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

Investing

together

for a

healthier

you.

Your benefits.

2017 Annual Enrollment

November 7 – November 18

Mid-Atlantic

Post-1989 Retiree

Dear Verizon Retiree:

This guide summarizes important health and insurance benefits

information and reflects the terms agreed upon by the Company and

the Unions in the 2016 labor contracts.

Effective January 1, 2017, the current MCN and MEP PPO Medicare medical

plan options will transition to the Verizon Advantage Plan. The Verizon

Advantage Plan — a UnitedHealthcare® Group Medicare Advantage Plan

(PPO) – is a passive PPO plan that offers affordable, quality health care

coverage for Medicare-eligible participants from any doctor or facility that

accepts Medicare. If you are Medicare-eligible, you should have already

received information describing the new Verizon Advantage Plan and a

summary of its features.

UnitedHealthcare® has the nation’s largest contracted network of Medicare

providers who participate in the Verizon Advantage Plan. We anticipate that

the overwhelming majority of providers who accept Medicare will accept

the Verizon Advantage Plan. In the rare instance a provider may not accept

the Plan, it is important to remember that you will continue to have access

to all health care providers that participate in Medicare and that the Verizon

Advantage Plan will provide coverage for all Medicare-accepting providers.

While Medicare-eligible retirees are experiencing a transition in Medicare

medical plan options for 2017, pre-Medicare retirees will continue to have

the same pre-Medicare medical plan options available in 2017.

Please review this Annual Enrollment guide, the Verizon Advantage

Plan guide, and any information UnitedHealthcare has provided you, as

applicable, for more information regarding the new Verizon Advantage Plan

for Medicare-eligible participants.

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.

If you are currently a pre-Medicare participant, your current benefits will

automatically continue unless you make a change during Annual Enrollment.

If you are currently a Medicare-eligible participant enrolled in either the

MCN or the MEP PPO Medicare medical plan option, you will automatically

be transitioned to the new MCN Advantage Plan option under the Verizon

Advantage Plan. If you are currently enrolled in another local Medicare medical

plan option, coverage under that option will automatically continue in 2017. No

action on your part is required. Coverage under the new MCN Advantage Plan

option will take effect January 1, 2017. For further information on this transition

to the new Verizon Advantage Plan, please see the Verizon Advantage Plan

transition information section in this guide.

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

contributions, and any plan changes for 2017.

To review or make changes to your coverage elections, dependents, or

beneficiaries, visit BenefitsConnection at verizon.com/BenefitsConnection

before midnight Eastern time on November 18.

2017 Annual Enrollment

Annual Enrollment opens November 7 and closes

November 18 at midnight Eastern time.

If you have questions or would like to review or make

changes to your coverage, you can call the Verizon Benefits

Center at 855.4VzBens (855.489.2367). Representatives

are available 9 am to 5 pm, Eastern time.

2017 Annual Enrollment: 4 November 7 – November 18

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 at verizon.com/

BenefitsConnection.

Log on to BenefitsConnection 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

Compare plan options

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

Year’s Health Plan Comparison Charts

Make election changes, add or drop dependents

and verify your beneficiaries

From the home page, in the Annual Enrollment section

under Suggestions for you, select Enroll Now.

Want more information? Please refer to your SPD. 5

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 home

address on file after you have enrolled your dependent.

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

dependent will be dropped from coverage.

Dependent child 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

In order for a dependent child to be eligible for dental coverage 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 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 and 25 and is not a full-time student,

and does not meet the conditions of being disabled, you must remove him/her

from dental 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 coverage. If full-time student status cannot

be verified, instructions will be sent to your home address on file. If you do not

comply with the instructions provided, your dependent will be dropped from

dental coverage.

If you have questions

about eligibility, please

refer to your SPD.

6 2017 Annual Enrollment: November 7 – November 18

The Health Insurance Marketplace

If you are not eligible for Medicare, depending on your personal situation, you

may have different medical plan options available to you through the Health

Insurance Marketplace established by the Affordable Care Act. For more details

about Marketplace options, go to the Marketplace website at healthcare.gov.

The Marketplace is intended to increase access to affordable health care for

individuals who do not have access to affordable health care benefits from

another source, such as their employer. As you consider whether to forgo your

Verizon retiree medical coverage and enroll in a Marketplace option, you need to

understand the following potential implications:

• If you purchase health insurance through the Marketplace, Verizon will not

contribute toward the cost of coverage or help you remit your payment.

• If you enroll in Verizon retiree medical coverage instead of a Marketplace

option, you are not eligible for any government subsidy to pay for that

coverage (i.e., a premium tax credit).

• If you enroll in a Marketplace option, you may be eligible for a government

subsidy depending on your household income level and whether you are

eligible for minimum essential coverage elsewhere.

• Individuals are required to have “minimum essential coverage,” or they must

pay a tax. Both the Marketplace options and Verizon retiree medical coverage

meet this definition, so if you are enrolled in either option, you will not be

subject to a tax in 2017.

