Participating in the Plan

Transcription

1 This section provides an overview for participating in the Plan offered to eligible Bosch associates, such as elected and nonelected benefits, who is eligible, enrolling for benefits and when coverage begins and ends. About the Benefit Programs The following list shows the Benefit Programs you may elect as an eligible associate, as well as those you will automatically receive from the Company. Coverage You May Elect Medical* Dental Vision Health Savings Account Healthcare FSA** Dependent Day Care FSA** Spouse Life Insurance Child(ren) Life Insurance Optional (i.e. additional or supplemental) Associate Life Insurance and Accidental Death and Dismemberment (AD&D) Insurance (dependent AD&D coverage or associate AD&D coverage) Optional Long Term Disability (LTD) Insurance (increases your LTD benefit to 65% of eligible pay) Coverage You ll Receive Automatically Basic Associate Life and AD&D Insurance Basic LTD Insurance (provides coverage equal to 50% of your eligible pay) Business Travel Accident Insurance Short Term Disability (STD)*** Employee Assistance Program (EAP) * When you enroll in medical benefits, you will receive prescription drug coverage automatically. Depending on the Medical Benefit Program option you elect, you may also be able to enroll in a Health Savings Account (HSA). HSAs are not available if you enroll in an HMO. ** You must re-enroll for these benefits each year. *** Although mentioned in this SPD, STD coverage is not offered as a benefit program under the Plan nor is it covered by ERISA. Please contact Bosch HR Service at for further information on STD coverage. Bosch Choice April

2 A Note about QMCSOs You may cover a child who qualifies as your dependent for the Healthcare Benefit Programs even if the child s parent has the right to claim the child as a dependent for tax purposes under the terms of your divorce. See Qualified Medical Child Support Orders (QMCSO) in Healthcare Benefit Programs for details. Who Is Eligible You are eligible to participate in the Plan if you are: classified by the Company (or a participating affiliate or subsidiary of the Company), pursuant to its regular administrative practices, as a regular, fulltime associate on the U.S. Payroll, and regularly scheduled to work at least 30 hours a week. You are not an eligible associate if you: are a leased employee, nonresident alien who receives no U.S. earned income, or an associate covered under a welfare plan of a foreign affiliate; are classified as an independent contractor, temporary associate or seasonal associate under the Company s customary work classification practices (whether or not you are an employee or reclassified as an employee by the Internal Revenue Service, administrative agency or a court or competent jurisdiction); are covered by a collective bargaining agreement, unless the collective bargaining agreement expressly provides that coverage under the Plan is provided to associates in the bargaining unit, and waive participation in the Plan through any means, including an employment agreement. Eligible Dependents When you enroll in the Plan, you also may enroll your eligible dependents. Eligible dependents include your: legal Spouse (including common-law spouses where recognized by the state) or Domestic Partner (see Spouse Eligibility and Domestic Partner Coverage Details below), dependent children (natural or adopted) under the age of 26 for Medical, Dental, Vision, and Child(ren) Life Insurance coverage, and children who must be provided healthcare coverage as required by a Qualified Medical Child Support order (QMCSO). Dependent Coverage Details Spouse Coverage Details If you elect coverage for yourself, you can also elect coverage for your Spouse. If you do not elect coverage for your eligible dependents when you enroll in the Plan, then they will not be eligible for coverage under the Plan until the next open enrollment period, or if you incur a life status event. 4 April 2015 Bosch Choice

3 Domestic Partner Coverage Details Bosch benefit plans extend medical, dental, vision and life insurance coverage to Domestic Partners and their dependent children. If you want to enroll a Domestic Partner and/or a Domestic Partner s dependent child(ren), be sure to review the following coverage details. Your Domestic Partner may be the same or opposite sex. To be eligible for Bosch benefits, your relationship must meet all of these requirements: be financially interdependent and jointly responsible for each other s common welfare; intend to remain in a committed relationship; share the same permanent address; not be closely related by blood so that legal marriage would otherwise be prohibited; be at least age 18; must not have been in a different Domestic Partner relationship or marriage within the last six months; and current relationship has been in effect for at least six months. If you enroll children of your Domestic Partner, they must satisfy all eligibility requirements of the Bosch health plan. You will be asked to provide verification that your partner and any enrolled children of your Domestic Partner meet these requirements. This may include birth certificates, marriage licenses, tax returns or other proof of eligibility. Dependent Child(ren) Coverage Dependent children include any children who depend on you and are not employed on a regular, full-time basis. The term children includes: natural children, legally adopted children, children who have been placed with you for adoption (see Placement for Adoption ), stepchildren, children of your Domestic Partner, foster children, and children under your legal guardianship residing with you. children age 19 or older who are physically or mentally incapable of earning a living and who were handicapped and enrolled in coverage before reaching age 19. Children are not eligible to be covered as dependents under the Plan if they: are eligible as associates of the Company, or are in the military. Placement for Adoption Placement for adoption means that, in anticipation of a child s adoption, the person with whom the child is being placed has the legal obligation for at least 50% of the child s support. Bosch Choice April

