annual retiree guide for participants in the liberty ...liberty mutual retiree benefits program...

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Annual Retiree Guide for participants in the Liberty Mutual Retiree Benefits Program Please read this Retiree Guide for important information regarding your benefit coverages for 2015. Enrollment dates are October 27 - November 7, 2014. Visit Your Total Rewards at: www.yourtotalrewards.com/ libertymutual

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Page 1: Annual Retiree Guide for participants in the Liberty ...Liberty Mutual Retiree Benefits Program Please read this Retiree Guide for important information ... dental and/or life insurance

Annual Retiree Guide for participants in the

Liberty Mutual Retiree Benefits Program

Please read this Retiree Guide

for important information

regarding your benefit

coverages for 2015.

Enrollment dates are

October 27 - November 7, 2014.

Visit Your Total Rewards at:

www.yourtotalrewards.com/libertymutual

Page 2: Annual Retiree Guide for participants in the Liberty ...Liberty Mutual Retiree Benefits Program Please read this Retiree Guide for important information ... dental and/or life insurance

Annual Benefits Enrollment Begins October 27 and Ends November 7, 2014

As a participant in a Liberty Mutual post-retirement benefit plan, you have an annual

opportunity to review your medical, dental and/or life insurance coverage and make any

allowed changes. We encourage you to take a look at your coverage to make sure it’s still the

right fit for you and any family members who may also be enrolled in coverage in 2015. Here’s

what we ask you to review:

• Information about your plans as explained in this Guide.

• Any dependents you have enrolled for coverage, to make sure they still meet the Liberty

Mutual plans’ dependent eligibility requirements (see page 5).

• The Personalized Enrollment Worksheet that accompanies this Guide to make sure you

understand the cost of your coverage for 2015.

Eligible coverage changes may be made during this annual enrollment period. Of course, if

you do not have any changes to make for 2015, then no action is required on your part.

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Page 3: Annual Retiree Guide for participants in the Liberty ...Liberty Mutual Retiree Benefits Program Please read this Retiree Guide for important information ... dental and/or life insurance

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Overview: Your 2015 Retiree Medical Options

For Medicare-Eligible Retirees and Eligible Dependents:There are two Medical Plan coverage options if you’re eligible for Medicare. You become Medicare-eligible when you reach age 65, or you may be certified as Medicare-eligible at a younger age due to disability.

• Medical with Prescription Drug option

• Medical Only option

If you or an eligible dependent are enrolled in or select the Medical Only option for 2015, you may not change to the Medical with Prescription Drug option at any time in the future.

For Pre-Medicare-Eligible Retirees and Eligible Dependents:If you are younger than age 65 and not otherwise eligible for Medicare, your post-retirement medical coverage is the national network Preferred Provider Organization (PPO) Medical Plan option. The Plan Design you were eligible to enroll in at retirement (A, B or C) was determined by the Plan Design in which you were enrolled just prior to your retirement.

Note:

For all Medical Plan coverage options, benefits are not payable for services received outside the United States, other than emergency coverage while traveling.

Page 4: Annual Retiree Guide for participants in the Liberty ...Liberty Mutual Retiree Benefits Program Please read this Retiree Guide for important information ... dental and/or life insurance

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Medical Plan “split family coverage” reminderHaving “split family coverage” means that one or more family members are Medicare-eligible and one or more family members are not yet eligible for Medicare. When this happens, members of the same family are covered under separate options (i.e., one as pre-Medicare and one as Medicare-eligible).

For example, if you and your spouse/domestic partner are both younger than age 65 now, but you turn age 65 in August of 2015, you will be asked to make a new coverage election in the weeks prior to reaching age 65. Your spouse/domestic partner, however, will remain in the Medical Plan option he/she is currently enrolled in until his or her 65th birthday (or earlier, if Medicare certifies eligibility).

The Medical Plan option elected by the first covered family member to become eligible for Medicare is the only option available for other family members when they become Medicare-eligible. Using the example above, if you elect the Medical Only option when you reach age 65, your spouse/domestic partner will be eligible only for the Medical Only option when he/she becomes eligible for Medicare.

Please be sure to review your 2015 Enrollment Worksheet to see the options for which you and your family members are eligible and their monthly premium costs.

