Explore + enroll + engage - Annual Enrollment begins Nov. 5, 2018 and ends Nov. 16, 2018 - CenturyLink Benefits
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2019 Annual Enrollment Guide
explore + enroll + engage
Annual Enrollment begins
Nov. 5, 2018 and ends Nov. 16, 2018
CenturyLink Retirees with Executive Medical
H HIGHLIGHTS
What’s New/
Welcome to Annual Reminders for 2019
PAGE 3
Enrollment for 2019!
Medical & Prescription
Drug Overview
PAGE 5
What’s Inside Executive Medical
Option Overview
PAGE 6
Dental Overview
PAGE 7
Paying for Your Coverage
PAGE 8
How to Enroll
PAGE 9
Helpful Resources
PAGE 10
CenturyLink Retiree and
Important Coverage Rules
Inactive Health Plan PAGE 11
It’s time for 2019 Annual Enrollment. If you are not
making any changes or updates to your coverage, Legal and Important
Required Notices
no action is required. PAGE 12
2 • 2019 Bene ts Annual Enrollment Guide • explore+enroll+engage • AE19-Ret-EXE • CenturyLink Retirees with Executive Medical
What’s New/Reminders For 2019
These updates are effective Jan. 1, 2019. This section serves as a Summary of Material
Modi cations (SMM). For further details, refer to the Legal and Important Required Notices
section of this Guide.
What’s New Out-of-Network (OON) Outpatient Surgery Coverage
Out-of-network outpatient surgery centers and facilities will no
CENTURYLINK SERVICE CENTER ENHANCEMENTS longer be covered.
The UPoint Mobile HR App has been redesigned and • Visit myuhc.com and/or call the number on the back of your
enhanced. It’s the perfect companion to your website medical ID card to con rm that your facility is in-network. If
experience. The Mobile HR App provides easy access to you do not have access to an in-network provider within a
bene ts information from your phone. Download the app 30-mile radius of your home, you may qualify for a network
today from the App® Store or Google Play. gap exception. In this case, you can receive care from a
closer provider who is not part of the network, and that care
will be covered as if the provider were in-network. Be sure
MEDICAL
to call the health plan member services number listed on
Emergency Room (ER) Redirection your medical plan ID card before you start services with
A $300 penalty will be charged on your fourth and any a provider that may be available through a network gap
subsequent ER visits within the calendar year for each exception. Network gap exceptions will not be granted
covered family member. The $300 penalty will not apply once you have received services.
toward your annual deductible or out-of-pocket maximums.
Quali ed Life Event (QLE)
Note: The penalty resets every calendar year. The penalty If you are removing a dependent as a result of a QLE,
will be waived if you contact the UHC advocacy team (call coverage will end on the last day of the month in which the
the number on the back of your medical ID card) within seven event occurs, regardless of the noti cation date.
days from the ER visit. The penalty will only be applied to
members over the age of 18. However, the penalty will not • You will be responsible for any claims that are paid after
apply if the participant is admitted to the hospital. coverage ends
• Any overpayment will result in a credit to your account as
Infertility Coverage soon as administratively possible
The lifetime maximum has increased from $3,000 to $10,000. • COBRA will not be offered if the noti cation date is beyond
Infertility coverage requires prior authorization before any 60 days from the QLE date
services will be considered as eligible expenses. The $10,000
maximum applies to both medical and prescription drug Important to Know: If you keep an ineligible dependent
expenses and applies to in- and out-of-network coverage. on the Plan, this is considered to be a misrepresentation of
If you and your spouse/domestic partner are eligible for eligibility and falsi cation of or omission to update information
CenturyLink bene ts and change your enrollment options, the to the Plan. This misrepresentation/omission is a violation
lifetime maximum will follow you. In other words, it does not of the Plan document, Section 8.3, which allows the Plan
reset. Administrator to determine how to remedy this situation. For
example, if you divorce, your former spouse is no longer
Note: If you accessed the infertility bene t in the past and eligible for Plan coverage and this must be reported to the
reached the $3,000 lifetime maximum, your bene ts would Service Center within 45 days, regardless if you have an
increase by an additional $7,000 to meet the new lifetime obligation to provide health insurance coverage to your ex-
maximum of $10,000. spouse through a Court Order.
Medica Transition (MN, ND, SD and Western Wisconsin)
UnitedHealthcare will replace Medica. If you are impacted, you
will receive a letter from UnitedHealthcare. New ID cards will
be issued as soon as administratively possible (before the end
of the year).
• Review your available bene t options on the CenturyLink
Service Center website
• Visit myuhc.com for further information
• If you are enrolled in the CDHP, you will receive a new
Health Care Spending Card (HCSC)
AE98-Ret-EXE • CenturyLink Retirees with Executive Medical • explore+enroll+engage • 2019 Bene ts Annual Enrollment Guide • 3
Reminders:
DEDUCTIBLES AND CO-INSURANCE ACCUMULATORS PRESCRIPTION DRUG LIST
RESET/START OVER JAN. 1 The Prescription Drug List (PDL) is updated in January and
If you elect to move from one of the CDHP plans to the July of each year. It is not available until Dec. 2018. Please log
HDHP plan, any HRA dollars will be transferred to your post- on to myuhc.com for further information at that time.
deductible HRA after a run-out period of 90 days.
PRESCRIPTION DRUG PRICING TOOL
Any HRA dollars will be moved to your spouse after a run-out
period of 90 days under your spouse’s plan. Use the UnitedHealthcare drug pricing tool to check pricing
and nd lower-cost alternatives at myuhc.com.
