MassMutual Health Reimbursement Account for Retirees (HRA)

Transcription

1 MassMutual Health Reimbursement Account for Retirees (HRA) Summary Plan Description for Retired Employees, Agents, General Agents and General Managers; Disabled Former Employees and Agents; and Survivors Effective January 1, 2016 This Summary Plan Description (SPD), published in February 2016, takes the place of any SPDs and Summaries of Material Modifications (SMMs) previously issued to you describing your benefits. Health Reimbursement Account for Retirees (HRA) February 2016 Page 1 of 32

2 Table of Contents Disclaimer 3 Introduction 4 Contact Information 5 Eligibility for the HRA 6 Receiving HRA Credits 10 Credits to Your HRA 13 Tax Information 16 Non-U.S. Residents Eligible for the HRA 17 Eligible Expenses 18 Catastrophic Drug HRA 19 When Participation Ends 20 Reimbursement of Premiums and Expenses 21 Claims and Appeals Procedures 24 Administrative Information 27 Plan Information 29 ERISA Rights 31 Health Reimbursement Account for Retirees (HRA) February 2016 Page 2 of 32

3 Disclaimer This Summary Plan Description ( SPD ) provides details of the MassMutual Health Reimbursement Account for Retirees (the HRA or the Plan ) available through the MassMutual Retired Employee Welfare Benefits Plan (the Retired Employee Plan ) or the MassMutual Retired Agents Welfare Benefits Plan (the Retired Agent Plan ). This SPD contains detailed and important information about the Plan; every attempt has been made to communicate this information clearly and in easily understandable terms. Benefits are determined under the terms of the Plan in effect at the time you become eligible for specific benefits. Benefits are based on current laws and regulations, which are subject to change. Massachusetts Mutual Life Insurance Company (the Company or MassMutual ) reserves the right to modify, revoke, change, suspend or terminate any one or all plans, programs, policies, benefits or services described in this SPD or the underlying Plan documents at any time and from time to time. This SPD does not guarantee any particular benefit. Your receipt of this SPD describing the Plan does not mean that you are eligible to participate in the Plan or receive HRA credits. Because of the many detailed provisions of the Plan, no one other than the Plan Administrator and the delegated representatives indicated in this SPD are authorized to advise you about your benefits. For this reason, MassMutual cannot be bound by statements made by unauthorized personnel. In the event of a discrepancy between descriptions in this SPD and information in the relevant Plan documents, the applicable Plan document will govern. The Plans are subject to the provisions of the Employee Retirement Income Security Act of 1974 ( ERISA ). Health Reimbursement Account for Retirees (HRA) February 2016 Page 3 of 32

4 Introduction This Summary Plan Description describes the MassMutual Health Reimbursement Account for Retirees (HRA), which is offered under the Retired Employee Plan and Retired Agent Plan to eligible retired employees, retired career contract agents, retired general agents, and retired general managers, as well as to former disabled employees and the survivors of deceased participants in the MassMutual Welfare Benefits Plan and the MassMutual Agents Welfare Benefits Plan (the Active Plans ) (collectively referred to as Retirees ). The purpose of the HRA is to provide Retirees with a contribution to be used for the reimbursement of eligible health expenses incurred by the Retiree and their eligible dependents. The HRA also includes a Catastrophic Drug Benefit, which may be used for prescription drug expenses if certain conditions are met. The HRA is effective as of January 1, 2016 for eligible Retirees. 1 To be eligible to receive HRA Credits, you must generally enroll in health care coverage through the Aon Retiree Health Exchange TM, a private health care exchange. If you live outside the United States (including U.S. territories, such as Puerto Rico) or in a state in which no coverage is available to you through the Aon Retiree Health Exchange, you may be eligible to receive HRA Credits by meeting other conditions as defined and determined by the Plan Administrator and subject to change from time to time. If, after reading this SPD, you have any questions about the HRA and how it works, contact the Aon Retiree Health Exchange between 9 a.m. and 9 p.m. ET. You can also obtain information directly on the Aon Retiree Health Exchange website. 1 Pre-Medicare-eligible Retirees use the Aon Retiree Health Exchange to shop for private-exchange coverage through ehealth, an online marketplace that allows individuals to purchase health insurance products. In addition to private-exchange coverage, you may also shop for public-exchange coverage through ehealth. You may enroll in private-exchange coverage or public-exchange coverage, but not both. If you enroll in public-exchange coverage, you may qualify for a public subsidy in the form of federal premium tax credits and/or cost-sharing subsidies. In order to qualify for a public subsidy, you must opt out of MassMutual s HRA by contacting MassMutual. If you opt out of MassMutual s HRA after Dec. 31, 2015, you will not be eligible for MassMutual s HRA in the future. Health Reimbursement Account for Retirees (HRA) February 2016 Page 4 of 32

5 Contact Information Resource Online Telephone Aon Retiree Health Exchange Aon Claims and Appeals Management (CAM) P.O. Box 1407 Lincolnshire, IL Retired Employees: MassMutual Benefits 1295 State Street, F105 Springfield, MA Retired Agents: Producer Services & Operations 1295 State Street, F210 Springfield, MA Your Spending Account 2 (Claims Administrator) P.O. Box Orlando, FL BenefitQuestions@MassMutual.com AgentBenefitQuestions@MassMutual.com Fax: , 10 a.m.-4 p.m. ET (business days) , Ext , 8 a.m.-6 p.m. ET (business days) Fax: (in the U.S.) (outside the U.S.) 2 Your Spending Account is a trademark of Hewitt Associates LLC. Health Reimbursement Account for Retirees (HRA) February 2016 Page 5 of 32

