2015 Enrollment Guide Benefits at Xerox ACS-GB6 In this Guide Welcome . . . . . . . . . . . . 1 Your Coverage Options . . .12 What to Know for 2015 . . . 2 How to Enroll . . . . . . . . 32 Benefit Changes for 2015 . . 5 Important Notices . . . . . 33 If You Don’t Enroll . . . . . . 7 Benefit Contacts . . . . . . 37 Wellness Screening Summary of Material Registration . . . . . . . . . . 9 Modifications . . . . . . . . .41 Who You Can Enroll . . . . 10 Welcome This guide is designed to provide the key information you need to choose the benefits that best meet your needs for 2015. Go to BenefitsWeb to see the benefits available to you and their associated costs. Annual Enrollment is from Monday, November 3 through Friday, November 14, 2014 at 11:59 p.m. ET. Take these steps to have a successful enrollment: • Remove the Working Spouse/Domestic Partner Surcharge on BenefitsWeb if it doesn’t apply to you, even if you previously removed it for 2014. See page 11 for more information. • Take advantage of wellness incentives and remove the tobacco surcharge, or you will pay more for your benefit coverage than you should. See page 2 or the 2015 Incentive Overview on BenefitsWeb for more information. • Make your decisions carefully. Once Annual Enrollment ends, you will not be able to change your elections until the next Annual Enrollment, unless you have a qualifying change in status, as described on page 8. • Review your coverage options in this guide. You can find more information on BenefitsWeb or through your plan’s phone number or website listed under “Benefit Contacts” on page 37. • Decide whether you want to cover dependents, and remove those that are no longer eligible, as described on page 10. Annual Enrollment is from Monday, November 3 through Friday, November 14, 2014 at 11:59 p.m. ET. Choose, Use and Improve With BenefitsWeb BenefitsWeb is your one-stop shop for information and resources all year ’round. • Gather the Social Security numbers of the dependents you will cover, if you have not already provided this information on BenefitsWeb (see page 3). • Choose: Review your benefit options and enroll in your benefits in a few simple steps. On BenefitsWeb, you’ll find summaries of benefits and coverage (SBCs), which are standardized at-a-glance charts of medical and prescription drug coverage. • Enroll by the deadline (November 14). If you don’t enroll by the deadline, you will receive default coverage, described on page 7. • Use: Learn tips on how to use benefits wisely. Find a medical provider in your plan’s network, or check your prescription drug costs. • Improve: Access a wealth of health and wellness information and tips. The 2015 Enrollment Guide is intended for eligible employees of Xerox Business Services, LLC (Xerox Services) and Xerox Technology and Corporate organizations, with the exception of Xerox Technology union employees. Other groups of employees may have varying eligibility requirements and/or benefit options. Projectbased employees of Xerox Services, certain part-time employees, temporary employees, and contractors, including (without limitation) leased employees, supplemental contract workers, consultants, or any other third-party personnel, or anyone classified by the company as such, who perform services for the company, are neither eligible for nor covered by the plans and programs summarized herein (unless they qualify as eligible dependents). Certain BenefitsWeb features such as wellness screening registration or direct access to programs and medical plan administrators are not available for residents of Guam, Hawaii or Puerto Rico or employees with coverage through Anthem Traditional Plan II. If you are an inpatriate or expatriate, your medical, dental and vision benefits are different than those discussed in this guide. You will receive a separate communication explaining those benefits. 1 What to Know for 2015 Xerox is stepping up the wellness incentive requirements this year. Xerox is serious about its commitment to better health for employees and their families. For 2015, incentives have changed, and there is more riding on your wellness screening. You and your spouse/domestic partner can each earn a $600 wellness incentive toward the cost of your medical coverage when you complete a wellness screening and online health questionnaire with Quest Diagnostics by November 30. New for this year, Xerox has introduced an annual tobacco surcharge of $500, which is applied automatically to the cost of medical plan coverage for all employees and covered spouses/domestic partners. To remove the surcharge, complete your wellness screening and online health questionnaire and test negative for tobacco use. Or, if you test positive for tobacco use in your screening, enroll in the Quit For Life program and complete five phone calls by March 31, 2015. To enroll, call 1.866.QUIT.4.LIFE (1.866.784.8454). You may also qualify for an opportunity to earn the same rewards by different means, such as following a program recommended by your physician. If you have questions, call the Xerox Employee Service Center or Workplace Solution Center. Don’t throw away $2,200. Earn the Wellness Incentive Complete your wellness screening Complete an online health questionnaire Earn $600 wellness incentive (for you, plus an additional $600 for your covered spouse/ domestic partner) If you test positive, enroll in and complete five calls with the Quit For Life tobacco cessation program by March 31, 2015 Remove $500 tobacco surcharge (for you, plus an additional $500 for your covered spouse/domestic partner) Remove the Tobacco Surcharge Test negative for tobacco use in your wellness screening 2 Enrollment Checklist £ Complete your wellness screening and online health questionnaire. You and your spouse/domestic partner should register for a wellness screening via BenefitsWeb to ensure incentives are properly credited to each of you (see “Wellness Screening Registration” on page 9). Your spouse/domestic partner must log in as a spouse/domestic partner using his or her own Social Security number (not under your employee ID), so be sure you have provided his or her Social Security number on BenefitsWeb. The only exception is if you and your spouse/domestic partner both work for Xerox. In that case, see the special instructions for Xerox couples on page 9. If you live in Guam, Puerto Rico or American Samoa, or if you are enrolled in Anthem Traditional Plan II, you and your spouse/domestic partner need to register for your screening on the Quest Diagnostics website, as shown on page 9. Note: If you live in Guam, these incentive requirements now apply to you also. If you live in Hawaii or are hired after September 15, 2014, these incentive requirements do not apply to you. For more information about wellness incentives, see the 2015 Incentive Overview, available in the Enrollment News section of BenefitsWeb. £ If you test positive for tobacco, complete the Quit For Life program. If you test positive for tobacco in your wellness screening, complete five phone calls by March 31, 2015 to remove the tobacco surcharge. Call 1.866.QUIT.4.LIFE (1.866.784.8454). £ Review your eligible dependents. It’s important that you enroll only eligible dependents for health care coverage. Xerox will conduct a Dependent Eligibility Verification Audit after 2015 Annual Enrollment. Review the dependent eligibility rules on page 10 and decide if you need to add dependents to your coverage or remove them. £ Have your dependents’ Social Security numbers ready. £ Check your medical or dental provider network. When you’re ready to enroll, make sure you have all your dependents’ Social Security numbers handy. You will not be able to enroll them without providing their Social Security numbers, even if they are already covered. You will be required to enter them before you can complete your enrollment. Go to BenefitsWeb > My Health > Manage My Coverage > View My Personal Information > Dependents. If you don’t see a My Health link at the top of the page, click Personal Information instead. If you have difficulty, you can also call the Xerox Employee Service Center or the Workplace Solutions Center. When you enroll in certain medical options (Consumer Choice Plan or Xerox Services PPO Plan) or dental options (Basic Dental or Enhanced Dental), your medical/dental plan administrators — and those administrators’ provider networks — are assigned to you based on where you live. That’s because Xerox is committed to providing comprehensive, affordable care. Medical/dental plan administrators are carefully selected to offer quality provider networks with competitive discounts. You could have a new medical/dental plan administrator for a couple of reasons: £ Don’t forget about the Working Spouse/Domestic Partner Surcharge. If your spouse/domestic partner is enrolled or will be enrolled in medical coverage for 2015, a $1,500 Working Spouse/Domestic Partner Surcharge is automatically added to your coverage costs. If your spouse/domestic partner does not have access to medical coverage through another employer, be sure to go to BenefitsWeb and remove the surcharge during the online enrollment process before Annual Enrollment ends on November 14. Note: You must remove this surcharge every year, even if you’ve done it in the past. • Did you move in 2014? If you moved during the year and you kept the same medical plan administrator (Aetna, Anthem or Cigna, for example), you will be reassigned to the medical plan administrator for your new location on January 1, 2015. • Do you live in one of these areas where the network has been reassigned? In some locations, assigned medical plan administrators are changing. If you live in: – The Dallas/Fort Worth Metroplex area, you will have Anthem. – Pittsburgh, you will have Aetna. If you live on the borders of these areas, check BenefitsWeb to confirm your new medical plan administrator for 2015. If you have a new medical plan or dental plan administrator, check to see if your doctor and/or dentist is in your new network. See the “Benefit Contacts” section of this guide to find out how to look for a doctor or dentist. If you need help, Health Advocate is available at 1.877.776.6211 to assist you in reviewing your options. 3 Transition of Care Issues In certain limited situations, when your provider network changes you may be allowed to continue to see your current doctor on an in-network basis even if he or she is not part of your new medical plan administrator’s network of participating providers. These exceptions are known as “transition of care” and are predominantly restricted to the third trimester of pregnancy, high risk pregnancies, cancer treatment, transplants, recent major surgeries and other acute conditions. Transition of care applies only for a limited time. After the end of the transition period, you will need to see a provider in your 2015 medical plan administrator’s network if you wish to receive in-network benefits. If you or an eligible dependent is undergoing orthodontia treatment and your dental plan administrator has changed, you may be eligible for transition of care to receive in-network benefits, if your provider would otherwise be considered “out-of-network” under the new dental plan administrator. Prior orthodontic expenses may apply toward meeting the lifetime maximum. To apply for transition of care, you (and in some situations, your doctor) will need to follow the instructions provided by your new medical or dental plan administrator. Information can be found at BenefitsWeb > My Health > Access My Forms and Documents > Transition of Care. What if I move during 2015? Generally, you’ll stay with your current medical plan administrator until 2016. However, if you are enrolled in a plan in Hawaii or Puerto Rico, or you’re in a Kaiser Permanente option, and you move to a location where your medical plan administrator is not available, you’ll be reassigned to the medical plan administrator and/or plan option designated for that location. Likewise, if you move during the year, you will generally keep the same dental plan administrator until the next Annual Enrollment period, unless you are in the Aetna DMO and you move to an area where the Aetna DMO is not available. If that happens, you will be enrolled automatically in the Basic Dental option with the dental plan administrator assigned to your new location (Aetna or Cigna). If you choose, you may enroll in the Enhanced Dental option instead. You might get new ID cards. Your medical and dental plan administrators are assigned based on your home ZIP code. During Annual Enrollment, BenefitsWeb will show you what plan administrators are assigned to you. If your medical plan administrator has changed since last year, or if you are enrolling in or changing to a dental plan with Cigna, please watch for your new ID card, which will be sent to your home address in January directly from your plan administrator. If you do not receive a new ID card and you feel you should, contact your medical or dental plan administrator through the contact information shown in the “Benefit Contacts” section of this guide. Note: You do not need an ID card for Aetna dental coverage or for vision coverage. 