1 © 2014 ibm corporation 2015 ibm benefits program overview for long term supplemental employees...

1 © 2014 IBM Corporation

2015 IBM Benefits Program Overview for Long Term Supplemental Employees

(Module I)

November 2014


AgendaModule I•IBM Benefits Overview

•Healthcare Enrollment Choices

•Tobacco Surcharge

•Health Savings Account (HSA) Incentives

•Administrators, Alternate Networks and Plan Administrators Contact Information

•Global Assignee Healthcare Plan

•Integrated Health Services Program

•Managed Pharmacy Program

•Dental Benefits

•Vision Plan and Vision Discount Card

•Monthly Contributions and Medical Plan Opt Out Credit

•Flexible Spending Accounts

•Dependent Eligibility

•New IBMer Enrollment

Module II•Additional Benefit Programs

•Available Resources

•Appendix


Overview of IBM Benefits

Key Features:

•Health Benefits Portfolio that provides strong support for employee well-being and preventive care, comprehensive coverage to meet a range of medical situations and solid protection against the cost of serious illness or injury

•Retirement Program that helps build future financial security through the 401(k) Plus Plan and other capital accumulation programs

•Income Protection in case of serious illness, injury or death, including life insurance and disability benefits

•Opportunity to follow leisure pursuits through vacation and holiday programs

IBM offers a competitive benefits program, designed to help employees build a solid financial foundation and meet a diverse array of needs


IBM Healthcare Enrollment Choices

MedicaloPPOoPPO PlusoExclusive Provider Organization (EPO) oPPO w/HSAoPPO Plus w/HSAoHMO (Where available) oGlobal Assignee Medical Plan (For Employees working Outside US) oNo Coverage Credit for Medical

DentaloDental BasicoDental PlusoCigna DMA (Where available)oNo Coverage

Health Savings Account (HSA)o$500 IBM depositoEarn additional IBM Healthy Living Incentives ranging from $300 - $1,100

Vision oIBM Vision PlanoVision Discount CardoNo Coverage

Flexible Spending AccountsoHealth Care Spending AccountoDependent Care Spending AccountoNo Coverage

Long Term Disability (LTD) o50%o66 2/3%oNo Coverage

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IBM Medical Plan Options • IBM PPO Provides in- and out-of network coverage, available at a low cost for employee-only coverage

• IBM PPO Plus Provides a higher level of benefits than the IBM PPO, in exchange for higher monthly contributions

• IBM Exclusive Provider Organization (EPO) You must use network providers in order to receive benefits; you pay either a coinsurance or a fixed copayment, depending on the serviceo Higher Contributions with No Deductibleo Co-pays for Inpatient Hospital and Surgery

• IBM PPO with Health Savings Account (HSA) Features a health savings account with IBM contributions of $500, and employee can earn additional incentives, but requires the highest deductible; available at no cost for employee-only

• IBM PPO Plus with Health Savings Account (HSA) Features a health savings account with IBM contributions of $500, and employee can earn additional incentives, but requires higher deductible; available at low cost for employee-only

• HMO Provides care through a specific network of providers and pay fixed co-pay for medical services; participants are not covered for care received outside of HMO network

• IBM Global Assignee Medical Plan is an indemnity plan for employees on International Assignment working in other countries

* A broad provider network is available for the PPO and EPO plan options; HMOs available in certain locations


Your Medical Options At-A-GlanceThe chart below shows what you pay for covered services under each IBM medical option. Information for HMOs is available from your Benefits Election page on netbenefits.com/ibm. There is no lifetime benefit maximum for eligible services received in-network; a $1 million lifetime benefit maximum applies for out-of-network care .