4 Not Covered Under the Plan Individuals are not eligible to be covered as dependents under the Plan if they: are in the military, are eligible for the Plan as associates of the Company or a participating company, or are eligible for the Plan as retirees of the Company or a participating company. Tax Implications Under IRS rules, the value of benefits for Domestic Partners and their children generally is taxable. Benefits may be offered on a pre-tax basis only if your Domestic Partner and/or their children qualify as your tax dependent under the Internal Revenue Code, Section 152. To qualify as a tax dependent, they must: reside with you; receive over 50% of their support from you; not be anyone s qualifying child (for dependents, not be anyone else s qualifying child); and be a citizen or national of the U.S., or a resident of the U.S. or a country contiguous to the U.S. If they do not meet these requirements, Bosch is required to record and apply taxes for the cost of those benefits as imputed income to you. Most states follow the federal guidelines described here; however, at the present time, California, Illinois, Iowa, Massachusetts, New Jersey and Oregon follow different rules. See your tax advisor for further assistance on the taxability of benefits for Domestic Partners and/or their children. Note: You will be asked to provide documentation that verifies your dependent s eligibility to participate in the plan. This may include birth certificates, marriage licenses, tax returns or other proof of eligibility. Coverage Options When enrolling for benefits, there are four coverage options to choose from: associate only, associate and Spouse/Domestic Partner, associate and child(ren), and family (associate, Spouse/Domestic Partner and child[ren]). You will be able to choose the level of coverage you want under the Medical, Dental, Vision, Life Insurance and AD&D Insurance Benefit Programs. However, to cover your Spouse/Domestic Partner or eligible dependents under the Benefit Programs, you must be enrolled in those Benefit Programs yourself. 6 April 2015 Bosch Choice

5 You and Your Spouse/Domestic Partner Are Both Eligible for Coverage Under the Plan If you are a Bosch associate eligible for coverage and have a Spouse/Domestic Partner who is also eligible for coverage under the Plan, please keep in mind the following limitations on coverage: you may not elect Spouse Life/AD&D Insurance, if a child is eligible for coverage under more than one associate, only one associate may cover the child, and you may not be covered as both an associate and your Spouse s/domestic Partner s dependent. Qualified Medical Child Support Order A child may be eligible for the Healthcare Benefit Program due to a Qualified Medical Child Support Order (QMCSO). If you receive an order for medical child support, please contact Bosch HR Service at The Plan Administrator will honor an order that is a QMCSO, including a national medical support notice. The Plan Administrator has established written procedures for determining whether a Medical Child Support Order (MCSO) is a QMCSO and for administering the provision of benefits under the Plan pursuant to a valid QMCSO. Note: The Plan Administrator has full discretionary authority to determine whether a MCSO is qualified within the meaning of ERISA and reserves the right, waivable at its discretion, to seek clarification with respect to the order from the court or administrative agency that issued the order, up to and including the right to seek a hearing before the court or agency. When You Can Enroll Generally, you can enroll for the Benefit Programs available under the Plan: during Annual Enrollment, as a new hire, or when you experience a change in status event. As a new hire or during Annual Enrollment, you will receive a benefits packet that includes an enrollment guide and a personalized enrollment worksheet listing all of the Benefit Programs for which you can enroll. See the specific Benefit Program sections for any eligibility requirements or enrollment processes that may be unique to those Benefit Programs. Annual Enrollment As a participant in the Plan, you can make new decisions about your health and welfare benefits once a year during the designated Annual Enrollment period (usually in February). Your new elections will become effective on April 1 and will remain in effect until you make a change at the next Annual Enrollment, unless you experience a change in status event during the year. Note: You need to reenroll in the Flexible Spending Account Benefit Programs at each Annual Enrollment to participate in one or both of the FSAs for the next Plan Year. QMCSO Coverage You may cover a child who qualifies as your dependent under the Retiree Medical Benefit Program even if the child s parent has the right to claim the child as a dependent for tax purposes under the terms of your divorce. Keep in Mind The Plan Year runs from April 1 to March 31 of the following year. Bosch Choice April

