Transcription
Benefits ForHilton U.S.Team Members(except for Hawaii andPuerto Rico) Health Care Disability Protection Life and Accident Insurance
This Summary Plan Description (SPD)summarizes the major features of thebenefits programs for U.S. full-time eligibleemployees and certain eligible leasedemployees of Hilton Domestic OperatingCompany Inc. and its affiliates (“Hilton”) asof January 1, 2021. This SPD does notapply to Team Members in Hawaii orPuerto Rico; benefits for these TeamMembers are described in a separatesummary plan description. Certain TeamMembers whose employment is subject toa collective bargaining agreement areexcluded or have modified coverage. Youshould also refer to any applicable coverletter accompanying this SPD for changesand additions to the SPD that apply toemployees at: Hilton BaltimoreHilton McLeanHilton Crystal CityDoubletree – Crystal CityEmbassy Suites – Crystal CityHilton – VancouverDoubletree – San Diego ValleyEmbassy Suites – San Diego LaJollaHilton La Jolla PinesHilton San Diego Bay FrontLa Quinta (Palm Springs)Hotel Del CoronadoYou should not rely on this informationother than as a general summary of thefeatures of the Hilton Health and WelfarePlan (the “Plan”).This SPD is based on legal documents(such as plan documents, insurancecontracts and summary booklets andHMO contracts) currently in effect. Thesedocuments provide further detail oncoverage benefits as well as importantexclusions, limitations, and requirementsapplicable to receive benefits. You mayobtain a copy of any of the official legaldocuments for your coverages online byfollowing the steps below and in the“General Information” section or bycontacting the Plan Administrator.To access any available insurancecertificates or Coverage Booklets, followthe instructions below:1.2.3.4.5.6.Access YBR via this website:http://digital.alight.com/hiltonClick on the “Choose a Language” dropdown box from the log on page, select“English” or “Spanish – Español”.Enter your User ID and password on theLogon page.From the YBR Home page, select the tabtitled “Health & Insurance.”From the Health & Insurance page choosethe “Coverage Details” drop down, then inthe menu items, click on the PlanInformation link.The SPD and available insurancecertificates and Coverage Booklets will bedisplayed on the next screen.While every effort has been made togive you correct and completeinformation about your benefits, in theevent of any conflict or inconsistencybetween this SPD and relevant legaldocuments with respect to benefitspayable, the terms of the legaldocuments will control. The SPD willgovern if the conflict or inconsistencyrelates to eligibility, except asdescribed in the “State InsuranceMandates and Dependent Coverage”section in the Participation chapter.
CONTENTS: HANDBOOKINTRODUCTION . 1PARTICIPATION . 3ADMINISTRATION . 29CLAIMS AND APPEALS . 41MEDICAL COVERAGE . 49PRESCRIPTION DRUGS . 53DENTAL COVERAGE . 59VISION COVERAGE . 61FLEXIBLE SPENDING ACCOUNTS . 63HEALTH SAVINGS ACCOUNT . 74EMPLOYEE ASSISTANCE PROGRAM . 77INTERNATIONAL BUSINESS TRAVEL PROGRAM . 80MEDICAL BENEFITS ABROAD PROGRAM . 82METLIFE LEGAL PLAN . 84DISABILITY COVERAGE . 86LIFE AND ACCIDENT PROTECTION . 94GENERAL INFORMATION . 105
IntroductionWHAT’S INSIDEThis handbook contains important informationon many of the benefit programs offered underthe Plan. Please read it carefully.AN OVERVIEW OF YOUR HEALTH ANDWELFARE BENEFITSThe Plan offers you a variety of benefits and levelsof coverage (Benefit Options) from which you canchoose.(Note: eligibility criteria may vary for each benefitoffering): Medical Coverage Dental Coverage Vision Coverage Flexible Spending Accounts (FSAs) Health Care FSA Dependent Day Care FSA Disability Short-term Disability Long-Term Disability Life Insurance (Basic, Supplemental andDependent) Retiree Life Insurance* Accidental Death and Dismemberment(AD&D) Employee assistance program (EAP) andwork/life benefit Business Travel Accident Legal Services Wellness Programs Voluntary Medical Benefits*This benefit is available only to a closed group of retirees.No new participants are allowed at this time.THIRD PARTY ADMINISTRATORSFor purposes of administrating the various BenefitOptions under the Plan, the Plan Administratorhas retained the services of certain independentthird-party administrators and insurancecompanies, such as Aetna, United Healthcare,Delta Dental and Alight Solutions. Generally thethird party administrator does not assume liabilityfor benefits payable under this Plan; some thirdparty administrators, however, may be designatedas a “named fiduciary”, as