Newspaper Guild Of New York The New York Times

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Newspaper Guild of New York The New York Times Guild-Times Benefits FundSummary Plan Description for Active Employeesand Retired Employees less than age 65Effective July 1, 2006Guild-Times Pension PlanSummary Plan DescriptionEffective July 1, 2006Guild-Times College ScholarshipFundSummary Plan DescriptionEffective July 1, 2006

Guild-Times Benefits FundSummary Plan Descriptionfor Active Employees and RetiredEmployees Less Than Age 65Effective July 1, 2006

SUMMARY PLAN DESCRIPTION FOR ACTIVE EMPLOYEES AND RETIRED EMPLOYEES LESS THAN AGE 65TABLE OF CONTENTSNewspaper Guild of New York/The New York Times Benefits Guide .1Highlights of Your Benefits Fund Program for ActiveEmployees and Eligible Retirees Younger Than Age 65 .3Eligibility for Benefits .7Who Is Eligible? .7For Yourself .7For Your Dependents .8When Does Coverage Begin? .10Is Coverage Automatic or Must I Enroll? .10If You Are an Active Employee .10If You Are a Retired Employee .11What Should I Do If My Family Status Changes? .11Contributions to the Cost of Coverage .12If You Are An Eligible Active Employee .12If You Are An Eligible Retired Employee .13Your Choices—Medical Benefits .14CIGNA International Expatriate Benefits (Working Abroad) .14Choice I: Hospital and Major Medical Coverage/EPO .15Out Of Network Benefits (Major Medical) .15The Deductible .15Out-of-Pocket Maximum.16Your Benefits At A Glance .17Coverage from Empire.23Where To Find Network Providers .23Your EPO Benefits Out-of-area .23Prescription Drug Program for Eligible Active Employees.24Prescription Drug Benefits for Eligible Retirees .25Expenses Not Covered .25Choice II: Coverage ThroughA Health Maintenance Organization (HMO) .26Hospital Care.27Emergency Care .27Medical Care.27How Do I Select My Primary Care Physician? .28NEWSPAPER GUILD OF NEW YORK THE NEW YORK TIMES PAGE I

SUMMARY PLAN DESCRIPTION FOR ACTIVE EMPLOYEES AND RETIRED EMPLOYEES LESS THAN AGE 65May I See a Specialist? .28Benefits and Services .28What Medical Care is Not Covered?.31Dental Benefits .33Using Your Own Dentist .33Sample Dental Benefits .33Using a Panel Dentist .34What Expenses Are Not Covered? .35Claims Procedures .37Are Dental Benefits Paid After Coverage Ends?.38Optical Benefits .39How Does the Plan Work? .39Panel Opticians .39Individual Reimbursement .39Are Any Services Not Covered?.40Life Insurance Benefit .41Conversion To a Personal Life Insurance Policy .41How Payment is Made .42Claiming Life Insurance Benefits.42Continuation of Life Insurance During Disability .43Additional Employee Benefits Through Payroll Deduction .45If You Continue To Work After Age 65 .46When Does Your Coverage End? .47Continuation Of Coverage .48Medical, Dental and Optical Benefits.48Continuation of Coverage Rights Under COBRA .48Introduction.48What Is COBRA Continuation Coverage? .48Loss of Other Group Helath Plan Coverage.50When Is COBRA Coverage Available? .51You Must Give Notice of Some Qualifying Events .51How Is COBRA Coverage Provided? .52How Long Does COBRAContinuation Coverage Last? .52Early Termination of Continuation Coverage.53PAGE II NEWSPAPER GUILD OF NEW YORK THE NEW YORK TIMES