6 New Hire You must enroll yourself and your eligible dependents within 31 days of the date on which your enrollment worksheet was prepared, as listed under the Associate Information section of the form. Your enrollment worksheet is part of the benefits packet you will receive in the mail shortly after you are hired. If you did not receive your packet call the Bosch Benefits Center. If you do not make an affirmative election to enroll in or decline coverage within 31 days, you will automatically be enrolled in and pay for the default coverage shown in your enrollment materials. The cost of this coverage will be deducted from your paycheck on a pre-tax basis, and your next opportunity to change your coverage will be during the next Annual Enrollment period. Similarly, if you decline coverage during your initial enrollment period, you will not be able to enroll yourself or your dependents until the next Annual Enrollment period. The only exception to these rules is if you experience a change in status event as described in the When Coverage Begins on page 10 or are eligible for a special enrollment period as described under Special Enrollment Rights below. Special Enrollment Rights You and your eligible dependents may enroll in the Medical Benefit Program (which includes prescription drugs) under the following circumstances: Individuals Losing Other Coverage If you declined coverage under the Medical Benefit Program when it was first available because of other health coverage, and that coverage is later lost on account of: exhaustion of COBRA continuation coverage, lost eligibility for other coverage, or termination of employer contributions towards the other coverage. You and your eligible dependents may enroll in the Medical Benefit Program on or before the date that is 60 days after the date you lost that other coverage. Lost eligibility for other coverage includes a loss of other health coverage as a result of your legal separation or divorce, domestic partnership ending, a dependent s loss of dependent status, death, or termination of employment or reduction in number of hours of employment - or you no longer reside, live or work in the service area of a health maintenance organization or other medical option in which you participated. Your enrollment will take effect on the date prior coverage is lost, as long as you request to enroll on or before the date that is 60 days after the loss of coverage. 8 April 2015 Bosch Choice

7 New Eligible Dependents If you initially declined enrollment for yourself or your eligible dependents and you later have a new eligible dependent because of marriage, domestic partnership, birth, adoption, or placement for adoption, you may enroll yourself and your new eligible dependents (including an eligible dependent Spouse/Domestic Partner if you have a new eligible dependent child) in the Medical Benefit Program, as long as you request enrollment on or before the date that is 60 days after the marriage, domestic partnership, birth, adoption, or placement for adoption. For example, if you and your eligible dependent Spouse/Domestic Partner have a child, you may enroll yourself, your eligible dependent Spouse/Domestic Partner and your new child in the Medical and Vision Benefit Programs, even if you were not previously enrolled. You will not, however, be able to enroll existing eligible dependent children for whom coverage has been waived in the past and who are not currently covered under these Benefit Programs. For birth, adoption, or placement for adoption, your participation or your eligible dependent s participation will start as of the date of the birth, adoption, or placement for adoption, as long as you timely requested enrollment. For marriage and domestic partnership, your participation or your eligible dependent s participation will start as of the date of the marriage or as soon as all of the eligibility requirements of a domestic partnership are met, provided you request enrollment on or before the date that is 60 days after the marriage/domestic partnership begins. Domestic partnership requirements are explained in the Participating in the Plan section. You will need to enroll your new eligible dependents on or before the date that is 60 days after the event by which they became your eligible dependent (for example, a new Spouse/Domestic Partner after your marriage/domestic partnership or your baby is born). If you do not add new eligible dependents within this 60-day period, you cannot enroll them until the next Annual Enrollment unless a change in status event occurs. You will need to provide proof of your dependent s status as an eligible dependent. Medicaid and CHIP If you or your eligible dependent children are eligible for, but not enrolled in, the Medical Benefit Program and you or your eligible dependent children: lose coverage under Medicaid or a State child health plan, or become eligible for a premium assistance subsidy through Medicaid or CHIP. You and your eligible dependent children may enroll in the Medical Benefit Program, as long as you request enrollment on or before the date that is 60 days after the loss of coverage or the date you or your eligible dependent children became eligible for the premium subsidy. Your enrollment will take effect on the date prior coverage is lost, as long as you request to enroll on or before the date that is 60 days after the loss of coverage. The 60-day periods described in this section are Special Enrollment Periods. Bosch Choice April

8 When Coverage Begins In addition to the Plan provisions explained under the Participating in the Plan section, the following rules also apply to the Healthcare Benefit Programs. Active Employment If you are absent from work on the day your coverage is scheduled to begin, or you do not begin working on the date scheduled, coverage generally will begin on the date you return to active employment. For purposes of the Medical Benefit Program (which includes prescription drugs), however, if you are absent from work due to any health status (for example, you are sick or disabled), the Company will treat you as if you started active employment and coverage may begin under the Medical Benefit Program. For the Dental and Vision Benefit Programs and EAP, if an eligible dependent is confined at home, in a hospital or elsewhere, or is not conducting normal daily activities on the date coverage is scheduled to begin, coverage for this dependent begins on the date confinement ends or normal activities resume. Pre-existing Medical Conditions The Health Insurance Portability and Accountability Act of 1996 (HIPAA) imposes rules for any pre-existing condition that you or your dependents may have. Under the Medical Benefit Program, there are no pre-existing condition limitations. Change in Status Events In general, you can change your current Plan enrollment elections during the plan year if you incur a Change in Status. If you decide to make a change to coverage due to a Change in Status event, you must change your benefit coverage within 60 days of the event. You can make changes to your Health Savings Account contributions at any time. In the event you decide to make a change under the terms of a Change in Status, you can make changes to all the Benefit Programs available under the Plan, except for the Flexible Spending Account Benefit Programs. See Changing Contributions during the Year in Flexible Spending Account Benefit Programs for the change in status events that apply for FSAs. Each Benefit Program also may have additional requirements (such as evidence of insurability) for changing coverage during the Plan Year. See the Changing Coverage during the Year sections for specific Benefit Programs for details. The following changes are considered Change in Status Events: a legal marital status change including marriage, divorce, legal separation, annulment, Domestic Partnership (beginning or ending), birth, death, adoption, placement for adoption, or court ordered guardianship of a dependent child, 10 April 2015 Bosch Choice

