2018 OPEN ENROLLMENT GUIDE - OCTOBER 16-29, 2017 - Kenko at SPE
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OCTOBER 16-29, 2017
2018 OPEN ENROLLMENT GUIDE
Enroll online at SPE Benefits Center: https://BenefitsCenter.spe.sony.com
Get answers to your questions from an SPE Benefits Center Representative: 1-833-9-SONY-01
Beginning October 16, 2017, report any 2017 changes/life events to both the old Benefits Connection and the new SPE Benefits Center
A copy of the updated Summary Plan Description (SPD) for your Sony Pictures Entertainment Health and Welfare Benefits Plan (“Plan”) is posted
on www.KENKOatSPE.com. This important document explains the terms and conditions of your Plan, including eligibility, coverage amounts and
exclusions. Please share this with your family members who are also covered under this Plan. If you want a paper version of the SPD, please
request one by emailing PO_EmployeeDirect@spe.sony.com. There is no additional charge for it.
SONY PICTURES ENTERTAINMENT
TABLE OF CONTENTS
3 IT’S GOOD TO HAVE A NETWORK
4 IMPORTANT DETAILS
6 MEDICAL PLANS
9 MEDICAL PLANS AT A GLANCE
10 PRESCRIPTION DRUG COVERAGE
11 YOUR COST FOR MEDICAL COVERAGE
12 FLEXIBLE SPENDING ACCOUNTS
13 VISION PLAN
14 DENTAL PLAN
15 LIFE / AD & D / DISABILITY
16 HEALTH & WELLNESS
17 MORE BENEFITS
18 AETNA TOOLS & RESOURCES
19 WHERE TO GET MORE INFORMATION
20 ADMINISTRATIVE INFORMATION
Information on Medicare Part D Prescription
Coverage can be found on page 20
Your Open Enrollment Checklist
• Review the Open Enrollment materials at www.KENKOatSPE.com
• Is your doctor in the Aetna Network? Go to Aetna’s Custom Docfind at www.aetna.com/dse/custom/sony
• Need to understand which plan may be right for you? Check out Ask Emma
• Review the Summary of Benefits Coverage (SBC) at www.KENKOatSPE.com
• Attend a benefits presentation or listen to a webinar for information on plan options. Have more questions?
If you’re in Culver City, stop by “Ask the Experts” October 16-27, from 12 - 2 p.m. on Main Street
2
IT’S GOOD TO HAVE A NETWORK
It’s Open Enrollment time, and we are excited to introduce a new benefits platform – SPE Benefits Center –
to guide you through the process and be a resource for benefits in 2018 and beyond. SPE Benefits Center
provides an enhanced employee experience, includes new tools and resources like “Ask Emma,” and
supports our “One Sony” initiative by aligning us with our sister companies in using the same platform.
We will continue to offer eligible employees a generous benefits package which includes: our dedicated
on-site Aetna nurse advocate MaeDel Martin, Best Doctors, and Teladoc. While there are minimal changes
to the benefit plans for the 2018 plan year, health care costs continue to rise and you will see this in your
cost of coverage. As always, we remind you to stay in-network as that is the best way to keep costs down.
We remain committed to making sure that your health care benefits are comprehensive, convenient, and
easy to understand. Visit www.KENKOatSPE.com for more information.
Stay well,
George Rose
Executive Vice President
People & Organization
• New SPE Benefits Center platform!
WHAT’S NEW
• Medical, dental and vision premiums are changing-
See the “Cost for Coverage” pages for details
FOR 2018? • Eliminated $10 vision office visit copay
• Consumer Choice deductible increasing to IRS minimum
3
IMPORTANT DETAILS
Enroll on our new platform, SPE Benefits
Center, by 9 p.m. PST, October 29, 2017 NOTE:
Please print your confirmation page and retain for
Online: https://BenefitsCenter.spe.sony.com
your records. Please notify the Plan Administrator
By Phone: 1-833-9-SONY-01
immediately if you see a discrepancy between the
Monday-Friday, 5 a.m. - 7 p.m. PST benefits you elect and the amount withheld on your pay.
Otherwise, you must wait until next year’s Open Enrollment to
make changes unless you have a change in status or qualifying
life event. Refer to your Plan’s Summary Plan Description
(SPD) on www.KENKOatSPE.com for a complete list of
qualifying life events and change in status rules. Making Changes to Your Coverage
If You Do Nothing During the Year
If you do not actively go into our new platform, SPE Benefits Consistent with IRS rules, you may make changes during the
Center, during Open Enrollment, most of your 2017 benefits year only if you have a change in status or qualifying life event.
will automatically roll over for 2018. These events may include the following:
REMEMBER: Health Savings Accounts (HSA) and Flexible • You get married or declare a domestic partnership
Spending Accounts (FSA) elections don’t roll over; a new • You become legally separated, get divorced, or terminate a
election is required to participate. domestic partnership
Eligibility • You have a baby, adopt a child, or obtain legal custody
of a child
Eligibility for some plans may vary by location. Generally,
if you are eligible for SPE benefits, you may also enroll your • You lose a dependent through death or loss of legal custody
legal spouse, same- or opposite-sex domestic partner, and • Your child loses eligibility for coverage
your children1.
• You or your dependent lose other coverage
Dependent Eligibility Audit If you experience one of these events, you must:
SPE conducts an audit of dependents covered under the 1. Notify SPE Benefits Connection to update your 2017 elections
company’s health plans to verify that they are eligible to 2. Notify SPE Benefits Center to update your 2018 elections
receive benefits. You must provide documentation that
confirms your dependents are eligible. A SSN is required Waiving Coverage
for all dependents over 1 year of age.
If you do not want benefits coverage through SPE, be sure to
Tax Implications of Covering a Domestic Partner choose “waive coverage”.
1
If you enroll your domestic partner and any of his or her Eligible children are your biological children, stepchildren, legally adopted
children, foster children, or children of your legal spouse or domestic
dependents in your health care coverage, the IRS requires that partner. For stepchildren and children of a domestic partner to qualify for
you pay federal income tax on the fair market value of their coverage, you must provide more than half of their support. You may enroll
coverage. This is called imputed income. For more information your domestic partner’s children only if your domestic partner is enrolled.
about imputed income, see the SPD at www.KENKOatSPE.com. For information about domestic partner eligibility, please refer to the
Summary Plan Description available on www.KENKOatSPE.com.
Update Your Dependent Status
Please review the information on file for your dependents to
make sure their Social Security Numbers (SSNs) are on file
and listed correctly. The Affordable Care Act (ACA) requires
SSNs so that SPE can provide you with accurate records. ATTEND A BENEFITS PRESENTATION
Attend a benefits presentation or listen to a webinar
for information on plan options. Find the details
on mySPE. Still have more questions? If you’re in
Culver City, stop by to “Ask the Experts” October
16-27 from 12 - 2 p.m. on Main Street.
4 4
Meet Ask Emma.
EMMA is SPE’s online virtual assistant that helps you get the most from your benefits. She can help you figure out
which plan is right for you and your family. She also explains how your benefits work. EMMA asks you questions to
help make sure you get — and understand — the benefits information you need.
