ROAD AHEAD ENROLL for the - Your 2019 Benefits Decision Guide - SPDxpressLSC.com
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ENROLL for the
ROAD AHEAD
Your 2019 Benefits Decision Guide
ybr.com/lsc • 1-844-LSC-BENS
ENROLL for the ROAD AHEAD
This Benefits Decision Guide describes the health and welfare benefit programs available for 2019. Please review
the information carefully so you can take full advantage of your benefit options.
ENROLL:
+ Online at ybr.com/lsc
+ By phone at 1-844-LSC-BENS (1-844-572-2367), Monday – Friday, 8:00 a.m. – 5:00 p.m. Central Time
What’s Inside
Page ALERT: SUMMARIES OF BENEFITS
Eligibility Requirements . . . . . . . . . . . . . . 1 AND COVERAGE (SBCs) AVAILABLE
Enrolling in Benefits . . . . . . . . . . . . . . . . 2 For summaries of your options, including examples
to illustrate common medical events, go to
Your 2019 Benefit Choices SPDxpressLSC.com/pages/enrollment/SBC.aspx.
Medical . . . . . . . . . . . . . . . . . . . . . . . 3 There you will find Summaries of Benefits and Coverage
Supplemental Health Care Benefits . . . . . . . 7 (SBCs) highlighting the key provisions, limitations and
Dental . . . . . . . . . . . . . . . . . . . . . . . . 8 exceptions for your Medical Program options.
Vision . . . . . . . . . . . . . . . . . . . . . . . . 9 The SBCs are designed to help you compare options and
Flexible Spending Accounts (FSAs) . . . . . .10 better understand the coverage and out-of-pocket costs for
Life and Accident Insurance . . . . . . . . . . . 11 each. Please review the SBCs before enrolling in benefits. You
may also call the LSC Benefits Center at 1-844-LSC-BENS
Disability . . . . . . . . . . . . . . . . . . . . . . 12
(1-844-572-2367) to request paper copies at no charge.
Your 2019 Benefit Premiums . . . . . . . . . 13
Useful Contacts . . . . . . . . . . . . . . . . . . 16
ABOUT THIS GUIDE: This guide describes the coverage offered to the majority of benefits-eligible employees under the LSC Group Benefits Plan
(the “Plan”). Your benefits eligibility will determine the coverage that is offered to you, your spouse/domestic partner and any dependent child(ren).
More details on benefits eligibility are available in the Summary Plan Descriptions (SPDs) and Summaries of Material Modifications (SMMs) online at
SPDxpressLSC.com.
NOTE: References to spouse throughout this guide include covered domestic partners. References to dependents include spouse and/or child(ren).
IMPORTANT: The descriptions in this guide are based on official Plan documents. Every effort has been made to ensure the accuracy of this material.
In the unlikely event there is a discrepancy between this document, the SPDs, SMMs, SBCs or any other materials summarizing the Plan and the official
Plan documents, the official Plan documents will control. LSC Communications US, LLC reserves the right to amend, change or terminate any or all of the
benefit Plans it sponsors, including without limitation, the LSC Group Benefits Plan, the LSC Flexible Benefits Plan and the LSC Separation Pay Plan in
whole or in part, at any time.
ii
ELIGIBILITY REQUIREMENTS
In general, you’re eligible for coverage under the LSC Group Benefits Plan (the “Plan”) if you’re
classified as a regular full-time or benefits-eligible part-time employee of LSC Communications
or any of its participating subsidiaries.
Who Is an Eligible Dependent?
In general, you may cover a spouse/domestic partner and/or child(ren) who qualify as dependents as defined in the SPD
and any related SMM.
Who Isn’t an Eligible Dependent?
Your parents, grandparents, brothers and sisters are not eligible for coverage. Your grandchildren are not eligible for coverage
except if you are the sole legal guardian. A spouse/domestic partner or child(ren) covered as an employee or as a dependent of
another employee under the Plan or who is on active military duty is not eligible to be covered by you.
Please refer to SPDxpressLSC.com for additional information on who may or may not be covered.
IMPORTANT NOTE ABOUT DEPENDENT COVERAGE
We may conduct an audit to confirm that dependents enrolled under the Plan are eligible for coverage. If you elect to
cover any dependents when you enroll in coverage, you may be asked to certify their eligibility.
When it is time for the audit, you will receive a letter in the mail outlining what to do. This process ensures only eligible
dependents are covered, which helps us manage health care costs for both you and the company. It is your responsibility
to ensure all covered dependents meet the dependent eligibility requirements. Please refer to the SPDs and related SMMs
for complete dependent eligibility requirement details.
IMPORTANT: If your dependent(s) were dropped from coverage during a prior audit, you will need to certify their
eligibility before you can enroll them in coverage for 2019.
1
ENROLLING in BENEFITS
Your benefit elections — including any default coverage assigned to you if you don’t enroll — will be in effect through
December 31, 2019. You cannot change your elections during the year unless you experience a qualified status change (e.g.,
marriage, divorce, birth of a child). If you experience a qualified status change during the year, you can make a new election,
consistent with the status change, generally within 30 calendar days through the LSC Benefits Center. Refer to the Qualified
Status Changes Summary Plan Description (SPD) and any related Summaries of Material Modifications (SMMs) for more
information about qualified status changes.