Annual Deductible1

(Individual/Family)

Annual Out-of-Pocket Maximum2

(Individual/Family)

Routine Preventive Services

Other Office Visits and Outpatient

Surgery

Urgent Care and Walk-in Clinics

Inpatient Hospital and Surgery

Emergency Room Other Services4

IBM PPO with HSA ►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$2,550 / $5,5005

$6,450 / $12,900 $0, no deductible PCP3: $0, after deductibleSCP3: 25%, after deductible

25% after deductible 30%, after deductible 30%, after deductible plus $150 copay (copay waived if admitted)

30%, after deductible

Out-of-Network $15,600 / $23,500 45%, no deductible 45%, after deductible 45%, after deductible 45%, after deductible 45%, after deductible

IBM PPO Plus with HSA ►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$2,000 / $4,0005

$6,450 / $12,900 $0, no deductible PCP3: $0, after deductibleSCP3: 25%, after deductible

25% after deductible 30%, after deductible 30%, after deductible plus $150 copay (copay waived if admitted)


Out-of-Network $15,600 / $23,500 45%, no deductible 45%, after deductible 45%, after deductible 45%, after deductible 45%, after deductible

IBM PPO

In-Network $1,350 / $4,000

$6,600 / $13,200

$0, no deductible PCP3: $0, no deductibleSCP3: 25%, no deductible

25% after deductible Facility: 20%, after deductiblePCP3: 20%, after deductibleSCP3: 25%, after deductible

20%, after in-network deductible plus $150 copay (copay waived if admitted)


Out-of-Network $2,350 / $7,200 $15,000 / $27,000 45%, no deductible 45%, after deductible 45%, after deductible 45%, after deductible 45%, after deductible

IBM PPO Plus

In-Network $300 / $600 $6,100 / $9,100

$0, no deductible PCP3: $0, no deductibleSCP3: 25%, no deductible

25% after deductible Facility: 20%, after deductiblePCP3: 20%, after deductibleSCP3: 25%, after deductible

20%, after in-network deductible plus $150 copay (copay waived if admitted)


Out-of-Network $2,350 / $7,200 $15,000 / $27,000 45%, no deductible 45%, after deductible 45%, after deductible 45%, after deductible 45%, after deductible

IBM EPO

In-Network $0 / $0 $6,600 / $13,200 $0 25% 25% $903 copay $184 copay plus $150 copay ($150 copay waived if admitted)

$0 for X-rays, DME and prosthetics; 20% for other imaging services

1Annual deductible applies to medical and mental health/substance abuse services combined.2Prescription drug coinsurance and copayments apply to the annual out-of-pocket maximum. 3PCP = Primary Care Physician; SCP = Specialty Care Physician4Other Services include: imaging, X-rays, durable medical equipment (DME), prosthetics and lab services (no deductible for lab); precertification is required for CT scans, MRIs, sleep studies, and cardiac studies.5If you enroll in Family coverage under an HSA-eligible health plan option, you must meet the Family deductible before the plan begins to pay benefits. Individual deductibles do not apply. Note: For Out-of-Area options, benefits for medical services will be paid at the in-network level for all IBM PPO options. Mental health/substance abuse care will be paid at the in-network level if care is pre-certified and provided by an in-network provider (or other provider if there is no in-network provider at your location).


Tobacco Surcharge• A $50 per month surcharge will apply if you and/or your enrolled spouse/domestic partner have

used any tobacco products within six months of the date your IBM medical coverage beginso The $50 monthly surcharge will apply for each individual indicating tobacco useo Surcharge helps offset the additional healthcare costs typically incurred by tobacco users

• Employees or spouse/domestic partner will have the opportunity to receive a full refund of surcharges paid upon the successful completion of health plan administrator’s Smoking Cessation Program within 6 months or by December 31, 2015, whichever occurs first

• During enrollment, you will be asked to choose from the following options for yourself and a separate option for your spouse/domestic partner: o Non-Tobacco User: Select this option if you have not used any tobacco products within the

last six monthso Tobacco User: Select this option if you have used any tobacco products within the last six

months and do not wish to participate in your health plan administrator’s tobacco cessation program

o Cessation Program: Select this option if you have used any tobacco products within the last six months but agree to complete a cessation program


IBM PPO or PPO Plus with Health Savings Account (HSA)• The HSA lets you use tax-free dollars to pay for current healthcare expenses or save for future healthcare

needs

• For 2015, IBM will contribute $500 to an HSA for active employees who enroll in the IBM PPO with HSA or the IBM PPO Plus with HSA

• Additional incentives may also be earned ranging from $300 for individual coverage to $1,100 for family coverage; incentives earned will be deposited into your HSA

