The annual benefits enrollment period runs from Tuesday, Nov. 4 to Tuesday, Nov. 18, 2014 for coverage effective Jan. 1, 2015. Changes for 2015 are outlined in this booklet. Please read it carefully and get answers to your questions (see Contacts on page 21) as you prepare to make benefit choices for 2015.

What’s inside 2 | Benefits enrollment to-do list 3 | Changes you can make during annual

benefits enrollment 3 | Medical coverage 6 | Health savings accounts (HSAs) 7 | New! Get free guidance on treatment options 8 | The right care at the right time: Know where to go 9 | Wellness within – and fun along the way:

The 2015 Live Healthy, Live Well program 10 | Dental coverage 12 | Vision coverage 13 | Health care flexible spending accounts (FSAs) 14 | Life insurance coverage changes and reminders 14 | Premium assistance under Medicaid and the Children’s

Health Insurance Program (CHIP) 17 | Annual reminders 20 | Benefit rates 21 | Contacts 22 | Enrollment instructions

DISCLAIMER: This communication describes benefits that become effective Jan. 1, 2015. This communication has been prepared for benefits-eligible active employees of Massachusetts Mutual Life Insurance Company (MassMutual); The MassMutual Trust Company fsb; MassMutual International, LLC; Babson Capital Management LLC; Babson Capital Finance, LLC; Invicta Advisors LLC; and Cornerstone Real Estate Advisors LLC. It is not for agents, field staff or retirees. This document is not a Summary Plan Description (SPD) but sections of this document represent Summaries of Material Modifications (SMMs) for the MassMutual Employee Welfare Benefits Plan.

All information contained in this booklet is for general information purposes only and is not tax or financial advice. Benefits are determined by the terms of the plans in effect. Receipt of this material does not imply your eligibility for any one or all of the benefits and programs described. The Company reserves the right to terminate, modify, amend or suspend any or all of its benefit plans and programs at any time and from time to time. In case of conflict between this information and the plan terms, the plan terms and documents will govern. Provisions are based on current law and regulations, which are subject to change. All information described here is current as of the November 2014 publication date.

November 2014

Annual benefits enrollmentFor employee benefits effective Jan. 1, 2015

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Review the information in this booklet and share it with any other decision-makers in your household.

Research your options:

• Visit ALEX®.• Visit https://member.express-scripts.com/preview/

massmutualemployees to estimate your 2015 prescription drug costs.

Ask questions:

• Call Cigna 24/7/365 at 800-548-3980 for questions about 2015 medical or dental coverage. (If you’re not a current participant, say, “Open Enrollment” at the prompt.)

• Call Express Scripts 24/7/365 at 866-219-1933 for questions about 2015 prescription coverage. (If you’re not a current participant, press 0 and follow the system prompts to reach a patient care advocate.)

• Call the Ayco AnswerLine® at 866-325-0092 with questions about the financial aspects of your benefits.

• And more! See page 21 for more contact info.

Decide what changes, if any, you want to make for 2015. If you don’t want to make any changes, you may not need to go through the enrollment process. If you don’t make any changes, the benefit elections you had in place prior to Sept. 2, 2014 will carry forward into 2015 automatically, subject to 2015 plan provisions and costs.

Exceptions:

• If you made or make changes to your benefits due to a mid-year qualifying event or were hired on or after Sept. 2, 2014, you must go through annual benefits enrollment to establish your 2015 benefits, as changes made on or after Sept. 2, 2014 will not carry forward automatically to the new year.

• If you only need to make your health savings account (HSA) contribution election, you can do that either during annual benefits enrollment or on or after January 1, 2015. Your 2014 HSA election will not automatically carry forward to 2015.

Enroll in your 2015 benefits using Employee Center by 11:59 p.m., ET, on Tuesday, Nov. 18, 2014. Enrollment instructions are on page 22.

Print or save a copy of your 2015 benefits confirmation form for your records as proof of your enrollment, and review it to make sure it’s accurate.

Benefits enrollment to-do list

Pick the benefit options that are best for you

www.alexformassmutual.com/2015/employees

can help.

ALEX® logo and characters used with permission.

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Annual benefits enrollment is the one time during the year that you can make changes to your benefit options without a mid-year qualifying event. Benefits you can elect or change at this time are as follows:

• Medical

• Dental

• Vision

• Group Term Life

• Dependent Life

• Long-Term Disability

• Dependent Care Flexible Spending Account (DCFSA)

• Health Care Flexible Spending Account (HCFSA)

Health savings account (HSA) contributions can be elected or changed at any time of the year. However, if you don’t elect a contribution amount during annual benefits enrollment, your contribution amount will revert to zero as of Jan. 1, and will remain at zero until you change it.

To learn more about all of the benefit options available to you, visit myHR on MX. On myHR, links to your current elections are listed under “Current information” on the left. Options you’re not currently enrolled in may be found under “Other options,” further down on the left. You may view summary plan descriptions for all of your benefit options by going to SPD Source.

Changes you can make during annual benefits enrollment

Medical changes for 2015This section of medical and prescription drug coverage information represents a Summary of Material Modifications (SMM) for the MassMutual Employee Welfare Benefits Plan High Deductible Health Plan (HDHP) Option 1 and Option 2 Medical SPD, effective Jan. 1, 2014. Changes described here are effective Jan. 1, 2015, unless otherwise specified.

Note: This list of changes is accurate as of the November, 2014 publication date, but it may be subject to further discretionary or legally required changes. Any further changes will be communicated as necessary on MX or by email.

Your health is important – to you and your family, and to MassMutual. MassMutual offers comprehensive medical coverage with a robust wellness incentive program that allows participants to earn company contributions to their health savings accounts (HSAs). A schedule of preventive services based on federal guidelines continues to be covered at 100%.

In 2015, the deductible for MassMutual High Deductible Health Plan Option 1 increases for individual and family coverage, and the out-of-pocket maximum increases for Option 1 family coverage. The deductibles and out-of-pocket maximums for MassMutual High Deductible Health Plan Option 2 are unchanged.

Medical coverage

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Medical coverage

For more information about how your medical coverage works, including the deductible, coinsurance and out-of-pocket maximum, please read the Summary of Benefits and Coverage (SBC), which has been updated for 2015:

• Option 1 SBC: English | Spanish | Chinese

• Option 2 SBC: English | Spanish | Chinese

• Puerto Rico SBC: English | Spanish

• Hawaii SBC: English | Spanish | Chinese

Tobacco-use surchargeSince 2011, if you or a covered dependent uses tobacco products, you’ve been paying a surcharge on your medical “premiums” ranging from $400 annually for individual coverage to $1,200 annually for family coverage. The surcharge remains the same in 2015; however, e-cigarettes are added to the list of products whose use is subject to the surcharge. The time you must be tobacco-free to enroll as a tobacco non-user is 12 months. You will have to attest to having stopped use of tobacco products and/or e-cigarettes for 12 consecutive months to avoid the tobacco-use surcharge.

You may be exempt from the tobacco-use surcharge, if, for example, it is medically inadvisable or unreasonably difficult due to a medical condition to stop smoking or using tobacco/e-cigarettes. You may avoid this surcharge if you provide attestation and satisfy an alternative standard. If there is any reason you believe you may be exempt from this surcharge, please contact MassMutual Benefits at BenefitQuestions@MassMutual.com for more information.