Make the Tobacco-free Pledge
LSC Communications offers a medical premium credit when you and your covered dependents make the Tobacco-free
Pledge — i.e., pledge that you are either tobacco-free or are willing to participate in the Tobacco: Kick It! program in 2019.
This credit is reflected in the annual medical premiums listed on page 13 of this guide.
If you and/or any covered dependents do not make the Tobacco-free Pledge, an annual surcharge is added to your
medical premium, up to the following maximums:
+ Employee Only or Spouse Only: $500
+ Employee + Spouse: $1,000
+ Dependent Child(ren) Only: $250
+ Employee + Child(ren) or Spouse + Child(ren): $750
+ Family [Employee + Spouse + Child(ren)]: $1,250
You will need to TAKE ACTION during enrollment and make your Tobacco-free Pledge for you and each
of your dependents to receive the premium credit (i.e., avoid the annual surcharge) in 2019. If you made
the Tobacco-free Pledge in 2018, it will NOT carry over to 2019.
If you already pay the surcharge and do not make the Tobacco-free Pledge during Annual Enrollment, that
surcharge and corresponding category (e.g., spouse) will carry over to 2019.
IMPORTANT:
You must make separate tobacco declarations for you and your dependents. If any of you declare you use tobacco but
agree to participate in the Tobacco: Kick It! program, we receive confirmation when you participate in the program.
If you do not participate in the program by November 30, 2019, you will be charged the surcharge retroactively. (Note:
Alternate cessation recommendations by your physician will be accommodated.) You can enroll in the Tobacco: Kick It!
program by calling 1-877-409-1488.
2
YOUR 2019 BENEFIT CHOICES
MEDICAL
You have Medical Program options that offer different levels of coverage to help meet your needs.
Coverage Options
Your medical coverage options for 2019 are:
+ Copay Advantage + HSA Advantage + HSA Value
Premiums
Refer to page 13 of this guide for the premiums associated with each option.
How Your 2019 Medical Program Options Differ
Eligible for a
Copays Full-Use Flexible Eligible for a Prescription Deductible and
for Certain Spending Health Savings Drugs Apply to Out-of-Pocket
Services Account (FSA) Account (HSA) Deductible Premiums Maximum
Copay
Advantage X X1 $$$ $$
HSA Advantage X X2 $$ $$
HSA Value X X2 $ $$$
1. Under Copay Advantage, the Plan applies copays/coinsurance immediately for prescription drugs without any deductible.
2. HSA Advantage and HSA Value are eligible for a limited-use FSA, as explained on page 10.
Your Medical Program Vendors: BCBSIL or UHC
For each of the medical coverage options, you will be assigned the vendor who offers the best overall discounts in your area:
Blue Cross and Blue Shield of Illinois (BCBSIL) or UnitedHealthcare (UHC). Note this can change from the prior year since the
overall discounts are re-evaluated annually. You can choose the other vendor when you enroll; however, the following
surcharge will be added to your medical premium if you do so:
+ $12.50 per month/$5.77 per pay period for Employee Only coverage
+ $25 per month/$11.54 per pay period for all other coverage categories
Learn the specifics of your vendor by looking at their website or calling the vendor directly:
Program Vendor Website & Telephone Network Name
BCBSIL bcbsil.com/lsc + 1-888-895-6985 PPO
UHC welcometouhc.com/lsccom + 1-844-263-1622 UHC Choice Plus Network
3
Exploring Your Medical Options
With all three medical options (Copay Advantage, HSA Advantage and HSA Value):
+ You can use in-network or out-of-network providers. The Plan pays a higher level of benefits when you receive care
from an in-network provider.
If you see an out-of-network provider, you will typically pay more for services. In addition, because out-of-network
providers can charge you the difference between their billed charges and the Medicare reimbursement level that the
Plan pays, the amount could be even higher.
+ Eligible in-network preventive care is covered at 100% with no deductible, coinsurance or copays.
+ Prescription drug coverage is provided through CVS Caremark. (You do not have to fill your prescription at CVS. To find
local pharmacies in your network, register at caremark.com or download the CVS Caremark app for iPhone or Android to
access the pharmacy search tool.)
+ Generic cholesterol and blood pressure medications are free.
+ Your out-of-pocket maximum protects you in case of unexpected or catastrophic expenses. The out-of-pocket
maximum is the most you will have to pay in a year for covered and allowed health care expenses and includes the deductible
and copays/coinsurance. Premiums and any surcharges you pay are NOT included in the out-of-pocket maximum.
Once the individual out-of-pocket maximum is reached (or the combined family out-of-pocket maximum, whichever
occurs first), the Plan pays 100% of covered services.
NOTE: You could pay much more if you go out-of-network because out-of-network service has an “allowed amount,” which is
generally the Medicare reimbursement level. The Plan pays 100% of the allowed amount, but you are responsible for paying
anything over that allowed amount directly to your provider.
