2020 Benefits Annual Enrollment Guide - Enrollment Period October 10th - October 23, 2020 - Avaya

 
2020 Benefits Annual Enrollment Guide - Enrollment Period October 10th - October 23, 2020 - Avaya
2020 Benefits
Annual Enrollment Guide
Enrollment Period October 10th – October 23, 2020
2020 Benefits Annual Enrollment Guide - Enrollment Period October 10th - October 23, 2020 - Avaya
Active
 Salaried
 Employees

Annual Enrollment is your once-a-year opportunity to review your benefit options for the coming year and select
the coverages that will work best for you and your family. Use this brochure to learn what’s changing for 2020 and
what you need to do.

                                                                                                                         Click on a topic below
                                       Annual Enrollment 2020                                                             to go directly to the
                                        October 10 – 23, 2019                                                            information you need.

                           Benefits selected during this enrollment period
                                                                                                                        What's New for 2020
                                  will be effective January 1, 2020.

                                                                                                                       Medical Plan Comparison
Please review this Guide in its entirety. It is your source of information for what’s changing in 2020. Consider all
of your benefit options and your financial and health care needs during Annual Enrollment. You will not need to
                                                                                                                        Important Reminders
actively enroll in most benefits for 2020 if you do not wish to make changes, with the exception of the following
elections that do not carry over from year to year:
                                                                                                                        Helpful Links & Tools
• Health Care or Limited Flexible Spending Account elections                                                            to Take Control of
• Dependent Care Flexible Spending Account elections                                                                       Your Health

• Employee tax-favored Health Savings Account contributions
We listened to your feedback and are excited to highlight some                                                            Legal Reminders
                                                                         If you (and/or your dependents)
of the enhancements to our plans for 2020. Details start on page 2.
• No Medical, Dental (PPO) or Vision Contribution Increases
                                                                         have Medicare or will become                    Important Contacts
•N  o Medical Deductible or Out-Of-Pocket Maximum Increases             eligible for Medicare in the next 12
• Fidelity Investments® will be the new HSA recordkeeper                 months, a Federal law gives you
• Aetna Customer Care Management Unit – health advocate nurse
   to assist with ongoing conditions or hospitalization
                                                                         more choices about your
• PPO Dental Care Enhancement                                            prescription drug coverage. Please
                                                                         see page 22 for more details.

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What's New for 2020

      Avaya knows how important health and insurance plans are for you                  The maximum visit for routine physical exams was changed to one per
      and your family. The following pages include a summary of what’s                  calendar year (was one visit per 12 months).
      changing for the year ahead. Additional details are available in later            Vision and Dependent Life Change
      sections of this Guide and at https://my.adp.com. If you have questions
      or need assistance, contact the Avaya Health & Benefits Decision Center           We have simplified the eligibility for your covered child(ren), so your child
      at 1-800-526-8056 option 1 (TDD 1-800-952-0450) or via e-mail at                  can be covered up to December 31 of the year in which your child reaches
      avayaservicecenter@adp.com.                                                       age 26 for Vision and Dependent Life. This is now consistent with Medical
                                                                                        and Dental coverage eligibility.
      Attend a What’s New Webinar to learn about 2020 benefits
                                                                                        Health Savings Account Update
      October 11 at 11 a.m. ET
                                                                                        On January 1, 2020, the Avaya Health Savings Account (HSA) vendor will
      October 16 at 4 p.m. ET
                                                                                        be Fidelity.
      See the Annual Enrollment email for details.
                                                                                        You will be able to see your 401(k) and HSA balance on the same website:
      Benefits Genius Bar                                                               www.401k.com
                                                                                        Fidelity has no minimum for investing so any savings that is not needed
      Call in with your annual enrollment benefit questions. Open daily
                                                                                        for current qualified expenses can be invested. You can pay for qualified
      through Annual Enrollment from 3 – 4p.m. ET. See the Annual
                                                                                        medical expenses through a variety of options to access your funds,
      Enrollment email for details.
                                                                                        including using an HSA checkbook, online bill paying service, or direct
      Aetna Enhancements                                                                debit.

      In 2020, there will be no increase in the individual and family deductibles       The HSA is only available if you enroll in the Aetna Healthy Direction
      and out-of-pocket (OOP) maximums! The Medical and Prescription Drug               CDHP with HSA Medical Plan.
      Plans have been enhanced:                                                         Here are the steps to take to open your new Fidelity HSA and transfer
      The list of Preventive Medications where members pay zero cost has                existing funds from your current HSA:
      expanded and now includes preventive medication for asthma, Chronic               From October 10, 2019 – October 23, 2019, make your new HSA election
      Obstructive Pulmonary Disease, diabetes, heart disease and stroke and             at https://my.adp.com and agree to Fidelity’s terms & conditions.
      high blood pressure among other categories. See https://www.express-
                                                                                        In December, go to www.401k.com to activate your HSA with Fidelity.
      scripts.com/avaya for the Preventive Medication List.
                                                                                        In December, after you activate your HSA with Fidelity, transfer any
      If you are enrolled with Aetna through the Avaya Medical Plan (and are
                                                                                        existing HSA funds from PayFlex to Fidelity by clicking on the link on the
      not enrolled in Medicare), you will have access to the Aetna Customer
                                                                                        www.401k.com website and approving the transfer. If you approve the
      Care Management Unit (CCMU) – based on having an ongoing medical
                                                                                        funds to be transferred from PayFlex to Fidelity by January 10, 2020 there
      condition or hospitalization, a dedicated nurse will contact you and your
                                                                                        will not be a fee to transfer the funds.
      family to provide support and coordination of services.
                                                                                        If you do not authorize to have your HSA funds transferred from PayFlex to
      Coverage of habilitative physical, occupational and speech therapy prescribed
                                                                                        Fidelity by January 10, 2020 PayFlex will charge you a fee to transfer funds
      by a physician for other Developmental Delays in addition to Autism.
                                                                                        after this date and you will also be charged a monthly maintenance fee
      Dermatology services are being added to Teladoc.                                  starting in January 2020 if you have funds remaining in your PayFlex HSA.
 Please review the Medical Comparison Chart for Active Salaried
 Employees on page 8 of this Guide for more details.
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What's New for 2020

           Kaiser Plan Changes
           2020 carrier-mandated changes:

                  Plan                 Benefit                      2019 Plan Design                      2020 Plan Design

                                                            Kaiser will cover and dispense     Kaiser will cover and dispense
            Kaiser MAS
                               Contraceptives               prescription contraceptives once   prescription contraceptives once every 12
            (Maryland)
                                                            every 6 months                     months

            Kaiser MAS         Autism Spectrum              Only covered for members aged 2
                                                                                               Coverage for all ages – no age limit
            (Virginia)         Disorder                     to 10

            Kaiser CO          Emergency Services           $75 copay for ER visit             $250 copay for ER visit

                               Allergy Evaluation and                                          Primary Care: $15 copay
            Kaiser CO                                       $40 copay
                               Testing                                                         Specialty Care: $40 copay

                                                                                               Cost share will depend on where surgery
                                                                                               takes place; cost share will be lower at
            Kaiser CO          Outpatient Surgery           10% coinsurance
                                                                                               an ambulatory surgery center than at an
                                                                                               outpatient hospital department

           TRICARE Changes for 2020
           Due to low enrollment, the TRICARE Supplemental Plan will no longer be offered in 2020. If you would like to continue
           your TRICARE Supplement Plan, please contact our third-party administrator, Selman & Co., at 1-855-637-1961.
           HMSA Medical Plan Changes
           Please visit https://www.avaya.com/benefits/salariedbenefits/ to review HMSA’s 2019/2020 carrier-mandated changes.

