TRANSOCEAN RETIREE HEALTH REIMBURSEMENT ACCOUNT (HRA) PLAN Plan and Summary Plan Description Effective January 1, 2016
TABLE OF CONTENTS ABOUT THE HRA PLAN... 1 DEFINITIONS USED IN THIS SPD... 2 Company... 2 Eligible Medical Expense... 2 Eligible Medical Plan... 2 Health Reimbursement Arrangement (HRA)... 2 HRA Plan... 2 Participant... 2 Transocean... 2 HRA PLAN HIGHLIGHTS... 3 ELIGIBILITY AND COVERAGE UNDER THE PLAN... 4 You... 4 Your Dependents... 5 Dependent Verification and Notice Requirements... 6 ENROLLMENT PROCESS... 7 Introduction... 7 Outreach by OneExchange... 7 Your Enrollment Appointment... 7 Other Resources and Ongoing Assistance... 7 HRA ACCOUNT DETAILS... 8 How the HRA Works... 8 OneExchange Establishes Your HRA Account... 8 HRA Subsidies... 8 You Submit Claims for Reimbursement from the HRA... 9 Your HRA Account Balance is Adjusted... 9 What Happens if You Divorce... 9 What Happens on Your Death... 9 What Happens if You Lose Coverage... 9 ELIGIBLE MEDICAL EXPENSES UNDER THE HRA... 11 CLAIMS PROCEDURES FOR HRA REIMBURSEMENTS... 13 Submitting HRA Claims... 13 Authorized Representatives... 13 Claims Deadlines... 13 Claims Processing Details... 14
Claims Decision Deadline... 14 Denials of Claims... 14 Appealing a Denied Claim... 14 Denials of Appeals... 15 Authority of the Claims Administrator... 16 Requirements Before Filing Suit... 16 Offsets for Overpaid Claims... 16 WHEN PARTICIPATION ENDS UNDER THE HRA PLAN... 17 Participation Termination Events... 17 COBRA Continuation Coverage... 17 HRA PLAN ADMINISTRATIVE AND ERISA INFORMATION... 18 Plan Name... 18 Plan Sponsor and Other Employers Participating in Plan... 18 Employer Identification Number... 18 ERISA Plan Number... 18 Type of Plan... 18 Plan Administrator/Agent for Legal Process... 18 Claims Administrator... 19 Plan Funding... 19 Right to Change or Terminate Plan... 19 Agent for Service of Legal Process... 20 Plan Year... 20 Contact for Questions... 20 YOUR ERISA RIGHTS UNDER THE HRA PLAN... 21 Receive Information about Your Plan and Benefits... 21 Prudent Actions by Plan Fiduciaries... 21 Enforce Your Rights... 21 Assistance with Your Questions... 22
ABOUT THE HRA PLAN Effective January 1, 2016, eligible employees and their eligible dependents, upon retirement from Transocean, may receive subsidies to a health reimbursement account (HRA) through the Transocean Retiree Health Reimbursement Account (HRA) Plan (the Plan ). The Plan is administered by the Transocean Administrative Committee (the Plan Administrator ), members of which are appointed by the Board of Directors of Transocean Inc. This document is both the plan document and the Summary Plan Description, or SPD for the Plan. As with all the plans it provides, Transocean reserves the right to modify or terminate the Plan at any time. 1
DEFINITIONS USED IN THIS SPD Some terms that are used frequently in this SPD are capitalized, because they have specific meanings. Those terms are defined below. Company. The Company is Transocean Inc. Eligible Medical Expense. An Eligible Medical Expense is an expense that you or your dependent who is a participant in the HRA Plan incur for medical care which is not reimbursed by any other plan. (Medical care is defined in Section 213(d) of the Internal Revenue Code. The Eligible Medical Expenses section of this SPD provides additional information.) Eligible Medical Plan. For a Participant who is not eligible for Medicare, an Eligible Medical Plan will be a medical plan that provides minimum essential coverage for purposes of the Patient Protection and Affordable Care Act of 2010. The Participant who is not eligible for Medicare may enroll in an Eligible Medical Plan other than through OneExchange but must provide proof of enrollment to OneExchange in order to receive an HRA Subsidy. For a Participant who is eligible for Medicare, an Eligible Medical Plan will be a Medicare Advantage Plan or Medicare Supplemental Insurance Plan (also known as a Medigap plan); provided that if a Participant has Medicaid coverage that would be jeopardized by enrollment in a Medicare Advantage Plan or Medicare Supplemental Insurance (Medigap) Plan, a Medicare Part D that the Participant enrolls in through OneExchange will be treated as an Eligible Medical Plan. The Medicareeligible Participant must enroll in this coverage through OneExchange. Health Reimbursement Arrangement (HRA). A Health Reimbursement Arrangement (HRA) is a bookkeeping account established by OneExchange for a Participant when they begin participating in the HRA Plan. HRA Plan. The HRA Plan is the plan described in this SPD. Participant. A Participant is a retiree or dependent who is eligible for and covered under the HRA Plan as described in the Eligibility and Coverage section of this SPD. Transocean. Transocean is the Company and all affiliates and subsidiaries. 2