SUMMARY PLAN DESCRIPTION FOR ACTIVE EMPLOYEES AND RETIRED EMPLOYEES LESS THAN AGE 65How Can You Elect COBRA Continuation Coverage? .54Pre-existing Conditions .54Leave of Absence (LOA) and COBRA.55How Much Does COBRAContinuation Coverage Cost? .55When and How Must Payment for COBRAContinuation Coverage Be Made? .55If You Have Questions .57Keep Your Plan Informed of Address Changes .57Plan Contact Information .57Other Ways Your Coverage Can Continue .57Certificate of Creditable Coverage.61How Benefits Are Coordinated .64Which Plan Pays First For You and Your Spouse? .64Which Plan Pays First For Your Children?.65How Does No-Fault Insurance AffectCoordination of Benefits? .66Reimbursement Agreement .66Plan Administration .69Claim Review Procedures .69Empire – Complaints, Appeals and Grievances .70Complaints .70Standard Internal Appeals .71Level 1 Grievances .75Level 2 Grievances .75Expedited Grievances .76Decision On Grievances .76How To File An Appeal Or Grievance .77How To Appeal (Dental, Optical, Life Insurance) .77Decision On Review (Dental, Optical, Life Insurance) .77How To File an Appeal With The Board of Trustees .78Delayed Benefits.78Qualified Medical Child Support Orders.78HIPAA Privacy Practices for Personal Health Information .79Your Rights Regarding Personal Health InformationThe Fund Maintains About You .86Additional Obligations of the Plan With Respect to YourPersonal Health Information .89NEWSPAPER GUILD OF NEW YORK THE NEW YORK TIMES PAGE III

SUMMARY PLAN DESCRIPTION FOR ACTIVE EMPLOYEES AND RETIRED EMPLOYEES LESS THAN AGE 65Electronic Health Information .92Interpreting the Plan.93If The Plan Ends/Changes in Plan .94Fraud and Recovery Rule.96Other Important Facts About The Benefits Fund .96Your Rights Under ERISA .102Receive Information About Your Plan and Benefits .102Continue Group Health Plan Coverage.102Prudent Actions by Plan Fiduciaries .103Enforce Your Rights .103Assistance with Your Questions .104PAGE IV NEWSPAPER GUILD OF NEW YORK THE NEW YORK TIMES

SUMMARY PLAN DESCRIPTION FOR ACTIVE EMPLOYEES AND RETIRED EMPLOYEES LESS THAN AGE 65NEWSPAPER GUILD OF NEW YORK/THE NEW YORK TIMES BENEFITS FUNDA Summary Plan Description for Active Employees and Retired Employees lessthan age 65 in Guild Jurisdiction of The New York Times, Interstate BroadcastingCompany (WQXR), Electronic Media Company (Times Digital) and The NewspaperGuild of New York.Dear Member:The Board of Trustees of the Newspaper Guild of New York-The New YorkTimes Benefits Fund is pleased to present you with this updated descriptionof the health and welfare benefits for eligible active employees in Guildjurisdiction, and their eligible dependents, eligible retirees younger than age65, and their eligible dependents younger than age 65. A separate bookletdescribes the Benefits Fund program for eligible retirees who have attainedage 65.The program provides financial protection and security if you or a dependentis ill or injured. Active employees also are provided with life insurance, dentaland optical benefits.As you look through this booklet, you will learn how you become eligiblefor benefits, what your benefits are and how you claim them. We urge you toread the booklet with care. Since the last booklet was published, a numberof changes in benefits have been implemented, particularly in health carebenefits. This booklet describes the Benefits Fund’s Plan in effect as ofJuly 1, 2006.Be sure to share this booklet with members of your family. We have tried tomake it as easy to read as possible by presenting the information about yourbenefits in everyday language. For instance, the “Highlights of Your BenefitsFund Program for Active Employees” section helps you see your benefits at aglance. (Of course, you should read further for details of those benefits.)The Trustees may modify or eliminate (without prior notice to you) anybenefits and the eligibility requirements for benefits described in this booklet.The Trustees have the authority and discretion to interpret the plan ofbenefits and make final determinations regarding them. Neither employmentnor benefits are guaranteed. Under no circumstances will any Plan benefitsbecome vested or non-forfeitable with respect to active or retired employeesor their beneficiaries or dependents.NEWSPAPER GUILD OF NEW YORK THE NEW YORK TIMES PAGE 1