Please note: If you change from the Premium CDHP to the
Standard CDHP (or vice versa) and have an HRA balance, ZIP CODE UPDATE
funds are not transferred until after 90 days. This is necessary Be sure to review the medical bene t options available to
for any run-out claims to be submitted. After 90 days, any prior you as networks are determined by ZIP code areas and are
HRA balances are moved automatically. revised annually. Review your Annual Enrollment Worksheet to
learn what bene t plan options are available.
MEDICAL AND/OR DENTAL PREMIUMS
Review your Annual Enrollment Worksheet, as your premiums STAY UP TO DATE WITH THE CENTURYLINK RETIREE
may have changed for 2019. NEWSLETTER
Visit www.centurylinkbene ts.com to get the latest retiree
news. This newsletter is designed to share information about
bene ts, the company and other topics.
4 • 2019 Bene ts Annual Enrollment Guide • explore+enroll+engage • AE19-Ret-EXE • CenturyLink Retirees with Executive Medical
Medical & Prescription Drug Overview
NON-MEDICARE GROUP PLAN OPTIONS
SAVINGS HDHP STANDARD CDHP PREMIUM CDHP
With Retiree-Funded HSA: With Company-Funded HRA
With Company-Funded HRA Contribution:
$3,500 Single (retiree) Contribution:
$1,000 Single (retiree)
$7,000 Single (retiree) + One or more $500 Single (retiree)
Note: If you are age 55 or older, $1,500 Single (retiree) + Spouse/
$750 Single (retiree) + Spouse/
you can contribute an extra $1,000 Domestic partner
Domestic partner
“catch-up” contribution annually. $1,500 Single (retiree) + Children
$750 Single (retiree) + Children
$2,000 Family
$1,000 Family
YOU PAY YOU PAY YOU PAY
In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network
Annual Deductible: (combined in-network and out-of-network)
Single Single Single
$1,500 $3,000 $1,500 $3,000 $1,500 $3,000
Single + Spouse/Domestic Partner Single + Spouse/Domestic Partner
$2,250 $4,500 $2,250 $4,500
Single + One or more enrolled Single + Children Single + Children
$3,000 $6,000 $2,250 $4,500 $2,250 $4,500
Family Family
$3,000 $6,000 $3,000 $6,000
Annual Out-of-Pocket Maximum: (includes deductible; combined for in-network and out-of-network expenses)
Single Single Single
$3,600 $7,200 $3,600 $7,200 $3,200 $6,400
Single + Spouse/Domestic Partner Single + Spouse/Domestic Partner
$5,400 $10,800 $4,800 $9,600
Single + One or more enrolled Single + Children Single + Children
$6,850 $14,400 $5,400 $10,800 $4,800 $9,600
(charges above Family Family
allowable amount
not included) $6,850 $14,400 $6,400 $12,800
(charges above (charges above
allowable amount allowable amount
not included) not included)
PLAN PAYS (AFTER DEDUCTIBLE) PLAN PAYS (AFTER DEDUCTIBLE) PLAN PAYS (AFTER DEDUCTIBLE)
In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network
Preventive Care: (No Deductible)
100% Not Covered 100% Not Covered 100% Not Covered
Inpatient (Facility), Of ce Visit, Outpatient (Facility), Prescriptions, Urgent Care
80% 60% of allowable 80% 60% of allowable 80% 60% of allowable
amount amount amount
Administered by UnitedHealthcare. Prescription drug REMEMBER: Any maintenance prescription, after two retail
expenses are paid the same as any other medical expense. lls, will require future lls through the mail order program.
“Charges above the allowable amounts not included” This chart is only a summary of your bene ts. For speci c
refers to reasonable and customary (R&C) charges. Refer details on how services are covered, please contact your
to the Summary Plan Description for information on what’s medical Claims Administrator.
not covered.
AE98-Ret-EXE • CenturyLink Retirees with Executive Medical • explore+enroll+engage • 2019 Bene ts Annual Enrollment Guide • 5
Executive Medical Option Overview
In addition to your other medical options, you are eligible for the Executive Medical option. Enrollment
is automatic, and there is no cost to you.
Percentage of Covered Expenses Payable $100%
Lifetime Maximum Bene t for Orthodontia for Each
$4,000
Covered Person
Calendar Year Maximum Bene t for Basic and Major
$1,500
Dental Services for Each Covered Person
Services Not Covered • Any service or supply not allowable as a tax deduction
under the Internal Revenue Code
• Custodial care
• Vision care
See your Executive Medical Summary Plan Description for
other services not covered.
HOW BENEFITS ARE PAID UNDER THIS PLAN
If you are enrolled in an individual Medicare plan, claims should rst be submitted to your Medicare plan. Then, submit any
remaining eligible out-of-pocket expenses to the Executive Medical Plan for reimbursement.
FOR THOSE WHO WILL BECOME
MEDICARE ELIGIBLE TO CONTINUE BENEFITS ONCE YOU BECOME
Options Outside of CenturyLink MEDICARE ELIGIBLE AND AVOID A GAP BETWEEN
• Your group health care coverage ends the rst day of the YOUR GROUP AND INDIVIDUAL COVERAGE, HERE’S
month in which you or your dependent becomes eligible WHAT TO DO:
for Medicare.
