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SUMMARY PLAN DESCRIPTION FOR HEALTH AND WELFARE BENEFITS OF ACTIVE EMPLOYEES

EFFECTIVE JANUARY 1, 2017

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Table of contents

WELCOME TO THE 2017 SUMMARY PLAN DESCRIPTION FOR ACTIVE EMPLOYEES

MUFG Union Bank, N.A. (the “company”) remains committed to providing a comprehensive health and welfare benefits package

that meets your personal needs and continues to be extremely competitive among the world’s leading financial institutions. Th is

Summary Plan Description (SPD) provides an overview of our 2017 health and welfare benefits program.

You can find more information about the specific benefits in the appendix to this document.

The table of contents will help you navigate the SPD and explain your rights under the laws that govern the group health and

welfare employee benefits programs sponsored by the company.

Overview and Plan contact information 3

Health and Welfare benefits 8

Eligibility 9

Enrollment procedures 14

Benefit descriptions 15

Medical and Prescription Drug Coverage 17

Dental 32

Vision 33

Basic life / supplemental life and Accidental Death and Dismemberment 34

Short-Term Disability (STD) and Salary Continuation 36

Long Term Disability Basic Plan and Buy up 38

Section 125 Plan—Flexible Spending Accounts (FSAs) 39

Health Savings Account (HSA) 41

Business Travel Accident (BTA) 42

Employee Assistance Program (EAP) 43

Wellness Program 44

Voluntary Legal Assistance Plan 44

Your costs 45

Rights under the plans 46

Appendix 67

Plan documentation 69

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Overview and Plan contact information

This document, together with the appendix and applicable certificates of insurance, booklets, summaries of benefits and

coverage, and contracts referenced herein that describe the benefits provided, constitutes an SPD, which summarizes the

important provisions of the MUFG Union Bank, N.A., health and welfare benefits plans (each a “Plan”; collectively, the “Plans”),

as restated and amended, effective as of January 1, 2017.

Complete details of each Plan are found in the certificates of insurance, booklets, summaries of benefits and coverage, and

contracts for the benefit options offered under such Plan. This SPD, the certificates of insurance, the booklets, the

summaries of benefits and coverage, the contracts, and any written administrative procedures pertaining to each Plan may

be reviewed by employees and their legal representatives upon request and without charge during regular business hours or

by appointment at a mutually convenient time with the Total Rewards department. If there is a conflict between this SPD and

any such Plan document, the Plan document will govern. Also, without limiting the foregoing, with respect to benefits

provided by an insurance company, if there is a conflict between the applicable certificates of insurance, summaries of

benefits and coverage, booklets, or contracts and this SPD, the provisions of the relevant certificates of insurance, summaries

of benefits and coverage, booklets, or contracts will govern. Copies of the certificates of insurance, summaries of benefits and

coverage, booklets, and contracts are available to employees upon request and without charge.

None of the Plans are a contract of employment or guarantee continued employment. The benefits under the Plans are

provided at the sole discretion of the Plan Sponsor and its designated affiliates. Neither the Plan Sponsor nor any of its

affiliates makes any promises to continue any Plan or benefits thereunder in the future, and rights to future benefits will never

vest.

It is recommended that you read this SPD carefully so you can understand each Plan’s operation and benefits. If you have

any questions after reading this SPD or would like additional information, please contact the Plan Administrator at the

address specified in the “Plan Information” section.

For more information or questions related to Health and Welfare benefits, you may contact the Benefits Service Center at 1

800 964-9907.or visit our website at mufgamericas.com/mybenefits. If you would like a printed copy of this SPD, you may

request one at no charge from the Benefits Service Center.

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PLAN INFORMATION

The SPD portion of this booklet relates only to certain health and welfare benefits offered under

the following Plans:

MUFG Union Bank, N.A., Health Benefit Plan

Plan Number: 541

Plan Sponsor: MUFG Americas Holdings Corporation

1251 Avenue of the Americas, 15th

Floor New York, NY 10020

212-782-4698

EIN: 94-1234979

Plan Administrator: Benefit Plans Administrative Committee

MUFG Union Bank, N.A.

Total Rewards

400 California Street, 10th Floor

San Francisco, CA 94104

800-365-5065, option 1

Employers: MUFG Union Bank, N.A., and its U.S.

subsidiaries

MUFG Securities Americas Inc.

BTMU Capital Corporation

BTMU Leasing & Finance, Inc.

BTMU Capital Leasing and Finance, Inc.

MUFG Americas Holdings Corporation

Mitsubishi UFJ Financial Group, Inc.

BTMU Securities, Inc.

The Bank of Tokyo-Mitsubishi UFJ, Ltd.,

Global Financial Crimes Intelligence Division

Other employers as designated by the Benefit

Plans Administrative Committee

Benefits Covered: Medical

Dental

Vision

Wellness Program

Type of Administration: The fully insured benefits are administered by

insurance companies, and the other benefits are

administered by third-party administrators.

Plan Year: January 1–December 31

Agent for Service of Legal Process: Plan Administrator

Funding and Contributions: The fully insured benefits are funded by the insurance

carriers. The other benefits are funded by a voluntary

employees beneficiary association (VEBA) trust or

company assets. Contributions to the benefits are

made by the employers, employees, retirees, and

COBRA beneficiaries.

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MUFG Union Bank, N.A., Employee Insurance Plan

Plan Number: 542

Plan Sponsor: MUFG Union Bank, N.A.

400 California Street, 10th Floor San Francisco,

CA 94104

EIN: 94-0304228

Plan Administrator: Benefit Plans Administrative Committee MUFG

Union Bank, N.A.

Total Rewards


CA 94104

800-365-5065, option 1 Employers: MUFG Union Bank, N.A., and its U.S. subsidiaries


BTMU Capital Corporation BTMU Leasing &

Finance, Inc.

BTMU Capital Leasing and Finance, Inc. MUFG Americas

Holdings Corporation Mitsubishi UFJ Financial Group,

Inc.


The Bank of Tokyo-Mitsubishi UFJ, Ltd., Global Financial

Crimes Intelligence Division

Other employers as designated by the Benefit Plans

Administrative Committee

Benefits Covered: Accidental Death and Dismemberment Insurance Business

Travel Accident Insurance

Term Life Insurance

Employee Assistance Program

Life Insurance for BTMU retirees retiring before January

1, 2015

Healthcare and Limited Scope Healthcare FSA portions of the

Section 125 Plan

Group Legal Benefits

Type of Administration: Most of the benefits are fully insured and administered

by the insurance carriers. However, the FSAs are self-

funded and administered by a third-party administrator.

Plan Year: January 1–December 31 Agent for

Service of Legal Process: Plan Administrator

Funding and Contributions: The benefits are funded by the insurance carriers,

except for the FSAs, which are self-funded benefits. Contributions

to benefits are made by the employers, employees, and retirees.

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MUFG Union Bank, N.A., Section 125 Plan (only the Healthcare FSA and Limited Scope Healthcare FSA

portions of the Section 125 Plan are subject to ERISA)

Plan Number: N/A



CA 94104

EIN: 94-0304228

Plan Administrator: Benefit Plans Administrative Committee MUFG Union Bank, N.A.

Total Rewards



800-365-5065, option 1

Employers: MUFG Union Bank, N.A., and its U.S.

subsidiaries


BTMU Capital Corporation

BTMU Leasing & Finance, Inc.

BTMU Capital Leasing and Finance, Inc.

MUFG Americas Holdings Corporation

Mitsubishi UFJ Financial Group, Inc.


The Bank of Tokyo-Mitsubishi UFJ, Ltd.,

Global Financial Crimes Intelligence Division

Other employers as designated by the Benefit

Plans Administrative Committee

Benefits Covered: Healthcare FSA

Limited Scope Healthcare FSA

Dependent Care FSA (not subject to ERISA)

Premium conversion, including HSA contributions by employees

and employers (not subject to ERISA)

Type of Administration: Benefits under the Plan are administered by

third-party administrators pursuant to administrative

services agreements between the administrators and

the Plan Sponsor.

Plan Year: January 1–December

31 Agent for Service of Legal Process: Plan Administrator

Funding and Contributions: Benefits under the Plan are self-funded.

Contributions to the Plan are made by

the employees and employers.

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MUFG Union Bank, N.A., Disability Plan

Plan Number: 546




EIN: 94-0304228

Plan Administrator: Benefit Plans Administrative Committee

MUFG Union Bank, N.A.

Total Rewards



800-365-5065, option 1

Employers: MUFG Union Bank, N.A., and its U.S. subsidiaries


BTMU Capital Corporation BTMU Leasing &

Finance, Inc.

BTMU Capital Leasing and Finance, Inc. MUFG Americas

Holdings Corporation Mitsubishi UFJ Financial Group, Inc.


The Bank of Tokyo-Mitsubishi UFJ, Ltd., Global Financial Crimes

Intelligence Division

Other employers as designated by the Benefit Plans

Administrative Committee

Benefits Covered: Long-Term Disability

MUFG Union Bank, N.A. California Voluntary Disability Plan Type of Administration: The Long-Term

Disability benefit effective for claims incurred after 2014 is administered

by an insurance company. The Long-Term Disability benefit effective for

claims incurred before 2015 and the California Voluntary Disability benefit

are administered by third-party administrators.

Plan Year: January 1–December 31

Agent for Service of Legal Process: Plan Administrator

Funding and Contributions: The fully insured Long-Term Disability benefit is funded by the insurance carrier.

The other benefits are funded by a voluntary employee beneficiary association (VEBA) trust and

employer general assets. Contributions to the benefits are made by the employers and

employees.

1 All references to the Medical plan or Medical benefits in this guide include prescription coverage.

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Health and Welfare Benefits Program

• Medical and Prescription Drug Coverages1

• Dental

• Vision

• Basic Life

• Supplemental Life (Employee, Spouse and Child)

• Accidental Death and Dismemberment (Employee and Family)

• Short-Term Disability

• Salary Continuation

• Long-Term Disability Base Plan

• Long Term Disability Buy Up

• Section 125- Flexible Spending Accounts (FSAs) (Healthcare, Dependent care, Limited Purpose)

• Health Savings Account (HSA)

• Business Travel Accident (BTA)

• Employee Assistance Program (EAP)

• Wellness Program

• Legal Assistance Plan

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Eligibility

When are you eligible?

If you are regularly scheduled to work 17.5 hours per week and on the U.S Payroll of a Participating Employer that has

been designated by the Administrative Committee to participate in the Plan, you and your dependents are eligible to join the

company’s health and welfare benefits plans. However, the following individuals are not eligible for benefits: employees

who are classified as flexible non-benefits-eligible employees, rotational employees, leased employees, seasonal

employees, interns, and temporary employees, whether or not they work more than 17.5 hours per week.

All benefits eligible employees and their eligible dependents can participate in the Employee Assistance Program (EAP)

and Healthy Guidance Wellness Program.

All benefits-eligible employees are automatically enrolled in the following company paid benefits:

Business travel accident insurance

Basic Life Insurance

State statutory Short Term Disability – applicable to CA, NJ and NY employees only

Salary Continuation (You qualify for Salary Continuation after you have been employed for 90 days)

Long Term Disability Insurance Base Plan

When do benefits become effective?

Your Medical, Dental, Vision, Supplemental life, AD&D, Buy Up LTD and FSA’s coverages become effective on the first of

the day of the month following your date of hire upon for completion of your online enrollment. Company paid benefits are

effective the first day of the month following your date of hire (except for the Salary Continuation Program, which takes

effect after 90 days of employment).

Note: You must complete your enrollment within 30 days of employment to obtain coverage. If you do not enroll timely, you

will not have coverage for the current year unless you experience a qualifying life event such as marriage, loss/gain of

spousal employment, birth/adoption). Life events require proof of change within 30 days of the event (see”Enrollment

Procedures”). If you do not experience a life event, your next opportunity to enroll will be during the next Annual Enrollment

Period.

Any contributions you are required to make will be deducted from your paychecks accordingly. However, retroactive

contributions may be required when, for example, you complete your online enrollment after the first day of the month

following your date of hire.

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The company offers you the opportunity to enroll in the following plans:

Medical

Dental

Vision

Supplemental Life and AD&D Insurance

Long-Term Disability Buy Up

Section 125- Flexible Spending Accounts (FSAs) (Healthcare, Dependent care, Limited Purpose)

Health Savings Account (HSA)

Legal Assistance Plan

Your prior service with a related employer will be credited to you for purposes of the Plans’ waiting period only if the break

in service between your periods of employment is less than 31 days. In such case, Plan coverage due to employment with

the second affiliate will start on the later of your first day of employment with the second affiliate or the first day after

coverage would normally end due to termination of employment with the prior affiliate, so long as you elect coverage with

the second affiliate no later than 30 days after your start date with the second affiliate. If your break in service between

periods of employment is more than 30 days your prior service will not count towards the Plans’ waiting period. If an

existing employee of a participating employer transfers from a benefits-ineligible class of employees to a benefits-eligible

class of employees (e.g., from less than 17 1/2 hours per week to at least 17 1/2 hours per week or from a non-US Payroll

position to a US-Payroll position) and elects coverage no later than 30 days after his or her transfer date, Plan coverage will

begin on his or her transfer date. To be covered under the Health and Welfare plans, you must complete your enrollment

within your enrollment window.

Who is an eligible dependent?2

The company defines your eligible dependent as:

• Your legal spouse unless the person is an employee of the bank and has elected independent coverage under the same

Plan.

• Your domestic partner who is a qualifying domestic partner or a registered domestic partner / civil union partner. A qualifying

domestic partner must be 18 years of age or older and live with you in a long-term committed relationship with all of the

following: You must live together in the same residence, have an exclusive mutual commitment similar to marriage, and be

financially responsible for each other and your debts; neither person can be married or have another domestic partner; you

cannot be related by blood in a way that would prevent you from being married to each other according to applicable state

law; and both persons must be capable of consenting to the domestic partnership. A registered domestic partner / civil

union partner is an individual who has entered into a valid domestic partnership or a civil union with you pursuant to the laws

of any state. Only those dependents that are defined by the company as an eligible dependent can participate under the Health

and Welfare plans described in this SPD.

2 For information on dependent eligibility, please contact the MUFG Benefits Service Center.

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• Your dependent children until the end of the month they attain age 26. This includes natural children and stepchildren as well

as legally adopted children from the date you assume legal responsibility, foster children who live with you, and children for

whom you assume legal guardianship. Also included are your children (or children of your spouse or domestic partner) for

whom you have legal responsibility resulting from a valid court decree.

• Children who are mentally or physically disabled and dependent on you for support, regardless of age including incapacitated

children age 26 or older. To be eligible for coverage as an incapacitated dependent, the dependent must have been covered

under the Plan and disabled prior to reaching age 26, must legally reside with you for at least half of the year and must receive

at least 50% of his or her financial support from you. Certification of the disability is required within 30 days of attainment of

age 26. A certification form is available from the Benefits Service Center or from the claims administrator and may be required

periodically.

Life Insurance (for your dependents)

• Your spouse or domestic partner. For information on spousal eligibility, please contact the Benefits Service Center.

• Your children under the age of 26.

• Children age 26 or over who are permanently disabled at any time during the year as a result of a disabling illness or injury

that commenced prior to attainment of age 26.

• Children under the age of 26 for whom you or your spouse or domestic partner have been assigned legal guardianship.

Section 125 Plan – Healthcare Flexible Spending Account (FSA) and Limited Scope Healthcare FSA

• Your spouse.

• Your dependent children up to age 26 and any dependent children over age 26, who are permanently disabled, legally reside

with you for more than half the year and receive at least 50% of their financial support from you.

• Any other dependent who is considered a qualifying dependent under IRS rules.

Section 125 Plan – Dependent Care FSA

• A child who has not reached the age of 13 and

• A dependent (i.e., a qualifying child or qualifying relative) who is physically or mentally incapable of self-care and who has the

same principal place of abode as the taxpayer for at least eight hours per day.

Disability

• There are no dependent benefits available under Short-Term or Long-Term Disability benefits.

Business Travel Accident

• Your spouse or domestic partner.

• Your children from the moment of birth, including a natural child, stepchild, or adopted child from the date of placement. The

children must be unmarried, under age 19 or under age 26 if enrolled as a full-time student at an institution of higher learning,

or considered to be an incapacitated dependent child.

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When do my benefits end?

Generally, your health and welfare benefits end either on your date of termination or on the last day of the month that your

employment terminates for any reason including death or, if earlier, when you cease to be an eligible employee. Coverage may

also cease if you fail to make required contributions. You may be able to continue some coverage, however, if you qualify as a

retiree or disabled individual.

Generally, coverage you have elected for your eligible dependents under any benefit ceases when your coverage ceases or, if

earlier, when such individual ceases to be your eligible dependent. If you are required to make contributions for certain coverage

that you have elected for yourself and your eligible dependent, then such coverage will cease if you fail to make the required

contributions. Further, all health and welfare benefits coverage provided under a Plan will cease on the date the Plan is

terminated.

Although coverage may otherwise cease, you may elect COBRA continuation coverage for Medical (including the HRA), Dental,

Vision, and the Healthcare and Limited Purpose FSAs. You may also be able to convert some of the group life and Accidental

Death and Dismemberment (AD&D) insurance coverage to personal coverage. You should consult this document and the

applicable certificates of insurance or contract for such conversion rights. It is your responsibility to convert your life or AD&D

insurance at the time your group coverage terminates (within 30 days of termination). A conversion notice may also be provided

to you from the company and can be requested directly from the insurance carrier.

Family Medical Leave Act (FMLA) leaves of absence

FMLA- Paid leave

If you are an eligible employee who is on an approved federal Family Medical Leave, you will continue to receive all employer-

paid and optional benefits during the period of such leave up to a maximum of 12 weeks (26 weeks for FMLA Service Member

Caregiver Leave), assuming you pay your share of any required premiums on a timely basis. Certain benefits contributions and

coverage, such as employee HSA contributions, Dependent Care FSA, and commuter benefits, will be stopped and you will

need to reenroll within 30 days when you return from your leave.

FMLA- Unpaid leave

While you are on an unpaid FMLA, you may continue certain benefits while on an unpaid leave of absence. Conexis, the bank’s

direct pay administrator, will bill you for premiums. If you elect not to continue benefits during an unpaid FMLA leave of absence,

then upon your return to employment with the company, benefits must be re-elected and will be reinstated on the first day of the

month following your return to work. Optional benefits can be continued based on the terms and provisions of each applicable

Plan or program.

Flexible Spending Accounts (FSA) - Healthcare and Limited Purpose Healthcare during Paid or Unpaid Leave While on a paid leave of absence, your contributions to your healthcare FSA will be paid by the bank (unless you elect to drop

coverage at the start of your leave or due to a qualifying life event) and you will be responsible to pay those contributions

back upon your return to work from your leave. Pre-tax contributions from your payroll will resume upon returning to active

employment status, unless otherwise elected upon returning to work

To stop your healthcare FSA contributions, your request must be made in writing while you’re on a leave of absence and upon

returning from your leave within 30 days you must re-elect by contacting the Total Rewards representative below:

Dedra Turner-Nelson

Associate, Health and Welfare Analyst

MUFG Total Rewards

Direct (415) 765-2398| Fax (415) 765-2476

MUFG Union Bank, N.A. | 400 California Street, 10th Floor


[email protected]

If you have a qualifying life event while on leave, you must report the qualifying event to the Benefits Center within 30 days

of the event date. You are required to furnish written proof of a status change event such as a birth certificate, marriage

certificate, divorce decree, or a letter from your spouse's employer. You may go online to

mailto:[email protected]

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http://www.mufgamericas.com/mybenefits, or call the Benefits Service Center at (800) 964-9907 to make changes to your

benefits.