4 Benefit Changes for 2015 Consumer Choice Plan Deductibles and Health Savings Account Contribution Limits • The Consumer Choice Plan will have new in-network deductibles of $1,300 per individual and $2,600 per family. The out-of-network deductibles are also changing to $3,900 per individual and $7,800 per family. • Health Savings Account (HSA) contribution limits have increased for 2015, so you can save more. The combined maximum amount that you and Xerox can contribute to an HSA in 2015 will be $3,350 for individuals or $6,650 for a family, plus catch-up contributions, if you are eligible for them. Xerox Services PPO Plan Out-of-Pocket Maximums • The Xerox Services PPO Plan (available to current enrollees only) will have new in-network out-of-pocket maximums of $6,600 per individual and $13,200 per family. The out-of-network out-of-pocket maximums are changing to $13,200 per individual and $26,400 per family. • Your prescription drug expenses will now count toward the in-network out-of-pocket maximum. • However, this does not include penalties for not complying with the mandatory generic rule (see page 14). If you purchase a brand-name drug when a generic equivalent is available, your out-of-pocket cost will be your share of the cost of the generic version of the drug plus the difference in price between the generic drug and the brand-name drug you purchased. This additional amount will not count toward the out-of-pocket maximum. Likewise, any penalty you pay for not complying with step therapy or prescription drug prior authorization rules also will not count toward the out-of-pocket maximum. Prescription Drug Coverage for the Consumer Choice Plan and the Xerox Services PPO Plan Xerox is committed to providing comprehensive prescription drug coverage, and partners with CVS Caremark to manage the prescription drug program. There are some changes outlined below that you will see for 2015. If you’re affected by any of these changes, you’ll be contacted in advance. To see a list of your plan’s preferred drugs, go to www.caremark.com/xerox and click on “Check Availability & Cost.” Prior authorization required. Some drugs require authorization by CVS Caremark before the prescription drug plan will cover them. This is not a new program, but five new drugs will be added to the list in January, and other drugs could be added quarterly throughout the year. If you’re already taking a drug when it is added to the prior authorization list, you’ll be notified in advance. Compounds. Compounding is a practice in which a pharmacist combines, mixes or alters ingredients of a drug. Compound prescriptions can include ingredients not approved by the FDA. To ensure members are being prescribed medications that are safe and effective, additional controls will be put in place. Beginning in January, some compounds will be excluded from coverage, while others will have new dollar or dosage limits. Specialty product management. Specialty drugs are prescription medications that require special handling, administration or monitoring. These drugs are used to treat complex, chronic conditions, such as multiple sclerosis, rheumatoid arthritis, hepatitis C and hemophilia. For 2015, the plan will feature a new generics-first approach, where it’s appropriate. Just as it sounds, you may be required to try a generic form of a drug before the plan will cover the brand name drug. The management program also includes dosage monitoring to ensure that doses prescribed are within safety limits, and a Day-1 Utilization Management Program will ensure that all newly approved specialty products are covered if they are being used in accordance with FDA-approved labeling. All of these are ongoing programs; there could be changes throughout the year on a quarterly basis. It’s important to note that any time there is a change that affects a prescription you’re already taking, you’ll be notified in advance by CVS Caremark. 5 If You Live in Guam or Hawaii Xerox is seeking to harmonize our approach to medical coverage for all U.S. employees, moving away from HMOs and toward offering PPO plans with a deductible that you must meet before the plan begins to share costs with you. Along these lines, there are changes to medical options in Hawaii and Guam. In Hawaii, there are changes to all three medical options: • Kaiser Hawaii HMO will be closed to new entrants. If you’re already enrolled in this plan, you may remain in the plan. However, if you choose other coverage for 2015, you will not be able to re-enroll in the Kaiser Hawaii HMO in the future. • HMSA Health Plan HMO will be discontinued, and HMSA HMO participants will automatically be enrolled in an HMSA PPO plan instead with the same covered dependents you have today. • For 2015, HMSA PPO is also making some important changes, such as introducing a deductible of $300 for individuals and $900 for families. The deductible doesn’t apply to contraceptives, emergency services, prescription drugs, preventive care or well-child care. In-network preventive care will still be covered at 100% with no deductible. In Guam, TakeCare Asia HMO has the following changes: • The out-of-network deductible is being reduced to $250 for individuals and $750 for families. • Instead of paying a flat dollar copayment for specialist office visits, emergency room, inpatient and outpatient hospital care, you will pay 20% coinsurance, which means you pay 20% of those expenses, and the plan pays the remaining 80% of the cost. • For prescription drugs, there are small changes in copay amounts if you use TakeCare’s FHP clinic. But if you use other pharmacies, you will pay a percentage of the cost of your prescription drug, rather than a flat dollar copayment. Note: Guam employees who enroll in medical coverage in 2015 will need to complete the wellness incentive activities set out on page 2 to earn incentives and remove the tobacco surcharge. If you are participating in the HMSA HMO, HMSA PPO or TakeCare Asia HMO, you will receive a separate communication from Xerox with more information about upcoming changes. Xerox Services Life Insurance Options Xerox is moving toward having a single life and accident insurance program. For 2015, Xerox Services is changing your life insurance options, giving you more flexibility to choose the coverage you want for yourself and your family. Now you may purchase supplemental life insurance coverage in the amount of one to 10 times your basic annual earnings, up to $3 million. Benefits That Are Not Changing There are no changes to the Dental, Vision, Health Care Flexible Spending Account (FSA), Dependent (Day) Care FSA, Disability, Legal Services (you may have seen this called “Group Legal” or “Hyatt Legal”) or Vacation Purchase Plans. In addition, the Supplemental Accidental Injury, Hospital Indemnity and Critical Illness plans will not change. However, if you want to participate the following benefits, you must re-enroll during Annual Enrollment: • Health Care FSA or Dependent (Day) Care FSA • Vacation Purchase Plan (for Xerox Technology employees) Health Advocate can help with your questions about health care and much more. Finding your way around our health care system can be challenging. We all need to be wise health care consumers to get the most out of our medical coverage and benefit the most from our care. That’s why Xerox provides a service to help you with a variety of needs. If you are enrolled in the Consumer Choice Plan or the Xerox Services PPO Plan, Health Advocate is available to you, your covered spouse/domestic partner, your covered dependent children, your parents and your parents-in-law. Health Advocate has live operators who can: • Assist with navigating your Xerox health benefits, and • Find a physician or second opinion. And their services don’t end there. If you have dependent care needs (for children or aging parents), Health Advocate can help with those too. See “Health and Wellness Resources” to learn more. You can reach Health Advocate by calling 1.877.776.6211. 6 If You Don’t Enroll Annual Enrollment ends November 14 at 11:59 p.m. ET. If you don’t enroll, here’s what happens. If you currently have… Your 2015 coverage will be… Medical Consumer Choice Plan • Your current coverage with the same covered dependents – and medical plan administrator (Aetna, Anthem, Cigna or Kaiser) – you have today. (Unless your network has changed, see page 3.) • If you have an HSA, your contribution election will roll over, and you’ll receive Xerox contributions (if you are eligible for company contributions). • If you haven’t opened an HSA, you may do so through BenefitsWeb > My Health > My HSA or at www.mybenefitwallet.com. You must open your HSA in order to receive Xerox contributions (if you are eligible). You must open your account by November 30, 2014 to get the full Xerox contribution for 2015. HMSA Health Plan HMO HMSA PPO with the same covered dependents you have today. • • • • • • Your current coverage with the same covered dependents you have today. Xerox Services PPO Plan Anthem Traditional Plan II Kaiser Hawaii HMO HMSA PPO Humana Puerto Rico HMO TakeCare Asia HMO Dental Basic or Enhanced Dental option Your current coverage with the same covered dependents you have today. Aetna DMO Aetna DMO unless the DMO is no longer available in your geographic area, in which case you will be assigned to the Basic Dental option with Aetna or Cigna, depending on your home ZIP code. Vision Vision Plan Your current coverage with the same covered dependents you have today. You and your covered dependents will be re-enrolled in vision coverage with VSP and locked into coverage for 2014 and 2015. Other Benefits Health Care FSA or Dependent (Day) Care FSA You will not participate in 2015. • Critical Illness Insurance • Accidental Injury Insurance • Hospital Indemnity Insurance Your current coverage with the same covered dependents you have today. Legal Services Plan Your current coverage. Disability, Life Insurance, Dependent Life Insurance, Accidental Death & Dismemberment Insurance Your current coverage. Vacation Purchase (Xerox Corporate and Technology only) You will not participate in 2015. 7 If you don’t enroll, you will pay more for your medical coverage: Wellness Incentive and Surcharges Working Spouse/Domestic Partner Surcharge If your spouse/domestic partner is enrolled in medical coverage, you will be charged the Working Spouse Surcharge/Domestic Partner Surcharge of $1,500 unless you visit BenefitsWeb and remove it. Wellness Incentive and Tobacco Surcharge If you or your spouse/domestic partner do not complete a wellness screening and online health questionnaire, before the November 30 deadline, you will each: • Be charged a $500 tobacco surcharge, and • Miss out on $600 of wellness incentives. Note: If you test positive for tobacco use in your wellness screening, you will need to enroll in the Quit For Life program and complete five phone calls by March 31, 2015 to remove the tobacco surcharge. To enroll, call 1.866.QUIT.4.LIFE (1.866.784.8454). See page 3 for more information. Are You a Xerox Technology Employee in Local Union 14Y? Because you are new to the benefits described in this enrollment guide, the coverage you will receive if you do not enroll is different, click here for details. Qualifying Changes in Status In most cases, the enrollment decisions you make will remain effective from January 1 through December 31, 2015. However, you may change some of your elections during the year if you have a qualifying change in status, provided the coverage change is consistent with your status change. Changes in status include: • Birth or adoption of a child • Marriage or domestic partnership • Divorce, legal separation, or termination of a domestic partnership • Death of a covered dependent • Change in employment status for you or your spouse/domestic partner that results in a gain or loss of benefits • Change in your dependent’s eligibility for benefits • Issuance of a qualified medical child support order You must make any coverage changes within 30 days of the change in status. To make a change, go to BenefitsWeb, or you can call the Xerox Employee Service Center at 1.800.428.2203 or the Workplace Solutions Center at 1.888.471.2271. If you don’t make the change within 30 days of the change in status, you may not make the change until the next Annual Enrollment period. 8 Wellness Screening Registration Register for Wellness Screening Online at BenefitsWeb Both you and your spouse/domestic partner can log on to BenefitsWeb. Click here for detailed instructions on how to register. To register for your wellness screening and take the online health questionnaire, go to My Health > Know My Numbers and follow the links. How to Log in to BenefitsWeb Xerox Technology and Corporate • Employees: Go to www.XeroxBenefitsWeb.com. The first time you log in to the new site, you should follow the instructions on the My Login page to set up your new BenefitsWeb User ID, Passcode and Security Questions to use going forward. • If you have login questions, call the Xerox Employee Service Center at 1.800.428.2203, and select “1” for benefit information. Xerox Services • Employees: Go to BenefitsWeb via InfoBank, https://infobank.acs-inc.com/login.asp. • If you have login questions, call the Workplace Solutions Center at 1.888.471.2271, and select “2” for benefit information. All Spouses/Domestic Partners: Last year, spouses/domestic partners registered directly with Quest Diagnostics. This year, spouses/domestic partners who are or will be enrolled in medical coverage should register through BenefitsWeb. They must go to www.XeroxBenefitsWeb.com, check the spouse/domestic partner box on the My Login page and follow the instructions to create their own BenefitsWeb login credentials. Note: Make sure you have provided your spouse’s/domestic partner’s Social Security number, or he or she will not be able to login and register on BenefitsWeb. Special Groups • If you are the employee, you should Registering for Your Wellness then enter 6-digit Employee ID or Screening if You Live in Guam, Hawaii 8-digit WIN. Puerto Rico, or if You Are Enrolled in Anthem Traditional Plan II • Your covered spouse/domestic Both you and your spouse/domestic partner should register by using your partner must register for your wellness employee ID and adding “S” to the screening at a Quest Diagnostics Patient end. Service Center or obtain a Physician • After you enter your Registration Key, Results Form at you will establish a Username and my.blueprintforwellness.com, Password that you can use to enter or call 1.855.332.2533. the site as a returning participant • You must register as a new going forward. participant, even if you participated • Residents of Hawaii receive the in screenings last year, and create a wellness incentive automatically, new Username and Password. but can follow these instructions to • Enter “Xerox” in the Registration complete a wellness screening. Key box. Xerox Couples If you and your spouse/domestic partner both work for Xerox, you can log in either as an employee or as the dependent of your Xerox spouse/ domestic partner. Note: When you take your wellness screening, if you are covering yourself for medical, you are the employee for benefit purposes and you should log in as the employee. If your spouse/domestic partner is covering you for medical, you are the dependent for benefit purposes and you should log in as the dependent of your spouse/domestic partner. Otherwise, your credit for the wellness screening will be delayed. 