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Effective Date 1/1/10 Your Guide to the JPMorgan Chase Expatriate Medical and Dental Plan Options 1

Your Guide to the JPMorgan Chase Expatriate Medical and Dental Plan Options JPMorgan Chase offers a variety of benefits plan options to expatriate employees. Your eligibility for benefits depends on your expatriate group:

If You Are a… You Are Eligible for… U.S. Home-Based Expatriate All U.S. benefits Health and Income Protection

Plans, except for the U.S. Medical and Dental Plan options, and the Transportation Spending Accounts

The Expatriate Medical Plan and Dental Plan options

Non-U.S. Home-Based Expatriate Assigned to the United States

The Vision Plan, Spending Accounts (Health Care, Child/Elder Care, and Transportation), Group Personal Excess Liability Insurance Plan, and Group Legal Services Plan


Non-U.S. Home-Based Expatriate Assigned Outside the United States


Questions? To Access the Benefits Web Center: Contact the Benefits Call Center through accessHR: 1-877-JPMChase (1-877-576-2427) Quick Path: Enter your Standard ID or U.S.

Social Security number; press 1; enter your PIN; press 1

TDD: 1-800-719-9980 If calling from outside the United States:

1-212-552-5100 (GDP# 352-5100) Service Representatives are available from 8 a.m. to 7 p.m. New York Time, Monday through Friday, except certain U.S. holidays. If you contact the Benefits Call Center after normal business hours, you can leave a message and a Service Representative will return your call within two business days.

From Work: Go to Company Home > My Rewards @ Work > Benefits Web Center From Home: Go to www.MyRewardsAtWork.com > Benefits Web Center


Table of Contents Page Important Terms ....................................................................................................................................... 4 Participating in the Expatriate Medical and Dental Plan Options ..................................................... 12

Eligibility .............................................................................................................................................. 12 Coverage Categories .......................................................................................................................... 12 Your Eligible Dependents ................................................................................................................... 13 Cost of Coverage ................................................................................................................................ 15 When Contributions Begin .................................................................................................................. 16 Cost for Domestic Partner Coverage.................................................................................................. 16 Smoker Status..................................................................................................................................... 17 How to Enroll....................................................................................................................................... 17 If You Do Not Enroll ............................................................................................................................ 18 When Coverage Begins ...................................................................................................................... 19 Qualified Change in Status ................................................................................................................. 19

Medical and Dental Coverage ............................................................................................................... 21 Identification (ID) Cards ...................................................................................................................... 22 24-Hour Customer Service ................................................................................................................. 22 Global Health Management Services ................................................................................................. 22 e-Cleveland Clinic ............................................................................................................................... 22 CIGNA Envoy—Secure Web Site Service.......................................................................................... 23 Filing a Claim for Benefits ................................................................................................................... 24 ePayment Plus .................................................................................................................................... 24 Appealing Claims ................................................................................................................................ 25

Expatriate Medical Plan Option ............................................................................................................ 26 How Your Medical Benefits Work ....................................................................................................... 26 Annual Deductible ............................................................................................................................... 33 Annual Out-of-Pocket Maximum ......................................................................................................... 34 Maximum Lifetime Benefit................................................................................................................... 35 If You Need Emergency Care ............................................................................................................. 35

What Is Covered Under the Expatriate Medical Plan Option ............................................................. 36 Inpatient Hospital and Related Services ............................................................................................. 36 Preventive Care Services.................................................................................................................... 38 Other Covered Services...................................................................................................................... 39 Hospice Care ...................................................................................................................................... 41 Infertility Treatment Procedures.......................................................................................................... 41 Coverage Limitations .......................................................................................................................... 42

What’s Not Covered ............................................................................................................................... 43 Expatriate Dental Plan Option............................................................................................................... 45

Annual Deductible ............................................................................................................................... 46 Coinsurance ........................................................................................................................................ 47 Maximum Benefits............................................................................................................................... 47 Orthodontic Covered Services ............................................................................................................ 47 In-Network Care .................................................................................................................................. 48 Out-of-Network Care ........................................................................................................................... 48

What Is Covered Under the Expatriate Dental Plan Option ............................................................... 49

The JPMorgan Chase U.S. Benefits Program is available to most employees on a U.S. payroll who are regularly scheduled to work 20 hours or more a week and who are employed by JPMorgan Chase & Co. or one of its subsidiaries to the extent that such subsidiary has adopted the JPMorgan Chase U.S. Benefits Program. This information does not include all of the details contained in the applicable insurance contracts, plan documents, and trust agreements. If there is any discrepancy between this information and the governing documents, the governing documents will control. JPMorgan Chase & Co. expressly reserves the right to amend, modify, reduce, change, or terminate its benefits and plans at any time. The JPMorgan Chase U.S. Benefits Program does not create a contract or guarantee of employment between JPMorgan Chase and any individual. JPMorgan Chase or you may terminate the employment relationship at any time.


Preventive Care Services.................................................................................................................... 49 Basic Restorative Care Services ........................................................................................................ 49 Major Restorative Care Services ........................................................................................................ 50 What’s Not Covered............................................................................................................................ 51 Other Limitations ................................................................................................................................. 53

If You Are Covered by More Than One Medical and/or Dental Plan ................................................. 54 Non-Duplication of Benefits ................................................................................................................ 54 Determining Primary Coverage........................................................................................................... 54 Coordination with Medicare ................................................................................................................ 55 Right of Recovery................................................................................................................................ 56

When Coverage Ends ............................................................................................................................ 58 Certificate of Creditable Coverage...................................................................................................... 58 Prescription Drug Notice of Creditable Coverage............................................................................... 59

Additional Plan Information .................................................................................................................. 60 HIPAA Privacy Rights and Protected Health Information ................................................................... 60 HIPAA Special Enrollment Rights ....................................................................................................... 61 Qualified Medical Child Support Order ............................................................................................... 62

If Your Situation Changes ..................................................................................................................... 63 Right to Amend....................................................................................................................................... 66


Important Terms As you read this summary of the JPMorgan Chase Expatriate Medical and Dental Plan options, you’ll come across some important terms related to each plan. To help you better understand the plans, many of those important terms are defined here.

Term Definition Before-Tax Contributions

U.S. home-based expatriate employees, or expatriate employees who are assigned to the United States, pay for coverage with before-tax dollars — contributions that are taken from your pay before U.S. federal (and, in most cases, state and local) taxes are withheld. Before-tax dollars are also generally taken from your pay before U.S. Social Security taxes are withheld. This lowers your U.S. taxable income and your U.S. income tax liability. This reduction to taxable income will not affect any other pay-related benefits, such as basic life insurance, long-term disability insurance, and your Retirement Plan benefits. So, your other benefits will continue to be based on your full, unreduced benefits pay. Keep in mind that before-tax contributions do not count as earnings for U.S. Social Security purposes. Therefore, your future U.S. Social Security benefit could be slightly reduced if your total earnings for the year are less than the Social Security wage base ($106,800 for 2010). However, this reduction is nominal and may be outweighed by the immediate tax savings resulting from using before-tax dollars to pay for your benefits.

Bitewing Dental X-ray showing approximately the coronal (crown) halves of the upper and lower teeth.

Bridge A prosthesis restoring the continuity of the dental arch by replacing on or more artificial teeth suspended between—and attached to—abutments that provide support and stability.

Claims Administrator

The company that provides certain claims administration services for the Medical and Dental Plan.

Coinsurance The way you share costs for certain covered services after you meet the annual deductible. The Medical and Dental Plan options pay a percentage of reasonable and customary (R&C) charges or a percentage of in-network negotiated fees for covered services, and you pay the remainder. The actual percentage depends on the type of covered service.

Consolidated Omnibus Budget Reconciliation Act of 1985 as Amended (COBRA)

A United States federal law that allows you and/or your covered dependents to continue Medical and/or Dental Plan coverage on an after-tax basis (under certain circumstances) when coverage would otherwise have ended. See the “Plan Administration” section of “Your Guide to Benefits at JPMorgan Chase.” Non-U.S. home-based expatriate employees assigned outside the United States and their dependents are not eligible for medical and/or dental continuation coverage.


Term Definition Coordination of Benefits

The rules that determine how benefits are paid when a patient is covered by more than one group plan. Rules include: Which plan assumes primary liability; The obligations of the secondary claims administrator or claims payer; and How the two plans ensure that the patient is not reimbursed for more than

the actual charges incurred. In general, the following coordination of benefits rules apply: As a JPMorgan Chase employee, your JPMorgan Chase coverage is

considered primary for you. For your spouse/domestic partner, or dependent child covered as an active

employee of another employer, that employer’s coverage is considered primary for him or her.

For children covered as dependents under two plans, the primary plan is the plan of the parent whose birthday falls earlier in the year (based on month and day only, not year).

Specific rules may vary, depending on whether the patient is an employee in active status (or the dependent of an employee) or covered by Medicare. These rules do not apply to any private insurance you may have.

Copay or Copayment

The amount you pay toward certain health care services under the Expatriate Medical and Dental Plan options. For example, the Expatriate Medical Plan Option requires a $10 copayment for X-rays and labs (for in-network care received in the U.S. or care received outside the U.S.).

Covered Expenses The reasonable and customary (R&C) charges for medically necessary covered services or supplies that qualify for full or partial reimbursement under the Medical and/or Dental Plans.

Covered Services Medical or dental procedures that are generally reimbursable by the Expatriate Medical and/or Dental Plans when they are “medically necessary.” While the plans provide coverage for numerous services and supplies, there are limitations on what’s covered. For example, experimental treatments, most cosmetic surgery expenses, and inpatient and outpatient private duty nursing are not covered under the Medical Plan. So, while a service or supply may be medically necessary, it may not be covered under the plans.

Custodial Care Medical or non-medical services that do not seek to cure, are provided during periods when the medical condition of the patient is not changing, or do not require continued administration by medical personnel. An example of custodial care is assistance in the activities of daily living.

Deductible The amount you pay in a calendar year for covered expenses before the Medical or Dental Plans begin to pay benefits. Amounts in excess of reasonable and customary (R&C) charges or ineligible charges do not count toward the deductible.

Denture Artificial teeth replacing missing natural teeth.


Term Definition Domestic Partner You may cover a “domestic partner” as an eligible dependent under the

Medical and/or Dental Plans if you’re not currently covering a spouse. You and your domestic partner must: Be age 18 or older; Have lived together for at least six months and have a serious, committed

relationship; Be financially interdependent; Not be related to each other in a way that would prohibit legal marriage; and Not be legally married to, or the domestic partner of, anyone else.

OR Have registered as domestic partners pursuant to a domestic partnership

ordinance or law of a state or local government, or under the laws of a foreign jurisdiction.

You must certify that your domestic partner meets the eligibility rules as defined under the plans before coverage can begin. You may also be asked to certify that your domestic partner and/or your domestic partner’s children qualify as a tax dependent as determined by the United States Internal Revenue Code to avoid any applicable imputed income. Please see the Domestic Partner Coverage Guide for additional information on covering a domestic partner. The Guide is available via the Key Resources box on the Expatriate Benefits page on HR & Personal, or contact the Benefits Call Center for more information on domestic partner coverage.

Eligible Dependents

Under the Medical and Dental Plans, your eligible dependents can include your spouse or domestic partner, and your dependent children. Please see “Your Eligible Dependents” on page 13 for more information.


Term Definition Experimental, Investigational, or Unproven Services

Medical, surgical, diagnostic, psychiatric, substance abuse, or other health care services, technologies, supplies, treatments, procedures, drug therapies, or devices that, at the time the claims administrator makes a determination regarding coverage in a particular case, are determined to be: Not approved by the U.S. Food and Drug Administration (FDA) to be

lawfully marketed for the proposed use and not identified in the American Hospital Formulary Service or the United States Pharmacopoeia Dispensing Information as appropriate for the proposed use; or

Subject to review and approval by any institutional review board for the proposed use; or

The subject of an ongoing clinical trial that meets the definition of a Phase 1, 2, or 3 clinical trial set forth in the FDA regulations regardless of whether the trial is actually subject to FDA oversight; or

Not demonstrated through prevailing peer-reviewed medical literature to be safe and effective for treating or diagnosing the condition or illness for which its use is proposed.

The claims administrator, in its judgment, may determine an experimental, investigational, or unproven service to be covered under the Medical Plan for treating a “life-threatening” sickness or condition if the claims administrator determines that a service: Is safe with promising effectiveness; and Is provided in a clinically controlled research setting; and Uses a specific research protocol that meets standards equivalent to those

defined by the National Institutes of Health. Please Note: For the purpose of this definition, the term “life-threatening” is used to describe sicknesses or conditions which are more likely than not to cause death within one year of the date of the request for treatment. If services are denied because they are deemed to be experimental, investigational, or unproven, and the service is approved by the claims administrator within six months of the date of service, you may resubmit your claim for payments.

Explanation of Benefits (EOB)

A statement that the claims administrator prepares, which documents your claim and provides a description of benefits paid and not paid under the Medical and/or Dental Plans.

Full-Time Student Generally, a full-time student is defined as a dependent enrolled in an educational institution on a full-time basis at the time services are received. An educational institution is defined as a school maintaining a regular faculty, an established curriculum, and having an organized student body in attendance. It includes high schools, colleges, technical schools, and similar institutions but not on-the-job training. JPMorgan Chase will use the educational institution’s definition of a full-time student. During the summer term, when few students are enrolled, coverage will be based on enrollment during the previous term, unless the student has completed his or her full course of studies. Dependents who are taking classes part-time in their last semester to complete their degree will continue to meet the definition of full-time student.

Home Health Care An alternative to inpatient hospitalization during a patient’s recovery period. If the attending physician believes that part-time care will suffice in treating the sickness or injury, the physician can prescribe a schedule of services to be provided by a licensed home health care agency. This schedule may include administration of medication, a regimen of physical therapy, suctioning or cleansing of a surgical incision, or the supervision of intravenous therapy.


Term Definition Hospice Care Program

A program that tends to the needs of a terminally ill patient as an alternative to traditional health care, while meeting medically necessary and acceptable standards of quality and sound principles of health care administration. The program must be a written plan of hospice care for a covered person, and it must be approved by the appropriate claims administrator.

Hospital An institution legally licensed as a hospital — other than a facility owned or operated by the United States Government — that’s engaged primarily in providing bed patients with diagnosis and treatment under the supervision of licensed physicians. The hospital must have 24-hour-a-day registered graduate nursing services and facilities for major surgery. Institutions that don’t meet this definition don’t qualify as hospitals.

In-Network/ Out-of-Network

Terms referring to whether a covered service is performed by a provider who is part of the networks associated with the Medical and Dental Plan options or by a provider who is not part of the networks (“out-of-network”). When a service is performed in-network, benefits are generally paid at a higher level than they are when a service is performed out-of-network.

Maximum Annual Benefit

The most the Dental Plan will pay for covered dental services for each participant in a year.

Maximum Lifetime Orthodontia Benefit

The most the Dental Plan will pay for covered orthodontia services for each participant’s lifetime. Any benefits that have been applied to a maximum provision under a U.S. domestic Dental Option will also be applied to the lifetime maximum for the Expatriate Dental Plan Option.

Maximum Lifetime Benefit

The most the Medical or Dental Plan options will pay for covered services in each participant’s lifetime.


