1
Welcome
What’s Ahead for 2015
Eligibility
2015 Benefits Options
Ready to Enroll
Other Important Information
Choose Well, Live Well
20
15
ANNUAL
OPEN ENROLLMENT
GUIDE
Terms to Know
Directory of Resources
CABLEVISION EMPLOYEES
2
Welcome
What’s Ahead for 2015
Eligibility
Welcome
Welcome to Cablevision’s 2015 Annual Open Enrollment Guide – your reference for benefits
information and the wellness resources available to you as a Cablevision employee.
Other Important Information
We want you to feel secure when it comes to your health and financial well-being, and confident
that the Company will support you through various life circumstances. That’s why we are excited to
share with you our benefit offerings for next year—it is our hope that you will share this information
with your family, and that you will make the best elections possible for you and your dependents
during Annual Open Enrollment.
Choose Well, Live Well
Our commitment to you is to:
Terms to Know
• Provide you with competitive medical and dental
coverage options
Directory of Resources
• Offer lower-paid employees health care coverage at
a reduced cost
2015 Benefits Options
Ready to Enroll
• Provide you with a retirement plan that includes
Company contributions and financial assistance
• Offer programs, tools and resources to help you
balance professional priorities, personal obligations
and leisure time
• Encourage you and your families through
Company-sponsored offerings to proactively make
better choices to live healthier lifestyles
• Help you prepare for life challenges through
increased coverage options and plans based on
your individual circumstances
• Provide opportunities to positively impact your
communities through Company-sponsored
programs and events
This Annual Open Enrollment Guide is clickable!
You can click on a link to go directly to the information you need, scroll through the document page by
page and print either the entire Guide or just the pages you’d like.
3
Welcome
Time to Enroll
What’s Ahead for 2015
Cablevision is committed to providing an environment where you and your family are supported through a competitive
and robust benefits program. And we are proud to continue this tradition in 2015.
Eligibility
2015 Benefits Options
We encourage you to make the most of your benefits by becoming familiar with all the offerings available to you, and
by using the tools and resources provided to help you and your family live even healthier lifestyles. When you play an
active role, you are opting to Choose Well, Live Well.
Ready to Enroll
Annual Open Enrollment for your 2015 Health and Welfare Benefit Plan begins Thursday, November 20, 2014, at
6:00 am EST and ends Thursday, December 4, 2014, at 8:00 pm EST. Coverage will be effective January 1, 2015.
Other Important Information
Choose Well, Live Well
Annual Open Enrollment is the time to make important decisions about your health and welfare benefits, while taking
a fresh look at your entire benefits package. The Annual Open Enrollment Guide is a great place to start – and with its
clickable format, it’s easy to find the benefits information you’re looking for.
Terms to Know
Directory of Resources
Review and Update Your Dependents
During the current Annual Open Enrollment period, we are going to ask you to review and update
whom you would like to cover under the Cablevision Benefits Program. If someone is no longer
eligible, be sure to remove them. For those whom you are covering, you will be asked to provide
documentation to confirm their eligibility. To learn more, see page 9.
Find out What’s Ahead for 2015.
4
Welcome
If You Do Not Enroll
What’s Ahead for 2015
Annual Open Enrollment is the only time during the year when you can make changes to your 2015 health and
welfare benefit plan elections, including adding and removing dependents. To make changes at any other time,
you must experience a qualifying life event and make changes within 31 days of the event.
Eligibility
2015 Benefits Options
Ready to Enroll
Other Important Information
If you do not enroll by 8:00 pm EST on Thursday, December 4, 2014, your 2015 health and welfare benefit plan
elections will be as follows:
2014 Coverage
2015 Coverage
•Medical
• Your current 2014 elections will continue in 2015. You will also continue to cover
any dependents who were covered in 2014, provided they continue to meet eligibility
requirements. Please be sure to review the eligibility section to determine if
your dependent(s) are eligible for coverage in 2015.
•Dental
Choose Well, Live Well
Terms to Know
Directory of Resources
•Vision
• Life Insurance
• Supplemental AD&D
• Long-Term Disability
• Group Legal
• Health Care and Dependent Care
Flexible Spending Accounts*
• Your participation will end December 31, 2014.
*To participate in a Flexible Spending Account (FSA) in 2015, you must enroll during the 2015 Annual Open Enrollment period, between
Thursday, November 20, and Thursday, December 4, 2014.
Don’t forget to make sure your dependents are listed under each plan you wish them to be covered
by in 2015. For example, if your newborn was covered under Medical in 2014 and you want your child
covered under Dental for 2015, you will have to add him or her to your Dental coverage during 2015
Annual Open Enrollment.
5
Welcome
What’s Ahead for 2015
Eligibility
2015 Benefits Options
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
What’s Ahead for 2015
Cablevision evaluates our benefits each year so that we can continue to offer our employees a
comprehensive and competitive benefits package. For 2015, we are pleased to share that there are
no plan design changes for your medical, dental or vision coverage.
We are also excited to announce the arrival of three new
offerings for 2015:
• Back-Up Care Advantage Program: To help provide
peace of mind when it comes to child, adult and
elder care, employees now have access to emergency
back-up care through Bright Horizons, as well as
access to Sittercity, an online caregiver database.
• Adoption Assistance: We know that expanding your
family through adoption can be rewarding. We also
know that the adoption process can be long and
costly. So to provide eligible employees with support,
we will now provide a reimbursement of up to
$10,000 to help cover adoption-related costs after
the adoption is complete.
• Bonding Leave: Cablevision understands the
importance of bonding with a new child. Beginning
in 2015, employees who are new parents will be able
to take up to eight weeks of unpaid leave, even if
ineligible for FMLA or if FMLA has been exhausted
due to a complicated pregnancy or other condition.
For more information about how to take advantage of
these exciting programs, see pages 60-62.
6
Welcome
What’s Ahead for 2015
Eligibility
2015 Benefits Options
The Affordable Care Act (ACA) has required some costly changes to our medical plan. In addition, under the ACA,
millions of individuals who previously did not have medical coverage now have access to health care subsidized by the
government. All employers who provide medical coverage to their employees are required to pay fees to fund a portion
of this cost. These fees add significant costs to the Cablevision Medical Plan.
For 2015, your Medical and Dental contributions will continue to be significantly less than what employees at other
large companies generally pay for coverage. However, as a result of costs associated with the ACA, there will be
employee contribution increases for both Medical Plans and the Dental PPO (DPPO) option.
• Your Vision Plan contributions will decrease slightly and there will be no increases for the Dental HMO (DHMO) option.
Ready to Enroll
• There will also be an increase to the contribution for the Hyatt Legal Plan.
Other Important Information
No Contribution Cost Options Still Available in 2015
Choose Well, Live Well
If you earn less than $50,000, you will still have a no-contribution cost Medical and Dental Plan option available to
you in 2015.
Terms to Know
Directory of Resources
True-Up Contribution
Beginning with the 2014 Plan year, the Cablevision 401(k) Plan is being enhanced to include an additional
“true-up” matching contribution. Cablevision will review your total contributions and the total matching
contributions you received. If you did not receive the maximum match based on your eligible contributions,
Cablevision will provide a “true-up” matching contribution to your account in the first quarter of 2015.
Did You Know?
Cablevision believes it is important for employees to take vacation time every year to relax,
rejuvenate and spend time with family and friends. That is why effective 2015, there will be a
change to the amount of vacation you may carry over into 2016 to a maximum of 75% of the
time you accrue annually.
7
Welcome
Welcome
What’s Ahead for 2015
What’s Ahead for 2015
Eligibility
Eligibility
Eligibility
Full-Time Employees of Cablevision
(Including employees of CCG Holdings LLC)
Dependent Eligibility Confirmation
2015 Benefits Options
You are eligible to participate in the Cablevision Benefits
Program if you are a full-time (exempt or non-exempt) employee
regularly scheduled to work at least 35 hours per week.
2015 Benefits Options
Ready to Enroll
Eligible full-time employees may participate in the:
Ready to Enroll
Other Important Information
Other Important Information
Choose Well, Live Well
Choose Well, Live Well
Terms to Know
Terms to Know
Directory of Resources
Directory of Resources
• Medical Plan
• Dental Plan
• Vision Plan
• Flexible Spending Accounts
• Short-Term Disability Program
• Long-Term Disability Plan
• Life and AD&D Plans
• Business Travel Accident Insurance
• Group Legal Plan
• Employee Assistance Program
Part-Time Employees of Cablevision
Part-time employees who are regularly scheduled to work
20 hours or more per week are eligible to participate in
the same plans as eligible full-time employees, with the
exception of the Long-Term Disability Plan. Part-time
employees who are not regularly scheduled to work at
least 20 hours per week are not eligible to participate in
the Cablevision Benefits Program.
Part-time employees of CCG Holdings LLC
are not eligible to participate in the Cablevision
Benefits Program.
8
Welcome
Your Dependents
What’s Ahead for 2015
If you are a benefits-eligible employee, you may also enroll your eligible dependents.
Eligibility
Dependent Eligibility Confirmation
Your eligible dependents include:
• Your spouse (provided you are not legally separated or divorced). For the purposes of the Plan, your spouse is
your legal partner in marriage, and from whom you are not legally divorced;
• Your same- or opposite-sex domestic partner;
2015 Benefits Options
• Your unmarried child(ren) or those of your spouse/domestic partner, until December 31st of the year in which
they reach age 19 (or 25 if they are full-time students); and
Ready to Enroll
• Your unmarried mentally or physically disabled child(ren), or those of your spouse/domestic partner, regardless of age,
who have been classified as disabled and incapable of self-support because of their disability, provided they became
disabled while covered under the Plan. Proof of disability will be required.
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
• Special Eligibility for Medical Plan Only: This applies to your adult children or those of your spouse/domestic partner,
until they reach age 26, regardless of whether they have access to coverage under another employer-sponsored
medical plan. Coverage ends on the last day of the month in which they reach age 26.
Please Note: Only benefits-eligible full-time and part-time employees may take advantage of the benefits listed in
this Guide. These benefits are not applicable to employees who are covered by a collective bargaining relationship
with the Company. Your benefits are subject to negotiations with your collective bargaining representative.
Review and Update Your Dependents
During Annual Open Enrollment, it is important for you to review and update whom you would like to
cover under the Cablevision Benefits Program. If someone is no longer eligible, be sure to remove them.
For those whom you are covering, you will be asked to provide documentation to confirm their eligibility.
To learn more, see page 9.
9
Welcome
Welcome
What’s Ahead for 2015
What’s Ahead for 2015
Eligibility
Eligibility
Dependent Eligibility Confirmation
2015 Benefits Options
2015 Benefits Options
Ready to Enroll
Ready to Enroll
Other Important Information
Dependent Eligibility Confirmation
It’s important this year to review and update your eligible dependents when you enroll in your benefits, because in
2015, as a best practice, we will conduct a dependent eligibility confirmation.
As part of the confirmation, employees who cover dependents in a Cablevision health care plan will be required to
certify their eligibility by providing key information to maintain coverage. Individuals found to be ineligible for coverage
under the Company’s plan will be dropped from coverage. The confirmation will cover only 2015 (not 2014 or
previous years).
Please take the time to review the eligibility requirements on the previous page and determine if your dependents meet
the requirements for the plans that you wish to enroll them in. Remember, covering an ineligible dependent is a serious
matter. Be sure to remove your dependents from your coverage if they no longer meet the eligibility criteria.
Other Important Information
Choose Well, Live Well
Choose Well, Live Well
Terms to Know
As you review dependent eligibility for additional information, consider whether your circumstances have
changed in ways that would affect your eligibility or that of your dependents. For example:
Terms to Know
Directory of Resources
Directory of Resources
Has your marriage status changed through marriage, divorce, separation, death?
Do you have a newborn or newly adopted child?
Are your children still eligible, or have they passed the age of eligibility?
Do your disabled children still meet the criteria for coverage? Are they still unmarried? Still incapable of self-support?
It is also important that you make sure to list your dependents’ personal information correctly, including dates of birth
and Social Security numbers. Social Security numbers are required.
If you are unsure if your dependent meets the eligibility requirements, you can contact the Corporate Benefits
Department or your local Human Resources (HR) Generalist.
10
Welcome
Welcome
What’s Ahead for 2015
Eligibility
What’s Ahead for 2015
2015
Benefits Options
Eligibility
Medical
2015 Benefits Options
• Medical Plan Comparison Chart
• Medical Plan Examples
Ready to Enroll
• Medical Contribution Schedule
Other Important Information
Prescription Drugs
Dental
Choose Well, Live Well
Vision
Flexible
Spending
Terms to
Know Accounts (FSAs)
Income Protection
Directory
of Resources
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Bonding Leave
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
2015 Benefits Options
Medical
Choice Plus Medical Plan Options
Through our Medical Plan options, Cablevision offers
benefits designed to help keep you and your family healthy
and protect you from financial hardship in the event of serious
illness or injury. Cablevision offers two options for medical
coverage, so you can select the coverage that’s right for you.
Both UnitedHealthcare Choice Plus Option 1 and
UnitedHealthcare Choice Plus Option 2 offer “open access”
flexibility. This means that whichever option you choose:
• You have access to both in-network and out-of-network
coverage through UnitedHealthcare’s Choice Plus Network.
• You can visit an in-network specialist without a referral.
• You don’t need to select a primary care physician.
Regardless of which Medical Plan option you choose,
you can use in- and out-of-network providers. You will pay
less out of pocket when using in-network providers (doctors
and facilities that contract with UnitedHealthcare’s Choice Plus
network). Out-of-network providers (doctors and facilities that
do not contract with UnitedHealthcare’s Choice Plus network)
will always cost you more than in-network providers, as you
will be responsible for any charges above what are considered
reasonable and customary (R&C).
For more details on the Medical Plan options, see the
Plan Comparison Chart. To find a medical network provider,
visit www.myuhc.com.
11
Welcome
What’s Ahead for 2015
Eligibility
Choose Well, Live Well
2015 Benefits Options
Remember: in-network preventive care services are available at no cost to you. Preventive services
include a routine checkup for yourself and your eligible dependents, and much more:
Medical
• Medical Plan Comparison Chart
• Medical Plan Examples
• Medical Contribution Schedule
Prescription Drugs
Dental
Vision
Flexible Spending Accounts (FSAs)
Income Protection
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
• Well-child care, including immunizations
• Adult screenings and immunizations, including for blood pressure, diabetes and cardiovascular disease
• Health services for women, including well-woman exams, routine mammograms, HPV DNA testing,
and breastfeeding and postpartum counseling
• Birth control devices for women, including Tier 1 contraceptives
• Adult counseling on tobacco use and alcohol use, as well as counseling on nutrition, physical activity
and depression
Use the resources available to you to proactively make better choices to live a healthier life. For more
information on preventive care, visit UnitedHealthcare (UHC) online at www.uhcpreventivecare.com
Remember: Certain services can be used for preventive or diagnostic reasons. Diagnostic services are
subject to the applicable copay or deductible and coinsurance amounts.
Adoption Assistance Program
Bonding Leave
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
Pre-certification means pre-approval of care. Receiving pre-approval of care may help you avoid unnecessary
hospital stays and costly medical procedures. You must contact Care Coordination before specific medical
services are performed. If you do not, your benefits under the Plan may be reduced. If you use an in-network
provider, your pre-certification will be the responsibility of your provider. If you use an out-of-network
provider, you will be responsible for pre-certification. To find out which services require pre-certification, refer to
your Medical Plan Summary Plan Description or call UnitedHealthcare at 1-800-525-5590.