For invoice / billing questions you may contact Conexis at (866) 206-5751.

Coverage and contributions may resume upon your return from your leave of absence.

Other leaves of absence

Employees may continue some benefits in the event of certain leaves as follows:

Type of Leave of Absence Period Coverage Continued

Short-Term Disability Duration of leave but not to exceed 52 weeks

Personal and Parental Leave Duration of leave but not to exceed four months

Military Leave Duration of leave but not to exceed 24 months

Other Leave Duration of leave but not to exceed four months

Premium payments to continue benefits will follow with the paid or unpaid leave type.

Payment of premiums during a leave of absence

If you are on paid leave, the premiums for Medical, Dental, Vision, Supplemental and Dependent Life and AD&D, will be deducted

from your paycheck. Your per paycheck contributions to the HSAs, Dependent care FSA and commuter benefits will stop. Upon

returning from your leave, you must reimburse the employer for payments made on your behalf. If you elected to stop

participation, upon returning from your leave, you must re-enroll.

.

International assignment

U.S. employees on international assignment (and their dependents) may only be enrolled in the international Medical Plan option

during their period of international assignment. You may, however, continue your other nonmedical benefits and coverage, if any,

during the period of international assignment, so long as you remain eligible. Your U.S per pay deductions will continue to be

taken for coverage under the U.S. benefits program.

International employees inbound to the United States from a related employer are eligible only for the international Medical Plan

option during the period of their assignment, but only if the employee is not covered by a medical plan sponsored by his or her

home country employer that covers services performed in the United States. In certain cases, statutory coverage or eligibility will

be available to those employees working in New Jersey, New York, and California.

Eligibility after employment termination

Certain disabled individuals and retirees under age 65 remain eligible for Medical, Dental, and Vision coverage after their

employment terminates. For more information, refer to the separate Retiree Guide and the Health and Welfare Plans’ Summary

Plan Description for Pre- 65 Retirees and Disabled Individuals.

http://www.mufgamericas.com/mybenefits

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Enrollment procedures

How to enroll as a new employee

Newly hired employees must complete the company’s online enrollment within the first 30 days of employment. If you fail to

do so, you’ll have to wait until the next annual open enrollment (see “Annual Open Enrollment”) or when you have a

qualifying life event.

Using online enrollment system for the first time

Go to mufgamericas.com/mybenefits.

You will need to create a user name and password. Select “Are you a new user?” on the home page. When prompted,

enter your personal security information. Once the system verifies this information, you’ll be prompted to create your own

user name and password. Going forward, you’ll use these to access your benefits information.

Next choose your benefits and submit your choices. You will receive confirmation of your elections and it’s your

responsibility to review this state and report any changes within your 30 day enrollment period. Future changes can be

made to your elections during the next annual enrollment period or in the event of a qualifying change life status

Changes are limited to Qualified Change of Life Status Events

You are allowed to make changes to your current benefit elections during the Plan Year if you experience a change in

status. Some of the status changes include:

• Marriage

• Gain or loss of an eligible dependent for reasons such as birth, adoption, court order, disability, death, marriage, or

reaching the dependent-child age limit

• Changes in your dependents’ employment affecting their benefits eligibility

• Changes in your dependents’ benefits coverage with another employer affecting their benefits eligibility

• Changes in your or your dependents’ residence affecting benefits eligibility

The change to your benefit elections must be consistent with and on account of the change in status. If you have a status

change, you must notify the Benefits Service Center within 30 days of the event. Along with your notification, you are

required to provide appropriate documentation timely. If you do not notify the Benefits Service Center during the 30 day

window or provide the required documentation, you and/ or your dependents must wait until the next annual open

enrollment period to make a change to your benefit elections. Your elections will become effective the first of the month

following your status change, with the exception of a change due to birth or adoption, which will be retroactive to the date of

birth or adoption.

In addition, if you experience a HIPAA special enrollment event, you may be able to elect group health coverage for

yourself and your dependents midyear.

Annual open enrollment

Each year during the annual open enrollment period, you are given the opportunity to make changes to your current health

and welfare benefits. Annual open enrollment is the only time during the year you can make changes to your benefits

unless you experience a qualifying life event. Our annual open enrollment period usually occurs in October or November for

a January 1 effective date.

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Benefit Descriptions

Medical and Prescription Drug Plans

The company offers three national medical plans the Anthem PPO, Anthem HSA and Anthem HRA which include prescription

coverage administered by Anthem. These plans offer the same in-network providers and only in-network prescription drug

programs after you meet your deductible. All of the plans allow out of network provider access but the reimbursement levels are

different as well as your deductibles. Two of the plans are Consumer-Driven Health Plans (CDHPs), the Anthem HSA allows you

to open a Health Savings Account to fund anticipated medical expenses. The Health Reimbursement Account (HRA) works

differently, you cannot contribute to this account the company contribution is automatically accessed by the insurance carrier to

cover your medical expenses. The company contribution to your high-deductible plan (HSA and HRA) is made annually and

prorated based on your coverage level and when you enter the plan. These contributions help you meet some of your out of

pocket medical expenses. For employees located in certain areas in California, the company offers the Kaiser HMO Plan... The

Kaiser plan provides cost effective coverage and provider services only within its network.

Dental

Through nationally recognized providers, we offer access to either one comprehensive PPO plan (determined by location) or a

cost-effective DMO program. All dental plans offer access to benefits for you and any covered eligible dependents members.

Vision

Vision Service Plan (VSP) is a nationally recognized carrier, providing access to the largest network of vision providers offering

preventive and routine vision care.

Life and supplemental AD&D

The company provides one times your base annual salary of company-paid life insurance for all eligible employees. To further

supplement income protection for your family, you can purchase supplemental life insurance and Accidental Death and

Dismemberment Insurance. Some levels require evidence of insurability.

Short- and Long-Term Disability

The company’s programs for short-duration and extended disabilities are comprehensive and provide income replacement levels

from one week to retirement age if your medical condition warrants such benefits. You can also increase your long-term income

protection with our buy-up LTD option.

Section 125- Flexible Spending Accounts (FSAs)

You can elect to participate in two types of FSAs, a Healthcare FSA and a Dependent Care FSA. There are two types of

Healthcare FSAs available to you, depending on the medical option you choose. You can choose to participate in the traditional

Healthcare FSA when enrolling in most of our health plans, except for the HSA plan requires enrollment in a

Limited Purpose Healthcare FSA, which can only be used for dental and vision expenses, as medical expenses are covered

under the HSA. The Dependent Care FSA helps you save for out-of-pocket expenses incurred for your children under age 13 and

elder dependents.


When you elect coverage under a CDHP with a Health Savings Account option, you can set aside money through payroll

deductions on a pretax basis to help cover qualified out-of- pocket medical expenses as well. The HSA also has investment

features similar to a retirement account. Funds can be used now or in the future to offset medical related expenses during

retirement. The bank provides an annual contribution toward your HSA on a prorated basis. This account is similar to a bank

account and the trustee may charge a monthly fee. The funds are yours even after terminating employment.

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Business Travel Accident (BTA)

The company provides additional financial protection for you and your family when you travel on approved company business.

Employee Assistance Program (EAP)

Benefits eligible employees are able to receive services through the EAP. The program provides confidential, professional counseling on a wide range of issues including the following: Family issues, child care, elder care as well as legal/financial issues. .

Wellness Program

All employees are eligible to participate in the wellness program offered under the Healthy Guidance Program. The program provides free and confidential support from certified health coaches, Tobacco Cessation, sleep and back care coaching, and a host of wellness tools and resources for physical, emotional, financials and social mindfulness.

Voluntary Legal Assistance Plan

The Hyatt Legal Plan provides up to 15 hours of pre-paid legal services.

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Medical and Prescription Drug Coverage

Comprehensive and preventive health coverage is important in protecting you and your family from the financial risks of

unexpected illness and injury, which is why the company offers you a variety of options to choose from. All of the Anthem

plans offer the same in-network providers and only allow in network prescription drug programs after you meet your

deductibles. The Anthem plans cover out of network providers; the reimbursement levels are subject to each plan design.

• Anthem Health Reimbursement Account (HRA) Plan is a high deductible plan. The. HRA is a company-funded account in

the group health plan from which qualified medical expenses up to a fixed dollar amount per year are paid by the

employer from the Plan. Unused amounts may be rolled over to be used in subsequent years if you remain a participant in

this Plan in the following year. The company funds and owns the account; therefore upon termination, any remaining funds

stay with the employer.

• Anthem Health Savings Account (HSA) Plan is a high deductible plan and if you are covered under this plan, the IRS

allows you to open an HSA to fund out of pocket expenses on a pretax basis. The Anthem HSA plan requires that you

first meet your deductible before the plan starts paying for your medical/prescription coverage. . You can invest HSA

funds, and save for future healthcare expenses. You have ownership of the funds and earnings within your HSA and can

take your account with you should you leave the company.

• Anthem Preferred Provider Organization (PPO) Plan. The PPO plan design allows for In-Network and Out-of-Network

providers. Once you’ve satisfied your plan deductible under the Plan, you pay a co-payment for In-Network services and

coinsurance for Out-of-Network services. The Plan offers convenience and lower deductibles but higher employee per-

paycheck contributions.

Anthem offers you a national network of doctors, hospitals, and pharmacies. All Anthem medical options cover both In-

Network and Out-of-Network care. In-Network care provides cost savings to you as fees are negotiated with the providers

and facilities by the carrier. .

In addition to the three Anthem plans, you have access to the Kaiser Permanente California Health Maintenance

Organization (HMO) Plan if you reside certain parts of California. With a HMO, you’ll typically pay a small co-payment if you

visit a physician or hospital within the Plan network.

HMOs feature a specific system of doctors, hospitals, and other healthcare providers. If you enroll in the HMO, you must

select a Primary Care Physician (PCP) to coordinate your care, and you will only receive benefits if you get care within the

HMO system—unless you have an emergency.

18

ANTHEM HRA HDHP/HSA PPO

In-Network Out-of-Network

In-Network Out-of-Network In-Network Out-of-Network

Referral Not Required Referral Not Required Referral Not Required

Bank Contribution Toward Your

Deductible

$750 Employee

$1,500 Employee + Family

$750 Employee

$1,500 Employee + Family

None

Your Deductible Your Plan has an embedded Deductible which means: If You, the Subscriber, is the only person covered by this Plan, only the “Individual” amounts apply to You.

If You also cover Dependents (other family members) under this Plan, both the “Individual” and the “Family” amounts apply. The “Family” Deductible amounts can be satisfied by any combination of family members but You could satisfy Your own “Individual” Deductible amount before the “Family” amount is met. You will never have to satisfy more than Your own “Individual” Deductible amount. If You meet Your “Individual” Deductible amount, Your other family member’s claims will still accumulate towards their own “Individual” Deductible and the overall “Family” amounts. This continues until Your other family members meet their own “Individual” Deductible or the entire “Family” Deductible is met

$2,500 Individual

$5,000 Family

In-Network and Out-of-

Network deductibles

are combined. Satisfying

one helps satisfy the

other. Embedded

deductible

$4,000 Individual

$8,000 Family

In-Network and

Out-of-Network

deductibles

are combined.

Satisfying one

helps satisfy

the other.

Embedded

deductible

$1,500 Individual

$3,000 Family


Network deductibles


one helps satisfy the other.

The individual deductible

does not apply if two or more

people are covered;

the entire family deductible

must be met before

coinsurance applies for any

individual.

$3,000 Individual

$6,000 Family

In-Network and

Out-of-Network

deductibles

are combined.

Satisfying one

helps satisfy

the other.

The individual

deductible does

not apply if two or

more people are

covered;

the entire family

deductible must

be met before

coinsurance

applies for any

individual.

$1,000 Individual

$2,000 Family


Network deductibles


one helps satisfy the other.

Embedded deductible

$1,500 Individual

$3,000 Family

In-Network and

Out-of-Network

deductibles

are combined.

Satisfying one

helps satisfy the

other. Embedded

deductible

Your Out-of-Pocket Max. (Includes

Your Deductible)

In-Network: $3,500 Individual; $6,850 Family Out-of-Network: $5,250 Individual; $10,500 Family

The individual out-of-pocket limit does not apply if two or more people are covered; the entire family out-of-pocket limit must be met in order to

satisfy the limit.

Lifetime Maximum Unlimited

Primary Care Visit to Treat an Injury

or Illness

20% coinsurance 40% coinsurance 10% coinsurance 30% coinsurance $25 co-pay 30% coinsurance

Specialist Visit 20% coinsurance 40% coinsurance 10% coinsurance 30% coinsurance $40 co-pay 30% coinsurance

Other Practitioner Office Visit (20

Visits per Year)

Chiropractor: 20%

coinsurance

Acupuncturist: 20%

coinsurance

Chiropractor: 40%

coinsurance

Acupuncturist: 40%

coinsurance

Chiropractor: 10%

coinsurance

Acupuncturist: 10%

coinsurance

Chiropractor: 30%

coinsurance

Acupuncturist: 30%

coinsurance

Chiropractor/

Acupuncturist:

$40 co-pay/visit

Chiropractor/

Acupuncturist: 30%

coinsurance

Preventive Care,

Screening, Immunization

100%, no

deductible

40%

Coinsurance

100%, no

deductible

30% coinsurance 100%, no

deductible

30% coinsurance

Diagnostic Test (X-ray, Blood Work) Lab – Office: 20%

coinsurance

X-ray – Office: 20%

coinsurance

Lab – Office: 40%

coinsurance


coinsurance

Lab – Office: 10%

coinsurance


coinsurance

Lab – Office: 30%

coinsurance

X-ray – Office:

30% coinsurance

Lab – Office: 10%

coinsurance


coinsurance

Lab – Office: 30%

coinsurance


coinsurance

Imaging (CT/PET Scans, MRIs) 20% coinsurance 40% coinsurance 10% coinsurance 30% coinsurance 10% coinsurance 30% coinsurance

19

Generic Drugs

(Retail: 30-Day Supply; Mail Order:

90-Day Supply)

$250 deductible per

member, 10% coinsurance

after deductible

For 30-day Retail supply:

min. cost of $5, max. cost of

$15

For 90-day Mail- Order

supply: min. cost of $10,

max. cost of $30

Not covered Deductible is integrated with

Medical,

10% coinsurance after

deductible

For 30-day Retail supply: min.

cost of $5, max. cost of $15

For 90-day Mail- Order supply:


$30 You pay the deductible

first before the Plan pays for

any prescription drugs.

Not covered $100 deductible per

member applicable to Retail

drugs, 10% coinsurance

after deductible

For 30-day Retail supply:


$15



max. cost of $30

Not covered

ANTHEM

(continued)

HRA HDHP/HSA PPO

In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network


Brand-Name Formulary Drugs (Retail:

30-Day Supply; Mail Order: 90-Day

Supply)

$250 deductible per

member, 20%

coinsurance after

deductible

For 30-day Retail

supply: min. cost of

$20, max. cost of $60



max. cost of $150

Not covered Deductible is integrated

with Medical,

20% coinsurance per

Rx for Retail

For 30-day Retail






You pay the deductible

first before the Plan

pays for any

prescription drugs.


member applicable to

Retail drugs, 20%

coinsurance after

deductible

For 30-day Retail





max. cost of $150

Not covered

Brand-Name Non- Formulary Drugs

(Retail: 30-Day Supply; Mail Order: 90-

Day Supply)

$250 deductible per

member, 30%

coinsurance after

deductible

For 30-day Retail





max. cost of $225

Not covered Deductible is integrated

with Medical

30% coinsurance after

deductible

For 30-day Retail






You pay the deductible

first before the Plan

pays for any

prescription drugs.


member applicable to

Retail drugs, 30%

coinsurance after

deductible

For 30-day Retail





max. cost of $225

Not covered

Outpatient Surgery 20% coinsurance 40% coinsurance 10% coinsurance 30% coinsurance 10% coinsurance 30% coinsurance

Physician/Surgeon Fees 20% coinsurance 40% coinsurance 10% coinsurance 30% coinsurance 10% coinsurance 30% coinsurance

Emergency Room Services 20% coinsurance 20% coinsurance 10% coinsurance 10% coinsurance $150 co-pay (waived if admitted)

Emergency Medical Transportation 20% coinsurance 20% coinsurance 10% coinsurance 10% coinsurance 10% coinsurance 10% coinsurance

Urgent Care 20% coinsurance 40% coinsurance 10% coinsurance 30% coinsurance $35 co-pay/visit 30% coinsurance

Hospital Stay – Facility Fee (e.g., Hospital

Room)

20% coinsurance 40% coinsurance 10% coinsurance 30% coinsurance 10% coinsurance 30% coinsurance

Hospital Stay – Physician/Surgeon Fee 20% coinsurance 40% coinsurance 10% coinsurance 30% coinsurance 10% coinsurance 30% coinsurance

20

Mental/Behavioral Health

Outpatient Services


Office Visit: 20%

coinsurance

Mental/Behavioral

Health Facility Visit –

Facility Charges:

20% coinsurance


Office Visit: 40%

coinsurance

Mental/Behavioral


Facility Charges:

40% coinsurance


Office Visit: 10%

coinsurance

Mental/Behavioral


Facility Charges:

10% coinsurance


Office Visit: 30%

coinsurance


Facility Visit – Facility

Charges:

30% coinsurance


Office Visit:

$25 co-pay/visit



Charges:

10% coinsurance


Office Visit: 30%

coinsurance

Mental/Behavioral


Facility Charges:

30% coinsurance

Mental/Behavioral Health Inpatient

Services


21

ANTHEM

(continued)

HRA HDHP/HSA PPO

In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network


Substance Use Disorder

Outpatient Services

Substance Abuse Office

Visit:

20% coinsurance

Substance Abuse

Facility Visit –

Facility Charges:

20% coinsurance


Visit:

40% coinsurance

Substance Abuse

Facility Visit –

Facility Charges:

40% coinsurance


Visit:

10% coinsurance

Substance Abuse

Facility Visit –

Facility Charges:

10% coinsurance


Visit:

30% coinsurance

Substance Abuse

Facility Visit –

Facility Charges:

30% coinsurance


Visit:

$25 co-pay/visit

Substance Abuse

Facility Visit –

Facility Charges:

10% coinsurance


Visit:

30% coinsurance

Substance Abuse

Facility Visit –

Facility Charges:

30% coinsurance


Inpatient Services


Pregnancy – Prenatal and

Postnatal Care

20% coinsurance 40% coinsurance 10% coinsurance 30% coinsurance $25 co-pay/visit 30% coinsurance

Pregnancy – Delivery and

All Inpatient Services


Home Health Care (120

Visits per Year)


Rehabilitation Services (20

Visits per Therapy)

20% coinsurance 40% coinsurance 10% coinsurance 30% coinsurance $40 co-pay/visit 30% coinsurance

Habilitation Services 20% coinsurance 40% coinsurance 10% coinsurance 30% coinsurance $40 co-pay/visit 30% coinsurance

Skilled Nursing Care (120

Visits)


Durable Medical

Equipment


Hospice Service 20% coinsurance 40% coinsurance 10% coinsurance 30% coinsurance 10% coinsurance 30% coinsurance

Child Care –

Eye Exam

Not covered Not covered Not covered Not covered Not covered Not covered

Child Care –

Glasses


Child Care – Dental

Checkup


To find a provider in Anthem’s network, go to anthem.com, choose “Useful Tools” on the right, and select “find a doctor or hospital” or call 844-736-4441.