HRA PLAN HIGHLIGHTS The Company established the HRA Plan effective January 1, 2016 as part of its healthcare coverage for its eligible retirees and their eligible dependents. Instead of employer-sponsored retiree medical coverage, you will have a choice of individual medical, prescription drug, dental and vision plans through OneExchange. If you are eligible for an HRA subsidy, OneExchange will establish an HRA account for you when you become eligible to participate in the HRA Plan. Subsidy contributions to your HRA account will assist you with the purchase of coverage through OneExchange or, if you are not yet eligible for Medicare, through another exchange. You (and your dependents) must be covered under an Eligible Medical Plan to participate in the HRA Plan. For each year you maintain the required Eligible Medical Plan coverage, properly notify OneExchange of such required coverage, and remain eligible for an HRA subsidy, your HRA account will be credited annually with a tax-free contribution from Transocean that may be used to pay for certain medical expenses for you and your eligible dependents. If you and your spouse both qualify for a subsidy, an annual contribution will be made for each of you and placed in a joint account, the balance of which can be used by both you and your spouse. Only Transocean can contribute to the HRA account. HRA funds can be used to pay for healthcare coverage (like premiums for Medicare Part B coverage and/or medical, prescription drug, dental and vision plan premiums) or to reimburse other eligible healthcare expenses. For information and assistance on the Transocean partnership with OneExchange, you can call the OneExchange team: For Participants who are Medicare-eligible: 1-844-570-2791 For Participants who not Medicare-eligible: 1-844-570-2792 For Participants outside the U.S. who are Medicare-eligible: 801-994-9805 For Participants outside the U.S. who are not Medicare-eligible: 801-994-9806 Benefit Advisors are available from 7 am to 8 pm CT Monday through Friday. Or, visit: http://medicare.oneexchange.com/transocean or http://oneexchange.com/transocean. More Important Details The only benefit provided under the HRA Plan is the HRA account. This SPD only describes that HRA benefit. It doesn t describe the individual healthcare plans offered through One Exchange. This section of the SPD only describes the highlights of the HRA benefit. You must read the rest of this SPD for other important details that apply to the HRA. 3
ELIGIBILITY AND COVERAGE UNDER THE PLAN You and/or your dependents may receive an HRA Subsidy if you meet the criteria below AND you are informed by OneExchange that you and/or your dependents are entitled to an HRA Subsidy based on your service with Transocean. If you and/or your dependents are entitled to an HRA Subsidy, you will be notified by OneExchange shortly after you retire from Transocean. You You may be eligible to receive an HRA Subsidy (to the extent you are entitled to such HRA Subsidy due to your service with Transocean) if, on the date immediately preceding your termination from Transocean you were: at least age 55 and have completed at least 10 years of eligible service enrolled in a Company-sponsored medical plan paid in U.S. dollars classified as a: o o o o National Resident; National Commuter; Expatriate Resident; Expatriate Commuter (who resides in the U.S. following your termination of employment, or resides outside the U.S. and is classified by Transocean as part of a grandfathered population for purposes of this Plan); Note: Provided you meet the above eligibility requirements, you may be eligible to receive an HRA Subsidy even if you have not elected to retire under a Company-sponsored retirement plan. Your eligibility for, and the amount of, any HRA Subsidy is based on factors including your years of service with Transocean, your age at the time of your retirement, and whether you provided service to the legacy GlobalSantaFe company. For the avoidance of doubt, no HRA Subsidy will be provided to a retiree (or his dependents) who is not classified as a Legacy Transocean retiree or a Legacy GlobalSantaFe retiree once that retiree reaches age 65. (Note that only whole years of service will count towards qualification as a legacy retiree.) In order to receive any HRA Subsidy to which you may be entitled: (1) You must have coverage under an Eligible Medical Plan and have provided proof of such coverage to OneExchange; (2) You must not be participating in any Transocean-sponsored health care coverage (for example, COBRA continuation coverage offered by Transocean after your retirement); and (3) You must have completed the OneExchange HRA enrollment procedures, including opting-in to the HRA Plan if you are not yet eligible for Medicare. 4
However, if you or your dependent resides outside of the United States, your or such dependent may receive any HRA Subsidy to which you may be entitled without purchasing coverage under an Eligible Medical Plan. When you retire, AonHewitt will determine whether you are eligible for an HRA Subsidy and the amount of any such HRA Subsidy. You will then receive a personalized notice from OneExchange detailing any HRA Subsidy to which you are entitled. You (and your dependents) are not eligible to receive an HRA Subsidy for a calendar year if: You fail to enroll in an Eligible Medical Plan and complete the HRA Plan enrollment procedures with OneExchange by the annual deadlines described by OneExchange; Elect only Medicare prescription drug coverage (Medicare Part D) without also enrolling in a Medicare medical plan through OneExchange; or Receive a health tax credit or subsidy from the U.S. government to assist you with the purchase of coverage on a public health exchange for that calendar year. In addition, an election of retiree coverage through OneExchange will be considered a rejection of COBRA continuation coverage for all persons who make such an election. Once you become eligible for Medicare, you (and your dependents) cease to be eligible to receive an HRA Subsidy if: You fail to enroll in an Eligible Medical Plan and complete the HRA Plan enrollment procedures with OneExchange by the deadlines described by OneExchange; You fail to