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What's New for 2020
Aetna Dental PPO Changes
After you obtain your preventive prophylaxis (cleaning), you will receive an additional $100 toward the annual benefit maximum in the following
calendar year. Preventive services will be excluded from the annual benefit maximum.

The following services were moved from a Major to a Basic Care benefit which means a lower cost for you: Endo/Perio(Osseous surgery, Partial Bony
Impactions and Full Bony Impactions) and General Anesthesia.

Annual Express Scripts (ESI) Prescription Drug Formulary Changes
The lists below describe some of the ESI carrier-mandated drug list and program changes, effective January 1, 2020. Personalized notifications, reminder
communications, and targeted alerts will go out to affected members before January 1. ESI’s formulary will continue to ensure that clinically sound, cost-
effective drugs are available to members and will drive greater savings. ESI's 2020 carrier-mandated drug exclusion list is available at
https://www.express-scripts.com/art/open_enrollment/DrugListExclusionsAndAlternatives.pdf. The 2020 formulary is available at https://my.adp.com
under the Forms & Plan Documents tile. Filter on “M” and click on the "MEDICAL BENEFITS - ESI RX PREFERRED DRUG GUIDE" link.

                 2020 Preferred-to-Non-Preferred Changes
         ABSORICA                   ADAGEN                   AMITIZA
    ARCAPTA NEOHALER                ARZERRA               ATROVENT HFA
         BYVALSON                   FIRDAPSE                 FULPHILA
          GRALISE                   HEXALEN                 LARTRUVO

          MOXEZA                    RELENZA                  SANCUSO

          TABLOID                 VARUBI VIAL                XOFLUZA

         ZONTIVITY

2020 HSA Contribution Maximums
Based on Internal Revenue Service rules, the maximum amount you can contribute to a Health Savings Account (HSA) in 2020 is $3,550 for self-only
CDHP medical plan coverage and $7,100 for all other coverage tiers. If you are turning age 55 in 2020 or are already over 55, you can contribute an
additional $1,000 in HSA catch-up contributions in 2020. These limits include: the contributions you make via payroll deductions, any contributions you
make to your HSA outside of payroll deductions, and the HSA dollars Avaya contributes to your HSA. Remember, the tax-favored HSA is only available if
you enroll in Avaya's Healthy Direction CDHP with HSA medical plan.

2020 Health Care or Limited FSA Contribution Maximum
The annual contribution maximum for Health Care or Limited Flexible Spending Account elections in 2020 has increased from $2,650 to $2,700. Please
make your new election at https://my.adp.com. 2019 elections will not carry over to 2020.

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What's New for 2020

Employee Paycheck Contributions
Avaya reviews the benefit plans every year to ensure they remain comprehensive and competitive, keeping the costs for you and the company
manageable. Avaya will be picking up the plan cost increase for 2020. What does that mean for you? No medical, dental or vision plan
contribution changes for 2020! Below, please find the monthly employee contributions for the 2020 medical, dental and vision plans. These
contributions will apply in your first paycheck of 2020.

                                                                                             Monthly Employee Contributions
  Benefit Type            Benefit Plan                 Status              Employee Only   Employee + Spouse   Employee + Child(ren)       Family
    Medical         Aetna CDHP Alternative       Salaried Non-Smoker          $60.00           $144.00                $113.00             $200.00
    Medical         Aetna CDHP Alternative         Salaried Smoker            $80.00            $192.00               $151.00             $267.00
    Medical           Aetna CDHP w/HSA           Salaried Non-Smoker          $99.00           $246.00               $192.00              $339.00
    Medical           Aetna CDHP w/HSA             Salaried Smoker            $132.00          $328.00               $256.00              $452.00

    Medical       Aetna Point-of-Service (POS)   Salaried Non-Smoker          $172.00          $429.00               $335.00              $598.00

    Medical       Aetna Point-of-Service (POS)     Salaried Smoker           $229.00           $572.00               $447.00              $797.00
                    Kaiser (CA, CO, GA, MD
    Medical                                      Salaried Non-Smoker          $191.00          $432.00               $377.00              $619.00
                         and NW only)
                    Kaiser (CA, CO, GA, MD
    Medical                                        Salaried Smoker           $255.00           $576.00               $503.00              $825.00
                         and NW only)

     Dental               Aetna DMO                                            $7.00            $13.00                $19.00               $30.00

     Dental               Aetna PPO                                           $16.00            $41.00                $33.00               $59.00

                                                                                           Monthly Employee Contributions
  Benefit Type            Benefit Plan                 Status              Employee Only      Two-Person              Family
    Medical         HMSA (HI residents only)     Salaried Non-Smoker          $99.00           $246.00               $339.00

    Medical         HMSA (HI residents only)       Salaried Smoker            $132.00          $328.00               $452.00

     Vision                 EyeMed                                             $8.01             $15.21               $22.33

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2020 POS and CDHP Medical and Prescription Drug Comparison Chart for Active Salaried Employees
Kaiser HMO information can be found online at https://my.adp.com under Forms & Plan Documents > Filter by the letter "S" for SBCs.