Check your Personalized Enrollment Worksheet for all of your 2015 coverage options and costs. More information is available within the Health Plan Comparison Charts that you can find in Your Total Rewards, your online resource for Liberty Mutual plan information.

Beginning October 27, visit Your Total Rewards via the Internet at www.yourtotalrewards.com/libertymutual.

Page 5: Annual Retiree Guide for participants in the Liberty ...Liberty Mutual Retiree Benefits Program Please read this Retiree Guide for important information ... dental and/or life insurance

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Dependent Eligibility Reminder

We can all help to control health care costs by using the plans wisely, asking providers about the services or prescription drugs they recommend and whether there are alternatives that may provide the same quality results at a lower cost, and by making sure that only eligible dependents are enrolled for coverage in the plan. All plan participants share in the cost of services that are provided to ineligible dependents. Many times, ineligible dependents are incorrectly enrolled because a participant doesn’t understand who is considered an “eligible” dependent.

Liberty Mutual contracts with an independent firm to conduct dependent eligibility verification audits to ensure that employees and retirees have enrolled only those dependents who meet the eligibility requirements under the Liberty Mutual Plans.

Eligible dependents include:

• Your legally married spouse of same or opposite sex (the Plan does not allow dependent coverage for a former spouse, even if a court mandates that you provide coverage).

• Your Domestic Partner.

• Your dependent children.

If you have an adult child younger than age 26, he or she is eligible to enroll in the Liberty Mutual Medical and/or Dental Plan whether or not access to his or her own employer-based coverage is available. Note: Beginning in 2015, coverage for your adult child who is reaching age 26 will continue through the last day of the month in which his or her birthday occurs. For example, if your daughter’s 26th birthday is March 15th, her coverage will be in effect through March 31st.

Your child is eligible for coverage if he or she meets the Internal Revenue Service’s criteria for a dependent child,

as detailed in each Plan’s summary plan description available within Your Total Rewards. In summary:

• Your biological child (this does not include a child for whom your parental rights have been legally terminated).

• Your legally adopted child (or child who has been placed for adoption).

• Your stepchild.

• Your eligible foster child.

• A child for whom a court order of custody or legal guardianship has been obtained.

• The child of your domestic partner.

• The child of your same sex spouse.

If a child does not meet the above criteria, he or she is not eligible for coverage under the Liberty Mutual benefit plans.

Review Your Enrollment WorksheetBe sure to review your Enrollment Worksheet or the information shown in Your Total Rewards to ensure that only eligible dependents are enrolled for coverage. Keep in mind that when you elect coverage for a dependent, you are certifying the eligibility of that individual as meeting the definition of a dependent as outlined in the applicable summary plan description. If you knowingly enroll an ineligible dependent or continue coverage for an individual who does not meet the dependent eligibility requirements (for example, a child age 26 or older or a former spouse after a divorce), this may result in termination of coverage for you and any enrolled dependents. When you cover a dependent through the Liberty Mutual benefit plan you are also agreeing to provide the required dependent eligibility documentation, if requested.

Page 6: Annual Retiree Guide for participants in the Liberty ...Liberty Mutual Retiree Benefits Program Please read this Retiree Guide for important information ... dental and/or life insurance

Resources to Know More

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Your Total Rewards The Your Total Rewards website is your resource for information on your post-retirement benefits. Use Your Total Rewards to make sure that your personal information is up-to-date. You can access the website at any time during the year. If you have a Thrift-Incentive Plan (TIP) balance, you can make investment option changes or check your balance on Your Total Rewards.

Make sure your information is up-to-date. When you visit Your Total Rewards during this annual benefits enrollment period, you should also review your personal information and make sure it is correct. Personal information includes:

• Your home address (including an alternate address if you live in another location for part of the year).

• Your financial institution information, if you’re receiving Retirement Benefit Plan (pension) payments.

• Your telephone (including mobile phone), email address and mailing address information. TIP: If you enter a mobile telephone number or a personal email address, you will be able to quickly receive Your Total Rewards password reset information. If you only have a postal mail address entered in Your Total Rewards, it may take 5-7 days for you to receive a password reset notice.

• Your electronic communication consent, so that you can receive certain updates via email rather than through the postal mail.

• Your beneficiary information, which is important to review on a regular basis to make sure the information is complete and up-to-date.

