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2 2015 Benefits

WHO IS ELIGIBLE?

If you are a full-time bargaining unit employee (working 30 or more hours per week), you are eligible to enroll in the benefits described in this guide. Your eligible dependents may be enrolled as well. The definition of eligible dependent is described in detail in the 2015 Benefits Guide.

HOW TO ENROLL

The first step is to review your current benefit elections.

Visit e*source Self Service at www.tk-esource.com. e*source is a secure website that provides online acess to your personal data and benefits information. Once online, verify your personal information or make necessary changes.

Step-by-step instructions for e*source Self Service are included on pages 4–9. For assistance with online enrollment, call toll free at (866) 910-6085. e*source is available Monday through Friday from 8 a.m. to 6 p.m. EST.

NOTE: Once you have made your elections, you will not be able to change them until the next open enrollment period, unless you have a qualified change in status, as detailed below.

WHEN TO ENROLL

The Open Enrollment period runs from October 20, 2014, through October 31, 2014. The benefits you elect during open enrollment will be effective from January 1, 2015, through December 31, 2015.

QUALIFIED CHANGE IN STATUS

Qualified changes in status include: marriage, divorce, legal separation, birth or adoption of a child, change in child’s dependent status, death of spouse, child or other qualified dependent, change in residence due to an employment transfer for you or your spouse, commencement or termination of adoption proceedings, or change in your spouse’s employment status. Status changes must be reported to e*source within 30 days of the change.

Qualified changes also include loss of coverage under a Medicaid or State Plan or becoming eligible for group health plan premium assistance under a Medicaid or State Plan. These status changes must be reported to e*source within 60 days of the date coverage terminates under a Medicaid or State Plan, or within 60 days after you or your dependent(s) is determined to be eligible for Medicaid or State premium assistance. Unless you have one of these qualified events take place during the 2015 calendar year, you cannot make changes to the benefits you elect until the next open enrollment period.

There are a few changes to the medical plan, but no changes to the dental or vision plans for 2015. Included in this booklet are summaries of these programs. However, there are changes to the contribution rates. The new rates are shown on the following page.

Enrolling for the 2015 Plan Year

Middleton Hourly Employees 3

This is a Summary of the Material Modifications to the Health Plan effective January 1, 2015.

EPO

Blue Cross and Blue Shield of Illinois will be the claim administrator. You will have the same network of Blue Cross and Blue Shield health care providers. CVS Caremark will continue to administer the prescription drug program. You will receive a new ID card for 2015 that will include both Blue Cross Blue Shield and Caremark.

The copayment for an office visit to a primary care physician is $25 and $40 for a specialist visit. Obstetricians and gynecologists are considered primary care physicians.

The coinsurance paid by the plan is 80% and you are responsible for the remaining 20%. The out-of-pocket maximum per calendar will stay the same as 2014.

Prescription Drug copayments for brand name drugs purchased at retail pharmacies are $40 for preferred brand and $60 for non-preferred drugs. Brand-name drugs purchased through Caremark mail order (up to a 90-day supply) have a copayment of $80 for preferred drugs and $120 for non-preferred.

A new out-of-pocket maximum applies to prescription drug copays. The limit is $2,500 per person or $5,000 per family. When the out-of-pocket maximum is reached, no copay is owed for covered prescriptions for the rest of the calendar year.

A Step Therapy program will apply. Step Therapy requires you to try an available generic drug for at least 30 days before brand name drugs will be covered for certain drug classes. These drug classes include drugs to treat high cholesterol, high blood pressure, ulcers or GERD, nasal congestion, pain (non-steroidal), sleep aids, bone loss, migraines, overactive bladder, depression, enlarged prostate, Alzheimer’s Disease, high triglycerides, and glaucoma (this list is subject to change). Brand name drugs used in these drug classes will not be covered unless the participant has tried a generic drug in the last 24 months through the Caremark plan or your doctor sends Caremark an explanation of why you should not try a generic drug. Your doctor can call Caremark at 1-877-203-0003 to obtain the authorization forms. For drugs to treat depression, only new prescriptions are applied to step therapy requirements.

HRA

Blue Cross and Blue Shield of Illinois will be the claim administrator. You will have the same network of Blue Cross and Blue Shield health care providers. You will receive a new ID card for 2015.

The calendar year deductible is $750 for Individual coverage, $1000 for employee + one, and $1500 for family. The out-of-pocket maximum (excluding the deductible) for in-network services is $2750 for individual coverage, $4250 for employee + one, and $5500 for family.

What’s New for 2015?

4 2015 Benefits

DENTAL

There are no changes to the plan for 2015, but there is an increase in the weekly payroll deduction. The Delta Dental schedule of benefits is enclosed.

VISION

There are some changes to the out-of-network benefits. There is an increase in the weekly payroll deductions. VSP schedule of benefits is enclosed.

FOR ADDITIONAL INFORMATION

Contact e*source via e-mail at [email protected], call toll-free at 866-910-6085 or visit your Middleton Human Resources Department.


Step 1: Go to www.tk-esource.com

Step 2: Click on either “e*source Self Service at Work” or “e*source Self Service at Home” depending on where you are accessing your account.

Step 3: Log onto e*source Self Service with your user name and password. (For assistance, call e*source at (866) 910-6085.)

Step 4: From the left side of the screen, click once on “TKE Employee Self Service.”

Enrollment through e*source Self Service

6 2015 Benefits

Step 5: From the left side of the screen, click once on “My Benefits,” then “Benefits.”

Step 6: Add the dependents you will cover under your medical plan and anyone that you would like to list as a beneficiary for your life insurance.

When adding a dependent and/or beneficiary, list your hire date as their effective date. When you are done, click “Apply.”


Continue adding dependents and/or beneficiaries until everyone is listed. Then click “Next.”

Step 7: To elect your benefits, click on “Update Benefits.”

8 2015 Benefits

Step 8: Select the Plans and Options you would like and click on the select the box next to your option. When you have elected all the benefits you would like, click “Next.”

Step 9: Select the dependents you would like to cover under each plan you have selected, then click “Next.”


Step 10: Choose your beneficiaries by listing the percent of your life insurance you would like to give each one, then click “Next.” Please note: Although your name is listed, you are not able to elect yourself as a beneficiary.

10 2015 Benefits

Step 11: This page shows which plans require certifications. No action is necessary on this page. Click “Next” to proceed.

Step 12: Review your elections, covered dependents and beneficiaries. If all is correct, click Finish.


YOUR BENEFITS PLAN

ThyssenKrupp Elevator offers you and your eligible family members a comprehensive and valuable benefits program. We encourage you to take the time to educate yourself about your options and choose the best coverage for you and your family.

ELIGIBILITY

You are eligible to enroll in the benefits described in this guide if you are an active, full-time, bargaining unit employee working 30 or more hours per week. Your benefits become effective on the first day following 90 days of active employment, provided you enroll in the plan within 90 days of your date of hire into an eligible class. Time worked for ThyssenKrupp Elevator in an ineligible class, such as a part-time employee, will be counted toward the 90 days. If you are not actively at work on the date your coverage would otherwise become effective, your benefits will not begin until the date you return to active employment. For purposes of satisfying the waiting period for health benefits, you will be considered actively at work if you are absent due to illness, injury, or disability.

If you are enrolled as an employee in this plan, your eligible dependents may also participate. Eligible dependents include your lawful spouse. Dependent children remain eligible up to the last day of the month in which they attain age 26.

NOTE: Please refer to the SPD or contact e*source for definitions of children, physically / mentally challenged dependents, spouse, and information regarding COBRA 1993 and Qualified Medical Child Support Orders.