                                          Aetna Salaried Point-of-Service (POS)1
                                                      Closed to new enrollees                                 Aetna Healthy Direction CDHP with HSA1                                           Aetna CDHP Alternative1
            Features
                                                                                                                       Annual HSA funding amount2:
                                               Each time you need care, you choose:                                                                                                       Each time you need care, you choose:
                                                                                                                  Up to $500/$1,000 (single/all other tiers)
                                            In-Network                      Out-of-Network                      In-Network                    Out-of-Network                             In-Network                   Out-of-Network
                                  Any Aetna Choice POS II                                                                                                                         Any Aetna Choice POS II
                                                                                                     Any Aetna Choice POS II
                                  network provider, including                                                                                                                     network provider,
                                                                                                     network provider, including
                                  Teladoc physicians and                                                                                                                          including Teladoc
                                                                                                     Teladoc physicians for 24/7
                                  dermatologists for 24/7 phone                                                                                                                   physicians for 24/7 phone
                                                                                                     phone or video physician visits
 Choice of doctors                or video physician and                                                                                                                          or video physician visits
                                                                   Any eligible provider             (available by downloading the         Any eligible provider                                             Any eligible provider
                                  dermatology visits (available by                                                                                                                (available by downloading
                                                                                                     Teladoc app on your
                                  downloading the Teladoc app                                                                                                                     the Teladoc app on your
                                                                                                     smartphone or tablet or by
                                  on your smartphone or tablet or                                                                                                                 smartphone or tablet or by
                                                                                                     visiting https://www.teladoc.
                                  by visiting https://www.teladoc.                                                                                                                visiting https://www.
                                                                                                     com/Aetna)
                                  com/Aetna)                                                                                                                                      teladoc.com/Aetna)
 Preventive care (age and         Covered at 100%; deductible       You pay 35% after deductible,    Covered at 100%; deductible           You pay 35%, plus anything over        Covered at 100%;            You pay 40% after deductible,
 frequency guidelines apply)      does not apply                    plus anything over R&C           does not apply                        R&C; deductible does not apply         deductible does not apply   plus anything over R&C
                                  $1,000 for single tier coverage $2,000 for single tier coverage $2,000 for single tier coverage          $3,375 for single tier coverage        $3,400 for single tier      $6,800 for single tier
 Annual deductible3               and up to $3,000 maximum for and up to $6,000 maximum for                                                                                       coverage, $6,800 for all    coverage, $13,600 for all
                                  all other coverage tiers        all other coverage tiers        $4,000 for all other coverage tiers      $6,750 for all other coverage tiers    other coverage tiers        other coverage tiers
 Coinsurance (Plan pays)
   Physician Office Visit         You pay 20% after deductible      You pay 35% after deductible,    You pay 20% after deductible          You pay 35% after deductible,          You pay 20% after           You pay 40% after deductible,
                                                                    plus anything over R&C                                                 plus anything over R&C                 deductible                  plus anything over R&C
   E mergency Room               You pay 20% after deductible      Paid as in-network if Aetna      You pay 20% after deductible          Paid as in-network if Aetna            You pay 20% after           Paid as in-network if Aetna
    (For emergencies)                                               Member Services is notified                                            Member Services is notified            deductible                  Member Services is notified
    Urgent Care, Ambulance4                                         within 48 hours                                                        within 48 hours                                                    within 48 hours
   In-Patient/Out-Patient        You pay 20% after deductible      You pay 35% after deductible,    You pay 20% after deductible          You pay 35% after deductible,          You pay 20% after           You pay 40% after
    Services includes: Lab &                                        plus anything over R&C                                                 plus anything over R&C                 deductible                  deductible, plus anything
    X-ray, Surgery, Anesthesia,                                                                                                                                                                               over R&C
    Physician Hospital Visits/
    Consultations, Room and
    Board, Maternity, Radiation
    Therapy, Chemotherapy
 Are you responsible for                                            Yes, unless you use a National                                         Yes, unless you use a National                                     Yes, unless you use a
 charges in excess of the         No                                Advantage Program (NAP)          No                                    Advantage Program (NAP)                No                          National Advantage Program
 Reasonable & Customary                                             network provider                                                       network provider                                                   (NAP) network provider
 Annual Out-of-Pocket             $4,500 for single tier coverage $9,000 for single tier coverage                                                                                 $5,000 for single tier      $10,000 for single tier
 Maximum5                                                                                            $3,500 for single tier coverage,      $8,000 for single tier coverage
                                  and up to $9,000 maximum for and up to $18,000 maximum                                                                                          coverage, $10,000           coverage, $20,000 for all
 (Includes Deductible)                                                                               $7,000 for all other coverage tiers   $16,000 for all other coverage tiers
                                  all other coverage tiers        for all other coverage tiers                                                                                    (embedded at $7,150) 6      other coverage tiers

 Precertification                 Your network provider             You                              Your network provider                 You                                    Your network provider       You
 responsibility

                                                                    Yes, unless you use a National                                         Yes, unless you use a National                                     Yes, unless you use a
 Are claim forms required?        No                                Advantage Program (NAP)          No                                    Advantage Program (NAP)                No                          National Advantage Program
                                                                    network provider                                                       network provider                                                   (NAP) network provider

Notes: 1) R&C: Reasonable & Customary;                                                                                                                                                                              (continued on next page)
       2) Cells shaded in light red denote change from 2019 plan design.
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2020 POS and CDHP Medical and Prescription Drug Comparison Chart for Active Salaried Employees
                                         Aetna Salaried Point-of-Service (POS)1                                                                                                                    Aetna CDHP Alternative1
                                                     Closed to new enrollees.                                   Aetna Healthy Direction CDHP with HSA1
                                                                                                                                                                                                  (No HSA with this option)
             Features
                                           Prescription Drug Program coverage offered                       Prescription Drug Program coverage offered through                       Prescription Drug Program coverage offered through
                                               through Express Scripts, Inc. (ESI)                                       Express Scripts, Inc. (ESI)                                              Express Scripts, Inc. (ESI)
                                            In-Network                   Out-of-Network                         In-Network                      Out-of-Network                           In-Network                     Out-of-Network
                                   Not subject to a deductible.      Not covered                     The full cost of the drug is applied to   Not covered                      The full cost of the drug is applied to Not covered
                                                                                                     the Medical deductible before                                              the Medical deductible before
                                   Retail Drugs                                                      benefits are considered for payment.                                       benefits are considered for payment.
                                   (up to a 30-day supply)                                           After the deductible, you pay:                                             After the deductible, you pay:
                                   • Tier 1 (Generic)
                                      $10 copay                                                      Retail Drugs                                                               Retail Drugs
                                   • Tier 2 (Preferred Brand)
                                                                                                     (up to a 30-day supply)                                                    (up to a 30-day supply)
                                      30% Coinsurance, $30 min.,                                     • Tier 1 (Generic) $10 copay                                              • Tier 1 (Generic) $10 copay
                                      $80 max.                                                       • Tier 2 (Preferred Brand)                                                • Tier 2 (Preferred Brand)
                                   • Tier 3 (Non-preferred Brand)                                      25% Coinsurance, $30 min.,                                                25% Coinsurance, $30 min.,
                                      50% Coinsurance, $60 min.,                                        $70 max.                                                                  $70 max.
    Prescription Drug                 $120 max.                                                      • Tier 3 (Non-preferred Brand)                                            • Tier 3 (Non-preferred Brand)
    Benefits7                                                                                           35% Coinsurance, $50 min.,                                                35% Coinsurance, $50 min.,
                                   ESI Mail Order, Walgreens                                            $90 max.                                                                  $90 max.
                                   Retail, or CVS Retail Drugs
                                   (up to a 90-day supply)                                           ESI Mail Order, Walgreens Retail,                                          ESI Mail Order, Walgreens Retail,
                                                                                                     or CVS Retail Drugs                                                        or CVS Retail Drugs
                                   • Tier 1 (Generic) $25 copay
                                                                                                     (up to a 90-day supply)                                                    (up to a 90-day supply)
                                   • Tier 2 (Preferred Brand)
                                                                                                     • Tier 1 (Generic) $20 copay                                              • Tier 1 (Generic) $20 copay
                                      30% Coinsurance, $60 min.,
                                      $200 max.                                                      • Tier 2 (Preferred Brand)                                                • Tier 2 (Preferred Brand)
                                                                                                        25% Coinsurance, $60 min.,                                                25% Coinsurance, $60 min.,
                                   • Tier 3 (Non-preferred Brand)
                                                                                                        $175 max.                                                                 $175 max.
                                      50% Coinsurance, $120 min.,
                                      $300 max.                                                      • Tier 3 (Non-preferred Brand)                                            • Tier 3 (Non-preferred Brand)
                                                                                                        35% Coinsurance, $100 min.,                                               35% Coinsurance, $100 min.,
                                                                                                        $225 max.                                                                 $225 max.
                                   $2,000 individual coverage tier                                   Same as Medical Out-of-Pocket                                              Same as Medical Out-of-Pocket
    Pharmacy Out-of-Pocket Max                                       N/A                             Maximum                                   N/A                              Maximum                              N/A
                                   $4,000 all other coverage tiers
                                  The Prescription Drug Utilization Management Program requires prior authorization for certain types of prescription drugs, including but not limited to Nonsedating Antihistamines and Antifungals.
    Prescription Drug Utilization Prior authorization means that requirements must be met before the Prescription Drug Program will cover the prescription. After three fills at the retail level, the member will pay 100% of the Express Scripts-
    Management Program            discounted cost for the medication for future retail fills not picked up at a Walgreens or CVS retail store. Out-of-pocket costs for long-term medications not ordered through ESI Home Delivery or CVS/Walgreens
                                  retail do not apply to the member/family deductible or out-of-pocket maximum. If you purchase a brand name medication when a generic medication is available, you will pay the generic copay plus the difference
                                  in cost between the brand name and the generic.
Notes: 1) R&C: Reasonable & Customary;
       2) Cells shaded in light red denote change from 2019 plan design.
1   If you do not have access to in-network providers, upon approval from Aetna, you may receive benefits at the in-network level.
2   Company HSA contributions will be processed once annually for eligible employees according to the date your Health Savings Account with Fidelity is opened. Company HSA contributions will be deposited to
     your Fidelity HSA within 10 business days of the paycheck in which it was processed. If you leave the company (voluntarily or involuntarily), or your coverage under the Aetna Healthy Direction CDHP with HSA
     medical plan terminates for any reason before the normal payroll date the HSA funds would otherwise be processed for deposit, your Avaya group HSA will close and employer and employee HSA contributions
     will not be deposited. Mid-year qualified status changes that result in a medical plan tier change will not result an adjustment to your company HSA contribution.
3 The medical deductible is separate from any deductible under the Prescription Drug Program for the POS. For the CDHP plans, the health care deductible must be met before plan benefits are paid, including

