Alcatel-Lucent Long Term Disability Plan for Occupational Employees Summary Plan Description Represented Employees January 2014

Transcription

1 Alcatel-Lucent Long Term Disability Plan for Occupational Employees Summary Plan Description Represented Employees January Occupational Employees. In the case of a discrepancy between this Summary Plan Description and the official plan document for the Alcatel-Lucent Long-Term Disability Plan for Occupational Employees, the official plan document shall control.

2 Appendix A Table of Contents Disclaimer This is a summary of the benefits offered to represented employees under the Alcatel-Lucent Long Term Disability Plan for Occupational Employees (the Long Term Disability Plan or the Plan"). This summary is provided for informational purposes only and is intended to comply with Department of Labor requirements for Summary Plan Descriptions ( SPDs ). More detailed information about the Plan is provided in the official Long Term Disability Plan document, a copy of which can be obtained by writing to the Plan Administrator (see Important Contacts, and Other Information). This summary is based on Long Term Disability Plan provisions effective January 1, 2014 and replaces all previous SPDs and other descriptions of benefits provided under the Plan. If there is any conflict between the information in this SPD and the Long Term Disability Plan document, the Long Term Disability Plan document will govern. Plan May Be Amended or Terminated The Company expects to continue the Long Term Disability Plan but reserves the right to amend or terminate the Long Term Disability Plan, in whole or in part, at any time by the resolution of the Board of Directors or its properly authorized designee, subject to the terms of applicable collective bargaining agreements. In addition, the Company does not guarantee the continuation of any long term disability benefits during employment or at or during retirement nor does it guarantee any specific level of benefits or contributions, subject to the terms of any applicable bargaining agreement(s). Questions regarding your benefits should be addressed as indicated in this SPD (see Important Contacts). Because of the many detailed provisions of the Plan, no one other than the personnel or entities identified in this SPD (see Important Contacts) is authorized to advise you as to your benefits. Neither Alcatel-Lucent nor the Plan can be bound by statements made by unauthorized personnel or entities. In the event of a conflict between any verbal information provided to you by an authorized resource and information in the official Long Term Disability Plan document, the Long Term Disability Plan document will govern. Please note: Participation in the Plan is neither an offer of nor a guarantee of continued benefits during future employment. 1

3 HOW THIS SPD IS ORGANIZED? Appendix A Table of Contents The Plan is organized into an Appendix A and an Appendix B. This SPD is also organized into an Appendix A and an Appendix B. You will only be eligible for the benefits described under either Appendix A or Appendix B. However, you should still review this entire SPD to ensure that you fully understand which Appendix is applicable to you. Please note that the descriptions provided in Appendix A and Appendix B of this SPD apply solely to that Appendix in which the descriptions are provided. Generally speaking, but explained more fully in this SPD: Appendix A is applicable to you if: (1) You began to receive benefits under the Plan before January 1, 2014 and you are currently receiving benefits under the Plan, or (2) You wish to apply for benefits under the Plan and on or before January 1, 2014 you were on sickness disability (or completing an applicable elimination period to receive sickness disability benefits) under the Sickness and Accident Disability Benefit Plan ( SADBP ) and you have received the maximum amount of sickness disability benefits that are available to you. Appendix B is applicable to you if: You began to receive sickness disability benefits under the SADBP for a sickness that began on or after January 1, 2014 and you have received the maximum amount of sickness disability benefits that are available to you. 2

4 Appendix A Table of Contents APPENDIX A 3

5 Appendix A Table of Contents APPENDIX A CONTENTS PAGE INTRODUCTION... 1 THE LONG TERM DISABILITY PLAN HIGHLIGHTS... 3 ELIGIBILITY AND PARTICIPATION... 3 Who Is Eligible... 3 How to Enroll... 4 When Coverage Begins...3 When Eligibility Ends... 4 Cost... 4 LTD BENEFITS... 5 How Benefits Are Paid... 5 Other Sources Of Disability Income... 4 About Social Security Disability Benefits... 5 How You Apply for Benefits... 6 Eligibility for Benefits... 7 How Long LTD Benefits Last... 7 Employment While You Are Disabled... 8 If You Are Disabled Again... 8 What Is Not Covered... 9 TERMS YOU SHOULD KNOW IMPORTANT CONTACTS OTHER IMPORTANT INFORMATION Coverage Under Other Company Plans Employment Status Benefits Cannot Be Assigned LTD Plan Document Governs Union Agreement Plan Funding and Payment of Benefits LTD Plan May Be Amended or Terminated LTD Plan Sponsor and Administrator CLAIM REVIEW AND APPEAL PROCEDURES Claim Review Procedures Appeal Procedures

6 Appendix A Table of Contents YOUR RIGHTS UNDER ERISA ADMINISTRATIVE INFORMATION

7 Introduction Appendix A Introduction Here s your summary of the key features of the Alcatel-Lucent Long Term Disability Plan for Occupational Employees (LTD Plan) for represented employees. The LTD Plan is one of the most important benefits that Alcatel-Lucent provides for eligible represented employees. If you ever become disabled, your disability is not jobrelated, and you qualify for Plan benefits, the LTD Plan may replace part of your pay if you are out of work due to disability for an extended period of time. If you qualify for LTD Plan benefits, the LTD Plan begins paying benefits when your sickness disability benefits under the Alcatel-Lucent Sickness and Accident Disability Benefit Plan ( SADBP ) expire. The LTD Plan provides benefits in combination with other plans provided by participating companies and with benefits provided by the government. This document is a working summary of the terms of the LTD Plan, but is not the Plan itself. To the extent that anything in this summary may be contradicted by the terms of the Plan, the Plan terms are controlling. You may always request a copy of the full plan document from the Plan Administrator (see Administrative Information). 1

