2017 BENEFITS ENROLLMENT GUIDE

Transcription

1 2017 BENEFITS ENROLLMENT GUIDE 1

2 Welcome to the Altice USA 2017 Benefits Enrollment Guide, your reference for benefits information and the wellness resources available to you as an Altice USA employee. These benefits are applicable to Brooklyn Union employees covered by a collective bargaining agreement with the Company. Altice USA supports you and your family s physical, emotional and financial well-being by offering a comprehensive benefits program. The 2017 benefits program includes: Health, dental and vision plans Health coverage for lower paid employees at a reduced cost Resources for healthy lifestyles Tax-free reimbursement plan to pay for certain health and dependent care expenses Plans to protect you financially if you are unable to work Plans to protect your family financially in the event of a death We encourage you to share this guide with your family to LEARN: About the Altice USA benefit plans and resources available to you DECIDE: What options are right for you and what eligible dependents you want to cover GO: To MyHRInfo (MyHRInfo.Cablevision.com) to enroll in coverage and update your Life Insurance and AD&D beneficiary information Throughout this guide, look for these icons to LEARN about your benefit plans, DECIDE which options are best for you and GO enroll for coverage. All new hires have 31 days from their hire date to enroll. Employees who need to change coverage or add dependents due to a qualifying life event have 31 days from the date of the qualifying life event to make appropriate benefit election changes. 2

3 LEARN About the Altice USA benefit plans and resources available to you This Guide offers you detailed information about your benefit plans so you can make decisions that are right for you and your family. As healthcare costs continue to rise year over year due to industry trends and the Affordable Care Act (ACA), also known as Health Care Reform, Altice USA will bear a majority of the costs for company provided healthcare. We are doing everything we can to minimize the impact to employees, and we remain committed to maintaining a competitive and affordable program for you and your families. Resources for you The following resources are available to help you determine what options are best for you: UnitedHealthcare offers a variety of online tools ( to help you learn about your health care options including the plan cost estimator at (User Name: AlticeUSA2017, Password: Benefits2017). Wellness360 is also a great resource to help you learn about healthy lifestyles. Have a question? Need help now? Call the HR Service Center at or send an to HRServiceCenter@alticeusa.com 3

4 DECIDE What benefit options are right for you? Altice USA s Medical, Dental, Vision, Life Insurance and AD&D plans offer different levels of coverage that you can choose based on your unique needs. Some benefits like Health Care and Dependent Care Flexible Spending Accounts require you to determine the amount you want to contribute each year. And other benefits are provided automatically at no cost to you. Now is the time to learn about each option and decide which ones and which levels of coverage are right for you and your family. Determine the eligible family members you want to cover Learn about the dependent eligibility guidelines for each benefit plan and decide if you want to cover any eligible dependents. It s very important that you confirm eligibility for each dependent. If you newly enroll a dependent under your coverage, you will receive a Dependent Eligibility Verification packet from Xerox HR Solutions, the administrator who manages the Dependent Eligibility Verification process. Failure to participate in the process, either at all or in a timely fashion, or providing coverage to a negligible dependent will lead to corrective action, up to and including termination of employment. If your beneficiaries are up to date Annual enrollment is a great time to review your beneficiaries for Life Insurance, AD&D and other benefits and be sure their information is current and complete. UnitedHealthcare offers a health plan cost estimator at to help you decide which plan is best for you. User ID: AlticeUSA2017; Password: Benefits2017 4

5 GO After you ve learned about the benefit program and decided which options are right for you and what dependents you want to cover, it s time to Go to MyHRInfo from the company s intranet (or MyHRInfo.Cablevision.com) to enroll. Newly hired employees have 31 days from their hire date to submit their benefit elections. Coverage for most benefits is effective as of your date of hire. Coverage under the Short-Term Disability (STD) Program becomes effective 90 days from your date of hire. If you do not enroll within 31 days of your date of hire, you will not be eligible to enroll until Annual Open Enrollment which occurs in the fall of each year for coverage beginning the following January 1. Your only other opportunity to enroll in coverage during the year will be within 31 days of a qualifying life event. Employees who need to change coverage or add dependents due to a qualifying life event have 31 days from the date of the qualifying life event to make the appropriate benefit election change. To enroll: Log onto MyHRInfo through the company s intranet (or go to MyHRInfo.Cablevision.com). Eligibility Full-Time Employees of Altice USA You are eligible to participate in the Altice USA Benefits Program if you are a full-time (exempt or non-exempt) benefits-eligible employee in accordance with the Company s policies. If you become eligible for coverage during the year due to the requirements of the Affordable Care Act, you will be contacted by the Benefits Department and provided an opportunity to enroll. Eligible full-time employees may participate in the: North Medical Plan* North Dental Plan* Vision Plan Flexible Spending Accounts Short-Term Disability Program Long-Term Disability Plan Life and AD&D Insurance Plans Business Travel Accident Insurance Group Legal Plan Employee Assistance Program *Applies to Brooklyn Union employees whose primary work location is located within the Northeast region of Altice USA are eligible for these plans 5

