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Eligibility GuidelinesThe Sandia Medicare Retiree must maintain coverage in a Sandia plan in order for aspouse and/or dependents to have coverage.If you are the primary member under theplan, your Class I dependents eligible formembership include your: Spouse, not legally separated or divorcedfrom you, which includes same-genderspouse (provided you were legally marriedin a jurisdiction that legally recognizessame-gender marriage) Child under age 26 Child who is recognized as an alternaterecipient in a Qualified Medical ChildSupport Order Child of any age who is incapacitated asdetermined by the claims administratorNote 1: The claims administrator determinesif the applicant is disabled. Please contactOneExchange for more information onenrolling your child as an incapacitateddependent.Note 2: For Survivors, no new dependentscan be added, except for children born oradopted with respect to a pregnancy orplacement for adoption that occurred beforethe employee’s or Retiree’s death.CHILD INCLUDES:Eligibility for coverage under the KaiserPermanente Senior Advantage Plan(Medicare) has the same eligibilityrequirements as stated above, however, theyalso include: Other unmarried dependent persons whomeet all of the following requirements(excluding foster children): He or she receives from you or your spouseall of his or her support and maintenance, He or she permanently resides with you(the primary member), You or your spouse is the court-appointedguardian (or was before the personreached age 18), or whose parent is anenrolled dependent under your familycoverage.* Kaiser Permanente disabled dependentrequires the following additionalrequirements: The dependent is incapable of selfsustaining employment because of mentalretardation or physical handicap thatoccurred prior to reaching the age limit fordependents Primary covered member’s own children,step-children, and legally adopted children Receive substantially all of their supportand maintenance from you and yourspouse Child for whom the primary coveredmember has legal guardianship You give Kaiser proof of their incapacitywithin 31 days after Kaiser requests it Natural child, legally adopted child,or child for whom the primary coveredmember has legal guardianship if a courtdecree requires coverageNote: Kaiser Permanente determines if theapplicant is disabled.10medicare.oneexchange.com/sandia 1-888-598-7809 (TTY: 711) M-F 6 a.m. - 7 p.m. MTCLASS II DEPENDENTSNo additional Class II Dependents can beenrolled in any of the Sandia medical plans.To continue to qualify for medical coverage, aClass II dependent must: Be “financially dependent” on you;financially dependent means that aperson receives greater than 50% of theirfinancial support for the calendar yearfrom the primary member, Have a total income from all sources ofless than 15,000/year other than thesupport you provide, and Have lived in your home, or one providedby you in the United States, for the mostrecent six months.Medicare Class II dependents will no longerbe eligible for coverage through Sandia.INELIGIBLE DEPENDENTSYou must disenroll your ineligible dependentswithin 31 calendar days. For example, thefollowing lists events that would make yourdependents ineligible. Divorce or annulment Legal separation Child reaches age 26 Incapacitated child no longer meetsincapacitation criteria Child, step-child, grandchild, brother,sister, parent, step-parent or grandparentno longer meets Class II eligibilityrequirements criteria Class II dependent becomes Medicareeligiblemedicare.oneexchange.com/sandia 1-888-598-7809 (TTY: 711) M-F 6 a.m. - 7 p.m. MT11

Changing Your Benefits ElectionsWhat Should You Expect After Your Call?Call OneExchange at 1-888-598-7809 (TTY: 711).When you call OneExchange, you willautomatically be connected with a benefitadvisor who is licensed and trained to findindividualized coverage for you. To speedup the process of connecting you to theright benefit advisor, you will be asked afew questions by the automated telephonesystem. You may either speak your answers,or use the numbers on your telephonekeypad.BEFORE YOU ARE CONNECTED TO ABENEFIT ADVISOR:1. Speak to a benefits advisor by saying orpressing “1” on your keypad.2. Enter your ZIP code.3. Provide the last four digits of your SocialSecurity number.