6 Eligibility for the HRA Who Is Eligible to Participate Retired Employees You are eligible for the HRA if you were a member of an Eligible Group and if you: Retired prior to Jan. 1, 2010 Were eligible for medical coverage and were employed on January 1, 2010, and on January 1, 2010, either: o You were at least age 50 with 10 or more years of service (as defined for pension vesting purposes); or o You have age and years of service equal to 75 or more with at least 10 years of service (as defined for pension vesting purposes). Began retiree medical benefits when you were either: o Age 55 or older with at least 10 years of service on your retirement date; or o A sunset participant in the MassMutual Employee Pension Plan who was age 50 or older with at least 10 years of service, and age plus service equaled 65 or more on January 1, Individuals who otherwise meet these requirements but are still working for MassMutual or who have deferred retiree medical coverage are not eligible until the later of the date they retire or the date they elect coverage to begin. Eligible Groups You were a member of an eligible group if you were: An employee of Connecticut Mutual and were a Participant in the Connecticut Mutual Comprehensive Medical Plan as of December 31, 1999; A non-grandfathered 3 employee of Connecticut Mutual and retired on or after January 1, 1993; An employee of Antares Capital Corp. and retired on or after January 1, 2001; An employee of Cornerstone Real Estate Advisers LLC who was hired by Cornerstone before January 1, 1994; An employee of Babson Capital Management LLC (formerly known as David L. Babson & Company Inc.) who was a Springfield-based employee as of January 1, 2001, including employees who transferred from Babson Capital Management LLC to Babson Capital Finance 3 You are considered grandfathered if, on December 31, 1992, you were: Retired; Eligible for early retirement; Within five years of normal retirement; A disabled employee who began receiving Group Long-Term Disability from GroupAmerica or Connecticut Mutual on or before December 1, 1992; or A surviving Spouse or Dependent of an active or a retired employee who died on or before December 31, Health Reimbursement Account for Retirees (HRA) February 2016 Page 6 of 32

7 LLC on or after June 30, 2013, except employees in the Restricted Stock or Stock Option plan or successor plans who had not attained age 45 with at least 10 years of service as of January 1, 2001; An employee of the Financial Products Division who was transferred from MassMutual to Babson Capital Management LLC, effective January 1, 2008, including employees who subsequently transferred from Babson Capital Management LLC to Babson Capital Finance LLC on or after June 30, 2013; An employee of Massachusetts Mutual Life Insurance Company; An employee of MassMutual Benefits Management, Inc.; An employee of MassMutual International LLC; An employee of MML Investors Services, Inc.; An employee of The MassMutual Trust Company, FSB; A disabled former employee of MassMutual or one of its eligible subsidiaries as of your retirement date; or Otherwise subsidy eligible and retired as of Dec. 31, 2015, including those retirees who previously deferred retiree health coverage. Note: If you had prior service with Connecticut Mutual Life Insurance Company, your Connecticut Mutual years of service will be taken into account only if you became employed by the Company immediately following the end of your service with Connecticut Mutual as of March 1, Retired Career Agents, General Agents and General Managers To be eligible to participate in the HRA, you must: (1) have retired and not elected to defer retiree coverage to a future date; and (2): for career agents whose contract date is Jan. 1, 2000 or later, have terminated your active career contract at age 60 or older with 10 or more continual years under a career contract immediately prior to retirement. for career agents whose contract date is prior to Jan. 1, 2000, have terminated your active career contract at age 60 or older with 6 or more continual years under a career contract immediately prior to retirement. Note: Agents with contract dates on or after Jan. 1, 2009 who terminated their career contract at age 65 or older with 5 to 9 years of continual years under a career contract immediately prior to retirement are not eligible for the HRA, but may access coverage through the Aon Retiree Health Exchange. General Agent/Brokerage Director Note: Service includes service under a general agent contract or brokerage director contract or similar management contract, as long as the retired agent was continually under one of these qualifying contracts with or endorsed by the Company during this continuous service period. Any general agent who attains at least 12 years of service as a general agent (up to two years of which may be as a general manager) is eligible for retiree health coverage. Health Reimbursement Account for Retirees (HRA) February 2016 Page 7 of 32