She’ll ask you questions that pertain to you. Her plan recommendations are based on those answers. The information
you share with EMMA is confidential. It’s used only to help you find the health plan that best fits your needs.
Try out EMMA as your benefits advisor in the SPE Benefits Center: https://BenefitsCenter.spe.sony.com
Aetna Plan Selection & Cost Estimator
Take a deeper dive with your actual expenses
Use Aetna’s Plan Selection and Cost Estimator that allows you to estimate out-of-pocket health care costs, compare
plan offerings and determine which plan best meets your needs and those of your family.
Log in at: https://www.aetna.com/planselection/mbrDis.jsp?id=1055
Helpful Terms to Know
Before you dive into the plans, it helps to understand some of the terms you’ll come across.
This is the percentage you pay for most covered expenses after you have satisfied the annual deductible.
Coinsurance
For example, if your plan pays 80%, your coinsurance is 20%.
This is a fixed dollar amount that you pay for specific covered expenses, such as an office visit or generic
prescriptions. When a copayment is required, the remaining cost isn’t subject to the annual deductible or to
Copayment coinsurance. For example, if you pay a $25 copayment for an office visit with your primary care physician, the
plan pays the balance; the annual deductible doesn’t apply. Copayments vary by plan and may be different for
in-network and out-of-network services. They also count toward your out-of-pocket maximum.
This is the amount you must pay each calendar year out-of-pocket for most covered medical expenses before
Deductible the plan pays benefits. For the Sony Consumer Choice Plan, almost all covered services and prescription
drugs are subject to the deductible.
This is the most you’ll pay in a calendar year for covered medical expenses. Your out-of-pocket maximum
Out-of-pocket maximum is based on which plan you choose, the number of people you cover and whether you use in-network or
(OOP) out-of-network providers. Your out-of-pocket expenses include money you pay for copays, coinsurance and
deductibles, whether for services or prescription drugs.
Certain services that you receive from a provider that are intended to help you avoid illness and improve your
health. In-network preventive care is covered at 100% under all plans, and may include services like:
Preventive care
• Annual physical
• Blood pressure, diabetes and cholesterol tests
5
MEDICAL PLANS
SPE provides four medical plan options that meet your Example 1:
individual and family needs. Barbara has medical coverage for herself, her spouse and
their two children.
Sony Consumer Choice Plan with The in-network family deductible of $2,700 has not been met.
Health Savings Account (HSA) Since the total family deductible has not been met, the family
will continue to pay Aetna’s full negotiated rate for services
The Sony Consumer Choice Plan is a PPO plan that includes and prescriptions until their covered expenses reach $2,700.
a Health Savings Account. You have the flexibility to visit any
doctor or specialist you choose, in-or out-of-network. You’ll Participant Covered Expenses
have lower monthly premiums than with any of the other plans
Barbara $1,350
offered – but also a higher annual deductible. In this plan,
many of your prescription drugs are subject to your medical Spouse $ 100
plan deductible so you will have to pay 100% of the cost for
Child #1 $ 250
them until you reach your deductible1.
Child #2 $ 50
The Sony Consumer Choice Plan is designed to work in
conjunction with a Health Savings Account. Total $1,750
Review the plan comparison chart on page 9 for more
information about the Plan’s coverage. Example 2:
Barbara’s family has met the deductible of $2,700 so the
How the Deductible Works in the plan benefits will pay at 80% for the whole family. The
family has also reached the total family in-network out of
Consumer Choice Plan pocket maximum (including annual deductible, copays and
The family deductible works differently than with the standard prescriptions) of $7,500, so the plan pays 100% of future
PPO plan. Family is defined as any coverage with more than in-network costs, including prescription drugs for the year.
employee only (i.e. employee + children or spouse/partner)
With the Sony Consumer Choice Plan, the family must meet Participant Covered Expenses
the family deductible before the plan starts paying benefits. Barbara $1,500
Remember, until the deductible is met, you pay the full cost of
health care and prescription drugs. Spouse $4,500
Once you meet the family in-network deductible, the plan’s Child #1 $1,000
coinsurance will kick in and you will only pay 20% for all Child #2 $ 500
covered in-network medical services until you reach the family
in-network out-of-pocket maximum. Prescription drugs will be Total $7,500
paid at the rates shown on page 10.
1
The Sony Consumer Choice Plan covers many preventive drugs at 100%. For more information, please see page 10 in the Prescription Drug section.
6
MEDICAL PLANS CONT’D
The Health Savings Account (HSA)
If you enroll in the Sony Consumer Choice Plan, you may
enroll in a Health Savings Account (HSA). ESTABLISH YOUR HSA
An HSA is a permanent and portable tax-deferred account that Your HSA must be established before qualified
is used to pay for qualified out-of-pocket medical expenses. medical expenses are incurred to receive
Unused funds can roll over year to year. distributions free from federal taxes and state tax (for
most states). The “Establishment Date” of an HSA is
Unlike a FSA, there is no “use it or lose it” penalty. The HSA is
important because account holders can only receive
a special tax-advantaged account, similar to a bank account
tax-free distributions from their HSA to pay or be
where you can earn interest and earnings on the balance. If
reimbursed for qualified medical expenses incurred
you leave the company, you can take the HSA with you. The
after the date the HSA is considered “established.”
HSA is not an SPE-sponsored benefit program or an insured
account. It’s an account that you own. For example, if you go to the doctor on January 5,
but don’t open your account until January 30,
Contributions those January 5 expenses are not eligible
for reimbursement.
The maximum that can be contributed to an HSA acount in 2018
is $3,450 for individuals, or $6,900 for a family, which includes When you enroll in the Sony Consumer Choice Plan,
the SPE contribution. You can contribute to your account on a your HSA account is automatically opened for you.
pre-tax basis with contributions deducted from your paycheck. If However, Section 326 of the Patriot Act requires
you don’t sign up for contributions when you are first hired, you all banks to verify the identity of anyone who tries
can change your contributions during the year or make after-tax to open an account. The information used is your
contributions later. If you’re age 55 or older, you can make an legal name, social security number, date of birth
additional $1,000 “catch-up” contribution to your HSA – also and address (no P.O. boxes). Aetna will automatically
tax-free.1 open your account, and will notify you if they need
more information for verification purposes.
2017 HSA Annual Contribution Limits Make sure that your legal name matches what is
SPE CONTRIBUTION on your social security card (i.e., if you recently got
HSA TYPE married or changed your name) and that your legal
CONTRIBUTION LIMIT
name matches your SPE file. If not, there may be a
Employee only $500 $3,450 delay in establising your account.
Family $1,000 $6,900
Qualifying for an HSA Contributions are free from federal taxes, but in some areas, state tax
1
may apply.
It is your responsibility to ensure you’re eligible to enroll in an 2
If you enroll in Medicare mid-year, you can use still use the existing
HSA. To be an eligible individual and qualify for an HSA, you funds in your HSA, you just cannot make new contributions or continue
must meet the following requirements: to receive contributions from SPE. If you do enroll in Medicare and are
contributing to the HSA, you must notify SPE Benefits Center that you
• You must be covered under the Sony Consumer Choice are no longer eligible to contribute to the HSA and waive future HSA
Plan, on the first day of the month. contributions from SPE.
