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for More Information More for Where to Go Go to Where Distributed to COBRA participants, recipients of company-extended coverage, surviving dependents and alternate and alternate dependents surviving coverage, of company-extended recipients participants, COBRA to Distributed plans. and welfare the health from benefits receiving above (QMCSOs) of the populations noted recipients Distributed to alternate payees and beneficiaries receiving benefits from the retirement plans. the retirement from benefits receiving and beneficiaries payees alternate to Distributed AT&T Support Services Company, Inc. and YELLOWPAGES.C Company, Support Services AT&T emp international This page left intentionally blank. IMPORTANT INFORMATION In all cases, the official documents for the Plans govern and are the final authority on the terms of the Plans, and if there are any discrepancies between the information in this SMM and the Plans, the Plan documents will control. AT&T reserves the right to terminate or amend any and all of its employee benefits plans or programs, at any time for any reason. Participation in the plans and programs is neither a contract nor a guarantee of future employment.
What is this document? This is an updated summary of material modifications (SMM) for the Contact Information for Employee Benefits Plans and Programs. This SMM is a one-stop reference guide for frequently called numbers, website addresses and other important AT&T benefits contact information. Este documento contiene un resumen de las modificaciones materiales, en inglés. Si usted tiene dificultad en entender este SMM, entre en contacto por favor con AT&T Benefits Center, 877-722-0020. Why did I receive this document? This SMM replaces your existing Where to Go for More Information: Contact Information for Employee Benefits Plans and Programs SMM dated April 2011. What action do I need to take? You should review this SMM and your plan and program summary plan descriptions (SPDs) in their entirety so that you can understand the details of your plans and programs. No other action is necessary. How do I use this document? As you read this SMM, pay special attention to the “Important” boxes that contain helpful examples and important notes. Also, throughout this SMM, there are cross-references to other sections in the SMM. Please consult the Table of Contents to help you locate these cross-referenced sections. Questions? If you have questions about this SMM, call the AT&T Benefits Center at 877-722-0020. If you still have ques- tions about the plans and programs after reading your SPDs, you can call the applicable administrator listed in the “Contact Information for AT&T Benefits Administrators” section for more information. CONTENTS
CONTENTS AT A GLANCE About This Summary of Material Modifications ...... 6 Agent for Service of Process ...... 6 How Do I Look Up a Contact? ...... 6 Contact Information for AT&T Benefits Administrators ...... 7 Requests for Copies of Documents...... 16 Filing Claims and Appeals ...... 18 Address Changes ...... 22 Glossary ...... 23 Appendix: Affected Benefits Plans, Policies and Programs ...... 24
About This Summary of Material Modifications ...... 6 Account Support - Wireline Voice, U-Verse, Information You Need to Know to Use This SMM ...... 6 High Speed Internet and DIRECTV ...... 9 Agent for Service of Process ...... 6 Account Support - Wireless ...... 9 How Do I Look Up a Contact? ...... 6 Preferred Customer Discount Program ...... 9 Contact Information for Flexible Spending Accounts and AT&T Benefits Administrators ...... 7 Health Reimbursement Accounts ...... 9 Adoption Reimbursement...... 7 SHPS ...... 9 AT&T Benefits Center ...... 7 Health Savings Accounts ...... 10 Beneficiary Designations, Death, and Survivor Benefits ... 7 OptumHealth Bank ...... 10 Fidelity Service Center ...... 7 International Expatriate and Inpatriate Benefits ...... 10 CarePlus and MedPlus ...... 8 CIGNA International ...... 10 UnitedHealthcare ...... 8 Leaves of Absence ...... 10 Commuter Benefits ...... 8 Life Insurance ...... 10 WageWorks ...... 8 AT&T Benefits Center ...... 10 Dental ...... 8 Long-Term Care Insurance ...... 11 CIGNA Dental ...... 8 John Hancock Life Insurance Company USA ...... 11 Disability (Short-Term and Long-Term), Medical ...... 11 Workers’ Compensation and Job Accommodations ...... 8 Blue Cross and Blue Shield of Illinois ...... 11 Sedgwick Claims Management Services ...... 8 Cancer Resource Service ...... 11 Eligibility for Health and Welfare Benefits Plans ...... 8 Consumer’s Medical Resource ...... 11 AT&T Benefits Center ...... 8 TelaDoc ...... 11 Employee Assistance Plan/Employee and UnitedHealthcare ...... 12 Family Assistance Program ...... 8 Alaska Electrical Health & Welfare Fund ...... 12 ValueOptions ...... 8 Medicare Part B Premium Reimbursement ...... 12 Employee Discount and Offers ...... 8 AT&T Benefits Center ...... 12 Policy & Program Eligibility ...... 8 Mental Health and Substance Abuse ...... 12
Legend Mailing Address Æ Website Telephone § Hours of Availability Fax Email
Page 4 Where to Go for More Information | 2012 CONTENTS
ValueOptions ...... 12 Alaska Electrical Workers Money Pension Plans ...... 13 Purchase Pension Plan ...... 17 Fidelity Service Center ...... 13 Benefits Not Specifically Listed ...... 17 AT&T Benefits Center ...... 13 Fully-Insured Managed Care Options ...... 17 National Electric Benefits Fund ...... 13 Bargaining Agreements ...... 17 Alaska Electrical Pension Plan ...... 13 Official Plan Documents ...... 17 Prescription Drugs ...... 13 Filing Claims and Appeals ...... 18 CVS Caremark ...... 13 Beneficiary Designations, Death, and Survivor Benefits ... 18 Savings Plans ...... 14 CarePlus and MedPlus ...... 18 Fidelity Service Center ...... 14 Dental ...... 18 Scarborough Alliance Group ...... 14 Disability (Short-Term and Long-Term), Workers’ Compensation and Job Accommodations ...... 18 Alaska Electrical Workers Money Purchase Pension Plan ...... 14 Eligibility for Health and Welfare Benefits Plans ...... 18 Stock Options ...... 14 Employee Assistance Plan/Employee and Family Assistance Program ...... 19 Merrill Lynch ...... 14 Flexible Spending Accounts and AT&T Equity Administration ...... 14 Health Reimbursement Accounts ...... 19 Terms of Employment International Expatriate and Inpatriate Benefits ...... 19 (also known as Net Credited Service) ...... 14 Life Insurance ...... 19 Fidelity Service Center ...... 14 Long-Term Care Insurance ...... 19 AT&T Benefits Center ...... 15 Medical ...... 19 Vision ...... 15 Medicare Part B Premium Reimbursement ...... 20 EyeMed Vision Care ...... 15 Mental Health and Substance Abuse ...... 20 Voluntary Benefits...... 15 Pension Plans ...... 20 Marsh PersonalPlans ...... 15 Prescription Drugs ...... 20 Work/Life Program ...... 15 Savings Plans ...... 21 LifeCare ...... 15 Terms of Employment (also known as Requests for Copies of Documents ...... 16 Net Credited Service) ...... 21 Summary Plan Descriptions, Summary of Vision ...... 21 Material Modifications or Printed Policies ...... 16 Address Changes ...... 22 Health and Welfare Plans ...... 16 Active Employee Address and AT&T Benefits Center ...... 16 Telephone Number Changes ...... 22 Alaska Electrical Health & Welfare Fund ...... 16 Retired and Inactive Employee Pension Plans ...... 16 Home Address Changes ...... 22 Fidelity Service Center ...... 16 Glossary ...... 23 AT&T Benefits Center ...... 16 Appendix: Affected Benefits Plans, National Electric Benefit Fund ...... 17 Policies and Programs ...... 24 Alaska Electrical Pension Plan ...... 17 Savings Plans ...... 17 Fidelity Service Center ...... 17 Scarborough Alliance Group ...... 17
Legend Mailing Address Æ Website Telephone § Hours of Availability Fax Email
2012 | Where to Go for More Information Page 5 ABOUT THIS SUMMARY OF MATERIAL MODIFICATIONS
This summary of material modifications (SMM) is a one-stop Welfare Benefits Plans” section for more information on how reference guide for frequently called numbers, website addresses to contact the AT&T Benefits Center. and other important AT&T benefits contact information. It is designed to help you find information quickly and easily. Important: Please verify your eligibility for (or participation in) a program before taking any action. See the “Requests for Copies of Documents” section for more information on how to obtain a copy of this SMM. Benefit eligibility for employees classified as nonmanagement Information You Need to Know to Use This SMM nonunion (NMNU) employees varies by employing company and type of benefit. If you are uncertain whether you should AT&T offers a wide variety of benefits, employee discounts receive management or bargained benefits, call the AT&T and other programs. You may not be eligible to participate in Benefits Center at 877-722-0020 to determine your job title every program listed in this SMM. Eligibility to participate in a classification. See the “How Do I Look Up a Contact” section program depends on certain factors, such as your: for more information on how to look up a contact. • Employment status (for example, active or retired) See the Appendix for a list of employee benefits plans and • Job title classification (for example, bargained or programs for which this SMM applies. management) • Employing company Important: Legacy AT&T means AT&T Corp. and its subsidiaries before the merger with SBC Communications Inc. Legacy • Service history (for example, hire date, termination date BellSouth means BellSouth Corporation and its subsidiaries or Term of Employment (also known as net credited before the merger with AT&T Inc. Legacy SBC means service or NCS)) subsidiaries of SBC Communications Inc. before the merger To understand what Programs apply to you, you will need to with AT&T Corp. A name change of the subsidiary you work for know the preceding information. The AT&T Benefits Center or retired from does not affect what legacy group of companies can provide these details. See the “Eligibility for Health and it is a part of.
