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Action Center
2017 Annual Enrollment
Posted On: Oct 25, 2016

2017 Annual Enrollment

November 7 – November 18

Mid-Atlantic Active CWA

Investing

together

for a

healthier

you.

Your benefits.

Investing together

for a healthier you.

This guide reflects the terms that were agreed upon in

the 2016 labor contracts. Read it carefully to ensure you

are aware of what is changing on January 1, 2017.

This is your opportunity to review and update coverage elections to ensure the

health and insurance coverages you have are what you and your family need

for the upcoming year. Please make this a priority, and take advantage of the

decision tools we provide to select the options that best meet your needs.

Enrollment is simple

If you’re keeping the same coverages, then you’re good to go. Your current

medical (including prescription drug), dental, vision, life insurance, accidental

death and dismemberment, and disability coverage will automatically continue

for 2017. Also, your tobacco user status, Health Assessment credit, and

spending account contributions will automatically carry over into 2017. If you

wish to make any changes, then you must complete an active election on

BenefitsConnection as part of Annual Enrollment. If you have questions or

need assistance, you can call the Verizon Benefits Center at 855.4VzBens

(855.489.2367). Representatives are available 9 am to 5 pm, Eastern time.

Review this guide to be sure you understand your coverage options,

contributions, and any plan changes for 2017.

2017 Annual Enrollment

Annual Enrollment opens November 7 and closes

November 18 at midnight Eastern time.

Start

here

Take the next step to review or

update your coverage:

BenefitsConnection

We provide you 24/7 access to information and

tools for managing your Verizon benefits.

Using any mobile device or computer, it’s easy to

find and easy to use, accessible through About

You or at verizon.com/BenefitsConnection.

Log on to BenefitsConnection through About You or

at verizon.com/BenefitsConnection

Review your current elections From the home page,

under My benefits > Health & Insurance, select View

This Year’s Coverage

Review your 2017 options From the home page, under

My benefits > Health & Insurance, select View Next

Year’s Coverage

Estimate your health care costs From the home page,

under I want to, select See Next Year’s Health Plan

Comparison Charts

Visit the Library page for more information about

your benefit plans From the home page, select Library

Take or update the Health Assessment

From the home page, under I want to, select

Take My Health Assessment

Make election changes, update tobacco user status,

add or drop dependents and verify your beneficiaries

From the home page, in the Annual Enrollment section

under Suggestions for you, select Enroll Now

2017 Annual Enrollment: 4 November 7 – November 18

Adding a dependent to coverage

When adding a dependent to coverage during Annual Enrollment, or at any

time during the year, you will need to provide documentation to verify eligibility.

Instructions for completing the dependent verification will be sent to your work

e-mail and home address on file after you have enrolled your dependent.

To enroll a spouse of any gender into coverage during Annual Enrollment, or as

a result of a qualified life event, follow the prompts to add a new dependent and

select spouse as the dependent relationship.

If appropriate documentation is not submitted in a timely manner, your

dependent will be dropped from coverage.

If you have questions about eligibility, please refer to your SPD.

Having an ineligible dependent enrolled on your Verizon coverage may result

in disciplinary action.

Learn more about it

To estimate your health care costs and compare plan options, from the

BenefitsConnection home page, under I want to, select See Next Year’s

Health Plan Comparison Charts. From there, as an active employee you

can also use the My Spending Account Calculators feature to estimate

how much money to contribute to your Health Care Spending Account.

From the BenefitsConnection home page, under I want to, select See

Next Year’s Health Plan Comparison Charts > My Spending Account

Calculators.

To compare your dental plan options, from the BenefitsConnection home

page, under I want to, select See Next Year’s Health Plan Comparison

Charts, then select My 2017 Dental Plan Options.

For more detailed information on your benefit plans, including Summary

Plan Descriptions (SPDs) and vendor contact information, visit the

Library page on BenefitsConnection.

Qualified life events prior to 2017

If you have a qualified life event (QLE) between now and the end of the year, you

will need to make any necessary changes on BenefitsConnection for both 2016

and 2017.

Remember:

Annual Enrollment is generally the only time during the year when

changes can be made to coverage, unless you have a qualified life

event such as the birth of a child or marriage. For information on what

constitutes a qualified life event, please refer to your SPD.

Want more information? Please refer to your SPD. 5

Dependent coverage age limit

Medical

A dependent child is eligible for medical coverage (including prescription drug)

through the end of the month in which he/she attains age 26 regardless of

student status. Coverage may be extended beyond age 26 for a dependent child

who meets the conditions of being disabled.