Term Definition Medically Necessary or Medical Necessity

Health care services and supplies that are determined by the claims administrator to be medically appropriate and: Necessary to meet the basic health needs of the covered person; Provided in the most cost-efficient manner and type of setting appropriate

for the delivery of the service or supply; Consistent in type, frequency, and duration of treatment with scientifically

based guidelines of national medical, research, or health care coverage organizations or governmental agencies that are accepted by the claims administrator;

Consistent with the diagnosis of the condition; Required for reasons other than the convenience of the covered person or

her or his physician; and Demonstrated through prevailing peer-reviewed medical literature to be

either: ⎯ Safe and effective for treating or diagnosing the condition or sickness for

which their use is proposed; or ⎯ Safe with promising effectiveness:

- For treating a life-threatening sickness or condition; - In a clinically controlled research setting; and - Using a specific research protocol that meets standards equivalent to

those defined by the National Institutes of Health. Please Note: For the purpose of this definition, the term “life-threatening” is used to describe sicknesses or conditions that are more likely than not to cause death within one year of the date of the request for treatment. The fact that a physician has performed or prescribed a procedure or treatment or the fact that it may be the only treatment for a particular injury, sickness, or condition does not mean that it is a medically necessary service or supply as defined above. The definition of “medically necessary” used here relates only to coverage and may differ from the way in which a physician engaged in the practice of medicine may define “medically necessary.” Finally, to be considered necessary, a service or supply cannot be educational or experimental in nature in terms of generally accepted medical standards.

Medicare Medicare is the Health Insurance for the Aged and Disabled provisions of Title XVIII of the Social Security Act of the United States, as enacted or later amended. Coverage is available to most U.S. residents age 65 and above, those with a disability for at least 29 months, and those with end-stage renal disease (ESRD). Generally, Medicare is the primary coverage for those individuals who are age 65 and above, unless these individuals are actively working.

Multiple Surgical Procedure Reduction Policy

Surgical procedures that are performed on the same date of service are subject to the multiple surgical procedure reduction policy. Of the reasonable and customary (R&C) charges, 100% are reimbursable for the primary/major procedure, 50% of R&C charges are reimbursable for the secondary procedure, and 50% of R&C charges are reimbursable for all subsequent procedures. Participants undergoing surgery are urged to discuss this policy with their health care provider.


Term Definition Necessary Services

Services or supplies that are accepted and used by the dental community as appropriate for the condition being treated or diagnosed. The services or supplies also must be prescribed by a dentist for the diagnosis or treatment of the condition to be considered necessary. Some prescribed services may not be considered necessary and may not be covered under the Expatriate Dental Plan option. CIGNA International will determine whether a service or supply is necessary. Finally, to be considered necessary, a service or supply cannot be cosmetic, educational or experimental in nature in terms of generally accepted dental standards.

Non-Duplication of Benefits

The Medical and/or Dental Plans do not allow for duplication of benefits. If you and your eligible dependents are covered under more than one group plan, the primary plan (the one responsible for paying benefits first) needs to be determined. You are entitled to receive benefits up to what you would have received under the Medical or Dental Plan if it were your only source of coverage, but not in excess of that amount. If you have other coverage that is primary to the Medical or Dental Plan, the claims administrator will reduce the amount of coverage that you would otherwise receive under these plans by any amount you receive from your primary coverage. Please see the definition of “Coordination of Benefits” in this section.

Out-of-Pocket Maximum

The most you would need to pay in a calendar year for medically necessary covered services under the Medical Plan. Once the out-of-pocket maximum is reached, the Medical Plan will pay 100% of reasonable and customary (R&C) charges for medically necessary covered services for the rest of the year. However, amounts that you pay toward your deductible, copayments, and amounts above R&C charges, do not count toward your out-of-pocket maximum.

Palliative A service or treatment that reduces the harmful effects of a condition — usually an acute (emergency) situation.

Periodontal Disease

A condition that weakens and destroys the gum, bone, and membrane which surround and support the teeth, such as pyorrhea, gingivitis, or Vincent’s disease.

Pre-Determination An itemization of the proposed course of treatment (including recent pre-treatment x-rays), which you should submit before work is begun, if you anticipate that charges will be more than $300. A dental consultant will review the proposed treatment before work begins and CIGNA International will inform you and your dentist of the amount of covered charges. That way, you’ll understand the benefits that will be paid before treatment begins. Benefits will be paid according to the plan provisions in effect when the services are actually rendered. The amount may change if the treatment changes from that which was predetermined or if frequency limits apply. Except in the case of an emergency, you may not want to begin the course of treatment until you know what amount the Expatriate Dental Plan option will pay.

Primary Plan The plan that provides initial coverage to the participant. If the participant is covered under both the JPMorgan Chase Expatriate Medical Plan and/or Dental Plan options and another plan, the rules of the primary plan govern when determining the coordination of benefits between the two plans. Specific rules may vary, depending on whether the patient is an active employee (or the dependent of an employee) or covered by Medicare. These rules do not apply to any private insurance you may have.


Term Definition Prophylaxis Prevention of disease by removal of tartar, stains, and other extraneous

materials from the teeth, or the cleaning of the teeth by a dentist or by a dental hygienist.

Prosthesis In general, something that replaces a missing part of the body. The dental specialty dealing with replacement of teeth is called prosthodontics.

Qualified Change in Status

The JPMorgan Chase benefits you elect during each annual benefits enrollment period will generally stay in effect throughout the plan year, unless you elect otherwise due to a qualified change in status (such as marriage, divorce, the birth or adoption of a child, etc. within 31 days of the qualifying event). Please Note: Any changes you make during the year must be consistent with your qualified change in status. Please see “Qualified Change in Status” on page 19 for more information.

Reasonable and Customary (R&C) Charges

The actual charges that are considered for payment when you receive medically necessary care for covered services under the Medical and/or Dental Plans. R&C means the prevailing charge for most providers in the same or a similar geographic area for the same or similar service or supply. These charges are subject to change at any time without notice. Reimbursement is based on the lower of this amount and the provider’s actual charge. If your provider charges more than the R&C charges considered under the plans, you’ll have to pay the difference. Amounts that you pay in excess of the R&C charge are not considered eligible expenses. Therefore, they don’t count toward your deductible, benefit limits, or maximums.

Self-Insured JPMorgan Chase pays for claims under the Expatriate Medical and Dental Plan options.

Skilled Nursing Facility

An institution that primarily provides skilled nursing care and related services for people who require medical or nursing care and that rehabilitates injured, disabled, or sick people.

Spouse Refers to any person to whom you are legally married as recognized by U.S. federal law. Even if you are legally married under state law (e.g., in Massachusetts and California), or non-U.S. law (e.g., Canada, Spain, etc.) to a person of the same sex, your same-sex spouse is considered to be your “domestic partner” for purposes of the administration of the JPMorgan Chase benefits plans, including the U.S. federal tax consequences for covering your domestic partner under your benefits (i.e., imputed income) and the benefits that may not be available to that person (e.g., the Health Care Spending Account).

Visit A visit is an encounter with a provider which involves direct patient contact. Some benefit provisions limit the number of covered visits. Unless a visit is defined for a particular benefit provision (such as home health care), each procedure code billed counts as a visit toward the limit. The length of a visit may vary by procedure code.


Participating in the Expatriate Medical and Dental Plan Options The general guidelines for participating in the JPMorgan Chase Expatriate Medical and Dental Plan options are described in this section.

Eligibility Your participation in the JPMorgan Chase Expatriate Medical and Dental Plan options is optional. In general, you are eligible to participate if you are:

An expatriate employee who receives salary or is eligible to receive draws, commissions, incentives or overrides (“salaried employee”);

Regularly scheduled to work 20 or more hours per week; and

Employed by JPMorgan Chase & Co or one of its subsidiaries to the extent that such subsidiary has adopted the plans.

Please Note: An individual classified or employed in a work status other than as a common law salaried employee by his/her employer, such as an

Independent contractor/agent (or its employee),

Hourly-paid employee,

Intern, and/or

Occasional/seasonal, leased, or temporary employee

is not eligible to participate in the plans regardless of whether an administrative or judicial proceeding subsequently determines this individual to have instead been a common law salaried employee.

Coverage Categories JPMorgan Chase provides a range of coverage levels. When you enroll in the Expatriate Medical and/or Dental Plan Options, your coverage level is based on the number of dependents you enroll and includes the following coverage categories:

Employee Only;

Employee Plus One Adult;

Employee Plus Child(ren); or

Employee Plus One Adult Plus Child(ren).

You can enroll yourself and your eligible dependents in the Expatriate Medical Plan option and/or the Expatriate Dental Plan option. You can also elect “No Coverage” for one or both of these options.


Important Note on Dependent Eligibility You are responsible for understanding the dependent eligibility rules and abiding by them. Each year during annual benefits enrollment, you must review your covered dependents and confirm that they continue to meet the eligibility requirements. JPMorgan Chase reserves the right to conduct dependent eligibility audits at any time. Such audits help ensure that dependents who have been certified for coverage during the annual enrollment process continue to meet plan rules for eligibility. As a result, you may be asked to provide documentation of eligibility for your covered dependents at any time. It is important that you review both the dependent eligibility rules and the status of your dependents on file, and make any necessary adjustments during your designated enrollment period or within 31 days of a qualified change in status (e.g., birth of a child, gain or loss of other coverage, etc.) Failure to either respond to a request for documentation or provide adequate proof of eligibility may result in termination of dependent coverage, repayment of the cost of that coverage, and/or disciplinary action up to and including termination of employment. For a listing of acceptable documentation, please see the Dependent Eligibility Requirements on HR & Personal > Benefits.

Your Eligible Dependents In addition to covering yourself under the Medical and/or Dental Plans, you can also cover your eligible dependents, but only under the same options you choose for yourself.

Your eligible dependents under the Medical and Dental Plan—and if you’re a U.S. home-based expatriate or an expatriate assigned to the U.S., under certain other plans as referenced in those plan sections of Your Guide to Benefits at JPMorgan Chase—include:

Your spouse* to whom you’re legally married or your domestic partner (please see the definition of “domestic partner” in “Important Terms” beginning on page 4 for more information);

* The term “spouse” refers to any person to whom you are legally married as recognized by U.S. federal law. Even if you are legally married under state law (e.g., in Massachusetts and California), or non-U.S. law (e.g., Canada, Spain, etc.) to a person of the same sex, your same-sex spouse is considered to be your “domestic partner” for purposes of the administration of the JPMorgan Chase U.S. benefits plans, including the U.S. federal tax consequences for covering your domestic partner under your benefits (i.e., imputed income) and the benefits that may not be available to that person (e.g., the Health Care Spending Account). For more information regarding domestic partner coverage and the various federal and state consequences, please refer to the 2010 Domestic Partner Coverage Guide on available online via the Key Resources box on the Expatriate Benefits page on HR & Personal.

Your unmarried dependent children up to the end of the month in which they reach:

⎯ age 19; or

⎯ age 23 if they are a “full-time student” (this includes dependent children of a domestic partner, whether or not they are legally adopted by you, as long as your domestic partner is also enrolled). Please see the definition of “full-time student” in “Important Terms” beginning on page 4.


Please Note: You may continue coverage for an unmarried dependent child who is not capable of supporting himself or herself due to a mental or physical disability, if that disability began before the age limits described previously and if he or she is fully dependent on you for financial support. If you have a dependent child who meets these criteria, you should contact the Benefits Call Center to update his or her status to continue coverage.

If JPMorgan Chase also employs or employed your spouse/domestic partner or dependent child, he or she can be covered as an employee or as your dependent, but not both. If you want to cover your eligible dependent child(ren), you or your spouse/domestic partner (but not both of you) may elect to provide this coverage.

Dependent Children “Children” include your natural children, stepchildren, children under your legal guardianship, children of your domestic partner, and legally adopted children whom you claim as dependents on your income tax return or for whom you provide at least 50% of support. “Children” also include children who live with you and for whom adoption proceedings have already begun, who are under age 18, and for whom you have the legal obligation to support (in whole or in part).

United States federal law requires that any child of a plan participant who is an alternate recipient under a Qualified Medical Child Support Order (QMCSO) will be considered as having a right to dependent coverage under the Medical and Dental Plans. In general, QMCSOs are state court orders requiring a parent to provide medical support to an eligible child, for example, in the case of a divorce or separation. For a detailed description of the procedures for a QMCSO, free of charge, contact the Benefits Call Center.

Please Note: If you are covering the child of a domestic partner who is not a tax dependent, imputed income for that child will be applied. Please see the Domestic Partner Coverage Guide for more information. The Guide is available online via the Key Resources box on the Expatriate Benefits page on HR & Personal.

Michelle’s Law If your covered dependent child age 19 or older must take a medically necessary leave of absence from school that begins on or after January 1, 2010 and causes him/her to no longer be a full-time student, your dependent may be eligible to continue coverage under the JPMorgan Chase U.S. Benefits Program. The leave of absence from the post-secondary school must be medically necessary, commence while the covered full-time student is suffering from a serious illness or injury, and otherwise cause the dependent to lose coverage (i.e., he or she no longer meets JPMorgan Chase’s definition of eligible dependent child). The coverage would continue in the same manner as if the dependent was a full-time student and would end one year after the date of the leave or earlier, if coverage would have otherwise ended (e.g., child turns age 23). If a dependent qualifies under these provisions, you should contact the Benefits Call Center at 1-877-JPMChase (1-877-576-2427) or 1-212-552-5100 (GDP# 352-5100) if calling from outside of the United States to update their status so their coverage may continue.


Domestic Partners In addition to the dependents previously listed, you may also cover a “domestic partner” as an eligible dependent under the Medical and Dental Plans — if you’re not currently covering a spouse. You generally must cover your domestic partner under the same options you choose.

For purposes of the Medical and Dental Plans, you and your domestic partner must:

Be age 18 or older;

Have lived together for at least six months and have a serious, committed relationship;

Be financially interdependent;

Not be related to each other in a way that would prohibit legal marriage; and

Not be legally married to, or the domestic partner of, anyone else;

OR

Have registered as domestic partners pursuant to a domestic partnership ordinance or law of a state or local government, or under the laws of a foreign jurisdiction.

In addition, you can enroll children of a domestic partner, as long as they meet the eligibility requirements of being your dependent children under the Medical and Dental Plans as described under “Your Eligible Dependents” on page 13, and the domestic partner is also enrolled. In the event that you reside in a location that does not recognize legal adoption with respect to a child of a domestic partner, coverage will be available provided that you submit, in writing, that your jurisdiction of residency does not permit adoption with respect to domestic partner relationships, and that if this restriction did not exist, you would otherwise adopt the child. This condition only applies if you do not cover the domestic partner.

For more information on covering a domestic partner, please refer to the Domestic Partner Coverage Guide, available online via the Key Resources box on the Expatriate Benefits page on HR & Personal.

To have your claim considered for benefits, all claims must be filed by December 31 of the year following the year in which services were provided. If you do not meet this deadline, your claim will be denied.

If your claim for reimbursement is denied, either in whole or in part, you can appeal the denial by following the appropriate procedures described in the “Plan Administration” section of Your Guide to Benefits at JPMorgan Chase, available in the Expatriate Library section of the Expatriate Programs page on HR & Personal. Go to HR & Personal > Expatriate Programs > Expatriate Library.

You may also contact the Benefits Call Center to request a copy of the Guide.

Cost of Coverage You and JPMorgan Chase share the cost of coverage under the Expatriate Medical and Dental Plan options. During your designated enrollment period, the cost under each of the coverage categories for each option offered will be available on the Benefits Web Center via My Rewards @ Work. Your cost depends on the options you choose and the number and type of eligible dependents you cover.


U.S. home-based expatriate employees or expatriate employees who are assigned to the U.S. pay for coverage with before-tax dollars, which means your U.S. federal, state, and local income taxes (if applicable) are reduced.

If you are a U.S. home-based expatriate employee and become totally and permanently disabled and are eligible for benefits from the JPMorgan Chase Long-Term Disability (LTD) Plan, you’re treated as having “benefits eligible” status for certain benefits. In the case of the Medical Plan, you’ll be eligible to continue coverage while receiving benefits from the LTD Plan. You’ll pay for coverage with after-tax dollars on a direct-bill basis.

When Contributions Begin Your contributions toward the cost of coverage start when your coverage begins. Your contributions are automatically deducted from your pay in monthly installments (unless retroactive payments are required).

If you have coverage but are away from work because of an unpaid leave of absence, you will be billed directly for any required contributions on an after-tax basis.