SUMMARY PLAN DESCRIPTION FOR ACTIVE EMPLOYEES AND RETIRED EMPLOYEES LESS THAN AGE 65This booklet, called the “summary plan description” summarizes the keyfeatures of the Plan. It also constitutes the Guild-Times Benefits Fund’splan document. Complete details of the Plan are also contained in the otherofficial Plan documents, including the Agreement and Declaration of Trustthat created the Fund, which legally govern the operation of the Plan. Allofficial Plan documents are available for your inspection at the Fund Officeduring normal business hours, and all statements made in this booklet aresubject to the provisions and terms of those documents. In case of a conflictor inconsistency between the official Plan documents and this booklet, theofficial documents will govern in all cases.If you have any questions about your benefits, please feel free to contact theBenefits Fund office at 212-556-3526 or fax to 212-556-3600.With our best regards,Board of TrusteesNeil A. LewisBarry F. LiptonWilliam O’MearaSam WeissCharlotte BehrendtJay McKillopRobert NusspickelCorinne OsbornPAGE 2 NEWSPAPER GUILD OF NEW YORK THE NEW YORK TIMES

SUMMARY PLAN DESCRIPTION FOR ACTIVE EMPLOYEES AND RETIRED EMPLOYEES LESS THAN AGE 65HIGHLIGHTS OF YOUR BENEFITS FUNDPROGRAM FOR ACTIVE EMPLOYEESAND ELIGIBLE RETIREESYOUNGER THAN AGE 65MEDICAL BENEFITSThe Benefits Fund Program offers you a CHOICE of Medical Plan to meet theneeds of you and your family. CHOICE I –Hospital, Major Medical, an EPO, andPrescription Drug CoverageHospital and Major Medical - EPOIn NetworkßAdministered through Empire BlueCross BlueShieldßYou pay only 15 per home or office visit when you receivemedically necessary care from a participating provider.Out of Network (major medical only):ßyou pay a 300 individual deductible ( 750 for a family)ßthe Plan pays 80% of most eligible expenses up to usual,customary and reasonable (U.C.R.) levels for the next 10,000ßafter that, the Plan pays 100% of the remaining eligible expensesup to U.C.R. levels for the rest of the calendar yearß 1 million lifetime maximum benefits per personPrescription Drug BenefitsßA prescription drug plan is offered through Pharmacare. Thereare no claim forms and no deductibles for active employees whoselect Choice 1.NEWSPAPER GUILD OF NEW YORK THE NEW YORK TIMES PAGE 3

SUMMARY PLAN DESCRIPTION FOR ACTIVE EMPLOYEES AND RETIRED EMPLOYEES LESS THAN AGE 65 ßCo-payment for brand name drugs is the greater of 20% ofthe drug cost or 8. In addition, if a generic drug is available,you must also pay the price difference between the brand andgeneric options.ßco-payment for generic drugs is the greater of 20% of the drugcost or 3.00ß 100 annual deductible for retireesßMail order program offers 90-day supply for 2 ½ times the 30day retail rate. The mail order program is mandatory after tworefills of a maintenance drug.CHOICE II – HMO CoverageHMO coverage (covering major medical, hospital and prescription drugbenefits) is available through:HIP (NY)www.hipusa.comHorizon (NJ)www.horizon-bcbsnj.com (800) 355-2583Empire (NY, CT)www.empireblue.com(800) 662-5193Oxford (NY, NJ, CT)www.oxfordhealth.com(800) 444-6222Care First Blue Choice (DC, VA, MD)www.carefirst.com(800) 296-5555Harvard Pilgrim (MA, ME, NH, RI)www.harvardpilgrim.org(800) 848-9995Keystone (PA)www.ibxpress.com(800) 275-2583Blue Shield (CA)www.blueshieldca.com(800) 424-6521Blue Cross Blue Shield Health Options(FL)(800) 447-8632(800) 955-3589ßno deductible applies to medical expenses, with the HMOpaying 100% of most eligible expenses as long as you use aprovider within the HMO.ßA deductible may apply to hospital and prescription drugcoverage, depending on which HMO you select.PAGE 4 NEWSPAPER GUILD OF NEW YORK THE NEW YORK TIMES