6 Part-Time Employees of Brooklyn Union Part-time employees who are regularly scheduled to work 20 hours or more per week are eligible to participate in the same plans as eligible full-time employees, with the exception of the Short-Term Disability Program and the Long-Term Disability Plan. Part-time employees who are not regularly scheduled to work at least 20 hours per week are not eligible to participate in the Altice USA Benefits Program. If you become eligible during the year due to the requirement of the Affordable Care Act, you will be contacted by the Benefits Department and provided an opportunity to enroll. Eligibility Under the Affordable Care Act You may be eligible for coverage during a particular period if you are scheduled to work 30 hours or more per week, or if you worked an average of 30 hours per week over the course of a corresponding measurement period (which is considered to be full-time under the Affordable Care Act). This is called the Lookback Method Altice USA looks back at your prior service to determine whether you might be considered eligible for benefits coverage during the next coverage period. To determine whether you are eligible for Medical benefits, Altice USA will measure your Hours of Service during a timeframe called the Standard Measurement Period. If you average at least 30 Hours of Service a week during the Standard Measurement Period, you will be eligible to participate in the Plan s Medical benefits for the Standard Stability Period. Decide When you enroll for benefits, it is important for you to review whom you would like to cover under the Altice USA Benefits Program. If someone becomes ineligible during the year, be sure to remove them. For those whom you are covering, you will be asked to provide documentation to confirm their eligibility. Failure to participate in the process, either at all or in a timely fashion, or providing coverage to an ineligible dependent will lead to corrective action up to and including termination of employment. You will be eligible for Medical benefits for the entire Standard Stability Period, even if your hours or wages decrease during the Standard Stability Period, so long as you remain an employee, comply with the terms of that coverage and continue to make any required contributions toward your coverage. 6

7 The Company will calculate how many Hours of Service you have worked during each Standard Measurement Period and will inform you if you are eligible for Medical benefits prior to the next Standard Stability Period. It is solely within the authority of the Plan Administrator to determine whether you are eligible for Medical coverage benefits under this Plan. A person whom the Plan Administrator determines is not an employee and who is later required to be reclassified as an employee will only be eligible prospectively, provided all other Plan eligibility requirements are met. If you experience a period of 13 consecutive weeks (or longer) without an Hour of Service either because you terminate employment or are absent for some other reason you will have a Break in Service and you will be treated as a New Employee to the extent permitted by law (see the rules that apply to New Employees below). Hours of Service means any hour for which you are paid, or entitled to payment, for (1) the performance of duties for the Company, or (2) for a period of time during which no duties are performed due to vacation, holiday, illness, incapacity (including disability), layoff, jury duty, military duty, or leave of absence. An Hour of Service does not include: Hours for which your compensation is considered non-us source income; Hours worked as a volunteer; or Hours worked as part of a Federal Work-Study Program Your Dependents If you are a benefits-eligible employee, you may also enroll your eligible dependents. Your eligible dependents include: Your spouse (provided you are not legally separated or divorced). For the purposes of the Plan, your spouse is your legal partner in marriage, and from whom you are not legally divorced; Your same- or opposite-sex domestic partner; Your unmarried child(ren) or those of your spouse/domestic partner, until December 31st of the year in which they reach age 19 (or 25 if they are full-time students); and Your unmarried mentally or physically disabled child(ren), or those of your spouse/domestic partner, regardless of age, who have been classified as disabled and incapable of self-support because of their disability, provided they became disabled while covered under the Plan. Proof of disability will be required. Special Eligibility for Medical Plan Only: This applies to your adult children or those of your spouse/domestic partner, until they reach age 26, regardless of whether they have access to coverage under another employer sponsored medical plan. Coverage ends on the last day of the month in which they reach age 26. 7

8 Dependent Eligibility Verification It s important to confirm and update your eligible dependents when you enroll in your benefits. As a best practice, the Company conducts a dependent eligibility verification. As part of the verification, employees who cover dependents in an Altice USA health care plan will be required to certify their eligibility by providing key information to maintain coverage. Individuals found to be ineligible for coverage under the Company s plan will be dropped from coverage. Please take the time to review the eligibility requirements on the previous page and determine if your dependents meet the requirements for the plans that you wish to enroll them in. Remember, covering an ineligible dependent is a serious matter. Be sure to remove your dependents from your coverage if they no longer meet the eligibility criteria. If you newly enroll a dependent under your coverage, you will receive a Dependent Eligibility Verification packet from Xerox HR Solutions, the administrator of this process. Failure to participate in the process, either at all or in a timely fashion, or providing coverage to an ineligible dependent will lead to corrective action up to and including termination of employment. As you review dependent eligibility for additional information, consider whether your circumstances have changed in ways that would affect your eligibility or that of your dependents. For example: Has your marriage status changed through marriage, divorce, separation, death? Do you have a domestic partner? Do you have a newborn or newly adopted child? Are your children still eligible, or have they passed the age of eligibility? Do your disabled children still meet the criteria for coverage? Are they still unmarried? Still incapable of self-support? It is also important that you make sure to list your dependents personal information correctly. If your dependent has a Social Security number, it must be included as part of their information in MyHRInfo. If you are unsure if your dependent meets the eligibility requirements, you can contact the HR Service Center at or HRServiceCenter@alticeusa.com. 8