*4. Confirm the first three letters of your lastname.When an advisor answers the phone he orshe will already have your information andbe ready to help you evaluate your optionsand help you enroll in a Medicare plan thatbest fits your needs.TOOLS & RESOURCESIn addition to working with our licensedbenefit advisors over the phone, you mayaccess online tools at https://medicare.oneexchange.com/sandia that will help youcompare and evaluate the plan optionsavailable to you.12IF YOU ARE MAKING A CHANGE TO YOURMEDICAL COVERAGE OR ENROLLING INMEDICAL COVERAGE, BEFORE YOU CALL: Make sure you have your basicidentification (address, SSN, etc.)information handy. Your current phone numbers, address(es),Social Security number and a MedicareID number will be required to enroll youin a plan for 2015. We also need youreffective dates for both Medicare Part Aand Part B, which can be found on yourMedicare card. Make a list of your prescriptionmedications. Since very specificinformation about your prescriptions isrequired, it may be helpful to gather yourmedications together and have the bottlesor boxes with you when you sign in onlineor call OneExchange. Refer to a label orbill for correct spelling. OneExchange can help you find a costeffective plan based on the informationyou give us about your prescription drugs,including dosage, form, and how often youtake the medication. Note: Do not forgetto include any medications you haveordered by mail.CONFIRMATIONSPREMIUM SHARE BILLINGAfter you make or change an election with anOneExchange benefit advisor over the phone,a Confirmation Statement will be mailed toyou within 10 business days indicating theplan selection(s) you made.If you enroll in one of the Sandia-sponsoredMedicare Advantage plans and/or theSandia Dental Care Program that requires apremium share, you will see the new rates onthe billing statement included in a welcomepacket mailed to you from OneExchange bymid-December. At that time you may chooseto have your monthly premium paymentsautomatically deducted from your checking orsavings account. If you are already enrolledin the automatic premium payment process,any premium change will be automaticallyupdated in the beginning of January everyyear.If you enrolled in a Sandia Group MedicarePlan you will receive a membership packetincluding your ID card(s) from the plan(s) youselected approximately 6-8 weeks after youmake your election.If you selected a plan through the YourSpending Arrangement (YSA) option youwill receive a membership packet includingyour ID card(s) from the plan(s) you selecteddirectly from the health plan or insurancecompany you selected.YOUR SPENDING ARRANGEMENT (YSA)GUIDEIf you enroll in the YSA, you will be billeddirectly by your medical plan(s), pay themdirectly, and submit for reimbursement fromthe YSA option.If you elect the YSA option, OneExchangewill mail the YSA Guide to you. This guideexplains how to access and manage the fundsin Your Spending Arrangement. Make a list of your doctors’ names andaddresses. A phone number is alsohelpful, but if you do not have one, we canlook it up for you.* Our privacy policy can be found athttps://medicare.oneexchange.com/sandia.Click on the “privacy policy” link at thebottom of any page.medicare.oneexchange.com/sandia 1-888-598-7809 (TTY: 711) M-F 6 a.m. - 7 p.m. MTmedicare.oneexchange.com/sandia 1-888-598-7809 (TTY: 711) M-F 6 a.m. - 7 p.m. MT13

Become familiar with MedicareHOW THE MEDICARE PARTS PROVIDE YOU COVERAGEThe simple outline shown here will familiarize you with the parts of Medicareand assist you to choose what is best for you. Visit www.medicare.gov for moredetailed descriptions of each plan.ORIGINAL MEDICARE (WHAT YOU GET):Part A & Part BOriginal Medicareconsists of Part A& Part B.You automaticallyreceive Part A &become eligiblefor Part B whenyou qualify forMedicare eitherdue to age ordisability.Part A provides you with inpatientcare, and covers inpatient hospitalstays, home health care, stays inskilled nursing facilities, and hospicecare.The Part A deductible for 2014 is 1,216 per benefit period.Coinsurance is not applicable for yourfirst 60 days of inpatient care.Enrollment is automatic when youbecome Medicare-eligible.There is no premium if you have morethan 10 years of Medicare-coveredemployment.