8 Disabled Former Employees and Former Career Agents, General Agents and General Managers If you are a disabled former employee or disabled former career agent, general agent or general manager, you are eligible to participate in the HRA if you are receiving Long-Term Disability benefits under one of the Active Plans and, if you are a career agent, no longer have an active career contract. Survivors The Eligible Survivor of a deceased Active Plan participant is eligible for an HRA. You are an Eligible Survivor if: you are a surviving dependent of a deceased participant; both you and the deceased participant were enrolled in an Active Plan at the time of the deceased participant s death; the deceased participant had: o died on or before December 31, 2013 and completed at least five (5) years of service under the MassMutual Pension Plan ( Pension Plan ) prior to his death; o died after December 31, 2013 and satisfied the requirements for retirement under the Pension Plan as of the time of his death. If the deceased participant has more than one dependent who meets the above requirements, the Eligible Survivor will be the deceased participant s spouse or domestic partner. If the deceased member had no spouse or domestic partner, the Eligible Survivor will be the deceased participant s oldest child who meets the eligibility requirements for the HRA. Dental HRA for Former Connecticut Mutual Agents If you were a retiree and had dental coverage through Connecticut Mutual Life Insurance Company on Nov. 30, 2003, or if you were a career agent or employee of Connecticut Mutual Life Insurance Company who was eligible to retire or was within 5 years of normal retirement age on Dec. 31, 1992, you may be eligible to participate and receive an HRA Credit to be used for the purchase of a retiree dental policy even if you do not meet the eligibility requirements above for a general HRA Credit. Dental HRA for Former Connecticut Mutual Employees If you were a retiree or disabled employee and had dental coverage through Connecticut Mutual Life Insurance Company on Dec. 31, 2002, or if you were an employee who was eligible to retire or was within five years of your normal retirement date on Feb. 29, 1996, you may be provided with an HRA Credit to be used for the purchase of a retiree dental policy. Such HRA Credit for dental coverage would be provided in addition to any HRA Credit for which you may otherwise be eligible to use for a medical policy. Health Reimbursement Account for Retirees (HRA) February 2016 Page 8 of 32

9 Who Is Not Eligible to Participate Not all Retirees are eligible for an HRA. You are not eligible for an HRA if you: Reside in the United States and enroll in medical or prescription drug coverage through any entity that is not the Aon Retiree Health Exchange o Note: Coverage offered through ehealth as part of a public exchange is not part of the Aon Retiree Health Exchange 4 o This requirement does not apply to Pre-Medicare-eligible Retirees who reside in states where the Aon Retiree Health Exchange is unavailable and purchase public-exchange coverage through their state-based Exchange Are eligible for the Retiree Health Reimbursement Arrangement under the Retired Employee Plan; Retired from a subsidiary that does not participate in the Retired Employee Plan or the Retired Agent Plan; Did not meet age and years of service requirements set forth in the Retired Employee Plan or the Retired Agent Plan as of Dec. 31, 2015 as applicable; or Were not or would not have been eligible for the company s subsidized Retiree health coverage prior to January 1, When Eligibility Ends Your eligibility to participate in the HRA will end: On the date your coverage through the Aon Retiree Health Exchange is terminated for any reason; If you are eligible as a Spouse and divorce the Retiree, on the date your divorce is final; If you are eligible as a Domestic Partner at the time of retirement and subsequently terminate your domestic partnership, on the date your domestic partnership ends. On the date you commit fraud against the Plan or make an intentional misrepresentation to the Plan. 4 Pre-Medicare-eligible Retirees use the Aon Retiree Health Exchange to shop for private-exchange coverage through ehealth, an online marketplace that allows individuals to purchase health insurance products. In addition to private-exchange coverage, you may also shop for public-exchange coverage through ehealth. You may enroll in private-exchange coverage or public-exchange coverage, but not both. If you enroll in public-exchange coverage, you may qualify for a public subsidy in the form of federal premium tax credits and/or cost-sharing subsidies. In order to qualify for a public subsidy, you must opt out of MassMutual s HRA by contacting MassMutual. If you opt out of MassMutual s HRA after Dec. 31, 2015, you will not be eligible for MassMutual s HRA in the future. Health Reimbursement Account for Retirees (HRA) February 2016 Page 9 of 32

10 Receiving HRA Credits For You (Retiree, including an Eligible Survivor) If you are eligible to participate in the HRA and enroll in individual medical or prescription drug coverage through the Aon Retiree Health Exchange, an HRA account will be automatically established for you. Aon s Your Spending Account ( YSA ) administers the HRA through the Aon Retiree Health Exchange. Aon Retiree Health Exchange will send you enrollment information at the time of your retirement or, if you previously chose to defer your retiree benefits, at the time you elect coverage. Because the medical plans offered to Medicare-Eligible Retirees are individual medical or prescription drug policies, the open enrollment period is defined by Medicare each year. For Pre-Medicare-Eligible participants, the open enrollment period is established by the Patient Protection and Affordable Care Act ( Affordable Care Act or ACA ). If you reside outside the United States (as determined based on your legal mailing address as of the first day of the plan year), you will not be required to obtain coverage through the Aon Retiree Health Exchange to receive HRA Credits. If you resume residence in the United States during a plan year, you will be subject to the coverage requirement to receive future HRA Credits beginning with the January 1 of the year following the year in which you resume living in the United States. If you live in a state within the United States that does not offer coverage for you, as determined by the Plan Administrator, you will be eligible to receive HRA Credits if you obtain coverage through a state or federal public health exchange. To receive HRA Credits, you must contact Aon and provide evidence of your state or federal exchange coverage. For Your Eligible Dependents You may be eligible for additional HRA credits for your Eligible Dependents. Eligible Dependents include: Your current legal spouse. Your eligible domestic partner, if he or she was enrolled in MassMutual medical coverage through one of the Active Plans at the time you retired. A domestic partner is someone of the same or opposite sex who: o Lived together with you as a domestic partner for at least 12 consecutive months before he or she was enrolled in coverage through the Active Plans and continued coverage without any break through the date you became eligible for retiree medical coverage; o Is at least 18 years old; o Is not legally married to or separated from anyone else; o Is not related in such a way that would make a marriage illegal in your state of residence; o Is your sole domestic partner and intends to remain so indefinitely; o Shares financial responsibilities and expenses with you; and o Has resided together with you as if married and intends to do so indefinitely. Note: You cannot add a domestic partner after you retire from MassMutual. Health Reimbursement Account for Retirees (HRA) February 2016 Page 10 of 32