9 2017 Benefit Options Medical Altice USA strives to provide valuable and cost-effective benefits to you and your families. As the Affordable Care Act (ACA), also known as Health Care Reform, is implemented, Altice USA s cost of providing medical care continues to rise. We are doing everything we can to minimize the impact on our employees. Altice USA North Medical Plan Options Through our Medical Plan options, Altice USA offers benefits designed to help keep you and your family healthy and protect you from financial hardship in the event of serious illness or injury. Altice USA offers two options for medical coverage, so you can select the coverage that s right for you. Both UnitedHealthcare Choice Plus Option 1 and UnitedHealthcare Choice Plus Option 2 offer open access flexibility. This means that whichever option you choose: You have access to both in-network and out-of-network coverage through UnitedHealthcare s Choice Plus Network. You can visit an in-network specialist without a referral. You don t need to select a primary care physician. Regardless of which Medical Plan option you choose, you can use in- and out-of-network providers. You will pay less out of pocket when using in-network providers (doctors and facilities that contract with UnitedHealthcare s Choice Plus network). Out-of-network providers (doctors and facilities that do not contract with UnitedHealthcare s Choice Plus network) will always cost you more than in-network providers, as you will be responsible for any charges above what are considered reasonable and customary (R&C). For more details on the Medical Plan options, see the Plan Comparison Chart. To find a medical network provider, visit 9

10 Learn In-network preventive care services are available at no cost to you. Preventive services include a routine checkup for yourself and your eligible dependents, and much more: Well-child care, including immunizations Adult screenings and immunizations, including blood pressure, diabetes and cardiovascular disease Health services for women, including well-woman exams, routine mammograms, HPV DNA testing, and breastfeeding and postpartum counseling Birth control devices for women, including Tier 1 contraceptives Adult counseling on tobacco use and alcohol use, as well as counseling on nutrition, physical activity and depression Use the resources available to you to proactively make better choices to live a healthier life. For more information on preventive care, visit UnitedHealthcare (UHC) online at Remember: Certain services can be used for preventive or diagnostic reasons. Diagnostic services are subject to the applicable copay or deductible and coinsurance amounts. PRE-CERTIFICATION means pre-approval of care. Receiving pre-approval of care may help you avoid unnecessary hospital stays and costly medical procedures. You must contact Care Coordination before specific medical services are performed. If you do not, your benefits under the Plan may be reduced. If you use an in-network provider, your pre-certification will be the responsibility of your provider. If you use an out-of-network provider, you will be responsible for pre-certification. To find out which services require pre-certification, refer to your Medical Plan Summary Plan Description or call UnitedHealthcare at Questions about a medical situation? Not sure whether a medical situation is really an emergency? Call mynurseline at for guidance from a registered nurse, live. Perhaps you ll discover that a visit to the doctor or an urgent care center is what you need, rather than a trip to the emergency room. In such an event, you would pay a $25 copay rather than the $250 copay. Feeling sick and don t want to leave the house? With Virtual Visits, you don t have to! A virtual visit lets you see and talk to a doctor from your mobile device or computer without an appointment. Log onto and register. 10

11 Medical Plan Comparison Chart Option 1 Option 2 In-Network Out-of-Network In-Network Out-of-Network Annual Deductible* Individual $500 $1,500 $900 $2,700 Family $1,500 $4,500 $2,700 $8,100 Annual Out-of-Pocket** Maximum Individual $3,000 $6,000 $6,850 $8,000 Family $7,500 $15,000 $13,700 $20,000 Lifetime Maximum Unlimited Unlimited Pre-existing Condition Limitation None None You Pay Doctor s Office Visits Primary Specialist 40% after deductible, $25 copay*** plus any amount over R&C $40 copay*** $25 copay*** $40 copay*** 50% after deductible, plus any amount over R&C Routine Preventive Care Well-child Care to Age 19 (including immunizations) $0 40% after deductible, plus any amount over R&C Well-woman Care Routine Mammograms $0 50% after deductible, plus any amount over R&C Routine Adult Physical Exams $0 Not Covered $0 Not Covered Inpatient Hospital Services 20% after deductible 40% after deductible, plus any amount over R&C 20% after deductible 50% after deductible, plus any amount over R&C * If you choose Employee + 1, you and your covered dependent have individual deductibles and out-of-pocket maximums. ** There are separate deductibles and out-of-pocket maximums for in-network and out-of-network services. They do not cross apply. *** Copays do not apply to the deductible; however, they do apply to the out-of-pocket maximum. 11

12 Option 1 Option 2 Plan Feature In-Network Out-of-Network In-Network Out-of-Network Hospital Emergency Room Visit $250 copay*, waived if admitted $250 copay*, waived if admitted Urgent Care $25 copay* 40% after deductible, plus any amount over R&C $25 copay* 50% after deductible, plus any amount over R&C Outpatient Facility Surgical Care 20% after deductible 40% after deductible, plus any amount over R&C 20% after deductible 50% after deductible, plus any amount over R&C Pre-Natal and Post-Natal Maternity Care $25 primary or $40 specialist copay for first visit* 40% after deductible, plus any amount over R&C $25 primary or $40 specialist copay for first visit* 50% after deductible, plus any amount over R&C Lab Work and X-Rays Mental Health/Substance Abuse Treatment Inpatient 20% after deductible 40% after deductible, plus any amount over R&C 40% after deductible, plus any amount over R&C 20% after deductible 50% after deductible, plus any amount over R&C 40% after deductible, plus any amount over R&C 20% after deductible 20% after deductible Outpatient (unlimited) $25 copay* $25 copay* Hearing Aids $1,000 allowance every 36 months $1,000 allowance every 36 months Other Covered Services 20% after deductible 40% after deductible, plus any amount over R&C 20% after deductible 50% after deductible, plus any amount over R&C * Copays do not apply to the deductible; however, they do apply to the out-of-pocket maximum. Copays for Emergency Room Visits are waived if admitted. 12