that term is defined inERISA, for purposes of processing claims.MORE INFORMATIONWe encourage you to retain this handbook forfuture reference. If you have questions about yourbenefits, please contact the Hilton Benefits Center.You may reach the Hilton Benefits Center at1.877.442.4772 Monday through Friday from 8:00a.m. to 6:00 p.m. CT.The role of the Hilton Benefits Center and theservice center representatives with the Plan’sinsurers and third party administrators is to assistyou with questions you may have about this Plan.However, statements made by suchrepresentatives do not have a binding effect on thePlan. If you need to bring or appeal a claim underthis Plan, you should follow the formal claims andappeals procedures described in this booklet.This SPD is based on legal documents (such asplan documents, insurance contracts and summarybooklets and HMO contracts) currently in effect.These documents provide further detail oncoverage benefits as well as important exclusions,limitations, and requirements applicable to receivebenefits. You may obtain a copy of any of theofficial legal documents for your coverages onlineby following the steps below:
Introduction1. Access YBR via this website:http://digital.alight.com/hilton2. Click on the “Choose a Language” drop-downbox from the log on page, select “English” or“Spanish – Español”.3. Enter your User ID and password on the Logonpage.4. From the YBR Home page, select the tab titled“Health & Insurance.”5. From the Health & Insurance page choose the“Coverage Details” drop down, then in the menuitems, click on the Plan Information link.6. The SPD and available insurance certificatesand Coverage Booklets will be displayed on thenext screen.While every effort has been made to give youcorrect and complete information about yourbenefits, in the event of any conflict orinconsistency between this SPD and relevant legaldocuments with respect to benefits payable, theterms of the legal documents will control. The SPDwill govern if the conflict or inconsistency relates toeligibility, except as described in the “StateInsurance Mandates and Dependent Coverage”section in the Participation chapter.2
PARTICIPATIONELIGIBILITY . 4Your Eligibility .4Your Eligible Dependents .8Proof of Dependent/Disabled Status .9Qualified Medical Child Support Order (QMCSO) .10Dual Coverage .10State Insurance Mandates and Dependent Coverage .10On-Site Medical Clinics .10COST OF COVERAGE . 11Pre-Tax vs. After-Tax .12Domestic Partners: Tax Implications and OtherInformation .12REDUCING THE AMOUNT YOU PAY FOR MEDICAL COVERAGE . 13Wellness Review Credit* .13ENROLLMENT . 14When to Enroll .14How to Enroll .14Annual Enrollment .14Medical Coverage Enrollment – After-Tax Basis.15Special Circumstances: Re-employment .16Changing Coverage During the Year .16WHEN COVERAGE ENDS . 283
Participationon a pre-tax basis starting on the 91st day ofemployment. Enrollment in Health SavingsAccounts and Health and Dependent CareFlexible Accounts, as applicable, must becompleted during the first 30 days of hire;however, contributions to Health SavingsAccounts and Health and Dependent CareFlexible Accounts would begin on the 91st day.During the first 90 days of employment,contributions to Health Savings Accounts andHealth and Dependent Care Flexible SpendingAccounts will not be permitted. If a CorporateTeam Member wants Life, Accidental Death andDismemberment, or Disability coverage, thecoverage should be elected during this 30-dayperiod, which, other than Basic Life Insurance, ispaid on an after-tax basis. To the extent requiredby applicable tax rules, for the first 90 days ofcoverage, the cost of Basic Life Insurancecoverage, less amounts paid by the TeamMember, will be reported to you on your Form W2 (“C” in Box 12) and on your paycheck (under“Group Term Life”). See the “Life Insurance”section in this SPD for information on how BasicLife Insurance will be taxed at the end of the 90day period.ELIGIBILITYYour EligibilityGenerally, you are eligible for health and welfarebenefits if: you are a regular U.S. Team Member ofHilton; and you are “full-time”, which for purposes of thisPlan means you are either:oan hourly or salaried employee who isreasonably expected to work at least 30hours a week (as determined by Hilton);oroan hourly or salaried employee who isnot reasonably expected to work at least30 hours when hired, but who averages30 or more hours of service during anapplicable measurement period, asdescribed in Sections II - V.Team Member does not include individualsemployed by a hotel owner or any other nonaffiliated entities (including