Dental and vision

In order for a dependent child to be eligible for dental and vision after the end

of the calendar year in which he/she reaches age 19, he/she must be a full-time

student at an accredited institution, or meet the conditions of being disabled.

Dental and vision coverage can continue through the end of the calendar

year in which a dependent child reaches age 25 as long as the child maintains

full-time student status. If the child is between the ages of 19-25 and is not a

full-time student, and does not meet the conditions of being disabled, you must

remove him/her from dental and vision coverage during Annual Enrollment. If

you would like to continue coverage for your dependent(s) through COBRA,

please contact the Verizon Benefits Center at 855.4VzBens (855.489.2367)

by December 30, 2016.

Similar to last year, Verizon will work with the National Student Clearinghouse

in early 2017 to confirm student eligibility for dependents between the ages of

19 and 25 that are enrolled in dental and/or vision coverage. If full-time student

status cannot be verified, instructions will be sent to your work e-mail and

home address on file. If you do not comply with the instructions provided, your

dependent will be dropped from dental and/or vision coverage.

Child life insurance and AD&D insurance

Effective January 1, 2017, you may cover a dependent child for child life insurance

up to the end of the month in which the child attains age 26 regardless of student

status. Coverage may be extended beyond age 26 for a dependent child who

meets the conditions of being disabled.

The child life insurance and AD&D insurance plans cover all of your eligible

dependent children. You are responsible for updating your election if your

previously eligible dependents no longer meet these eligibility requirements.

6 2017 Annual Enrollment: November 7 – November 18

Plan provision

Deductible

Out-of-pocket

maximum: Innetwork

and

out-of-network

Emergency

room

As of August 1, 2016

Individual: $100 in-network

and out-of-network combined,

plus an additional $650 outof-

network

Employee + 1 or More: 2.5

times the individual deductible

amount; an individual will never

need to exceed his or her own

individual amount

Individual: $1,200 in-network

and out-of-network combined,

plus an additional $800 outof-

network

Employee + 1 or More: 2.5

times the individual out-ofpocket

maximum amount;

an individual will never need

to exceed his or her own

individual amount

$100 copay (waived if

admitted)

2017

Individual: $125 in-network

and out-of-network combined,

plus an additional $650 outof-

network

Employee + 1 or More: 2.5

times the individual deductible

amount; an individual will never

need to exceed his or her own

individual amount

Individual: $1,250 in-network

and out-of-network combined,

plus an additional $800 outof-

network

Employee + 1 or More: 2.5

times the individual out-ofpocket

maximum amount;

an individual will never need

to exceed his or her own

individual amount

$110 copay (waived if

admitted)

At a glance – MCN

Medical coverage

For 2017, you will continue to have a choice of the MCN and MEP PPO medical

plan options. There are some changes to your deductibles, out-of-pocket

maximums, and emergency room copay amounts. Please refer to the following

charts for details. The EPO medical plan option will continue to be available to

those currently enrolled in it.

If an HMO is currently available to you, it will continue to be available to you

in 2017 as long as you live in a zip code where the HMO is offered. See the

Important changes to your plan section of this guide for details. If you

have a change in address, please review the options available to you on

BenefitsConnection.

If you participate in an HMO or the EPO medical plan option, your emergency

room copay amount will be $110 in 2017 (waived if admitted).

Want more information? Please refer to your SPD. 7

Plan provision

Deductible

Out-of-pocket

maximum: Innetwork

and

out-of-network

Emergency

room

As of August 1, 2016

Individual: $525 in-network

and out-of-network combined,

plus an additional $225 out-ofnetwork

Employee + 1 or More: 2.5

times the individual deductible

amount; an individual will never

need to exceed his or her own

individual amount

Individual: $1,300 in-network

and out-of-network combined,

plus an additional $900 outof-

network

Employee + 1 or More: 2.5

times the individual out-ofpocket

maximum amount;

an individual will never need

to exceed his or her own

individual amount

$100 copay (waived if

admitted)

2017

Individual: $550 in-network

and out-of-network combined,

plus an additional $225 out-ofnetwork

Employee + 1 or More: 2.5

times the individual deductible

amount; an individual will never

need to exceed his or her own

individual amount

Individual: $1,350 in-network

and out-of-network combined,

plus an additional $900 outof-

network

Employee + 1 or More: 2.5

times the individual out-ofpocket

maximum amount;

an individual will never need

to exceed his or her own

individual amount

$110 copay (waived if

admitted)

At a glance – MEP PPO

Amounts paid toward the deductible apply toward the out-of-pocket maximum.

Under the Affordable Care Act, additional out-of-pocket cost protection applies

to your medical, including prescription drug, in-network out-of-pocket maximum.

See the Important changes to your plan section of this guide for details.