9 an eligible dependent s status change (for example, your dependent is no longer eligible for coverage because of age), employment status change that affects eligibility for current benefits for you or a dependent, residence or worksite change that affect eligibility for current benefits for you or a dependent, a change in coverage due to an election made by your Spouse/Domestic Partner or dependent under the Spouse s/domestic Partner s or dependent s employer s benefit plan if: the other employer s plan has a different open enrollment period that relates to a period that is different from the Plan Year (April 1 March 31) for this Plan (for example, your Spouse s/domestic Partner s open enrollment period is in October and your Spouse/Domestic Partner changes coverage), or the other employer s plan allows an election change for a change in status event as provided under the cafeteria plan regulations. a change in the availability of a benefit option or coverage (addition or removal) under the Plan s Benefit Programs (for example, a new HMO or PPO option is added to the Medical Benefit Program), or a significant increase or decrease in the cost of coverage during the Plan Year. In addition to the change in status event listed above, you may change your benefit elections for the Healthcare Benefit Programs if: a judgment, decree, or order, resulting from a divorce, legal separation, annulment, or change in legal custody (including a qualified medical child support order) is entered by a court of competent jurisdiction and it requires accident or health coverage for your child under this Plan or it requires another individual to provide the coverage for the child; you or your eligible dependent becomes enrolled or loses coverage under Part A or Part B of Medicare or Medicaid (other than coverage solely with respect to the distribution of pediatric vaccines); for the Medical Benefit Program only, you or your eligible dependent are eligible for a Special Enrollment Period (see the Special Enrollment section); or you or your eligible dependent loses coverage under any group health coverage sponsored by a governmental or educational institution including: a State children s health insurance program (SCHIP); a medical care program of an Indian Health Service or a tribal organization; a State health benefits risk pool; or a foreign government group health plan. Bosch Choice April

10 Please review your paycheck after you enroll to make sure that the appropriate deductions or credits are being processed. If you have any questions, contact the Bosch Benefits Center at ( internationally). If you experience a change in status event as listed above, you have 60 days from the date of the event to access the Bosch Benefits Center website or call the Bosch Benefits Center and change your benefit elections. For contact information, see Contact Information. The benefit change you request must be consistent with the change in status event. For example, if you have a baby, you can add your baby to your existing medical coverage or enroll for coverage; however, you may not cancel your medical benefits. Note: The change in coverage will take effect as of the date of the event, even though you file your change request after the date of the event (but within 60 days of the event). If you do not provide timely notice of the change in status event and complete a new election within the 60-day timeframe, you will not be able to change coverage until the next Annual Enrollment period, or until you have another change in status event, whichever occurs first. Your Cost The Company pays a major portion of the cost of medical, dental and vision benefits. Your share of the cost will be paid automatically through payroll deductions on a Pre-Tax basis. If you elect vision benefits, you pay the entire cost for coverage on a Pre-Tax basis. The Company pays the entire cost of the EAP. The cost of each option will depend on: the Benefit Options and Benefit Programs you elect under the Plan (Medical, Dental and/or Vision), the number of dependents you want to enroll (i.e., the coverage option you elect), and your annual base pay, as defined below. Your payroll deductions will begin as soon as administratively possible following receipt of your elections. Under IRS rules, the value of benefits for domestic partners and their children generally is taxable. Benefits may be offered on a pre-tax basis only if your domestic partner and/or their children qualify as your tax dependent under the Internal Revenue Code, Section 152. See the Participating in the Plan section for more information. 12 April 2015 Bosch Choice

11 Annual Base Pay For full-time associates, your annual base pay is your regular base compensation excluding items such as bonuses and overtime as of the January 1 st preceding the Plan Year. For sales associates earning commission, any commission sales wages paid in the last 24-month period will be averaged and annualized for this period. The calculated annualized commission amount will then be added to your benefit salary affecting benefit coverage and contributions. This look back will be calculated each January 1 st with the benefit commission wage used for the entire Plan Year. Your annual base pay will be used to determine the percentage you contribute for your medical benefits. COBRA Continuation Coverage Under certain circumstances you or your eligible dependents covered by any of the Healthcare Benefit Programs or the Healthcare FSA have the right, under the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended (COBRA), to continue coverage under the Healthcare Benefit Programs. You and your covered dependents may also continue coverage under the Healthcare FSA with certain limitations. The rules explained in this section apply to the Healthcare Benefit Programs and Healthcare FSA. See the Flexible Spending Account Benefit Programs section for additional rules that apply to the Healthcare FSA. COBRA coverage is available to you and to covered dependents when you or they would otherwise lose coverage under the Healthcare Benefit Programs. This section generally explains COBRA coverage, when it may become available to you and your family, and what you need to do to protect the right to receive it. COBRA coverage for the Plan is administered by the COBRA administrator listed in the Contact Information section. You may have other options available to you when you lose coverage under the Healthcare Benefit Programs. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for Medicaid, or other group health plan coverage options (such as a spouse s plan) through what is called a special enrollment period. Some of these options may cost less than COBRA continuation coverage. You can learn more about may of these options at Qualifying Events COBRA coverage is available if you are enrolled in the any of the Healthcare Benefit Programs and your coverage or your covered dependent s coverage would otherwise end on account of a qualifying event. COBRA coverage is offered to each person who is a qualified beneficiary. A qualified beneficiary is someone who will lose coverage under a Healthcare Benefit Program because of a qualifying event. Your HSA under COBRA If you participate in one of the Bosch CDHP Benefit Options and have a Health Savings Account (HSA) through the Plan s benefit provider, you can take your HSA with you when your Healthcare Benefit Program coverage ends. However, once your benefits end, the Company will not provide contributions to your HSA, even if you continue your medical coverage under COBRA. See the Health Benefits Program for more information. Bosch Choice April