11 Your or your qualifying domestic partner s Children, if they: o Were covered as a dependent under your MassMutual coverage on your last day of participation in coverage under an Active Plan; o Are disabled as determined by the Social Security Administration and are Medicare-Eligible; o Are considered your dependents for tax purposes; and o Commence participating in the HRA at the time you first become eligible. Participation is not available to any non-medicare-eligible Child, a Child s Spouse or a Child s children. Child or Children means a disabled, Medicare-Eligible individual who was covered under an Active Plan while you were still in active service, who is: Your biological Child; Your legally adopted Child; Your stepchild; Your eligible foster Child; and A Child for whom you are the permanent legal guardian. For more information about reporting your Child as a Dependent on your federal tax return, refer to the section in this SPD titled Tax Information. If there is any change to the status of your covered dependents (e.g., due to marriage, divorce, death, etc.), you must notify MassMutual Benefits or Producer Services & Operations within 30 days of the date of the event. If you have an Eligible Dependent and wish to receive an HRA Credit to your Account for such Eligible Dependent, they must also purchase an individual medical or prescription drug policy through the Aon Retiree Health Exchange provided you are also eligible for the HRA and are enrolled in an individual medical or prescription drug policy through the Aon Retiree Health Exchange. Annual HRA Credits from MassMutual for you and your Eligible Dependents are combined into one HRA that is set up under your name. If you marry while enrolled in coverage through the Aon Retiree Health Exchange and your new Spouse meets the eligibility requirements set forth in the Retired Employee Plan or Retired Agent Plan, as applicable, once he or she enrolls in coverage through the Aon Retiree Health Exchange, MassMutual will provide HRA Credits to your Account for such Spouse. You will not receive any HRA Credits for an ex-spouse once your divorce is final. If you are an Eligible Survivor and you remarry or enter into a new domestic partnership, you can continue to receive HRA Credits as long as you continue to be enrolled in medical or prescription drug coverage through the Aon Retiree Health Exchange. You will not receive HRA Credits for your new spouse, domestic partner or their children. If an Eligible Dependent resides outside the United States (as determined based on his or her legal mailing address on the first day of the plan year), he or she will not be required to obtain coverage through the Aon Retiree Health Exchange in order for you to receive HRA Credits. If he or she resumes residence in the United States, he or she will be subject to the Aon Retiree Health Exchange coverage Health Reimbursement Account for Retirees (HRA) February 2016 Page 11 of 32

12 requirement in order for you to receive future HRA Credits beginning with the January 1 of the year following the year in which the Eligible Dependent resumes living in the United States. If an Eligible Dependent lives in a state within the United States that does not offer coverage for him or her, as determined by the Plan Administrator, you will be eligible to receive HRA Credits for such Eligible Dependent if he or she obtains coverage through a state or federal health exchange. To receive HRA Credits for a Dependent who is covered through a state or federal health exchange, you must contact Aon and provide evidence of your state or federal exchange coverage. You must submit valid receipts to YSA in order to be reimbursed for qualified expenses. Health Reimbursement Account for Retirees (HRA) February 2016 Page 12 of 32

13 Credits to Your HRA Amount of the Annual HRA Credit If you are eligible to participate in the HRA and meet the requirements to receive HRA Credits for a Plan Year, MassMutual will provide you with HRA Credits in each plan year as follows: Retired 1/1/2002 or earlier and met age and years of service requirements for subsidized Retiree medical coverage upon retirement Retired on or after 1/2/2002 and met age and years of service requirements for subsidized Retiree medical coverage upon retirement If eligible for dental HRA credits Pre-Medicare-Eligible $5,700 per eligible retiree/eligible dependent $5,100 per eligible retiree/eligible dependent Medicare-Eligible $2,700 per eligible retiree/eligible dependent $2,000 per eligible retiree/eligible dependent $300 per eligible retiree/eligible spouse Annual HRA Credits are generally provided on January 1 each year as long as you remain eligible. If you or an Eligible Dependent becomes eligible during the Plan Year, your HRA Credits will be prorated. See Proration Rules below. Your HRA Credits will also be prorated in the year you or an Eligible Dependent becomes eligible for Medicare. HRA credits do not earn interest. You cannot contribute to your HRA and the account does not have any investment options. You also cannot roll credits from your HRA into any other instrument, including health savings accounts, health care flexible spending accounts or dependent care flexible spending accounts. Proration Rules If you or an Eligible Dependent becomes eligible during the year, the following proration rules will apply based on the effective date of your coverage through the Aon Retiree Health Exchange: If you retire midyear, your first HRA Credit will be equal to 1/12 of the annual amount you are eligible to receive multiplied by the number of complete months remaining in the year. If your Eligible Dependent becomes eligible midyear, your HRA will be credited with an additional amount equal to 1/12 of the annual amount you are eligible to receive for that eligible dependent multiplied by the number of complete months remaining in the year. If you are a Pre-Medicare-Eligible Retiree receiving an HRA Credit and you become eligible for Medicare during the year, your HRA Credits will be prorated at the beginning of the year for the Pre-Medicare-Eligible portion of the year only. When you enroll in Medicare and purchase a Medicare-Eligible medical or prescription drug policy through the Aon Retiree Health Exchange, you will then receive a second HRA Credit allocation for the period starting on the Medicare enrollment date and continuing through the end of the year. Both allocations will go into one account. The same pro-ration applies to the HRA Credit made for an Eligible Dependent in the year they become Medicare-Eligible. Health Reimbursement Account for Retirees (HRA) February 2016 Page 13 of 32