DEPENDENT VERIFICATION

In order to ensure the dependents enrolled in our plans are eligible for coverage, we require employees to submit documentation as proof of eligibility for all dependents covered under the plan. If we discover an employee has covered an ineligible dependent, the dependent will not have coverage. Any erroneous benefit payments made for any ineligible dependent must be refunded by the employee.

Examples of acceptable documentation include copies of a marriage certificate for a spouse, birth certificate for children, adoption agreement, and court orders.

CHANGES IN PLAN PARTICIPATION

Unless you have a qualified change in status, you cannot make changes to the benefits you elect (excluding Life and AD&D) until the next open enrollment period. Qualified changes in status include: marriage, divorce, legal separation, birth or adoption of a child, change in child’s dependent status, death of a spouse, child or other qualified dependent, change in residence due to an employment transfer for you or your spouse, commencement or termination of adoption proceedings, or change in spouse’s benefits or employment status.

Status changes must be reported to e*source within 30 days of the change in order to change, if applicable, the payroll deductions. Qualifed changes also include loss of coverage under a Medicaid or State Plan or becoming eligible for group health plan premium assistance under a Medicaid or State Plan. These status changes must be reported to e*source within 60 days of the date coverage terminates under a Medicaid or State Plan, or within 60 days after you or your dependent(s) is determined to be eligible for Medicaid or State premium assistance.

Welcome to Your Benefitsfor Plan Year 2015

12 2015 Benefits

ThyssenKrupp Elevator remains committed to providing our employees with a comprehensive, competitive healthcare package. As we all know, healthcare and prescription drug costs in the U.S. continue to escalate at double-digit rates annually. Our objective is to provide a selection of benefit choices that meet your individual needs.

Enclosed you will find summary information regarding the ThyssenKrupp Elevator benefit programs for 2015. We encourage you to review this information carefully before making your benefits decisions.

MEDICAL PLAN OPTIONS

Blue Cross Blue Shield of Illinois (BCBSIL) will be our healthcare partner for 2015. BCBSIL provides the same robust network of health care professionals currently available to our employees throughout the US. For the most current listing of in-network providers, you can go online to www.bcbsil.com.

In addition to the EPO through BCBSIL, we also continue to offer a consumer driven health plan, the HRA. This plan gives you access to the same extensive BCBS network.

The medical plan choices have varying payroll contributions so you can choose the plan that best meets your needs. A detailed comparison grid of the current medical plans is included in this guide. Please refer to this information for a description of the benefits offered. Further plan details can be found in the Summary Plan Description (SPD).

PRESCRIPTION DRUG PROGRAM FOR THE EPO

CVS/Caremark will continue to be our prescription drug benefits partner in 2015 for the EPO. When you enroll in the EPO, you are automatically enrolled in prescription drug coverage through CVS/Caremark. You will receive new CVS/Caremark cards for 2015.

NOTE: If you are electing to participate in the HRA, the prescription drug coverage is included as part of the medical plan. Please refer to the HRA materials for more information on its prescription drug coverage.

DELTA DENTAL PLAN

ThyssenKrupp Elevator is pleased to offer comprehensive dental benefits. Enclosed is a Schedule of Benefits that outlines the coverage provided by Delta Dental.

VSP VISION PLAN

The company considers vision care to be part of a comprehensive healthcare package. We provide vision benefits through Vision Service Plan (VSP). Enclosed is a Schedule of Benefits that outlines the benefits provided in this plan.

Healthcare Summary:Our Comprehensive Package


LIFE & ACCIDENTAL DEATH PLAN

ThyssenKrupp Elevator offers life insurance and accidental death plans through The Hartford. These programs provide additional financial security during difficult times. Additional detail concerning these plans follows.

VOLUNTARY LIFE PLANS

For additional protection, additional life insurance, dependent life insurance, and accidental death and dismemberment coverage can be purchased by the employee. ThyssenKrupp partners with The Hartford to offer these coverages. During open enrollment you can add or change your Voluntary Life, AD&D, and Dependent Life coverages. For 2015, you may add Voluntary Life or AD&D up to $250,000 with no required Proof of Eligibility. You may also add Spouse Life up to $20,000 and Child Life up to $10,000 with no required Proof of Eligibility. More information is listed in this benefits guide.

EMPLOYEE CONTRIBUTIONS FOR 2015 BENEFIT PLANS

Our goal is to provide comprehensive benefit choices with different levels of employee cost to permit our employees to choose the plan that best satisfies their personal needs. Each year plan costs are evaluated, and costs for the coming year are estimated based on several factors.

OPT-OUT CREDIT OPTION

In today’s economic environment, many families have dual working spouses with healthcare coverage available to them by both employers. As healthcare costs continue to skyrocket, most employers are seeking ways to control these costs by implementing contribution incentives. Therefore, we are pleased to continue to offer our Opt-Out Credit Option.

If you are already or choose to be covered under another family member’s medical plan for 2015, you may waive coverage under the ThyssenKrupp Elevator Medical Plan and receive an Opt-Out Credit. The Opt-Out Credit amount is $1,000 per year and will be paid to you on a pro-rated basis each payroll period. Employees electing to Opt-Out of coverage must do so during the enrollment process, and will be required to submit verification of other coverage (copy of ID card or application from other plan) to be eligible to receive the Opt-Out Credit amount. You may not receive the Opt-Out Credit if you enroll in a state or federal high-risk pool. If your spouse works for ThyssenKrupp Elevator AND you are enrolled as a dependent under his/her coverage (excluding the NEI Benefit Plan), you are not eligible to receive the Opt-Out Credit. The Opt-Out Credit will not go into effect until proof of other coverage is submitted to the e*source team.

It is very important to compare the plan benefits, out-of-pocket costs, and payroll contributions of both employers’ plans before deciding which plan you will enroll in. The annual open enrollment period is the ideal time to consider your elections.

NOTE: If you wish to enroll for the first time or continue to participate in the Opt-Out Credit, you MUST enroll or re-enroll for the Plan Year 2015.

14 2015 Benefits

PRE-TAX PAYROLL DEDUCTIONS

The pre-tax program allows employees to pay medical/dental payroll contributions with “pre-tax” dollars, saving employees money and taxes. For example, if you contribute $2,000 towards family medical/dental premiums, based on a combined 25% tax rate, you save $500 in taxes. All employees are automatically enrolled in this program, unless you submit a “waiver” form.

YOUR RESPONSIBILITIES

• Review enrollment materials.

• Complete the enrollment process, including any necessary waivers, within specified time frame.

• Complete the Section 125 Waiver, if you wish to make your payroll contributions on an after-tax basis.

• Provide proof of eligibility for dependents, if applicable.

• Opt out of coverage if you are declining coverage under our plan and wish to receive the Opt-Out Credit (requires action on your part).

• Provide proof of other coverage, if applicable (to receive the Opt-Out Credit)

COORDINATION OF BENEFITS

Coordination of Benefits sets out rules for the order of payment of covered charges when this plan and one or more other plans providing health coverage — including Medicare — are paying. When you or your dependents are covered by our plan and another plan, our plan will coordinate benefits when claims are received.

The plan that pays first according to the rules, outlined in your certificate of coverage, will pay as if there were no other plan involved. If this plan is secondary, this plan will pay the balance due up to the allowed benefit. For example, if the primary health plan benefit is 70% of the allowed amount and this plan’s allowed benefit is 80%, this plan as secondary payor would pay an allowable charge of 10%. If the primary plan pays an amount that is equal to or greater than what this plan would have paid as primary, then this plan, as secondary payor, would not pay further benefits.