• In order to receive the IBM contribution or any earned incentives you must open an HSA account with Fidelity. Additional forms and agreements required

• Employees may contribute up to the annual contribution limit of $3,350 for single coverage and $6,650 for a couple or family set by the Internal Revenue Service (IRS)

• Unlike a Health Care Spending Account, unused HSA funds remaining at the end of the plan year are not forfeited and remain in your account

• Deductible and out-of-pocket maximum are administered differently compared to other plan options:o Those who enroll one or more dependents:

o Must meet the Family Deductible before the plan will pay benefits for covered serviceso Must meet the Family Out-of-Pocket Maximum before plan will begin paying 100% for the remainder of the year

o Certain preventive prescription drugs, however, are not subject to the deductible

• You may not contribute to an HSA if:o Your spouse covers you or any eligible dependents under a different health plano You or your spouse participates in a health care flexible spending account


Health Savings Account (HSA) IncentivesIf you enroll in the IBM PPO with HSA or IBM PPO Plus with HSA

Individual coverage

You can earn two $150 incentives when you complete the program requirements.$150 Consumer Education (choose one of the following):

o HSA education o ALEX o Better Choices, Better Health

$150 Wellness Checkpoint Health Risk Assessment

In addition, you’ll have access to the Active Track Fitbit Program

Family coverage

You can earn the two $150 incentives above plus two additional $400 incentives when your spouse/domestic partner or family completes the program requirements. $400 Consumer Education (choose one of the following):

o HSA education o ALEX o Better Choices, Better Health

$400 Wellness Checkpoint Health Risk Assessment

How incentives are paid

Payments will be processed after you certify that you have completed all program requirements and will be deposited in your HSA; payments are not subject to taxes.


IBM Medical Plan Administrators by State

10

Albany/Poughkeepsie/ Binghamton/Endicott

VT

NY MA

RICT

ME

NH

MD

PA NJ

NC

WV VA

ALMS

KY

TN

AR

LA

FL

GA

SC

IL

WIMI

OH

OK

TX

MO

IA

MN

IN

AZ

SD

NDMT

NE

KS

NM

WA

COUT

WY

NV

ORID

CA

DCDE

HI

AK

Aetna

Anthem Blue Cross Blue Shield

MVP

UnitedHealthcare

* Plan Administrators for IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with Health Savings Account, IBM PPO Plus with Health Savings Account


Anthem Alternate Networks for Certain LocationsState Service Area Alternate Network

Georgia Entire State Blue Open Access POS

Kansas Kansas City (Includes Counties of Johnson & Wyandotte) Preferred Care Blue PPO

Missouri

Kansas City (Includes the Counties of Andrew, Atchison, Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton, Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson, Johnson, Lafayette, Livingston, Mercer, Nordaway, Pettis, Platte, Ray, Saline, St. Clair, Vernon, and Worth)

St Louis (Includes the city of St. Louis and the Counties of Franklin, Jefferson, St. Charles, St. Louis and Warren)

Preferred Care Blue PPO &

Blue Access Choice

New Hampshire Entire StateBlue Choice Open Access POS

New York

NY City and Suburbs (Includes Doctors & Hospitals in 28 Eastern NY Counties: Albany, Bronx, Clinton, Columbia, Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery, Nassau, New York, Orange, Putnam, Queens, Rensselaer, Richmond, Rockland, Saratoga, Schenectady, Schoharie, Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)

Empire POS

Tennessee Entire State Network S

I. Alternate Networks apply to those enrolled in the IBM PPO, PPO Plus, EPO or High Deductible PPO or PPO Plus w/ HSA in these service areas.II. If you reside in one of these areas you must use a provider that participates in the alternate provider network when obtaining services to receive the higher, In-

Network Benefit. If you use a provider that does not participate in the alternate provider network you will receive the Out-of-Network Benefit (or No Benefits if you are in enrolled in the IBM EPO) and your Out-of-Pocket costs will be higher.

III. Outside these areas, you will have access to the Blue Card PPO network.IV. Many providers participate in both the current Anthem network and the alternate provider network. Go to www.anthem.com to check your provider’s participation.