     Prescription Drug Program benefits. Under the CDHP plans, for two-person or family coverage, the deductible is not satisfied for any family member until the two-person or family deductible is met.
4 Non-emergent Emergency Room or Ambulance services will be covered at the out-of-network level plus amounts over R&C.

5 Certain expenses (e.g., precertification penalties and any expenses in excess of the Reasonable & Customary charge) do not count toward the annual Out-of-Pocket Maximum. The annual Out-of-Pocket

     Maximum for the POS Prescription Drug Program is separate from the annual Out-of-Pocket Maximum for the POS Medical plan.
6 Once one member of the family hits $7,150 in combined medical/Rx expenses, that individual will no longer incur expenses towards the family out-of-pocket maximum and most covered expenses would be

   paid at 100% of the allowable amount for the rest of the calendar year for that family member; it would be up to the other covered members in the family to reach the remaining in-network out-of-pocket
   maximum (before their covered expenses would be paid at 100% of the allowable amount for the remainder of the calendar year).
7 Mandatory home delivery through ESI or retail pick-up from either Walgreens or CVS applies to all long-term (maintenance) drugs.

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Important Reminders

 Which Medical Plan is Right for You?                                                           Active employees are eligible for Avaya's HSA contribution based on the
                                                                                                date your HSA is opened, not the date you enroll in the Aetna Healthy
 ALEX, Avaya's interactive Benefits Advisor, explains your medical plan
                                                                                                Direction CDHP with HSA medical plan. Company HSA contributions
 options to determine which may be best for you, It is personalized, easy
                                                                                                will be deposited to your PayFlex HSA within 10 business days of the
 to use and confidential. Try ALEX today by visiting https://www.myalex.                        paycheck in which it was processed. Mid-year qualified status changes
 com/avaya/2020! ALEX is best viewed in Google Chrome.                                          that result in a medical plan tier change will not result in an adjustment to
                                                                                                your company HSA contribution. It is your responsibility to ensure you do
 Employer HSA Contribution Process
                                                                                                not exceed the annual maximum contribution.
 Company HSA contributions will be processed once annually for eligible
 employees, as follows:                                                                         2019 Employee HSA Contribution Elections Do Not Rollover to 2020

                                                                                                If you continue to be enrolled in the Aetna Healthy Direction CDHP with
                                                                          On the first
 For HSA's opened between             You are eligible for this          normal payroll         HSA medical plan for 2020 and elected to defer tax-favored Health
       these dates...                         much...                     date in this          Savings Account contributions from your paycheck in 2019, you will need
                                                                           month*...            to log in to https://my.adp.com to continue those contributions, or elect
                                                                                                new contributions for 2020. HSA and HSA Catch-Up contributions can
                                       $500/indiv or $1,000/
   On/before 1/13/2020                 family CDHP with HSA             February                be changed at any time throughout the year by selecting “DECLARE AN
                                       election tier                                            EVENT” under the Report a Qualifying Change tile on the home page.
                                       $375/indiv or $750/                                      HSA contributions will be deposited to your personally-owned Health
   1/14/2020 - 4/13/2020               family CDHP with HSA             May                     Savings Account with Fidelity within 10 business days of the paycheck
                                       election tier                                            from which they are deducted and cannot be used until deposited. HSA
                                       $250/indiv or $500/                                      contributions made by both you and Avaya will cease if you terminate
   4/14/2020 - 7/13/2020               family CDHP with HSA             August                  employment or leave the Healthy Direction CDHP with HSA medical
                                       election tier                                            plan. You must be actively employed and enrolled in the CDHP with
                                                                                                HSA medical plan on the normal payroll date your or the company HSA
                                       $125/indiv or $250/
                                                                                                contributions would otherwise be processed to be eligible to receive
   7/14/2020 - 10/13/2020              family CDHP with HSA             November
                                                                                                them.
                                       election tier
                                       Funding will begin in                                    Cutoff Date for Earning 2019 Raffle Tickets with SonicBoom
   10/14/2020 or after
                                       2021                                                     The cutoff date for earning 2019 wellness raffle tickets is December 13,
 * If you leave the company (voluntarily or involuntarily), or your coverage under the Aetna   2019.
    Healthy Direction CDHP with HSA medical plan terminates for any reason before the
    normal payroll date the HSA funds would otherwise be processed for deposit, your Avaya
    group HSA will close and employer and employee HSA contributions will be forfeited and
    will not be deposited.