AGENT FOR SERVICE OF PROCESS This Section of the SMM only applies to ERISA plans. See the A legal action should not be filed until you complete the claim Appendix for more details. and appeal process. Legal action involving a plan should be filed directly against the plan and served at the address below: If you wish to bring a legal action concerning your right to participate in a plan or your right to receive any benefits under AT&T Services, Inc. a plan (or any of its programs), you must first file a claim for P.O. Box 132160 benefits and go through the ERISA claim and appeal process. Dallas, TX 75313-2160
HOW DO I LOOK UP A CONTACT? It’s simple. Refer to this section any time you need contact • Under the administrator for your employee group, you will information for employee benefits, discounts or other find available website addresses, telephone numbers, programs. Here’s how: hours of operation and mailing addresses. • Determine the factors that describe what kind of Example: Assume you are a manager who retired from employee you are. See the “Information You Need to BellSouth Telecommunications, Inc. in 2005. You live in Know to Use This SMM” section for more information. Florida and have questions about your employee wireline • Find the type of benefit, employee discount or other voice discount. program — e.g., medical, prescription drugs or commuter. Find the “Employee Discount & Offers” section. • Find the administrator for your employee group. See the “Active Employees and Retirees Who Receive Discounts on an AT&T Bill” under the “Account Support- Important: If you do not see your employee group listed, call Wireline Voice, U-Verse, High-Speed Internet and DIRECTV” the administrator at the beginning of the section. heading, and call the AT&T Employee and Retiree Sales and Service Center at 877-377-9010, Monday through Friday from 9 a.m. to 6 p.m. Central time.
Page 6 Where to Go for More Information | 2012 CONTACT INFORMATION FOR AT&T BENEFITS ADMINISTRATORS
Adoption designation that you have on file. Many You may request an AT&T Benefi- benefits plans and programs allow you Reimbursement ciary Designation Form through the to designate a beneficiary. Although you Fidelity Service Center. An AT&T AT&T Benefits Center are not required to update your Beneficiary Designation Form will beneficiary designation, it is be mailed to you within three For information on adoption reimburse- recommended that you do so when business days. ment and eligibility, contact the AT&T certain life events occur (for example, Benefits Center. getting married or divorced, having or Fidelity Service Center adopting a child, or losing a loved one). P.O. Box 770003 AT&T Benefits Center Cincinnati, OH 45277-0088 100 Half Day Road You may manage your beneficiary P.O. Box 1474 designations via the AT&T On Line Æ www.netbenefits.fidelity.com Lincolnshire, IL 60069-1474 Beneficiary tool. (Note: Some Retirees and former vested employees may need 800-416-2363 877-722-0020 to call the Fidelity Service Center for further assistance.) Dial your country’s toll-free AT&T 847-883-0866 (international) Direct Access number, then enter If you have not completed an AT&T 800-416-2363 (international). 847-883-8217 Beneficiary Designation, or if you wish to change your current beneficiary 888-343-0860 (hearing-impaired) § Monday through Friday from designation on file: 7 a.m. to 7 p.m. Central time § Monday through Friday from Æ You may create, update, print or 7:30 a.m. to 11 p.m. Central time § An interactive voice response request an AT&T Beneficiary system is available 24 hours a day Designation through Fidelity’s § The automated voice response (except Sunday from 1 a.m. to noon NetBenefits website at netbenefits. system is available 24 hours a day, Central time and periodically fidelity.com. You may also go to the seven days a week. during the week for one hour Quick Reference section of the between midnight and 5 a.m. for OneStop homepage at onestop. Important: The AT&T Beneficiary maintenance and updates). web.att.com (from work), or access. Designation applies to most, but not all, att.com (from home). Click on B, and AT&T-provided benefits. Carefully review Important: To access the website, you then click Beneficiary Designation the AT&T Rules for Employee Beneficiary will need your AT&T Benefits Center user (On Line). Designations, the AT&T Beneficiary ID and password. To access the AT&T Designation and the accompanying Benefits Center via the phone, you will Retirees may also go to the instructions to determine whether the need to provide the last four digits of Benefits section of access.att.com. AT&T Beneficiary Designation applies to your Social Security number, your date Click on Your Finances, and then all of your benefits. If one of your of birth and your AT&T Benefits Center click Beneficiary Designation. company-sponsored benefit plans or password. programs does not use the AT&T Rules for All beneficiary designations made Employee Beneficiary Designations to using the On Line Beneficiary tool distribute the proceeds of your benefits in Beneficiary Designations, will be available for future viewing the event of your death, please refer to Death and Survivor and updating at your convenience. the SPD of that plan or program. Benefits Please note that you in some cases you may have to print your AT&T You will need your Fidelity Service Fidelity Service Center Beneficiary Designation, gather Center PIN and Social Security number/ additional signatures, and then Call the Fidelity Service Center to report customer ID when you access the Fidelity return the Form before your AT&T NetBenefits website or IVR or to speak the death of an employee, a retiree, an Beneficiary Designation is valid inactive employee and/or an eligible to a service associate. You do not need (for example, in cases for which a Fidelity Service Center PIN or dependent, or ask questions about spousal consent is required by the beneficiary designations. (If you have Social Security number/customer ID applicable benefit plan). Please to report a death. submitted an AT&T Beneficiary follow the prompts for when a Designation to the Fidelity Service printed Form must be returned to Center, service associates will be able the Fidelity Service Center. to answer questions regarding the
2012 | Where to Go for More Information Page 7 CONTACT INFORMATION FOR AT&T BENEFITS ADMINISTRATORS
CarePlus and MedPlus Disability (Short-Term Employee Assistance and Long-Term), Workers’ Plan/Employee and Compensation and Family Assistance Program UnitedHealthcare Job Accommodations To confirm whether a specific procedure ValueOptions Sedgwick Claims is covered under CarePlus or MedPlus or Æ www.achievesolutions.net/att to obtain preapproval for a procedure: Management Services 800-554-6701 877-261-3340 AT&T Integrated Disability Service Center § Available 24 hours a day, seven 877-246-8173 (international) P.O. Box 14627 days a week Lexington, KY 40512-4627 § Monday through Friday from Employee Discount 7 a.m. to 7 p.m. Central time 866-276-2278 & Offers § Monday through Friday from Commuter Benefits 7 a.m. to 7 p.m. Central time Policy and Program Eligibility 866-224-4627 FOR AT&T PRODUCTS AND SERVICES: WageWorks WIRELINE VOICE, WIRELESS, U-VERSE, Eligibility for Health and HIGH SPEED INTERNET AND DIRECTV WageWorks Welfare Benefits Plans P.O. Box 14053 Active Employees Lexington, KY 40512 AT&T Benefits Center Æ Go to the OneStop home page, and Æ www.wageworks.com select Your Money Matters and go to AT&T Benefits Center Discounts & Offers section. [email protected] 100 Half Day Road P.O. Box 1474 • If you need additional informa- 877-924-3967 Lincolnshire, IL 60069-1474 tion, contact OneStop. 877-353-9236 (Claims submission) Æ resources.hewitt.com/att 888-722-1787 (speak Policy for concessions) § Monday through Friday from 877-722-0020 7 a.m. to 7 p.m. Central time, Customer-care specialists are 847-883-0866 (international) § excluding holidays. An interactive available Monday through Friday voice response system is available 847-883-8217 from 8 a.m. to 6 p.m. Central time. 24 hours a day, 7 days a week. Retirees § Monday through Friday from Important: Commuter Benefits are not 7 a.m. to 7 p.m. Central time 888-251-0645 AT&T Call available to employees located in Guam, Center (Wells Fargo Third Party Puerto Rico or the Virgin Islands. § An interactive voice response Administrator) system is available 24 hours a day (except Sunday from 1 a.m. to noon [email protected] Dental Central time and periodically during the week for one hour § Monday through Friday from between midnight and 5 a.m. for 8 a.m. to 6 p.m. Eastern time CIGNA Dental maintenance and updates). Appeals For Eligibility AT&T Dental Service Center Important: To access the website, To pursue program eligibility issues P.O. Box 188040 you will need your AT&T Benefits Center write to AT&T Employee Discount Chattanooga, TN 37422 user ID and password. To access the Administrator Æ www.mycigna.com AT&T Benefits Center via the phone, you AT&T Employee will need to provide the last four digits 888-722-5505 Discount Administrator of your Social Security number, your One AT&T Way § Monday through Friday from date of birth and your AT&T Benefits Room 4A158A 7 a.m. to 7 p.m. Central time Center password. Bedminster, NJ 07921 [email protected] Page 8 Where to Go for More Information | 2012 CONTACT INFORMATION FOR AT&T BENEFITS ADMINISTRATORS