Select “Find a Doctor”, enter the provider your seeking (The name if you know it) or use the Specialty drop down box. From the Search Results page, choose “Insurance Options, ” choose “Add/Edit Selections.” A new window will open. Enter the state where you reside, choose “Alternate Network” for the type of Health Medical Plan and choose your alternate network from the drop down menu. Select “Search” to see your In-Network providers. You should also confirm your provider’s participation directly with your provider by giving him/her the specific name of your alternate network as shown above.


IBM Health Plan Administrator ContactsIBM Self Insured Medical

Plan Administrators: Aetna Anthem BC & BS MVP UnitedHealthcare

Customer Services Hours Mon-Fri, 8:00 am - 6:00 pm (ET) Mon-Fri, 8:00 am - 6:00 pm (ET)Mon-Fri, 8:00 am - 8:00 pm. (ET)

Sat., 8:00 am - 4:00 pm. (ET)Mon-Fri, 8:00 am - 8:00 pm (ET)

Phone Number 888-725-1841 800-238-6597 800-765-3773 877-222-4261

TTY 877-301-5038 800-241-6895 800-662-1220 877-218-7138

Outside US 860-273-0123 845-695-4505 518-370-4793 (call collect) 877-265-9200

Web Address www.aetna.com www.anthem.com www.mvpselectcare.com/ibm www.myuhc.com

Login Details Not Required Not Required Not RequiredUsername: IBM; Password:

IBM

Carrier Name Aetna Inc Anthem Blue Cross Blue Shield MVP Select Care UnitedHealthcaare

Group Contract Number 719982 0003330081 N/A 401010

Network NameAetna Choice POS II

(Open Access)Refer to Page 9 for Network

DetailsMVP Select Care UHC Choice Plus

Prescription Drug Administrator

CVS/caremark

Customer Service Hours 24 hours a day, 365 days a year

Phone Number 855-465-0030

TTY 800-863-5488

Outside US 855-465-0030

Web Address www.caremark.com

Mental Health & Substance Abuse Administrator

Optum

Customer Service HoursClaims Customer Service: Mon-Fri,

8:00 am - 7:00 pm (ET)


TTY Dial 711 and enter 800-445-9720

Outside US 267-216-3277

* The HMO Plan Administrator contacts are located within the HMO Plan Detail Sheets on the Transition Website ** Plan Administrator web sites have current information on participating Network Providers

*** The IBM Employee Services Center is available @ 800.426.2008 before Date of Hire & @ 800.796.9876 after DOH


IBM Health Plan Administrator Contacts - Continued

IBM Dental Basic & Plus Plans

MetLife

Customer Service HoursMon-Fri, 8:00 am - 11:00 pm (ET); Automated

System, 24 hours per day/7 days per week


TTY 800-843-2896

Outside US AT&T Access Code + 1-866-989-8542

Web Address www.metlife.com/MyBenefits

CIGNA Dental Maintenance. Alternative

Cigna

Customer Service Hours Available 24 hours a day/ 7 days a week

Phone Number 800-CIGNA24

Web Address www.cigna.com

IBM Vision Plan Anthem Blue View Vision


Web Address www.anthem.com

Login Details Employer ID = IBM

EyeMed Discount Card EyeMed Vision Care


Web Address www.eyemedvisioncare.com

Dental Options

Vision Options

IBM Global Assignee Medical Plan

CIGNA Global Health Benefits

Customer Service Hours24 Hours per day / 7 Days per week / 365

Days per year

Phone Number: North America Clients

In US: 1.800.441.2668International: Use the country AT&T Code or

+1.302797.3100 (Reverse Charges Accepted)

Direct Fax 302.797.3150

Web Address www.cignaenvoy.com

Global Assignee Medical Plan


IBM Global Assignee Plan• Available to employees on International Assignments; Administered by Cigna Global Health Benefits

• Provides Medical, Dental and Vision Coverage

• Annual Deductible: $100 Single / $200 Family

• Annual Out-of-Pocket Maximum:o In-Network: $2,000 Single / $4,000 Familyo Out-of-Network: $3,000 Single / $6,000 Family