KAISER PERMANENTE HMO

In-Network Only

Bank Contribution Toward Your Deductible None

Your Deductible None

Your Out-of-Pocket Max. (Includes Your

Deductible)

$1,500 Individual

$3,000 Family

Lifetime Maximum Unlimited

Primary Care Visit to Treat an Injury or

Illness

$30 per visit

Specialist Visit $30 per visit

Other Practitioner Office Visit $30 per visit for

acupuncture services

Preventive Care, Screening, Immunization $30 per visit

22

KAISER PERMANENTE

(continued)

HMO In-Network Only

Diagnostic Test

(X-ray, Blood Work)

X-ray: no charge; lab tests: no

charge

Imaging (CT/PET Scans, MRIs) No charge

Generic Drugs Plan pharmacy: $10 per

prescription

for 1 to 30 days; Mail Order:

usually two times the plan

pharmacy cost sharing for up

to a 100-day supply

Preferred Brand Drugs Plan pharmacy:

$30 per prescription for 1 to

30 days; Mail Order: usually

two times the plan pharmacy

cost sharing for up to a 100-

day supply

Non-Preferred Brand Drugs Same as preferred brand

drugs

Specialty Drugs Same as preferred brand

drugs

Outpatient Surgery $30 per procedure

Physician/Surgeon Fees No charge

Emergency Room Services $100 per visit (your cost is the

same if you use a Non-Plan

Provider)

Emergency Medical

Transportation

$50 per trip (your cost is the


Provider)

Urgent Care $30 per visit (your cost is the


Provider)

Hospital Stay – Facility Fee (e.g., Hospital

Room)

$500 per admission

Hospital Stay – Physician/ Surgeon Fee No charge

Mental/Behavioral Health Outpatient

Services

$30 per individual visit; $15

per group visit

Mental/Behavioral Health Inpatient

Services

$500 per admission

Substance Use Disorder Outpatient

Services

$30 per individual visit; $5

per

group visit

23

To find a provider in Kaiser Permanente’s network, go to kp.org or call 800-278-3296. .

KAISER

PERMANENTE

(continued)

HMO)

In-Network Only


Inpatient Services

$500 per admission

Pregnancy – Prenatal and

Postnatal Care

Prenatal care: $15 per visit; postnatal

care: $15 per visit

Pregnancy – Delivery and All

Inpatient Services

$500 per admission

Home Healthcare No charge (100 visits)

Rehabilitation Services Inpatient: $500 per admission;

outpatient: $30 per visit

Habilitation Services $30 per visit

Skilled Nursing Care No charge (100 visits)

Durable Medical Equipment 20% coinsurance per item

Hospice Service No charge

Child Care – Eye Exam $30 per visit

Child Care – Glasses Not covered

Child Care – Dental Checkup Not covered

24

Expatriates

Expatriates or employees participating in the Global Rotational Training Program are eligible to participate in GeoBlue, an

international medical plan, if you are paid under the U.S. payroll. Please contact the Benefits Service Center at 800-964-9907 for

more information.

GEOBLUE Inside the U.S. Outside the U.S.

In-Network Out-of-Network

Referral Not Required

Your Deductible $1,000 Individual

$2,500 Family

In-Network and Out-of-Network

deductibles are combined.

Satisfying one helps satisfy the

other. Embedded deductible?

$1,500 Individual

$3,750 Family

In-Network and Out-of-Network

deductibles are combined.

Satisfying one helps satisfy the

other. Embedded Deductible?

$1,000 Individual

$2,500 Family

Your Out-of-Pocket Max.

(Includes Your Deductible)

$4,500 Employee

$13,500 Family

$5,000 Employee

$15,000 Family

$4,500 Employee

$13,500 Family

Lifetime Maximum Unlimited Unlimited Unlimited

Primary Care Visit to Treat an

Injury or Illness

$25 co-pay 30% coinsurance 10% coinsurance

Specialist Visit $25 co-pay 30% coinsurance 10% coinsurance

GEOBLUE

(Continued)

Inside the U.S. Outside the U.S.

In-Network Out-of-Network Referral Not Required

Other Practitioner Office Visit (20 Visits per

Year)

Chiropractor:

$25 co-pay

Acupuncturist:

$25 co-pay

Chiropractor: 30%

coinsurance

Acupuncturist: 30%

coinsurance

Chiropract

or: 10%

coinsuranc

e

Acupunctu

rist: 10%

coinsuranc

e

Preventive Care, Screening, Immunization 100%, no deductible 30% coinsurance 100%, no deductible

Diagnostic Test

(X-ray, Blood Work)

Lab – Office: 10%

coinsurance


coinsurance

Lab – Office: 30%

coinsurance


coinsurance

Lab –

Office:

10%

coinsuranc

e

X-ray –

Office:

10%

coinsuranc

e

Imaging (CT/PET Scans, MRIs) 10% coinsurance 30% coinsurance 10% coinsurance

Generic Drugs $10 co-pay; maximum 180-day

supply

$10 co-pay; maximum 180-day

supply

$10 co-pay; maximum 180-

day supply

Brand-Name Formulary Drugs $25 co-pay; maximum 180-day

supply


supply


day supply

Brand-Name Non-Formulary Drugs $25 co-pay; maximum 180-day

supply


supply


day supply

Outpatient Surgery 10% coinsurance 30% coinsurance 10% coinsurance

Physician/Surgeon Fees 10% coinsurance 30% coinsurance 10% coinsurance

Emergency Room Services 10% coinsurance 30% coinsurance 10% coinsurance

Emergency Medical

Transportation

10% coinsurance 30% coinsurance 10% coinsurance

Urgent Care 10% coinsurance 30% coinsurance 10% coinsurance

Hospital Stay – Facility Fee (e.g.,

Hospital Room)


Hospital Stay – Physician/Surgeon

Fee


25

Mental/Behavioral Health Outpatient

Services

Mental/Behavioral Health Office Visit:

$25 co-pay

Mental/Behavioral Health Facility Visit

– Facility Charges:

10% coinsurance

Mental/Behavioral Health Office Visit:

No deductible,

30% coinsurance

Mental/Behavioral Health Facility Visit

– Facility Charges:

30% coinsurance


Office Visit: No deductible,

10% coinsurance



Charges:

10% coinsurance Mental/Behavioral Health Inpatient

Services


Substance Use Disorder Outpatient

Services

Substance Abuse Office Visit:

$25 co-pay

Substance Abuse Facility Visit –

Facility Charges:

10% coinsurance

Substance Abuse Office Visit:

30% coinsurance

Substance Abuse Facility Visit – Facility

Charges:

30% coinsurance


Visit: 10% coinsurance

Substance Abuse Facility

Visit – Facility Charges:

10% coinsurance

Substance Use Disorder Inpatient

Services


Pregnancy – Prenatal and Postnatal

Care


Pregnancy – Delivery and All Inpatient

Services


Home Health Care (120 Visits

per Year)


Rehabilitation Services (50 Visits

per Therapy)

$25 co-pay No deductible; 30% coinsurance No deductible; 10% coinsurance

Habilitation Services 10% coinsurance 30% coinsurance 10% coinsurance

Skilled Nursing Care (120 Visits) 10% coinsurance 30% coinsurance 10% coinsurance

Durable Medical Equipment 10% coinsurance 30% coinsurance 10% coinsurance

Hospice Service 10% coinsurance 30% coinsurance 10% coinsurance

GEOBLUE

(Continued)

Inside the U.S. Outside the U.S.

In-Network Out-of-Network Referral Not Required

Child Care – Eye Exam Not covered Not covered Not covered

Child Care – Glasses Not covered Not covered Not covered

Child Care – Dental Checkup Not covered Not covered Not covered

To find a provider in GeoBlue’s network, go to geo-blue.com or call 855-282-3517 (in U.S.) or 610-254-5304 (outside U.S.).

26

Benefit exclusions and limitations

Each Medical benefit option under the Plan has its own benefit exclusions and limitations applicable to the benefits that it will and

won’t cover. To learn more about which benefits are covered (and to what extent) and excluded from coverage, you must read that

medical option’s Plan summary or certificate of insurance. These documents, which may be found at the end of this document in

the section titled “Appendix,” are incorporated by reference into this SPD.

Designating a primary medical care provider

The MUFG Union Bank, N.A., Health Benefit Plan generally allows the designation of a primary care provider. You have the right

to designate any primary care provider who participates in the insurance plan’s network and is available to accept you or your

family members. For information on how to select a primary care provider, and for a list of the participating primary care providers,

contact the insurer or third-party administrator. For children, you may designate a pediatrician as the primary care provider.

You do not need prior authorization from the Plan or any other person (including a primary care provider) in order to obtain access

to obstetrical or gynecological care from a healthcare professional in our network who specializes in obstetrics or gynecology. The

healthcare professional, however, may be required to comply with certain procedures, including obtaining prior authorization for

specific services, following a preapproved treatment plan, or procedures for making referrals. For a list of participating healthcare

professionals who specialize in obstetrics or gynecology, contact the insurer or third-party administrator.

A note regarding the grandfathered medical

The company believes that the Kaiser HMO under the MUFG Union Bank Health Benefit Plan is a “grandfathered health

plan” under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care

Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was

enacted. Being a grandfathered health plan means that the plan may not include certain consumer protections of the

Affordable Care Act that apply to other plans—for example, the requirement for the provision of preventive health services

without any cost sharing.

However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act—for

example, the elimination of lifetime limits on benefits.

Questions regarding which protections do and do not apply to a grandfathered health plan and what might cause a plan to

change from grandfathered health plan status can be directed to the Plan Administrator at Benefit Plans Administrative

Committee,

c/o Benefits Service Department, 400 California Street, 10th Floor, San Francisco, CA 94104.

You may also contact the U.S. Department of Labor’s Employee Benefits Security Administration at 866-444-3272 or

dol.gov/ebsa/healthreform. This website has a table summarizing which protections do and do not apply to grandfathered health

plans.

27

Emergency services

Life-threatening medical emergency or serious accidental injury

Coverage is provided for emergency-room care, including a medical screening examination that is within the

capabilities of the hospital’s emergency department, ancillary services routinely available to the emergency

department to evaluate an emergency medical condition that are within the capabilities of the hospital staff and

facilities, and such further medical examination and treatment as are required to stabilize the patient.

Emergency service care does not require any prior authorization from the Plan.

“Stabilize,” with respect to an emergency medical condition, means to provide such medical treatment of the

condition as may be necessary to assure, within reasonable medical probability that no material deterioration of

the condition is likely to result from or occur during the transfer of the individual from a facility. With respect to a

pregnant woman who is having contractions, the term “stabilize” also means to deliver a child (including the

placenta) if there is inadequate time to provide safe transfer to another hospital before delivery or if the transfer

may pose a threat to the health or safety of the woman or the unborn child.

The maximum allowed amount for emergency care from an Out-of-Network provider will be the greatest of the

following:

• The amount negotiated with network providers for the emergency service furnished;

• The amount for the emergency service calculated using the same method the Claims Administrator generally

uses to determine payments for Out-of-Network services but substituting the network cost-sharing provisions

and a review of the uncontrollable out of network cost-to the members; or

• The amount that would be paid under Medicare for the emergency service.

The coinsurance percentage payable for both network and Out-of-Network are shown in the Schedule of

Benefits. Note: An Out-of-Network provider may still balance bill you for any amounts not covered by the Plan.

28

When you enroll in any medical plan, you’ll also get prescription drug coverage (for In-Network pharmacies and mail order; no Out-of-

Network coverage). That means you don’t need to make a separate prescription drug plan election. For details regarding coinsurance

and co-pay fees, please go online and review the Summary of Benefits and Coverage (SBC) under each insurance plan.

Prescription drug term comparison

Generic versus brand-name: Generics are copies of brand-name drug products in dosage form, strength, route of administration,

quality and performance characteristics, and intended use.

Brand formulary versus non-formulary: A formulary drug is one that is preferred by your insurance; a non-formulary, even though

covered, has higher co-pay, as your insurance prefers you to use another product.

Retail versus mail order: In general, consider using mail order for maintenance drugs to take advantage of lower costs. Mail-order

drugs are usually for 90-day supplies.

Preventive Rx Plus Benefit

All the Anthem plans cover certain conditions under the Preventive Rx Plus Benefit. The summary below provides the coinsurance

for retail and mail order drugs by formulary type.

Drug Quantity Generic Formulary Brand-Name

Retail:

30-day supply

Coinsurance: 10%

Minimum cost: $5

Maximum cost: $15

Coinsurance: 20%

Minimum cost: $20

Maximum cost: $60

Coinsurance: 30%

Minimum cost: $30

Maximum cost: $90

Mail Order:

90-day supply

No coinsurance

Cost: $0

Coinsurance: 20%

Minimum cost: $50

Maximum cost: $150

Coinsurance: 30%

Minimum cost: $75

Maximum cost: $225

Conditions for Preventive Rx Plus Benefit

Asthma

Blood clots Diabetes

Flu

Heart health and high blood pressure

High cholesterol Vaccines

29

ANTHEM PRESCRIPTION DRUG PROGRAM AND PHARMACY BENEFIT

The following Anthem prescription plan provisions should be taken into consideration when using the plan. They note how prescription drugs are managed by the Anthem plans: Prior Authorization and Quantity Limits: You may be required to get approval before certain prescriptions can be filled and/or the

quantity of the prescription may be limited. Check the Preferred Drug List online at anthem.com to see if your medication requires approval. Prescriptions covered by these programs will have the “PA” and/or “Q/L” abbreviation next to their name. If your prescription falls into these categories, speak with your doctor. Specialty Prescription Changes: Accredo, the bank’s preferred specialty pharmacy, now provides medications for complex chronic conditions after one initial specialty prescription fill at a retail pharmacy, except for medications needed on an urgent or emergency basis. Call 1-800-870-6419 Monday through Friday, 8:00 a.m. to 11:00 p.m. Eastern Time and Saturday, 8:00 am to 5:00 p.m. Eastern time, to

learn how Accredo's support programs can help you manage your health issue. Step Therapy: You will now be required to use certain first line (clinically approved) therapies prior to the approval, initiation, or

continuation of second or third line (higher cost) therapies. If you are affected by this, you will be notified by your pharmacist. Specialty Site of Care: If you use infused specialty (non-chemotherapy) drugs, you now have the option of using Coram (CVS Specialty) infusion services in your home or at a private infusion suite. Call 1-800-870-6419 Monday through Friday, 8:00 a.m. to 11:00 p.m. Eastern

Time and Saturday, 8:00 am to 5:00 p.m. Eastern time, to learn how Accredo's support programs can help you manage your health issue. Home Delivery Pharmacy Choice: Home delivery is a safe, efficient, and in many cases more cost-effective way to receive your

prescription medication when you need it. You are strongly encouraged to have home-delivery of maintenance medications. After two initial fills of maintenance medication, a choice of retail/home delivery must be made. Plus, you may be able to cut costs and get a 90-day supply of your medicine by switching to home delivery. To switch to home delivery, call 1-888-613-6091 Monday through Friday, 8:30 a.m. to 8:00 p.m. Eastern time. Or go to anthem.com. Be sure to have your medication names/strengths, doctor’s name, phone number and cred it card information ready. Pharmacists are available 24/7 to answer your questions. Preferred Formulary Drugs Update: The Anthem Preferred Drug List, also called a formulary, has drugs on it that are approved by the

U.S. Food and Drug Administration (FDA). This includes brand-name and generic drugs, reviewed and recommended for their quality, safety, how well they work and their value. You can see your new formulary list at anthem.com (select the Preferred Drug List). It’ll show what drugs are covered and at what tier level.

30

HRA VERSUS HSA Both the Anthem HRA Plan and the Anthem HSA Plan are consumer-driven health plans that offer comprehensive coverage for you and your family, and both provide accounts to help pay for your portion of medical expenses. But they work differently. The key differences between the plans are: • The premium amount you pay before tax per paycheck (please go online to see the premium rates). • Your portion of medical costs when you use the plan (for example, your deductible and your portion after the plan pays for costs). • How the accounts in the plan work. The chart below shows how the two accounts differ.

Account Feature HRA HSA

Bank contribution1 Same for both accounts: $750 for you only; $1,500 for you and one or more covered family members

Your contributions You cannot make contributions to your HRA. You can contribute pre-tax dollars to your personal HSA to help pay medical expenses. You can start, stop, or change your contributions at any time. For 2017, you can contribute up to: • Employee only: $3,400 • Employee + spouse/domestic partner or employee + child(ren) or family: $6,750 • The Bank’s contribution counts toward the maximum you can contribute for the year. Example: The “employee only” maximum of $3,400 less $750 = $2,650 available for you to contribute. • If you are age 55 or older, you also can make a catch-up contribution up to $1,000.

Account earnings HRA dollars do not earn interest and are not available for investment.

Account balances earn interest and you can choose among investment options once your balance reaches $1,000.

Account Fees

None Account fees are subject to the customer setup requirement and can change at any time. Note that this is an individual account, similar to a personal bank account; therefore the trustee can charge a fee for the monthly maintenance.

Tax savings No tax savings opportunities. You save on taxes in two ways:

Your contributions reduce your federal and state income taxes.2 Interest and earnings on your account are tax-free. You won’t pay

taxes on these amounts.3 When you take money out of your account to pay qualified medical expenses, your withdrawal is not taxed.

Using money in your account

The bank’s HRA contribution is available immediately in full on the first business day of the year or soon after. The plan automatically uses your HRA dollars to help pay your deductible. You can use your HRA to pay for medical and prescription drug expenses only. HRA dollars cannot be used to pay for dental and vision expenses, but you may use a Healthcare FSA to cover these expenses.

Your contributions are available to use once they are deposited into your account. You decide how and when to spend the money. You can choose to spend it on healthcare expenses now or save it to pay for future expenses. You can use your HSA to pay for medical, prescription drug, dental, and vision expenses. Note that you also can enroll in the Limited Purpose Healthcare FSA for dental and vision expenses only.

Keeping the money The balance in your HRA rolls over each year as long as you stay in the HRA plan. You do not get to keep your HRA balance if you are no longer enrolled in the HRA plan.

The balance in your HSA rolls over each year. You own the money in your HSA, even if you are no longer enrolled in the HSA plan or you leave the bank. You can still use funds in your HSA even after termination and or retirement to pay for eligible health expenses, even though you may no longer be able to contribute to your HSA.

1Bank contribution is taxed in AL, CA, and NJ 2 Except in AL, CA, and NJ 3Except in NH and TN

31

Nearing Age 65 and Interested in the HSA Plan?

If you’re nearing age 65, there are special rules regarding the HSA plan. Once you reach age 65 and enroll in Medicare, you may not continue contributing to your Health Savings Account-you can only use funds already deposited. You may want to consider a different plan if you cannot contribute for your health care expenses. At age 65, you may use your HSA to pay for qualified health expenses and some insurance premiums (such as Medicare premiums) on a tax free basis. Please see irs.gov for a complete list of qualified medical expenses.