Account Support – Wireline Voice, Account Support - Wireless Preferred Customer U-Verse, High Speed Internet Discount Program FOR BILLING, PAYMENT, REIMBURSEMENTS, and DIRECTV SERVICE AND REPAIR INQUIRES The AT&T Preferred Customer Discount FOR Program (PCDP) gives active AT&T BILLING, PAYMENT, REIMBURSEMENTS, Active Management Employees SERVICE AND REPAIR INQUIRES employees access to special prices on select products and services provided Active Employees and Retirees Who Æ Employee Mobility Offer (E.M.O) Receive Discounts On An AT&T Bill: website: https://emprateplan.edc. by certain business customers. Email cingular.net/emo/ and Chat features are available on Æ https://attathome.att.com/athome_ the webpage. web/index.jsp 800-331-0500 AT&T Customer Care Team or dial 611 from your Æ To search for companies, go to 877-377-9010 (AT&T Employee and wireless phone the OneStop home page, and Retiree Sales and Service Center) select Your Money Matters, go to § Monday through Friday from 5 a.m. Discounts & Offers section, and § Monday through Friday from to 9 p.m. Pacific time select the Preferred Customer 9 a.m. to 6 p.m. Central time Discount section Active Non-management Employees Retirees Who Receive Reimbursements: Æ AT&T Mobility Employee Rate Plan • If you need additional informa- LegacyAT&T (ERP) website: https://emprateplan. tion, contact OneStop. edc.cingular.net/erp/ Wells Fargo TPA 888-722-1787 (speak Policy P.O. Box 11296 Æ Non-Management Employees for concessions) Charleston, WV 25339-1296 - Other Than AT&T Mobility Premier § Customer-care specialists are website: www.att.com/wireless/att 888-251-0645 available Monday through Friday from 8 a.m. to 6 p.m. Central time. 800-331-0500 AT&T Customer [email protected] Care Team or dial 611 from your [email protected] § Monday through Friday from wireless phone 8 a.m. to 6 p.m. Eastern time Flexible Spending § Monday through Friday from 5 a.m. Accounts and Health Legacy BellSouth to 9 p.m. Pacific time Reimbursement Wells Fargo TPA Retirees Accounts P.O. Box 2911 Æ Retired Management and retired SHPS Charleston, WV 25330-2911 non-management Premier website: 866-444-5207 www.att.com/wireless/att SHPS Spending Accounts P.O. Box 34740 [email protected] Æ Retired AT&T Mobility non-manage- Louisville, KY 40232-4740 ment Employee Rate Plan (ERP) § Monday through Friday from website: https://emprateplan.edc. Æ https://myspendingaccount. 8 a.m. to 7 p.m. Eastern time cingular.net/erp/ shps.com
Legacy SBC 800-331-0500 AT&T Customer 800-283-3211 Care Team or dial 611 from your 502-267-4900 (international) Wells Fargo TPA wireless phone P.O. Box 11296 800-952-0450 (hearing-impaired) Charleston, WV 25339-1296 RetiredERP@amcustomercare. att-mail.com 866-643-2219 800-542-8515 § Monday through Friday from 5 a.m. § Monday through Friday from [email protected] to 9 p.m. Pacific time 7 a.m. to 7 p.m. Central time
§ Monday through Friday from Important: Please direct all account § The IVR is available 24 hours a day, 8 a.m. to 6 p.m. Eastern time issues on billing, service, repair, seven days a week. reimbursement or payment inquiries to the identified sources previously listed. Important: Employees located in Puerto Rico are not eligible for an FSA.
2012 | Where to Go for More Information Page 9 CONTACT INFORMATION FOR AT&T BENEFITS ADMINISTRATORS
Health Savings International Expatriate Life Insurance Accounts and Inpatriate Benefits
FOR ALL PARTICIPANTS IN THE FOR MEDICAL, PRESCRIPTION DRUGS, For information regarding eligibility, CONSUMER-DRIVEN HEALTH DENTAL AND VISION enrollment or cost of coverage contact PROGRAM UNDER THE AT&T the AT&T Benefits Center. MEDICAL PLAN CIGNA International AT&T Benefits Center Many financial institutions offer HSAs. CIGNA International You may wish to check with your financial Expatriate Benefits AT&T Benefits Center institution concerning the availability and P.O. Box 15050 100 Half Day Road terms of an HSA. To facilitate Employee Wilmington, DE 19850 USA P.O. Box 1474 participation in an HSA, the Company Lincolnshire, IL 60069-1474 has arranged to permit payroll deduc- § The following numbers are tions by eligible Employees into an HSA available 24 hours a day, seven Æ resources.hewitt.com/att established with OptumHealth Bank days a week: 877-722-0020 (formerly Exante Bank). 800-441-2668 (If dialing OptumHealth Bank internationally, use that country’s 847-883-0866 (international) AT&T Direct Access number.) OptumHealth Bank 847-883-8217 P.O. Box 271629 302-797-3100 (reverse charges Monday through Friday from Salt Lake City, Utah 84127-1629 accepted) § 7 a.m. to 7 p.m. Central time Æ www.optumhealthbank.com 800-243-6998 (If dialing internationally use that country’s § An interactive voice response 866-234-8913 AT&T Direct Access number.) system is available 24 hours a day (except Sunday from 1 a.m. to noon 866-538-9701 Æ www.cignaenvoy.com Central time and periodically during the week for one hour § Monday through Friday from Important: Registration is required to between midnight and 5 a.m. for 7 a.m. to 7 p.m. Central time use the member website. Secure mail maintenance and updates). The IVR is available 24 hours a day, is also available at this site. § Important: To access the website, you seven days a week. will need your AT&T Benefits Center user ID and password. To access the AT&T Important: The HSA offered by Leaves of Absence Benefits Center via the phone, you will OptumHealth is not an arrangement need to provide the last four digits of that is established and maintained by For information regarding leaves of your Social Security number, your date the Company. Rather, the OptumHealth absence, use the following resources of birth and your AT&T Benefits Center HSA is established and maintained by in the order listed: password. OptumHealth Bank, the HSA trustee. It is the Company’s intention to comply • Your immediate supervisor. Call the Fidelity Service Center to report with Department of Labor guidance set • Go to: the death of an employee, a retiree, an forth in Field Assistance Bulletin No. inactive employee and/or an eligible 2004-1, which specifies that an HSA Æ the OneStop home page, and dependent. You do not need a Fidelity is not an ERISA plan if certain require- select Company Leaves of Absence Service Center PIN or Social Security ments are satisfied. in the Your Time and Attendance number/customer ID to report a death. section. See the “Beneficiary Designations, • If you need additional information, Death and Survivor Benefits” section for contact OneStop. contact information. 888-722-1787 § Customer-care specialists are available Monday through Friday from 8 a.m. to 6 p.m. Central time.
Page 10 Where to Go for More Information | 2012 CONTACT INFORMATION FOR AT&T BENEFITS ADMINISTRATORS
Long-Term Æ www.bcbsil.com/att Consumer’s Medical Resource Care Insurance 800-621-7336 FOR ALL ACTIVE MANAGERS ENROLLED IN THE AT&T MEDICAL PLAN, AS WELL John Hancock Life Insurance 800-621-0965 (for medical AS ALL LEGACY AT&T ACTIVE LEGACY Company USA services requiring precertification) AT&T BARGAINED EMPLOYEES ENROLLED IN THE AT&T MEDICAL John Hancock Life Insurance 800-299-0274 (NurseLine) EXPENSE PLAN FOR OCCUPATIONAL EMPLOYEES Company USA § The customer service center is Group Long-Term Care Department available Monday through Friday Consumer’s Medical Resource provides B-6 7 a.m. to 7 p.m. Central time. Medical Decision Support, a service that P.O. Box 111 provides you with current, comprehen- Boston, MA 02117 § For medical services requiring sive, objective and personalized infor- precertification, the customer 800-732-3220 mation about medical conditions, your service center is available treatment options and their effective- Monday through Friday from 617-572-0048 (international) ness. The service is for you and your 8 a.m. to 5 p.m. Central time. dependents who are facing a serious or 800-255-1808 (hearing-impaired) § The NurseLine is available 24 hours chronic illness. a day, seven days a week. § Monday through Friday from 888-644-1640 7:30 a.m. to 5:30 p.m. Central time § During off hours, the IVR is available Monday through Friday from § Monday through Friday from Important: To be directed to the 6 a.m. to 11:30 p.m. Central time 8:30 a.m. to 5 p.m. Eastern time appropriate website, call Customer and on Saturday from Service at the above telephone numbers. 6 a.m. to 3 p.m. Central time. Important: Consumer’s Medical Resource does not provide advice or Cancer Resource Service recommend a particular treatment. Medical FOR ALL ACTIVE AND RETIRED MANAGERS AND CERTAIN ACTIVE AND RETIRED BARGAINED EMPLOYEES ENROLLED IN TelaDoc For information regarding self-insured THE AT&T MEDICAL PLAN, AS WELL AS FOR ALL ACTIVE AND RETIRED MANAGERS medical programs, see the contact ALL LEGACY AT&T ACTIVE AND RETIRED AND CERTAIN ACTIVE AND RETIRED information listed in this section of the BARGAINED EMPLOYEES ENROLLED IN BARGAINED EMPLOYEES ENROLLED IN SMM. The AT&T Benefits Center can THE AT&T MEDICAL EXPENSE PLAN FOR THE AT&T MEDICAL PLAN OCCUPATIONAL EMPLOYEES OR THE provide contact information for fully- Participants located in Puerto Rico insured managed care options. See the AT&T CORP. POSTRETIREMENT WEL- FARE BENEFITS PLAN are not eligible for TelaDoc. “Eligibility for Health and Welfare Benefits Plans” section for more The Cancer Resource Service is designed TelaDoc is a national network of information on how to contact the AT&T to help you better understand oncology/ board-certified physicians providing Benefits Center. cancer diagnoses and available treat- medical consultations 24 hours a day, ment options, and to give you access to 365 days a year. TelaDoc physicians Blue Cross and the providers and services available at use electronic health records and Blue Shield of Illinois many of the country’s leading cancer telephone/video consultations to centers — all at network rates. FOR ACTIVE AND RETIRED BARGAINED diagnose, recommend treatment and write short-term, non-DEA controlled EMPLOYEES OF AT&T EAST, AT&T 866-936-6002 MIDWEST, AND AT&T SOUTHEAST AND prescriptions when appropriate. TelaDoc RETIRED MANAGEMENT EMPLOYEES § Monday through Friday from physicians are available to resolve your OF AT&T EAST, AT&T SOUTHEAST 7 a.m. to 7 p.m. Central time routine medical issues when you need AND ALL PARTICIPANTS ENROLLED it, from wherever you happen to be. IN THE AT&T CONSUMERWISE Important: To receive the network MEDICAL PROGRAM (UNLESS YOU level of benefits, you must contact the Æ www.teladoc.com (to enroll or ARE ENROLLED IN THE AMERITECH, Cancer Resource Service before receiv- schedule a consult) PTG, OR SNET MEP) ing treatment. All provisions, terms and Blue Cross and Blue Shield conditions of the AT&T Medical Plan of Illinois continue to be applicable when services P.O. Box 805107 are provided through the Cancer Chicago, IL 60680-4112 Resource Service.
