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).
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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).
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ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche
Hilfsdienstleistungen zur Verfügung. Rufnummer: 855.489.2367.
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?????? ????????. ??????? 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