To ensure you have the medical coverage that best meets your needs, we

provide some useful tools on BenefitsConnection to help you make those

important choices, such as Health Plan Comparison Charts to estimate your

health care costs and compare plan options.

As an active employee, you may also want to consider enrolling in or increasing

contributions to the Health Care Spending Account to take advantage of pre-tax

savings. Please refer to the Spending accounts section of this guide for more

details.

For more information about the medical plan, please refer to your SPD.

8 2017 Annual Enrollment: November 7 – November 18

Prescription drug coverage

The medical plan options discussed above continue to include prescription drug

coverage through Express Scripts. There are no changes to the cost sharing

features of your prescription drug coverage in 2017.

Under the Affordable Care Act, additional out-of-pocket cost protection applies

to your medical, including prescription drug, in-network out-of-pocket maximum.

There are also some changes in service coverage you may want to review. See

the Important changes to your plan section of this guide for further details.

Be in the know about how you can save.

Save time and money by taking a few small steps when it comes to your

prescriptions.

Choose generic drugs over brand-name when available. They are typically less

expensive and have the same active ingredients as brand-name drugs. Also, if

you have long-term prescriptions that you fill regularly, sign up for mail order,

saving you both time and money.

You can access Express Scripts information directly on BenefitsConnection.

From the home page, select Library. Under Prescription (Rx), select Access

Express Scripts.

For more information about your prescription plan, log on to express-scripts.com

or scan the QR code below. Here, you can research lower cost alternatives

for prescriptions you take regularly using MyRXChoices, transfer long-term

prescriptions from a retail pharmacy to mail order (home delivery), and compare

the cost of medications at retail versus mail order using the “price a medication”

tool.

Take ten minutes

If you are an active employee and haven’t already taken the Health

Assessment in the past, take ten minutes of your time now and you can

save $100 in medical coverage contributions for the upcoming year (prorated

if you take after Annual Enrollment). Plus, you’ll receive a detailed

report about your personal health risk factors and a plan to reduce or

eliminate them. If you took the Health Assessment prior to 2016, we

encourage you to update it annually to receive valuable information about

your current health status, as your health risks can change at any time. To

access the Health Assessment, from the BenefitsConnection home page,

under I want to, select Take My Health Assessment. See the Important

legal notices section of this guide for information that applies to the

Health Assessment.

Access the Express Scripts mobile app

by scanning the QR code.

Want more information? Please refer to your SPD. 9

2017 medical plan costs

Your medical plan option contributions are changing. Below are the monthly

medical plan contribution amounts effective for 2017.

Contribution amounts for other medical plan options, including COBRA

continuation coverage, that may be available to you can be viewed on

BenefitsConnection.

1 Contributions are based on employees scheduled to work 25 or more hours per week. If

you are scheduled to work less than 25 hours per week, please visit BenefitsConnection

for your contribution amounts. If you have not already done so, you can reduce your

medical plan option contributions by completing an online Health Assessment and

certifying that you and your covered dependents do not use tobacco products. See

Other important information for more details about the non-tobacco user credit.

Non-tobacco user credit?

Completed Health Assessment?

Employee Only (monthly)

Employee + 1 or More (monthly)

Non-tobacco user credit?

Completed Health Assessment?

Employee Only (monthly)

Employee + 1 or More (monthly)

Yes

Yes

$88.00

$176.00

Yes

No

$96.33

$184.33

No

Yes

$138.00

$226.00

No

No

$146.33

$234.33

Yes

Yes

$132.00

$264.00

Yes

No

$140.33

$272.33

No

Yes

$182.00

$314.00

No

No

$190.33

$322.33

MCN and MEP PPO1

EPO and HMOs (HMOs will be no greater than the amounts in the chart)1

10 2017 Annual Enrollment: November 7 – November 18

Emergency room alternatives

If you need emergency care, be sure to go to the emergency room or dial 911.

However, if you want or need immediate care but don’t have a true emergency,

where can you go?

There are plenty of choices, including retail health clinics, local urgent care

centers, or walk-in doctor’s offices. With these options, you’ll likely get quicker

and less costly service than trying to schedule an appointment with your

primary doctor.

Emergency room visits can cost 4-6 times more than a doctor’s office, retail

health clinic, or urgent care facility visit. For example, the copay for a primary

care or specialist physician visit, or for an urgent care facility visit, is in the

$25 to $30 range, whereas the copay for an emergency room visit will be

$110 in 2017.

Let’s explore the options.

You can find more information through BenefitsConnection on WellConnect.

From the BenefitsConnection home page, select VISIT WellConnect > My

Healthy Living > Wise Care.