Pre-Medicare medical plan options

For 2017, you will continue to have a choice of the pre-Medicare MCN and MEP

PPO medical plan options. There are some changes to your out-of-pocket

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

charts for details. The pre-Medicare EPO medical plan option will continue to be

available to those currently enrolled in it.

If a pre-Medicare HMO is currently available to you, it will also 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).

If you retired prior to January 1, 2017, your deductible will remain the same.

Participants who retire in 2017 or later will be subject to a different deductible.

Want more information? Please refer to your SPD. 7

Plan provision

Out-of-pocket

maximum:

In-network and

out-of-network

Emergency

room

Plan provision

Out-of-pocket

maximum:

In-network and

out-of-network

Emergency

room

As of August 1, 2016

Individual: $1,200 in-network

and out-of-network combined,

plus an additional $800 outof-

network

Individual + 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: $1,250 in-network

and out-of-network combined,

plus an additional $800 outof-

network

Individual + 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)

As of August 1, 2016

Individual: $1,300 in-network

and out-of-network combined,

plus an additional $900 outof-

network

Individual + 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: $1,350 in-network

and out-of-network combined,

plus an additional $900 outof-

network

Individual + 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 – Pre-Medicare MCN

At a glance – Pre-Medicare 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 compare plan options.

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

8 2017 Annual Enrollment: November 7 – November 18

Medicare-eligible medical plan options

As previously communicated, the current MCN and MEP PPO Medicare medical

plan options will transition to the new Verizon Advantage Plan effective January

1, 2017. The Verizon Advantage Plan – a UnitedHealthcare Group Medicare

Advantage Plan (PPO) Plan – is a passive PPO plan that offers affordable, quality

health care coverage for Medicare-eligible participants from any doctor or facility

that accepts Medicare.

Any current participant in either the MCN or MEP PPO Medicare medical plan

option will be automatically enrolled into the new MCN Advantage Plan option as

further explained in the Verizon Advantage Plan transition information section

of this guide.

Please reference the Verizon Advantage Plan guide mailed to you for details and

information about the new MCN Advantage Plan option.

If you did not receive a copy of the Verizon Advantage Plan guide, you can access

the guide in the Library section of BenefitsConnection or by calling the Verizon

Benefits Center and requesting a copy be mailed to you.

In addition, you may also have received a Plan guide from UnitedHealthcare. If you

have any questions about the Verizon Advantage Plan and how it works, please call

UnitedHealthcare at 877.211.6548, TTY 711, or visit UHCRetiree.com/verizoneast.

UnitedHealthcare representatives are available from 8 am to 8 pm local time,

seven days a week. through December 7. Starting December 8, UnitedHealthcare

representatives will be available from 8 am to 8 pm local time, Monday through Friday.

Want more information? Please refer to your SPD. 9

Verizon Advantage Plan transition information

If you’re currently enrolled in the MCN or MEP PPO Medicare

medical plan option

As part of 2017 Annual Enrollment, you will automatically transition to the new

MCN Advantage Plan. No action on your part is required. Your coverage under

the new MCN Advantage Plan option will take effect as of January 1, 2017.

If you’re currently enrolled in a local Medicare medical plan option through

Verizon, coverage under that option will automatically continue in 2017. You will

not be automatically transitioned to the MCN Advantage Plan option for 2017.

However, if you would like to enroll in the MCN Advantage Plan option for 2017,

you may do so during Annual Enrollment.

In summary

If you would like to change your medical plan option or waive coverage for 2017,

you will need to take action during Annual Enrollment. You can also change your

election anytime using Anytime Enrollment. Simply log on to BenefitsConnection,

go to the Life Events page and select Anytime Enrollment or call the Verizon

Benefits Center. Your change will be effective the first of the month following a

30-day waiting period. For more information about mid-year changes to benefits,

please refer to your SPD.

10 2017 Annual Enrollment: November 7 – November 18

Plan

provision

Annual

deductible

Annual outof-

pocket

maximum

Lifetime

maximum

Preventive care

Primary care

physician (PCP)

visit (includes

OB-GYN and

mental health/

substance

abuse)

In-network

None

Individual: $1,200

in-network and outof-

network combined,

plus an additional

$800 out-of-network

Individual + 1 or More:

2.5 times the individual

out-of-pocket

maximum amount; an

individual will never

need to exceed his

or her own individual

amount

None

100%

$10 copay

Out-of-network

Individual: $725

Individual + 1 or

More: 2.5 times the

individual deductible;

an individual will never

need to exceed his

or her own individual

deductible

Individual: $1,200

in-network and outof-

network combined,

plus an additional

$800 out-of-network

Individual + 1 or More:

2.5 times the individual

out-of-pocket

maximum amount; an

individual will never

need to exceed his

or her own individual

amount

None

80%

After meeting your

deductible, the Plan

pays 60%

MCN

Advantage Plan

2017

Applies in- and

out-of-network

None

$1,050 per member

None

100%

$10 copay

At a glance – MCN to MCN Advantage Plan

MCN

As of August 1, 2016

2017 Medicare plan option overview

The following chart provides a comparison of the 2016 Medicare plan option and the

corresponding 2017 Verizon Advantage Plan option.