Cost for Domestic Partner Coverage If you’re covering a domestic partner as described in Your Eligible Dependents” beginning on page 13, there are some cost implications of which you should be aware. Specifically, in many cases a “Domestic Partner” will not satisfy the definition of “Dependent” under the U.S. Internal Revenue Code (IRC). As a result, if you are subject to U.S. tax withholding, U.S. federal law requires JPMorgan Chase to report the entire value of the medical coverage for a “Domestic Partner” to the Internal Revenue Service as taxable income to you. The entire value of this coverage includes the amount that both you and JPMorgan Chase contribute towards the cost of coverage.

Please Note: If you are covering the child of a domestic partner who is not a U.S. tax dependent, imputed income for that child will be applied.

Favorable Tax Treatment in Certain States Based on the availability of more favorable tax treatment in certain states, employees who certify that their domestic partner and/or domestic partner’s children are tax-qualified in the following states (based on the individual state’s requirements) are not subject to state imputed income tax related to benefits coverage for their domestic partner and partner’s child(ren):

California

Connecticut

Massachusetts

New Jersey

Oregon

Vermont

Washington, D.C.

Please Note: In order to be eligible for this state income tax treatment, you must contact the Benefits Call Center to certify that your domestic partner and partner’s child(ren) (if applicable) qualify for this tax treatment.

Enrolling a Domestic Partner

For more information on enrolling and the tax consequences of covering a domestic partner, please refer to the Domestic Partner Coverage Guide available via the Key Resources box on the Expatriate Benefits page on HR & Personal.


Smoker Status When you enroll for coverage, and each year at annual benefits enrollment, you must verify the smoker status of yourself and your covered dependents as a non-smoker or smoker. If you and/or any of your dependents meet the definition of a smoker but fail to declare your smoker status, you will be subject to disciplinary action. Please Note: While you must verify your smoker and/or non-smoker status, your cost of coverage under the Expatriate Medical Plan option will be the lower non-smoker rates, regardless of whether you certify as a smoker or non-smoker. To be considered a non-smoker, you and/or any covered dependents must be a non-smoker for at least 12 months as of January 1 of that plan year, or complete an approved smoking cessation program.

Smoking cessation programs are available throughout the year. For more information on smoking cessation programs and requirements, go to the Key Resources box on the Expatriate Benefits page on HR & Personal. You’ll receive more information regarding the opportunity to update your smoker status during each annual benefits enrollment period.

How Smoker Is Defined Under the JPMorgan Chase U.S. Benefits Program, a person who has smoked any type of tobacco product (e.g., cigarettes, cigars, or a pipe) regardless of the frequency or location (this includes daily, occasionally, socially, at home only, etc.) in the 12 months preceding any January 1 is considered a “smoker.” This definition does not pertain to users of tobacco products that are not smoked, such as chewing tobacco or snuff.

How to Enroll Participation in the Medical Plan is optional.

If You: What You Need to Do to Enroll: Are an Expatriate Employee

During an annual benefits enrollment period, you can make your elections through the Benefits Web Center via My Rewards @ Work or via the Benefits Call Center. At the beginning of each enrollment period, you’ll receive instructions on how to enroll. You’ll also receive information about the choices available to you and their costs at that time. You need to review your available choices carefully and enroll in the options that best meet your needs. You can’t change your choices during the year unless you have a qualified change in status. Please see “Qualified Change in Status” on page 19 for more information.


If You: What You Need to Do to Enroll: Are a Newly Hired U.S. Home-Based Expatriate Employee or New to Expatriate Status

If you’ve just joined JPMorgan Chase or are new to expatriate status and are enrolling for the first time, you need to make your choices through the Benefits Web Center via My Rewards @ Work or via the Benefits Call Center, or within 31 days of your date of hire if you are a newly hired full-time employee within 31 days of commencing an expatriate assignment, or within 31 days prior to becoming eligible if you are a newly hired part-time employee. Part-time employees will receive their enrollment materials within 31 days prior to becoming eligible and can enroll at that time. You can access your benefits enrollment materials online via Company Home > HR & Personal > Expatriate Programs > Expatriate Benefits.

Have a Change in Work Status or Experience a Qualifying Event

If you’re enrolling during the year because you have a qualified change in status (including birth or adoption of a child, etc.), you’ll have 31 days from the date of the change in status to make your new choices through the Benefits Web Center via My Rewards @ Work or by contacting the Benefits Call Center and speaking with a Service Representative. Please see “Qualified Change in Status” on page 19 for more information.

Please see “Expatriate Medical Plan Option” on page 26“”on page for information about the options available under the U.S. benefits plan options available to you.

You can find additional information on these plans in Your Guide to Benefits at JPMorgan Chase available via the Key Resources box on the Expatriate Benefits page on HR & Personal.

If You Do Not Enroll If You: What Happens If You Do Not Enroll: Are an Expatriate Employee

If you’re already participating in the Medical and/or Dental Plan and do not change your elections or cancel coverage during the annual benefits enrollment period, you’ll keep the same coverage for the following plan year that you had before the annual benefits enrollment period (if available) or you will be assigned coverage by JPMorgan Chase. However, you’ll be subject to any changes in the plan and coverage costs.

Are a Newly Eligible or Newly Hired Expatriate Employee

If you’re a new hire or newly eligible employee and do not enroll within the designated 31-day eligibility period, generally you will not have coverage for the remainder of the calendar year and your next opportunity to enroll will be during the next annual benefits enrollment period, unless you experience a qualified change in status. Please see “Qualified Change in Status” on page 19 for more information.


If You: What Happens If You Do Not Enroll: Have a Qualified Change in Status

If you have a qualified change in status (including the birth or adoption of a child, etc.) that allows you to enroll in the Medical and/or Dental Plan mid-year and you do not enroll within the designated 31-day period. You will not be able to make the change in coverage until the following annual benefits enrollment period. Please see “Qualified Change in Status” on page 19 for more information.

When Coverage Begins If You: When the Coverage You Elect Begins: Are an Expatriate Employee

The coverage you elect during the annual benefits enrollment period takes effect the beginning of the following plan year (January 1).

Are a Newly Eligible or Newly Hired Expatriate Employee

The coverage you elect as a new expatriate employee becomes effective on the date of your transfer to expatriate status.

Have a Change in Work Status or Experience a Qualifying Event

The coverage you elect as a result of a qualifying event (such as marriage or the birth or adoption of a child) or a work-related event, such as an adjustment to your regularly scheduled work hours that results in a change in eligibility, will take effect the day of the qualifying event, if you enroll within 31 days of the event and if you have already met the plans’ eligibility requirements.

Please Note: The Expatriate Medical Plan option covers pre-existing conditions. So, under this option, your coverage for any pre-existing condition begins as soon as you enroll.

Qualified Change in Status The Medical and Dental Plan elections you make during the annual benefits enrollment period will stay in effect through the following plan year (or the current plan year if you enroll during the year as a newly eligible employee). However, you may be permitted to change your elections before the next enrollment period if you have a qualified change in status. Please Note: Any changes you make during the year must be consistent with your qualified change in status. If you miss the 31-day deadline, generally you will not have coverage for the remainder of the calendar year and your next opportunity to enroll will be during the next annual benefits enrollment period.

If you have a qualified change in status and want to change your elections, please see the Benefits Status Change Guide available online under the Key Resources box on the Expatriate Benefits page on HR & Personal.

This Guide is also available on request through the Benefits Call Center.

You need to enroll through the Benefits Web Center via My Rewards @ Work or via the Benefits Call Center within 31 days of the qualifying event. Otherwise, you will not be able to make the change in coverage until the next annual benefits enrollment period.

Please Note: Documentation of eligibility isn’t always required when you enroll but may be requested at any time by JPMorgan Chase or the claims administrator.


Qualified changes in status for eligible dependents under the Medical and Dental Plans are listed in the following table.

Medical and Dental Plan Changes for Qualified Change in Status Event Medical and/or Dental Plan

Changes You get married Add coverage for you, spouse, and/or

eligible dependent children You enter into a domestic partner relationship or civil union

Add coverage for you, your domestic partner, and any eligible dependent children

You have, adopt, or obtain legal guardianship of a child

Add coverage for you and/or your eligible dependents

You and/or your covered dependents gain other benefits coverage

Cancel coverage for you and/or your covered dependents who have gained other coverage

You and/or your eligible dependents lose other benefits coverage

Add coverage for you and/or your eligible dependents who have lost other coverage

You get legally separated or divorced

Cancel coverage for your former spouse and/or dependent children who are no longer eligible

You end a domestic partner relationship or civil union

Cancel coverage for your domestic partner, and your domestic partner’s dependent children who are no longer eligible

A covered family member dies Cancel coverage for your deceased dependent and any dependent children who are no longer eligible

A dependent child is no longer eligible

Cancel coverage for your dependent child

Please Note: Your deadline to report a qualifying event may be extended to 60 days if your newly eligible dependent dies prior to adding him or her to coverage. Please contact the Benefits Call Center if this situation applies to you.


Medical and Dental Coverage Here are some important points to remember about the JPMorgan Chase Expatriate Medical Plan and Dental Plan options, administered by CIGNA International.

Highlights of Service Offered by CIGNA International Coverage For medical benefits, you must satisfy an annual deductible before the plan will pay benefits. The plan offers 100% coverage for many preventive screenings received in-network in the United States or outside the United States. For dental benefits, there is no deductible for preventive or diagnostic care. These options also offer participants:

A multilingual, around-the-clock Customer Service hotline to verify benefits in the event of an emergency as well as to assist with hospital admissions. Customer Service Representatives can also be contacted either electronically or via fax.

Translation services for participants and/or providers who prefer to speak with a Customer Service Representative in a language other than English.

A global provider network comprised of 141,000 physicians, dentists, specialists, and hospitals.

Preferred medical provider networks in Africa, Australia, Hong Kong, Malaysia, the Middle East (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates), Singapore, Spain, and the U.S. and U.K., with direct payment to providers, many that have agreed to provide services at discounted rates.

Dental PPO network available in the United States, offering negotiated, discounted fees from more than 100,000 pre-screened providers.

Direct payment to a hospital or medical provider (if accepted by the provider).

Payment of claims in over 100 currencies.

Expedited claims processing. (Claims submitted for payment in U.S. dollars are generally processed within 10 business days from receipt of complete claim information. Claims submitted for payment in non-U.S. currency will take a few days longer due to currency conversion banking procedures.) There are no additional charges for payment in non-U.S. currency.

Reimbursement checks, wire transfers that can be sent to your bank account anywhere in the world, and ePayment Plus (electronic fund transfer (EFT) or international ACH) for depositing funds to your bank account without incurring bank service charges.

Direct mailing of explanation of benefits statements.

An international physician referral service.

One standard claim form for medical, dental, and prescription drug expenses.

Global health management services, which provide medical advice and consultation.

Expert second opinion via the Internet through e-Cleveland Clinic.


Identification (ID) Cards If you elect Medical and/or Dental Plan coverage, you will receive a CIGNA International ID card for yourself and each covered dependent containing important claim filing instructions and telephone numbers for verification of coverage. Please remember to always carry your ID card with you. To replace lost ID cards, please contact CIGNA International Customer Service.

Participants assigned to a location where a CIGNALinks® provider network is available may receive a separate ID card to use when seeking care in that CIGNALinks® network.

Participants in select locations where a CIGNALinks® provider network is not available may receive a CIGNALinks® ID card for use in a nearby CIGNALinks® location.

You may have more than one CIGNALinks® ID card; therefore, if you expect to receive care in another location where a CIGNALinks® provider network is available (e.g., your home country), please contact CIGNA International Customer Service if you do not have the appropriate CIGNALinks® ID card. Please see “In-Network Care Outside the United States — CIGNALinks®” on page 27 for additional information about CIGNALinks®.

24-Hour Customer Service CIGNA International Customer Service Representatives are available 24 hours a day, seven days a week to verify benefits in the event of an emergency, facilitate hospital admissions, arrange for medical care when needed, and address routine claim inquiries. Translation services are available for employees or medical providers who prefer to speak with a Customer Service Representative in a language other than English.

CIGNA International Customer Service Representatives are available at 1-800-390-7183 or by calling collect at 1-302-797-3644 if calling from outside the United States.

Local CIGNALinks® Customer Service is available during local daytime hours by calling the Customer Service telephone number that appears on your CIGNALinks® ID card.

Global Health Management Services Depending upon your location and needs, CIGNA International can assist you by facilitating hospital admissions (including advance payment of fees), providing a full range of medical advice and consultation, as well as offering medical/dental referrals and telephone access to a medical doctor who can advise you on the appropriate course of action for your specific symptoms/condition in the context of your specific location. Services also include patient advocacy, medical monitoring, case management, replacement/transfer of emergency prescription drugs (outside the United States when legally permissible), and supervision of medically required repatriation/evacuations. All services can be accessed by calling CIGNA International Customer Service.

e-Cleveland Clinic CIGNA International offers a comprehensive expert second opinion available via the Internet through e-Cleveland Clinic. This online second opinion is provided by physician specialists associated with the e-Cleveland Clinic in Cleveland, Ohio, USA, one of the foremost institutions in the world for treating cancer, heart disease, and other serious illnesses. The specialists are world-renowned for their diagnostic expertise in these and other fields.

Updating Your Home Address

CIGNA International will mail your ID card(s) to your home address on record with JPMorgan Chase. Therefore, it is important that you update your home address as soon as possible upon relocation by using the Pay & Personal Information Self-Service tool available from the Quick Links box on the HR & Personal page on Company Home or by calling accessHR at 1-877-JPMChase (1-877-576-2427) or 1-212-552-5100 (GDP# 352-5100) if calling from outside the United States. Service Representatives are available Monday through Friday, from 8 a.m. to 7 p.m. New York Time, except certain U.S. holidays.

Please Note: You must change your home address on record as instructed above; you cannot change your address by contacting CIGNA International directly.


Once you have registered to use the CIGNA Envoy secure web site, you have access to the e-Cleveland Clinic web site through a link at the secure site. (For more information about the CIGNA Envoy Secure Web Site, please see “CIGNA Envoy—Secure Web Site Service” below.)

You may also contact e-Cleveland Clinic by telephone Monday through Friday, from 8 a.m. to 5 p.m. New York Time; AT&T Direct access number 1-800-223-2273 ext. 43223. (Be sure to mention that you participate in a Medical Plan option administered by CIGNA International.)

A second opinion from e-Cleveland Clinic is covered under the Expatriate Medical Plan option, subject to the applicable deductible and/or coinsurance amount.

CIGNA Envoy—Secure Web Site Service CIGNA International offers expatriate employees access to various online services. Registration for the site may be done online at www.cignaenvoy.com. Please have your CIGNA International ID card available to begin the online registration process.

Here’s what you can do at the site:

Review your claims (which are refreshed daily, Monday through Friday) as well as your claims payment information.

Scan your claim form and receipts and send via secure e-mail from the site. (Your claims arrive promptly, which helps expedite receipt of your reimbursement.)

Download claim forms in 16 languages.

Enroll for ePayment Plus to receive elections claim reimbursements (see “ePayment Plus” on page 24“”on page for more information).

Review the International Provider Directory to assist you in identifying providers with whom you can create a relationship in advance of requiring care — an excellent first step when you arrive in your assignment location. Providers who have signed a formal agreement for direct settlement of claims are noted in the directory (you simply pay your portion of the bill and the provider bills CIGNA International directly for the remainder). In some instances, providers offer discounts on certain services. (If you are sick or injured or need medical advice, it is recommended that you call CIGNA International Customer Service to speak with a doctor experienced in international medicine who can refer you to the most appropriate provider, based on your symptoms and location.)

Review the U.S. Preferred Provider Directory of doctors, dentists, hospitals, and/or clinics that offer discounts on services and have agreed to bill CIGNA International directly for services (you simply pay your copayment or coinsurance at the time services are rendered).

Take a tour of more than 200 countries in the Country Guides section of the site. You’ll find the latest news for each country, including medical and security alerts, as well as up-to-date health, cultural, general, and travel information.

