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CenturyLink Retiree and Inactive Health Care Plan

Issued August 2020 Summary Plan DescriptionFor Qwest RepresentedCenturyLink, January 1, 2020 This SPD must be read in conjunction with the Retiree General Information SPD, which explains many details of your coverage and provides a listing of the other bene t options under the Retiree and Inactive Health Care Plan Retiree Health Reimbursement Account (HRA)(Administered by YSA)iiRetiree HRA SPD Issued August 2020I. OVERVIEW SUMMARY 1II. ADMINISTRATOR S CONTACT LIST3 III. INTRODUCTION4 The Required Forum for Legal Disputes 5 HOW TO USE THIS DOCUMENT5 CenturyLink s right to use your Social Security number for administration of bene ts6IV. WHO IS ELIGIBLE6 ELIGIBLE DEPENDENTS7 NON-MEDICARE PARTICIPANTS (excluding Qwest Pre-1991 and ERO 92 retirees)8 REHIRED RETIREES8V.

The Benet provisions vary by the company Retiree group and Benets are subject to change from time to time and overtime, in accordance with the Company’s reserved rights under the Plan. HRA funding is subject to a “Cap” on the Company’s contributions (or subsidy) of coverage, and this Cap will not increase for 2020 or in the future.

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Transcription of CenturyLink Retiree and Inactive Health Care Plan

1 Issued August 2020 Summary Plan DescriptionFor Qwest RepresentedCenturyLink, January 1, 2020 This SPD must be read in conjunction with the Retiree General Information SPD, which explains many details of your coverage and provides a listing of the other bene t options under the Retiree and Inactive Health Care Plan Retiree Health Reimbursement Account (HRA)(Administered by YSA)iiRetiree HRA SPD Issued August 2020I. OVERVIEW SUMMARY 1II. ADMINISTRATOR S CONTACT LIST3 III. INTRODUCTION4 The Required Forum for Legal Disputes 5 HOW TO USE THIS DOCUMENT5 CenturyLink s right to use your Social Security number for administration of bene ts6IV. WHO IS ELIGIBLE6 ELIGIBLE DEPENDENTS7 NON-MEDICARE PARTICIPANTS (excluding Qwest Pre-1991 and ERO 92 retirees)8 REHIRED RETIREES8V.

2 WHEN YOU BECOME MEDICARE-ELIGIBLE8 For additional Medicare information:9VI. HOW TO ENROLL IN AN INDIVIDUAL MEDICARE POLICY10 VII. EFFECTIVE DATES OF COVERAGE - DEADLINES YOU MUST BE AWARE OF11 VIII. FUNDING/COST-WHO PAYS FOR COVERAGE11IX. AMOUNT OF HRA SUBSIDY AND YEAR END BALANCE RULES11 CDHP HRA13 COMPANY COUPLES HRA ACCOUNT13X. DENTAL HRA SUBSIDY14 DENTAL PREMIUMS AND BILLINGS15XI. HOW THE HRA SUBSIDY CAN BE USED15 XII. HOW THE HRA ACCOUNT IS SET UP16 DEFER (SUSPEND) HRA ACCOUNT17 XIII. CLAIMING BENEFITS /HOW TO SUBMIT FOR REIMBURSEMENT17 FILING DEADLINES FOR REIMBURSEMENTS18 XIV. BENEFIT CLAIMS AND APPEAL PROCEDURES18 POST-SERVICE CLAIM19 QUESTIONS, COMPLAINTS, HOW TO APPEAL AN HRA CLAIM20 How Do You Appeal an Adverse Bene t Decision?20 Notice to Claimant of Adverse Bene t Determinations (First Level)21 Notice of Bene t Determination on Appeal (Second Level appeal)21 ELIGIBILITY/PARTICIPATION CLAIM22 Time Deadline to File a Bene t Claim and the Time Deadline to File a Bene t-Related Lawsuit.