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Important Reminders
      HSA Customer Identification Process Requirement                              Account. You are not able to enroll in Avaya’s Limited Flexible Spending
                                                                                   Account unless you are enrolled in the Healthy Direction CDHP with HSA
      If you are newly enrolling in the Healthy Direction CDHP with Health         medical plan offered by Avaya.
      Savings Account (HSA) medical plan and are opening an HSA with Fidelity
      for the first time, Section 326 of the U.S. Patriot Act requires that you    Spousal Surcharge
      verify your identity through the Customer Identification Process before      If you choose to cover your spouse/domestic partner under an Avaya
      the HSA can be opened. If you do not complete and pass the Customer          medical plan and your spouse/domestic partner has the opportunity
      Identification Process, you will not be eligible to make HSA contributions   to enroll in medical coverage through his/her employer, an additional
      or receive Avaya’s HSA contributions. Go to www.401k.com and click on        $100 per month will be added to your health insurance premium. This
      Activate Health Savings Account to complete the opening of your account.     surcharge is waived if your spouse or domestic partner works for an
                                                                                   employer who doesn't offer medical coverage, doesn’t qualify for their
      2019 Flexible Spending Account Elections Do Not Rollover to 2020             employer’s coverage, or is eligible for Medicare.
      If you wish to participate in the Health Care Flexible Spending Account      Dependent Verification
      (HCFSA), Limited Flexible Spending Account (LFSA), and/or the Dependent
      Care Flexible Spending Account (DCFSA) in 2020, you must re-enroll during    If you choose to enroll an eligible dependent(s) that is not currently
      Annual Enrollment. Your 2019 elections do not carry over to 2020.            covered under Avaya's health benefits, you will be required to
                                                                                   provide proof that they are your eligible dependent(s) per the Plan
      Flexible Spending Account Balance Carryover                                  guidelines. Dependent coverage will be pended until the appropriate
      Avaya allows HCFSA and LFSA participants to carryover up to $500             documentation is received by ADP, our Dependent Verification vendor.
      of unused funds into the following calendar year. If you have unused         Upon completion of your enrollment, you will receive a verification letter
      HCFSA or LFSA funds at the end of 2019, the rollover will happen for         from ADP explaining how to verify dependent eligibility. Verification is
      you automatically. Please factor this in to your 2020 elections to ensure    due by the deadline on your request for verification form.
      you don’t over-contribute in the upcoming year.                              2020 Mid-Year Changes
      Hyatt Legal Services Plan                                                    Once Annual Enrollment ends, you will not be able to make changes to
                                                                                   most benefits unless you have a qualified status change. Information on
      Annual Enrollment is the one time of year you can enroll in (if not
                                                                                   qualified status changes is available in the Summary Plan Descriptions
      already enrolled) or drop the Hyatt Legal benefit. To make changes
                                                                                   (SPDs) at https://www.avaya.com/benefitanswers.
      to your legal services plan coverage, visit https://my.adp.com before
      October 23, 2019.
      Planning to Enroll in the CDHP Alternative Medical Plan in 2020?
 If you enroll in the CDHP Alternative medical plan (which does not have
 an HSA) and you intend to open a private HSA through your own bank,
 you are strongly encouraged NOT to enroll in Avaya’s Health Care Flexible
 Spending Account (HCFSA). Per IRS guidelines, if you are contributing
 to or receiving contributions to an HSA, you may only be reimbursed
 for eligible dental and vision expenses (no medical or prescription drug
 expense reimbursement is allowed) from a Limited Flexible Spending
			                                                                       10
                                                                                                                                            ▶ Back     Next   ▶
Important Reminders
Prescription Drug Coverage
Drugs are the fastest growing category of health spending. In cases where
you select a brand name drug when a generic equivalent is available, you
will be required to pay the generic copayment plus the difference in cost
between the brand name drug and the generic drug. If you are prescribed
a medication, ask your doctor or pharmacist if your condition could be
treated effectively with a lower-cost or generic version of the drug.
Remember, the Prescription Drug Program has a mandatory fill-provision
for long-term (maintenance) medications. Aside from a limited number of
exceptions, after the third fill of a long-term medication, you must begin
obtaining your prescription through Express Scripts Pharmacy Mail Order
service, or at either a CVS or Walgreens retail location, to avoid paying a
penalty.
Beneficiaries
Maintaining beneficiary information is an important part of your financial
planning. Annual Enrollment is a good time to review your life and
AD&D insurance beneficiaries. You can update life and AD&D insurance
beneficiary information online at any time at https://my.adp.com by
selecting "MANAGE" under the Manage Information tile on the home
page. If you do not have Internet access, you may contact the Avaya
Health & Benefits Decision Center at 1-800-526-8056 (option 1), TDD
1-800-952-0450 or via e-mail at avayaservicecenter@adp.com to obtain
a beneficiary form.
Summary of Benefits Coverage (SBC)
In compliance with health care reform, Avaya provides a SBC for each
medical plan for which you are eligible to help you compare your
coverage options. Please note that the SBC is not a full plan description
like the Summary Plan Descriptions. SBCs are available at https://my.adp.
com under the Forms & Plan Documents tile on the home page. Paper
copies are also available, free of charge, by contacting the Avaya Health &
Benefits Decision Center at 1-800-526-8056 (option 1), TDD 1-800-952-
0450, or via e-mail at avayaservicecenter@adp.com.

			                                                                          11   ▶ Back   Next   ▶
Helpful Links and Tools to Take Control of Your Health

    Taking Control of Your Health                         Tool (click link)                                                 Description

• Enroll in or change your benefits                                                         Your one-stop-shop for all of your benefit needs.
• Update your HSA contribution                                                              Note: Need to update your HSA or HSA Catch-Up contribution mid-year or
                                              https://my.adp.com
• Change a beneficiary                                                                      outside of Annual Enrollment? From https://my.adp.com, select "DECLARE
• Find information on your medical carrier                                                 AN EVENT" under the Report a Qualifying Change tile on the home page.

                                                                                            • Understand your medical plan options and determine which option may
Choose the right medical plan for you and      https://www.myalex.com/avaya/2020
                                                                                               be best for you
your family using ALEX, our interactive       (Available to Kaiser and Aetna members)
                                                                                            • See how you may benefit from contributing to a Flexible Spending
Benefit Advisor                               ALEX is best viewed in Chrome
                                                                                               Account and/or Health Savings Account
                                              www.aetna.com
                                              (for Aetna medical members)
Get the best price on health care services                                                  Search for doctors and health care services based on cost, quality and
                                              Login using your existing Navigator
without sacrificing quality                                                                 convenience.
                                              credentials or download the Aetna Health
                                              app at the App Store® or Google Play™ store

                                              Current Aetna members may log on to their     Aetna’s online participating directory allows you to locate physicians
                                              account at www.aetna.com                      and other health care providers such as dentists and hospitals. Try the
                                                                                            Aetna Mobile App for quick and convenient access to in-network providers.
Locate Aetna in-network physicians or         Potential members may log on to
dentists where you need them                  www.aetna.com > Find a doctor > Under         Participating physicians are also available 24/7 via phone or video chat
                                              “Not a member yet?", select “Plan from an     through Teladoc, Avaya's telemedicine vendor through Aetna. You may
                                              employer"> When asked to Select a Plan,       download the Teladoc app on your smartphone or tablet or visit
                                              choose Aetna Choice POS II (Open Access)      https://www.teladoc.com/Aetna for access.