9 Who You Can Enroll You may enroll your eligible dependents in medical, dental, vision, supplemental insurance benefits, life insurance and accidental death and dismemberment (AD&D) coverage. Generally, eligible dependents include your legal spouse, your same-sex or opposite-sex domestic partner, and your or your spouse’s/domestic partner’s dependent children, up to certain age limits. For a complete definition, click on the applicable rules in the table below. Dependent Eligibility Verification Xerox will be conducting a Dependent Eligibility Verification Audit to ensure that all dependents enrolled in our medical plan meet the criteria to be eligible for coverage. The Dependent Eligibility Verification Audit will be conducted after the 2015 Annual Enrollment. During this fall’s enrollment, it will be vital to go to BenefitsWeb and ensure your dependent information is current, including Social Security numbers, dates of birth and addresses. Annual Enrollment will serve as your opportunity to drop any dependents that are no longer eligible for coverage without fear of penalty. If you do not know if your dependents meet the eligibility qualifications, please use the table below to review the eligibility rules. Documentation (for example, birth certificates or marriage documents) will be required for all dependents enrolled in the benefits plan effective January 1, 2015. This includes all newly enrolled dependents and dependents that are continuing coverage. Ineligible dependents identified during the audit will no longer have access to our group medical plan in early 2015, which may make it more difficult to obtain coverage under another health plan option. Dependent Eligibility Xerox Technology & Corporate Click here to view eligibility rules. Xerox Services Click here to view eligibility rules. Paying for Coverage Your contributions are paid by payroll deduction, and you pay for certain coverage with before-tax dollars, which lowers your taxable income. Paying your share of the cost on a before-tax basis means your contribution is deducted from your pay before federal income and Social Security taxes (and in most cases, state income taxes, if applicable) are withheld. This lowers the amount of your taxable compensation, which in turn lowers the income taxes you pay. You should also know that the contributions the company pays for coverage for your domestic partner and/or your domestic partner’s dependent children are considered taxable (imputed) income, and you will pay income tax on the employer’s contributions toward the cost of coverage for these dependents. You are also required to pay tax on the value of any basic life insurance coverage in excess of $50,000. If you work for Xerox Services, please note that: • If your annual pay changes during the year, this change may affect the amount of your medical plan, life insurance and short-term disability contributions. The adjustment to your contributions will be made as soon as possible with retroactive adjustments, as necessary, back to the pay period your pay adjustment was effective. • Your costs for coverage of a domestic partner or a domestic partner’s child(ren) will be deducted on an after-tax basis. If you are a Xerox Technology or Corporate employee: • Health coverage (medical, dental and vision) for most domestic partners and domestic partners’ children cannot be paid for on a before-tax basis, unless they qualify as your dependents for tax purposes. Check with an accountant or tax attorney to determine whether your domestic partner qualifies as a tax dependent under IRC Section 152 or is eligible for tax-favored health coverage. If you elect this coverage, you must designate whether these dependents qualify to be treated as tax dependents. • Your contributions for benefit coverage are not affected by mid-year changes in pay. 10 Are you covering a same-sex spouse? You can enroll your same-sex spouse as a spouse rather than as a domestic partner, and your benefits will not be treated as imputed income. (Depending on where you live, you still might have to pay state taxes.) Here’s what you need to do: • Enroll your same-sex spouse. If he or she is already enrolled as a domestic partner, be sure to change the relationship status from domestic partner to spouse, during Annual Enrollment. The change will become effective January 1. • If your spouse does not have medical coverage through another employer, be sure to remove the Working Spouse/Domestic Partner Surcharge, or you will pay an additional $1,500 for medical coverage. If you and your domestic partner are not lawfully married, you may cover him or her as a domestic partner. Note: Neither a civil union nor a domestic partnership is considered a marriage for federal income tax purposes. If you have questions about the enrollment process, call the Xerox Employee Service Center or the Workplace Solution Center for assistance. Working Spouse/Domestic Partner Surcharge A Working Spouse/Domestic Partner Surcharge in the amount of $1,500 per year will be applied automatically if you cover your spouse or domestic partner on Xerox-sponsored medical coverage. (The surcharge does not apply to any other coverage.) If your spouse or domestic partner is not eligible for medical coverage through another employer, you must remove the surcharge during the online election process. You may not remove the surcharge if medical coverage was offered to your spouse or domestic partner through another employer, even if he or she is not enrolled in that coverage. Even if you removed the surcharge for 2014, you will need to remove it again for 2015. You will see the surcharge appear in your list of benefit coverage options on BenefitsWeb during the online enrollment process, or after you add your spouse or domestic partner to medical coverage if he or she was not previously enrolled. You are eligible to remove the surcharge if your spouse or domestic partner: • Does not work, even if he or she is enrolled in Medicare • Was laid off from his or her job and did not elect COBRA • Works for a company that does not offer medical coverage, works part-time, or was not offered medical coverage through his or her employer for any other reason, or • Is also a Xerox or Xerox Services employee. If this surcharge should not apply to you, you must remove it during the online enrollment process on BenefitsWeb by indicating whether your spouse is eligible for another employer’s medical coverage. 11 Your Coverage Options Medical Medical options at Xerox provide comprehensive coverage — including extensive coverage for preventive care — to help you and your family stay healthy. In most locations, Xerox offers the Consumer Choice Plan with an assigned medical plan administrator (Aetna, Anthem or Cigna), based on where you live. In some locations, you may also have a choice of the Consumer Choice Plan with Kaiser Permanente. Options for Some Xerox Services Employees Options in Hawaii, Puerto Rico, Guam and American Samoa Some employees may have one of these options in addition to the Consumer Choice Plan. These plans have limited eligibility: In Hawaii, Puerto Rico, Guam and American Samoa, you have different options instead of the Consumer Choice Plan. In these options, your medical plan provides both medical and prescription drug coverage. • Xerox Services PPO Plan — only those currently enrolled in the plan can maintain this coverage. • Anthem Traditional Plan II (sometimes called the State of Indiana plan) — only former employees of the State of Indiana hired before June 28, 2009 may elect this plan. • In Hawaii, you may enroll in HMSA PPO. Xerox Technology and Corporate employees enrolled in Kaiser Hawaii HMO in 2014 may remain in this plan for 2015 (this plan is closed to new participants). Benefits in these options may change from year to year. To see the coverage available for 2015, be sure to review the SBCs, available on BenefitsWeb > My Health > My Benefit Resources > Forms And Documents. If you have questions, please call the medical plan administrators at the phone number shown in the “Benefit Contacts” section of this guide. • In Puerto Rico, you may enroll in Humana Puerto Rico. • In Guam and American Samoa, you may enroll in TakeCare Asia. Don’t pay more for medical coverage than you need to. • Complete the wellness screening and online health questionnaire by November 30, 2014 or submit a Physician Results Form directly to Quest Diagnostics by November 12, and save on the cost of medical plan coverage. • If your wellness screening indicated that you are a tobacco user, remove the tobacco surcharge by enrolling in Quit For Life and completing five sessions by March 31, 2015. • Remove the Working Spouse/Domestic Partner Surcharge on BenefitsWeb, if you’re covering a spouse/domestic partner and he/she doesn’t have coverage available through her/his employer. Need to find a doctor? To find a new network doctor, visit your medical plan administrator’s website and search the appropriate provider network. To check whether your current doctor participates in the network offered in your area, you’ll want to go online to the medical plan administrator’s website or call member services. See the “Benefit Contacts” section of this guide for each medical plan administrator’s website, provider network and phone number. If you participate in the Consumer Choice Plan or the Xerox Services PPO Plan, you can also call Health Advocate for assistance. 12 About Your Medical Options Consumer Choice Plan The Consumer Choice Plan is a high deductible health plan that gives you greater control over how you spend your benefit dollars, including any funds provided by the company. Coverage is summarized in the at-a-glance table, shown on page 15. Here are the plan’s main features: • Certain routine in-network preventive care is covered at 100%. • Certain generic preventive medications that are on the CVS Caremark preventive drug list are covered at 100% and certain brand-name preventive medications are covered at 80% — both with no deductible or other out-of-pocket cost to you. Go to www.caremark.com/xerox for the full preventive drug list. • When you open an HSA, you may receive a contribution from Xerox (if you are eligible), as shown on page 17, to help pay for eligible health care expenses, even if you do not contribute to the account. • For non-preventive services, including medical and prescription drugs, you pay the full cost of services until you meet an annual deductible. Then you and the plan each pay a percentage of eligible expenses. There are minimum and maximum limits on the amount you pay for prescription drugs. • An annual out-of-pocket maximum caps the amount of medical expenses you have to pay in a year. If your share of expenses reaches this maximum, the plan will pay 100% of eligible in-network expenses for the rest of the year. Note: If you have family coverage and Kaiser Permanente is your medical plan administrator, the out-of-pocket maximum works differently. See “Consumer Choice Plan Administrators” for information. • You may choose in-network or out-of-network providers, but you will pay more for out-of-network care. For more information, see the Consumer Choice Plan Guide, available on BenefitsWeb > My Health > My Benefit Resources > Forms And Documents. Why pay for extra coverage that doesn’t provide extra benefits? More coverage doesn’t always mean more benefits. If you or your dependents are covered by more than one group medical or dental plan, reimbursements from the Xerox plan are coordinated between the plans so that benefits are not duplicated. Your claims reimbursements from Xerox will be adjusted so that the total reimbursement you receive from both plans is not more than the amount that would have been paid if you were only covered by the Xerox plan. 13 Prescription Drug Coverage Under the Consumer Choice Plan When you enroll in the Consumer Choice Plan with Aetna, Anthem or Cigna, you automatically receive prescription drug coverage through CVS Caremark (the prescription benefit manager), with a separate prescription benefit ID card. The CVS Caremark network has more than 64,000 pharmacies nationwide, including more than 7,600 CVS pharmacies plus Walmart, Target and many other national and independent retail pharmacies. Coverage is available for pharmacies outside the CVS Caremark network, but you will save money if you use participating network pharmacies. Note: Walgreens is excluded from the pharmacy network. Other Prescription Drug Coverage Features Specialty medication. If you need special medication for conditions such as cancer, hepatitis C, rheumatoid arthritis, or infertility, your medicine will be provided through the CVS Caremark Specialty Pharmacy rather than your local retail pharmacy. Safety measures. Prescription drug coverage includes features (like prior authorization, step therapy and quantity limits) to help make sure the medicines covered by your prescription benefits are used safely and appropriately, and the benefit plan is kept as affordable as possible. This means that, for some medicines, CVS Caremark will need to conduct a confidential, clinical review to determine whether coverage will be provided by your plan based on clinical guidelines for best medical practices. Consumer Choice Plan Administrators If you enroll in the Consumer Choice Plan, your medical plan administrator and network will be Aetna, Anthem or Cigna, depending on your home ZIP code. Under Aetna, Anthem and Cigna, the plan offers the same level of benefits. In some locations, you will have a choice between your ZIP code-based medical plan administrator and Kaiser Permanente. Each medical plan administrator has its own network of providers. Be sure to check whether your providers participate in the network. Kaiser Permanente benefits under the Consumer Choice Plan differ from benefits under Aetna, Anthem and Cigna. In Kaiser Permanente: • Prescription drug coverage is provided by Kaiser Permanente instead of CVS Caremark and the minimum and maximum coinsurance amounts for prescription drugs are different. • The way family expenses count toward the annual out-of-pocket maximum is different. The full family out-of-pocket maximum must be satisfied before the plan pays 100% for any family member. • Certain services — such as infertility treatment, private duty nursing, physical therapy, massage therapy or acupuncture — may be covered differently or not at all. • There also are variations from state to state. Please visit BenefitsWeb to see which medical plan administrator is assigned to you and whether the Consumer Choice Plan with Kaiser Permanente is available to you. For more information about the Kaiser Permanente coverage available to you, please call Kaiser Permanente at the phone number shown under the “Benefit Contacts” section of this guide. • Generally, there are no out-of-network benefits (you must use providers and facilities in the Kaiser Permanente network). However, emergency services are covered for any provider. Why pay more than you need to for prescription drugs? Stick with: • Generics. If you purchase a brand-name drug when a generic equivalent is available, your out-of-pocket cost will be your share of the cost of the generic version of the drug plus the difference in price between the generic drug and the brand-name drug you purchased. This additional amount does not count toward the out-of-pocket maximum. • Mail order for long-term medications (medicines taken regularly for chronic conditions such as high blood pressure, asthma, diabetes or high cholesterol). You can take advantage of mail order rates for 90-day prescriptions at the mail order pharmacy or through CVS Caremark Maintenance Choice, which allows you to pick up your 90-day prescription at a retail CVS pharmacy. • Network pharmacies. At a network pharmacy your cost will be based on the network price for covered expenses, which is usually less than the cost at an out-of-network pharmacy, saving you money. To locate a network pharmacy, visit www.caremark.com/xerox. 