Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 385 Open Enrollment Activity Dates Open Enrollment begins October 17, 2016 Open Enrollment information sessions See calendar on page 3 Open Enrollment ends November 10, 2016 Benefit plan elections take effect January 1, 2017 New benefit deductions begin January 1, 2017 Open Enrollment Timeline The purpose of this Open Enrollment Guide is to give you basic information about your benefit options and how to enroll for coverage or make changes to existing coverage. This guide is only a summary of your choices and does not fully describe each benefit option. For a more detailed description of benefits, please refer to the plan’s benefit booklet, brochure, summary plan description (SPD), summary of benefits and coverage (SBC) or evidence of cover- age (EOC). You may also call the plan using the customer service phone number on the last page of this booklet. Please note that plans will not cover a service if it is not considered medically necessary. Additionally, if your physician or facility discontinues participation in a plan, you will not be allowed to change plans outside the window of Open Enrollment as this is NOT considered a qualifying life event for you or your dependents. Every effort has been made to make the information contained in this booklet accurate; however, if there are discrepancies between this document and the contract with the carrier, the contract will govern. •  Open Enrollment Period is October 17–November 10, 2016. •  During Open Enrollment, you have the following options: •  Elect vision coverage (if currently enrolled in medical). •  Change to a different health and/or dental plan. •  Change coverage levels by adding or deleting dependents.** •  Waive health and/or dental coverage for the 2017 Plan Year. •  Update beneficiary information for Basic and Supplemental Life Insurance (if applicable). •  Continue, decrease or waive Supplemental Life Insurance (if applicable). •  All changes become effective January 1, 2017. •  If you are enrolling a dependent age 19–26 for the first time, you are required to complete an affidavit. Please see page 6 for information on dependent coverage. •  Medical, Dental and Vision selections will be done on the Benefits Request Form that is enclosed with your open enrollment book. IF YOU ARE NOT MAKING ANY CHANGES, YOU DO NOT NEED TO SEND YOUR FORM BACK. •  If you are changing plans, you should receive your new ID cards no later than January 1, 2017. Otherwise, you will not receive a new card. •  Once Open Enrollment closes, your selections are bind- ing and cannot be changed, modified or canceled unless you have a qualified change of life event. See Change of Life Event section on page 7 for further details. Important Things To Remember **PLEASE NOTE: Any benefits change to add or delete dependents requires legal documentation before benefits will be available. See Insurance Coverage for Dependents section on page 6.