Summary of Material Modifications for the Flexible Spending Accounts Program

Summary of Material Modifications for the Flexible Spending Accounts Program This notice serves as a Summary of Material Modifications (SMM) updating information in the 2012 Flexible Spending Accounts Program Summary Plan Description (SPD) booklet. This SMM provides information about important changes to that document. The changes noted in this SMM are effective as of January 1, 2013, except as noted. Please review your 2012 Flexible Spending Accounts Program SPD booklet for Flexible Spending Accounts Program details. Change in Accessing the Prudential Benefits Center Website through the Prudential Intranet The first paragraph of the Via the Prudential Intranet section on page 1 of the 2012 Flexible Spending Accounts Program SPD booklet is replaced by the following. To access the Prudential Benefits Center website through the Prudential intranet, visit PRU Today, select the My Prudential tab under Most Popular, then go to the Health, Life & Wellness tab. The Prudential Benefits Center website link is in the right column under Popular Destinations. Addition of Notice Regarding Civil Union Partnership and Same-Sex Marriage Important Notice Regarding Civil Union Partnership and Same-Sex Marriage Certain states have passed legislation that requires insurers to provide equal benefit coverage for civil union partners and same-sex spouses, if spousal coverage is provided through an employer s group insurance plan. For more details regarding eligibility requirements for these programs, please contact the Prudential Benefits Center at 1-800-PRU-EASY (1-800-778-3279) and follow the prompts for Health and Welfare benefits. Change to the Claims Period Update to Definition of Claims Period The Claims Period definition in the Glossary of the 2012 Flexible Spending Accounts Program SPD booklet is replaced by the following. The period during which you incur eligible expenses that can be reimbursed from the HCRA, Limited Purpose HCRA and DCRA. The Claims Period is January 1 of the Calendar Year or the date your participation took effect, if later, through March 15 of the year following the Calendar Year or the end of the pay period during which your employment ends, if earlier. However, if your participation ends during a pay period that includes or ends on December 31, you may continue to incur eligible expenses through March 15 of the year following the Calendar Year in which your participation ends to apply against any balance remaining in your accounts. For example, the Claims Period for Flexible Spending Account contributions made in 2013 is January 1, 2013, through March 15, 2014. Other Sections Updated by the Revised Claims Period The following sections in the 2012 Flexible Spending Accounts Program SPD booklet describe the period during which eligible expenses can be incurred. The same periods of time described in the Claims Period definition above, apply in these sections. Eligible vs. Ineligible Expenses sections beginning on pages 11, 24 and 33; Use It or Lose It Rule sections beginning on pages 13 and 25 and on page 35; If You Retire or Your Employment Ends section on page 40; If You No Longer Meet Eligibility Requirements section on page 41; Flexible Spending Accounts Program Summary of Material Modifications Page 1

Unpaid Leave of Absence section beginning on page 41 (under the If You Take a Leave of Absence section); If You Are Disabled section beginning on page 42; and Health Care Reimbursement Account and Limited Purpose HCRA and Dependent Care Reimbursement Account sections on page 61 (under the Family and Medical Leave Act section). Changes to Claim Forms Availability of Online Claims Submission The Claim Forms sections of the 2012 Flexible Spending Accounts Program SPD booklet applicable to the Health Care Reimbursement Account (HCRA) beginning on page 15, applicable to the Limited Purpose HCRA on page 27 and applicable to the Dependent Care Reimbursement Account beginning on page 49 are modified by the following addition. Instead of submitting a paper form, you also have the option to submit your claim and request reimbursement online. You can arrange for your reimbursement to be direct deposited into your checking or savings account. Visit the Cigna website at www.mycigna.com for details. If You Are Enrolled in the Consumer Directed Health Program 80 (CDHP 80) or Consumer Directed Health Program 90 (CDHP 90) The box in the Health Care Reimbursement Account Claim Forms section on page 16 of the 2012 Flexible Spending Accounts Program SPD booklet is replaced by the following. Please note: If you are enrolled in the CDHP 80 or CDHP 90, your covered medical expenses (for example, office visits, labs, x-rays, Hospital charges) will be paid under the CDHP 80 or CDHP 90, and any