14 Consumer Choice Plan At-a-Glance Type of Service In-Network Out-of-Network* (Aetna, Anthem or Cigna only) Annual Deductible The amount you pay out of pocket for medical and prescription drug expenses before the plan starts to pay benefits. Counts toward the out-of-pocket maximum. Individual: $1,300 Family: $2,600 Individual: $3,900 Family: $7,800 Out-of-network amounts above the plan’s allowance do not count toward the deductible. Note: If you are covering dependents, you must meet the full family deductible before the plan begins to pay benefits. Annual Out-of-Pocket Maximum The most you have to pay each year for eligible medical expenses, including coinsurance and the annual deductible. Once you reach the individual out-of-pocket maximum, the plan pays covered expenses for the remainder of the year. Penalties for not complying with the mandatory generic rule, step therapy rules or prescription drug prior authorization rules do not count toward the out-of-pocket maximum. Individual: $5,000 Family: $10,000 Individual: $10,000 Family: $20,000 Note: Under Kaiser Permanente, the full family out-of-pocket maximum must be satisfied before the plan pays 100% of covered expenses for any family member. Out-of-network amounts above the plan’s allowance do not count toward the out-of-pocket maximum. Coinsurance** After you meet the deductible, you and the plan share of the cost of most eligible expenses. After the deductible, you pay 20%; the plan pays 80% After the deductible, you pay 40% of the plan’s allowance, plus any amounts over the plan allowance; the plan pays 60% Routine Preventive Care/Wellness Includes preventive care as required by the Affordable Care Act. See your medical plan administrator’s website for more details. 100% with no deductible Same as above *If you have coverage with Kaiser Permanente, generally, there are no out-of-network benefits. However, emergency services are covered for any provider. ** For in-network services, reimbursement is based on negotiated rates. For out-of-network claims, the plan reimburses a percentage of the plan’s allowance for that service; if your provider’s charge is greater than the plan’s allowance, you must pay the additional cost. Any amount over the plan’s allowance does not count toward the annual deductible or the out-of-pocket maximum. Note: If your assigned medical plan administrator (Aetna, Anthem or Cigna) determines that you live in an area where no network is available, you receive in-network benefits. For covered services subject to a deductible and coinsurance: charges billed by the provider are paid at the in-network rate. You are not responsible for paying any difference between the actual charge and the negotiated rate that an in-network provider or facility would have charged. You must contact member services to verify if there are any participating providers within your area and obtain authorization in order for a claim to be paid at the innetwork level. Prescription Drug At-a-Glance through CVS Caremark (Aetna, Anthem and Cigna) Under Kaiser Permanente, prescription drug coverage is provided through Kaiser Permanente, not CVS Caremark and maximum coinsurance amounts for prescription drugs are different. Coinsurance Minimum Maximum Applies after deductible. Retail Pharmacy (Up to a 30-day supply) and Specialty Prescription Drugs Generic 80% $4 $60 Brand-name 80% $10 $60 Mail Order Pharmacy/CVS Caremark Maintenance Choice (Up to a 90-day supply) Generic 80% $10 $150 Brand-name 80% $25 $150 Preventive Prescription Drugs (retail or mail order) Certain generics are covered at 100% with no deductible; certain brand-name drugs are covered at 80% with no deductible. For a list of preventive drugs, visit www.caremark.com/xerox and select “Save Me Money.” 15 Health Savings Accounts When you enroll in the Consumer Choice Plan, you may establish an HSA, an exclusive tax-advantaged savings account that you can use to pay for eligible health care expenses now — or save to pay for health care expenses in the future. The money in your account can be used to pay deductibles, coinsurance and other out-of-pocket health care expenses. Funds in the HSA are in an interest-bearing, FDIC-insured checking account that you can use to pay for out-of-pocket health care expenses. You pay for these expenses with an HSA debit card, checkbook or online. Here’s how HSAs work. Open your HSA online through BenefitsWeb during Annual Enrollment. Even if you don’t want to make your own contributions to the HSA, YOU MUST open your HSA online or mail in a signed Master Signature Card provided by BenefitWalletTM (the HSA administrator) to receive Xerox contributions. Xerox cannot make contributions until you open your HSA with BenefitWallet. If you do not open your account during Annual Enrollment, you can go to www.mybenefitwallet.com, or watch for additional information from BenefitWallet about how to open your account before January 1, 2015. Don’t leave money on the table. HSA contributions are not retroactive. If you enroll in the Consumer Choice Plan, open your HSA by November 30, so Xerox can put money in it for you to use on your eligible health expenses in 2015. Xerox HSA At-a-Glance Eligibility You are eligible to establish an HSA only if you enroll in the Consumer Choice Plan. Note: You cannot contribute to an HSA if you are covered by another health care plan, such as Medicare, TRICARE, a health plan sponsored by your spouse’s employer (unless that plan is also a qualified high deductible health plan), or a general purpose health care FSA. You also are not eligible to contribute if you can be claimed as a dependent on another individual’s tax return. Advantages of an HSA • Company contribution. If you are an eligible employee and you have opened an HSA with BenefitWallet, the company’s HSA administrator, Xerox will contribute to your HSA account. • Tax advantages. As long as you use the account for qualified health care expenses, your contributions and contributions from Xerox are exempt from federal and, in most cases, state income taxes, as well as Social Security taxes. • Can be used in the future. Unlike a Health Care FSA, unused funds in your HSA at the end of the year remain in your account to pay for future health care expenses. • Portability. You can take all the money in your account with you if you change employers or retire. At age 65 or older, you can use any of your HSA funds to pay for qualified health care expenses tax free. • Investments. Once your balance reaches $1,000, you can elect to invest any excess funds among a selection of 22 investment options. 16 Maximum HSA Contributions Xerox may make a contribution to your Health Savings Account (HSA) to help you cover the cost of your deductible and other out-of-pocket expenses. The annual amount you and Xerox may contribute to an HSA, based on IRS maximums, is shown in the tables below. Xerox Services Contributions are made on a per-pay-period basis from the first two paychecks of each month. Coverage Level Maximum Annual Company Contribution Your Maximum Annual Contribution Maximum Total Annual Contribution Employee Only $540 ($22.50 per paycheck) $2,810 $3,350 Family $1,080 ($45.00 per paycheck) $5,570 $6,650 If you’re age 55 or older, you may contribute an additional $1,000 per year to your HSA as a catch-up contribution. Xerox Technology & Corporate The amount of the contribution, if any, is based on your annualized pay. Contributions are made on a per-pay-period basis. If Your Annualized Pay Is… Maximum Annual Company Contribution Your Maximum Annual Contribution $40,000 or less $600 Employee Only $1,200 Family $2,750 Employee Only $5,450 Family $40,000+ to $80,000 $450 Employee Only $900 Family $2,900 Employee Only $5,750 Family $80,000+ to $120,000 $300 Employee Only $600 Family $3,050 Employee Only $6,050 Family More than $120,000 None $3,350 Employee Only $6,650 Family If you’re age 55 or older, you may contribute an additional $1,000 per year to your HSA as a catch-up contribution. 17 Xerox Services PPO Plan If you were enrolled in this plan for 2014, you may continue your coverage under this option. However, this plan is closed to any new participants. For 2015, the plan has new out-of-pocket maximums — see “Benefit Changes for 2015” on page 5. Prescription drug expenses count toward the in-network out-of-pocket maximum. However, any penalties for not complying with plan rules will not apply toward out-of-pocket maximum. This includes the mandatory generic rule: If you purchase a brand-name drug when a generic equivalent is available, your out-of-pocket cost will be your share of the cost of the generic version of the drug plus the difference in price between the generic drug and the brand-name drug you purchased. This additional amount will not count toward the out-of-pocket maximum. Step therapy penalties and prior authorization penalties also do not count toward the out-of-pocket maximum. Under this option, medical benefits are provided by a medical plan administrator assigned to your location — Aetna, Anthem or Cigna. Prescription drug benefits are provided through CVS Caremark. Each medical plan administrator has its own network of providers. Be sure to check whether your providers participate in the network. Please visit BenefitsWeb to see which medical plan administrator is assigned to you. Then visit the medical plan administrator’s website to see if your doctor is in your new plan’s network. For more information, see “Need to Find a Doctor?” on page 12. Anthem Traditional Plan II (Former State of Indiana Employees) If you are a former employee of the State of Indiana hired before June 28, 2009, you are eligible to elect the Anthem Traditional Plan II. The medical plan administrator is Anthem Blue Cross Blue Shield. Prescription drug coverage is provided through Express Scripts. For more information, call Anthem at 1.800.295.4119 or visit www.anthem.com. To find a network provider online, click on “Find a Doctor.” Choose your state and under “Select a Plan” choose “Anthem Blue Cross Blue Shield Blue Access.” If You Live in American Samoa, Guam, Hawaii or Puerto Rico If you live in American Samoa, Guam or Puerto Rico, you will have an HMO option. An HMO is a network of independent health care providers offering a comprehensive package of medical services within a set geographic area. When you enroll in an HMO, you may be required to select a Primary Care Physician (PCP). You may choose any participating PCP who is available to accept new patients. You may designate any participating physician specializing in pediatrics as your child’s PCP. If your HMO requires PCPs, you will receive benefits only if your medical care is coordinated by your selected PCP. In this case, your PCP would provide all your routine care and refer you to specialists when needed. The exception is that you do not need a referral to obtain care from a professional in the network who specializes in obstetrical or gynecological care. The provider, however, may be required to comply with certain rules, including obtaining pre-authorization for certain procedures, following a pre-approved treatment plan or rules, and making referrals. For each doctor’s visit or for other routine care, you typically pay a small flat fee called a “copayment” and your provider submits your claims to the HMO for you. Special rules apply to routine preventive services and immunizations. For other services, you may need to meet an annual deductible before the plan will pay benefits. Copayments and deductibles vary by HMO. In general, HMOs do not pay for benefits if you go to a health care provider who does not participate in the HMO network, except in an emergency. In an emergency, care will usually be covered if you notify your PCP of the care within 48 hours. Your HMO will also provide prescription drug coverage. In Hawaii, you also have access to a PPO plan. With this option, you have the flexibility to see any health care provider. However, you save money when you use providers who are part of the plan’s network. Prescription drug coverage is provided by the PPO plan. For office visits and prescription drugs, you pay a copayment. For other services, you share a percentage of the cost, called coinsurance. If an HMO or PPO is available to you, you will see it listed among your benefit options on BenefitsWeb. Benefits may change from year to year, so be sure to review the option’s SBC, available on BenefitsWeb > My Health > My Benefit Resources > Forms And Documents. Or, you may contact the medical plan administrator through the phone number or website shown under the “Benefit Contacts” section of this guide. 18 Supplemental Insurance Benefits If you or your family members should ever become seriously ill or injured, you may face expenses which are not typically covered by medical insurance. Xerox offers you a choice of supplemental plan options, provided through Aetna, to supplement the valuable health, life and accident, and disability benefits available to you, even if you are not enrolled in the company’s medical coverage. In the event of a covered illness or injury, these benefits pay cash directly to you so that you can spend them as you see fit, reducing the added financial stress so you can focus on getting better. Coverage is available for you or you and your dependents. If you elect to purchase any of these voluntary benefits, you will pay the full cost of coverage through automatic payroll deductions. You pay the cost of this coverage on a before-tax basis. Note: Supplemental insurance benefits are meant to serve as an extra layer of protection. They are not meant to be a substitute for medical insurance. For more information about these supplemental benefits, contact the supplemental insurance plan administrators through the phone number or website shown under the “Benefit Contacts” section of this guide. Supplemental Critical Illness Insurance This plan pays a lump-sum cash benefit when a diagnosis of a specific illness is made or a health event occurs (such as cancer, heart attack or stroke), provided the initial diagnosis is after the effective date of the policy. It is designed to help offset catastrophic expenses that can arise as a result of such illnesses. In addition, to encourage you to seek preventive care, the plan also provides a $50 benefit per covered person per year for certain diagnostic wellness procedures and tests, which applies even if the preventive care is already covered 100% by the Xerox medical plan. Note: Your coverage costs, which are shown on BenefitsWeb, are affected by the cash benefit you elect and your age. Supplemental Accidental Injury Insurance This plan pays benefits for inpatient and outpatient services related to an injury (including a benefit per hospital admission), injury-related physician or physical therapy visits, emergency room costs and ambulance charges resulting from an accident, and more. For policies issued January 1, 2015 and later, services are covered for accidents occurring after the effective date of the policy. In addition, the plan provides a $25 or $50 benefit when you or a covered dependent visit a doctor for any reason (even when it’s unrelated to an accident), which may help to offset the cost of the policy. Supplemental Hospital Indemnity Insurance If you are hospitalized, this plan provides cash benefits for you to spend as you see fit. The amount to be paid is determined in advance and is in addition to benefits payable from your medical coverage. You can elect either the Basic Plan ($1,000 per admission and $150 per day for up to 10 days) or the Enhanced Plan ($3,000 per admission and $300 per day for up to 10 days). 