8 APPENDIX A The Long Term Disability Plan - Highlights The Long Term Disability Plan Highlights Here s a summary of the key features of the Alcatel-Lucent LTD Plan. Long Term Disability Plan Features Eligibility Benefits When LTD Benefits Begin When LTD Benefits End Summary In general, if you are an eligible employee of a participating company with at least six months of net credited service, who was on sickness disability under the Sickness and Accident Disability Benefit Plan ( SADBP ) on or before December 31, (See Who is Eligible ). The company provides LTD Plan coverage at no cost to you. This coverage, when combined with other sources of disability income such as your pension and primary Social Security income, replaces up to 50% of your eligible base pay while you remain disabled. Benefits are based on your eligible base pay in effect on the last day of sickness disability benefits under the Alcatel-Lucent Sickness and Accident Disability Benefit Plan. LTD benefits begin after 52 weeks of sickness disability benefits are paid under the Alcatel-Lucent Sickness and Accident Disability Benefit Plan. An Eligible Employee must apply for benefits within 90 days of the expiration of his/her Sickness Disability Benefits. LTD benefits end when: You are no longer disabled as defined under the LTD Plan, You reach the maximum time limit for receiving benefits (see How Long LTD Benefits Last ), or You die. Other Sources of Disability Income Benefits are reduced by income you are eligible to receive from other sources such as Social Security (see How Benefits Are Paid ). 3

9 APPENDIX A Eligibility Eligibility Who Is Eligible You are Eligible under this Appendix A of the Plan if: In general, you are an eligible employee of a participating company with at least six months of net credited service, who was on sickness disability under the Sickness and Accident Disability Benefit Plan ( SADBP ) on or before December 31, (See Who is Eligible ). To be able to apply for benefits under Appendix A of the Plan you must be eligible as explained above and you must meet the requirements below: 1) You have been an Occupational Employee with a term of employment equal to at least 6 months of credited service, as determined by the records of the Company, who is not covered by any other long term disability program maintained by the Company other than a program which is part of the SADBP; AND 2) One of the following situations applies to you: (a) On December 31, 2013, you were receiving sickness disability benefits under SADBP and you exhaust such sickness disability benefits; or (b) You were absent from work on the account of sickness or nonjob related injury, or a job-related injury that is not covered under the provisions of Accident Disability under SADBP, as classified by the Company, and such first date of absence for such sickness or non-job related injury or job-related injury not covered by Accident Disability was on or before December 31, 2013 and continued for seven consecutive days (even if such seven consecutive days began in year 2013 and ended in year 2014), which resulted in the employee applying for and being granted benefits under SADBP and such employee exhausts sickness benefits; or 3

10 APPENDIX A Eligibility (c) You received sickness disability benefits for a portion of year 2013 but returned to work prior to the end of However, during year 2014 and within 13 weeks of the your return to work following your receipt of sickness disability benefits in year 2013, you again are absent from work and exhaust sickness disability benefits under SADBP; or (d) You received sickness disability benefits under SADBP for a portion of year 2013 and such sickness disability benefits continued into 2014 but you returned to work in However, during the year 2014 and within 13 weeks of your return to work following your receipt of sickness disability benefits in year 2014, you are again absent from work and exhaust sickness disability benefits under SADBP. Note: individuals who are not paid from the U.S. payroll of a participating company, who are employed by an independent company (such as an employment agency), or whose services are rendered pursuant to an agreement excluding participation in benefit plans are not eligible to participate in the LTD Plan. How to Enroll No action is required on your part. Eligible employees will automatically be enrolled for LTD coverage on the first day of the month in which they meet the eligibility requirements (see Who Is Eligible ). When Eligibility Ends Your eligibility for LTD Plan benefits ends when you leave the company for any reason other than for a disability covered under the LTD Plan. Cost The company pays the full cost of your self-insured LTD coverage. 4

11 APPENDIX A LTD Benefits LTD Benefits How Benefits Are Paid LTD benefits are paid in combination with other sources of disability income so that your total LTD income from all sources would equal 50% of your eligible base pay. For example: If Your Income From Other Sources Is LTD Coverage Pays 30% of eligible base pay 20% of eligible base pay 40% of eligible base pay 10% of eligible base pay 50% or more of eligible base pay 0% of eligible base pay Important! Because the company pays the full cost of your LTD coverage, any LTD benefits you receive from the Plan will be taxable. Other Sources of Disability Income The LTD Plan is designed to work with other sources of disability income to provide your total disability income. The LTD Plan looks at all of your sources of disability income (except disability income from individual insurance you have purchased), and makes up the difference after benefits which you are eligible to receive from other sources are determined, such as: Primary Social Security benefits (payable to you), Workers compensation or any similar benefits, Any state or federal disability benefits except veteran s benefits, and Any Alcatel-Lucent pension benefits you may be entitled to receive at the time your LTD benefits begin. If the amount of your disability income from other sources increases after you begin receiving benefits from the LTD Plan, your LTD Plan benefits will not be further reduced unless the increase in other benefits is retroactive to the start of your disability. 5