Access a wide variety of health and wellness resources through healthinfoseeker.com, where you’ll find links to useful information on more than 5,000 health topics.


Filing a Claim for Benefits Depending upon your provider, medical expenses may need to be paid by you at the time of service. You will then be reimbursed based on the schedule of benefits described under “How Your Medical Benefits Work” beginning on page 26 of this Guide.

When you or your eligible dependents incur expenses, a claim form must be completed by you and the attending physician. (An itemized bill may be submitted in lieu of the attending physician’s statement.) There is only one CIGNA International claim form to claim reimbursement for medical, dental, and/or prescription drug expenses. The CIGNA International claim form is available in the Expatriate Library on the Expatriate Benefits page on HR & Personal.

Completed claim forms, with original itemized bills, should be sent to CIGNA International via:

Fax: 1-302-797-3150 (or ATT access code 1-800-243-6998)

Mail: CIGNA International P.O. Box 15050 Wilmington, DE 19850-5050 U.S.A.

Courier: CIGNA International 590 Naamans Road Claymont, DE 19703-2308 U.S.A.

Email: You may also e-mail your claim form using the CIGNA Envoy web site, as described under “CIGNA Envoy—Secure Web Site Service” on page 23. (You will need to scan your receipts and attach the scanned copies to your e-mail.)


If your claim for reimbursement is denied, either in whole or in part, you can appeal the denial by following the appropriate procedures described in the “Plan Administration” section of Your Guide to Benefits at JPMorgan Chase, available in the Expatriate Library on the Expatriate Programs page on HR & Personal. Go to HR & Personal > Expatriate Programs > Expatriate Library.

Claims submitted for payment in U.S. dollars will generally be processed within 10 business days from the date complete information is received by CIGNA International, regardless of the language or currency.

ePayment Plus CIGNA International offers ePayment Plus (electronic fund transfer (EFT) and international ACH), a valuable service designed to complement the existing array of electronic payment options that enable cross-border payments virtually anywhere in the world. In most cases, ePayment Plus provides the added feature of depositing funds to your bank account without incurring bank service charges.


Employees with a bank account in any of the following countries may now elect to receive claim reimbursements electronically (deposited in local currency):

Belgium

Canada

France

Germany

Hong Kong

Portugal

Singapore

Spain

United Kingdom

ePayment Plus includes automatic notification of payments. You can quickly and easily self-enroll in ePayment Plus at the CIGNA Envoy web site at www.cignaenvoy.com via the Internet. Please see “CIGNA Envoy—Secure Web Site Service” on page 23 for more information about accessing the site.

If a claim reimbursement is deposited directly into your bank account, CIGNA International will send you an explanation of benefits statement as confirmation.


If your claim for reimbursement is denied, either in whole or in part, you can appeal the denial by following the appropriate procedures described in the “Plan Administration” section of Your Guide to Benefits at JPMorgan Chase, available in the Expatriate Library section of the Expatriate Programs page on HR & Personal. Go to HR & Personal > Expatriate Programs > Expatriate Library.

Appealing Claims If a claim for reimbursement under the Medical and/or Dental Plans is denied, either in whole or in part, you can appeal the denial by following the appropriate procedures described in the “Plan Administration” section of Your Guide to Benefits at JPMorgan Chase available via the Pay Resources box on the Expatriate Benefits page on HR & Personal.

JPMorgan Chase is not involved in deciding appeals for any benefit claim denied under the Medical and/or Dental Plans. All fiduciary responsibility and decisions regarding a claim for a denied benefit under these plans rest solely with CIGNA International.


Expatriate Medical Plan Option The Expatriate Medical Plan option is designed to provide you and your family with a full range of health care services, as long as the services are medically necessary. (See the definition of “medically necessary” in “Important Terms” beginning on page 4.)

Under the Expatriate Medical Plan option, administered by CIGNA International, you have access to any licensed hospital or physician around the world. The plan pays medical benefits based on where you receive care; however, for some services, you must satisfy an annual deductible before the plan will pay benefits.

How Your Medical Benefits Work If You Receive Care in the United States When you receive care in the United States, you can choose between receiving care in-network or out-of-network each time you need medical care. You will generally pay less when you receive your care from a network provider.

In-Network Care in the United States You may use a provider in the CIGNA International Preferred Care Network.

For information on the Preferred Care Network, call CIGNA International at 1-800-390-7183, or call collect at 1-302-797-3644 if calling from outside the United States. You may also visit the CIGNA International web site at www.cignaenvoy.com. Please see “CIGNA Envoy—Secure Web Site Service” on page 23 for additional information about this site.

In-network care is generally covered at a higher percentage, and network providers have agreed to charge lower, negotiated fees for their services when treating participants.

The plan offers 100% coverage for many preventive screenings. The plan generally pays 100% of the cost for hospitalization (after a $250

copayment) and 80% of most other covered services after you meet an annual deductible ($250 individual; $500 individual plus one; $500 individual plus child[ren]; and $750 family).

In most instances, the provider will bill CIGNA International directly, so you do not have to file a claim form.

Prescription Drug Purchases in the United States For prescription drug purchases in the United States, you can use the CIGNA Pharmacy Management network of participating pharmacies to obtain discounted brand-name and generic prescription drugs through more than 50,000 U.S. pharmacies. Simply present your CIGNA International ID card containing the RxPrime logo and account number at any participating network pharmacy to take advantage of this prescription service. When you purchase prescription medications at in-network pharmacies within the U.S., you pay 25% of the discounted price at the point of sale. If you have questions about the CIGNA Pharmacy Management network, please call CIGNA International Customer Service or visit the CIGNA Envoy web site at www.cignaenvoy.com via the Internet.

Out-of-Network Expenses All out-of-network expenses are subject to reasonable and customary (R&C) limits; you are responsible for 100% of all charges above the R&C amounts. Since in-network charges for covered services have been negotiated with the providers, those charges would always be within the R&C limits.

Annual Deductible Applies to In-Network Care and Care Received Outside the U.S.

If you elect coverage for yourself or yourself plus one dependent, the annual deductible must be satisfied for each person before benefits begin for that person.

If you elect coverage for yourself plus two or more dependents, all expenses incurred are combined to meet the appropriate total deductible.


Out-of-Network Care in the United States

You may use any licensed provider.

The plan generally pays 70% of eligible expenses (subject to reasonable and customary charge limits) after you meet the annual deductible ($750 individual; $1,500 individual plus one; $1,500 individual plus child[ren]; and $2,250 family).

You must pay for services at the time you receive care and file claim forms to be reimbursed. Certain providers may accept assignment of benefits and choose to accept payment directly from CIGNA International. You would then be responsible for the difference not paid by the plan.

Hospital Admission It is not necessary to call CIGNA International’s case manager when entering a hospital outside the United States. However, for non-emergency hospital admissions in the United States, it is necessary to call CIGNA International’s case management company, Care Allies/Intracorp. You can reach Care Allies/Intracorp by calling CIGNA International and a Customer Service Representative will route your call. Failure to do so may result in reduced benefits payments.

If You Receive Care Outside the United States When you receive care in select locations outside the United States, you can choose between receiving care in a CIGNALinks® network or out-of-network. You will generally pay less when you use a CIGNALinks® network provider.

In-Network Care Outside the United States — CIGNALinks®

CIGNALinks® is a service enhancement to the global Expatriate Medical Plan option. The key to the CIGNALinks® concept is an alliance with a local company. CIGNA International works with local health care companies in select locations, integrating its global medical plans with the administrative services and provider networks of the local health care company. CIGNA International has entered into alliances with local administrators (and/or insurers) in:

Africa

Australia

Hong Kong

Malaysia

Middle East (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates)

Singapore

Spain

United Kingdom

Basic to CIGNALinks® is a provider network of doctors, hospitals and clinics that have agreed to provide services at discounted rates. When going to a hospital or clinic that is in the network, you simply present your CIGNALinks® ID card, pay any applicable coinsurance, and receive treatment. In most instances, providers in the network will file their claims directly with CIGNA — limiting your out-of-pocket costs when services are rendered.


The schedule of benefits for the Expatriate Medical Plan option will not change in conjunction with CIGNALinks®; however, because of local regulations and considerations, your benefit plan design in certain locations will differ somewhat from your global Expatriate Medical Plan coverage (for example, in certain locations the annual deductible is waived). In the event that a benefit is not covered under your local CIGNALinks® plan design, the claim will be processed by CIGNA International, pursuant to the schedule of benefits of the global Expatriate Medical Plan option.

When receiving care in a CIGNALinks® network, local Customer Service is available during normal business hours, and as always, CIGNA International Customer Service is available 24 hours a day, seven days a week. Contact information for the local CIGNALinks® administrator can be found on your CIGNALinks® ID Card.

Out-of-Network Care Outside the United States

You may use any licensed provider.

The plan offers 100% coverage for many preventive screenings.

The plan generally pays 100% of the cost for hospitalization (after a $250 copayment) and 80% of most other covered services after you meet the annual deductible ($250 individual; $500 individual plus one; $500 individual plus child[ren]; and $750 family).

You must pay for services at the time you receive care and file a claim to be reimbursed. Certain providers may accept assignment of benefits and choose to accept payment directly from CIGNA International. You would then be responsible for the difference not paid by the plan.

The Expatriate Medical Plan option pays benefits as follows:

Care Received Inside the United States

Care Received Outside the United States*

Provision In-Network Out-of-Network* Annual deductible** (any individual family member need only satisfy the single deductible amount)

$250 individual $500 individual + one $500 individual + child(ren) $750 family

$750 individual $1,500 individual + one $1,500 individual + child(ren) $2,250 family

$250 individual $500 individual + one $500 individual + child(ren) $750 family

Annual out-of-pocket maximum (stop loss limit)

$1,500 individual $3,000 individual + one $3,000 individual + child(ren) $4,500 family



* All out-of-network expenses are subject to reasonable and customary (R&C) limits; you are responsible for 100% of all charges above R&C amounts. Since in-network charges for covered services have been negotiated with the providers, those charges would always be within the R&C limits.

** If you elect coverage for yourself plus two or more dependents, all expenses incurred are combined to meet the appropriate total deductible.




Provision In-Network Out-of-Network* Lifetime maximum (separate lifetime maximums apply to fertility services, skilled nursing facility, and TMJ dysfunction)

Unlimited $2,000,000 per individual

$2,000,000 per individual

Preventive Care (A service that is normally considered preventive may be classified and coded as diagnostic rather than preventive medical care by your physician in certain circumstances. A medical service will only be covered at 100% if it is coded as preventive care. Before receiving any service, you should check with your physician to be sure a procedure is considered, and will be submitted to the claims administrator, as preventive medical care rather than as a diagnostic service.) Routine physical exams Covered 100% at the

following frequency: From birth to 12 months:

seven exams Age 13-36 months: three

exams per year Age 3 and over: one

exam per year

Not covered Covered 100% at the following frequency: From birth to 12

months: seven exams Age 13-36 months:

three exams per year Age 3 and over: one

exam per year Routine mammograms (age 40 and over; one per year)

100% Not covered 100%

Routine gynecological exams and Pap smears (maximum one exam and Pap smear per year-- including related laboratory fees; age guidelines apply)


Routine Prostate Specific Antigen (PSA) Test (age 40 and over; one exam per year)


Digital Rectal Exam (age 40 and over; one exam per year)


Fecal Occult Blood Test (age 50 and over; one test per year)






Provision In-Network Out-of-Network* Sigmoidoscopy / Colonoscopy (baseline screening at age 50; follow-up screening every five years)


Routine eye exams (maximum one exam per year)


Routine hearing (maximum one exam every 2 years)


Outpatient Services Doctor’s office visits (includes doctors certified in family, general, internal medicine and pediatrics, and consultations, specialist visits and second surgical opinions; excludes eligible preventive care visits)

80% after deductible 70% after deductible 80% after deductible

X-rays and labs (when preformed to diagnose a medical problem or treat an illness or injury)

100% after $10 copayment 70% after deductible 100% after $10 copayment

Surgery/major medical


Fertility services (includes diagnostic procedures, in vitro fertilization, artificial insemination, etc.; limited to combined in-/out-of-network/outside the U.S. maximum of $20,000 lifetime for each covered individual)






Provision In-Network Out-of-Network* Speech, physical, or occupational therapy — outpatient (combined in-/out-of-network/outside U.S. limit of 40 visits/calendar year per therapy type)

100% after $10 copayment per visit

70% after deductible 100% after $10 copayment per visit

Chiropractic care (must be medically necessary; coverage ends when medical recovery is achieved and treatment is for maintenance or managing pain; 20 visits/calendar year per year)


Mental health care 80% after deductible 70% after deductible 80% after deductible Substance abuse care


Inpatient Services Hospital (based on hospital’s standard rate for semi-private or common rooms, except for isolation of communicable diseases; excluding emergency room care)

100% after $250 copayment per admission; waived if re-admitted for same condition within 14 days

70% after deductible per admission

100% after $250 copayment per admission; waived if re-admitted for same condition within 14 days

Skilled nursing facility (must be ordered by physician as medically necessary; limited to combined in-/out-of-network/outside U.S. maximum of 365 days per lifetime for each covered individual)

100% after $250 copayment; waived if admitted from hospital

70% after deductible 100% after $250 copayment; waived if admitted from hospital





Provision In-Network Out-of-Network* Surgery/major medical


Hospice care 100% after $250 copayment; waived if admitted from hospital

70% after deductible 100% after $250 copayment; waived if admitted from hospital

Mental health care 100% after $250 copayment per admission

70% after deductible 100% after $250 copayment per admission

Substance abuse care

100% after $250 copayment per admission

70% after deductible 100% after $250 copayment per admission

Home health care (medically necessary only; limited to combined in-/out-of-network/outside U.S. maximum of 200 visits/calendar year; one visit = four hours)


Durable medical equipment and prosthetics


Prescription Drugs Prescription drugs ($10,000 lifetime maximum for fertility drugs)

75% (deductible waived) 75% (deductible waived)

75% (deductible waived)

Other Services Hospital — emergency room

100% after $150 copayment per visit, must be sudden and serious; waived if admitted. 80% coverage after deductible if not considered an emergency

100% after $150 copayment per visit, must be sudden and serious; waived if admitted 70% coverage after deductible if not considered an emergency

100% after $150 copayment per visit, must be sudden and serious; waived if admitted 80% coverage after deductible if not considered an emergency


Please Note: Whenever benefits are limited to a certain dollar amount or number of visits/days, care received in-network, out-of-network, and outside the United States will be combined and counted toward the benefit limit.


Annual Deductible If you enroll in the Expatriate Medical Plan option, you must satisfy an annual deductible before you receive coverage for most in-network or out-of-network services. The in-network annual deductible applies to services such as doctor’s visits, surgery and chiropractic care. It does not apply to x-rays, emergency room charges, and eligible preventive care services. Only reasonable and customary (R&C) charges for medically necessary services will count toward the out-of-network deductible. Amounts above R&C charges do not count toward your deductible.

Under the Expatriate Medical Plan option, if you elect coverage for yourself or yourself plus one dependent:

Each covered person must pay all eligible expenses until the individual deductible is met. Then, eligible expenses are covered at the coinsurance indicated for that expense. Expenses for two covered individuals are not combined.

After a covered person meets the individual deductible amount, that person will pay no further deductible for that year.

If you elect coverage for yourself plus two or more dependents:

All expenses incurred by you and/or your covered dependents combine to meet the appropriate total deductible (individual plus children or family deductible).

If no one person meets the individual deductible, but combined participant expenses meet the total deductible amount, no further deductible is required for that year.

After a covered person meets the individual deductible amount, that person will pay no further deductible.

The maximum deductible any one covered person must pay is equal to the individual amount. After one person meets the individual deductible, that person will pay no further deductible, but other covered persons must continue to pay deductibles until the total is satisfied.