*Part B provides you with outpatient care, andcovers physician fees, and other medical servicesnot requiring hospitalization.The 2014 deductible for Part B 147. Part B covers 80% of medically necessary services. You areresponsible for the remaining 20%.You must actively enroll in Part B.The monthly premium for 2014 is 104.90 for mostindividuals, depending on income (adjustment ratesmay apply).TYPES OF MEDICARE SUPPLEMENTAL PLANS:MedicareAdvantage,Medigap, &Part DMedicare Advantage plans are offered by private companies to provideyou with all your Medicare Part Aand Part B benefits plus additionalbenefits.There are two versions of MedicareAdvantage plans: MAPD and MA.MAPD plans include prescriptiondrug coverage, MA plans do not.Within these two Medicare Advantage types there are three doctornetworks: HMO, PPO, and PrivateFee-for-Service Plans (PFFS).Medicare Advantage is also referredto as Part C.The Presbyterian MediCare PPO, theLovelace Employer Group MedicarePlan (HMO) provided by BCBSNM,and the Kaiser Senior Advantage Planare all MAPD plans being offered bySandia.Note: You cannot enroll in a MedicareAdvantage plan offered by Sandiain addition to another Medicare plansuch as Part DMedigap is supplementalinsurance sold by privateinsurance companiesto fill “gaps” in OriginalMedicare plan coverage.These 10 plans (labeledPlans A, B, C, D, F, G, K,L, M & N) offer standardized menus of benefits.(Massachusetts, Minnesota, and Wisconsinhave their own versions ofthese plans).Medigap policies onlywork in conjunction withthe Original Medicareplans.Generally, there is no prescription drug coverage.Part D refers to optionalprescription drug coverage, which is availableto all people who areeligible for Medicare.Plans are offeredthrough private insurance companies.Part D covers genericand brand-name drugsincluded in the plan’sformulary, which is a listof drugs the plan willcover.Prescription drug plansmay be purchased separately or as an add-onfor Medicare Advantageplans that do not offer aprescription drug benefit(MA) or Medigap plans.(Refer to the Sandia Prescription Drug ProgramCreditable CoverageNotice on page 43.)Pages 15 - 31 Detail the Retiree MedicalBenefits for Employees Who Retired on or BeforeDecember 31, 2011.Refer to the Sandia Health Benefits Plan for Retirees Summary PlanDescription (SPD) for additional information regarding eligibility for benefits.Employees Who Retired On or Before December 31, 2011Understanding Your Sandia BenefitsChoicesThe options listed below are available to Medicare-primary retirees, survivingspouses, LTD terminees (who are enrolled in both Medicare A and B andcontinue to pay Medicare Part A if applicable, and Part B premiums). Theoptions are also available to eligible Medicare-primary Class I dependents whoare enrolled in both Medicare Part A and Part B and continue to pay MedicarePart A (if applicable) and Part B premiums. If you have not yet already enrolledin Medicare Part A and Part B, contact your local Social Security Administrationoffice. For more information on eligibility, contact OneExchange.Each Medicare individual will make anindependent election. For example, if a retireeand his spouse live in New Mexico and theyare both Medicare eligible, the retiree canelect the Lovelace Employer Group MedicarePlan (HMO) provided by BCBSNM and thespouse can elect the Presbyterian MediCarePPO. Keep in mind, the Retiree must beenrolled in a Sandia group or individual planin order for the spouse and/or dependents tohave Sandia coverage.NEW MEXICO PLAN OPTIONS Presbyterian MediCare PPO Lovelace Employer Group Medicare Plan(HMO) provided by BCBSNM Your Spending Arrangement Waive coverage Dental - Sandia-sponsored only for retirees* If your dependent is a foreign national and/or has not worked enough to qualify for Medicare Part A on their own, your dependent canpurchase Medicare Part A. The cost for Part A for 2014 is 426 per month. However, if your dependent does not qualify for no-cost Part Adue to insufficient Medicare-covered employment, once you turn 62, your dependent is then eligible for Part A at no cost.14medicare.oneexchange.com/sandia 1-888-598-7809 (TTY: 711) M-F 6 a.m. - 7 p.m. MTmedicare.oneexchange.com/sandia 1-888-598-7809 (TTY: 711) M-F 6 a.m. - 7 p.m. MT15

NORTHERN CALIFORNIA PLAN OPTIONS Kaiser Senior Advantage Plan Your Spending Arrangement Waive coverageImportant: You cannot enroll in a Sandiasponsored group Medicare Advantage Plan andelect the Your Spending Arrangement option.You must select one or the other. Dental - Sandia-sponsored only for retireesThis plan is fully-insured through BlueCross Blue Shield of New Mexico (BCBSNM)for eligible Medicare-primary participantsresiding in New Mexico. Benefits areavailable only from providers who are in theBCBSNM network. Your Spending Arrangement Waive coverage Dental - Sandia-sponsored only for retireesSandia-Sponsored Medicare Advantage PlansOverviewThis HMO Medicare Advantage plan withprescription drug benefits is fully-insuredthrough the Lovelace Health Plan for eligibleMedicare-primary participants who live inNew Mexico. Benefits are available only fromproviders who are from a Lovelace MedicareHMO Senior Plan Provider.PRESBYTERIAN MEDICARE PPOThis Medicare Advantage plan