Under Age 65 Retiree and Dependents

Medical Coverage (including Prescription Drugs and Vision) and Dental Coverage:

• You may continue medical and dental coverage for yourself, your spouse, and eligible children.
• If you are under age 65 and your spouse is over age 65, you may cover your spouse under your plan. Your spouse must be enrolled in Medicare Part A and Part B (but not Part D).
• If you marry after your retirement effective date, you cannot add your newly acquired spouse or children to your medical or dental retiree coverage, nor will they be eligible at open enrollment.
• A surviving spouse may continue his/her medical and dental coverage if he/she gets married, but the newly acquired spouse or children cannot be added.
• If you are under age 65 and have dental coverage when you retire, but elect to cancel the dental coverage at retirement because of coverage under another employer’s group dental plan, you may later enroll in the Company dental plan if you lose coverage under that employer’s plan. You must show proof of loss of coverage and enroll within 30 days of the date of coverage loss.
• If you are under age 65 and do not continue medical coverage at retirement, you may enroll during the annual Open Enrollment period each October or November, if eligible. Your coverage will be effective on the following January 1.
• A spouse or child cannot be covered under the medical or dental plan unless the Retiree is covered.
• You and your spouse must have continuous medical coverage under the Company plan or another employer’s plan to be eligible to participate in the Major Medical Medicare Supplement Plan upon reaching age 65.

Over Age 65 Retiree and Dependents

Medical Coverage (including Prescription Drugs) and Dental Coverage (including Vision):

• You and your spouse must be covered for Medicare Part A and Part B (but not Part D prescription drug coverage) in order to be eligible for the Major Medical Medicare Supplement Plan.
• If you or your spouse enroll in Medicare Part D prescription drug coverage, you will be dropped from the Major Medical Medicare Supplement Plan and cannot ever re-enroll again.
• You must enroll in the Major Medical Medicare Supplement Plan within 30 days of your 65th birthday, or within 30 days of your retirement date if you retire after age 65. Enrollment forms are available from the Benefit Plans Office. To enroll, you must elect coverage for yourself only or for you and your eligible spouse. You must authorize the Company to deduct your share of the cost of the coverage you elect from your pension payments. If you fail to give this timely authorization on the enrollment form, neither you nor your spouse will be covered.
• If you or your surviving spouse cancels dental/vision coverage or the Major Medical Medicare Supplement Plan, or if your medical coverage is dropped because you are covered under the Medicare Part D prescription drug plan, you or your surviving spouse cannot re-enroll at a later time.
• An eligible spouse cannot be covered under the medical or dental/vision plan unless the Retiree is covered. This applies if you are a Retiree or an over or under age 65.
• A surviving spouse may continue medical or dental/vision coverage upon remarriage but cannot add the new spouse. This applies to a surviving spouse of a Retiree regardless of the age at remarriage.
• A Retiree or surviving spouse may enroll in the dental/vision plan, or the medical plan, or both.

When You May Change Your Elections
There are limited circumstances under which you may change your benefit elections. You may change most savings program elections at anytime by calling the CitiStreet Information Line. In addition, you can drop your medical, dental or group life coverage at any time by signing a cancellation form. Cancellation forms are available from the Benefit Plans Office.

The term “Retiree” is defined in the Glossary.