maintain continuous coverage under an Eligible Medical Plan for the calendar year; Elect only Medicare prescription drug coverage (Medicare Part D) without also enrolling in a Medicare medical plan through OneExchange; or Receive a health tax credit or subsidy from the U.S. government to assist you with the purchase of coverage on a public health exchange for that calendar year. Once you become eligible for Medicare, you will forever forfeit the right to participate in the Plan if you don t enroll with OneExchange by the deadline set by OneExchange. Your Dependents Provided they were covered under your medical coverage on your date of termination, the following dependents may be eligible to receive an HRA Subsidy to the extent they are entitled to such HRA Subsidy due to your service with Transocean: Your legal spouse or domestic partner; Your children under age 26 who are: o o your biological children; your stepchildren; or 5
o children for whom you have legal guardianship, are legally adopted by you or placed with you for adoption; Your children over age 26 who otherwise meet the definition of children above and are: o o o severely disabled by prolonged physical or mental incapacity; were disabled at the time their coverage would have otherwise terminated; and remain unmarried and principally dependent on you for support because they re unable to independently earn a living. You may not add any additional dependents for purposes of the HRA Plan at any time after your initial enrollment. Dependent Verification and Notice Requirements If you have a disabled dependent you wish to cover beyond the date his or her eligibility would otherwise end, you must provide proof of disability within 60 days of the date your dependent would otherwise lose coverage. If a dependent loses his or her status as an eligible dependent, you must notify the Benefits Center in writing within 60 days of the loss of status. 6
ENROLLMENT PROCESS Introduction This section of the SPD briefly describes the main steps in the Plan enrollment process with respect to the HRA Subsidy. Detailed information regarding the process in effect when it s your time to enroll will be provided to you directly by OneExchange. You must enroll under the HRA Plan with OneExchange and be covered by an Eligible Medical Plan by the deadline communicated by OneExchange in order to receive any HRA Subsidy for which you may be eligible. You won t automatically be enrolled in any Eligible Medical Plan. Once you become eligible for Medicare, you will forever forfeit the right to participate in the Plan if you don t enroll with OneExchange by the deadline. Outreach by OneExchange OneExchange will send you information about the steps you ll need to take to enroll in the HRA Plan and an Eligible Medical Plan when you retire from Transocean. Your Enrollment Appointment After receiving the information that OneExchange mails to you, you ll call OneExchange to schedule an enrollment appointment. During your scheduled enrollment appointment, you ll talk with an experienced representative who ll provide these services: Unbiased education about the types of individual Eligible Medical Plans available to you, how much they cost, and how your eligible expenses will be covered under those plans. Advice and decision-making support for your plan selection, based on your current coverage and future needs. Help enrolling in the plans you select. Review of premium costs and payment options so you can select a payment option that works best for you (because you ll make payments for your coverage directly to the insurance carrier(s) of the plan(s) you elect). OneExchange can assist you with dental, vision and prescription drug plans, in addition to medical plans. Other Resources and Ongoing Assistance You ll also have access to online decision-making tools and other resources anytime you need them through the OneExchange website. Visit OneExchange at http://medicare.oneexchange.com/transocean or http://oneexchange.com/transocean. If you are enrolled in an Eligible Medical Plan through OneExchange, OneExchange can provide ongoing advocacy and support, including answering your questions on coverage, claims, provider networks, and premiums under your Eligible Medical Plan in addition to questions on HRA reimbursements. 7
HRA ACCOUNT DETAILS How the HRA Works OneExchange Establishes Your HRA Account OneExchange will automatically establish an HRA in your name if you qualify to receive an HRA Subsidy under the HRA Plan and you complete the HRA enrollment process with OneExchange. (The account may be established in your spouse s name if your spouse enrolls before you.) If you and your spouse enroll at the same time, OneExchange will establish a joint HRA in both of your names. Except as provided in the box below, you and your dependents who are HRA Plan participants will always have a single, combined HRA. If you and your spouse are each eligible to participate in the HRA Plan as a Transocean retiree, OneExchange will establish a separate HRA for each of you when you enroll. You may request that these accounts be combined within 30 days following the date you receive an HRA Funding Kit from OneExchange. You must contact OneExchange to request a joint HRA account. Requests made following the 30 day deadline will not be honored. Please request a joint account. If you don t have a joint account when you die or otherwise lose eligibility, your account balance will be forfeited once the claims submission deadline of 6 months past the date of loss of eligibility has passed. HRA Subsidies If you qualify to receive an HRA Subsidy, Transocean will make a contribution to your HRA at the beginning of each year, as long as you remain a Participant. A contribution will also be made for each of your eligible dependents who are Participants and who also qualify for an HRA Subsidy. After you retire from Transocean, you will receive a notice from OneExchange detailing any HRA Subsidy for which you are eligible. Contact OneExchange with any questions regarding your eligibility for an HRA Subsidy. Pro-ration. A Participant s initial HRA Subsidy will be prorated based on the number of months the person will be a Participant in the initial year of coverage. However, proration will not apply to retirees and dependents who become Participants on January 1, 2016. 8