14 If you do not enroll in Medicare upon eligibility and you have a gap in coverage, your Medicare HRA Credit will not be made until you have enrolled in Medicare coverage. It will be prorated for the remainder of the year based on the number of complete months you will have Medicare-eligible coverage through Aon for that Plan Year. The same pro-ration applies to the HRA Credit made for an Eligible Dependent in the year they become Medicare-Eligible. Other Rules If you were previously enrolled in MassMutual s Retiree health care coverage, were included in the 2015 transition special enrollment period, and you did not enroll in a medical or prescription drug policy for 2016 through the Aon Retiree Health Exchange at that time, you will not be eligible for an HRA or any HRA Credits in the future, except as noted in the Non-U.S. Residents Eligible for the HRA section of this SPD. If you become eligible after the start of the Plan Year, HRA Credits will be made to your account as soon as administratively feasible after your eligibility date. If coverage through the Aon Retiree Health Exchange is terminated for your eligible Dependent, any HRA Credits already allocated to your HRA for your eligible Dependent will remain available in your HRA account. However, you may only submit for reimbursement of services for that Dependent if the services were incurred during the time your eligible Dependent was enrolled. You may continue to use any remaining balance for your own or other eligible dependent s expenses. However, no future annual HRA Credits will be allocated to your account for a Dependent who terminates his or her Aon Retiree Health Exchange coverage. If your coverage is terminated for any reason (except your death), any HRA Credits already allocated to your HRA will remain available for the reimbursement of services that were incurred during the time you were enrolled. However, no future annual HRA Credits will be allocated for you or your Eligible Dependent. For more information about how the HRA Credit amount is determined, contact the Aon Retiree Health Exchange. MassMutual has the right to adjust the amount of the HRA Credit or discontinue the HRA Credit at any time and for any reason. Subsidy Considerations Pre-Medicare-Eligible Retirees may wish to determine their eligibility for a government subsidy. During the transition special enrollment period only (prior to March 1, 2016), if a Pre-Medicare-Eligible Retiree enrolled in coverage through ehealth and decides to take the federal government subsidy instead of the HRA Credits in 2016, the Retiree will be allowed a one-time deferral of the HRA Credits. However, once the Retiree requests the HRA Credits and enrolls in coverage through the Aon Retire Health Exchange, the Retiree cannot defer HRA participation. If the Retiree later decides to take the government subsidy instead of HRA Credits, they are no longer eligible to receive the HRA Credits at any time in the future, even if they become ineligible for a government subsidy at a later date. Year-End Remaining HRA Balances If you do not use all of your HRA Credits during the year for reimbursement of eligible health care expenses, any unused remaining balance is automatically carried forward into your next year s HRA as Health Reimbursement Account for Retirees (HRA) February 2016 Page 14 of 32

15 long as you continue to have coverage through the Aon Retiree Health Exchange in that year (unless an exception applies) and you remain eligible for HRA Credits. Forfeiting Your HRA Balance HRA Credits will cease and be forfeited in the situations described below: If you have an HRA balance when you die, and, as of the date of your death, you do not have an Eligible Dependent enrolled in coverage through the Aon Retiree Health Exchange (unless an exception applies), any amounts remaining in your HRA six months after your death will be forfeited. (Note: Expenses may be submitted for reimbursement on behalf of your estate up to six months after your date of death). If you terminate your individual medical or prescription drug coverage purchased through the Aon Retiree Health Exchange for any reason (including nonpayment of premiums), any HRA Credits remaining after any eligible premium or health care expenses (incurred prior to the termination date) have been reimbursed will be forfeited. If your participation is terminated due to fraud or intentional misrepresentation, any HRA Credits will be forfeited. Account Statements Each January, you will receive an HRA Balance Reminder confirming the amount of the annual HRA Credit allocation made to your account for the Plan Year. You also will receive an HRA statement in the fourth quarter of each year showing your available balance and amounts paid to date. Your available balance and any HRA Credit or reimbursement history can be obtained at any time on the Aon Retiree Health Exchange website ( or by calling the Aon Retiree Health Exchange. Health Reimbursement Account for Retirees (HRA) February 2016 Page 15 of 32

16 Tax Information Except as noted below, generally neither HRA Credits nor any reimbursements paid through the HRA will be considered part of your taxable income. However, these amounts may be included in income and subject to tax if: You are a retired general agent or the Eligible Dependent of a retired general agent: General agents are not employees of MassMutual. For that reason, benefits cannot be provided on a tax-free basis. You are a domestic partner or an Eligible Dependent of a domestic partner: Domestic partners and their Dependent Children may not satisfy the definition of Dependent under federal tax laws. If HRA Credits cannot be provided on a tax-free basis for you or your Eligible Dependent, MassMutual is legally required to report the entire taxable value of your HRA as taxable income to you for income tax purposes. The value that is reported is equal to the average HRA reimbursement for all similarly situated individuals under the Retired Employee Plan or the Retired Agent Plan, whichever is applicable. If your domestic partner and his or her Children meet the definition of a dependent under federal tax laws, you may not be required to report the HRA Credits as income for income-tax purposes. You should consult a tax advisor for advice on your specific situation. Health Reimbursement Account for Retirees (HRA) February 2016 Page 16 of 32