SUMMARY PLAN DESCRIPTION FOR ACTIVE EMPLOYEES AND RETIRED EMPLOYEES LESS THAN AGE 65 DENTAL BENEFIT (maximum 2,500 per year permember)This benefit covers a wide variety of treatments, including orthodontia foryou and your covered dependents.ßat a participating dentist, the dental benefit will provide you withfull coverage for preventive care and substantially discountedrates for other care.ßAt a nonparticipating dentist, you will need to pay for a portionof the costs associated with preventive care and you will notenjoy discounts for other care.ßBenefits are paid according to a schedule (your dentist mayrequest a pretreatment estimate) for care provided by anydentistYou and your covered dependents are eligible for the dental benefit no matterwhich Medical Benefit you choose.Note: Dental coverage is not provided to a retiree or a dependent of aretiree. OPTICAL BENEFITßat any optician, you may receive up to 100 in annual coveragefor an eye examination and a basic pair of eyeglasses for you andeach of your dependents; orßat a participating provider, you may receive an eye examination(by an optometrist) and a pair of glasses with no out-of-pocketcost to you.You and your covered dependents are eligible for the optical benefit nomatter which Medical Benefit you choose.Note: Optical coverage is not provided to a retiree or a dependent of aretiree.NEWSPAPER GUILD OF NEW YORK THE NEW YORK TIMES PAGE 5

SUMMARY PLAN DESCRIPTION FOR ACTIVE EMPLOYEES AND RETIRED EMPLOYEES LESS THAN AGE 65 GROUP LIFE INSURANCE 10,000 of life insurance for you.Note: Group Life Insurance coverage is not provided to a dependent, retireeor a dependent of a retiree.Additional life insurance coverage is available through payroll deduction.See page 45 for more details.PAGE 6 NEWSPAPER GUILD OF NEW YORK THE NEW YORK TIMES

SUMMARY PLAN DESCRIPTION FOR ACTIVE EMPLOYEES AND RETIRED EMPLOYEES LESS THAN AGE 65ELIGIBILITY FOR BENEFITSWHO IS ELIGIBLE?For YourselfYou are eligible to join the Plan if you are actively employed by The New YorkTimes, Interstate Broadcasting Company (WQXR), Electronic Media Company(Times Digital) and The Newspaper Guild of New York and you are:ßa regular full-time employee, scheduled to work at least 34.5hours a week, orßa regular part-time employee who is scheduled to work at least20.7 hours a week. If you were hired as a regular part-timeemployee before August 1, 1987, and you were a Plan participanton that date, the 20.7 hours a week requirement does not applyto you, and you may therefore join the Plan, provided that youare otherwise eligible.If you are a full-time employee who voluntarily reduces your scheduled worktime to less than 20.7 hours a week, you will lose your eligibility for the Plan.If such a reduction is involuntary, you may be able to elect continuationcoverage. See “Continuation of Coverage” for more details.Temporary and/or casual employees as well as employees who are classified asindependent contractors and not as employees at the time of any determination(even if they are later retroactively reclassified as a common-law or other typeof employee pursuant to applicable law or otherwise) are generally excluded.However, if you are a temporary replacement for an employee who is onmilitary, Vista, Peace Corps or disability leave, you are eligible to participate inthe Fund after working for a period of one year and a day.You are also eligible for health benefits under the Plan if, immediately afteryou terminate your employment, you begin collecting your pension underthe Guild-Times Pension Plan. Effective May 1, 2004, in order to receive thisretiree coverage, you will be required to make a contribution of 30% of thecost of premiums for benefit coverage as annually determined by the Fundactuary – unless you are under age 55 at the time of retirement, in whichcase you will be required to pay 100% of the medical premium. As a retiredemployee, however, at no time are you eligible for dental, optical, and lifeinsurance benefits.NEWSPAPER GUILD OF NEW YORK THE NEW YORK TIMES PAGE 7

