these persons as “business associates,” and this Notice also applies to the Fund’s business associates. Your personal physician or health care provider, and also HMOs and health insurers, may have different policies or notices regarding their use and disclosure of your protected health information.

If you have any questions about this Notice, please contact the Fund’s Privacy Official at (646) 237-1672.

Our Pledge Regarding Health Information

The Fund understands that medical information about you and your health is personal information. The Fund is committed to protecting your personal information. Under HIPAA, your protected health information (“Health Information”) includes any individually identifiable information (including your name, address, date of birth, employee ID number, and Social Security number) that is linked to your past, present or future physical or mental health, the health care that you have received or payment for your health care. This Notice covers any such Health Information that is maintained by or on behalf of the Fund.

The Fund is required by law to:

§ Make sure that your Health Information is kept private;

§ Provide you with this Notice of the Fund’s legal duties and privacy practices with respect to your Health Information;

§ Notify affected individuals following a breach of unsecured Health Information; and

§ Follow the terms of this Notice (as currently in effect or subsequently amended).

Newspaper Guild of New York – The New York Times Benefits Fund Page 134

HIPAA PRIVACY PRACTICES FOR PERSONAL HEALTH INFORMATION (PHI)

How the Fund May Use and Disclose Your Health Information

1. Uses and Disclosures for Treatment, Payment and Health Care Operations

The Fund may use or disclose your Health Information in connection with your receiving treatment from a health care provider, the Fund’s payment for such treatment and for Fund health care operations.

§ For Treatment: Although the Plan does not provide treatment, the Fund may use or share your Health Information to support the provision, coordination or management of your health care treatment. For example, the Fund or its business associate may disclose the name of your treating physician to a treating orthopedist so that the orthopedist can obtain your x-rays from your physician.

§ For Payment: The Fund may use or disclose Health Information for the Fund’s payment activities or those payment activities of another health plan or provider. “Payment” includes all activities in connection with processing claims for your health care (including billing, claims management, eligibility, coordination of benefits, adjudication of claims, subrogation, reviews for medical necessity and appropriateness of care and utilization review and pre-authorizations). For example, the Fund may disclose your Health Information to your health care provider to determine whether a particular surgery is medically necessary, or to determine whether the Fund will cover that surgery.

§ For Health Care Operations: The Fund may use or disclose your Health Information as part of the general administrative or business functions of the Fund that the Fund must perform in order to function as a health plan, and for certain health care operations of other health plans or providers. Additionally, the Fund may use your Health Information in connection with conducting quality assessment and improvement activities and other activities relating to Fund coverage, submitting claims for stop-loss (or excess loss) coverage, conducting or arranging for medical review, legal services, or audit services. For example, the Fund may need to review your Health Information as a part of the Fund’s efforts to uncover instances of health care provider abuse and fraud.

§ Business Associates: In any circumstance where the Fund discloses Health Information to a business associate to also protect the privacy of your Health Information.

2. Disclosures to the Fund Sponsor and to Your Representatives

§ Disclosure to the Fund Sponsor: The Fund may disclose your Health Information to the Fund’s Board of Trustees, which serves as the plan sponsor for the Fund, for purposes related to payment of benefits, Fund operations, and other matters pertaining to Fund administration that involve the Board of Trustees, for example in connection with appeals that you file following a denial of a benefit claim. This includes that the Trustees may receive your Health Information if necessary for them to fulfill their fiduciary duties with respect to the Fund. When disclosing Health Information to the Board of Trustees, the Fund will make reasonable efforts not to disclose more than the minimum necessary amount of Health Information to achieve the particular purpose of the disclosure. In accordance with the Plan documents, the Board of Trustees has agreed that unless it has your written permission, it will not use or disclose your Health Information:

Newspaper Guild of New York – The New York Times Benefits Fund Page 135

HIPAA PRIVACY PRACTICES FOR PERSONAL HEALTH INFORMATION (PHI)

(1) other than as permitted in this Notice or as required by law, (2) with respect to any employment- related actions or decisions, or (3) with respect to any benefit plan sponsored by or maintained by the Board of Trustees.

In addition, the Fund may disclose “summary health information” to the Board of Trustees for obtaining premium bids or modifying, amending or terminating the benefits provided under the Fund. Summary health information summarizes the claims history, claims expenses or type of claims experienced by individuals for whom a plan sponsor (such as the Board of Trustees) has provided health benefits under a group health plan. Identifying information will be deleted from summary health information, in accordance with federal privacy rules.