Make the right choice for you and your family to get the care you need,

when you need it.

Service choice

Retail health

clinic

Walk-in doctor’s

office

Urgent care

centers

What they can do

Many major pharmacies and retail stores now offer walk-in

clinics where you can get routine medical care like flu shots or

tend to a bad cough, sore throat, or ear ache.

Here, you don’t have to be an existing patient and appointments

are not required. This is great for quick medical attention for

symptoms such as asthma, a sprain, or nausea.

Staff here can help with larger medical issues that need

immediate attention but are not life-threatening, such as animal

bites, stitches, sprains, and x-rays.

Want more information? Please refer to your SPD. 11

Dental coverage and plan costs

Verizon offers two dental plan options so you can choose the plan that meets

your needs.

If you’d like to review your dental plan options and related plan costs (including

the cost for COBRA continuation coverage), from the BenefitsConnection home

page, under I want to, select See Next Year’s Health Plan Comparison Charts

then select My 2017 Dental Plan Options. For more information about the dental

plan, please refer to your SPD.

No medical, dental, and/or vision coverage

If you are currently an active employee in No Coverage for medical, dental

and/or vision, and you make no changes during this Annual Enrollment, your

No Coverage election for medical, dental and/or vision will carry over for 2017.

Please note: Verizon’s medical coverage meets the definition of Minimum

Essential Coverage (MEC), which is the type of coverage that can help you avoid

a penalty under the Affordable Care Act’s individual mandate. If you want to enroll

in MEC and currently have No Coverage, you must make an affirmative election.

If you have coverage today and would like to waive coverage for 2017, you need

to choose No Coverage during Annual Enrollment. If you choose No Coverage,

you cannot enroll in coverage during the year unless you have a qualified life

event or as otherwise required by law. Please refer to your SPD for guidelines on

qualified life events.

Life and Accidental Death &

Dismemberment (AD&D) Insurance

Take the time to assess your current life and AD&D needs. They can change from

year to year, especially if your family dynamics or lifestyle has changed.

Verify your beneficiary information

It’s important to verify that your beneficiary information on BenefitsConnection

is both accurate and up to date. In the event of your death, the insurance plan

administrator will pay proceeds based on your beneficiary information on record.

Supplemental life insurance rates

The rates for an active employee with supplemental life insurance and spouse life

insurance are based on age ranges. As you and your spouse age and fall into a

new age band, your costs could increase. Your costs for 2017 are based on age

as of December 31, 2017.

12 2017 Annual Enrollment: November 7 – November 18

Spending accounts

A spending account is a great way to save money by contributing pre-tax dollars

to pay for out-of-pocket eligible health care and dependent day care expenses,

and lower your taxable income.

You cannot modify your spending account election during the year unless you

have certain qualified life events. So, be sure you’ve taken a close look at your

2017 needs to see if you should make any spending account election changes.

Please refer to your SPD for guidelines on qualified life events.

For 2017, the annual maximum contribution amounts are as follows:

• Health Care Spending Account: $2,500

• Dependent Day Care Spending Account: $5,000

As an active employee, unless you make an active election to change your

contributions, your 2016 elections will automatically carry over to 2017. If you

are an active employee considering changing the amount you contribute,

you may want to use the My Spending Account Calculators feature on

BenefitsConnection. From the BenefitsConnection home page, under I want to,

select See Next Year’s Health Plan Comparison Charts > My Spending Account

Calculators.

Important note: According to IRS regulations, you must use all the money in your

account each plan year for eligible expenses or it will be forfeited. Verizon offers

a 2-1/2 month grace period that allows you to incur expenses until March 15 of

the following plan year. You have until May 31 of the current plan year to submit

claims from the prior plan year. Please see your SPD for details.

COBRA Health Care Spending Account (HCSA)

If you are currently contributing to a COBRA HCSA, you can continue to

contribute through the end of the calendar year (December 31, 2016) of your

COBRA qualifying event. However, you cannot elect a COBRA HCSA for the

2017 plan year. Remember, you must submit all claims by the claim filing deadline

of May 31, 2017 or it will be forfeited.

Confirmation statement

You can confirm your current election information online at any time, 24/7, on

BenefitsConnection from any mobile device or computer, so you can go green

and stay green.

Still want a paper confirmation statement? Simply log on to BenefitsConnection

from About You or at verizon.com/BenefitsConnection. From the home page,

under My benefits > Health & Insurance, select View Next Year’s Coverage, then

select Print in the upper-right corner.

You can also request a confirmation statement be mailed to you by calling the

Verizon Benefits Center.

Want more information? Please refer to your SPD. 13

Retiree medical contributions

Medical plan contributions

Your contributions depend on your retirement date, your net credited service

date, and the medical plan option you select.