2012 | Where to Go for More Information Page 11 CONTACT INFORMATION FOR AT&T BENEFITS ADMINISTRATORS
800-835-2362 FOR ALL OTHER PARTICIPANTS NOT ENROLLED IN THE AT&T MEDICAL Medicare Part B Premium Reimbursement § 24 hours a day, seven days a week PLAN WHO ARE ADMINISTERED BY . UNITEDHEALTHCARE AT&T Benefits Center Important: When you log on to the UnitedHealthcare member website for the first time: P.O. Box 30557 AT&T Benefits Center 1. Click Set up account. Salt Lake City, UT 84130-0557 100 Half Day Road 2. Were you given a Teladoc username? P.O. Box 1474 Select ‘No’. Æ www.myuhc.com (for information Lincolnshire, IL 60069-1474 3. Enter your first name, last name, date on claims, benefits, explanation of of birth, and the following Company benefits, ID cards, search for Æ resources.hewitt.com/att Code: ATTMP hospitals, physicians, specialists 877-722-0020 4. Complete the set up process and and more) enter your medical history information. 847-883-0866 (international) 877-506-7221 847-883-8217 UnitedHealthcare 866-802-8572 (international) Monday through Friday from FOR ALL PARTICIPANTS ENROLLED IN 877-218-7138 (hearing-impaired) § THE AT&T MEDICAL PLAN 7 a.m. to 7 p.m. Central time The customer service center is § An interactive voice response UnitedHealthcare available Monday through Friday § system is available 24 hours a day P.O. Box 30557 from 7 a.m. to 7 p.m. Central time, (except Sunday from 1 a.m. to noon Salt Lake City, UT 84130-0557 except some holidays. Central time and periodically Æ www.myuhc.com (for information § For medical services requiring during the week for one hour on claims, benefits, explanation precertification, preauthorization or between midnight and 5 a.m. for of benefits, ID cards, search for prenotification, the customer maintenance and updates). hospitals, physicians, specialists service center is available Monday and more) through Friday from 8 a.m. to 5 p.m. Important: To access the website, Central time, except some holidays. you will need your AT&T Benefits Center 866-705-9767 user ID and password. To access the 866-802-8572 (international) § The IVR and Optum NurseLine are AT&T Benefits Center via the phone, you available 24 hours a day, seven will need to provide the last four digits 877-218-7138 (hearing-impaired) days a week. of your Social Security number, your date of birth and your AT&T Benefits Alaska Electrical Health § The customer service center is Center password. available Monday through Friday & Welfare Fund from 7 a.m. to 7 p.m. Central time, FOR BARGAINED EMPLOYEES OF AT&T except some holidays. MOBILITY – IBEW LOCAL 1547 HIRED Mental Health and BEFORE DEC. 31, 2011 Substance Abuse § For medical services requiring precertification, preauthorization Alaska Electrical Trust Funds ValueOptions or prenotification, the customer 2600 Denali Street, Suite #200 service center is available Monday Anchorage, Alaska 99503 ValueOptions through Friday from 8 a.m. to 5 p.m. P.O. Box 1860 Central time, except some holidays. Æ www.aetf.com Latham, NY 12110 § The IVR and Optum NurseLine are 800-478-1246 Æ www.achievesolutions.net/att available 24 hours a day, seven Monday through Friday from 8 a.m. days a week. § 800-554-6701 to 5 p.m. Alaska time § The IVR is available 24 hours a day, seven days a week.
Page 12 Where to Go for More Information | 2012 CONTACT INFORMATION FOR AT&T BENEFITS ADMINISTRATORS
An interactive voice response Pension Plans § Prescription Drugs system is available 24 hours a day (except Sunday from 1 a.m. to noon Fidelity Service Center Central time and periodically CVS Caremark during the week for one hour FOR LEGACY AT&T EMPLOYEES AND between midnight and 5 a.m. for CVS Caremark Inc. RETIREES, LEGACY SBC EMPLOYEES maintenance and updates). Attn: Research Team AND RETIREES AND AT&T MOBILITY P.O. Box 6590 EMPLOYEES AND RETIREES Important: To access the website, you Lee’s Summit, MO 64064-6590 Fidelity Service Center will need your AT&T Benefits Center user www.caremark.com P.O. Box 770003 ID and password. To access the AT&T Æ Cincinnati, OH 45277-0065 Benefits Center via the phone, you will 800-378-8851 need to provide the last four digits of Æ www.netbenefits.fidelity.com your Social Security number, your date 800-231-4403 (hearing-impaired) of birth and your AT&T Benefits Center 800-416-2363 password. § Monday through Friday from 7 a.m. to 11 p.m. and Saturday Dial your country’s toll-free AT&T from 7 a.m. to 5 p.m. Central time, Direct Access number, then enter National Electrical Benefit Fund except some holidays 800-416-2363 (international). FOR BARGAINED EMPLOYEES OF SBC The IVR is available 24 hours a day, 888-343-0860 (hearing-impaired) GLOBAL SERVICES, INC. – IBEW § LOCAL 494 seven days a week. § Monday through Friday from 7:30 a.m. to 11 p.m. Central time National Electrical Benefit Fund Important: To access the member 2400 Research Blvd., Suite 500 website, you must be a registered user § The interactive voice response Rockville, MD 20850-3266 and will need your username and system is available 24 hours a day, password. If you’re not registered, seven days a week. Æ www.nebf.com select Not Registered and follow the instructions listed. The group code Important: You will need your Fidelity 301-556-4300 is ATTRX. Service Center PIN and Social Security 301-869-4322 number/customer ID when you access To access the IVR or to speak to a the Fidelity NetBenefits website or IVR § Monday through Friday from service associate, you will need the CVS or to speak to a service associate. 8 a.m. to 5 p.m. Eastern time Caremark ID or Social Security number of the primary member. Alaska Electrical Pension Plan AT&T Benefits Center FOR BARGAINED EMPLOYEES OF AT&T If you have a claim or wish to use the FOR LEGACY BELLSOUTH EMPLOYEES MOBILITY – IBEW LOCAL 1547 IN THE mail service program, claim forms and/ AND RETIREES JOB TITLES OF JOURNEYMAN CELL or mail service order forms are available SITE TECHNICIAN AND FOREMAN, OR AT&T Benefits Center HIRED BEFORE MAY 31, 2011 INTO A on the website or by phone. Mailing P.O. Box 785038 RETAIL SALES AND SERVICE POSITION addresses are listed on the form. Orlando, FL 32878-5038 Alaska Electrical Trust Funds Æ resources.hewitt.com/att 2600 Denali Street, Suite #200 Anchorage, Alaska 99503 877-722-0020 Æ www.aetf.com 847-883-0866 (international) 800-478-1246 847-883-9145 § Monday through Friday from 8 a.m. § Monday through Friday from 9 a.m. to 5 p.m. Alaska time to 5 p.m. Eastern time
2012 | Where to Go for More Information Page 13 CONTACT INFORMATION FOR AT&T BENEFITS ADMINISTRATORS