12 You will become a qualified beneficiary if you will lose your coverage under the Healthcare Benefit Programs because either of the following qualifying events occurs: your hours of work are reduced, or your employment ends for any reason other than your gross misconduct. Each of your covered dependents will become a qualified beneficiary if coverage under the Healthcare Benefit Programs will be lost because any of the following qualifying events occur: your death, your hours of work are reduced, your employment ends for any reason other than your gross misconduct, you become entitled to Medicare benefits (under Part A, Part B, or both) while enrolled in COBRA, you become divorced or legally separated from your Spouse, your domestic partnership ends, or your child stops being eligible for coverage under the Healthcare Benefit Programs as an eligible dependent. (For this qualifying event, only the covered dependent child becomes a qualified beneficiary.) The Plan offers COBRA coverage to qualified beneficiaries only after the Bosch Benefits Center has been notified that a qualifying event has occurred. When the qualifying event is the termination of your employment, a reduction of your hours of employment, your death, the Bosch Benefits Center will notify the COBRA administrator of the qualifying event. For the other qualifying events (e.g., divorce or legal separation, domestic partnership ending or a dependent child s loss of eligibility for coverage as an eligible dependent), you or a qualified beneficiary, or a person acting on your or his or her behalf, must notify the Bosch Benefits Center within 60 days after the latest of: the date of the qualifying event, or the date on which you or a covered dependent loses (or would lose) coverage under the Healthcare Benefit Programs. If you, a qualified beneficiary, or a person acting on your or his or her behalf, do not provide the notice to the Bosch Benefits Center within the time limit explained above, coverage under the Healthcare Benefit Programs cannot be continued. After a qualifying event has occurred, the COBRA administrator, on behalf of the Plan Administrator, has 44 days from the date of the loss of coverage or the qualifying event, to provide you and your family members with a notice of your right to elect COBRA coverage. 14 April 2015 Bosch Choice

13 Electing COBRA Continuation Coverage If it is determined that you and each of your covered dependents qualify for COBRA coverage, each of you may individually decide whether or not to continue coverage. You and each of your covered dependents will have the right to elect the same coverage under the Healthcare Benefit Programs in which you were enrolled immediately before the qualifying event. Both you and your Spouse/Domestic Partner may elect COBRA coverage, or only one of you may choose it. Spouses/domestic partners may elect coverage for each other and parents may elect to continue coverage on behalf of their covered dependent children. If you or a covered dependent wants to elect COBRA coverage, you must do so within 60 days of the date the notice of your right to elect COBRA coverage was sent by the COBRA administrator. As long as you elected and you are covered by COBRA coverage during the Plan s Annual Enrollment, you may make changes to your coverage under the Healthcare Benefit Programs during the Annual Enrollment, including adding new coverage or changing your Benefit Options under Medical, Dental and Vision Benefit Programs. Premium Payments COBRA coverage is at your expense or your covered dependent s expense. The monthly cost of COBRA coverage will be included in the notice sent to you. The amount you must pay for COBRA coverage will not exceed 102 percent of the cost for this coverage to the Plan (including both the Company s and your contributions) for a similarly situated participant or beneficiary who is not receiving COBRA coverage (or, in the case of an extension of COBRA coverage due to a disability, 150 percent of that cost). You will have to pay COBRA premiums on an After-Tax basis. For coverage to continue, the first premium must be received by the date stated in the notice sent to you. Normally, this date will be 45 days after COBRA coverage is elected. Premiums for every following month of COBRA coverage must be paid monthly on or before the premium due date stated in the notice sent to you. There is a 30-day grace period for these monthly premiums. If they are not paid within 30 days after their due date, COBRA coverage will end as of the first day of that period of coverage and cannot be reinstated. If a partial premium payment is made that falls short of the current amount due by a minimal amount, you will be notified, and, if the shortfall is not paid within 30 days of the date the notice is received, COBRA coverage will end as of the first day of that monthly period of coverage. Duration of Coverage COBRA continuation coverage for you and/or your covered dependents will start on the date of the qualifying event and may continue until the earliest of the following: 18 months if your employment ends and/or your hours are reduced, 29 months if you or a covered dependent qualify for a disability extension (refer to Disabled Individuals, below), Bosch Choice April