12 APPENDIX A LTD Benefits About Social Security Disability Benefits It is important to be aware of the following facts about the Plan and Social Security benefits: In order to receive maximum disability benefits, you need to apply for Social Security benefits as soon as you become disabled. Call Social Security to learn how to apply for Social Security benefits. Your LTD Plan benefits will be reduced by your estimated Social Security benefit even if you aren t actually receiving Social Security disability benefits. Only your primary Social Security benefits reduce your LTD Plan benefits. Social Security benefits of a spouse or other family member won t affect your benefit. If your Social Security benefit is determined after your LTD benefit begins, your LTD benefit will be recalculated retroactively. If this recalculation results in an overpayment, you must repay the difference to the company. You may either make direct payments to the company or have your monthly LTD payments reduced until the overpayment is recovered. If Social Security denies you benefits, the LTD Plan may require you to file an appeal with Social Security. If you have been notified by the Plan to file an appeal and you have not done so, your monthly LTD Plan benefits may be reduced by the amount of Social Security benefits you could be receiving had your appeal been successful. If you are not eligible for a Social Security Disability Insurance Benefit (DIB), Plan benefits will not be offset. However, your LTD Plan benefit will be reduced by your Old Age Insurance Benefit starting as soon as you are eligible to receive it. If you choose not to start your Social Security Old Age Insurance Benefit until later, the Claims Administrator will reduce your LTD benefit by an estimated Social Security Old Age Insurance Benefit amount. How You Apply for Benefits LTD benefits can begin after 52 weeks of sickness disability benefits are paid under the Alcatel-Lucent Sickness and Accident Disability Benefit Plan. An Eligible Employee must apply for benefits within 90 days of the expiration of his/her Sickness Disability Benefits. If you are disabled and are receiving sickness disability benefits, you will receive LTD forms for you and your physician to complete before the end of the period for which benefits are payable under the Sickness and Accident Disability Benefit Plan. You may also need to be examined by a physician of the Plan Administrator s choice. The 6

13 APPENDIX A LTD Benefits Claims Administrator will then determine the extent of your disability and your eligibility for LTD benefits. You must apply for benefits no later than 90 days after the expiration of your benefits under the Sickness and Accident Disability Benefit Plan. If you fail to apply within 90 days following the last day of sickness disability benefits, your case may be determined to be inactive. This may result in a permanent denial of benefits. Requirements to Receive Benefits To receive LTD benefits, you do not have to be hospitalized or confined to a home, but you must meet the following requirements: You must be considered disabled under the LTD Plan. This may differ from being considered disabled for purposes of the Sickness and Accident Disability Benefit Plan, Alcatel-Lucent pension plans, workers compensation, Social Security or other benefits you might be eligible for under a private insurance plan. You must have been disabled for 52 weeks, receiving sickness disability benefits under the Sickness and Accident Disability Benefit Plan. You must be unable to do any job for any employer for which you are qualified, or may reasonably become qualified by training, education or experience, other than one that pays less than 50% of your eligible base pay at the time you became disabled. At all times during your disability, you must be under a physician s care and following the recommended care and course of treatment to receive benefits. You may be required to submit proof of your disability to the Claims Administrator from time to time. Failure to do so may result in a suspension of payments and possible closure/denial of your claim. The Claims Administrator will determine the extent of your disability based on medical evidence and reserves the right to have a physician of his/her/its choice examine you. If you are requested by the Claims Administrator to be examined by a physician of his or her choice and you do not consent or fail to appear at said examination your benefit payments may be immediately suspended until such examination takes place and the Claims Administrator s physician certifies the disability. How Long LTD Benefits Last If you remain disabled, LTD benefits begin after you have received 52 weeks of sickness disability benefits under the Sickness and Accident Disability Benefit Plan. LTD benefits then continue until the earliest of these events: 7

14 APPENDIX A LTD Benefits You are no longer disabled as defined under the LTD Plan, You reach the maximum time limit for receiving benefits (see the chart below), or You die. Age When Disability Begins Maximum Duration of LTD Benefits 61 or younger To age /2 years 63 2 years /2 years 65 1 year 66 3/4 year 67 1/2 year 68 or older 1/4 year Employment While You Are Disabled If you are able to find and accept suitable employment and earn a wage while you are disabled, you may still be entitled to LTD benefits for your disability. In this case, your LTD Plan benefit will be limited to an amount which, when added to your wages and other sources of disability income, won t exceed 75% of the eligible base pay upon which your LTD benefits were based. If, while you are disabled, you are able to work for an employer other than the company, in a job that pays 50% or more of your previous eligible base pay, you are no longer covered by the LTD Plan. In applying for and accepting benefits under the LTD Plan you are agreeing to notify the company of any employment you may accept and the amount you are paid while out on disability. Failure to do so may result in your benefits being stopped and you having to repay benefits to the LTD Plan. If You Are Disabled Again If you recover from your disability and then become disabled again, benefits will work as explained below: If you are rehired and you return to work for the company for fewer than 13 weeks and become disabled again (as determined under the Sickness and Accident Disability Benefit Plan) as a result of sickness or non-job related injury, LTD benefits will begin immediately. 8

15 APPENDIX A LTD Benefits If you are rehired and you return to work for the company for 13 weeks or more and become disabled again (as determined under the Sickness and Accident Disability Benefit Plan) as a result of sickness or non-job-related injury, LTD benefits will not begin again until the end of another 52-week period of sickness disability benefits under the Sickness and Accident Disability Benefit Plan. What Is Not Covered The LTD Plan does not cover disabilities caused or contributed to by: Your commission of a felony, Military service, War or any act of war, declared or undeclared, Your active participation in a riot, insurrection, rebellion or civil commotion, Illness or injury classified as job-related under the Accident Disability benefit provision of the Sickness and Accident Disability Benefit Plan, or Intentionally self-inflicted injury while sane or insane. 9