§ Disclosure to Your Personal Representatives: The Fund may disclose your Health Information with your personal representative in accordance with applicable state law and HIPAA (e.g., to parents if you are an unemancipated child under 18, to those people with unlimited powers of attorney, etc.) In addition, you may authorize a personal representative to receive your Health Information and act on your behalf. Contact the Privacy Official to obtain a copy of the appropriate form to authorize the people who may receive this information.

§ Individuals Involved in Your Care or Payment for Your Care: Unless you object in writing, the Fund may disclose Health Information to a close friend or family member involved in or who helps pay for your health care, but only to the extent relevant to that friend or family member’s involvement in your care or payment for your care. For example, if a family member or a caregiver calls the Fund with prior knowledge of a claim, the Fund may confirm whether or not the claim has been received and paid. The Fund may also disclose your Health Information to any authorized public or private entities assisting in disaster relief efforts.

3. Other Permitted Uses and Disclosures of Your Health Information

§ Required by Law: The Fund may use or disclose your Health Information to the extent that the Fund is required to do so by applicable law. You will be notified, if required by law, of any such uses or disclosures.

§ Public Health: The Fund may disclose your Health Information for public health and safety purposes to a public health authority that is permitted by law to collect or receive the information. Your Health Information may be used or disclosed for the purpose of preventing or controlling disease (including communicable disease), injury or disability. If directed by the public health authority, the Fund may also disclose your Health Information to a foreign government agency that is collaborating with the public health authority.

§ Health Oversight: The Fund may disclose your Health Information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections and legal actions. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.

§ Abuse or Neglect: The Fund may disclose your Health Information to any public health authority authorized by law to receive information about abuse, neglect or domestic violence if the Fund reasonably believes that you have been a victim of abuse, neglect or domestic violence. In this case, the Fund will inform you that such a disclosure, however, would only be to someone reasonably able to help prevent or lessen the threat.

Newspaper Guild of New York – The New York Times Benefits Fund Page 136

HIPAA PRIVACY PRACTICES FOR PERSONAL HEALTH INFORMATION (PHI)

§ To Avert a Serious Threat to Health or Safety: The Fund may use or disclose your Health Information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone reasonably able to help prevent or lessen the threat.

§ Legal Proceedings: The Fund may disclose your Health Information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal. In addition, the Fund may disclose your Health Information under certain conditions in response to a subpoena, court-ordered discover request or other lawful process, in which case reasonable efforts must be undertaken by the party seeking the Health Information to notify you and give you an opportunity to object to the disclosure.

§ Law Enforcement: The Fund may disclose your Health Information if requested by law enforcement official as part of certain law enforcement activities.

§ Coroners, Funeral Directors, and Organ Donation: The Fund may disclose your Health Information to a coroner or medical examiner for identification purposes, or other duties authorized by law. The Fund may also disclose your Health Information to a funeral director, as authorized by law, in order to permit the funeral director to carry out his/her duties. The Fund may also disclose such information in reasonable anticipation of death. The Fund may also disclose Health Information for cadaveric organ, eye or tissue donation purposes.

§ Research: The Fund is permitted to disclose your Health Information to researchers when their research has been approved by an institutional review board or privacy board that has established protocols to ensure the privacy of your Health Information.

§ Military Activity and National Security: When the appropriate conditions apply, the Plan may use or share Personal Health Information of individuals who are Armed Forces personnel: (1) for activities deemed necessary by military command authorities; or (2) to a foreign military authority if you are a member of that foreign military service. The Plan may also share your Personal Health Information with authorized federal officials conducting national security and intelligence activities.

§ Workers’ Compensation: The Fund may disclose your Health Information to comply with workers’ compensation laws and other similar legally established programs.

§ Inmates: If you are inmate of a correctional institution or under the custody of a law enforcement official, the Fund may disclose your Health Information to the institution or official if the Health Information is necessary for the institution to provide you with health care; to protect you with health care; to protect the health and safety of you or others; or for the security of the correctional institution.

§ Required Uses and Disclosures: The Fund must make disclosures of Health Information to the Secretary of the U.S. Department of Health and Human Services (“HHS”) to investigate or determine the Fund’s compliance with the federal regulations regarding privacy.

