CenturyLink Retiree and Inactive Health Care Plan Retiree ...

1 SPD Updated October 2019 CenturyLink Retiree and Inactive Health Care plan Retiree Health Reimbursement Account (HRA) (Administered by YSA) Summary plan Description For CenturyLink Retirees CenturyLink , Inc. Effective 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 benefit options under the plan . Retiree HRA SPD 2020 TABLE OF CONTENTS I. OVERVIEW SUMMARY .. 4 II. ADMINISTRATOR S CONTACT LIST .. 7 III. INTRODUCTION .. 7 THE REQUIRED FORUM FOR LEGAL DISPUTES .. 9 HOW TO USE THIS 9 IV. WHO IS eligible .. 10 eligible DEPENDENTS .. 11 NON- medicare PARTICIPANTS (excluding Qwest Pre-1991 and ERO 92 retirees).

2 12 REHIRED RETIREES .. 12 V. WHEN YOU BECOME medicare - eligible .. 13 VI. HOW TO ENROLL IN AN INDIVIDUAL medicare POLICY .. 14 VII. EFFECTIVE DATES OF COVERAGE - DEADLINES YOU MUST BE AWARE OF .. 16 VIII. FUNDING/COST-WHO PAYS FOR COVERAGE .. 16 IX. AMOUNT OF HRA SUBSIDY AND YEAR END BALANCE RULES .. 17 CDHP HRA .. 19 COMPANY COUPLES HRA 19 X. DENTAL HRA SUBSIDY .. 20 DENTAL PREMIUMS AND BILLINGS .. 21 XI. HOW THE HRA SUBSIDY CAN BE USED .. 22 XII. HOW THE HRA ACCOUNT IS SET UP .. 23 DEFER (SUSPEND) HRA ACCOUNT .. 23 XIII. CLAIMING BENEFITS /HOW TO SUBMIT FOR 24 FILING DEADLINES FOR REIMBURSEMENTS .. 25 XIV. BENEFIT CLAIMS AND APPEAL PROCEDURES .. 25 POST-SERVICE CLAIM .. 26 QUESTIONS, COMPLAINTS, HOW TO APPEAL AN HRA CLAIM.

3 27 HOW YOU APPEAL AN ADVERSE BENEFIT DECISION .. 28 NOTICE TO CLAIMANT OF ADVERSE BENEFIT DETERMINATIONS (FIRST LEVEL) .. 28 NOTICE OF BENEFIT DETERMINATION ON APPEAL (SECOND LEVEL APPEAL) .. 29 ELIGIBILITY/PARTICIPATION CLAIM .. 29 TIME DEADLINE TO FILE A BENEFIT CLAIM AND TIME DEADLINE TO FILE A BENEFIT-RELATED LAWSUIT .. 30 THE REQUIRED FORUM FOR LEGAL DISPUTES .. 31 XV. FALSE OR FRAUDULENT CLAIMS .. 31 XVI. RIGHTS OF RECOVERY .. 31 XVII. CONTINUATION OF medical COVERAGE - COBRA .. 32 Retiree HRA SPD 3 2020 DOMESTIC PARTNER CONTINUATION COVERAGE .. 34 HRA COBRA COVERAGE COST .. 35 SURVIVING SPOUSE medical CONTINUATION COVERAGE .. 35 XVIII. plan ADMINISTRATOR .. 35 XIX. CLAIMS 36 XX.