16 APPENDIX A Terms You Should Know Terms You Should Know Several words and phrases have a specific meaning under the LTD Plan. This section explains those terms so that you can better understand your benefits. These terms are printed in boldface when they appear to let you know that they re defined here. Eligible base pay: base salary (or full salary equivalent if on a reduced salary plan), plus any differentials in effect, on the first day of absence, that are also included in the definition of compensation under the Lucent Technologies Inc. Retirement Plan. Eligible employee: a regular, active, full-time or part-time represented employee of a participating company with at least six months of net credited service. Note that individuals who are not paid from the U.S. payroll of a participating company, who are employed by an independent company (such as an employment agency), or whose services are rendered pursuant to an agreement excluding participation in benefit plans, are not eligible to participate in the LTD Plan. Net credited service: your current continuous service plus all service credited under the service bridging rules (including mandatory portability, if applicable) of the Lucent Technologies Inc. Retirement Plan. Participating Company(ies): the companies that participate in the LTD Plan, as listed below. As of January 1, 2014, Participating Companies are: Alcatel-Lucent USA Inc. Alcatel-Lucent Investment Management Corporation LGS Innovations LLC LGS Innovations International Inc. Note: Effective April 1, 2014, each of LGS and LGS Innovations LLC is no longer a participating company. Sickness and Accident Disability Benefit Plan (SADBP): Alcatel-Lucent Sickness and Accident Disability Benefit Plan, which provides short-term disability benefits for eligible employees. 10

17 APPENDIX A Important Contacts Important Contacts Contact/Service Provided Claims Administrator: Approves or denies claims. Address/Telephone Number CIGNA PO Box Pittsburgh, PA or Overnight Mail: CIGNA 1600 West Carson St. Pittsburgh, PA Telephone: or

18 APPENDIX A Other Important Information Other Important Information This section contains administrative information about the LTD Plan and other details required under the terms of a federal law, the Employee Retirement Income Security Act of 1974, as amended (ERISA). Coverage Under Other Company Plans While you are receiving LTD benefits, your coverage under the company medical and life insurance plans may continue. See the medical and life insurance summary plan descriptions for more details. Employment Status If you continue to be disabled, your employment with the company ends after you receive sickness disability benefits under the Sickness and Accident Disability Benefit Plan for 52 continuous weeks. There is no guarantee of reemployment after this period. Benefits Cannot Be Assigned Generally, you cannot assign or transfer benefits received under the LTD Plan. However, the LTD Plan is required to comply with qualified federal tax levies. LTD Plan Document Governs This summary plan description is designed to describe the benefits available to eligible represented employees under the Alcatel-Lucent Long Term Disability Plan for Occupational Employees in easy-to-understand terms. It is shorter and less technical than the legal LTD Plan document. However, the Plan document and contract determine your rights under the LTD Plan. In all instances the LTD Plan document governs. Union Agreement The benefits described in this summary plan description reflect the provisions of the Alcatel-Lucent Long Term Disability Plan for Represented Employees as outlined in applicable collective bargaining agreements between the company and the unions representing employees of the company. Copies of these agreements are distributed or made available to those employees covered by the agreements and to any other employee who submits a written request for a copy to the Plan Administrator. A reasonable duplication charge may be made for copies furnished in response to such written request. 12

19 APPENDIX A Other Important Information Plan Funding and Payment of Benefits With certain limited exceptions, plan benefits are funded by Alcatel-Lucent. LTD benefits provided by the LTD Plan are paid directly by CIGNA, PO Box 22325, Pittsburgh, PA 15222, from funds made available for this purpose. LTD Plan benefits are not insured. CIGNA only provides administrative services. LTD Plan May Be Amended or Terminated The company expects to continue the LTD Plan, but reserves the right to amend or terminate the LTD Plan at any time by the resolution of the Board of Directors or a properly authorized designee, subject to the terms of applicable collective bargaining agreements. Alcatel-Lucent does not guarantee the continuation of any disability benefits, nor does it guarantee any specific level of benefits. However, changes to or termination of the LTD Plan will not adversely affect your rights to any benefits under the LTD Plan that you may receive or have become eligible to receive before the change or termination. LTD Plan Sponsor and Administrator The LTD Plan Administrator has the full discretionary authority and power to control and manage all aspects of the LTD Plan, to determine eligibility for LTD Plan benefits, to interpret and construe the terms and provisions of the LTD Plan, to determine questions of fact and law, to direct disbursements, and to adopt rules for the administration of the LTD Plan as they may deem appropriate in accordance with the terms of the LTD Plan and all applicable laws. The Company shall be the named fiduciary in accordance with Section 402 of ERISA. 13