withprescription drug benefits is fully-insuredthrough the Presbyterian InsuranceCompany, Inc. for eligible Medicare-primaryparticipants who live in New Mexico.This PPO provides both in- and out-ofnetwork benefits. In-network benefits areavailable only from providers who are in thePresbyterian PPO network.Plan Details: Lovelace Employer Group MedicarePlan (HMO) provided by BCBSNMA Medicare Advantage Plan with Prescription Drug BenefitsOUTSIDE OF NEW MEXICO AND NORTHERNCALIFORNIA PLAN OPTIONSLOVELACE EMPLOYER GROUP MEDICAREPLAN (HMO) PROVIDED BY BCBSNMEmployees who retired on or before December 31, 2011KAISER SENIOR ADVANTAGE PLANThis HMO Medicare Advantage plan withprescription drug benefits is fully-insuredthrough Kaiser Permanente for eligibleMedicare-primary participants who livein Northern California, within Kaiserdesignated service areas (currently Alameda,Contra Costa, Marin, Sacramento, SanFrancisco, San Joaquin, San Mateo, Solano,and Stanislaus counties are entirely insidea Kaiser service area; service areas for otherNorthern California counties are determinedby specific ZIP codes within those counties).Enrolling in one of the Sandia-sponsoredMedicare Advantage plans is not affected byyour current or past health status. In general,if you enroll during the specified enrollmentperiod you are guaranteed coverage by one ofthe plans available in your area, regardless ofyour current medical conditions.You can obtain information on this plan(including a provider directory, drugformulary list, etc.) by contacting LovelaceEmployer Group Medicare Plan (HMO)provided by BCBSNM Customer Service at(888) 731-7503 from 8:00 a.m. to 8:00 p.m. 7days a week.For additional information, refer to theLovelace Employer Group Medicare Plan(HMO) provided by BCBSNM Evidence ofCoverage at hbe.sandia.gov. If there are anydiscrepancies between this information andthe Evidence of Coverage, then the Evidenceof Coverage supersedes.ELIGIBILITYThis plan is available to Medicare-primaryretirees, surviving spouses, LTD terminees,and their eligible Medicare-primary Class Idependents who: Reside in the state of New Mexico; Are enrolled in both Medicare Part A andPart B; and Continue to pay Medicare Part A (ifapplicable) and Part B premiums.KEY POINTS16medicare.oneexchange.com/sandia 1-888-598-7809 (TTY: 711) M-F 6 a.m. - 7 p.m. MT Referrals to specialists are not required. Unlimited prescription drug coverage isavailable under this plan. By enrolling in this plan, you willautomatically be enrolled in the MedicarePart D prescription drug benefit andwill receive all of your prescription drugbenefits through this Plan. You will be required to assign yourMedicare benefits to the LovelaceEmployer Group Medicare Plan (HMO)provided by BCBSNM; therefore, youcannot be enrolled in this plan andanother Medicare Advantage plan oranother Medicare Part D plan at the sametime. When you select the Lovelace EmployerGroup Medicare Plan (HMO) provided byBCBSNM, your regular Medicare benefitsare provided by this plan. You mustmaintain your Medicare Parts A and Benrollment in order to keep your coverage. You must inform Lovelace EmployerGroup Medicare Plan (HMO) providedby BCBSNM and OneExchange beforemoving or leaving the service area formore than six (6) months. Your permanentresidence must be in the BCBSNM servicearea, which is the state of New Mexico. Outside the service area, this plan coversemergency and urgent care. If you arehospitalized in a non-participatinghospital for emergency care, you or afamily member must call Customer Carewithin 48 hours (or as soon as reasonablypossible). Primary Care Physician (PCP) is required.You must select a PCP or one will beassigned to you. Obtain a directory bycontacting Customer Service.medicare.oneexchange.com/sandia 1-888-598-7809 (TTY: 711) M-F 6 a.m. - 7 p.m. MT17

Employees who retired on or before December 31, 2011Employees who retired on or before December 31, 2011Plan Details: Presbyterian Medicare PPOPlan Details: Kaiser Senior AdvantageA Medicare Advantage Plan with Prescription Drug BenefitsA Medicare Advantage Plan with Prescription Drug BenefitsThis plan is fully-insured through thePresbyterian Insurance Company, Inc. foreligible Medicare-primary participants wholive in New Mexico. This PPO provides bothin- and out-of-network benefits.You can obtain information on thisplan (including a provider directory,drug formulary list, etc.) by contactingPresbyterian at 1-505-923-8458 or 1-800347-4766, M-F, 8

2015 Medicare Benefits Choices and Enrollment Guide For Medicare Retirees, Surviving Spouses, Long-Term Disability (LTD) Terminees, and/or Medicare