For all retirees who retired after December 31, 1989 with a net credited

service date before August 3, 2008

The 2012 labor contracts provide for limits on the amount the Company will

contribute toward retiree medical coverage in 2016 and later plan years. These

limits are referred to as retiree medical caps which are listed below. The retiree

medical caps limits were not changed by the 2016 labor contracts.

In the 2017 plan year, the cost of coverage of each of the Medicare plan options

is less than the applicable retiree medical caps. In addition, the cost of coverage

of the MCN and MEP PPO pre-Medicare medical plan options is less than the

applicable retiree medical caps. The cost of coverage of some Mid-Atlantic pre-

Medicare HMO options exceeds the applicable retiree medical caps; for each

such option the excess amount over the applicable retiree medical caps is less

than the annual minimum contribution.

In addition, the cost of coverage of certain out-of-area HMOs exceeds the

applicable retiree medical caps in 2017.

Consistent with the labor contracts and the previously described provisions,

the 2017 retiree medical contributions that are payable each month for post-

12/31/1989 retirees are as follows:

Retired before 1/1/13

$0

$0

$0

Retired on or after

1/1/13

$39.33

$67.42

$67.42

2017 pre-Medicare MEP PPO and MCN monthly retiree contributions

Coverage category

Retiree Only

Retiree + 1

Retiree + Family

Pre-Medicare

$12,580

$25,160

$31,450

Medicare-eligible

$6,330

$12,660

$18,990

Retiree medical caps

Coverage category

Retiree Only

Retiree + 1

Retiree + Family

14 2017 Annual Enrollment: November 7 – November 18

EPO

$132.00

$200.00

$264.00

Other Mid-Atlantic

HMOs (Varies by plan

option)

$110.00 - $123.20

$166.67 - $186.67

$220.00 - $246.40

2017 pre-Medicare EPO and HMO monthly retiree contributions

Coverage category

(Retired before, on,

or after 1/1/13)

Retiree Only

Retiree + 1

Retiree + Family

1Effective January 1, 2017, the MCN Advantage Plan option replaces the MEP PPO plan

option and the MCN plan option.

Coverage

category

Retiree Only

Retiree + 1

Retiree + Family

$0

$0

$0

$20.00 - $40.00

$34.00 - $64.00

$34.00 - $64.00

2017 Medicare-eligible monthly retiree contributions

MCN Advantage Plan1 HMOs

Want more information? Please refer to your SPD. 15

In plan years after 2017, additional plan options may exceed the applicable retiree

medical caps and require contributions pursuant to the caps. If you would like

more information about the retiree caps and how they affect retiree contributions,

visit the Library page on BenefitsConnection. From there, under Documents for

all retirees > Medical/Prescription within the SPD section, select the Retiree

Medical Contributions Supplemental Guide.

For retirees with a net credited service date of August 3, 2008 or later (and

did not previously qualify for Company-provided retiree medical benefits)

For the 2017 plan year, the Company will provide the following contributions

toward the cost of retiree medical coverage for eligible retirees:

Not eligible for Medicare: $480 for each full year of net credited service that

commences on or after August 3, 2008, up to a maximum of 30 years.

Medicare-eligible: A reduced amount that is not less than half of the amount

provided for pre-Medicare retirees with the same net credited service.

Additional information

Please remember that to be eligible for retiree medical benefits, you

must meet applicable retirement eligibility requirements (30 years of

net credited service; 25 years at age 50; 20 years at age 55; 15 years

at age 60 or 10 years at age 65). Please also remember that retiree

medical benefits are subject to change in the future.

16 2017 Annual Enrollment: November 7 – November 18

Important changes to your plan

Changes to the Affordable Care Act maximums

As required by the Affordable Care Act, your total in-network out-of-pocket costs

in 2017, including copays and prescription drug expenses under the medical

plan options available to you, will not exceed $7,150 for individual coverage and

$14,300 for family coverage. The individual in-network out-of-pocket maximum

required by the Affordable Care Act applies to expenses incurred by each

individual covered by the plan, regardless of whether the individual is covered

under self-only coverage or other-than-self-only coverage (for example, family

coverage). Your underlying medical plan’s out-of-pocket maximums are not

affected by the change, and copays and prescription drug expenses will not

apply toward such amounts.

Preventive care updates to the medical plan, including

prescription drug options

Your medical options must offer certain preventive care benefits to you innetwork

without cost sharing. Under the Affordable Care Act, the medical plans

generally may use reasonable medical management techniques to determine

frequency, method, treatment, or setting for a recommended preventive care

service.