Use a Health Savings Account (HSA) to Save and Pay Tax-Free
You can contribute to a Health Savings Account (HSA) if you enroll in the HSA Value or HSA Advantage medical option. An
HSA is a smart way to save and pay for your health care. Your unused account balance rolls over from year to year. Money in
your HSA is always yours, even if you change medical options, leave the company or retire.
2019 HSA CONTRIBUTION LIMITS SET BY THE IRS
Employee Only Coverage $3,500 ($50 more than 2018)
Family Coverage (i.e., all other coverage levels) $7,000 ($100 more than 2018)
Catch-up Contribution (if you are 55 or older and not enrolled in Medicare) $1,000
If you participated in an HSA during 2018, your same HSA contribution amount will automatically continue in 2019 unless you
make a change. If you want to contribute the new IRS maximum, you will need to increase your 2019 contribution. HSA
contributions may be changed mid-year even without a qualified status change. IMPORTANT: You are responsible to make sure
you don’t exceed the annual IRS limit, so track your contributions regularly.
MEDICARE AND YOUR HSA
Once you enroll in Medicare (generally at age 65), you can no longer contribute to your HSA.(This occurs even if just the
automatic Medicare Part A coverage goes into effect when you start collecting Social Security retirement benefits. So unless
you defer receipt of Social Security and decline Part A, you need to stop any HSA contributions you may be making to avoid
any tax consequences.) However, you can continue to use the existing balance in your HSA to pay for eligible out-of-pocket
health care expenses tax-free. This includes premiums, deductibles, copays and coinsurance under Medicare. This does not
include MediGap premiums.
HSA CONTRIBUTION RULES FOR MARRIED PEOPLE
If both you and your spouse are eligible for an HSA, you may each set up individual accounts. The total contribution between
those two accounts can’t exceed $7,000. This is true even if both of you work for LSC and have separate coverage. For example,
if you have Employee Only coverage and your spouse has Family coverage, your two accounts combined cannot exceed the
$7,000 maximum. Please see IRS Publication 969 for more information about contribution limits.
4
Summary of Benefits for COPAY ADVANTAGE
With the Copay Advantage medical option, you pay a flat-dollar amount (i.e., a copay) for certain covered services, such as
doctor’s office visits. This may help you predict your costs. (Note, however, the deductible and coinsurance still apply for
certain diagnostic and treatment services performed in a doctor’s office or hospital/outpatient setting.)
+ EMPLOYEE +SPOUSE OR CHILD(REN)
COVERAGE CATEGORY EMPLOYEE ONLY + FAMILY
Annual Deductible (Medical only) $3,200 $6,400 1
Coinsurance
+ In-Network You pay 20% after deductible
+ Out-of-Network You pay 40% after deductible
Annual Out-of-Pocket Maximum $12,400 1
$6,200
(Medical and Prescription Drug combined) (individual cap of $6,200)
Office Visit
+ In-Network You pay $25 PCP / $40 Specialist
+ Out-of-Network You pay 40% after deductible
Preventive Care
+ In-Network You pay 0%
+ Out-of-Network You pay 40% after deductible
Emergency Room — You pay copay + coinsurance:
+ In-Network $500 copay + 20% of the remaining balance
+ Out-of-Network
Note: If admitted, inpatient $500 copay + 20% of the remaining balance if true emergency,
stays apply to deductible and otherwise 50% of the remaining balance after deductible
out-of-pocket maximum
Prescription Drugs Through CVS Caremark — You pay (does NOT apply to your deductible): 2
Retail Mail-Order
+ Generic 20% ($10 min / $40 max) 20% ($25 min / $100 max)
+ Brand Formulary 30% ($40 min / $75 max) 30% ($100 min / $185 max)
+ Brand Non-Formulary 40% ($55 min / $125 max) 40% ($140 min / $315 max)
+ Specialty $150 More than 30-day supply not allowed
1. The Plan starts paying benefits for an individual’s claims only after the total deductible for the coverage category has been met — even if those expenses are incurred by only
one individual. The out-of-pocket maximum works differently. No one in your family pays more than the individual out-of-pocket maximum before the Plan starts paying 100%
of his/her covered expenses.
2. Any penalties related to the Prescription Drug Program — such as penalties for failure to obtain prior authorization, failure to use step therapy, or for prescriptions that specify
they should be dispensed as written — will not count toward your deductible or out-of-pocket maximum.
TIPS FOR CHOOSING A MEDICAL OPTION
In general, consider your typical health care use and your ability to cover unexpected health care
costs to determine which method (coinsurance vs. copays, lower premium vs. higher deductible, etc.)
will work best for your situation.
For an interactive side-by-side comparison of your medical options, use the Health Plan Comparison
Chart at ybr.com/lsc. You can compare medical options by key features such as cost, ease of use,
coverage and access.
5
Summary of Benefits for HSA ADVANTAGE and HSA VALUE
The HSA Value and HSA Advantage medical options are eligible for a health savings account (HSA), which can help you save
and pay for health care tax-free. While these medical options have lower premiums than Copay Advantage, you might pay
more out-of-pocket when you seek care.
TIPS TO HELP YOU PAY YOUR DEDUCTIBLE
Since your premiums for the HSA options are lower than Copay Advantage, consider contributing your
premium savings to an HSA.