STEP 1
• You can purchase any individual Medicare Supplement,
Medicare Advantage and/or Medicare Prescription Drug Enroll in Medicare Part A & Part B
Policy available to you. These policies are not associated
with CenturyLink. STEP 2
• Group dental coverage continues to be offered under the
Enroll in an individual Medicare Policy prior to the month
CenturyLink bene t option.
of becoming Medicare eligible
• If you have access to other coverage, such as through
another employer or your spouse’s/domestic partner’s STEP 3
employer plan, you may want to defer Step 1 and Step 2
(listed to the right) Let ViaBene ts Help You Enroll
• You will receive a letter from the Service Center regarding
IF YOU ARE ELIGIBLE FOR A COMPANY SUBSIDY enrollment in a Medicare policy approximately 120 days
prior to you or your dependent’s 65th birth date
When your Non-Medicare CenturyLink medical group plan
options end, CenturyLink will fund an HRA with company • ViaBene ts will contact you approximately 90-120 days
subsidy dollars that help pay for your individual Medicare prior to the month you turn age 65
medical policy and dental premiums. Your HRA dollars will roll • You can contact ViaBene ts within 90 days of your
over, and any remaining balance at the end of the year will be Medicare enrollment deadline at 888-825-4252 to help
forfeited. Your annual Company-funded medical HRA amounts you select a medical and/or prescription policy
remain the same for 2019.
NOTE: You are not obligated to enroll in a Medicare Policy
NOTE: It is your responsibility to notify the Service Center if you through ViaBene ts.
or your dependents become Medicare eligible prior to age 65
(for example, if you are disabled). If you don’t advise the Service
Center when you become Medicare eligible due to a disability,
Medicare may assess penalties to you or you may experience a
gap in your coverage.
6 • 2019 Bene ts Annual Enrollment Guide • explore+enroll+engage • AE19-Ret-EXE • CenturyLink Retirees with Executive Medical
Dental Overview
PASSIVE PPO IN-NETWORK
Annual Bene t Maximum
$1,000 (does not include oral surgery)
Per Person
You Pay
Annual Deductible $25 for General Care and Major and Restorative; no
Per Person deductible for Diagnostic, Preventive or Oral Surgery
Plan Pays (After Deductible)
Diagnostic and Preventive - No deductible
100% up to maximum allowable amount
Cleanings, exams and X-rays
General Care
50% up to maximum allowable amount
Fillings, root canals and periodontics
Major and Restorative
50% up to maximum allowable amount
Crowns, dentures and bridges
Oral Surgery - No deductible 80% no limit
When you use network dentists, you pay a percentage of
Passive PPO Network
discounted fees
MetLife, Group Number: 305521
Administrator
Phone Number: 888-356-4191
DENTAL
If You and All of Your Dependents Are Medicare Eligible
• Once you choose to waive your group dental coverage, you
will not be eligible to enroll at Annual Enrollment or if you
experience a Quali ed Life Event (QLE).
• If you opt out of the group coverage, waive or suspend
coverage, you can enroll in an individual dental policy of
your choice outside of CenturyLink.
• You may enroll in an individual dental policy through
ViaBene ts (my.viabene ts.com/centurylink) or on your
own directly with a dental insurance carrier or a local broker
of your choice.
AE98-Ret-EXE • CenturyLink Retirees with Executive Medical • explore+enroll+engage • 2019 Bene ts Annual Enrollment Guide • 7
Paying for Your Coverage
CENTURYLINK MAKES IT EASY TO PAY FOR YOUR BE SURE TO MAKE TIMELY PAYMENTS!
RETIREE BENEFITS If your premium payments are not received by the Service
Your 2018 bene t payment election will continue in 2019 Center in a timely manner, the payments may be processed
unless you make a change. If you do not have an automatic due to the delay in updating records internally. In this case,
payment plan in place for your health and/or life insurance you will receive a refund for the untimely payment and your
premiums, then your premiums are due on the rst day of coverage will not be reinstated, except as may be determined
each month for the current month’s bene t coverage. You can upon a written appeal made by you to the Plan.
contact the Service Center for payment options such as:
Please note that checks that are returned or direct debit
• check or money order,
requests that are refused due to insuf cient funds are not
• direct debit (automatic monthly withdrawal from your re-deposited.
checking or saving account), or
• a reimbursement account, if applicable. Regardless of how you pay your premiums, be sure that your
full contribution is received by the Service Center by the last
day of the month. If not, your coverage will be terminated
retroactively to the last day of the prior month for which full
payment was received.
8 • 2019 Bene ts Annual Enrollment Guide • explore+enroll+engage • AE19-Ret-EXE • CenturyLink Retirees with Executive MedicalENROLL ANNUAL ENROLLMENT BEGINS NOV. 5 AND ENDS NOV. 16, 2018
If you don’t enroll, you will default to your current medical/prescription drug, and/or dental bene t
options, if applicable (shown on your Annual Enrollment Worksheet).
ONLINE
NOTE: If you are not making any changes or updates to your coverage, no action is required.
If you are using the website for the rst time, click on
Register as a New User and follow the prompts to set up your
4. Click Enroll in Your Bene ts then Enroll Now.
User ID and password. Store this information in a safe and
secure place.
5. Review your choices and associated premiums to make
your elections.
1. Go to www.centurylinkhealthandlife.com and 6. After you have made your elections, click Complete
Enrollment.
Log On with your User ID and password.
2. Once you are logged in, select Make Your Elections 7. Look for the Completed Successfully! message and
print a Con rmation of Enrollment for your records. You
to start enrolling.
also will receive a Con rmation of Enrollment Statement at
3. You will be taken to a step-by-step page with helpful your address on le.
enrollment resources. Use the tools to nd:
If you forgot your User ID or Password:
» information on your bene t options Click I Forgot My Password and enter the correct information.
» comparisons of Plan deductibles and coinsurance, First, con rm your identity, then reset your password.
if applicable You’ll receive your log on information via email if you have a
valid email address on le. If not, your log on information will
» whether a doctor or other medical provider is an be mailed to the address on le. It can take up to 10 business
in-network or out-of-network provider days to receive this information by mail.
» links to vendor websites
If you are adding a previously suspended dependent to your
» printable copies of Summary Plan Descriptions (SPDs) and
coverage, please see page 11 for additional information.