12
Welcome
Medical Plan Comparison Chart
What’s Ahead for 2015
Plan Feature
Eligibility
2015 Benefits Options
Medical
Option 1
Option 2
In-Network
Out-of-Network
In-Network
Out-of-Network
•Individual
$300
$1,000
$600
$2,000
•Family
$900
$3,000
$1,800
$6,000
Annual Deductible
• Medical Plan Comparison Chart
• Medical Plan Examples
Annual Out-of-Pocket Maximum
• Medical Contribution Schedule
•Individual
$1,800
$3,600
$3,600
$7,200
•Family
$4,500
$9,000
$9,000
$18,000
Prescription Drugs
Dental
Lifetime Maximum
Vision
Pre-existing Condition Limitation
Flexible Spending Accounts (FSAs)
You Pay...
Income Protection
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Bonding Leave
Doctor’s Office Visits
• Primary Care
$20 copay*
•Specialist
$35 copay*
• Well-child Care to Age 19
(including immunizations)
Ready to Enroll
• Routine Mammograms
Other Important Information
• Routine Adult Physical Exams
Terms to Know
Directory of Resources
Unlimited
None
None
40%
after deductible,
plus any amount
over R&C
$20 copay*
$35 copay*
40%
after deductible,
plus any amount
over R&C
Routine Preventive Care
• Well-woman Care
Choose Well, Live Well
Unlimited
Inpatient Hospital Services
$0
40%
after deductible,
plus any amount
over R&C
$0
40%
after deductible,
plus any amount
over R&C
$0
Not covered
$0
Not covered
20% after
deductible
40%
after deductible,
plus any amount
over R&C
20% after
deductible
40%
after deductible,
plus any amount
over R&C
Continued on next page >
13
Welcome
What’s Ahead for 2015
Plan Feature
Option 1
Option 2
In-Network
Out-of-Network
In-Network
Out-of-Network
Hospital Emergency Room Visit
$100 copay*
$100 copay*
$100 copay*
$100 copay*
Urgent Care
$20 copay*
40%
after deductible,
plus any amount
over R&C
$20 copay*
40%
after deductible,
plus any amount
over R&C
Outpatient Facility
Surgical Care
20% after
deductible
40%
after deductible,
plus any amount
over R&C
20% after
deductible
40%
after deductible,
plus any amount
over R&C
$20 primary or
$35 specialist copay
for first visit*
40%
after deductible,
plus any amount
over R&C
$20 primary or
$35 specialist copay
for first visit*
40%
after deductible,
plus any amount
over R&C
20% after
deductible
40%
after deductible,
plus any amount
over R&C
20% after
deductible
40%
after deductible,
plus any amount
over R&C
•Inpatient
20% after
deductible
20% after
deductible
Ready to Enroll
• Outpatient (unlimited)
$20 copay*
40%
after deductible,
plus any amount
over R&C
40%
after deductible,
plus any amount
over R&C
Other Important Information
Hearing Aids
Eligibility
2015 Benefits Options
Medical
• Medical Plan Comparison Chart
• Medical Plan Examples
• Medical Contribution Schedule
Prescription Drugs
Dental
Vision
Pre-Natal and Post-Natal
Maternity Care
Flexible Spending Accounts (FSAs)
Income Protection
Survivor Protection
Lab Work and X-Rays
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Bonding Leave
Choose Well, Live Well
Terms to Know
Directory of Resources
Mental Health/Substance
Abuse Treatment
$1,000 allowance every 36 months
Other Covered Services
20% after
deductible
40%
after deductible,
plus any amount
over R&C
$20 copay*
$1,000 allowance every 36 months
20% after
deductible
40%
after deductible,
plus any amount
over R&C
Continued on next page >
14
Welcome
What’s Ahead for 2015
Plan Feature
Eligibility
• Medical Contribution Schedule
Cardiac Rehabilitation,
Physical Therapy,
Chiropractic Therapy,
Occupational Therapy,
Speech Therapy
and Pulmonary
Rehabilitation Therapy
Prescription Drugs
Skilled Nursing Facility
2015 Benefits Options
Medical
• Medical Plan Comparison Chart
• Medical Plan Examples
Option 1
In-Network
Out-of-Network
$35 copay*
40%
after deductible,
plus any amount
over R&C
Up to 60 visits per plan year combined
in- and out-of-network
20% after
deductible
Dental
Vision
40%
after deductible,
plus any amount
over R&C
Option 2
In-Network
Out-of-Network
$35 copay*
40%
after deductible,
plus any amount
over R&C
Up to 60 visits per plan year combined
in- and out-of-network
20% after
deductible
40%
after deductible,
plus any amount
over R&C
Flexible Spending Accounts (FSAs)
Up to 120 visits per plan year
combined in- and out-of-network
Income Protection
Survivor Protection
Group Legal
Home Health Care
20% after
deductible
Back-Up Care
Advantage Program
Adoption Assistance Program
Bonding Leave
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
40%
after deductible,
plus any amount
over R&C
Up to 120 visits per plan year
combined in- and out-of-network
Prosthetics and
Durable Medical Equipment
20% after
deductible
40%
after deductible,
plus any amount
over R&C
Up to 120 visits per plan year
combined in- and out-of-network
20% after
deductible
40%
after deductible,
plus any amount
over R&C
Up to 120 visits per plan year
combined in- and out-of-network
20% after
deductible
40%
after deductible,
plus any amount
over R&C
Continued on next page >
15
Welcome
What’s Ahead for 2015
Plan Feature
Option 1
In-Network
Option 2
Out-of-Network
In-Network
Eligibility
Prescription Drugs (OptumRx)
2015 Benefits Options
Retail Pharmacy
(up to a 31-day supply)
Medical
• Tier 1
$7 copay*
$7 copay*
• Medical Plan Comparison Chart
• Tier 2
$25 copay*
$25 copay*
• Medical Plan Examples
• Tier 3
$40 copay*
• Medical Contribution Schedule
$40 copay*
Not covered
Prescription Drugs
Mail Order
(up to a 90-day supply)
Dental
• Tier 1
$14 copay*
$14 copay*
Vision
• Tier 2
$50 copay*
$50 copay*
• Tier 3
$80 copay*
$80 copay*
Flexible Spending Accounts (FSAs)
Income Protection
Fertility Treatment
Survivor Protection
Treatment Maximum
Group Legal
Back-Up Care
Advantage Program
$25,000 lifetime maximum for medical and
$25,000 lifetime maximum for prescription drug
treatment combined in- and out-of-network
$35 specialist
copay* per visit
40%
after deductible,
plus any amount
over R&C
20% after
deductible
40%
after deductible,
plus any amount
over R&C
20% after
deductible
40%
after deductible,
plus any amount
over R&C
Pharmacy copay
Not covered
Pharmacy copay
Not covered
Ready to Enroll
In Vitro Fertilization (GIFT, ZIFT, etc.)
Other Important Information
Inpatient and
Outpatient Facilities
Choose Well, Live Well
Directory of Resources
$25,000 lifetime maximum for medical and
$25,000 lifetime maximum for prescription drug
treatment combined in- and out-of-network
40%
after deductible,
plus any amount
over R&C
Bonding Leave
Drug Therapy
Not covered
$35 specialist
copay* per visit
Office Visit
Adoption Assistance Program
Terms to Know
Out-of-Network
*Copays do not apply to the deductible; however, they do apply to the out-of-pocket maximum
16
Welcome
What’s Ahead for 2015
Medical Plan Examples
Eligibility
Which Plan Is Right for Me?
2015 Benefits Options
Cablevision offers two Medical Plan options for 2015: UnitedHealthcare Choice Plus Option 1 and UnitedHealthcare
Choice Plus Option 2. Both plans offer the flexibility of in- and out-of-network care.
Medical
• Medical Plan Comparison Chart
• Medical Plan Examples
• Medical Contribution Schedule
Prescription Drugs
Dental
Vision
Flexible Spending Accounts (FSAs)
Income Protection
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Bonding Leave
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
The following examples can help you choose which Medical Plan option may be right for you. Review them to see
which best matches your situation. Then conduct your own comparison using UnitedHealthcare’s Health Plan
Cost Estimator (User ID: Cable2015, Password: benefits), which can help you estimate your total health care costs
for 2015 under each of the options.
17
Welcome
What’s Ahead for 2015
Meet Brad
He:
Eligibility
• Earns $45,000 a year
• Values low per-paycheck contributions
2015 Benefits Options
• Is single and doesn’t have any children
• Plans to seek preventive care
Medical
• Doesn’t anticipate any major health care • Always uses in-network providers
expenses in 2015
• Medical Plan Comparison Chart
• Medical Plan Examples
• Medical Contribution Schedule
Given Brad’s situation, let’s see how each Medical Plan option could work for him.
Prescription Drugs
Dental
Vision
Service
UHC Option 1
UHC Option 2
Brad pays…
Brad pays…
Annual physical exam = $0
Annual physical exam = $0
Additional visit = $20
Additional visit = $20
Income Protection
Annual physical exam (in-network)
+ one additional visit to his primary
care physician
Survivor Protection
Two in-network specialist visits
$35 per visit = $70
$35 per visit = $70
Two generic drug prescriptions
$7 per prescription = $14
$7 per prescription = $14
Cost for services in 2015
$104
$104
Annual contributions for 2015
$657
$0
Total cost
$761
$104
Flexible Spending Accounts (FSAs)
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Bonding Leave
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
Because Brad makes less than $50,000 a year, Option 2 is available to him at no cost. Because the cost of care is
the same with both options, Option 2 is the most cost-effective choice for Brad.
What exactly is a copayment?
How does a deductible differ from coinsurance?
Find out in the Terms to Know section.
18
Welcome
What’s Ahead for 2015
Eligibility
2015 Benefits Options
Medical
• Medical Plan Comparison Chart
• Medical Plan Examples
• Medical Contribution Schedule
Prescription Drugs
Dental
Vision
Flexible Spending Accounts (FSAs)
Income Protection
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Bonding Leave
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
Choose Well, Live Well
Not sure whether a medical situation is really an emergency? Call myNurseLine at 1-866-425-2148 –
you’ll get guidance from a registered nurse, live. Perhaps you’ll discover that a visit to your doctor or
an urgent care center is what you need, rather than a trip to the emergency room. In such an event,
you would pay a $20 copay rather than the $100 (ER) copay.
19
Welcome
Meet Linda
She:
What’s Ahead for 2015
• Earns $57,000 a year
• Is married to Tim and they have one
daughter, Nora, who is asthmatic and
needs medical care from specialists
Eligibility
2015 Benefits Options
Medical
• Medical Plan Comparison Chart
• Values both in- and out-of-network care
providers for her daughter’s care
• Plans to seek preventive care in 2015
• Provides the medical coverage for her family
Given Linda’s situation, let’s see how each Medical Plan option could work for her and her family.
• Medical Plan Examples
UHC Option 1
UHC Option 2
Linda pays…
Linda pays…
• Medical Contribution Schedule
Service
Prescription Drugs
Linda’s annual physical exam (in-network)
$0
$0
Dental
Tim’s annual physical exam (in-network)
$0
$0
Vision
Nora’s well child care office visit (in-network)
$0
$0
Nora’s 30 specialist office visits for asthma
symptoms (out-of-network – $200 per visit)
$1,000 deductible +
40% coinsurance ($2,000) = $3,000
$2,000 deductible +
40% coinsurance ($1,600) = $3,600
Nora’s emergency room visit for an asthma
attack, resulting in a hospital admission and
a five-night stay (hospital bill of $18,000*)
$300 deductible +
20% coinsurance ($3,540) = $3,840
$600 deductible +
20% coinsurance ($3,480) = $4,080
$1,800 in-network individual
out-of-pocket limit has been reached
$3,600 in-network individual
out-of-pocket limit has been reached
$0**
$0**
Flexible Spending Accounts (FSAs)
Income Protection
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Bonding Leave
Nora’s asthma medication, four 90-day
supplies of Tier 2 medication through
mail-order program ($50 per prescription)
Ready to Enroll
Cost of services for 2015
$4,800
$7,200
Annual contributions for 2015
$2,626
$965
Total cost
$7,426
$8,165
Other Important Information
Choose Well, Live Well
Terms to Know
* The $100 ER copay was waived because Nora was admitted to the hospital
** Because Nora has met her in-network out-of-pocket maximum, she is covered at 100% for covered in-network services for the remainder
of the plan year.
Directory of Resources
Because of the type and amount of care her family will need, Option 1 is the more cost-effective choice for Linda.
20
Welcome
What’s Ahead for 2015
Eligibility
Medical Contribution Schedule
Full-Time Employees – Bi-weekly Pay Frequency
2015 Benefits Options
Medical
Your medical election
Your annual eligible pay
Employee only
Employee+1
Family
Up to $49,999
$25.25
$49.24
$75.75
$50,000 – $69,999
$33.67
$65.65
$101.00
$70,000 – $89,999
$53.87
$105.04
$161.60
$90,000 – $109,999
$80.80
$157.56
$242.40
$110,000 or more
$87.54
$170.69
$262.60
Up to $49,999
$0.00
$0.00
$0.00
$50,000 – $69,999
$12.38
$24.13
$37.13
$70,000 – $89,999
$39.19
$76.43
$117.58
$90,000 – $109,999
$55.70
$108.60
$167.09
$110,000 or more
$57.76
$112.63
$173.28
• Medical Plan Comparison Chart
• Medical Plan Examples
• Medical Contribution Schedule
UnitedHealthcare Choice
Plus Option 1
Prescription Drugs
Dental
Vision
Flexible Spending Accounts (FSAs)
Income Protection
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Bonding Leave
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
UnitedHealthcare Choice
Plus Option 2
Your bi-weekly contribution
21
Welcome
Full-Time Employees – Monthly Pay Frequency
What’s Ahead for 2015
Your medical election
Your annual eligible pay
Eligibility
Your monthly contribution
Employee only
Employee+1
Family
Up to $49,999
$54.71
$106.68
$164.13
$50,000 – $69,999
$72.95
$142.24
$218.84
$70,000 – $89,999
$116.71
$227.59
$350.14
• Medical Plan Examples
$90,000 – $109,999
$175.07
$341.38
$525.21
• Medical Contribution Schedule
$110,000 or more
$189.66
$369.83
$568.97
Up to $49,999
$0.00
$0.00
$0.00
$50,000 – $69,999
$26.82
$52.29
$80.45
Vision
$70,000 – $89,999
$84.92
$165.59
$254.76
Flexible Spending Accounts (FSAs)
$90,000 – $109,999
$120.68
$235.31
$362.02
Income Protection
$110,000 or more
$125.15
$244.03
$375.43
2015 Benefits Options
UnitedHealthcare Choice Plus
Option 1
Medical
• Medical Plan Comparison Chart
Prescription Drugs
Dental
UnitedHealthcare Choice Plus
Option 2
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Part-Time Employees – Monthly Pay Frequency*
Adoption Assistance Program
Bonding Leave
Your medical election
Ready to Enroll
Your monthly contribution
Employee only
Employee+1
Family
Other Important Information
UnitedHealthcare
Choice Plus Option 1
$189.66
$369.83
$568.97
Choose Well, Live Well
UnitedHealthcare
Choice Plus Option 2
$125.15
$244.03
$375.43
Terms to Know
Directory of Resources
*If you are paid on a bi-weekly basis, your bi-weekly contribution can be determined by multiplying the monthly amount by 12 and dividing
the total by 26.