14 for your covered dependents, 36 months in the event of your divorce or legal separation, domestic partnership ending, your death, or your becoming entitled to Medicare benefits (under Part A or Part B, or both), or your covered dependent child s loss of dependency status, the date on which a premium payment was due but not paid, the date after the qualified beneficiary first becomes covered under another employer s group health plan without an exclusion or limitation affecting coverage of his/her pre-existing condition, if any; provided the qualified beneficiary becomes covered after his/her election of COBRA continuation coverage, the date the qualified beneficiary first becomes entitled to Medicare benefits (under Part A or Part B, or both); provided the qualified beneficiary becomes enrolled in Medicare benefits after his/her election of COBRA continuation coverage, or the date the Company terminates all of its group health plans. Newborns and Adopted Children If you or your Spouse/Domestic Partner elect COBRA coverage, any child born to or adopted by you and your Spouse/Domestic Partner during the period of COBRA coverage will also be a qualified beneficiary, and be entitled to COBRA coverage for the maximum period of coverage available to any family member, as long as you notify the COBRA administrator within 60 days of the birth or adoption. Second Qualifying Event If COBRA coverage was elected by a covered dependent because your employment ended or your hours were reduced (including COBRA coverage during a disability extension period) and if, during the period of continuation coverage, another qualifying event occurs, the maximum period of COBRA coverage for the covered dependent is extended, upon proper notice to the COBRA administrator, for up to an additional 18 months (that means, to a maximum of 36 months from the date your employment ended or your hours were reduced). This extension may be available to your covered dependents receiving COBRA coverage in the event of your death or divorce, domestic partnership ending or if your dependent child stops being an eligible dependent under the Healthcare Benefit Programs, but only if the event would have caused the covered dependent to lose coverage under the Healthcare Benefit Programs when a covered employee becomes entitled to Medicare after his/her termination of employment or reduction of hours. COBRA coverage will still end for any of the other reasons listed above, such as failure to pay premiums when due. You or the covered dependent, or a person acting on your or his/her behalf, must notify the COBRA administrator in writing within 60 days after the latest of: the date of the second qualifying event, or the date on which the covered dependent would lose coverage under the Healthcare Benefit Programs as a result of the second qualifying event. 16 April 2015 Bosch Choice

15 If you or the covered dependent, or a person acting on your or his/her behalf, do not provide the notice to the COBRA Administrator within the time limit explained above, the maximum period for COBRA continuation coverage will not be extended beyond the original 18-month coverage period. Medicare-eligible Associates If you become entitled to Medicare (Part A or B) while you are still employed by the Company (but no more than 18 months before the qualifying event) and you then lose your health coverage because of a qualifying event that is a termination or reduction in your hours of employment, you can elect to have both COBRA coverage and Medicare coverage at the same time. After the qualifying event, your COBRA coverage will be secondary to Medicare with respect to services or supplies that are covered, or would be covered upon proper application, under Parts A or B of Medicare. If you think you will need both Medicare and COBRA after your retirement, you should enroll in Medicare on or before the date on which you elect COBRA coverage. If you do not enroll in Medicare on or before the date on which you elect COBRA coverage, your COBRA benefits will end when your Medicare coverage begins. Your covered dependents, however, will remain eligible for COBRA coverage. Covered Dependents of Medicare-eligible Associates If you become entitled to Medicare (Part A or B) while you are still employed by the Company (but no more than 18 months before the qualifying event) and you then lose your health coverage because of a qualifying event that is a termination or reduction in your hours of employment, then your covered dependents may elect COBRA coverage for the balance of the 36-month period starting when you became entitled to Medicare, or 18 months from your later termination or reduction in hours of employment, whichever period is longer. You or your covered dependents, or a person acting on your or their behalf must provide notice to the COBRA administrator of your entitlement to Medicare benefits (under Part A, Part B or both) within the time limit and in the manner described above for second qualifying events. Disabled Individuals When the qualifying event for COBRA coverage is your termination of employment or the reduction in your hours of employment, the 18-month period of COBRA coverage is extended by an additional 11 months (to a total of 29 months) if these two conditions are met: the Social Security Administration determines that a qualified beneficiary (you or a covered dependent) is disabled, and that the date the qualified beneficiary s disability began was either: within the first 60 days of COBRA coverage (in the case of a child born to or placed for adoption with you and your Spouse/Domestic Partner, the 60-day period is measured from the date of birth or placement for adoption), or Bosch Choice April