                                              Review the Medical Benefits - CDHP
Learn more about the Healthy Direction
                                              Newsletter under the Forms & Plan
Consumer Directed Health Plan (CDHP) with                                                   A great way to set aside tax-favored dollars for future medical expenses.
                                              Documents tile on the home page at
HSA medical plan
                                              https://my.adp.com
                                                                                            Robust Annual Enrollment support including formulary lookup, pharmacy
Express Scripts (ESI) Annual Enrollment
                                              www.express-scripts.com/avaya                 lookup, pricing medications, and ability to attach PDFs & full customer
website
                                                                                            service and web support
                                                                                            It’s important to find a doctor who's right for you. Choose or change
Locate Kaiser physicians in your region       https://www.kp.org                            doctors at any time, browse online profiles by region, or call Member
                                                                                            Services in your area.
                                              www.payflex.com (no longer the HSA            A Health Savings Account (HSA) is designed to help pay for your current
• Review your HSA balance
                                              vendor effective 1/1/2020)                    eligible health care costs and save for future health care expenses. Your
• Send a payment to a provider
                                              www.401k.com (Fidelity will be the new        contributions, earnings and withdrawals are all tax-favored. It’s a triple tax-
• Update your notification settings
                                              vendor effective 1/1/2020)                    savings opportunity that can put more money in your pocket.

			                                                                            12                                                                      ▶ Back      Next   ▶
Helpful Links and Tools to Take Control of Your Health

    Taking Control of Your Health                      Tool (click link)                                               Description
Wondering where to get your next EyeMed                                                  With 87,500 vision care providers nationwide, you’re sure to find one you
                                           https://www.eyemedvisioncare.com
in-network eye exam?                                                                     love in your area.

Take control of your wellbeing with
Avaya Wellness
                                                                                         All the confidential tools and information you need to take stock in
• Talk to a coach
                                           https://avaya.app.sbwell.com                  your current health status and resources to work toward improving it
• Manage a chronic condition
                                                                                         every day.
• Take the Health Quality Assessment
• Participate in a group challenge

                                                                                         An FSA (not to be confused with an HSA) may be used for reimbursement
                                                                                         of eligible health care* expenses, and child or elder daycare expenses. The
                                                                                         amount you decide to contribute to the account for the year is deducted
                                           Go to the Forms & Plan Documents tile on      from your salary before income taxes. This reduces your taxable income,
What are Flexible Spending Accounts?       the home page at https://my.adp.com. Filter   saving you money on taxes.
                                           on “F” for FSA forms and resources.           *If contributing to or receiving contributions to an HSA, medical expenses
                                                                                         are not reimbursable under a general-purpose FSA. Let ALEX teach you
                                                                                         about this at https://www.myalex.com/avaya/2020! ALEX is best viewed
                                                                                         in Google Chrome.
                                                                                         Now it’s really easy to figure out how much you should contribute to your
                                                                                         Health Care and/or Dependent Care Flexible Spending Account with this
Determine the right amount to contribute   https://dtg.adp.com/ExpenseViewer#/
                                                                                         intuitive online tool. ALEX, our interactive Benefit Advisor (https://www.
to your Flexible Spending Account          home
                                                                                         myalex.com/avaya/2020) can also assist you with this decision! ALEX is
                                                                                         best viewed in Google Chrome.
                                           Go to the Forms & Plan Documents tile on
                                                                                         • Saves you money on parking and transportation expenses to work
Save tax dollars on your commute to and    the home page at https://my.adp.com.
                                                                                         • Lets you pay for certain commuting expenses with pre-tax dollars
from work every day!                       Filter on “C” for Commuter Benefit
                                                                                         • A great way to LOWER your taxable income
                                           resources.

                                                                                         The Employee Assistance Program (EAP) is available 24/7 to help you
                                                                                         and your family successfully deal with life’s problems and challenges. The
Talk to someone about a personal issue     https://www.magellanascend.com
                                                                                         EAP is a prepaid, confidential counseling and referral resource coordinated
                                                                                         through Magellan Behavioral Health.

                                                                                         The Family Resource Program provides services to busy parents
Looking for childcare and eldercare                                                      who are looking for help on issues such as adoption, senior care, and
                                           https://www.magellanascend.com
resources?                                                                               education resources. Additionally, the Family Resource Program offers
                                                                                         free tutoring through its Homework Connection program.

			                                                                         13
                                                                                                                                                 ▶ Back      Next   ▶
Legal Reminders

Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium
assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for
Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the
Health Insurance Marketplace. For more information, visit www.healthcare.gov.

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed on the following pages, contact your State Medicaid or
CHIP office to find out if premium assistance is available.

If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either
of these programs, contact your State Medicaid or CHIP office or call 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you
qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.

If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer
must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request
coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact
the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).

			                                                                        14                                                            ▶ Back      Next   ▶
Legal Reminders
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 January 31, 2019. Contact your State for more information on eligibility.

 ALABAMA – Medicaid                                                                  FLORIDA – Medicaid

 Website: http://myalhipp.com/                                                       Website: http://flmedicaidtplrecovery.com/hipp/
 Phone: 1-855-692-5447                                                               Phone: 1-877-357-3268

 ALASKA – Medicaid                                                                   GEORGIA – Medicaid

 The AK Health Insurance Premium Payment Program
 Website: http://myakhipp.com/                                                       Website: www.medicaid.georgia.gov
 Phone: 1-866-251-4861                                                               (Click on Health Insurance Premium Payment (HIPP))
 Email: CustomerService@MyAKHIPP.com                                                 Phone: 1-404-656-4507
 Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx

 ARKANSAS – Medicaid                                                                 INDIANA – Medicaid
                                                                                     Healthy Indiana Plan for low-income adults 19-64
                                                                                     Website: http://www.in.gov/fssa/hip/
 Website: http://myarhipp.com/                                                       Phone: 1-877-438-4479
 Phone: 1-855-MyARHIPP (855-692-7447)                                                All other Medicaid
                                                                                     Website: http://www.indianamedicaid.com
                                                                                     Phone: 1-800-403-0864
 IOWA – Medicaid                                                                     KANSAS – Medicaid

 Website: http://dhs.iowa.gov/hawk-i                                                 Website: http://www.kdheks.gov/hcf/
 Phone: 1-800-257-8563                                                               Phone: 1-888-346-9562

 KENTUCKY – Medicaid                                                                 NEW HAMPSHIRE – Medicaid
                                                                                     Website: https://www.dhhs.nh.gov/oii/hipp.htm
 Website: https://chfs.ky.gov
                                                                                     Phone: 1-603-271-5218
 Phone: 1-800-635-2570
                                                                                     Toll-Free: 1-800-852-3345, ext 5218
 LOUISIANA – Medicaid                                                                NEW JERSEY – Medicaid and CHIP
                                                                                     Medicaid Website: http://www.state.nj.us/humanservices/dmahs/clients/medicaid/
 Website: http://dhh.louisiana.gov/index.cfm/subhome/1/n/331                         Medicaid Phone: 1-609-631-2392
 Phone: 1-888-695-2447                                                               CHIP Website: http://www.njfamilycare.org/index.html
                                                                                     CHIP Phone: 1-800-701-0710

			                                                                             15                                                               ▶ Back     Next   ▶
Legal Reminders

MAINE – Medicaid                                                                    NEW YORK – Medicaid
Website: http://www.maine.gov/dhhs/ofi/public-assistance/index.html
                                                                                    Website: https://www.health.ny.gov/health_care/medicaid/
Phone: 1-800-442-6003
                                                                                    Phone: 1-800-541-2831
TTY: Maine relay 711
MASSACHUSETTS – Medicaid and CHIP                                                   NORTH CAROLINA – Medicaid