22
Welcome
What’s Ahead for 2015
Eligibility
Remember, your deductible and out-of-pocket maximum both reset each year. For example, if you elected
employee only coverage Option 1 in 2014 and elect employee only coverage again for 2015, you will need to
meet the in-network deductible of $300 in 2015 before the Plan begins to pay. Your out-of-pocket medical
expenses paid in the previous year do not carry over.
2015 Benefits Options
Medical
• Medical Plan Comparison Chart
• Medical Plan Examples
• Medical Contribution Schedule
Prescription Drugs
Dental
Vision
Flexible Spending Accounts (FSAs)
Income Protection
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Bonding Leave
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
Choose Well, Live Well
Remember that timely preventive care such as annual checkups, well-woman and well-child care,
and immunizations can help you catch and deal with medical issues before they become more
serious (and costly) conditions. And all of these services and more are available at no cost to you.
23
Welcome
What’s Ahead for 2015
Eligibility
Prescription Drugs
When you enroll in a Medical Plan option, you automatically receive prescription drug coverage. OptumRx
administers the prescription drug benefit.
Your prescription drug costs are based on three different tiers of prescription drugs:
2015 Benefits Options
Tier 1 – This is your lowest-cost option and typically includes generic drugs and the lowest-cost brand-name drugs.
Medical
Tier 2 – This mid-range cost option includes most preferred brand-name drugs.
Prescription Drugs
Tier 3 – This is your highest-cost option and includes drugs that are usually the newest and most expensive, and are
considered non-preferred brand-name drugs. If your doctor prescribes you a Tier 3 drug, ask your doctor if there is
a lower-cost alternative in Tier 1 or Tier 2 that would provide the same treatment benefits.
Dental
Vision
Flexible Spending Accounts (FSAs)
Income Protection
Survivor Protection
Group Legal
Present your UHC Medical ID card at a pharmacy that participates in the OptumRx network for up to a 31-day
supply. Or you can save money on maintenance medications by using the mail-order program and receive a
90-day supply of medication for the cost of a 60-day supply – delivered right to your door. Either way, you will pay
a copayment for your medication. Visit www.myuhc.com to order online. You may also send your prescription
and applicable copayment to OptumRx.
Back-Up Care
Advantage Program
Adoption Assistance Program
Bonding Leave
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
When budgeting for your 2015 Health Care Flexible Spending Account (FSA) election, please keep in
mind that drug tiers, including drugs for which you currently have a prescription, may change as generic
equivalents become available. Please refer to the 2015 UHC Prescription Drug List on www.myuhc.com to
find out what tier your current prescription is listed under for 2015. For a complete list of copays for 2015,
see the chart on page 24. Remember, your prescription drug copays count toward your medical
out-of-pocket maximum.
24
Welcome
Drug Benefit Overview
Tier 1
Tier 2
Tier 3
Retail (up to 31-day supply)
You pay $7 copay
You pay $25 copay
You pay $40 copay
Mail-order (up to 90-day supply)
You pay $14 copay
You pay $50 copay
You pay $80 copay
What’s Ahead for 2015
Eligibility
2015 Benefits Options
Medical
Prescription Drugs
Dental
Vision
Flexible Spending Accounts (FSAs)
Income Protection
Survivor Protection
Group Legal
Choose Well, Live Well
Back-Up Care
Advantage Program
Here are some ways to save on prescription drugs:
Adoption Assistance Program
Bonding Leave
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
•Visit www.myuhc.com, click on the Prescription tab and select Pharmacy Benefits for a wealth of
information that can help you control the cost of your prescriptions – including a tool that lets you
compare the cost of brand and generic medications.
• Ask your doctor about generic brands. They cost less than brand-name drugs and contain the same
active ingredients.
• If you’ve just been prescribed a new medication, ask your doctor for free samples so you can see
how well it works before you pay for it.
25
Welcome
What’s Ahead for 2015
Eligibility
2015 Benefits Options
Medical
Prescription Drugs
Dental
Vision
Flexible Spending Accounts (FSAs)
Income Protection
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Bonding Leave
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
If you suffer from a chronic or complex condition, the appropriate use of specialty medications
can be important to your health — and your quality of life. OptumRx’s Specialty Pharmacy Program
provides the resources and personalized support that you need to help you better manage your
condition. If you or a covered dependent is currently taking a specialty medication, you can take
advantage of OptumRx’s personalized patient support at no charge to you. You will have 24/7
access to knowledgeable pharmacists and nurses who specialize in your condition. To find out more
call OptumRx at 1-888-739-5820 or log on to www.uhcspecialtyrx.com. You may no longer fill
new specialty drug prescriptions at a retail pharmacy. You must go to a specialty pharmacy if one
or more of your prescriptions falls into this category as defined by UnitedHealthcare.
26
Welcome
What’s Ahead for 2015
Dental
Eligibility
Dental Plan Options
2015 Benefits Options
Medical
Prescription Drugs
Dental
• Dental Plan Comparison Chart
• Dental Contribution Schedule
Vision
Flexible Spending Accounts (FSAs)
Income Protection
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Bonding Leave
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
You can choose either a Dental Preferred Provider Organization (DPPO) or a Dental Maintenance Organization® (DMO®).
Both Dental Plan options encourage preventive care and provide coverage for a wide range of services to help you
and your covered family members maintain good dental health. Each option covers preventive dental care at 100%,
including regular cleanings and X-rays, with no deductibles. Aetna administers both options.
27
Welcome
What’s Ahead for 2015
Eligibility
2015 Benefits Options
Medical
Prescription Drugs
Dental
• Dental Plan Comparison Chart
• Dental Contribution Schedule
Aetna Dental Preferred Provider Organization (DPPO) Option 1
The DPPO option gives you the choice of receiving dental care from dentists who participate in the Aetna Dental
PPO/PDN II network (in-network benefits) or from dentists outside of the network (out-of-network benefits).
No primary care dentist (PCD) referral is necessary – simply visit the dentist of your choice when you need dental
care. Visit www.aetna.com to find a list of participating dentists.
The DPPO option pays 100% of the costs of in-network preventive care (exams and cleanings). Once you meet the
annual deductible, the Plan also pays a percentage of charges for basic and major services until the calendar year
maximum is met. The Plan does not pay benefits after the calendar year maximum is met.
This option also gives you the flexibility of visiting a dentist who is outside of the Aetna Dental PPO/PDN II network.
However, you will generally pay less when you choose an in-network dentist. That’s because in-network dentists agree
to charge negotiated rates for services. In addition, when you choose an out-of-network dentist, you are responsible
for any expenses that are above the Plan’s reasonable and customary (R&C) limits.
Vision
Flexible Spending Accounts (FSAs)
Aetna Dental Maintenance Organization® (DMO®) Option 2
Income Protection
With the Aetna DMO® option, you must designate a DMO® primary care dentist (PCD) to coordinate your care.
You can select the same or a different PCD for each covered family member. Then, each time you need dental care,
you must visit your PCD, who can refer you to a specialist in the network if necessary. Visit www.aetna.com to find
a list of participating dentists.
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Bonding Leave
There is no annual deductible to meet and no calendar year maximum benefit – so you never have to worry about
exceeding your benefits for the year. Most preventive and basic services are covered in full. Major services and
orthodontia are also covered at 60% and 50%, respectively. The Plan will not pay benefits if you:
• Use an in-network dentist who is not on file at Aetna as your PCD,
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
• Use an in-network dentist without a referral from your PCD, or
• Use an out-of-network dentist.
You can change your primary care dentist (PCD) at any time by logging on to Aetna Navigator or by calling Aetna at
1-877-238-6200. If you make the change before the 15th of the month, the change will be effective the first of the
following month.
Some dental services may require pre-certification. To find out which services require pre-certification, refer to your
Dental Plan Summary Plan Description or call Aetna at 1-877-238-6200.
28
Welcome
What’s Ahead for 2015
Dental Plan Comparison Chart
Eligibility
2015 Benefits Options
Medical
DPPO Option 1
Plan feature
In-network
Calendar-year deductible
Out-of-network
DMO® Option 2
In-network only
Employee: $50
Employee+1: $100
Prescription Drugs
None
Family: $150
Dental
• Dental Plan Comparison Chart
• Dental Contribution Schedule
Vision
Calendar-year maximum
$2,000 per person
None
Separate orthodontia
lifetime maximum
$2,000 per person
One course of
treatment per person
per lifetime
Not required
Required
Flexible Spending Accounts (FSAs)
Income Protection
Primary care dentist referral
Survivor Protection
Services
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Bonding Leave
Ready to Enroll
Preventive care includes:
• Routine exams and cleanings*
•Prophylaxis
(cleaning and polishing)
• Fluoride treatments*
• Periapical X-rays*
• Bitewing, full mouth X-rays*
Other Important Information
You Pay:
$0
You Pay:
Any amount over R&C
You Pay:
$0
Plan Pays:
100% of pre-set,
negotiated fee
(deductible does not apply)
Plan Pays:
100% of R&C
(deductible does not apply)
Plan Pays:
100%
• Emergency treatment for
dental pain
Choose Well, Live Well
Terms to Know
Directory of Resources
Continued on next page >
29
Welcome
DPPO Option 1
What’s Ahead for 2015
Plan feature
Eligibility
Basic services include:
• White fillings for molars (DPPO only)
2015 Benefits Options
• Stainless steel crowns
Medical
• Root canal therapy for anterior,
bicuspid teeth (and molar teeth
under DPPO)
Prescription Drugs
Dental
• Dental Plan Comparison Chart
• Dental Contribution Schedule
•Apicoectomy
• Scaling and root planing
• Subgingival curettage
DMO® Option 2
In-network
Out-of-network
In-network only
You Pay:
20% of pre-set,
negotiated fee,
after deductible
You Pay:
20% of R&C
after deductible,
plus any amount over R&C
You Pay:
$0
Plan Pays:
80% of pre-set,
negotiated fee,
after deductible
Plan Pays:
80% of R&C,
after deductible
Plan Pays:
100%
You Pay:
50% of pre-set,
negotiated fee
after deductible
You Pay:
50% of R&C
after deductible,
plus any amount over R&C
You Pay:
40%
Plan Pays:
50% of pre-set,
negotiated fee,
after deductible
Plan Pays:
50% of R&C,
after deductible
Plan Pays:
60%
•Gingivectomy
Vision
• Incision/draining of abscesses
Flexible Spending Accounts (FSAs)
• Simple extractions
Income Protection
• Surgical removal of erupted or
soft tissue impacted teeth
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
• Denture repairs
Major services include:
• Osseous surgery**
Bonding Leave
• Surgical removal of partial
or full bony impacted tooth**
Ready to Enroll
• Root canal therapy for
molar teeth**
Other Important Information
•Inlays/onlays/bridges
• Crowns/crown buildups
Choose Well, Live Well
• Full and partial dentures
Terms to Know
• Full mouth debridement
Directory of Resources
• Implants (DPPO only)
Continued on next page >
30
Welcome
What’s Ahead for 2015
DPPO Option 1
Eligibility
2015 Benefits Options
Medical
Prescription Drugs
Dental
• Dental Plan Comparison Chart
• Dental Contribution Schedule
Vision
Flexible Spending Accounts (FSAs)
Income Protection
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Bonding Leave
Plan feature
Orthodontia for adults
and children
DMO® Option 2
In-network
Out-of-network
In-network only
You Pay:
Remaining balance
after Plan pays 50%
of pre-set, negotiated fee,
up to the separate
$2,000 orthodontia
lifetime maximum
You Pay:
Remaining balance
after Plan pays 50% of R&C,
up to the separate
$2,000 orthodontia
lifetime maximum
You Pay:
50%
You are responsible for
100% once the lifetime
maximum has been met
Plan Pays:
50% of pre-set,
negotiated fee,
up to the separate
$2,000 orthodontia
lifetime maximum
(deductible and
calendar-year maximum
do not apply)
You are responsible for
100% once the lifetime
maximum has been met
Plan Pays:
50% of total fee,
up to the separate
$2,000 orthodontia lifetime
maximum
Plan Pays:
50%
(up to one course
of treatment per
person per lifetime)
(deductible and
calendar-year maximum
do not apply)
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
Important Note: Pre-existing conditions apply to certain services, including orthodontia; please contact Aetna directly
for more information.
*Frequency and age limitations apply to these services. Please contact Aetna Member Services directly for description of coverage.
**Covered as a major service under DMO®. Dental PPO covers root canal therapy for molar teeth, osseous surgery and the surgical removal
of a partial or full bony impacted tooth as a basic service.
31
Welcome
Dental Contribution Schedule
What’s Ahead for 2015
Eligibility
2015 Benefits Options
Full-Time Employees – Bi-weekly Pay Frequency
Your dental election
Your annual eligible pay
Your bi-weekly contribution
Employee only
Employee+1
Family
Up to $49,999
$1.81
$3.54
$5.37
$50,000 – $69,999
$2.56
$5.12
$6.41
• Dental Contribution Schedule
$70,000 – $89,999
$2.95
$5.89
$7.37
Vision
$90,000 – $109,999
$3.88
$7.75
$9.70
$110,000 or more
$4.05
$8.11
$10.14
Up to $49,999
$0.00
$0.00
$0.00
$50,000 – $69,999
$1.00
$1.96
$2.49
$70,000 – $89,999
$2.10
$4.10
$5.19
Bonding Leave
$90,000 – $109,999
$2.73
$5.33
$6.83
Ready to Enroll
$110,000 or more
$2.87
$5.59
$7.17
Medical
Prescription Drugs
Aetna DPPO Option 1
Dental
• Dental Plan Comparison Chart
Flexible Spending Accounts (FSAs)
Income Protection
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
Aetna DMO® Option 2
32
Welcome
What’s Ahead for 2015
Eligibility
2015 Benefits Options
Full-Time Employees – Monthly Pay Frequency
Your dental election
Your annual eligible pay
Your monthly contribution
Employee only
Employee+1
Family
Up to $49,999
$3.93
$7.68
$11.62
$50,000 – $69,999
$5.55
$11.08
$13.89
• Dental Contribution Schedule
$70,000 – $89,999
$6.39
$12.76
$15.96
Vision
$90,000 – $109,999
$8.41
$16.80
$21.01
$110,000 or more
$8.78
$17.57
$21.97
Up to $49,999
$0.00
$0.00
$0.00
$50,000 – $69,999
$2.16
$4.24
$5.40
$70,000 – $89,999
$4.54
$8.88
$11.25
Bonding Leave
$90,000 – $109,999
$5.92
$11.54
$14.79
Ready to Enroll
$110,000 or more
$6.22
$12.12
$15.54
Medical
Prescription Drugs
Aetna DPPO Option 1
Dental
• Dental Plan Comparison Chart
Flexible Spending Accounts (FSAs)
Income Protection
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
Aetna DMO® Option 2
33
Welcome
What’s Ahead for 2015
Eligibility
Part-Time Employees – Monthly Pay Frequency*
Your dental election
Your monthly contribution
Employee only
Employee+1
Family
Aetna DPPO Option 1
$16.33
$31.84
$41.64
Aetna DMO® Option 2
$12.10
$23.54
$32.93
2015 Benefits Options
Medical
Prescription Drugs
Dental
• Dental Plan Comparison Chart
• Dental Contribution Schedule
Vision
Flexible Spending Accounts (FSAs)
Income Protection
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Bonding Leave
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
*If you are paid bi-weekly, your bi-weekly contribution can be determined by multiplying the monthly amount by 12 and dividing the total by 26.