17 Non-U.S. Residents Eligible for the HRA If you are eligible for an HRA and live outside the United States (including U.S. territories, such as Puerto Rico), you must submit eligible premiums and expenses to YSA for reimbursement from the HRA. All receipts and other documentation must be submitted in English. You are responsible for any translation services needed. Health Reimbursement Account for Retirees (HRA) February 2016 Page 17 of 32

18 Eligible Expenses Eligible expenses can be reimbursed from your HRA if the expenses are incurred during the time you participate in the Aon Retiree Health Exchange (or are subject to an exception), provided such expenses do not exceed your HRA balance. The following after-tax expenses are eligible for reimbursement through your HRA: Health care expenses allowed under IRS Publication 502, Internal Revenue Code section 213(d); Medical premiums; Dental premiums; Vision premiums; Prescription premiums; Medicare Part B premiums; and Medicare Part D premiums. Note: Over-the counter (OTC) medication expenses, such as pain relievers and cold medications, will be eligible for reimbursement only with your health care provider s prescription or statement of medical necessity. Expenses are eligible only to the extent that they are not paid for by any health care coverage and have not been paid by other programs; i.e., your health savings account balance or other insurance. Expenses that exceed the balance in your HRA as of the date on which the claim is processed will not be reimbursed. However, if your expenses carry over to the following year, they can be reimbursed once the next year s HRA Credit has been made to your HRA. Expenses Not Covered The following expenses are not reimbursable under the HRA: Ineligible medical expenses not allowed under IRS Publication 502 (such as certain cosmetic procedures or expenses paid through health coverage); Premiums paid before-tax for group health plan coverage available through an employer; and Premium expenses incurred while not eligible for the HRA. List of Covered Expenses For a complete list of expenses the IRS allows (and does not allow) to be reimbursed, and any special requirements for a service or supply (including those in the list above) to be reimbursable under the HRA, refer to Internal Revenue Service (IRS) Publication 502, available by calling 800-TAX-FORM ( ). You can also access IRS Publication 502 by logging on to the IRS website at Health Reimbursement Account for Retirees (HRA) February 2016 Page 18 of 32

19 Catastrophic Drug HRA The Catastrophic Drug HRA is separate from your personal HRA and can be used to help pay for certain prescription drug expenses only. All Medicare-Eligible Retirees are eligible for the Catastrophic Drug HRA. You become eligible for the Catastrophic Drug HRA when you (or an Eligible Dependent): Are Medicare-Eligible; Use all of the HRA Credits in your HRA; and Meet the $250 threshold after reaching the Medicare Part D true annual out-of-pocket limit that qualifies you for the Catastrophic reimbursement level. Reimbursement for Catastrophic Prescription Drug Expenses If you are eligible for reimbursement of your catastrophic prescription drug expenses, the Catastrophic Prescription Drug HRA will separately reimburse you for eligible prescription drug expenses that exceed your annual Medicare true out-of-pocket limit, after the $250 threshold outlined above. The Medicare Part D true out-of-pocket limit may change from year to year (for 2016 it is $4,850). A prescription drug expense is only eligible for reimbursement from this Plan if it is an otherwise eligible prescription drug expense under your Medicare Part D or Medicare Part C (Medicare Advantage, which includes prescription drug) coverage. For example, in 2016, an eligible drug expense is reimbursable from the Catastrophic Drug HRA after you have paid $5,100 out of pocket for prescription drugs ($4,850 true out-of-pocket limit, plus $250 threshold). You will then be reimbursed for the copayments and 5% coinsurance not covered by Medicare Part D. There is a $1 million individual annual limit on Catastrophic Drug HRA benefits. This limit applies independently to you and any Eligible Dependents. Health Reimbursement Account for Retirees (HRA) February 2016 Page 19 of 32

20 When Participation Ends Retirees Your participation in the HRA ends on the earliest of the date on which: You die; You become ineligible for the HRA for any reason, including the amendment of the Plan s eligibility provisions; You were participating in the HRA as a disabled employee, are no longer deemed to be disabled or become eligible for retirement and are not eligible for retiree coverage under the HRA; For any reason, you are no longer enrolled in a medical or prescription drug plan though the Aon Retiree Health Exchange (unless you live outside the United States or in a state in which no coverage is offered for you and you meet the requirements for an HRA Credit); Your coverage through the Aon Retiree Health Exchange is terminated voluntarily or for nonpayment of premiums (Note: If coverage is reinstated in the future, the HRA will not be reinstated.); You again become a Career Agent; or The Retired Employee Plan, Retired Agent Plan or the HRA under either Plan is terminated. Spouse, Domestic Partner and Child Your Eligible Dependent s participation in the HRA ends on the earliest of the date on which: Your Dependent dies; Your Dependent no longer meets the HRA s eligibility requirements for any reason, including the amendment of the Plan s eligibility provisions; For a Spouse or domestic partner, you get divorced or your domestic partnership ends; For an eligible Child, the Child is no longer disabled or eligible for Medicare; Your coverage through the Aon Retiree Health Exchange is terminated for nonpayment of premiums; You are no longer enrolled in a medical or prescription drug plan though the Aon Retiree Health Exchange for any reason (unless you live outside the United States, or in a state in which no coverage is offered for you, and you meet the requirements for an HRA Credit); Your eligible Dependent is no longer enrolled in a medical or prescription drug plan through the Aon Retiree Health Exchange (unless your Dependent lives outside the United States, or in a state in which no coverage is offered for him or her, and he or she meets the requirements for an HRA Credit); or The Retired Employee Plan, Retired Agent Plan or the HRA under either Plan is terminated. Health Reimbursement Account for Retirees (HRA) February 2016 Page 20 of 32