Verify your covered dependents’ tax identification numbersAs part of the Patient Protection and Affordable Care Act (PPACA), MassMutual must report information about who is covered under MassMutual medical options to the federal government. For that reason, during the annual benefits enrollment period, please enter or verify your covered dependents’ names, dates of birth and Social Security numbers (SSNs). If any of your dependents does not have an SSN, please include their Individual Taxpayer Identification Number (ITIN) in the SSN field. This information is required for all covered dependents age 1 and older.

If any of your dependents does not have an ITIN, please request one. The General ITIN Information page on www.IRS.gov may provide helpful information.

All SSNs and ITINs for covered dependents must be provided to MassMutual by Dec. 31, 2014.

1 Cigna’s Maximum Reimbursable Charge (MRC) is based on typical charges made by providers in a given geographic region for a similar service or supply. Only out-of-network charges are subject to the MRC. Coinsurance applies only to charges up to the MRC limit; any charges exceeding MRC do not count towards your deductible or out-of-pocket maximum and are your responsibility.

Medical 2015 2014 (for reference)

Option 1 Option 2 Option 1 Option 2

DeductibleIndividual $1,500 $2,500 $1,300 $2,500Individual plus one or more dependents (family) $3,000 $5,000 $2,600 $5,000

Out-of-Pocket Maximum

Individual $3,000 $4,500 $3,000 $4,500Individual plus one or more dependents (family) $6,000 $9,000 $5,000 $9,000

CoinsuranceIn-Network After deductible, you pay 10%; Plan pays 90%

Out-of-Network After deductible, you pay 30%; Plan pays 70% up to Maximum Reimbursable Charge (MRC)1

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Per-script maximums

Drug tierPlan pays

(% or more)You pay

(up to maximum)2015 maximums 2014 maximums (for reference)

30-day supply 90-day supply 30-day supply 90-day supplyGeneric 85% or more 15% up to max $25 $63 $20 $50Preferred brand 70% or more 30% up to max $100 $250 $80 $200Non-preferred brand 50% or more 50% up to max $150 $375 $120 $300

Change in Express Scripts formularyThe lists of drugs included and excluded from Express Scripts’ formulary will change in 2015. Please see the 2015 Express Scripts National Preferred Formulary, which includes both lists, available at www.express-scripts.com or by calling Express Scripts.

New Express Scripts preventive drug listThe list of drugs covered as preventive has been updated by Express Scripts to conform with guidelines set by the Department of Health and Human Services. See the updated Preventive Drug List at www.express-scripts.com.

Change in specialty drug pharmacyAs of Jan. 1, 2015, Express Scripts’ specialty drug pharmacy will change from CuraScript to Accredo®. Members with specialty drug prescriptions will receive a call and mailing before this change takes place.

Compound Management ProgramExpress Scripts is implementing a Compound Management Program. As of Jan. 1, 2015, certain compound drugs that

do not meet the program’s guidelines for inclusion will no longer be covered. If your compound drug will be excluded from coverage as of Jan. 1, Express Scripts will contact you prior to this change. Please contact Express Scripts for further information.  

Preventive use of certain breast cancer drugsIf a woman is prescribed tamoxifen, raloxifene or Soltamox (liquid form of tamoxifen) for primary prevention of breast cancer, these drugs may be covered as preventive with no deductible or coinsurance if the following conditions are met:

• Female gender

• Age 35 or older

• High risk for breast cancer

• No current or previous diagnosis of breast cancer

The woman’s physician must contact Express Scripts for coinsurance review. If the request is approved, the patient may be reimbursed for any deductible amount or coinsurance paid for the drugs listed above. Contact Express Scripts for more information.

Medical coverage

Certificates of Creditable Coverage will no longer be issued after December 31, 2014Under the Patient Protection and Affordable Care Act (PPACA), HIPAA Certificates of Creditable Coverage will

no longer be issued by Cigna as of Jan. 1, 2015. They are no longer needed because the Affordable Care Act prohibits insurers from limiting coverage for people with pre-existing conditions and because of the availability of health insurance exchanges.

Prescription drug changesNew per-script maximumsDue to the rising cost of prescription drugs, MassMutual’s prescription drug coverage per-script maximums will increase for the first time since 2011. These changes apply to those covered under MassMutual Medical Options 1 and 2 and the Hawaii PPO plan. Reminder: Per-script maximums apply only in the “coinsurance” phase of coverage. Once you meet your deductible in 2015, the following coinsurance schedule will apply:

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Increase in health savings account (HSA) contribution limits The Internal Revenue Service has raised the health savings account (HSA) annual contribution limits as follows:

IRS maximums apply to both your own HSA contributions and any company contributions you receive (such as wellness incentive dollars).

10 facts every HSA owner should knowBecause of their tax advantages, health savings accounts (HSAs) provide a valuable way to save on health care expenses now and in the future. The savings percentage will depend on your tax bracket, but for most people the savings are significant. (Generally, HSAs are available to those enrolled in a high-deductible health plan, such as MassMutual Medical Options 1 and 2. See page 3 of IRS Publication 969 for eligibility guidelines.)

Here are 10 things to know that can help you get the most from your Cigna Choice Fund® HSA.

1 | HSAs offer a triple tax advantage. Under federal tax law and in most states, your contributions are tax-free, your balance earns interest tax-free and your withdrawals for qualified expenses are tax-free, too. As long as you use it for qualified expenses, you never pay federal taxes on the money you contribute to your HSA. (While most states follow federal tax treatment of HSAs, Alabama, California and New Jersey tax HSA contributions.)

2 | There’s no use-it-or-lose-it rule. Unlike health care flexible spending accounts (FSAs), unused funds aren’t forfeited at the end of the year. Your balance can grow from year to year.

3 | You can contribute up to the IRS maximum every year that you’re enrolled in a high-deductible health plan. Both company contributions, such as wellness incentive dollars, and your contributions count toward the annual IRS maximum.

4 | Your HSA funds can be used for: • qualified medical, prescription, dental and vision

expenses now,

• certain qualified medical expenses in the future – including in retirement, and

• qualified long-term care insurance premiums.

5 | Your HSA belongs to you – and becomes part of your estate. Remember to name a beneficiary.

6 | You must be enrolled in a qualified high-deductible health plan (e.g., Option 1 or Option 2) to contribute to an HSA.

7 | You don’t need to be enrolled in a high-deductible health plan to use your HSA funds – which means you can use them in the future for qualified medical expenses. There’s no time limit on when reimbursements can be made for expenses incurred after the HSA was established. (Keep your receipts!)

8 | Deposits earn interest – tax-free interest. 9 | Balances of $2,000 or more can be invested in certain

designated funds. Investment earnings are also tax-free.

10 | You can change your contribution amount or timing at any time during the year. On or after Jan. 1, 2015, you can change your 2015 contribution amount or the pay periods that your contributions are made in by logging on to Employee Center. Click on “Enrollment Event,” choose “Health Savings Act” in the drop-down menu, and follow the system prompts.

Remember: Keep your receipts! You must be able to document that your withdrawals from your HSA were used for qualified medical expenses.

For information on HSA tax rules see IRS Publication 969. For qualified medical expenses, see IRS Publication 502.