16 before the qualifying event, and the Social Security Administration considers that the qualifying beneficiary remains disabled as of the date of the qualifying event, you or a covered dependent, or a person acting on your or his/her behalf, provide written notice to the COBRA administrator of the Social Security Administration s disability determination before the end of the original 18- month period of continuation coverage and within 60 days after the latest of: the date of the disability determination by the Social Security Administration, the date on which the qualifying event occurred, the date on which you or a covered dependent loses (or would lose) coverage under the Healthcare Benefit Programs as a result of the qualifying event, or the date on which you or a covered dependent are informed, through receipt of this document or an initial notice of COBRA coverage, of both your obligation to provide the notice of the qualifying event and the Plan s procedures for providing such notice to the COBRA administrator. If you or a covered dependent, or a person acting on your or his/her behalf, do not provide the notice to the COBRA administrator within the time limit explained above, the maximum period for continuation coverage will not be extended beyond the original 18-month coverage period. Continuation coverage will still end for any of the other reasons listed above, such as failure to pay premiums when due. You, a covered dependent, or another person acting on your or his/her behalf, must notify the COBRA administrator within 30 days of the date you are finally determined not to be disabled under the Social Security Act, if such a determination is made. The 11- month disability extension of COBRA coverage will end on the first day of the month following the date the qualified beneficiary is determined not to be disabled. Continuation coverage due to the initial employment-related qualifying event, or any subsequent qualifying event, may still be available if the maximum period for such continuation coverage has not expired as of the date a determination of no longer disabled is made. The cost of COBRA coverage for the 11-month disability extension will, however, increase after the 18 th month of continuation coverage, unless coverage would continue in any event on account of a second qualifying event. The increase, if any, will not exceed 150 percent of the cost to the Plan, including both employer and associate contributions, for coverage of a similarly situated participant (as applicable) or beneficiary who is not receiving COBRA coverage. 18 April 2015 Bosch Choice

17 Form of Notice to Human Resources and COBRA Administrator When you or the covered dependent, or a person acting on your or his/her behalf, must notify Human Resources or the COBRA administrator, the notice must be in writing. The notice must include: the name of the employee or former employee who is or was a Plan participant, a description of the qualifying event or second qualifying event (if any), the date of the qualifying event (and second qualifying event, if any), the name(s), address(es) and Social Security number(s) of the covered dependents affected by the qualifying event, and for a notice relating to a disabled individual, a copy of the Social Security Administration s disability determination and the date of the determination. The timely provision of the notice by one individual will satisfy the notice requirement on behalf of all related qualified beneficiaries with respect to the qualifying event. Trade Act If you should lose your job, and, as a consequence, you are eligible for trade adjustment assistance under the Trade Act of 2002, or if you are at least age 55 and receiving a pension benefit from the Pension Benefit Guaranty Corporation, you may be eligible to take a tax credit or get advance payment of up to 65 percent of your COBRA coverage premiums or other qualified health insurance. In certain circumstances, you may also be eligible for a second 60-day COBRA coverage election period. If you have questions about these Trade Act provisions, you may contact the Health Coverage Tax Credit Customer Contact Center toll-free at or (TTD/TTY). More information about the Trade Act is also available at Questions about COBRA Continuation Coverage If you are an active employee or a COBRA participant and you have questions about COBRA coverage, you may contact the COBRA administrator. For more information about your rights under ERISA, including COBRA, the Health Insurance Portability and Accountability Act of 1996 ( HIPAA ), and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor s Employee Benefits Security Administration in your area or visit its website at Addresses and phone numbers of Regional and District Employee Benefits Security Administration offices are available through its website. For more information about the Health Insurance Marketplace, visit Keep the Plan Informed of Address Changes In order to protect your family s rights, you should keep your local Human Resources representative informed of any changes in the addresses of family members. You should also keep copies, for your records, of any notices you send to the COBRA administrator. Bosch Choice April

18 Note! As used in this section, you refers to any person who is a covered person (that is, anyone on whose behalf the Plan pays or provides any medical or dental benefit, including but not limited to, the minor child or dependent of any Plan member or person entitled to receive any benefits from the Plan). When You Have Coverage Elsewhere Coordination of Benefits (COB) The Medical and Dental Benefit Programs coordinate their benefits with other group plans to reimburse you or your dependents up to the allowable payment from these plans. An allowable expense is any expense covered at least in part by a Medical and Dental Benefit Program. Here is how the benefits are coordinated when a claim is made: As an Associate Employed by the Company. The Medical or Dental Benefit Program is primary it pays its benefit first without regard to any other plan. For a Spouse/Domestic Partner Who Has Other Healthcare Insurance. The Medical or Dental Benefit Program is secondary benefits from the Medical or Dental Benefit Programs will be adjusted so that the total benefit payable will not be greater than the maximum reimbursement under the Medical or Dental Benefit Program. If You Have Children and You and Your Spouse/Domestic Partner Have Separate Medical Coverage. Bosch considers the plan of the parent whose birthday comes first in the year as the primary plan; the other plan is secondary. Any legal requirements that vary from these rules will take precedence. After a claim has been processed by the plan that is primary, it may be submitted to the secondary plan. The written explanation of benefits (EOB) from the primary plan must accompany the claim when it is sent to the secondary plan. The Company has the right to obtain information from any other organization necessary to coordinate benefits. The Company also has the right to recover any amounts paid in excess of benefits payable by the Plan. Coordination of Benefits does not apply to prescription drug expenses, vision benefits or any individual medical insurance you have purchased on your own. Coordination of benefits applies only to group benefit plans. Subrogation and Right of Recovery When you are injured or become ill because of the actions of a responsible party (defined as a third party who is responsible for making any payment to you because of your injury, illness or condition), the Plan may cover your eligible medical, prescription drug or dental expenses. However, to receive coverage, you must notify the Plan of your illness or injury and identify the responsible party. 20 April 2015 Bosch Choice

