Summary of Benefits Upon Termination 2012

Transcription

1 Summary of Benefits Upon Termination 2012 Dewey & LeBoeuf Benefits Department or benefits@dl.com HEALTH & WELFARE PLANS IMPORTANT: Coverage under the benefits program will end at 11:59 pm on May 31, 2012, unless otherwise specified in this summary. If you are covered under any of the plans listed below, and assuming the firm continues to sponsor any or all the programs listed below, your options as of June 1, 2012 are as follows: COBRA COVERAGE Federal COBRA coverage New York State mini-cobra Medical/Dental/Vision Administered by ADP COBRA Services. ADP COBRA Services will send you a COBRA enrollment package with information on how you enroll and make payment. You can continue your medical, dental, and vision coverage through COBRA for a total of 18 months (i.e. through November 30, 2013) and the costs are listed below. Important: You will not be covered during the time period between May 15, 2012 and when the enrollment form is received by ADP and your payment clears. Once your payment clears, coverage will be reinstated retroactively and you will reimbursed for any eligible expenses incurred during the gap period. Please direct your questions to ADP COBRA Services at In New York State, the COBRA period for medical coverage only may be extended to 36 months by adding 18 months of New York State mini-cobra for medical coverage only after the 18 months of federal COBRA ends. ADP COBRA Services does not administer New York State mini-cobra. If the firm continues to sponsor the healthcare plans beyond November 30, 2013, you will need to contact the firm nearer the expiration of federal COBRA for information about how to obtain New York State mini-cobra. You can continue coverage through COBRA for up to 18 months or to age 65, whichever occurs first. ADP, our COBRA administrator, will send you notification of your COBRA entitlement. You will need to complete the enrollment forms and make timely payments to ensure continuation of coverage. Please direct your questions to ADP COBRA Services at Monthly COBRA rates for medical, dental and vision appear overleaf: Source: Dewey & LeBoeuf Benefits Department_HR version Page 1 of 7 Rev. March 2012 (ra) Americas Europe Russia/CIS Asia Pacific Africa Middle East dl.com

2 BLUECROSS BLUE SHIELD - MONTHLY COBRA RATES PPO EPO HDHP EE only $ $ $ EE+Spouse $1, $1, $ EE+Child(ren) $1, $ $ FAMILY $1, $1, $1, Albany office - Capital District: EE: $551.87; EE+Spouse: $1,103.74; EE+Child(ren): $1,103.74; Family: $1, CIGNA International participants only: EE: $536.53; EE+Spouse: $1,151.09; EE+Child(ren): $1,121.32; Family: $1, CIGNA DENTAL - MONTHLY COBRA RATES PPO HMO EE only $ $23.62 EE+Spouse $ $43.30 EE+Child(ren) $ $50.41 FAMILY $ $76.45 Albany office only - MVP Dental: EE: $46.82; EE+Spouse: $93.25; EE+Child(ren): $93.25; Family: $ UHC VISION - MONTHLY COBRA RATES EE only $ 5.31 EE+Spouse $ 8.96 EE+Child(ren) $ 9.38 Family $12.97 Please direct your questions to ADP COBRA Services at Flexible Spending Accounts (FSA) Expenses incurred from January 1, 2012 through the May 31, 2012 are eligible for reimbursement under the Plan. Assuming that the firm continues to sponsor flexible spending accounts, you have until March 31, 2013 to submit your 2012 eligible expenses. If the firm terminates the program, you will be notified. Please remember that eligible 2012 expenses are only those you incur while actively employed with the firm. Source: Dewey & LeBoeuf Benefits Department_HR version Page 2 of 7 Rev. May 2012 (jr/ra/ncj)

3 To access your account, please contact WageWorks, our FSA administrator, at or call After termination, you may continue your flexible spending account by making COBRA contributions for the current plan year, on an after-tax basis, to the Healthcare FSA. By doing so, it extends the time you can incur eligible expenses past May 31, 2012 and you can incur eligible expenses during the months you are making your COBRA FSA contributions. ADP, our COBRA administrator, will send you notification of your COBRA entitlement. You will need to complete enrollment forms and make timely payments to ensure continuation of coverage. For premium questions, contact ADP COBRA Services at For claims or benefits questions related to your FSA account, contact WageWorks at Healthcare Flexible Spending Account Card Your FSA card will be disabled on May 15, 2012, your termination date. You can submit any expenses incurred through the end of May 2012 (or longer if you continue with COBRA FSA contributions) using the Healthcare FSA Pay Me Back Claim form via fax, mail or online. You can access the form online from Note: If you elect FSA COBRA you can submit claims though the end of the month for which the COBRA premium is paid. You therefore have until March 31, 2013 to submit your 2012 eligible expenses, assuming that the firm continues to sponsor the FSA program. Life Insurance Basic Coverage You may convert this coverage to an individual plan, which will be issued without medical examination by MetLife, the firm's life insurance carrier, if you apply for it and the required premium payment is made. The firm will notify MetLife of your termination, and MetLife will send you a conversion package. The conversion form must be returned directly to MetLife within the required timeframe at the address indicated on the form. In the meantime, if you have questions, please contact MetLife at Life Insurance Supplemental Coverage This coverage is portable. The firm will notify MetLife of your termination, and MetLife will send you a conversion package. The completed form should be returned directly to MetLife within the required timeframe at the address indicated on the form. Please direct all questions or requests to MetLife at Source: Dewey & LeBoeuf Benefits Department_HR version Page 3 of 7 Rev. May 2012 (jr/ra/ncj)