• Medical Coverage Highlights:o Preventive Medical and Wellness Care covered @ 100%o Coinsurance: 80% In-Network / 60% Out-of-Network (Applies to services received in US only)o Prescription Drug Coverageo Emergency Evacuation and Repatriation Benefits @ 100%o Immediate access to on-duty Physicians around the world (via telephone)o Access to Nurses and/or Medical Clinicians throughout the world & coordination of Hospital Admissionso Guaranteed/advance payment of hospital and clinic feeso A dedicated 24/7/365 Multilingual Help Line

• Vision Coverageo Annual Eye Exam at 100% Reimbursemento $200 per year allotted for Frames, Lenses, or Contacts per year

• Dental Coverageo 100% of Eligible Preventive Care and 2 Routine Exams per yearo 80% of Basic Restorative Care (Fillings, Extractions, etc.)o 50% of Major Restorative Care (Crowns, Bridges, etc.)o $2,000 per individual Calendar Year Maximumo Orthodontia (dependent children under age 19), $2,000 lifetime maximum

• A complete Summary Plan Description Document will be available during the open enrollment period


Integrated Health Services Program• Employees have a unique opportunity to met their health care needs through our

innovative integrated health services program

• Think of it as a one-stop shop for all clinical services, including disease management, through the IBM Self-insured Medical Plan options (IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with HSA and IBM PPO Plus with HSA), at no cost to participants

• Employees will have access to a personal care coordinator who can help them navigate the complex health care system and assist with questions regarding any aspect of their health care

• Disease management services are available under the program


IBM Managed Pharmacy Program• CVS/caremark administers the IBM Managed Pharmacy Program

• Covers IBM employees enrolled in the IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with HSA and IBM PPO Plus with HSA Plan options

• Per prescription maximums are different for traditional medications and specialty medications

• Members will save on out-of-pocket costs when they choose generic over brand name drugs

• Some prescriptions require prior authorization

• Under both HSA-eligible health plan options, preventive prescription drugs are not subject to annual deductible

• CVS/caremark Network has nearly 68,000 retail pharmacies; including 7,100+ CVS/caremark Pharmacies

• Participants can choose to receive their 90-Day maintenance medication prescriptions through the mail or at one of the 7,100 CVS/caremark Pharmacy locations nationwide for the same price as mail order

• View information on new prescription Benefits, including drug costs, network pharmacy locations and the formulary list at: www.caremark.com/ibmactives

• Customer Service Team for IBM is available at: 855.465.0030 (TTY: 800.863.5488) 24 hours a day, 7 Days a week


IBM Managed Pharmacy Program Per Rx Maximums for employees who enroll in the IBM PPO, IBM PPO Plus or IBM EPO

17

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply

**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

Traditional MedicationsParticipating PharmaciesParticipating Pharmacies

(Up to 30-Day Supply)(Up to 30-Day Supply)

Mail OrderMail Order


Non-Participating PharmaciesNon-Participating Pharmacies


GenericGeneric 20% of discounted cost, up to $24 20% of discounted cost, up to $26 30% of actual cost

Formulary BrandFormulary Brand20% of discounted cost, up to $90*

20% of discounted cost, up to $225*

30% of actual cost

Non- Formulary BrandNon- Formulary Brand50% of discounted cost, up to $180*


55% of actual cost

Specialty Medications

(Special Handling Required)

Participating PharmaciesParticipating Pharmacies

(Up to 30 -Day Supply)(Up to 30 -Day Supply)





GenericGeneric 20% of discounted cost, up to $31 20% of discounted cost, up to $33 30% of actual cost

Formulary BrandFormulary Brand20% of discounted cost, up to $97*


30% of actual cost

Non- Formulary BrandNon- Formulary Brand50% of discounted cost, up to $201*

50%of discounted cost, up to $503* 55% of actual cost


IBM Managed Pharmacy Program Per Rx Maximums for employees who enroll in the IBM PPO with HSA or IBM PPO Plus with HSA

18

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply

**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

Traditional MedicationsParticipating PharmaciesParticipating Pharmacies






GenericGeneric10% of discounted cost after deductible, up to $150

10% of discounted cost after deductible, up to $450

30% of actual cost after deductible

Formulary BrandFormulary Brand30% of discounted cost after deductible, up to $150



