Newspaper Guild of New York The New York Times

Newspaper Guild of New York The New York Times Benefits Fund Pension Plan Scholarship Fund TO: FROM: Guild-Times Benefits Fund Participants Robert A. Costello, Administrator DATE: February 10, 2011 RE: Annual Open Enrollment During the period February 15, 2011 through March 15, 2011, the Plan of benefits of the Newspaper Guild of New York-The New York Times Benefits Fund (the Plan ) will have its annual open enrollment period, to be effective April 1, 2011. During this time, you may elect to change your current health insurance plan and/or enroll your dependents. Active participants may elect to enroll in the voluntary disability and term life insurance program. If you do not want to make a change to your present election or cover an adult child, do nothing. However, if you are enrolling or continuing to cover any child who is age 19 or older, then you must complete and return to the Fund Office the Special Adult Child Enrollment Form at the end of this notice. Failure to complete this form for a child who is age 19 or older will result in loss of coverage for such child as of April 1, 2011 (if the child is currently covered) or in no coverage for such child (if the child is not currently covered). The Enrollment Period for the Flexible Benefits Plan for Employees under the Jurisdiction of the Newspaper Guild of New York is February 15 through March 31, 2011. Evergreen enrollment is in effect, which means your current elections, if available will remain in effect. There is nothing you need to do unless you would like to change your coverage level, sign up for the first time, or waive coverage. HMO s Please note the increase in the additional monthly contributions for the HMO plans listed below. Employees who are enrolled in a Health Maintenance Organization (HMO) available through the Plan are required to pay additional contributions, if their HMO carries a higher premium than the cost of the Choice I Hospital and Major Medical/EPO coverage. Please see the table below to determine if your HMO will cost more in employee contributions. You will, of course, be able to switch to a different HMO, or into the Choice I Hospital and Major Medical/EPO coverage, during the upcoming Open Enrollment period, in order to avoid any additional contributions required by the HMO. If you are considering such a switch, please be sure to review plan information carefully because each option provides different coverage. Services covered by your current HMO plan may not be covered by your new choice. 1501 Broadway, Suite 1724 New York, NY 10036 Phone (646) 237-1670 Fax (212) 395-9299

Name of HMO 1 Additional Monthly Contribution Individual Additional Monthly Contribution Family Oxford $42.89 $203.99 Empire HMO-Region 1 2 $207.05 $597.22 Empire HMO-Region 2 3 $248.57 $705.17 CareFirst (Washington DC) $99.23 $454.09 If your HMO is not listed above, there is no additional contribution required. Please note that HMO coverage is not available to retirees. Health Care Reform Changes Changes soon will be taking effect as a result of the new health care reform law, the Patient Protection and Affordable Care Act of 2010 (the Affordable Care Act ). Some of these changes are described below; others will be described in a future notice. Grandfathered Status Under the Affordable Care Act: The Board of Trustees believes that the Plan s Choice I Hospital and Major Medical/EPO coverage, the Empire HMO, and the HIP HMO are grandfathered health plans under the Affordable Care Act. As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that your plan may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits. Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the Fund Office at (646) 237-1670. You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at (866) 444-3272 or www.dol.gov/ebsa/healthreform. This website has a table summarizing which protections do and do not apply to grandfathered health plans. 1 Horizon and BlueShield of California are no longer available under the Plan. 2 Region 1 is Bronx, Brooklyn, Staten Island, Rockland County and New Jersey. 3 Region 2 is Manhattan, Queens and Long Island. 2

Coverage for Your Children up to Age 26: The Affordable Care Act requires the Plan to cover your eligible children up until the end of the month in which they attain age twenty-six (26). As a result, you are able to enroll your eligible children* during the period February 15, 2011 through March 15, 2011, for coverage to be effective April 1, 2011. *Children whose coverage ended, or who were denied coverage (or were not eligible for coverage), because the availability of dependent coverage of children ended before attainment of age 26 are eligible to enroll in the Plan. Participants may request enrollment for such children during the period February 15, 2011 through March 15, 2011, to be effective April 1, 2011. For more information contact the Fund Office at (646) 237-1670. Effective as of April 1, 2011, coverage for your eligible children is available whether a child is married or unmarried, regardless of student status, employment status, financial dependency on you (except noted below), or any other factor other than the relationship between yourself and the child. However, if you are enrolled in Choice I Hospital and Major Medical/EPO coverage, the Empire HMO or the HIP HMO, children who are age 19 or older (but below age 26) cannot have access 4 to health insurance coverage through an employer (besides that of another parent s employer). If a child is married, though, coverage will not be extended to the child s spouse or children. Also effective as of April 1, 2011, coverage for your domestic partner s eligible child(ren) is available under the same conditions as set forth in the SPD except that the child is eligible until the end of the month in which he or she attains age 26 (rather than age 23). As a result of these changes, as of April 1, 2011, verification of your child s reliance upon you for support will no longer be required by the Plan. However, such verification will continue to be required for children of your domestic partner. Also, you will be required to verify the eligibility of your children (e.g., by providing a birth certificate), just as you re required to verify the eligibility of your spouse. The extension of adult child coverage is not automatic. If you wish to participate in this extension, you must request enrollment by March 15, 2011. Enrollment will be effective April 1, 2011. To request enrollment of your eligible child who is age 19 or older, even if the child is already enrolled, you must complete the enclosed Special Adult Child Enrollment Form and submit it along with a copy of your child s birth certificate to: Guild Times Benefits Fund 1501 Broadway, Suite 1724 New York, New York 10036 (646) 237-1670 4 Access means that the child is eligible to enroll in, or purchase health coverage through an employer (regardless of the costs of that coverage or the benefits in provides). 3

