Rev. 1/1/12 Sprint Flex Plans Eligibility and Enrllment Sectin
What is Inside Sprint Flex Plans... 3 Wh Is Eligible T Participate In Sprint Flex Plans... 3 Duplicate Cverage... 6 Enrllment... 6 Enrllment Appeals... 8 Csts... 9 When Cverage Begins... 10 When Cverage Ends... 10 Legal Infrmatin and Other Sectins... 10 Rev. 8/23/12 Page 2
Sprint Flex Plans Except as superseded by any insurance plicies/certificates prvided by any applicable insurer, this Sectin is part f a Summary Plan Descriptin fr the fllwing Sprint Nextel Crpratin (Sprint) flexible welfare benefit plans (Sprint Flex Plans): Grup Health Plans Medical Plans (including prescriptin drug cverage) SprintSelect Plan Health Accunt Plan HMO Medical Plans TRICARE Supplement Medical Plan Dental Plan Visin Plan Health Care Flexible Spending Accunt Plan Dependent Care Flexible Spending Accunt Plan Supplemental Emplyee Life Insurance Plan Dependent Life Insurance Plan Accidental Death and Dismemberment (AD&D) Plan Supplemental Lng-Term Disability Plan Legal Services Plan Wh Is Eligible T Participate NOTE: This dcument des nt cver the eligibility and enrllment, if any required, fr yur ther Sprint benefits, such as Retirement and Wealth (401(k), Pensin, ESPP, Deferred Cmpensatin), Discunts (e.g., Phne Prgrams), Other Benefits (e.g., Aut/Hme/Pet insurance, universal life, accident (Aflac)), PTO, incentive cmpensatin r equity awards. Fr this infrmatin, please visit i-cnnect>my Life and Career> Benefits. This Sectin prvides imprtant details abut wh is eligible t participate in and enrllment rules fr the Sprint Flex Plans. This Sectin will use the terms we, ur r us t refer t Sprint r its whlly-wned US subsidiary and t yu r yur t refer t ur emplyees (and their Eligible Dependents as applicable) eligible t participate in a Sprint Flex Plan as described belw. Emplyees Yu are eligible t participate in the Sprint Flex Plans if yu are classified n ur payrll recrds as: ur regular, cmmn law emplyee; and regularly scheduled t wrk 20 r mre hurs per week; and nt n a persnal leave f absence exceeding 30 cnsecutive calendar days (and fr initial cverage nt n any leave f absence). A regular, cmmn-law emplyee des nt include an individual classified in ur payrll recrds as an intern, temprary emplyee r temprary wrker r cntractr, even if a curt, administrative agency r ther persn r entity determines such an individual is a cmmn law emplyee. In additin: fr Life Insurance/AD&D nly, yu must be a U.S. citizen r resident f the U.S. and nt a resident f Puert Ric; and yu are nt eligible t participate in the Health Care Flexible Spending Accunt ( FSA ) if yu are rehired after 30 cnsecutive calendar days after yur Rev. 8/23/12 Page 3
terminatin f emplyment, r return frm an unpaid leave f absence (except extended military) f mre than 30 cnsecutive calendar days, and within the same calendar year f yur prir Sprint Health Care FSA cverage (nt COBRAcntinued) ending. Yur Family Members ( Eligible Dependents ) If yu participate in a Sprint Medical, Dental, Visin, Life r AD&D Plan, yu may als cver yur Eligible Dependents, defined belw, under that plan. Yu may nt cver any persn wh des nt meet the definitins belw. Enrlling, attempting t enrll r maintaining enrllment fr ineligible persns is cnsidered misrepresentatin r fraud, which is prhibited by the Sprint Flex Plans and will result in (a) the immediate end f cverage fr such persn retractive t the date f the persn s ineligible cverage and yur bligatin t repay any benefits paid after that date by a Sprint Flex Plan n behalf f such persn and (b) applicable emplyment and/r incme tax cnsequences. We, ur applicable third party administratrs r ur insurers may frm time t time require prf, satisfactry in ur/their sle judgment, that a persn yu have enrlled fr cverage is an Eligible Dependent. Minimum prf dcuments are listed belw. NOTE: yu will be asked t prvide nly cpies (i.e., nt riginals) f prf dcumentatin and yu may redact (black ut) persnal financial infrmatin. Yu will be permitted 45 days after being requested t prvide satisfactry prf; failure t timely d s is cnsidered yur admissin f misrepresentatin r fraud as t the eligibility f the persn whse eligibility is nt prved, with the cnsequences described abve. Fax the required dcumentatin t 866-523-8544. Eligible Dependents are: Spuse the ppsite-sex persn t whm yu are legally married Dmestic partner (DP) ** yur same- r ppsite-sex partner fr s lng as yu bth: are at least 18 years ld and legally cmpetent t cnsent t the DP relatinship, are nt related t each ther by bld, are in an exclusive cmmitted relatinship similar t marriage and intend t remain s indefinitely but are nt married t each ther r any ther persn, have nt ended a marriage r dmestic partnership with each ther r any ther persn fr at least 12 mnths, have resided tgether cntinuusly fr at least 12 mnths and intend t reside tgether indefinitely, share jint respnsibility fr each ther s cmmn welfare r financial bligatins, and are nt dmestic partners fr the sle purpse f btaining Sprint benefits. Prf f eligibility: A cpy f yur mst recently filed federal tax return 1, AND A cpy f yur marriage certificate. 