Newspaper Guild of New York – The New York Times Benefits Fund Page 137

HIPAA PRIVACY PRACTICES FOR PERSONAL HEALTH INFORMATION (PHI)

Uses and Disclosures of Your Health Information that Require Your Written Authorization

The Fund will not use or disclose your Health Information for the following purposes without your prior written authorization:

§ Psychotherapy Notes: Except for certain narrow exceptions permitted by law (such as legal defense in a proceeding you bring against the Fund), the Fund will not use or disclose any mental health professional’s psychotherapy notes (discrete notes that document the contents of conversations during counseling sessions) without your prior written authorization.

§ Marketing or Sales: Unless you give the Fund your prior written authorization, the Fund will not use or disclose your Health Information for any paid marketing activities or sell your Health Information.

§ Other Uses and Disclosures of Health Information: Other uses and disclosures of your Health Information not described in this Notice will only be made with your prior written authorization. For example, a written authorization from you would be necessary to disclose your Health Information to a disability insurance company for purposes of obtaining disability benefits, or to a law firm in connection with litigation, unless otherwise permitted or required as outlined above. If you provide the Fund with written authorization to use or disclose your Health Information for purposes other than those set forth in this Notice, you may revoke that authorization in writing at any time. If you revoke your authorization, the Fund will no longer use or disclose your Health Information for the reasons covered by your written authorization. However, you understand that the Fund is unable to take back any disclosures the Fund has already made with your authorization, and that the Fund is required to retain records of the services the Fund provided to you.

No Use or Disclosure of Genetic Information for Underwriting

The Fund is prohibited by law from using or disclosing Health Information that is genetic information of an individual for underwriting purposes. Generally, genetic information involves information about differences in a person’s DNA that could increase or decrease his or her change of getting a disease (for example, diabetes, heart disease, cancer or Alzheimer’s disease).

Additional Special Protections

Additional special privacy protections, under federal or state law, may apply to certain sensitive information, such as genetic information, HIV-related information, alcohol and substance abuse treatment information, and mental health information. If you have questions, please contact the Privacy Official at (646) 237-1672.

Newspaper Guild of New York – The New York Times Benefits Fund Page 138

HIPAA PRIVACY PRACTICES FOR PERSONAL HEALTH INFORMATION (PHI)

Your Rights with Respect to Your Health Information

You have the following rights regarding the Health Information that the Fund maintains:

§ Right to Request a Restriction on the Use and Disclosure of Your Health Information: You may ask the Fund to restrict the uses and disclosures of your Health Information to carry out treatment, payment of health care operations. You may also request that the Fund restrict uses and disclosures of your Health Information to family members, relatives, friends, or other persons identified by you who are involved in your care. However, the Fund is not required to agree to a restriction that you request. If the Fund does agree to the request, the Fund will not use or disclose your Health Information in violation of that restriction unless it is needed to provide emergency treatment or the Fund terminates the restriction with or without your agreement. If you do not agree to the termination, the restriction will continue to apply to Health Information created or received prior to the Fund’s notice to you of the Fund’s termination of the restriction. To request a restriction, you must write to the Privacy Official at the address below indicating (1.) what information you want to restrict; (2.) whether you want to restrict use, disclosure, or both, and (3.) to whom you want the restriction to apply.

§ Right to Request to Receive Confidential Communications by Alternative Means or at an Alternative Location: The Fund will accommodate your reasonable request to receive communications of Health Information from the Fund by alternative means or at alternative locations if the request includes a statement that disclosure using the Fund’s regular communications procedures could endanger you. Please direct your written request to the Privacy Official at the address below.

§ Right to Inspect and Copy: As long as the Fund maintains it, you may inspect and obtain a copy of your Health Information that is contained in a “designated record set” – which are records used in making enrollment, payment, claims adjudication, medical management, and other decisions. To request access to inspect and/or obtain a copy of any of your Health Information, you must submit your request in writing to the Privacy Official at the address below indicating the specific information requested, and you may also direct the Fund to transmit the copy of Health Information directly to another person that you designate in writing. If you request a copy of Health Information, please indicate in which form you want to receive it (i.e. paper or electronic). The Fund may impose a fee to cover the cost of producing, copying, and mailing the requested Health Information. The Fund may deny your request inspect and copy your Health Information in certain limited circumstances. For example, under federal law, you may not inspect or copy psychotherapy notes or information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding. If access is denied, you or your personal representative will be provided with a written denial setting forth the basis for the denial, a description of how you may exercise your review rights and a description of how you may complain to the Fund and to the U.S. Department of Health & Human Services (HHS).