21 Reimbursement of Premiums and Expenses Deadline for Claims for Reimbursement There is no time limit to file claims for reimbursement, except that in the case of death, your estate must file any claims for reimbursement from your HRA within six months following the date of your death. See Reimbursement After Your Death for details. How to Get Expenses Reimbursed Aon Hewitt (the Claims Administrator ) administers the HRA for MassMutual through Your Spending Account (YSA). Reimbursements are issued from a YSA bank account operated by UMB Financial. Auto-Reimbursement If You Are Medicare-Eligible In most cases, you are automatically enrolled in auto-reimbursement when you initially purchase an individual medical or prescription drug policy through the Aon Retiree Health Exchange. (See note below.) Once you have paid your premium, your premium will automatically be reimbursed to you from your HRA up to the current balance of your HRA Credits. Note: Most individual medical or prescription drug policy providers offer the auto-reimbursement option. If you enroll with a health care provider that does not offer this option, you will be responsible for submitting claims for reimbursement of your premiums. If you do not want the auto-reimbursement feature when you enroll in an individual medical or prescription drug policy through the Aon Retiree Health Exchange, contact the Aon Retiree Health Exchange. If You Are Pre-Medicare-Eligible Auto-reimbursement is available to Pre-Medicare-Eligible individuals; however, it is not automatic. If you wish to elect auto-reimbursement, you must file an initial online or paper claim (or reimbursement request) and provide documentation to YSA to initiate auto-reimbursement. YSA will reimburse the first month and then set auto-reimbursement to recur for future months. Note: It is your responsibility to contact YSA if you disenroll from a plan while you are receiving automatic reimbursement. Filing a Form for Reimbursement When you have eligible expenses under the HRA that are not reimbursed through auto-reimbursement, you can go online to the Aon Retiree Health Exchange and print and complete the Your Spending Account Claim form. If you do not have online access, contact the Aon Retiree Health Exchange for a paper form. Health Reimbursement Account for Retirees (HRA) February 2016 Page 21 of 32

22 You may submit a request for reimbursement online, by mail or by fax. Reimbursement requests are processed each business day. You may speed the processing of your claim by submitting your claim form and receipts online or via fax rather than by submitting them by mail. Via mail: Aon Hewitt Your Spending Account P.O. Box Orlando, FL Via Fax: Online: You will be reimbursed by check. However, for faster reimbursement, you may sign up to have reimbursements electronically deposited to your bank account via the Your Spending Account link from the Exchange website ( Note: Banking laws do not permit electronic deposit (direct deposit) to international bank accounts. (This does not apply to U.S. territories such as Puerto Rico.) Information Required for Reimbursement To make a claim for reimbursement, complete the Your Spending Account Claim form. You must sign and date the form, verifying the expenses have not been reimbursed by another insurance policy or plan. You need to include supporting documentation with your claim form, showing the following: For premium reimbursements: Premium amount(s) paid; Coverage period start date, typically the first day of the month; and Proof of payment, which may include: o Bank statements; o Copies of mailed checks; and o Statements provided by your insurance carrier. For reimbursement of other medical expenses: Type of service; Date of service; Service provider; Who service is for; Receipt or other proof of payment; and Requested reimbursement amount. Note: Verbal or handwritten information for general merchandise, illegible receipts, credit card receipts, and statements with a forwarding balance will not be accepted. Health Reimbursement Account for Retirees (HRA) February 2016 Page 22 of 32

23 Receiving Reimbursements You can only request and receive reimbursements for your own or your Eligible Dependent s eligible health care expenses, up to your current HRA balance. Reimbursement After Your Death If you die while participating in the HRA, reimbursement from your HRA will not be available for expenses incurred after your death. However, your estate may request reimbursement on your behalf for eligible health care expenses incurred before your death while you were participating in the HRA, as long as a request for reimbursement is filed within six months following the date of your death and such request does not exceed your remaining HRA Credits. Requests for reimbursements filed after the sixmonth period will be denied and any remaining balance in your HRA will be forfeited. Your HRA balance may be transferred to your surviving Eligible Dependent following your death (see below). Surviving Spouse, Domestic Partner or Eligible Child If you die while participating in the HRA and your Eligible Dependent is participating in the HRA at the time of your death, your Eligible Dependent will become the HRA holder as long as he or she continues to meet eligibility requirements. Your Eligible Dependent will receive your remaining HRA balance at the time of your death and will continue to receive future HRA Credits (except for certain dental participants see below), if such Eligible Dependent continues to meet the eligibility requirements, until the earlier of his or her death, the date he or she is no longer eligible for the HRA, or the termination of the applicable Retired Employee or Retired Agent Plan. In the event you have multiple surviving eligible Dependents, your spouse or domestic partner will become the HRA accountholder. If you do not have an eligible spouse or domestic partner participating in the HRA at the time of your death, then your oldest disabled child will become the HRA accountholder, if any. If you were eligible for a dental HRA Credit, the dental HRA Credit will cease upon your death. If eligible, your Dependent will only be eligible to receive the medical HRA Credit amount going forward and will not receive future dental HRA Credits. Health Reimbursement Account for Retirees (HRA) February 2016 Page 23 of 32