34
Welcome
What’s Ahead for 2015
Eligibility
2015 Benefits Options
Vision
The Vision Plan, administered by Vision Service Plan (VSP), is available to you and your eligible dependents. If you
enroll in the Vision Plan, you pay the full cost of the benefits. The Vision Plan is available as a stand-alone plan – you
do not have to enroll in other Cablevision health care plans to join.
Medical
Under the Basic Option (Option 2), you may purchase:
Prescription Drugs
• One set of lenses for your glasses or one set of contact lenses (up to a $105 allowance) every calendar year
Dental
• One set of frames every two (2) calendar years, up to a $120 allowance (20% discount on any amount in excess
of allowance), provided you did not utilize the contact lens allowance in the prior year
Vision
• Vision Plan Comparison Chart
• Vision Contribution Schedule
Under the Buy-up Option (Option 1), you may purchase:
• One set of lenses for your glasses or one set of contact lenses (up to a $105 allowance) every calendar year
Flexible Spending Accounts (FSAs)
Income Protection
Survivor Protection
• One set of frames every calendar year, up to a $120 allowance (20% discount on any amount in excess of allowance)
• Either a second pair of glasses or a second set of contact lenses each year (up to the applicable allowance)
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Bonding Leave
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
More Options in the VSP Network
In addition to 2,000 regional retail chain locations, the VSP Network also offers more than 1,000 optical
stores for your convenience, including Shopko, Costco® Optical, Visionworks® and Cohen’s Fashion Optical.
There are no forms required and participants will pay only copays and the costs over coverage amounts,
and/or for non-covered options when visiting these stores.
Please note: If you purchase eyewear at Costco® Optical, VSP permits a frame allowance of $65 only.
You will be responsible for any amounts over $65.
35
Welcome
What’s Ahead for 2015
Vision Plan Comparison Chart
Benefit
Medical
Prescription Drugs
Dental
Vision
Out-of-network
In-network
Out-of-network
You Pay:
$10 copay
Plan Pays:
up to $40
You Pay:
$10 copay
Plan Pays:
up to $40
Lenses
You Pay:
Plan Pays:
You Pay:
Plan Pays:
•Single
$25 copay
up to $35
$25 copay
up to $35
•Bifocal
$25 copay
up to $52
$25 copay
up to $52
•Trifocal
$25 copay
up to $65
$25 copay
up to $65
You Pay:
Plan Pays:
up to $45
You Pay:
Plan Pays:
up to $45
Exam, once every
calendar year
Frames
• Vision Plan Comparison Chart
$25 copay*
and any amount above
$120 allowance
• Vision Contribution Schedule
Flexible Spending Accounts (FSAs)
Income Protection
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Contact lenses**
Adoption Assistance Program
Benefit frequency
Bonding Leave
• Eye exam
Ready to Enroll
Other Important Information
Basic Option (Option 2)
In-network
Eligibility
2015 Benefits Options
Buy-up Option (Option 1)
$25 copay*
and any amount above
$120 allowance
Plan Pays:
Plan Pays:
$120 (20% discount is
applied to any amount
in excess of allowance)
$120 (20% discount is
applied to any amount
in excess of allowance)
Plan Pays:
up to $105
Plan Pays:
up to $105
Plan Pays:
up to $105
Plan Pays:
up to $105
once every calendar year
once every calendar year
•Lenses
up to two every calendar year
once every calendar year
•Frames
up to two every calendar year
once every two calendar years
Second pair
benefit***
Applies
N/A
N/A
N/A
Choose Well, Live Well
Terms to Know
*If frames and lenses are purchased together, a single $25 copay applies. If purchased on separate occasions, a separate $25 copay will apply for
each purchase.
**In-network allowance applies to the cost of the contacts, the fitting and the evaluation exam.
Directory of Resources
***Where benefit applies, it allows you to obtain a second pair of glasses or contacts, in addition to those received under the Basic Option (Option 2).
36
Welcome
What’s Ahead for 2015
Eligibility
Vision Contribution Schedule
Full-Time Employees – Bi-weekly Pay Frequency
2015 Benefits Options
Your bi-weekly contribution
Medical
Employee only
Employee+1
Family
Option 1 (Buy-up)
$3.44
$6.31
$9.83
Option 2 (Basic)
$1.98
$3.59
$5.56
Prescription Drugs
Dental
Vision
• Vision Plan Comparison Chart
• Vision Contribution Schedule
Flexible Spending Accounts (FSAs)
Income Protection
Survivor Protection
Part-Time Employees – Monthly Pay Frequency*
Group Legal
Your monthly contribution
Back-Up Care
Advantage Program
Adoption Assistance Program
Employee only
Employee+1
Family
Option 1 (Buy-up)
$7.45
$13.68
$21.29
Option 2 (Basic)
$4.28
$7.77
$12.05
Bonding Leave
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
*If you are paid bi-weekly, your bi-weekly contribution can be determined by multiplying the monthly amount by 12 and dividing the total by 26.
37
Welcome
What’s Ahead for 2015
Eligibility
2015 Benefits Options
Flexible Spending Accounts (FSAs)
What if you could pay for expenses such as deductibles, copayments, prescription medications and certain child
care costs with tax-free dollars? With Flexible Spending Accounts (FSAs), you can do just that!
Dental
The money you set aside into an FSA is not subject to federal income, Social Security (FICA) and, in most areas,
state and local taxes. In effect, participating in an FSA reduces your annual taxable income and the income taxes
withheld each pay period. Then, once you’ve incurred and paid for eligible expenses, you submit your expenses and
are reimbursed with the tax-free money in your account. These accounts are voluntary – you decide if you want to
participate and how much to contribute (up to IRS limits).
Vision
You may participate in two FSAs:
Flexible Spending Accounts (FSAs)
•The Health Care FSA, and
• Health Care FSA
•The Dependent Care FSA.
Medical
Prescription Drugs
• Dependent Care FSA
• IRS Guidelines
Income Protection
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Because of the tax advantages of FSAs, the IRS imposes certain guidelines on participants. If you choose to
participate in these accounts, you must enroll every year in order to continue participating.
You must elect to participate in the 2015 Health Care or Dependent Care Flexible Spending Account during
Annual Open Enrollment. Enrollment is not automatic – if you elected to participate in an FSA in 2014 and
you do not enroll during this year’s Annual Open Enrollment, your participation will end as of December 31, 2014.
Remember: Due to IRS regulations, any money you set aside in an FSA and do not use by the end of the grace period
is forfeited and cannot be carried over to the next year.
Bonding Leave
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
Access www.payflexdirect.com and click on Eligible Expense Items for a complete list of eligible health
care and dependent care expenses, or call PayFlex at 1-800-284-4885.
38
Welcome
What’s Ahead for 2015
Eligibility
2015 Benefits Options
FSA Administrator
PayFlex will continue to be the FSA administrator for 2015. PayFlex is affiliated with Aetna, which is Cablevision’s
Dental Plan administrator. If you were enrolled in an FSA for 2014 and enroll again for 2015, you can continue to use
your 2014 card to access your 2015 FSA dollars. You will not receive a new PayFlex card. If you need to request a
new PayFlex card, you can call PayFlex Customer Service at 1-800-284-4885 or log on to www.payflexdirect.com.
Medical
Prescription Drugs
Dental
Vision
Flexible Spending Accounts (FSAs)
Choose Well, Live Well
• Health Care FSA
Plan ahead to get the most out of your FSA
• Dependent Care FSA
• IRS Guidelines
Income Protection
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Estimate carefully what you think you will need for the year, since any unused funds are forfeited.
When planning for your FSAs, make sure to:
• Review your health care out-of-pocket expenses for the last year or two, including office visits and
prescription drugs prescribed by a qualified provider. Do you expect an increase or decrease in the
coming year?
Adoption Assistance Program
• Consider any potential new health care expenses – are you having or adopting a baby? Are you
planning for a procedure – such as an outpatient surgery or orthodontia – for yourself or for an
eligible dependent?
Bonding Leave
• Use the UnitedHealthcare Health Plan Cost Estimator tool to see how much you may save by enrolling.
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
• Check with your dependents’ day care providers and summer camps for any fee changes.
39
Welcome
PayFlex Card®
What’s Ahead for 2015
Eligibility
2015 Benefits Options
The PayFlex Card is a great way to pay for eligible items
and services from your Health Care and Dependent Care
FSAs. It’s a debit card that you can use to pay for any
legitimate FSA expense.
Medical
If you elect to contribute to a Health Care FSA, you can use
your PayFlex Card to pay for:
Prescription Drugs
• Copayments
Dental
• Prescriptions
Vision
• Vision and hearing products
Flexible Spending Accounts (FSAs)
• Bandages, contact lens solution and other eligible
non-medicinal items
• Health Care FSA
• Dependent Care FSA
• IRS Guidelines
Income Protection
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Bonding Leave
Ready to Enroll
If you have a Dependent Care FSA, you can use your
PayFlex Card to pay for eligible dependent care expenses.
You can use the PayFlex Card at any qualified service
provider or merchant where MasterCard is accepted.
The service provider or merchant needs to have
implemented an inventory information approval system
(IIAS), or some other IRS-approved system. If you
try to use your card somewhere that’s not a qualified
merchant, your card may be turned down. When that
happens, you can still pay for the item or service
and submit a claim for reimbursement.
Benefits of the card:
Other Important Information
• It’s easy to use – works just like a regular debit or
credit card.
Choose Well, Live Well
• You can pay legitimate FSA expenses immediately.
Terms to Know
• There is no need to file a claim and wait for
reimbursement.
Directory of Resources
40
Welcome
Submitting Your Health Care and Dependent Care FSA Claims
What’s Ahead for 2015
PayFlex Mobile
2015 Benefits Options
You can use mobile technology to submit a claim right from your phone! You can submit a claim and upload receipts
with the PayFlex mobile app and your phone’s camera. You can also access your account information 24/7, including
your account balances and claims processed, and you can receive important account updates to let you know the
status of your account and when action may be required.
Medical
PayFlex Online
Prescription Drugs
If you don’t want to use mobile technology, you can file a claim online via the PayFlex website. Once you log in,
you can view your account balance, order additional PayFlex cards, file a claim, set up “Pay Me Back” (or “Pay Them”
to pay your provider directly) and sign up for electronic account updates or direct deposit.
Eligibility
Dental
Vision
Flexible Spending Accounts (FSAs)
When you use PayFlex you don’t have to mail your FSA reimbursement requests, although you can still do that if you choose.
• Health Care FSA
Remember, if you enroll in PayFlex’s direct deposit feature, your FSA reimbursement will be not only easier, but quicker!
• Dependent Care FSA
Of course, if you use your PayFlex Card to pay for your eligible health care expenses, you won’t need to submit a
claim for reimbursement.
• IRS Guidelines
Income Protection
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Bonding Leave
Keep your receipts
When you use your PayFlex Card to pay for a service or to buy a health care item, it’s still a good idea to
keep your receipts. Even if a transaction is automatically approved at the point of purchase, you may still
be required to provide documentation later on to verify that you used your card to pay for an eligible item
or service. You will be asked to provide documentation to substantiate your out-of-pocket costs including
deductibles, coinsurance or dental and vision expenses.
Ready to Enroll
Other Important Information
Choose Well, Live Well
Questions?
Terms to Know
Visit www.payflexdirect.com or call1-800-284-4885.
Directory of Resources
41
Welcome
What’s Ahead for 2015
Health Care FSA
2015 Benefits Options
Although your medical, dental and vision benefits pay for many of your health-related expenses, not all health care
costs are covered in full. You may contribute up to $2,550 each year to the Health Care FSA to pay for eligible
expenses that you and your eligible dependents (not including your domestic partner or your domestic partner’s
eligible dependents) incur during the year. These include:
Medical
• Deductibles
Prescription Drugs
• Copayments and coinsurance
Dental
• Amounts you pay above “reasonable and customary” limits
Vision
• Eligible prescription drug costs that may not be covered by the Plan
Flexible Spending Accounts (FSAs)
• Medical treatments, such as acupuncture and chiropractic care
• Health Care FSA
• Major dental and orthodontia expenses above the maximum amounts paid by the Plan
• Dependent Care FSA
• Vision care expenses beyond those paid by the Plan
Eligibility
• IRS Guidelines
Income Protection
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Please note: For 2015 the amount that you are permitted to contribute to a Health Care FSA has increased
to $2,550. The amount you are permitted to contribute to a Dependent Care FSA in 2015 will remain the
same at $5,000 per family.
Adoption Assistance Program
Bonding Leave
Ready to Enroll
Other Important Information
Using your Health Care FSA for Prescription Medications
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If there is not a generic equivalent available for the medication you are currently taking,
be sure to plan ahead and increase your Health Care FSA election in 2015 to help with your
Tier 2 and Tier 3 copays.
Terms to Know
Directory of Resources
42
Welcome
What’s Ahead for 2015
Health Care FSA Grace Period
Eligibility
You may use your 2015 Health Care FSA for eligible expenses incurred through March 15, 2016. You will then have until
June 15, 2016 to submit your eligible expenses for reimbursement. Please note that the amount you elect to contribute
will be deducted from your paycheck in equal installments throughout the calendar year. Deductions will end with the last
paycheck of the year, unless you make a new election to enroll in the Health Care FSA for the next plan year.
2015 Benefits Options
Medical
Prescription Drugs
Dental
Vision
Flexible Spending Accounts (FSAs)
• Health Care FSA
• Dependent Care FSA
• IRS Guidelines
Income Protection
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Bonding Leave
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
Submitting a Claim
When you incur and submit an eligible health care expense, you will be reimbursed up to the amount you have
elected to contribute for the Plan year (minus any claims you’ve already submitted).
43
Welcome
What’s Ahead for 2015
Dependent Care FSA
Eligibility
You may need dependent day care services for your
children while you and your spouse/domestic partner
work, and perhaps while caring for an elderly or disabled
parent. You may deposit up to $5,000 a year into the
Dependent Care FSA to reimburse yourself for the cost
of dependent day care services, or up to $2,500 if
you are married and file separate tax returns from your
spouse. However, there are certain IRS restrictions. For
example, in order to use this account, you and your
spouse (if you’re married) must be at work or school at
the time your dependents are receiving care.
2015 Benefits Options
Medical
Prescription Drugs
Dental
Vision
Flexible Spending Accounts (FSAs)
• Health Care FSA
• Dependent Care FSA
• IRS Guidelines
Income Protection
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Eligible dependents for this account include:
• Your children under age 13, whom you claim as
exemptions for income tax purposes
• Children age 13 or older and adult dependents who
spend at least eight hours in your home each day
and are unable to care for themselves because of a
mental or physical disability
Bonding Leave
You can use the Dependent Care FSA to pay for eligible
expenses during the year, such as:
Ready to Enroll
• Day care provided by individuals inside or outside
of your home
Other Important Information
• Day care at a licensed nursery school, day camp
(not sleep-away camp) or day care center
Choose Well, Live Well
• Day care for an elderly dependent
Terms to Know
Directory of Resources
• A housekeeper who cares for your eligible dependent(s)
44
Welcome
What’s Ahead for 2015
Eligibility
2015 Benefits Options
Medical
Prescription Drugs
Submitting a Claim
Your Dependent Care FSA works differently from your Health Care FSA in an important way. While the Health Care
FSA will reimburse you up to the amount you have elected to contribute for the year, the Dependent Care FSA will
reimburse only your claims up to the amount already contributed. This is important to remember if you are using
your PayFlex Card to pay for your dependent care expenses. Only the amount you have already contributed will be
loaded on the PayFlex Card and available for use.