§ Right to Amend Your Health Information: If you believe that Health Information that the Fund has about you is incorrect or incomplete, you may request that it be amended. Your request must be made in writing and submitted to the Privacy Official. In addition, you must provide a reason that supports your request. The Fund may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, the Fund may deny your request if you ask the Fund to amend information that did not originate with the Fund (unless the person or entity that originated the Health Information is no longer available to make the amendment), is not contained in the records maintained by the Fund, is not part of the information that you would legally be permitted to inspect and copy, or is accurate and complete.

Newspaper Guild of New York – The New York Times Benefits Fund Page 139

HIPAA PRIVACY PRACTICES FOR PERSONAL HEALTH INFORMATION (PHI)

§ Right to an Accounting of Disclosures: You have the right to request an accounting (i.e. a list) of certain non-routine disclosures of your Health Information. In general, the list will not include disclosures that were made: in connection with your receiving treatment, payment for such treatment and for certain health care operations; to you regarding your own Health Information; pursuant to your written authorization; to a person involved in your care or for other permitted notification purposes; for national security or intelligence purposes; or to correctional institutions or law enforcement officials. To request a list of disclosures, contact the Privacy Official at the address below. You have the right to receive an accounting of disclosures of Health Information made within six years (or less) of the date on which the accounting is requested. Your request should indicate the form in which you want the list (e.g. paper or electronic). The first accounting you request within a 12-month period will be free of charge. For additional requests within a 12-month period, the Fund will charge you for the costs of providing the accounting. The Fund will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any cost is incurred.

§ Right to Obtain a Paper Copy of this Notice: You may request a paper copy of this Privacy Notice, at any time, even if you have previously agreed to accept the Notice electronically. Requests should be made to the Privacy Official at the address below.

Complaints

If you believe that your privacy rights have been violated, you may file a written complaint with the Fund at the address below or with the Secretary of the U.S. Department of Health and Human Services, Hubert H. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201. The Fund will not retaliate against you for filing a complaint.

Changes to this Notice

The Fund reserves the right to change the terms of this or any subsequent notice at any time. If the Fund elects to make a change, the revised notice will be effective for all Health Information that the Fund maintains at that time. If the Fund makes a material change to this notice, and if the Fund posts this notice on its website, the Fund will post the revised notice by the effective date of the material change and also provide the revised notice by mail. If the Fund does not post this notice on its website, within 60 days of any material change of this notice the Fund will provide the revised notice to members.

For Questions or Requests

Privacy Official Newspaper Guild of New York – The New York Times Benefits Fund 1501 Broadway, Suite 1724 New York, NY 10036

(646) 237-1672

Newspaper Guild of New York – The New York Times Benefits Fund Page 140

INTERPRETING THE PLAN

The Board of Trustees, and any person or persons it designates (including, without limitation, any claim or appeal reviewer), has the exclusive right, power, and authority, in its sole discretion, to administer, apply and interpret the Plan, including this SPD and any other Plan documents, and to decide all matters that arise in the operation and administration of the Plan.

Without limiting the generality of the foregoing, the Board of Trustees, and its designees, have the sole and absolute authority to:

§ Take all actions and make all decisions related to eligibility for, and the amount of, benefits under the Plan;

§ Formulate, interpret and apply rules, regulations and policies necessary to administer the Fund in accordance with the terms of the Plan;

§ Decide questions (both legal and factual) related to eligibility and the calculation and payment of benefits, and any other issues arising under the Plan;

§ Resolve and/or clarify any ambiguities, inconsistencies and omissions arising under the official Plan documents including this SPD or other Plan documents;

§ Approve or deny benefit claims; and

§ Determine the standard of proof required in any case.

Please note that this list is for illustration purposes only and is not meant to be exhaustive of the types of determinations and interpretations under the control of the Board of Trustees or its designates.

Any and all determinations and interpretations made by the Board of Trustees or its designees are final and binding on all members, beneficiaries and any other individuals claiming benefits under the Plan.