Term of Employment Savings Plans Stock Options 20102011 2012 (also known as Net Credited Service) Fidelity Service Center Merrill Lynch Fidelity Service Center Fidelity Service Center Æ www.benefits.ml.com P.O. Box 770003 FOR LEGACY AT&T EMPLOYEES AND Cincinnati, OH 45277-0070 § Online is available 24 hours a day, RETIREES, LEGACY SBC EMPLOYEES seven days a week AND RETIREES AND AT&T MOBILITY www.netbenefits.fidelity.com EMPLOYEES AND RETIREES Æ 888-722-6767 800-416-2363 609-818-8849 (international) Fidelity Service Center P.O. Box 770003 Dial your country’s toll-free AT&T Cincinnati, OH 45277-0065 Direct Access number, then enter Important: No person has been 800-416-2363 (international). authorized to give any information or to Æ www.netbenefits.fidelity.com make representations other than those 888-343-0860 (hearing-impaired) contained in the Plan Prospectus. 800-416-2363 § Monday through Friday from To access the website, you will need Dial your country’s toll-free AT&T 7:30 a.m. to 11 p.m. Central time, your Merrill Lynch PIN. Call Merrill Lynch Direct Access number, then enter except some holidays for a PIN reset, if needed. 800-416-2363 (international). Scarborough Alliance Group 888-343-0860 (hearing-impaired) FOR BARGAINED EMPLOYEES OF SBC AT&T Equity Administration GLOBAL SERVICES, INC. LOCAL 21 § Monday through Friday from If Merrill Lynch is unable to resolve your 7:30 a.m. to 11 p.m. Central time WHO PARTICIPATE IN THE IBEW issue, you may contact the AT&T Equity LOCAL UNIONS SAVINGS AND Administration Team. SECURITY PLAN § The interactive voice response system is available 24 hours a day, [email protected] Scarborough Alliance Group seven days a week. One Bridge St., Suite 70 866-533-4390 Irvington, NY 10533 Important: You will need your Fidelity § Monday through Friday from Service Center PIN and Social Security Æ www.scarboroughalliance.com 7 a.m. to 5 p.m. Central time number/customer ID when you access the Fidelity NetBenefits website or IVR 800-223-7608 or to speak to a service associate. 914-591-8801 § Monday through Friday from 9 a.m. to 5 p.m. Eastern time Alaska Electrical Workers Money Purchase Pension Plan FOR BARGAINED EMPLOYEES OF AT&T MOBILITY – IBEW LOCAL 1547 HIRED BEFORE DEC. 31, 2011 Alaska Electrical Trust Funds 2600 Denali Street, Suite #200 Anchorage, Alaska 99503 Æ www.aetf.com 800-478-1246 § Monday through Friday from 8 a.m. to 5 p.m. Alaska time
Page 14 Where to Go for More Information | 2011 CONTACT INFORMATION FOR AT&T BENEFITS ADMINISTRATORS
AT&T Benefits Center Vision Work/Life Program FOR LEGACY BELLSOUTH EMPLOYEES AND RETIREES EyeMed Vision Care LifeCare AT&T Benefits Center P.O. Box 785038 EyeMed Vision Care Æ www.lifecare.com Orlando, FL 32878-5038 Attn: Quality Assurance 4000 Luxottica Place 800-873-4636 Æ resources.hewitt.com/att Mason, OH 45040-7111 800-873-1322 (hearing-impaired) 877-722-0020 800-638-4288 § Available 24 hours a day, seven 847-883-0866 (international) 866-308-5375 (hearing-impaired) days a week 847-883-9145 Æ www.eyemedvisioncare.com Important: When you log on to the Monday through Friday from 9 a.m. member website for the first time, enter § § The IVR is available 24 hours a day, att to 5 p.m. Eastern time the Registration Code and Member seven days a week (except during ID, your AT&T User ID. Then follow the § An interactive voice response days that require scheduled instructions on the screen to create a system is available 24 hours a day maintenance). username and password. (except Sunday from 1 a.m. to noon § Service associates are available Central time and periodically Monday through Saturday from during the week for one hour 6:30 a.m. to 10 p.m. and Sunday between midnight and 5 a.m. for from 10 a.m. to 7 p.m. Central time. maintenance and updates). Voluntary Benefits Important: To access the website, you will need your AT&T Benefits Center user ID and password. To access the AT&T Marsh PersonalPlans Benefits Center via the phone, you will need to provide the last four digits of Æ www.volbenefitsadvisor.com your Social Security number, your date of birth and your AT&T Benefits Center 866-909-5149 password. § Monday through Friday from 7 a.m. and 5 p.m. Central time
Important: Voluntary Benefits exclude employees located in Guam, Puerto Rico or the Virgin Islands.
2012 | Where to Go for More Information Page 15 REQUESTS FOR COPIES OF DOCUMENTS
Summary Plan Descriptions, Summary of Material Modifications, or Printed Policies If you would like a summary plan description (SPD), a • You may send your request in writing to the following summary of material modifications (SMM) or a printed policy: address: • Go to OneStop at onestop.web.att.com, which provides AT&T Services, Inc. access to administrator websites, or Attn: Plan Documents • Go to the Your Benefits section of access.att.com (AT&T’s P.O. Box 132160 secure Internet site) for benefits information at home Dallas, TX 75313-2160 • You may call or go to one of the following administrators’ websites directly
Health and Welfare Alaska Electrical Health & Welfare Fund Important: You will need your Fidelity Plans Service Center PIN and Social Security FOR BARGAINED EMPLOYEES OF AT&T number/customer ID when you access AT&T Benefits Center MOBILITY – IBEW LOCAL 1547 the Fidelity NetBenefits website or IVR HIRED BEFORE DEC. 31, 2011 For any of the following plans, you may or to speak to a service associate. call the AT&T Benefits Center or access Æ www.aetf.com the AT&T Benefits Center website to AT&T Benefits Center view an SPD or SMM: 800-478-1246 FOR LEGACY BELLSOUTH EMPLOYEES • Adoption Reimbursement § Monday through Friday from 8 a.m. AND RETIREES to 5 p.m. Alaska time • CarePlus and MedPlus Æ resources.hewitt.com/att From the Homepage, select the • Commuter Benefits Pension Plans “AT&T Benefits Center” link under • Dental “Your Money Matters” then click the • Disability Fidelity Service Center “Benefits Manual-Pension” link under the Learn More section. Then • Employee Assistance Plans FOR LEGACY AT&T EMPLOYEES AND click on the SPD for your Program. RETIREES, LEGACY SBC EMPLOYEES • Flexible Spending Accounts AND RETIREES AND AT&T MOBILITY 877-722-0020 • Group Life Insurance EMPLOYEES AND RETIREES 847-883-0866 (international) • Long-Term Care Insurance Æ www.netbenefits.fidelity.com From the Homepage, select the Monday through Friday from • Medical (including prescription drugs) § appropriate Pension Program 9 a.m. to 5 p.m. Eastern time • Vision under the Pension section, then click “Pension Resources” under Important: To access the website, you Æ resources.hewitt.com/att the View section. Then click will need your AT&T Benefits Center user Pension Plan Basics and select the ID and password. To access the AT&T 877-722-0020 SPD link for your Program. Benefits Center via the phone, you will 847-883-0866 (international) need to provide the last four digits of 800-416-2363 your Social Security number, your date Monday through Friday from of birth and your AT&T Benefits Center § Dial your country’s toll-free AT&T 7 a.m. to 7 p.m. Central time password. Direct Access number, then enter 800-416-2363 (international). Important: To access the website, you will need your AT&T Benefits Center user 888-343-0860 (hearing-impaired) ID and password. To access the AT&T Benefits Center via the phone, you will § Monday through Friday from need to provide the last four digits of 7:30 a.m. to 11 p.m. Central time your Social Security number, your date of birth and your AT&T Benefits Center password.