IMPORTANT IRS RULES FOR HSAs

IRS regulations do not allow the transfer of funds between a HRA and a HSA. HSA participation restricts Health Care Flexible Spending Account (FSA) participation to avoid duplicating tax advantages. If you enroll in the HSA plan, you can participate only in the Limited Purpose Health Care FSA. You can use the Limited Purpose Health Care FSA to pay for dental and vision care only. You can choose to reimburse yourself from your HSA for other health care expenses, or pay these expenses out of pocket and continue to let your HSA fund grow tax-free. Eligible children, up to age 26, and domestic partners can be covered under the HSA plan. Due to IRS regulations, their health care expenses are not eligible for reimbursement from your Health Savings Account (HSA) unless they qualify as your tax dependent. IRS REQUIREMENT UNDER THE AFFORDABLE CARE ACT FOR MEDICAL PLANS

You must provide the Social Security number (SSN) (or other tax identification number) for yourself and any dependents covered by the bank’s medical insurance. If you fail to do so, the IRS may fine you $50 under Internal Revenue Code Section 6723. Please ensure that the name, date of birth, and SSN that is on file for you and any covered dependents are correct. After you’ve enrolled, you can view your dependent information on the benefits portal. ENROLLING IN MEDICARE

It is your responsibility to timely enroll in Medicare in order to avoid a permanent late-enrollment penalty. Continued coverage under a company-sponsored medical plan after your employment termination (regardless of any severance period) or upon first becoming eligible for Medicare due to disability will not exempt you from a late enrollment penalty under Medicare. The bank does not monitor your Medicare eligibility and will not provide you further notice of your Medicare obligations. For more information about your Medicare rights and responsibilities, visit www.medicare.gov.

http://www.medicare.gov/

32

Dental

Staying healthy includes obtaining quality dental care. The company offers you two dental choices:

• MetLife Dental PPO or Delta Dental PPO (depending on where you reside)

• DeltaCare DHMO

Either option helps pay the cost of dental expenses and is designed to promote and encourage preventive dental care.

The PPOs provide access to a large network of dentists. You may choose any dentist you wish, but you save money when

you use In-Network dentists.

Under the Dental Health Maintenance Organization (DHMO), you must select a DeltaCare dentist to receive care. This

option is available in most locations; check your options online to see if the DHMO is offered in your area.

Plan Feature MetLife Dental PPO or Delta Dental PPO

(carriers will vary depending

on where you live)

DeltaCare DHMO

Choice of dentists Choose any dentist but save money with In-

Network dentists

You must select a dentist from the

DeltaCare list

Annual maximum

benefit

$1,500 per person No dollar limit but plan provisions limit

access to certain services

Orthodontia maximum

benefit

$1,500 lifetime per person and not

subject to annual maximum benefit

Plan pays 100% of covered

expenses after you pay:

• $325 start-up fee, and

• $1,700 per child or

$1,900 per adult

Preventive care services,

such as exams, cleanings,

and X-rays

100%, no deductible, subject to

frequency limits

100%, subject to frequency limits

Annual deductible $50 per individual or $100 per family None

Basic services such as

extractions, root canals,

gum therapy, and amalgam

fillings

In-Network: 80% after deductible

Out-of-Network: 60% after deductible

Co-pay schedule

Major services such as

crowns, gold fillings, and

dentures

In-Network: 60% after deductible

Out-of-Network: 50% after deductible

Co-pay schedule

Orthodontia Plan pays 50% up to $1,500 lifetime per

person, not subject to annual maximum

benefit

Plan pays 100% of covered

expenses after you pay:

• $325 start-up fee, and

• $1,700 per child or

$1,900 per adult


Each dental benefit option under the Plan has its own benefit exclusions and limitations applicable to the benefits that it will

and won’t cover. To learn more about which benefits are covered (and to what extent) and excluded from coverage, you must

read that dental option’s Plan summary or certificate of insurance. These documents, which may be found at the end of this

document in the section titled “Appendix,” are incorporated by reference into this SPD.

33

Vision

Regular eye examinations not only determine your need for corrective eyewear but also may detect general health problems in

their earliest stages.

The company offers two vision options with the Vision Service Plan (VSP):

• Basic VSP

• Enhanced VSP

VSP offers access to a large network of vision providers and additional discounts. If you use

In-Network providers, you receive periodic vision care services, like eye exams, lenses, and frames, at low cost after typically low

annual co-pays. Or you can receive a partial cash reimbursement of expenses if you use a provider outside the VSP network.

Below is how the two options compare. Both provide In-Network and Out-of-Network care, but you save money using In-Network

providers.

The Well Vision Exam (your annual eye exam) is covered 100% after a $10 co-pay for both options in network. The options differ in

the coverage for glass lenses, frames, and contacts. The differences start with glass lenses, with the basic plan requiring a $25 co-pay

and the enhanced plan a $10 co-pay. For frames, the basic plan covers up to $130, while the enhanced plan covers up to $150. For

contacts, the basic plan covers up to $130, and the enhanced plan covers up to $150.

Most expenses are covered every 12 months, except the basic option covers frames every 24 months while the enhanced covers

frames every 12 months.

In addition to what you see here, VSP provides extra benefits and discounts under both options, including laser vision correction,

retinal screening, and additional glasses and sunglasses.

Plan Feature Basic VSP Enhanced VSP

In-Network Out-of-Network In-Network Out-of-Network

Doctor Network VSP Signature Any provider VSP Signature Any provider

Well Vision Exam $10 co-pay, then covered

100%

Up to $50 covered $10 co-pay, then covered

100%

Up to $50 covered

Glass lenses by

type

$25 co-pay, then covered

100% Progressive lenses:

$50 co-pay Standard $80–$90

co-pay

Premium $120–$160 Custom,

then covered at 100%

Up to $50 for single

lenses, $75 for bifocals,

and $100 for trifocals

$10 co-pay, then covered 100%;

progressive lenses:

$40 co-pay for all progressive

lens types, then covered at

100%

Up to $50 for single

lenses, $75 for bifocals or

progressive lenses, and

$100 for trifocals

Glass frames Up to $130 covered; up to $150

VSP featured brand

Up to $70 covered Up to $150 covered; up to $170

VSP featured brand

Up to $70 covered

Contacts (in lieu of

glasses)

Up to $130 covered Up to $105 covered Up to $150 covered Up to $105 covered

Frequency of

services

Exams: Every 12 months Lenses:

Every 12 months Frames: Every 24

months

Exams: Every 12 months Lenses: Every 12

months Frames: Every 12 months


Each vision benefit option under the Plan has its own benefit exclusions and limitations applicable to the benefits that it will and


vision option’s Plan summary or certificate of insurance. These documents, which may be found at the end of this document in the

section titled “Appendix,” are incorporated by reference into this SPD.

34

Basic life / Supplemental life and Accidental

Death and Dismemberment

The company provides you with basic life insurance, at no cost to you. Your company-provided coverage equals one times your

annual base pay, up to a maximum of $1,000,000, if you die while employed by the company. No evidence of insurability (EOI) is

required for this coverage. If your base pay exceeds $50,000, you may “opt down” to $50,000 in coverage to avoid imputed

income (described below) on the cost of your basic life insurance coverage. If you choose to opt down but then later increase your

life insurance coverage, EOI is required.

In addition to your basic life insurance coverage, you may choose from among the following optional insurance coverage:

• Supplemental Employee Life Insurance—giving you the flexibility to tailor your coverage to your needs

• Spouse / Domestic Partner Life Insurance—covering the life of your spouse or domestic partner

• Child Life Insurance—covering the life of your child(ren)

• Supplemental Employee AD&D Insurance—providing additional coverage if you die or are seriously injured in an accident

• Supplemental Family AD&D Insurance—providing coverage if a family member dies or is seriously injured in an accident

If you choose Supplemental Employee AD&D Insurance, you may elect family coverage, providing additional coverage if your

spouse/domestic partner or child dies or is seriously injured in an accident.

Remember to select your beneficiaries for basic life insurance and any supplemental insurance. Here are the highlights of your

options.

Supplemental Employee Life Insurance

Choose from 1 to 10 times your annual base pay up to a maximum of $2,500,000 in coverage. (This is in addition to your basic

life insurance maximum of $1,000,000.)

Supplemental Spouse / Domestic Partner Life Insurance

Choose from one to six times your annual base pay up to a maximum of $200,000 in coverage.

Child Life Insurance

Choose $10,000 in coverage per child. No EOI of a child is required when you elect dependent life insurance of a child as a new

hire, during annual open enrollment, or within 31 days of a “Qualified Status Change.”

Supplemental Employee AD&D Insurance

Choose from 1 to 10 times your annual base pay up to a maximum of $2,000,000 in coverage.

Supplemental Family AD&D Insurance

If you elect Supplemental Employee AD&D Insurance, you may elect to cover your family. The plan provides different amounts of

family coverage, depending on your Supplemental Employee AD&D election and your family configuration.

If you have a spouse / domestic partner and a child or children, your family AD&D coverage is:

• Spouse / domestic partner coverage equal to 50% of your Supplemental Employee AD&D Insurance up to a maximum of

$250,000. For example, if your coverage equals $100,000, your supplemental spouse / domestic partner AD&D coverage equals

$50,000.

• Child(ren) coverage equal to 10% of your Supplemental Employee AD&D Insurance up to a maximum of $50,000. For example,

if your coverage equals $100,000, your supplemental child AD&D coverage equals $10,000.

35

If you have a spouse / domestic partner but no children or you have a child(ren) but no spouse / domestic partner, then your family AD&D coverage works this way:

• If you do not have a child, your spouse / domestic partner coverage equals 60% of your Supplemental Employee AD&D

Insurance up to a maximum of $300,000. For example, if your coverage equals $100,000, your supplemental spouse / domestic

partner AD&D coverage equals $60,000.

• If you do not have a spouse / domestic partner but do have an eligible child(ren), your coverage equals 20% of your

Supplemental Employee AD&D Insurance up to a maximum of $50,000. For example, if your coverage equals $100,000, your

supplemental child AD&D coverage equals $20,000.

Evidence of Insurability (EOI)

Depending on your life insurance election, you may be required to submit EOI to prove good health. If you need to submit EOI, the

online enrollment system will give you instructions and you will not have life insurance coverage until the EOI is submitted and

accepted by the carrier.

If an employee elects supplemental life coverage at the time of hire, any coverage in excess of the lesser of three times the base

pay or $500,000 requires EOI.

If an employee experiences a Qualified Status Change (as defined by the carrier) and requests an increase in supplemental

coverage within 31 days of the event to an amount that is no greater than the lesser of three times the base pay or $500,000, no

EOI is required.

If an employee elects dependent life insurance coverage for their spouse or domestic partner in any amount, EOI of the spouse or

domestic partner is required.

For more information on EOI requirements, please go to mufgamericas.com/mybenefits.

Imputed income

The IRS values certain benefits as taxable income, even though you do not receive this value in cash. This is called “imputed income.”

The value of providing basic life insurance above $50,000 is considered imputed income. This is only a small addition to your tax bill.

Because your contributions for any supplemental life insurance are made on an after-tax basis, imputed income is not charged. You see

imputed income noted on your regular pay statement and the total annual imputed income added to your W-2 at the end of the

year. Social Security tax (FICA) is withheld on imputed income during the year.

Conversion rights

If you terminate employment, have the right to convert your life insurance coverage to an individual life insurance policy without

EOI after your coverage under the Plan terminates. You have 31 days within which to exercise your life insurance conversion

rights. To do so, contact the insurance company directly. You may also have the right to convert your AD&D coverage to an

individual AD&D policy if you are actively at work as of the date of your employment termination if you notify the insurance

company within 60 days after your employment termination.

To do so, contact the insurance company directly.


The life and AD&D benefit options under the Plan have benefit exclusions and limitations applicable to the benefits that they will

and won’t cover. To learn more about which benefits are covered (and to what extent) and excluded from coverage, you must

read that option’s Plan summary or certificate of insurance. These documents, which may be found at the end of this document in

the section titled “Appendix,” are incorporated by reference into this SPD.

36

Short-Term Disability (STD) and

Salary Continuation

Salary Continuation program (not subject to ERISA)

Eligibility

You are eligible for a benefit under this program if you are scheduled to work at least 17.5 hours per week and have been

employed by the company for at least 90 days.

Effective 1/1/2015 the Salary Continuation program provides Salary Continuation benefits for up to 25 weeks after you incur a total

disability (within the meaning of the policy for this program) after 2014 due to physical injury or mental illness (other than an

occupational sickness or injury). Benefits are based on years of service and coordinate with any state disability payments. The

company pays the full cost of the program. Payments are subject to tax.

Benefits

The benefit under this program begins on the eighth day of disability and continues for up to 25 weeks (or the date, if earlier, on

which you return to work, the third-party program administrator determines that the disability has ceased, or you terminate service).

The benefit payable is reduced for any payments from other sources, a state disability program, or the federal Social Security

disability program. The amount of the payment depends on your length of service with the company as follows (based on your most

recent date of hire):

• Less than one year of service: 60% of salary or wages

• At least one year but less than two years: 3 weeks at 100% and 22 weeks at 60%

• At least two but less than three years: 4 weeks at 100% and 21 weeks at 60%

• At least three but less than five years: 6 weeks at 100% and 19 weeks at 60%

• At least five but less than eight years: 12 weeks at 100% and 13 weeks at 60%

• At least 8 but less than 10 years: 16 weeks at 100% and 9 weeks at 60%

• 10 or more years: 25 weeks at 100%

Short-Term Disability benefits – state-mandated benefits

New York employees

Disability benefits are temporary cash benefits paid to you if you are an eligible wage earner and if you are disabled by an off-the-job

injury or illness. The New York Disability Benefits Law provides weekly cash benefits to replace, in part, wages lost due to injuries or

illnesses that do not arise out of or in the course of employment. Cash benefits are 50% of an average weekly wage, but no more

than the maximum benefit allowed, currently $170 per week. Benefits are paid for a maximum of 26 weeks of disability during 52

consecutive weeks. There is a seven-day waiting period for which no benefits are paid. Benefits begin on the eighth consecutive

day of disability.

New Jersey employees

The New Jersey state–mandated Short-Term Disability (STD) plan provides a benefit of 66⅔% of your average weekly salary up to

a maximum of $633 per week for 2017 to you if you are unable to work due to a non-occupational illness or injury. In order to be

eligible for benefits, you must have earned at least $168 per week for 20 base weeks of New Jersey–covered employment OR

earned at least $8,400 in covered employment during the 52-week period immediately preceding the week in which the disability

began.

37

California employees

California employees are also covered by the “Self-Insured Voluntary Disability and Paid Family Leave Benefit Plan for California

Employees of MUFG Union Bank, N.A. (no longer includes KLIK Technologies as of June 2016)” as set forth in a separate plan

document. California employees are entitled to a benefit under this program if they are disabled within the meaning of the policy or

are on paid family leave under California law by reason of a serious health condition of a family member, to bond with a child after a

birth or adoption, or in certain other circumstances. The benefit is generally 60% of salary or wages (up to a maximum weekly

benefit of $1.173 and is payable for up to 52 weeks. Benefits under this program are subject to offset by, among other things, the

first three weeks of benefits under the company’s Salary Continuation Program described above. Contact the Benefits Service

Center for more information.


Each short-term disability option under the Plan has its own benefit exclusions and limitations applicable to the benefits that it will

and won’t cover. To learn more about which benefits are covered (and to what extent) and excluded from coverage, you must read

that option’s Plan summary or certificate of insurance. These documents, which may be found at the end of this document in the

section titled “Appendix,” are incorporated by reference into this SPD.

38

Basic and supplemental Long-Term

Disability (LTD)

Long-term disability (LTD) benefits provide income replacement after you’ve been totally disabled and unable to work for at least

180 days. If you qualify for LTD benefits for a disability occurring after 2014, the company provides basic coverage of 50% of

your monthly pre-disability base pay, up to a maximum monthly payment of $10,000. If you live in California, the LTD plan

coordinates with benefits paid under the Voluntary Disability Plan.

Under the basic plan, your benefit will be 50% of your monthly earnings up to a maximum monthly benefit of $10,000, and the

entire benefit will be taxable to you. Alternatively, you may elect to share the cost of coverage with the company buy-up, in

which case the monthly benefit will be 60% of your monthly earnings up to a maximum monthly benefit of $15,000 and a

portion of your benefit will be tax-free. If you incur a covered disability before age 62, the benefit will be paid until your normal

retirement age for Social Security purposes. If you incur a disability after age 62, the payment period is reduced depending

on your age when you incur the disability. You may change your election during the annual open enrollment period or within

30 days after you have a change in status as defined in Section 125 of the Code.

Payments begin after 180 days (or, if later, when any short-term disability payments cease) of disability and are subject to

reduction by certain other payments such as workers’ compensation and Social Security disability. Payments for disability

by reason of mental illness that does not entail continued hospitalization are limited to 24 months. If you become eligible for

the Plan on or after January 1, 2015, payments will not begin for 12 months if the disability is attributable to

a condition that existed within the three-month period preceding your eligibility to participate.

LTD Buy-Up

You have the option to increase your LTD benefits to 60% of your monthly pre-disability base pay, up to a maximum

monthly payment of $15,000. For example, If you earn $50,000 per year: Your basic monthly LTD benefit amount would

be: $2,083. Your monthly Supplemental LTD benefit amount would be: $2,500.


Each LTD benefit option under the Plan has its own benefit exclusions and limitations applicable to the benefits that it will

and won’t cover. To learn more about which benefits are covered (and to what extent) and excluded from coverage, you

must read that option’s Plan summary or certificate of insurance. These documents, which may be found at the end of this

document in the section titled “Appendix,” are incorporated by reference into this SPD.

39

Section 125 Plan—

Flexible Spending Accounts (FSAs)

The company offers two types of FSAs (a Healthcare FSA and a Dependent Care FSA). The Healthcare FSA available to you

depends on the medical option you choose. These accounts can help you save for out-of-pocket health and dependent care

expenses.

• You can use the Healthcare FSA for eligible unreimbursed healthcare expenses such as deductibles, co-pays, coinsurance,

prescription drugs, and dental and vision expenses. However, if you enroll in the Anthem Health Savings Account medical

option, you will only have access to the Limited Scope Healthcare FSA to reimburse you for vision and dental expenses.

• You can use the Dependent Care FSA for eligible child and elder care expenses so you (and your spouse, if married) can work

or go to school. The Dependent Care FSA is not subject to ERISA.

Visit mufgamericas.com/mybenefits for a complete list of eligible expenses.

You can contribute up to $2,550 to the Healthcare FSAs and up to $5,000 to the Dependent Care FSA during 2017. Your entire

contribution amount to the Healthcare FSAs is available to you right away—even if you haven’t made a deposit yet.

There are tax savings too because your FSA contributions are taken from your paycheck before taxes are figured. This lowers

your taxable income, so you pay less in taxes. Plus, when you have eligible expenses, you pay for them with tax-free money.

Know how easy it can be

Your accounts are administered through WageWorks. Please refer to mufgamericas.com/ mybenefits for a healthcare and

dependent care savings calculator. The calculator helps you answer questions such as:

• Should you participate?

• How much can you save?

• What health and dependent care expenses do you expect to have?

Know how much to contribute

With an FSA, you need to use the money in your account by the end of the Plan Year. But with a little planning, you can do it.

Here’s how:

• If you’re trying an FSA for the first time, contribute an amount you know you’ll use, to see how the account works.

• If you’ve already participated in an FSA and you used all the money in your account, you could contribute the same amount—or

a little more if you ran out early in the year.

• Remember that even if you have money in your FSA toward the end of the year, you can always use it on healthcare expenses

you may have put off—such as dental work, glasses, or contact lenses. You have until March 31 to submit expenses incurred

during the prior calendar year (for example, for 2016 expenses you have until March 31, 2017, to submit expenses incurred in

2016).

• For the Healthcare FSAs, you may roll over up to $500 into the following year. If you participate in the HSA medical option during

the following year, you can only use that rollover money for dental and vision expenses (the Limited Scope Healthcare FSA).

40

HSA versus FSA

If you enroll in the Anthem HSA medical option, your FSA-eligible expenses are limited. You can use the Limited Scope

Healthcare FSA to pay for nonmedical-related healthcare expenses

(for example, dental and vision care), and you can use the money in your HSA to pay for other medical expenses, like your

deductible. Go to mufgamericas.com/mybenefits to learn more.