SUBROGATION

This plan reserves the right to be reimbursed for benefits paid under this plan if the person for whom benefits are paid has a right to recover these benefits from a third party. This is called subrogation. The purpose of this provision is to help ThyssenKrupp Elevator continue providing high-quality healthcare benefits, while controlling the costs of the plan. By accepting benefits under this plan, you specifically acknowledge the plan’s right of subrogation and reimbursement.


Healthcare Schedule of Benefits2015 Plan Year

EPO Plan HRA Plan

Benefits In-Network Benefits Only In-Network Benefits Out-of-Network Benefits

Office Visits and Preventative Care

Primary care physician (PCP) office visits and lab $25 copay, then 100% 80% after deductible 60% after deductible

Specialists (SPC) office visits and lab $40 copay, then 100% 80% after deductible 60% after deductible

Routine annual physical exam (includes gyn exam) 18 years or older / one per calendar year

100% 100%

Routine mammography 100% 100%

Child well care exams including immunizations Under 18 years of age

100% 100%

Prostate cancer screening Frequency as allowed by the PPACA

100% 100%

Preventative services as defined under the Patient Protection and Affordable Care Act and subsequent amendments

100% 100%

Calendar Year Deductible and Out-of-Pocket Limits

Calendar year deductible Referred to as a Bridge in the HRA Plan Individual: $300

Family: $900 (maximum $300/person)

Individual: $750 EE+1: $1,000

Family: $1,500

Health Reimbursement AccountNone

Individual: $900 EE+1: $1,350

Family: $1,800

Out-of-pocket maximum (excluding deductible)Individual: $2,000

Family: $5,000 (maximum $2,000/person)

Individual: $2,750 EE+1: $4,250

Family: $5,500

Individual: $5,500 EE+1: $8,250

Family: $11,000

Lifetime maximum None None

Hospital/Facility Expenses

In-patient expenses including semi-private room and board

$200 per admission copay, then 80% after deductible

80% after deductible 60% after deductible

Out-patient facility $100 copay per visit, then 80% 80% after deductible 60% after deductible

Hospital emergency room care Outpatient facility emergency care

$100 copay, then 80% 80% after deductible 80% after deductible

Skilled nursing facility $200 per admission copay, then 80% after deductible

60 days per calendar year

80% after deductible 60 days per calendar year

60% after deductible 60 days per calendar year

Professional Services and Surgical Expenses

In-patient surgery 80% after deductible 80% after deductible 60% after deductible

Out-patient surgery 80% after deductible 80% after deductible 60% after deductible

In-patient visits 80% after deductible 80% after deductible 60% after deductible

Mental Health and Substance Abuse Treatment Expenses

In-patient psychiatric $200 per admission copay, then 80% after deductible


Out-patient visits $25 copay per visit 80% after deductible 60% after deductible

16 2015 Benefits

NOTE:

1. This schedule is intended to be a summary of benefits and does not include all plan provisions, including exclusions or limitations. If there is a discrepancy between this document and the group contract, the provisions of the group contract will govern.

2. Precertification required for specific inpatient and outpatient services (not applied to CDHP).

3. Coinsurance applies towards the Out-of-Pocket Maximums.

4. Diagnostic Services and Other Procedures includes but is not limited to X-ray, MRI, CT scans, biopsy, excisions, etc. All X-rays and Labs are subject to the calendar year deductible if not performed during a physician office visit.

5. Prosthetic Devices – Repairs and replacements limited to once during:

• Any 12-month period if member is 19 years of age or under

• Any 36-month period if member is 20 years of age or older

This is a brief summary of benefits; it is not a certificate of coverage. For full coverage provisions, including a description of waiting periods, limitations and exclusions, please contact Blue Cross Blue Shield or your Human Resources Department.

EPO Plan HRA Plan

Benefits In-Network Benefits Only In-Network Benefits Out-of-Network Benefits

Out-Patient Therapies

Chemotherapy, radiation, renal dialysis and inhalation

In doctor’s office: $25 PCP / $40 SPC copay, then 100%

Outpatient facility: 100%80% after deductible 60% after deductible

Physical, speech, occupational cardiac rehab $25 PCP / $40 SPC copay, then 100%


Miscellaneous

Diagnostic testing and procedures: MRI, CT scans, etc. (see #5 below)

80% after deductible 80% after deductible 80% after deductible

Dental services related to accidental injury 80% after deductible 80% after deductible 60% after deductible

Durable medical equipment (pre-authorization required)

80% after deductible 80% after deductible 60% after deductible

Orthotic devices for foot and shoe 80% after deductible 80% after deductible 60% after deductible

Prosthetic appliances (see #6 below) 80% after deductible 80% after deductible 60% after deductible

Ambulance service 80% after deductible 80% after deductible 80% after deductible

Allergy testing 80% after deductible 80% after deductible 60% after deductible

Home health care (plan of treatment required) 80% after deductible 120 visits per calendar year

80% after deductible 120 visits per calendar year

60% after deductible 120 visits per calendar year

Hospice (plan of treatment required) 80% after deductible 80% after deductible 60% after deductible

Medical supplies (plan of treatment required) 80% after deductible 80% after deductible 60% after deductible

Prescription Drugs

Drug typeGeneric

Preferred Brand

Non-Preferred Brand

Generic/Brand at Participating Pharmacy

Generic/Brand at Non-Participating

Pharmacy

Retail copay (30-day supply) $15 $40 $6080% after deductible 60% after deductible

Mail-order copay (90-day supply) $30 $80 $120

Annual out-of-pocket maximum for copays Individual $2,500 Family $5,000

N/A

Other prescription information Step therapy included N/A

No copays for women’s generic and single-source brand contraceptive medications

No copays for women’s generic and single-source brand contraceptive medications


COPAY SCHEDULE FOR PRESCRIPTION DRUGS IN THE EPO FOR 2015

Retail (up to 30-day supply)

Current Plans Generic Preferred-brand (formulary) Brand-name

EPO $15 $40 $60

Mail-order (up to 90-day supply)

Current Plans Generic Preferred-brand (formulary) Brand-name

EPO $30 $80 $120

The prescription drug co-pay structure for 2015 is designed to encourage the use of lower cost generic drugs whenever possible. Brand name drugs are expensive to create. Pharmaceutical companies spend years to develop, test and get FDA approval. In contrast, generic drugs must meet the same standards and contain the same active ingredients as brand name drugs — but they are priced a lot lower than the equivalent brand name drugs, usually 50% to 60% less.

Generic drugs offer a significant savings which will translate to lower co-pays for our employees. Additional savings on co-pay cost can also be achieved by taking advantage of the Mail-Order program for maintenance drugs.

We encourage you to talk to your doctor about generic and formulary drugs that can save you money. We also encourage our employees to use the CVS/Caremark website to monitor your prescription usage, compare generic vs. brand name prices, confirm your mail-order receipt and shipment, and try to learn more about drugs you may be taking (as well as the potential interactions between them).

The website is www.caremark.com. Please refer to the medical plan comparison, and your certificate of coverage, for further benefit details.

THE CVS/CAREMARK THREE-TIER (GENERIC, FORMULARY, BRAND) PRESCRIPTION DRUG PROGRAM

This program is designed to offer prescription drug coverage for EPO users that encourages the use of cost effective medications while providing quality medical treatment. The plan encourages the use of generic drugs and certain brand-name drugs (also known as Formulary drugs). Under this program you pay different co-pay depending on whether you choose a generic drug, a preferred brand-name drug on the formulary listing, or a non-formulary brand-name drug.

Always remember to talk to your doctor about using generic or formulary drugs that can save you money. You and your doctor should check your formulary list before you receive a prescription. An updated formulary listing is available on the CVS/Caremark website at www.caremark.com or by calling them at 877-406-4465.

WHAT IS A GENERIC DRUG?