4 plan FUNDING AND PAYMENT OF BENEFITS .. 36 XXI. plan RECORDS .. 36 XXII. plan SPONSOR, EMPLOYER IDENTIFICATION NUMBER OF plan SPONSOR AND plan 37 XXIII. plan DOCUMENTS .. 37 COMPANY S RESERVED RIGHTS .. 37 THE REQUIRED FORUM FOR LEGAL DISPUTES .. 38 INVALID PROVISIONS .. 38 PARTICIPATING COMPANIES .. 38 XXIV. LEGAL SERVICE .. 38 XXV. plan TYPE .. 39 XXVI. YOUR RIGHTS AS A plan PARTICIPANT .. 39 RECEIVE INFORMATION ABOUT YOUR plan AND BENEFITS .. 39 PRUDENT ACTIONS BY plan FIDUCIARIES .. 39 ENFORCE YOUR RIGHTS .. 39 ASSISTANCE WITH YOUR QUESTIONS .. 40 A WORD ABOUT YOUR PRIVACY .. 40 XXVII. GENERAL INFORMATION .. 40 ANNUAL ENROLLMENT .. 40 QUALIFIED LIFE EVENTS .. 41 REPORT CHANGE OF STATUS DUE TO QUALIFIED LIFE EVENT: GAIN IN ELIGIBILITY.

5 41 REPORT CHANGE OF STATUS DUE TO QUALIFIED LIFE EVENT: LOSS IN ELIGIBILITY .. 41 HIPAA - NOTICE OF PRIVACY PRACTICES .. 42 A Health plan COVERAGE IS NOT Health CARE ADVICE .. 43 MISCELLANEOUS INFORMATION .. 43 REFUND OF BENEFIT OVERPAYMENTS .. 45 TIME LIMITATION ON CIVIL ACTIONS .. 45 XXVIII. LEGAL NOTICES .. 46 QUALIFIED medical CHILD SUPPORT ORDERS (QMCSOS) .. 46 CIRCUMSTANCES THAT MAY AFFECT YOUR plan BENEFITS .. 46 CONSEQUENCES OF FALISIFICATION OR MISREPRESENTATION .. 47 YOU MUST FOLLOW plan PROCEDURES .. 48 plan NUMBER .. 48 Retiree HRA SPD 4 2020 I. OVERVIEW SUMMARY This Summary plan Description (SPD) provides information regarding the Retiree Health Reimbursement Account (HRA) Benefit offered to only those medicare - eligible Retirees and their medicare - eligible Dependents* who are eligible for the CenturyLink Retiree Health care Benefits under the CenturyLink Retiree and Inactive Health plan .

6 This HRA Benefit option is a part of the umbrella CenturyLink Retiree and Inactive Health plan . See the Who is eligible section 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 Benefit provisions vary by the company Retiree group and Benefits 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.

7 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 below. COMPANY/ HRA NAME AMOUNT OF HRA SUBSIDY/ FUNDING FREQUENCY HOW HRA FUNDING CAN BE USED HRA YEAR END BALANCE RULE Embarq (LEQ)/ SHARE RRA The SHARE/RRA balance 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 /Dependent This has a onetime allocation of funding at your retirement, as agreed to in the collective bargaining agreement, if applicable.

8 Premiums and out-of- pocket expenses for medical /prescription, dental and vision (including medicare Part B premium, but excluding any COBRA premiums). Balance rolls over from year to year, but once it is depleted there is no more or additional funding. Retiree HRA SPD 5 2020 Qwest Pre-1991 HRA/ LQ Pre-91 HRA Annual 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. Qwest ERO 92 HRA/ LQ ERO 92 HRA Annual 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).

9 Balance at year end, if any, is forfeited each year. There is no rollover. Qwest Post- 1990 Occupational/ LQ HRA Annual 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 year. Qwest (LQ) Post- 1990 Management/ CS HRA Annual 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).

10 Balance at year end, if any, is forfeited each year. There is no rollover. Retiree HRA SPD 6 2020 CenturyTel (LCTL), including Madison River/ CS HRA An amount based on a calculation as determined by CenturyLink . The amount in your HRA varies by person. Annual allocation of funding, each January 1 in accordance with the collective bargaining agreement, if applicable. 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. There is no rollover. Post-1990 Management and certain LCTL Retirees only/ Dental HRA Amount based on Company subsidy and only available when all enrolled family members are medicare - eligible .