Summaries of Material Modi cations (SMMs)
BY PHONE
Service Center representatives will be available to answer your questions or help with your
enrollment. You must call 800-729-7526 before Friday, Nov.16 at 5:30 p.m. Mountain time
to complete your enrollment.
REMEMBER: If you need to call the Service Center during Annual Enrollment, please keep in mind that the rst and last days
of Annual Enrollment are usually the busiest. You can also nd answers to many of your bene t questions in this Annual
Enrollment Guide or on the Health and Life website. You also have the ability to ask questions via the Web Chat
feature on the Health and Life website.
If you do not make any changes, your Annual Enrollment Worksheet will serve as your Con rmation of Enrollment Statement.
You can print a copy of your 2019 elections until Dec. 31, 2018, by following the instructions below.
1. Log on to www.centurylinkhealthandlife.com. 4. To print, click on the Print icon on the top right side of
the screen.
2. Click on the Health and Insurance tab.
5. Keep a copy of this page for your records.
3. Click on the blue tile labeled View Pending Coverage
Costs (effective Jan. 1, 2019).
AE98-Ret-EXE • CenturyLink Retirees with Executive Medical • explore+enroll+engage • 2019 Bene ts Annual Enrollment Guide • 9Helpful Resources
BENEFIT OPTION PHONE ONLINE
Health Care
CenturyLink Service Center 800-729-7526 M–F, The CenturyLink Health and Life website
7:30 a.m. to 5:30 p.m. www.centurylinkhealthandlife.com
Mountain time Search: UPoint HR Mobile App
available for free in the App Store®
and Google Play
Medical UnitedHealthcare: UnitedHealthcare:
CDHPs, HDHP and Executive 800-842-1219 www.myuhc.com
Medical Option
Prescription Drug Program UnitedHealthcare: UnitedHealthcare:
800-842-1219 www.myuhc.com
Dental Plan MetLife: 888-356-4191 www.metlife.com/mybene ts
Group Number: 305521
Health Care Advocacy Services CenturyLink Service Center for www.alight.com/advocacy
Free assistance with health and life Health and Welfare Bene ts:
claims and accessing health care 800-729-7526
services if enrolled in health care
bene ts through CenturyLink
ViaBene ts 888-825-4252 my.viabene ts.com/centurylink
(Medicare-eligible participants)
Need to update your address or phone number? Log on to www.centurylinkhealthandlife.com or contact the Service
Center at 800-729-7526 (press Option 2, then Option 1).
10 • 2019 Bene ts Annual Enrollment Guide • explore+enroll+engage • AE19-Ret-EXE • CenturyLink Retirees with Executive MedicalImportant Coverage Rules
REFER TO YOUR SUMMARY PLAN DESCRIPTION FOR 2. Plan coverage for your previously suspended dependents
A COMPLETE DESCRIPTION OF COVERAGE RULES.* will become effective Jan. 1, 2019, with the following
Dual Coverage exception. If validation is required and veri cation forms
CenturyLink retirees are prohibited from being enrolled in more are not received by the Service Center by the deadline, your
than one CenturyLink medical/prescription drug or dental Plan dependents will be removed retroactively from coverage.
bene t option (except as noted below). You will be required to reimburse the Plan for any claims
paid while the previously suspended dependents were
• If you elect coverage during Annual Enrollment, and are ineligible under the Plan.
also covered as a dependent on another employee’s/ .
retiree’s coverage, you will remain in coverage under your What happens to your bene ts if you return to work
own record, but you will be removed as a dependent from directly for the company as an active employee or work
the other employee’s/retiree’s coverage once the enrollment for a supplier on assignment to the company after you
period ends. retire or leave employment? If you are eligible for retiree
• If you are a retired CenturyLink employee enrolled as a health care or life insurance from the company, refer to the
dependent through a Qwest Pre-1991 retiree’s coverage, applicable section below to see how your retiree bene ts may
you will be allowed to remain enrolled as both a dependent be impacted.
and as a retiree, and you also may cover the Pre-1991
retiree as your dependent. NOTE: If you have VEBA life insurance, that coverage will not
be impacted.
NOTE: Pre-1991 retirees must be enrolled in the Company
Guaranteed Plan; otherwise, dual coverage does not apply. If you are rehired in a status that is eligible for active
employee bene ts, you will be offered the same bene ts
Waiving Coverage as other similarly situated CenturyLink employees based on
You may waive medical/prescription drug and/or dental your employee classi cation. If you have retiree supplemental
retiree coverage. If you do, you will not be eligible to enroll life insurance coverage, you will be eligible to elect active
in that coverage at any time in the future for any reason. supplemental life insurance coverage. If there is a loss of
“Waiving” coverage is permanent and different from supplemental life coverage between what you previously
“suspending”coverage (meaning you can’t be covered again). had prior to your rehire date and the amount as an active
employee, you may convert the difference with Metropolitan
Suspending Coverage Life Insurance Company. If you continued supplemental life
If you suspended medical/prescription drug or dental coverage through Metropolitan Life Insurance Company, you
coverage when you retired and do not make an af rmative will be required to surrender this policy when you return to
election during Annual Enrollment, your coverage will remain retiree status in order to resume your retiree supplemental life
in suspended status. If you now wish to participate in the coverage, if applicable.
medical/prescription drug or dental Plan bene t options, you
must make an af rmative election during Annual Enrollment. If you return to work for a supplier on assignment to
You may suspend your coverage one time and re-enroll at a the company, you are not eligible to continue your
later date. (This is not the same as waiving coverage.) This CenturyLink retiree health care bene ts. This means
rule does not apply to retirees who become re-employed that while you are working for the supplier, your retiree
directly with the Company as an active employee or who work health care bene ts will be suspended. However, you will
for a supplier to the Company. be offered the opportunity to continue your retiree medical
and/or dental options under COBRA. Your retiree basic and
Covering Previously Suspended Dependents During supplemental life coverage, if applicable, will continue under
Annual Enrollment the terms of the CenturyLink Life Insurance Plan (“the Plan”).