An Example: Amounts Applied Toward Deductible for Out-of-Network Care Received in the United States On behalf of you $750

On behalf of your spouse/domestic partner $650

On behalf of one child $450

On behalf of a second child $400

TOTAL $2,250

In this example, one person has met the $750 individual deductible (you), and the combined costs have reached $2,250. So any additional reasonable and customary (R&C) charges for medically necessary covered services would be reimbursable at 70% until your out-of-pocket limit is met, even if they were on behalf of a person who has not yet met the $750 individual deductible. No other covered family members need to meet their individual deductible for the rest of the year.


Annual Out-of-Pocket Maximum This is the maximum amount (excluding items such as annual deductibles and copayments) you must pay in a calendar year toward each covered person’s eligible expenses. Only reasonable and customary (R&C) charges for medically necessary services will count toward the annual out-of-pocket maximum. Amounts above R&C charges do not count toward your annual out-of-pocket maximum.

If you elect coverage for yourself or yourself plus one dependent:

Each covered person must pay all eligible out-of-pocket expenses until the individual maximum is met. Eligible out-of-pocket expenses for the remainder of that year are then covered at 100% for that person.

After a covered person meets the individual out-of-pocket maximum, that person will pay no further out-of-pocket expenses for the remainder of that year.

If you elect coverage for yourself plus two or more dependents:

All eligible out-of-pocket expenses paid by you and/or your covered dependents combine to meet the appropriate total maximum amount (employee plus children or family).

If no one covered person meets the individual maximum, but combined covered participant out-of-pocket payments meet the total amount, eligible out-of-pocket expenses are then covered at 100% for the remainder of that year.

After a covered person meets the individual out-of-pocket maximum, that person will pay no further out-of-pocket expenses for the remainder of that year.

The maximum out-of-pocket expense any one covered person must pay in a particular year is equal to the individual amount. After one person’s expenses for that year reach the individual out-of-pocket maximum, eligible out-of-pocket expenses for the remainder of that year are then covered at 100% for that person, but other covered persons must continue to pay out-of-pocket expenses until the total family out-of-pocket maximum is satisfied.

An Example: Amounts Applied Toward Family Out-of-Pocket for Out-of-Network Care Received in the United States On behalf of you $3,000

On behalf of your spouse/domestic partner $2,500

On behalf of one child $2,500

On behalf of a second child $1,000

TOTAL $9,000

In this example, one person has met the $3,000 individual out-of-pocket maximum (you), and the combined out-of-pocket costs have reached $9,000. So, any additional reasonable and customary (R&C) charges for medically necessary covered services would be reimbursable at 100% for the remainder of the year, even if they were on behalf of a person who has not yet met the individual out-of-pocket maximum. No other covered family members need to meet their individual out-of-pocket maximum for the rest of the year.


Maximum Lifetime Benefit The maximum lifetime benefit for each individual covered under the Expatriate Medical Plan Option for out-of-network care received in the U.S. or for care received outside the U.S. is $2,000,000. This includes the $30,000 lifetime maximum for fertility services and prescription drugs. There is also a lifetime limit of 365 days for care received in a skilled nursing facility. The fertility services and skilled nursing facility lifetime maximum benefits apply to care received in-/out-of-network in the U.S. and care received outside the U.S.

If You Need Emergency Care If you have a medical emergency that’s sudden, urgent, and life-threatening,

you should go to the nearest physician, hospital emergency room, or other urgent care facility.

If the claims administrator determines that the situation was not sudden, urgent and life-threatening, your benefits will be paid as a doctor’s office visit, subject to the reasonable and customary limit.


What Is Covered Under the Expatriate Medical Plan Option The Medical Plan covers a wide variety of services, as long as the services are medically necessary. See the definition of “Medically Necessary” in “Important Terms” beginning on page 4. However, covered services under the Expatriate Medical Plan option may be subject to limits or restrictions. For specific information on covered services, please contact CIGNA International directly. (Please see “24-Hour Customer Service” on page 22 for contact information.)

Inpatient Hospital and Related Services The Expatriate Medical Plan option covers medically necessary inpatient hospital admissions for an unlimited number of days. Covered services include, but are not limited to the following services, subject to any limitations or requirements of the plan:

Allergy testing and treatment, when provided as part of inpatient care for another covered condition and based on medical necessity;

Anesthetics and their administration;

Bariatric surgery subject to claims administrator guidelines;

Basic metabolic examinations;

Certain dental surgeries that are medical in nature and required to be performed in a hospital setting or medical doctor’s office, if the surgery is needed because of a congenital disorder or accidental injury and treatment is received within 12 months of the accident, and charges are not covered by the Dental Plan;

Cosmetic surgery when needed to:

⎯ Reconstruct or treat a functional defect of a congenital disorder or malfunction;

⎯ Treat an infection or disease;

⎯ Treat an injury or accident; or

⎯ Reconstruct a breast after mastectomy. Coverage for the following services is available under the Medical Plan in a manner determined in consultation with you and your physician:

- Reconstruction of the breast on which the mastectomy was performed;

- Surgery and reconstruction for the other breast to produce a symmetrical appearance; and

- Prostheses and treatment of physical complications for all stages of mastectomy, including lymphedemas.

Diagnostic services, including:

⎯ EEG, EKG, and other diagnostic medical procedures;

⎯ Laboratory and pathology tests; and

⎯ Radiology services.

Electrocardiographic and physiotherapeutic equipment;

Hemodialysis for kidney failure;

Intensive care unit service if medically necessary;

Certain Limitations

Keep in mind that certain services listed here are limited to a specific number of visits or days of treatment. Any services that have such limits (for example, chiropractic treatment) are determined by medical necessity. In other words, the treatment must be medically necessary, even if the number of visits or days of treatment is within the prescribed limitations. The limitations are described within the coverage chart.


⎯ Maternity care, including: Care required due to miscarriage or ectopic pregnancy;

⎯ Coverage of eligible expenses if your dependent child has a baby, but not including nursery or other expenses incurred by the newborn child;

⎯ Delivery by a certified, registered nurse or midwife in a birthing center;

⎯ Drugs, medications, and anesthesia;

⎯ Normal or cesarean section delivery;

⎯ A semi-private room. The period of hospitalization for childbirth (for either the mother or the covered newborn child) is up to 48 hours following a vaginal delivery or 96 hours following a cesarean section. (However, your attending physician — after consulting with the mother — may decide to discharge the mother or newborn child earlier.)

Operative and surgical procedures by a licensed provider for the treatment of a disease or injury, including pre-operative preparation and post-operative care;

Pre-admission testing when completed within seven days of hospital admission;

Semi-private room and board; and

Take-home drugs and medications.

This list is subject to change at any time. Please contact CIGNA International for the complete details of covered services.

Outpatient Services As with inpatient services, the Expatriate Medical Plan option covers many of the same medically necessary outpatient services. Covered services include, but are not limited to the following services, subject to any limitations or requirements of the plan:

Acupuncture when used as a form of pain control and performed by a licensed provider (check with CIGNA International);

Allergy testing and treatment;

Chemotherapy and radiation treatments;

Chiropractic care when medically necessary as determined by CIGNA International to diagnose or treat illness, injury, or disease. Coverage ends once maximum medical recovery has been achieved and treatment is primarily for maintenance or managing pain;

Diagnostic services, including:

⎯ EEG, EKG, and other medical electronic procedures;

⎯ Laboratory and pathology tests; and

⎯ Radiology services.

Education therapy, but only for participants with a diagnosis of diabetes mellitus;

Hemodialysis provided at a free-standing facility such as a dialysis center, or your home, when ordered by a licensed provider;

Multiple Surgical Procedure Reduction Policy

The Medical Plan limits the benefits you are eligible to receive if you have more than one surgical procedure performed at the same time. When you have multiple procedures performed at the same time, these options will pay:

100% of the reasonable and customary (R&C) amount for the primary or major surgical procedure;

50% of the R&C amount for the secondary procedure; and

If more than two procedures are performed, please check with CIGNA International for coverage details.


Licensed, general hospital emergency room use for treatment of an injury or sudden illness, including: ⎯ Emergency treatment rooms; ⎯ Laboratory and pathology tests; ⎯ Licensed providers’ services; ⎯ Supplies and medicines administered during the visit; and ⎯ Radiology services.

Licensed provider-prescribed respiratory therapy approved by CIGNA International;

Occupational therapy rendered by a licensed therapist; Outpatient surgery and related follow-up care; Physical therapy rendered by a licensed therapist; Podiatric care when medically necessary as determined by CIGNA

International to diagnose or treat illness, injury, or disease. Coverage ends once maximum medical recovery has been achieved and treatment is primarily for maintenance or managing pain;

Prenatal care; Speech therapy rendered by a licensed therapist; and Temporomandibular joint syndrome (TMJ) treatment that is medical in nature;

including exams, X-rays, injections, anesthetics, physical therapy, and oral surgery up to $1,000 combined for in-/out-of-network care and care received outside the United States.


Preventive Care Services The Medical Plan covers preventive care services when care is received in-network in the United States or outside the United States. (Please check with your claims administrator for any age or frequency limitations. Please see “24-Hour Customer Service” on page 22 for contact information.) These services include: Routine care including: ⎯ PAP tests (one per year, includes related laboratory fees, age guidelines

apply); ⎯ Prostate exams (age 40 and over, one exam per year); ⎯ Flexible sigmoidoscopy (age 50 and over, one baseline screening and one

follow-up screening every five years); ⎯ Screening colonoscopy (age 50 and over, one baseline screening and one

follow-up screening every five years); ⎯ Fecal occult blood test (age 50 and over, one test per year) ⎯ Routine physical exams (office visit with appropriate laboratory and

radiology services): - Birth to age 12 months: seven exams

- Age 13-36 months: three exams per year

- Age 3 and over: one exam per year

⎯ Mammography screenings (age 40 and over, one mammogram per year); and

Well-child/adult care office visits (plus immunizations and labs).

This list is subject to change at any time. Please contact CIGNA International for complete details of covered services.


Please note: A medical service will only be covered at 100% if it is coded as preventive. Before receiving any services, you should check with your physician to be sure a procedure is considered, and will be submitted to the claims administrator, as preventive medical care rather than as a diagnostic service.

Other Covered Services The Medical Plan covers a wide variety of other medically necessary services, although benefits levels may vary substantially depending upon whether care is received from an in-network or out-of-network provider. These services include, but are not limited to the following services, subject to any limitations or requirements of the Medical Plan:

Gender Reassignment Surgery (GRS) coverage will be limited to $20,000 per lifetime and the participant must meet certain medically established guidelines for obtaining the surgery (Harry Benjamin guidelines) which require the member to, among other things:

Be at least 18 years old

Have a GID (Gender Identity Disorder) diagnosis

Have been approved for hormone therapy

Have at least 1 year real life experience living and working in desired gender

Have two letters recommending surgery, including one from a doctor

Follow-up procedures such as electrolysis, breast augmentation surgery, and facial surgery will not be covered. In addition, based on current U.S. Internal Revenue Service guidance, any payments from the Medical Plan for GRS will result in imputed income to the employee (including payments made under the plan for a covered dependent). U.S. taxes will be applied as appropriate.

Surgery must be preauthorized by the medical plan administrator whether in or out-of-network or outside the United States. Both the employee and covered dependent, if applicable, must sign an authorization form allowing JPMC to be made aware of any payments. This information would be used solely to impute income on the value of the benefit received. Payment would be made up to the lifetime limit subject to applicable plan provisions such as deductibles, co-pays and coinsurance.

Other covered services include:

Hearing aid evaluations and hearing tests;

Hearing aids through age 12 up to $2,500 every 24 months;

Home health care approved by CIGNA International. The attending physician must submit a detailed description of the medical necessity and scope of services to CIGNA International. The following are covered if ordered by the physician under the home health care plan and provided in the patient’s home. (Please check with CIGNA International for any age or frequency limitations. Please see “24-Hour Customer Service” on page 22 for contact information):

Part-time or intermittent nursing care provided or supervised by a registered nurse (R.N.);

Part-time or intermittent home health services, primarily for the patient’s medical care;

Physical, occupational, speech, or respiratory therapy by a licensed qualified therapist;


Nutrition counseling provided by or under the supervision of a registered dietitian; and

Medical supplies, laboratory services, drugs, and medications prescribed by a physician.

Jobst stockings (two pair per calendar year for the following conditions only: varicose veins, varicose ulcers, statis dermatitis, post-phlebitic syndrome, and lymphedema);

Local ambulance service or air ambulance to the nearest hospital if medically necessary and confirmed by a licensed provider;

Medical equipment and supplies including blood and blood plasma (unless donated on behalf of the patient); artificial limbs (excluding replacements), artificial eyes and larynx (including fitting); heart pacemaker; surgical dressings; casts; splints; trusses; orthopedic braces; crutches; wheelchair; walker; cane; insulin pump; Athner monitor; shoe orthotic devices (for diabetic-related conditions only); hospital bed; ventilator; iron lung; colostomy bags; and other items necessary to the treatment of an illness or injury, that are not excluded under the plans. The claims administrator may authorize purchase of an item if more cost-effective than rental.

Medically necessary visits to licensed physicians, surgeons, and chiropractors, whether in the office or in your home;

Organ and tissue transplants including replacing a non-functioning or damaged organ or tissue with a working organ or tissue from another person. Covered services include physician and hospital costs, donor search, tests to establish donor suitability, organ harvesting and procurement, and anti-rejection drugs. Eligible travel and lodging expenses for the transplant recipient and a companion are determined by the medical plan claims administrator (meals not covered, effective March 1, 2010). Donor expenses related to the transplant procedure are covered if the transplant recipient is a covered member under this plan, but only to the extent that the donor expenses are not covered under another health insurance plan;

Oxygen and supplies for its administration; Prosthetic devices and supplies, including fitting, adjustments, and repairs, if

ordered by a licensed provider. Please check with CIGNA International for frequency or other limitations. (Please Note: Dentures, bridges, etc., are not considered medical prosthetic devices.);

Radiation, chemotherapy, and kidney dialysis; Rental or purchase of durable medical equipment, if ordered by a licensed

provider. Please check with CIGNA International for frequency or other limitations;

Services and supplies that are part of an alternate care proposal. This is a course of treatment developed by CIGNA International and authorized by JPMorgan Chase as an alternative to the services and supplies that would otherwise have been considered covered services and supplies. Unless specified otherwise, the provisions of the plan related to benefit amounts, maximum amounts, copayments, and deductible will apply to these services;

Skilled nursing facility for up to 365 days per lifetime (combined in-/out-of-network care and care received outside the United States);

Surgery for the treatment of morbid obesity when determined to be medically appropriate as determined by CIGNA International guidelines;

Urgent care;

Voluntary sterilization; and

Wigs, following chemotherapy or radiation, or due to a diagnosis of Alopecia.



Hospice Care If you or a covered dependent is diagnosed as terminally ill with six months or less to live, you may be eligible to receive reimbursement for hospice care services under the Medical Plan. Hospices provide care in a setting designed to make the patient comfortable while still providing professional medical attention.

To be eligible for reimbursement, a hospice facility must offer a hospice program that’s approved by the claims administrator. It must be either a hospital or a free-standing hospice facility that provides inpatient care or an organization that provides health care services in your own home.

Hospice services include:

Hospice room and board while the terminally ill person is an inpatient in a hospice;

Outpatient and other customary hospice services provided by a hospice or hospice team; and

Counseling services provided by a member of the hospice team.

These services and supplies are eligible only if the hospice operates as an integral part of a hospice care program, and the hospice team includes at least a doctor and a registered graduate nurse. Each service or supply must be ordered by the doctor directing the hospice care program and be:

Provided under a hospice care program that meets standards set by CIGNA International. If such a program is required by law to be licensed, certified, or registered, it must meet that requirement.

Provided while the terminally ill person is in a hospice care program.