20 APPENDIX A Claim Review and Appeal Procedures Claim Review and Appeal Procedures Claim Review Procedures Participants, their beneficiaries (if applicable) or any individual duly authorized by them have the right under ERISA and the LTD Plan to file a written claim for benefits with the Claims Administrator (see Important Contacts ). If a claim is denied in whole or in part, the claimant will receive a written notice from the Claims Administrator of the Claims Administrator s decision, including the specific reason for the decision, within 45 days after the Claims Administrator receives the claim. The written notice will include: The specific reason(s) for the denial, Reference to the specific LTD Plan provisions, statutes or regulations on which the denial was based, A description of any additional material or information necessary to perfect the claim and an explanation of why the material or information is necessary, and Information about the steps to be taken if you, your dependent, or an authorized representative wishes to submit the claim for review. If the Claims Administrator needs more than 45 days to make a decision, a representative will notify you in writing within the initial 45-day period and explain why more time is required. An additional 30 days (for a total of 75 days) may be taken if the Claims Administrator sends this notice. The extension notice will show the date by which the Claims Administrator s decision will be sent. If you submit your claim according to the procedures described in this section and you do not hear from the Claims Administrator within the time limits given here, your claim is considered denied. If a claim for benefits is denied in whole or in part, or if you or your dependents believe that benefits under the LTD Plan to which you are entitled have not been provided, an appeal process is available to you. You, your dependents, or your authorized representative may appeal in writing within 60 days after the denial is received or the 45- (or 75) day period has expired. 14

21 APPENDIX A Claim Review and Appeal Procedures Appeal Procedures If your claim for benefits is denied, in whole or in part, an appeal process is available to you. If you wish to file an appeal, you must do so in writing within 180 days of receiving notification of the Claims Administrator s decision. You are entitled to request a copy of and review the LTD Plan Plan Document when you prepare your appeal. If you believe an error has occurred, you can support your request by giving the reason you think there is an error. Also, whenever possible, send copies of any documents or records that support your appeal. Whether or not you can provide such additional information, your claim will be reconsidered after your request is received. Send a written request for review of any denied claim directly to the Claims Administrator (see Important Contacts ). The Claims Administrator will conduct a review and make a final decision within 45 days after receiving the written request for review. If special circumstances cause the Claims Administrator to need more than 45 days to make a decision, a representative will notify you in writing within the initial 45-day period and explain why more time is required. An additional 45 days (for a total of 90 days) may be taken if the Claims Administrator sends this notice. The decision will be in writing and will specify the pertinent plan provisions on which the decision is based. If you submit your request for a written review according to the procedures described in this section and you do not hear from the Claims Administrator within the time limits given here, your appeal is considered denied. Although this decision is final and is not subject to further review, you or your beneficiary may have additional rights under ERISA. However, applicable law and the LTD Plan s provisions require you to pursue all your claim and appeal rights on a timely basis before seeking any other legal recourse regarding claims for benefits. 15

22 APPENDIX A Your Rights Under ERISA Your Rights Under ERISA You are entitled to certain rights and protection under the Employee Retirement Income Security Act of 1974, as amended (ERISA). These rights are described in this section. It s your right to know about your benefits. This summary plan description describes your benefits under the LTD Plan. You also may examine the LTD Plan document. This document is available for you to examine without charge in the Plan Administrator s office. In addition, you automatically will receive a summary of the LTD Plan s annual financial report each year. You can receive a copy of any of these documents, for a reasonable charge, by making a written request to the Plan Administrator. If you don t receive the requested documents within 30 days (unless the delay is beyond the control of the Plan Administrator), you have a right to file suit in a federal court. The Plan Administrator may be required to pay a fine as much as $110 per day for each day s delay, in addition to furnishing the requested documents to you. You also have the right to expect the fiduciaries the people responsible for the operation of the LTD Plan to act prudently and in the best interest of those who participate as a whole. The LTD Plan s fiduciaries must act in the best interest of all LTD Plan participants. If a fiduciary misuses funds, if you are improperly denied a benefit or if you are discriminated against for asserting your rights under ERISA, you have the right to ask the U.S. Department of Labor for help or to file suit in a federal or state court. The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you sued to pay the costs and fees. If you lose, the court may order you to pay the costs and fees for example, if the court finds your claim is frivolous. The company will not (and cannot) dismiss you or discriminate against you to prevent you from obtaining benefits or exercising any of your rights under ERISA. For answers to questions about the LTD Plan, contact the Claims Administrator. If you have any questions about this statement or about your rights under ERISA, contact the nearest Area Office of the Employee Benefits Security Administration (EBSA), U.S. Department of Labor, listed in your telephone directory; or contact the Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue N.W., Washington, D.C

23 APPENDIX A Administrative Information Administrative Information Plan Name Plan Sponsor Type of Administration Plan Administrator Claims Administrator The official Plan Name is the Alcatel-Lucent Long Term Disability Plan for Occupational Employees. The Plan Sponsor is Alcatel-Lucent USA Inc. Alcatel-Lucent administers the Alcatel-Lucent Long Term Disability Plan for Occupational Employees on a contract administration basis with CIGNA, which has the right to grant and deny claims for benefits under the LTD Plan and to review, on appeal, claims it has denied. The Plan Administrator is: Alcatel-Lucent Mountain Ave. Room 2B-410 Murray Hill, NJ The Claims Administrator for the Alcatel-Lucent Long Term Disability Plan for Occupational Employees is: CIGNA PO Box Pittsburgh, PA Or By Overnight Mail CIGNA 1600 West Carson St. Pittsburgh, PA Agent for Service of Legal Process Plan Records, Plan Year and Type of Plan Telephone: or Direct any process of legal service regarding a claim for benefits to the Claims Administrator. All other legal actions should be directed to Alcatel-Lucent. The LTD Plan is considered a welfare benefit plan under the Employee Retirement Income Security Act of 1974, as amended (ERISA). The LTD Plan and all of its records are kept on a calendar year basis, beginning January 1 and ending December 31 of each year. 17

24 APPENDIX A Administrative Information Plan Identification Number Employer Identification Number The Plan Identification Number is 517. The Employer Identification Number is

25 APPENDIX B

26 YOUR BENEFIT PLAN Alcatel-Lucent USA Inc. Represented Employees Disability Income Insurance: Long Term Benefits Certificate Date: January 1, 2014

27 Alcatel-Lucent USA Inc. 600 Mountain Avenue, Room 2B410 Murray Hill, NJ TO OUR EMPLOYEES: All of us appreciate the protection and security insurance provides. This certificate describes the benefits that are available to you. We urge you to read it carefully. Alcatel-Lucent USA Inc.