eligible out-of-pocket expenses will be automatically paid out of the Health Fund as long as there is an available balance. Your EOB will identify the covered expenses, the portion of those charges that were paid from the Health Fund, the portion for which you are responsible to satisfy the annual Deductible and then the portion paid by the CDHP 80 or CDHP 90 versus the portion that is your responsibility (Coinsurance). You may request reimbursement from your HCRA via the claim form for eligible medical expenses not reimbursable under the CDHP 80 or CDHP 90 (for example, expenses incurred after you have exhausted your Health Fund that are subject to the annual Deductible or Coinsurance, as well as out-of-network expenses that exceed Reasonable and Customary [R&C] fees). You must follow the claims processing procedures under the CDHP 80 or CDHP 90 before you request reimbursement from your HCRA (for more information about the CDHP 80 or CDHP 90 claims processing procedures, refer to the Medical Program SPD booklet). Under the CDHP 80 or CDHP 90, generally, you must first exhaust your Health Fund before you can use your HCRA to reimburse yourself for medical expenses. However, during the extended claims period for the HCRA (January 1 through March 15 of the year after the year you contributed to the HCRA), Cigna will reimburse your eligible medical expenses from any balance remaining in your prior year HCRA before reimbursing you from your Health Fund. Change to Claims Administrator for COBRA (Effective April 1, 2013) References to the Claims Administrator for enrollment and eligibility claims in the Enrollment and Eligibility Claims for COBRA Coverage or COBRA-Like Coverage section on page 55 and in the Glossary definition of Claims Administrator on page 64 of the 2012 Flexible Spending Accounts Program SPD booklet are updated by the following. The Prudential Benefits Center is the Claims Administrator for COBRA enrollment and eligibility claims, and the Administrative Committee is the Claims Fiduciary for COBRA. Flexible Spending Accounts Program Summary of Material Modifications Page 2

Changes to Continuing Your Coverage The Health Care Reimbursement Account and the Limited Purpose Health Care Reimbursement Account (Effective April 1, 2013) The Continuing Your Coverage The Health Care Reimbursement Account and the Limited Purpose Health Care Reimbursement Account section beginning on page 56 (including sub-sections through page 59) of the 2012 Flexible Spending Accounts Program SPD booklet are modified by the following. Change to COBRA Administrator (Effective April 1, 2013) The COBRA administrator has changed and is now the Prudential Benefits Center. All references to Ceridian Benefits Services in the 2012 Flexible Spending Accounts Program SPD booklet are replaced with the Prudential Benefits Center. Telephone Access (Effective April 1, 2013) You can contact the Prudential Benefits Center by calling 1-800-PRU-EASY (1-800-778-3279) and following the prompts for Health and Welfare benefits and then COBRA. Prudential Benefits Center Representatives are available to assist you between 8 a.m. and 6 p.m., Eastern time, Monday through Friday, except on holidays. Mail Access (Effective April 1, 2013) The mailing address for filing claims related to program enrollment and eligibility is: Prudential Benefits Center Claims and Appeals Management (CAM) P.O. Box 1407 Lincolnshire, IL 60069-1407 Changes to How to Continue HCRA or Limited Purpose HCRA Coverage (Effective April 1, 2013) The second and third paragraphs of the "How to Continue HCRA or Limited Purpose HCRA Coverage" section on page 58 of the 2012 Flexible Spending Account Programs SPD booklet are replaced by the following. To elect continuation of coverage, you must make your COBRA election on the Prudential Benefits Center website at www.prubenefitscenter.com or by calling the Prudential Benefits Center at 1-800-PRU-EASY (1-800-778-3279) within 60 days after the later of the following dates: The date on the notice of the right to continue coverage; or The date the HCRA or Limited Purpose HCRA coverage ends. An additional 45-day period is available to pay the initial premium from the date of your COBRA election. Contribution Due Date (Effective April 1, 2013) The Contribution Due Date section on page 58 of the 2012 Flexible Spending Accounts Program SPD booklet is replaced by the following. If you elect COBRA continuation coverage for the HCRA or Limited Purpose HCRA, you must pay the initial contribution within 45 days of the date of your COBRA election. Your invoice will indicate the amount of the first payment. Thereafter, COBRA contributions must be paid monthly and within 30 days after the date each one is due. If payment is not received in a timely manner, your coverage will be terminated retroactively to the last day for which timely payment was made. Paying for Coverage (Effective April 1, 2013) The Paying for Coverage section on page 58 of the 2012 Flexible Spending Accounts Program SPD booklet is replaced by the following. You can choose to pay for your coverage monthly by submitting payment to the Prudential Benefits Center or using the Pay Now feature on the Prudential Benefits Center website to process a one-time bank payment from your checking or savings account. You can also take advantage of direct debit with the Prudential Benefits Center and have automatic deductions from your checking or savings Flexible Spending Accounts Program Summary of Material Modifications Page 3