Your Health Plan Administrators’ SitesThrough Your Total Rewards you can also link out to the Aetna, Blue Cross Blue Shield and Express Scripts websites for information such as your online Explanation of Benefits (EOBs), provider network and benefit coverage information. If you visit these sites through Your Total Rewards, you don’t need to remember separate log-in information!

Can’t Find What You Need?You can contact your claims administrators at the telephone number on the back of your ID card or see the last page of this Guide for detailed contact information.

Page 7: Annual Retiree Guide for participants in the Liberty ...Liberty Mutual Retiree Benefits Program Please read this Retiree Guide for important information ... dental and/or life insurance

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Medical Plan Overview for Medicare-Eligible Retirees

Both of the Medical Plan options available to individuals who are eligible for Medicare have annual deductibles and coinsurance, as well as an out-of-pocket maximum to protect you financially:

Plan Option Annual Deductible* Annual Out-of-Pocket Maximum*

$300 individual$600 retiree and dependent$900 family

$1,500 individual$3,000 retiree and dependent$4,500 family

Medical with Prescription Drug

$300 individual$600 retiree and dependent$900 family

$1,500 individual$3,000 retiree and dependent$4,500 family

Medical Only

*Emergency room charge of $200 does not apply to your annual deductible or out-of-pocket maximum. Prescription drug coinsurance amounts paid by participants in the Medical with Prescription Drug option for Medicare-eligible participants also do not apply to your annual deductible or out-of-pocket maximum.

Important Medicare InformationIf you are eligible for Medicare Part A (hospital insurance) and Part B (medical insurance) coverages and are enrolled in either of the Liberty Mutual Medical Plan options for Medicare-eligible participants, Medicare is considered your primary plan. This means that your medical (excluding prescription drug) benefits under the Liberty Mutual Medical Plan are coordinated with your Medicare Part A and Part B benefits, under the “Maintenance of Benefits” provision in the Medical Plan.

Changes for 2015 to Medical with Prescription Drug OptionIf you are enrolled in the Medical with Prescription Drug option, there are changes to the prescription drug formulary. If you are currently taking a medication that is affected by the formulary changes, Express Scripts will be sending you communications about the change later this year.

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What does this mean to you? When the Medical Plan claims administrator processes your claim, a comparison is made between the benefit Medicare would pay versus the benefit the Medical Plan would pay under the Maintenance of Benefits provision.

• If the benefit Medicare would pay is greater than or equal to what the Medical Plan would pay, then the Liberty Mutual Medical Plan will not provide any benefits. However, if there are medical expenses not covered by Medicare Part A and B, generally, those expenses will be covered by the Medical Plan. Important: Both the Medical with Prescription Drug option and the Medical Only option assume you have enrolled in both Part A and Part B Medicare coverage – even if you have not enrolled in Part B. So it is important that you enroll in Part B as soon as you are eligible (enrollment in Part A is automatic).

• If the benefit Medicare would pay is less than what the Medical Plan would pay, then you will receive a benefit for the covered amount that is above the Medicare allowance, after you meet your annual deductible and pay your coinsurance under the Medical Plan.

Here’s an example of how the Maintenance of Benefits provision works, assuming this is your first hospital charge for 2014:

Original billed amount from hospital $2,250

Medicare-approved charge $1,750

Medicare 2014 hospital deductible - $1,216 Amount paid by Medicare ($1,750 - $1,216) = $534 Under the Maintenance of Benefits provision, the Plan calculates:

Medicare-approved charge $1,750

Medical Plan deductible - $300

= $1,450

Medical Plan coinsurance x 80%

Amount Liberty Mutual would have paid in the absence of Medicare ($1,450 x 80%) = $1,160

Subtract amount already paid by Medicare - $534

Medical Play payment ($1,160 - $534) = $626 To calculate the amount you pay:

Medicare payment $534

Liberty Mutual Medical Plan payment + $626

Total payments = $1,160

Medicare approved charge $1,750

Minus total payments - $1,160 Your payment $590

Your $300 deductible and the remaining $290 are both applied to your annual out-of-pocket maximum for covered charges.

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Aetna’s Medicare Direct ProgramAs a participant in the Medical with Prescription Drug or Medical Only option, you are automatically enrolled in Aetna’s Medicare Direct Program. This program allows for your medical expense claims to go directly from Medicare (your primary insurer) to Aetna, meaning that you don’t need to submit the claim yourself to Aetna for processing under the Liberty Mutual Medical Plan. The claim is submitted just once to Medicare – so there’s less confusion with multiple Explanation of Benefits (EOBs), as well.