19 Dental Xerox dental options generally cover the same types of eligible expenses, but differ in how much you pay for care. • You can choose from two plans, Basic Dental or Enhanced Dental. With these options, you will be assigned to either Aetna’s or Cigna’s network of providers, depending on your home ZIP code. You have the freedom to see any provider, but you save money if you use a dentist in your network, and the dentist will file claims for you. • In some locations, you will also have a third option, the Aetna Dental Maintenance Organization (DMO). This plan pays benefits only if you use a participating Aetna DMO network provider. If you are covering dependents, you must each select a primary dentist from the network (but you don’t have to select the same one). There is no annual deductible or annual maximum benefit. Instead, you pay a copayment for each covered service you receive. Note: The Aetna DMO provider network is different from the network for the Basic and Enhanced Dental options. If you’re considering this option, be sure to check that your dentist participates within this more restricted network before you make your election. Please visit BenefitsWeb to see which dental plan administrator is assigned to you and whether the Aetna DMO is available to you. Dental Plan At-a-Glance Covered Services Enhanced Dental Basic Dental Aetna DMO In-Network* In-Network* In-Network Only Annual Deductible $50/person (3 per family) $75/person (3 per family) None Diagnostic/Preventive Care 100% (no deductible) 100% (no deductible) 100% Basic Care 80% after the deductible 60% after the deductible 100% of negotiated fees after $5 copay Major Care 50% after the deductible 50% after the deductible 60% of negotiated fees after $5 copay Maximum Annual Benefit $1,500/person $1,000/person None Orthodontia 50% (no deductible) for adults and children 50% (no deductible) for children only (must be “banded” before age 20) 100% after $2,400 copay for adults and children Maximum Lifetime Orthodontic Benefit $1,500/person $1,000/person 24 months of treatment plus 24 months of retention * This chart displays only in-network benefits. In the Basic and Enhanced Dental options, benefits for out of network services are based on reasonable and customary (R&C) charges. Need to find a dentist? You can visit your dental plan administrator’s website and search the appropriate provider network or call member services, as shown in the “Benefit Contacts” section of this guide. If you participate in the Consumer Choice Plan or the Xerox Services PPO Plan, you can also call Health Advocate for help finding a dentist. 20 Vision Vision coverage, provided by VSP Vision Care, includes coverage for eye exams, eyeglasses or contact lenses, and discounts for laser surgery. If you visit a VSP network provider, you pay a fee at the time you receive care, and the plan pays the rest of the expense. If you see an out-of-network provider, you pay in full at the time that you receive care and submit a claim for reimbursement. If you elect vision coverage, your election will remain in effect for two calendar years for you and your covered dependents. If you choose No Coverage, your decision will remain in effect for 2015, unless you have a qualifying change in status. BenefitsWeb will indicate whether you may change your election for 2015. Vision Plan At-a-Glance Covered Services Frequency In-Network Out of Network WellVision Exam Once every calendar year. You pay $10 Reimbursed up to $45 Retinal Screening Exam Once every calendar year. You pay up to $39 Not applicable Frames** Once every two calendar years. You pay 80% of the balance over Reimbursed up to $70 $130 Laser Vision Correction On average, you’ll save 15% off the regular price or 5% off the promotional price from participating centers. Find a VSP Laser VisionCare Doctor on www.vsp.com. Not applicable Standard Plastic And Glass Eyeglass Lenses** • Single, bifocal, trifocal, lenticular In lieu of contact lenses; once every calendar year. You pay $25 Reimbursed up to $30 - $100 • Standard progressive You pay $55 Reimbursed up to $50 • Premium progressive You pay $95 – $105 Reimbursed up to $50 • Additional eyeglass lens options (scratch, anti-reflective or ultraviolet coating, tint, polycarbonate) You pay $0 – $41 Not applicable Contact Lenses** • Contact lens exam (includes fitting, evaluation) Once every calendar year. You pay $15 Reimbursed up to $105 • Conventional or disposable Once every calendar year in lieu of a pair of glasses. You pay the balance over $130* Reimbursed up to $105 * The $130 contact lens allowance must be used on the initial purchase. Any remaining balances cannot be used for additional contact lens purchases within the same 12-month benefit period. **The plan covers either eyeglass lenses or contact lenses once per calendar year, not both in the same year. Looking for a VSP provider? To find a VSP doctor or retail chain affiliate within the VSP Choice network, such as Costco Optical, Visionworks or Cohen’s Fashion Optical, visit www.vsp.com or call 1.800.877.7195. 21 Flexible Spending Accounts FSAs offer a great way for you to save on taxes and budget for the health care and dependent care expenses you expect to pay during the year. Normally you would pay these expenses out of your take-home pay after taxes are deducted. But when you enroll in one or both accounts, the money you put into FSAs is never taxed, which saves you money. Just be sure to estimate your expenses carefully each year. You have to use up your account balance by the end of the year. There are two types of FSAs: • Health Care FSA. This account comes with a convenient debit card that you can use to pay eligible health care expenses. • Dependent (Day) Care FSA. Note: This account cannot be used to pay for dependent health care expenses. FSAs At-a-Glance Health Care FSA Dependent (Day) Care FSA Who is Eligible Benefit-eligible employees who are not enrolled in the CCP. All benefit-eligible employees. Amount You Can Contribute Per Year $100 to $2,500. $100 generally up to $5,000, with a few exceptions as noted in “Dependent (Day) Care FSA Limits” on page 23. Use It or Lose It Rule Plan your contribution amount carefully because you’ll lose unused funds at the end of the year. You have through December 31, 2015 (or your last day of employment, if earlier) to incur expenses. How You Get Reimbursed You may use your debit card to pay expenses on the spot or pay the provider directly and submit a claim for reimbursement. The Xerox Employee Service Center or BenefitWallet must receive all claims for eligible 2015 expenses no later than June 30, 2016. Pay your day care provider directly and submit a claim for reimbursement up to the amount currently available in your account. The Xerox Employee Service Center or BenefitWallet must receive all claims for eligible 2015 expenses no later than June 30, 2016. Which Expenses are Eligible Health care expenses that are not covered by your medical, prescription drug, dental or vision plans, such as deductibles, coinsurance, copays, insulin and certain over-the-counter prescribed drugs (see IRS Publication 502, on the IRS website at: www.irs.gov/pub/irs-pdf/p502.pdf, for more information). Eligible childcare (for children under 13) and elder care expenses, including in-home babysitters, day care, after-school care and summer day camp, so you or your spouse/ domestic partner can work or attend school full-time (see IRS Publication 503, on the IRS website at: www.irs.gov/pub/irs-pdf/p503.pdf, for more information). When You Can Access the Money iIn Your Account You can access the full amount of your annual contribution at the beginning of the year. You can access only the amount in your account at the time you submit your claim. If You Leave Xerox You may continue to submit claims for expenses incurred while you were a participant in the account. If you still have money left in your current year’s account after filing all claims incurred before your last day of work, you can continue to submit claims for eligible expenses incurred after your last day of work until the end of the plan year by continuing your participation in the Health Care FSA at your current contribution rate through the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended (COBRA). You can submit requests for reimbursement of dependent care expenses incurred through your last day of work. Any remaining balance after all claims have been submitted will be forfeited. 22 Dependent (Day) Care FSA Limits The IRS sets a maximum amount you can contribute to this account each year. Generally, the maximum is $5,000, with a few exceptions noted below. Note: The Dependent Care FSA is for day care expenses only. This account may not be used for health care expenses for your dependents. Use the Health Care FSA for your dependents’ health care expenses. Dependent (Day) Care FSA Contribution Limits If you are: Your annual contribution maximum is: Married and your spouse earns less than $5,000 per year Any amount up to your spouse’s annual earnings Married, and you and your spouse file separate tax returns $2,500 (if your spouse has access to a separate Dependent Care FSA, he or she may also contribute $2,500 to his or her Dependent Care FSA) Married and file a joint tax return, and your spouse is a student or disabled $3,000 (for one dependent) $6,000 (for two or more dependents) A highly compensated employee (HCE), as defined by the IRS, for the prior calendar year $2,750 Contact a financial advisor or tax accountant if you have questions about tax rules. 23 Survivor Benefits The Xerox benefit program features several survivor benefit plans, including life insurance, AD&D insurance and company-provided business travel accident insurance, which provide you and your family with important financial protection. The company provides a basic level of coverage and options which you can purchase to design the survivor benefit package that’s right for you. Don’t forget to designate a beneficiary. You must designate a beneficiary to receive payment of your employee life and AD&D insurance benefits in the event of your death. Xerox Technology and Corporate employees can designate a beneficiary or make a change, by calling Prudential at 1.800.367.9769 to get a beneficiary designation form. Xerox Services employees can designate a beneficiary or make a change at any time by visiting BenefitsWeb (from the home page go to My Health, scroll down under Manage My Coverage and click View My Personal Information). If you do not designate a beneficiary, your employee life and accident benefits will be distributed in the following order to your: spouse/domestic partner, child(ren), parent(s), siblings or estate. You are the beneficiary for any spouse/domestic partner and child life and AD&D coverage you elect. Life Insurance for Xerox Technology & Corporate Xerox offers a variety of life insurance options to protect your family’s financial future. The company provides basic life insurance at no cost to you. You may purchase additional coverage for yourself and your eligible dependents. You may see all your coverage options in the at-a-glance chart below. Note: If you make any changes to your life insurance coverage, the additional coverage (and the associated premiums) will not be effective until your evidence of insurability is approved. You will provide this additional information or evidence during the online enrollment process. The IRS requires you to pay income taxes on the value of basic life insurance over $50,000, known as imputed income. Life Insurance At-a-Glance Type of Service Your Coverage Options When Evidence of Insurability is Required Basic Employee Life Insurance Xerox pays the full cost of coverage in the amount of one times pay,* up to $200,000. Evidence of insurability is not required. Optional Employee Life • No coverage Insurance • 1 to 10 times pay* up to $5 million Your rates will be lower if you re-certify your status that you have not use tobacco products for at least 12 months as of the date of your enrollment. Note: This certification is separate from the tobacco-free status determined in wellness screenings. Spouse/Domestic Partner Life Insurance** • No coverage • $35,000 • $50,000 • $75,000 • $100,000 Child(ren) Life Insurance** Children may be covered up to age 19, or age 23 if they are full-time students (or any age if disabled). You may be required to provide evidence of insurability if: • You are newly hired, and you choose coverage of more than three times pay or a coverage amount of more than $800,000. • You are currently enrolled, and you wish to increase your coverage. • You have a qualifying change in status and you want to increase your coverage by more than 1 times pay. Evidence of insurability will be required if your spouse/ domestic partner: • Wishes to increase his or her current coverage, or • Is newly eligible and chooses coverage of more than $35,000. Evidence of insurability is not required. • No coverage • $5,000 per child • $10,000 per child Note: You do not need to elect separate coverage for each child. All eligible children are automatically covered for the same amount. Once your children are no longer eligible for child life insurance coverage, you are responsible for removing them from coverage by calling the Xerox Employee Service Center. *Pay means your pay as of September 1, 2014, or your date of hire, whichever is later. **You are the beneficiary of spouse/domestic partner and/or child(ren) coverage. 