IRS Annual Contribution Limits for HSAs

2015 2014

Individual $3,350 $3,300

Individual plus one or more dependents $6,650 $6,550

Catch-up for participants who turn age 55 or older in 2015 $1,000 $1,000

Health savings accounts (HSAs)

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Learn more about your HSA and eligibility requirements on myHR. Ayco AnswerLine® financial counselors can answer questions about HSAs and help you develop a savings strategy that considers both your current medical claims and future savings goals. Contact them on business days at 866-325-0092, 9 a.m. to 5 p.m., ET. Evening appointments are also available.

Six steps to figuring out your 2015 HSA contribution amount:

1. Start with your estimated 2014 health care expenses

2. Multiply by 1.05 (assumes a 5% increase in costs; you may choose another amount)

3. Add any additional contribution you wish to make for expected 2015 expenses – or for future years, including retirement

4. Subtract any Live Healthy, Live Well wellness incentives you expect to earn

5. Check the 2015 IRS maximum contribution limits to make sure you don’t exceed them; adjust accordingly

6. Divide by 24 pay periods and elect your 2015 contributions accordingly. (Dividing by 24 will spread your contributions evenly throughout the year; however, you may choose to contribute on a different schedule and may change them throughout the year)

Note: If your spouse has their own HSA, their contributions to their HSA may affect the amount you can contribute to your HSA. Consult your tax advisor.

New! Get free guidance on treatment optionsIn 2015, MassMutual is excited to introduce ConsumerMedicalTM – a new, free-to-you resource to help MassMutual medical option participants and their covered dependents navigate the health care system.

ConsumerMedical offers a variety of services to help you make informed decisions about medical treatments to lead to better outcomes. ConsumerMedical is unaffiliated with Cigna. An overview of their services:

Guided Patient Support (GPSTM) delivers confidential, comprehensive, and up-to-date information about any health topic. GPS can help you –

confirm whether the diagnosis you’ve been given is correct

understand your treatment options

get to leading doctors and hospitals for care

shop for the best quality care at the best price

build a strong support network

Surgery Decision Support provides specialized support for members whose doctors have recommended elective surgery for low back pain or weight loss, a hip or knee replacement, or a hysterectomy. This program offers a financial incentive to patients who engage with experienced ConsumerMedical representatives to learn about risks, benefits and alternative treatment options.

Remote Second Opinion provides free, timely and easily accessible expert second opinions from world-leading specialists.

Claims Advocacy Services helps members resolve health care access, claims and billing issues.

There’s no limit to the number of times a member may access ConsumerMedical services. We’ll tell you more about this new program as it rolls out in 2015.

Health Savings Accounts (HSAs)

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The right care at the right time: Know where to go

Health care setting Conditions treated* Cost & time

MDLIVE

MDLIVE provides immediate, on-demand 24/7/365 access to quality, non-emergency care through a national network of licensed, board-certified, U.S.-based doctors and pediatricians by video, phone or email.

• Allergies• Bronchitis• Common cold/flu• Fever• Gout

• Headache• Ear infection• Pink eye• Rashes or

skin conditions

• Low cost: $38 per consultation – and it’s an in-network expense so after deductible is met, cost is $3.80!

• No appointment needed – start on myCigna.com and click MDLIVE or call 888-726-3171 to register. Then speak to a doctor from anywhere.

• Wait times are typically less than 20 minutes.

Convenience Care Clinic

Usually located in retail stores and pharmacies and staffed by nurse practitioners and physician assistants. Treat minor medical concerns that are not life-threatening. They’re often open nights and weekends.

• Common cold/flu• Rashes or

skin conditions• Sore throat, earache,

sinus pain

• Minor cuts or burns• Pregnancy testing• Vaccinations

• Costs are same or lower than office visit.

• No appointment needed.• Wait times typically 15 minutes

or less.

Doctor’s Office

The best place to receive routine or preventive care, track medications, or get a referral to see a specialist.

• General health issues• Monitoring and

treatment of chronic conditions

• Preventive services

• Routine checkups• Immunizations and

screenings

• May include coinsurance and/or deductible.

• Appointment usually needed.• May have short wait time.

Urgent Care Center

For conditions that are not life-threatening. They’re staffed by nurses and doctors and usually have extended hours, including nights and weekends.

• Minor cuts, sprains, burns, rashes

• Fever and flu symptoms• Headaches• Chronic lower back pain

• Joint pain• Minor respiratory

symptoms• Urinary tract

infections

• Costs are lower than an ER visit.• No appointment needed.• Wait times vary.

Emergency Room (ER)

Open 24/7 for the immediate treatment of critical injuries or illness. If a situation seems life-threatening, call 911 or go to the nearest emergency room.

• Sudden numbness, weakness

• Uncontrolled bleeding• Seizure or loss of

consciousness• Shortness of breath• Chest pain

• Head injury/ major trauma

• Blurry or loss of vision

• Severe cuts or burns• Overdose

• Costs are highest.• No appointment needed.• Wait times may be long.

use the myCigna Mobile App, log on to myCigna.com or call Cigna at 800-548-3980, 24/7/365.

This chart can help you choose the right care at the right time – for the right price. To find a provider near you in a jiffy,

To find a specific health care facility or doctor, go to myCigna.com using any web-enabled device or use the myCigna Mobile App. Or, call Cigna at 800-548-3980. The listing of a health care professional or facility in the online directory does not guarantee that the services rendered by that professional or facility are covered under your specific medical plan. Check your summary plan description (available on SPD Source) for information about the services covered under your plan benefits. The information provided here is for informational purposes only. During a medical emergency, you should always visit the nearest hospital or call 911 for assistance.

*List is not all-inclusive

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The 2015 Live Healthy, Live Well program

Change is the essence of modern life. In 2015, the Live Healthy, Live Well program is adding two features to keep up with the changes – and help you do so as well.

The first new feature you’ll notice is ZenseySM. Zensey (zen-say) is a secure wellness website with a social network that’s designed to make health goals fun. Accessed through myCigna.com, Zensey offers opportunities to earn wellness incentive dollars by accruing “coins” through a variety of

individual and group goals. Several of these goals support popular mobile fitness apps.

While change can be energizing, at times it can challenge our inner resources. A new wellness incentive, “Personal Strength and Life Balance,” recognizes this and encourages participants to use resources to foster balance and resilience. We’ll talk more about this in the year ahead.

Most of the 2014 wellness incentives are being carried forward into 2015. Here’s a preview of the 2015 Live Healthy, Live Well program:

Wellness within – and fun along the way

Note: Live Healthy, Live Well is not available to Hawaii and Puerto Rico participants.

Live Healthy, Live Well 2015 program highlights

Important guidelinesEligibility for incentives

To be eligible, you must be enrolled in a MassMutual medical option and be in active service both when you complete and report the activi-ties and when wellness incentive dollars are deposited into your health savings account.

If you cover a spouse or domestic partner…

He or she may also participate.

Health assessment

Between Jan. 1 and Oct. 15, 2015, you and your covered spouse or domestic partner must complete a health assessment on myCigna.com. (Required before any wellness incentive dollars will be awarded for your incentive activities.)

2015 incentive maximum

• $500 if you participate

• $500 if your covered spouse/domestic partner participates

• … for a total of up to $1,000 if you both participate

It’s confidential

• Your health assessment and all other personal health information pertaining to the Live Healthy, Live Well program is confidential.