2015 Pricing for Medicare-Eligible ParticipantsYou and Liberty Mutual continue to share in the cost of your medical coverage, based on factors such as your years of eligible credited service with the Company, the cost-sharing “cap” in place for retiree coverage, as well as your retirement date. Your Medical Plan summary plan description, available within the Plan Information section of Your Total Rewards has additional details.

Overall, both higher use and increases in the costs of services continue to result in increased costs across the country. However, the plan design changes that have been implemented over the past several years helped to avoid an increase in premiums for 2015. Participants in both the Medical with Prescription Drug option and in the Medical Only option will have no increase in premiums for 2015.

Page 10: Annual Retiree Guide for participants in the Liberty ...Liberty Mutual Retiree Benefits Program Please read this Retiree Guide for important information ... dental and/or life insurance

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Are you Medicare-eligible and looking for alternate medical coverage instead of your current Liberty Mutual medical coverage?

If you are considering leaving the Liberty Mutual Medical Plan post-retirement coverage, there are a number of options available through private exchanges. One exchange that you may be interested in Retiree Health Access® (RHA) —a private health insurance exchange partnership with eHealth that offers retirees a choice of individual plans from leading carriers that supplement your Medicare benefits and includes a range of benefit levels and monthly premium amounts, including prescription drug coverage.

RHA is a personalized and confidential service available at no cost to you (and to your Medicare-eligible dependents), as long as you are enrolled in Medicare Part A and Part B. For some retirees, the options available through RHA may provide a financially attractive alternative to the Liberty Mutual Medical Plan.

RHA and eHealth are not associated in any way with Liberty Mutual.

If you are interested, you can get more information through the RHA website at www.retireehealthaccess.com/one or by calling 1-888-458-6804 and speaking with an eHealth representative. Representatives are available Monday-Friday, 8:00 a.m.-10:00 p.m. and Saturday 8:00 a.m.-8:00 p.m. Eastern Time to answer your questions and provide information about options available in your area.

Note: If you decide to leave the Medical Plan altogether, or if you leave the Medical with Prescription Drug option for the Medical Only option, you may not re-enroll at any time in the future.

Page 11: Annual Retiree Guide for participants in the Liberty ...Liberty Mutual Retiree Benefits Program Please read this Retiree Guide for important information ... dental and/or life insurance

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Medical Plan Overview for Pre-Medicare Retirees

For Plan A, B and C, the out-of-network deductibles remain at $1,500 individual/$3,000 retiree and dependent/$4,500 family. The out-of-network out-of-pocket maximums remain at $4,000 individual/$8,000 retiree and dependent/$12,000 family.

Your Medical Plan At-a-GlanceYour medical coverage is provided through a national network Preferred Provider Organization (PPO) that has a network of providers who have contracted with the claims administrators on the cost of services. If you choose to use a provider outside of the network, your share of the costs is higher.

The annual in-network deductibles and out-of-pocket maximums remain:

Plan Design In-Network Deductible In-Network Out-of-Pocket Maximum

In-Network$400 individual $800 retiree and dependent$1,200 family

In-Network$1,500 individual$3,000 retiree and dependent$4,500 family

Plan A

In-Network$600 individual$1,200 retiree and dependent$1,800 family

In-Network$2,000 individual$4,000 retiree and dependent$6,000 family

Plan B

In-Network$1,000 individual$2,000 retiree and dependent$3,000 family

In-Network$2,750 individual$5,500 retiree and dependent$8,250 family

Plan C

Page 12: Annual Retiree Guide for participants in the Liberty ...Liberty Mutual Retiree Benefits Program Please read this Retiree Guide for important information ... dental and/or life insurance

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Prescription Drug Program Changes for 2015If you are enrolled in the PPO option, there are several prescription drug changes effective January 1, 2015. The changes reflect our continuing efforts to ensure that medications are provided in settings that adhere to high quality of care standards, while also looking for ways to control the escalating costs of prescription medications. The changes include:

• Formulary changes: There are changes to the prescription drug formulary, beginning January 1, 2015. If you are currently taking a medication that is affected by the formulary changes, Express Scripts will send you personalized communications about the change later this year.

