DIRECTORY OF CONTACTS - app3.unisys.com

1 DIRECTORY OF CONTACTS . The table of contents and index should help you locate information. However, if you have a question and the answer is not in this booklet, contact the appropriate resource noted below. On all correspondence, reference your name, Social Security number and current mailing address. DIRECTORY of CONTACTS For answers to questions about Write Or call/contact via Internet Unisys Benefits Service Center Unisys Benefits Service Center 1-800-600-4015, 24 hours a day, 7 days a enrollment PO Box 9233 week; Participant Service Representative, changing benefit elections Boston MA 02205-9233 8:30 am to midnight any business day COBRA coverage (except NY Stock Exchange holidays).

2 Hearing impaired, 1-800-610-4015. Health Alliance Plan HMO Health Alliance Plan (HAP) 1-800-422-4641. plan benefits 2850 West Grand Blvd. 1-313-872-8100. primary care physician selection Detroit MI 48202 weekdays 8 am to 6 pm claims Blue Cross Indemnity Plan (CMM100) Blue Cross Blue Shield of Michigan 1-800-637-2227. plan benefits National Account Service Center reference Group 69900. claims PO Box 341 weekdays 8:30 am to 5 pm Detroit MI 48231. Mail Servi ce Prescription Drug Merck-Medco Rx Services 1-800-903-4734. Program (for those in CMM100) PO Box 67007 24 hours a day, 7 days a week plan benefits Harrisburg PA 17106-7007 hearing impaired difference in cost for brand-name 1-800-289-1230.

3 Versus generic drugs weekdays 8 am to 8 pm preauthorization Saturday 8 am to noon status of refill request Unisys Dental Plan: MetLife 1-800-942-0854, all time zones plan benefits Group Dental Claims Monday - Thursday 8 am to 8 pm claims PO Box 14093 Friday 8 am to 5 pm preauthorization for dental work Lexington KY 40512-4093 For local PDP providers: costing $300 or more PDP network providers For PDP directories: 1-800-474-7371. Health Care and Day Care Unisys Benefits Payment Office 1-800-223-3580. Reimbursement Accounts (UBPO) weekdays 9 am to 7 pm plan benefits PO Box 2909 Loop Station hearing impaired, 1-800-325-5961.

4 Claims Minneapolis MN 55402. Sickness and Accident Benefits Hartford Life 1-800-707-5333. plan benefits Disability Claims Department weekdays 9 am to 5:15 pm report absence due to disability 3800 West 80th Street claims Bloomington MN 55431-4440. Long-Term Disability Plan Same as above for Sickness and Accident 1-800-752-9713. plan benefits Benefits weekdays 9 am to 5:15 pm claims Group Universal Life Program KVI 1-800-222-1617. UAW Local 1313 as of 5/10/99 i apply for coverage; increase, PO Box 9122 weekdays 9 am to 6 pm decrease, terminate coverage Des Moines IA 50306-0905.

5 Change GULP beneficiary ii UAW Local 1313 as of 5/10/99. UAW Local 1313 as of 5/10/99 iii CONTENTS. Contents Flexible Benefits Program .. 1. 2. Who Is Eligible and Effective Dates of 2. Eligible 4. Preexisting Conditions .. 8. How the Flexible Benefits Program 9. Your Choices .. 11. How to 17. If You Fail to Enroll .. 18. Interim 20. Changing Elections: Status Changes .. 21. When Coverage Ends & Continuation Options .. 31. Return to Work after Coverage Ends .. 31. Your Medical Options .. 33. 34. More Information About Your Medical 34.

6 Newborns' and Mothers' Health Protection 35. Women's Health and Cancer Rights Act of 35. Mail Service Prescription Drug Program .. 36. Unisys Dental 43. Your Dental Options .. 44. How the Dental Plan Works .. 45. The Annual Dental Deductible .. 46. Dental 47. Annual and Lifetime Dental Benefit 47. Alternative Courses of Treatment .. 47. Reasonable and Customary (R&C) .. 48. Preauthorization Review .. 48. MetLife's Preferred Dentist Program (PDP) .. 49. Covered Expenses and 52. Expenses Not Covered .. 58. Requesting Benefits from the Dental Plan.

7 60. Facility of 62. If You Have Coverage Under Another Plan .. 63. When Coverage Ends & Continuation Options .. 66. Additional Plan 66. iv UAW Local 1313 as of 5/10/99. CONTENTS. Reimbursement Accounts .. 67. 68. Advance 69. Changing Your Reimbursement Account Elections .. 69. Your Contributions .. 69. How the Reimbursement Accounts 71. The Tax 73. Covered Health-Care Expenses .. 75. Covered Day-Care Expenses .. 76. Expenses Not Covered .. 77. Requesting Benefits from Reimbursement Accounts .. 78. At Year End .. Forfeitures and Filing Limitations.

8 79. When Before-Tax Contributions 80. Continuation Options After Coverage Ends .. 80. Additional Plan 80. Disability Income Benefits .. 81. 82. Sickness and Accident Benefits (S&A).. 83. Unisys Long-Term Disability Plan (LTD) .. 90. Other Benefits If Disabled Longer Than 26 Weeks .. 111. Death Benefits .. 113. 114. Company-Provided Life 115. Accidental Death and Dismemberment (AD&D) 120. Business Travel Accident and Seat Belt Insurance .. 123. Group Universal Life Program (GULP) .. 128. Other Benefits Available to Your Survivors.

9 129. UAW Local 1313 as of 5/10/99 v CONTENTS. When Coverage Ends & Continuation 131. 132. Certification of Creditable 132. When Coverage Ends .. Your 133. When Coverage Ends .. Your Dependents .. 134. COBRA 135. Company-Sponsored COBRA .. 139. Extended Dental Benefits .. 149. Extended Company-Provided Life Insurance Benefits .. 149. Conversion to an Individual Life Insurance Policy .. 150. No Conversion 150. Additional Plan Information .. 151. Official Plan Names and Plan Numbers .. 152. Plan 152. Employer Identification Number.

10 152. Plan Year .. 152. Type of Plan .. 152. Plan Administrator .. 153. Administrator for Processing Benefits Requests .. 154. How to Appeal a Benefits Request 155. Right to Recover Excess 157. Case Review .. 157. Third-Party 157. Type of Administration and Funding .. 159. Indemnification .. 160. Agent for Legal Process .. 160. Governing Law .. 160. Your Rights Under 160. Plan Termination/Revision .. 162. Index .. 163. vi UAW Local 1313 as of 5/10/99. CONTENTS. UAW Local 1313 as of 5/10/99 vii CONTENTS. viii UAW Local 1313 as of 5/10/99.