• You have no other health coverage (except what is
permitted under IRS rules).
• You are not enrolled in Medicare.2
• You cannot be claimed as a dependent on someone else’s
tax return.
• You or your spouse cannot have a general purpose Health
Care FSA or Health Reimbursement Account (HRA). But
you can enroll in a limited Purpose Health Care FSA (See
page 12 for details).
• The HSA can only be used for federal tax dependents.
When opening up an HSA, the account holder is the only one
that must meet the IRS eligibility requirements even if covered
under a family medical plan. Review the IRS rules on HSAs for
more details: www.irs.gov (Publication 969).
7
MEDICAL PLANS CONT’D
Sony PPO Plan How the deductible works in the PPO/EPO Plan
This plan allows you to visit any health care provider you want, Example 1:
but pays more when you use in-network providers. The PPO Robert and his family are in the Sony PPO Plan. He has met
Plan’s network is the same as the Consumer Choice Plan. You the individual deductible of $600, so his plan benefits will
must meet the deductible before the plan starts paying except begin paying at 80%. However, the total family deductible of
for in-network office visits, which are subject to a copayment, $1,200 has not been met, so his spouse and child will continue
and in-network preventive care. If you have enrolled any to pay Aetna’s full negotiated rate for services until the family
dependents, each person will be subject only to the individual deductible is met.
deductible amount until the entire family deductible is met. You
may meet the family deductible by any combination of covered Participant Covered Expenses
medical expenses you and your covered family members incur.
Robert $600
How the deductible works
When you use in-network doctors and facilities, the annual Spouse $100
individual deductible is $600 and the family deductible is $1,200.
Child $200
Sony EPO Plan Total $900
The EPO is an in-network-only PPO with a modest deductible.
You may visit any doctor in the Aetna Select EPO network
without needing a referral. Like the Sony PPO, you’ll pay for Example 2:
all expenses until you reach the deductible, but preventive Robert’s family has met the deductible in-network so the plan
care and certain preventive drugs are covered at 100%, and benefits will pay at 80% for the whole family.
office visits are subject only to a copayment. Note that this
network is slightly different from the Aetna network for the Participant Covered Expenses
Sony Consumer Choice and PPO plans, so make sure you
refer to the correct network when checking on your provider. Robert $500
You don’t have to choose a primary care physician (PCP), but
Spouse $200
having one provides better care continuity.
Child $500
Kaiser HMO Plan (available in California only)
Total $1,200
You must use health care providers and facilities in the Kaiser
network only. You choose a primary care doctor who will
direct you to a specialist if necessary. Most services require a
copay, and there are no deductibles.
For more information, review the “Sony Medical Plans at a
Glance” chart on page 9.
8
SONY 2018 MEDICAL PLANS AT A GLANCE
This table is an overview of your medical plan options and the coverage available under each plan. For additional plan details, see
the applicable Summary Plan Description (SPD) or Summary of Benefits and Coverage (SBCs) on www.KENKOatSPE.com.
Changes for 2018 are in PINK.
SONY CONSUMER KAISER HMO
PLAN FEATURE SONY PPO SONY EPO
CHOICE (CA ONLY)
TYPE OF PLAN PPO PPO EPO HMO
Payroll Contribution Lowest Highest Moderate Moderate
IN-NETWORK IN-NETWORK NETWORK ONLY NETWORK ONLY
$1,350 single1 $600 individual $150 individual
Annual deductible None
$2,700 family1 $1,200 family $300 family
Annual out-of-pocket (includes $3,750 single $4,000 individual $3,000 individual $1,500 individual
deductibles, copays & prescriptions) $7,500 family3 $8,000 family $6,000 family $3,000 family
Preventive care 100% 100% 100% 100%
Office Visits (primary care) 80%2 $25 copay $20 copay $20 copay
Office Visits (specialists) 80%2 $40 copay $35 copay $35 copay
Teladoc $40 $25 copay $20 copay N/A
Coverage for most services 80%2 80%2 90%2 $20 copay
Emergency Care 80%2 80%2 90%2 $75 copay
Inpatient Hospital 80%2 80%2 90%2 $250 per admission
Outpatient Testing 80%2 80%2 90%2 $50 per procedure
Diagnostic X-ray and laboratory 80%2 80%2 90%2 No Charge
Inpatient mental health & substance use 80%2 80%2 90%2 $250 per admission
Outpatient facility $25 office visit $20 office visit
80%2 $20 copay
Per admission copayment/coinsurance copay copay
OUT-OF-NETWORK
$2,700 single1 $1,200 individual
Annual Deductible No Coverage No Coverage
$5,400 family1 $2,400 family
Coinsurance after deductible
60% 60% No Coverage No Coverage
Annual out-of-pocket limit $7,500 individual $8,000 individual
Note: Any amount over maximum allowable No Coverage No Coverage
charge is not included. $15,000 family $16,000 family
Preventive Care 80% 80% No Coverage No Coverage
1
onsumer Choice Plan annual deductible includes all health care expenses and prescription drug costs, except for certain preventive medications.
C
2
A
fter deductible
3
Family out-of-pocket has an embedded per member out-of-pocket maximum of $6,850 for in-network services.
Note: Out-of-pocket and deductible cross apply in- and out-of-network.
9
PRESCRIPTION DRUG COVERAGE
Express Scripts (for Aetna Plans) Kaiser
SONY CONSUMER CHOICE /
KAISER HMO (CALIFORNIA ONLY)
SONY PPO/SONY EPO
RETAIL MAIL
RETAIL (30-DAY SUPPLY) MAIL (100-DAY SUPPLY)
(30-DAY SUPPLY) (90-DAY SUPPLY)
Generic $10 $20
$10 $20
30% 30%
Preferred
$25 min, $75 max $55 min, $125 max
40% 40% $20 $40
Non-Preferred
$40 min, $100 max $70 min, $150 max
All Sony medical plans cover the full cost of certain contraceptives, tobacco cessation medications and other preventive drugs as
required by the Affordable Care Act (ACA).
Express Scripts Sony Consumer Choice Plan and Prescriptions
If you purchase a brand-name (preferred or non-preferred) For most prescriptions, you’ll pay 100% of the cost of a
drug when a generic is available, you’ll pay the coinsurance prescription until you reach the plan’s deductible. However,
plus the difference in cost between the brand-name and these certain medications that can help you avoid or curtail
generic drug, unless your prescription specifically prohibits certain illnesses and conditions may also be covered at 100%.1
generic substitution. This list includes medications used for prevention or for
treatment. Conditions that may be covered include:
Mail Order • Asthma • Cholesterol
If you take a maintenance medication, you may fill it three times • Diabetes • High blood pressure
at a retail pharmacy. On the fourth refill, you must use the mail
order service or pay the full cost of your prescription. • Heart disease • Side effects of cancer treatment
For a complete list of covered preventive prescriptions
covered at 100%, go to www.KENKOatSPE.com.