A generic drug is a prescription that by law must have the same chemical composition as a specific brand-name prescription drug. Generic medications that are recommended for us by CVS/Caremark have been thoroughly evaluated and certified by the FDA as bioequivalent to their brand name counterparts. This ensures that quality generic medications are used, maximizing your prescription benefits. Therefore, these generic medications can provide you with the same high quality of prescriptions at drastically reduced costs. This translates into lower co-pays for you.

Prescription Drug Coverage

18 2015 Benefits

WHAT IS A PREFERRED-BRAND (FORMULARY) DRUG?

Preferred-Brand (Formulary) drugs are certain brand-name prescription drugs that are on the CVS/Caremark Formulary List that have been approved by the FDA as safe and effective. Most drugs listed on the Formulary are subject to manufacturer volume discounts and therefore are more cost-effective than those not on the formulary listing. These discounts translate into greater savings over brand-name drugs and therefore offer you a lower co-pay than the brand-name drugs.

WHAT IS A BRAND-NAME DRUG?

A brand-name drug is a prescription drug that has been given a name by a pharmaceutical company to distinguish it as produced or sold by a specific company. It may be protected by a trademark. Brand-name drugs are expensive to create. Pharmaceutical companies spend years to develop, test and get FDA approval for all new drugs. All of these costs are included in the price you pay for the drug. This is why brand-name drugs cost more than generic or preferred brand-name drugs. This means higher costs and higher patient co-pays.

WHAT IS A MANDATORY GENERIC DRUG PROGRAM?

The Mandatory Generic Drug Program requires that the pharmacist fill your prescriptions with a generic equivalent whenever one is available, unless your physician requires that you have a brand name drug. If you choose to purchase the brand name drug, you will be responsible for the co-pay plus the difference in the cost between the generic drug and the brand name drug. The Mandatory Generic Drug Program will continue in the 2015 Plan Year.

WHAT IS MAIL ORDER?

If you currently have a prescription for maintenance drugs, you can take advantage of additional savings on your co-pays by using the Mail-Order program. A 90-day supply of your maintenance prescription is mailed directly to your home at a reduced co-pay. Contact Caremark/CVS at 877-406-4465 for more information.

NOTE: If you are electing to participate in the HRA, the prescription drug coverage is included as part of the medical plan. Please refer to the plan materials for more information on the prescription drug coverage.

WHAT IS STEP THERAPY?

Step therapy requires you to try an available generic drug for at least 30 days before brand name drugs will be covered for certain drug classes. These drug classes include drugs to treat high cholesterol, high blood pressure, ulcers or GERD, nasal congestion, pain (non-steroidal), sleep aids, bone loss, migraines, overactive bladder, depression, enlarged prostate, Alzheimer’s Disease, high triglycerides and glaucoma (this list is subject to change). Brand-name drugs used in these drug classes will not be covered unless the participant has tried a generic drug in the last 24 months through the Caremark plan or your doctor sends Caremark an explanation of why you should not try a generic drug. Your doctor can call Caremark at 1-877-203-0003 to obtain the authorization forms. For drugs to treat depression, only new prescriptions are applied to step therapy requirements.


Delta Dental Schedule of Benefits2015 Plan Year

Dental BenefitsIn-Network Benefit

(Delta Preferred Option and Delta Premier Dentist)

Out-of-Network Benefit (Non-Delta Dentist)

Deductibles & Calendar Year Benefit Maximums

Calendar Year Deductible $50 for each Eligible Person $50 for each eligible person

Calendar Year Maximum (except Ortho) $1,250 for each Eligible person $1,250 for each eligible person

Diagnostics (Not Subject to the Deductible)

Oral Exam Limited to twice in a calendar year

100% of allowed amount 80% of allowed amount

X-Rays Full mouth x-rays provided not more than once each 5 years. Bitewing x-rays once each 6 months for enrollees under age 18; once each 12 months for enrollees age 18 and over


Preventive (Not Subject to the Deductible)

Prophylaxis (Cleaning) Limited to twice in a calendar year


Fluoride Application Limited to enrollees to age 19


Space Maintainer 100% of allowed amount 80% of allowed amount

Restorative (Subject to the Deductible)

Fillings 80% of allowed amount after Deductible 50% of allowed amount after Deductible

Denture Repairs 80% of allowed amount after Deductible 50% of allowed amount after Deductible

Sealants Limited to dependent enrollees to age 15 on permanent molars only

80% of allowed amount after Deductible 50% of allowed amount after Deductible

Oral Surgery (Subject to the Deductible)

Extractions 80% of allowed amount after Deductible 50% of allowed amount after Deductible

General Anesthesia When administered by a Dentist for a covered Oral Surgery procedure

80% of allowed amount after Deductible 50% of allowed amount after Deductible

Endodontics (Root Canals) 80% of allowed amount after Deductible 50% of allowed amount after Deductible

Periodontics (Gum Treatment) 80% of allowed amount after Deductible 50% of allowed amount after Deductible

Crowns & Prosthodontics (Subject to the Deductible)

Crowns 50% of allowed amount after Deductible 50% of allowed amount after Deductible

Bridges 50% of allowed amount after Deductible 50% of allowed amount after Deductible

Dentures 50% of allowed amount after Deductible 50% of allowed amount after Deductible

Orthodontics (Not Subject to the Deductible)

Orthodontics Lifetime maximum of $1,000 per child Limited to dependent children to age 26


20 2015 Benefits

Claims should be submitted to:

Delta Dental Insurance Company P.O. Box 1809 Alpharetta, GA 30023-1809

To obtain a list of dentists, visit our website at www.deltadentalins.com

NOTE:

• Allowed amount for Delta Preferred Dentists is limited to the DPO fee schedule.

• Allowed amount for DeltaPremier Dentists is limited to the lesser of: the dentist’s filed fee, submitted fee, or Delta’s UCR (Usual, Customary and Reasonable) fee.

• Allowed amount for Non-Delta Dentists is Delta Dental’s UCR (Usual, Customary and Reasonable) fee. These dentists may also balance bill for amounts over Delta’s UCR.

• This is a summary of benefits. Please refer to the Evidence of Coverage for further exclusions and limitations. For additional information regarding benefits and eligibility, please contact Customer Service at 1-800-510-9545 or visit our website at www.deltadentalins.com

• These services are performed as needed and deemed as necessary by your attending dentist; subject to the limitations and exclusions governing administrative policies of the program.


VSP Vision Benefits2015 Plan Year

Vision Benefits

In-Network Benefit (Delta Preferred Option and Delta

Premier Dentist)Out-of-Network Benefit

(Non-Delta Dentist)

Deductibles & Calendar Year Benefit Maximums

Calendar Year Deductible $0 $0

Calendar Year Maximum (except Ortho) By Benefit By Benefit

Eye Examination

Eye Exam Limited to one in a calendar year

$20 co-payment Up to $50 will be reimbursed

Materials Benefits

Lenses Limited to one in a calendar year

VSP’s standard lenses are covered in full (less any applicable plan co-payment), including glass or plastic single vision, bifocal, trifocal, or other more complex

lenses necessary for the patient’s visual welfare.

Frames Limited to one every two years

VSP provides a $130 allowance for frames. If the patient selects a frame that exceeds the plan allowance, VSP offers a 20% discount off the amount over the

retail allowance.

Contact Lenses Limited to one in a calendar year

Covered up to $130 allowance, applied to the contact lens exam (fitting and evaluation) and lenses. VSP providers also provide a 15% discount off their

professional services for prescription contact lenses.