Newspaper Guild of New York – The New York Times Benefits Fund Page 141

IF THE PLAN ENDS/CHANGES IN THE PLAN

The Board of Trustees intends to continue the Plan described in this SPD indefinitely.

Nevertheless, the Board reserves the right to end the Plan or amend it at any time and for any reason. If the Plan is amended, modified or terminated, in whole or in part, the ability of members and dependents (including retirees, both present and future) to participate in the Plan and/or to receive benefits thereunder, as well as the type and amount of benefits provided under the Plan, may be modified or terminated.

Among other things, the Board of Trustees has the power to do the following:

§ Change the eligibility rules; § Diminish the amounts of benefits; § Increase deductibles or coinsurance; § Eliminate particular types of benefits; § Substitute certain benefits for others; § Impose or decrease maximums on the amount of benefits payable; and § Change contributions or increase contributions from members and beneficiaries as a condition of eligibility.

All benefits provided under the Plan and eligibility rules for members and dependents, including without limitation those available to retirees:

§ Are not guaranteed; § May be changed or discontinued by the Board of Trustees at any time, in its sole and absolute discretion; § Are subject to the rules and regulations adopted by the Board of Trustees; and § Are subject to the Trust Agreement that establishes and governs the Plan’s operations, the collective bargaining agreements and the Plan’s contracts with the applicable insurance companies or other providers.

Under no circumstances will any person obtain a vested or non-forfeitable right to receive, directly or indirectly, any benefits provide by, or assets of, the Plan.

Without limiting any other Plan provision for the discontinuance of coverage, your coverage under the Plan will be terminated when the Plan terminates or when you are no longer eligible to receive benefits under the Plan, whichever occurs first.

If the Plan ends, subject to the Trust Agreement, the Board of Trustees will apply any unused reserves to provide benefits or otherwise carry out the purpose of the Plan in an equitable manner.

At no point may your benefits hereunder be pledged to any creditor, third-party or otherwise be alienated.

Newspaper Guild of New York – The New York Times Benefits Fund Page 142

MISREPRESENTATION AND FRAUD

If the Board of Trustees (or its designee) determines that you or any dependent is ineligible for coverage under the Plan, coverage will be terminated and the Plan may require you or the dependent to repay amounts incorrectly paid by the Plan. Coverage may also be terminated and a member or dependent will be required to repay amounts incorrectly paid by the Plan where a member or dependent commits fraud or makes an intentional misrepresentation or otherwise provides false information to the Plan. By way of example, fraud includes (among other things) a person’s failure to disclose any other group health coverage under which such person is entitled to receive reimbursement of a claim submitted to the Plan, failure to notify the Plan of life events that render a person ineligible for coverage, such as divorce, and false statements in an application for coverage, a claim or appeal or in response to information requested by the Plan. The Board of Trustees may commence legal action against a member or other individual for restitution and hold them liable for all costs of collection, including interest and attorneys’ fees. The Board of Trustees may also revoke or rescind eligibility and offset future claim payments with respect to the member or dependent to recoup the amount owed. In cases where coverage is terminated, it may also be done retroactively and without advance notice (except where required by law) if it would not be considered a rescission or is considered a permissible rescission under the Affordable Care Act.

Newspaper Guild of New York – The New York Times Benefits Fund Page 143

PLAN FACTS

The following information will help you find answers if you have any questions about your benefits.

This is a welfare benefit plan administered by a joint labor-management board of trustees. The Plan Administrator (the Board of Trustees) establishes the Plan’s rules and regulations, interprets the Plan and is otherwise responsible for the Plan’s operation.

Certain administrative services with regard to the processing of claims and payment of benefits are provided to the Plan. Please note your choice of benefit plan in order to find your specific benefit plan information:

Medical and optical benefits are self-insured and administered by:

Board of Trustees Newspaper Guild of New York – The New York Times Benefits Fund c/o C&R Consulting 1501 Broadway, Suite 1724 New York, NY 10036 (646) 237-1670

Dental benefits are self-insured and administered by:

Empire BlueCross BlueShield Dental Benefits Program PO Box 810 Minneapolis, MN 55440-0810 (877) 606-3338

Prescription drug benefits are self-insured and administered by:

Express Scripts, LLC PO Box 66587 St Louis, MO 63166-6587 (877) 680-4880

Newspaper Guild of New York – The New York Times Benefits Fund Page 144

PLAN FACTS (continued)