SUMMARY PLAN DESCRIPTION FOR ACTIVE EMPLOYEES AND RETIRED EMPLOYEES LESS THAN AGE 65If you are a covered retired employee who reaches age 65, coverage under thehealth care program described in this booklet stops and you are covered bya medical program which supplements Medicare benefits. This program isdescribed in a separate booklet available free of charge from the Fund Office.For Your DependentsThe Benefits Fund offers medical, dental and optical benefit protection foryour eligible dependents. This includes your:ßspouseßunmarried natural, adopted (or placed with you for adoption), orstepchild(ren), until December 31 of the year the child reachesage 19 years (or age 23 if a full-time student working towards adegree in an accredited educational institution).In all cases, in order to be eligible for coverage, a dependent child mustalso rely on you for support. Before coverage for a dependent becomeseffective, you must supply the Benefits Fund with a copy of your marriagelicense, dependent’s birth certificate, adoption decree or other appropriatedocumentation that demonstrates your relationship to your dependent oryour dependent’s reliance on you for support.If you are a retired employee, for a dependent to be covered under the healthcare benefits described in this booklet, your dependent must be less than age65. At no time is the dependent of a retired employee covered for dental,optical or life insurance benefits.Notwithstanding the limit on dependents’ age above, unmarried childrenof any age who are unable to do any work to support themselves becauseof mental illness, developmental disability, mental retardation, or physicalhandicap are covered provided that, before reaching the age of 19, they (1)satisfied this condition and (2) covered by the Fund. If requested, proofof your dependent’s status as a disabled or handicapped person must beprovided to the Fund. In order for a dependent age 23 or older to be classifiedas disabled under the Guild-Times Benefits Fund, you must supply the Fundwith proof of your dependent’s disability and a copy of your dependent’sSupplemental Security Income (SSI) Award.PAGE 8 NEWSPAPER GUILD OF NEW YORK THE NEW YORK TIMES

SUMMARY PLAN DESCRIPTION FOR ACTIVE EMPLOYEES AND RETIRED EMPLOYEES LESS THAN AGE 65The Benefits Fund also offers medical, dental and optical benefit protectionfor a domestic partner of the same or opposite sex provided you submitthe proof of domestic partnership required by the Plan. The Benefits Fundconsiders a person to be your domestic partner when:ßthe relationship with you is exclusive and one of mutual support,caring and commitmentßthe intent is for the relationship to be permanentßyou and your domestic partner live together in the samepermanent residence and are jointly responsible for commonexpensesßyou and your domestic partner are not married to anyone elseßyou and your domestic partner are not related by blood closerthan would bar marriage under the law, andßyou and your domestic partner are 18 years of age or older andare mentally competent to contract.A dependent child of your domestic partner is eligible for coverage if:ßthe child is under age 19, unmarried and lives in the samehousehold as you and your domestic partner or is between ages19 and 23, is a full-time student and lists your address as theprimary place of residenceßyou assume full responsibility and control, including all debtsincurred by the child, such as charges for health care servicesand supplies, andßyou or your domestic partner are the biological, adoptive, orstepparent of the child.Note: Domestic partner coverage is not provided for a retiredemployee.NEWSPAPER GUILD OF NEW YORK THE NEW YORK TIMES PAGE 9