Out-of-Network Benefit Allowance

Single-Vision Lenses Up to $55 will be reimbursed

Bifocal Lenses Up to $75 will be reimbursed

Trifocal Lenses Up to $100 will be reimbursed

Frames Up to $70 will be reimbursed

Contact Lenses Up to $105 will be reimbursed

The following items are excluded under this plan:

• Plano lenses (non-prescription)

• Two pairs of glasses instead of bifocals

• Replacement/repair of lost/broken lenses or frames

• Medical or surgical treatment

• Orthoptics, vision training, or supplemental testing

• Expenses associated with securing materials

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Life & Accidental Death Coverage

ThyssenKrupp Elevator provides employees with basic life and AD&D insurance. These coverages can give your family additional financial security during difficult times. The Hartford is our partner in offering these coverages.

BASIC LIFE AND AD&D BENEFITS

Basic Life and AD&D are paid for by ThyssenKrupp Elevator. Full-time, active, bargaining unit employees receive:

• Life insurance in the amount of $27,000.

• Accidental death and dismemberment insurance equal to $27,000 for accidental death, and a scheduled amount for dismemberment (see contract for details).

On January 1st, following the date you obtain age 65, your benefit amount will be reduced by 8% of the original amount and reduced by an additional 8% at each January 1st, until reaching age 71 when the benefit will be 50% of the original amount.

SUPPLEMENTAL LIFE BENEFIT ELECTION

Supplemental Life is an insurance program that provides employees the opportunity to choose additional protection that best suits them and their family members. You purchase the plan through convenient payroll deductions.

• You may elect benefit coverage in increments of $10,000 up to a maximum of $250,000. Current employees may elect up to $250,000 without providing an Evidence of Insurability (EOI) during the 2014 Open Enrollment only (effective 1/1/2015). This is a one-time special enrollment period for current employees. New Hires may elect up to $250,000 without providing an Evidence of Insurability (EOI) as long they apply within 90 days of their hire date. Any election of or change in your supplemental coverage outside of these enrollment periods will require an EOI.

• Your spouse is eligible for coverage in increments of $10,000, up to a maximum of $100,000 not to exceed 50% of your combined Basic Life and Supplemental Life elections. Current employees may elect up to $20,000 without providing an Evidence of Insurability (EOI) during the 2014 Open Enrollment only (effective 1/1/2015). This is a one-time special enrollment period for current employees. New Hires may elect up to $20,000 without providing an Evidence of Insurability (EOI) as long they apply within 90 days of their hire date. Any election of or change in your supplemental coverage outside of these enrollment periods will require an EOI.

• Dependent child(ren) six months to age 26 are eligible for coverage in increments of $2,000 up to a maximum of $10,000.

VOLUNTARY ACCIDENTAL DEATH & DISMEMBERMENT ELECTION

Voluntary AD&D is a separate benefit that can be elected with the Supplemental Life. Coverage is equal to the coverage amount elected for Supplemental Life.


BENEFIT HIGHLIGHTS FOR MIDDLETON HOURLY UNION EMPLOYEES

What is Supplemental Life and AD&D Insurance? Supplemental Life and AD&D Insurance is coverage that you pay for. Supplemental Life and AD&D Insurance pays your beneficiary (please see below) a benefit if you die while you are covered. This highlight sheet is an overview of your Supplemental Life and AD&D Insurance. Once a group policy is issued to your employer, a certificate of insurance will be available to explain your coverage in detail.

Am I eligible? You are eligible if you are an active full time employee who works at least 30 hours per week on a regularly scheduled basis.

When can I enroll? As a new hire, you may enroll during your 90-day new hire enrollment period. After that period, you may elect or make changes within 30 days of the date you have a change in family status or during annual open enrollment.

When is it effective? Coverage goes into effect subject to the terms and conditions of the policy. You must be actively at work with your employer on the day your coverage takes effect.

How much Supplemental Life and AD&D Insurance can I purchase? You can purchase Supplemental Life and AD&D Insurance in increments of $10,000. The maximum amount you can purchase cannot be more than $250,000. Annual Earnings are as defined in The Hartford’s contract with your employer. You may elect life insurance without electing AD&D, but you cannot elect AD&D without life insurance. The amount of AD&D must equal your approved life insurance election.

SUPPLEMENTAL LIFE AND AD&D INSURANCE WEEKLY COSTS

Your cost may change when you move into a new age category.

Life Benefit AmountEmployee Age Bracket

<29 30-34 35-39 40-44 45-49 50-54 55-59 60+

$50,000 $0.87 $0.98 $1.21 $1.85 $3.17 $5.25 $8.31 $12.81

$100,000 $1.73 $1.96 $2.42 $3.69 $6.35 $10.50 $16.62 $25.62

$150,000 $2.60 $2.94 $3.63 $5.54 $9.52 $15.75 $24.92 $38.42

$200,000 $3.46 $3.92 $4.85 $7.38 $12.69 $21.00 $33.23 $51.23

$250,000 $4.33 $4.90 $6.06 $9.23 $15.87 $26.25 $41.54 $64.04

Voluntary AD&D is a separate benefit that can be elected with the Supplemental Life. You may elect life insurance without electing AD&D, but you cannot elect AD&D without life insurance. The amount of AD&D must equal your approved life insurance election.

AD&D Benefit Amount Cost

$50,000 $0.23

$100,000 $0.46

$150,000 $0.69

$200,000 $0.92

$250,000 $1.15

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SPOUSE SUPPLEMENTAL LIFE INSURANCE WEEKLY COSTS

Costs are based on the employee’s age. Your cost may change when the employee moves into a new age category.

Life Benefit AmountAge Bracket

<29 30-34 35-39 40-44 45-49 50-54 55-59 60+

$10,000 $0.17 $0.20 $0.24 $0.37 $0.63 $1.05 $1.66 $2.56

$20,000 $0.35 $0.39 $0.48 $0.74 $1.27 $2.10 $3.32 $5.12

CHILD(REN) SUPPLEMENTAL LIFE INSURANCE WEEKLY COSTS

Life Benefit Amount Cost (for all covered children)

$10,000 $0.18

Please note that the rate information listed above is only a sample. For a complete rate sheet showing all options, please contact e*source at 866-910-6085.


Disability Coverage

In the event you become disabled from a non work-related injury or sickness, disability income benefits are provided as a source of income.

SHORT-TERM DISABILITY

Benefits begin:

• For disability caused by injury: on the 1st day of disability.

• For disability caused by sickness: on the 8th consecutive day of disability

For hospital confinements of 24 hours or more, benefits commence on the first day of hospital confinement. You are not eligible to receive short-term disability benefits if you are receiving Workers’ Compensation benefits.

Weekly benefit:

• For your weekly benefit please refer to the benefit schedule in the union agreement.

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Employee Assistance Program (EAP)

ThyssenKrupp Elevator is increasingly aware of the stress our families face during these troubling economic times, both at work and at home. Our EAP, offered through LifeWorks, offers free, confidential, professional counseling and consultation services. Through the EAP, employees and their family members have access to qualified consultants 24 hours a day, 365 days a year. You may call for any number of reasons: family issues, financial concerns, crisis intervention assistance, short-term problem resolution. EAP can offer referrals, information, assessment or action planning.

Access to this benefit is convenient and completely confidential, via phone at 888-267-8126 or via the web at www.lifeworks.com

• User ID: thyssenkrupp

• Password: tke


Important Notices: ThyssenKrupp Elevator Group Health Plan

SPECIAL ENROLLMENT RIGHT

Loss of Other Coverage

If you decline enrollment for yourself or for an eligible dependent (including your spouse) while other health insurance or group health plan coverage is in effect, you may be able to enroll yourself and your dependents in this plan as a Special Enrollee if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 30 days after you or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage). You will be asked to provide proof that you had other coverage and the reason that the other coverage ended . Benefits may be subject to pre-existing condition limitations.