13 Option 1 Option 2 Plan Feature In-Network Out-of-Network In-Network Out-of-Network Cardiac Rehabilitation, Physical Therapy, Chiropractic Therapy, Occupational Therapy, Speech Therapy, Pulmonary Rehabilitation Therapy $40 copay* 40% after deductible, plus any amount over R&C Up to 60 visits per plan year combined inand out-of-network $40 copay* 50% after deductible, plus any amount over R&C Up to 60 visits per plan year combined inand out-of-network Skilled Nursing Facility 20% after deductible 40% after deductible, plus any amount over R&C 20% after deductible 50% after deductible, plus any amount over R&C Up to 120 visits per plan year combined inand out-of-network Up to 120 visits per plan year combined inand out-of-network Home Health Care 20% after deductible 40% after deductible, plus any amount over R&C 20% after deductible 50% after deductible, plus any amount over R&C Up to 120 visits per plan year combined inand out-of-network Up to 120 visits per plan year combined inand out-of-network Prosthetics and Durable Medical Equipment 20% after deductible 40% after deductible, plus any amount over R&C 20% after deductible 50% after deductible, plus any amount over R&C * Copays do not apply to the deductible; however, they do apply to the out-of-pocket maximum. 13

14 Option 1 Option 2 Plan Feature In-Network Out-of-Network In-Network Out-of-Network Prescription Drugs (Express Scripts) Retail Pharmacy (up to a 31-day supply) Tier 1 $10 copay* N/A $10 copay* Tier 2 $30 copay* $30 copay* Tier 3 $45 copay* $45 copay* Mail Order (up to a 90-day supply) Tier 1 $20 copay* N/A $20 copay* Tier 2 $60 copay* $60 copay* Tier 3 $90 copay* $90 copay* Fertility Treatment Treatment Maximum Office Visit In Vitro Fertilization (GIFT, ZIFT, etc.) Inpatient and Outpatient Facilities Drug Therapy $25,000 lifetime maximum for medical and $25,000 lifetime maximum for prescription drug treatment combined in- and out-ofnetwork $40 specialist copay* per visit 20% after deductible 40% after deductible, plus any amount over R&C 40% after deductible, plus any amount over R&C N/A N/A $25,000 lifetime maximum for medical and $25,000 lifetime maximum for prescription drug treatment combined in- and out-of-network $40 specialist copay* per visit 20% after deductible 40% after deductible, plus any amount over R&C 50% after deductible, plus any amount over R&C Pharmacy copay Not covered Pharmacy copay Not covered * Copays do not apply to the deductible; however, they do apply to the out-of-pocket maximum. 14

15 Medical Plan Examples Which Plan Is Right for Me? Altice USA offers two Medical Plan options for 2017: UnitedHealthcare Option 1 and UnitedHealthcare Option 2. Both plans offer the flexibility of in- and out-of-network care. The examples on the following pages can help you choose which Medical Plan option may be right for you. Review them to see which best matches your situation. Then conduct your own comparison using UnitedHealthcare s Health Plan Cost Estimator ( User ID: AlticeUSA2017, Password: Benefits2017) which can help you estimate your total health care costs for 2017 under each of the options. Learn Your deductible and out-of-pocket maximum both reset each year. You need to meet the full deductible ach year before the Plan begins to pay. Your out-of-pocket medical expenses paid in the previous year do not carry over. Remember that timely preventive care such as annual checkups, well-woman and well-child care, and immunizations can help you catch and deal with medical issues before they become more serious (and costly) conditions. And all of these services and more are available at no cost to you. Meet Eric Earns $45,000 a year Has no dependents Doesn t anticipate any major health care expenses in 2017 Values low per-paycheck contributions Plans to seek preventive care Always uses in-network providers Given Eric s situation, let s see how each Medical Plan option could work for him. 15

16 UHC Option 1 UHC Option 2 Service Eric pays Eric pays Annual physical exam (in-network) + one additional visit to his primary care physician Annual physical exam = $0 Additional visit = $25 Annual physical exam = $0 Additional visit = $25 Two in-network specialist visits Two generic drug prescriptions Cost for services in 2017 $40 per visit = $80 $40 per visit = $80 $10 per prescription = $20 $10 per prescription = $20 $125* $125* Annual contributions for 2017 $762 $190 Total cost $887 $315 * If Eric participated in a Health Care FSA, some of his costs would be reimbursed tax free. Because the cost of care is the same with both options and Option 2 has lower medical contributions, Option 2 is the most cost-effective choice for Eric. What exactly is a copayment? How does a deductible differ from coinsurance? Find out in the Terms to Know section. 16

17 Meet Sofia Earns $57,000 a year Is married to Ed and they have one daughter, Luisa, who is asthmatic and needs medical care from specialists Values both in- and out-of-network care providers for her daughter s care Plans to seek preventive care in 2017 Provides the medical coverage for her family Given Sofia s situation, let s see how each Medical Plan option could work for her and her family. UHC Option 1 UHC Option 2 Service Sofia pays Sofia pays Sofia s annual physical exam (in-network) $0 $0 Ed s annual physical exam (in-network) $0 $0 Luisa s well child care office visit (in-network) $0 $0 Luisa s 30 specialist office visits for asthma symptoms (outof-network $200 per visit) $1,500 deductible + 40% coinsurance ($1,800) = $3,300 $2,700 deductible + 50% coinsurance ($1,650) = $4,350 Luisa s emergency room visit for an asthma attack, resulting in a hospital admission and a five-night stay (hospital bill of $18,000*) $500 deductible + 20% coinsurance ($3,500) = $4,000 $3,000 in-network individual out-of-pocket limit has been reached $900 deductible + 20% coinsurance ($3,420) = $4,320 Luisa s asthma medication, four 90-day supplies of Tier 2 medication through mail-order program ($60 per prescription) $0** $240 Cost for services in 2017 $6,300 $8,910 Annual contributions for 2017 $3,229 $1,899 Total cost $9,529 $10,809 * The $250 ER copay was waived because Luisa was admitted to the hospital. ** Because Luisa has met her in-network out-of-pocket maximum, she is covered at 100% for covered in-network services for the remainder of the plan year. If Sofia participated in the Health Care FSA, some of her costs would be reimbursed tax free. Because of the type and amount of care her family will need, Option 1 is the more cost-effective choice for Sofia. 17