Page 16 Where to Go for More Information | 2012 REQUESTS FOR COPIES OF DOCUMENTS
National Electrical Benefit Fund Scarborough Alliance Group Bargaining Agreements FOR BARGAINED EMPLOYEES OF SBC FOR BARGAINED EMPLOYEES OF SBC GLOBAL SERVICES, INC. – IBEW GLOBAL SERVICES, INC. LOCAL 21 LOCAL 494 WHO PARTICIPATE IN THE IBEW If you would like to request a copy of LOCAL UNIONS SAVINGS AND the collective bargaining agreement Æ www.nebf.com SECURITY PLAN that covers you, please go to the 301-556-4300 800-223-7608 OneStop home page and select Labor Relations in the Tools & Resources § Monday through Friday from § Monday through Friday from section in the right navigation bar, 8 a.m. to 5 p.m. Eastern time 9 a.m. to 5 p.m. Eastern time contact your immediate supervisor, or write to the address in the “Official Plan Alaska Electrical Pension Plan Alaska Electrical Workers Money Documents” section. Purchase Pension Plan FOR BARGAINED EMPLOYEES OF AT&T MOBILITY – IBEW LOCAL 1547 IN THE FOR BARGAINED EMPLOYEES OF AT&T Official Plan Documents JOB TITLES OF JOURNEYMAN CELL MOBILITY – IBEW LOCAL 1547 HIRED SITE TECHNICIAN AND FOREMAN, OR BEFORE DEC. 31, 2011 HIRED BEFORE MAY 31, 2011 INTO A If you wish to request copies of ERISA RETAIL SALES AND SERVICE POSITION Æ www.aetf.com plan documents — or other documents under which an ERISA plan is estab- Æ www.aetf.com 800-478-1246 lished or operated — you must send 800-478-1246 § Monday through Friday from 8 a.m. your request in writing to the following to 5 p.m. Alaska time address: § Monday through Friday from 8 a.m. to 5 p.m. Alaska time Benefits Not Specifically AT&T Services, Inc. Attn: Plan Documents Listed P.O. Box 132160 Savings Plans Dallas, TX 75313-2160 If you would like to request information for all other programs, Employee Fidelity Service Center Discounts & Offers or plans, please www.netbenefits.fidelity.com contact the particular administrator Æ listed in the “Contact Information for 800-416-2363 AT&T Benefits Administrators” section for more information. Dial your country’s toll-free AT&T Direct Access number, then enter Fully-Insured Managed 800-416-2363 (international). Care Options
888-343-0860 (hearing-impaired) If you would like to request an Evidence of Coverage of the provisions of the § Monday through Friday from managed care option in which you are 7:30 a.m. to 11 p.m. Central time, enrolled, contact the managed care except some holidays option directly. The AT&T Benefits Center can provide contact information. See the “Eligibility for Health and Welfare Benefits Plans” section for more information on how to contact the AT&T Benefits Center.
2012 | Where to Go for More Information Page 17 FILING CLAIMS AND APPEALS
This section only applies to ERISA plans. See the Appendix for more details. Unless your provider submits the claim for you, or the applicable claims administrator allows you to call to initiate a claim for benefits, claims for benefits must be mailed to the applicable claims administrator for the plan in which you are enrolled at the addresses listed in this section. However, urgent care medical claims that require expedited action may be initiated by calling the number for your claims administrator listed in this section. If your claim is denied, ERISA requires you to exhaust administrative remedies, including filing an appeal of the claim denial before you initiate external review, if applicable, or commence a lawsuit. Some claims administrators have a different address to file an appeal of a denied claim. If so, the appeal address is also listed in this section. If an external review is available, informa- tion regarding how to request the review will be provided along with the denial of your appeal. Administrative remedies are considered to be exhausted either when your appeal is denied or when the claims administrator fails to issue a decision on your appeal before the end of the time frames described in the applicable SPD or SMM. If you wish to file a written claim or a written appeal of a denied claim for benefits, use the appropriate address in this section.
Beneficiary Disability (Short-Term UNUM - The Benefits Center Designations, Death and Long-Term), Workers’ P.O. Box 100158 and Survivor Benefits Compensation and Columbia, SC 29202-3158 Job Accommodations Important: UNUM insures claims Beneficiary Designation that occurred Jan. 1, 2004, through Administrator To initiate a claim for benefits, call the Dec. 31, 2008. P.O. Box 770003 AT&T Integrated Disability Service Center. Cincinnati, OH 45277-0072 866-276-2278 Eligibility for Health
CarePlus and MedPlus § Monday through Friday from and Welfare Benefits
7 a.m. to 7 p.m. Central time Plans Claims incurred in the United States: Written claims: FOR FSA, MEDICAL, DENTAL, LIFE INSUR- AT&T CarePlus Plan/Cingular AT&T Integrated Disability ANCE, MEDICARE PART B PREMIUM Wireless MedPlus Plan Service Center REIMBURSEMENT AND VISION P.O. Box 30557 P.O. Box 14627 Lexington, KY 40512-4627 AT&T Benefits Center Salt Lake City, UT 84130-0557 Benefits Determination Claims incurred outside 866-224-4627 Review Team of the United States: P.O. Box 1407 Appeals for denied disability claims: Lincolnshire, IL 60069-1407 UnitedHealthcare AT&T Integrated Disability International Claims Service Center Urgent Care claims regarding P.O. Box 740817 Quality Review Unit eligibility that require expedited Atlanta, GA 30374 P.O. Box 14626 action may be initiated by calling 877-722-0020 (domestic) or Appeals: Lexington, KY 40512-4626 847-883-0866 (international). UnitedHealthcare 866-856-5065 Attn: Appeals - AT&T CarePlus Plan/ § Monday through Friday from For AT&T East employees Cingular Wireless MedPlus Plan 7 a.m. to 7 p.m. Central time Coordinator Written claims for Supplemental 847-554-1397 P.O. Box 740816 Long-Term Disability Benefits under the Atlanta, GA 30374-0816 AT&T East Disability Benefits Program Important: To access the AT&T Benefits must be sent to the carrier of the Center via the phone, you will need to Dental insurance policy under which the provide the last four digits of your Social particular claimant is covered. Security number, your date of birth and your AT&T Benefits Center password. AT&T Dental Service Center Prudential Disability P.O. Box 188044 Management Services Chattanooga, TN 37422 P.O. Box 13480 Philadelphia, PA 19176 Page 18 Where to Go for More Information | 2012 FILING CLAIMS AND APPEALS
Claims of Life Insurance, Accidental Death Blue Cross Blue Shield of Illinois Employee Assistance & Dismemberment or Accelerated Death Plan/Employee and Benefit that have been denied: Claims: Family Assistance Program MetLife Group Life Claims Blue Cross and Blue Shield ValueOptions P.O. Box 6100 of Illinois Scranton, PA 18505-6100 P.O. Box 805107 Claims: Chicago, IL 60680-4112 800-638-6420 (select option 2) ValueOptions 800-621-7336 P.O. Box 1920 FOR LEGACY AT&T BARGAINED EMPLOYEES Appeals: Latham, NY 12110 Claims of Special Accidental Loss Insurance that have been denied: Appeals: Blue Cross and Blue Shield of Illinois ACE American Insurance Company ValueOptions (AT&T Appeals) Attn: Appeals Coordinator 1 Beaver Valley Road P.O. Box 1860 3405 Liberty Drive P. O. Box 15417 Latham, NY 12110 Springfield, IL 62704 Wilmington, DE 19850 Flexible Spending UnitedHealthcare 800-336-0627 Accounts and Health Claims incurred in the United States: Reimbursement Important: Call the Fidelity Service UnitedHealthcare Accounts Center to report the death of an P.O. Box 30557 employee, a retiree, an inactive Salt Lake City, UT 84130-0557 SHPS Spending Accounts employee and/or an eligible dependent. P.O. Box 34740 See the “Beneficiary Designations, Claims incurred outside Louisville, KY 40232-4740 Death and Survivor Benefits” section for of the United States: contact information. International Expatriate UnitedHealthcare International Claims and Inpatriate Benefits Long-Term Care P.O. Box 740817 Atlanta, GA 30374 FOR MEDICAL, PRESCRIPTION DRUGS, Insurance DENTAL AND VISION Appeals: John Hancock Life CIGNA International Insurance Company USA UnitedHealthcare Expatriate Benefits Group Long-Term Care Attention: Appeals P.O. Box 15050 Department, B-6 P.O. Box 740816 Wilmington, DE 19850 USA Attn: Claim Unit Atlanta, GA 30374-0816 P.O. Box 111 Alaska Electrical Health & Life Insurance Boston, MA 02117 Welfare Fund FOR Medical BARGAINED EMPLOYEES OF AT&T Claims that Evidence of Insurability (EOI) MOBILITY – IBEW LOCAL 1547 HIRED has been denied: BEFORE DEC. 31, 2011 MetLife Statement of Health For information regarding self-insured Alaska Electrical Trust Funds Appeals Unit medical programs, see the contact 2600 Denali Street, Suite #200 P.O. Box 14069 information listed in this section. For Anchorage, Alaska 99503 Lexington, KY 40512-4069 information regarding fully-insured managed care options, please refer to 800-638-6420 (select option 1) your Evidence of Coverage. The AT&T Benefits Center also can provide addresses for these plans. See the “Eligibility for Health and Welfare Benefits Plans” section for more information on how to contact the AT&T Benefits Center.