Enroll in MetLife Supplemental Health Care Benefits and receive cash payments for certain illnesses and
injuries. See page 7.
HSA ADVANTAGE HSA VALUE
+ EMPLOYEE +SPOUSE + EMPLOYEE +SPOUSE
COVERAGE OR CHILD(REN) OR CHILD(REN)
CATEGORY EMPLOYEE ONLY + FAMILY EMPLOYEE ONLY + FAMILY
Annual Deductible $3,200 $6,400 1 $4,600 $9,2001
Coinsurance
+ In-Network You pay 20% after deductible You pay 30% after deductible
+ Out-of-Network You pay 40% after deductible You pay 50% after deductible
Annual Out-of-Pocket
Maximum $12,4001 $13,1001
$6,200 $6,550
(Medical and Prescription (individual cap of $6,200) (individual cap of $6,550)
Drug combined)
Office Visit
+ In-Network You pay 20% after deductible You pay 30% after deductible
+ Out-of-Network You pay 40% after deductible You pay 50% after deductible
Preventive Care
+ In-Network You pay 0% You pay 0%
+ Out-of-Network You pay 40% after deductible You pay 50% after deductible
Emergency Room
+ In-Network You pay 20% after deductible You pay 30% after deductible
You pay 20% after deductible if true You pay 30% after deductible if true
+ Out-of-Network
emergency, otherwise 40% after deductible emergency, otherwise 50% after deductible
Prescription Drugs Through CVS Caremark — You pay (after deductible) 2:
Retail and Mail-Order Retail and Mail-Order
+ Generic 20% 30%
+ Brand Formulary 30% ($1 minimum) 40% ($1 minimum)
+ Brand Non-Formulary 40% ($16 minimum) 50% ($16 minimum)
+ Specialty 40% 50%
1. The Plan starts paying benefits for an individual’s claims only after the total deductible for the coverage category has been met — even if those expenses are incurred by only
one individual. The out-of-pocket maximum works differently. No one in your family pays more than the individual out-of-pocket maximum before the Plan starts paying 100%
of his/her covered expenses.
2. Any penalties related to the Prescription Drug Program — such as penalties for failure to obtain prior authorization, failure to use step therapy, or for prescriptions that specify
they should be dispensed as written — will not count toward your deductible or out-of-pocket maximum.
6SUPPLEMENTAL
HEALTH CARE BENEFITS
MetLife Supplemental Health Care Benefits provide a cash payment directly to you that you may use toward your
medical deductible, copays/coinsurance and other out-of-pocket costs. Policies include:
+ Hospital Indemnity One coverage option; no high and low plan for 2019.
+ Critical Illness and Accident Insurance These two policies are now bundled as one enrollment election.
You must be actively at work on the date the policy takes effect; otherwise, your coverage will not take effect until you return.
See page 14 of this guide for premiums. Note you pay the full cost of these benefits, available at group rates, through after-tax
payroll deductions.
You must re-enroll if you want coverage in 2019. Your current Supplemental Health Care elections will end December 31, 2018.
Hospital Indemnity
Hospital Indemnity provides payment when an eligible accident or sickness puts you or a covered family member in the
hospital, on or after your coverage effective date.
HOSPITAL INDEMNITY
Hospital Coverage — Accident
Hospital Admission Benefit 1,2 $350 per accident
Hospital Confinement Benefit 2
$200 per day, up to 31 days per covered person per accident
Hospital Coverage — Sickness
Hospital Admission Benefit 1 $350 per calendar year
Hospital Confinement Benefit $200 per day, up to 31 days per covered person per sickness
1. Paid directly to employee on flat schedule per claim (does not vary by length or service received). 2. Must occur within 180 days after the accident.
Critical Illness and Accident Insurance Review policy documents at ybr.com/lsc.
Critical Illness Insurance provides a lump sum payment of $10,000 or $20,000 for certain health conditions that are diagnosed
and treated on or after your coverage effective date, such as cancer, heart attack, stroke and kidney failure. Accident Insurance
provides payment for certain injuries resulting from accidents such as a car crash, sports injury or common child mishaps,
such as a broken bone or concussion.
IMPORTANT: If you have a current condition and you enroll in Critical Illness and Accident Insurance, be sure to review the
full details regarding pre-existing conditions. Policy documents can be found at ybr.com/lsc.
METLIFE CRITICAL ILLNESS AND ACCIDENT INSURANCE
Critical Illness Benefit Coverage OPTION 1 OPTION 2
Employee $10,000 $20,000
Spouse/Domestic Partner 100% of the employee’s initial benefit amount
Dependent Child(ren) 100% of the employee’s initial benefit amount
Accident Insurance for Injuries
Fractures $200 – $2,000
Concussions $200
Cuts/Lacerations $25 – $400
Accident Insurance for Medical Services & Treatment
Ambulance $150
Therapy (including physical therapy) $25
Inpatient Surgery $1,000
NOTE: In the event you or a loved one experience more than one covered condition, the total benefit amount available is 5 times that of your initial benefit amount — in other words, $50,000 or $100,000.