2 Sprint Affidavit f Dmestic Partnership certifying t the eligibility criteria at left AND A cpy f a jint residency dcument 3 r a jint respnsibility dcument. 4 ** Fr residents f Califrnia under the HMO Plan nly, DP may als mean yur CA Registered Dmestic Partner and the nly required dcumentatin is yur Registratin. Rev. 8/23/12 Page 4
Eligible Dependents are: Child a persn frm live birth up t age 26 wh is: yur, yur Spuse s r DP s* bilgical, legally adpted r step child; r placed fr adptin r therwise placed by curt rder r placement agency (e.g., fster children, under legal guardianship) with yu, yur Spuse r yur DP; r a child wh is an alternate recipient pursuant t a Qualified Medical Child Supprt Order (QMCSO) per QMCSO Prcedures in Legal Infrmatin Sectin. Disabled Child yur, yur Spuse s r DP s* bilgical r legally adpted child age 26 r mre wh is ttally disabled and was cvered under the applicable Sprint plan immediately befre turning age 26 and has been cvered cntinuusly thereafter. *if DP als enrlled Dcumentatin cnstituting prf f eligibility: Shwing bth yu (r Spuse/DP as applicable) and the Child, a cpy f ne f the fllwing: birth certificate, baptismal certificate, paternity/ maternity test, schl recrd with parent signature, curt adptin r guardianship rder, placement agreement AND, if n birth date/age in abve A cpy f gvernment dcumentatin (e.g., driver s license, city clerk ntice with fficial seal dcumenting birth date, r state-issued birth registratin card) shwing Child s age r birth date AND, fr step r DP Child Spuse r DP dcumentatin as applicable The dcumentatin fr Child AND A statement frm the Child s health care prvider that the Child is unable t engage in any substantial gainful activity because f a medically determinable physical r mental impairment which can be expected t result in death r which has lasted r can be expected t last fr a perid f nt less than 12 mnths 1 Yur mst recently filed federal tax return must be fr the immediately preceding calendar year unless it is unavailable slely because ur deadline fr prviding is befre yur filing deadline, in which case yu must prvide yur return fr the previus tax year (and timely-filed extensin applicatin if applicable). If yur filing status was nt married filing jintly r married filing separately, shwing yur Spuse, further dcumentatin will be required, unless a return with a married filing status is unavailable because ur deadline fr prviding is befre the filing deadline fr yur first required return filing as married r neither yu nr yur Spuse earned incme fr any prir tax year during which yu were married. 2 A cpy f yur marriage certificate may be btained by cntacting the vital recrds department f the state in which yu btained yur license. If yu were nt statutrily/ceremnially married, but are married accrding t cmmn law in the states belw, yu must instead prvide a dcument evidencing yur jint residency, dated at least ne year befre yur Spuse s Benefit Effective Date (r grandfather date, if applicable), shwing bth yur and yur Spuse s name at the same address, such as a residential lease agreement, mrtgage statement r ther lan statement r cupn, a bank r credit card statement, a prperty tax statement, a utility bill, r bth parties drivers licenses. Jurisdictins currently recgnizing cmmn-law marriages are AL, CO, IA, KS, MT, RI, SC, TX and UT. Jurisdictins that recgnized the creatin f cmmn-law marriages befre the date indicated ( grandfather date ) are GA (1/1/97), ID (1/1/96), OH (10/10/91), OK (11/1/98), and PA (1/1/05). 3 One dated at least 12 mnths, and ne dated within 30 days, befre yur DP s Benefit Effective Date, (r individual dcuments shwing the same address) and shwing bth yur and yur Rev. 8/23/12 Page 5