• MassMutual complies with federal laws prohibiting it from access-ing personal health information obtained by Cigna, the company that administers MassMutual’s medical plan and wellness program.

Deadline: Oct. 15, 2015

All health assessments, program activity results and alternative standards must be completed and received by Cigna no later than 11:59 p.m., ET, on Oct. 15, 2015.

Incentive GoalsBlood Pressure: Earn $150 when you or your covered spouse or domestic partner achieves a verified blood pressure of 139/89 or less.

Body Mass Index (BMI): Earn $150 when you or your covered spouse or domestic partner achieves a verified BMI of less than 30 or verified weight loss of 5%.

Physical Activity: Earn $100 per month for up to two months when you or your covered spouse or domestic partner completes 150 minutes of physical activity each week for four consecutive weeks.

Earn 500 Coins with Zensey: Earn $150 in wellness incentive dollars when you “cash in” Zensey “coins” earned through fun individual or group wellness activities. (More details in January!)

Colon Cancer Screening: Earn $200 if you or your covered spouse or domestic partner completes an age-appropriate colon cancer screen-ing (if eligible).

Personal Strength and Life Balance: Earn $150 by working with a health coach, EAP network counselor or other licensed counselor on any personal issue, or by devoting a total of 60 minutes a week to a relaxation, yoga or meditation practice for four consecutive weeks.

Healthy Pregnancies, Healthy Babies: Earn $200 or $100, depend-ing on trimester when starting program, when you or your eligible spouse or domestic partner completes the Healthy Pregnancies, Healthy Babies program.Alternative standards

• If you’re unable to meet the requirements of the blood pressure and/or BMI incentive, first submit a verified blood pressure or BMI to Cigna, then talk to a Cigna health coach at 800-548-3980 about how to meet an alternative standard.

• If you’re unable to meet the requirements of the physical activity incentive, you may meet an alternative standard determined by your doctor. Contact Cigna for details.

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This section of dental coverage information represents a Summary of Material Modifications (SMM) for the MassMutual Employee Welfare Benefits Plan Dental Summary Plan Description for Employees, effective Jan. 1, 2014.

MassMutual offers Basic and Major dental options administered by Cigna Dental.

Effective January 1, 2015, Cigna Dental will be moving to a single preferred provider organization. This network, Total Cigna DPPO, will incorporate all of their contracted providers as in-network providers.

What does this mean to you? If your dental provider is part of Cigna Radius (the dental option’s current network), he or she will continue to be an in-network provider as part of Total Cigna DPPO, but “Radius” will no longer be the network’s name. In addition, some providers who were not previously part of the Radius network will now be part of Total Cigna DPPO. This provides MassMutual dental option members with more choices for in-network care.

Dental providers in the Total Cigna DPPO network will always charge at or below the maximum reimbursable charge (MRC) (see page 4).

Oral health is overall health – and prevention is key. Each year, Cigna Dental members can receive two preventive visits covered at 100% up to MRC. (If you’re pregnant, you can receive a third preventive visit covered at 100% up to MRC. Contact Cigna for details.) Schedule your and your family’s preventive visits in advance to make the most of this benefit.

Reminder: You will not receive a dental card. Bring a copy of the Dental Claim Form to the dentist with you, or, if you have MassMutual medical coverage, use your Cigna medical ID card.

To learn more about dental coverage, visit the dental topic on myHR or read your summary plan description. For questions about your dental options, call Cigna at 800-548-3980 or visit myCigna.com.

See page 20 for rates.

Dental coverage

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Dental options coverage chart

Deductible – The amount you pay each year before the plan pays any benefits

Per individual $75

Per family $225

Services Basic Dental Major Dental

Preventive and Diagnostic Care (Type I)

Oral exams (twice per year), cleanings (two per year; may be spaced less than six months apart), two periodontal cleanings within 12 months of periodontal work, fluoride treatment (twice per year for persons younger than age 19), routine exams, sealants (for a person younger than 18 years old, one treatment per tooth per every three calendar years), space maintainers, x-rays

You pay $0 in network plus any amount over maximum reimbursable charge (MRC) (no deductible)

Plan pays 100% up to MRC

You pay $0 in network plus any amount over MRC (no deductible)

Plan pays 100% up to MRC

Basic Restorative Care (Type II)

Anesthesia, extractions, fillings (amalgam, acrylic, porcelain, composite, or silicate), oral surgery, root canal, bite guards, periodontal root scaling and planing, bridge and crown repairs, dentures (adjustments, repairs, relining, rebasing more than 6 months after installation), injection of antibiotics

After deductible, you pay 20% of the charges plus any amount over MRC

Plan pays 80% up to MRC

After deductible, you pay 20% of the charges plus any amount over MRC

Plan pays 80% up to MRC

Major Restorative Care (Type III)

Bridgework, crowns, dentures, gold fillings, inlays, onlays, periodontics, devices for TMJ (temporomandibular joint), prosthetics, orthodontic appliances, implants

Not covered After deductible, you pay 50% of charges plus any amount over MRC

Plan pays 50% up to MRC

Orthodontia (Type IV)

Orthodontia

Not covered You pay 50% of charges plus any amount over MRC (no deductible; $2,000 per person lifetime maximum)

Plan pays 50% up to MRC

Maximums

Calendar year per-person dental services $1,500 $2,000

Lifetime orthodontia, per person Not covered $2,000

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MassMutual’s vision coverage (administered by EyeMed) offers an array of benefits for you and your eligible dependents. There are no changes in the vision option for 2015. You can receive services from any vision provider. If you receive services from a vision provider who’s part of EyeMed’s Select network, it may cost you less than using an out-of-network provider.

To learn more about vision coverage, visit the vision topic on myHR or read your summary plan description. For questions about the vision option, call EyeMed at 877-217-2539 or visit www.eyemedvisioncare.com.

See page 20 for rates.

Vision coverage

In-Network Member CostOut-of-Network Reimbursement(claim form required)

Exams – Once every calendar yearExam $15 Up to $65Contact lens fit and follow-up Standard Up to $40 N/AContact lens fit and follow-up Premium 10% off retail price N/ARetinal imaging Up to a $39 copay N/AFrames – Once every calendar year 1

Frame $0 if $130 or less plus 80% of the balance over $130, if any Up to $75Lenses – Once every calendar year1

Single Vision $15 copay Up to $75Bi-focal $15 copay Up to $85Tri-focal $15 copay Up to $95Standard Progressives $80 copay Up to $95

Premium Progressives$80 copayPlus 80% of any retail chargeMinus a $120 allowance

Up to $95

Lenticular $15 copay Up to $115Lens OptionsTints $15 copay N/AUV Coating $15 copay N/AStandard Scratch Resistance $0 copay $12Standard Polycarbonate $40 copay N/AStandard Anti-reflective Coating $45 copay N/AOther Lens Options 20% off retail price N/AContact Lenses – Once every calendar year1

Contact Lens – Conventional $0 if $130 or less, plus 85% of the balance over $130, if any Up to $125Contact Lens – Disposable $0 if $130 or less, plus 100% of the balance over $130, if any Up to $125Medically Necessary Contacts Plan pays 100% Up to $200Laser Surgery – Call 877-5LASER6 for nearest facility and authorization for discountLASIK

15% off retail price or 5% off promotional pricing N/APRK Correction Procedures

Vision coverage chart

1 Participants cannot get eyeglasses and contacts in the same calendar year.

https://mx.massmutual.com/_layouts/MassMutualSP.ApplicationPage.AuthoriaSSO/AuthoriaSSO.aspx?authoriapage=User_homehttps://mx.massmutual.com/_layouts/MassMutualSP.ApplicationPage.AuthoriaSSO/AuthoriaSSO.aspx?authoriapage=SPDhttp://www.eyemedvisioncare.com

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With a heath care flexible spending account (FSA), you can set aside between $120 and $2,500 in before-tax income for qualified out-of-pocket health care expenses. The funds are deducted in installments from your pay throughout the year. However, you have access to the full amount of your election at the beginning of the plan year. You may use the My Care Card® Visa to pay at point of service, or you may pay out of pocket and apply for reimbursement. MassMutual’s health care FSA is administered by Benefit Concepts.