7DENTAL
Your dental options include MetLife PPO and MetLife PPO Plus. Both options allow you to choose any
dentist, but you receive a higher level of coverage with lower out-of-pocket costs if you use participating
network dentists.
To find an in-network dentist, go to metlife.com/mybenefits, select Employee Benefits and then
Dental. Look for the PDP Plus Network under Find a Dentist.
If you use an out-of-network provider, the Program pays benefits in accordance with the two options’ usual and
customary (U&C) limits. This means you may be responsible to pay your provider directly for any difference between the billed
charges and what the Plan pays.
METLIFE PPO METLIFE PPO PLUS
Benefit Description IN-NETWORK & OUT-OF-NETWORK IN-NETWORK & OUT-OF-NETWORK
Deductible (no deductible
$50 individual / $150 family $50 individual / $150 family
applies for Type A services)
Annual Benefit Maximum —
$1,500 per individual $2,000 per individual
Non Orthodontia
$2,000 per individual receiving
Lifetime Orthodontia Maximum Benefit NA
treatment per lifetime
Preventive — Type A (routine exams,
cleanings, bitewing x-rays, fluoride 100% 100%
application, sealants, etc.)
Basic — Type B (fillings, full mouth
x-rays, routine extractions, root canals, 50% 80%
periodontics, oral surgery, etc.)
Major — Type C
(crowns, dentures, bridges, 50% 50%
surgical extractions, implants, etc.)
Orthodontia — Type D NA 50%
See page 14 of this guide for the premiums associated with each option and coverage category.
8VISION
Your Vision Care Program options include EyeMed and EyeMed Enhanced. Both options provide:
+ Comprehensive coverage for exams, lenses, frames and contact
lenses through a network of providers
+ Discounts on laser vision correction
+ Hearing care discounts through Amplifon
To find an EyeMed vision provider, visit eyemed.com and look for the Vision Care Program network. Prospective members can
also call 1-866-299-1358 for assistance. To find hearing providers, visit amplifonusa.com or call 1-844-526-5432.
EYEMED EYEMED ENHANCED
Benefit Description IN-NETWORK OUT-OF-NETWORK IN-NETWORK OUT-OF-NETWORK
Frequency of Vision
+ 12 mo. exam + 12 mo. frames + 12 mo. lens
Service (months)
Routine Vision Exam $10 copay Up to $35 allowance $0 copay Up to $35 allowance
Retinal Imaging $39 NA $39 NA
$0 copay — $130 $0 copay — $160
Frames allowance; 20% off Up to $60 allowance allowance; 20% off Up to $80 allowance
balance over $130 balance over $160
Lens (single vision)* $20 copay Up to $25 allowance $10 copay Up to $25 allowance
$0 copay — $150 $0 copay — $170
Contacts* allowance; 15% off Up to $150 allowance allowance; 15% off Up to $150 allowance
balance over $150 balance over $170
15% off retail price 15% off retail price
or or
Laser Surgery NA NA
5% off promotional 5% off promotional
price price
40% off hearing exams 40% off hearing exams
Hearing Benefits and a discount on NA and a discount on NA
hearing aids hearing aids
* IMPORTANT: Benefit coverage is for either contact lenses OR frame lenses but not both.
See page 14 of this guide for the premiums associated with each option and coverage category.
Extra Savings on Lenses
Both EyeMed and EyeMed Enhanced offer the Freedom Pass: Any frame, any price for $0 out-of-pocket at Sears Optical or
Target Optical. Present offer code 755288. If you need contacts, register at contactsdirect.com for a $20 coupon.
9FLEXIBLE SPENDING ACCOUNTS (FSAs)
FSAs allow you to reimburse yourself for eligible out-of-pocket health and dependent care expenses with
pre-tax contributions you make to your FSAs during the Plan year. You could save up to 40% or more on
eligible expenses, depending on your tax bracket.
Here’s how they work:
+ Contribute from $200 to $2,650 to the Health Care FSA. You can use the Health Care FSA to reimburse
eligible health care-related expenses such as coinsurance, the cost of contact lenses, prescription drug copayments,
over-the-counter drugs prescribed by a doctor and more.
+ Contribute from $200 to $5,000 to the Dependent Care FSA. You can use the Dependent Care FSA to reimburse eligible
dependent day care-related expenses such as day care for your child, elderly parent or disabled spouse. NOTE: The amount
you elect to contribute to your Dependent Care FSA during enrollment may be reduced for high-income employees to
comply with government requirements. You’ll be notified if your maximum contribution amount must be reduced.
+ Make a new election each year. Your prior year's election will not carry over.
+ Plan carefully. Per IRS rules, you forfeit any money remaining in your FSAs at the end of the 2019 Plan year. However, you
have until March 31, 2020, to submit claims for services incurred during the 2019 Plan year.
The Flexible Spending Account Estimator at ybr.com/lsc can help you calculate eligible health care expenses and
may help you determine the amount you should contribute to an FSA.
IMPORTANT
+ If you leave the company during the Plan year, you can only submit Health Care FSA claims for services incurred up to your
termination date. The exception is if you elect to continue your Health Care FSA coverage during your COBRA eligibility
period and you pay your COBRA premiums. For the Dependent Care FSA, you may submit claims for services incurred
following termination through December 31, 2019, up to the amount you contributed through your termination date.