28 Metropolitan Life Insurance Company 200 Park Avenue, New York, New York CERTIFICATE OF INSURANCE Metropolitan Life Insurance Company ( MetLife ), a stock company, certifies that You are insured for the benefits described in this certificate, subject to the provisions of this certificate. This certificate is issued to You under the Group Policy and it includes the terms and provisions of the Group Policy that describe Your insurance. PLEASE READ THIS CERTIFICATE CAREFULLY. This certificate is part of the Group Policy. The Group Policy is a contract between MetLife and the Policyholder and may be changed or ended without Your consent or notice to You. Policyholder: Group Policy Number: Type of Insurance: Alcatel-Lucent USA Inc G Disability Income Insurance: Long Term Benefits MetLife Toll Free Number(s): For Claim Information THIS CERTIFICATE ONLY DESCRIBES DISABILITY INSURANCE. THE BENEFITS OF THE POLICY PROVIDING YOU COVERAGE ARE GOVERNED PRIMARILY BY THE LAWS OF A STATE OTHER THAN FLORIDA. THE GROUP INSURANCE POLICY PROVIDING COVERAGE UNDER THIS CERTIFICATE WAS ISSUED IN A JURISDICTION OTHER THAN MARYLAND AND MAY NOT PROVIDE ALL THE BENEFITS REQUIRED BY MARYLAND LAW. WE ARE REQUIRED BY STATE LAW TO INCLUDE THE NOTICE(S) WHICH APPEAR ON THIS PAGE AND IN THE NOTICE(S) SECTION WHICH FOLLOWS THIS PAGE. PLEASE READ THE(SE) NOTICE(S) CAREFULLY. GCERT2000 fp 1

29 For Texas Residents: Para Residentes de Texas: IMPORTANT NOTICE AVISO IMPORTANTE To obtain information or make a complaint: Para obtener información o para someter una queja: You may call MetLife s toll free telephone number for information or to make a complaint at Usted puede llamar al numero de teléfono gratis de MetLife para información o para someter una queja al You may contact the Texas Department of Insurance to obtain information on companies, coverages, rights or complaints at Puede comunicarse con el Departamento de Seguros de Texas para obtener información acerca de compañías, coberturas, derechos o quejas al You may write the Texas Department of Insurance P.O. Box Austin, TX Fax # (512) Web: ConsumerProtection@tdi.state.tx.us PREMIUM OR CLAIM DISPUTES: Should You have a dispute concerning Your premium or about a claim, You should contact MetLife first. If the dispute is not resolved, You may contact the Texas Department of Insurance. Puede escribir al Departamento de Seguros de Texas P.O. Box Austin, TX Fax # (512) Web: ConsumerProtection@tdi.state.tx.us DISPUTAS SOBRE PRIMAS O RECLAMOS: Si tiene una disputa concerniente a su prima o a un reclamo, debe comunicarse con MetLife primero. Si no se resuelve la disputa, puede entonces comunicarse con el departamento (TDI). ATTACH THIS NOTICE TO YOUR CERTIFICATE: This notice is for information only and does not become a part or condition of the attached document. UNA ESTE AVISO A SU CERTIFICADO: Este aviso es solo para propósito de información y no se convierte en parte o condición del documento adjunto. GCERT2000 notice/tx 2

30 NOTICES NOTICE FOR RESIDENTS OF ALL STATES WORKERS COMPENSATION This certificate does not replace or affect any requirement for coverage by workers compensation insurance. MANDATORY DISABILITY INCOME BENEFIT LAWS For Residents of California, Hawaii, New Jersey, New York, Rhode Island and Puerto Rico This certificate does not affect any requirement for any government mandated temporary disability income benefits law. NOTICE FOR RESIDENTS OF ARKANSAS If You have a question concerning Your coverage or a claim, first contact the Policyholder or group account administrator. If, after doing so, You still have a concern, You may call the toll free telephone number shown on the Certificate Face Page. If You are still concerned after contacting both the Policyholder and MetLife, You should feel free to contact: Arkansas Insurance Department Consumer Services Division 1200 West Third Street Little Rock, Arkansas (501) or (800) NOTICE FOR RESIDENTS OF CALIFORNIA IMPORTANT NOTICE TO OBTAIN ADDITIONAL INFORMATION, OR TO MAKE A COMPLAINT, CONTACT THE POLICYHOLDER OR THE METLIFE CLAIM OFFICE SHOWN ON THE EXPLANATION OF BENEFITS YOU RECEIVE AFTER FILING A CLAIM. IF, AFTER CONTACTING THE POLICYHOLDER AND/OR METLIFE, YOU FEEL THAT A SATISFACTORY SOLUTION HAS NOT BEEN REACHED, YOU MAY FILE A COMPLAINT WITH THE CALIFORNIA INSURANCE DEPARTMENT AT: DEPARTMENT OF INSURANCE 300 SOUTH SPRING STREET LOS ANGELES, CA (800) GCERT2000 Combined Notices 3