Each FSA option under the Plan has its own benefit exclusions and limitations applicable to the benefits that it will and won ’t

cover. To learn more about which benefits are covered (and to what extent) and excluded from coverage, you must read that

option’s Plan summary. These documents, which may be found at the end of this document in the section titled “Appendix,”

are incorporated by reference into this SPD.

41


Health Savings Account (not covered by ERISA)

In general, if you are eligible for coverage and participate in an HSA “high-deductible” medical option, you may elect to contribute to

your HSA on a pretax basis through payroll deductions.1 The account operates in a manner similar to that of an individual retirement

account, except that you are not taxed on distributions that are used to pay qualifying health expenses for you and your qualified

dependents (including domestic partners who qualify as IRS tax dependents). You are also not taxed on income in the account.

Qualifying health expenses in general include co-pays and deductibles you and your qualifying dependents incur for qualified

medical treatment as well as out-of-pocket dental and vision expenses. In general, if you do not use a distribution from the account to

pay for a qualifying health expense, you are subject to a tax on the distribution and, if you are under age 65, an additional 20 percent

tax.

You decide how much to contribute to your account. The company may also determine to contribute to the account for you on a

pretax basis. Total contributions, which consist of your contributions plus any contributions the company makes on your behalf, are

limited to a maximum for 2017 of $3,400 for self-only coverage or $6,750 for family coverage. Employees who are at least age 55

may contribute up to an additional $1,000. In general, your pre-elected contributions will be deducted in equal amounts throughout

the year from your pay as long as you are eligible to participate. The amounts are then deposited into your account. You may

change your contribution election at least once each month.

You may not contribute to a HSA if you are enrolled in Medicare. You should consider this if you are nearing age 65 or retirement.

If you terminate employment for any reason, you take your account with you. The HSA is administered through WageWorks. The

trustee of your HSA, BNY Mellon, may charge you a monthly fee to maintain your HSA.

1 State income tax applies in AL, CA and NJ.

42

Business Travel Accident (BTA)

The company provides business travel accident (BTA) insurance should you suffer a serious accident or die while you travel on

business. The amount of BTA insurance coverage available and the level of benefit that would be payable depend on your position

with the company.

• Senior executives, including the Board of Directors, Board Chair, CEO, President, General Managers, Managing Directors,

Directors, and Vice Presidents, are insured for $500,000.

• All other full-time active employees are insured for $250,000.

• All active U.S. employees who are on international assignment (and their families) have specified trip insurance in the amount of

$150,000.

– All active non-U.S. employees who are on international assignment in the United States (and their families) have specified trip

insurance in the amount of $150,000.

When your family members travel with you, they too are protected should they suffer a serious accident or die in the course of the

business-related travel. Your spouse or domestic partner has $50,000 of insurance coverage, and each dependent child is insured

for $25,000.

There is a $10,000,000 limit on the benefits payable under this policy for injuries or deaths that result from a common accident.

There are also various levels of AD&D benefits that can be payable depending on the nature of the accident and the type of injury

involved. In addition, certain types of accidents may be excluded from paying any BTA benefits, such as injuries you may suffer

during illegal activity, if

you fly in a noncommercial aircraft, or if you are found to be intoxicated or under the influence of narcotics or a controlled substance

at the time of the accident. You can learn more about the BTA insurance the company provides to you online via the Benefits Portal.


Each BTA benefit option under the Plan has its own benefit exclusions and limitations applicable to the benefits that it will and won’t

cover. To learn more about which benefits are covered (and to what extent) and excluded from coverage, you must read that

option’s Plan summary or certificate of insurance. These documents, which may be found at the end of this document in the section

titled “Appendix,” are incorporated by reference into this SPD.

43

Employee Assistance Program (EAP)

All employees of the company are eligible for an Employee Assistance Program (EAP), called “GuidanceResources®,” which can

help you with any concerns you may have about your health, work, family, or life in general. Dealing with personal issues, planning

for life events, or simply managing your daily life can affect your work, health, and family. ComPsych® GuidanceResources® provides

support, resources, and information about managing personal issues and maintaining work-life balance. You can use the services of

GuidanceResources at any time, including during leaves of absence. The EAP is also available to your spouse, domestic partner and

dependent children.

When you should use the EAP. Contact GuidanceResources whenever you need help with an issue that interferes with your job or

personal life. You can call at any time; your concern does not have to be an emergency or a crisis. The EAP is a good source of

information when you need help identifying appropriate resources for an issue or a concern—or even if you’re wondering whether

you should be concerned about something in your life.

What services are covered by the EAP. Traditionally, EAPs have focused on providing counsel and resources for behavioral issues,

from work-related problems to more disruptive challenges such as substance abuse and depression. GuidanceResources can not

only handle these matters but also connect you with experts in family care, work-life balance, and financial and legal issues.

When you call the EAP, ComPsych professionals will listen to your concerns and help you identify the cause of your problem.

They’ll then work with you, drawing on the program’s network of specialized providers to develop a practical solution, including

follow-up. These specialists include masters- and doctoral-level clinicians, work-life experts, attorneys, and CPAs.

Confidential counseling: Someone to talk to. This no-cost counseling service helps you address stress, relationship and other personal issues you and your family may face. It is staffed by GuidanceConsultantsSM— highly trained masters- and doctoral-level clinicians who will listen to your concerns and quickly refer you to in-person counseling and other resources for:

• Stress, anxiety, and depression • Grief and loss • Job pressures • Problems with children • Relationship/marital conflicts • Substance abuse

Financial information and resources: Discover your best options. Speak by phone with our CPAs and Certified Financial Planners™ on a wide range of financial issues, including:

• Getting out of debt • Estate planning • Retirement planning • Tax questions • Credit card or loan problems • Saving for college

Legal support and resources: Expert information when you need it. Talk to our attorneys by phone. If you require representation, we’ll refer you to a qualified attorney in your area for a free 30-minute consultation with a 25% reduction in customary legal fees thereafter. Call about:

• Divorce and family law • Civil and criminal actions • Real estate transactions • Landlord-tenant issues • Debt and bankruptcy • Contracts

Work-life solutions: Delegate your to-do list. A Work-Life specialist will do the research for you, providing qualified referrals and customized resources for:

• Child and elder care • Pet care • College planning • Making major purchases • Moving and relocation • Home repair

Wellness: Take charge of your health. ComPsych® HealthyGuidance® helps you make positive lifestyle changes. You and your spouse or domestic partner can get the tools and support you need to make smarter decisions about your health. This confidential program includes:

• Wellness coaching by phone for tobacco cessation • Online health information, learning modules, and other tools

Call for an appointment with a health coach or go online to guidanceresources.com and click on the HealthyGuidance link.

GuidanceResources® Online: Knowledge at your fingertips. GuidanceResources Online is your one-stop website for expert information on the issues that matter most to you: relationships, work, school, children, wellness, legal, financial, free time, and more.

• Timely articles, HelpSheetsSM, tutorials, streaming videos, and self-assessments

• “Ask the Expert” personal responses to your questions • Child care, elder care, attorney, and financial planner searches


The EAP benefit under the Plan has its own benefit exclusions and limitations applicable to the benefits that it will and won’t cover.

To learn more about which benefits are covered (and to what extent) and excluded from coverage, you must read the Plan

summary or certificate of insurance. These documents, which may be found at the end of this document in the section titled

“Appendix,” are incorporated by reference into this SPD.

44

Wellness Program

All employees, spouses, and domestic partners who are covered participants in a bank medical plan have the opportunity to

participate in the 2017 Wellness Program.

ComPsych: Healthy Guidance will be administering many enhanced features of our wellness program, leading you to better health through a series of wellness webinars, a monthly newsletter and informational videos. Our medical providers, Anthem and Kaiser, offer a variety of wellness programs and services. Securian and Prudential offer financial wellness programs and services as well. Healthy Guidance wellness services let you take a “snapshot” of your current health with an online Health Assessment. Completing the assessment gets you on a more focused path to improving your health—giving you a report of your current health, based on national standards. GuidanceResources also offers wellness services such as: • Free and confidential support from certified health coaches. You can participate in one-on-one Telephonic Coaching sessions designed to help you improve your health and wellness and stay on track. • Online Wellness Coaching Modules to work at your own pace using structured programs ranging from 2 – 6 weeks. • Tobacco cessation, weight management, lifestyle coaching, healthy pregnancy, sleep and back care coaching, and other total well-being multi-media resources. Go online to register and learn more about the vast amount of services, tools, tips, and features offered. Visit www.guidanceresources.com and use Web ID: MUFG to log in. You can also call 1-855-813-4922, TDD: 1-800-697-0353. Don’t forget to visit the Wellness Page on Bridge for regular updates and resources.


The Wellness Program benefit under the Plan has its own benefit exclusions and limitations applicable to the benefits that it will and


option’s Plan summary or certificate of insurance. These documents, which may be found at the end of this document in the section

titled “Appendix,” are incorporated by reference into this SPD.

VOLUNTARY LEGAL SERVICES Your financial wellness is important to us so we are offering a new voluntary benefit through Hyatt Legal Plans, a MetLife company, to provide employees the option to access up to 15 hours per year of pre-paid, convenient, professional legal counsel. You can utilize the EAP as well as Hyatt Legal to establish a will, estate planning, and other legal services. You get access to MetLaw®, which provides fully covered legal advice and representation for most personal legal matters such as: • General phone advice and office consultations • Wills and estate planning documents • Document preparation and review • Real estate, debt, consumer, traffic defense, and juvenile court matters • Defense of civil lawsuits (excludes defense against your employer) • Family law Learn more about this benefit online at info.legalplans.com (enter access code Legal) or by calling 1-800-821-6400. Benefit exclusions and limitations

The Group Legal benefit under the Plan has its own benefit exclusions and limitations applicable to the benefits that it will and won’t cover. To learn more about which benefits are covered (and to what extent) and excluded from coverage, you must read that option’s P lan summary or certificate of insurance. These documents, which may be found at the end of this document in the section titled “Appendix,” are

incorporated by reference into this SPD.

45

Your costs

The table below shows monthly contribution amounts for coverage. For the medical rates, the chart shows the non-tobacco user

rates, if you or your spouse or domestic partner uses tobacco, you will be charged an additional surcharge of $60, which will be

added to the monthly medical rates shown below. To calculate the deduction from a biweekly paycheck, multiply the amount by 12

and then divide by 24.

Monthly Premiums by Plan Type

Medical Plan You only You and spouse /

domestic partner

You and children only

You and family

Anthem HRA $76.79 $182.35 $157.79 $247.85

Anthem HSA* $120.95 $275.09 $237.28 $375.92

Anthem PPO $196.24 $434.00 $373.54 $595.22

Kaiser HMO (CA) $133.10 $298.82 $260.68 $411.13

No Medical coverage $0.00

Dental Plan You only You and spouse /

domestic partner


You and family

MetLife Dental PPO $18.42 $39.02 $37.07 $56.57

Delta Dental PPO $18.42 $39.02 $37.07 $56.57

DeltaCare USA DMO $7.12 $12.95 $13.02 $18.77

No Dental coverage $0.00

Vision Care Plan You only You and spouse /

domestic partner


You and family

VSP Basic $1.74 $3.74 $3.36 $5.23

VSP Enhanced $7.14 $14.53 $13.07 $20.34

No Vision care coverage $0.00

Legal Assistance Benefit (Metlaw)

$16.50

*This Plan option gives you the opportunity to make a before-tax contribution to an HSA.

Note: Life Insurance and AD&D amounts are based on the level of coverage you elect.

Visit the Benefits Portal for rates per $100 of coverage or rates per $1,000 of coverage.

46

Rights under the plans Plan sponsor’s right to amend or terminate the plans

The Plan Sponsor reserves the right, in its sole and absolute discretion, to amend, modify, or terminate, in whole or in part, any or

all of the provisions of the Plans (including any related documents and underlying policies) at any time and for any or no reason.

Third-party recovery

If you are paid benefits from another welfare benefit plan, the Plan may be entitled to reimbursement. In particular, the Plan may be

entitled to reimbursement for benefits that are related to medical expenses and are also payable under workers’ compensation, any

statute, any uninsured or underinsured motorist program, any no-fault or school insurance program, any other insurance policy, or

any other plan of benefits, or when related medical expenses that arise through an act or omission of another person are paid by a

third party, whether through legal action, settlement, or for any other reason.

By participating in the Plan, you and your covered dependents consent and agree that a constructive trust, a lien, or an equitable

lien by agreement in favor of the Plan exists with regard to any settlement or recovery from a third person or party. In accordance,

you and

your covered dependents agree to cooperate with the Plan in reimbursing it for Plan costs and expenses. If you or your covered

dependents have any reason to believe that the Plan may be entitled to recovery from any third party, you must notify the Plan.

And, at that time, you (and your attorney, if applicable) must sign a subrogation/reimbursement agreement that confirms the prior

acceptance of the Plan’s subrogation rights and the Plan’s right to be reimbursed for expenses arising from circumstances that

entitle the participant or covered dependent to any payment, amount, or recovery from a third party.

YOU AND YOUR COVERED DEPENDENT CONSENT AND AGREE THAT YOU WILL NOT ASSIGN YOUR RIGHTS TO

SETTLEMENT OR RECOVERY AGAINST A THIRD PERSON OR PARTY TO ANY OTHER PARTY, INCLUDING YOUR ATTORNEY,

WITHOUT THE PLAN’S CONSENT. AS SUCH, THE PLAN’S REIMBURSEMENT WILL NOT BE REDUCED BY ATTORNEY’S FEES

AND YOUR ERISA RIGHTS.

ERISA statement of rights

As a participant in the Plan, you are entitled to certain rights and protections under the Employee Retirement Income Security Act of

1974 (ERISA). ERISA provides that all Plan participants shall be entitled to:

Receive information about your plan and benefits examine, without charge, at the Plan Administrator’s office and other specified

locations, such as worksites and union halls, all documents governing the Plan, including insurance contracts and collective

bargaining agreements, and a copy of the latest annual report (Form 5500 Series) filed by the Plan with the U.S. Department of Labor

and available at the Public Disclosure Room of the Pension and Welfare Benefit Administration.

Obtain, upon written request to the Plan Administrator, copies of documents governing the operation of the Plan, including

insurance contracts and collective bargaining agreements, and copies of the latest annual report (Form 5500 Series) and the

updated SPD. The administrator may request a reasonable charge for the copies.

Receive a summary of the Plan’s annual financial report. The Plan Administrator is required by law to furnish each participant with a

copy of this summary annual report.

47

Continue group health plan coverage

Continue healthcare coverage for yourself, your spouse, or your dependents if there is a loss of coverage under the Plan as a

result of a qualifying event. You or your dependents may have to pay for such coverage. Review this SPD and the documents

governing the Plan on the rules concerning your COBRA continuation coverage rights.

Prudent actions by plan fiduciaries

In addition to creating rights for Plan participants, ERISA imposes duties upon the people who are responsible for the operation of

the employee benefit plan. The people who operate your Plan, called “fiduciaries” of the Plan, have a duty to do so prudently and

in the interest of you and other Plan participants and beneficiaries. No one, including your employer, your union, or any other

person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a (pension, welfare) benefit or

exercising your rights under ERISA.

Enforce your rights

If your claim for a (pension, welfare) benefit is denied or ignored, in whole or in part, you have a right to know why this was done,

obtain copies of documents relating to the decision without charge, and appeal any denial, all within certain time schedules.

Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request a copy of Plan documents or the

latest annual report from the Plan and do not receive them within 30 days, you may file suit in a federal court. In such a case, the

court may require the Plan Administrator to provide the materials and pay you up to $110 a day until you receive the materials, unless

the materials were not sent because of reasons beyond the control of the administrator. If you have a claim for benefits that is denied or

ignored, in whole or in part, you may file suit in a state or federal court (after you exhaust the claims and appeals procedures set forth

below). In addition, if you disagree with the Plan’s decision or lack thereof concerning the qualified status of a domestic relations order

or a medical child support order, you may file suit in federal court. If it should happen that Plan fiduciaries misuse the Plan’s

money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor

or file suit in a federal court. The court will decide who should pay the court costs and legal fees. If you are successful, the court

may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees—for

example, if it finds your claim is frivolous.

Assistance with your questions

If you have any questions about your Plan, you should contact the Plan Administrator. If you have any questions about this

statement or your rights under ERISA or if you need assistance in obtaining documents from the Plan Administrator, you should

contact the nearest office of the

U.S. Department of Labor’s Employee Benefits Security Administration listed in your telephone directory or the Division of Technical

Assistance and Inquiries, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue N.W.,

Washington, DC 20210. You may also obtain certain publications about your rights and responsibilities under ERISA by calling the

publications hotline of the Employee Benefits Security Administration.

Function of the Plan Administrator

The Plan Administrator (or its designees) shall have the authority to interpret the Plans; decide all questions of eligibility of persons

to participate in the relevant Plan; and make findings of fact, correct any defect, and construe any uncertain or disputed term or

provision in the Plan, this document, and any Plan documents, unless this function is the responsibility of an insurance company

or the Plan Administrator has delegated such functions to a Claims Administrator.

The determinations made in the exercise of this discretionary authority shall be binding upon all interested parties, including, but

not limited to, you, your estate, your beneficiaries, and the Plan Sponsor and its affiliates. To the extent that an insurer or other

provider or a third-party contract administrator exercises discretionary authority or discretionary responsibility over claims for

benefits under a Plan, it shall have the authority and discretion to construe any uncertain or disputed term or provision in its

certificates, booklets, summaries of benefits and coverage, and contracts or to determine the amount to be paid pursuant to a claim

for benefits.

Additionally, the Plan Administrator has the authority and responsibility to (i) adopt such regulations, rules, procedures, and forms

consistent with the Plans that are deemed necessary or desirable for the administration of the Plans, and (ii) employ individuals

and firms to provide legal and actuarial advice and counsel, as necessary, to assure that the provisions of the Plans are properly

interpreted and administered.

48

Your rights under WHCRA

The group medical, hospitalization, and prescription drug plan, as required by the Women’s Health Cancer Rights Act of 1998

(WHCRA), provides the following benefits for a Plan participant or beneficiary who is receiving healthcare benefits in connection

with a mastectomy:

• Reconstruction of the breast on which the mastectomy has been performed;

• Surgery and reconstruction of the other breast to produce a symmetrical appearance; and

• Prostheses and treatment of physical complications at all stages of mastectomy, including lymphedemas.

Coverage for these benefits or services will be provided in consultation with the participant’s or beneficiary’s attending physician.

Coverage for the mastectomy-related services or benefits required under the WHCRA are subject to the same deductibles and

coinsurance or co-payment provisions that apply with respect to other medical or surgical benefits provided by your healthcare

medical contract. Contact the Plan Administrator for more information.

Your rights under HIPAA

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights relating to group health

benefits.

a. Special enrollment rights. HIPAA amended the Code, ERISA, and the Public Health Service Act to provide special enrollment

rights to certain individuals who earlier declined group health coverage and later wish to elect enrollment for themselves, one or

more eligible dependents, or both themselves and their dependents. Group health plans and any insurer offering group health

coverage must provide special enrollment periods to certain individuals eligible for group health coverage.