HELPFUL PRESCRIPTION TERMS
BRAND NAME: A drug marketed under a trademark-protected name like
Ambien or Prozac.
COMPOUND MEDICATION: Medications that are combined, mixed or
altered by a licensed pharmacist. The FDA does not verify the quality,
safety or effectiveness of compound medications, they are not covered
under the plan.
GENERIC: A generic drug is equivalent to the original brand-name drug in
dosage, safety, strength, quality, performance and intended use. By law,
the amount of active ingredient in a generic drug must be identical to the
brand-name product.
NON-PREFERRED DRUGS: Non-preferred medications under your plan
for which you’ll pay more.
PREFERRED DRUGS: Preferred generic and brand-name medications
under your plan for which you’ll pay a reduced rate.
10YOUR COST FOR 2018 MEDICAL COVERAGE
Below is a breakdown of your cost per month for each benefit. How much you pay is based on your elections and your base salary
when you’re hired (and each September 1st thereafter). SPE shares the cost of most of your benefits with you as part of our
commitment to offering you the protection you need. Your payroll deductions are generally taken out of your pay on a pre-tax basis,
which means you pay less in taxes. Consult your tax advisor for details. The chart below shows your monthly contribution rates.
MEDICAL PLAN EMPLOYEE CONTRIBUTION RATES
(includes Prescription Drug Coverage)
$60,000 to $200,000 to $300,000 and
BASE SALARY Under $60,000
$199,999 $299,999 Above
EMPLOYEE MONTHLY COST
SONY CONSUMER CHOICE PPO
Employee only $64 $64 $64 $64
Employee + spouse/partner $157 $184 $229 $303
Employee + child(ren) $125 $148 $181 $235
Employee + family $211 $261 $325 $425
SONY PPO
Employee only $231 $274 $318 $374
Employee + spouse/partner $463 $550 $647 $782
Employee + child(ren) $370 $426 $509 $580
Employee + family $637 $758 $893 $1,073
SONY EPO
Employee only $126 $142 $167 $182
Employee + spouse/partner $255 $294 $345 $390
Employee + child(ren) $205 $231 $276 $315
Employee + family $372 $420 $505 $520
KAISER HMO (CA ONLY)
Employee only $98 $106 $133 $146
Employee + spouse/partner $219 $255 $295 $327
Employee + child(ren) $187 $212 $252 $319
Employee + family $296 $335 $401 $414
11SAVE NOW, SPEND LATER — FSA
USE IT OR LOSE IT:
You have until December 31, 2018 to use your
FSA funds. Make sure you plan your contributions
carefully because unused amounts are forfeited.
Flexible Spending Accounts (FSAs) increase your spendable income through pre-tax contributions. We offer three types of FSAs.
You determine how much you need to contribute to each account. Your contributions are deducted from your paycheck on a
before-tax (subject to IRS) basis. FSAs and the HSA are administered by Payflex.
Health Care FSA (general purpose) Dependent Care FSA
Annual Contribution: Up to $2,600 each year, before taxes Annual Contribution: Up to $5,0001 each year, before taxes
You may pay for items such as medical and dental plan Similar to the Health Care FSA, you may increase your
deductibles, copayments, coinsurance, contact lenses, spendable income by enrolling in the Dependent Care FSA for
orthodontics, medical equipment and vision care expenses. qualified dependent day care or elder care expenses.
Limited Purpose Health Care FSA Qualified Caregivers Include:
• Licensed child care centers
Annual Contribution: Up to $2,600 each year, before taxes
• Nursery & preschools
Under IRS guidance, individuals cannot contribute to an HSA
and a general purpose Health Care FSA, so SPE offers a • In-home care (au pair/nanny) and babysitting
Limted Purpose Health Care FSA to participants in the Sony • Elder/senior day care
Consumer Choice Plan. This will allow HSA participants to
be reimbursed for dental and vision expenses, as well as any Qualified Dependents Include:
qualified medical expenses once the Sony Consumer Choice • Your child who is age 12 or younger
Plan’s deductible is met.
• A spouse or dependent of any age who lives with you, relies
For a complete list of qualified Health Care FSA on you and is physically or mentally unable to care for him
expenses, view IRS Publication 502: or herself, listed as a dependent on your income taxes.
www.irs.gov/pub/irs-pdf/p502.pdf
Consult your tax advisor on whether you should enroll in the
Dependent Care FSA or take advantage of the depdendent
care tax credit.
1
Highly compensated employees (those earning more than $115,000 in 2016) will be limited to $2,800 annual contribution.
12VISION COVERAGE
The Vision Plan is provided by VSP. Under this plan, you and
your family are covered for eye exams, lenses and frames
once per calendar year. If you use an in-network provider,
your plan covers your eye exam, and glasses (frame and
lens) or contact lens allowance. If you use an out-of-network
provider, your plan may or may not cover the full cost of your
exam, and your glasses or contact lens allowance will vary
by selection. When you use an in-network provider, you may
also be eligible for discounts on additional products or services
purchased during the same visit or even later in the same year.
You’ll find a list of certified network optometrists and
ophthalmologists at www.vsp.com.
2018 Vision Plan Monthly Contributions
COVERAGE LEVEL STANDARD PLAN
Employee only $5.25
Employee + Spouse/Partner $8.50
Employee + Child(ren) $8.50
Employee + Family $14
Vision Plan at a Glance (In-Network Benefits1)
BENEFIT DESCRIPTION COPAY FREQUENCY
WellVision exam • Focuses on your eyes and overall wellness No copay
Prescription Glasses $10 Copay See Frames & Lenses
Frames • $150 allowance for a wide selection of frames
• $170 allowance for featured frame brands No Copay
Every Calendar Year
• 20% savings on the amount over your allowance Combined with exam
• Or, $80 allowance at Costco® Optical
Lenses • Single vision, lined bifocal and lined trifocal lenses No Copay
Every Calendar Year
• Polycarbonate lenses for dependent children Combined with exam
Contacts •$ 150 allowance for contacts and contact lens exam
(fitting and evaluation) Every Calendar Year
(instead of glasses)
• 15% off contact lens exam (fitting and evaluation)
Extra savings Glasses and sunglasses
• 30% savings on additional glasses and sunglasses, including lens enhancements, from the same VSP
provider on the same WellVision exam. Or, get 20% from any VSP provider within 12 months of your
last WellVision exam.
Laser vision correction
• Average 15% off the regular price or 5% off the promotional price; discounts only available from
contracted facilities.
1 Out-of-network benefits are available; contact VSP for details.
13DENTAL COVERAGE
Like your medical plan, dental coverage also includes
preventive care benefits. Take advantage of these benefits and
schedule regular checkups with your dentist.
You are able to select from two dental options through Delta
Dental: the Sony High Plan and the Sony Standard Plan.
2018 Dental Monthly Contributions
SONY
SONY HIGH
PLAN FEATURE STANDARD
PLAN
PLAN
In-Network In-Network
Employee only $23 $9
Employee + Spouse/Partner $50 $19
See if your dentist is in the Delta PPO or Premier
Employee + child(ren) $54 $21
network. You can check on www.deltadentalins.