18 Medical Contribution Schedule Full-Time Employees Bi-weekly Pay Frequency* Your medical election Your annual eligible pay Your bi-weekly contribution Employee only Employee+1 Family UnitedHealthcare Choice Plus Option 1 UnitedHealthcare Choice Plus Option 2 to $49,999 $29.33 $57.18 $87.98 $50,000 $69,999 $41.40 $80.73 $ $70,000 $89,999 $65.55 $ $ $90,000 $109,999 $98.33 $ $ $110,000 $199,999 $ $ $ $200,000 or more $ $ $ Up to $49,999 $7.30 $14.24 $21.90 $50,000 $69,999 $24.34 $47.46 $73.02 $70,000 $89,999 $48.68 $94.92 $ $90,000 $109,999 $69.36 $ $ $110,000 $199,999 $80.32 $ $ $200,000 or more $87.62 $ $ * For your monthly contribution amount, multiply the bi-weekly amount by 26 and divide by

19 Part-Time Employees Bi-Weekly Pay Frequency* Your bi-weekly contribution Your medical election Employee only Employee+1 Family UnitedHealthcare Choice Plus Option 1 $ $ $ UnitedHealthcare Choice Plus Option 2 $80.32 $ $ * For your monthly contribution amount, multiply the bi-weekly amount by 26 and divide by

20 Prescription Drugs When you enroll in a Medical Plan option, you automatically receive prescription drug coverage. Express Scripts (ESI) administers the prescription drug benefit. Your prescription drug costs are based on three different tiers of prescription drugs: TIER 1 This is your lowest-cost option and typically includes generic drugs and the lowest-cost brand name drugs. TIER 2 This mid-range cost option includes most preferred brand-name drugs. If you choose a non-generic drug when a generic is available, you will pay the generic copay plus the difference in cost between the non-generic and the generic. It s important to talk to your doctor about generic options. TIER 3 This is your highest-cost option and includes drugs that are usually the newest and most expensive, and are considered non-preferred brand-name drugs. If your doctor prescribes you a Tier 3 drug, ask your doctor if there is a lower-cost alternative in Tier 1 or Tier 2 that would provide the same treatment benefits. If you choose a non-generic drug when a generic is available, you will pay the generic copay plus the difference in cost between the non-generic and the generic. Please refer to the ESI Preferred Drug List ( to find out what tier your prescriptions are listed under. To purchase your prescription medicine, either present your ESI ID card at a pharmacy that participates in the ESI network for up to a 31-day supply or you can save money on your maintenance medication by using the mail order program. With the mail order program you can receive a 90-day supply of medication for the cost of a 60-day supply delivered right to your door. With either purchase option, you will pay a copayment for your medication. Visit express-scripts.com to order online. Your doctor can also submit your prescription to ESI electronically, or you may also mail your prescription and applicable copayment to ESI using the form included in your Welcome Packet. Drug Benefit Overview Tier 1 Tier 2 Tier 3 Retail (up to 31-day supply) You pay $10 copay You pay $30 copay You pay $45 copay Mail-order (up to 90-day supply) You pay $20 copay You pay $60 copay You pay $90 copay 20

21 Learn When budgeting for your 2017 Health Care Flexible Spending Account (FSA) election, please keep in mind that drug tiers, including drugs for which you currently have a prescription, may change as generic equivalents become available. Please refer to the ESI Preferred Drug List to find out what tier your current prescription is listed under. Remember, your prescription drug copays count toward your medical out-of-pocket maximum. Specialty Pharmacy Medications If you suffer from a chronic or complex condition, the appropriate use of specialty medications can be important to your health and your quality of life. Accredo, an Express Scripts specialty pharmacy, provides the resources and personalized support that you need to help you better manage your condition. If you or a covered dependent is currently taking a specialty medication, you can take advantage of Accredo s personalized patient support at no charge to you. You will have access to knowledgeable pharmacists and nurses who specialize in your condition. To find out more call Accredo at between 8:00 am (ET) and 11:00 pm (ET) Monday-Friday, or between 8:00 am (ET) and 5:00 pm (ET) on Saturday. Please reach out to Accredo at least two weeks before your medication supply runs out. You are unable to fill specialty drug prescriptions at a retail pharmacy, and you must go through the Accredo Specialty Pharmacy if one or more of your prescriptions falls into this category as defined by Accredo. Go Here are some ways to save on prescription drugs: Visit the ESI Preferred Drug list and access the Formulary. You can look up prescriptions by name, as well as lower cost alternatives (if available). Ask your doctor about generic brands. They cost less than brand-name drugs and contain the same active ingredients. And remember, if you choose a non-generic drug when a generic is available, you will pay the generic copay plus the difference in cost between the non-generic and the generic. If you ve just been prescribed a new medication, ask your doctor for free samples so you can see how well it works before you pay for it. 21