franchisees). Thisdefinition of Team Member shall apply to this SPDand any other communications sent to participantsrelating to benefits offered under the Plan.The following sections describe in more detail whowill be eligible and when you can enroll if youbecome eligible. Definitions for the capitalizedterms are provided in Section V.You are eligible for disability insurance, life andAD&D insurance, business travel accidentinsurance and MetLaw legal services if you are afull-time U.S. Team Member of Hilton (and acorporate salaried Team Member for salarycontinuation). Except as provided below forCorporate Team Members, coverage will beginfollowing a 90-day waiting period.A. Non-variable Hour Team Members – Nonvariable Hour Team Members are eligible andmay enroll in coverage as of the date specifiedin Section II.I.ELIGIBILITYB. Variable Hour Team Members – Variable HourTeam Members are eligible if they average 30or more Hours of Service during the applicablemeasurement period below:Notwithstanding this rule, a newly hiredCorporate Team Member must enroll in the Planwithin the first 30 days of hire. If coverage iselected, with exception of Health and DependentCare Flexible Spending Accounts and HealthSavings Accounts, coverage will be effective asof the first day of employment, subject toEvidence of Insurability requirements for Life andAccidental Death and Dismemberment coverage.However, medical, dental and vision coveragewill be paid on an after-tax basis through the 90thday of employment. Such coverage will be paid(1) New Team Members – the applicablemeasurement period is your InitialMeasurement Period; and(2) Ongoing Team Members – the applicablemeasurement period is the most recentStandard Measurement Period.Team Members who become eligible pursuantto either A or B shall be referred to collectivelyas “Full-Time Team Members.”4
ParticipationSee Section II.C. for eligibility rules when youare transitioning between the Initial StabilityPeriod and the Standard Stability Period.II.coverage beginning on the first dayafter the end of your Initial StabilityPeriod and coverage will continuethrough the end of the StandardStability Period.ENROLLMENT(b) If you do not average 30 or moreHours of Service per week during yourfirst Standard Measurement Period,your coverage will terminate at theend of your Initial Stability Period andyou will not be eligible to enroll incoverage unless you average 30 ormore Hours of Service per weekduring a subsequent StandardMeasurement Period. If you areenrolled in coverage at the end ofyour Initial Stability Period, you will beoffered continuation coverage underCOBRA beginning as of the dayfollowing the end of your InitialStability Period.A. New Team Members(1) Non-variable Hour Team Members – Nonvariable Hour Team Members will beeligible to enroll in benefit coverageeffective on their ninety-first (91st) day ofemployment.(2) Variable Hour Team Members – EligibleVariable Hour Team Members will beeligible to enroll in benefit coverage duringthe Administrative Period following theirInitial Measurement Period. Coverage willbecome effective as of the first day of theInitial Stability Period.B. Ongoing Team Members – Eligible OngoingTeam Members will be eligible to enroll duringthe open enrollment period designated by thePlan Administrator. Coverage will becomeeffective as of the first day of the nextStandard Stability Period.(2) No Coverage During Initial Stability Period- If you did not average 30 or more Hoursof Service per week during your InitialMeasurement Period, you will not beeligible to enroll in coverage during yourInitial Stability Period.Ongoing Team Members who fail to average30 or more Hours of Service per week duringthe Standard Measurement Period are noteligible to enroll and will not be offeredcoverage during the Standard Stability Period.If such Ongoing Team Members were eligiblefor coverage during the Standard StabilityPeriod that includes the annual enrollmentperiod, they will be offered continuationcoverage under COBRA beginning as of thefirst day of the next Standard Stability Period.(a) If you average 30 or more Hours ofService per week during your firstStandard Measurement Period, youwill be eligible to enroll in coverageeffective as of the first day of yourStandard Stability Period, even if thatfalls within your Initial Stability Period.