Employee + family $83 $32 com/sony, or call 1-800-471-7059.
Sony Dental Plans at a Glance
PLAN FEATURE SONY HIGH PLAN SONY STANDARD PLAN
In-Network In-Network
Annual deductible $50 per person, $150 per family $25 per person, $50 per family
Annual maximum benefit1 $3,000 (includes orthodontia) $1,500
Preventive and diagnostic services1
100%2 (Two cleanings per year) 100%2 (Two cleanings per year)
(Exams, routine cleanings3, X-rays, etc.)
Basic restorative services
90% after deductible 80% after deductible
(fillings, extractions, root canals, periodontal3)
Major restorative services
85% after deductible 60% after deductible
(crowns, bridges, dentures, implants)
Orthodontia
50% after deductible Not covered
(for adults and dependent children)
Preventive 100%, Basic 80%,
Out-of-Network Preventive 100%, Basic 80%, Major 50%
Major 50%, Ortho 50%
1
Preventive and diagnostic services are applied toward the annual maximum.
2
You do not need to meet the deductible before preventive and diagnostic services are covered.
3
Two periodontal cleanings are covered in addition to two covered routine cleanings.
14LIFE / AD&D / DISABILITY
Financial health is just as important as physical health. We all • You may purchase Optional Life and AD&D coverage for
have concerns about how loved ones would get by if something yourself or family up to eight times your annual base
happened to us. SPE offers you the opportunity to replace salary, (rounded to the next $1,000) or up to $1,500,000,
concern with solid financial planning to protect your loved ones. whichever is less.
• You may purchase Optional Life for your legally married
Life / Accidental Death & Dismemberment spouse or domestic partner in increments $10,000,
$25,000, $50,000, $100,000 or $250,000. You may
(AD&D) Insurance also purchase coverage of $10,000 or $20,000 for your
Eligible employees are provided with Basic Life Insurance dependent children.
and Basic AD&D equal to 1x annual base pay at no cost to you. • Optional AD & D coverage may be purchased for your family
Coverage is provided by Cigna. Basic life insurance paid by as follows:
SPE in excess of $50,000 in coverage is taxable to you as - Legally married spouse/partner - 60% of your
imputed income. insurance amount.
- Children - 25% of your insurance amount up to
OPTIONAL LIFE INSURANCE EMPLOYEE CONTRIBUTION $50,000 per child.
RATES (CIGNA)
Additional Employee Additional spouse/ Long Term Disability (LTD)
Life Insurance partner Life
This coverage pays benefits in the event of an illness or injury
Age Monthly Cost Insurance Monthly
that prevents you from working for an extended period of
(Per $1,000 of Cost (Per $1,000
time. Through Liberty Mutual, you are automatically enrolled
Coverage) of Coverage)
for basic coverage that pays a benefit of 60% of your monthly
Under 25 $0.034 $0.050 base pay, up to a maximum of $20,000 (after 180 days of
25-29 $0.041 $0.060 disability) at no additional cost to you.
30-34 $0.054 $0.080 • You may purchase optional coverage, which increases
35-39 $0.062 $0.090 your coverage amount to 70% of your monthly base pay, to
a maximum of $20,000.
40-44 $0.068 $0.100
45-49 $0.102 $0.150
Important tax information:
Your premium for basic and optional LTD will be taxed. However, the
50-54 $0.157 $0.230 LTD benefit, should you ever need it, will not be taxable.
55-59 $0.294 $0.430
60-64 $0.449 $0.660 OPTIONAL LTD EMPLOYEE CONTRIBUTION RATES
65-69 $0.864 $1.270 (LIBERTY MUTUAL)
70 and older $1.400 $2.060 Additional Employee LTD Monthly Cost
Age
Child Life $10,000 coverage: $0.200 per month (Per $100 of Coverage)
$20,000 coverage: $0.400 per month Under 25 $0.029
OPTIONAL AD&D RATES 25-29 $0.033
The monthly cost is $0.011 per 30-34 $0.037
Employee only
$1,000 of coverage. 35-39 $0.063
The monthly cost is $0.023 per 40-44 $0.083
Employee and family
$1,000 of coverage.
45-49 $0.137
Leaves of Absence 50-54 $0.212
SPE provides a variety of leaves of absence that allow 55-59 $0.253
employees to take time off. Some of these leaves are required 60-64 $0.253
by Federal and State Law. Other leaves, such as a Personal
Leave, are offered at the discretion of SPE. For specific 65-69 $0.270
information applicable to a particular leave, please refer to the 70 and older $0.362
Leave of Absence policies in the Employee Handbook. Contact
SPE Leave Administration at 1-800-530-6506 to report a leave.
15HEALTH & WELLNESS
Employee Assistance Program (EAP)
To help manage the competing time demands and stress of
today’s fast-paced world, SPE has partnered with ComPsych®
Corporation to bring all employees and their dependents
GuidanceResources®. It is your one stop for expert information
on the issues that matter most to you.
• Eight visits per year for counseling, addiction, stress, etc.
• Timely articles, HelpSheetsSM, tutorials, streaming videos
and self-assessments
• “Ask the Expert” personal responses to your questions
• Child care, elder care, attorney and financial
planner searches
Just call 1-855-327-7669 (1-855-EAP-SONY) or click
www.guidanceresources.com, web ID: EAPSONY to access
your services, 24 hours a day, seven days a week. The
information shared with the Guidance Resources counselor
(and outside resources) is completely confidential.
Best Doctors
Best Doctors is available to all eligible employees and their
dependents enrolled in SPE’s benefit plans. It is 100%
confidential and provided at no cost to you. Best Doctors offers
three important services to help you and your family members
make medical decisions with confidence.
• In-Depth Medical Review – It’s like getting a second
opinion, only much better. Through special patented
process called InterConsultation™ the Best Doctors As part of SPE’s ongoing partnership with you in
expert reviews everything in great detail and creates a managing your health and well-being, SPE offers
comprehensive report, either confirming what you’ve been tools and resources that help you understand your
told or recommending a change.
options, evaluate the financial impact and give the
• Ask the Expert – Discuss your concerns and get answers
support to make smart health care decisions for
to basic questions about a diagnosis, treatment options or
a health condition. They will also help you determine what you and your family.
questions to ask.
• Find a Doctor – If you need to find a specialist in your local
area who is approved by your health plan, Best Doctors
can help. They have a database of more than 53,000
Back-Up Care Advantage
medical experts in over 450 specialties and subspecialties • The Bright Horizons® Back-Up Care Advantage (BUCA)
worldwide. Go to https://members.bestdoctors.com or Program provides back-up care – where and when you
call 1-866-904-0910. need it. It is designed for any type of emergency situation
when your regular child or adult/elder care arrangements
break down. For example, you can rely on back-up
ON SITE NURSE ADVOCATE care when:
Need a helping hand? Reach out to MaeDel Martin. • A regular caregiver is unavailable or in need of respite.