account. If you choose direct debit, all future payments will be taken from your account on the first of the month. To make a direct debit payment, you can access the Prudential Benefits Center website at www.prubenefitscenter.com or call the Prudential Benefits Center at 1-800-PRU-EASY (1-800-778-3279). Changes to Family and Medical Leave Act The first four paragraphs of the Family and Medical Leave Act section beginning on page 60 of the 2012 Flexible Spending Accounts Program SPD booklet are replaced by the following. All Employees who have at least one year of service and have worked at least 1,000 hours (excluding any unpaid leave, any disability absences and any designated FMLA absences during that period) during the 12 months prior to commencing a leave are eligible for unpaid leave under the Federal Family and Medical Leave Act of 1993 (FMLA). Eligible Employees may take an unpaid leave of absence, up to 12 weeks, under the following circumstances: To care for the Employee s child (as defined by applicable law) after birth, or placement for adoption or foster care; To care for the Employee s Spouse, child or parent (as defined by applicable law) with a serious health condition; To care for the Employee s child who is 18 years of age or older with a serious health condition, but is incapable of self-care because of a mental or physical disability (as defined by applicable law), regardless of when the disability commenced; For the Employee s own serious health condition that renders the Employee unable to perform the essential functions of the Employee s job; or For qualifying exigency leave when (1) the Employee s Spouse, child or parent is a member of a regular component of the United States Armed Forces (i.e., is a military member ) and is deployed to a foreign country; or (2) the family member belongs to the National Guard or Reserves and is called to military duty in support of a contingency operation. Qualifying exigencies may include: attending certain military events; arranging for alternative childcare for the military member s child; addressing certain financial and legal arrangements arising from the military member s covered active duty; attending counseling for the Employee, the military member or the military member s child when the need for the counseling arises from the military member s covered active duty; attending post-deployment reintegration briefings and handling other situations arising out of the military member s deployment; spending up to 15 calendar days with a military member who is on Rest and Recuperation leave during covered active duty; and addressing certain activities related to the care of the military member s parent who is incapable of self-care, such as arranging for alternative parental care, providing care on a non-routine, urgent basis, admitting the parent to a new care facility or attending meetings with staff at a care facility. The Company also provides a special leave entitlement that permits eligible Employees who are the Spouse, son, daughter, parent or next of kin of a covered service member (as defined by applicable law) to take up to 26 weeks of leave to care for a covered service member during a single 12-month period. A covered service member is a: Current member of the Armed Forces, including a member of the National Guard or Reserves, who has a serious injury or illness incurred in the line of active duty (or had a serious injury or illness that existed before the beginning of the member s active duty and was aggravated by service in the line of duty while on active duty in the Armed Forces) that may render the service member medically unfit to perform his/her duties for which the service member is undergoing medical treatment, recuperation or therapy; or is in outpatient status; or is on the temporary disability retired list; or Flexible Spending Accounts Program Summary of Material Modifications Page 4