Additional updates have been made to the preventive care benefits that must

be offered without cost sharing, including (but not limited to) clarification

on services related to lactation counseling, obesity screening for adults,

additional details on colonoscopies (including a specialist consultation before

the procedure, coverage for a pathology exam on a polyp biopsy, and bowel

preparation medication), and additional details on coverage for breast cancer

genetic counseling. Contact the Verizon medical plan option or prescription drug

administrator, such as Express Scripts, for more details.

Important change to domestic-partner coverage

If you currently cover a same-sex domestic partner for one or more employee

benefits in the 2016 plan year, you must be married and provide proof of marriage

by December 31, 2016 in order to continue coverage of your domestic partner

effective January 1, 2017. Proof of marriage in the form of a government issued

marriage certificate must be sent by December 31, 2016 (postmark date) to:

Verizon Benefits Center

P.O. Box 8998

Norfolk, VA 23501-8998

If you do not act as noted above, your domestic partner will be dropped from

your medical and/or dental coverage effective January 1, 2017. Your domestic

partner will receive a COBRA Continuation Coverage Election Notice that

includes the 2017 COBRA rates after January 1, 2017, explaining his/her

entitlement to continued coverage under COBRA due to loss of dependent

status.

Wellness disclaimer

The Verizon group health

plans are committed to

helping you achieve your

best health. Your Verizon

group health plan offers

the opportunity to qualify

for lower contributions

for non-tobacco users

(a non-tobacco user

credit), which is a wellness

program. If you think you

might be unable to meet

a standard for a reward

under this wellness

program, you might qualify

for an opportunity to

earn the same reward by

different means. Contact

the Verizon Benefits

Center at 855.4VzBens

(855.489.2367) and we will

work with you (and, if you

wish, with your doctor) to

find a wellness program

with the same reward that

is right for you in light of

your health status.

Want more information? Please refer to your SPD. 17

If you have elected Domestic Partner Life Insurance and do not act as noted above

regarding proof of marriage, your domestic partner will be dropped from Domestic

Partner Life Insurance effective January 1, 2017. You will be eligible to convert

coverage to an individual whole life or variable universal life insurance policy.

After January 1, 2017, Prudential will send you a letter describing life insurance

continuation options, along with an application and the applicable premium.

Coverage for medical, including prescription drug,

emergency services out-of-network

Generally, the same cost sharing (copayments and coinsurance) applies for innetwork

and out-of-network emergency services. You have a right to determine

how the plan calculates payment for out-of-network services, since nuances apply,

under this Affordable Care Act requirement. Contact the Verizon medical plan

option or prescription drug administrator, such as Express Scripts, for more details.

Clinical trials

If you are participating in a clinical trial and you are receiving chemotherapy

through that clinical trial, your chemotherapy coverage will not be adversely

impacted by that clinical trial.

HMO eligibility

Under the Affordable Care Act, if your child lives outside an HMO’s service area

(for example, s/he attends college in a zip code where the HMO is not offered),

s/he will still be eligible for coverage under the HMO until the end of the month in

which s/he attains age 26 and is not subject to the requirement to reside within a

zip code where the HMO is offered.

Transgender and Autism Spectrum Disorder coverage

Verizon provides coverage for care related to gender dysphoria or gender

transition services that are “medically necessary.” If your benefit package

previously excluded coverage for gender transition services, the exclusion has

been removed. Contact the Verizon medical plan option or prescription drug

administrator, such as Express Scripts, for more details on what gender transition

services and benefits are available.

Verizon provides coverage for “medically necessary” Applied Behavior Analysis

(ABA) Therapy for the treatment of Autism Spectrum Disorder. Contact your

Verizon medical plan option for more details on what benefits are available.

Women’s Health Cancer Rights Act

Under the Women’s Health Cancer Rights Act (WHCRA), the Plan is required

to provide coverage for all stages of reconstruction of the breast on which the

mastectomy was performed (with consultation with the attending physician

and patient), including as of January 1, 2017, details, such as re-pigmentation,

to restore the physical appearance of the breast. As always, cost sharing

(deductibles and coinsurance) for these benefits must be consistent with other

benefits under the Plan. Contact the Verizon medical plan option for more details.

Form 1095-C

Form 1095-C, Employer-

Provided Health Insurance

Offer and Coverage,

is a form that you may

receive at the beginning

of each year as part of the

Affordable Care Act. The

form includes information

about the health insurance

coverage offered to you

by Verizon. Save it to file

your taxes. It will assist

you with completing the

‘Health Care – Individual

Responsibility’ section

on your Form 1040 tax

filing (or other tax form as

appropriate).