Think of her as your personal benefits advisor – • A child is mildly ill and cannot attend school or child care.
ready with the answers or to connect you to the • Schools/child care programs are closed for vacation, in-
appropriate resources to guide you. She is also a service days, or holidays.
professional nurse so she is adept at maneuvering • An adult/elder relative is unexpectedly ill or recovering
through the healthcare maze. Contact MaeDel directly from medical treatment.
at 310-244-6636, or email MartinM7@aetna.com. For more information on SPE’s Back-Up Care program,
go to the Discover section at www.KENKOatSPE.com
16MORE BENEFITS
Business Travel Benefits Financial Wellness
Business Travel Accident Plan (Cigna) Sony USA 401(K) Plan
Covers you and your eligible dependents while you are
Everyone strives for the chance to retire comfortably. The
traveling on Company business at least 100 miles away
Sony USA 401(k) Plan is the ideal way to achieve retirement
from your home.
dreams by investing money now so you can enjoy the benefits
Cigna Medical Benefits Abroad (MBA) later.
Pays a benefit of up to $200,000 (per calendar year) if Simply log on to www.empower-retirement.com/sony
you have an accident or illness while you are traveling on
Our Plan offers you:
Company business outside your home country or country
of residence. • Pre-tax and/or after-tax savings
International SOS • Immediate match and immediate vesting
Provides medical assistance, travel assistance, and security • Company match 100% for the first 3% you contribute, then
services to those traveling internationally on Company 50% for the next 3%
business. For more information on your business travel
To manage your account, visit www.empower-retirement.
benefits, contact International SOS at 800-523-6523 (US).
com/sony and enter your Username and Password or call
Commuter Benefits the Sony Savings Plans Service Center at 1-877-SONY-SAVE
(1-877- 766-9728) from 8 a.m. to 9 p.m. Eastern time, Monday
Commuting to work can take its toll on your wallet. The through Friday, for assistance.
Commuter Benefits products allow you to pay for certain
work-related transportation expenses on a pre-tax basis. Employee Stock Purchase Plan (ESPP)
You can own a piece of Sony. Through the Employee Stock
Two Ways to Save Purchase Plan (ESPP), you can be a shareholder in Sony
Parking Benefit: Use pretax dollars to pay for work-related with the convenience of payroll deductions to purchase Sony
parking expense. Eligible expenses include: American Depositary Receipt (ADR) common stock. Sony ADR
• the cost of parking at or near your worksite. stock is traded on the New York Stock Exchange (ticker symbol
SNE) in U.S. dollars. Eligible employees can purchase shares
• the cost of parking at a location from which you commute
through after-tax payroll deductions. For more information call
to work, either by mass transit or a qualifying commercial
the plan administrator, Computershare at 1-800-621-3777 or
or non-commercial vehicle or carpool.
go to www.Computershare.com. You can find the enrollment
Transit Benefit: Purchase passes or vouchers on a pre-tax forms on mySPE.
basis to cover the cost of mass transit to and from work.
Eligible expenses include:
• Subway, train, bus.
• Vanpool costs are also covered.
The IRS sets the monthly reimbursement rates. These are
adjusted periodically for inflation. Visit www.irs.gov for more
information or go to www.payflexdirect.com.
17AETNA TOOLS & RESOURCES
Teladoc Aetna Navigator®
Teladoc is a convenient and affordable alternative for non- When you enroll in an Aetna medical plan, register for the
emergency medical care. Whether you’re at home, at work or secure Aetna Navigator member website. You can:
out of town (in the U.S. only), you can request a consultation • Review benefits information
with a board-certified, telemedicine-trained doctor any time.
• View Explanation of Benefits statements
How does it work? • View Personal Health Record (PHR)
After you set up a Teladoc account, get in touch with Teladoc
at www.teladoc.com/Aetna or call 1-855-Teladoc (1-855- • Download and print standard Aetna forms
835-2362) and request a consult from a physician. A doctor • Order an ID card or print a temporary card
will call you back in approximately 15 minutes. You will then:
• See if your doctor is in the Aetna network on
• Receive a diagnosis and short-term prescriptions* (if SPE’s Custom DocFind®
necessary) during your appointment for conditions
Visit www.aetna.com/dse/custom/sony. You can search by
including: allergies, sinus problems, bronchitis, cold and
zip code, doctor name, specialty, hospital affiliation or gender.
flu symptoms, pink eye, urinary tract and respiratory
When prompted for your plan type, select your plan.
infections, poison ivy and more.
• Teladoc and Aetna will confirm your eligibility in real time
along with determining how much you will be responsible
Aetna In Touch Care
to pay for the consultation. If you are enrolled in the Sony The Aetna In Touch CareSM program puts Aetna nurses on your
Consumer Choice Plan, this service will costs $40 per case. When your records show that you have certain health
visit (until the deductible is reached). If you are enrolled in risks, an Aetna nurse or consultant will call to offer support.
the PPO or EPO, it will be charged as a primary care office You can choose to work one-on-one with your assigned nurse,
visit copay. or use the self-directed programs. You can even try both for a
*Charges for prescriptions are subject to pharmacy benefits. well-rounded level of help. And, if you chose online programs,
you can still connect with your assigned nurse when you have
Consulting with Teladoc a question or issue. Working with an In Touch Care Nurse is
You can speak with a Teladoc doctor via a phone consult, video voluntary. However, the nurse is properly trained to assist
consult within the secure member portal, or video consult you in navigating through the health care system to help you
within the Teladoc mobile app. optimize your health benefits.
Teladoc costs far less than urgent care or emergency room
visits for non-emergency medical care. It also qualifies as an Talk to a Registered Nurse – Anytime, 24/7
expense for HSA and FSA accounts. Teladoc does not replace Sometimes your question can’t wait until a doctor visit. Or even
your primary care physician. the next morning! As an Aetna member, you’ll have round-the-
clock access to a registered nurse with the Informed Health®
Line at 1-800-556-1555.
A WORD ABOUT PRIVACY Know Before You Go!
Before selecting Aetna, we made sure that they The Cost of Medical Procedure by Facility Tool helps you
comply with all applicable data privacy laws review and compare the cost of medical procedures at
as well as Sony’s data privacy and security facilities in select locations around the country. This tool gives
requirements. Sony will not have access to you an easy way to find the cost for over 30 common medical
your medical information. procedures performed at specific hospitals and other health
care facilities. Rates can vary by provider based on their
contracted rate with Aetna.