Medical and Prescription Drug benefits are also provided through insurance policies underwritten by:

Oxford (United Healthcare) P.O. Box 29135 Hot Springs, AR 71903 (800) 444-6222

HIP Prime (EmblemHealth) 55 Water Street New York, NY 10041-8190 (800) 447-8255

Empire BlueCross BlueShield 1 Liberty Plaza New York, NY 10006 (800) 453-0113

Coverage for employees living and working outside of the United States is provided through an insurance policy underwritten by:

Cigna International Expatriate Benefits (CIEB) P.O. Box 15050 Wilmington, DE 19850 (800) 243-6998

Life Insurance is provided through an insurance policy underwritten by:

Cigna Life Insurance Company of New York 140 East 45th Street New York, NY 10017 (800) 732-1603 TDD (800) 552-5744

Plan Sponsor: Board of Trustees Newspaper Guild of New York – The New York Times Benefits Fund c/o C&R Consulting 1501 Broadway, Suite 1724 New York, NY 10036 Phone: (646) 237-1670

Employer Identification Number: 13-3094045

Plan Number: 501

Type of Plan: Welfare

Plan Administrator: The Board of Trustees

Type of Administration: Benefits are provided on both a self-insured and an insured basis.

Newspaper Guild of New York – The New York Times Benefits Fund Page 145

PLAN FACTS (continued)

Agent for Service of Legal Process: The Board of Trustees

Plan Trustees: Correspondence or inquiries addressed to all Trustees may be sent to:

Board of Trustees, Newspaper Guild of New York - The New York Times Benefits Fund 1501 Broadway, Suite 1724 New York, NY 10036

Union Trustees Address Employer Trustees Address

Grant Glickson 1501 Broadway, Room 708 Andrew Gutterman 620 Eight Avenue Peter Szekely New York, NY 10036 Charlotte Behrendt New York, NY 10018 Anthony Napoli Christopher Biegner Matthew Seaton Terry L. Hayes

Plan Year: July 1 to June 30 (Fund’s fiscal year)

Legal Co-Counsel: Meyer, Suozzi, English & Klein, PC 1350 Broadway New York, NY 10018

Proskauer Rose LLP Eleven Times Square New York, NY 10036

Collective Bargaining Agreement and Plan Funding:

The Fund is maintained under the terms of collective bargaining agreements between The New York Times and the NewsGuild* of New York, Local 31003, Communications Workers of America. These agreements require contributions from the employers to the Fund. You can obtain for yourself or review in person a copy of the agreements by written request to the Plan Administrator at the Fund Office, The New York Times, or the NewsGuild of New York, Local 31003, Communications Workers of America. These contributions are made to a trust fund intended to be tax exempt. This money is reserved for payments on behalf of Plan members and beneficiaries for reasonable administrative expenses. It cannot be used for any other purpose and it cannot be withdrawn by either the employers or the union.

The financial activities of the Fund are audited annually by a firm of certified public accountants:

Novak Francella, LLC 450 Seventh Avenue, Suite 3500 New York, NY 10123

* In 2015, the Newspaper Guild of New York, Local 31003 changed its name to the NewsGuild of New York, Local 31003.

Newspaper Guild of New York – The New York Times Benefits Fund Page 146

YOUR RIGHTS UNDER ERISA

As a participant in the Newspaper Guild of New York – Guild-Times Benefits Fund, you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (“ERISA”). ERISA provides that all plan participants shall be entitled to:

Receive Information about Your Plan and Benefits

Ø Examine, without charge, at the Fund’s Office and at other specified locations, such as worksites and union halls, all documents governing the Plan, including insurance contracts and collective bargaining agreements, and a copy of the latest annual report (Form 5500 Series) filed by the Plan with the U.S. Department of Labor and available at the Public Disclosure Room of the Employee Benefits Security Administration.

Ø Obtain, upon written request to the Plan Administrator, copies of documents governing the operation of the Plan, including insurance contracts and collective bargaining agreements, and copies of the latest annual report (Form 5500 Series) and updated summary plan description. The Fund may make a reasonable charge for the copies.

Ø Receive a summary of the Plan’s annual financial report. The Plan Administrator is required by law to furnish each participant with a copy of this summary annual report.