Health care FSAs may be “full-use” – for eligible medical, dental and vision expenses, or “limited-use” – for vision and dental expenses only. Due to tax laws, contributing to a health savings account (HSA) makes you ineligible for a full-use FSA.

If you elect a health care FSA, you’ll automatically be enrolled in a limited-use FSA unless you attest in the enrollment portal that you are enrolled in Medicare or have recently used Veterans Affairs benefits. If you have “Other health coverage” as defined in IRS Publication 969 that makes you ineligible to contribute to an HSA (for example, Tricare), you may be eligible for a full-use FSA. Contact MassMutual Benefits for more information.

Reminders:• Health care FSA funds not used for qualified health

expenses by Dec. 31, 2015 are forfeited (the IRS “use-it-or-lose it” rule).

• If you don’t wish to change your election: Your 2014 election will be carried forward automatically to 2015 unless you elect otherwise.

• To change your election: You must make an election during annual benefits enrollment.

• The “limited-use” or “full-use” feature of your FSA cannot be changed mid-year for any reason.

Health care flexible spending accounts (FSAs)

Important tax information

Save your receipts! Benefit Concepts will ask for itemized receipts to prove that you used your My Care Card® Visa for qualified expenses. (For qualified health care expenses, see IRS Publication 502.) Similarly, when you pay out of pocket and submit your claim for reimbursement from Benefit Concepts, you must provide a receipt along with a reimbursement request form. If you don’t substantiate your expenses by March 31 following the end of the plan year, any unsubstantiated expenses will be taxed retroactively. MassMutual will deduct the taxable portion of any unsubstantiated expenses from your pay.

http://benecontent.massmutual.com/FORMS/HSA_OtherHealthCvg.pdfhttp://benecontent.massmutual.com/FORMS/HSA_OtherHealthCvg.pdfhttp://www.irs.gov/pub/irs-pdf/p969.pdfhttp://www.irs.gov/pub/irs-pdf/p502.pdf

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This section of life insurance coverage information represents a Summary of Material Modifications (SMM) for the MassMutual Employee Welfare Benefits Plan Group Term Life, Business Travel Accident and Group Variable Universal Life Insurance Options Summary Plan Description for Employees and Retired Employees of MassMutual, effective Jan. 1, 2014. The following changes are effective Jan. 1, 2015:

Effective Jan. 1, 2015, the requirement to carry a specific minimum amount of Basic Life coverage will no longer apply for Dependent Life option 2.

As a reminder, for Supplemental Life and Dependent Life, the cost per thousand dollars of coverage is based on

your age and increases at certain intervals. See a chart of Age-Based Rates for Supplemental Life and Dependent Life Insurance Coverage, available on the Group Term Life and Dependent Life topics on myHR.

In addition, as of January 1, 2015, Group Variable Universal Life’s (GVUL) guidelines for mid-year qualifying events will be the same as for all other MassMutual benefit plans. Subscribers will be able to make changes to GVUL coverage within 90 days of the birth, adoption or placement for adoption of a child. For all other mid-year qualifying events, the time period remains 30 days following the event.

Life insurance coverage changes and reminders

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 MassMutual-sponsored health coverage, 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 who also have access to health insurance through a company-sponsored plan. If you or your children are not eligible for Medicaid or CHIP, you will not 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, 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 either contact your state Medicaid or CHIP office at 877-KIDS-NOW or go to 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 a company-sponsored plan.

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as under a company plan, your company’s health plan is required to permit you and your dependents to enroll in the plan if you and your dependents 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 the company-sponsored plan, you can contact the Department of Labor electronically at www.askebsa.dol.gov or by calling toll-free 866-444-EBSA (3272).

http://benecontent.massmutual.com/FORMS/GTLratesEE.pdfhttp://benecontent.massmutual.com/FORMS/GTLratesEE.pdfhttps://mx.massmutual.com/_layouts/MassMutualSP.ApplicationPage.AuthoriaSSO/AuthoriaSSO.aspx?authoriapage=User_homehttp://www.healthcare.gov/http://www.askebsa.dol.gov/

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KANSAS – MedicaidWebsite: www.kdheks.gov/hcf Phone: 800-792-4884

KENTUCKY – MedicaidWebsite: http://chfs.ky.gov/dms/default.htm Phone: 800-635-2570

LOUISIANA – MedicaidWebsite: www.lahipp.dhh.louisiana.gov Phone: 888-695-2447

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

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

MINNESOTA – MedicaidWebsite: www.dhs.state.mn.us Click on Health Care, then Medical Assistance Phone: 800-657-3629

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

MONTANA – MedicaidWebsite: http://medicaidprovider.hhs.mt.gov/clientpages/clientindex.shtml Phone: 800-694-3084

NEBRASKA – MedicaidWebsite: www.ACCESSNebraska.ne.gov Phone: 855-632-7633

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

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

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

ALABAMA – MedicaidWebsite: www.medicaid.alabama.gov Phone: 855-692-5447

ALASKA – MedicaidWebsite: http://health.hss.state.ak.us/dpa/programs/medicaid/ Phone (Outside of Anchorage): 888-318-8890 Phone (Anchorage): 907-269-6529

ARIZONA – CHIPWebsite: www.azahcccs.gov/applicants Phone (Outside of Maricopa County): 877-764-5437 Phone (Maricopa County): 602-417-5437

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

FLORIDA – MedicaidWebsite: www.flmedicaidtplrecovery.com/ Phone: 877-357-3268

GEORGIA – MedicaidWebsite: http://dch.georgia.gov Click on Programs, then Medicaid, then Health Insurance Premium Payment (HIPP) Phone: 800-869-1150

IDAHO – MedicaidMedicaid Website: http://healthandwelfare.idaho.gov/Medical/Medicaid/PremiumAssistance/tabid/1510/Default.aspx Medicaid Phone: 800-926-2588

INDIANA – MedicaidWebsite: www.in.gov/fssa Phone: 800-889-9949

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

Medicaid and CHIP Notice

If you live in one of the following states, you may be eligible for assistance paying your company-sponsored health plan premiums. The following list of states is current as of July 31, 2014. Contact your state for further information on eligibility.