To cover previously suspended dependents during Annual In addition, please be advised that as a worker for a supplier
Enrollment, your action is required. or company contractor, you are not eligible for CenturyLink
active employee health care bene ts. Retiree health care
1. To add previously suspended dependents, follow the bene ts are reinstated once your work with the supplier/
prompts during your online enrollment or contact the Service contractor for the company has ended. You will need to call the
Center. A Dependent Veri cation packet may be sent to you Service Center to get your bene ts reinstated.
automatically in December 2018. Follow the instructions
outlined in the packet and respond by the deadline.
* If you can’t locate your SPD, you can access it on the Health and Life website at www.centurylinkhealthandlife.com.
Alternatively, you can request a paper copy by calling the Service Center at 800-729-7526 (press Option 2, then Option 1).
AE98-Ret-EXE • CenturyLink Retirees with Executive Medical • explore+enroll+engage • 2019 Bene ts Annual Enrollment Guide • 11Once your employment or assignment ends, you NOTE: If you are Medicare eligible and have enrolled in
may resume your retiree health care, basic and supplemental an individual Medicare policy, you may need to complete a
life insurance coverage, if applicable, in accordance with disenrollment process to be released by that carrier from the
the terms of the Plan by calling the Service Center at individual plan (which can take up to 60 days).
800-729-7526. If you returned to work for a supplier on
assignment to the company, CenturyLink will validate that
your assignment has ended before you will be allowed to If this applies to you and you have questions regarding
resume your retiree health care coverage. coverage, call the Service Center at 800-729-7526 Monday –
Friday, 7:30 a.m. to 5:30 p.m. Mountain time.
Legal and Important Required Notices
A Note About Privacy the right to interpret and resolve any Bene ts and contribution obligations,
Keeping your personal information ambiguities in the Plan or any document if any, are determined by CenturyLink
secure is of primary importance to relating to the Plan. in its sole discretion or by collective
CenturyLink. That’s why we, along bargaining, if applicable.
with the bene ts administrators, have Coverage Is Not Advice
implemented various security measures Health Plan coverage is not health care NOTE: While the Plan has processes
and policies to help reduce the risk of advice. Please keep in mind that the in place to prevent errors and mistakes,
unauthorized processing or disclosure sole purpose of the Plan is to provide if a clerical error or mistake happens
of your personal information. You can payment for certain eligible health care (however occurring), such error or
also help by keeping con dential your expenses – not to guide or direct the mistake does not create a right to a
User ID and password for accessing the course of treatment for any employee, Bene t or level of contribution rate
CenturyLink Health and Life website. inactive retiree or eligible dependent. If under the Plan. You have an obligation
Please keep this information safe and your health care provider recommends to correct any errors or omissions that
don’t share it with anyone. Never use a course of treatment, be sure to check come to your attention by calling the
your Social Security number as your with the Plan to determine whether or Service Center to correct the error or
password. Together, we can make sure not that course of treatment is covered omission.
your personal information stays safe and under the Plan. However, only you and
secure. Please be advised that using an your health care provider can decide Right to Amend and/or Discontinue
email that is not secured may increase what the right health care decision is for and Make Rules
your risk of unauthorized disclosure. you. Decisions by a claims administrator The company and its delegate, the
or the Plan Administrator are solely CenturyLink Plan Design Committee,
Notice of Privacy Practices decisions with respect to Plan coverage each has reserved the right in its
You can review and print the complete and do not constitute health care sole discretion, to change, modify,
notice at www.centurylinkhealthandlife. recommendations or advice. discontinue or terminate the Plan and/
com. You may obtain a paper copy upon or any of the bene ts under the Plan
request by calling the Service Center The Company’s Reserved Rights and/or contribution levels, with respect
at 800-729-7526 (press option 2 and then This document summarizes certain to all participants classes, retired or
option 1). provisions of the CenturyLink Disability otherwise, and their bene ciaries at any
Plan, the CenturyLink Life Insurance time without prior notice or consultation,
This Is a Summary of Material Plan and the CenturyLink Retiree and subject to applicable law, speci c written
Modi cations (SMM) Inactive Health Plan (collectively referred agreement and the terms of the Plan
This document is intended to serve as a to as the “Plan”). For speci c employee Document and with respect to the Health
Summary of Material Modi cations (the bene t Plan information, refer to the Plan, the written agreement speci c to
“SMM”) pursuant to the requirements respective of cial Plan Documents, Qwest Pre-1991 Retirees and Qwest
of Section 104 of the Employee including the applicable Summary Plan ERO ’92 Retirees. The CenturyLink
Retirement Income Security Act of Description and Summaries of Material Employee Bene ts Committee, as
1974, as amended (“ERISA”). This Modi cations, if any. If there is any the Plan Administrator, may adopt, at
SMM noti es you of certain changes to con ict between the terms of the of cial any time, rules and procedures that it
the CenturyLink sponsored Plans (the Plan Documents and this document, determines to be necessary or desirable
“Plan”). Please keep this SMM with your the terms of the of cial Plan Documents with respect to the operation of the Plan.