18 2017 Annual Enrollment: November 7 – November 18

Important legal notices

Update to the Notice of Privacy Practices for the Verizon

Communications Inc. Health Plans

The Notice of Privacy Practices for the Verizon Communications Inc. Health Plans

(“HIPAA Privacy Notice”) explains the uses and disclosures the Verizon Health

Plans may make of your protected health information, your rights with respect

to your protected health information, and the Plans’ duties and obligations with

respect to your protected health information. Verizon updated the HIPAA Privacy

Notice, Contact Information section, to reflect changes to the contact information

for the Verizon HIPAA Unit.

The HIPAA Privacy Notice can be found on BenefitsConnection. You may

view the notice and/or print a paper copy from the website; or you also may

request a paper copy by calling the Verizon Benefits Center at 855.4VzBens

(855.489.2367).

Summaries of Benefits and Coverage (SBCs) required by the

Patient Protection and Affordable Care Act

Summaries of Benefits and Coverage (SBCs) required by the Affordable Care

Act are available on BenefitsConnection at verizon.com/BenefitsConnection. If

you would like a paper copy of the SBCs (free of charge), you may contact the

Verizon Benefits Center at 855.4VzBens (855.489.2367).

Verizon is required to make SBCs, which summarize important information about

health benefit plan options in a standard format, available to help you compare

across plans and make an informed choice. The health benefits available to

you provide important protection for you and your family in the case of illness

or injury and choosing a health benefit option is an important decision. SBCs

are being made available in addition to other information regarding your health

benefits including Health Plan Comparison Charts which also can be found on

BenefitsConnection.

Americans with Disabilities Act (ADA) notice

regarding wellness program

The wellness program offered to you by Verizon is a voluntary wellness program

available to all employees. The program is administered according to federal

rules permitting employer-sponsored wellness programs that seek to improve

employee health or prevent disease, including the Americans with Disabilities Act

of 1990, the Genetic Information Nondiscrimination Act of 2008, and the Health

Insurance Portability and Accountability Act, as applicable, among others. If you

choose to participate in the wellness program you will be asked to complete a

voluntary Health Assessment that asks a series of questions about your healthrelated

activities and behaviors and whether you have or had certain medical

conditions (e.g., cancer, diabetes, or heart disease). You are not required to

complete the Health Assessment.

Want more information? Please refer to your SPD. 19

However, employees who choose to participate in the wellness program

will receive an incentive of $100, which will be used to reduce your medical

premiums. Although you are not required to complete the Health Assessment,

only employees who do so will receive the $100 medical premium reduction.

The information from your Health Assessment will be used to provide you with

information to help you understand your current health and potential risks, and

may also be used to offer you services through the wellness program, such as

a voluntary health coaching program. You also are encouraged to share your

results or concerns with your own doctor.

Other important information

Protections from disclosure of medical information

We are required by law to maintain the privacy and security of your personally

identifiable health information. Although the wellness program and Verizon may

use aggregate information it collects to design a program based on identified

health risks in the workplace, the wellness program will never disclose any of

your personal information either publicly or to the employer, except as necessary

to respond to a request from you for a reasonable accommodation needed to

participate in the wellness program, or as expressly permitted by law. Medical

information that personally identifies you that is provided in connection with the

wellness program will not be provided to your supervisors or managers and may

never be used to make decisions regarding your employment.

Your health information will not be sold, exchanged, transferred, or otherwise

disclosed except to the extent permitted by law to carry out specific activities

related to the wellness program, and you will not be asked or required to waive

the confidentiality of your health information as a condition of participating

in the wellness program or receiving an incentive. Anyone who receives your

information for purposes of providing you services as part of the wellness

program will abide by the same confidentiality requirements. The only

individual(s) who will receive your personally identifiable health information are a

registered nurse, a doctor, or a health coach in order to provide you with services

under the wellness program.

In addition, all medical information obtained through the wellness program

will be maintained separate from your personnel records, information stored

electronically will be encrypted, and no information you provide as part of

the wellness program will be used in making any employment decision. The

confidentiality of medical information will be maintained in accordance with

Verizon policies and procedures. Appropriate precautions will be taken to avoid

any data breach, and in the event a data breach occurs involving information you

provide in connection with the wellness program, we will notify you immediately.

You may not be discriminated against in employment because of the medical

information you provide as part of participating in the wellness program, nor may

you be subjected to retaliation if you choose not to participate.

If you have questions or concerns regarding this notice, or about protections

against discrimination and retaliation, please contact the Verizon Benefits

Center at 855.4VzBens (855.489.2367), and indicate that you have a question or

concern regarding this notice.