CONTINUE GROUP HEALTH PLAN COVERAGE

Ø Continue health care coverage for yourself, spouse or dependents if there is a loss of coverage under the Plan as a result of a qualifying event. You or your dependents may have to pay for such coverage. Review this summary plan description and the documents governing the Plan on the rules governing your COBRA continuation coverage rights.

PRUDENT ACTIONS BY PLAN FIDUCIARIES

In addition to creating rights for plan participants ERISA imposes duties upon the people who are responsible for the operation of the employee benefit plan. The people who operate your Plan, called “fiduciaries” of the Plan, have a duty to do so prudently and in the interest of you and other plan participants and beneficiaries. No one, including your employer, your union, or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a welfare benefit or exercising your rights under ERISA.

Newspaper Guild of New York – The New York Times Benefits Fund Page 147

YOUR RIGHTS UNDER ERISA (continued)

ENFORCE YOUR RIGHTS

If your claim for a welfare benefit is denied or ignored, in whole or in part, you have a right to know why this was done, to obtain copies of documents relating to the decision without charge, and to appeal any denial, all within certain time schedules.

Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request a copy of Plan documents or the latest annual report from the Plan and do not receive them within 30 days, you may file suit in a Federal court. In such a case, the court may require the plan administrator to provide the materials and pay you up to $110 a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the administrator. If you have a claim for benefits which is denied or ignored, in whole or in part, you may file suit in a state or Federal court, in addition, if you disagree with the Plan’s decision or lack thereof concerning the qualified status of a domestic relations order or a medical child support order, you may file suit in Federal court. If it should happen that plan fiduciaries misuse the plan’s money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a Federal court. The court will decide who should pay court costs and legal fees. If you are successful the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees, for example, if it finds you claim if frivolous.

ASSISTANCE WITH YOUR QUESTIONS

If you have any questions about your plans, you should contact the Fund Office. If you have any questions about this statement or about your rights under ERISA, or if you need assistance in obtaining documents from the Plan Administrator, you should contact the nearest office of the Employee Benefits Security Administration, U.S. Department of Labor, listed in your telephone directory or the Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue N.W., Washington, D.C. 20210.

You may also obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the Employee Benefits Security Administration.

Newspaper Guild of New York – The New York Times Benefits Fund Page 148

DEFINITIONS

1. Allowable Charges: Maximum amount on which payment is based for covered health care services. This may be called “eligible expense,” “payment allowance" or "negotiated rate." If your provider charges more than the allowable amount, you may have to pay the difference. (See Balance Billing.)

2. Appeal: A request for your health insurer or plan to review a decision or a grievance again.

3. Balance Billing: When a provider bills you for the difference between the provider’s charge and the allowable amount. For example, if the provider’s charge is $100 and the allowable amount is $70, the provider may bill you for the remaining $30. A preferred provider may not balance bill you for covered services.

4. Benefits: The health care items or services covered under a health insurance plan. Covered benefits and excluded services are defined in the health insurance plan's coverage documents. In Medicaid or CHIP, covered benefits and excluded services are defined in state program rules.

5. Claim: A request for payment that you or your health care provider submits to your health insurer or plan when you get items or services you think are covered.

6. COBRA: A Federal law that may allow you to temporarily keep health coverage after your employment ends, you lose coverage as a dependent of the covered employee, or another qualifying event. If you elect COBRA coverage, you pay 100% of the premiums, including the share the employer used to pay, plus a small administrative fee.

7. Coinsurance: Your share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the allowable amount for the service. You pay coinsurance plus any deductibles you owe. For example, if the health insurance or plan’s allowable amount for an office visit is $100 and you’ve met your deductible, your coinsurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowable amount.

8. Copays: A fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service.

9. Deductible: The amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay. For example, if your deductible is $1,000, your plan won’t pay anything until you’ve met your $1,000 deductible for covered health care services subject to the deductible. The deductible may not apply to all services.

10. Exclusive Provider Organization (EPO) Plan: A managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan’s network.

11. Excluded Services (Exclusions): Health care services that your health insurance or plan doesn’t pay for or cover.

12. Fee for Service: A method in which doctors and other health care providers are paid for each service performed. Examples of services include tests and office visits.

Newspaper Guild of New York – The New York Times Benefits Fund Page 149

DEFINITIONS (continued)

13. Formulary: A list of drugs your insurance plan covers. A formulary may include how much you pay for each drug. (If the plan uses “tiers,” the formulary may list which drugs are in which tiers.) Formularies may include both generic drugs and brand-name drugs.