Website: http://www.mass.gov/eohhs/gov/departments/masshealth/                      Website: https://dma.ncdhhs.gov/
Phone: 1-800-862-4840                                                               Phone: 919-855-4100

MINNESOTA – Medicaid                                                                NORTH DAKOTA – Medicaid
Website: https://mn.gov/dhs/people-we-serve/seniors/health-care/health-care-
                                                                                    Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/
programs/programs-and-services/other-insurance.jsp
                                                                                    Phone: 1-844-854-4825
Phone: 1-800-657-3739 or 651-431-2670
MISSOURI – Medicaid                                                                 OKLAHOMA – Medicaid and CHIP

Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm                      Website: http://www.insureoklahoma.org
Phone: 573-751-2005                                                                 Phone: 1-888-365-3742

MONTANA – Medicaid                                                                  OREGON – Medicaid and CHIP
                                                                                    Website: http://healthcare.oregon.gov/Pages/index.aspx
Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP
                                                                                    Website: http://www.oregonhealthcare.gov/index-es.html
Phone: 1-800-694-3084
                                                                                    Phone: 1-800-699-9075
NEBRASKA – Medicaid                                                                 PENNSYLVANIA – Medicaid
                                                                                    Website: http://www.dhs.pa.gov/provider/medicalassistance/
Website: http://www.ACCESSNebraska.ne.gov
                                                                                    healthinsurancepremiumpaymenthippprogram/index.htm
Phone: (855) 632-7633; Lincoln: (402) 473-7000; Omaha: (402) 595-1178
                                                                                    Phone: 1-800-692-7462
NEVADA – Medicaid                                                                   RHODE ISLAND – Medicaid

Website: http://dhcfp.nv.gov                                                        Website: http://www.eohhs.ri.gov/
Phone: 1-800-992-0900                                                               Phone: 855-697-4347

SOUTH CAROLINA – Medicaid                                                           VIRGINIA – Medicaid and CHIP

Medicaid Website: https://www.scdhhs.gov                                            Website: https://www.coverva.org/famis/
Medicaid Phone: 1-888-549-0820                                                      Phone: 1-800-432-5924

			                                                                            16
                                                                                                                                                 ▶ Back   Next   ▶
Legal Reminders

     SOUTH DAKOTA - Medicaid                                                           WASHINGTON – Medicaid
                                                                                       Website: http://www.hca.wa.gov/free-or-low-cost-health-care/program-adminis-
     Website: http://dss.sd.gov
                                                                                       tration/premium-payment-program
     Phone: 1-888-828-0059
                                                                                       Phone: 1-800-562-3022 ext. 15473
     TEXAS – Medicaid                                                                  WEST VIRGINIA – Medicaid

     Website: http://gethipptexas.com/                                                 Website: http://mywvhipp.com/
     Phone: 1-800-440-0493                                                             Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)

     UTAH – Medicaid and CHIP                                                          WISCONSIN – Medicaid and CHIP
     Medicaid Website: https://medicaid.utah.gov/
                                                                                       Website: https://www.dhs.wisconsin.gov/publications/p1/p10095.pdf
     CHIP Website: http://health.utah.gov/chip
                                                                                       Phone: 1-800-362-3002
     Phone: 1-877-543-7669
     VERMONT– Medicaid                                                                 WYOMING – Medicaid

     Website: http://www.greenmountaincare.org/                                        Website: https://health.wyo.gov/healthcarefin/medicaid/
     Phone: 1-800-250-8427                                                             Phone: 307-777-7531

   To see if any other states have added a premium assistance program since January 31, 2019 or for more information on special enrollment rights,
   contact either:
   U.S. Department of Labor 					               U.S. Department of Health and Human Services
   Employee Benefits Security Administration			 Centers for Medicare & Medicaid Services
   www.dol.gov/agencies/ebsa					www.cms.hhs.gov
   1-866-444-EBSA (3272)					                   1-877-267-2323, Menu Option 4, Ext. 61565

   Paperwork Reduction Act Statement
   According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such
   collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor
   a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to
   respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions
   of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently
   valid OMB control number. See 44 U.S.C. 3512.
   The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested parties are
   encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this
   burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200
   Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email ebsa.opr@dol.gov and reference the OMB Control Number 1210-0137.

OMB Control Number 1210-0137 (expires 12/31/2020)                                 17
                                                                                                                                                  ▶ Back     Next   ▶
Legal Reminders

Notice of Availability: The Avaya Inc. Medical Expense Plan for             a voluntary Health Quality Assessment or "HQA" that asks a series
Salaried Employees, a component of the Avaya Inc. Health &                  of questions about your health-related activities and behaviors and
Welfare Benefits Plan for Salaried Employees, Notice of Privacy             whether you have or had certain medical conditions (e.g., cancer,
Practices                                                                   diabetes, or heart disease). You may also be asked to complete
                                                                            a voluntary biometric screening, which will include a blood test
THIS NOTICE DESCRIBES HOW YOU MAY OBTAIN A COPY OF THE                      for Glucose, HDL Cholesterol, Total Cholesterol, LDL Cholesterol,
PLAN’S NOTICE OF PRIVACY PRACTICES, WHICH DESCRIBES THE                     and Triglycerides. You are not required to complete the HQA or
WAYS THAT THE PLAN USES AND DISCLOSES YOUR PROTECTED                        participate in the blood test or other medical examinations.
HEALTH INFORMATION.
                                                                            Employees who choose to participate in the wellness program will
The Avaya Inc. Medical Expense Plan for Salaried Employees,                 receive incentives in the form of raffle tickets for completing the
a component of the Avaya Inc. Health & Welfare Benefits Plan                various activities listed on their SonicBoom Rewards page.
for Salaried Employees, (the “Plan”) provides health benefits to
eligible employees of Avaya Inc. (the “Company”) and their eligible         Additional incentives may be available for employees who participate
dependents as described in the summary plan description(s) for the          in certain health-related activities or achieve certain health outcomes.
Plan. The Plan creates, receives, uses, maintains and discloses health      If you are unable to participate in any of the health-related activities
information about participating employees and dependents in the             or achieve any of the health outcomes required to earn an incentive,
course of providing these health benefits. The Plan is required by          you may be entitled to a reasonable accommodation or an alternative
law to provide notice to participants of the Plan’s duties and privacy      standard. You may request a reasonable accommodation or an
practices with respect to covered individuals’ protected health             alternative standard by contacting SonicBoom Wellness at
information, and has done so by providing to Plan participants a            support@sbwell.com.
Notice of Privacy Practices, which describes the ways that the Plan         The information from your HQA and the results from your biometric
uses and discloses protected health information. To receive a copy          screening will be used to provide you with information to help you
of the Plan’s Notice of Privacy Practices you should contact Avaya’s        understand your current health and potential risks, and may also be
Health Plan Administrator, who has been designated as the Plan’s            used to offer you services through the wellness program, such as
contact person for all issues regarding the Plan’s privacy practices and    health coaching, physical activity opportunities, and healthy-habit
covered individuals’ privacy rights. You can reach this contact person      tracking tools. You also are encouraged to share your results or
at: 4655 Great America Parkway, Santa Clara, CA 95054, or via e-mail        concerns with your own doctor.
at hwplanadmin@avaya.com.