You Submit Claims for Reimbursement from the HRA You can use amounts credited to your HRA for tax-free reimbursement of Eligible Medical Expenses that you or your dependents who are also HRA Plan participants incur. These Eligible Medical Expenses include Medicare Part B premiums and premiums for your medical, dental, vision and prescription drug coverage. You must first pay your premiums and other healthcare expenses, then submit claims to receive reimbursements. However, OneExchange offers an auto-reimbursement option for many plans premiums for Participants who are Medicare-eligible. Details on how to submit claims are in the Claims Procedure section of this SPD. You may be reimbursed for up to the full amount credited to your HRA at any time. Tax Considerations. Any expenses reimbursed under an HRA cannot be claimed as deductions or used for tax credits on federal income taxes. You are ultimately responsible for correctly reporting your tax information to the IRS and for correctly using your HRA. Your HRA Account Balance is Adjusted When Transocean makes its annual contribution, OneExchange credits the full amount of the contribution to your HRA account. When you re reimbursed for expenses, OneExchange reduces the amount credited to your account. Any money remaining credited to your account at the end of each year will automatically roll over to the next year. What Happens if You Divorce If you have a joint HRA account with your spouse and you divorce, you must notify OneExchange. Your spouse may be eligible to continue to access a portion of the HRA account balance if he or she elects continuation coverage under COBRA and pays any applicable premiums. Otherwise, your spouse will have 180 days to file for reimbursement of any claims incurred prior to the date of the divorce, subject to the remaining balance in the joint HRA account. What Happens on Your Death If you die and you have a joint HRA account with a spouse or dependent child, the joint account will continue as your dependent s account. Your dependents may submit Eligible Medical Expenses you incurred for 180 days following your death. If you die without a joint HRA account, your account will be forfeited. This is true even if you have a spouse who is an HRA Plan participant with a separate HRA account (because you were both eligible Transocean employees and you did not choose to combine your accounts). However, your dependents, estate or representatives may submit claims for Eligible Medical Expenses you incurred for 180 days following your death. What Happens if You Lose Coverage If you lose HRA Plan coverage and you have a joint HRA account with a spouse or dependent child who continues to be a Participant, your HRA account will continue even though you may no longer receive 9
HRA Subsidies. (This could happen, for example, if you are no longer enrolled in Eligible Medical Coverage but your spouse continues to have the required coverage.) You may submit Eligible Medical Expenses you incurred while you were a Participant for up to 180 days following your loss of coverage. If you lose coverage and you don t have a joint HRA account with a dependent who continues as a Participant, your HRA account will be forfeited. However, you may submit claims for Eligible Medical Expenses you incurred for 180 days following your loss of coverage. 10
ELIGIBLE MEDICAL EXPENSES UNDER THE HRA The HRA can only be used to reimburse Eligible Medical Expenses. An Eligible Medical Expense is an expense you or your dependent who is an HRA Plan Participant incurs for medical care, as that term is defined in Internal Revenue Code Section 213(d), which is not reimbursed by any other plan. These generally are expenses related to the diagnosis, care, mitigation, treatment or prevention of disease. Some common examples of Eligible Medical Expenses include: Medications prescribed by a doctor; Insulin; Dental expenses; Dermatology; Physical therapy; Contact lenses or glasses used to correct a vision impairment; Birth control pills; Chiropractor treatments; Hearing aids; Wheelchairs; and Premiums for medical, prescription drug, dental, vision or long-term care insurance. Some examples of common items that are not Eligible Medical Expenses include: Baby-sitting and child care; Long-term care services; Cosmetic surgery or similar procedures (unless the surgery is necessary to correct a deformity arising from a congenital abnormality, accident or disfiguring disease); Funeral and burial expenses; Household and domestic help; Massage therapy; Custodial care; Health club or fitness program dues; and Cosmetics, toiletries, toothpaste, etc. You can find more information about what items are and are not Eligible Medical Expenses in IRS Publication 502, Medical and Dental Expenses. (Be careful in relying on this Publication, however, as it is specifically designed to address what medical expenses are deductible on Form 1040, Schedule A, not what is reimbursable under a health reimbursement account.) If you need more information regarding whether an expense is an Eligible Medical Expense under the HRA Plan, contact OneExchange. Timing of Eligible Medical Expenses. Only Eligible Medical Expenses incurred by a person while that person is a Participant may be reimbursed from an HRA. Expenses are incurred when the medical care is provided, not when the person is billed, charged or pays for the expense. Therefore, an expense that has been paid but not incurred, like a pre-payment to a physician, cannot be reimbursed until the service or treatment has been provided. 