• Maintenance medication change: In order to provide long-term, maintenance medications in a high-quality and cost-effective way, changes are being made to how maintenance medications are covered. If you take a maintenance medication, such as those used to treat high blood pressure or high cholesterol, you’ll pay the entire cost for a maintenance medication at a retail pharmacy after the third purchase if you choose not to use the Express Scripts Pharmacy.

Here’s an example of how this will work in 2015 compared to 2014:

If you are currently taking a medication that is part of the retail refill allowance program and are not already using the Express Scripts Pharmacy mail-order service, you will receive additional information from Express Scripts later this year. You can also visit http://express-scripts.com for information on how to move your prescription from retail to the Express Scripts Pharmacy mail-order service.

Drug Type Brand Name Indication Price Coinsurance 2014 Penalty 2015 Penalty Generic FLUTICASONE PROPIONATE Asthma $21.52 $6.46 $9.04 $21.52 Formulary Brand CRESTOR High Blood Cholesterol $194.81 $58.44 $81.82 $194.81 Non-Formulary Brand FLOVENT HFA Asthma $184.87 $92.44 $129.41 $184.87

The total cost of a 30-day supply

at retail.

The amount paid in 2015 (penalty equals 100% of price)

after prescription fills 1, 2 and 3

The 2014 retail coinsurance for prescription fills 1, 2 and 3

The amount paid in 2014 (coinsurance plus 40% penalty) after prescription fills 1, 2 and 3

Page 13: Annual Retiree Guide for participants in the Liberty ...Liberty Mutual Retiree Benefits Program Please read this Retiree Guide for important information ... dental and/or life insurance

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Deductible: A fixed dollar amount during the Plan year that you pay before the Medical Plan starts to make payments for covered medical services. The Plan has both an individual and a family deductible (see chart). Deductibles for in-network providers are lower than when out-of-network providers are used.

Note: Covered preventive care services are paid at 100% by the Medical Plan, whether or not you have paid your annual deductible.

Coinsurance: How you and Liberty Mutual share the cost of eligible expenses after you meet your annual deductible.

• Scheduled preventive care is paid 100% by Liberty Mutual, regardless of whether you have met your annual deductible.

• Liberty Mutual pays either 90% or 80% of in-network charges and you pay just 10% (for primary care providers) or 20% (for specialists and labs, radiology and other tests).

• If you choose to use out-of-network providers, Liberty Mutual pays 70% of covered expenses and you pay 30%.

Out-of-Pocket Maximum: This is the maximum dollar amount you are required to pay out of your pocket during the year. Until this maximum is met, you and Liberty Mutual share in the cost of covered expenses. After the maximum is reached, Liberty Mutual pays 100% of covered expenses.

Note: There are certain expenses that do not count toward the deductible and out-of-pocket maximum, such as the Emergency Room charge. Refer to your Medical Plan summary plan description for details.

How Deductibles and Coinsurance Work

If Out-of-Pocket Maximum Reached, Liberty pays 100%

You and Liberty Pay

Coinsurance

You Pay

Deductible

Page 14: Annual Retiree Guide for participants in the Liberty ...Liberty Mutual Retiree Benefits Program Please read this Retiree Guide for important information ... dental and/or life insurance

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Reaching age 65 in the coming year?If you (or an eligible dependent who is enrolled in the Medical Plan) are celebrating your 65th birthday soon, then you’ll be contacted in the near future to elect a Medical Plan option for Medicare-eligible participants.

If you or an eligible dependent enrolled in the Medical Plan become eligible for Medicare for any other reason, please call Benefits Express at 1-800-758-4460 and let the representative know. You can reach a Benefits Express representative Monday-Friday, 9:00 a.m. to 5:00 p.m., ET. It is important to call as soon as Medicare eligibility is determined, so that your coverage can be updated.

2015 Pricing for Participants Who are Not Eligible for MedicareYou and Liberty Mutual continue to share in the cost of your medical coverage, based on factors such as your years of eligible credited service with the Company, the cost-sharing “cap” in place for retiree coverage, as well as your retirement date. Your Medical Plan summary plan description, available within the Plan Information section of Your Total Rewards has additional details.

Health care costs increased for both the Company and for non-Medicare eligible participants for a number of reasons in the past year, including:

• Increases in costs charged for providers and for services.

• The relatively smaller population enrolled in this option.