24 Life Insurance for Xerox Services Xerox offers a variety of life insurance options to protect your family’s financial future. The company provides basic life insurance at no cost to you. You may purchase additional coverage for yourself and your eligible dependents. This year, Xerox Services is expanding your options for supplemental employee life insurance. You may see all your coverage options in the at-a-glance chart. Note: If you make any changes to your life insurance coverage, the additional coverage (and the associated premiums) will not be effective until your evidence of insurability is approved and if you on leave, once you return to work. Life insurance coverage may reduce or end at age 70. The IRS requires you to pay income taxes on the value of basic life insurance over $50,000, known as imputed income. Life Insurance At-a-Glance* Type of Service Your Coverage Options When Evidence of Insurability is Required Basic Employee Life Insurance Xerox Services pays the full cost of coverage for one times your base annual earnings, up to $200,000. Evidence of insurability is not required. Supplemental Employee Life Insurance • No coverage • 1 to 10 times base annual earnings, up to $3 million You may be required to submit evidence of insurability if: • You do not enroll for coverage when you are first eligible and wish to at a future date, • When you are first eligible, you elect coverage that exceeds the lower of $350,000 or three times your basic annual earnings, or • You make any change to your coverage. Spouse/Domestic Partner • No coverage Life Insurance** • $10,000 to $250,000, in $10,000 increments, up to 100% of your combined basic and supplemental employee coverage amounts. Child(ren) Life Insurance** Children may be covered up to age 26 (for children of a domestic partner, age 19, or age 23 if they are full-time students). • No coverage • $2,000 • $4,000 • $6,000 • $8,000 • $10,000 Note: You do not need to elect separate coverage for each child. All eligible children are automatically covered for the same amount. Once your children are no longer eligible for child life insurance coverage, you are responsible for removing them from coverage by calling the Workplace Solutions Center. You may be required to submit evidence of insurability if: • You do not enroll your spouse or domestic partner for coverage when first eligible and wish to at a future date, • When you are first eligible, you elect coverage that exceeds $50,000, or • You make any change in your spouse’s coverage. Evidence of insurability is not required. * If you are an employee of Buck Consultants at Xerox, the benefits described here do not apply to you. For more information, see the 2015 Enrollment Guide Supplement for Buck Consultants. **You are the beneficiary of spouse/domestic partner and/or child(ren) coverage. 25 Accidental Death & Dismemberment Insurance for Xerox Technology & Corporate Xerox offers a number of AD&D insurance options to meet your needs. This coverage pays benefits in the event you and/or your eligible dependents die or suffer certain serious impairments due to an accidental injury. You pay the full cost of any supplemental AD&D coverage you elect. AD&D Insurance At-a-Glance Type of Service Your Coverage Options Employee AD&D Insurance • No coverage • $50,000 to $1 million, in $50,000 increments Spouse/Domestic Partner AD&D Insurance • No coverage Child AD&D Insurance Children may be covered up to age 19, or age 23 if they are full-time students (or any age if disabled). • No coverage • $50,000 to $500,000, in $50,000 increments • $50,000 • $100,000 Note: You do not need to elect separate coverage for each child. All eligible children are automatically covered for the same amount. Once your children are no longer eligible for child life insurance coverage, you are responsible for removing them from coverage by calling the Xerox Employee Service Center. Accidental Death & Dismemberment Insurance for Xerox Services Xerox offers a number of AD&D insurance options to meet your needs. This coverage pays benefits in the event you and/or your eligible dependents die or suffer certain serious impairments due to an accidental injury. You pay the full cost of any supplemental AD&D coverage you elect. AD&D Insurance At-a-Glance* Type of Service Your Coverage Options Basic Employee AD&D Insurance The company provides basic coverage equal to one times your basic annual earnings, up to $200,000, at no cost to you. Employee Supplemental AD&D Insurance • No coverage Family Supplemental AD&D Insurance Children may be covered up to age 26 (for children of a domestic partner, age 19, or age 23 if they are full-time students) After the deductible, you pay 20% and the plan pays 80%. Your dependents’ coverage will be based on the employee coverage you elect for yourself, as follows: • $10,000 to $1 million, in $10,000 increments • If you have a spouse and child(ren), your spouse’s coverage is equal to 40% of your coverage amount and each child’s coverage is equal to 10% of your coverage amount. • If you do not have children, your spouse’s coverage is equal to 50% of your coverage amount. • If you do not have a spouse, each child’s coverage is equal to 15% of your coverage amount. • Once your children are no longer eligible for child life insurance coverage, you are responsible for removing them from coverage by calling the Workplace Solutions Center. *If you are an employee of Buck Consultants at Xerox, the benefits described here do not apply to you. For more information, see the 2015 Enrollment Guide Supplement for Buck Consultants. 26 Disability Insurance For Xerox Technology & Corporate Employees If you’re unable to work due to a sickness or injury, disability insurance can help you maintain your standard of living — helping you pay your health insurance premiums and other expenses. Xerox offers disability coverage, designed to provide income replacement. Xerox offers both short-term disability (STD) and long-term disability (LTD) coverage, which are designed to work together to provide continuous income replacement. Xerox pays the full cost of STD coverage, which pays benefits for up to five months while you remain disabled. There’s no need to enroll. Your LTD options are shown below. Pre-existing condition limitations may apply to you. STD benefits are subject to pre-existing condition limitations. A pre-existing condition is any condition for which you received medical advice or treatment during the six months before coverage begins. No benefits are paid for pre-existing conditions, including pregnancy, until you have been covered for 12 months. LTD At-a-Glance Type of Service Your Coverage Options Xerox LTD Coverage* If you are disabled for more than five months, this plan pays benefits for the 6th month through the 29th month of disability. Your options depend on how long you’ve been with Xerox. Extended LTD Coverage* You must enroll in Xerox LTD coverage before you can elect this coverage. With up to 12 months of service With one year of more of service • No coverage • No coverage • 40% of pay (Xerox pays the full cost) • 40% of pay • 60% of pay • 60% of pay (Xerox pays the full cost) This plan, insured by Prudential, pays benefits beginning after the 29th month and generally continuing through age 65, if you remain continuously disabled. With up to 12 months of service With one year of more of service • No coverage • No coverage • 40% of pay (Xerox pays the full cost) • 50% of pay (Xerox pays the full cost) • 50% of pay • 60% of pay • 60% of pay • 70% of pay • 70% of pay No Coverage You may opt out of Xerox LTD coverage only if you have other LTD coverage or are eligible for retirement (that is, you are age 55 or older and have at least 10 years of service). If you select this option, you will receive a credit that will be applied toward the cost of your other benefits coverage. Note: With this option, you will not receive company-paid coverage or be eligible for Extended LTD coverage. *If your pay increases or decreases during the year, your coverage and costs will change accordingly. Disability benefits are reduced by income replacement benefits received from other sources, including Social Security and Workers’ Compensation. Be sure to take this into consideration before electing a lower pay replacement option. 27 Xerox Services Employees If you’re unable to work due to a sickness or injury, disability insurance can help you maintain your standard of living — helping you pay your health insurance premiums and other expenses. Xerox offers both short-term disability (STD) and long-term disability (LTD) coverage, which are designed to work together to provide continuous income replacement: • STD coverage provides continuing income for up to 150 days when you are unable to work due to a short-term illness or injury. You choose whether to be covered by this plan. • LTD coverage provides continuing income after you have been unable to work due to illness or injury for more than 150 days. Xerox Services employees do not need to elect LTD coverage. The company pays the full cost of the LTD plan. For more information about your LTD benefits, please see your Summary Plan Description. Your STD options are shown here. STD At-a-Glance Type of Service* Your Coverage Options STD Coverage If you are unable to work due to illness or injury, STD coverage replaces 60% of your basic earnings, up to a maximum of $8,000 per month, for up to 150 days of disability. There is a waiting period before benefit payments begin. When you enroll, you may choose the length of this waiting period, as follows: • Option 1 — Benefit payments begin after you have been disabled for 7 consecutive days • Option 2 — Benefit payments begin after you have been disabled for 14 consecutive days • Option 3 — Benefit payments begin after you have been disabled for 30 consecutive days Note: You pay for STD coverage on an after-tax basis. Benefits continue as long as you remain disabled, up to 150 days from your date of disability, including the waiting period. For example, if you choose option 3 you will not receive more than 120 days of benefit payments. This benefit is reduced by other sources of income, such as state disability income. If you work in a state with a mandatory state disability plan, including CA, HI, NJ, NY, RI and PR, you should review the state disability plan before making a decision to enroll in the company’s STD plan. Your combined benefits from the state and the company plan will not exceed 60% of your base annual earnings. *If you an employee of Buck Consultants at Xerox, the benefits described here do not apply to you. For more information, see the 2015 Enrollment Guide Supplement. Pre-existing condition limitations may apply to you. STD benefits are subject to pre-existing condition limitations. A pre-existing condition is any condition for which you received medical advice or treatment during the six months before coverage begins. No benefits are paid for pre-existing conditions, including pregnancy, until you have been covered for 12 months. 28 Additional Benefits Legal Services Plan The Legal Services Plan provides free or discounted legal services — such as wills and estate planning, traffic and criminal matters and family law — for you and your eligible dependents, through Hyatt Legal Plans, Inc. Your enrollment automatically covers your entire family including you, your spouse or domestic partner, and your eligible children. You pay the full cost of coverage on an after-tax basis through automatic payroll deduction. Annual Enrollment is your only opportunity to enroll in or drop this coverage. Commuter Benefits Program for Xerox Services Full-Time Employees and Part-Time, Bay Area, California Employees Xerox Services’ Commuter Benefits Program, provided through WageWorks, is a tax-savings program for employees who have parking expenses at their work location or use mass transit to commute to and from work. The program allows you to pay for your transit and parking costs on a before-tax basis. Using before-tax dollars can save you up to 40% on your commuting costs. The amount of your savings depends on your state and federal tax rates. You may enroll in this program any time during the year, and you have the option to change your commute options each month, as your transportation needs change. The amount you can get tax-free in any given month is determined by the IRS and can change annually. Currently, the limits are: • Transit and vanpool: $130 a month • Parking: $250 a month The specified limits apply individually to each calendar month. For more information, or to enroll, visit www.wageworks.com, click “Sign Up Now” and follow the steps; or call WageWorks at 1.877.924.3967. Vacation Purchase Plan for Xerox Technology & Corporate Employees To help you balance your work and family responsibilities, Xerox offers the Vacation Purchase Plan, which lets you buy one week of extra vacation time. The Annual Enrollment period is your only opportunity to enroll in this plan. The cost of vacation time is based on your annualized pay as of September 1, 2014 and is deducted in equal amounts from each of your paychecks on a before-tax basis throughout 2015. The amount of time you may purchase is based on the number of hours you’re scheduled to work each week as of September 1, 2014. For example, if you work 40 hours a week, you can purchase 40 hours of additional vacation time. If you work 25 hours a week, you can purchase 25 hours of additional vacation time. If you have unused Purchased Vacation Time at the end of the year, it will be refunded to you in December in the form of taxable pay. If you have questions about this benefit, please call the Xerox Employee Service Center at 1.800.428.2203. 29 Health and Wellness Resources The challenge of rising health care costs requires that we think differently about how we choose and use health care services. That’s why Xerox provides information and tools to help you and your family members become healthier and to manage the rising cost of health care. Over time, healthy choices can lower the health risks of Xerox employees, and enable better management of health care costs for both you and the company. Xerox, along with its health care partners, supports you by providing tools and resources to help you lead a healthier life and make the most of your medical benefits. Employee Assistance Program Tobacco Cessation Program Your emotional health is linked to your physical health. Unmanaged, stress takes a physical toll and can lead to illness. That’s why Xerox makes several support programs available to help manage life’s challenges. The Employee Assistance Program (EAP) provided through GuidanceResources® by ComPsych offers support, resources and information for personal and work-life issues. Personal issues, planning for life events or simply managing daily life can affect your work, health and family. The Quit For Life® tobacco cessation program, through Alere, is available to all benefits-eligible employees, whether covered by a Xerox medical plan or not, and to all spouses/domestic partners and dependent children (18 or older) who are covered under a Xerox medical plan. Participation is free. GuidanceResources is confidential and provided at no charge to you and your dependents. You do not need to be enrolled in a Xerox medical plan to take advantage of these services. All employees and their family members can call 1.877.335.6031, 24 hours a day, every day of the year, for an initial assessment and consultation, and will be directed to confidential counseling, financial or legal representatives or work-life specialists. Xerox encourages tobacco users to participate in the Quit For Life program. See the “What to Know for 2015” section of this guide to learn about wellness incentives for employees and their spouses/domestic partners. If you enroll in the voluntary and confidential program, your Quit Coach will help you develop a personalized quit plan. The Quit Coach will also determine whether nicotine patches, gum or prescription medication will be helpful for you during the quit process. If you choose to incorporate the nicotine patch or gum into your quitting plan they will be mailed directly to your home along with a Quit Guide. Participants will also have access to Web Coach, the Quit For Life program’s interactive website where you can: • Track your progress and further track your personalized quit plan. • Interact with others who are trying to quit and with Quit Coach Moderators on the discussion forums. Peer support is a key factor in success. • Receive coaching emails between calls with tips on quitting and reminders to help you stay on track. Participants will receive ongoing coaching calls and text messages around your quit date followed by support calls and for maintenance and relapse prevention. To enroll, call 1.866.QUIT.4.LIFE (1.866.784.8454) to get started. A registration specialist will verify your eligibility to enroll and transfer you to a Quit Coach. You have until March 31, 2015 to enroll and complete five phone calls in order to remove the annual $500 tobacco surcharge. 