Summary Plan Description for the Plan will govern. The Plan Administrator has The Plan Administrator has the authority,
for future reference. This document the authority, discretion and the right to discretion and the right to interpret and
summarizes only certain provisions of interpret and resolve any ambiguities in resolve any ambiguities in the Plans or
the Plan. If there is any con ict between the Plan or any document relating to the any document relating to the Plans.
the terms of the Plan documents Plan, to supply omissions and resolve
and this SMM, the terms of the Plan con icts.
documents will govern. The company
has reserved to the Plan Administrator
12 • 2019 Bene ts Annual Enrollment Guide • explore+enroll+engage • AE19-Ret-EXE • CenturyLink Retirees with Executive MedicalNotice of “Exempt” Retiree Medical documentation under any of the Plans; mastectomy, including lymphedemas,
Plan Status you certify that you or your dependent(s) in a manner determined in consultation
The CenturyLink Retiree and Inactive are eligible to enroll in a bene t option, with the attending physician and the
Health Plan, and all of its bene t options including voluntary or supplemental patient.
meet the requirements of a stand- coverages. Please refer to the applicable • As with other bene t coverages under
alone exempt retiree medical bene t Plan document or SPD for details the Plan, this coverage is subject
plan under Section 732 of ERISA and, about eligibility for coverage or call the to each medical bene t option’s
therefore, is not required to comply Claims Administrator – limitations may annual deductible (if any), required
with bene t mandates of the Patient apply including, but not limited to, being coinsurance payments, bene t
Protection and Affordable Care Act actively at work in order to be eligible for maximums, and copay provisions that
(PPACA). However, CenturyLink has coverage. You understand that it is your may apply under each of the bene t
decided to voluntarily apply certain responsibility to con rm your eligibility options available under the Plan.
provisions of the PPACA to these bene t to enroll in a bene t option, including
options. This voluntary application of voluntary or supplemental coverages; • You should carefully review the
certain PPACA provisions is separate enrolling in and paying for coverage for provisions of the Plan, the medical
from and not part of the health care which you are ineligible will not entitle bene t option in which you elect to
commitment to the Qwest Pre-1991 and you to Bene ts; you understand that it is participate, and its SPD and SMM
Qwest ERO ’92 Retiree populations. your responsibility to terminate bene t (if any) regarding any applicable
This means that for all retirees, this coverage once you or your dependent(s) restrictions. Contact the Claims
voluntary compliance with PPACA may become ineligible, for example, divorce, Administrator of your medical bene t
be changed or ended at any time and death, etc. option for more information.
does not waive the Plan’s status as For speci c employee bene t plan
“exempt” from PPACA. If you choose Health Insurance Portability and
information, including terms and
to participate in the new Medicare Accountability Act (HIPAA)
conditions for eligibility, limitations and
Advantage PPO or HRA, the policy you Bene ts refer to the respective Plan Under the Special Enrollment rules
elect is an individual policy. Documents, including the applicable under HIPAA, you may enroll yourself
Summary Plan Description and and eligible dependents in the Health
Important Note Regarding Your Summaries of Material Modi cations, if Plan upon the loss of other coverage,
Annual Enrollment Elections any. If there is any con ict between the referred to as the “other plan,” to include
By electing to participate in the Plans terms of the Plan Documents and this the following:
(the CenturyLink Disability Plan, the correspondence, the terms of the Plan
CenturyLink Life Insurance Plan and the • Termination of employer contribution
Documents will govern. toward other coverage;
CenturyLink Retiree and Inactive Health
Plan), by your submission of information, Women’s Health and Cancer Rights • Moving out of a service area if the
you have agreed to be bound to and by Act other plan does not offer other
the provisions of each of the Plans and • This notice is provided to you in coverage;
their administrative practices, including, compliance with the federal law entitled • Ceasing to be a dependent, as de ned
but not limited to with respect to the the Women’s Health and Cancer in the other plan;
recovery of over and underpayments, Rights Act of 1998 (the “Act”). The Plan
terms and conditions for eligibility and • Loss of coverage to a class of similarly
provides medical and surgical bene ts
Bene ts. You certify that the submission situated individuals under the other
in connection with a mastectomy. In
of information by you in this enrollment plan (e.g., when the other plan does
accordance with the requirements of
process is true and accurate to the best not cover temporary/contractors).
the Act, the Plan also provides bene ts
of your knowledge, unless you submit for certain reconstructive surgery. If your spouse/domestic partner
changes as instructed; you agree that or other dependents have special
you’ll submit new information timely • In particular, the Plan will provide,
enrollment rights, you may enroll and
as changes occur. You understand to an eligible participant who is
make changes to your enrollment in
that if you are found to have falsi ed receiving (or who presents a claim to
any health plan bene t option available
any document in support of a claim receive) bene ts in connection with
to you based upon your home ZIP
for eligibility or reimbursement, the a mastectomy and who elects breast
code and plan service areas within 45
Plan Administrator may, subject to reconstruction in connection with
days following the qualifying event.
and as may be permitted under the such mastectomy, coverage for: (1)
For example, if you have Employee
requirements of law, without anyone’s reconstruction of the breast on which
Only coverage in a CenturyLink bene t
consent, terminate your and/or your the mastectomy has been performed;
option, and your spouse/ domestic
dependent(s’) coverage, and the Claims (2) surgery and reconstruction of the
partner loses coverage under his/
Administrator may refuse to honor any other breast to produce a symmetrical
her employer’s plan and has special
claim you or your dependent(s’) may appearance; and (3) prostheses and
enrollment rights, both you and your
have made or will make under the Plans treatment of physical complications
spouse/domestic partner may enroll in
if applicable. You understand that you associated with all the stages of
any of the CenturyLink bene t options
are liable and bear the full nancial available to you, provided you verify your
responsibility for the misappropriation spouse’s/domestic partner’s eligibility for
of Plan funds through the ling of false the Plan.