Non- Formulary BrandNon- Formulary Brand50% of discounted cost after deductible, up to $150



Specialty Medications

(Special Handling Required)

Participating PharmaciesParticipating Pharmacies

(Up to 30 -Day Supply)(Up to 30 -Day Supply)





GenericGeneric10% of discounted cost after deductible, up to $150



Formulary BrandFormulary Brand30% of discounted cost after deductible, up to $150



Non- Formulary BrandNon- Formulary Brand50% of discounted cost after deductible, up to $150




Dental BenefitsBelow is a summary of the dental options with plan features IBM offers:

Plan FeaturePlan Feature IBM Dental BasicIBM Dental Basic IBM Dental PlusIBM Dental Plus CIGNA DMACIGNA DMA

Annual DeductibleAnnual Deductible None

In network: None

Out-of-network: $50 per person (Waived for Preventive Care)

None

Annual Benefit Maximum Annual Benefit Maximum (Excludes Orthodontia)(Excludes Orthodontia)

$500$2,000 per person (Excludes orthodontia)

None

Lifetime Benefit MaximumLifetime Benefit Maximum None None None

Diagnostic/Preventive CareDiagnostic/Preventive Care

In network: No charge

Out-of-network: 20% of U&P plus any amount over the U&P

In network: No charge


No charge

Minor Restorative CareMinor Restorative Care

In network: 20% of negotiated fee




No charge

Major Restorative CareMajor Restorative Care Not covered


Out-of-network: 35% of U&P rate plus any amount over the U&P

Copayments vary ($0 - $350)

Orthodontic TreatmentOrthodontic Treatment Not covered



Up to $2,450 (24 Months)

Orthodontic Lifetime Benefit Orthodontic Lifetime Benefit MaximumMaximum

N/A$2,500 per person

(In and Out-of-Network combined)None


IBM Vision Plan• The IBM Vision Plan provides coverage for standard eye exams, glasses and contacts

• Participants can receive benefits from In or Out-of-Network providers

• Out-of-Network reimbursement is based on a schedule of benefits

• The Vision Plan is administered by Anthem Blue View Vision

• Anthem is available by phone at: 855.765.4552 or online: www.anthem.com

• An ID Card will be issued on enrollment

Below is a summary of coverage:

Plan FeaturePlan Feature In-NetworkIn-Network Out-of-NetworkOut-of-Network

Annual eye examAnnual eye exam Full eligible charge Up to $35

Glasses - Lenses Glasses - Lenses

Single vision: Covered @ 100%Bifocal: Covered @ 100%Trifocal: Covered @ 100%

Single vision: up to $25Bifocal: up to $40Trifocal: up to $55

Lens OptionsLens OptionsAdditional Savings on lens options (i.e., Polycarbonate, progressive, transition and anti-reflective coating)

Additional Savings Not available

FramesFrames $120 Allowance, then 20% off balance Up to $35

Contact LensesContact Lenses

Elective:- Conventional Lenses: $120, then 15% off balance - Disposable Lenses: 120 Allowance- Non Elective: Covered in Full

Elective:- Conventional Lenses: Up to $105- Disposable Lenses: Up to $105 - Non Elective: Up to $165

Laser Vision Correction SurgeryLaser Vision Correction SurgerySavings available via www.anthem.com/special offers

See any provider

Eligible ProvidersEligible Providers Go to www.anthem.com See any provider

Filing ClaimsFiling Claims Providers file claims on your behalfYou pay for services then submit the bill to Anthem for reimbursement


Vision Discount Card

• EyeMed is IBM’s Administrator for the Vision Discount Card

• The free EyeMed Vision Discount Card enables you to save money on eye exams, eyewear and other vision care services from EyeMed’s nationwide network of providers

• Up to 40% Savings on Frames, Lenses, Lens Options and Contact Lenses

• You can choose to enroll in the IBM Vision Plan or in the EyeMed Vision Discount Card, but not both

• Questions about discounts available or to locate a provider can be directed to EyeMed Vision Care directly at: 855.245.0621