1. Loss of coverage. An employee who is eligible but not enrolled for medical coverage under the terms of the Plan (or his or

her dependent if the dependent is eligible but not enrolled for coverage) is permitted to enroll for medical coverage under the

Plan if:

1a. The employee or dependent was covered under a group health plan or had health insurance coverage at the time the

Plan’s medical benefits were previously offered to the employee or individual;

1b. The coverage of the employee or dependent that has lost the other coverage was

(i) under COBRA continuation coverage (as generally described below) and the COBRA coverage was exhausted, or

(ii) was not covered under COBRA and either the coverage was terminated as a result of loss of eligibility for the coverage

(including as a result of legal separation, divorce, death, termination of employment, or reduction in the number of hours of

employment) or employer contributions toward the coverage were terminated; and

1c. The employee requests enrollment in writing within 30 days after the date of exhaustion of COBRA coverage or the

termination of coverage or employer contribution.

2. Addition of a new dependent. Employees, as well as their spouses and dependents, may have special enrollment rights after

a marriage, birth, adoption, or placement for adoption.

The Plan has to provide at least 30 days for the employee or dependents to request coverage after the occurrence of one of

these events.

If the event was a marriage, the coverage is required to be effective no later than the first day of the first calendar month

beginning after the date the completed request for enrollment is received by the Plan. In the case of birth, adoption, or

placement for adoption, coverage is required to be effective no later than the date of the event.

3. Medicaid/CHIP

Your rights under CHIP

You and your dependents who are eligible for coverage under the Plan but who have not enrolled have the right to elect

coverage during the Plan year under two circumstances:

• You or your dependent’s state Medicaid or CHIP (Children’s Health Insurance Program) coverage terminated because you

ceased to be eligible.

• You become eligible for premium assistance under state Medicaid or CHIP.

You must request special enrollment in writing within 60 days of the loss of coverage and/or within 60 days of when eligibility is

determined for the premium subsidy.

a. Nondiscrimination based on health factors. The Plan generally may not establish any rule for eligibility to enroll in the Plan

(including continued eligibility) that discriminates against an employee or dependent because of a health factor or charge

higher premiums on account of a health factor. Health factors include, with respect to an individual, (i) health status,

49

(ii) medical condition (including both physical and mental illnesses), (iii) claims experience,

(iv) receipt of healthcare, (v) medical history, (vi) genetic information, (vii) EOI (includes conditions arising out of acts of

domestic violence and activities such as motorcycling, snowmobiling, all-terrain vehicle riding, horseback riding, skiing, and

other similar activities), or (viii) disability.

Your rights under the Newborns’ and Mothers’ Health Protection Act of 1996 (NMHPA) Group health plans and health insurance

issuers and other providers generally may not, under federal law, restrict benefits for any hospital length of stay in connection

with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery or less than 96 hours following a

cesarean section. However, federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting

with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, Plans

and issuers may not, under federal law, require that a provider obtain authorization from the Plan or the insurance issuer for

prescribing a length of stay not in excess of 48 hours (or 96 hours).

Your rights under the Mental Health Parity and Addiction Equity Act of 2008

This act expands the mental health parity requirements in ERISA, the Code, and the Public Health Services Act by imposing new

mandates on group health plans that provide both medical and surgical benefits and mental health or substance abuse disorder

benefits. Among the requirements, such plans (or the health insurance coverage offered in connection with such plans) must

ensure that the financial requirements applicable to mental health or substance abuse disorder benefits are no more restrictive

than the predominant financial requirements applied to substantially all medical and surgical benefits covered by the Plan (or

coverage), and there are no separate cost-sharing requirements that are applicable only with respect to mental health or

substance abuse disorder benefits.

Your rights under the Genetic Information Non-Discrimination Act (GINA)

GINA broadly prohibits covered employers from discriminating against an employee, an individual, or a member because of the

employee’s “genetic information,” which is broadly defined in GINA to mean (1) genetic tests of the individual, (2) genetic tests of

family members of the individual, and

(3) the manifestation of a disease or disorder in family members of such individual. GINA also prohibits employers from

requesting, requiring, or purchasing an employee’s genetic information. This prohibition does not extend to information that is

requested or required to comply with the certification requirements of family and medical leave laws or to information inadvertently

obtained through lawful inquiries under, for example, the Americans with Disabilities Act, provided the employer does not use the

information in any discriminatory manner. In the event a covered employer lawfully (or inadvertently) acquires genetic information, the

information must be kept in a separate file and treated as a confidential medical record and may be disclosed to third parties only in

very limited situations.

50

Qualified medical child support orders (QMCSOs)

The Plan is required to provide health benefits in accordance with the applicable provisions of any qualified medical child support

order (QMCSO) as required under ERISA. In general, the term “qualified medical child support order” means a medical child support

order that requires the Plan to provide a child of a participant with health coverage under the Plan where the child would not

otherwise be covered—for example, if the child would lose coverage as a result of a parent’s divorce. A medical child support order

is a judgment, decree, or order (including approval of a settlement agreement) issued by a court of competent jurisdiction. It also

includes a National Medical Support Notice that meets the requirements of the regulations of the Department of Labor set forth in 29

CFR §2590.609-2. Under a QMCSO, the Plan can be ordered to enroll the child in any available healthcare expense coverage option

and deduct the applicable cost from the participant’s wages. Accordingly, the Plan Administrator has the right to make any necessary

changes to the participant’s medical coverage elections in order to provide the child(ren) with the coverage required by the QMCSO

and to authorize on the participant’s behalf the payment of any additional premium costs from the participant’s wages. The Plan

Administrator has established procedures for qualifying medical support orders. Participants and beneficiaries may obtain, without

charge, a copy of the Plan’s QMCSO procedures from the Plan Administrator.

Certain legal rights under group health plans – Special rules regarding military leaves An employee on leave will be entitled to

group health plan coverage no less favorable than as required under the Uniformed Services Employment and Reemployment

Right Act (USERRA) provided, however, that coverage pursuant to the terms of USERRA and COBRA coverage will run

concurrently. If you take a leave of absence because of voluntary or involuntary service in the uniformed services (for active duty or

training), group health coverage (medical, dental, vision, and Healthcare FSA) for you and your dependents continues during

military leave if your leave is less than 31 days. If your leave continues 31 days or more, you and your dependents can continue

coverage under

USERRA by paying 102% of the cost of coverage. Coverage will end on the earliest of the following:

• The 24-month period beginning on the date your leave started; or

• The day after the date your leave ends and you fail to apply for or return to employment, whichever occurs first; or

• The date you fail to make a timely payment for coverage; or

• The date you are discharged from military service under other than honorable conditions or if you are dismissed or dropped from

military rolls under conditions that result in a loss of reemployment rights under USERRA; or

• The date the Health Benefit Plan is terminated.

You and your dependents must elect this coverage; it is not automatic. To be eligible for this coverage, you must give your

employer advance notice of the leave unless the requirement to provide such advance notice has been excused in accordance

with USERRA because the provision of such notice was impossible, unreasonable, or precluded by military necessity. The

duration of this leave, combined with all of your previous periods of military leaves, may not exceed five years (unless extended by

a national emergency or similar circumstance).

51

Certain legal rights under group health plans – Your rights under COBRA

You have a right to choose continuation coverage under the Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA)

for yourself, your covered spouse, and your dependent children if you lose group medical and prescription drug coverage or

dental, vision, or a Healthcare or Limited Scope Healthcare FSA coverage under any of the Plans because of a reduction in your

hours of employment or the termination of your employment (for reasons other than gross misconduct on your part). (A child who

is born to or placed for adoption with a participant during a period of COBRA coverage is also considered a covered dependent

child.)

Employees enrolled in a California policy may have the opportunity to continue coverage for up to a total of 36 months through a

combination of COBRA and Cal-COBRA. Once you exhaust federal COBRA, you have the opportunity to receive the same

benefits in the same insured option health plan as under COBRA. However, if you have nonmedical coverage under COBRA

(dental or vision care) from a specialized health plan, or any of the Anthem medical options, you cannot continue this under Cal-

COBRA. The premium under the Cal-COBRA continuation of federal COBRA will be more than that under federal COBRA. Just

like the premium for federal COBRA, you will have to pay the entire premium yourself.

If your continuation period under COBRA is less than 36 months and you are interested in continuing coverage of your medical

option under Cal-COBRA, you must contact the insurance carrier directly before your initial COBRA period ends.

The California Department of Health Care Services will pay health insurance premiums for certain persons who are losing

employment and have a medical condition that requires a physician’s treatment. In order to qualify for the health insurance

premium payment (HIPP) program, you must meet all of the following conditions:

1. You must have full scope or fee-for-service Medi-Cal;

2. You must have a medical condition that requires a physician’s treatment;

3. The monthly cost savings to Medi-Cal must be 1.1 or greater;

4. You must have a current health insurance policy that covers your medical condition, COBRA, a Cal-COBRA continuation policy,

or a COBRA conversion policy in effect or available at the time of application;

5. The health insurance policy must cover your medical condition; and

6. You are not enrolled in a Medi-Cal-related prepaid health plan, County Health Initiative, Geographic Managed Care Program,

County Medical Services Program (CMSP), or Medicare.

Apply online at http://dhcs.ca.gov/HIPP, then click on the “HIPP Application Form-Fillable” link to access the form.

Eligible California residents with an HIV/AIDS diagnosis may qualify for premium payment assistance through the Office of AIDS

(OA) HIPP. For information regarding eligibility requirements and how to apply, please see this website:

http://www.cdph.ca.gov/programs/ aids/Pages/OAHIPPForms.aspx.

http://dhcs.ca.gov/HIPP

http://www.cdph.ca.gov/programs/

52

Continuation coverage rights under COBRA

Introduction

This notice has important information about your right to COBRA continuation coverage, which is a temporary extension of

coverage under the Plan. This notice explains COBRA continuation coverage, when it may become available to you and your

family, and what you need to do to protect your right to get it. When you become eligible for COBRA, you may also become

eligible for other coverage options that may cost less than COBRA continuation coverage.

The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985

(COBRA). COBRA continuation coverage can become available to you and other members of your family when group health coverage

would otherwise end. For more information about your rights and obligations under the Plan and federal law, you should review the

Plan’s SPD or contact the Plan Administrator.

You may have other options available to you when you lose group health coverage

For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage

through the marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally,

you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a

spouse’s plan), even if that plan generally doesn’t accept late enrollees.

What is COBRA continuation coverage?

COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event. This is

also called a “qualifying event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA

continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your dependent

children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan,

qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage.

If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following

qualifying events:

• Your hours of employment are reduced; or

• Your employment ends for any reason other than your gross misconduct.

If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of

the following qualifying events:

• Your spouse dies;

• Your spouse’s hours of employment are reduced;

• Your spouse’s employment ends for any reason other than his or her gross misconduct;

• Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or

• You become divorced or legally separated from your spouse.

Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following

qualifying events:

• The parent-employee dies;

• The parent-employee’s hours of employment are reduced;

• The parent-employee’s employment ends for any reason other than his or her gross misconduct;

• The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both);

• The parents become divorced or legally separated; or

• The child stops being eligible for coverage under the Plan as a “dependent child.”

Sometimes, filing a proceeding in bankruptcy under Title 11 of the United States Code can be a qualifying event. If a proceeding

in bankruptcy is filed with respect to MUFG Union Bank, N.A., and that bankruptcy results in the loss of coverage of any retired

employee covered under the Plan, the retired employee will become a qualified beneficiary. The retired employee’s spouse,

surviving spouse, and dependent children will also become qualified beneficiaries if bankruptcy results in the loss of their

coverage under the Plan.

When is COBRA continuation coverage available?

The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified

that a qualifying event has occurred. The employer must notify the Plan Administrator of the following qualifying events:

• The end of employment or reduction of hours of employment;

53

• Death of the employee;

• Commencement of a proceeding in bankruptcy with respect to the employer; or

• The employee becoming entitled to Medicare benefits (under Part A, Part B, or both).

For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent child losing eligibility for

coverage as a dependent child), you must notify the Plan Administrator within 60 days after the qualifying event occurs. You must

provide this notice to: MUFG Union Bank, N.A., Benefits Service Center.

How is COBRA continuation coverage provided?

Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered

to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation

coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect

COBRA continuation coverage on behalf of their children.

COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment

termination or reduction of work hours. Certain qualifying events, or a second qualifying event during the initial period of coverage,

may permit a beneficiary to receive a maximum of 36 months of coverage. There are also ways in which this 18-month period of

COBRA continuation coverage can be extended:

• Disability extension of 18-month period of COBRA continuation coverage

If you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan

Administrator in a timely fashion, you and your entire family may be entitled to get up to an additional 11 months of COBRA

continuation coverage, for a maximum of 29 months. The disability would have to have started at some time before the 60th day

of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage.

• Second qualifying event extension of 18-month period of continuation coverage

If your family experiences another qualifying event during the 18 months of COBRA continuation coverage, the spouse and

dependent children in your family can get up

to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if the Plan is properly notified about

the second qualifying event. This extension may be available to the spouse and any dependent children getting COBRA

continuation coverage if the employee or former employee dies, becomes entitled to Medicare benefits (under Part

A, Part B, or both), or gets divorced or legally separated or if the dependent child stops being eligible under the Plan as a

dependent child. This extension is only available if the second qualifying event would have caused the spouse or dependent

child to lose coverage under the Plan had the first qualifying event not occurred.

Are there other coverage options besides COBRA continuation coverage?

Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through

the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse’s plan) through what

is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn

more about many of these options at www.healthcare.gov.

If you have questions

Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts

identified below. For more information about your rights under the Employee Retirement Income Security Act (ERISA), including

COBRA, the Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest

regional or district office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or

visit www.dol.gov/ebsa (addresses and phone numbers of regional and district EBSA offices are available through EBSA’s

website). For more information about the marketplace, visit www.healthcare.gov.

Keep your Plan informed of address changes

To protect your family’s rights, let the Plan Administrator know about any changes in the addresses of family members. You

should also keep a copy, for your records, of any notices you send to the Plan Administrator.

Plan contact information

Contact the Benefits Service Center at 800-964-9907 or mufgamericas.com/mybenefits.

http://www.healthcare.gov/

http://www.dol.gov/ebsa


54

Claims Procedures

How to file a claim

To complete your claim filing, the insurer or Claims Administrator must receive the claim information it requests from you (or your

authorized representative), your attending physician and your employer. If you or your authorized representative has any questions

about what to do, you or your authorized representative should contact the insurer or Claims Administrator directly. If you wish to

file a claim for benefits, you should follow the claim procedures described in the applicable Plan summary of insurance certificate,

which can be found in the appendix to this document. Below is a general explanation of the claims processes for Plan benefits,

as required by ERISA. However, to the extent an insurer’s or administrator’s claims process differs from that found in the

applicable Plan summary of certificate of insurance found in the appendix of this document, the summary or insurance certificate

will control.

Unless there are special circumstances, this administrative appeal process must be completed before you begin any legal action

regarding your claim.

Exhaustion of Remedies Any claim for benefits must be presented for payment within one year of being incurred. No legal action may be brought by a claimant under Section 502(a) of ERISA more than one year following the final adverse benefit notification or, if earlier, more than four years after the claim was incurred.

Medical, Dental, Vision, Healthcare FSAs, EAP, and Wellness benefits

Participants in an Anthem medical option may not assign their rights to benefit payments to a healthcare provider. All claims must

be filed within one year of being incurred.

You as a participant may file a claim with the relevant carrier or third-party administrator for benefits. The claim must be in writing

and must contain the following information:

(i) A description of the claim;

(ii) The facts supporting the claim;

(iii) The amount claimed; and

(iv) The name and address of the person filing the claim.

Preservice claims. If you fail to follow the preapproval procedures for preservice claims, you will be notified of the failure and the

proper procedures for filing these claims no later than five days (24 hours in the case of a failure to file a claim for urgent care)

following the failure if your communication is received by the organizational unit that normally handles these claims and if the

communication names a specific claimant, a specific medical condition, and a specific product or treatment for which approval is

requested. You may request written notification.

Timing of benefit determinations. The timing of benefit determinations for the following types of claims and decisions is as

follows:

• Urgent care claims. The carrier or other provider will designate a representative to answer urgent care claims as soon as

possible (taking into account medical exigencies) but no later than 72 hours after receipt of the claim if sufficient information is

provided so that a determination may be made as to the extent benefits are covered under the Plan. If you fail to provide

sufficient information, you shall (1) be notified as soon as possible (and no later than 24 hours after the receipt of the claim by the

Plan) of the specific information needed to complete the claim and (2) given a reasonable amount of time (no less than 48 hours)

to provide such information. For the purposes of these claims procedures, the term “urgent care claim” means any claim for

medical care or treatment with respect to which the application of the time periods for making non–urgent care determinations

(1) could seriously jeopardize your life or health or your ability to regain maximum function, or (2) in the opinion of a physician

with knowledge of your medical condition, would subject you to severe pain that cannot be adequately managed without the care

or treatment that is the subject of the claim.

The carrier or other provider will notify you of the Plan’s benefit determination as soon as possible, but in no case later than 48

hours after the earlier of:

(i) The Plan’s receipt of the specified information, or

(ii) The end of the period afforded to you to provide the specified additional information.

If your claim is denied, you may request orally or in writing an expedited review of the claim. If such a review occurs, all

55

necessary information shall be transmitted by telefax or telephone or another equivalent method.

• Concurrent care decisions. If the Plan has approved an ongoing course of treatment over a specified time or for a specified

number of treatments, any reduction or termination by the Plan of such course of treatment before the end of such period of time

or number of treatments will constitute an adverse benefit determination. The carrier or other provider will notify you of the

adverse benefit determination sufficiently in advance of the reduction or termination to allow you to appeal and obtain a

determination on review of that adverse

benefit determination before the benefit is reduced or terminated. For claims involving urgent care, if you request to extend the

course of treatment beyond the period of time or number of treatments, your request will be reviewed as soon as possible, taking

into account the medical exigencies. The carrier or other provider will notify you of the benefit determination within 24 hours after

receipt of the claim by the Plan, provided that any such claim is made to the Plan at least 24 hours prior to the expiration of the

prescribed period of time or number of treatments.

• Preservice claims. The carrier or other provider will notify you of the Plan’s benefit determination within a reasonable period of time

appropriate to the medical circumstances, but no later than

15 days after receipt of the claim by the Plan. This period may be extended one time by the Plan for up to 15 days, provided that the

carrier both determines that such an extension is necessary due to matters beyond the control of the Plan and notifies you, prior to the

expiration of the initial 15-day period, of the circumstances requiring the extension of time and the date by which the Plan expects to

render a decision. If such an extension is necessary due to your failure to

submit the information necessary to make a decision about the claim, the notice of extension will specifically describe the required

information, you will be afforded at least 45 days from receipt of the notice within which to provide the specified information, and the

period for making the benefit determination will be tallied from the date on which the notification of the extension is sent to you until the

date on which you respond to the request for additional information.

• Post-service claims. The carrier or other provider will notify you of the Plan’s adverse benefit determination within a reasonable

period of time, but no later than 30 days after receipt of the claim. This period may be extended one time by the Plan for up to 15

days, provided that the carrier or other provider both determines that such an extension is necessary due to matters beyond the

control of the Plan and notifies you, prior to the expiration of the initial 30-day period, of the circumstances requiring the extension of

time and the date by which the Plan expects

to render a decision. If an extension is necessary due to your failure to submit the information necessary to make a decision about

the claim, the notice of extension will specifically describe the required information, you shall be afforded at least 45 days from receipt

of the notice within which to provide the specified information, and the period for making the benefit determination will be tallied from

the date on which the notification of the extension is sent to you until the date on which you respond to the request for additional

information.

Notification of benefit determinations. If the claim results in an adverse benefits decision, you will be provided with a written or

electronic notice containing:

(i) The specific reasons for the denial;

(ii) References to the specific provisions in the Plan document on which the denial is based;

(iii) A description of any additional information needed to perfect the claim and an explanation of why the additional

information is needed; and

(iv) A description of the Plan’s review procedures and the time limits applicable to such procedures, including a statement of

your right to bring a civil action under ERISA Section 502(a).