Hospice benefits also include eligible expenses for counseling services for the family unit, if ordered and received under the hospice care program, up to a maximum bereavement benefit per family unit of $250. Benefits will be paid if:

On the day before the terminally ill person passed away, he/she was:

⎯ In a hospice care program;

⎯ A member of the family unit; and

⎯ A covered participant.

The charges are incurred within three months after the death of the terminally ill person.


Infertility Treatment Procedures There are special covered procedures under the Medical Plan that induce pregnancy but do not treat the underlying medical condition. They include (but are not limited to) artificial insemination and in-vitro fertilization. Fertility services are subject to a $20,000 combined lifetime maximum benefit. Fertility drugs are subject to a $10,000 combined lifetime maximum benefit. Limits apply to all benefits combined in a lifetime, and apply regardless of whether the services were received in-/out-of-network or outside the United States. These limits do not apply to the diagnosis of infertility and/or its cause. All procedures and access will be governed by CIGNA International’s protocols for determining appropriateness of care. Please contact CIGNA International for specific details.

Important Note

While the services listed here are covered by the Medical Plan, they must be “medically necessary.” Please see the definition of “medically necessary” in “Important Terms” beginning on page 4.


Infertility Diagnostic Services Diagnostic services to determine or cure the underlying medical conditions are covered in the same manner as any other medically necessary services.

Coverage Limitations As mentioned earlier, certain covered services are limited to a specific number of visits or days of limitations, subject to applicable deductibles and copayments. These limitations are included in the coverage charts beginning on page 28.

Please keep in mind that any benefits listed that have limitations on the number of visits or days of treatment are determined by medical necessity. In other words, the treatment must be medically necessary, even if the number of visits or days is within the prescribed limitations.

Newborns’ and Mothers’ Health Protection Act In accordance with the Newborns’ and Mothers’ Health Protection Act, group medical plans and health insurance issuers may not, under United States federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother to less than 48 hours following a normal vaginal delivery, or to less than 96 hours following a cesarean section. Further, the plan cannot require that any medical provider obtain authorization from the plan or any insurance issuer for prescribing a length of stay not in excess of the above periods.

Women’s Health and Cancer Rights Act of 1998 Solely to the extent required under the United States Women’s Health and Cancer Rights Act (hereinafter “WHCRA”), the Medical Plan will provide certain benefits received in connection with a mastectomy. The Medical Plan will include reconstructive surgery following a mastectomy.

If you or your dependent(s) (including your spouse/domestic partner) are receiving benefits under the Medical Plan in connection with a mastectomy and you or your dependent(s) (including your spouse/domestic partner) elect breast reconstruction, the coverage will be provided in a manner determined in consultation with the attending physician and you or your dependent(s) (including your spouse/domestic partner) for reconstruction of the breast on which the mastectomy was performed; surgery and reconstruction of the other breast to produce a symmetrical appearance; and prostheses and treatment of physical complications at all stages of the mastectomy, including lymphedemas.

Reconstructive benefits are subject to annual plan deductibles and coinsurance provisions like other medical and surgical benefits covered under the Medical Plan.


What’s Not Covered While the Medical Plan covers a wide variety of medically necessary services, there are some services that are not covered. Some of these are listed below. Expenses not covered by the Expatriate Medical Plan Option include, but are not limited to:

Care from a person who is a member of your family or your spouse’s family;

Charges for the difference between a private and semi-private hospital room;

Correction of weak, unstable, or flat feet; arch supports; corrective shoes; shoe orthotics (except as related to diabetes); or treatment of corns, calluses, or chronic foot strain;

Cosmetic surgery treatment, except to repair damage from accident or injury; to treat a functional birth defect; reconstruct a breast after mastectomy and/or reconstruction of the non-affected breast to produce a symmetrical appearance; or treat an infection or disease;

Custodial services, including custodial nursing care;

Donor expenses with regard to fertility treatment;

Educational therapy (except for members with a diagnosis of diabetes) and social or marital counseling;

Expenses for which you’re not obligated to pay (for example, if a licensed provider or hospital waives a copayment, the plan will not pay any benefit to you or a licensed provider);

Expenses in excess of reasonable and customary (R&C) charges;

Expenses submitted later than December 31 of the year following the year in which services were provided;

Experimental, investigational, or unproven services, devices, or supplies (See “Important Terms” beginning on page 4 for the definition of “Experimental, Investigational, or Unproven Services”);

Hospital admissions and other services that began before the participant’s effective date of coverage under the Medical Plan;

Non-medical charges for care in a nursing or convalescent home or long-term custodial care, even if prescribed by a licensed provider;

Non-prescription contraceptive devices, unless medically necessary (prescription oral contraceptives are covered under the Medical Plan);

Non-surgical correction of temporomandibular joint (TMJ) syndrome, such as appliances or devices;

Personal hospital services, such as television, telephone, etc.;

Private duty nursing;

Refractive eye examinations for new lenses or the cost of eyeglasses or contacts;

Refractive eye surgery including, but not limited to, Lasik or Radial Keratotomy;

Reproductive education and prevention classes;

Reversals of sterilization;


Routine dental care (please see the section of this Guide for more information about services covered under the Expatriate Dental Plan option);

Services, supplies, or treatment for weight loss, nutritional supplements, or dietary therapy;

Sickness or loss covered by state workers’ compensation law or automobile insurance;

Sickness or loss that is later determined to be the legal responsibility of another person or company;

Treatment related to an illness or injury received as a result of war, declared or undeclared, or any act of war;

Treatments, services, or supplies that are not medically necessary or not approved by a licensed provider; and

Unbundled medical expenses — charges billed separately when considered by the claims administrator in its sole discretion to be part of a global procedure.



Expatriate Dental Plan Option Under the Expatriate Dental Plan option, administered by CIGNA International, you may use any licensed provider. However, when you visit a participating dentist in the United States, you realize cost savings, while at the same time receiving quality care. The CIGNA Dental PPO network in the United States includes more than 100,000 pre-screened providers. Here is a summary of how your dental coverage works:

The plan generally pays 100% for preventive care such as oral exams, fluoride treatments, prophylaxis, x-rays (including intra-oral x-rays), sealants, and emergency palliative treatments, without a deductible.

The plan generally pays 75% for basic restorative and 50% for major restorative care after you meet an annual deductible ($75 per individual).

The plan pays 50% for orthodontic appliances and treatment up to $2,500 per lifetime for dependent children up to age 19 after you meet a lifetime orthodontia deductible ($150 per child).

If you see a non-network dentist, there is no penalty, but you may have to file your own claims if the dentist does not bill CIGNA International directly.

The Expatriate Dental Plan option pays benefits as follows:

Provision Care Received Inside or Outside the United States*

Annual deductible Preventive: None Restorative: $75 individual/$225 family Orthodontia: $150 per child per lifetime

Annual maximum benefit (per individual per plan year)

$1,500

Lifetime maximum (orthodontia benefit)

$2,500 per dependent child up to age 19

Preventive 100% Oral exams Maximum two per calendar year Fluoride Maximum one per calendar year; up to

age 19 only Prophylaxis Maximum two per calendar year Full-mouth X-ray Maximum one every 36 months Bitewing X-ray Maximum one per calendar year** Sealants Maximum two treatments per tooth

(permanent molars only) per lifetime up to age 19

Basic restorative care (fillings, extractions, certain X-rays, endodontics, and periodontics, and surgery and anesthesia)

75% after deductible

* This option pays for a percentage of covered services up to the reasonable and customary (R&C) amount subject to certain annual limits; you are responsible for 100% of all charges above the annual limits and R&C amounts.

** Two per calendar year for children up to age 19.

Pre-Determination of Benefits

If you anticipate that charges will be more than $300 for a proposed treatment, a dental consultant can review the proposed treatment before work begins, and the claims administrator will inform you and your dentist of the amount of the covered charges. That way, you’ll understand the benefits that will be paid before treatment begins.


Provision Care Received Inside or Outside the United States*

Major restorative care (services to replace lost teeth, including crowns, inlays, tooth implants, bridges, and dentures)

50% after deductible

Orthodontia (for dependent children up to age 19)

50% after $150 lifetime orthodontia deductible

* This option pays for a percentage of covered services up to the reasonable and customary (R&C) amount subject to certain annual limits; you are responsible for 100% of all charges above the annual limits and R&C amounts.

Please Note: Whenever benefits are limited to a certain number of visits, care received in-network, out-of-network, and outside the U.S. will be combined and counted toward the benefit limit.

Annual Deductible If you elect coverage for yourself or yourself plus one dependent:

Each covered person must pay all eligible expenses until the individual deductible is met. Then, eligible expenses are covered at the coinsurance indicated for that expense.

After a covered person meets the individual deductible amount, that person will pay no further deductible.

If you elect coverage for yourself plus two or more dependents: All expenses incurred by you and/or your covered dependents combine to

meet the appropriate total deductible (individual plus children or family deductible).

If no one person meets the individual deductible, but combined participant expenses meet the total deductible amount, no further deductible is required.

The maximum deductible any one covered person must pay is equal to the individual amount. After one person meets the individual deductible, that person will pay no further deductible, but other covered persons must continue to pay deductibles until the total is satisfied. Please Note: There are separate deductibles for restorative care and orthodontia.

An Example: Amounts Applied Toward Restorative Care Deductibles On behalf of you $75 On behalf of your spouse/domestic partner $75 On behalf of one child $50 On behalf of a second child $25 Total $225 In this example, four people have met the family annual deductible for restorative care. So, any other covered person’s restorative care would be reimbursed by the plan, even if it were on behalf of a person who has not yet met the $75 individual annual deductible. No other covered family members need to meet their restorative care deductible for the rest of the year. Please Note: No more than $75 of expenses per individual will be applied towards the family deductible.


Coinsurance After you meet the applicable deductible, the plan will pay a percentage of the in-network dentist’s negotiated fees, or, for out-of-network expenses, a percentage of the reasonable and customary (R&C) charges for eligible expenses (see “Important Terms” on page 4 for the definition of “Reasonable and Customary”). The exact percentage depends on the type of care you receive. Please see the chart on page 45 for the applicable coinsurance rate. You’ll pay the remaining amount as coinsurance, plus any amounts above R&C charges.

Maximum Benefits There are limits on the benefits you can receive from the Dental Plan. The maximum for combined in-network and out-of-network benefits is $1,500 per person per year for preventive and restorative care. The lifetime maximum benefit for orthodontia is $2,500 per child. The lifetime orthodontia maximum reflects a combined amount for in- and out-of-network care and care received outside the United States.

Any benefits that have been applied to a maximum provision under a U.S. domestic Dental Plan option will also be applied to the lifetime maximums for the Expatriate Dental Plan option.

An Important Note on the Lifetime Orthodontia Maximum If you transfer to a U.S. domestic Dental Plan option, or vice versa, you do not gain a new lifetime orthodontia maximum. Any benefits paid under one Dental Plan option will apply against the other. The most you can ever receive in orthodontia benefits under the Dental Plan for each eligible dependent child under age 19 is $2,500.

For example, assume you’ve received $2,000 in orthodontia benefits for one dependent child under the Expatriate Dental Plan option. Then, you elect coverage under the U.S. domestic PDP Dental Plan option upon repatriation/transfer to the U.S. The most the PDP Option will pay toward that dependent child’s orthodontia expenses is the difference between what was paid under the Expatriate Dental Plan option and the PDP’s lifetime orthodontia maximums — $2,500 for in-network expenses and $2,000 for out-of-network expenses.

In this case, if care is received in-network, the most the PDP Option will pay for that dependent child’s orthodontia expenses is $500 ($2,500-$2,000=$500). However, the PDP would not pay anything more for care received out-of-network for that dependent child, since the lifetime orthodontia maximum had already been met under the Expatriate Dental Plan option.

Orthodontic Covered Services Orthodontia is covered for a child under 19 if the orthodontic appliance is initially installed while dental coverage is in effect for the child. The orthodontic appliance is a device used for influencing tooth position and may be classified as fixed or removable, active or retaining, and intraoral or extraoral.

Orthodontic treatment generally consists of the initial placement of an appliance and periodic follow-up. It also includes other services required for the orthodontic treatment such as extractions of certain teeth.

The benefit payable for the initial placement will not exceed 20% of the amount charged by the dentist. If the initial placement was made prior to the child becoming covered under the Expatriate Dental Plan option, the benefit payable will be reduced by the portion attributable to the initial placement.


The benefit payable for periodic follow-up visits will be payable on a quarterly basis during the course of the orthodontic treatment if:

Dental coverage is in effect for the child receiving the orthodontic treatment; and

Proof is given to CIGNA International that the orthodontic treatment is continuing.

If the periodic follow-up visits commenced prior to the child becoming covered under the Expatriate Dental Plan option:

The number of months for which benefits are payable will be reduced by the number of months of treatment performed before the child became covered under the Expatriate Dental Plan option; and

The total amount of the benefit payable for the periodic visits will be reduced proportionately.

Please Note: Whenever benefits are limited to a certain number of visits, care received in-network, out-of-network, and outside the U.S. will be combined and counted toward the benefit limit.

In-Network Care When you visit a CIGNA Dental PPO Network provider in the United States:

Network dentists cannot charge you more than the negotiated, discounted fee for covered services.

In addition to lowering your out-of-pocket costs, participating dentists submit their charges directly to CIGNA International, so you do not need to submit a claim form to seek reimbursement.

You may use your current CIGNA International ID card at any CIGNA Dental PPO Network provider.

You can locate a participating CIGNA Dental PPO Network provider (both general dentists and specialists) by visiting the CIGNA Envoy secure web site at www.cignaenvoy.com.

CIGNA has screened network providers to ensure that selected providers conform to an expected standard of care. If you don’t have a relationship with a dental care provider and are experiencing symptoms, you can visit the CIGNA Envoy secure web site at www.cignaenvoy.com or call Customer Service at 1-800-390-7183 or 1-302-797-3644 to be referred to the most appropriate provider for your condition and location.

Out-of-Network Care You may go to any general dentist or specialist at any time without a referral. You may have to file your own claims if the dentist does not bill CIGNA International directly.


What Is Covered Under the Expatriate Dental Plan Option The Dental Plan option covers a wide variety of services, as long as the services are necessary and their costs do not exceed reasonable and customary (R&C) charges. (Please see “Important Terms” beginning on page 4 for the definitions of “Necessary Services” and “Reasonable and Customary Charges.”) Since in-network charges for covered services have been negotiated with the providers, those charges would always be within the R&C limits. The following list includes examples of covered services, but the list is not exhaustive and coverage remains subject to any plan requirements or limitations. For specific information on covered services, please contact CIGNA International directly. (Please see “24-Hour Customer Service” on page 22“”on page for contact information.) The list of covered services may change at any time.

Preventive Care Services Covered preventive care services include the following services (please see the chart on page 45 for age and frequency limitations): Bitewing x-rays; Emergency palliative treatment; Fluoride treatments; Full mouth X-rays; Oral exams; Space maintainers; Prophylaxis; and Sealants.

Basic Restorative Care Services Covered basic restorative care services include: Consultations (two per calendar year); Administration of general anesthesia in conjunction with oral surgery when

necessary; Extractions; Fillings; Injections of antibiotic drugs; Most periodontal or other gum disease treatment; Periodontal maintenance (four visits per calendar year, combined with regular

cleanings); Oral surgery (except as covered by the Expatriate Medical Plan option); Periodontal scaling/root planing (one per quadrant per 24 months); Periodontal surgery (one per quadrant per 36 months); Relines/rebases (one per denture per 36 months, after six months from

installation); Repair or recementing of crowns, inlays, or onlays; dentures; or

bridgework; and

Root canal treatments.


Major Restorative Care Services Covered major restorative care services include:

Only appliances related to temporomandibular joint syndrome (TMJ) and only to a lifetime maximum of $500. Adjustments and diagnostics for TMJ are not separately eligible under the Expatriate Dental Plan option. Contact CIGNA International for specific details;

Initial placement and replacement of dentures and bridges — if the original appliance is at least five years old and cannot be repaired;

Services necessary to replace teeth lost while coverage is in effect;

Crowns/inlays/onlays (one per tooth per five calendar years);

Treatment for harmful habits; and

Treatment for accidental injury. (Eligible dental expenses are covered under the Dental Plan; eligible medical expenses are covered under the Medical Plan.)

