Update to Your SPD Benefit Booklets: Summary of Benefit Changes Resulting From Collective Bargaining

 

Contents

The Purpose of This Update. 1

Verizon Pension Plan for New York and New England Associates. 2

Verizon Savings and Security Plan for New York and New England Associates. 8

Voluntary Termination Bonus. 8

Verizon Medical Expense Plan for New York and New England Associates... X

Verizon Dental Expense Plan for New York and New England Associates. 9

Updated Disability Claims and Appeals Procedures. 10

Your Rights Under ERISA.. 10

 

The Purpose of This Update

This information is a supplement to your summary plan description (SPD) booklets for these plans:

·    Verizon Pension Plan for New York and New England Associates,

·    Verizon Savings and Security Plan for New York and New England Associates,

·    Verizon Medical Expense Plan for New York and New England Associates,

·    Verizon Dental Expense Plan for New York and New England Associates,

·    Verizon Vision Care Plan for New York and New England Associates,

·    Verizon Health Care Spending Account for New York and New England Associates,

·    Verizon Sickness and Accident Disability Benefit Plan for New York Associates,

·    Verizon Sickness and Accident Disability Benefit Plan for New England Associates,

·    Verizon Sickness and Accident Disability Benefit Plan for New York and New England Associates of Non-Regulated Companies and

·    Verizon Long‑Term Disability Plan for New York and New England Associates.

This update is a summary of material modification (SMM) and includes the most recent collective bargaining provisions related to the benefits agreed to between your union and Verizon for the plans listed on the previous page. The most recent collective bargaining provisions related to your medical benefits are communicated separately. Specifically, your medical benefits SPD booklet for the Verizon Medical Expense Plan for New York and New England Associates and the Verizon Alternate Choice Plan for New York and New England Associates has been updated to include these provisions. Please keep this SMM with your SPD booklets for future reference.

If you have any questions after reading this information, please call the Verizon Benefits Center at  1-877-Ask-VzHR (1-877-275-8947) and speak with a Benefits Center representative.

Verizon Pension Plan for New York and New England Associates

Single Lump‑Sum Payment Included in Supplemental Benefit Calculation

Supplemental earnings taken into account in determining a participant’s supplemental monthly pension benefit will include in 2003 the single lump‑sum payment equal to 3% of the associate’s basic weekly wage for one year. This payment was calculated as of August 3, 2003 and paid by October 31, 2003.

Temporary 5% Pension Band Basic Monthly Benefit Increase and Cashout Opportunity

For an associate participating in the pension plan who terminates employment with a vested benefit between October 1, 2003 and December 31, 2003:

·    The pension band used to calculate the associate’s basic monthly benefit will be increased by 5%. For associates with multiple bands, the 5% pension band increase will apply to all pension band values used in the associate’s benefit calculation. (The increase does not apply to any supplemental benefit or to the minimum monthly pension benefit, if applicable.)

·    The associate will have the opportunity to elect a lump‑sum distribution (cashout) of his or her pension benefit. The associate may elect to receive a lump-sum distribution on a commencement date that is the day following termination of employment or the first day of any following month. However, any commencement date must be elected in writing in advance of such date. Additionally, if termination of employment occurs no later than November 30, 2003, the associate’s lump‑sum distribution amount will be the larger of the lump sums determined using:

ľ    The third quarter 2003 interest rate and mortality table basis, or

ľ    The interest rate and mortality table basis effective under the pension plan when the associate’s commencement date occurs.

Scheduled Pension Band Basic Monthly Benefit Increases

The pension band basic monthly benefits shown on page 16 of your pension plan booklet will increase as shown in the chart below over the term of the collective bargaining contract. These pension band basic monthly benefit amounts reflect a 2% increase effective November 1, 2004, and a 3% increase per year thereafter effective October 1, 2005, October 1, 2006 and October 1, 2007. The increased monthly benefit amounts apply to associates with “pension effective dates” (i.e., first day following the last day on the payroll) on or after the applicable effective dates shown in the table below.