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Note: The contact information above was listed by the U.S. Department of Labor as current as of July 31, 2014. For up-to-date contact information, to find out if any other states have added a premium assistance program since that date, or for more information on special enrollment rights, contact either:

TEXAS – MedicaidWebsite: www.gethipptexas.com Phone: 800-440-0493

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

VERMONT– MedicaidWebsite: www.greenmountaincare.org Phone: 800-250-8427

VIRGINIA – Medicaid and CHIPMedicaid Website: www.coverva.org/programs_premium_assistance.cfm Medicaid Phone: 800-432-5924 CHIP Website: www.coverva.org/programs_premium_assistance.cfm CHIP Phone: 855-242-8282

WASHINGTON – MedicaidWebsite: www.hca.wa.gov/medicaid/premiumpymt/pages/index.aspx Phone: 800-562-3022 Ext. 15473

WEST VIRGINIA – MedicaidWebsite: www.dhhr.wv.gov/bms Phone: 877-598-5820, HMS Third Party Liability

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

WYOMING – MedicaidWebsite: http://health.wyo.gov/default.aspx Phone: 307-777-7531

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

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

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

OKLAHOMA – Medicaid and CHIPWebsite: www.insureoklahoma.org Phone: 888-365-3742

OREGON – Medicaid Website: www.oregonhealthykids.gov www.hijossaludablesoregon.gov Phone: 800-699-9075

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

RHODE ISLAND – MedicaidWebsite: www.eohhs.ri.gov Phone: 401-462-5300

SOUTH CAROLINA – MedicaidWebsite: www.scdhhs.gov Phone: 888-549-0820

SOUTH DAKOTA - MedicaidWebsite: http://dss.sd.gov Phone: 888-828-0059

Medicaid and CHIP Notice

U.S. Department of Labor Employee Benefits Security Administration

www.dol.gov/ebsa

866-444-EBSA (3272)

U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services

www.cms.hhs.gov

877-267-2323, menu option 4, Ext. 61565

OMB Control Number 1210-0137 (expires 10/31/2016)

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Annual remindersFor information about our integrated health and wellness program and other benefits and programs, please visit myHR.

Making benefit changes after annual benefits enrollmentAnnual benefits enrollment is the only time during the year that you can make changes to your benefits without a mid-year qualifying event. A mid-year qualifying event is a life event that affects your need for benefits coverage – for instance, getting married, divorced, having a baby, adopting a child, or losing or gaining coverage due to a change in your spouse or domestic partner’s employment. (This is not a complete list. Call MassMutual Benefits or go to myHR for more information.) Please note that depending on the type of life event, you may not be permitted to change the medical option you elected during annual benefits enrollment through a mid-year qualifying event.

If you experience a mid-year qualifying event, you must notify MassMutual, provide required documentation and complete the changes to your coverage online within 30 days of the event. For birth, adoption, or placement for adoption, you have 90 days from the event.

Notify MassMutual right away about your event so you can find out what documentation to provide and what action steps need to be taken to modify your coverage. Any changes must be consistent with and on account of your mid-year qualifying event.

When a dependent becomes ineligible for the plan (e.g., divorce, termination of domestic partnership), please inform MassMutual as soon as possible – and no later than 30 days after the event. Coverage termination will be effective as of the date of the event. The affected dependent has 60 days from the date of the event to elect COBRA continuation coverage.

Emergency coverage outside of United StatesMassMutual health options cover only emergency services outside of the United States. If emergency care is needed, pay out of pocket, obtain an itemized receipt, and submit your claim to Cigna. Primary and routine care is not covered outside the U.S.

Mastectomy-related services are coveredMassMutual’s medical plans, as required by the Women’s Health and Cancer Rights Act of 1998, provide benefits for mastectomy-related services including reconstruction and surgery to achieve symmetry between the breasts, prostheses, and complications resulting from a mastectomy, including lymphedema. For details, contact Cigna at 800-548-3980.

Call Cigna’s 24-hour nurse lineHave a question you’d like to ask a nurse? Call Cigna at 800-548-3980 and say, “24-hour nurse line” for answers to basic medical questions and help deciding if you need to seek further care.

MDLIVE – 24/7 access to a doctor!MassMutual medical plan participants may consult with a doctor for non-emergency care by phone (video conference also available with certain providers). At $38 per session, MDLIVE provides 24/7/365 access to a national network of licensed, board-certified, U.S.-based doctors and pediatricians. The fee applies to your deductible and out-of-pocket maximum. Note: Hawaii participants will pay the PCP copay. MDLIVE isn’t available to Puerto Rico participants. To access MDLIVE, log on to myCigna.com or call 888-726-3171.

https://mx.massmutual.com/_layouts/MassMutualSP.ApplicationPage.AuthoriaSSO/AuthoriaSSO.aspx?authoriapage=User_homehttps://mx.massmutual.com/_layouts/MassMutualSP.ApplicationPage.AuthoriaSSO/AuthoriaSSO.aspx?authoriapage=User_homehttp://www.mycigna.com/

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Have financial questions?Ayco AnswerLine® financial counselors can provide assistance as you make decisions about retirement savings, debt management, budgeting, saving for college and much more. Call today at 866-325-0092 (Hearing impaired: TTY 800-437-6380). The Ayco AnswerLine® is free and available to both you and your spouse or domestic partner. MassMutual pays for your access to Ayco whether you use it or not – so please use it!

• Call 866-325-0092, Monday – Friday, 9 a.m. – 5 p.m., ET; evening appointments available Monday – Thursday until 8 p.m., ET

• Want a counselor to contact you? Email Ayco at appointments@ayco.com with the times you’re available

• Or go to the Aycofn® website for web-based tools

ID and debit cardsIf you’re continuing enrollment in any benefit options with ID or debit cards, keep and use your current card(s). There’s often a fee for replacement cards.

If you’re newly electing any of the following benefits, you’ll receive cards at your home address:

• MassMutual medical options – Cigna medical ID; Express Scripts prescription ID

• Vision – EyeMed ID• Health care flexible spending account (FSA) – My

Care Card® Visa debit card from Benefit Concepts

• Cigna Choice Fund® HSA – Debit card

There’s no dental ID card. See page 10.

Group Variable Universal Life (GVUL) insurance coverage is not part of annual benefits enrollmentIf you’re an officer or an employee earning $100,000 or more in base pay as of Sept. 1, 2014, your group life insurance effective Jan. 1, 2015 will be through GVUL, not Group Term Life. Although the enrollment periods overlap, GVUL has a separate enrollment process and portal from general annual benefits enrollment. If you’re newly eligible, you’ll receive a packet of information from MassMutual Executive Group Life and will need to complete an online GVUL enrollment by Nov. 18. Contact MassMutual Executive Group Life for more information.

Your confidential Employee Assistance Program (EAP) is just a phone call awayThis free resource is available to you and every member of your household, whether or not you’re enrolled in any other MassMutual benefits. The EAP can help you with a range of personal, relationship and work/life balance issues in a variety of ways.

• An advocate is ready 24/7 to help assess your needs and help resolve your concerns. He or she can also direct you to resources in your community and to online tools.

• You and each of your household members can receive up to six free face-to-face counseling sessions per issue per year with a Cigna EAP network provider. Call the EAP or go to their website to request preauthorization and a list of participating providers in your area.

• Call for advice or a referral to a service in your community for legal issues, support for parents and caregivers, eldercare, identity theft, child care, contractors and pet care.