Dental
Vision
Flexible Spending Accounts (FSAs)
• Health Care FSA
• Dependent Care FSA
• IRS Guidelines
Income Protection
Survivor Protection
Group Legal
Dependent Care FSA Grace Period
Back-Up Care
Advantage Program
Similar to the Health Care FSA, you may use your 2015 Dependent Care FSA for eligible expenses
incurred through March 15, 2016. You then have until June 15, 2016, to submit your eligible expenses
for reimbursement. Please note that the amount you elect to contribute will be deducted from your
paycheck in equal installments throughout the calendar year. Deductions will end with the last paycheck
of the year, unless you make a new election to enroll in the Dependent Care FSA for the next plan year.
Adoption Assistance Program
Bonding Leave
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
Remember, if you do not submit your eligible health care or dependent care expenses by the applicable
deadlines, any amount remaining in your accounts at the end of the year will be forfeited.
45
Welcome
What’s Ahead for 2015
Eligibility
2015 Benefits Options
Medical
Prescription Drugs
Dental
Vision
Flexible Spending Accounts (FSAs)
• Health Care FSA
• Dependent Care FSA
• IRS Guidelines
Income Protection
IRS Guidelines
Because an FSA can offer you substantial tax savings, the IRS requires that you follow a number of guidelines:
• Estimate Carefully. Be sure to estimate your expenses
for the year before you make your election. Any
money remaining in your account after the deadline
to submit claims will be forfeited.
• No Account-to-Account Transfers. You cannot transfer
money from one account to the other to pay for
eligible expenses. You must keep the funds in each
account separate.
• No Double Reimbursement. You cannot claim expenses
on your federal income tax return if you’ve already
been reimbursed for them through an FSA.
• Domestic Partner. Your FSAs are not available for
reimbursement of expenses relating to your domestic
partner or his or her eligible dependents (unless
they meet the definition of a tax-qualified eligible
dependent).
• No Mid-Year Changes. You may not change the amount
you elect to contribute to the account(s) during the
year, unless you experience a qualifying life event
and the change is consistent with that event.
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Bonding Leave
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
If you leave Cablevision, you are eligible to continue to contribute to the Health Care FSA account through COBRA
on an after-tax basis.
46
Welcome
What’s Ahead for 2015
Eligibility
Income Protection
Would you be concerned about meeting your financial responsibilities if an illness or injury prevented you from
working for a period of time? The Short-Term Disability (STD) Program and Long-Term Disability (LTD) Plan offer you a
level of financial security when you need it most.
2015 Benefits Options
Medical
Prescription Drugs
Dental
Vision
Short-Term Disability (STD) Program
STD coverage is designed to provide you with a level of income replacement if you are unable to work because of a
disabling illness or injury (including a pregnancy-related condition). Here’s what you should know about STD coverage:
Flexible Spending Accounts (FSAs)
• If you are a full-time employee or a part-time employee regularly scheduled to work at least 20 hours or more per week.
You are automatically eligible for this coverage
Income Protection
• Coverage begins 90 days from your date of hire
Survivor Protection
• Company provided – you pay nothing for this coverage
Group Legal
• Begins paying benefits on the eighth consecutive day of a qualifying disability
Back-Up Care
Advantage Program
• Continues to pay benefits for up to 26 weeks, if you continue to qualify
Adoption Assistance Program
Bonding Leave
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
• Payments you receive from the Plan are taxable income
• Benefit amount is based on your eligible pay and length of service at onset of disability
Please contact the HR Accommodation and Leave Management Team or your HR Generalist for further details,
or refer to the Short-Term Disability Summary Plan Description.
47
Welcome
What’s Ahead for 2015
Eligibility
2015 Benefits Options
Long-Term Disability (LTD) Plan
If you are a full-time employee, Long-Term Disability coverage provides a level of income if you are disabled for at
least 26 weeks. Here’s what you should know about LTD coverage:
• Benefits are payable after a 180 consecutive day (six-month) waiting period beginning with the onset of your disability
Medical
• Benefit amount is 60% of your eligible monthly pay, up to a monthly maximum of $25,000
Prescription Drugs
• Benefit amount may be reduced by any income you are entitled to receive from other sources such as Workers’
Compensation or Social Security Disability Benefits
Dental
Vision
Flexible Spending Accounts (FSAs)
Income Protection
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Bonding Leave
Choose Well, Live Well
Although Cablevision provides LTD protection at no cost to you (if you are eligible), you could have even
more money available when you need it most by paying for it yourself. If you elect to pay for LTD coverage
with after-tax payroll deductions, any benefits paid by the Plan may not be subject to federal income
or Social Security taxes (or, in most instances, state or local taxes). If Cablevision pays the premium for
coverage, you will be taxed on any LTD benefits that are paid to you.
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
If you elect to pay for your LTD coverage on an after-tax basis, your cost is $0.55 for every $100
of your monthly eligible pay. For example, if your eligible pay for the month is $1,000, you will pay
$5.50 a month (or $66.00 a year) for coverage.
48
Welcome
What’s Ahead for 2015
Eligibility
2015 Benefits Options
Medical
Prescription Drugs
Dental
Vision
Flexible Spending Accounts (FSAs)
Income Protection
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Bonding Leave
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
Eligible Pay
For the purpose of determining LTD benefits, your eligible pay means the base pay you were earning as of your
last day of active work before your disability began, plus any commissions you were paid in the twelve-month period
ending September 30 of the previous year, or since your date of hire if you are a new employee. This amount is
calculated monthly.
Please contact the HR Accommodation and Leave Management Team or your HR Generalist for further details, or
refer to the Long-Term Disability Summary Plan Description.
49
Welcome
What’s Ahead for 2015
Eligibility
2015 Benefits Options
Medical
Prescription Drugs
Survivor Protection
The Basic Life Insurance and Accidental Death & Dismemberment (AD&D) plans help your family with financial
obligations in the event of a death, terminal illness or serious injury by providing a level of Life and AD&D Insurance
for you, and Life Insurance for your spouse/domestic partner and eligible children. Cablevision provides this basic
coverage at no cost to you. Since each person’s Life Insurance needs can vary, you have the opportunity to elect
Supplemental Life Insurance and Supplemental AD&D coverage.
Dental
Vision
Flexible Spending Accounts (FSAs)
Income Protection
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Bonding Leave
Ready to Enroll
Choose Well, Live Well
How much insurance is enough?
Cablevision provides you with Basic Life and AD&D Insurance coverage, with the option for you to purchase
additional coverage. Life Insurance can help to replace the loss of income and help your family to maintain its
standard of living. Thinking about these things may not be easy, but have you considered these questions:
• Would your family be financially prepared if your income suddenly stopped?
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
• What about future expenses, such as your children’s college education or home mortgage payments?
50
Welcome
What’s Ahead for 2015
Eligibility
2015 Benefits Options
Medical
Naming a Beneficiary
Your beneficiary is the person you designate to receive benefits under your Life and AD&D plans. You may name
more than one beneficiary, and change this designation at any time. If you choose Supplemental Life Insurance
for your spouse/domestic partner or children, you are automatically the beneficiary. You can designate your Life and
AD&D beneficiary online via MyHRInfo. Simply log in and click on the Self Service link, click on Benefits and then
Life and AD&D Summary. You should have your beneficiary’s address, date of birth and Social Security number
available when making your designation.
Prescription Drugs
Dental
Vision
Flexible Spending Accounts (FSAs)
Income Protection
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Bonding Leave
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
Company-provided Term Life and AD&D Insurance
If you are eligible to participate in the Cablevision Benefits Program, Cablevision provides you with Term Life Insurance
in the amount of two times (2x) your annual eligible pay. (This coverage is automatically reduced when you reach age
70.) You also receive an equal amount of AD&D Insurance. AD&D Insurance pays a full benefit if you die as a result of
an accident or a partial benefit if you lose a limb or eyesight or suffer paralysis as the result of an accident. There is a $3
million maximum for your Basic AD&D coverage. Cablevision also provides Dependent Life Insurance in the amount of
$5,000 for your spouse/domestic partner and eligible children. See a summary of Life and AD&D coverage.
Eligible Pay
For the purpose of the Life and AD&D plans, your eligible pay is your current base pay plus any commissions you
were paid in the twelve-month period ending September 30 of the previous year, or since your date of hire if you are
a new employee. It does not include overtime, bonuses, differentials, fringe benefits, incentives or any other pay you
have received on an intermittent basis or not as part of your primary compensation structure.
51
Welcome
What’s Ahead for 2015
Eligibility
2015 Benefits Options
Medical
Prescription Drugs
Dental
Vision
Flexible Spending Accounts (FSAs)
Income Protection
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Supplemental Term Life Insurance
For You
If you would like additional life insurance protection,
you may purchase Supplemental Term Life Insurance
for yourself in an amount up to six times (6x) your annual
eligible pay (rounded up to the next higher $1,000).
There is a $4 million maximum for your Basic and
Supplemental Term Life Insurance combined.
You will be required to provide evidence of good health
to the insurance company when you are first eligible to
participate (e.g., when you are hired) if:
• You elect more than three times (3x) your annual
eligible pay of Supplemental Term Life Insurance, or
• You elect more than $1 million of coverage
(combined with your Company-provided Basic Term
Life Insurance).
You will be required to provide evidence of good health
to the insurance company during the Annual Open
Enrollment period if:
• You currently have coverage under the Life Insurance
Plan and:
• You increase your election by more than one
times (1x) your annual eligible pay, and
• Your election exceeds $1 million (combined
with your Company-provided Basic Term Life
Insurance); or
• You are eligible for Supplemental Term Life Insurance
and have not yet participated, and you elect any
amount of coverage.
Bonding Leave
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
You pay the full cost for Supplemental Term Life Insurance if you elect this coverage. Your cost is based on your age
and the amount of coverage you select.
52
Welcome
What’s Ahead for 2015
Eligibility
2015 Benefits Options
For Your Spouse/Domestic Partner
If you elect Supplemental Term Life Insurance for yourself, you can purchase Supplemental Term Life Insurance for your
spouse or qualified domestic partner in an amount up to six times (6x) your annual eligible pay (rounded up to the next
higher $1,000).
Medical
Your spouse/domestic partner’s Supplemental Term Life Insurance cannot exceed the lesser of your own Supplemental
Term Life Insurance coverage or $500,000.
Prescription Drugs
You will be required to provide evidence of your spouse’s/domestic partner’s good health to the insurance company:
Dental
• When you are first eligible to participate (e.g., when you are hired), if the coverage for your spouse/domestic
partner exceeds the lesser of 1x your annual eligible pay or $50,000
Vision
Flexible Spending Accounts (FSAs)
Income Protection
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
• If you were eligible for Supplemental Term Life Insurance for your spouse/domestic partner and have not yet
participated, and you elect any amount of coverage for your spouse/domestic partner
• During Annual Open Enrollment, if you elect any additional Supplemental Term Life Insurance coverage for your
spouse/domestic partner
You pay the full cost of Supplemental Term Life Insurance for your spouse/domestic partner, which is based on your
spouse/domestic partner’s age and the amount of coverage you elect.
Adoption Assistance Program
Bonding Leave
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
You must be covered under the Supplemental Term Life Insurance benefit in order to cover your
dependents under Spouse/Domestic Partner or Child Supplemental Term Life Insurance. Your dependent’s
personal information must be listed in MyHRInfo in order for your dependent to be covered under
Spouse/Domestic Partner or Child Supplemental Term Life Insurance coverage.
53
Welcome
What’s Ahead for 2015
Supplemental Term Life Insurance Employee Contribution Schedule
Eligibility
Your Age or Spouse/
Domestic Partner’s Age*
Monthly Cost Per $1,000 of Supplemental
Term Life Insurance Coverage
Younger than 30
$0.05
30 – 34
$0.07
35 – 39
$0.08
Flexible Spending Accounts (FSAs)
40 – 44
$0.10
Income Protection
45 – 49
$0.15
50 – 54
$0.23
55 – 59
$0.43
60 – 64
$0.56
65 – 69
$1.06
70 or older
$1.70
2015 Benefits Options
Medical
Prescription Drugs
Dental
Vision
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Bonding Leave
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
*When your birthday (or the birthday of your spouse/domestic partner) occurs and places you in the next age/premium category, your
monthly premium will increase automatically.
54
Welcome
What’s Ahead for 2015
Eligibility
2015 Benefits Options
Medical
Prescription Drugs
Dental
Vision
Supplemental Term Life Insurance Reduction Factor Schedule
Your Age or Spouse/Domestic Partner’s Age*
Reduction Factor
70 – 74
.55
75 – 79
.36
80 – 84
.27
85 – 89
.20
90 – 94
.15
95 or older
.11
Flexible Spending Accounts (FSAs)
Income Protection
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Bonding Leave
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
How to Determine Your Cost for Coverage
For Your Child
• Determine the amount of Supplemental Term Life
Insurance (if any) you wish to elect (1x, 2x, 3x, 4x, 5x
or 6x your annual eligible pay). If you are age 70 or
older, determine your coverage amount by applying
the appropriate reduction factor in the schedule above.
If you elect Supplemental Term Life Insurance for
yourself, you can purchase Supplemental Term Life
Insurance for your eligible dependent children.
You may choose coverage amounts of either $10,000
or $20,000. The benefit amounts apply to all your
eligible dependent children. You will be required to
provide evidence of your child(ren)’s good health to
the insurance company if:
• To determine the monthly premium, divide your annual
eligible pay by 1,000. Then, multiply this amount by
the monthly cost per $1,000 of Supplemental Term
Life Insurance that applies to your age.
For example: If you are 40 years old and your annual eligible
pay is $50,000, divide your annual eligible pay by 1,000.
Then, multiply that result (50) by the monthly cost of $0.10,
which equals $5.00. So, in this example, every multiple of
your annual pay would cost $5.00 per month.
To determine your bi-weekly premium, multiply your
monthly premium by 12 and divide the total by 26.
• You currently have Supplemental Life Insurance
for your dependent child and increase your election
during the enrollment period, or
• You elect Supplemental Life Insurance for your
dependent child for the first time during the
enrollment period.
55
Welcome
What’s Ahead for 2015
Eligibility
2015 Benefits Options
Supplemental Term Life Insurance for Dependent Children Contribution Schedule
Employee Election
Monthly Cost
$10,000
$0.71
$20,000
$1.41
Medical
Prescription Drugs
Dental
Vision
Supplemental Accidental Death And Dismemberment (AD&D) Coverage
Flexible Spending Accounts (FSAs)
Income Protection
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Supplemental AD&D allows you to purchase up to $500,000 of additional AD&D coverage in increments of $10,000.
If you elect supplemental coverage for yourself, you may also purchase coverage for your spouse/domestic partner
and dependent children. The benefit applicable to your dependents is based on the Plan you select and the number
of family members you decide to cover.
If you elect Supplemental AD&D coverage, you pay the full cost of coverage.