Pension Band Number

Monthly Benefit Effective July 1, 2003*

Monthly Benefit Effective November 1, 2004

Monthly Benefit Effective October 1, 2005

Monthly Benefit Effective October 1, 2006

Monthly Benefit Effective October 1, 2007

101

$34.37

$35.06

$36.11

$37.19

$38.31

102

$35.83

$36.55

$37.65

$38.78

$39.94

103

$37.33

$38.08

$39.22

$40.40

$41.61

104

$38.74

$39.51

$40.70

$41.92

$43.18

105

$40.19

$40.99

$42.22

$43.49

$44.79

106

$41.64

$42.47

$43.74

$45.05

$46.40

107

$43.12

$43.98

$45.30

$46.66

$48.06

108

$44.57

$45.46

$46.82

$48.22

$49.67

109

$46.04

$46.96

$48.37

$49.82

$51.31

110

$47.46

$48.41

$49.86

$51.36

$52.90

111

$48.92

$49.90

$51.40

$52.94

$54.53

112

$50.39

$51.40

$52.94

$54.53

$56.17

113

$51.82

$52.86

$54.45

$56.08

$57.76

114

$53.27

$54.34

$55.97

$57.65

$59.38

115

$54.71

$55.80

$57.47

$59.19

$60.97

116

$56.18

$57.30

$59.02

$60.79

$62.61

117

$57.63

$58.78

$60.54

$62.36

$64.23

118

$59.08

$60.26

$62.07

$63.93

$65.85

119

$60.53

$61.74

$63.59

$65.50

$67.47

120

$61.98

$63.22

$65.12

$67.07

$69.08

121

$63.41

$64.68

$66.62

$68.62

$70.68

122

$64.89

$66.19

$68.18

$70.23

$72.34

123

$66.33

$67.66

$69.69

$71.78

$73.93

124

$67.77

$69.13

$71.20

$73.34

$75.54

125

$69.23

$70.61

$72.73

$74.91

$77.16

126

$70.68

$72.09

$74.25

$76.48

$78.77

127

$72.14

$73.58

$75.79

$78.06

$80.40

128

$73.59

$75.06

$77.31

$79.63

$82.02

129

$75.04

$76.54

$78.84

$81.21

$83.65

130

$76.48

$78.01

$80.35

$82.76

$85.24

131

$77.97

$79.53

$81.92

$84.38

$86.91

132

$79.39

$80.98

$83.41

$85.91

$88.49

133

$80.85

$82.47

$84.94

$87.49

$90.11

134

$82.31

$83.96

$86.48

$89.07

$91.74

135

$83.71

$85.38

$87.94

$90.58

$93.30

*A temporary 5% pension band increase applies to these basic monthly benefit amounts for associates who terminated employment during the period October 1, 2003 to December 31, 2003.

To find out your pension band, please refer to the most current collective bargaining agreement.

Lump‑Sum Distribution (Cashout) Option

As noted on the previous page, lump-sum distributions are available for associates who terminate employment between October 1, 2003 and December 31, 2003. Lump-sum distributions will also be available for associates who terminate employment on or after November 1, 2004 and on or before August 2, 2008. An associate who is eligible to take a lump-sum distribution may choose to receive a lump‑sum distribution on a commencement date elected by the associate that occurs on or after the date the associate’s written request is received by the pension plan administrator and that is either the day following termination of employment or the first day of any month following termination. (The 90‑day window for receiving a lump‑sum distribution has been eliminated.)

Please note that associates who terminate employment during the period January 1, 2004 through October 31, 2004 will not be eligible to receive a lump‑sum distribution option unless:

·    The associate’s lump‑sum distribution value is $3,500 or less. In this case, the associate will automatically receive his or her benefit in a lump‑sum distribution.

·    The associate is eligible for a vested or a service pension and terminates employment due to the exhaustion of 52 weeks of sickness disability benefits. In this case, the associate will have the option to receive a lump‑sum distribution of his or her vested or service pension. (The associate may not receive a lump-sum distribution of any disability pension for which he or she may qualify – see page 40 of the pension plan booklet.)

Changes to Preretirement Survivor Death Benefits

The following changes apply to preretirement survivor death benefits:

·    If an associate dies while employed between January 1, 2004 and October 31, 2004 and his or her beneficiary is eligible to receive a preretirement survivor death benefit, the associate’s beneficiary is eligible to receive a lump‑sum distribution. The beneficiary’s lump-sum death benefit will equal the greater of:

ľ    The lump-sum value of the 65% preretirement survivor death benefit (or in the case of a nonspouse beneficiary who is more than 25 years younger, the 50% preretirement survivor death benefit) that is otherwise payable under the pension plan, or

ľ    The lump-sum benefit the associate would have received if he or she had terminated employment at death and received payment in a lump sum on the beneficiary’s commencement date.