31 NOTICES NOTICE FOR RESIDENTS OF GEORGIA IMPORTANT NOTICE The laws of the state of Georgia prohibit insurers from unfairly discriminating against any person based upon his or her status as a victim of family violence. NOTICE FOR RESIDENTS OF IDAHO If You have a question concerning Your coverage or a claim, first contact the Policyholder. If, after doing so, You still have a concern, You may call the toll free telephone number shown on the Certificate Face Page. If You are still concerned after contacting both the Policyholder and MetLife, You should feel free to contact: Idaho Department of Insurance Consumer Affairs 700 West State Street, 3 rd Floor PO Box Boise, Idaho or NOTICE FOR RESIDENTS OF ILLINOIS IMPORTANT NOTICE To make a complaint to MetLife, You may write to: MetLife 200 Park Avenue New York, New York The address of the Illinois Department of Insurance is: Illinois Department of Insurance Public Services Division Springfield, Illinois NOTICE FOR RESIDENTS OF INDIANA Questions regarding your policy or coverage should be directed to: Metropolitan Life Insurance Company GCERT2000 Combined Notices 4

32 NOTICES NOTICE FOR RESIDENTS OF INDIANA (continued) If you (a) need the assistance of the government agency that regulates insurance; or (b) have a complaint you have been unable to resolve with your insurer you may contact the Department of Insurance by mail, telephone or State of Indiana Department of Insurance Consumer Services Division 311 West Washington Street, Suite 300 Indianapolis, Indiana Consumer Hotline: (800) ; (317) Complaint can be filed electronically at NOTICE FOR MASSACHUSETTS RESIDENTS CONTINUATION OF DISABILITY INCOME INSURANCE 1. If Your Disability Income Insurance ends due to a Plant Closing or Covered Partial Closing, such insurance will be continued for 90 days after the date it ends. 2. If Your Disability Income Insurance ends because: You cease to be in an Eligible Class; or Your employment terminates; for any reason other than a Plant Closing or Covered Partial Closing, such insurance will continue for 31 days after the date it ends. Continuation of Your Disability Income Insurance under the CONTINUATION OF INSURANCE WITH PREMIUM PAYMENT subsection will end before the end of continuation periods shown above if You become covered for similar benefits under another plan. Plant Closing and Covered Partial Closing have the meaning set forth in Massachusetts Annotated Laws, Chapter 151A, Section 71A. Notice of Protection Provided by Utah Life and Health Insurance Guaranty Association This notice provides a brief summary of the Utah Life and Health Insurance Guaranty Association ("the Association") and the protection it provides for policyholders. This safety net was created under Utah law, which determines who and what is covered and the amounts of coverage. The Association was established to provide protection in the unlikely event that your life, health, or annuity insurance company becomes financially unable to meet its obligations and is taken over by its insurance GCERT2000 Combined Notices 5

33 NOTICES regulatory agency. If this should happen, the Association will typically arrange to continue coverage and pay claims, in accordance with Utah law, with funding from assessments paid by other insurance companies. The basic protections provided by the Association are: Life Insurance Notice of Protection Provided by Utah Life and Health Insurance Guaranty Association (continued) o $500,000 in death benefits o $200,000 in cash surrender or withdrawal values Health Insurance o $500,000 in hospital, medical and surgical insurance benefits o $500,000 in long-term care insurance benefits o $500,000 in disability income insurance benefits o $500,000 in other types of health insurance benefits Annuities o $250,000 in withdrawal and cash values The maximum amount of protection for each individual, regardless of the number of policies or contracts, is $500,000. Special rules may apply with regard to hospital, medical and surgical insurance benefits. Note: Certain policies and contracts may not be covered or fully covered. For example, coverage does not extend to any portion of a policy or contract that the insurer does not guarantee, such as certain investment additions to the account value of a variable life insurance policy or a variable annuity contract. Coverage is conditioned on residency in this state and there are substantial limitations and exclusions. For a complete description of coverage, consult Utah Code, Title 3 la, Chapter 28. Insurance companies and agents are prohibited by Utah law to use the existence of the Association or its coverage to encourage you to purchase insurance. When selecting an insurance company, you should not rely on Association coverage. If there is any inconsistency between Utah law and this notice, Utah law will control. To learn more about the above protections, as well as protections relating to group contracts or retirement plans, please visit the Association's website at or contact: Utah Life and Health Insurance Guaranty Assoc. Utah Insurance Department 60 East South Temple, Suite State Office Building Salt Lake City UT Salt Lake City UT (801) (801) A written complaint about misuse of this Notice or the improper use of the existence of the Association may be filed with the Utah Insurance Department at the above address. NOTICE FOR RESIDENTS OF VIRGINIA IMPORTANT INFORMATION REGARDING YOUR INSURANCE In the event You need to contact someone about this insurance for any reason please contact Your agent. If no agent was involved in the sale of this insurance, or if You have additional questions You may contact the insurance company issuing this insurance at the following address and telephone number: GCERT2000 Combined Notices 6