MassMutual provides EAP services through Cigna free of charge to help you live a better and more balanced life. The EAP is confidential to the full extent of the law. No one at MassMutual will know you contacted the EAP unless you choose to tell them.

• Call 800-548-3980 and say “Employee Assistance Program” to be connected with an advocate.

• Visit www.CignaBehavioral.com (company ID: mmfgroup) for additional resources.

Annual reminders

mailto:appointments%40ayco.com?subject=https://mmfgonlineep6.massmutual.com/irj/servlet/prt/portal/prtroot/mm.com.mm.ebs.aycoforward.DoRedirecthttp://apps.cignabehavioral.com/web/websecurity/EntryPoint?empcode=mmfgroup

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If you’ll turn age 65 in 2015 and maintain active service, here’s how it affects your benefits:

• MassMutual will continue to be the primary payer for your (and your covered dependents’) medical expenses, even though you (or your dependent) are eligible for Medicare.

• If you enroll in Medicare, you’ll no longer be eligible to contribute to a health savings account (HSA). It’s your responsibility to end your contributions. If your dependent enrolls in Medicare and you do not, you may still be eligible to contribute to an HSA up to applicable IRS annual limits.

• If you’re enrolled in Medicare, you’ll be eligible to contribute to a “full-use” health care flexible spending account (FSA) in 2015 (see page 13).

• Waiver of premium for group term life or group variable universal life is not available for disabilities that begin on or after age 65.

• If you have group term life insurance through MassMutual, tax on imputed income on group term life amounts in excess of $50,000 increases sharply and applies for the full year in which you turn age 65. Imputed income does not apply to group term life insurance amounts at or below $50,000. (See pages 5 -7 of IRS Publication 525 for more information on tax rules governing your group term life insurance.) If you want to avoid imputed income by adjusting your group term life insurance coverage to basic coverage or to a flat $50,000, please do so as part of annual benefits enrollment. Contact MassMutual Benefits for more information.

Automatic adjustments for salary increases occur during the calendar yearIf you receive a salary increase during the year, your group term life insurance coverage will automatically increase to account for it. Your per-paycheck costs will increase as well. Your salary-based contributions for medical coverage are determined differently: they’re based on your base salary as of October 1, 2014. They’ll remain the same throughout 2015, regardless of whether you receive a salary increase. Increased contributions for medical coverage based on a salary increase take effect the following January 1. (For Variable Incentive Compensation Plan employees, these adjustments are based on base salary plus variable incentive compensation.)

Health coverage assistance is available for children and familiesIf you’re eligible for company-sponsored health coverage, but unable to afford the premiums, some states have premium assistance programs that can help pay for coverage. Refer to the Medicaid and CHIP Notice on page 14 for more information.

Annual reminders

http://www.irs.gov/pub/irs-pdf/p525.pdf

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IndividualIndividual plus Spouse

or Domestic Partner Individual plus Children FamilyMedicalCigna HDHP – Option 1

Pay b

and1 < $50,000 $50,000 – $99,999

$100,000 – $149,999 $150,000 – $249,999

≥ $250,000

46.1152.8459.8767.1874.78

101.45116.25131.70147.79164.52

92.22105.68119.73134.36149.57

142.95163.81185.58208.26231.83

Cigna HDHP – Option 2

Pay b

and1 < $50,000 $50,000 – $99,999

$100,000 – $149,999 $150,000 – $249,999

≥ $250,000

1.296.52

11.8517.2722.79

2.8414.3426.0637.9950.14

2.5813.0423.7034.5445.58

4.0120.2136.7353.5370.65

Hawaii – PPO2 < $50,000

$50,000 – $99,999 $100,000 – $149,999 $150,000 – $249,999

≥ $250,000

63.6869.4875.4281.4287.52

140.09152.86165.91179.14192.55

127.35138.96150.83162.85175.04

197.40215.40233.78252.42271.32

Puerto Rico – MCS3

< $50,000 $50,000 – $99,999

$100,000 – $149,999 $150,000 – $249,999

≥ $250,000

22.2029.0335.8542.6849.51

44.3958.0571.7085.3699.02

44.3958.0571.7085.3699.02

55.4872.5589.63

106.70123.77

Tobacco-use Surcharge4 (annual) $400.00 $800.00 $800.00 $1,200.00DentalCigna – Basic $4.30 $9.46 $8.60 $13.33Cigna – Major $9.27 $20.39 $18.54 $28.73VisionEyeMed $2.70 $5.94 $5.40 $8.36

Available coverage levels

1 Your annual base salary as of Oct. 1 each year (or your hire date, if later) is used to determine medical premiums for the following year. If you’re eligible for the Variable Incentive Compensation Plan (VICP), your incentive compensation earned from September through August will be added to your annual base salary. If you’re a part-time or hourly employee, your annual base salary will be based on a 40-hour work week, excluding overtime.

2 Available only to residents of Hawaii.3 Available only to residents of Puerto Rico. Also includes dental and life insurance coverage.4 Add this amount to your annual cost if you or any of your covered dependents uses tobacco products. For the purposes of this surcharge, “tobacco use”

includes the use of any of the following products: cigarettes, e-cigarettes, pipes, cigars, snuff, chew, and any other product not listed here that contains tobacco. You can access national online self-help programs by calling 800-Quit-Now or visiting Smokefree.gov. In addition, a Cigna health coach can provide you or your covered dependents with free nicotine replacement patches and one-on-one telephonic support to help you identify barriers, form a plan, and take action toward becoming tobacco-free. Call 800-548-3980 to get started.

The following 2015 rates apply to the health benefit options available to eligible MassMutual employees. Rates shown are the amounts deducted each pay period (there are 26 periods per year).

Note: 2015 medical rates include a reinsurance fee levied on plan sponsors as part of the Patient Protection and Affordable Care Act of $44 per covered life. (In 2014, the fee was $63 per covered life.)

Benefit rates

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Contacts

Resource Contact with questions about Online/Email TelephoneAyco Financial Network

• Anything related to your finances, including budgeting, saving for retirement, saving for a child’s education, HSAs and other financial counseling questions

www.aycofn.com 866-325-0092 business days between 9 a.m. and 5 p.m., ET, or call for an appointment

Benefit Concepts

• Retiree Health Reimbursement Arrangement (RHRA)• Dependent care or health care flexible spending accounts

(FSAs), including qualified expenses• New or replacement FSA card (fee for replaced cards)• COBRA

https://mybenefits.benefitconcepts.com 866-629-6350

Cigna • Medical and dental coverage – what’s covered, what’s not• Preventive care• In-network providers and services• Annual deductible and out-of-pocket maximum• Explanation of Benefits (EOB)• Live Healthy, Live Well and wellness incentive activities• 24-hour nurse line, health coaching and disease management• Employee Assistance Program (EAP)• New or replacement ID cards (N/A for dental; no card needed)

www.myCigna.com 800-548-3980 24/7/365

Ernst & Young • Health care marketplace application process MassMutual.Marketplace@ey.com 855-901-1222

Express Scripts • Prescription drug coverage and preventive prescriptions – what’s covered, what’s not

• Annual deductible and out-of-pocket maximum• In-network pharmacies and mail order pharmacy• Step therapy• New or replacement ID cards

www.express-scripts.com 866-219-1933 24/7/365

Accredo, Express Scripts’ specialty pharmacy: 800-803-2523 (as of 1/1/2015)

EyeMed • Vision coverage – what’s covered, what’s not• In-network providers and services• New or replacement ID cards

www.eyemedvisioncare.com 877-217-2539

Internal Revenue Service

• Health savings accounts (HSAs) www.IRS.gov 800-829-1040 Mon. – Fri., 7 a.m. –10 p.m.