Want more information? Please refer to your SPD. 11

Plan

provision

Specialist visit

Outpatient

surgery

Inpatient

hospitalization

Urgent care

Emergency

room

In-network

$15 copay

If performed at an

outpatient facility:

The Plan pays 90%

If performed in a

provider’s office:

$10 copay (PCP)

$15 copay (specialist)

The Plan pays 90%

$10 copay

$25 copay

(waived if admitted)

Out-of-network

After meeting your

deductible, the Plan

pays 60%

After meeting your

deductible, the Plan

pays 60%

After meeting your

deductible, the Plan

pays 60%

$10 copay

$25 copay

(waived if admitted)

MCN

Advantage Plan

2017

Applies in- and

out-of-network

$15 copay

If performed at an

outpatient facility:

The Plan pays 90%

If performed in a

provider’s office:

$10 copay (PCP)

$15 copay (specialist)

The Plan pays 90%

$10 copay

$25 copay

(waived if admitted)

At a glance – MCN to MCN Advantage Plan (continued)

MCN

As of August 1, 2016

12 2017 Annual Enrollment: November 7 – November 18

Plan provision

Retail

(In-network)

Mail order

2016

Generic: lower of $9 copay or

discounted network price

Brand (Single-source): 20%

of discounted network price

up to $25 maximum copay

Brand (Multi-source): 20% of

discounted network price up

to $25 maximum copay

Generic: lower of $18 copay

or discounted network price

Brand (Single-source): 20%

of discounted network price

up to $50 maximum copay

Brand (Multi-source): 20% of

discounted network price up

to $50 maximum copay

2017

Generic: lower of $10 copay

or discounted network price

Brand (Preferred): 20% of

discounted network price up

to $25 maximum copay

Brand (Non-preferred): 30%

of discounted network price

up to $30 maximum copay

Generic: lower of $20 copay

or discounted network price

Brand (Preferred): 20% of

discounted network price up

to $50 maximum copay

Brand (Non-preferred): 30%

of discounted network price

up to $60 maximum copay

At a glance – Medicare prescription drug changes

Medicare prescription drug coverage

There are some important changes to how prescription drugs are covered under

your plan resulting from the 2016 labor contracts.

Starting January 1, 2017, the member cost share for brand-name prescription

drugs will be differentiated by preferred and non-preferred tiers. The cost

of brand-name prescription drugs will vary based on the tier they fall into as

displayed in the chart below. The copay for generic prescription drugs at retail

will increase from $9 to $10 and for mail order will increase from $18 to $20.

Please refer to the following chart for details.

Want more information? Please refer to your SPD. 13

Medicare Part D

For most Medicare-eligible retirees, if you or a covered family member is or

becomes eligible for Medicare, your prescription drug coverage is provided

through a Verizon-sponsored group Medicare Part D plan. This benefit consists

of a standard Medicare Part D benefit, plus a supplemental “wrap-around” plan

to preserve a comprehensive level of prescription drug benefits.

Medicare-eligible retirees who have moved to the Medicare Part D plan with the

wrap-around will receive additional information about the program each year,

as required by Medicare. Retirees and family members who become eligible for

Medicare will receive additional information at that time.

Learn more about it

To compare plan options, from the BenefitsConnection home

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

Comparison Charts.

For more detailed information on your benefit plans, including

Summary Plan Descriptions (SPDs) and vendor contact

information, visit the Library page on BenefitsConnection. You can

also request copies of your benefits information including SPDs,

benefit comparisons, and other materials be mailed to you by

calling the Verizon Benefits Center.

14 2017 Annual Enrollment: November 7 – November 18

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:

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

Want more information? Please refer to your SPD. 15

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

Retired before 1/1/13

$0

$0

$0

Retired on or after 1/1/13

$39.33

$67.42

$67.42

2017 pre-Medicare EPO and HMO monthly retiree contributions

2017 pre-Medicare MCN and MEP PPO monthly retiree contributions

Coverage

category

(Retired before,

on, or after 1/1/13)

Retiree Only

Retiree + 1

Retiree + Family

Coverage

category

Retiree Only

Retiree + 1

Retiree + Family

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.

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.

1 Effective January 1, 2017, the MCN Advantage Plan 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

16 2017 Annual Enrollment: November 7 – November 18

Life insurance

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 supplemental life insurance are based on age ranges. As you 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.

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

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. 17

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.

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.

Pre-Medicare only:

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

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.

Want more information? Please refer to your SPD. 19

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 855.4Vz.Bens (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.

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).

?

Actual plan provisions for Company benefits are contained in the appropriate plan documents or applicable Company policies. This Annual Enrollment guide provides updates

to your existing Summary Plan Description (SPD) as of January 1, 2017. Please keep this guide and any additional Summary of Material Modification (SMM) with your SPDs

until Verizon provides you with SPDs that have been updated to reflect the changes to your benefits. 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. 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.

R9A Mid-Atl Post-89


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