20 2017 Annual Enrollment: November 7 – November 18

Notice Informing Individuals about Nondiscrimination and

Accessibility Requirements with respect to Verizon’s Group Health

Plans that are “Covered Entities”

Discrimination is against the law.

Verizon’s group health plans that are “covered entities” (referred to in this notice

as “Verizon’s group health plans”) comply with applicable Federal civil rights laws

and do not discriminate on the basis of race, color, national origin, age, disability,

or sex. Verizon’s group health plans do not exclude people or treat them

differently because of race, color, national origin, age, disability, or sex. Verizon’s

group health plans1:

• Provide 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)

• Provide 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 the Verizon Benefits Center at 855.4VzBens

(855.489.2367).

If you believe that Verizon’s group health plans have 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 in person or by mail, fax,

or e-mail. If you need help filing a grievance, Ralph Fader, Sr. Analyst Benefits,

Verizon’s Civil Rights Coordinator, is available to help you.

Verizon Benefits Center

Attn: Civil Rights Coordinator

P.O. Box 8998

Norfolk VA 23501-8998

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 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

800.368.1019, 800.537.7697 (TDD)

Complaint forms are available at hhs.gov/ocr/office/file/index.html.

Fax: 908.630.2639

E-mail: ralph.p.fader@verizon.com

Phone: 908.559.3620

TTY: 711

Civil Rights Coordinator

address and contact

information

Want more information? Please refer to your SPD. 21

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia

lingüística. Llame al 855.489.2367 (TTY: 711).

?????????????????????????????? 855.489.2367.

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo

ng tulong sa wika nang walang bayad. Tumawag sa 855.489.2367.

CHÚ Ý: N?u b?n nói Ti?ng Vi?t, có các d?ch v? h? tr? ngôn ng? mi?n phí dành cho

b?n. G?i s? 855.489.2367.

ATTENTION: Si vous parlez français, des services d’aide linguistique vous sont

proposés gratuitement. Appelez le 855.489.2367 (ATS: 711).

??: ???? ????? ??, ?? ?? ???? ??? ???? ? ????.

855.489.2367 ??? ??? ????.

ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche

Hilfsdienstleistungen zur Verfügung. Rufnummer: 855.489.2367.

??????: ??? ??? ????? ???? ?????? ??? ????? ???????? ??????? ?????? ?? ???????. ???? ???? 7632.984.558 )???

.:???? ???? ??????

????????: ???? ?? ???????? ?? ??????? ?????, ?? ??? ???????? ??????????

?????? ????????. ??????? 855.489.2367.

ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou

ou. Rele 855.489.2367.

ATTENZIONE: In caso la lingua parlata sia l’italiano, sono disponibili servizi di

assistenza linguistica gratuiti. Chiamare il numero 855.489.2367.

ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis.

Ligue para 855.489.2367.

UWAGA: Je?eli mówisz po polsku, mo?esz skorzysta? z bezp?atnej pomocy

j?zykowej. Zadzwo? pod numer 855.489.2367.

??????????????????????????????????855.489.2367

????????????????.

????: ??? ?? ???? ????? ????? ?? ????? ??????? ????? ????? ?????? ???? ???

.????? ?? ????. ?? 855.489.2367 ???? ??????

1 With respect to the nondiscrimination rules explained in this notice, the following

Verizon group health plans are “covered entities:” The Plan for Group Insurance,

The Verizon Retiree Group Health Plan for Management & Non-Union Hourly

Employees, The Verizon Retiree Group Health Plan for West Associates, Verizon

Business Health and Welfare Plan, Verizon Plan 550, Verizon’s Mid-Atlantic Group

Health Plan for Retired Associates (Pre-1990), Verizon Medical Expense Plan

for New York and New England Associates, Verizon New York and New England

Retiree Health (Post-1992 Retirees) and Group Life Insurance Plan for Active and

Retired Associates, and Verizon Post-1995 Collectively Bargained Retiree Health

Plan (Pre-1993 Retirees).

?

This Annual Enrollment Guide provides updates to your existing Summary Plan Description(s) as of January 1, 2017. Please keep this Guide and any other Summary of

Material Modification (SMM) with your SPDs. As always, the official plan documents determine what benefits are provided to Verizon employees, former employees eligible

for COBRA, retirees and their dependents. Please note you may not be eligible to participate in or receive benefits from all plans and programs referenced in this Guide.

Your SPDs and corresponding documents (e.g., SMM) are available at verizon.com/BenefitsConnection, or you can call the Verizon Benefits Center and request a printed

copy free of charge. As explained in your SPD, Verizon reserves the right to amend or terminate any of its plans or policies at any time with or without notice or cause,

subject to applicable law and any duty to bargain collectively.

A12B Mid-Atl CWA


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