Alcatel-Lucent

Nokia Coverage Options When You Are Medicare-Eligible but Your Dependent Is Not
(and Vice Versa)

In most cases, covered dependent(s) must be enrolled in the same Nokia medical option and with the same healthcare carrier that you choose for yourself. However, there are exceptions:

If You Are Medicare-Eligible

If you elect the following medical option…	Then coverage for you and your Medicare-eligible dependent(s) will be…	And coverage for your dependent(s) not eligible for Medicare will be…
UnitedHealthcare Group Medicare Advantage (PPO)	UnitedHealthcare Group Medicare Advantage (PPO) and Express Scripts prescription drug coverage	Point of Service (POS) medical and Express Scripts prescription drug coverage, if there is a UnitedHealthcare POS in your area — otherwise, Traditional Indemnity medical and Express Scripts prescription drug coverage
Traditional Indemnity	Traditional Indemnity medical and Express Scripts prescription drug coverage
Medicare Health Maintenance Organization (HMO)	Medicare HMO, with Medicare HMO prescription drug coverage	HMO, with HMO prescription drug coverage

If You Are Not Eligible for Medicare

If you elect the following medical option…	Then coverage for you and your dependent(s) not eligible for Medicare will be…	And coverage for your Medicare-eligible dependents will be…
Point of Service (POS)	POS medical and Express Scripts prescription drug coverage	Traditional Indemnity medical and Express Scripts prescription drug coverage, with Medicare primary
Traditional Indemnity	Traditional Indemnity medical and Express Scripts prescription drug coverage
Health Maintenance Organization (HMO)	HMO, with HMO prescription drug coverage	Medicare HMO, with Medicare HMO prescription drug coverage

You Must Be Enrolled in Medicare Part B

Under Nokia Plan provisions, Medicare-eligible participants must be entitled to Medicare Part A and enrolled in Medicare Part B to receive benefits coverage through the Plan. When you are enrolled in Medicare Part B, you will pay a monthly premium cost for coverage and may also be required to pay a monthly contribution for the Nokia retiree healthcare coverage that you choose.

Medicare Part B offers medical benefits, such as doctor and ambulance services. You may become automatically enrolled in Medicare Part B if you receive Social Security benefits. Check with Medicare for information about your personal situation.

Medicare Part C Medical Options — What You Should Know

Medicare Advantage Preferred Provider Organization (PPO) plans (like the UnitedHealthcare Group Medicare Advantage [PPO]) and Medicare HMOs are “Medicare Part C” options. By enrolling in one of these medical options, you agree to receive standard Medicare Part A and Medicare Part B services through that medical option.
If you enroll (or continue coverage) in a Medicare HMO offered by the Plan, you will receive prescription drug coverage directly through that Medicare HMO. Plan designs vary. You must go to hospitals, doctors, pharmacies and other providers in the Medicare HMO’s network to receive coverage.
Shortly after enrolling in a Medicare HMO through the YBR website or the Nokia Benefits Resource Center, you may receive form(s) in the mail from the Nokia Benefits Resource Center. Complete the form(s) with your personal information, Medicare information and signature, and return them to the Nokia Benefits Resource Center by the deadline stated on the form(s) to avoid any delays in receiving coverage.
Other Medicare HMO and Medicare Part C options may be available to you from other private insurers. You cannot be enrolled in more than one Medicare Part C plan option at the same time. Enrolling in a private insurer’s Part C plan does not automatically cancel any Nokia coverages you may have defaulted to or enrolled in during the annual open enrollment period. To enroll in a private insurer’s Part C plan outside of the Company-sponsored Plan during the year, you must call the Nokia Benefits Resource Center to disenroll from your Nokia medical and prescription drug coverage.
Medicare HMO contribution costs will be final in December. Because the Medicare HMOs require approval by CMS, the final plan designs and contribution costs will not be available to the Nokia Benefits Resource Center during the annual open enrollment period. It is expected that the Nokia Benefits Resource Center will have the final plan designs and contribution costs in December. If you decide to enroll in a Medicare HMO during the Nokia annual open enrollment period, and the contribution cost is later reduced, you will receive written notification. The contribution cost will not be higher than what is shown on the YBR website during the annual open enrollment period.

Enrollment and Disenrollment Are Not Solely Within the Control of Nokia, and Rely Heavily on Decisions Made by CMS

If you are Medicare-eligible, at any time during the year, you can disenroll from or switch between the UnitedHealthcare Group Medicare Advantage (PPO), Traditional Indemnity and Medicare HMO options offered by the Plan by calling the Nokia Benefits Resource Center at 1-888-232-4111. However, CMS approval is required. As a result, all elections and effective dates of coverage are driven by CMS. To determine which Medicare HMOs are available to you through the Plan, review the YBR website during the annual open enrollment period.

Important note: If you switch between these medical options during the year, any amounts that you have paid toward your prior option’s deductible and out-of-pocket maximum will not carry over to your new option. Your deductible and out-of-pocket maximum will start over when your coverage in your new option begins.

Medicare Part D Plans May Be Available to You

If you enroll in a Medicare Part D prescription drug plan outside of the Nokia plan, then you are making the choice to opt out of the Nokia plan’s prescription drug coverage. This means that all of the following apply:

Your Nokia prescription drug coverage will no longer pay any portion of your prescription medications ― even if the Medicare Part D coverage does not pay for a claim.
You and/or your dependent(s) will need to begin paying premium costs to the new Medicare Part D provider for Medicare Part D coverage.
Your contribution costs, if any, for coverage under the Nokia plan will not be adjusted. Nokia cannot provide varying contribution structures, so you will continue to pay the same contribution costs as someone who still has prescription drug coverage under the Nokia plan.
Nokia prescription drug coverage will continue to cover:
- Any dependent(s) not eligible for Medicare who are enrolled in the Nokia plan; and
- Any Medicare-eligible dependent(s) who have not enrolled in another Medicare Part D plan.

*Including Long Term Disability (LTD) and COBRA participants and survivors in the Family Security Program (FSP).