4 Accidental Death & Dismemberment Insurance Basic Coverage Accidental Death & Dismemberment Insurance Supplemental Coverage Conversion is not available for this benefit. This coverage is portable. The firm will notify MetLife of your termination, and MetLife will send you a conversion package. Please direct all questions or requests to MetLife at Spouse/Domestic Partner and Child Term Life Insurance You may convert this coverage to an individual plan, which will be issued without medical examination by MetLife, if you apply for it and the required premium payment is made. The firm will notify MetLife of your termination, and MetLife will send you a conversion package. The conversion form should be returned directly to MetLife within the required timeframe at the address indicated on the form. Please direct all questions or requests to MetLife at Long-Term Disability Conversion is not available for this benefit. Long-Term Care Insurance (LTC) The firm will notify Prudential Insurance, the Long-Term Care insurance carrier, of your termination, and Prudential will bill you directly to continue this coverage. Please direct all questions or requests to Prudential Insurance Company of America at Group Universal Life Insurance (GUL) The firm will notify CIGNA Insurance, the GUL insurance carrier, of your termination, and CIGNA will bill you directly to continue this coverage. Please direct all questions to CIGNA GUL Customer Service at Health Savings Account (HSA) Your HSA is portable. This means that you can take your HSA with you when you leave and continue to use the funds you have accumulated. Funds left in your account continue to grow tax-free. If you are covered by a qualified HDHP, you can even continue to make tax-free contributions to your HSA. Distributions from your HSA that are used exclusively to pay for qualified expenses for you, your spouse, or dependents are excludable from your gross income. Your HSA funds can be used for qualified expenses and will continue tax-free even if you are not currently eligible to make contributions to Source: Dewey & LeBoeuf Benefits Department_HR version Page 4 of 7 Rev. May 2012 (jr/ra/ncj)

5 your HSA. (You do not need to continue your qualified HDHP coverage through COBRA, but you must maintain qualified HDHP coverage to continue making contributions. You may pay your COBRA premiums with tax-free HSA dollars should you elect. Your HSA is not subject to COBRA provisions. It is your account to take with you and to maintain as you choose.) To access your account and obtain information on how the HSA works, please contact the Mellon HSA Solution Contact Center at between 8:00am and 8:00pm EST Monday through Friday or Empire Member Services at or log onto Source: Dewey & LeBoeuf Benefits Department_HR version Page 5 of 7 Rev. May 2012 (jr/ra/ncj)

6 SAVINGS AND RETIREMENT PLANS If you were an eligible participant in the plan, upon termination your options are: Dewey & LeBoeuf 401(k) Savings Plan Your contributions to the Plan will cease with your May 15, 2012 paycheck. Your account can remain in the Dewey & LeBoeuf 401(k) Savings Plan as long as your account balance is greater than $1,000. You can request a distribution by contacting Fidelity Investments, the 401(k) plan's record-keeper directly at or by visiting If you have a loan under the Plan, you may continue to repay that loan as long as your account balance remains in the Plan, and the firm continues to sponsor the Plan. If you wish to rollover your account, then you must first satisfy your outstanding loan balance; otherwise, the outstanding balance will be deemed a taxable withdrawal at the time your account is rolled over. You will have 60 day to deposit all or part of that amount into an IRA. Please direct all questions to Fidelity Investments at Dewey & LeBoeuf Cash Balance Retirement Plan, or Dewey & LeBoeuf Pension Plan You will be notified if you have a benefit entitlement and what your benefit commencement options are. OTHER PROGRAMS If you were covered under any of the programs below, your options upon termination are as follows: Group Personal Liability Insurance MetLaw Legal Services Your coverage is effective through December 31, If you have any questions about this program or about coordinating your personal insurance with this group coverage, please contact Dorothy Zaleski at HUB Personal Insurance, or Dorothy.Zaleski@hubinternational.com. If you wish to continue your legal plan benefit after May 31, 2012, you must enroll for portable enrollment within 30 days of May 15, your last payroll deduction for the legal plan. To apply for portable enrollment, please contact the Hyatt Client Service Center at Enrollment is prepaid via remittance Source: Dewey & LeBoeuf Benefits Department_HR version Page 6 of 7 Rev. May 2012 (jr/ra/ncj)

7 MedjetAssist Commuter Program Gym Memberships of a lump sum payment equal to the sponsor s monthly rate times 30 months ($18.00 X 30 months = $540.00). Your coverage is active for 12 months after you have enrolled in the program. At the end of the 12-month period you have the option to renew the MedjetAssist program. If you have any questions about this program, please contact them at or access the website Participation ends May 31, If you have a commuter card, you have 90 days from May 31 to use the balance on your card. Participation ends May 31, You will need to contact your gym directly to discuss options for continuing your membership. Source: Dewey & LeBoeuf Benefits Department_HR version Page 7 of 7 Rev. May 2012 (jr/ra/ncj)