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-
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