22 Dental Altice USA North Dental Plan Options You can choose either a Dental Preferred Provider Organization (DPPO) or a Dental Maintenance Organization (DMO ). Both Altice USA North Dental Plan options encourage preventive care and provide coverage for a wide range of services to help you and your covered family members maintain good dental health. Each option covers preventive dental care at 100%, including regular cleanings and X-rays. Aetna administers both options. Aetna Dental Preferred Provider Organization (DPPO) The DPPO option gives you the choice of receiving dental care from dentists who participate in the Aetna Dental PPO/PDN II network (in-network benefits) or from dentists outside of the network (out-of-network benefits). No primary care dentist (PCD) referral is necessary simply visit the dentist of your choice when you need dental care. Visit to find a list of participating dentists. The DPPO option pays 100% of the costs of in-network preventive care (exams and cleanings). Once you meet the annual deductible, the Plan also pays a percentage of charges for basic and major services until the calendar year maximum is met. The Plan does not pay benefits after the calendar year maximum is met. This option also gives you the flexibility of visiting a dentist who is outside of the Aetna Dental PPO/PDN II network. However, you will generally pay less when you choose an in-network dentist. That s because in-network dentists agree to charge negotiated rates for services. In addition, when you choose an out-of-network dentist, you are responsible for any expenses that are above the Plan s reasonable and customary (R&C) limits. Aetna Dental Maintenance Organization (DMO ) With the Aetna DMO option, you must designate a DMO primary care dentist (PCD) to coordinate your care. You can select the same or a different PCD for each covered family member. Then, each time you need dental care, you must visit your PCD, who can refer you to a specialist in the network if necessary. Visit to find a list of participating dentists. There is no annual deductible to meet and no calendar year maximum benefit. Most preventive and basic services are covered in full. Major services are covered at 60% and orthodontia is covered at 50%. The Plan will not pay benefits if you: Use an in-network dentist who is not on file at Aetna as your PCD, Use an in-network dentist without a referral from your PCD, or Use an out-of-network dentist. You can change your primary care dentist (PCD) at any time by logging on to Aetna Navigator or by calling Aetna at Requests made before the 15th of the month will be effective the first of the following month. Some dental services may require precertification. To find out which services require pre-certification, refer to your Dental Plan Summary Plan Description or call Aetna at

23 Dental Plan Comparison Chart Aetna DPPO Aetna DMO* Plan feature In-network Out-of-network In-network only Calendar year deductible Employee: $50 Employee+1: $100 None Family: $150 Calendar year maximum $2,000 per person None Separate orthodontia lifetime maximum $2,000 per person One course of treatment per person per lifetime Primary care dentist referral Not required Required Services Preventive care includes: Routine exams and cleanings* Prophylaxis (cleaning and polishing) Fluoride treatments* Periapical X-rays* Bitewing, full mouth X-rays* Emergency treatment for dental pain (DMO only) You Pay: $0 Plan Pays: 100% of pre-set, negotiated fee (deductible does not apply) You Pay: Any amount over R&C Plan Pays: 100% of R&C (deductible does not apply) You Pay: $0 Plan Pays: 100% * Frequency and age limitations apply to these services. Please contact Aetna Member Services directly for description of coverage. 23

24 Aetna DPPO Aetna DMO* Plan feature In-network Out-of-network In-network only Basic services include: White fillings for molars (DPPO only) Stainless steel crowns Root canal therapy for anterior, bicuspid teeth Apicoectomy Scaling and root planning Subgingival curettage Gingivectomy Incision/draining of abscesses Simple extractions Surgical removal of erupted or soft tissue, impacted teeth You Pay: 20% of pre-set, negotiated fee, after deductible Plan Pays: 80% of pre-set, negotiated fee, after deductible You Pay: 20% of R&C after deductible, plus any amount over R&C Plan Pays: 80% of R&C, after deductible You Pay: $0 Plan Pays: 100% Major services include: Osseous surgery* Surgical removal of partial or full bony impacted tooth* Root canal therapy for molar teeth* Inlays/onlays/bridges Crowns/crown buildups Full and partial dentures Implants (DPPO only) Full mouth debridement Denture repairs You Pay: 50% of pre-set, negotiated fee after deductible Plan Pays: 50% of pre-set, negotiated fee, after deductible You Pay: 50% of R&C after deductible, plus any amount over R&C Plan Pays: 50% of R&C, after deductible You Pay: 40% Plan Pays: 60% * Covered as a basic service under DPPO. 24

25 Dental Contribution Schedule Full-Time Employees Bi-weekly Pay Frequency* Your dental Your annual eligible pay election Employee only Employee+1 Family Up to $49,999 $3.47 $6.76 $10.40 Aetna DPPO $50,000 $69,999 $4.82 $9.39 $12.72 $70,000 $89,999 $5.40 $10.52 $13.87 $90,000 or more $7.13 $13.90 $18.49 Up to $49,999 $0.43 $0.82 $1.56 Aetna DMO $50,000 $69,999 $1.66 $3.13 $4.68 $70,000 $89,999 $3.25 $6.13 $8.31 $90,000 or more $4.41 $8.31 $11.17 * For your monthly contribution amount, multiply the bi-weekly amount by 26 and divide by 12 Part-Time Employees Bi-weekly Pay Frequency* Your dental election Your annual eligible pay Employee only Employee+1 Family Aetna DPPO $7.13 $13.90 $18.49 Aetna DMO $4.41 $8.31 $11.17 * For your monthly contribution amount, multiply the bi-weekly amount by 26 and divide by 12 25