30 Additional Wellness Benefits for Consumer Choice Plan or Xerox Services PPO Plan Participants If you enroll in the Consumer Choice Plan or the Xerox Services PPO Plan, the following benefits are available to you and your covered family members. Health Advocate Wellness Coaching Health Advocate is your one-stop for all health-related questions. Health Advocate can help you: StayWell is a lifestyle improvement program that provides support for managing your weight, physical activity, back care, blood pressure, cholesterol and stress. Through StayWell, you can access information and resources, participate in voluntary programs, and even work one-on-one with a wellness coach – whatever works best for you. In addition, StayWell will review your wellness screening and health questionnaire results and reach out to you to offer support. • Understand your plan options • Navigate your Xerox health benefits • Answer questions about health care issues • Clarify Medicare, Medicaid and Medicare Supplemental plans • Find help for your parents, such as in-home care, adult day care, assisted living and long-term care • Resolve medical billing issues • Provide referrals to other clinical programs and resources within the plan • Identify external or community resources to help address needs not met by plan resources • Find a physician or second opinion, and If you are enrolled in the Consumer Choice Plan or the Xerox Services PPO Plan, you and your covered spouse/ domestic partner are welcome to use the StayWell program. You can get in touch with a health coach via BenefitsWeb, or you may call 1.855.428.6319, Monday through Thursday, from 9 a.m. to 9 p.m. ET, from Friday 9 a.m. to 7 p.m. ET, and Saturday from 9 a.m. to 1 p.m. ET. • Prepare for doctor visits. Medical Plan Resources If you are enrolled in the Consumer Choice Plan or the Xerox Services PPO Plan, Health Advocate is available to you, your covered spouse/domestic partner, your covered dependent children, your parents and your parents-in-law. When you participate in the Consumer Choice Plan or the Xerox Services PPO Plan, your medical plan administrator (Aetna, Anthem, Cigna or Kaiser Permanente) offers you and your covered family members a number of wellness programs and resources designed to encourage health improvement. These confidential programs are available at no cost to you. You can access Health Advocate 24 hours a day, 7 days a week by calling 1.877.776.6211. Normal business hours are Monday through Friday, from 8 a.m. to 9 p.m. ET. After hours and during weekends, staff is available for limited assistance. • Maternity Management gives you the resources of an experienced maternity nurse who can offer advice and answer your questions so you can have a healthy pregnancy. You’ll receive support through every stage of pregnancy and delivery. • Nurseline services allow you to contact experienced, registered nurses, toll free, 24 hours a day, seven days a week. During a confidential conversation, you may be given information on self-care, referred to your physician, or advised to go to an urgent care center or emergency room. • Telemedicine services, an extension of Nurseline, provides 24-hour access to a variety of medical professionals. These health care professionals include pediatricians, internal medicine physicians and other specialists who are available to consult with you by phone, email or video chat. You can typically schedule these appointments at your convenience, and at a fraction of the cost of a regular office visit. • Health Management services, such as utilization management, are intended to encourage the highest quality, cost-effective care, in the most appropriate setting, from the most appropriate provider, so that services are neither over-used nor under-used. All medical plan administrators also have case management programs designed to support you and your family when you have complex care needs associated with severe illness, injury, or other conditions, such as a high-risk pregnancy, cancer treatment or a transplant. • Disease Management programs like case management and condition support supplement your doctor’s care for health conditions which require special care and attention, such as asthma, cancer, depression, diabetes, heart disease, high blood pressure and stroke. Experienced registered nurses can help you prepare for physician visits, answer questions and reduce the barriers that may interfere with your health. To learn more about these programs, call your medical plan administrator at the phone number shown in the “Benefit Contacts” section of this guide. 31 How to Enroll Before you begin the enrollment process, you should review your benefit options on BenefitsWeb and in the Enrollment Guide to help you make informed benefit decisions for you and your family. Enroll by Phone • Xerox Technology and Corporate Employees: Call 1.800.428.2203 between 8 a.m. and 8 p.m. ET, Monday through Friday, except holidays. Select “1” for benefit information. • Xerox Services Employees: Call 1.888.471.2271 between 8 a.m. and 8 p.m. ET, Monday through Friday, except holidays. Select “2” for benefit information. Enroll Online Follow these simple steps to log onto BenefitsWeb: Xerox Technology & Corporate • Go to www.XeroxBenefitsWeb.com. • The first time you log in to the new site, you should follow the instructions on the My Login page to set up your new BenefitsWeb User ID, Passcode and Security Questions to use going forward. • If you have login questions, call the Xerox Employee Service Center at 1.800.428.2203, and select “1” for benefit information. Xerox Services Xerox Couples • Go to InfoBank at https://infobank.acs-inc.com. Enter your Worldwide Identification Number (WIN) and password to enter the site. If you’ve forgotten your password, use the Reset Password feature. If you and your spouse/domestic partner both work for Xerox, you can log in either as an employee or as the dependent of your Xerox spouse/domestic partner. Note: When you take your wellness screening, if you are covering yourself, you are the employee for benefit purposes and you should log in as the employee. If your spouse/domestic partner is covering you, you are the dependent for benefit purposes and you should log in as the dependent of your spouse/domestic partner. Otherwise, your credit for the wellness screening will be delayed. • From the InfoBank home page, select the BenefitsWeb link. From BenefitsWeb, you can access all the information you need to make the right benefits decisions for you and your family. • If you have login questions, call the Workplace Solution Center at 1.888.471.2271, and select “2” for benefit information. Use the Enrollment News tab to view important information about your 2015 benefit options and select Choose from the Home page to elect the benefits you want for 2015. Once you’ve made your elections, click Submit Changes. Your deadline to submit elections is Friday, November 14 at 11:59 p.m. ET. After submitting your elections, review your Confirmation Statement carefully. Print a copy of your Confirmation Statement and keep it for your records. If you made your elections online, you will not receive a Confirmation Statement in the mail. Spouses/Domestic Partners Spouses/domestic partners who are enrolled in medical coverage can go to www.XeroxBenefitsWeb.com and create their own account to review coverage or register for a wellness screening and take the online health questionnaire. Check the spouse/domestic partner box on the registration page and follow instructions to create a User ID and Password. Your spouse/domestic partner must log in as a spouse/domestic partner using his or her own Social Security number (not under your employee ID), so be sure you have provided his or her Social Security number on BenefitsWeb. Xerox employees can update dependent information (including Social Security number) by going to BenefitsWeb > My Health > Manage My Coverage > View My Personal Information > Dependents. Note: If you live in Guam or Puerto Rico, or if you are enrolled in Anthem Traditional Plan II, your spouse/domestic partner does not have access to BenefitsWeb. 32 Important Notices Health Plan Participation By electing to enroll in a Xerox sponsored health plan, you acknowledge that you understand, consent to and authorize the following: 1. Certain of our health plan options share claims data with health plan vendors (or their subcontractors) who are business associates of the plan and have entered into special agreements with the plans that require them to maintain the privacy of such data to and use it only to identify individuals eligible for wellness management programs. Examples of such companies include StayWell and Alere Health. Eligible individuals may be contacted, but participation in these programs is entirely voluntary. 2. To be eligible to receive the $600 Xerox wellness incentive ($1,200 if you cover a spouse/domestic partner), you must each finish all requirements by the deadlines specified — that is, you must complete the free, confidential wellness screening and health questionnaire by November 30, 2015. A tobacco surcharge of $500 per individual will be applied automatically to the cost of medical plan coverage. You can remove the surcharge if you test negative for tobacco use or if you enroll in the Quit For Life program and complete five phone calls by March 31, 2015. For purposes of the incentives, the Xerox Employee Service Center or the Xerox Workplace Solutions Center will receive a Yes/No indicator to reflect the completeness of the wellness screening and online health questionnaire, as well as your tobacco status. No individual results from the wellness screening will be shared with anyone from Xerox, outside of the health plan and our health plan vendors with whom we have business associate agreements. Furthermore, if you complete the online health questionnaire, you are giving consent for your results to be released to Xerox health care partners solely for the purpose of supporting efforts to promote health and wellness. All Xerox health care partners are legally and contractually required to preserve your privacy. Your individual results will never be shared with anyone outside of the Xerox health plan or used for any purpose other than supporting your health and wellness. 3. Xerox recognizes that your health information is private. Accordingly, personally identifiable health information (PHI) is not shared with Xerox for non plan-related purposes. Xerox may receive aggregate data not containing personally identifiable information. 4. You are responsible for ensuring that only eligible dependents are enrolled in the Xerox plans. If you enroll someone as a dependent who is not an eligible dependent under the terms of the plan, such as a child over the age limit, a grandchild or a former spouse — or anyone else not eligible under the plan — and the plan learns that the individual is not eligible, the ineligible individual may not be covered by the plan for any expenses. Failure to notify the plan in a timely manner that an individual is or has become ineligible could cause the individual to lose his or her ability to continue coverage under COBRA (the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended). Confidentiality of Your Health Information Federal law, according to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), as amended, includes rules that require that health plans protect the confidentiality of your private health information. HIPAA applies to all Xerox medical, dental and vision care plans and plan options (collectively referred to as “the plan”). A complete description of your rights under HIPAA can be found in the plan’s privacy notice, which is available on BenefitsWeb or by calling the Xerox Employee Service Center. It spells out what the plan is required by law to do, including notifying you of a breach of your unsecured protected health information (PHI), and how the plan will comply, as well as provides an explanation of your rights regarding your own PHI. For example, under the new regulations you may request access to electronic copies of your PHI, or you may request in writing or electronically that another person receive an electronic copy of these records. Neither the plan nor Xerox will use or further disclose information that is protected by HIPAA (“protected health information”) except as necessary for treatment, payment, health plan operations and plan administration, or as permitted or required by law. Regardless, in no event will your PHI, that is genetic information, be used for underwriting purposes. By law, the plan has required all of its business associates to observe HIPAA’s privacy rules. In particular, the plan will not, without authorization, use or disclose protected health information for employment-related or union-related actions and decisions or in connection with any other benefit or employee benefit plan sponsored by Xerox. Under HIPAA, you have certain rights with respect to your PHI, including certain rights to see and copy the information, receive an accounting of certain disclosures of the information and, under certain circumstances, amend the information. You also have the right to file a complaint with the plan or with the Secretary of the U.S. Department of Health and Human Services if you believe your rights under HIPAA have been violated. 