Implant(s). Benefits may also be available for the final restoration or prosthesis (crown or partial denture) over the implant. A pre-treatment estimate should be submitted for a dental consultant to evaluate the claim to determine if any benefits are payable.

Important Alternate Benefit Provision Generally benefits will be limited to the R&C charge for the least expensive method of treatment that is appropriate and that meets acceptable dental standards — as determined by CIGNA International. Pursuant to the Plan’s Alternate Benefit provision, if CIGNA International determines that a service less costly than the Covered Service the dentist performed could have been performed to treat a dental condition, the plan will pay benefits based upon the less costly service if such service:

Would produce a professionally acceptable result under generally accepted dental standards; and

Would qualify as a Covered Service.

For example:

When an amalgam filling and a composite filling are both professionally acceptable methods for filling a molar, CIGNA International may base the benefit determination upon the amalgam filling, which is the less costly service;

When a filling and an inlay are both professionally acceptable methods for treating tooth decay or breakdown, CIGNA International may base the benefit determination upon the filling, which is the less costly service;

When a filling and a crown are both professionally acceptable methods for treating tooth decay or breakdown, CIGNA International may base the benefit determination upon the filling, which is the less costly service; and

When a partial denture and fixed bridgework are both professionally acceptable methods for replacing multiple missing teeth in an arch, CIGNA International may base the benefit determination upon the partial denture, which is the less costly service.

If the plan pays benefits based upon a less costly service in accordance with these provisions, the dentist may charge you or your dependent for the difference between the service that was performed and the less costly service. This is the case even if the service was performed by an in-network dentist.


Certain comprehensive dental services have multiple steps associated with them. These steps can be completed at one time or during multiple sessions. For benefit purposes, these separate steps of one service are considered to be part of the more comprehensive service. Even if the dentist submits separate bills, the total benefit payable for all related charges will be limited to the maximum benefit payable for the more comprehensive service. For example, root canal therapy includes x-rays, opening of the pulp chamber, additional x-rays, and filling of the chamber. Although these services may be performed in multiple sessions, they all constitute root canal therapy. Therefore, the plan will only pay benefits for the root canal therapy.

What’s Not Covered While the JPMorgan Chase Expatriate Dental Plan option covers a wide range of services, some expenses are not covered by the plan.

These include but are not limited to those listed as follows. This list of excluded services is not exhaustive and may change at any time.

Any of the following services:

⎯ A gold restoration or crown, unless:

- It is treatment for decay or traumatic injury, and teeth can’t be restored with a filling material; or

- The tooth is an abutment to a covered partial denture or fixed bridge.

⎯ An appliance — or modification of one — if an impression for it was made before the person became covered.

Any of the following services incurred more than 31 days after the date the person’s coverage ends:

⎯ A crown, bridge, or gold restoration for which the tooth was prepared while the person was covered;

⎯ An appliance — or alteration of one — for which an impression was made while the person was covered; or

⎯ Root canal therapy for which the pulp chamber was opened while the person was covered.

Charges in connection with:

⎯ A charge for a service to the extent that it is more than the usual charge made by the provider for the service when there is no insurance;

⎯ Appliances or restorations needed to alter vertical dimensions or restore occlusion, or for the purposes of splinting or correcting attrition, abrasion, or erosion; or

⎯ Replacement of lost, missing, or stolen appliances or appliances that have been damaged due to abuse, misuse, or neglect.

Treatment for problems of the jaw joint, including:

⎯ Craniomandibular disorder;

⎯ Temporomandibular joint syndrome (TMJ), other than what is noted in “What Is Covered”; or

⎯ Other conditions of the joint linking the jaw bone and skull, and of the complex of muscles, nerves, and other tissues related to that joint.


Expenses submitted later than December 31 of the year following the year in which services were provided.

Installation of prosthetic devices (including bridges and crowns) while not covered or which were installed more than 31 days after coverage ends.

Loss — or portion of a loss — for which mandatory automobile no-fault benefits are recovered or recoverable.

Partial or full removable denture, removable bridge, or fixed bridgework if it includes replacement of one or more natural teeth (including congenitally missing teeth) missing before the person became covered under this plan. The exclusion does not apply if the denture, bridge, or bridgework also includes replacement of a natural tooth that:

⎯ Is removed while the person is covered; and

⎯ Was not an abutment to a partial denture, removable bridge, or fixed bridge installed during the prior five years.

Procedures related to occupational illness or injury.

Replacement or modification of a partial or full removable denture, a removable bridge or fixed bridgework, or for a replacement or modification of a crown or gold restoration or inlay/onlay within five years after that denture, bridgework, crown, inlay/onlay, or gold restoration was installed.

Expenses or charges with respect to services rendered by hospitals, clinics, laboratories (except dental X-rays are covered), or other institutions.

Services and supplies included as covered medical expenses under:

⎯ Any other employer-sponsored plan that covers you, including the U.S. Medicare program;

⎯ Any other governmental health program, except the U.S. Medicaid program; or

⎯ The Expatriate Medical Plan option.

Services and supplies rendered in a veteran’s facility or government hospital, or services furnished in whole or in part under the laws of the United States or any of its state or political subdivisions.

Services furnished for cosmetic purposes. Facings on crowns or pontics — which are behind the second bicuspid — will always be considered cosmetic. This limitation does not apply if the service is needed as a result of accidental injuries sustained while a person is covered.

Services not reasonably necessary as determined by CIGNA International.

Services to the extent that a benefit for those services is provided under any other program paid in full or in part, directly or indirectly, by JPMorgan Chase. This includes insured and uninsured programs. If a program provides benefits in the form of services, the cash value of each service rendered is considered the benefit provided for that charge.

Services to the extent that the charges are above the prevailing charge in the area for dental care of a comparable nature. A charge is above the prevailing charge to the extent that it’s above the range of charges generally made in the area for dental care of a comparable nature. The area and that range are determined by CIGNA International.

Treatment by a dental or medical department maintained by or on behalf of an employer, a mutual benefit association, a labor union, a trustee, or a similar person or group.


Expenses in connection with services, procedures, drugs, or other supplies that are determined by CIGNA International to be experimental, or still under clinical investigation by health professionals.

Charges for oral hygiene programs, completion of claim forms by the provider on your behalf, and broken appointments.

Services provided by a relative, or for which a charge would not normally be made.

Treatment by anyone except a licensed dentist (except for cleaning or scaling of teeth and topical application of fluoride performed by a licensed dental hygienist, if rendered under the supervision and guidance of a licensed dentist).

Other Limitations Replacements of — or additions to — existing dentures or bridgework will be covered under the Dental Plan only if at least one of the following conditions exists:

The present denture or bridgework cannot be made serviceable, and it is at least five years old;

It’s necessary to replace teeth extracted after the present denture or bridgework was installed; or

Replacement by a permanent denture is needed because the present denture is temporary, and replacement occurs within 12 months after the date the temporary denture was installed.

Please contact CIGNA International at the number listed under “24-Hour Customer Service” on page 22 for more information about services, procedures, charges, and expenses not covered by the Expatriate Dental Plan option.


If You Are Covered by More Than One Medical and/or Dental Plan The JPMorgan Chase Expatriate Medical Plan and Dental Plan options have provisions to ensure that payments from all of your group health care plans don’t exceed the amount the JPMorgan Chase Plans would pay if they were your only coverage. The rules described here apply to the JPMorgan Chase Medical and Dental Plan options. The following rules do not apply to any private, personal insurance you may have.

Non-Duplication of Benefits The Medical and Dental Plans do not allow for duplication of benefits. If you and your eligible dependents are covered under more than one group plan, the primary plan (the one responsible for paying benefits first) needs to be determined. The non-duplication provisions of the plans will ensure that, in total, you receive benefits up to what you would have received with the plans as your only source of coverage (but not in excess of that amount), based on the primary carrier’s allowable amount. A summary of coordination rules (i.e., how JPMorgan Chase coordinates coverage with another group plan to ensure non-duplication of benefits) is provided below. If you have questions, please contact CIGNA International for help. (See “24-Hour Customer Service” on page 22 for contact information.)

Determining Primary Coverage To determine which plan pays first as the primary plan, here are some general guidelines: If you are an active JPMorgan Chase employee, the Expatriate Medical

and/or Dental Plan Options will be primary for you and consider claims for your expenses first.

If your covered dependent has a claim, the plan covering your dependent as an employee will be considered primary to these plans.

If your claim is for a covered dependent child who has coverage under both parents’ plans, the plan covering the parent who has the earlier birthday in a calendar year (based on month and birthday only) will be considered primary. In the event of divorce or legal separation, and in the absence of a qualified medical child support order, the plan covering the parent with court-decreed financial responsibility will be considered primary for the covered dependent child. If there is no court decree, the plan of the parent who has custody of the covered dependent child will be considered primary for the covered dependent child. (Please see “Qualified Medical Child Support Order” on page 62 for more information on a qualified medical child support order.)

If your other plan doesn’t have a coordination of benefits provision, that plan will be considered primary and will pay first for you and your covered dependents.

If payment responsibilities are still unresolved, the plan that has covered the claimant the longest pays first.

After it’s determined which plan is primary, you’ll need to submit your initial claim to that plan. After the primary plan pays benefits (up to the limits of its coverage), you can then submit the claim to the other plan (the secondary plan) to consider your claim for any unpaid amounts. You’ll need to include a copy of the Explanation of Benefits Statement from your primary plan.


Coordination with Medicare This section describes how your benefits coordinate with Medicare (the United States federal health insurance program for senior citizens and qualifying disabled people) if you or a covered dependent are Medicare-eligible due to a disability, or because you or the dependent have end-stage renal disease (ESRD).

Medicare Overview Medicare is a federal health insurance program designed to assist disabled people and senior citizens in paying for some of their medical care. Medicare is composed of Part A and Part B (together known as “Original Medicare”) and Part D. Medicare Part A (Hospital Insurance). Medicare Part A helps cover

approved expenses for basic inpatient care (e.g., semi-private room, general nursing), care in a skilled nursing facility, home health care, and hospice care. In most cases, there’s no monthly premium for Part A. That’s because most people pay Medicare taxes while they are working, which covers the cost of participating in Part A.

Medicare Part B (Medical Insurance). Medicare Part B helps cover expenses for doctor’s services, outpatient care, and other medical services that aren’t covered by Medicare Part A, such as diagnostic tests, ambulatory surgery centers, and second surgical opinions. Participating in Medicare Part B is optional. You must pay a monthly premium to receive Medicare Part B benefits. Premiums are set prior to January 1 of each year and are subject to change on an annual basis.

Medicare Part D (Medicare Prescription Drug Program). Effective January 1, 2006, a new Medicare Prescription Drug Program (Medicare Part D) was added to the current Original Medicare program (Part A for hospital insurance and Part B for medical insurance). Under Medicare Part D, people with Medicare can purchase coverage for prescription drugs — a benefit that had not been part of Original Medicare. Under Medicare Part D, Medicare prescription drug plans are offered by private health insurance companies, not by the federal government. These plans work much like other types of medical insurance. In other words, you pay a monthly premium and then pay a share of the cost of each prescription drug. The premiums vary based on the plan you choose and your geographic area. Premiums are expected to increase annually. In addition to the annual premium, Medicare prescription drug plans have some or all of the following features: ⎯ Annual deductibles (the amount you pay before the plan starts paying

benefits); ⎯ Coinsurance/copayment requirements (the percentage or amount you pay

for prescription drugs after you meet your annual deductible); ⎯ Coverage gaps (a range of prescription drug expenses, aside from an

up-front deductible, that may not be covered under the plan); ⎯ Formularies (a “preferred” drug list, typically with better coverage than

drugs excluded from the formulary); and

⎯ Participating pharmacies.

Important Reminder

Covered services and benefits levels under Medicare are subject to change by the U.S. federal government. Contact your local Social Security office to obtain the most recent information on Medicare costs and coverage.


Medicare has outlined a “standard” way that Medicare prescription drug plans will cover prescription drug expenses. However, it’s important to understand that private health insurance companies offering Medicare prescription drug plans can deviate from the “standard” benefit — as long as their benefits are at least as good as the “standard.” This means that depending on where you live, the Medicare prescription drug plans in your area may vary by the monthly premiums you pay, the types of prescription drugs covered, how much you have to pay out of pocket, and which pharmacies you can use.

Coordination with Medicare Parts A and B If You Are Disabled

Entitlement to Medicare coverage is automatic for anyone who receives Social Security Disability Income for 24 months. Medicare entitlement begins on the first day of the 25th month of disability. If you (or a covered dependent) become entitled to Medicare because of a qualifying disability, Medicare becomes the primary source of medical coverage for the disabled individual 29 months after the disability determination date. This means that Medicare pays benefits first. Then, the JPMorgan Chase Medical Plan pays the difference between what Medicare paid and what the JPMorgan Chase Medical Plan would have paid if it were the only coverage available (in other words, if Medicare did not exist). These provisions also apply to your Medicare-eligible dependents.

Please Note: If you and/or a covered dependent are eligible for Medicare and do not apply for Medicare coverage, the Medicare benefits that would have been paid will still be considered before JPMorgan Chase benefits are determined (if Medicare is the primary payer). Therefore, even if you do not elect Medicare Part B, benefits for the Medicare-eligible individual will be provided on a Medicare primary basis.

Coordination of Benefits with Medicare Parts A and B Based on ESRD Entitlement

Medicare pays secondary to the JPMorgan Chase Medical Plan only during the first 30 months that you (or your covered dependents) are entitled to Medicare based on end-stage renal disease (ESRD).

Coordination of Benefits with Medicare Part D

Enrolling in a Medicare prescription drug plan is your choice — it’s completely voluntary. To enroll, you must have Medicare Part A and Part B. It’s important to note that the JPMorgan Chase Retiree Medical Plan does not coordinate benefits with Medicare Part D. You and/or your dependents cannot have prescription drug coverage under both the JPMorgan Chase U.S. Retiree Medical Plan and a Medicare prescription drug plan. If you enroll in a Medicare prescription drug plan, you and your dependents’ medical and prescription drug coverage under the JPMorgan Chase U.S. Retiree Medical Plan will be discontinued (even if all of your covered dependents are not eligible for Medicare) and you may not be able to get this coverage back.

Right of Recovery If the Medical and/or Dental Plans provide benefits to you or a covered dependent that are later determined to be the legal responsibility of another person or company, the Medical and Dental Plans have the right to recover these payments from you. You should know that an assignment of your claim to a third party does not exempt you from your responsibility for repayment of overpayments.


Subrogation of Benefits The purpose of the Medical and/or Dental Plans is to provide benefits for eligible health care expenses that are not covered by any third party. If a covered person or agency receives payment from any third party for any expenses that have already been paid by the plans, the covered person or agency will have to reimburse the plans for the full amount of those expenses. However, if the payment received from the third party (minus attorney’s fees and other legal expenses) is not enough to reimburse the plans for the full amount paid in benefits, the covered person will have to reimburse the plans with the amount that is left after attorney’s fees and other legal expenses are paid. This is known as “subrogation of benefits.” The JPMorgan Chase Plans have the right to pursue subrogation against any person or insurer. The covered person agrees to help the plan use this right when requested.

Right of Reimbursement In addition to their subrogation rights, the plans are entitled to reimbursements from a covered person who receives compensation from any third parties (other than family members) for health care expenses that have been paid by the Medical and/or Dental Plan.


When Coverage Ends When you retire, or if you are repatriated back to your home country, you will no longer be eligible for coverage under the Expatriate Medical and Dental Plan options, and will therefore need to elect coverage under your local/domestic, home-country medical plan and/or dental plan. If you were enrolled in the Expatriate Medical and/or Dental Plan options, this coverage will automatically end on the last day of the month in which your assignment ends.