·    Also, a lump‑sum distribution (cashout) will be available to the beneficiary of an associate who dies after terminating employment and before his or her commencement date if the associate was otherwise eligible to elect a lump‑sum distribution at the time he or she died. In this case, the death benefit will be the greater lump‑sum value of:

ľ    The lump-sum value of the 65% preretirement survivor death benefit (or in the case of a nonspouse beneficiary who is more than 25 years younger, the 50% preretirement survivor death benefit) otherwise payable under the pension plan, or

ľ    The lump-sum benefit the associate would have received on the commencement date for a lump sum elected by the associate prior to his or her death, or if no lump‑sum election was in effect, the lump-sum benefit the associate would have received on the beneficiary’s commencement date.

Updated Claims and Appeals Procedures

The “Claims and Appeals Procedures” section of your pension plan SPD has changed. For all pension claims, except disability pension, the procedure remains as described in the pension plan SPD, with the exception of where to direct your claims. The P.O. Box of your claims and appeals administrator has changed, as follows:

 

Verizon Claims Review Committee

c/o Verizon Claims Review Unit

P.O. Box 1438

Lincolnshire, IL 60069-1438

 

Claims should be directed to the Verizon Claims Review Unit, while appeals should be directed to the Verizon Claims Review Committee in care of Verizon Claims Review Unit. In either case, the P.O. Box is 1438.

In addition, to ensure that your claim is properly directed, you may want to request a Claim Initiation Form by calling the Verizon Benefits Center at 1-877-Ask-VzHR (1-877-275-8947).

However, for disability pension claims, the following chart applies in place of the “Filing a Claim,” “Claim Denial,” “Filing an Appeal” and “Review of Your Appeal” sections of your pension plan SPD. If you have an Employee Retirement Income Security Act of 1974 (ERISA) claim for a disability pension plan benefit, you should follow these procedures. While these procedures were previously communicated, in general, the following chart provides more details. It applies to disability pension claims initially filed on or after January 1, 2002.

 

 

Claims and Appeals Procedures

Step 1

How to file a claim

To file a claim, request a disability kit from the Verizon Benefits Center at 1-877-Ask-VzHR (1-877-275-8947). You (or your authorized representative) must return the disability pension request form (“Disability Form”) to the Verizon Benefits Center at the address on the form.

 

You must include:

·   A description of the benefits you’re applying for

·   The reason(s) for the request and

·   Relevant documentation

 

If you do not return the Disability Form within 90 days, your request expires. If you do return the Disability Form, the ERISA claims process for disability pension benefits begins (e.g., the ERISA claims time frames described in this chart commence upon the Verizon Benefits Center’s receipt of your Disability Form).

 

The Verizon Benefits Center forwards your Disability Form to the disability vendor for processing

 

When you will be notified of the claims decision

You will be notified of the decision within 45 days of Verizon Benefits Center’s receipt of your Disability Form (75 or 105 days, when special circumstances apply)

 

Failure to provide sufficient information

If you fail to provide sufficient information, the claim may be decided based on the information provided. However, the Verizon Benefits Center or the disability vendor may notify you within either the 75- or 105-day extension period that additional information is needed. In some cases, you may be required to have an Independent Medical Examination.

 

You will have 45 days to provide the additional information. Otherwise, the claim will be decided based on the information originally provided.

 

If you provide additional information, you will be notified of the decision by the Verizon Benefits Center no later than 105 days after the initial claim was submitted, not including the time that it takes you to provide the additional information

 

How you will be notified of the claim decision

If your claim is approved, the Verizon Benefits Center will provide you with a letter explaining approval

 

If your claim is denied, in whole or in part, the Verizon Benefits Center will notify you in writing. Your denial notice will contain:

·   The specific reason(s) for the denial

·   The plan provisions on which the denial was based

·   Any additional material or information you may need to submit to complete the claim

·   Any internal procedures or clinical information on which the denial was based and

·   The plan’s appeal procedures

 

Step 2

About appeals and the claims fiduciary

Before you can bring any action at law or at equity to recover plan benefits, you must exhaust this process. Specifically, you must file an appeal as explained in this Step 2 and the appeal must be finally decided by the Claims Review Committee, the claims fiduciary. As such, the Claims Review Committee is authorized to finally determine appeals and interpret the terms of the plan in its sole discretion. All decisions by the Claims Review Committee are final and binding on all parties.