11
In the event that an overpayment or erroneous payment is made as a reimbursement from a Participant s HRA Account, OneExchange will be entitled to recover the amount of the overpayment or erroneous payment, including by offset of future benefits under the HRA Plan. 12
CLAIMS PROCEDURES FOR HRA REIMBURSEMENTS This section describes the procedures for submitting claims for reimbursements from your HRA. This SPD does not describe how you should submit claims under the Eligible Medical Plan you choose through OneExchange. For information on how to submit those claims, contact the insurer of the Eligible Medical Plan(s) you have chosen. Submitting HRA Claims Your HRA balance can only be used to reimburse Eligible Medical Expenses that you have already paid. You can t make payments directly from the HRA. However, OneExchange has entered into automatic premium reimbursement agreements with many insurers. This will allow you to obtain reimbursement for insurance plan premiums each month without submitting a new reimbursement request form each month. You can activate automatic reimbursement of your healthcare plan premiums by visiting the OneExchange website or speaking with OneExchange customer service at 1-844-570-2791. To receive reimbursement from your HRA for Eligible Medical Expenses that are not automatically reimbursed, you must obtain a reimbursement form from OneExchange, complete it and mail or fax it to: Mail: Towers Watson s OneExchange, P.O. Box 981155, El Paso, TX 79998-1155 Fax: 1-855-321-2605 You must also include a copy of (1) your insurance premium bill, or (2) an explanation of benefits or EOB from a healthcare plan, or (3) if no EOB is provided, a written statement from the service provider that includes the name of the patient, the date service or treatment was provided, a description of the service or treatment; and proof of payment. Claims Administrator. The Claims Administrator referred to in this SPD with respect to HRA reimbursements is the OneExchange department that handles HRA reimbursement claims processing. The Claims Administrator with respect to eligibility for an HRA subsidy and the amount of such HRA Subsidy is Aon Hewitt at the claim level and the Plan Administrator at the appeal level. The address and fax number listed above are only used for HRA reimbursement claims submission. For HRA reimbursement claims questions, contact OneExchange at 1-844-570-2791. For questions on eligibility for and amounts of HRA Subsidies, contact the Transocean Benefits Center. Authorized Representatives You may authorize another person to represent you in making a claim for a benefit or in appealing the denial of a claim. The HRA Plan may, from time to time, specify forms you must use or procedures you must follow to authorize another person to represent you. Claims Deadlines Most claims can be submitted for reimbursement at any time. However, no reimbursements will be made for claims submitted after these deadlines: Claims for a deceased Participant must be submitted within 180 days following the date of the Participant s death. Claims for Participants who cease to be eligible under the HRA Plan must be submitted within 180 days following loss of eligibility for HRA Subsidies. 13
When is a claim submitted? A claim is considered submitted to the Claims Administrator upon actual delivery to the Claims Administrator in the proper form with all of the required information. If the claim is not complete, it may be denied or the Claims Administrator may contact you for the additional information. Claims Processing Details Claims Decision Deadline The Claims Administrator must notify you of an initial claim payment or denial within 30 days of receiving the initial claim. If the Claims Administrator needs more information from you and if the Claims Administrator provides an extension notice during the initial 30-day period, the Claim Administrator has 45 days to notify you of a claim payment or denial. After receiving an extension notice, you have 45 days to complete your claim. If you do not supply the requested information within the 45-day period, your claim will likely be denied. If your claim for reimbursement is approved, you will be provided reimbursement as soon as reasonably possible following the determination. Claims are paid in the order in which they are received. Denials of Claims If any part of your claim is denied you will be given a written or an electronic notice that will include: The reason for the denial; A reference to the specific plan provisions on which the denial was based; A description of any additional material or information needed to perfect the claim and a statement of why the information is necessary; If any