2012 | Where to Go for More Information Page 19 FILING CLAIMS AND APPEALS
Medicare Part B Premium Pension Plans Prescription Drugs Reimbursement
AT&T Benefits Center FOR LEGACY AT&T EMPLOYEES AND CVS Caremark RETIREES, LEGACY SBC EMPLOYEES Benefits Determination Claims for reimbursement for retail Review Team AND RETIREES AND AT&T MOBILITY EMPLOYEES AND RETIREES prescription drugs: P.O. Box 1407 Lincolnshire, IL 60069-1407 Regular Mail: CVS Caremark Inc. Fidelity Service Center Attn: Claims Department § Monday through Friday from P.O. Box 52196 7 a.m. to 7 p.m. Central time Claims and Appeals P.O. Box 770003 Phoenix, AZ 85072-2196 847-554-1397 Cincinnati, OH 45277-1060 Requests for prescription drugs by mail service: Ove rnight: Important: To access the AT&T Benefits Fidelity Service Center Claim forms and/or mail-service order Center via the phone, you will need to Claims and Appeals forms are available via the website or provide the last four digits of your Social 100 Crosby Parkway, KC1F-D by phone. See the “Prescription Drugs” Security number, your date of birth and Covington, KY 41015 section for more information on how your AT&T Benefits Center password. to contact CVS Caremark. Mailing FOR LEGACY BELLSOUTH ACTIVE AND addresses are listed on the form. RETIRED EMPLOYEES WHO PARTICI- Mental Health and PATE IN THE SOUTHEAST MANAGE- For retail or mail-order claims that have Substance Abuse MENT PROGRAM OR THE SOUTHEAST been denied: PROGRAM OF THE AT&T PENSION BENEFIT PLAN CVS Caremark Inc. ValueOptions Appeals Department/AT&T Claims: AT&T Benefits Center MC109 P.O. Box 785038 P.O. Box 52084 ValueOptions Orlando, FL 32878-5038 Phoenix, AZ 85072-2084 P.O. Box 1860 Latham, NY 12110 FOR BARGAINED EMPLOYEES OF 866-689-3092 SBC GLOBAL SERVICES, INC. – Appeals: IBEW LOCAL 494 ValueOptions (AT&T Appeals) National Electrical Benefit Fund P.O. Box 1860 2400 Research Blvd., Suite 500 Latham, NY 12110 Rockville, MD 20850-3266 Alaska Electrical Pension Plan FOR BARGAINED EMPLOYEES OF AT&T MOBILITY – IBEW LOCAL 1547 IN THE JOB TITLES OF JOURNEYMAN CELL SITE TECHNICIAN AND FOREMAN, OR HIRED BEFORE MAY 31, 2011 INTO A RETAIL SALES AND SERVICE POSITION Alaska Electrical Trust Funds 2600 Denali Street, Suite #200 Anchorage, Alaska 99503
Page 20 Where to Go for More Information | 2012 FILING CLAIMS AND APPEALS
Term of Employment Savings Plans 20102011 Vision 2012 (also known as Net Credited Service) Regular Mail: Claims: Fidelity Service Center FOR LEGACY AT&T EMPLOYEES AND EyeMed Vision Care Claims and Appeals RETIREES, LEGACY SBC EMPLOYEES Attn: Out-of-Network Claims P.O. Box 770003 AND RETIREES AND AT&T MOBILITY P.O. Box 8504 Cincinnati, OH 45277-1060 EMPLOYEES AND RETIREES Mason, OH 45040-7111 F i delity Service Center Overnight: Appeals: Benefits Plan Administrator Fidelity Service Center P.O. Box 770003 Claims and Appeals EyeMed Vision Care Cincinnati, OH 45277-1060 100 Crosby Parkway, KC1F-D Attn: Quality Assurance Covington, KY 41015 FOR LEGACY BELLSOUTH ACTIVE AND 4000 Luxottica Place RETIRED EMPLOYEES WHO PARTICI- Mason, OH 45040-7111 FOR BARGAINED EMPLOYEES OF SBC PATE IN THE SOUTHEAST MANAGE- GLOBAL SERVICES, INC. LOCAL 21 MENT PROGRAM OR THE SOUTHEAST WHO PARTICIPATE IN THE IBEW PROGRAM OF THE AT&T PENSION LOCAL UNIONS SAVINGS AND BENEFIT PLAN SECURITY PLAN AT&T Benefits Center Scarborough Alliance Group P.O. Box 785038 1 Bridge St., Suite 70 Orlando, FL 32878-5038 Irvington, NY 10533 Alaska Electrical Workers Money Purchase Pension Plan FOR BARGAINED EMPLOYEES OF AT&T MOBILITY – IBEW LOCAL 1547 HIRED BEFORE DEC. 31, 2011 Alaska Electrical Trust Funds 2600 Denali Street, Suite #200 Anchorage, Alaska 99503
2012 | Where to Go for More Information Page 21 ADDRESS CHANGES
FOR RETIRED AND INACTIVE EMPLOYEES Active Employee Address and Retired and Inactive Employee OF LEGACY BELLSOUTH: Telephone Number Changes Home Address Changes . You must change your address for both It’s important to keep your work and It’s important to keep your home pension and savings. To change your home addresses current because the address up to date because your address for both purposes, contact both majority of your benefits, payroll or benefits information is sent there. the AT&T Benefits Center and the similar information is sent to them. Fidelity Service Center (savings). Please include any room, cubicle or Important: These instructions are also suite number that will help make for LTD recipients, employees on a leave AT&T Benefits Center mail-routing more efficient. of absence, as well as COBRA partici- P.O. Box 785038 pants, alternate payees and survivors Orlando, FL 32878-5038 For employees with access to the that have a pension benefit (including a employee intranet: resources.hewitt.com/att retiree death benefit) or savings plan Æ Home and Work address updates: benefit that has yet to be paid to you. 877-722-0020 • Go to insider.web.att.com If you are not eligible to receive a 847-883-0866 (international) • Click on the OneStop website (one- pension or savings plan benefit, or have stop.web.att.com) and select eLink already received your entire pension 847-883-9145 (eCORP) under Tools & Resources. and savings plan benefits in a lump sum Monday through Friday from 9 a.m. and are not eligible for a retiree death § • Enter your AT&T User ID and password to 5 p.m. Eastern time for the AT&T Global Logon. (If you do benefit from your pension plan, contact not know your password, please the AT&T Benefits Center to update your § An interactive voice response follow the instructions on the screen.) home address. See the “Eligibility for system is available 24 hours a day Health and Welfare Benefits Plans” (except Sunday from 1 a.m. to noon • Once logged on, click OK. section for more information on how to Central time and periodically • On the eCORP home page, click on contact the AT&T Benefits Center. during the week for one hour Employee Services. between midnight and 5 a.m. for Note: Please be sure the far right- FOR ALL RETIRED AND INACTIVE maintenance and updates). hand scroll bar is all the way to the top. EMPLOYEES OF LEGACY AT&T, LEGACY SBC AND AT&T MOBILITY: Important: To access the website, you • Select Personal Information. will need your AT&T Benefits Center Call • Select Maintain Addresses and Phone the Fidelity Service Center to user ID and password. To access the Numbers. change your address. AT&T Benefits Center via the phone, you Fidelity Service Center will need to provide the last four digits • To update your home address, select of your Social Security number, your Edit at the bottom of the Permanent 800-416-2363 date of birth and your AT&T Benefits Residence box, make any necessary Centerpassword. changes and click Save. Dial your country’s toll-free AT&T Direct Access number, then enter • To update your work address, select Fidelity Service Center Edit at the bottom of the Cubicle/ 800-416-2363 (international). Office box, make any necessary 888-343-0860 (hearing-impaired) 800-416-2363 changes and click Save. Dial your country’s toll-free AT&T For employees without access to the § Monday through Friday from employee intranet: 7:30 a.m. to 11 p.m. Central time Direct Access number, then enter 800-416-2363 (international). Contact your supervisor or eLink Important: You will need your Fidelity assistant. Service Center PIN and Social Security 888-343-0860 (hearing-impaired) For Commuter Benefits: number/customer ID when you speak § Monday through Friday from to a service associate. To update your home address: 7:30 a.m. to 11 p.m. Central time. • Go to www.wageworks.com, or Important: You will need your Fidelity • Call the WageWorks Service Center at Service Center PIN and Social Security 877-924-3967. number/Customer ID to speak to a service associate.