 

How to file an appeal

If your claim is denied and you want to appeal it, you must file your appeal within 180 days from the date you receive written notice of your denied claim. You may request access to all documents relating to your appeal. To file your appeal, write to the address specified on your claim denial notice.

 

You should include:

·   A copy of your claim denial notice

·   The reason(s) for the appeal and

·   Relevant documentation

 

The individual/committee (and any medical professional) reviewing your appeal will be independent from the individual/committee who reviewed your claim. In addition, if your appeal involves a medical judgment, the Claims Review Committee will consult with a healthcare professional who has appropriate experience. You are entitled to the identity of such a professional, upon request.

 

When you will be notified of the appeal decision

You will be notified of the decision within 45 days of the Claims Review Committee’s receipt of your appeal (90 days, when special circumstances apply)

 

How you will be notified of the appeal decision

If your appeal is approved, the Claims Review Committee will generally notify you in writing

 

If your appeal is denied, in whole or in part, the Claims Review Committee will notify you in writing. Your denial notice will contain:

·   The specific reason(s) for denial

·   The plan provisions on which the denial was based

·   Any internal procedures or clinical information on which the denial was based

·   A statement regarding the documents that you are entitled to and

·   The following statement: “You and your plan may have other voluntary resolution options, such as mediation. One way to find out what may be available is to contact your local U.S. Department of Labor Office and your State insurance regulatory agency.”

 

Step 3

How to proceed if necessary

The decision on your appeal is final. As a result, Verizon will not review your matter again, unless new facts are presented. You have a right to bring a civil action.

 

 

Verizon Savings and Security Plan for New York and New England Associates

For purposes of determining your contribution to the plan as a percentage of pay, annual pay in 2003 will include the single lump‑sum payment equal to 3% of the associate’s basic weekly wage for one year. This payment was calculated as of August 3, 2003 and paid by October 31, 2003.

Voluntary Termination Bonus

Effective August 3, 2003 and continuing through August 2, 2008, if an associate accepts a voluntary offer to leave the company under the provisions of the Verizon Income Protection Plan for New England Associates covered by the collective bargaining agreements with the IBEW (“IPP for NE IBEW Associates”) or the Verizon Income Protection Plan for New York and New England Associates covered by collective bargaining agreements with the CWA and New York Associates covered by collective bargaining agreements with the IBEW (“IPP for NY/NE CWA and NY IBEW Associates”) and leaves the company pursuant to that offer, the following additional benefits will be provided:

·    A lump‑sum benefit of $10,000 (reduced for applicable taxes and withholdings), and

·    Medical coverage continued for the associate and eligible dependents for six months if the associate is not otherwise eligible for continuation of coverage for at least six months. The medical coverage will be at the same level of benefits that the associate had as of the associate’s last day actively at work, pursuant to the terms of the Verizon Medical Expense Plan for New York and New England Associates or the Verizon Alternate Choice Plan (providing HMO coverage). If the associate and any eligible dependents participate in the Verizon Medical Expense Plan for New York and New England Associates, the coverage will be provided at no cost. However, if the associate and any eligible dependents participate in the Verizon Alternate Choice Plan, the associate will be responsible for the additional cost if the HMO costs more than the company’s contribution toward the Verizon Medical Expense Plan for New York and New England Associates.

These additional benefits are not part of (and do not modify in any way) the IPP for NE IBEW Associates or IPP for NY/NE CWA and NY IBEW Associates.

Verizon Medical Expense Plan for New York and New England Associates

 

Eligibility of Same-Sex Domestic Partners for the Aetna MEP PPO Option

Effective January 1, 2005, same-sex domestic partners and their children who meet the Plan

requirements for a same-sex domestic partner (and children of a same-sex domestic partner) are eligible for coverage under the Aetna MEP preferred provider organization (PPO) option. The restriction as stated on page 6 of your medical plan SPD no longer applies.

