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How the Prescription Drug Benefit Works Introduction ORNL BENEFITS PO Box 2008, MS 6465 Oak Ridge, TN 37831-6465 (865) 576-7766 | [email protected] July 2020 Dear Active Employee: Your Benefits Summary Plan Description (SPD) outlines the benefits available to you as an active employee. Because of the many legal and plan design changes, the SPD has now been updated with current plan information. The employee SPD is available to view or download at https://benefits.ornl.gov/employee- book-of-benefits-atlc/. You may also request a free CD or print copy by contacting [email protected]. Please discard the older versions of Your Book of Benefits issued as a three-ring binder or CD and refer to the most current Web-based edition. If you have any questions or need assistance, you may access the ORNL Benefits website at https://ornl.sharepoint.com/sites/benefits/ or contact the ORNL Benefits Service Center at 1-800-211-3622. Sincerely yours, G. Scott McIntyre Manager, Employee Benefits 1/1/2020 UT-B Introduction i ACTIVE—IGUA CAS This Notice applies only to UT-Battelle, LLC’s group health plan and any health program that receives financial assistance from the Department of Health and Human Services UT-Battelle, LLC (UT-Battelle) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. UT-Battelle does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. • UT-Battelle: o Provides free aids and services to people with disabilities to communicate effectively with us, such as: . Qualified sign language interpreters . Written information in other formats (large print, audio, accessible electronic formats, other formats) o Provides free language services to people whose primary language is not English, such as: . Qualified interpreters . Information written in other languages If you need these services, contact Deborah Bowling, Civil Rights Coordinator, P.O. Box 2008, MS 6217, Oak Ridge, TN 37831-6217, Telephone - 865-574-9846. If you believe that UT-Battelle has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Deborah Bowling, Civil Rights Coordinator, P.O. Box 2008, MS 6217, Oak Ridge, TN 37831-6217, Telephone - 865.574.9846, Fax - 865.574.4441, Email - [email protected]. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Deborah Bowling, Civil Rights Coordinator is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 1.800.368.1019, 800.537.7697 (TDD) Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html. Introduction UT-B 1/1/2020 ACTIVE—IGUA CAS ii Tagline Informing Individuals with Limited English Proficiency of Language Assistance Services Spanish ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1.865.574.9846. Arabic ﻣﻠﺤﻮظﺔ: إذا ﻛﻨﺖ ﺗﺘﺤﺪث اذﻛﺮ اﻟﻠﻐﺔ، ﻓﺈن ﺧﺪﻣﺎت اﻟﻤﺴﺎﻋﺪة اﻟﻠﻐﻮﯾﺔ ﺗﺘﻮاﻓﺮ ﻟﻚ ﺑﺎﻟﻤﺠﺎن. اﺗﺼﻞ ﺑﺮﻗﻢ 1.865.574.9846 (رﻗﻢ ھﺎﺗﻒ اﻟﺼﻢ واﻟﺒﻜﻢ: . Chinese 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1.865.574.9846。 Vietnamese CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1.865.574.9846. Korean 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1.865.574.9846 번으로 전화해 주십시오. French ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1.865.574.9846. Laotian ໂປດຊາບ: ຖ້ າວ່ າ ທ່ ານເວົ້ າພາສາ ລາວ, ການໍບິລການຊ່ ວຍເຫືຼ ອດ້ ານພາສາ, ໂດຍບໍ່ ເສັ ຽຄ່ າ, ແ ມ ່ ນ ມີ ພ້ ອມໃຫ້ ທ່ ານ. ໂທຣ 1.865.574.9846. Amharic ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉም እርዳታ ድርጅቶች፣ በነጻ ሊያግዝዎት ተዘጋጀተዋል፡ ወደ ሚከተለው ቁጥር ይደውሉ 1.865.574.9846. German ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1.865.574.9846. 1/1/2020 UT-B Introduction iii ACTIVE—IGUA CAS Gujarati �ચનાુ : જો તમે �જરાતીુ બોલતા હો, તો િન:�쫍કુ ભાષા સહાય સેવાઓ તમારા માટ� ઉપલ닍ધ છે. ફોન કરો 1.865.574. 9846. Japanese 注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。 1.865.574.9846 まで、お電話にてご連絡ください。 Tagalog PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1.865.574.9846. Hindi 鵍यान द�: य�द आप �हंद� बोलते ह� तो आ प के �लए मु굍त म� भाषा सहायता सेवाएं उपल녍ध ह�। 1.865.574.9846 पर कॉल कर�। Russian ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1.865.574.9846. Persian (provided in Farsi language) ﺗﻮﺟﮫ: اﮔﺮ ﺑﮫ زﺑﺎن ﻓﺎرﺳﯽ ﮔﻔﺘﮕﻮ ﻣﯽ ﮐﻨﯿﺪ، ﺗﺴﮭﯿﻼت زﺑﺎﻧﯽ ﺑﺼﻮرت راﯾﮕﺎن ﺑﺮای ﺷﻤﺎ ﻓﺮاھﻢ ﻣﯽ ﺑﺎﺷﺪ. ﺑﺎ 1.865.574.9846 ﺗﻤﺎس ﺑﮕﯿﺮﯾﺪ. Introduction UT-B 1/1/2020 ACTIVE—IGUA CAS iv Contents Introduction .................................................................................................................. i 1 About Your Benefits .......................................................................................... 1—1 Highlights ..............................................................................................................1—2 Eligibility and Enrollment .......................................................................................1—3 Employee ...........................................................................................................................................1 —3 Dependents ........................................................................................................................................1 —3 Special Eligibility Rules for Families ................................................................................................... 1—4 When You May Enroll .........................................................................................................................1 —4 When You May Change Your Elections .............................................................................................. 1—7 When Coverage Begins ........................................................................................1—8 New Hires ...........................................................................................................................................1 —8 Current Employees .............................................................................................................................1 —8 Changes at Other Times .......................................................................................1—9 Qualifying Life Events .........................................................................................................................1 —9 How Changes Affect Your Benefits ..................................................................... 1—11 Steps to Take If You Get Married or Divorced .................................................................................. 1—11 Steps to Take If You Are Expecting or Adopting a Child ................................................................... 1—12 Steps To Take If You Become Disabled ........................................................................................... 1—13 What Happens to Your Benefits If You Become Disabled ................................................................. 1—13 Steps to Take If You Leave the Company ........................................................................................ 1—15 What Happens to Your Benefits If You Leave the Company ............................................................. 1—15 What Happens to Your Benefits When You Turn Age 65 .................................................................. 1—16 Steps to Take If You Retire............................................................................................................... 1—17 What Happens to Your Benefits If You Retire ................................................................................... 1—17 Steps to Be Taken If You or a Family Member Dies ......................................................................... 1—19 What Happens to Your Benefits If You Die ....................................................................................... 1—20 Paying for Your Benefits ..................................................................................... 1—21 Rights and Responsibilities............................................................................................................... 1—21 When Coverage Ends ......................................................................................... 1—23 Coverage for You ............................................................................................................................. 1—23 Coverage for Your Dependents ........................................................................................................ 1—23 Glossary ............................................................................................................. 1—24 2 Medical Plans ..................................................................................................... 2—1 Choice Plus and Choice Preferred Medical Plans Overview ................................................... 2—2
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