SUMMARY PLAN DESCRIPTION FOR ACTIVE EMPLOYEES AND RETIRED EMPLOYEES LESS THAN AGE 65WHEN DOES COVERAGE BEGIN?If you are a regular, active full-time employee or a regular, active parttime employee who is scheduled to work at least 20.7 hours per week,your coverage begins on the first day of the month coinciding with or nextfollowing your date of employment. If you are a temporary replacementfor an employee who is on military, Vista, Peace Corps or disability leave,your coverage begins on the first day of the month coinciding with or nextfollowing the first anniversary of the day after your employment began.Coverage for an eligible dependent begins on the same date as yours, or iflater, on the date the dependent first becomes eligible.IS COVERAGE AUTOMATIC OR MUST I ENROLL?If You Are an Active EmployeeThe Fund requires that you complete an enrollment form and supplycertain information (birth certificates for you and your family, a certificateof marriage, proof of dependency, etc.) in order to provide benefits for youand/or your family. If you do not enroll, you and your family can lose thesignificant benefits available under the Plan.If you enroll your domestic partner, you must complete an enrollment formfor your partner, an affidavit of domestic partnership, and, if applicable,certification of eligibility for the child(ren) of your domestic partner andprovide proof of cohabitation.You may change your coverage each year during the open enrollment periodheld from February 15th through March 15th to become effective on April1st each year.If you are eligible for dependent coverage during the open enrollmentperiod and you elect individual coverage, generally, you may not add anycurrent dependents until the next open enrollment period. However, ifyou have a new child during the waiting period (whether through pregnancyor adoption), you may elect dependent coverage in order to cover that child.An exception to this rule will be made if you elect not to pay the premium(or if you are an eligible active employee, enroll on behalf of yourself) at thebeginning of your eligibility period because you, your spouse or dependentshad coverage under another plan, but you (or your dependents) then losethat coverage because employer contributions cease or because of a lossPAGE 10 NEWSPAPER GUILD OF NEW YORK THE NEW YORK TIMES

SUMMARY PLAN DESCRIPTION FOR ACTIVE EMPLOYEES AND RETIRED EMPLOYEES LESS THAN AGE 65of eligibility resulting from a change in family status (i.e., legal separation,divorce, termination of employment, reduction in hours, exhaustion ofCOBRA, children’s aging out of coverage, or moving out of an HMO servicearea) other than a failure to pay participant premiums or termination ofcoverage for cause (such as fraud). In that event, you will be given theopportunity to purchase coverage for them and you (and/or enroll on behalfof yourself if you are an eligible active employee) provided that you notify theFund in writing within 30 days of the change in family status. If you bothprovide this notice and pay the required premium on time, the coverage willbegin on the date of the change. If the other coverage was COBRA coverage,this exception only applies after the COBRA coverage is exhausted.A participant who is transferred by the New York Times Company outside thetri-state area, can elect to have their dependents enrolled in the Guild-TimesBenefits Fund at the time of transfer.If You Are a Retired EmployeeYou can elect retiree coverage for yourself and your eligible dependentsduring an open enrollment period held every year February 15th throughMarch 15th to become effective April 1st. If you are eligible for dependentcoverage during the open enrollment period and you elect individualcoverage, generally, you may not add any current dependents until the nextopen enrollment period.WHAT SHOULD I DO IF MY FAMILY STATUS ORRESIDENCE CHANGES?You should notify the Fund office as soon as possible, but not more than 30days after a change in family status. A change in family status includes thebirth of a new dependent child or if you marry, divorce, are legally separated,or an eligible dependent dies. If you have a new dependent child, your babyis automatically covered under the Plan for the first 30 days if you have familycoverage. However, you will need to add your baby to your coverage. If youdo not have family coverage, call the Fund office within 30 days to add yournewborn as a dependent.If you have any questions about whether a change in family status requires anew election, please call the Fund as soon as possible.You should also contact the Fund office if you move out of your HMO’sservice area.NEWSPAPER GUILD OF NEW YORK THE NEW YORK TIMES PAGE 11

SUMMARY PLAN DESCRIPTION FOR ACTIVE EMPLOYEES AND RETIRED EMPLOYEES LESS THAN AGE 65CONTRIBUTIONSTO THE COST OF COVERAGEIF YOU ARE AN ELIGIBLE ACTIVE EMPLOYEEPRIOR TO MARCH 31, 2005:You did not contribute to the Fund for your own coverage.If you elected to participate in family coverage, you contributed 10 aweek to the Plan for dependent or domestic partner coverage; unless youwere a WQXR employee, in which case you contributed 14.50 a week.Contributions were made through payroll deduction.EFFECTIVE MARCH 31, 2005:You must pay the amount shown on the table below plus 5 per week on apre-tax basis through your company caf

Keystone (PA) www.ibxpress.com (800) 275-2583 Blue Shield (CA) www.blueshieldca.com (800) 424-6521 Blue Cross Blue Shield Health Options (FL) (800) 955-3589 ß no deductible applies to medical expenses, with the HMO paying 100% of most eligib