Notice Regarding Wellness Program
Avaya’s Wellness program is a voluntary wellness program available
to all employees. The program is administered according to federal
rules permitting employer-sponsored wellness programs that seek
to improve employee health or prevent disease, including the
Americans with Disabilities Act of 1990, the Genetic Information
Nondiscrimination Act of 2008, and the Health Insurance Portability
and Accountability Act, as applicable, among others. If you choose
to participate in the wellness program you will be asked to complete

			                                                                    18                                                           ▶ Back     Next   ▶
Legal Reminders

Protections from Disclosure of Medical Information                           You may not be discriminated against in employment because of
We are required by law to maintain the privacy and security of your          the medical information you provide as part of participating in the
personally identifiable health information. Although the wellness            wellness program, nor may you be subjected to retaliation if you
program and Avaya may use aggregate information it collects to               choose not to participate.
design a program based on identified health risks in the workplace,          If you have questions or concerns regarding this notice, or about
SonicBoom Wellness will never disclose any of your personal                  protections against discrimination and retaliation, please contact
information either publicly or to the employer, except as necessary          SonicBoom Wellness at support@sbwell.com.
to respond to a request from you for a reasonable accommodation
needed to participate in the wellness program, or as expressly               HIPAA Special Enrollment Rights for Medical Plan Coverage
permitted by law. Medical information that personally identifies you
                                                                             Loss of Eligibility for Other Health Coverage
that is provided in connection with the wellness program will not be
provided to your supervisors or managers and may never be used to            If you are declining medical plan enrollment for yourself or your
make decisions regarding your employment.                                    dependents (including your spouse) because of other health insurance
                                                                             or group health plan coverage, you may be able to enroll yourself and
Your health information will not be sold, exchanged, transferred, or
                                                                             your dependents in the medical plans under the Avaya Inc. Health &
otherwise disclosed except to the extent permitted by law to carry
                                                                             Welfare Benefits Plan, the Avaya Inc. Health & Welfare Benefits Plan
out specific activities related to the wellness program, and you will
                                                                             for Salaried Employees, or any other group health plan(s) that are
not be asked or required to waive the confidentiality of your health
                                                                             applicable to your health status and may be maintained by Avaya
information as a condition of participating in the wellness program
                                                                             from time to time (collectively and/or individually, as applicable, the
or receiving an incentive. Anyone who receives your information for
                                                                             “Plan” or “Health Plan”), or switch health benefit options under the
purposes of providing you services as part of the wellness program
                                                                             applicable plan, if you or your dependents lose eligibility for that other
will abide by the same confidentiality requirements.
                                                                             coverage (or if the employer stops contributing toward your or your
The only individuals who will receive your personally identifiable           dependents’ other non-COBRA coverage). However, you must request
health information are the account management team at SonicBoom              enrollment within 31 days after the date your or your dependents’ other
and a SonicBoom health coach in order to provide you with services           coverage ends (or after the employer stops contributing toward the
under the wellness program.                                                  other coverage) by contacting the Avaya Health & Benefits Decision
                                                                             Center at 1-800-526-8056 (option 1). Loss of eligibility for coverage
In addition, all medical information obtained through the wellness           includes:
program will be maintained separate from your personnel records,
information stored electronically will be encrypted, and no information
you provide as part of the wellness program will be used in making
any employment decision. Appropriate precautions will be taken to
avoid any data breach, and in the event a data breach occurs involving
information you provide in connection with the wellness program, we
will notify you immediately.

			                                                                     19                                                            ▶ Back      Next   ▶
Legal Reminders

•L
  oss of eligibility as a result of legal separation, divorce, cessation        if your spouse is not enrolled in the health plan, you may enroll him or
 of dependent status (such as attaining the maximum age to be                    her and any other eligible dependents in the plan when you enroll a
 eligible as a dependent child under the plan), death of an employee             child due to birth, adoption or placement for adoption.
 or partner, termination of employment, reduction in the number of
 work hours of employment
                                                                                 When coverage begins. In the case of marriage, coverage will begin
•A
  situation in which a plan no longer offers any benefits to the class          on the day the election is made in the enrollment system as long as
 of similarly situated individuals that includes the individual, and             you notify the Company within 31 days of the event. In the case of
• In the case of an individual who has COBRA continuation coverage,             birth, adoption or placement for adoption, coverage is retroactive to
   at the time the COBRA continuation coverage is exhausted.                     the date of birth, adoption or placement for adoption.
However, loss of eligibility for other coverage does not include a loss          Childrens’ Health Insurance Program Reauthorization Act (CHIPRA)
of coverage due to:
                                                                                 On April 1, 2009, The Children’s Health Insurance Program
•T
  he failure of the employee or dependent to pay premiums on a                  Reauthorization Act of 2009 (CHIPRA) added two new HIPAA special
 timely basis                                                                    enrollment rights that will apply to Avaya’s medical and dental plans.
• Voluntary disenrollment from a plan, or                                       If you or your dependent(s) are eligible, but not enrolled in medical or
•T
  ermination of coverage for cause (such as making a fraudulent                 dental coverage, you will be entitled to a special enrollment period if:
 claim or an intentional misrepresentation of a material fact in                 •Y
                                                                                   ou or your dependent decline enrollment because your dependent
 connection with the plan).                                                       is covered under a Medicaid or State child health plan and your
                                                                                  dependent’s eligibility for the Medicaid or the State child health plan
When coverage begins. If you enroll yourself, your spouse/domestic                ends, or
partner and/or your eligible dependent child(ren) in a group health
plan due to a loss of eligibility for coverage event described above,            •Y
                                                                                   our dependent becomes eligible for state premium assistance
coverage under this plan will begin the date the election is made.                from a Medicaid or State child health plan with respect to cover
                                                                                  under this Plan.
Gaining a New Dependent
                                                                                 You must request enrollment in the medical and dental plans within
If you have a new dependent as a result of marriage, birth, adoption,            60 days after the date your dependent(s) loses coverage under a
or placement for adoption, you may be able to enroll yourself and                Medicaid or a State child health plan or the date your dependent
your dependents in a medical plan offered by Avaya. However, you                 becomes eligible for assistance under Medicaid or a State child health
must request enrollment within 31 days after the marriage, birth,                plan where premiums are charged by the plans by contacting the
adoption, or placement for adoption.                                             Avaya Health & Benefits Decision Center at 1-800-526-8056 (option 1).
In addition, if you are not enrolled in the Avaya Inc. Health & Welfare
Benefits Plan, the Avaya Inc. Health & Welfare Benefits Plan for
Salaried Employees, or any other group health plan(s) that are
applicable to your health status and maybe maintained by Avaya from
time to time (collectively and/or individually, as applicable, the “Plan”
or “Health Plan”), as an employee, you also must enroll in the plan
when you enroll any of these dependents by contacting the Avaya
Health & Benefits Decision Center at 1-800-526-8056 (option 1). And,

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