DP s name at the same address, a residential lease agreement, mrtgage statement r ther lan statement r cupn, a bank r credit card statement, a prperty tax statement, a utility bill r bth parties drivers licenses. 4 Dated at least 12 mnths befre yur DP s Benefit Effective Date and shwing bth yur and yur DP s name, at the same address as applicable, (r individual dcuments shwing the same address) a residential lease agreement, mrtgage statement r ther lan statement r cupn, real estate r persnal prperty (e.g., car) title, a bank r credit card statement, a prperty tax statement, a utility bill, frm designating yur DP as primary beneficiary fr life insurance, retirement plan, r will, frm designating yur DP as health care pwer f attrney, c-parenting agreement, r an adptin agreement. If yur request t cver an individual is denied, see the Legal Infrmatin Sectin (Eff. 8/8/11) fr infrmatin n yur rights t appeal that determinatin. Duplicate Cverage Enrllment Please nte that n persn, including yu, may be duble-cvered under a Sprint Grup Health Plan as: bth an emplyee and a Dependent r a Dependent f tw emplyees. If bth yu and anther Sprint emplyee are hired at the same time r bth elect cverage during Annual Enrllment fr a dependent nt currently cvered under a Sprint Grup Health Plan, which results in dual cverage, Sprint will request yu bth t agree n the cntrlling electin with respect t that cverage. If this request is nt met timely, the latest electin will cntrl, retractive t the Benefits Effective Date. If a dependent child is currently cvered under a Sprint Grup Health Plan and anther Sprint emplyee enrlls the dependent child ( as the result f New Hire r Annual Enrllment electins), resulting in dual cverage, the earliest electin will cntrl. If a dependent child r spuse is currently cvered under a Sprint Grup Health Plan and becmes emplyed by Sprint, Sprint will request yu bth t agree n the cntrlling electin with respect t that cverage. Persns may, hwever, be duble- cvered under the FSA, Life Insurance, AD&D and Legal Services as: bth an emplyee and a Dependent r a Dependent f tw emplyees (except fr the Legal Services Plan). Fr tax and ther reasns, yur enrllment in r waiver f cverage under any Sprint Flex Plan is a binding electin fr the entire calendar year (r remainder f the year, as applicable), unless yu experience a Life Event permitting a mid-year electin change as described in the Life Events Sectin (Eff. 8/8/11). Regular enrllment perids and rules are: Rev. 8/23/12 Page 6
WHO Current Emplyees New Hires (See belw) WHAT Annual Enrllment each fall emplyees may enrll r re-enrll in, r waive Sprint Flex Plans cverage fr the fllwing calendar year withut any waiting perid r prf f insurability (except fr certain life insurance cverage levels, as described in the applicable materials) NOTIFICATION Annual Enrllment materials mailed t yur hme address befre the Annual Enrllment perid ENROLLMENT PROCEDURE ENROLLMENT DEADLINE AUTOMATIC DEFAULT COVERAGE www.sprint.cm/be nefits r at i-cnnect > My Life & Career > Benefits Overview > Benefits Enrllment Guide Fllw the applicable links n i-cnnect > Emplyee Self Service > Benefits Hme End f Published Annual Enrllment Perid New Hire Enrllment as a newlyhired emplyee yu becme eligible fr cverage in the Sprint Flex Plans n and effective beginning the 30 th cnsecutive calendar day after yur date f hire (except fr Supplemental LTD, which is effective as f the first calendar day in which yu are actively at wrk immediately after yu cmplete 12 mnths f emplyment) Rev. 8/23/12 Page 7 New Hire Enrllment materials mailed t yur hme address after yur emplyment ffer www.sprint.cm/benefits r at i-cnnect > My Life & Career > Benefits Overview > Benefits Enrllment Guide Fllw the applicable links n i- Cnnect > Emplyee Self Service > Benefits Hme 30 th cnsecutive calendar day after yur date f hire If yu d nt enrll in r waive cverage in the Sprint Flex Plans by the applicable deadline, yu will autmatically be enrlled in and will have t pay fr: Fr the entire next calendar year all f yur prir year Sprint Flex Plans that are still available in the new calendar year (except fr Flexible Spending Accunts, which require enrllment every year), and/r a replacement plan as described in the applicable Annual Enrllment materials if a prir year Sprint Flex Plan will nt be available in the new calendar year Effective n the 30 th cnsecutive calendar day after yur date f hire thrugh the entire rest f the calendar year: Medical/Prescriptin Drug: Sprint Health Accunt Plan fr yu nly - Smker status Life Insurance: $10,000 Emplyee Life Insurance cverage fr yu nly Yu will nt be eligible fr any ther Sprint Flex Plan until the next Annual Enrllment perid, unless yu experience a Life Event permitting a mid-year Benefit Change.