internal rule, guideline, or protocol was relied on in denying the claim, a copy of the rule, guideline or protocol will be provided; If the claim was denied on appeal and was based on an exclusion or a limit like medical necessity or experimental treatment, either the scientific or clinical judgment for the exclusion or limit as applied to your circumstance, or a statement that such an explanation will be provided to you free of charge upon request; A statement describing any appeal procedures offered by the plan including any applicable deadlines, and your right to obtain further information about the procedures; and A statement of your right to file a lawsuit under ERISA if your claim is denied on final appeal to the Plan Administrator. Appealing a Denied Claim If you wish to appeal a denied claim, you may do so. The appeal must be made in writing to the Claims Administrator within 180 days after the date on which you receive the original claim denial. You may give the Claims Administrator written comments, documents, records and other information relating to your claim for benefits that you want to have considered on appeal, and all that information will be considered, even if it was not submitted or considered in the original claim decision. The review on appeal won t defer to the claim denial and won t be made by the person who made the original claim denial, or a subordinate of that person. 14
You are also entitled, upon request, to see and get a free copy of any plan policy statement or guideline that relates to the denied benefit, even if the policy statement or guideline was not relied on in denying the claim. You may also request to see all documents, records, and other information relevant to your claim for benefits and to get free copies of that information. This includes any information that: Was relied on in making the benefit decision; Was submitted, considered or generated in making the benefit decision, even if it was not relied on; Shows that administrative procedures or safeguards were followed to make sure that the benefit decision was appropriately made based on the plan documents (excluding information in other claimants' files); and Is a statement of policy or guidance under the plan concerning the denied treatment or benefit for your diagnosis, even if it was not relied on in making the benefit decision. In deciding an appeal of any claim denial that is based in any way on a medical judgment (including things like whether a treatment is experimental or not medically necessary), the Claims Administrator must get advice from a health care professional who has training and experience in the relevant area of medicine. Upon your request, you will be provided the names of any medical experts who were consulted in connection with your claim denial, even if the advice was not relied upon in making the denial. The health care professional consulted by the Claims Administrator cannot be a person who was consulted by the Claims Administrator in connection with the claim denial (or a subordinate of the person who was consulted in the original claim). The Claims Administrator must make its decision on your appeal within a reasonable time following the date the appeal was received but not longer than 60 days. Denials of Appeals If any part of your claim is denied on appeal, you will be given a written or an electronic notice that will include: The specific reason(s) for the denial; A reference to each of the specific plan provision(s) on which the denial is based; If any internal rule, guideline or protocol was relied on in denying the claim on appeal, either include that specific rule, guideline or protocol, or a statement that a rule, guideline or protocol was relied on in denying the claim and that a copy will be provided to you free of charge on request; If the claim denial on appeal was based on an exclusion or a limit like "medical necessity" or "experimental treatment, either the scientific or clinical judgment for the exclusion or limit as applied to your circumstances, or a statement that such an explanation will be provided to you free of charge upon request; A statement that you are entitled, upon request, to see all documents, records, and other information relevant to your claim for benefits and to get free copies of that information; A statement describing any further appeal procedures offered by the plan, including any applicable deadlines, and your right to obtain further information about any such procedures; and A statement of your right to file a lawsuit under ERISA if you claim is denied on final appeal to the Claims Administrator. 15
Authority of the Claims Administrator The Plan Administrator has delegated the Claims Administrator discretionary authority and responsibility for determining benefits under the HRA Plan, as described earlier in these Claims Procedures. In processing claims and appeals, the Claims Administrator has discretionary authority to interpret the provisions of the HRA Plan and to interpret the facts and circumstances of claims for benefits. No benefits will be paid under the HRA Plan unless the Claims Administrator decides in its sole discretion that the claimant is entitled to them. Any decision made by the Claims Administrator on final appeal is conclusive and binding, unless you file suit under ERISA upon denial of your claim on final appeal. Requirements Before Filing Suit You cannot bring any legal action against the HRA Plan, Plan Administrator or Claims Administrator for any reason unless you first complete all the steps in the appeal process described in this document. After completing that process, if you want to bring a legal action against the HRA Plan, Plan Administrator or Claims Administrator, you must do so within one year of the date you re notified of the final decision on your appeal, or you lose any rights to bring such an action. Offsets for Overpaid Claims If you re paid more than you should have been reimbursed for a claim or if a claim is paid for ineligible expenses, the Claims Administrator may deduct the overpayment from future claim payments due to you under the HRA Plan. 16