JPMorgan Chase

• Health savings account (HSA) details, including qualified medical expenses

• New or replacement HSA debit cards (fee)• Excess contribution forms

www.myCigna.com

Select “Review My Coverage” then “Health Savings Account”

866-524-2483

Liberty Mutual • Short- and long-term disability benefits and claim process

• FMLA benefits and claim process

www.MyLibertyConnection.com

(Company code: “MassMutual”)

888-408-7300

MassMutual Benefits

• General benefit questions, including benefit changes due to a mid-year qualifying event

• Group term life and dependent life questions• Excess Pension Plan questions

https://mmfgonline.massmutual.com (select “myHR”)

BenefitQuestions@MassMutual.com

866-662-6448 or Ext. 46169, 10 a.m. – 4 p.m. on business days

MassMutual Executive Group Life

• Questions about Group Variable Universal Life Insurance (GVUL) LCMClientServices@MassMutual.com

Newly eligible: EGL@MassMutual.com

800-548-0073, prompt 1. Then, choose prompt 2 for coverage and product questions or prompt 3 for online enrollment questions.

MassMutual Retirement Services

• Thrift Plan/401(k) contributions, funds and benefits• Pension Plan benefits

www.RetireSmart.com 800-743-5274 8 a.m. – 9 p.m., ET

The Newport Group

• Nonqualified deferred compensation contributions, funds and benefits

www.plandestination.com

support@plandestination.com

800-230-3950 8 a.m. – 8 p.m., ET

Your Personal Tax Advisor

• Advice on how to maximize your MassMutual benefits and health savings account, if applicable

Contact your personal tax advisor directly.

https://mmfgonlineep6.massmutual.com/irj/servlet/prt/portal/prtroot/mm.com.mm.ebs.aycoforward.DoRedirecthttps://mybenefits.benefitconcepts.com/http://www.mycigna.com/mailto:MassMutual.Marketplace%40ey.com?subject=http://www.express-scripts.comhttp://www.eyemedvisioncare.comhttp://www.IRS.govhttp://www.mycigna.com/http://www.MyLibertyConnection.comhttps://mmfgonline.massmutual.commailto:BenefitQuestions%40MassMutual.com?subject=mailto:LCMClientServices%40MassMutual.com?subject=mailto:EGL%40MassMutual.com?subject=http://www.RetireSmart.comhttps://www.plandestination.com/mailto:support%40plandestination.com?subject=

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Step 1 Click here, or, on the MassMutual network, go to Mutual Exchange (MX). Under, “I need to…,” choose “Access Employee Tools” to get to Employee Center.

Step 2 From Employee Center, click on Enrollment Event under the ‘Benefits’ heading.

Step 3 Below ‘Select the appropriate enrollment event below,’ select 2015 Enrollment from the drop-down menu and click Enter.

Step 4 From the Research Benefits page, click the links on the right side of the screen to research your options. Worksheet shows all your available options and costs. When you click on any of the research links, they’ll pop up in another window and won’t disturb your enrollment process. Close any new windows to return to the enrollment portal.

Step 5 Click Start Enrollment Process.

Step 6 You will be prompted to Maintain Dependents/Beneficiaries. Make any adjustments by selecting add or edit. If you’re married, certify that you’re legally married by checking the box at the bottom of the screen. Verify that all information is correct.

If you’re adding a new dependent to your coverage during annual benefits enrollment:

• Be sure you add your dependent as part of your 2015 Enrollment (rather than as a separate “enrollment event”) and complete the annual benefits enrollment process in order to connect them to your coverage.

• Enter your dependent’s name, date of birth and Social Security number (SSN) or Individual Taxpayer Identification Number (ITIN).

• After adding a dependent, you must provide documentation to MassMutual Benefits upon request (e.g., birth certificate for a child).

You can’t delete a dependent (historical information must be maintained), but you can have some historical information hidden from your view. Contact MassMutual Benefits at Ext. 46169 or 866-662-6448 or email BenefitQuestions@MassMutual.com for more information.

Step 7 If you plan to enroll in medical coverage, confirm the Health Partnership Acknowledgement and attest to your and your dependents’ tobacco use status.

Step 8 Follow the on-screen directions to continue your enrollment process.

Step 9 In the Savings Account Setup section, enter the total amount you want deducted from your pay to be deposited into your health savings account (HSA), and the number of pay periods for that deduction (e.g., $100 per pay statement, for 24 pay periods). Note: Your HSA election from 2014 will not carry forward. You must elect an amount for 2015. Acknowledge that you have read and understand the HSA/FSA disclosures.

If you don’t already have an HSA, the system may ask you if you want to set up an account. To enable before-tax contributions to be automatically deducted from your pay, MassMutual must facilitate the opening of your HSA. Click I accept to allow this.

Step 10 Review your selections and click I Accept. You’ve completed the online enrollment process. Print a Confirmation Form for your records. You may need to take additional action before your enrollment is complete. For example, if you elect to cover a domestic partner, you must provide MassMutual Benefits with a Domestic Partner Affidavit, available in the enrollment portal as well as on myHR. Important: If you were hired or had a mid-year qualifying event after Sept. 2, 2014, you’ll need to complete two separate enrollments (2014 and 2015).

Step 11 Review your printed Confirmation Form for accuracy. Make sure that any dependents you want covered are listed on the form. If you need to make any adjustments to your elections, please do so prior to the end of the annual benefits enrollment period.

Enrollment instructions

• For technical assistance, including browser compatibility issues, call IT Customer Service at Ext. 44357 or 800-767-1000, Ext. 44357.

• For questions about your benefits, contact MassMutual Benefits at 866-662-6448 or internally at Ext. 46169.

• Use only the back button within the enrollment application. Don’t use your browser’s back button.

• If enrolling from home, log on to https://mmfgonlineep6.massmutual.com/irj/portal/beneenroll (use your MM number and the same password you use to log on to your work computer).

• For password resets, use the PRESTO – The Password Reset Tool.

Enrollment instructionsEnroll online for your 2015 benefits by 11:59 p.m., ET on Nov. 18, 2014. Elections are effective Jan. 1, 2015.

https://mmfgonlineep6.massmutual.com/irj/portal/beneenrollmailto:BenefitQuestions%40MassMutual.com?subject=https://mx.massmutual.com/_layouts/MassMutualSP.ApplicationPage.AuthoriaSSO/AuthoriaSSO.aspx?authoriapage=User_homehttps://mmfgonlineep6.massmutual.com/irj/portal/beneenrollhttps://mmfgonlineep6.massmutual.com/irj/portal/beneenrollhttps://presto.massmutual.com/ResetPWhttps://presto.massmutual.com/ResetPW

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AskALEX!

ALEX is a smart, funny benefits expert who explains your benefit options and helps you choose what’s best for you.

Visit at www.alexformassmutual.com/2015/employees during annual benefits enrollment, Nov. 4 – 18!

ALEX® logo and characters used with permission.

http://www.alexformassmutual.com/2015/employees

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