+ You cannot change your FSA election during the year unless you experience a qualified status change (e.g., marriage,
divorce, birth of a child). If you experience a qualified status change during the year, you can make a new election,
consistent with the status change, within 30 calendar days through the LSC Benefits Center. Not all qualified status
changes apply to FSAs. See the Qualified Status Changes SPD for more information.
+ Over-the-counter medicines (except insulin) require a doctor’s prescription to be reimbursed through an FSA or HSA.
Know How Your Medical Option Affects Your Health Care FSA
The IRS has rules that apply to how you can use your Health Care FSA based on the type of Medical Program option you have.
Here are some key things to know as you make your decision:
Expenses You Can Pay Through Your FSA*
Your Health Care
If Your Medical FSA Option Before You Meet Your After You Meet Your Eligible For an
Program Option Is … Will Be … Medical/Rx Deductible Medical/Rx Deductible FSA Debit Card?
+ Eligible out-of-pocket dental
HSA Value Eligible out-of-pocket and vision expenses
or Limited-use FSA dental and vision No
+ Eligible medical and
HSA Advantage expenses
prescription drug expenses**
Regular, + Eligible out-of-pocket dental and vision expenses
Copay Advantage Yes
full-use FSA + Eligible medical and prescription drug expenses
* These rules also apply for expenses for eligible dependents even if they do not have coverage under your Medical Program option.
** Even if the expense is not a covered expense under the Medical and Prescription Drug Programs, you still cannot pay it through your FSA until you have met your deductible.
For more information about FSA rules, eligible expenses and claims, go to Your Spending Account™ at ybr.com/lsc. You can
also refer to IRS publication 969 at irs.gov.
Your Spending Account is a trademark of Alight Solutions.
10LIFE and ACCIDENT INSURANCE
The Life and Accident Insurance Program provides important Optional AD&D Insurance*
financial protection in the event something happens to you,
You can purchase optional accidental death
your spouse or child(ren).
& dismemberment (AD&D) insurance for yourself and your
family. With this coverage, the Program pays a benefit of one
IMPORTANT: You cannot cover another employee as a
to seven times your annual base pay (up to $2 million for
spouse or child under the Life and Accident Insurance
yourself) in accordance with Plan provisions for accidental
Program. Also, if you increase your life insurance coverage
death and certain other losses.
and you are on leave of absence, the increase will not take
effect until you are actively back at work. IMPORTANT: If you elect optional AD&D for your family, you
will need to indicate which dependents you want enrolled in
that coverage.
Basic Employee Life Insurance* The optional AD&D amount a beneficiary would receive on claim
The Life Insurance Program pays a basic employee life insurance approval differs for an employee and covered eligible dependents:
benefit to your beneficiary if you die. The benefit equals one
+ The amount for an eligible spouse is 60% of the
times your annual base pay, up to a maximum benefit of
employee’s amount if there are no children (up to a
$125,000 in accordance with Plan provisions. You don’t have
maximum of $750,000).
to elect this coverage — it is provided to you automatically.
+ The amount for an eligible dependent child is 25%
of the employee’s amount, if there is no spouse (up to
Optional Employee Life Insurance a maximum of $150,000).
You can purchase optional employee life insurance from + If there is a spouse AND child(ren), the amount for an
one to seven times your annual base pay, up to a combined eligible spouse is 50% of the employee’s amount (up to a
benefit (basic and optional) of $2 million. If you die, the maximum of $750,000), and the amount for an eligible
Program pays a benefit to your designated beneficiary in child(ren) is 20% of the employee’s amount (up to a
accordance with Plan provisions. maximum of $150,000).
Your premium for this coverage is based on your age, Please see page 15 for rates, and refer to SPDxpressLSC.com
tobacco user status and coverage amount, as shown on for more information.
page 15. Note that as your coverage amount or age increases,
so do your premiums.
OPTIONAL LIFE INSURANCE —
EVIDENCE OF INSURABILITY (EOI)
IMPORTANT: Your tobacco declarations for medical
and optional life insurance must match. For example, If you are newly electing or increasing coverage, you
you can’t declare yourself tobacco-free for the will be required to provide evidence of insurability (EOI).
Medical Program but declare yourself a tobacco Likewise, if you are electing or increasing spouse life
user for optional life insurance. You must make separate insurance coverage, your spouse will need to provide
tobacco declarations for yourself and your covered EOI. EOI is not required for optional AD&D insurance
dependent. You can contact the LSC Benefits Center if or optional child life insurance.
you need assistance.
BENEFICIARY DESIGNATIONS
FOR LIFE INSURANCE
Optional Spouse
and Child Life Insurance You can change your beneficiary or make a new designation
at any time by using one of the methods described below:
You can purchase spouse and child life insurance coverage.
Please see page 1 for more information on who is considered + Go to prudential.com/lscc. Click the “Register
an eligible spouse or child(ren). If your covered eligible Now” button and follow the prompts to register
spouse or child(ren) dies, the Program will pay the life if you haven’t already done so. NOTE: Be sure to
insurance benefit in accordance with Plan provisions. Please click “Submit” when you are finished changing
see page 15 for rates and refer to the SPD (and any related your beneficiary designations online.