19 Terms to Know Responsible Party. In addition to any party actually, possibly or potentially responsible for making a payment to you because of your injury, illness or condition, this term includes the responsible party s liability insurer or any insurance coverage. Insurance Coverage. This refers to any coverage providing medical expense coverage or liability coverage, including but not limited to, uninsured motorist coverage, underinsured motorist coverage, personal umbrella coverage, medical payments coverage, workers compensation coverage, no-fault automobile insurance coverage or any first party insurance coverage. Subrogation Immediately upon paying or providing any benefit under the Medical and Dental Benefit Programs, the Plan will be subrogated to (i.e., will stand in the place of) all rights of recovery you have against any responsible party with respect to any payment you receive from the responsible party because of your injury, illness, or condition, to the full extent of benefits provided or to be provided by the Plan. Reimbursement In addition, if you receive any payment from any responsible party or insurance coverage as a result of an injury, illness, or condition, the Plan has the right to recover from, and be reimbursed by, you for all amounts this Plan has paid and will pay as a result of that injury, illness, or condition. This includes payments from any insurance proceeds, settlement amounts, judgments, or amounts recovered in a lawsuit. Reimbursement will be taken from such payment, up to and including the full amount you receive from any responsible party. Constructive Trust By accepting benefits from the Plan (whether benefits are paid to you or paid on your behalf to any provider), you agree that if you receive any payment from any responsible party as a result of an injury, illness, or condition, you will serve as a constructive trustee over the funds that constitute that payment. Failure to hold those funds in trust will be deemed a breach of your fiduciary duty to the Plan. Lien Rights Further, the Plan will automatically have a lien against the proceeds of your recovery and against future benefits due under the Plan (for benefits paid by the Plan for the treatment of your illness, injury, or condition or due to an act or omission of the responsible party). The lien will attach as soon as any person or entity agrees to pay any money to you or on your behalf that could be subject to the Plan s right of recovery. The lien will be imposed upon any recovery (whether by settlement, judgment, arbitration award or otherwise, including from any insurance coverage), related to treatment for any illness, injury, or condition for which the Plan paid benefits. Bosch Choice April

20 The lien may be enforced against any party who possesses funds or proceeds representing the amount of benefits paid by the Plan including, but not limited to, you, your representative or agent, the responsible party, the responsible party s insurer, representative, or agent, and/or any other source possessing funds representing the amount of benefits paid by the Plan. If you fail to repay the Plan from the proceeds of any recovery, the Plan Administrator may satisfy the lien by deducting the amount from future claims otherwise payable under the Plan. The Plan s provisions concerning subrogation, equitable liens, and other equitable remedies are also intended to supersede the applicability of the federal common law doctrines commonly referred to as the make whole rule and the common fund rule. First-Priority Claim By accepting benefits (whether benefits are paid to you or paid on your behalf to any provider) from the Plan, you acknowledge that this Plan s recovery rights are a first-priority claim against all responsible parties and are to be paid to the Plan before any other claim for your damages. This Plan is entitled to full reimbursement on a first-dollar basis from any responsible party s payments, even if payment to the Plan results in a recovery that is insufficient to make you whole or to compensate you in part or in whole for the damages sustained. The Plan s right to recover will not be limited by application of any statutory or common law make whole doctrine. The Plan also is not required to participate in or pay court costs or attorney fees to any attorney hired by you to pursue your damage claim. Applicability to All Settlements and Judgments The terms of this entire subrogation and right of recovery provision apply and the Plan is entitled to full recovery regardless of whether any liability for payment is admitted by any responsible party and regardless of whether the settlement or judgment you receive identifies the benefits the Plan provided or purports to allocate any portion of such settlement or judgment to payment of expenses other than medical expenses. The Plan is entitled to recover from any and all settlements or judgments, regardless of the identity of the party from which recovery is obtained, even those designated as pain and suffering, non-economic damages, and/or general damages only. Cooperation You must fully cooperate with the Plan s efforts to recover its benefits paid. Such cooperation includes, where requested, the filing of suit by you against the responsible party and the giving of testimony in any action filed by the Plan. It is your duty to notify the Plan within 30 days of the date when any notice is given to any party, including an insurance company or attorney, of your intention to pursue or investigate a claim to recover damages or obtain compensation due to injury, illness, or condition sustained by you. 22 April 2015 Bosch Choice