 

Certificate of Creditable Coverage

The following applies in addition to the information in the “Certificate of Creditable Coverage” section on page 21 of your medical plan SPD:

When any person’s coverage under the Medical Plan and the Alternate Choice Plan ends for any reason, including the end of COBRA continuation coverage, Verizon will send that person a Certificate of Creditable Coverage at no charge, as required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Changes and Clarifications to Certain Plan Exclusions

As always, benefits are available to you only when you and your dependents are eligible for and properly enrolled in the Plans. However, the following updates are being made to clarify that the Plans do not impose pre-existing condition exclusions, as defined by HIPAA:

·    On pages 47 and 83 of your medical plan SPD, under “Special Rules for Surgery Coverage,” the bullet related to cosmetic surgery is updated as follows:

–   Cosmetic surgery is covered only if required to correct an accidental injury or illness, or to correct a child’s congenital defect. Reconstructive surgery after a mastectomy also is covered (as described below).

·    Accordingly, exceptions to the exclusion for coverage for cosmetic surgery (or drugs used for cosmetic purposes), as stated on pages 55 and 90 of your medical plan SPD, is revised, as follows:

–   Cosmetic surgery (or drugs used for cosmetic purposes), unless required to correct an accidental injury or illness, or to correct a child’s congenital defect. Reconstructive surgery after a mastectomy is covered, as described on page 47.

·    The exclusions for (1) care provided before coverage begins or after coverage ends, and (2) charges during a continuous hospital confinement that began before the person’s coverage began, as stated on pages 55 and 90 of your medical plan SPD, are not intended to exclude coverage for a condition that began before the effective date of coverage. Instead, these provisions are merely intended to exclude coverage for care provided or charges incurred during periods when you (and/or your dependents) are not eligible for and properly enrolled in the Plans.

Verizon Dental Expense Plan for New York and New England Associates

Effective January 1, 2004, the plan will cover services related to dental implants, with reimbursement consistent with plan coverage for other corrective care services such as dental bridges. In addition to the implant procedure, the dental plan covers any separate charge related to a finishing crown.

For each covered individual, the maximum benefit payable for all covered dental services is $1,500 per calendar year.

Updated Healthcare Claims and Appeals Procedures

Please note that the “If a Benefit Is Denied” section of your updated medical plan SPD applies to claims and appeal procedures under these healthcare plans, as well:

·    Verizon Dental Expense Plan for New York and New England Associates,

·    Verizon Vision Care Plan for New York and New England Associates and

·    Verizon Health Care Spending Account for New York and New England Associates.

Updated Disability Claims and Appeals Procedures

The “Claims and Appeals Procedures” section of your disability benefits SPD has changed. It applies to disability claims initially filed on or after January 1, 2004. Specifically, the procedure is slightly different, depending on whether you have an “eligibility” claim or a “benefit” claim. An eligibility claim is a claim for eligibility to have coverage in a plan. A benefit claim is any claim that is not a claim for eligibility. An example of a benefit claim is a claim for disability benefits due to alleged failure to satisfy the definition of “disabled” under the Verizon Long‑Term Disability Plan for New York and New England Associates.

The authority and discretion to designate each of the claims and appeals administrators is granted to the Verizon Employee Benefits Committee (VEBC) and the Verizon Claims Review Committee (VCRC), and to the individuals who chair each of these committees. At this time, for eligibility‑related claims, the claims and appeals administrator is the VCRC. For benefit‑related claims, the claims and appeals administrator is MetLife.

The addresses of the claims and appeals administrators for the disability plans are:

VCRC

c/o Verizon Claims Review Unit

P.O. Box 1438

Lincolnshire, IL 60069-1438

 

Metropolitan Life Insurance Company (MetLife)

P.O. Box 3017

Utica, NY 13504

 

If you have a claim or appeal, you should contact the appropriate claims and appeals administrator for the type of claim or appeal you have.

The claims and appeals administrators, as the claims fiduciaries, have discretionary authority to:

·    Interpret the plans based on their provisions and applicable law and make factual determinations about claims arising under the plans,

·    Determine whether a claimant is eligible for benefits,

·    Decide the amount, form and timing of benefits, and

·    Resolve any other matter under the plans that is raised by a participant or a beneficiary, or that is identified by either the claims or appeals administrator.

The claims and appeals administrators have sole discretionary authority to decide claims under the plans and review and resolve any appeal of a denied claim. In case of an appeal, the claims and appeals administrators’ decisions are final and binding on all parties to the full extent permitted under applicable law, unless the participant or beneficiary later proves that a claims or appeals administrator’s decision was an abuse of administrator discretion.