New Hires includes emplyees wh: have an increase in regularly scheduled hurs per week t 20 r mre; r return frm an unpaid leave f absence (except extended military) f mre than 30 cnsecutive calendar days; r are rehired frm prir Sprint emplyment mre than 30 cnsecutive calendar days after their terminatin date. New Hires excludes emplyees wh: return frm any extended military leave f absence r frm any persnal leave f absence within 30 cnsecutive calendar days; r are re-hired within 30 cnsecutive calendar days after their terminatin date. Instead, these emplyees will be re-enrlled autmatically, retractive t their prir terminatin date, in their previus Sprint Flex Plan benefits. Enrllment Appeals Yur benefits enrllment must be cmpleted by 11:59 p.m. CT n the applicable deadline. It is yur respnsibility t ensure that Emplyee Self Service (ESS) reflects the enrllment yu elected s yu need t check yur pay advice and ESS regularly. Sprint vluntarily prvides an pprtunity fr yu t appeal any Sprint Flex Plan enrllment r denial theref by filing a written request fr review t Sprint s Health & Prductivity Grup within 60 cnsecutive calendar days after the date f the applicable enrllment deadline. Appeals filed after 60 cnsecutive calendar days after the applicable enrllment deadline will nt be reviewed. Appeals must be sent t Sprint Health and Prductivity Benefits, ATTN: Benefit Appeals, at: POSTAL SERVICE: KSOPHL0302-3A774 6500 Sprint Parkway Overland Park, KS 66251 FAX: 913-523-0481 Interffice Mail: Email: KSOPHL0302-3A774 Appeal.Benefit@sprint.cm Appeals must include dcumentatin supprting yur request t enrll r change yur benefit electin specifically as t missed deadlines, either prf f yur meeting the deadline r extenuating circumstances fr yur failure t meet the deadline. If yu have any questins abut this prcess, please cntact the Emplyee help Line at 800-697-6000 The decisin rendered n yur appeal is final and binding. There is n further r ther prcess fr appeal. New Hire Enrllment Example: Hire date Enrllment Deadline Appeal Deadline April 1 st May 1 st (30th calendar day after date f hire) June 30 th (60 th cnsecutive calendar day after enrllment deadline Rev. 8/23/12 Page 8
Annual Enrllment Example: Enrllment Enrllment Deadline Perid Nvember 1 Nvember 30th (last day f Nvember 30 enrllment perid) Appeal Deadline January 29 th (60 th cnsecutive calendar day after enrllment deadline Csts Yu are required t pay sme r all f the cst f cverage under the Sprint Flex Plans. Cntributin amunts fr yur prtin are available in the Benefits Enrllment Guide and/r n the n-line enrllment system n i-cnnect > Emplyee Self Service > Benefits Hme. Mst f the Sprint Flex Plans are ffered n a pre-tax basis, meaning that yu can pay fr yur prtin f the cverage cst thrugh payrll deductins frm yur befre-tax incme. The fllwing, hwever, are ffered nly n an after-tax basis, meaning that yu pay fr yur prtin f the cst f such cverage thrugh payrll deductins frm yur after-tax incme: Dependent Life Insurance and Cverage fr yur DP and yur DP s Child wh is nt als yur Child. Als, as a general rule, Sprint s prtin f the cverage cst is nt cnsidered taxable incme t yu. The exceptin t this rule is that Sprint s prtin f the cst f cverage fr yur DP and yur DP s Child wh is nt als yur Child is cnsidered taxable incme t yu and therefre is subject t applicable withhlding taxes. Medical/Prescriptin Drug Plans Healthy Living Discunt T receive the Healthy Living Discunt fr 2012 Medical/Prescriptin Drug premiums, yu must select the with Discunt ptin when enrlling in yur Medical/Prescriptin plan and bth f the fllwing statements must be true: Yu and all yur cvered dependents frm the date yu enrll* thrugh yur 2012 cverage perid and anyne while living in yur hme during this perid must be 100% tbacc free. Yu have cmpleted (r will cmplete) an nline Health Assessment at