Veteran who is undergoing medical treatment, recuperation or therapy, for a serious injury or illness that was incurred in the line of active duty (or had a serious injury or illness that existed before the beginning of the member s active duty and was aggravated by service in the line of duty while on active duty in the Armed Forces) and who was a member of the Armed Forces, including a member of the National Guard or Reserves, at any time during the period of five years preceding the date on which the veteran undergoes that medical treatment, recuperation or therapy. The 26-week leave available to eligible Employees to care for a covered service member is not in addition to the 12-week leave allotment available for other types of FMLA leave. Thus, if an Employee takes leave for any other reason permitted by the FMLA, the leave will be deducted from the 26-week allotment during that year. Certain state statutes may provide additional leave rights and coverage. For complete information regarding your FMLA leave rights and responsibilities, as well as your family and medical leave rights and obligations in the specific state in which you work, contact your local Human Resources Consultant or refer to the Human Resources Policies Lotus Notes database under the Quick Links tab on Prudential s intranet site, PRU Today. Update to Definition of Extended Family Member The definition of Extended Family Member on page 68 of the 2012 Flexible Spending Accounts Program SPD booklet is replaced by the following. To meet the eligibility requirements of an Extended Family Member under a program, your Extended Family Member must meet all of the following criteria: Be age 18 or older, but not have reached the first day of the month in which he/she attains Medicare eligibility. In situations where the Extended Family Member is not eligible for Medicare (for example, a non-u.s. citizen), eligibility ends at either the end of the month during which he/she attains age 65 (for all birth dates that do not fall on the first of a month) or on the date he/she attains age 65 (for all birth dates that fall on the first of a month); Meet the definition of a Qualifying Relative as defined in Internal Revenue Code Section 152 (without regard to the requirement that the child has gross income less than the exemption amount or whether the Extended Family Member has dependents or has filed a joint return with his Spouse) during the period of coverage; Have lived with you for at least six months and remain a member of your household during the period of coverage; Not otherwise be eligible for coverage under the Program (for example, as a Prudential Employee); Be related to you as follows: mother, father, grandmother, grandfather, stepmother, stepfather, mother-in-law, father-in-law, brother, sister, stepbrother, stepsister, niece, nephew, aunt, uncle, son, daughter, stepson, stepdaughter, son-in-law, daughter-in-law, brother-in-law or sister-in-law, or any person (other than your Spouse) who, for that Calendar Year, lives with you and is a member of your household; Not file a joint return for Federal income tax purposes; and Be a citizen or resident of the United States, Canada or Mexico. Flexible Spending Accounts Program Summary of Material Modifications Page 5

Important Notice This SMM is not a substitute for the official Plan Document(s) that govern(s) the operation of the program. All terms and conditions of the program, including your eligibility and any benefits, will be determined pursuant to and are governed by the provisions of the applicable Plan Document(s). If there is any discrepancy between the information in this summary or in any other Prudential materials related to the program and the actual Plan Document(s), or if there is a conflict between information discussed by anyone acting on Prudential s behalf and the actual Plan Document(s), the Plan Document(s), as interpreted by the applicable Plan Administrator in its sole discretion, will always govern. Prudential may, in its sole discretion, modify, amend, suspend or terminate any or all of its HR policies, programs, Plans and benefits including those described in this summary, in whole or in part, at any time, without notice to or consent of any participant, employee or former employee to the extent permissible under applicable law. Nothing contained in this summary is intended to constitute or create a contract of employment, nor shall it constitute or create the right to remain associated with or in the employ of Prudential for any particular period of time. In addition, no oral or written statements made by anyone acting on Prudential s behalf are intended to create the right to remain associated with or in the employ of Prudential for any particular period of time. Employment with Prudential is employment at-will. This means that either you or Prudential may terminate the employment relationship at any time, with or without cause or notice. Flexible Spending Accounts Program Summary of Material Modifications Page 6