Adoption Assistance Program
Bonding Leave
Ready to Enroll
Other Important Information
Remember: If you and your spouse/domestic partner both work for the Company, then you and your
spouse/domestic partner cannot elect Supplemental Term Life Insurance or Supplemental AD&D
insurance for each other. In addition, if you choose to elect Supplemental Life or AD&D coverage for
your child(ren), your child(ren) can only be covered under one employee’s coverage.
Choose Well, Live Well
Terms to Know
Directory of Resources
See a summary of Life and AD&D coverage.
56
Welcome
What’s Ahead for 2015
Supplemental AD&D Employee Contribution Schedule
Coverage Level
Monthly Cost per $10,000 of Coverage
Eligibility
Employee only
$0.11
2015 Benefits Options
Employee + child(ren)
$0.17
Family
$0.21
Medical
Prescription Drugs
Dental
Vision
Flexible Spending Accounts (FSAs)
How to Determine Your Cost for Coverage
Income Protection
• Determine what coverage level is appropriate for you and your family. Remember, if you elect coverage for your eligible
family member(s), that coverage will be based on your coverage election (as outlined in the coverage summary).
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Bonding Leave
• Determine the amount of Supplemental AD&D coverage (if any) you wish to elect for yourself (from $10,000 to
$500,000 in increments of $10,000).
• Refer to the Supplemental AD&D Employee Contribution Schedule on this page. Multiply the rate that applies to
your coverage level by the amount of coverage you elect for yourself.
For example: If you decide to elect $20,000 of Supplemental AD&D coverage at the family coverage level, your
monthly contribution for $20,000 of coverage will be $0.42 ($0.21 x 2).
Ready to Enroll
Other Important Information
Business Travel Accident Insurance (BTA) Coverage
Choose Well, Live Well
Company-provided Business Travel Accident Insurance provides additional financial protection if you suffer accidental
death, paralysis and/or dismemberment while traveling on company business. BTA coverage may equal up to an
additional four times (4x) your annual eligible pay, up to $3 million. This coverage is in effect 24 hours a day, 7 days a
week while you are traveling on company business.
Terms to Know
Directory of Resources
57
The following chart summarizes your Company-provided and Supplemental Life and AD&D Insurance options.
Welcome
What’s Ahead for 2015
Eligibility
2015 Benefits Options
Medical
Type of Coverage
Coverage Amount
Basic Term Life Insurance
2x your annual eligible pay (rounded up to next $1,000)
Basic AD&D Insurance
2x your annual eligible pay (rounded up to next $1,000)
Dependent Life Insurance
• Spouse/domestic partner
$5,000
• Child(ren) up to age 19 (or 25 if full-time student)
$5,000
• Unmarried disabled child(ren) over age 25
$5,000
Supplemental Term Life Insurance
Prescription Drugs
•You
1x to 6x your annual eligible pay (rounded up to next $1,000)
Dental
• Your spouse/domestic partner
1x to 6x your annual eligible pay (rounded up to next $1,000)
Vision
•Child(ren)
$10,000 or $20,000 (per child)
Flexible Spending Accounts (FSAs)
You must elect Supplemental Term Life Insurance for yourself to elect it for your
spouse/domestic partner or your children
Income Protection
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Bonding Leave
Supplemental AD&D
•Employee
Up to $500,000 in increments of $10,000
• Employee + child(ren)
For you: up to $500,000 in increments of $10,000 plus
For your child(ren): 20% of your Supplemental AD&D coverage
• Employee + Family
(employee + spouse /domestic partner or
employee + spouse/domestic partner + children)
For you: up to $500,000 in increments of $10,000, plus
For your spouse/domestic partner: 55% of your Supplemental AD&D coverage, plus
For your child(ren): 15% of your Supplemental AD&D coverage
Coverage Maximums
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Life Insurance
• For you – Basic and Supplemental Term Life Insurance combined cannot exceed $4 million
• For your spouse/domestic partner – Supplemental Term Life Insurance coverage cannot exceed the lesser of your own
Supplemental Term Life Insurance coverage or $500,000
AD&D Insurance
• For you – Basic AD&D cannot exceed $3 million
• For your family – Supplemental AD&D cannot exceed $500,000
Directory of Resources
Business Travel Accident Insurance
Coverage cannot exceed $3 million
58
Welcome
What’s Ahead for 2015
Eligibility
2015 Benefits Options
Medical
Prescription Drugs
Dental
Vision
Flexible Spending Accounts (FSAs)
Income Protection
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Bonding Leave
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
Group Legal
As part of Cablevision’s Benefits Program, you may elect to participate in the Group Legal Plan, which provides
you and your covered dependents with certain legal services, including:
• Consultation and advice on a broad range of personal legal issues
• Preparation of a will or codicil (an amendment to an existing will), not including tax planning
• Preparation of any deed for which you are the grantor or grantee
• Preparation of any non-business-related promissory note
• Review or preparation of all relevant documents involved in the sale, refinance or purchase of a home
• Preparation of a living will
• Preparation of any power of attorney when you are granting the power
If you use an attorney who participates in the Hyatt Legal Plans network, the Plan pays 100% of the cost of the
attorney’s time and work for covered services. Expenses and third-party costs (such as filing fees or court costs) are
not covered by the Plan. If you use an attorney who does not participate in the network, you will be reimbursed for
covered services up to a set dollar limit established by Hyatt Legal Plans. Any charges above the set dollar limit will
be your responsibility. You cannot use this plan to take legal action against Cablevision or its subsidiaries regarding
any employment-related matters.
Visit the Group Legal Plan online at www.legalplans.com. To find out how Hyatt Legal Plans can help you,
select Employees/Members Click Here and enter the password METLAW. You can also call the Group Legal Plan
at 1-800-821-6400.
59
Welcome
What’s Ahead for 2015
Contribution Schedule
Eligibility
If you elect to participate in the Group Legal Plan, your monthly cost is $16.50.
2015 Benefits Options
Medical
Prescription Drugs
If you are enrolled in the Group Legal Plan, you can also enroll your parents or your spouse/domestic partner’s
parents for a two-year membership in the Family Matters program. For a fee of $240, this program provides
assistance with estate planning documents. You pay the fee directly to Hyatt Legal Plans, not through payroll
deductions. You can elect this benefit at any time, provided you have already elected coverage under the
Group Legal Plan.
Dental
Vision
Flexible Spending Accounts (FSAs)
Income Protection
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Choose Well, Live Well
Bonding Leave
Enrolling in the Group Legal Plan is like having a lawyer on retainer – at reduced rates!
Ready to Enroll
Your participation in the Plan carries over automatically to the following year. If you enrolled in the
Group Legal Plan in 2014, you will automatically be enrolled in 2015, unless you waive coverage
during Annual Open Enrollment.
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
60
Welcome
What’s Ahead for 2015
Eligibility
Back-Up Care Advantage Program
As part of our founding values, Cablevision strives to offer programs, tools and resources to help you balance professional
priorities, personal obligations and leisure time. With the Bright Horizons Back-Up Care Advantage Program® you get:
• Up to 10 days of back-up care per calendar year through Bright Horizons:
2015 Benefits Options
• Center-based child care
Medical
• In-home child care, including care for a mildly ill child
Prescription Drugs
• In-home adult/elder care
Dental
Vision
Flexible Spending Accounts (FSAs)
Income Protection
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Bonding Leave
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
• Unlimited access to Sittercity, an online caregiver database for longer term care
61
Welcome
Cost
What’s Ahead for 2015
With Bright Horizons, you are responsible for a copay:
Eligibility
• Center-based care – $15/day for a child; $25/day for more than one child
• In-home child, adult or elder care – $6/hour with a four-hour minimum
2015 Benefits Options
With Sittercity, you’re responsible for the full cost of the service.
Medical
Prescription Drugs
How It Works
Dental
Vision
Flexible Spending Accounts (FSAs)
Income Protection
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Bonding Leave
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
When you need back-up, you can call Bright Horizons or contact them online any time of the day or night by calling
1-877-BH-CARES. A care consultant takes down your information and identifies the most appropriate care option
from Bright Horizons’ contracted provider network. Depending on your situation, it could be:
• A Bright Horizon-managed center
• A network center
• An in-home provider
The care consultant gets back to you to discuss available options. Once you accept an option, the consultant takes
down your copay information and provides details about the back-up care.
If you have used up your 10 days of allotted back-up care, or if you need longer term care, you can access Sittercity by
calling 1-877-BH-CARES. Sittercity partners with Bright Horizons and gives you access to a vast network of licensed,
fully credentialed caregivers, all of whom must meet stringent standards to become part of the Back-Up Care Advantage
Program’s extended network. There you’ll find child care centers, as well as in-home care and nanny agencies.
62
Welcome
What’s Ahead for 2015
Eligibility
Adoption Assistance Program
Adopting a child can be costly, and Cablevision is committed to helping support employees during this process.
Employees who are adopting a child will now be reimbursed up to $10,000 for adoption-related costs after the
adoption is complete.
2015 Benefits Options
Medical
Prescription Drugs
Dental
Vision
Flexible Spending Accounts (FSAs)
Eligibility
Eligible Employees. All regular full-time and part-time benefits-eligible employees of Cablevision who are not covered by
a collective bargaining relationship are eligible for this benefit.
Eligible Child. The adopted child must be under the age of 18 at the time a qualified adoption expense is paid or
incurred and may not be the child of the employee’s spouse or domestic partner.
Income Protection
Survivor Protection
Qualified Adoption Expenses
Group Legal
Qualified adoption expenses are adoption fees, court costs, attorneys’ fees and other expenses directly related to the
legal adoption of an eligible child, such as:
Back-Up Care
Advantage Program
Adoption Assistance Program
Bonding Leave
Ready to Enroll
Other Important Information
• Public and private adoption agency fees permitted or
required under the law of the state having jurisdiction
over the adoption.
• Travelling expenses, while away from home,
which are associated with the adoption, including:
transportation, meals, and lodging.
• Legal and court fees.
• Immigration, child’s immunization and translation fees.
• Fees for medical and hospital services provided to
the child (not otherwise covered by insurance).
• Temporary foster care charges provided before
placement of the eligible child in the employee’s home.
Choose Well, Live Well
How Reimbursement Works
Terms to Know
When you are ready to be reimbursed, you must submit documentation of expenses paid up to a maximum of $10,000.
For more information, contact Corporate Benefits.
Directory of Resources
63
Welcome
What’s Ahead for 2015
Eligibility
2015 Benefits Options
Medical
Prescription Drugs
Dental
Vision
Flexible Spending Accounts (FSAs)
Income Protection
Survivor Protection
Group Legal
Back-Up Care
Advantage Program
Adoption Assistance Program
Bonding Leave
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
Bonding Leave
Having a new child is an exciting life event for you and your family, and Cablevision wants to support you during this
time. Bonding Leave provides up to eight weeks leave time for an employee to bond with a newborn or newly-adopted
child. If you are eligible for leave under the Family Medical Leave Act (FMLA), the two run concurrently. This benefit
applies only to regular full-time employees.
To request Bonding Leave, please contact the HR Accommodation and Leave Management Team at least 30 days
prior to when the leave will begin. Bonding Leave is unpaid; however, employees must utilize any accrued personal or
vacation days (in that order) when the leave is taken.
64
Welcome
What’s Ahead for 2015
Eligibility
Ready to Enroll
Before you enroll:
2015 Benefits Options
Ready to Enroll
Other Important Information
• Read this Annual Open Enrollment Guide to learn
more about what benefits are available to you.
• Review your current coverages and consider
your benefits needs for the coming year.
• Discuss your benefits options with your family.
Choose Well, Live Well
• Attend an Annual Open Enrollment meeting.
Terms to Know
• Visit www.myuhc.com for a variety of tools
and resources.
Directory of Resources
• Access UnitedHealthcare’s Health Plan Cost Estimator.
(User ID: Cable2015, Password: benefits).
• Use the Estimator to find the medical plan that
best meets your needs, and
• Be sure to consider enrolling in a Health Care or
Dependent Care Flexible Spending Account,
both of which allow you to use pre-tax dollars for
eligible health care and dependent care expenses.
65
Welcome
To enroll:
What’s Ahead for 2015
1. Log on to MyHRInfo.
Eligibility
2015 Benefits Options
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
There are two ways to log on:
Through the Internet at https://myhrinfo.cablevision.com, or through the link on Marquee.
2. Enter your User ID and password.
Your User ID is your six-digit PeopleSoft Employee ID number. This number is located on your iPay Statement.
If you do not know what your Employee ID number is, please reach out to your HR Generalist.
You will need an iAuthenticate password to access the system. If you have a Network ID (or login for Cablevision’s
internal network), your iAuthenticate password is the same as your Network password.
If you do not have a Network password, you will need to register with iAuthenticate by clicking on the Register with
iAuthenticate link. You will be directed to the iAuthenticate Password Self Service site, where your initial password is
your first and last initials in lowercase plus the last four digits of your SSN, followed by the number 99. After entering
the iAuthenticate Password Self Service site, follow the instructions and prompts to set up your password and
security questions.
If you forgot your password, click the Forgot your password link to reset your password. You will be asked
to answer security questions as part of the process. You can also call the Cablevision Enterprise IT Help Desk
at 1-516-803-HELP.
3. Now you are ready to enroll.
After you log on to MyHRInfo, select the Employee Self-Service link, Benefits, and then Health and Welfare Enrollment.
This will take you to your Welcome page. You will see that your Open Enrollment event status is Open. Click Select.
You will see your Health and Welfare Enrollment Summary. Select the Edit button next to each plan to enroll or make
changes to an existing election.
66
Welcome
What’s Ahead for 2015
Eligibility
2015 Benefits Options
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
4. Adding or Removing Dependent(s).
To add or remove dependent(s) to your Plan(s), select the Edit button next to the first plan you wish to
include your dependent(s) in (e.g., Medical, Dental and/or Vision). Scroll to the bottom of the page and select
the Add/Review Dependents button.
To add a dependent, select Add a Dependent and enter your dependent’s personal information. Please be sure
to enter a Social Security number for each dependent that you intend to cover for the 2015 plan year. If you
do not enter an SSN for your new dependent(s), your 2015 benefit elections will not save. When entering your
dependent’s SSN, please do not include dashes. Click the Save button on the bottom of the page, and then click
OK. Scroll to the bottom of the page and click Return to Enrollment Dependent/Beneficiary Summary. Repeat steps
to add additional dependents OR scroll to the bottom of the page and click Return to Event Selection.
Now you will see your dependent(s) listed under the Enroll Your Dependents section. This does not mean that
your dependent(s) are covered under your benefits. In order to cover your dependent(s) under each benefit
plan, you will need to place a check mark in the box beside the name of each dependent that you wish to include
on your plans. If you do not check the box next to a dependent’s name, he/she will not be covered under
the benefits options you selected.
You will only need to add your dependent’s personal data once. If you wish to enroll your dependent under
another plan, you may do so by selecting the Edit button next to each plan and marking the check box beside
your dependent’s name. Remember, adding a dependent under your Medical coverage does not automatically
enroll that same dependent under your Dental and/or Vision coverage.
Please note: If you wish to enroll your dependent(s) in Supplemental Term Life Insurance, you must enter
your dependent’s personal information by following the steps above. The Medical, Dental and Vision pages
are the only areas that provide access to the Add/Review Dependents button, so you must access Supplemental
Term Life Insurance through the Medical, Dental or Vision page. Once you’ve saved your dependent’s information,
if you do not wish to enroll your dependent in Medical, Dental and/or Vision coverage, be sure you do not check
the box beside his/her name. If you check the box beside a dependent’s name, he/she will be listed as a covered
dependent under that plan election.