26 Vision The Vision Plan, administered by Vision Service Plan (VSP), is available to you and your eligible dependents. If you enroll in the Vision Plan, you pay the full cost of the benefits. The Vision Plan is available as a stand-alone plan you do not have to enroll in other Altice USA health care plans to join. Under the Basic Option, you may purchase: One set of lenses for your glasses or one set of contact lenses (up to a $150 allowance) every calendar year One set of frames every two (2) calendar years, up to a $150 allowance (20% discount on any amount in excess of allowance), provided you did not utilize the contact lens allowance in the prior year Under the Buy-up Option, you may purchase: One set of lenses for your glasses or one set of contact lenses (up to a $150 allowance) every calendar year One set of frames every calendar year, up to a $150 allowance (20% discount on any amount in excess of allowance) Either a second pair of glasses or a second set of contact lenses each year (up to the applicable allowance) Learn The VSP signature Network is comprised of more than 33,000 vision care providers nationwide. In addition, the VSP Network offers more than 2,000 regional retail chain locations and 1,000 optical stores for your convenience, including Shopko, Costco Optical, Visionworks and Cohen s Fashion Optical. There are no forms required and participants will pay only copays and the costs over coverage amounts, and/or for non-covered options when visiting these stores. Note: If you purchase eyewear at Costco Optical, VSP permits a frame allowance of $80 only. You will be responsible for any amounts over $80. 26

27 Option 1 Option 2 Benefit In-Network Out-of-Network In-Network Out-of-Network Exam, once every calendar year You Pay: $10 copay Plan Pays: up to $50 You Pay: $10 copay Plan Pays: up to $50 Lenses You Pay: Plan Pays: You Pay: Plan Pays: Single $25 copay up to $50 $25 copay up to $50 Bifocal Trifocal $25 copay $25 copay up to $75 up to $100 $25 copay $25 copay up to $75 up to $100 You Pay: $25 copay* and any You Pay: $25 copay* and any amount above amount above Plan Pays: $150 allowance $150 allowance Plan Pays: up to $70 Frames Plan Pays: Plan Pays: up to $70 $150 (20% discount $150 (20% discount is applied to any amount in excess of allowance) is applied to any amount in excess of allowance) Contact lenses** Plan Pays: up to $150 Plan Pays: up to $105 Plan Pays: up to $150 Plan Pays: up to $105 Benefit frequency Eye exam Lenses Frames once every calendar year up to two sets every calendar year up to two pairs every calendar year once every calendar year one set every calendar year one pair every two calendar years Second pair benefit*** Applies N/A N/A N/A * If frames and lenses are purchased together, a single $25 copay applies. If purchased on separate occasions, a separate $25 copay will apply for each purchase. ** Contact lens allowance (both in and out of network) applies to the cost of the contact lens exam (fitting and evaluation) and contacts. *** Where benefit applies, it allows you to obtain a second pair of glasses or contacts, in addition to the first pair received under the Buy Up Option. 27

28 Vision Contribution Schedule Full-Time and Part-Time Employees Bi-weekly Pay Frequency* Your vision election Your annual eligible pay Employee only Employee+1 Family Buy-up Option (Option 1) $3.78 $7.57 $12.19 Basic Option (Option 2) $2.35 $4.70 $7.56 * For your monthly contribution amount, multiply the bi-weekly amount by 26 and divide by 12 Flexible Spending Accounts (FSAs) FSAs help you pay for expenses such as deductibles, copayments, prescription medications and certain child care costs with taxfree dollars. WageWorks is the administrator for the FSAs. The money you set aside into an FSA is not subject to federal income, Social Security (FICA) and, in most areas, state and local taxes. In effect, participating in an FSA reduces your annual taxable income and the income taxes withheld each pay period. Then, once you ve incurred and paid for eligible expenses, you submit your expenses and are reimbursed with the tax-free money in your account. These accounts are voluntary you decide if you want to participate and how much to contribute (up to IRS limits). You may participate in two FSAs: The Health Care FSA, and The Dependent Care FSA. Because of the tax advantages of FSAs, the IRS imposes certain guidelines on participants. If you choose to participate in these accounts, you must enroll every year in order to continue participating. REMEMBER: Due to IRS regulations, any money you set aside in your Dependent Care FSA and do not use by the end of the grace period is forfeited and cannot be carried over to the next year. Go For a complete list of eligible health care expenses, you can access and click on Employees > Healthcare > Healthcare Flexible Spending Account > eligible healthcare expenses. For a complete list of eligible dependent care expenses, you can access and click on Employees > Dependent Care > eligible dependent care expenses. Or you can call WageWorks at

29 Health Care FSA Although your medical, prescription drug, dental and vision benefits pay for many of your health-related expenses, not all health care costs are covered in full. You may contribute from $100 to up to $2,600 each year to the Health Care FSA to pay for eligible expenses that you and your eligible dependents (not including your domestic partner or your domestic partner s eligible dependents) incur during the year. These include: Deductibles Copayments and coinsurance Amounts you pay above reasonable and customary limits Eligible prescription drug costs that may not be covered by the Plan Medical treatments, such as acupuncture and chiropractic care Major dental and orthodontia expenses above the maximum amounts paid by the Plan Vision care expenses beyond those paid by the Plan Bandages, braces and crutches Dependent Care FSA You may need dependent day care services for your children while you and your spouse/domestic partner work, and perhaps while caring for an elderly or disabled parent. You may deposit from $100 to up to $5,000 a year into the Dependent Care FSA to reimburse yourself for the cost of dependent day care services, or $100 up to $2,500 if you are married and file separate tax returns from your spouse. However, there are certain IRS restrictions. For example, in order to use this account, you and your spouse (if you re married) must be at work or school at the time your dependents are receiving care. Eligible dependents for this account include: Your children under age 13, whom you claim as exemptions for income tax purposes Children age 13 or older and adult dependents who spend at least eight hours in your home each day and are unable to care for themselves because of a mental or physical disability You can use the Dependent Care FSA to pay for eligible expenses during the year, such as: Day care provided by individuals inside or outside of your home Day care at a licensed nursery school, day camp (not sleep-away camp) or day care center Day care for an elderly or disabled dependent A housekeeper who cares for your eligible dependent(s) 29