2015 Monthly Contributions for Full Time Employees

* These Contributions are for Full Time active and Long Term Supplemental employees with no dependents on Medicare

** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services Center during enrollment.

Plan Cost for EmployeeCost for Spouse or Domestic Partner

Cost for Each Child (Up to 6)

IBM PPO $15 $247 $142

IBM PPO Plus $73 $315 $176

IBM EPO $93 $335 $186

IBM PPO with HSA $0 $98 $68

IBM PPO Plus with HSA $10 $193 $116

HMO (National Average is listed; actual cost will vary by HMO)

National Avg. = $103 (Cost varies by HMO)

National Avg. = $350 (Cost varies by HMO)

National Avg.= $193 (Cost varies by HMO)

IBM Dental Basic $22 $22 $15

IBM Dental Plus $52 $52 $34

CIGNA Dental Maintenance Alt. $37 $37 $24

IBM Vision Plan $8.90 $8.90 $8.90

EyeMed Vision Discount Card $0 $0 $0


2015 Monthly Contributions for Part-Time EmployeesWorking 27 – 32 Hours Per Week

* These Contributions are for Part Time employees working 27-32 hours a week with no dependents on Medicare




IBM PPO $72 $275 $156

IBM PPO Plus $130 $346 $191

IBM EPO $150 $366 $201


IBM PPO with HSA $67 $228 $132

HMO - National Average is listed; Cost will vary by HMO)

National Avg. = $160(Cost varies by HMO)

National Avg. = $378(Cost varies by HMO





IBM Vision Plan $8.90 $8.90 $8.90



2015 Monthly Contributions for Part-Time EmployeesWorking 20 – 26 Hours Per Week

* These Contributions are for Part Time employees working 20 - 26 hours a week with no dependents on Medicare




IBM PPO $112 $295 $166

IBM PPO Plus $170 $364 $200

IBM EPO $190 $384 $210


IBM PPO with HSA

HMO - National Average is listed; Cost will vary by HMO)

National Avg. = $199(Cost varies by HMO)






IBM Vision Plan $8.90 $8.90 $8.90



Medical Plan Opt Out Credit• If you decline Medical coverage, you can receive a $30 per month credit for opting out

of Medical coverage

• The credit is paid in semi-monthly paycheck; treated as taxable income

• If you elect No Medical Coverage, you will not be able to enroll in Medical Benefits until the next annual enrollment period, unless you experience a qualified status change that allows you to enroll


Flexible Spending AccountsHealth Care Spending Account (HCSA)

•You can set aside $10 to $208.34 monthly in pre-tax dollars to pay for eligible, unreimbursed health care expenses up to the Annual IRS Maximum limit of $2,500

•You can claim reimbursement for expenses incurred by any dependent claimed on your Federal Tax Return

•Eligible expenses include deductibles, co-payments and other unreimbursed medical, dental, vision and hearing costs

•See IRS Publication 502 for a complete list of eligible HCSA expenses at: http://www.irs.gov/uac/Publication-502,-Medical-and-Dental-Expenses-1

•Monies not used during the coverage period are subject to forfeiture

•A Health Debit Card can be used at a participating CVS/caremark retail pharmacies or through CVS/caremark’s Mail Order Service to purchase prescription drugs only

•Per IRS rules, you may enroll in the HCSA or a Health Savings Account (HSA), but not both

Dependent Care Spending Account (DCSA)

•You can set aside as little as $20 monthly and as much as $5,000 annually in pretax dollars to pay for eligible dependent care expenses

•Reimburses care that enables both you and your spouse to work, or you to work and your spouse to attend school full-time

• Eligible expenses include day care and certain elder care expenses

•Monies not used during the participation period of subject to forfeiture


Dependent Eligibility• Eligible Dependents

o Your spouseo A qualified, same-gender domestic partner o Your natural and legally-adopted children to age 26 o Your stepchildren to age of 26o Other children to age 26 for whom IBM determines that you have been granted permanent legal

guardianship of the child’s person and property by a court of lawo A child who is incapable of self-support and was mentally or physically handicapped before age

26 who meets the criteria for continued coverage upon reaching age 26 as determined by IBM

Note: Some HMOs do not offer domestic partner coverage. To find out more you will need to contact the HMO directly.