3 23 The Required Forum for Legal Disputes 23 Table of ContentsiiiRetiree HRA SPD Issued August 2020XV. FALSE OR FRAUDULENT CLAIMS23 XVI. RIGHTS OF RECOVERY24 XVII. CONTINUATION OF MEDICAL COVERAGE - COBRA 24 Domestic Partner Continuation Coverage26 HRA COBRA COVERAGE COST26 SURVIVING SPOUSE MEDICAL CONTINUATION COVERAGE27 XVIII. PLAN ADMINISTRATOR27 XIX. CLAIMS ADMINISTRATION27XX. PLAN FUNDING AND PAYMENT OF BENEFITS27 XXI. PLAN RECORDS28 XXII. PLAN SPONSOR, EMPLOYER IDENTIFICATION NUMBER OF PLANSPONSOR AND PLAN NUMBER28 XXIII. PLAN DOCUMENTS28 Company s Reserved Rights29 The Required Forum for Legal Disputes 29 Invalid Provisions29 Participating Companies29 XXIV. LEGAL SERVICE30 XXV. PLAN TYPE30 XXVI. YOUR RIGHTS AS A PLAN PARTICIPANT30 Receive Information About Your Plan and Bene Actions by Plan Fiduciaries30 Enforce Your Rights30 Assistance with Your Questions31A Word About Your Privacy31 XXVII.

4 GENERAL INFORMATION31 Annual Enrollment31 Quali ed Life Events31 Report Change of Status Due to Quali ed Life Event: Gain in Eligibility32 Report Change of Status Due to Qualifying Life Event: Loss in Eligibility32 HIPAA - NOTICE OF PRIVACY PRACTICES33A Health PLAN COVERAGE IS NOT Health CARE ADVICE34 MISCELLANEOUS INFORMATION34 Interpretation of Plan34 Clerical Error34 The Required Forum for Legal Disputes35 Conformity with Statutes35 REFUND OF BENEFIT OVERPAYMENTS35 TIME LIMITATION ON CIVIL ACTIONS36ivRetiree HRA SPD Issued August 2020 XXVIII. LEGAL NOTICES36 QUALIFIED MEDICAL CHILD SUPPORT ORDERS (QMCSOS)36 CIRCUMSTANCES THAT MAY AFFECT YOUR PLAN BENEFITS36 Consequences of Falsi cation or Misrepresentation37 You Must Follow Plan Procedures381 Retiree HRA SPD Issued August SUMMARYThis Summary Plan Description (SPD) provides information regarding the Retiree Health Reimbursement Account (HRA) Bene t offered to only those Medicare-eligible Retirees and their Medicare-eligible Dependents* who are eligible for the CenturyLink Retiree Health care Bene ts under the CenturyLink Retiree and Inactive Health Plan.

5 This HRA Bene t option is a part of the umbrella CenturyLink Retiree and Inactive Health Plan. See the IV. WHO IS ELIGIBLE on page 6 of this SPD for more information. (*Note: Embarq is the exception with non-Medicare eligible participants allowed to access the SHARE/RRA as noted in the below chart.)The Bene t provisions vary by the company Retiree group and Bene ts are subject to change from time to time and overtime, in accordance with the Company s reserved rights under the Plan. HRA funding is subject to a Cap on the Company s contributions (or subsidy) of coverage, and this Cap will not increase for 2020 or in the future. The amount of the Company s Capped subsidy for an eligible Retiree s coverage is based on which legacy Retiree group you retire from.

6 Therefore, there are several HRA group names established to facilitate the differences in the provisions. The Embarq SHARE/RRA account is also considered one of the HRAs under this Plan. More details and explanations are provided throughout this document and in the Summary Chart HRA NAMEAMOUNT OF HRA SUBSIDY/ FUNDING FREQUENCYHOW HRA FUNDING CAN BE USEDHRA YEAR END BALANCE RULEE mbarq (LEQ)/SHARE RRAThe SHARE/RRAbalance at the time you retire as determined by CenturyLink . The amount of the SHRARE/RRA varies by person/and can be used by both Medicare and non-Medicare- eligible Retiree /DependentThis has a onetime allocation of funding at your retirement, as agreed to in the collective bargaining agreement, if and out-of- pocket expenses for medical/prescription, dental and vision (including Medicare Part B premium, but excluding any COBRA premiums).