• Higher usage of services.

• New medical treatments, technologies and therapies that can be more expensive.

• Early influences of Affordable Care Act (ACA) requirements, including government-mandated benefits and new taxes and fees.

You will see on your Enrollment Worksheet that your monthly premium is increasing for 2015.

Page 15: Annual Retiree Guide for participants in the Liberty ...Liberty Mutual Retiree Benefits Program Please read this Retiree Guide for important information ... dental and/or life insurance

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Wellness Resources – Helping You Maintain Your Health

As a retiree who is younger than age 65 and enrolled in the Liberty Mutual Medical Plan, you have access to a well-being program that is paid for fully by Liberty Mutual.

In early January 2015 you will receive information about a new wellness program that we are offering to our active employees and retirees who are not eligible for Medicare. This program will replace the current Optimal Health program and portal.

And remember – under the Medical Plan, preventive care, as defined by an age-based schedule, is covered at 100%, without any deductible or coinsurance. An annual preventive care exam can help identify health risks such as high blood pressure or high cholesterol and let you take preventive steps to improve your health.

Page 16: Annual Retiree Guide for participants in the Liberty ...Liberty Mutual Retiree Benefits Program Please read this Retiree Guide for important information ... dental and/or life insurance

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Other Post-Retirement Benefits

DentalThere are no plan changes to the Dental Plan for 2015.

If you are enrolled in coverage, your 2015 monthly price tags are shown on your Enrollment Worksheet and in Your Total Rewards. Dental Plan price tags are increasing by a small amount, to reflect increases in the cost of claims.

You and the Company continue to share in the cost of the annual premium.

Life InsurancePrice tags for Retiree Life Insurance in 2015 will not change.

Keep in mind that rates increase at certain age levels – the older you are, the more expensive your coverage will be. Also remember that your retiree life insurance coverage reduces according to your reduction schedule.

Note: If you have life insurance coverage, the “value” of any group term life insurance amounts greater than $50,000 is considered to be taxable income under the Internal Revenue Code (IRC). The value of any Company-paid benefit over the $50,000 IRC limit will be included in your taxable income.

Page 17: Annual Retiree Guide for participants in the Liberty ...Liberty Mutual Retiree Benefits Program Please read this Retiree Guide for important information ... dental and/or life insurance

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Understanding Your Coverage

Understanding how your plan works, what services are covered and what your share of the costs will be is an important part of becoming an educated health care consumer:

• Your Total Rewards is where you can find your summary plan descriptions, which contain the details about your coverage, as well as your health plan comparison charts which highlight key information for your plan. You can also search for in-network providers using the provider search tool within the website.

• Your claims administrators can also help you with questions that you may have about your coverage. You can find the telephone number on your ID card or on the back page of this Guide.

• Has your doctor recommended non-emergency services and you’re looking for information on the cost of those services? Did you know that prices can vary by as much as 70% for the same services in any geographic area? If you are not eligible for Medicare, you can access the Health Care Bluebook website at https://www.healthcarebluebook.com/ for information on the cost of services in your geographic area. If you are eligible for Medicare, your healthcare provider may be able to tell you what is covered by Medicare and what the services will cost. Or you can visit www.medicare.gov.

• Considering changing your coverage? Make sure you understand the following:

- If you are enrolled in the Medical Plan and choose No Coverage for 2015, you may not re-enroll in the Liberty Mutual Medical Plan at any time in the future.

- If you are enrolled in the Medical with Prescription Drug option and instead elect the Medical Only option for 2015, you may not re-enroll for prescription drug coverage under the Liberty Mutual Medical Plan at any time in the future.

• Are you or a covered dependent turning age 65 soon? If you retired before you and your eligible dependents were eligible for Medicare, several months before you reach age 65 you will be contacted to make an enrollment election for one of the Medicare-eligible options. Please note:

- The coverage election of the first family member eligible for Medicare will govern the coverage of all other eligible family members. For example, if you become eligible for Medicare before your spouse and elect the Medical Only option, your spouse will only have the Medical Only option available when he or she becomes eligible for Medicare.

- Note: If you or a covered dependent become eligible for Medicare for a reason other than reaching age 65, please call Benefits Express (1-800-758-4460) as soon as this happens so that your coverage can be updated.