Dependent Eligibility Confirmation

• Employees must provide documentation supporting their eligibility after enrollment

• Reference the Dependent Eligibility Process on the Benefits Page of the Transition website for details on required documentation

• Within three weeks, you will receive a package from the Dependent Eligibility Confirmation Center, administered by Budco, describing the process, the due date, and acceptable documents you need to provide to confirm your dependent’s eligibility

• If you do not provide sufficient documentation by the required date indicated in your package, your dependent will be removed from IBM benefits coverage approximately 60 days after your IBM date of hire

Sample of DEC envelope mailed to your home


Healthcare Enrollment

• Your HR Transition Manager will provide further information regarding the dates for the health care benefits enrollment period, and the materials available to you on the medical, dental and vision options.

• IBM Employee Services Center:o Before your Date of Hire: 800.426.2008 (TTY: 800.426.6537)o After your Date of Hire: 800.796.9876

• When the enrollment period opens: you may call the IBM Employee Services Center between 8:30 a.m. and 8:30 p.m. ET to enroll. To protect your privacy and guard against identity theft, you will be asked a few questions for authentication purposes

• After your IBM Date of Hire you may also enroll via NetBenefits: http://netbenefits.com • You must make your elections by the enrollment deadline date; otherwise, you and your

eligible dependents will have No Medical, Dental, or Vision Coverage for the entire Plan Year unless you have a qualified status change. You will also be defaulted to 50% LTD coverage and be charged for any associated premium

• Coverage is generally effective as of your Date of Hire


What to Do if You Need Care Before You Enroll• Generally, it will take a minimum of three weeks (or Longer), from the time you enroll in IBM

Benefits, for eligibility information to be processed by IBM’s Plan Administrators, for you to be recognized by the administrators Customer Service Teams and/or for you to be able to register/print Medical ID Cards on the administrators web sites.

• We encourage you to refill any prescriptions and/or to obtain any known necessary medical services under your previous employer’s benefits prior to starting with IBM.

• In the event of a True Medical Emergency, you should obtain the medically necessary care immediately, at the closest Hospital. The IBM Plan and most HMOs will cover Emergency Care rendered by Out-of-Network providers at the In-Network Benefit level until the point where you can be stabilized and be safely moved to an In-Network facility.

• You may call the IBM Employee Services Center @ 1-800-426-2008 to request an Emergency Enrollment if you are admitted to a hospital. You will need to explain the nature of the emergency, and if it meets the definition of a “True Emergency” resulting in a Hospitalization the ESC representative will work to process your enrollment within 24 hours. As noted earlier, there is a $150 ER Surcharge if you are not admitted.


What to Do if You Need Care Before You Enroll - continued• Once the Plan Administrator has your enrollment information you can request their help in

validating you as a new member to your providers so you will not have to pre-pay for services and so the services you receive will be billed and considered by the IBM Plan first (at the In-Network Benefit level if appropriate) before you are billed.

• Employees requiring non-emergency care, where they are not admitted to a hospital, should: (1) Ensure the providers they wish to see are In-Network for the IBM Medical Plan option and respective Administrator they wish to enroll; (2) Obtain and pay for any medically necessary services; and (3) Submit a claim form to the Plan Administrator once the enrollment is processed. Claim forms are available on request from the Plan Administrator and enrollments will be processed retroactively back to an employee’s IBM Date of Hire.

• Review your medical plan coverage options, which are normally effective retroactive to the IBM Date of Hireo Services rendered from the Benefits effective date may affect your enrollment decision

and reimbursemento The IBM PPO, IBM PPO Plus, IBM PPO with HSA & IBM PPO Plus with HSA provide a

higher level of benefits if you use an In-Network provider, but coverage is available from Out-of-Network providers at a lower Benefit level

o True emergencies are covered at the In-Network Benefit level under the IBM PPO and EPO options, regardless of where care is received

o Most HMOs only cover Medically Necessary In-Network treatment, and Out-of-Network services only when such services meet the definition of a True Medical Emergency and where care is “Medically Necessary”


End of Module I

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