18WHERE TO GET MORE INFORMATION
BENEFIT PROVIDER PHONE NUMBER WEBSITE
SPE Benefits Center SPE 833-9-SONY-01 https://benefitscenter.spe.sony.com
SPE Benefits Connection
SPE 1-866-941-4773 https://benefits.spe.sony.com
2017 Benefits Only
Medical
Aetna 1-888-385-1053 www.aetna.com
• Sony Consumer Choice
• Sony PPO
• Sony EPO Kaiser Permanente 1-800-464-4000 www.kp.org
• Kaiser HMO
www.teladoc.com/Aetna
Teladoc Aetna 1-855-835-2362
Mobile: www.teladoc.com/mobile
Express Scripts 1-800-716-2773 www.express-scripts.com/sonypics
Prescription Drugs
Kaiser (Sony Plans) 1-800-464-4000 www.kp.org
Emma: https://benefits.spe.sony.com
Medical Plan Compare Tools SPE N/A Aetna Plan Compare Tool:
https://www.aetna.com/planselection/
mbrDis.jsp?id=1055
Dental
• Sony Standard Plan Delta Dental 1-800-471-7059 www.deltadentalins.com/sony
• Sony High Plan
Flexible Spending Accounts (FSAs) www.aetna.com
Aetna/Payflex 1-888-678-8242
Health Savings Account (HSA) https://www.payflex.com
Vision Coverage Vision Service Plan 1-800-877-7195 www.vsp.com
Financial Wellness: Empower
1-877-766-9728 www.empower-retirement.com/sony
• Sony USA 401(k) Plan Retirement
• Employee Stock Purchase Plan
(ESPP) ComputerShare 1-800-621-3777 www.computershare.com
Employee Assistance Program ComPsych Guidance www.guidanceresources.com
1-855-327-7669
(EAP) Resources (Web ID: EAPSONY)
KENKŌ Health & Wellness SPE N/A www.KENKOatSPE.com
http://backup.brighthorizons.com
Back-Up Care Advantage Benefits Bright Horizons 1-877-242-2937 (first time users: User name: SPE/
password: backup1 )
Best Doctors Best Doctors 1-866-904-0910 www.bestdoctors.com/members
1-800-523-6586 (US) www.internationalsos.com
Business Travel Benefits Information International SOS
1-215-942-8226 (Member Number 11BCPA000212)
www.mylibertyconnection.com
Leaves of Absence/Disability Liberty Mutual 1-800-530-6506
(Company code: sony pictures)
19ADMINISTRATIVE INFORMATION
Summary of Benefits and Coverage
The health benefits available to you represent a significant component of your SPE Total Rewards package, in addition to your
compensation, and provides important protection for you and your family in the case of illness or injury. Your SPE plan offers a
series of health coverage options. Choosing a health coverage option is an important decision.
To help you make an informed choice, your plan makes available a Summary of Benefits and Coverage (SBC) to help you
compare your options. The SBC is available on SPE Benefits Center at https://BenefitsCenter.spe.sony.com under the Forms
and Documents section and at www.KENKOatSPE.com. You can also request a paper copy, free of charge, by contacting a SPE
Benefits Center Representative at 1-888-9-SONY-01. If you have dependents in your household who are enrolled in the SPE plan,
please share this information with them. Be aware that any SBC provided to you will be deemed to have been provided to your
dependents unless the plan is advised of a different address.
under Medicare’s prescription drug coverage. This information
MEDICARE PART D can help you decide whether or not you want to join a
Medicare prescription drug plan. If you are considering joining,
PRESCRIPTION DRUG COVERAGE you should compare your current coverage, including which
drugs are covered at what cost, with the coverage and costs
Important Notice for Medicare-Eligible of the plans offering Medicare prescription drug coverage in
your area. Information about where you can get help to make
Employees and Covered Dependents decisions about your prescription drug coverage is at the end
of this notice.
Sony Pictures Entertainment (SPE) is required to provide the There are two important facts you need to know about your
notice that follows to all Medicare-eligible plan participants. current coverage and Medicare’s prescription drug coverage:
The purpose of the notice is to provide you with a statement 1. Medicare prescription drug coverage became available in
of assurance that while you are enrolled in Sony EPO, Sony 2006 to everyone with Medicare.
PPO, Sony Consumer Choice or Kaiser HMO, the prescription
drug coverage you have under any of these SPE medical You can get this coverage if you join a Medicare
plans is “Creditable Coverage.” This means that, on average, prescription drug plan or join a Medicare Advantage
your SPE coverage is at least as good as the standard plan (like an HMO or PPO) that offers prescription drug
Medicare prescription drug coverage. (For more information coverage. All Medicare drug plans provide at least a
on Creditable Coverage, you can refer to the “Creditable standard level of coverage set by Medicare. Some
Coverage” section of the notice below.) plans may also offer more coverage for a higher
monthly premium.
Medicare prescription drug coverage is optional, and you
may find that you have all the coverage you need with SPE. 2. SPE determined that the prescription drug coverage
If you decide in a subsequent year that you want to enroll in offered by SPE is, on average for all plan participants,
a Medicare prescription drug plan, this notice will serve as expected to pay out as much as standard Medicare
confirmation to Medicare that you had Creditable Coverage in prescription drug coverage pays and is considered
the interim. As a result, you will not have to pay a late penalty Creditable Coverage.
on your Medicare prescription drug plan monthly premium if Because your existing coverage is, on average, at least as
you decide to enroll during a subsequent annual enrollment good as standard Medicare prescription drug coverage, you
window. Note, however, that if you opt out (choose the “No can keep this coverage and not pay a higher premium (a
Coverage” option) with SPE, you do not have Creditable penalty) if you later decide to join a Medicare prescription
Coverage and may be subject to a future premium penalty if drug plan.
you subsequently enroll in a Medicare prescription drug plan.
The notice that follows explains the effect of having Creditable
and non-Creditable Coverage.
When Can You Join a Medicare Drug Plan?
You can join a Medicare prescription drug plan when you first
Important Notice from SPE About Your become eligible for Medicare and each year from October
15 through December 7. However, if you lose creditable
Prescription Drug Coverage and Medicare prescription drug coverage through no fault of your own, you
will be eligible for a two-month Special Enrollment Period
Please read this notice carefully and keep it where you
(SEP) to join a Medicare drug plan.
can find it. This notice has information about your current
prescription drug coverage with SPE and about your options
20ADMINISTRATIVE INFORMATION CONT’D
What Happens to Your Current Coverage If year from Medicare. You may also be contacted directly by
Medicare prescription drug plans.
You Decide to Join a Medicare Drug Plan? For more information about Medicare prescription drug coverage:
If you decide to join a Medicare prescription drug plan, your • Visit www.medicare.gov
current SPE coverage is not affected.
• Call your State Health Insurance Assistance Program (see
If you decide to join a Medicare prescription drug plan and the inside back cover of your copy of the “Medicare & You”
drop your SPE prescription drug and medical coverage, handbook for the telephone number) for personalized help
be aware that you and your dependents may not be able
to get this coverage back. Please remember that your SPE • Call 1-800-MEDICARE (1-800-633-4227).
prescription drug coverage is bundled with your medical plan TTY users should call 1-877-486-2048
option. Therefore, there is no separate employee contribution
for prescription drug coverage. If you want to keep your SPE If you have limited income and resources, extra help paying
coverage and you want to avoid duplicate premiums, you for Medicare prescription drug coverage is available. For
should NOT enroll in Medicare prescription drug coverage information about this extra help, visit Social Security on
for 2017. the Web at www.socialsecurity.gov, or call 1-800-772-1213
(TTY 1-800-325-0778).
Please contact us for more information about what happens
to your coverage if you enroll in a Medicare prescription
drug plan. Remember: Keep this Creditable Coverage notice.