• If you are enrolled in the national PPO option for participants who are not yet eligible for Medicare and you move outside of your claims administrator’s (Aetna or Blue Cross Blue Shield) service area, please call Benefits Express (1-800-758-4460) at the time you move, so that you can participate in the correct provider network and receive the highest level (in-network) of benefits

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Eligible Status Changes

In certain circumstances, such as divorce, legal separation or your dependent child reaching age 26, you are required to drop those dependents from your Liberty Mutual coverage. In other cases, such as marriage or the birth or adoption of a child, you may be eligible to add your family member to your coverage.

If you have elected retiree Medical and/or Dental Plan coverage, eligible status changes include:

• You may change your coverage category and enroll your spouse or domestic partner if he or she has involuntarily lost coverage under his or her employer’s plan and has no other group coverage available. Your spouse’s or domestic partner’s retirement is not considered to be an involuntary loss of coverage.

• You may change your coverage category if you marry or enter into a domestic partnership. You may enroll your spouse or domestic partner and any eligible dependent children. You are required to complete an Affidavit of Domestic Partnership if you are adding a domestic partner.

• You may change your coverage category if one of your covered family members dies.

• You must change your coverage category if you divorce or end your domestic partnership and your spouse or domestic partner was enrolled in the Liberty Mutual benefit plans. You must notify Benefits Express within 60 days of the date of the divorce or end of the domestic partnership, as former spouses and domestic partners are not eligible dependents under the Medical and/or Dental Plans. Your former spouse or domestic partner may be able to continue coverage for a certain period of time through COBRA, but you must call Benefits Express within 60 days of the divorce or end of the partnership in order for COBRA to be available.

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Contact:

Benefits Express™: 1-800-758-4460

Representatives are available Monday-Friday, 9:00 a.m. to 5:00 p.m., Eastern Time, except for holidays.

Have your User ID and password handy, to expedite your call.

Your Total Rewards:

www.yourtotalrewards.com/libertymutual is also available 24 hours a day, 7 days a week except Sunday from 2 a.m. to 1 p.m. Eastern Time.

These toll-free telephone numbers are also on your identification (ID) card(s).

Aetna (representatives available Monday-Friday, 8:00 a.m. to 6:00 p.m., Eastern Time).

• Medical with Prescription Drug, Medical Only options: 1-800-882-0456• PPO option*: 1-800-882-0455

Blue Cross Blue Shield (representatives available Monday-Friday, 8:00 a.m. to 9:00 p.m., Eastern Time).

• PPO option*: 1-800-377-2449

*Check your Enrollment Worksheet for your claims administrator or refer to the listing in the summary plan description for the state guide to PPO network and claims administrators.

Express Scripts

• Medical with Prescription Drug option for Medicare-eligible participants: 1-877-703-7348

• PPO option for non-Medicare eligible participants: 1-800-717-6710

Or visit the Express Scripts website through the link in Your Total Rewards or at http://express-scripts.com

Delta Dental: 1-888-433-3582 (1-888-4DELTA)

Liberty Mutual Auto and Homeowners Insurance:

• Contact your local Personal Sales Representative or call 1-800-981-2372Safeco Insurance Group Plan: 1-888-824-4223

John Hancock: 1-800-440-4740

For help with:

Changing coverage, pension check questions, updating your address, updating dependents or beneficiaries, etc. and general questions on:

Retirement Benefit (pension) Plan Thrift-Incentive (401(k) savings) Plan Retiree Medical Plan Retiree Dental Plan Retiree Life Insurance Plan

Medical Plan Coverage or Claims Questions

Prescription Drug Questions

Dental Plan Coverage or Claims Questions

Voluntary Benefits Questions (auto and homeowners insurance)

Grandfathered LTC Plan Questions

Who to Contact for Assistance

Page 20: Annual Retiree Guide for participants in the Liberty ...Liberty Mutual Retiree Benefits Program Please read this Retiree Guide for important information ... dental and/or life insurance

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This Guide provides an overview of the Liberty Mutual Retiree Benefits Program. Complete information about our Retiree Benefits Program is included in the legal documents for each plan. As always, if there are any discrepancies between this Guide and the legal documents, the legal documents will govern. The Company reserves the right to change or terminate any plan, the terms of any plans, or cost-sharing arrangement at any time.

Fall 2014 Printed in U.S.A. 148056 - AE Retiree Guide