New Dependent by Marriage, Birth, Adoption, or Placement for Adoption

In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, after your initial enrollment period, you may be deemed a Special Enrollee and able to enroll yourself and/or your new dependents . However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption.

Medicaid or State Plan

If you and your dependent child(ren) lose coverage under a Medicaid or State Plan or become eligible for group health plan premium assistance under a Medicaid or State Plan, you and your eligible dependent child(ren) may be deemed a Special Enrollee and eligible to enroll in this health plan as long as your enrollment request is made within 60 days of the date coverage terminates under a Medicaid or State Plan, or within 60 days after you or your dependent(s) is determined to be eligible for Medicaid or State premium assistance.

Late Enrollees

If you waive coverage for you and/or your eligible dependents under this Plan and later wish to enroll, you will be considered a Late Enrollee unless you qualify as a Special Enrollee as noted above. A Late Enrollee may enroll only during the Annual Enrollment Period each year and coverage will be effective January 1. No evidence of good health is required to obtain coverage as a Late Enrollee.

To request special enrollment or obtain more information about enrollment, please contact your human resources department.

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WOMEN’S HEALTH AND CANCER RIGHTS ACT

If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for:

• all stages of reconstruction of the breast on which the mastectomy was performed;

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

• prostheses; and

• treatment of physical complications of the mastectomy, including lymphedema.

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under your elected medical plan.

If you would like more information on your special enrollment rights or the Women’s Health and Cancer Rights Act, please call the e*source team at 866-910-6085.

MEDICARE PART D CREDITABLE COVERAGE NOTICE

The required Medicare Part D Creditable Coverage Notice was distributed to all employees and spouses over age 55. If you, or your spouse, require a copy of the notice, please contact e*source at 866-910-6085 or [email protected] and a copy will be made available.


Notice of Privacy Practices

THIS NOTICE OF PRIVACY PRACTICES DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This Notice of Privacy Practices (the “Notice”) describes the legal obligations of the healthcare components of the ThyssenKrupp Elevator Health and Welfare Plan (hereinafter the “Plan”) and your legal rights regarding your protected health information held by the Plan under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and the Health Information Technology for Economic and Clinical Health Act (“HITECH Act”). Among other things, this Notice describes how your protected health information may be used or disclosed to carry out treatment, payment, or health care operations, or for any other purposes that are permitted or required by law.

We are required to provide this Notice of Privacy Practices to you pursuant to HIPAA.

The HIPAA Privacy Rule protects only certain medical information known as “protected health information.” Generally, protected health information is health information, including demographic information, collected from you or created or received by a health care provider, a health care clearinghouse, a health plan, or your employer on behalf of a group health plan, from which it is possible to individually identify you and that relates to:

(1) Your past, present, or future physical or mental health or condition; (2) The provision of health care to you; or (3) The past, present, or future payment for the provision of health care to you.

This Notice is effective October 1, 2014.

If you have any questions about this Notice or about our privacy practices, please contact:

ThyssenKrupp Elevator Attn: HR Manager (HIPAA) 11605 Haynes Bridge Rd. Suite 650 Alpharetta, GA 30009 Phone: (866) 910 6085

OUR RESPONSIBILITIES

We are required by law to:

• Maintain the privacy of your protected health information;

• Provide you with certain rights with respect to your protected health information;

• Provide you with a copy of this Notice of our legal duties and privacy practices with respect to your protected health information; and

• Follow the terms of the Notice that is currently in effect.

We reserve the right to change the terms of this Notice and to make new provisions regarding your protected health information that we maintain, as allowed or required by law. If we make any material changes to this Notice, we will provide you with a copy of the revised Notice of Privacy Practices by mailing a copy to your address on file.

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HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION

Under the law, we may use or disclose your protected health information under certain circumstances without your permission. The following categories describe the different ways that we may use and disclose your protected health information. For each category of uses or disclosures we will explain what we mean and present some examples. Not every use or disclosure in a category will be listed. However, all of the ways that we are permitted to use and disclose information will fall within one of the categories.

For Treatment. We may use or disclose your protected health information to facilitate medical treatment or services by providers. We may disclose medical information about you to providers, including doctors, nurses, technicians, medical students, or other hospital personnel who are involved in taking care of you. For example, we might disclose information about your prior prescriptions to a pharmacist to allow the pharmacist to determine if prior prescriptions contraindicate a pending prescription.

For Payment. We may use or disclose your protected health information to determine your eligibility for Plan benefits, to facilitate payment for the treatment and services you receive from health care providers, to determine benefit responsibility under the Plans, or to coordinate Plan coverage. For example, we may tell your health care provider about your medical history to determine whether a particular treatment is experimental, investigational, or medically necessary, or to determine whether the Plans will cover the treatment. We may also share your protected health information with a utilization review or precertification service provider. Likewise, we may share your protected health information with another entity to assist with the adjudication or subrogation of health claims or to another health plan to coordinate benefit payments.

For Health Care Operations. We may use and disclose your protected health information for other Plan operations. These uses and disclosures are necessary to run the Plans. For example, we may use medical information in connection with conducting quality assessment and improvement activities; underwriting, premium rating, and other activities relating to Plan coverage; submitting claims for stop-loss (or excess-loss) coverage; conducting or arranging for medical review, legal services, audit services, and fraud and abuse detection programs; business planning and development such as cost management; and business management and general Plan administrative activities. However, we will not use your genetic information for underwriting purposes.

Treatment Alternatives or Health-Related Benefits and Services. We may use and disclose your protected health information to send you information about treatment alternatives or other health-related benefits and services that might be of interest to you.

To Business Associates. We may contract with individuals or entities known as Business Associates to perform various functions on our behalf or to provide certain types of services. In order to perform these functions or to provide these services, Business Associates will receive, create, maintain, transmit, use, and/or disclose your protected health information, but only after they agree in writing with us to implement appropriate safeguards regarding your protected health information. For example, we may disclose your protected health information to a Business Associate to process your claims for Plan benefits or to provide support services, such as utilization management, pharmacy benefit management, or subrogation, but only after the Business Associate enters into a Business Associate contract with us.

As Required by Law. We will disclose your protected health information when required to do so by federal, state, or local law. For example, we may disclose your protected health information when required by national security laws or public health disclosure laws.

To Avert a Serious Threat to Health or Safety. We may use and disclose your protected health information when necessary to prevent a serious threat to your health and safety, or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat. For example, we may disclose your protected health information in a proceeding regarding the licensure of a physician.


To Plan Sponsors. For the purpose of administering the Plans, we may disclose to certain employees of the Company protected health information. However, those employees will only use or disclose that information as necessary to perform plan administration functions or as otherwise required by HIPAA, unless you have authorized further disclosures. Your protected health information cannot be used for employment purposes without your specific authorization.

SPECIAL SITUATIONS

In addition to the above, the following categories describe other possible ways that we may use and disclose your protected health information without your specific authorization. For each category of uses or disclosures, we will explain what we mean and present some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

Organ and Tissue Donation. If you are an organ donor, we may release your protected health information after your death to organizations that handle organ procurement or organ, eye, or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.

Military. If you are a member of the armed forces, we may release your protected health information as required by military command authorities. We may also release protected health information about foreign military personnel to the appropriate foreign military authority.

Workers’ Compensation. We may release your protected health information for workers’ compensation or similar programs, but only as authorized by, and to the extent necessary to comply with, laws relating to workers’ compensation and similar programs that provide benefits for work-related injuries or illness.

Public Health Risks. We may disclose your protected health information for public health activities. These activities generally include the following:

• to prevent or control disease, injury, or disability;

• to report births and deaths;

• to report child abuse or neglect;

• to report reactions to medications or problems with products;

• to notify people of recalls of products they may be using;

• to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;

• to notify the appropriate government authority if we believe that a patient has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree, or when required or authorized by law.