(v) If applicable, a copy of any internal rule, guideline, protocol, or other similar criterion that was relied upon in making the

adverse determination or a statement that such a rule, guideline, protocol, or other similar criterion was relied upon in

making the adverse determination and that a copy of such rule, guideline, protocol, or other criterion will be provided

free of charge to you upon request;

(vi) If the adverse benefit determination is based on medical necessity or experimental treatment or similar exclusion or limit,

either an explanation of the scientific or clinical judgment for the determination, applying the terms of the Plan to your

medical circumstances, or a statement that such explanation will be provided free of charge upon request;

(vii) In the case of an adverse benefit determination concerning a claim involving urgent care, a description of the expedited

review process applicable to such claims.

56

For urgent care claims, the above information may be provided to you orally provided that a written or electronic notification

containing this information is furnished to you no later than three days after the oral notification.

Appeals of adverse benefit decisions. You have the right to appeal an adverse benefit determination including a rescission of

coverage for fraud or intentional misrepresentation. To appeal the adverse benefit determination, you must file a written request for

appeal with the carrier or other provider within 180 days after receiving notice of the adverse benefit determination. This written

request for appeal should contain:

(i) A statement of the grounds on which the appeal is based;

(ii) Reference to the specific provisions in the Plan document on which the appeal is based;

(iii) The reason or argument why you feel the claim should be granted and the evidence supporting each reason; and

(iv) Any other documents, comments, or information you wish to submit to support the appeal.

If you are seeking review, you will (1) have the opportunity to submit written comments, documents, records, and other information

relating to the claim, and (2) be provided, upon request and free of charge, reasonable access to, and copies of, all documents,

records, and other information relevant to your claim for benefits. The review shall take into account all comments, documents,

records, and other information you submit relating to the claim, without regard to whether such information was submitted or

considered in the initial benefit determination.

The carrier or other provider will notify you of the Plan’s benefit determination on review in accordance with the following:

• Urgent care claims. The carrier or other provider will notify you of the Plan’s benefit determination on review as soon as

possible, taking into account the medical exigencies, but no later than 72 hours after receipt of your request for review.

• Preservice claims. The carrier will notify you of the Plan’s benefit determination on review within a reasonable period of

time appropriate to the medical circumstances. Such notification will be provided no later than 30 days after receipt by the

Plan of your request for review of an adverse benefit determination.

• Post-service claims. The carrier or other provider will notify you of the Plan’s benefit determination on review within a

reasonable period of time. Such notification will be provided no later than 60 days after receipt by the Plan of your request

for review of an adverse benefit determination.

The review of adverse benefit determinations will be conducted by a Plan fiduciary other than the individual who made the adverse

benefit determination and who is not a subordinate of that individual. No deference shall be given to that benefit determination. In

deciding an appeal of any adverse benefit determination that is based in whole or in part on a medical judgment, the fiduciary

conducting the review shall consult with a healthcare professional that has appropriate training and experience in the field of

medicine involved in the medical judgment. This healthcare professional shall not be an individual who was consulted in connection

with the adverse benefit determination that is on appeal nor the subordinate of any such individual. Any medical or vocational

experts whose advice was obtained on behalf of the Plan in connection with your adverse disability benefit determination shall be

identified.

The carrier or other provider will provide you with electronic or written notification of the determination on review. If the

determination on review is adverse, the carrier’s or other provider’s notification will give:

(i) Specific reasons for the adverse determination;

(ii) References to the Plan provisions supporting the adverse determination;

(iii) A statement that you are entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents,

records, and other information relevant to your claim for benefit;

(iv) A statement describing any voluntary appeal procedures offered by the Plan and your right to obtain the information about

these procedures and a statement of your right to bring an action under Section 502(a) of ERISA; if an internal rule, guideline,

protocol, or other similar criterion was relied upon in making the adverse determination, either (1) the specific rule, guideline,

protocol, or other similar criterion, or (2) a statement that such rule, guideline, protocol, or other similar criterion was relied

upon in making the adverse determination and that a copy of the rule, guideline, protocol, or other similar criterion will be

provided free of charge to you upon request;

(v) If the adverse benefit determination was based on a medical necessity or experimental treatment or similar exclusion or limit,

either an explanation of the scientific or clinical judgment for the determination, applying the terms of the Plan to your medical

circumstances, or a statement that such explanation will be provided free of charge upon request;

(vi) The following statement: “You and your plan may have other voluntary alternative dispute resolution options, such as

mediation. One way to find out what may be available is to contact your local U.S. Department of Labor Office and your State

57

insurance regulatory agency.”

In the case of an adverse benefit determination on review, the carrier or other provider shall provide such access to, and copies of,

documents, records, and other information described in items (iii), (iv), (v), (vi), and (vii) above as is appropriate.

Expedited review process. For claims involving urgent care, you may submit a request for an expedited review of an adverse

benefit determination. If the carrier or other provider concurs with the request, your appeal may be submitted orally or in writing and

all necessary information, including the Plan’s benefit determination on review, shall be transmitted between you and the Plan by

telephone, facsimile, or other available similarly expeditious method.

The Plan Administrator has the discretion to determine eligibility for benefits (eligibility to participate), and the carrier or other

provider has the discretion to determine the amount of benefits payable, both initially and on review; make factual determinations;

and construe the terms of the Plan. Such determinations and constructions shall be conclusive and binding on all persons and

entities.

For certain medical claims only

External review is available only for certain claims that involve a medical judgment and for rescissions of coverage. External review

is not available for any other type of claim, including claims that are denied because you fail to meet the requirements for coverage under

the terms of the Plan.

Right to external review for medical claims. You must exhaust the internal claims and appeals process described above before you

can request an external review, except as described in the section below titled “Expedited Requests for External Review” and in the

case of a “deemed exhaustion.” If the Plan fails to adhere to the internal claims and appeals process above, you will be deemed to

have exhausted the internal claims and appeals process and may initiate an external review as described below. Note: The internal

claims and appeals process will not be “deemed exhausted” based on de Minimis violations that do not cause, and are not likely to

cause, prejudice or harm to the claimant so long as the Plan demonstrates that the violation was for due cause or due to matters

beyond the control of the Plan and that the violation occurred in the context of an ongoing, good faith exchange of information

between the Plan and the claimant.

Non-expedited requests for external review. If you receive notice of an adverse benefit determination, upon the exhaustion or

deemed exhaustion of the internal claims and appeals process described above, you (or your authorized representative) may file a

written request for an external review with the insurance company or Claims Administrator, provided the request is filed within four

months after the date of your receipt of the denial of your appeal. If there is no corresponding date four months after the date of

receipt of such a notice, then the request must be filed by the first day of the fifth month following the receipt of the notice. For

example, if the date of receipt of the notice is October 30, because there is no February 30, the request must be filed by March 1.

If the last filing date falls on a Saturday, Sunday, or federal holiday, the last filing date is extended to the next day that is not a

Saturday, Sunday, or federal holiday.

Within five business days of the Plan’s receipt of the request for external review, a preliminary review will be conducted to

determine whether the request is suitable for external review. The following determinations will be made:

a. Whether you were covered under the Plan at the time the healthcare item or service was requested or, in the case of a

retrospective review, was covered under the Plan at the time the healthcare item or service was provided;

b. Whether the adverse benefit determination relates to your failure to meet the requirements for eligibility under the terms

of the Plan (e.g., worker classification or similar determination);

c. Whether the adverse benefit determination qualifies for external review because it involves a medical judgment or a

rescission of coverage, as applicable;

d. Whether you have exhausted the Plan’s internal appeal process, as applicable; and

e. Whether you have provided all the information and forms required to process an external review.

Within one business day after completion of the preliminary review, a written notification will be provided to you (or your authorized

representative) as to whether the request is eligible for external review. If the request is complete but not eligible for external review,

the notification will include the reason(s) for its ineligibility and contact information for the Employee Benefits Security Administration

(toll-free number: 866-444-EBSA [3272]). If the request is NOT complete,

the notification will describe the information or materials needed to make the request complete. The required information must be

provided no later than the last day of the four-month period after the date of the notice (for example, no later than March 1 for a

denial notice dated October 30) or 48 hours after receipt of the preliminary review notification, whichever is later.

58

Requests that are eligible for external review will be reviewed by an accredited independent review organization (IRO). The IRO

will not provide any deference to any prior determination and will not be bound to any decisions or conclusions that were reached

by the insurer or Claims Administrator. The assigned IRO will provide you (or your authorized representative) with a notice inviting

you (or your authorized representative) to submit any additional information that you (or you authorized representative) wish the

IRO to consider within 10 business days after the date of the notice. (Note: The IRO will not be required to consider any additional

information that is submitted after 10 business days.) Any additional information that the IRO receives from you (or your authorized

representative) will be provided to the Claims Administrator. The Claims Administrator may reconsider its prior denial on the basis

of such information. If the denial is reversed and coverage or payment is provided, you (or your authorized representative) will be

notified in writing and the external review will be terminated.

The IRO will review any timely received additional information you (or your representative) provides and the documents and

information that the insurer or Claims Administrator reviewed in connection with its denial (for example, medical records, the

attending healthcare professional’s recommendation, the terms of the Plan, appropriate practice guidelines, any applicable clinical

review criteria developed and used by the Plan, the opinion of the IRO’s clinical reviewer[s], etc.). The IRO will provide you (or your

authorized representative) and the Plan with its final external review decision in writing within 45 days after the IRO’s receipt of the

request for external review. The IRO’s final external review decision is binding. If the IRO’s decision reverses the insurer or Claims

Administrator’s adverse benefit determination or final internal adverse benefit determination, the Plan will provide the coverage or

payment for the claim.

Expedited requests for external review. If the adverse benefit determination involves a medical condition for which the time frame for

completion of an expedited internal appeal would seriously jeopardize your life or health or would jeopardize your ability to regain

maximum function, you (or your authorized representative) may file a request for an expedited external review of your claim by an IRO,

provided you (or your authorized representative) file a request for an expedited internal appeal of the denied claim with the applicable

insurer or Claims Administrator at the same time.

You (or your authorized representative) may also file a request for an expedited external review by an IRO if you receive notice of

an adverse benefit determination that involves a medical condition upon the exhaustion of the internal claims and appeals process

where (1) the time frame for completion of a non-expedited external review would seriously jeopardize your life or health or would

jeopardize your ability to regain maximum function, or (2) the final internal adverse benefit determination concerns an admission,

availability of care, continued stay, or healthcare item or service for which you received emergency services but have not been

discharged from a facility. The standards and processes described above regarding the preliminary review for eligibility and review

by the IRO also apply to expedited requests except that the IRO will provide you (or your authorized representative) and the Plan

with its final external review decision as expeditiously as your medical condition or circumstances require, but in no event more

than 72 hours after the assigned IRO’s receipt of the request for external review. If the notice is not in writing, the IRO will provide

written confirmation of its decision within 48 hours after the date it provided you (or your authorized representative) with oral notice

of its decision.

Disability benefits

The insurer or Claims Administrator will give you notice of the decision no later than 45 days after the claim is filed. This time

period may be extended twice by 30 days if the insurer or Claims Administrator both determines that such an extension is

necessary due to matters beyond the control of the Plan and notifies you of the circumstances requiring the extension of time and

the date by which it expects to render a decision. If such an extension is necessary due to information necessary to make a

decision about the claim, the notice of extension will specifically describe the required information, and you will be afforded at least

45 days within which to provide the specified information. If you deliver the requested information within the time specified, any 30-

day extension period will begin after you have provided that information. If you fail to deliver the requested information within the

time specified, the insurer or Claims Administrator may decide your claim without that information.

If your claim for benefits is wholly or partially denied, the notice of adverse benefit determination under the Plan will:

• State the specific reason(s) for the determination;

• Reference specific Plan provision(s) on which the determination is based;

• Describe additional material or information necessary to complete the claim and why such information is necessary;

• Describe Plan procedures and time limits for appealing the determination and your right to obtain information about those

procedures and the right to bring a lawsuit under Section 502(a) of ERISA following an adverse determination on appeal; and

• Disclose any internal rule, guidelines, protocol, or similar criterion relied on in making the adverse determination (or state that

59

such information will be provided free of charge upon request). Notice of the determination may be provided in written or

electronic form. Electronic notices will be provided in a form that complies with any applicable legal requirements.

Appeal procedures

You have 180 days from the receipt of notice of an adverse benefit determination to file an appeal. Requests for appeals should be

sent to the address specified in the claim denial. A decision on review will be made no later than 45 days following receipt of the

written request for review.

If the insurer or Claims Administrator determines that special circumstances require an extension of time for a decision on review,

the review period may be extended by an additional 45 days (90 days in total). The insurer or Claims Administrator will notify you

in writing if an additional 45-day extension is needed.

If an extension is necessary due to your failure to submit the information necessary to make a decision about the appeal, the

notice of extension will specifically describe the required information, and you will be afforded at least 45 days to provide the

specified information.

If you deliver the requested information within the time specified, the 45-day extension of the appeal period will begin after you

have provided that information. If you fail to deliver the requested information within the time specified, the insurer or Claims

Administrator may decide your appeal without that information.

You will have the opportunity to submit written comments, documents, or other information in support of your appeal. You will

have access to all relevant documents as defined by applicable

U.S. Department of Labor regulations. The review of the adverse benefit determination will take into account all new information,

whether or not presented or available at the initial determination. No deference will be afforded to the initial determination.

The review will be conducted by the insurer and will be made by a person different from the person who made the initial

determination and such person will not be the original decision maker’s subordinate. In the case of a claim denied on the

grounds of a medical judgment, the insurer or Claims Administrator will consult with a healthcare professional with appropriate

training and experience. The healthcare professional who is consulted on appeal will not be the individual who was consulted

during the initial determination or a subordinate. If the advice of a medical or vocational expert was obtained by the Plan in

connection with the denial of your claim, the insurer or Claims Administrator will provide you with the names of each such expert,

regardless of whether the advice was relied upon.

A notice that your request on appeal is denied will contain the following information:

• The specific reason(s) for the determination; a reference to the specific Plan provision(s) on which the determination is based;

• A statement disclosing any internal rule, guidelines, protocol, or similar criterion relied on in making the adverse determination

(or a statement that such information will be provided free of charge upon request);

• A statement describing your right to bring a lawsuit under Section 502(a) of ERISA if you disagree with the decision;

• The statement that you are entitled to receive upon request, and without charge, reasonable access to, or copies of, all

documents, records, or other information relevant to the determination; and

• The following statement: “You or your plan may have other voluntary alternative dispute resolution options, such as mediation.

One way to find out what may be available is to contact your local U.S. Department of Labor Office and your State insurance

regulatory agency.”

Notice of the determination may be provided in written or electronic form. Electronic notices will be provided in a form that

complies with any applicable legal requirements.



60

All other Plan benefits (Life, AD&D, BTA, Group Legal)

The insurer will give you notice of the decision no later than 90 days after the claim is filed. This time period may be extended if

the insurer determines that such an extension is necessary due to matters beyond the control of the Plan and notifies you of the

circumstances requiring the extension of time and the date by which it expects to render a decision. If such an extension is necessary

due to information necessary to decide the claim, the notice of extension will specifically

describe the required information, and you will be afforded at least 45 days within which to provide the specified information. If you fail

to deliver the requested information within the time specified, the insurer may decide your claim without that information.

If your claim for benefits is wholly or partially denied, the notice of adverse benefit determination under the Plan will:

• State the specific reason(s) for the determination;

• Reference specific Plan provision(s) on which the determination is based;

• Describe additional material or information necessary to complete the claim and why such information is necessary; and

• Describe Plan procedures and time limits for appealing the determination and your right to obtain information about those

procedures and the right to bring a lawsuit under Section 502(a) of ERISA following an adverse determination on appeal.

Appeal procedures

You have 60 days from the receipt of notice of an adverse benefit determination to file an appeal. Requests for appeals should be

sent to the address specified in the claim denial. A decision on review will be made no later than 60 days following receipt of the

written request for review. If the insurer determines that special circumstances require an extension of time for a decision on review,

the review period may be extended by an additional 60 days. The insurer will notify you in writing if an additional 60-day extension

is needed.

If an extension is necessary due to your failure to submit the information necessary to decide the appeal, the notice of extension

will specifically describe the required information, and you will be afforded at least 45 days to provide the specified information. If

you fail to deliver the requested information within the time specified, the insurer or Claims Administrator may decide your appeal

without that information.

You will have the opportunity to submit written comments, documents, or other information in support of your appeal. You will have

access to all relevant documents as defined by applicable

U.S. Department of Labor regulations. The review of the adverse benefit determination will take into account all new information,

whether or not presented or available at the initial determination. No deference will be afforded to the initial determination.

Any notice that your request on appeal is denied will contain the following information:

• The specific reason(s) for the determination;

• A reference to the specific Plan provision(s) on which the determination is based;

• A statement describing your right to bring a lawsuit under Section 502(a) of ERISA if you disagree with the decision;

• The statement that you are entitled to receive upon request, and without charge, reasonable access to or copies of all

documents, records, or other information relevant to the determination; and

• The following statement: “You or your plan may have other voluntary alternative dispute resolution options, such as mediation.

One way to find out what may be available is to contact your local U.S. Department of Labor Office and your State insurance

regulatory agency.”

Notice of the determination may be provided in written or electronic form. Electronic notices will be provided in a form that

complies with any applicable legal requirements.



61

Claims Procedures – Eligibility

If you have a question about whether you are eligible to participant in any of the bank’s Health and Welfare plans or if you or a

dependent has been denied participation when you believe you or they should be eligible, you can file a written claim with the

Total Rewards department. Your letter should include the grounds on which your claim is based and any documents, records,

written comments or other information that will support your claim. Total Rewards (or its designee) shall make a determination on

your claim within 60 days after your claim is received. However, if there are special circumstances that require additional time,

Total Rewards (or its designee) will provide written notice of the need for an extension prior to the termination of the initial 60 day

period. In such case, Total Rewards (or its designee) shall make a determination within 120 days after your claim is received.

If Total Rewards (or its designee) denies your claim for eligibility, it will send you a written notice explaining the reason(s) for the

denial, including references to any specific plan provision(s) or policy upon which the denial was based. If your claim was denied

because you did not furnish complete information or documentation, the notice will specify the additional materials or information

needed to support your claim and an explanation of why such information or materials are necessary. The notice will also state

how and when to request a review of the denied claim.

Right of Appeal

If your claim for eligibility to participate in a plan is denied, in whole or in part, you may appeal such denial by submitting to the

Plan Administrator (the Benefit Plans Administrative Committee) a written request for review of your claim denial within 60 days

after receiving written notice of such denial from Total Rewards. Any request for review must be in writing and shall set forth all of

the grounds upon which it is based, all facts in support thereof and any other matters that you deem pertinent. You may submit

written comments, documents, records, and other information relating to your claim. Upon request, and free of charge, you will be

provided reasonable access to and copies of, all documents, records, and other information relevant to your claim that is not

privileged or protected.

The Administrative Committee shall act on each request for a review within 60 days after receipt thereof. However, if there are

special circumstances that require additional time, the Administrative Committee will provide written notice of the need for an

extension prior to the termination of the initial 60 day period. In such case, the Administrative Committee shall make a

determination within 120 days after your appeal is received.

The Administrative Committee will either reverse the earlier decision and permit participation in the plan or deny your appeal. In

the event that the Administrative Committee confirms the denial of your claim, in whole or in part, the Administrative Committee

will give you written notice of its decision.