(b) If you do not average 30 or moreHours of Service per week during yourfirst Standard Measurement Period,you will not be eligible to enroll incoverage unless you average 30 ormore Hours of Service per weekduring a subsequent StandardMeasurement Period.C. Transitioning Team Members – The followingrules apply to you when you transition fromyour Initial Stability Period to your StandardStability Period:(1) Coverage During Initial Stability Period - Ifyou averaged 30 or more Hours of Serviceper week during your Initial MeasurementPeriod and elected coverage, yourcoverage will continue through the end ofyour Initial Stability Period.III. CHANGES IN EMPLOYMENT STATUSA. Variable Hour Team Member to Non-variableHour Team Member – If you changeemployment status from a Variable Hour TeamMember to a Non-variable Hour Team Memberduring your Initial Measurement Period, youwill be eligible to enroll as of the earlier of:(a) If you average 30 or more Hours ofService per week during your firstStandard Measurement Period, youcan elect to continue medical5
Participation(1) The first day of your Initial Stability Period,if you satisfy Section II.C(1); orthe Standard Measurement Period that includesthe date you return to active service.(2) The date of your change in employmentstatus (or your 91st day of employment, iflater).Notwithstanding that rule, you will be eligible forbenefits upon rehire if you are a Non-Variable HourTeam Member rehired within 12 months oftermination of employment.B. Non-variable Hour Team Member to VariableHour Team Member – If you changeemployment status from a Non-variable HourTeam Member to a Variable Hour TeamMember before you begin your first StandardStability Period, you will remain eligible forcoverage until the end of your first StandardMeasurement Period (plus AdministrativePeriod), at which time your status as a FullTime Team Member will be determined basedon Hours of Service during the StandardMeasurement Period.B. Special Provision for Furloughed TeamMembers as Of March 31, 2021.1.Group medical dental and vision coverage ends April1, 2021 for furloughed Team Members who remainedemployed, retained active coverage eligibility, butwhose hours were reduced to 0 while on furlough ForTeam Members who remained in active coveragewhile on furlough through March 31, 2021, thistermination of coverage will allow you to electCOBRA continuation coverage due to your priorreduction in hours as the COBRA qualifying event.Team Members eligible for COBRA coverage, butwho are not eligible for coverage through Medicareor another group health plan, will generally beeligible to elect a 100% COBRA subsidy for themonths April 1, 2021 through September 30, 2021.If eligible, this subsidy may reduce the net out ofpocket amount you actually pay for coverageduring these months. Those not eligible for thesubsidy will be required to pay the full COBRApremium.III. LEAVES OF ABSENCEWhile you are on an approved leave of absence,you will remain eligible for coverage as long as youremain employed and you make timelycontributions, assuming you are otherwise eligiblefor, and enrolled in, such coverage. But pleasesee Section IV below for furloughed employees asof March 31, 2021.IV. REHIRES AND RETURNS FROM LEAVE OFABSENCEFor these furloughed Team Members the noticeperiod in which Hilton is required to notify the PlanAdministrator of certain qualifying events such as areduction in hours begins on the date of the loss ofcoverage (April 1, 2021) rather than the date of theTeam Member’s reduction in hours. What thismeans is that the 18 months that you are entitled toCOBRA coverage will run from April 1, 2021instead of the date that you had a reduction inhours/furlough (but subsidized coverage forCOBRA, if eligible, will only run through September30, 2021 unless extended further by Congress).A. GenerallyWhen you are rehired following termination ofemployment, you will be treated as a New TeamMember (e.g., subject to a new Initial MeasurementPeriod) if: Variable Hour Team Member: your period ofno service lasted 13 weeks or longer; or Non-Variable Hour Team Member: your periodof no service lasted longer than 12 months.End of Coverage and COBRA2.When you return from an approved leave ofabsence, you will be treated as an Ongoing TeamMember, even if your leave of absence lasted 13weeks or longer.Return from FurloughExcept as otherwise may be provided by acollective bargaining agreement, Team Memberswho were eligible for group medical, dental orvision coverage at the time of furlough will beeligible for active coverage on the first day thatthey return from furlough (notwithstanding anyotherwise applicable minimum hours requirementapplicable during the prior Standard MeasurementPeriod to qualify for coverage in 2021). This alsoIf your period of no service was less than 13 weekslong, you will be treated as a continuing employee,as if you had not been gone. However, Hours ofService may not be awarded for the period of noservice when averaging your Hours of Service for6