For information about enrolling your domestic partner, please contact the Corporate Benefits Department or your
HR Generalist.
67
Welcome
What’s Ahead for 2015
Eligibility
2015 Benefits Options
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
5. Track your elections.
As you make your selections under each plan, the New line on your enrollment page will reflect your 2015
elections. If the New line does not accurately reflect your benefit plan choices, please return to the appropriate
benefit option, click Edit and elect your coverage levels again. Your 2014 election will roll over to 2015 if you
make no changes. You will see these elections in the New line, with the exception of the FSAs, as enrollment in
the Health Care or Dependent Care FSA is not automatic. You must elect to participate in the FSAs during
Annual Open Enrollment in order to be covered in 2015.
6. Submit your 2015 elections.
You must select Submit when you have completed your elections in order to save them. If you do not select
Submit, your elections will not be recorded and you may not get the coverage you intended for the 2015 plan year.
7. Print your elections.
After you select Submit, you will receive a message confirming that your elections have been submitted.
Select OK to reach your Health and Welfare Enrollment confirmation page. If you do not see your Health and Welfare
Enrollment confirmation page, your election may not have saved. Print a copy of this page as confirmation of your
elections. You may be asked to provide a copy of your confirmation page if there is an issue with your election.
Please note: You will not receive a confirmation statement in the mail.
68
Welcome
Other Important Information
What’s Ahead for 2015
Eligibility
2015 Benefits Options
Ready to Enroll
Other Important Information
Life Event Changes
During the Year
When Coverage Begins
Cost for Coverage
Important Notices
Choose Well, Live Well
Terms to Know
Directory of Resources
Life Event Changes During the Year
Your benefit elections will be in effect through December 31 of the year in which you enroll. The next opportunity to
make new elections or changes will be during Annual Open Enrollment, in the fall of 2015, for coverage beginning
January 1, 2016.
You cannot change your elections during the year
unless you or a covered family member experience a
qualifying life event that affects your coverage under
the plans and request to make a change within 31 days
of the life event. Qualifying life events include:
In accordance with the Children’s Health Insurance
Program Reauthorization Act (“CHIP”), you can take
advantage of a special opportunity to enroll or waive
coverage under the Cablevision Benefits Program if
you and/or your eligible dependent(s) either:
• Marriage, divorce or legal separation
• Lose coverage under Medicaid or the Children’s
Health Insurance Program because you are no
longer eligible, or
• Birth, adoption or placement for adoption of a child
• Death of a spouse/domestic partner or dependent
• A change in employment status for you, your spouse/
domestic partner or your dependent that affects health
care coverage (such as changing from full-time to
part-time employment or your spouse/domestic partner
or dependent commencing or terminating employment)
• A change in benefit status for you or your spouse/
domestic partner (such as your spouse/domestic
partner losing coverage elsewhere or enrolling you
as a dependent under his/her health care coverage)
• The end of COBRA coverage under another health plan
• A dependent satisfying or ceasing to satisfy plan
requirements for unmarried dependents (such as
age limitations or graduation from college)
• Entitlement to, or loss of, Medicare or Medicaid benefits
• Become eligible for an applicable state’s premium
assistance program under Medicaid or CHIP.
Annual Open Enrollment is the only time during the
year that you can make any changes to your health
and welfare benefit plan elections, including adding and
removing dependents, unless you have a qualifying life
event and make changes within 31 days of the event.
69
Welcome
What’s Ahead for 2015
Eligibility
2015 Benefits Options
Ready to Enroll
Other Important Information
Life Event Changes
During the Year
Please note that if you are making any changes to your benefits outside the Annual Open Enrollment period,
you must provide documentation that indicates you have experienced a qualifying life event (e.g., a copy of
your marriage certificate or birth/adoption certificate for your child) within 31 days of the life event.
When Coverage Begins
Cost for Coverage
Important Notices
Choose Well, Live Well
Terms to Know
Directory of Resources
Choose Well, Live Well
Having a baby? Remember to contact your HR Generalist or Corporate Benefits within 31 days of the
birth to enroll your new arrival. Otherwise, you will miss out on your opportunity to enroll your newborn
and you will have to pay all medical expenses out of pocket.
70
Welcome
Special Enrollment Rights for Health and Welfare Coverage
What’s Ahead for 2015
Any elections you make when you enroll for coverage will remain in effect through December 31 of the year in which
you enroll. However, keep in mind the following important points:
Eligibility
2015 Benefits Options
Ready to Enroll
Other Important Information
Life Event Changes
During the Year
When Coverage Begins
Cost for Coverage
Important Notices
Choose Well, Live Well
Terms to Know
Directory of Resources
• If you waive medical, dental and/or vision coverage for yourself and/or your eligible dependents when you first
become eligible because you have other health care coverage, you may enroll in health care coverage at a future
date if you lose that other coverage. If this happens, you may enroll yourself and/or your eligible dependents as long
as you do so within 31 days of your other coverage ending. You will be asked to provide documentation indicating
that your and/or your dependents’ coverage has terminated. This documentation must also be submitted within 31
days of the termination of your other coverage.
• If you have a new dependent as a result of a marriage, birth or adoption, you may enroll the new dependent during
the year, within 31 days of the event. Otherwise, you will miss your opportunity to enroll your dependent and you
will have to wait until the next Annual Open Enrollment period to elect coverage for the following year. You will be
asked to provide documentation as proof of the event, such as a marriage certificate, birth certificate or adoption
paperwork. The date of the event (e.g., date of birth or marriage date) is day one.
• Acquiring a new dependent also grants special enrollment rights to you, your spouse/domestic partner or both,
even if you previously declined coverage. However, special enrollment rights aren’t available for other dependents
who previously declined coverage or for dependents who are newly acquired for reasons other than marriage,
birth, adoption or placement for adoption. If your documentation is approved, you will be able to select from
all the benefits options on the same terms as they are made available to you at initial enrollment (e.g., you may
choose Medical Plan Option 2, even if you are currently enrolled in Medical Plan Option 1). Please note, if you
switch plans or tiers due to special enrollment rights, your deductibles and out-of-pocket maximums do not
reset. You may apply year-to-date accumulated amounts toward your new plan election.
• To qualify for this special enrollment period, the following requirements must be satisfied:
71
Welcome
What’s Ahead for 2015
• You must be either participating in the Medical Plan or eligible to enroll in it.
Eligibility
• Your dependent, as determined by the Plan’s terms, must have become your dependent through marriage, birth,
adoption or placement for adoption. This special enrollment right does not apply to any other qualifying life event.
2015 Benefits Options
Ready to Enroll
Other Important Information
Life Event Changes
During the Year
• If you experience a Medicaid or CHIP event, you will have 60 days (instead of 31 days) from the date of the eligibility
change described above to request enrollment in the Benefits Program. Please note that this 60-day eligibility period
does not apply to any qualifying life event changes other than the Medicaid/CHIP eligibility change. You will be
asked to provide documentation as proof of either your loss of coverage or eligibility to participate in the applicable
Medicaid or CHIP program.
• Your change must be consistent with your qualified change in status. For example, if you get divorced, you will need
to remove your ex-spouse from your existing coverage. In this situation, however, you would not be able to choose
the other coverage option under the Choice Plus Medical Plan (e.g., switch from Option 1 to Option 2).
When Coverage Begins
Cost for Coverage
Important Notices
Choose Well, Live Well
Terms to Know
Choose Well, Live Well
Directory of Resources
Remember: If you waive coverage under the Cablevision Medical Plan and elect to purchase coverage through
the Marketplace, you cannot re-enroll in the Cablevision Medical Plan until the next Annual Open Enrollment
period, unless you have a qualifying life event that would allow changes under the Medical Plan (e.g., marriage,
birth of a child, etc.). Loss of coverage through the Marketplace is not a qualifying life event that will allow
changes under the Medical Plan.
72
Welcome
What’s Ahead for 2015
Eligibility
2015 Benefits Options
Ready to Enroll
Other Important Information
Life Event Changes
During the Year
When Coverage Begins
Cost for Coverage
Important Notices
Choose Well, Live Well
Terms to Know
Directory of Resources
When Coverage Begins
Eligible Full-Time and Part-Time Employees of Cablevision
Coverage under the Long-Term Disability (LTD) Plan and Company-provided Life and Accidental Death &
Dismemberment (AD&D) Insurance plans begin on your first day of employment. Your other elections also take
effect on your first day of employment, provided you enroll within 31 days (date of hire is considered first day of
employment). Coverage under the Short-Term Disability (STD) Program begins 90 days from your date of hire.
If you do not enroll within 31 days of your date of hire, you will not be eligible to enroll until Annual Open Enrollment
occurs in the fall of 2015, for coverage beginning January 1, 2016. Your only other opportunity to enroll in coverage
during the year will be within 31 days of a qualifying life event (see the Life Event section for more information).
73
Welcome
What’s Ahead for 2015
Cost of Coverage
Cablevision pays the full cost for certain benefits, such as your Basic Life Insurance and Short-Term Disability.
For other benefits, you are required to either make a contribution each pay period or pay the full cost.
Eligibility
2015 Benefits Options
Benefit
Who Pays
• Short-Term Disability (STD) Program
When you are eligible, Cablevision provides coverage at no cost to you.
Ready to Enroll
• Long-Term Disability (LTD) Plan
(if you don’t elect to pay for coverage)
Other Important Information
• Basic Life Insurance*
• Basic AD&D Insurance
Life Event Changes
During the Year
• Business Travel Accident (BTA) Insurance
When Coverage Begins
• Medical Plan
You pay a portion of the cost, and Cablevision pays the majority of the cost.
Cost for Coverage
• Dental Plan
Generally, your cost is deducted from your paycheck before federal income,
Social Security and most state and local taxes are deducted.**
• Vision Plan
You pay the full cost of the group rates that Cablevision negotiates on your behalf.
• Supplemental Life Insurance
For vision, generally, your cost is deducted from your paycheck before federal
income, Social Security and most state and local taxes are deducted.**
Important Notices
Choose Well, Live Well
Terms to Know
• Supplemental AD&D Insurance
• Group Legal Plan
Directory of Resources
For Supplemental Life, Supplemental AD&D and Group Legal, your contribution is
deducted from your paycheck after taxes are deducted. You can also choose to
pay for LTD coverage on an after-tax basis.
*While Cablevision pays for this coverage, the IRS requires that Cablevision pass on the cost of any coverage exceeding $50,000 as income
to employees. If this applies to you, it will be reflected on your iPay statement.
**Contributions you make for a domestic partner and/or his or her eligible dependents must be made on an after-tax basis. The cost for
domestic partner coverage (minus any contributions you make for that coverage) will be reflected as income on your paycheck.
74
Welcome
Your Eligible Pay
What’s Ahead for 2015
Your “eligible pay” determines how much (if anything) you contribute for medical and dental coverage. For purposes
of determining Medical and Dental contributions for the plan year (January 1 through December 31, 2015), your eligible
pay in your first year of employment is your annual base pay rate. In successive years of employment, your eligible
pay is your annual base pay as of September 30, plus any commissions you may have been paid in the twelve-month
period ending September 30 of the previous year. If you are not a commissioned employee, your eligible pay is your
base pay as of September 30.
Eligibility
2015 Benefits Options
Ready to Enroll
Other Important Information
Life Event Changes
During the Year
When Coverage Begins
Cost for Coverage
Important Notices
Choose Well, Live Well
Terms to Know
Directory of Resources
Overtime, differentials, bonuses, fringe benefits, incentives and any other pay you may have received either on an
intermittent basis or not part of your primary compensation structure is not included in eligible pay for determining
contributions for medical and/or dental coverage.
75
Welcome
Important Notices
What’s Ahead for 2015
Eligibility
2015 Benefits Options
Ready to Enroll
Other Important Information
Provisions of the Affordable Care Act (ACA)
As the latest provisions of the Affordable Care Act (ACA) – also known as Health Care Reform– become active, all
Americans will be affected to some degree. Nearly every American must have medical coverage in 2015 or pay a
penalty. This is known as the individual mandate. Individuals can now purchase health insurance coverage through
private insurance companies through the Health Insurance Marketplace, also known as the “Marketplace” or “Public
Exchange.” You will be hearing more discussions in the media about the Marketplace and government subsidies
which are available to help low-income individuals without employer coverage buy coverage in the Marketplace.
Here is what it means for you, as a Cablevision employee.
Life Event Changes
During the Year
When Coverage Begins
Cost for Coverage
Important Notices
Choose Well, Live Well
Terms to Know
Directory of Resources
1. Enrolling in a Cablevision medical plan will meet your individual requirement to have medical coverage for
2015 and you will not be required to pay a penalty.
2. Our health plans are designed to more than meet the government requirements for affordable employee
coverage and benefit value. This means that if you are eligible for our coverage, you can shop for coverage
through the public health insurance Marketplace, but you and your eligible dependents generally won’t qualify for
a government subsidy to help pay for coverage there.
3. You’ll generally find that Marketplace coverage is more expensive for you. That’s because Cablevision pays
a large share of the cost for your coverage under the Cablevision Medical Plan, while you will generally pay the
whole cost of coverage in the Marketplace.
76
Welcome
Your Prescription Drug Coverage and Medicare
What’s Ahead for 2015
This notice has information about your current prescription drug coverage with Cablevision and about your options under
Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare
drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at
what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information
about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.
Eligibility
2015 Benefits Options
There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:
Ready to Enroll
Other Important Information
Life Event Changes
During the Year
When Coverage Begins
Cost for Coverage
Important Notices
Choose Well, Live Well
1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this
coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO)
that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set
by Medicare. Some plans may also offer more coverage for a higher monthly premium.
2. Cablevision has determined that the prescription drug coverage offered by the Cablevision Choice Plus
Medical Plan Options (both Option 1 and Option 2) is, on average for all Plan participants, expected to pay out
as much as does standard Medicare prescription drug coverage, and is therefore considered Creditable
Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a
higher premium (a penalty) if you later decide to join a Medicare drug plan.
Women’s Health and Cancer Rights Act of 1998
Terms to Know
Directory of Resources
Solely to the extent required under the Women’s Health and Cancer Rights Act (hereinafter “WHCRA”), the Medical
Plan will provide certain benefits related to benefits received in connection with a mastectomy. The Medical Plan will
include coverage for reconstructive surgery following a mastectomy.
If you or your dependent(s) (including your spouse/domestic partner) are receiving benefits under the Medical Plan
in connection with a mastectomy and you or your dependent(s) (including your spouse/domestic partner) elect breast
reconstruction, the coverage will be provided in a manner determined in consultation with the attending physician
and you or your dependent(s) (including your spouse/domestic partner) for reconstruction of the breast on which the
mastectomy was performed, surgery and reconstruction of the other breast to produce a symmetrical appearance,
and prostheses and treatment of physical complications at all stages of the mastectomy, including lymphedemas.
Reconstructive benefits are subject to annual plan deductibles and coinsurance provisions like other medical and
surgical benefits covered under the Medical Plan.
77
Welcome
What’s Ahead for 2015
Eligibility
2015 Benefits Options
Choose Well, Live Well
There are many ways to be a smart health care consumer. It can be as simple as making sure everyone
in your family gets an annual checkup, or getting information on treatment alternatives before taking action.