If you fail to request enrollment by March 15, 2011, your adult children will not be eligible to enroll in the Plan until the next annual open enrollment period (unless a special exception to the annual open enrollment rules, described below, applies). In addition, failure to submit the form for any child age 19 or older who is currently covered under the Plan will result in that child s loss of coverage as of April 1, 2011. If you remain eligible under the Plan, coverage for your eligible child will generally be provided until the last day of the month of his or her 26 th birthday. General Annual Open Enrollment Information You may elect to cover or decline coverage for yourself and to cover all, some, or none of your dependents. The election choices you make at the annual open enrollment period cannot generally be changed until the next annual open enrollment period. You cannot choose to decline coverage for yourself but then elect coverage for a dependent under the Plan. An exception to the annual open enrollment rule will be made if you elect not to enroll in the Plan because you, your spouse or children had coverage under another plan, but you (or your dependents) then lose that coverage because employer contributions cease or because of a loss of eligibility resulting from a change in family status (i.e., legal separation, divorce, death of the employee, termination of employment, reduction in hours, exhaustion of COBRA, loss of dependent status such as children s aging out of coverage, or moving out of an HMO service area) other than a failure to pay participant premiums or termination of coverage for cause (such as fraud). In that event, you will be given the opportunity to enroll them and yourself provided that you notify the Fund Office in writing within 30 days of the change in family status. An exception may also be made if you acquire a new dependent through marriage, birth, adoption, or the placement of a child for adoption. In that event, you may add the new dependent to coverage by providing written notice to the Fund Office within 30 days of the marriage, birth, adoption or placement for adoption. If you provide this notice and pay the required premium on time, the coverage will become effective on the date of the event (in the case of birth, adoption or placement for adoption) or the first of the month following the notice (in the case of marriage). Again, if you do not want to make a change to your present election and are not covering children age 19 or older, do nothing. If you want to cover a child who is age 19 or older, you must complete the Special Adult Child Enrollment Form at the end of this notice and submit it to the Fund Office no later than March 15, 2011. If you wish to change your medical plan option to a different medical plan, add or remove dependents other than children age 19 or older, or if you need additional information, please contact the Fund Office at (646) 237-1670. 4

This Annual Open Enrollment notice constitutes a Summary of Material Modifications ( SMM ) intended to provide you with an easy to understand description of changes made to the Plan. You should share it with your family and file it with your copy of the Fund s summary plan description. While every effort has been made to make this description as complete and as accurate as possible, this SMM, of course, cannot contain a full restatement of the terms and provisions of the Plan. Except to the extent this SMM explicitly purports to amend the Plan, if any conflict should arise between this SMM and the Plan, or if any point is not discussed in this SMM or is only partially discussed, the terms of the Plan will govern in all cases. The Board of Trustees (or its duly authorized designee) reserves the right, in its sole and absolute discretion, to amend, modify or terminate the Plan, or any benefits provided under the Plan, in whole or in part, at any time and for any reason, in accordance with the applicable amendment procedures established under the Plan and the Agreement and Declaration of Trust establishing the Plan (the Trust Agreement ). The Trust Agreement and the full Plan documents are at the Fund Office and may be inspected by you free of charge during normal business hours. No individual other than the Board of Trustees (or its duly authorized designee) has any authority to interpret the Plan documents, make any promises to you about benefits under the Plan, or to change any provision of the Plan. Only the Board of Trustees (or its duly authorized designee) has the exclusive right and power, in its sole and absolute discretion, to interpret the terms of the Plan and decide all matters, legal and/or factual, arising under the Plan. 5

GUILD-TIMES BENEFITS FUND SPECIAL ADULT CHILD ENROLLMENT FORM You must complete this form if you wish to enroll or continue the enrollment of any child who is at least age 19 and under age 26. Participant s Name & Address Participant s Social Security #: Participant s Telephone number By signing this form, the Participant certifies (1) that his or her child(ren) listed below is(are) currently at least 19 but less than 26 years of age and otherwise eligible under the Plan; (2) that such child(ren) is(are) not eligible for other employer health coverage (whether or not they actually elect it); and (3) that the Participant will notify the Fund Office immediately in writing if any child who is age 19 or older becomes eligible for other employer health coverage or if any other statement made on this form is no longer true or correct. PLEASE NOTE THAT COVERAGE UNDER THE PLAN WILL END ON THE LAST DAY OF THE MONTH THAT THE ADULT CHILD TURNS 26 YEARS OLD. PLEASE COMPLETE THIS SECTION TO CONTINUE OR OBTAIN COVERAGE FOR YOUR ADULT CHILD(REN): Child s Full Name Relationship Address Birth Date Soc Sec # 1. 2. 3. Participant s Signature Date Please return this form and, for any child not currently enrolled in the Plan, a copy of the child s birth certificate to: Guild-Times Benefits Fund 1501 Broadway, Suite 1724 New York, New York 10036 6