The “Filing a Claim,” “If Your Claim Is Denied,” “Filing an Appeal” and “Review of Your Appeal” sections of the disability benefit plans SPD are updated by the following chart, which outlines the process that applies if you have an ERISA claim or appeal for a disability plan benefit.

 

Disability plan eligibility claims procedure

Disability plan benefit claims procedure

Step 1

How to file a claim

To file an eligibility claim, request a Claim Initiation Form from the Verizon Benefits Center at 1-877-Ask-VzHR (1-877-275-8947). You (or your authorized representative) must return the form to the Verizon Claims Review Unit at the address on the form.

 

You must include:

·   A description of the benefits you’re applying for

·   The reason(s) for the request and

·   Relevant documentation

 

To file a claim, write to the disability administrator for the plan (MetLife) and include:

·   A description of the benefits you’re applying for

·   The reason(s) for the request and

·   Relevant documentation

 

 

 

 

When you will be notified of the claims decision

You will be notified of the decision within 45 days of the Claims Review Unit’s receipt of your Claim Initiation Form (75 or 105 days, when special circumstances apply)

 

You will be notified of the decision within 45 days of the disability administrator’s receipt of your written claim (75 or 105 days, when special circumstances apply)

 

Failure to provide sufficient information

If you fail to provide sufficient information, the claim may be decided based on the information provided. However, the Claims Review Unit may notify you within either the 75‑ or 105‑day extension period that additional information is needed.

 

You will have 45 days to provide the additional information. Otherwise, the claim will be decided based on the information originally provided.

 

If you provide additional information, you will be notified of the decision by the Claims Review Unit no later than 105 days after the initial claim was submitted, not including the time that it takes you to provide the additional information

If you fail to provide sufficient information, the claim may be decided based on the information provided. However, the disability administrator may notify you within either 75‑ or 105‑day extension period that additional information is needed. In some cases, you may be required to have an independent medical examination.

 

You will have 45 days to provide the additional information. Otherwise, the claim will be decided based on the information originally provided.

 

If you provide additional information, you will be notified of the decision by the disability administrator no later than 105 days after the initial claim was submitted, not including the time that it takes you to provide the additional information

 

How you will be notified of the claim decision

If your claim is approved, the Claims Review Unit will generally notify you by telephone

 

If your claim is denied, in whole or in part, the Claims Review Unit will notify you in writing. Your denial notice will contain:

·   The specific reason(s) for the denial

·   The plan provisions on which the denial was based

·   Any additional material or information you may need to submit to complete the claim

·   Any internal procedures on which the denial was based and

·   The plan’s appeal procedures

If your claim is approved, the disability administrator will notify you by telephone or in writing

 

If your claim is denied, in whole or in part, the disability administrator will notify you in writing. Your denial notice will contain:

·   The specific reason(s) for the denial

·   The plan provisions on which the denial was based

·   Any additional material or information you may need to submit to complete the claim

·   Any internal procedures or clinical information on which the denial was based and

·   The plan’s appeal procedures

 

Step 2

About appeals and the claims fiduciary

Before you can bring any action at law or at equity to recover plan benefits, you must exhaust this process. Specifically, you must file an appeal as explained in this Step 2 and the appeal must be finally decided by the Claims Review Committee, the claims fiduciary. As such, the Claims Review Committee is authorized to finally determine eligibility appeals and interpret the terms of the plan in its sole discretion. All decisions by the Claims Review Committee are final and binding on all parties.

 

Before you can bring any action at law or at equity to recover plan benefits, you must exhaust this process. Specifically, you must file an appeal as explained in this Step 2 and the appeal must be finally decided by the disability administrator. The Claims Review Committee has delegated its authority to finally determine claims to the disability administrator. As such, MetLife is the claims fiduciary and is authorized to finally determine benefit appeals and interpret the terms of the plan in its sole discretion. All decisions by the disability administrator are final and binding on all parties, unless it is later proven that the administrator’s decision was an abuse of discretion.

 

How to file an appeal

If your claim is denied and you want to appeal it, you must file your appeal within 180 days from the date you receive written notice of your denied claim. You may request access to all documents relating to your appeal. To file your appeal, write to the address specified on your claim denial notice.