WHEN PARTICIPATION ENDS UNDER THE HRA PLAN Participation Termination Events A Participant s participation in the HRA Plan will end on the earliest of: If the Participant is a retiree, the date the Participant is rehired by Transocean as an active employee. (The participation of the retiree s dependents who are Participants will terminate at the same time.) If the Participant is a retiree who is eligible for Medicare, the date the Participant ceases to maintain continuous coverage under an Eligible Medical Plan. (The participation of the retiree s dependents who are Participants will terminate at the same time.) The date of the Participant s death. (If the Participant is a retiree, the participation of the retiree s dependents who are Participants will terminate upon the retiree s death. However, a surviving spouse may be eligible to continue to receive a reduced HRA Subsidy (based on the same factors used to determine the amount of the retiree s HRA Subsidy). Aon Hewitt will determine eligibility for such reduced HRA Subsidy and will communicate any such eligibility to the retiree s surviving spouse.) The date an amendment that terminates the Participant s eligibility under the HRA Plan is effective. The date the HRA Plan is terminated. Transocean currently intends that the HRA Plan will terminate no later than December 31, 2025. As with all the plans it provides, Transocean reserves the right to modify or terminate the Plan at any time, including prior to December 31, 2025. Termination permanent. Once a Participant s participation ends, it cannot be reinstated at any later date. COBRA Continuation Coverage A federal law commonly referred to as COBRA (the Consolidated Omnibus Budget Reconciliation Act), requires most employers sponsoring group health plans to offer employees and their families the opportunity to temporarily extend their health coverage at group rates in certain cases where their coverage would otherwise end. It provides similar rights to retirees if the employer commences a Chapter 11 bankruptcy proceeding and they lose coverage as a result. If this occurs, the Plan Administrator will inform you of your right to elect COBRA coverage and all of the related details. 17
HRA PLAN ADMINISTRATIVE AND ERISA INFORMATION Plan Name The formal name of the plan is the Transocean Retiree Health Reimbursement Arrangement (HRA) Plan. The plan is commonly known as the HRA Plan. Plan Sponsor and Other Employers Participating in Plan The Plan sponsor is Transocean Inc. (referred to in this SPD as the Company ). Although the Company is the most significant employer maintaining the HRA Plan, the HRA Plan does provide for the possibility of adoption by affiliated companies. HRA Plan participants and covered dependents may, upon written request to the Plan Administrator, receive information as to whether a particular employer is a sponsor and, if so, the address of that employer. Employer Identification Number The EIN assigned to the Company by the IRS is 66-0582307. ERISA Plan Number 519 Type of Plan The HRA Plan is a welfare benefit plan providing medical benefits. The HRA Plan is intended to qualify as a self-insured medical reimbursement plan for purposes of Sections 105 and 106 of the Internal Revenue Code, as amended ( Code ), as well as a health reimbursement arrangement as defined in IRS Notice 2002-45. Plan Administrator/Agent for Legal Process The Transocean Administrative Committee appointed by the Board of Directors of the Company is the Plan Administrator and named fiduciary of the Plan. The Plan Administrator has the discretionary authority under the Plan to interpret and construe all terms of the Plan and to decide all questions of eligibility and to determine the amount, manner and time of payment of all benefits. The Plan Administrator may delegate its responsibilities and authority under the Plan, and has delegated all HRA reimbursement claims and appeal processing responsibilities (and discretionary authority to perform those functions) to the Claims Administrator. To the extent the Claim Administrator processes appeals, they serve as appeals fiduciaries. 18