Cablevision provides you with an array of tools and resources to help you Choose Well, Live Well.
And best of all, these resources are available at no cost to you.
Ready to Enroll
Other Important Information
Choose Well, Live Well
myuhc.com
This UnitedHealthcare website is your first stop for health and wellness information. You can find a physician,
print temporary ID cards, get health tips, access the Online Health Assessment and create and maintain your
Personal Health Record.
Terms to Know
Online Health Assessment
Directory of Resources
Complete this brief, confidential survey and you will receive customized information and have an opportunity to
participate in no-cost health improvement programs geared to your specific health goals.
Visit www.myuhc.com to complete the survey.
Choose Well, Live Well
Being overweight is associated with countless health problems, including heart disease, diabetes, breathing
problems, arthritis and certain types of cancer. If your Online Health Assessment indicates that you need
to lose weight, you’ll be provided with resources that can help you achieve and maintain a healthy weight,
including Online Health Coaching and customized health information.
78
Welcome
What’s Ahead for 2015
Personal Health Record
Eligibility
Safely and securely keep track of your health history by updating your Personal Health Record. Your Personal
Health Record allows you to have an easy reference for medication information, completed procedures and lab
results. Plus, when you take the Health Assessment or have lab tests, all of the information you provide will be
transferred directly to your Personal Health Record to make keeping track of your health even simpler.
2015 Benefits Options
Ready to Enroll
Visit www.myuhc.com to create or maintain your Personal Health Record.
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
Privacy Protection
The information you enter into your Online Health Assessment and the data in your Personal Health Record are
confidential. The Online Health Assessment and Personal Health Record are managed by UnitedHealthcare,
so no one at Cablevision has access to your personal results. In addition, UnitedHealthcare is required to adhere
to privacy laws and regulations to ensure that your personal data is safe and protected.
79
Welcome
UnitedHealthcare Health Plan Cost Estimator
What’s Ahead for 2015
This tool helps you choose the right Medical Plan
option for you and your family by comparing the
annual out-of-pocket costs for the health plans you
are considering and, based on your geographical area,
estimating what your medical expenses could be.
Enter your personal information and your anticipated
medical needs to see which plan works best for you.
Eligibility
2015 Benefits Options
Ready to Enroll
Other Important Information
Choose Well, Live Well
The estimates are not a guarantee of actual costs,
but will help you “ballpark” what your costs would be
based on your unique circumstances.
To check out the Health Plan Cost Estimator, visit
https://www.pcestimator.com/. When prompted for a
username, enter Cable2015. The password is benefits.
Terms to Know
Directory of Resources
myNurseLine
If you are enrolled in the Cablevision Medical Plan and
you or a covered family member would like to speak
to a registered nurse about a specific health concern,
you can call myNurseLine or talk with a nurse online
free of charge. Registered nurses can provide you with
information about health conditions – for both routine
and urgent health concerns, medications, treatment
options and more. Nurses can also connect you to
resources that will help you better manage your health.
myNurseLine is available 24 hours a day, 7 days a week
at 1-866-425-2148.
80
Welcome
Healthy Pregnancy Program
What’s Ahead for 2015
Get the support you need from the beginning of your pregnancy right up to delivery – and beyond. A care coordinator
will assess your needs and risks to match you with the level of support you require. Call 1-800-411-7984 to enroll.
After you enroll, you can call the same phone number to speak with a maternity nurse 24 hours a day, 7 days a week.
You can also visit www.healthy-pregnancy.com for more information.
Eligibility
2015 Benefits Options
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
Cancer Resource Services (CRS) Program
If you (or a covered family member) are diagnosed with cancer and have questions about treatment or just need
assistance or support, CRS nurses are just a phone call away. Experienced cancer nurses can help you access cancer
treatment services or second opinions at cancer centers within the network. You will also have access to leading,
nationally recognized cancer care “Centers of Excellence,” where you may receive out-of-network care at in-network
rates. Memorial Sloan-Kettering Cancer Center is currently a participating center under the UHC Choice Plus network.
For more information, call 1-866-936-6002 or visit www.myoptumhealthcomplexmedical.com.
Treatment Decision Support
Registered nurses can assist you in making treatment decisions by providing you with information about your condition
and treatment options to discuss with your provider. Call 1-888-866-8295 between 8:00 am and 11:00 pm EST,
Monday through Friday.
Chronic Condition Support
This resource provides live one-on-one nurse support and mail-based educational materials to participants living
with chronic conditions. The program targets four chronic conditions: diabetes, asthma, congestive heart failure and
coronary artery disease.
If you have recently been diagnosed with one of these conditions, you can also call myNurseLine to learn what
information is available to you.
81
Welcome
Employee Assistance Program (EAP)
What’s Ahead for 2015
The EAP provides you and your family with objective viewpoints and expert guidance on an array of issues, including:
Eligibility
• On-the spot advice over the phone or a referral for face-to-face sessions with a network clinician who has
expertise in the relevant field
2015 Benefits Options
• Master’s-degree-level clinicians available 24 hours a day, 7 days a week
• Up to six face-to-face sessions (per issue, per year) at no charge
Ready to Enroll
Other Important Information
• A comprehensive work/life resources and referral service
All issues are kept confidential.
Call 1-800-985-6901 or visit www.liveandworkwell.com for more information. Access code: 228594.
Choose Well, Live Well
Terms to Know
Directory of Resources
The Employee Assistance Program (EAP) can provide assistance with:
• Work/life balance
•Stress
• Family issues
• Substance abuse
• Financial and legal matters
• Eating disorders
• Finding nursing homes
• And more…
Help is just a phone call or a click away!
82
Welcome
Cablevision’s Wellness Program
What’s Ahead for 2015
Dr. Bernie Monteleone, Cablevision’s Medical Director, provides a wealth of useful medical advice and wellness
counseling on Cablevision’s own Wellness website, located on Marquee. Search the HealthWatch section by topic
to find the information you need.
Eligibility
2015 Benefits Options
Ready to Enroll
Other Important Information
Choose Well, Live Well
Choose Well, Live Well
Terms to Know
Directory of Resources
Staying healthy means taking some simple steps to a healthier lifestyle, including:
• Getting an annual checkup
• Eating a healthy diet
• Being physically active
• Maintaining a healthy weight
• If you use tobacco, quitting tobacco
• Drinking alcohol only in moderation
Simple – yes. But not always easy. That’s why Cablevision provides you with the support and
resources you need to stay on track. You don’t have to go it alone.
83
Welcome
What’s Ahead for 2015
Eligibility
Aflac Cancer Care Plan
2015 Benefits Options
The Aflac Cancer Care Plan is a supplemental cancer insurance policy that can help you and your family. If you
receive a positive diagnosis of cancer. You must enroll during the Annual Open Enrollment period to be eligible
for coverage. You enroll with and make payment directly to Aflac. There are pre-existing limitations that should
be discussed If you are enrolling in the plan. To enroll or ask Questions call Aflac at 1-866-400-4928 and refer
to account number NP453.
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
Getting married? Having or adopting a child?
Remember, you only have 31 days following a qualifying life event to make changes to your benefits.
Learn about Life Event Changes During the Year and how they can affect your coverage. You can
also find information about When Coverage Begins and the Cost for Coverage.
84
Welcome
Terms to Know
What’s Ahead for 2015
Eligibility
2015 Benefits Options
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
Beneficiary—The person you designate to receive
benefits under the Life and AD&D Insurance plans.
You may have more than one beneficiary and you
may change this designation at any time.
Centers of Excellence—Best providers (physician and
facility) for certain complex illnesses. A program rates
providers and identifies Centers of Excellence based
on the use of treatments that provide the best chances
for positive outcomes and on the efficiency or cost
effectiveness of those treatments.
Coinsurance—The percentages of the total cost of
health care services that you pay and that the Plan pays
after a deductible has been met (e.g., for in-network care
under Option 1 Medical Plan, you pay 20% and the Plan
pays 80% of the total cost of services after you meet a
$300 deductible).
Copayment (or Copay)—The fixed amount you pay for
network services (such as office visits). Your copays –
including those for office visits, prescription drugs and
emergency room visits – count toward your Medical
Plan in-network out-of-pocket maximum.
Deductible—The amount you pay each calendar year
before the Plan pays benefits. There are separate inand out-of-network deductibles.
Dental Plan Calendar-Year Maximum Benefit—The most
the Plan will pay in one calendar year for dental
expenses. Once the annual maximum benefit is reached,
you pay the full cost of dental care for the rest of the
calendar year.
Emergency—Generally, a condition will be considered
a true emergency under the Plan if it is severe, begins
suddenly or unexpectedly, and requires care as soon
as possible after the condition begins and immediate
treatment to avoid serious injury or death.
Evidence of Good Health—Information used to review
factors concerning a person’s physical condition and
medical history. From this information, the Plan or
insurance company evaluates whether the risk of the
individual will be accepted and whether the Plan or
insurance company will offer coverage to that individual.
Generic Drugs—Drugs that are labeled with the
medication’s basic chemical name and that usually have
brand-name equivalents. They have exactly the same
active ingredients as, and are therapeutically equivalent
to, brand-name drugs. They must meet the same FDA
standards for safety, purity, strength and quality, but are
generally less expensive.
Network—A group of medical or dental providers,
including physicians, specialists, primary care clinics and
hospitals, who agree to provide care at pre-set rates.
Non-Preferred Brand-Name Drugs—Brand-name drugs
that generally have either an equally effective generic
equivalent and/or at least one preferred brand-name
equivalent. They are therefore more expensive than
generic and preferred brand-name drugs.
85
Welcome
What’s Ahead for 2015
Eligibility
2015 Benefits Options
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
Out-of-Pocket Maximum—This is the most you will pay
for covered expenses in a calendar year. Please note
that if you use out-of-network providers, you may
also have to pay more than the amount that the Plan
considers reasonable and customary. These charges
do not apply to the out-of-pocket maximum. There are
separate maximums for in-network and out-of-network
charges. Your copays under the Medical Plan – including
those for office visits, prescription drugs and emergency
room visits – will count toward your in-network
out-of-pocket maximum.
Pre-certification of Care—Authorization for a specific
medical or dental procedure before it is done or for
admission to an institution for care.
Preferred Brand-Name Drugs—Brand-name drugs that
do not have a generic equivalent. They generally cost
less than non-preferred brand-name drugs.
Qualifying Life Event—A qualifying life event is an event
that you or a covered family member may experience
that allows you to change your benefit election during
the year provided you enroll/make changes within 31
days of the qualifying life event, such as:
• Marriage, divorce or legal separation
• Birth, adoption or placement for adoption of a child
• Death of a spouse/domestic partner or dependent
• A change in employment status for you, your
spouse/domestic partner or your dependent that
affects health care coverage (such as changing from
full-time to part-time employment or your spouse/
domestic partner or dependent commencing or
terminating employment)
• A change in benefit status for you or your spouse/
domestic partner (such as your spouse/domestic
partner losing coverage elsewhere or enrolling you as
a dependent under his/her health care coverage)
• COBRA coverage under another health plan
is exhausted
• A dependent satisfies or ceases to satisfy plan
requirements for unmarried dependents
(such as age limitations or graduation from college)
• Entitlement to, or loss of, Medicare or Medicaid benefits
Reasonable and Customary (R&C)—The maximum amount
a plan will consider eligible for reimbursement, based
upon prevailing fees in a geographic area. You are
responsible for paying any amounts over R&C costs.
Specialty Medication—A medication that is used to treat
a chronic or complex condition, requires extra oversight,
has unique storage or shipping requirements, and
typically is not available at retail pharmacies.
Term Life Insurance—Provides a specific benefit to the
covered person’s beneficiary(ies) when death occurs
during the “term” period (such as while employed).
This type of coverage does not build up cash reserves
and the death benefit generally decreases when the
covered person reaches the age defined in the policy.
Under the Life Insurance Plan, coverage decreases at
age 70. See the Supplemental Term Life Insurance
Reduction Factor Schedule for more details.
86
Welcome
What’s Ahead for 2015
Directory of Resources
If you have questions about your Cablevision benefits, or need assistance, please refer to the following directory
of resources.
Eligibility
Cablevision Benefits
For More Information
UnitedHealthcare Choice Plus
Options 1 and 2
1-800-525-5590
www.myuhc.com
United Behavioral Health
1-866-374-6060
www.liveandworkwell.com
Access code: 228594
Choose Well, Live Well
UnitedHealthcare Network Doctors and Hospitals
1-800-525-5590
www.myuhc.com
Terms to Know
UnitedHealthcare Cancer Resource Services
1-866-936-6002
www.myoptumhealthcomplexmedical.com
Directory of Resources
UnitedHealthcare Healthy Pregnancy Program
1-800-411-7984
www.healthy-pregnancy.com
UnitedHealthcare myNurseline
1-866-425-2148
UnitedHealthcare Health Plan Cost Estimator
https://www.pcestimator.com/
Username: Cable2015
Password: benefits
Aetna Dental Preferred Provider Organization (DPPO)
Option 1
1-877-238-6200
www.aetna.com
Aetna Dental Maintenance Organization® (DMO®)
Option 2
1-877-238-6200
www.aetna.com
Aetna Dental Plan Selection Tool and Cost Estimator
Register under Aetna Navigator:
www.myaetna.com
Click on “Coverage & Benefits” and
“Plan Selection Cost Estimator”
2015 Benefits Options
Ready to Enroll
Medical
Group Number – 228594
Other Important Information
Dental
Group Number – 101930
Continued on next page >
87
Welcome
Cablevision Benefits
For More Information
What’s Ahead for 2015
Vision
Group Number – 12247290
VSP Options 1 and 2
1-800-877-7195
www.vsp.com
Eligibility
Flexible Spending Accounts
Group Number – 125404
Health Care FSA
Dependent Care FSA
1-800-284-4885
www.payflexdirect.com
Survivor Protection
Group Number – 117405
Short-Term Disability
Long-Term Disability
Life Insurance
1-800-300-4296
www.metlife.com/mybenefits
Company Name:
Cablevision Systems Corporation
Group Legal Plan
Hyatt Legal Plans
1-800-821-6400
www.legalplans.com
Password: METLAW
Back-Up Care
Advantage Program
Bright Horizons
Sittercity
1-877-BH-CARES
www.careadvantage.com/cablevision
Username: cablevision
Password: care4you
(Note: Website will be available 1/1/15)
Employee
Assistance Program
Group Number – 228594
WorkingSolutions
1-800-985-6901
(or 1-866-216-9926 TDD)
Work/Life Resource
and Referral Service
United Behavioral Health
www.liveandworkwell.com
Access code: 228594
2015 Benefits Options
Ready to Enroll
Other Important Information
Choose Well, Live Well
Terms to Know
Directory of Resources
Please note: Only benefits-eligible full-time and part-time employees may take advantage of the benefits listed above.
These benefits are not applicable to employees who are covered by a collective bargaining relationship with the
Company. Those benefits are subject to negotiations with a collective bargaining representative.
Actual plan provisions for Company benefits are contained in the appropriate Plan documents or applicable Company
policies. In the event of any conflict between information presented herein or elsewhere, the terms of the actual plans
or policies will govern. Cablevision reserves the right to amend or terminate any of its plans or policies at any time
and without notice or cause.

Karen Lui, RN, MS, MAACVPR

Government of Wes Bengal

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