AE98-Ret-EXE • CenturyLink Retirees with Executive Medical • explore+enroll+engage • 2019 Bene ts Annual Enrollment Guide • 13Premium Assistance Under Medicaid If you or your dependents are already If you or your dependents are eligible
and the Children’s Health Insurance enrolled in Medicaid or CHIP and you for premium assistance under Medicaid
Program (CHIP) live in a State listed below, contact your or CHIP, as well as eligible under your
State Medicaid or CHIP of ce to nd out employer plan, your employer must
NOTE: This is an updated notice. if premium assistance is available. allow you to enroll in your employer plan
if you aren’t already enrolled. This is
If you or your children are eligible for If you or your dependents are NOT called a “special enrollment” opportunity,
Medicaid or CHIP and you’re eligible for currently enrolled in Medicaid or CHIP, and you must request coverage
health coverage from your employer, and you think you or any of your within 60 days of being determined
your state may have a premium dependents might be eligible for eligible for premium assistance. If you
assistance program that can help pay either of these programs, contact have questions about enrolling in your
for coverage, using funds from their your State Medicaid or CHIP of ce employer plan, contact the Department
Medicaid or CHIP programs. If you or or dial 1-877-KIDS NOW or of Labor at www.askebsa.dol.gov or
your children aren’t eligible for Medicaid www.insurekidsnow.gov to nd out call 1-866-444-EBSA (3272).
or CHIP, you won’t be eligible for these how to apply. If you qualify, ask your
premium assistance programs but you state if it has a program that might help
may be able to buy individual insurance you pay the premiums for an employer-
coverage through the Health Insurance sponsored plan.
Marketplace. For more information, visit
www.healthcare.gov.
If you live in one of the following states, you may be eligible for assistance paying your employer health plan
premiums. The following list of states is current as of July 31, 2018. Contact your State for more information on
eligibility.
ALABAMA – Medicaid INDIANA – Medicaid
Website: http://myalhipp.com Healthy Indiana Plan for low-income adults 19-64
Phone: 1-855-692-5447 Website: http://www.in.gov/fssa/hip/
Phone: 1-877-438-4479
ALASKA – Medicaid All other Medicaid
The AK Health Insurance Premium Payment Program Website: http://www.indianamedicaid.com
Website: http://myakhipp.com/ Phone 1-800-403-0864
Phone: 1-866-251-4861
Email: CustomerService@MyAKHIPP.com IOWA – Medicaid
Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/ Website: http://dhs.iowa.gov/hawk-i
medicaid/default.aspx Phone: 1-800-257-8563
ARKANSAS – Medicaid KANSAS – Medicaid
Website: http://myarhipp.com/ Website: http://www.kdheks.gov/hcf/
Phone: 1-855-MyARHIPP (855-692-7447) Phone: 1-785-296-3512
COLORADO – Health First Colorado (Colorado’s KENTUCKY – Medicaid
MedicaidProgram) & Child Health Plan Plus (CHP+) Website: http://chfs.ky.gov
Health First Colorado Website: Phone: 1-800-635-2570
https://www.health rstcolorado.com/
Health First Colorado Member Contact Center: LOUISIANA – Medicaid
1-800-221-3943/ State Relay 711 Website: http://dhh.louisiana.gov/index.cfm/subhome/1/n/331
CHP+: Colorado.gov/HCPF/Child-Health-Plan-Plus Phone: 1-888-695-2447
CHP+ Customer Service: 1-800-359-1991/State Relay 711
MAINE – Medicaid
FLORIDA – Medicaid Website: http://www.maine.gov/dhhs/o /public-assistance/
Website: http:// medicaidtplrecovery.com/hipp/ index.html
Phone: 1-877-357-3268 Phone: 1-800-442-6003
TTY: Maine relay 711
GEORGIA – Medicaid
Website: http://dch.georgia.gov/medicaid MASSACHUSETTS – Medicaid and CHIP
Click on Health Insurance Premium Payment (HIPP) Website: http://www.mass.gov/eohhs/gov/departments/
Phone: 404-656-4507 masshealth/
Phone: 1-800-862-4840
14 • 2019 Bene ts Annual Enrollment Guide • explore+enroll+engage • AE19-Ret-EXE • CenturyLink Retirees with Executive MedicalMINNESOTA – Medicaid PENNSYLVANIA – Medicaid
Website: http://mn.gov/dhs/people-we-serve/seniors/health- Website: http://www.dhs.pa.gov/provider/medicalassistance/
care/health-care-programs/programs-and-services/other- healthinsurancepremiumpaymenthippprogram/index.htm
insurance.jsp Phone: 1-800-692-7462
Phone: 1-800-657-3739
RHODE ISLAND – Medicaid
MISSOURI – Medicaid Website: http://www.eohhs.ri.gov/
Website: http://www.dss.mo.gov/mhd/participants/ Phone: 855-697-4347
pages/hipp.htm
Phone: 573-751-2005 SOUTH CAROLINA – Medicaid
Website: http://www.scdhhs.gov
MONTANA – Medicaid Phone: 1-888-549-0820
Website: http://dphhs.mt.gov/MontanaHealthcare
Programs/HIPP SOUTH DAKOTA – Medicaid
Phone: 1-800-694-3084 Website: http://dss.sd.gov
Phone: 1-888-828-0059
NEBRASKA – Medicaid
Website: http://www.ACCESSNebraska.ne.gov TEXAS – Medicaid
Phone: 1-855-632-7633 Website: http://gethipptexas.com/
Lincoln: 402-473-7000 Phone: 1-800-440-0493
Omaha: 402-595-1178
UTAH – Medicaid and CHIP
NEVADA – Medicaid Medicaid Website: https://medicaid.utah.gov/
Website: https://dhcfp.nv.gov CHIP Website: http://health.utah.gov/chip
Phone: 1-800-992-0900 Phone: 1-877-543-7669
NEW HAMPSHIRE – Medicaid VERMONT – Medicaid
Website: https://www.dhhs.nh.gov/ombp/nhhpp/ Website: http://www.greenmountaincare.org/
Phone: 603-271-5218 Phone: 1-800-250-8427
Hotline: NH Medicaid Service Center at 1-888-901-4999
VIRGINIA – Medicaid and CHIP
NEW JERSEY – Medicaid and CHIP Medicaid Website: http://www.coverva.org/programs_