24 Claims and Appeals Procedures For this section, any reference to you or your also refers to a representative or provider designated by you to act on your behalf, unless otherwise noted. If you file a claim for reimbursement and one or more of your expenses is not reimbursed, or if you believe you have not been provided with the appropriate HRA Credit, you may file an appeal using the following procedures. In this SPD, a claim for reimbursement from your HRA for eligible expenses received by either you or your eligible Dependent is referred to as your claim. An appeal is a written request for benefits. The Appeals Reviewer means the body responsible for reviewing and deciding your claim. General Appeal Procedure Aon is the Appeals Reviewer for claims involving HRA reimbursements. The MassMutual Claims Committee is the Appeals Reviewer for claims involving the amount of your HRA Credit. To initiate an appeal, you must submit a request for an appeal in writing to the appropriate Appeals Reviewer within 180 days of receipt of a denial-to-reimburse notice. You should state the reason why you feel your appeal should be approved and include any information supporting your appeal. As a part of your appeal, you can submit written comments, documents, records or other information relating to your claim. In addition, you will be provided, upon written request and free or charge, reasonable access to (and copies of) all documents, records and other information relevant to your claim. The review will take into account all comments, documents, records and other information submitted relating to the claim regardless of whether the information was submitted or considered in the initial benefit determination. However, no consideration will be given to the initial denial of your claim during the review of the claim or appeal. In addition, someone who was not involved in the initial decision and who is not a subordinate or any individual who was involved in the initial decision will conduct the review. Responding to Your HRA Claim If the Appeals Reviewer needs information to process your appeal, the Appeals Reviewer will notify you, in writing, within 30 days after receiving your claim of the specific information required and the date when you can expect a determination. You will have 45 days to provide the additional information. The determination period to respond to your appeal will be suspended as of the date the Appeals Reviewer sends the notice and will resume again once you have provided the additional information. This determination date will be no later than 45 days after the date you filed your initial appeal. If you do not provide the requested information within the specified timeframe, the Appeals Reviewer will decide the appeal without the requested information. If the Appeals Reviewer, due to reasons beyond its control, determines that extra time is required to process your appeal, it will notify you in writing of the reasons for the extension and the new due date for its response to your appeal. The Appeals Reviewer will notify you of the extension within 30 days after its initial receipt of your appeal. The new due date will not be later than 45 days after the date you filed your initial appeal. Health Reimbursement Account for Retirees (HRA) February 2016 Page 24 of 32

25 Once you have filed an appeal, the Appeals Reviewer will notify you of its decision as soon as practical, but no later than 30 days after receipt of your appeal. If you do not follow the required procedures for filing an appeal, the Appeals Reviewer will notify you and explain the proper procedures to follow in filing your appeal. If Your Appeal Is Denied If your appeal is denied, in whole or in part, the Appeals Reviewer will send you a written notice of its decision, including: The specific reason(s) for the denial of the appeal; Reference to the specific Plan provision(s) on which the denial is based; A description of additional material or information necessary to perfect the claim and an explanation of why the material or information is necessary; A statement that you are entitled to receive, upon request and free of charge, reasonable access to and copies of all documents, records and other relevant information; and A description of the HRA s second-level appeal procedures and the time limits under those procedures, including your right to bring a civil action under Section 502(a) of ERISA if your appeal is denied. Appealing Your Adverse Determination If your appeal is denied, you will have 180 days following the receipt of the denial notice to file a written second-level appeal. The Appeals Reviewer for a second-level appeal is the MassMutual Plan Administrative Committee. The following procedures will apply in considering your second-level appeal. You may submit your second-level appeal in writing or by fax to the appropriate Appeals Reviewer. The Appeals Reviewer will review the facts, the reasons for the claim decision, and the information you have provided. The Appeals Reviewer will respond in writing within 60 days following the receipt of your second-level appeal. You may submit written comments, documents, records, and other information relevant to your appeal. Upon request, you will be provided (free of charge) copies of all Appeals Reviewer s documents, records, and other information relevant to your appeal. The review of your second-level appeal will consider all comments, documents, records, and other information you submit on the second-level appeal and will not afford deference to the initial denial of your appeal. The Appeals Reviewer will notify you, in writing, of its decision of your second-level appeal as soon as possible, but no later than 60 days after its receipt of your second-level appeal request. If the Appeals Reviewer determines that an extension of time for processing the second-level appeal is needed, it will notify you of the reasons for the extension and the extended due date before the end of the 60-day period. If Your Second-Level Appeal Is Denied This Plan is governed by ERISA. You have the right to bring a civil action under ERISA Section 502(a) if you are not satisfied with the outcome of the appeal process. In most instances, you may not initiate a legal action against the Plan until you have completed the appeal process. If your appeal is expedited, Health Reimbursement Account for Retirees (HRA) February 2016 Page 25 of 32