www.sprintalive.cm within the Annual Enrllment deadline r 30 calendar days after hire/rehire/life event benefits effective date. Tbacc free means never smking r chewing tbacc r any similar prduct. * Since the 100% tbacc-free requirement runs frm the date yu enrll, even if all cvered dependents becme 100% tbacc-free after enrllment, yu will nt be able t switch t the Healthy Living Discunt mid-year. If bth criteria are nt met, yu will nt receive the Health Living Discunt fr yur 2012 Medical/Prescriptin Drug plan premiums. If yu r a cvered dependent meet the 100% tbacc free requirement but stp during the year (fr example, yu begin living with a smker), yu are required t ntify Sprint within five business days after, and will be charged the undiscunted premium rate as f the date Sprint is ntified that, yu n lnger meet the criteria. Als if yu select the with Discunt ptin but d nt take a Health Assessment by the deadline, yur premiums will be Rev. 8/23/12 Page 9
switched t the undiscunted rate fr all f 2012, even if the 100% tbacc-free requirement is met. Life Insurance Plans Nn-Smker Discunt When enrlling in Emplyee and/r Spuse/Dmestic Partner (DP) Life Insurance cverage, yu must select the apprpriate ptin based n whether yu/yur cvered Spuse/DP, if applicable, are a smker r nn-smker. Fr Life Insurance Plans, a smker is defined as anyne wh will use a tbacc prduct during the 2012 plan year such as cigars, cigarettes r chewing tbacc. Fr Life Insurance, the smker status is based upn the cvered individual and nt the husehld. Fr example, if yu are a nn-smker but yur Spuse smkes, the Emplyee Life Insurance will be at the nn-smker discunt, but the Spuse Life Insurance will be at the smker rate. The same rules fr n lnger meeting the tbacc free requirement abve apply t the nn-smker status. When Cverage Begins Sprint Flex Plan cverage yu elect begins n the Benefit Effective Date as fllws: Fr New Hires, as f the 30 th cnsecutive calendar day after yur date f hire (subject t apprval f evidence f insurability fr certain life insurance cverage levels). Fr Annual Enrllment, as f the January 1 after the Annual Enrllment (subject t apprval f evidence f insurability fr certain increases in life insurance cverage levels). Fr Life Events, as described in the Life Events Sectin. When Cverage Ends Sprint reserves the right t change r end a Sprint Flex Plan at any time and cverage wuld end prspectively frm the date f any terminatin. Otherwise, cverage ends as f the earlier f the end f the: applicable calendar year if yu s elect r d nt re-enrll, as applicable, during the Annual Enrllment perid fr that year; r as described in the separate Life Events Sectin that is als a part f a Summary Plan Descriptin fr the Sprint Flex Plans, incrprated herein by reference n the Benefits site f i-cnnect under Summary Plan Descriptins. Legal Infrmatin and Other Sectins Fr imprtant infrmatin n participating emplyers, plan identificatin, service f legal prcess, ERISA rights, including claims and appeals prcedures, and ther legally-required ntices regarding the Sprint Flex Plans, see the separate Legal Infrmatin Sectin that is als a part f a Summary Plan Descriptin fr the Sprint Flex Plans, incrprated herein by reference n the Benefits site f i-cnnect under Summary Plan Descriptins. Rev. 8/23/12 Page 10
Fr ther infrmatin n changes in yur electins, see the separate Life Events Sectin that is als a part f a Summary Plan Descriptin fr the Sprint Flex Plans, incrprated herein by reference n the Benefits site f i-cnnect under Summary Plan Descriptins. Fr infrmatin n each individual benefit under a Sprint Flex Plan, see the applicable Cverage Infrmatin Sectin that is als a part f a Summary Plan Descriptin fr the applicable Sprint Flex Plan, incrprated herein by reference n the Benefits site f i-cnnect under Summary Plan Descriptins. Rev. 8/23/12 Page 11