7 Balance rolls over from year to year, but once it is depleted there is no more or additional Pre1991 HRA/ LQ Pre91 HRAA nnual Company Contribution: $3,800/year single$7,600/year single w/spouse or domestic partner(Additional funds are available for Medicare-eligible child(ren))Premiums for after-tax medical and prescription drug, dental and vision coverage (no out-of-pocket expenses or Medicare Part B premiums).Balance at year end, if any, is forfeited each year. There is no rollover. 2 Retiree HRA SPD Issued August 2020 COMPANY/ HRA NAMEAMOUNT OF HRA SUBSIDY/ FUNDING FREQUENCYHOW HRA FUNDING CAN BE USEDHRA YEAR END BALANCE RULEQ west ERO 92 HRA/ LQ ERO 92 HRAA nnual Company Contribution:$3,800/year single$7,600/year single w/spouse or domestic partner(Additional funds are available for Medicare-eligible child(ren))Premiums for after-tax medical and prescription drug, dental and vision coverage (no out-of-pocket expenses or Medicare Part B premiums).

8 Balance at year end, if any, is forfeited each year. There is no rollover. Qwest Post- 1990 Occupational/LQ HRAA nnual Company Contribution:$2,570/year single$5,140/year single w/spouse or domestic partner(Additional funds are available for Medicare-eligible child(ren))Premiums and out-of- pocket expenses for medical/prescription, dental and vision (including Medicare Part B, but excluding COBRA premiums).Balance, if any, rolls over from year to (LQ) Post- 1990 Management/CS HRAA nnual Company Contribution:$1,740/year single$3,480/year single w/spouse or domestic partner(Additional funds are available for Medicare-eligible child(ren))Premiums only for medical/prescription, dental and vision (excluding Medicare Part B and COBRA premiums).Balance at year end, if any, is forfeited each year.

9 There is no (LCTL), including Madison River/CS HRAAn amount based on a calculation as determined by CenturyLink . The amount in your HRA varies by allocation of funding, each January 1 in accordance with the collective bargaining agreement, if only for medical/prescription, dental and vision (excluding Medicare Part B and COBRA premiums).Balance at year end, if any, is forfeited each year. There is no HRA SPD Issued August 2020 COMPANY/ HRA NAMEAMOUNT OF HRA SUBSIDY/ FUNDING FREQUENCYHOW HRA FUNDING CAN BE USEDHRA YEAR END BALANCE RULEPost-1990 Management and certain LCTL Retirees only/Dental HRAA mount based on Company subsidy and only available when all enrolled family members are allocation of funding, each January 1 in accordance with the collective bargaining agreement, if as the medical subsidy dollars.

10 Dollars are added to the medical HRA (but are not tracked separately as dental dollars).Balance at year end, if any, is forfeited each year. There is no with a group CDHP balance/CDHP HRAB alance as determined by UHC or Bind when moved from the group has a onetime allocation of funding at the time the funds are moved. These funds can be used after all other HRA funds are depleted, as only one HRA can be accessed at a only (not premiums) for medical the balance can be applied for the same types of expenses as under the CDHP group medical plan bene t , if any, continues to roll over at year end until depleted. There is no additional S CONTACT LISTThe following list provides toll free numbers for your use should you need to contact any of the administrators below for assistance: 1) CenturyLink Service Center:For any questions about you or your Dependents eligibility for the HRA/SHARE/RRA Bene ts, or your Medicare/ Non-Medicare medical coverage Press 2, then 1 for Healthcare and continue the prompts to the Heath Reimbursement Account.


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