The contact information for the Plan Administrator is: Claims Administrator Transocean Inc. Administrative Committee c/o Benefits Department 4 Greenway Plaza Houston, TX 77046 (713) 232-7500 The Plan Administrator has delegated the authority to OneExchange to provide the daily administration of the HRA Plan and to process claims and decide appeals related to HRA reimbursements under the HRA Plan. The Plan Administrator retains the authority to process claims and decide appeals related to eligibility for HRA Subsidies. The applicable Claims Administrator shall have the authority, in its discretion, to interpret the terms of the Plan, to decide questions of eligibility for coverage or benefits under the Plan, and to make any related findings of fact. All decisions made by the Claims Administrator shall be final and binding on the participants and beneficiaries to the full extent permitted by law. The Claims Administrator s contact information for questions related to HRA reimbursements is: Towers Watson 10975 South Sterling View Drive South Jordan, UT 84905 1-844-570-2791 (U.S. number for Medicare-eligible Participants) 1-844-570-2792 (U.S. number for non-medicare-eligible Participants) 801-944-9805 (non-u.s. number for Medicare-eligible Participants) 801-944-9806 (non-u.s. number for non-medicare-eligible Participants) http://medicare.oneexchange.com/transocean or http://oneexchange.com/transocean The Claims Administrator s contact information for submitting claims for HRA reimbursements only is: Towers Watson P.O. Box 981155 El Paso, TX 79998-1155 Fax: 855-321-2605 Plan Funding The Company pays the entire cost of the HRA Plan from the general assets of the Company. Right to Change or Terminate Plan The Company reserves the right to amend or terminate all benefits under the HRA Plan for any reason and without notice. If the HRA Plan is amended or terminated, you will not be entitled to any plan benefits or have any further rights other than payment of benefits you had accrued before the HRA Plan was amended or terminated. 19
In general, no plan assets may ever revert to or be paid to the Company. If the plan is terminated, amounts then credited to HRA accounts may continue to be made available to Participants or forfeited as provided in the document(s) by which the plan is terminated. Agent for Service of Legal Process The person designated to receive service of legal process for the Plan is the Plan Administrator. Plan Year HRA Plan financial records are kept on a calendar year basis (January 1 - December 31). Contact for Questions For questions relating to your eligibility for an HRA subsidy: Benefits Center 1-855-744-5005 +1 646-259-0401 www.yourtransoceanbenefits.com For questions relating to the administration of the HRA: Based on age: Pre-65: 1+844-570-2792, or www.oneexchange.com/transocean 65 +: 1+844-570-2791, or medicare.oneexchange.com/transocean 20
YOUR ERISA RIGHTS UNDER THE HRA PLAN As a participant in the plan, you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA). ERISA provides that all plan participants are entitled to: Receive Information about Your Plan and Benefits Examine, without charge, at the Plan Administrator s office and at other specified locations, such as worksites and union halls, all documents governing the plan, including insurance contracts and collective bargaining agreements, and a copy of the latest annual report (Form 5500 Series) filed by the plan with the U.S. Department of Labor and available at the Public Disclosure Room of the Employee Benefits Security Administration. Obtain, upon written request to the Plan Administrator, copies of documents governing the operation of the plan, including insurance contracts and collective bargaining agreements, and copies of the latest annual report (Form 5500 Series) and updated summary plan description. The administrator may make a reasonable charge for the copies. Receive a summary of the plan s annual financial report. The Plan Administrator is required by law to furnish each participant with a copy of this summary annual report. Prudent Actions by Plan Fiduciaries In addition to creating rights for plan participants, ERISA imposes duties upon the people who are responsible for the operation of the employee benefit plan. The people who operate your plan, called fiduciaries of the plan, have a duty to do so prudently and in the interest of you and other plan participants and beneficiaries. No one, including your employer, your union, or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a plan benefit or exercising your rights under ERISA. Enforce Your Rights If your claim for a plan benefit is denied or ignored, in whole or in part, you have a right to know why this was done, to obtain copies of documents relating to the decision without charge, and to appeal any denial, all within certain time schedules. Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request a copy of a plan document or the latest annual report from the plan and do not receive them within 30 days, you may file suit in a federal court. In such a case, the court may require the Plan Administrator to provide the materials and pay you up to $110 a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the administrator. If you have a claim for benefits which is denied or ignored, in whole or in part, you may file suit in a state or federal court (after you have followed all of the claims and appeals procedures provided for under the plan). If it should happen that plan fiduciaries misuse the plan s money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a federal court. The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees, for example, if it finds your claim is frivolous. 21
Assistance with Your Questions If you have any questions about your plan, you should contact the Plan Administrator. If you have any questions about this statement or about your rights under ERISA, or if you need assistance in obtaining documents from the Plan Administrator, you should contact the nearest office of the Employee Benefits Security Administration, U.S. Department of Labor, listed in your telephone directory or the Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue N.W., Washington, D.C. 20210. You may also obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the Employee Benefits Security Administration. 22