SMM) for details. + Contact Prudential at 1-800-778-3827 to receive a
beneficiary election form via US mail.
* The amount of coverage for active employees age 65 and older is subject to annual
age reductions in accordance with the Plan. Please see the Life Insurance Certificate
of Coverage & Schedule of Benefits at SPDxpressLSC.com for more information.
11DISABILITY
The Disability Benefit Program provides protection against the Monthly LTD benefits continue until
loss of your regular pay if you’re unable to work because of a the earlier of age 65 or the date you are
covered illness or injury, subject to the claims administrator’s no longer disabled according to the
approval. Aetna Life Insurance Company is the claims Program. If you become disabled after age
administrator for the program. 60, your benefits duration schedule may vary. Benefits are
For more information about how the Disability Benefit stopped after 24 months for mental health and substance use
Program works, review the SPD (and any related SMM) disabilities.
through the website at SPDxpressLSC.com.
LTD Buy-up Coverage
STD Coverage You may purchase an additional 10% of
Your short-term disability (STD) coverage provides a monthly LTD coverage, which would provide a total
benefit of 60% of your pre-disability earnings for up to 26 LTD benefit of 60% of your pre-disability
weeks. You don’t have to elect STD coverage — it is provided earnings, up to $10,000 a month. This
to you automatically and is company-paid. additional LTD coverage can help protect your income and pay
your bills while you’re on the road to recovery. Note: Evidence
of insurability (EOI) is required for LTD Buy-up if you
Basic LTD Coverage are electing it for the first time but not if you are newly
Basic long-term disability (LTD) coverage provides a monthly eligible for the coverage.
benefit of 50% of your earnings, up to $10,000 a month. You
don’t have to elect Basic LTD coverage — it is provided to IMPORTANT: See the Long-term Disability SPD for
you automatically and is company-paid. pre-existing condition limitations if you elect LTD Buy-up for
the first time, including as a new hire. See page 15 for rates.
12YOUR 2019 BENEFIT PREMIUMS
As you review the 2019 medical premiums below, note:
+ The tobacco-free credit is already included and applies only if you and your covered dependents pledge to: (a) be
tobacco-free in 2019, or (b) participate in the Tobacco: Kick It! program in 2019. See page 2 of this guide for information
about the surcharge that will be applied if you or any of your dependents do NOT take the Tobacco-free Pledge. Call
1-877-409-1488 to enroll in the Tobacco: Kick It! program.
+ Premiums are based on your pay band (see the chart below for details on the pay bands).
+ Premiums for medical, dental, vision and Optional AD&D are generally deducted pre-tax*; all other premiums are
deducted after-tax.
NO
Biweekly Medical Premiums for 2019 CHANGES FROM 2018
MEDICAL PROGRAM OPTION
PAY BAND COVERAGE HSA VALUE HSA ADVANTAGE COPAY ADVANTAGE
Employee Only $10.62 $66.35 $146.19
1 Employee + Spouse
Employee + Child(ren)
$123.58
$51.00
$236.54
$197.19
$388.50
$351.00
UNDER $50,000
Family $130.85 $351.92 $575.08
Employee Only $16.38 $97.15 $182.77
2 Employee + Spouse
Employee + Child(ren)
$150.58
$64.50
$307.73
$250.96
$498.12
$417.35
$50,000 - $79,999
Family $162.58 $434.65 $712.50
Employee Only $32.77 $140.42 $245.19
3 Employee + Spouse
Employee + Child(ren)
$181.73
$91.38
$382.73
$318.35
$620.19
$545.19
$80,000 - $99,999
Family $199.04 $523.15 $873.12
Employee Only $43.85 $206.77 $329.88
4 Employee + Spouse
Employee + Child(ren)
$198.12
$107.77
$443.31
$365.42
$676.04
$601.04
$100,000 - $149,999
Family $231.81 $586.62 $936.58
Employee Only $43.85 $245.65 $350.93
5 Employee + Spouse
Employee + Child(ren)
$217.38
$124.04
$492.28
$467.31
$703.26
$688.25
$150,000 & OVER
Family $262.50 $711.58 $1,040.14
* Employee contributions for the coverage of non-tax-dependents, such as domestic partners and their children, are deducted on a pre-tax basis based on the premium amounts
noted above. However, you will also pay taxes on the value of the coverage as imputed income. Imputed income is calculated by subtracting the COBRA premium for Employee
Only coverage from the COBRA premium for the coverage you have in effect such as Employee + Spouse in the case of just covering a domestic partner. The difference is your
imputed income. COBRA coverage for this purpose is 100% of the unsubsidized cost of coverage and not 102%. The imputed income amount is added to your paycheck as taxable
income and results in income tax withholdings.