30 Decide If there is no generic equivalent available for the medication you are currently taking, be sure to plan ahead and increase your Health Care FSA election in 2017 to help with your Tier 2 and Tier 3 copays. FSA Administrator WageWorks is the FSA administrator. If you enroll in a Health Care FSA for 2017 you will receive a debit card from WageWorks for eligible health care expenses. You won t use the card for dependent care expenses. Submitting Your Health Care and Dependent Care FSA Claims When you pay for an eligible health care or dependent care expense, WageWorks provides you with several options to submit your claims for reimbursement. Mobile Application: WageWorks EZ Receipts You can submit a claim and upload receipts with the WageWorks EZ Receipts mobile app available for iphone, Android, and Blackberry. You can also access your account information 24/7, including your account balances and claims processed, and you can receive important account updates to let you know the status of your account and when action may be required. WageWorks Online If you don t want to use mobile technology, you can file a claim online via the WageWorks website ( Once you log in, you can view your account balance, order additional WageWorks cards, file a claim, set up Pay Me Back (or Pay Them to pay your provider directly) and sign up for electronic account updates or direct deposit. Pick and Process You can review claims on that are received from your health plan(s) and tell WageWorks how to process them. These are claims provided to WageWorks by your available carriers, allowing you to choose processing without having to enter the claim information. After you select the available claims for reimbursement, you can select how you want each claim processed. Your options include: As a Health Care Card receipt to verify a previous Card transaction; As a Pay My Provider claim to be paid directly to your provider; or As a Pay Me Back claim to be reimbursed directly to you 30

31 QUESTIONS? Visit or call Learn When you use your WageWorks Card to pay for a service or to buy a health care item, it s still a good idea to keep your receipts. Even if a transaction is automatically approved at the point of purchase, you may still be required to provide documentation later on to verify that you used your card to pay for an eligible item or service. You will be asked to provide documentation to substantiate your out-ofpocket costs including deductibles, coinsurance or dental and vision expenses. Health Care FSA Carryover At the end of the 2017 plan year, you may carry over up to $500 of unused funds remaining in your Health Care FSA. These carryover funds will be available to reimburse claims that you and your eligible dependent(s) incur after the 2017 run out period has ended. The carryover funds can be used for claims you incur beginning April 2018 through December Your deductions will end with the last paycheck of 2017, unless you make a new election to enroll in the Health Care FSA for the next plan year. Dependent Care FSA Grace Period You may use your 2017 Dependent Care FSA for eligible expenses incurred through March 15, You will then have until June 15, 2018 to submit your eligible expenses for reimbursement. Please note that the amount you elect to contribute will be deducted from your paycheck in equal installments throughout the calendar year. Deductions will end with the last paycheck of 2017, unless you make a new election to enroll in the Dependent Care FSA for the next plan year. Submitting a Claim HEALTH CARE: When you incur and submit an eligible health care expense, you will be reimbursed up to the amount you have elected to contribute for the Plan year (minus any claims you ve already submitted). DEPENDENT CARE: While the Health Care FSA will reimburse you up to the amount you have elected to contribute for the year, the Dependent Care FSA will reimburse only your claims up to the amount already contributed. 31

32 Decide Plan ahead to get the most out of your FSA. Estimate carefully what you think you will need for the year, since any unused funds are forfeited. When planning for your FSAs, make sure to: Review your health care out-of-pocket expenses for the last year or two, including office visits and prescription drugs prescribed by a qualified provider. Do you expect an increase or decrease in the coming year? Consider any potential new health care expenses are you having or adopting a baby? Are you planning for a procedure such as an outpatient surgery or orthodontia for yourself or for an eligible dependent? Use the UnitedHealthcare Health Plan Cost Estimator tool ( to see how much you may save by enrolling. Check with your dependents day care providers and summer camps for any fee changes. IRS Guidelines Because an FSA can offer you substantial tax savings, the IRS requires that you follow a number of guidelines: Estimate Carefully. Be sure to estimate your expenses for the year before you make your election. Any money remaining in your account after the deadline to submit claims will be forfeited. No Account-to-Account Transfers. You cannot transfer money from one account to the other to pay for eligible expenses. You must keep the funds in each account separate. No Double Reimbursement. You cannot claim expenses on your federal income tax return if you ve already been reimbursed for them through an FSA. Domestic Partner. Your FSAs are not available for reimbursement of expenses relating to your domestic partner or his or her eligible dependents (unless they meet the definition of a tax-qualified eligible dependent). No Mid-Year Changes. You may not change the amount you elect to contribute to the account(s) during the year, unless you experience a qualifying life event and the change is consistent with that event. If you leave Altice USA you are eligible to continue to contribute to the Health Care FSA through COBRA on an after-tax basis. 32