Health Oversight Activities. We may disclose your protected health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose your protected health information in response to a court or administrative order. We may also disclose your protected health information in response to a subpoena, discovery request, or other lawful process by someone involved in a legal dispute, but only if efforts have been made to tell you about the request or to obtain a court or administrative order protecting the information requested.

32 2015 Benefits

Law Enforcement. We may disclose your protected health information if asked to do so by a law-enforcement official:

• in response to a court order, subpoena, warrant, summons, or similar process;

• to identify or locate a suspect, fugitive, material witness, or missing person;

• about the victim of a crime if, under certain limited circumstances, we are unable to obtain the victim’s agreement;

• about a death that we believe may be the result of criminal conduct; and

• about criminal conduct.

Coroners, Medical Examiners, and Funeral Directors. We may release protected health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients to funeral directors, as necessary to carry out their duties.

National Security and Intelligence Activities. We may release your protected health information to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

Inmates. If you are an inmate of a correctional institution or are in the custody of a law-enforcement official, we may disclose your protected health information to the correctional institution or law-enforcement official if necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.

Research. We may disclose your protected health information to researchers when:

(1) the individual identifiers have been removed; or

(2) when an institutional review board or privacy board has reviewed the research proposal and established protocols to ensure the privacy of the requested information, and approves the research.

REQUIRED DISCLOSURES

The following is a description of disclosures of your protected health information we are required to make.

Government Audits. We are required to disclose your protected health information to the Secretary of the United States Department of Health and Human Services when the Secretary is investigating or determining our compliance with the HIPAA privacy rule.

Disclosures to You. When you request, we are required to disclose to you the portion of your protected health information that contains medical records, billing records, and any other records used to make decisions regarding your health care benefits. We are also required, when requested, to provide you with an accounting of most disclosures of your protected health information if the disclosure was for reasons other than for payment, treatment, or health care operations, and if the protected health information was not disclosed pursuant to your individual authorization.

OTHER DISCLOSURES

Personal Representatives. We will disclose your protected health information to individuals authorized by you, or to an individual designated as your personal representative, attorney-in-fact, etc., so long as you provide us with a written notice/authorization and any supporting documents (i.e., power of attorney). Note: Under the HIPAA privacy rule, we do not have to


disclose information to a personal representative if we have a reasonable belief that:

(1) you have been, or may be, subjected to domestic violence, abuse, or neglect by such person; or

(2) treating such person as your personal representative could endanger you; and

(3) in the exercise of professional judgment, it is not in your best interest to treat the person as your personal representative.

Spouses and Other Family Members. With only limited exceptions, we will send all mail to the employee. This includes mail relating to the employee’s spouse and other family members who are covered under the Plans, and includes mail with information on the use of Plan benefits by the employee’s spouse and other family members and information on the denial of any Plan benefits to the employee’s spouse and other family members. If a person covered under the Plans has requested Restrictions or Confidential Communications (see below under “Your Rights”), and if we have agreed to the request, we will send mail as provided by the request for Restrictions or Confidential Communications.

Authorizations. Other uses or disclosures of your protected health information not described above will only be made with your written authorization. For example, in general and subject to specific conditions, we will not use or disclose your psychiatric notes; we will not use or disclose your protected health information for marketing; and we will not sell your protected health information, unless you give us a written authorization. You may revoke written authorizations at any time, so long as the revocation is in writing. Once we receive your written revocation, it will only be effective for future uses and disclosures. It will not be effective for any information that may have been used or disclosed in reliance upon the written authorization and prior to receiving your written revocation.

YOUR RIGHTS

You have the following rights with respect to your protected health information:

Right to Inspect and Copy. You have the right to inspect and copy certain protected health information that may be used to make decisions about your Plan benefits. If the information you request is maintained electronically, and you request an electronic copy, we will provide a copy in the electronic form and format you request, if the information can be readily produced in that form and format; if the information cannot be readily produced in that form and format, we will work with you to come to an agreement on form and format. If we cannot agree on an electronic form and format, we will provide you with a paper copy.

To inspect and copy your protected health information, you must submit your request in writing to the Health Plan Privacy Contact at the address above. If you request a copy of the information, we may charge a reasonable fee for the costs of copying, mailing, or other supplies associated with your request.

We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to your medical information, you may request that the denial be reviewed by submitting a written request to the Health Plan Privacy Contact at the above address.

Right to Amend. If you feel that the protected health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the Plans.

To request an amendment, your request must be made in writing and submitted to the Health Plan Privacy Contact at the above address. In addition, you must provide a reason that supports your request.

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We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

• is not part of the medical information kept by or for the Plans;

• was not created by us, unless the person or entity that created the information is no longer available to make the amendment;

• is not part of the information that you would be permitted to inspect and copy; or

• is already accurate and complete.

If we deny your request, you have the right to file a statement of disagreement with us and any future disclosures of the disputed information will include your statement.

Right to an Accounting of Disclosures. You have the right to request an “accounting” of certain disclosures of your protected health information. The accounting will not include (1) disclosures for purposes of treatment, payment, or health care operations; (2) disclosures made to you; (3) disclosures made pursuant to your authorization; (4) disclosures made to friends or family in your presence or because of an emergency; (5) disclosures for national security purposes; and (6) disclosures incidental to otherwise permissible disclosures.

To request this list or accounting of disclosures, you must submit your request in writing to Health Plan Privacy Contact at the above address. Your request must state the time period you want the accounting to cover, which may not be longer than six years before the date of the request. Your request should indicate in what form you want the list (for example, paper or electronic). The first list you request within a 12-month period will be provided free of charge. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

Right to Request Restrictions. You have the right to request a restriction or limitation on your protected health information that we use or disclose for treatment, payment, or health care operations. You also have the right to request a limit on your protected health information that we disclose to someone who is involved in your care or the payment for your care, such as a family member or friend. For example, you could ask that we not use or disclose information about a surgery that you had.

Except as provided in the next paragraph, we are not required to agree to your request. However, if we do agree to the request, we will honor the restriction until you revoke it or we notify you.

We will comply with any restriction request if (1) except as otherwise required by law, the disclosure is to a health plan for purposes of carrying out payment or health care operations (and is not for purposes of carrying out treatment); and (2) the protected health information pertains solely to a health care item or service for which the health care provider involved has been paid in full by you or another person.

To request restrictions, you must make your request in writing to the Health Plan Privacy Contact at the above address. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply-for example, disclosures to your spouse.

Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.

To request confidential communications, you must make your request in writing to the Health Plan Privacy Contact at the above address. We will not ask you the reason for your request. Your request must specify how or where you wish to be contacted. We will accommodate all reasonable requests.


Right to Be Notified of a Breach. You have the right to be notified in the event that we (or a Business Associate) discover a breach of unsecured protected health information.

Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.

You may obtain a copy of this notice by contacting your Human Resources Department or by writing to the Health Plan Privacy Contact at the above address.

COMPLAINTS

If you believe that your privacy rights have been violated, you may file a complaint with the Plans or with the Office for Civil Rights of the United States Department of Health and Human Services. To file a complaint with the Plans, contact the Health Plan Privacy Contact at the above address. All complaints must be submitted in writing.

You will not be penalized, or in any other way retaliated against, for filing a complaint with the Office for Civil Rights or with us.

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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 are eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage. These states use funds from their Medicaid or CHIP programs to help people who are eligible for these programs, but also have access to health insurance through their employer. If you or your children are not eligible for Medicaid or CHIP, you will not be eligible for these premium assistance programs.