Medicaid Website: http://www.state.nj.us/ premium_assistance.cfm
humanservices/dmahs/clients/medicaid/ Medicaid Phone: 1-800-432-5924
CHIP Website: http://www.njfamilycare.org/index.html CHIP Website: http://www.coverva.org/programs_premium_
Medicaid Phone: 609-631-2392 assistance.cfm
CHIP Phone: 1-800-701-0710 CHIP Phone: 1-855-242-8282
NEW YORK – Medicaid WASHINGTON – Medicaid
Website: https://www.health.ny.gov/health_care/medicaid/ Website: http://www.hca.wa.gov/free-or-low-cost-health-care/
Phone: 1-800-541-2831 program-administration/premium-payment-program
Phone: 1-800-562-3022, ext. 15473
NORTH CAROLINA – Medicaid
Website: https://dma.ncdhhs.gov/ WEST VIRGINIA – Medicaid
Phone: 919-855-4100 Website: http://mywvhipp.com/
Phone: 1-855-MyWVHIPP (1-855-699-8447)
NORTH DAKOTA – Medicaid
Website: http://www.nd.gov/dhs/services/medicalserv/ WISCONSIN – Medicaid and CHIP
medicaid/ Website: https://www.dhs.wisconsin.gov/publications/p1/
Phone: 1-844-854-4825 p10095.pdf
Phone: 1-800-362-3002
OKLAHOMA – Medicaid and CHIP
Website: http://www.insureoklahoma.org WYOMING – Medicaid
Phone: 1-888-365-3742 Website: https://wyequalitycare.acs-inc.com/
Phone: 307-777-7531
OREGON – Medicaid
Website: http://healthcare.oregon.gov/Pages/index.aspx To see if any other states have added a premium assistance
http://www.oregonhealthcare.gov/index-es.html program since July 31, 2018, or for more information on
Phone: 1-800-699-9075 special enrollment rights, contact either:
AE98-Ret-EXE • CenturyLink Retirees with Executive Medical • explore+enroll+engage • 2019 Bene ts Annual Enrollment Guide • 15U.S. Department of Labor events, or a second qualifying event OTHER COVERAGE OPTIONS
Employee Bene ts Security during the initial period of coverage, There may be other, more affordable
Administration may permit a bene ciary to receive a coverage options for you and your
www.dol.gov/ebsa maximum of 36 months of coverage. family through the Health Insurance
1-866-444-EBSA (3272) Upon termination, or other COBRA Marketplace, Medicaid, or other group
qualifying event, the former employee health plan coverage options (such as
U.S. Department of Health and Human and any other QBs will receive COBRA a spouse’s plan) through what is called
Services enrollment information. Qualifying a “special enrollment period,” even if
Centers for Medicare & Medicaid events for employees include voluntary/ the plan generally doesn’t accept late
Services involuntary termination of employment, enrollees.
www.cms.hhs.gov and the reduction in the number of hours
1-877-267-2323, Menu Option 4, of employment. In the Marketplace, you could be eligible
Ext. 61565 for a new kind of tax credit that lowers
Qualifying events for spouses/domestic your monthly premiums right away,
OMB Control Number 1210-0137 partners or dependent children include and you can see what your premium,
(expires 12/31/2019) those events above, plus, the covered deductibles, and out-of-pocket costs
employee’s becoming entitled to will be before you make a decision to
If You Voluntarily Elect to Drop Medicare, divorce or legal separation enroll. Being eligible for COBRA doesn’t
Coverage of the covered employee, death of the limit your eligibility for coverage for a tax
If you voluntarily drop coverage for covered employee, and the loss of credit through the Marketplace.
yourself or a dependent during Annual dependent status under the plan rules. If
Enrollment, without there being a a QB chooses to continue group bene ts You should compare your other
Quali ed Life Event (QLE), you and/or under COBRA, he or she must complete coverage options with COBRA
your dependent will not be eligible for an enrollment form and return it to the continuation coverage and choose
continuation of health care coverage Plan Administrator with the appropriate the coverage that is best for you. For
under the federal law known as COBRA. premium due. Upon receipt of premium example, if you move to other coverage,
Eligibility for COBRA continuation payment and enrollment form, the you may pay more out of pocket than
coverage occurs only in cases of QLEs. coverage will be reinstated. Thereafter, you would under COBRA, because
For more information on what is a QLE, premiums are due on the rst of the the new coverage may impose a new
refer to the Summary Plan Description. month. If premium payments are not deductible.
received in a timely manner, federal law
Continuation of Coverage stipulates that your coverage will be When you lose job-based health
Under the Consolidated Omnibus canceled after a 30-day grace period. If coverage, it’s important that you choose
Budget Reconciliation Act (COBRA) of you have any questions about COBRA carefully between COBRA continuation
1985, COBRA quali ed bene ciaries or the Plan, please contact the Service coverage and other coverage options,
(QBs) generally are eligible for group Center at 800-729-7526. because once you’ve made your choice,
coverage during a maximum of 18 it can be dif cult or impossible to switch
months for qualifying events due to to another coverage option.
employment termination or reduction of
hours of employment. Certain qualifying More information on health insurance
options through the Marketplace can be
found at www.HealthCare.gov.
H000209368 2019 CTL Executive Enrollment Guide
16 • 2019 Bene ts Annual Enrollment Guide • explore+enroll+engage • AE19-Ret-EXE • CenturyLink Retirees with Executive MedicalYou can also read