The Total Rewards department and the Administrative Committee may request documents necessary to prove eligibility or

dependent status.

Any claim for eligibility must be brought within one year of the event giving rise to such claim. Unless there are special

circumstances, this administrative appeal process must be completed before you begin any legal action regarding your claim. No

legal action may be brought by a claimant under Section 502(a) of ERISA more than one year following the final adverse benefit

notification or, if earlier, more than four years after the claim was incurred.

62

HIPAA NOTICE OF PRIVACY PRACTICES

THIS NOTICE IS EFFECTIVE JANUARY 1, 2017. IT DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT

CAREFULLY. “We” refers to the MUFG Union Bank, N.A Health Benefit Plan and the healthcare flexible spending account and limited healthcare flexible spending account portions of the MUFG Union Bank, N.A Section 125 Plan, also referred to as "Plan". "You” or “yours" refers to individual participants in the Plan. If you are covered by an insured health option under the Plan you will receive a separate notice from the insurer or HMO. Use and Disclosure of Protected Health Information

We are required by federal law to protect the privacy of your individual health information (referred to in this notice as "Protected Health Information"). We are also required to provide you with this notice regarding our policies and procedures regarding your Protected Health Information, and to abide by the terms of this notice, as it may be updated from time to time. Under applicable law, we are permitted to make certain types of uses and disclosures of your Protected Health Information, without your authorization, for treatment, payment, and health care operations purposes. For treatment purposes, such use and disclosure may take place in providing, coordinating, or managing health care and its related services by one or more of your providers, such as when your primary care physician consults with a specialist regarding your condition. For payment purposes, such use and disclosure may take place to determine responsibility for coverage and benefits, such as when we confer with other health plans to resolve a coordination of benefits issue. We also may use your Protected Health Information for other payment-related purposes, such as to assist in making plan eligibility and coverage determinations, for utilization review activities, or to determine eligibility for wellness program incentives. However, you may request that a HIPAA Covered Entity (e.g., a health care provider) not disclose Protected Health Information to the Plan for payment purposes if the disclosure is not otherwise required by law and the Protected Health Information pertains solely to a health care item or service for which you (or any person other than the Plan) have paid the HIPAA Covered Entity in full. For health care operations purposes, such use and disclosure may take place in a number of ways involving plan administration, including for quality assessment and improvement, vendor review, population-based activities relating to improving health or reducing health care costs (such as the Plan’s wellness programs), and underwriting activities. Your information could be used, for example, to assist in the evaluation of one or more vendors who support us, or we may contact you to provide reminders or information about treatment alternatives or other health-related benefits and services available under the Plan. We may disclose your Protected Health Information to the plan sponsor in connection with these activities. If you are covered under an insured health plan, the insurer also may disclose Protected Health Information to the plan sponsor in connection with payment, treatment or health care operations. In addition, we may use or disclose your Protected Health Information without your authorization under conditions specified in federal regulations, including: as required by law, provided the use or disclosure complies with and is limited to the relevant requirements of such

law, for public health activities, disclosures to an appropriate government authority regarding victims of abuse, neglect or domestic violence, to a health oversight agency for oversight activities authorized by law, in connection with judicial and administrative proceedings, to a law enforcement official for law enforcement purposes, to a coroner or medical examiner, to cadaveric organ, eye or tissue donation programs, for research purposes, as long as certain privacy-related standards are satisfied, to avert a serious threat to health or safety, for specialized government functions (e.g., military and veterans activities, national security and intelligence,

federal protective services, medical suitability determinations, correctional institutions and other law enforcement custodial situations), and

for workers compensation or other similar programs established by law that provide benefits for work-related injuries or illness without regard to fault.

We may disclose to one of your family members, to a relative, to a close personal friend, or to any other person

63

identified by you, Protected Health Information that is directly relevant to the person's involvement with your care or payment related to your care. In addition, we may use or disclose the Protected Health Information to notify a member of your family, your personal representative, another person responsible for your care, or certain disaster relief agencies of your location, general condition, or death. If you are incapacitated, there is an emergency, or you otherwise do not have the opportunity to agree to or object to this use or disclosure, we will do what in our judgment is in your best interest regarding such disclosure and will disclose only the information that is directly relevant to the person's involvement with your health care.

Other uses and disclosures of your Protected Health Information, including psychotherapy notes and the use and disclosure of Protected Health Information for marketing purposes, will be made only with your written authorization, and you may revoke your authorization in writing at any time. You may ask us to restrict uses and disclosures of your Protected Health Information to carry out treatment, payment, or health care operations, or to restrict uses and disclosures to family members, relatives, friends, or other persons identified by you who are involved in your care or payment for your care. However, we are not required to agree to your request. You have the right to request the following with respect to your Protected Health Information: (i) inspection and copying; (ii) amendment or correction; (iii) an accounting of certain disclosures of this information by us (you are not entitled to an accounting of disclosures made for payment, treatment or health care operations, or disclosures made pursuant to your written authorization); and (iv) the right to receive a paper copy of this notice upon request, even if you agreed to receive the notice electronically. You have the right to request in writing that you receive your Protected Health Information by alternative means or at an alternative location if you reasonably believe that disclosure could pose a danger to you. You also have the right to be notified if the Plan breaches your unsecured Protected Health Information. Genetic information is Protected Health Information. In accordance with the Genetic Information Nondiscrimination Act, we will not use or disclose genetic information for underwriting purposes, which include eligibility determinations, premium computations, and any other activities related to the creation, renewal, or replacement of a contract of health insurance or health benefits. We reserve the right to change the terms of this notice and to make the new notice provisions effective for all Protected Health Information we maintain. If we change this notice, you will receive a new notice. If you believe that your privacy rights have been violated, you may complain to us in writing at the location described below under “Contacting Us" or to the Secretary of the Department of Health and Human Services, Hubert H. Humphrey Building, 200 Independence Avenue SW, Washington, DC 20201. You will not be retaliated against for filing a complaint. Contacting Us

To receive a paper copy of this notice, contact the Benefits Service Center at 1-800-964-9907. To exercise your individual HIPAA rights, contact the appropriate Plan vendor, as follows:

For an insured health options, including the EAP, contact the insurer or HMO. Please refer to the privacy notice sent to you by the insurer or HMO for contact information. For a self-funded health options, contact:

Anthem (medical plan options): 1-844-736-4441 Wage Works (healthcare flexible spending accounts): 1-877-924-3967 Delta Dental (dental plan PPO option): 1-800-280-6010 MetLife (dental plan PPO option): 1-888-466-8673 VSP (vision option): 1-800-877-7195

To file a complaint or report a potential HIPAA violation, send your written complaint to the Plan’s Privacy Official: Evette Hernandez-Leadbetter, Director - Total Rewards, MUFG Union Bank, N.A., 1251 Avenue of Americas, 43rd Floor, New York, NY 10020.

64

Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272). If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of July 31, 2016. Contact your State for more information on eligibility –

ALABAMA – Medicaid FLORIDA – Medicaid

Website: http://myalhipp.com/ Phone: 1-855-692-5447

Website: http://flmedicaidtplrecovery.com/hipp/ Phone: 1-877-357-3268

ALASKA – Medicaid GEORGIA – Medicaid

The AK Health Insurance Premium Payment Program Website: http://myakhipp.com/ Phone: 1-866-251-4861 Email: [email protected] Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx

Website: http://dch.georgia.gov/medicaid - Click on Health Insurance Premium Payment (HIPP) Phone: 404-656-4507

ARKANSAS – Medicaid INDIANA – Medicaid

Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447)

Healthy Indiana Plan for low-income adults 19-64 Website: http://www.hip.in.gov Phone: 1-877-438-4479 All other Medicaid Website: http://www.indianamedicaid.com Phone 1-800-403-0864

COLORADO – Medicaid IOWA – Medicaid

Medicaid Website: http://www.colorado.gov/hcpf Medicaid Customer Contact Center: 1-800-221-3943

Website: http://www.dhs.state.ia.us/hipp/ Phone: 1-888-346-9562

KANSAS – Medicaid NEW HAMPSHIRE – Medicaid

Website: http://www.kdheks.gov/hcf/ Phone: 1-785-296-3512

Website: http://www.dhhs.nh.gov/oii/documents/hippapp.pdf Phone: 603-271-5218

KENTUCKY – Medicaid NEW JERSEY – Medicaid and CHIP

Website: http://chfs.ky.gov/dms/default.htm Phone: 1-800-635-2570

Medicaid Website: http://www.state.nj.us/humanservices/ dmahs/clients/Medicaid/ Medicaid Phone: 609-631-2392


http://www.insurekidsnow.gov/

http://www.askebsa.dol.gov/

http://myalhipp.com/

http://flmedicaidtplrecovery.com/hipp/

http://myakhipp.com/

mailto:[email protected]

http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx

http://dch.georgia.gov/medicaid

http://myarhipp.com/

http://www.hip.in.gov/

http://www.indianamedicaid.com/

http://www.colorado.gov/hcpf

http://www.dhs.state.ia.us/hipp/

http://www.kdheks.gov/hcf/

http://www.dhhs.nh.gov/oii/documents/hippapp.pdf

http://chfs.ky.gov/dms/default.htm

http://www.state.nj.us/humanservices/dmahs/clients/medicaid/

http://www.state.nj.us/humanservices/dmahs/clients/medicaid/

65

CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710

LOUISIANA – Medicaid NEW YORK – Medicaid

Website: http://dhh.louisiana.gov/index.cfm/subhome/1/n/331 Phone: 1-888-695-2447

Website: http://www.nyhealth.gov/health_care/medicaid/ Phone: 1-800-541-2831

MAINE – Medicaid NORTH CAROLINA – Medicaid

Website: http://www.maine.gov/dhhs/ofi/public-assistance/index.html Phone: 1-800-442-6003 TTY: Maine relay 711

Website: http://www.ncdhhs.gov/dma Phone: 919-855-4100

MASSACHUSETTS – Medicaid and CHIP NORTH DAKOTA – Medicaid

Website: http://www.mass.gov/MassHealth Phone: 1-800-462-1120

Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/ Phone: 1-844-854-4825

MINNESOTA – Medicaid OKLAHOMA – Medicaid and CHIP

Website: http://mn.gov/dhs/ma/ Phone: 1-800-657-3739

Website: http://www.insureoklahoma.org Phone: 1-888-365-3742

MISSOURI – Medicaid OREGON – Medicaid

Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm Phone: 573-751-2005

Website: http://healthcare.oregon.gov/Pages/index.aspx http://www.oregonhealthcare.gov/index-es.html Phone: 1-800-699-9075

MONTANA – Medicaid PENNSYLVANIA – Medicaid

Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP Phone: 1-800-694-3084

Website: http://www.dhs.pa.gov/hipp Phone: 1-800-692-7462

NEBRASKA – Medicaid RHODE ISLAND – Medicaid

Website: http://dhhs.ne.gov/Children_Family_Services/AccessNebraska/Pages/accessnebraska_index.aspx Phone: 1-855-632-7633

Website: http://www.eohhs.ri.gov/ Phone: 401-462-5300

NEVADA – Medicaid SOUTH CAROLINA – Medicaid

Medicaid Website: http://dwss.nv.gov/ Medicaid Phone: 1-800-992-0900

Website: http://www.scdhhs.gov Phone: 1-888-549-0820

http://www.njfamilycare.org/index.html

http://dhh.louisiana.gov/index.cfm/subhome/1/n/331

http://www.nyhealth.gov/health_care/medicaid/

http://www.maine.gov/dhhs/ofi/public-assistance/index.html

http://www.maine.gov/dhhs/ofi/public-assistance/index.html

http://www.ncdhhs.gov/dma

http://www.mass.gov/MassHealth

http://www.nd.gov/dhs/services/medicalserv/medicaid/

http://mn.gov/dhs/ma/

http://www.insureoklahoma.org/

http://www.dss.mo.gov/mhd/participants/pages/hipp.htm

http://healthcare.oregon.gov/Pages/index.aspx

http://www.oregonhealthcare.gov/index-es.html

http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP

http://www.dhs.pa.gov/hipp

http://dhhs.ne.gov/Children_Family_Services/AccessNebraska/Pages/accessnebraska_index.aspx

http://dhhs.ne.gov/Children_Family_Services/AccessNebraska/Pages/accessnebraska_index.aspx

http://www.eohhs.ri.gov/

http://dwss.nv.gov/

http://www.scdhhs.gov/

66

SOUTH DAKOTA - Medicaid WASHINGTON – Medicaid Website: http://dss.sd.gov Phone: 1-888-828-0059

Website: http://www.hca.wa.gov/free-or-low-cost-health-care/program-administration/premium-payment-program Phone: 1-800-562-3022 ext. 15473

TEXAS – Medicaid WEST VIRGINIA – Medicaid

Website: http://gethipptexas.com/ Phone: 1-800-440-0493

Website: http://www.dhhr.wv.gov/bms/Medicaid%20Expansion/Pages/default.aspx Phone: 1-877-598-5820, HMS Third Party Liability

UTAH – Medicaid and CHIP WISCONSIN – Medicaid and CHIP

Website: Medicaid: http://health.utah.gov/medicaid CHIP: http://health.utah.gov/chip Phone: 1-877-543-7669

Website: https://www.dhs.wisconsin.gov/publications/p1/p10095.pdf Phone: 1-800-362-3002

VERMONT– Medicaid WYOMING – Medicaid

Website: http://www.greenmountaincare.org/ Phone: 1-800-250-8427

Website: https://wyequalitycare.acs-inc.com/ Phone: 307-777-7531

VIRGINIA – Medicaid and CHIP

Medicaid Website: http://www.coverva.org/programs_premium_assistance.cfm Medicaid Phone: 1-800-432-5924 CHIP Website: http://www.coverva.org/programs_premium_assistance.cfm CHIP Phone: 1-855-242-8282

To see if any other states have added a premium assistance program since July 31, 2016, or for more information on special enrollment rights, contact either:

U.S. Department of Labor U.S. Department of Health and Human Services Employee Benefits Security Administration Centers for Medicare & Medicaid Services www.dol.gov/ebsa www.cms.hhs.gov

1-866-444-EBSA (3272) 1-877-267-2323, Menu Option 4, Ext. 61565

http://dss.sd.gov/

http://www.hca.wa.gov/free-or-low-cost-health-care/program-administration/premium-payment-program

http://www.hca.wa.gov/free-or-low-cost-health-care/program-administration/premium-payment-program

http://gethipptexas.com/

http://www.dhhr.wv.gov/bms/Medicaid%20Expansion/Pages/default.aspx

http://health.utah.gov/medicaid

http://health.utah.gov/chip

https://www.dhs.wisconsin.gov/publications/p1/p10095.pdf

http://www.greenmountaincare.org/

https://wyequalitycare.acs-inc.com/

http://www.coverva.org/programs_premium_assistance.cfm




http://www.dol.gov/ebsa

http://www.cms.hhs.gov/

67

Appendix

Contact information

Type of Benefit Carrier Group Number Customer Service Number Website Tools

Benefit Questions Benefits Service Center

800-964-9907 mufgamericas.com/ mybenefits

Contact the Benefits Service Center: • Enroll in and ask questions about

health and welfare benefits

• Initiate qualifying life events

• View, change, and update beneficiary and/or dependent information

Medical Anthem All plans 003330150 844-736-4441 www.anthem.com • Find a doctor: Select the network based on your location

• NY: Empire POS Alt

• GA: Blue Open Access POS Alt

• All other locations: National PPO/BlueCard PPO

• Prescription Tool

• Temporary ID Card

• Continuation of Care

Medical Kaiser Permanente

Northern CA HMO: 1931

Southern CA HMO: 4620

CA: 800-464-4000

www.kp.org

Medical GeoBlue 4EL-7941-15 855-282-3517 (in U.S.)

610-254-5304 (outside U.S.)

www.geo-blue.com

Dental MetLife 85439 888-466-8673 www.metlife.com Provider Search

Dental Delta Dental PPO

7535 800-280-6010 www.deltadentalins.com

Dental Delta Dental DMO

1818 800-422-4234 www.deltadentalins.com

Vision VSP 811801 800-877-7195 www.vsp.com

Flexible Spending Accounts and Health Savings Accounts

WageWorks 877-924-3967 www.wageworks.com

http://www.anthem.com/

http://www.kp.org/

http://www.geo-blue.com/

http://www.metlife.com/

http://www.deltadentalins.com/

http://www.deltadentalins.com/

http://www.vsp.com/

http://www.wageworks.com/

68

NY/NJ STD LTD

UNUM Sedgwick

STD – NY: 462165-0002 6

STD – NJ: 162167-001 3

LTD: 462166 001

866-779-1054 sedgwick.com The Sedgwick STD provider coordinates with NY, NJ, and LTD benefits

Type of Benefit

(continued)

Carrier Group Number Customer Service Number Website Tools

Salary Continuation and Short-Term Disability

Sedgwick CA: 990040

NY: 347002

ERISA: 96541

800-326-2187 www.sedgwick.com

Sedgwick CMS: https://viaoneexpress. sedgwickcms.net

Leave Administration:

800-554-6075

619-230-4822

619-230-3063 (fax)

Life Insurance and Accidental Death and Dismemberment (AD&D)

Securian Life 34380-G 800-815-7636 www.LifeBenefits.com

Employee Assistance Program

ComPsych Company Web ID: MUFG

800-272-7255 www. guidanceresources.com

Legal Assistance Benefit

MetLife Access Code: Legal 800-821-6400 www.info.legalplans.com

Business Travel Accident

Chubb Policy # 9907-6868 Chubb Claims (U.S.): 800-252-4670

Europ Assistance: 888-987-5920 (U.S. and Canada)

240-330-1571 (international)

Chubb Claims (U.S.): http://www.chubb.com/ claims/accident-health. html

Europ Assistance: www.chubb.com/ travelhelp/eb

Workers’ Compensation

Gallagher Bassett Services

Policy # WCD

640096303

619-230-3119

619-230-3148 (fax)

Return to Work Program: 619-230-3102

http://www.sedgwick.com/

http://www.lifebenefits.com/

http://www/

http://www.chubb.com/

http://www.chubb.com/

69

Plan documentation

For further information, claims procedures, and benefits limitations, please refer to the relevant Plan Document Appendix noted below.

These documents can be accessed electronically on the Benefits Portal (mufgamericas.com/mybenefits) or by requesting a paper copy

from the MUFG Benefits Service Center at 800-964-9907.

Medical Insurance Flexible Spending Accounts

Anthem HRA Plan WageWorks FSAs

Anthem HSA Plan Health Savings Accounts

Anthem PPO Plan WageWorks FSAs

Kaiser HMO SoCal Health Savings Accounts

Kaiser HMO NorCal WageWorks HSAs

GeoBlue International Business Travel Accident

Dental Insurance Chubb BTA

Delta Dental PPO Legal Assistance

Delta Dental DMO Met Life

MetLife PPO Employee Assistance Program

Wellness Program Vision Insurance ComPsych EAP

VSP Basic Flexible Spending Accounts

VSP Enhanced WageWorks FSAs

Life and AD&D Insurance Health Savings Accounts

Securian Basic Life WageWorks FSAs

Securian Supplemental Life Health Savings Accounts

Securian AD&D WageWorks HSAs

Disability Insurance Business Travel Accident

Sedgwick Salary Continuance

Chubb BTA

CA Statutory STD Legal Assistance

NY Statutory STD Met Life

NJ Statutory STD Employee Assistance Program

Wellness Program Unum LTD ComPsych EAP

summary plan description · union bank, n.a. total rewards 400 california street, 10th floor san...

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