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a state listed below, you can 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, you can contact your state Medicaid or CHIP office at 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan.

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must permit you to enroll in your employer plan if you are not 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, you can contact the Department of Labor electronically at www.askebsa.dol.gov or by calling toll-free 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, 2013. You should contact your state for further information on eligibility.

ALABAMA – Medicaid Website: www.medicaid.alabama.gov Phone: 1-855-692-5447

ALASKA – Medicaid Website: health.hss.state.ak.us/dpa/programs/medicaid Phone (Anchorage): 907-269-6529 Phone (outside of Anchorage): 1-888-318-8890

ARIZONA – CHIP Website: www.azahcccs.gov/applicants Phone (Maricopa County): 602-417-5437 Phone (outside of Maricopa County): 1-877-764-5437

COLORADO – Medicaid Website: www.colorado.gov Phone (in state): 1-800-866-3513 Phone (out of state): 1-800-221-3943

FLORIDA – Medicaid Website: www.flmedicaidtplrecovery.com Phone: 1-877-357-3268

GEORGIA – Medicaid Website: dch.georgia.gov/medicaid (Click on Programs, then Medicaid, then Health Insurance Premium Payment [HIPP])

Phone: 1-800-869-1150

IDAHO – Medicaid and CHIP Medicaid Website: www.accesstohealthinsurance.idaho.gov Medicaid Phone: 1-800-926-2588 CHIP Website: www.medicaid.idaho.gov CHIP Phone: 1-800-926-2588

INDIANA – Medicaid Website: www.in.gov/fssa Phone: 1-800-889-9949

IOWA – Medicaid Website: www.dhs.state.ia.us/hipp/ Phone: 1-888-346-9562

KANSAS – Medicaid Website: www.kdheks.gov/hcf/ Phone: 1-800-792-4884

KENTUCKY – Medicaid Website: chfs.ky.gov/dms/default.htm Phone: 1-800-635-2570

LOUISIANA – Medicaid Website: www.lahipp.dhh.louisiana.gov Phone: 1-888-695-2447


MAINE – Medicaid Website: www.maine.gov/dhhs/ofi/public-assistance/index.html Phone: 1-800-977-6740 TTY: 1-800-977-6741

MASSACHUSETTS – Medicaid and CHIP Website: www.mass.gov/MassHealth Phone: 1-800-462-1120

MINNESOTA – Medicaid Website: www.dhs.state.mn.us (Click on Health Care, then Medical Assistance) Phone: 1-800-657-3629

MISSOURI – Medicaid Website: www.dss.mo.gov/mhd/participants/pages/hipp.htm Phone: 573-751-2005

MONTANA – Medicaid Website: medicaidprovider.hhs.mt.gov/clientpages/clientindex.shtml Phone: 1-800-694-3084

NEBRASKA – Medicaid Website: dhhs.ne.gov/medicaid/Pages/med_kidsconx.aspx Phone: 1-800-383-4278

NEVADA – Medicaid Website: dwss.nv.gov Phone: 1-800-992-0900

NEW HAMPSHIRE – Medicaid Website: www.dhhs.nh.gov/oii/documents/hippapp.pdf Phone: 603-271-5218

NEW JERSEY – Medicaid and CHIP Medicaid Website: www.state.nj.us/humanservices/dmahs/clients/medicaid Medicaid Phone: 609-631-2392 CHIP Website: www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710

NEW YORK – Medicaid Website: www.nyhealth.gov/health_care/medicaid Phone: 1-800-541-2831

NORTH CAROLINA – Medicaid Website: www.ncdhhs.gov/dma Phone: 919-855-4100

NORTH DAKOTA – Medicaid Website: www.nd.gov/dhs/services/medicalserv/medicaid Phone: 1-800-755-2604

OKLAHOMA – Medicaid and CHIP Website: www.insureoklahoma.org Phone: 1-888-365-3742

OREGON – Medicaid and CHIP Website (English): www.oregonhealthykids.gov Website (español): www.hijossaludablesoregon.gov Phone: 1-888-564-9669

PENNSYLVANIA – Medicaid Website: www.dpw.state.pa.us/hipp Phone: 1-800-692-7462

RHODE ISLAND – Medicaid Website: www.dhs.ri.gov Phone: 401-462-5300

SOUTH CAROLINA – Medicaid Website: www.scdhhs.gov Phone: 1-888-549-0820

SOUTH DAKOTA – Medicaid Website: dss.sd.gov Phone: 1-888-828-0059

TEXAS – Medicaid Website: www.gethipptexas.com Phone: 1-800-440-0493

UTAH – Medicaid and CHIP Website: health.utah.gov/upp Phone: 1-866-435-7414

VERMONT – Medicaid Website: www.greenmountaincare.org Phone: 1-800-250-8427

VIRGINIA – Medicaid and CHIP Medicaid Website: www.dmas.virginia.gov/rcp-HIPP.htm Medicaid Phone: 1-800-432-5924 CHIP Website: www.famis.org CHIP Phone: 1-866-873-2647

WASHINGTON – Medicaid Website: hrsa.dshs.wa.gov/premiumpymt/Apply.shtm Phone: 1-800-562-3022 ext. 15473

38 2015 Benefits

WEST VIRGINIA – Medicaid Website: www.dhhr.wv.gov/bms Phone: 877-598-5820 (HMS Third Party Liability)

WISCONSIN – Medicaid Website: www.badgercareplus.org/pubs/p-10095.htm Phone: 1-800-362-3002

WYOMING – Medicaid Website: health.wyo.gov/healthcarefin/equalitycare Phone: 307-777-7531

To see if any more States have added a premium assistance program since July 31, 2013, or for more information on special enrollment rights, you can contact either:

U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/ebsa 1-866-444-EBSA (3272)

U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services cms.hhs.gov 1-877-267-2323 ext. 61565

OMB Control Number 1210-0137 (expires 09/30/2013)


Contact Information

e*source 866-910-6085 www.tk-esource.com [email protected]

Blue Cross Blue Shield of Illinois (BCBSIL)

888-895-1563 www.bcbsil.com

CVS/Caremark Rx 888-886-8520 www.caremark.com

Delta Dental Insurance 800-521-2651 www.deltadentalins.com

VSP Vision Service Plan 800-877-7195 www.vsp.com

LifeWorks EAP 888-267-8126 www.lifeworks.com

The Hartford (Short-Term Disability) 800-445-9057 www.thehartfordatwork.com

This benefit guide includes a general description of the ThyssenKrupp Elevator benefit plans offered as of January 1, 2015. This guide is meant to be brief and informational. Please refer to the SPD for details. This guide is not intended to create a contract or promise for benefits. Participation in the plans, as well as benefits offered under the plans, are all subject to applicable terms and conditions of the plans. The official plan documents will govern administration of these programs in the event any unintentional discrepancy is found between this guide and the SPD. ThyssenKrupp Elevator reserves the right to make all revisions and interpretations with respect to the plans described here. The decisions of ThyssenKrupp Elevator shall be final and binding upon all participants. ThyssenKrupp Elevator reserves the right, without your consent or concurrence, to amend, modify, suspend, replace, or terminate the plans, in whole or in part. If the plans are amended, modified, suspended, replaced, or terminated, you or other participants may not receive benefits as described here.

Middleton Hrly 09/14

ThyssenKrupp Elevator

2600 Network Blvd., Ste. 450, Frisco, TX 75034

Phone (877) 230-0303

thyssenkruppelevator.com | version 10.14

All illustrations and specifications are based on information in effect at time of publication approval.

ThyssenKrupp Elevator reserves the right to change specifications or design and to discontinue items without

prior notice or obligation. Copyright © 2013 ThyssenKrupp Elevator Corporation. CA License #651371

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