34 NOTICES MetLife 200 Park Avenue New York, New York Attn: Corporate Consumer Relations Department To phone in a claim related question, You may call Claims Customer Service at: If You have been unable to contact or obtain satisfaction from the company or the agent, You may contact the Virginia State Corporation Commission s Bureau of Insurance at: NOTICE FOR RESIDENTS OF VIRGINIA (continued) The Office of the Managed Care Ombudsman Bureau of Insurance P.O. Box 1157 Richmond, VA toll-free locally - web address ombudsman@scc.virginia.gov - NOTICE FOR RESIDENTS OF WISCONSIN KEEP THIS NOTICE WITH YOUR INSURANCE PAPERS PROBLEMS WITH YOUR INSURANCE? - If You are having problems with Your insurance company or agent, do not hesitate to contact the insurance company or agent to resolve Your problem. MetLife Attn: Corporate Consumer Relations Department 200 Park Avenue New York, NY You can also contact the OFFICE OF THE COMMISSIONER OF INSURANCE, a state agency which enforces Wisconsin s insurance laws, and file a complaint. You can contact the OFFICE OF THE COMMISSIONER OF INSURANCE by contacting: Office of the Commissioner of Insurance Complaints Department P.O. Box 7873 Madison, WI outside of Madison or in Madison. GCERT2000 Combined Notices 7

35 TABLE OF CONTENTS Section Page CERTIFICATE FACE PAGE... 1 NOTICES... 2 SCHEDULE OF BENEFITS... 9 DEFINITIONS ELIGIBILITY PROVISIONS: INSURANCE FOR YOU Eligible Classes Date You Are Eligible for Insurance Enrollment Process Date Your Insurance Takes Effect Date Your Insurance Ends CONTINUATION OF INSURANCE WITH PREMIUM PAYMENT For Family And Medical Leave At The Policyholder's Option DISABILITY INCOME INSURANCE: LONG TERM BENEFITS DISABILITY INCOME INSURANCE: INCOME WHICH WILL REDUCE YOUR DISABILITY BENEFIT DISABILITY INCOME INSURANCE: INCOME WHICH WILL NOT REDUCE YOUR DISABILITY BENEFIT DISABILITY INCOME INSURANCE: DATE BENEFIT PAYMENTS END DISABILITY INCOME INSURANCE: EXCLUSIONS GENERAL PROVISIONS Assignment Disability Income Benefit Payments: Who We Will Pay Entire Contract Incontestability: Statements Made by You Misstatement of Age Conformity with Law Physical Exams Autopsy Overpayments for Disability Income Insurance Lien and Repayment GCERT2000 toc 8

36 SCHEDULE OF BENEFITS This schedule shows the benefits that are available under the Group Policy. You will only be insured for the benefits: for which You become and remain eligible; which You elect, if subject to election; and which are in effect. BENEFIT BENEFIT AMOUNT AND HIGHLIGHTS Disability Income Insurance For You: Long Term Benefits Monthly Benefit.. 50% of the first $50,000 of Your Predisability Earnings, subject to the INCOME WHICH WILL REDUCE YOUR DISABILITY BENEFIT section Maximum Monthly Benefit $25,000 Minimum Monthly Benefit. None Elimination Period. The end of the sickness disability maximum benefit period set forth in the Policyholder s sickness and accident disability plan. Note: If You are receiving benefits for a disability due to sickness or injury under the accident disability provisions of the Policyholder s Sickness and Accident Disability Benefit Plan (SADBP), You are not eligible to receive Long Term Benefits for that injury or sickness under this certificate. Maximum Benefit Period* the period shown below: Age on Date of Benefit Period Your Disability 61 or younger To age months months months 65 or older 12 months *The Maximum Benefit Period is subject to the LIMITED DISABILITY BENEFITS and DATE BENEFIT PAYMENTS END sections. Rehabilitation Incentives. No GCERT sch

37 DEFINITIONS As used in this certificate, the terms listed below will have the meanings set forth below. When defined terms are used in this certificate, they will appear with initial capitalization. The plural use of a term defined in the singular will share the same meaning. Actively at Work or Active Work means that You are performing all of the usual and customary duties of Your job on a Full-Time or Part-Time basis. This must be done at: the Policyholder s place of business; an alternate place approved by the Policyholder; or a place to which the Policyholder s business requires You to travel. You will be deemed to be Actively at Work during weekends or Policyholder approved vacations, holidays or business closures if You were Actively at Work on the last scheduled work day preceding such time off. Appropriate Care and Treatment means medical care and treatment that is: given by a Physician whose medical training and clinical specialty are appropriate for treating Your Disability; consistent in type, frequency and duration of treatment with relevant guidelines of national medical research, health care coverage organizations and governmental agencies; consistent with a Physician s diagnosis of Your Disability; and intended to maximize Your medical and functional improvement. Beneficiary means the person(s) to whom We will pay insurance as determined in accordance with the GENERAL PROVISIONS section. Disabled or Disability means that, due to Non Job-Related Sickness or as a direct result of a Non Job- Related accidental injury. You are receiving Appropriate Care and Treatment and complying with the requirements of such treatment; and You are unable to earn more than 50% of Your Predisability Earnings for any employer in Your Local Economy at any gainful occupation for which You are reasonably qualified taking into account Your training, education and experience. For purposes of determining whether a Disability is the direct result of a Non Job-Related Sickness or Non Job-Related accidental injury, the Disability must have occurred within 90 days of the Non Job-Related Sickness or Non Job-Related accidental injury and resulted from such injury independent of other causes. Accidental injuries for which You receive benefits under the accident disability provisions of SADBP are not eligible for Long Term Benefits. If Your occupation requires a license, the fact that You lose Your license for any reason will not, in itself, constitute Disability. Domestic Partner means each of two people, one of whom is an employee of the Policyholder, who: have registered as each other s domestic partner, civil union partner or reciprocal beneficiary with a government agency where such registration is available; or are of the same or opposite sex and have a mutually dependent relationship so that each has an insurable interest in the life of the other. Each person must be: years of age or older; GCERT2000 def as amended by GCR09-07 dp 10