Page 22 Where to Go for More Information | 2012 GLOSSARY
COBRA — Consolidated Omnibus Legacy AT&T — AT&T Corp. and its MEP — Medical Expense Plan Budget Reconciliation Act of 1985 subsidiaries before the merger with SBC NCS — Net Credited Service, officially Communications Inc. ERISA — Employee Retirement Income known as Term of Employment Security Act of 1974 Legacy BellSouth — BellSouth PIN — Personal Identification Number Corporation and its subsidiaries before FSA — Flexible Spending Account the merger with AT&T Inc. SMM — Summary of Material IBEW — International Brotherhood of Modifications Legacy SBC — Subsidiaries of SBC Electrical Workers Communications Inc. before the merger SPD — Summary Plan Description IVR — Interactive Voice Response with AT&T Corp. (System) LTD — Long-Term Disability
2012 | Where to Go for More Information Page 23 APPENDIX: AFFECTED BENEFITS PLANS, POLICIES AND PROGRAMS
This document applies to several ■ Savings Plans BellSouth Retiree Medical Assistance employee benefits plans, policies and Plan programs sponsored by AT&T. Some of AT&T Long Term Savings and Cingular Wireless Health and Welfare the plans, policies and programs are Security Plan Benefits Plan for Bargained subject to ERISA, and some are not. AT&T of Puerto Rico Inc. Long Term Employees - Cingular Wireless ERISA is a federal law that gives you Savings and Security Plan Medical Plan for Bargained Employees certain rights and protections. Refer to the applicable summary plan description AT&T Puerto Rico Retirement Cingular Wireless Medical Plus Plan for more details about ERISA. Savings Plan Pacific Telesis Group Health Care AT&T Retirement Savings Plan Network Plan ERISA Plans AT&T Savings and Security Plan For the following employee benefits Pacific Telesis Group Medical plans, this document is a summary of BellSouth Savings and Security Plan Expense Plan for Retirees material modifications. ■ Health and Welfare SNET Active Bargaining Unit Employee Benefits Plans Health Plan – SNET Point-of-Service ■ Pension Plans AT&T Umbrella SNET Bargaining Unit Retiree Health AT&T Pension Benefit Plan Benefit Plan No. 1 Plan – SNET Point-of-Service, SNET Medical Plan for Retirees and SNET AT&T Legacy Bargained Program MEDICAL PROGRAMS Medical Expense Plan AT&T Legacy Management Program Ameritech Management Umbrella SNET Management Retiree Health Bargained Cash Balance Program Welfare Benefit Plan – Ameritech Plan – SNET Point-of-Service, SNET Medical Expense Plan Medical Plan for Retirees and SNET Bargained Cash Balance Program #2 Ameritech Non-Management Medical Expense Plan East Program Umbrella Welfare Benefit Plan – DENTAL PROGRAMS Management Cash Balance Program Ameritech Comprehensive Health Care Plan and Ameritech Medical Ameritech Non-Management Midwest Program Expense Plan Umbrella Welfare Benefit Plan – Ameritech Dental Expense Plan Midwest Publishing Ventures Program AT&T CarePlus – A Supplemental Medical Plan AT&T Corp. Postretirement Welfare Mobility Bargained Program Benefits Plan AT&T ConsumerWise Medical Program Mobility Program AT&T Dental Expense Plan for Nonbargained Program AT&T Corp. Postretirement Welfare Active Employees Benefits Plan Southeast Management Program AT&T Dental Plan AT&T International Health Plan Southeast Program AT&T International Health Plan AT&T Medical & Group Life Insurance Southwest Program Plan – CustomCare BellSouth Medical Assistance Plan - The BellSouth Dental Assistance West Program AT&T Medical Expense Plan for Plan Occupational Employees AT&T Puerto Rico Pension Benefit Plan BellSouth Retiree Medical Assistance AT&T Legacy Bargained Program AT&T Medical Plan Plan -The BellSouth Retiree Dental Assistance Plan AT&T Legacy Management Program AT&T of Puerto Rico, Inc. Group Health Coverage Plan Cingular Wireless Health and Mobility Program BellSouth Medical Assistance Plan Welfare Benefits Plan for Bargained Employees - Cingular Wireless Dental Plan for Bargained Employees Pacific Telesis Group Dental Expense Plan
Page 24 Where to Go for More Information | 2012 APPENDIX: AFFECTED BENEFITS PLANS, POLICIES AND PROGRAMS
SNET Active Bargaining Unit Employee DISABILITY PROGRAMS Legacy AT&T Disability Benefits Health Plan – SNET Dental Plan AT&T Disability Income Program Program (formerly the AT&T Long Term Disability Plan for Occupational SNET Bargaining Unit Retiree Health (formerly the Southwestern Bell Employees, the AT&T of Puerto Rico Plan – SNET Dental Plan Corporation Long Term Disability Benefit Plan, the Southwestern Bell Sickness and Accident Disability VISION PROGRAMS Corporation Long Term Disability Plan Benefit Plan for Occupational Ameritech Vision Care Program for Salaried Employees, and the Employees, the AT&T of Puerto Rico Southwestern Bell Corporation Long Term Disability Plan for AT&T International Health Plan Sickness and Accident Disability Occupational Employees, and the AT&T of Puerto Rico, Inc. Benefit Plan) AT&T Sickness and Accident Disability Group Health Coverage Plan Benefit Plan for Occupational AT&T Disability Income Program for Employees) AT&T Vision Care Program Bargained Employees AT&T Umbrella AT&T Vision Program AT&T Disability Income Program for Benefit Plan No. 2 Southwest Bargained Employees BellSouth Vision Assistance Program EMPLOYEE ASSISTANCE PROGRAM AT&T East Disability Benefits Program Cingular Wireless Health and AT&T Employee Assistance Plan AT&T Midwest Disability Benefits Welfare Benefits Plan for Bargained VISION PROGRAM Employees - Cingular Wireless Program (formerly the Ameritech Long Vision Program Term Disability Plan and the Ameri- AT&T Retiree Vision Care Program tech Sickness and Accident Disability LIFE INSURANCE PROGRAMS Pacific Telesis Group Vision Benefit Plan) Care Program Ameritech Supplementary AT&T Mobility Disability Benefits Life Insurance Plan SNET Vision Program Program LIFE INSURANCE PROGRAMS AT&T Dependent Group Life AT&T Mobility Disability Benefits Insurance Program Ameritech Group Life Insurance Plan Program for Southwest Bargained AT&T Special Accidental Death Policy AT&T Corp. Postretirement Welfare Employees (formerly the Cingular Benefits Plan Wireless Disability Benefits Plan for AT&T Special Accidental Loss Bargained Employees) Insurance Plan AT&T Medical & Group Life Insurance Plan – Group Life Insurance AT&T Southeast Disability Benefits AT&T Supplementary Group Program (formerly the BellSouth Long Life Insurance Program BellSouth Group Life Plan Term Disability Plan for Non-Salaried Employees and the BellSouth Short AT&T Supplementary Life Cingular Wireless Health and Term Disability Plan) Insurance Plan Welfare Benefits Plan for Bargained Employees AT&T Southeast Disability Benefits The BellSouth Special Program for Special Represented Accidental Death Plan Cingular Wireless Health and Welfare Employees Benefits Plan for Non-Bargained LONG-TERM CARE INSURANCE PROGRAMS Employees AT&T West Disability Benefits Program AT&T Consolidated Long-Term Care (formerly the Pacific Telesis Group L.M. Berry and Company Health & Insurance Plan Comprehensive Disability Benefits Accident, Weekly Indemnity, Long- Plan, the Pacific Telesis Group Long AT&T Group Long-Term Care Term Disability, Dental Benefits & Term Disability Plan and the Pacific Insurance Plan Retired Lives Plan Telesis Group Sickness and Accident Pacific Telesis Group Basic & Disability Benefit Plan) Supplemental Death Benefit Plan SNET Retiree Life Insurance Plan
2012 | Where to Go for More Information Page 25 APPENDIX: AFFECTED BENEFITS PLANS, POLICIES AND PROGRAMS
■ Flexible Spending Account ■ Employee Discounts & Offers ■ Voluntary Benefit Program Plan AT&T High Speed Internet Marsh PersonalPlans AT&T Flexible Spending Account Plan AT&T Management 9 State In-Region ■ Work/Life Program Voice Discount Policy LifeCare Benefits, Policies and Programs AT&T Management 13 State In-Region Not Subject to ERISA Voice Discount Plan Pension and Savings Plans This document is not a summary of AT&T Out-of-Region Voice Discount Plan Not Sponsored by AT&T material modifications for the following employee benefits, policies AT&T U-verse and DIRECTV Employee Some AT&T employees and retirees or programs because they are not Discounts Terms and Conditions participate in pension and savings subject to ERISA. This document is plans that are sponsored by unions, AT&T Wireless - Employee Mobility Offer provided for your information and not the Company. Therefore, this (EMO) review; no other action is necessary. document is not a summary of AT&T Wireless - Employee Mobility material modifications for the follow- ■ Adoption Reimbursement Premier ing plans. Summary plan descriptions, SMMs and other documents required AT&T Adoption Reimbursement Program AT&T Wireless - Employee Mobility Rate by ERISA are the responsibility of, and Plan (ERP) will be sent directly from, the plan Cingular Wireless Adoption Assistance sponsor, not AT&T. This document is Program Legacy AT&T Non-management Tele- phone Concession Plan provided for your information and ■ Commuter Benefits review; no other action is necessary. Legacy BellSouth Employee Telephone AT&T Commuter Benefit Program Concession Program The contents of this document for the ■ Company Leaves of Absence Legacy SBC East Region Telephone following plans are subject to change Concession Program for Residential AT&T Leave of Absence Policy without notice from AT&T: Service AT&T Mobility Bargained Edge Leave Alaska Electrical Health & Welfare Fund Legacy SBC Midwest Region Telephone of Absence Policy Concession Highlights for Residential Alaska Electrical Pension Plan AT&T Mobility Bargained Leave of Service Alaska Electrical Workers Money Absence Policy for Bargained Legacy SBC Southwest Telephone Purchase Pension Plan Employees in District 6 Concession Policy Program National Electrical Benefit Fund AT&T Southeast Leave of Absence Policy Legacy SBC West Telephone Concession The IBEW Local Unions Savings and Legacy AT&T Occupational Employee Highlights for Residential Service Security Plan Leaves of Absence Policy Limited Time Employee Offers (LTD) Midwest Leave of Absence Policy Other Discount Programs and Offers West Leave of Absence Policy Preferred Customer Discount Program SNET Leaves of Absence Policy (PCDP)
Page 26 Where to Go for More Information | 2012 AT&T Inc. and Participating Companies
Human Resources-Benefits P.O. Box 460582 St. Louis, MO 63146
Forwarding Service Requested NIN: 78-24049