Participationapplies for those Team Members who lostcoverage while on furlough for failure to timely paycontributions.is reasonably expected at the time of hire towork 30 or more hours per week, unless theTeam Member is a Seasonal Employee.For Team Members who remained in activecoverage through March 31, 2021 they will bereinstated according to the Plan Year 2021 openenrollment elections. For those Team Memberswho did not remain in active coverage a newenrollment will be required.G. Ongoing Team Member – a Team Memberwho has been employed at least one completeStandard Measurement Period.H. Standard Measurement Period – the periodbeginning on October 3 and ending onOctober 2 of the following year during whichHours of Service will be averaged for OngoingTeam Members.V. DEFINITIONSA. Administrative Period – the period runningfrom October 4 to December 31, or withrespect to a New Team Member, the periodrunning from the day after the InitialMeasurement Period through the first day ofthe month following the month in which theTeam Member’s anniversary of employmentoccurs.I.J. Seasonal Team Member – a Team Memberwho performs services on a seasonal basis, asdetermined by the Plan Administrator in itssole discretion in accordance with applicableguidance. Seasonal Employees may includefull-time temporary employees who meet theIRS requirements to be treated as seasonal.B. Hour of Service – each hour for which a TeamMember is paid, or entitled to payment, for theperformance of duties by Hilton and each hourfor which a Team Member is paid, or entitledto payment by Hilton for a period of time duringwhich no duties are performed due to vacation,holiday, illness, incapacity (including disability),layoff, jury duty, military duty or leave ofabsence.K. Variable Hour Team Member – a TeamMember who is not reasonably expected as ofthe Team Member’s start date to be employedon average at least 30 Hours of Service perweek during the Initial Measurement Periodbecause the Team Member’s Hours of Serviceare variable or otherwise uncertain.C. Initial Measurement Period – the 11-monthperiod beginning on a Team Member’s date ofhire over which hours will be averaged for NewTeam Members who are Variable Hour TeamMembers.If you are a non-union Team Member regularlyscheduled to work 30 or more hours per week atthe time Hilton takes over management orownership of the property at which you areemployed, your service at that property may counttoward satisfaction of the eligibility requirements.You will be notified if your service will be counted.Absent such notification, your prior service doesnot count. Prior service for union Team Memberswill be determined pursuant to the terms of thecollective bargaining agreement.D. Initial Stability Period – the 12-month periodbeginning on the first day of the monthfollowing the month in which occurs theanniversary of your date of hire.E. New Team Member – a Team Member whohas been employed less than one completeStandard Measurement Period, or a VariableTeam Member who has experienced a periodof no service equaling or exceeding 13 weeks(or a Non-Variable Team Member who hasexperienced a period of service that equals orexceeds 12 months) in accordance withSection IV.F.Standard Stability Period – the 12-monthperiod beginning each January 1 and endingthe following December 31.If you are eligible for benefits and you are placedon furlough and/or your property is partially or fullyclosed for renovations, due to significant businessdisruption, or as a result of a national or localdisaster or emergency (e.g., hurricane, tornado,earthquake, pandemic), you may be allowed tocontinue your coverage during the closure undercertain conditions and you may be credited withhours of service for eligibility purposes under theNon-variable Hour Team Member – a TeamMember, including a temporary employee, who7