14. Health Maintenance Organization (HMO) Plan: A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out- of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.

15. Hospice Services: Services to provide comfort and support for persons in the last stages of a terminal illness and their families.

16. Home Health Care: Health care services a person receives at home.

17. Network: The facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services.

18. Non-Preferred Provider/Non-Participating Provider: A provider who doesn’t have a contract with your health insurer or plan to provide services to you (out-of-network). It will cost you more to see a non- participating provider.

19. Out-of-Pocket Maximum: The most you pay during a plan year before your health insurance or plan begins to pay 100% of the allowable amount. This limit never includes your premium, balance-billed charges or health care your health insurance or plan doesn’t cover. Some health insurance or plans don’t count all of your copays, deductibles, coinsurance payments, out-of-network payments or other expenses toward this limit.

20. Open Enrollment Period: The period of time set up to allow you to choose from available plans, usually once a year.

21. Plan: A benefit your employer, union or other group sponsor provides to you to pay for your health care services.

22. Plan Year: A 12-month period of benefits coverage under a group health plan.

23. Preauthorization/Precertification: A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or precertification. Your health insurance or plan may require preauthorization for certain services before you receive them, except in an emergency. Preauthorization isn’t a promise your health insurance or plan will cover the cost.

24. Preferred Provider/Participating Provider: A provider who has a contract with your health insurer or plan to provide services to you at a discount.

Newspaper Guild of New York – The New York Times Benefits Fund Page 150

DEFINITIONS (continued)

25. Preferred Provider Organization (PPO) Plan: A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside of the network for an additional cost.

26. Preventive Services: Routine health care that includes screenings, check-ups, and patient counseling to prevent illnesses, disease, or other health problems.

27. Primary Care Provider (PCP): A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services for a patient.

28. Rehabilitation Services: Health care services that help a person keep, get back or improve skills and functioning for daily living that have been lost or impaired because a person was sick, hurt or disabled. These services may include physical and occupational therapy, speech-language pathology and psychiatric rehabilitation services in a variety of inpatient and/or outpatient settings.

29. Self-Insured Plan: Type of plan usually present in larger companies where the employer itself collects premiums from enrollees and takes on the responsibility of paying employees’ and dependents’ medical claims. These employers can contract for insurance services such as enrollment, claims processing, and provider networks with a third party administrator, or they can be self-administered.

30. UCR (Usual, Customary and Reasonable): The amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service. The UCR amount sometimes is used to determine the allowable amount. 31. Well-Child Visits: Routine doctor visits for comprehensive preventive health services that occur when a baby is young and annual visits until a child reaches age 21. Services include physical exam and measurements, vision and hearing screening, and oral health risk assessments.

32. Wellness Programs: A program intended to improve and promote health and fitness that's usually offered through the work place, although insurance plans can offer them directly to their enrollees. The program allows your employer or plan to offer you premium discounts, cash rewards, gym memberships, and other incentives to participate. Some examples of wellness programs include programs to help you stop smoking, diabetes management programs, weight loss programs, and preventative health screenings.

Newspaper Guild of New York – The New York Times Benefits Fund Page 151 Notes Pages.qxp_Layout 1 5/9/16 9:36 AM Page 1

NOTES

Newspaper Guild of New York – The New York Times Benefits Fund Page 152 Notes Pages.qxp_Layout 1 5/9/16 9:36 AM Page 2

NOTES

Newspaper Guild of New York – The New York Times Benefits Fund Page 153 Notes Pages.qxp_Layout 1 5/9/16 9:36 AM Page 3

NOTES

Newspaper Guild of New York – The New York Times Benefits Fund Page 154 Notes Pages.qxp_Layout 1 5/9/16 9:36 AM Page 4

NOTES

Newspaper Guild of New York – The New York Times Benefits Fund Page 155 Notes Pages.qxp_Layout 1 5/9/16 9:36 AM Page 5

NOTES

Newspaper Guild of New York – The New York Times Benefits Fund Page 156 SPD BackCover.qxp_Layout15/9/169:48AMPage

Newspaper Guild of New York - PRESORTED STANDARD The New York Times Benefits Fund U.S. POSTAGE 1501 Broadway, Suite 1724 PAID HUNTINGTON, NY New York, NY 10036 PERMIT NO. 14