13Biweekly Critical Illness and Accident Insurance Premiums for 2019
EMPLOYEE +
EMPLOYEE ONLY EMPLOYEE + SPOUSE CHILD(REN) FAMILY
EMPLOYEE’S
AGE $10,000 $20,000 $10,000 $20,000 $10,000 $20,000 $10,000 $20,000
< 25 $2.27 $3.02 $4.30 $5.82 $4.73 $6.24 $6.30 $8.56
25 - 29 $2.32 $3.13 $4.41 $6.04 $4.78 $6.34 $6.41 $8.78
30 - 34 $2.69 $3.86 $5.08 $7.38 $5.14 $7.07 $7.08 $10.12
35 - 39 $3.33 $5.15 $6.27 $9.76 $5.79 $8.36 $8.27 $12.51
40 - 44 $4.56 $7.62 $8.58 $14.36 $7.02 $10.83 $10.57 $17.10
45 - 49 $6.55 $11.59 $12.24 $21.68 $9.00 $14.79 $14.23 $24.43
50 - 54 $9.45 $17.39 $17.45 $32.11 $11.90 $20.59 $19.44 $34.86
55 - 59 $13.35 $25.20 $24.41 $46.03 $ 15.81 $28.40 $26.41 $48.78
60 - 64 $19.20 $36.90 $34.91 $67.02 $21.66 $40.11 $36.90 $69.77
65 - 69 $28.92 $56.33 $52.16 $101.53 $31.38 $59.54 $54.15 $104.27
70+ $42.45 $83.39 $77.55 $152.31 $44.91 $86.60 $79.55 $155.06
Biweekly Hospital Indemnity Premiums for 2019
Employee Only $5.34
Employee + Spouse $12.05
Employee + Child(ren) $9.42
Employee + Spouse + Child(ren) $16.95
NO
Biweekly Dental and Vision Premiums for 2019 CHANGES FROM 2018
DENTAL PROGRAM OPTION VISION PROGRAM OPTION
COVERAGE METLIFE PPO METLIFE PPO PLUS EYEMED EYEMED ENHANCED
Employee Only $11.56 $19.13 $2.73 $8.16
Employee + Spouse $23.11 $38.26 $4.98 $14.91
Employee + Child(ren) $22.53 $37.30 $4.85 $14.52
Family $34.09 $56.42 $6.71 $20.08
14Monthly Rates for Optional Life Insurance for 2019 NO
(Per $1,000 of Coverage) CHANGES FROM 2018
EMPLOYEE OR SPOUSE DEPENDENT CHILD OPTIONAL LIFE INSURANCE
AGE NON-TOBACCO USER TOBACCO USER Dependent Child $0.1052019 USEFUL CONTACTS
Benefit/Vendor Telephone/Hours of Operation Website
General Benefits Information
1-844-LSC-BENS (1-844-572-2367),
LSC Benefits Center ybr.com/lsc
Monday – Friday, 8:00 a.m. – 5:00 p.m. Central Time
Summary Plan Descriptions
(SPDs) & Summaries of — SPDxpressLSC.com
Material Modifications (SMMs)
Medical Benefits (Including Condition Management) and Prescription Drug Benefits
Blue Cross and Blue Shield 1-888-895-6985, Monday – Friday,
bcbsil.com/lsc
of Illinois (BCBSIL) 7:00 a.m. – 7:00 p.m. Central Time
1-844-263-1622, Monday – Friday,
UnitedHealthcare (UHC) welcometouhc.com/lsccom
8:00 a.m. – 8:00 p.m. Central Time
CVS Caremark
1-888-528-7457, 24 hours a day, 7 days a week caremark.com
(Prescription Drug Benefits)
Supplemental Health Care Benefits (Hospital Indemnity and Critical Illness/Accident)
1-855-JOINMET (1-855-564-6638), Monday –
MetLife metlife.com/mybenefits
Friday, 7:00 a.m. – 10:00 p.m. Central Time
Dental Benefits
1-800-942-0854, Monday – Friday,
MetLife Dental metlife.com/mybenefits
7:00 a.m. – 10:00 p.m. Central Time
Vision Benefits
1-866-723-0514, Monday – Saturday,
6:30 a.m. – 10:00 p.m. Central Time;
EyeMed Vision Sunday, 10:00 a.m. – 7:00 p.m. Central Time eyemed.com
1-866-299-1358 (for prospective members)
Disability Benefits
1-888-437-8671, Monday – Friday,
Aetna Life Insurance Company aetnadisability.com
7:00 a.m. – 7:00 p.m. Central Time
Life Insurance Benefits
1-800-778-3827, Monday – Friday, prudential.com/lscc
Prudential
7:00 a.m. – 7:00 p.m. Central Time (company code: 52177)
Health Savings Account
HealthEquity 1-844-281-0928, 24 hours a day, 7 days a week healthequity.com
Flexible Spending Account
1-844-LSC-BENS (1-844-572-2367),
Your Spending Account ™ ybr.com/lsc
Monday – Friday, 8:00 a.m. – 5:00 p.m. Central Time
16ENROLL IN YOUR 2019 BENEFITS + Online at ybr.com/lsc + By phone at 1-844-LSC-BENS (1-844-572-2367) Monday – Friday, 8:00 a.m. – 5:00 p.m. Central Time Copyright © 2018 LSC Communications US, LLC All Rights Reserved H000208665
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