If you decide to join one of the Medicare prescription
When Will You Pay a Higher Premium drug plans, you may be required to provide a copy of this
(Penalty) To Join a Medicare Drug Plan? notice when you join to show whether or not you have
maintained Creditable Coverage and whether or not you
You should know that if you drop or lose your coverage with are required to pay a higher premium (a penalty).
SPE and don’t join a Medicare prescription drug plan within
63 continuous days after your current coverage ends, you
may pay a higher premium (a penalty) to join a Medicare Date: October 1, 2017
prescription drug plan later. If you go 63 continuous days or Name of Sender: Sony Pictures Entertainment
longer without creditable prescription drug coverage, your
Contact Office: People & Organization - Total Rewards
monthly premium may go up by at least 1% of the Medicare
base beneficiary premium per month for every month that you Address: 10202 West Washington Boulevard,
did not have that coverage. For example, if you go 19 months Culver City, CA 90232
without Creditable Coverage, your premium may consistently Phone Number: 1-310-244-4000
be at least 19% higher than the base beneficiary premium. You
may have to pay this higher premium (a penalty) as long as
you have Medicare prescription drug coverage. In addition, Notification of Your Rights to Plan
you may have to wait until the following October to join.
Modification, Termination, and Interpretation
For More Information About This Notice or SPE reserves the right in its sole and absolute discretion to
amend, modify, or terminate any or all employee benefit plans at
Your Current Prescription Drug Coverage any time and for any reason. This means that SPE may decide to
If you have questions, call a SPE Benefits Center change the design of the prescription drug benefit so that it no
representative toll-free at 1-833-9-SONY-01. longer constitutes Creditable Coverage. If this happens, we will
notify you of the change and of your options at that time.
NOTE: You’ll get this notice each year. You will also get it
before the next period you can join a Medicare prescription In addition, SPE reserves the sole and absolute discretionary
drug plan, and if this coverage through SPE changes. You also right to interpret and apply the terms of the medical plan and
may request a copy of this notice at any time from an SPE to render final and binding decisions about the plan and its
Benefits Center representative toll-free at 1-833-9-SONY-01. coverage. In the event of a conflict between this notice and the
terms of the plan, the terms of the plan will govern in all cases.
For More Information About Your Options Notification of Your Rights for Benefits
Under Medicare Prescription Drug Coverage Continuation of Coverage
More detailed information about Medicare plans that offer
prescription drug coverage is in the “Medicare & You” On April 7, 1986, a federal law was enacted (Public Law 99-
handbook. You’ll get a copy of the handbook in the mail every 272, Title X – The Consolidated Omnibus Budget Reconciliation
21ADMINISTRATIVE INFORMATION CONT’D
Act of 1985 [“COBRA”]) – requiring that most employers
sponsoring group health plans offer employees and their
HIPAA Privacy Statement
families the opportunity for a temporary extension of health Sony Pictures maintains the privacy and security of your
coverage (called “Continuation Coverage”) at group rates personal health information in compliance with HIPAA. All
in certain instances where coverage under the plan would policies regarding the HIPAA Privacy and Security regulations
otherwise end (called “qualifying events”). For additional may be found in Sony Pictures’ HIPAA Privacy Notice which
information about your rights and obligations under the Plan describes our legal duties and privacy practices relating to how
and under federal law, you should review the Plan’s Summary medical information about you may be used and/or distributed.
Plan Description or contact the plan administrator. You can get a copy of the Privacy Notice, for no charge, on
SPE Benefits Center or on www.KENKOatSPE.com. You can
Special Enrollment Periods request a paper copy at no charge by calling (310) 244-4748.
If you decline enrollment for yourself or your dependents
(including your spouse) because of other health insurance or
Patient Protection Notice
group health plan coverage, you may be able to enroll yourself The Kaiser Permanente HMO generally requires the
and your dependents in this Plan if you or your dependents designation of a primary care provider. You have the right to
lose eligibility for that other coverage (or if the employer stops designate any primary care provider who participates in our
contributing toward your or your dependents’ other coverage). network and who is available to accept you or your family
members. Until you make this designation, Kaiser Permanente
However, you must request enrollment within 31 days after
will designate one for you. For information on how to select
your or your dependents’ other coverage ends (or after the
a primary care provider, and for a list of the participating
employer stops contributing toward the other coverage).
primary care providers, contact Kaiser at 1-800-464-4000.
In addition, if you have a new dependent as a result of
For children, you may designate a pediatrician as the primary
marriage, birth, adoption, or placement for adoption, you may
care provider. You do not need prior authorization from Kaiser
be able to enroll yourself and your dependents. However, you
or from any other person (including a primary care provider)
must request enrollment within 31 days after the marriage,
in order to obtain access to obstetrical or gynecological
birth, adoption, or placement for adoption.
care from a health care professional in our network who
If you decline enrollment for yourself or for an eligible specializes in obstetrics or gynecology. The health care
dependent (including your spouse) while Medicaid coverage or professional, however, may be required to comply with
coverage under a state children’s health insurance program certain procedures, including obtaining prior authorization
is in effect, you may be able to enroll yourself and your for certain services, following a pre-approved treatment plan,
dependents in this plan if you or your dependents lose eligibility or procedures for making referrals. For a list of participating
for that other coverage. However, you must request enrollment health care professionals who specialize in obstetrics or
within 60 days after you or your dependents’ coverage ends gynecology, contact Kaiser at 1-800-464-4000.
under Medicaid or a state health insurance program.
If you or your dependents (including your spouse) become Women’s Health and Cancer Rights Act of
eligible for a state premium assistance subsidy from Medicaid
or through a state children’s health insurance program with
1998 (“WHCRA”)
respect to coverage under this plan, you may be able to enroll Your health care plan, as required by the Women’s Health and
yourself and your dependents in this plan. However, you Cancer Rights Act of 1998, provides benefits for mastectomy-
must request enrollment within 60 days after your or your related services, including all stages of reconstruction and
dependents’ determination of eligibility for such assistance. surgery to achieve symmetry between breasts, prostheses,
and complications resulting from a mastectomy (including
To request special enrollment or obtain more information,
lymphedema). These benefits will be provided subject to the
contact a SPE Benefits Center representative toll-free at
same deductibles and coinsurance applicable to other medical
1-833-9-SONY-01. Individuals who have questions about
and surgical benefits provided under the plan. Call your
HIPAA may contact The Centers for Medicare & Medicaid
health care provider at 1-888-385-1053, Aetna or Kaiser
Services (CMS) toll-free at 1-877-267-2323. The CMS website
at 1-800-464-4000, for more information.
also provides answers to your questions about the provisions
of HIPAA, which can be found at the following Internet address:
http://www.cms.hhs.gov/HIPAAGenInfo/. Individuals may also Newborns’ and Mothers’ Health Protection
contact CMS directly, by mail, at:
Act of 1996
The Centers for Medicare & Medicaid Services, 7500 Security Group health plans and health insurance issuers generally
Boulevard, Baltimore, MD 21244. may not, under Federal law, restrict benefits for any hospital
length of stay in connection with childbirth for the mother or
22You can also read