 

You should include:

·   A copy of your claim denial notice

·   The reason(s) for the appeal and

·   Relevant documentation

 

The individual/committee reviewing your appeal will be independent from the individual/committee who reviewed your claim

If your claim is denied and you want to appeal it, you must file your appeal 180 days from the date you receive written notice of your denied claim. You may request access to all documents relating to your appeal. To file your appeal, write to the disability administrator for the plan and include:

·   A copy of your claim denial notice

·   The reason(s) for the appeal and

·   Relevant documentation

 

The individual/committee (and any medical expert) reviewing your appeal will be independent from the individual/committee who reviewed your claim. In addition, if your appeal involves a medical judgment, the disability administrator will consult with a healthcare professional who has appropriate relevant experience. You are entitled to the identity of such an expert, upon request.

 

When you will be notified of the appeal decision

You will be notified of the decision within 45 days of the Claims Review Committee’s receipt of your appeal (90 days, when special circumstances apply)

You will be notified of the decision within 45 days of the disability administrator’s receipt of your appeal (90 days, when special circumstances apply)

 

How you will be notified of the appeal decision

If your appeal is approved, the Claims Review Committee will generally notify you in writing

 

If your appeal is denied, in whole or in part, the Claims Review Committee will notify you in writing. Your denial notice will contain:

·   The specific reason(s) for denial

·   The plan provisions on which the denial was based

·   Any internal procedures on which the denial was based

·   A statement regarding the documents that you are entitled to and

·   The following statement: “You and your plan may have other voluntary dispute resolution options, such as mediation. One way to find out what may be available is to contact your local U.S. Department of Labor Office and your State insurance regulatory agency.”

 

If your appeal is approved, the disability administrator will notify you in writing or by telephone

 

If your appeal is denied, in whole or in part, the disability administrator will notify you in writing. Your denial notice will contain:

·   The specific reason(s) for denial

·   The plan provisions on which the denial was based

·   Any internal procedures or clinical information on which the denial was based

·   A statement regarding the documents that you are entitled to

·   The plan’s voluntary appeal procedures and

·   The following statement: “You and your plan may have other voluntary dispute resolution options, such as mediation. One way to find out what may be available is to contact your local U.S. Department of Labor Office and your State insurance regulatory agency.”

 

Step 3

How to proceed if necessary

The decision on your appeal is final. As a result, Verizon will not review your matter again, unless new facts are presented. You have a right to bring a civil action.

Voluntary benefit appeals:

If you had a benefit appeal that was denied at Step 2, you may submit a voluntary appeal to the disability administrator. You must file your voluntary appeal within 60 days from the date you receive written notice of your denied appeal. To file your voluntary appeal, write to the disability administrator at the address provided to you in your Step 2 denial letter and include:

·   A copy of your appeal denial notice

·   The reason(s) for the appeal and

·   Relevant documentation

 

This appeal is voluntary. You have a right to bring a civil action without submitting a voluntary appeal.

 

When you will be notified of the voluntary appeal decision

Not applicable

You will receive a response within 45 days of the disability administrator’s receipt of your voluntary appeal (90 days when special circumstances apply)

 

 

Your Rights Under ERISA

The following information applies in place of the “Your Rights Under ERISA” section of the following SPDs:

·    Verizon Medical Expense Plan for New York and New England Associates

·    Verizon Dental Expense Plan for New York and New England Associates

·    Updated Disability Claims and Appeals Procedures

 

As a participant in the plans you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA). ERISA provides that all plan participants shall be entitled to the following.

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.

Continue Group Health Plan Coverage

·    Continue health care coverage for yourself, spouse or dependents if there is a loss of coverage under the plan as a result of a qualifying event. You or your dependents may have to pay for such coverage. Review this summary plan description and the documents governing the plan on your COBRA continuation coverage rights.

·    Reduction or elimination of exclusionary periods of coverage for preexisting conditions under your group health plan, if you have creditable coverage from another plan. You should be provided a certificate of creditable coverage, free of charge, from your group health plan or health insurance issuer when you lose coverage under the plan, when you become entitled to elect COBRA continuation coverage, when your COBRA continuation coverage ceases, if you request it before losing coverage, or if you request it up to 24 months after losing coverage. Without evidence of creditable coverage, you may be subject to a preexisting condition exclusion for 12 months (18 months for late enrollees) after your enrollment date in your coverage.

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 welfare benefit or exercising your rights under ERISA.

Enforce Your Rights

If your claim for a welfare 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 plan documents 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. In addition, if you disagree with the plan’s decision or lack thereof concerning the qualified status of a  medical child support order, you may file suit in Federal court.

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.

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.