ParticipationPlan during the closure. Hilton has sole discretionto determine which events qualify, which TeamMembers are affected and the requirements forcontinued coverage and crediting hours solely forPlan eligibility purposes, and Hilton will attempt toapply those requirements consistently to allaffected Team Members, to the extent it deemssuch application feasible in its sole discretion. Inthe event any coverage is required to be continuedunder applicable law, Hilton may determine thatsuch continuation will apply concurrently with or inlieu of coverage continuation under this provision.For the Employee Assistance Program (EAP),coverage begins on the first day of work.In some cases, certain coverages may start earlieror be subject to additional requirements. For thefollowing coverages, you must be actively at workon the date coverage is scheduled to begin:There are special provisions for Team Memberson furlough as of March 31, 2021. Please seethe section on Rehires and Returns From Leaveof Absence in the Eligibility section of this SPDfor those provisions. Disability; Life Insurance; Accidental Death and Dismemberment; and Business Travel Accident.See the chapters on individual benefit options forother requirements.Excluded IndividualsPreexisting ConditionsThe following individuals are not eligible toparticipate in the Plan: (i) independent contractors,(ii) individuals subject to a consultant or employeeleasing agreement, (iii) employees whoseemployment is covered by a collective bargainingagreement with Hilton (unless the collectivebargaining agreement requires otherwise), (iv)individuals employed by a hotel owner other thanHilton or one of its affiliated entities where Hiltonmanages employees at that hotel but does notactually employ them, unless eligibility is approvedby the Plan Administrator, or (v) individualsemployed at franchised properties. In addition,even if you are an otherwise eligible Employee, butwork at a property that is managed, but not owned, byHilton and the owner sponsors and offers its ownhealth and welfare benefits, you will not be eligible toparticipate in this Plan.Benefits under the LTD program may be limited ifyou have a disability due to a preexisting condition.See the “Disability” section of this handbook fordetails.Your Eligible DependentsSubject to certain limitations, your eligibledependents may also participate in the Plan.Your eligible dependents include your: Legal Spouse. Unless you are legallyseparated, “Spouse” means the individualrecognized as your spouse for federal taxpurposes. “Spouse” shall not include anindividual legally separated from theParticipant under a decree of divorce orseparate maintenance nor shall it include, forpurposes of the Dependent Day CareAccount, an individual who, although marriedto the Participant, files a separate federalincome tax return, maintains a separateresidence during the last six months and doesnot furnish more than one-half of the cost ofmaintaining the principal residence of thequalifying individual. Domestic Partner. The Plan defines adomestic partnership as a same-sex oropposite-sex relationship where:When Coverage BeginsSubject to certain exceptions and if you timelyenroll for coverage, your coverage will begin onthe date set forth above.Payroll deductions for your share of the coveragecosts will begin as soon as administrativelyfeasible based on your eligibility date and paycycle. Your contribution for a pay cycle will not bepro-rated by how many days of coverage areprovided during that pay cycle. 8Each partner is age 18 or older;
Participation Each partner is a U.S. citizen or a U.S.resident alien (not applicable for STD,LTD, Life and AD&D coverage); The partners are not blood relatives; Neither partner is currently, nor have beenin the past six (6) months, legally married,or legally separated from each other orsomeone else, nor does either partnerhave another domestic partner (notapplicable for STD, LTD, Life and AD&Dcoverage); The partners maintain an intimate,committed relationship of mutual caringand support; The partners have lived together for atleast six (6) months, during which time thepartners were not married to, or legallyseparated from, each other or someoneelse before enrollment in any of thecoverages; The partners do and will continue to havethe same principal address indefinitely;and The partners agree to share basic livingexpenses during their domesticpartnership and will permit anyone who isowed money in connection with theseexpenses to collect from either partner.Your natural children; Your stepchildren or except for Life andAD&D coverage, foster children; Your legally adopted children (includingchildren placed with you for adoption); Children of your domestic partner who yousupport and who live with you; Children who live with you and for whomyou are the legal
benefits, please contact the Hilton Benefits Center. You may reach the Hilton Benefits Center at 1.877.442.4772 Monday through Friday from 8:00 a.m. to 6:00 p.m. CT. The role of the Hilton Benefits Center and the service center representatives with the Plan's insurers and third party administrators is to assist