33 This plan maintains a privacy notice, which provides a complete description of your rights under HIPAA’s privacy rules. A copy of this notice is available in the Health and Welfare section of BenefitsWeb, or if you are an employee of: • Xerox Technology or Corporate, call the Xerox Employee Service Center at 1.800.428.2203 (TDD users should call 1.800.833.8334) to request a copy. • Xerox Services, call the Xerox Business Services, LLC, VP of Corporate Governance, at 1.214.841.6111 to request a copy. If you have questions about the privacy of your health information, please contact the claims administrator associated with those benefits. Contact information is included in the “Benefit Contacts” section of this guide. The Women’s Health and Cancer Rights Act Notice Xerox medical plans cover mastectomies and certain related reconstructive surgeries. The law requires Xerox to notify you annually of the availability of this coverage. Covered participants who have a mastectomy can elect the following procedures after consulting with their physician. By law, they will be covered for the following expenses: • All stages of reconstruction of the breast on which the mastectomy was performed • Surgery and reconstruction of the other breast to produce a symmetrical appearance • Prosthesis • Treatment required as a result of physical complications for all stages of mastectomy, including lymphedemas Keep in mind, coverage is subject to all the terms of the health plan you elect, including applicable copayments, deductibles and/or coinsurance provisions. Notice of Important Rights Under Medicaid and the Children’s Health Insurance Program (CHIP) Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from Xerox, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a state listed below, contact your state Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your state Medicaid or CHIP office or dial 1.877.KIDS.NOW or visit www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under a Xerox plan, Xerox must allow you to enroll in the Xerox plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in a Xerox plan, contact the Department of Labor at www.askebsa.dol.gov or call 1.866.444.EBSA (3272). If you live in one of the states listed on page 35, you may be eligible for assistance paying your Xerox health plan premiums. 34 The following list of states is current as of July 31, 2014. Contact your state for more information on eligibility. Alabama – Medicaid Website: http://www.medicaid.alabama.gov Phone: 1.855.692.5447 Alaska – Medicaid Website: http://health.hss.state.ak.us/dpa/ programs/medicaid/ Phone (Outside of Anchorage): 1.888.318.8890 Phone (Anchorage): 907.269.6529 Arizona – CHIP Website: http://www.azahcccs.gov/applicants Phone (Outside of Maricopa County): 1.877.764.5437 Phone (Maricopa County): 602.417.5437 Colorado – Medicaid Medicaid Website: http://www.colorado.gov/ Medicaid Phone (In state): 1.800.866.3513 Medicaid Phone (Out of state): 1.800.221.3943 Florida – Medicaid Website: https://www.flmedicaidtplrecovery.com/ Phone: 1.877.357.3268 Georgia – Medicaid Website: http://dch.georgia.gov/ Click on Programs, then Medicaid, then Health Insurance Premium Payment (HIPP) Phone: 1.800.869.1150 Idaho – Medicaid Medicaid Website: http://healthandwelfare.idaho.gov/ Medical/Medicaid/PremiumAssistance/ tabid/1510/Default.aspx Medicaid Phone: 1.800.926.2588 Indiana – Medicaid Website: http://www.in.gov/fssa Phone: 1.800.889.9949 Iowa – Medicaid Website: www.dhs.state.ia.us/hipp/ Phone: 1.888.346.9562 Nebraska – Medicaid Website: www.ACCESSNebraska.ne.gov Phone: 1.855.632.7633 Kansas – Medicaid Website: http://www.kdheks.gov/hcf/ Phone: 1.800.792.4884 Nevada – Medicaid Website: http://dwss.nv.gov/ Phone: 1.855.632.7633 Kentucky – Medicaid Website: http://chfs.ky.gov/dms/default.htm Phone: 1.800.635.2570 New Hampshire – Medicaid Website: http://www.dhhs.nh.gov/oii/ documents/hippapp.pdf Phone: 603.271.5218 Louisiana – Medicaid Website: http://www.lahipp.dhh.louisiana.gov Phone: 1.888.695.2447 New Jersey – Medicaid and CHIP Medicaid Website: http://www.state.nj.us/humanservices/ dmahs/clients/medicaid/ Medicaid Phone: 609.631.2392 CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1.800.701.0710 Maine – Medicaid Website: http://www.maine.gov/dhhs/ofi/publicassistance/index.html Phone: 1.800.977.6740 TTY 1.800.977.6741 Massachusetts – Medicaid and CHIP Website: http://www.mass.gov/MassHealth Minnesota – Medicaid Website: http://www.dhs.state.mn.us/ Click on Health Care, then Medical Assistance Phone: 1.800.657.3629 Missouri – Medicaid Website: http://www.dss.mo.gov/mhd/ participants/pages/hipp.htm Click on Health Care, then Medical Assistance Phone: 1.800.657.3629 Montana – Medicaid Website: http://www.dphhs.mt.gov/medicaid/ member/ Phone: 1.800.694.3084 New York – Medicaid Website: http://www.nyhealth.gov/health_care/ medicaid/ Phone: 1.800.541.2831 North Carolina – Medicaid Website: http://www.ncdhhs.gov/dma Phone: 919.855.4100 North Dakota – Medicaid Website: http://www.nd.gov/dhs/services/ medicalserv/medicaid/ Phone: 1.800.755.2604 Oklahoma – Medicaid and CHIP Website: http://www.insureoklahoma.org Phone: 1.888.365.3742 Oregon – Medicaid Website: http://www.oregonhealthykids.gov http://www.hijossaludablesoregon.gov Phone: 1.800.699.9075 35 Rhode Island – Medicaid Website: http://www.eohhs.ri.gov/ Phone: 401.462.5300 South Carolina – Medicaid Website: http://www.scdhhs.gov Phone: 1.888.549.0820 South Dakota - Medicaid Website: http://dss.sd.gov Phone: 1.888.828.0059 Texas – Medicaid Website: http://www.gethipptexas.com/ Phone: 1.800.440.0493 Virginia – Medicaid and CHIP Medicaid Website: http://www.coverva.org/programs_ premium_assistance.cfm Medicaid Phone: 1.800.432.5924 CHIP Website: http://www.coverva.org/programs_ premium_assistance.cfm CHIP Phone: 1.855.242.8282 Washington – Medicaid Website: www.dhhr.wv.gov/bms/ Phone: 1.877.598.5820, HMS Third Party Liability Utah – Medicaid and CHIP Website: http://health.utah.gov/upp Phone: 1.866.435.7414 Wisconsin – Medicaid Website: http://www.badgercareplus.org/ pubs/p-10095.htm Phone: 307.777.7531 Vermont– Medicaid Website: http://www.greenmountaincare.org/ Phone: 1.800.250.8427 Wyoming – Medicaid Website: http://health.wyo.gov/ Phone: 307.777.7531 To see if any other states have added a premium assistance program since July 31, 2014, or for more information on special enrollment rights, contact either: U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/ebsa 1.866.444.EBSA (3272) U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1.877.267.2323, Menu Option 4, Ext. 61565 OMB Control Number 1210-0137 (expires October 31, 2016) 36 Benefit Contacts Benefit Plan Administrator Contact Information Member Services Phone Website Aetna 1.855.695.3416 www.aetna.com To find a network provider online, search the Aetna Choice POS II (Open Access) network plan. Anthem 1.855.804.2076 To find a network provider: Medical Consumer Choice Plan • If you live in GA, WI, FL or MO, call the customer service number for assistance. • If you live elsewhere, go to www.anthem.com, click on “Find a Doctor,” enter the type of provider and your ZIP code, choose “PPO” under “Plan Type/Network.” Under “Plan Name” choose National PPO (BlueCard PPO). Or, call and ask for the National PPO (BlueCard PPO) network plan. Cigna 1.855.820.6604 www.cigna.com To find a network provider, search Open Access Plus (OAP), OA Plus, Choice Fund OA Plus with Carelink online. Or, call and ask for the Open Access Plus with Carelink (OAPC) network plan. Kaiser Permanente (for medical and prescription drug coverage) California: 1.800.464.4000 http://my.kp.org/rightopt-xeroxcorp To find a network provider online, select “Find a Doctor,” select your location and click “Go.” Colorado Denver Metro area: 1.303.338.3800 Other North CO areas: 1.800.632.9700 Colorado Springs: 1.888.681.7878 Georgia Atlanta Metro area: 1.404.261.2590 Other areas: 1.888.865.5813 Mid-Atlantic D.C. Metro area: 1.301.468.6000 Other areas: 1.800.777.7902 Northwest Portland area: 1.503.813.2000 Other areas: 1.800.813.2000 Prescription Drug Coverage (If you enroll in the Consumer Choice Plan with Aetna, Anthem or Cigna) CVS Caremark 1.855.559.1385 Open Enrollment website: www.caremark.com/xerox Specialty Customer Care: 1.800.237.2767 Returning users: www.caremark.com Specialty Customer Care: www.CVSCaremarkSpecialtyRx.com 37 Benefit Plan Administrator Contact Information Member Services Phone Website Health Savings Account (If you enroll in the Consumer Choice Plan) BenefitWallet 1.877.472.4200 www.mybenefitwallet.com Anthem Traditional Plan II (former State of Indiana employees only) Anthem 1.800.295.4119 www.anthem.com To find a network provider online, click on “Find a Doctor.” Choose your state and under “Select a Plan” choose Anthem Blue Cross Blue Shield Blue Access. Medical Plans for Employees in Hawaii, Puerto Rico, Guam and American Samoa Kaiser Hawaii HMO Oahu: 1.808.432.5955 Neighbor Islands: 1.800.966.5955 Hearing Impaired: 1.877.447.5990 http://my.kp.org/xeroxcorp HMSA PPO Oahu: 1.808.948.6372 Neighbor Islands: 1.800.776.4672 www.hmsa.com Humana of Puerto Rico HMO 1.800.314.3121 www.humana.com TakeCare Asia HMO 1.877.484.2411 Guam: 1.671.647.3526 CNMI/Saipan: 1.670.235.7687 www.takecareasia.com Aetna (Basic and Enhanced) 1.855.695.3416 www.aetna.com To find a network dentist online, search the Dental PPO/PDN with PPO II network. Aetna (DMO) 1.855.695.3416 www.aetna.com To find a network dentist online, search the Dental Maintenance Organization (DMO) network Cigna (Basic and Enhanced) 1.855.820.6604 www.cigna.com To find a network dentist online, search the Radius network. 1.800.877.7195 www.vsp.com Dental Vision VSP Supplemental Insurance Benefits Critical Illness 1.877.750.5434 BenefitsWeb > My Health Accidental Injury Insurance 1.877.750.5434 BenefitsWeb > My Health Hospital Indemnity 1.800.571.4015 BenefitsWeb > My Health 38 Benefit Plan Administrator Contact Information Member Services Phone Website Health Advocate 1.877.776.6211 BenefitsWeb > My Health > My Benefit Resources > My Health Advocate Employee Assistance Program (Guidance Resources) 877.335.6031 www.guidanceresources.com Web ID: Xerox Quit For Life, Tobacco Cessation Program (Alere Health) 1.866.QUIT.4.LIFE (1.866.784.8454) www.quitnow.net Enter Xerox as your employer and your home ZIP code (you do not need to enter your Health Plan). Wellness Coaching (StayWell) 1.855.428.6319 BenefitsWeb > My Health > My Benefit Resources > My Wellness Coach Wellness Screening and Online Health Questionnaire (Quest Diagnostics) 1.855.332.2533 BenefitsWeb > My Health > Know My Numbers Xerox Wellness Programs Spouse/domestic partners must create their own login to BenefitsWeb to register. See page 9 for additional instructions. If You Live in Guam, Hawaii or Puerto Rico, or if You Are Enrolled in Anthem Traditional Plan II: my.blueprintforwellness.com You must register as a new participant, even if you registered last year. After your first successful log in, you will log in under Returning Participants for the remainder of 2014. Your Registration Key is “Xerox.” When you are prompted, enter your WIN ID. Your spouse/domestic partner should register using your ID and adding “S” to the end. Flexible Spending Accounts Xerox Technology & Corporate: Xerox Employee Service Center 1.800.428.2203 BenefitsWeb > My Health > My Benefit Resources > My FSA Xerox Services: BenefitWallet 1.877.472.4200 BenefitsWeb > My Health > My Benefit Resources > My FSA Life and Accidental Death & Dismemberment Insurance Xerox Technology & Corporate: Xerox Employee Service Center 1.800.428.2203 BenefitsWeb > My Health > My Benefit Resources > Other Plan Benefit Resources Xerox Services: MetLife 1.800.638.6420 www.metlife.com 39 Benefit Plan Administrator Contact Information Member Services Phone Website Xerox Technology: Xerox Employee Service Center 1.800.428.2203 BenefitsWeb > My Health > My Benefit Resources > Other Plan Benefit Resources Xerox Services: MetLife 1.800.823.1703 www.metlife.com 1.800.821.6400 www.legalplans.com Disability Insurance Legal Services Plan Hyatt Legal Services Commuter Benefits Program (Xerox Services) WageWorks 1.877.924.3967 www.wageworks.com Xerox Employee Service Center (Xerox Technology & Corporate) Xerox Employee Service Center 1.800.428.2203 BenefitsWeb www.XeroxBenefitsWeb.com for employees and spouses/ domestic partners Workplace Solutions Center (Xerox Services) Workplace Solutions Center 1.888.471.2271 BenefitsWeb Employees login in via InfoBank at https://infobank.acs-inc.com/login.asp Spouses/domestic partners go to www.XeroxBenefitsWeb.com 40 Summary of Material Modifications This 2015 Enrollment Guide for Xerox employees constitutes a Summary of Material Modifications (SMM) and provides a general description of plan options. It is your responsibility as an employee to review the Summary Plan Description (SPD) for specific information about the terms of your benefit plans. This document is intended only as a summary of your benefit options, and it does not create a contract between the company and any employee.* The plans are governed by the terms of more detailed plan documents and insurance contracts. In the event of any difference between the information contained in this guide and the plan documents and insurance contracts, the documents and insurance contracts will control. Subject only to any applicable regulations or contracts, the company reserves the right to amend or terminate the plans or programs at any time for any reason. *Project-based employees of Xerox Services, certain-part-time employees, temporary employees, and contractors, including (without limitation) leased employees, supplemental contract workers, consultants, or any other third-party personnel, or anyone classified by the company as such, who perform services for the company, are neither eligible for nor covered by the plans and programs summarized herein (unless they qualify as eligible dependents). This document is intended only as a summary of your benefit options, and it does not create a contract between the company and any employee. The plans are governed by the terms of more detailed plan documents and insurance contracts. In the event of any difference between the information contained in this guide and the plan documents and insurance contracts, the documents and insurance contracts will control. Subject only to any applicable regulations or contracts, the company reserves the right to amend or terminate the plans or programs at any time for any reason. ©2014 Xerox Corporation. All rights reserved. Xerox® and Xerox and Design® are trademarks of Xerox Corporation in the United States and/or other countries. BR12155 ACS-GB6 41