If your employment with JPMorgan Chase terminates, participation for you and your covered dependents usually ends on the last day of the month of active employment. However, under certain circumstances, you may be eligible to continue Medical and/or Dental Plan participation for a certain period of time under the United States Consolidated Omnibus Reconciliation Act (COBRA) of 1985.

Expenses incurred after you leave JPMorgan Chase cannot be reimbursed by the Medical and/or Dental Plans unless you choose to continue your participation under COBRA.

Please Note: Non-U.S. home-based expatriate employees assigned outside the United States and their dependents are not eligible for medical and/or dental continuation coverage under COBRA.

Certificate of Creditable Coverage Under the United States Health Insurance Portability and Accountability Act of 1996 (HIPAA), JPMorgan Chase is required to provide you with a Certificate of Creditable Coverage if your JPMorgan Chase-provided health care coverage ends. The certificate identifies the names of you and/or your eligible dependents and the duration for which you were covered under the JPMorgan Chase health care benefit plans.

You may need to present this certificate to your new employer at the time you are enrolling for benefits under the new employer’s plan, especially if you or your dependents have a pre-existing condition that would limit coverage under your new employer’s plan. If you have proof of creditable coverage from another plan, exclusion periods for pre-existing conditions are reduced or eliminated. Without proof of creditable coverage, you may be subject to an exclusion period of 12 months (18 months for late enrollees) after your enrollment date for your new coverage. You should always keep a copy of your HIPAA certificate for your records.

You automatically will be sent a Certificate of Creditable Coverage at the time your coverage ends and again when your continued coverage under COBRA (if elected) ends. You also may request a Certificate of Creditable Coverage from the plan administrator at any time within the 24-month period after your coverage under the benefit plans ends.


Prescription Drug Notice of Creditable Coverage JPMorgan Chase will send a Notice of Creditable Coverage to participants who become eligible for Medicare. This notice states that the JPMorgan Chase Medical Plan options provide prescription drug benefits that are, on average, at least as good as the standard Medicare prescription drug plan benefits. The notice is important because it can help you avoid late enrollment penalties associated with Medicare prescription drug plans that may apply given that JPMorgan Chase benefits-eligible employees would generally wait until retirement to enroll in Medicare Part B and Part D.

If you have a dependent who is eligible for Medicare benefits and you do not receive a Notice of Creditable Coverage, you can contact the Benefits Call Center to request one.


Additional Plan Information Your primary contact for all matters relating to the general administration of the Expatriate Medical and Dental Plan options is the Benefits Call Center.

Your benefits as a participant in the Medical and Dental Plans are provided under the terms of the official plan text and insurance policies, and/or contracts, if any, issued to JPMorgan Chase. If there is any discrepancy between the official plan documents and this summary, the official plan documents control. Please Note: No person or group, other than the Plan Administrator for the JPMorgan Chase U.S. Benefits Program has any authority to interpret the Expatriate Medical and Dental Plans (or official plan documents) or to make any promises to you about them. The Plan Administrator for the JPMorgan Chase U.S. Benefits Program has complete authority in his or her sole and absolute discretion to construe and interpret the terms of the Expatriate Medical and Dental Plans and any underlying policies and/or contracts, including the eligibility to participate in the plan. All decisions of the Plan Administrator for the JPMorgan Chase U.S. Benefits Program are final and binding upon all affected parties.

HIPAA Privacy Rights and Protected Health Information JPMorgan Chase is committed to maintaining the confidentiality of your personal compensation and benefits information. However, United States federal legislation under the Health Insurance Portability and Accountability Act (HIPAA) now legally requires employers — like JPMorgan Chase — to specifically communicate how certain “protected health information” under employee and retiree health care plans may be used and disclosed, as well as how plan participants can get access to their protected health information. The information included in this section is a summary of HIPAA privacy regulations. To comply with the law, JPMorgan Chase will distribute to you annually a “Privacy Notice of Protected Health Information Under the JPMorgan Chase Health Care Plans” that describes in detail how your personal health information may be used and your rights with regard to this information. A copy of the privacy notice is also available in the Expatriate Library on the Expatriate Benefits page on HR & Personal, or you can contact the Benefits Call Center at any time to request a paper copy. Under HIPAA, protected health information is confidential, personal, identifiable health information about you that is created or received by a claims administrator (like those under the JPMorgan Chase Medical Plan), and is transmitted or maintained in any form. (“Identifiable” means that a person reading the information could reasonably use it to identify an individual.) Under HIPAA, JPMorgan Chase may only use and disclose Medical Plan participants’ protected health information in connection with payment, treatment, and health care operations. In addition, JPMorgan Chase must restrict access to and use of protected health information by all employees/groups except for specific purposes of administering the Medical Plan, including payment and health car operations. In compliance with HIPAA, JPMorgan Chase agrees to: Not use or further disclose protected health information other than as

permitted or required by law; Ensure that any agents (including a subcontractor) to whom the company

gives protected health information received from the claims administrators agree to the same restrictions and conditions that apply to JPMorgan Chase with respect to this information;


Not use or disclose the information for employment-related actions and decisions or in connection with any other benefit or employee benefit plan of JPMorgan Chase;

Report to the claims administrators any use or disclosure of the information that is inconsistent with the designated protected health information uses or disclosures;

Make available protected health information in accordance with individuals’ rights to review their protected health information;

Make available protected health information for amendment and incorporate any amendments to protected health information consistent with the HIPAA rules;

Make available the information required to provide an accounting of disclosures in accordance with the HIPAA rules;

Make the company’s internal practices, books, and records relating to the use and disclosure of protected health information received from the claims administrators available to the Secretary of Health and Human Services for purposes of determining compliance by the JPMorgan Chase Medical Plan; and

Return or destroy all protected health information received in any form from the claims administrators. JPMorgan Chase will retain no copies of protected health information when no longer needed for the purpose of a disclosure. An exception may apply if the return or destruction of protected health information is not feasible. However, JPMorgan Chase must limit further uses and disclosures of this information to those purposes that make the return or destruction of the information infeasible.

If you believe that your rights under HIPAA have been violated, you can file a complaint with the Plan or with the Secretary of the U.S. Department of Health and Human Services. If you wish to file a HIPAA complaint with the Plan, please complete a HIPAA complaint form (available by contacting the Benefits Call Center) and send it to:

HIPAA Privacy Officer for the JPMorgan Chase Health Care Plans Corporate Benefits JPMorgan Chase 611 Woodward Avenue Mail Code: MI1-8010 Detroit, MI 48226 Fax: 1-313-256-0683

HIPAA Special Enrollment Rights The Health Insurance Portability and Accountability Act (HIPAA) is a United States federal law that provides special enrollment rights to employees and eligible dependents who decline coverage under the Expatriate Medical and/or Dental Plans because they have other health care coverage.


If you or your eligible dependent declined coverage under the Expatriate Medical and/or Dental Plans, you may enroll for coverage within 31 days of one of the following events for coverage to be effective the date of the event. If you miss the 31-day deadline, coverage for certain benefits will be effective as of the date you contact the Benefits Call Center, and in order to have retroactive coverage, you may be required to pay for your coverage on an after-tax basis for the period prior to the date you contact the Benefits Call Center. Otherwise, you will not be able to make the change in coverage until the following annual benefits enrollment period:

You and/or your eligible dependents lose other coverage because you no longer meet the eligibility requirements (due to legal separation, divorce, death, termination of employment, or reduced work hours);

If you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents provided that you request enrollment within 31 days after the marriage, birth, adoption, or placement for adoption. If you are eligible for coverage but do not enroll, your dependent cannot enroll;

Employer contributions for the other coverage end; or

The other coverage was provided under The Consolidated Omnibus Budget Reconciliation Act (COBRA) and the COBRA coverage period ends.

If you qualify for this HIPAA special enrollment, your coverage under the Expatriate Medical and/or Dental Plans will begin on the date of the event described previously provided you enroll and pay the required contributions.

Effective April 1, 2009, if you or your eligible dependent loses U.S. Medicaid or Children’s Health Insurance Program (CHIP) coverage because you are no longer eligible, or become eligible for a premium assistance subsidy under Medicaid or CHIP, you may enroll for JPMorgan Chase coverage, as long as you make your request within 60 days of the event.

Qualified Medical Child Support Order If the Medical Plan and/or Dental Plan receive a judgment, decree, or order — including a Qualified Medical Child Support Order (QMCSO) — requiring the plans to provide health coverage to your child or foster child who is your dependent, the plans will automatically change your benefits elections to provide coverage for the child. In the case of a child whom you are required to cover pursuant to a QMCSO, coverage will begin on the date specified in the order, or if none is specified, the date of the order. You may decrease your coverage for that child, if the court order requires the child’s other parent to provide coverage and your spouse’s or former spouse’s plan actually provides that coverage. You also may make other corresponding changes to your benefit elections under the plans, to the extent permitted by the United States Internal Revenue Code (IRC) and the Expatriate Medical and/or Dental Plans.

A participant or beneficiary may obtain a description of the procedures governing medical support order determinations, without charge, from the plan administrator.


If Your Situation Changes The following chart summarizes how your JPMorgan Chase Medical Plan coverage may be affected in certain situations, for example, if you have a qualified change in status.

If Your Work Status Changes

Your Medical and/or Dental Plan coverage will end on the last day of the month in which your work status changes and you are then scheduled to work fewer than 20 hours per week. Even if your coverage ends, however, if you are a U.S. home-based expatriate or an expatriate assigned to the United States, you may be able to continue medical coverage for a certain period of time under the Consolidated Omnibus Budget Reconciliation Act of 1985 as amended (COBRA). Non-U.S. home-based expatriate employees assigned outside the United States and their dependents are not eligible for medical and/or dental continuation coverage. (Please see the “Plan Administration” section of “Your Guide to Benefits at JPMorgan Chase” for more information on COBRA.)

If You Go on Disability Leave

For the approved period of your short-term disability leave, you’ll remain eligible to be covered under the Medical Plan. JPMorgan Chase will deduct any required contributions for medical coverage from any pay you receive during this period. If you are not receiving pay via Expat Payroll during this time, JPMorgan Chase will bill you directly for any required contributions.

If You Go on Long-Term Disability

If you qualify for long-term disability (LTD) benefits from a JPMorgan Chase long-term disability plan, your expatriate assignment will end and, coincidentally, so will your eligibility for the Expatriate Medical and Dental Plan options. You must then elect coverage under your home country Medical and/or Dental Plan options, if available. If you are a U.S. home-based expatriate employee, medical coverage under one of the U.S. domestic options may continue while you are receiving LTD benefits under the U.S. LTD Plan. Be sure to consider this carefully before you decline coverage under the LTD Plan. (Please see the “Long-Term Disability” section of “Your Guide to Benefits at JPMorgan Chase” for more information.)

If You Go on Unpaid Leave

For an approved leave of absence, you’ll still be covered by the Medical Plan. JPMorgan Chase will bill you directly for any required contributions. If you do not make the required contributions to continue your Medical Plan coverage, your coverage will be canceled. However, your coverage may be reinstated when you return to work. Please see the “Plan Administration” section of “Your Guide to Benefits at JPMorgan Chase” for more information about what happens to your benefits during an unpaid leave of absence (i.e., FMLA, Military Leave).


If You Leave JPMorgan Chase

If your employment with JPMorgan Chase terminates, participation for you and your covered dependents usually ends on the last day of the month in which you end active employment. However, if you are a U.S. home-based expatriate or an expatriate assignment to the U.S., under certain circumstances, you may be eligible to continue participation for a certain period of time under COBRA. Non-U.S. home-based expatriate employees assigned outside the United States and their dependents are not eligible for medical and/or dental continuation coverage. (Please see the “Plan Administration” section of “Your Guide to Benefits at JPMorgan Chase” for more information on COBRA.) Expenses incurred after you leave JPMorgan Chase cannot be reimbursed by the Medical Plan unless you choose to continue your participation under COBRA.

If Your Expatriate Assignment Ends

If your expatriate assignment ends, your Medical and/or Dental Plan coverage will end on the last day of the month in which your work status changes. If you remain an active JPMorgan Chase employee, you will need to elect coverage under your local/domestic, home-country Medical Plan and/or Dental Plan.

If You Retire from JPMorgan Chase

You must be a U.S. home-based expatriate employee and meet minimum age and service requirements and have active medical coverage at the time of retirement to be eligible for U.S. retiree medical coverage. For more information, please refer to the As You Retire Guide available on HR & Personal > Benefits.

If You Work Past Age 65

If you continue to work for JPMorgan Chase after you reach age 65 (and/or if your spouse reaches age 65 while you’re still working at JPMorgan Chase), you and your spouse can continue to be covered under the Medical Plan. If you or your spouse enrolls in U.S. Medicare at that time, Medicare coverage will provide secondary benefits to the JPMorgan Chase U.S. Medical Plan. If you’re covered under both the Medical Plan and Medicare, you need to submit your claims for benefits to the Medical Plan first. If any bills remain unpaid after the Medical Plan has paid up to the limits of its coverage, you should file a claim with Medicare. Please note that medical coverage under Medicare is not automatic. You must file for coverage when you first become eligible. If you continue to work past age 65 and you have coverage under the JPMorgan Chase Medical Plan, you may wait and apply for Medicare when you leave JPMorgan Chase. For more information about Medicare, contact your local U.S. Social Security office.


If You Divorce or Become Legally Separated

If your spouse and/or dependent children lose coverage as a result of divorce/separation, they may have a right to elect COBRA for up to 36 months. (Please see the “Plan Administration” section of “Your Guide to Benefits at JPMorgan Chase” for more information on COBRA.) Non-U.S. home-based expatriate employees assigned outside the United States and their dependents are not eligible for medical and/or dental continuation coverage. If you divorce or become legally separated, certain court orders could require you to provide medical benefits to covered dependent children. JPMorgan Chase is legally required to recognize qualified medical child support orders within the limits of the Medical Plan. If you’re a party in a divorce settlement that involves the Medical Plan, you should have your attorney contact the Benefits Call Center to make sure the appropriate documents are filed and that the court order in question is actually a qualified medical child support order that complies with governing legislation. See “Qualified Medical Child Support Order” on page 62 for more information.

If You Die If you die while actively employed at JPMorgan Chase, any dependents who were covered under the Medical Plan before your death will continue to be covered until the end of the month in which you die. Covered dependents may then be eligible elect to continue coverage under COBRA and pay the active employee rate for coverage for up to 36 months of the COBRA period. Dependents must be covered under the Medical Plan at the time of your death to be eligible for COBRA coverage at JPMorgan Chase-subsidized rates. (Please see the “Plan Administration” section of “Your Guide to Benefits at JPMorgan Chase” for more information on COBRA.) Non-U.S. home-based expatriate employees assigned outside the United States and their dependents are not eligible for medical and/or dental continuation coverage. In addition, if you are a U.S. home-based expatriate, any dependents who were enrolled in the Medical Plan at the time of your death may be eligible to continue coverage under the U.S. Retiree Medical Plan if, at the time of death: You have already met the general eligibility requirements for

retirement. (For more information, please refer to the As You Retire Guide available on HR & Personal > Benefits); or

You have already met the alternative eligibility requirements for retirement in the event of position elimination (For more information, please refer to the As You Retire Guide available on HR & Personal > Benefits); or

You have 25 years of total service with JPMorgan Chase. Dependents of U.S. home-based expatriate employees may continue coverage under the U.S. Retiree Medical Plan as long as they meet the Medical Plan’s requirements. Please Note: The requirements detailed above denote the requirements to qualify for unsubsidized or “access only” retiree medical coverage under the U.S. Benefits Program. To qualify for subsidized retiree medical coverage, the deceased employee must have met certain requirements with respect to hire dates, age, and service requirements as of December 31, 2005, and must meet the requirements above in relation to “cumulative” service (rather than total service). Please refer to the As You Retire Guide for details of these additional requirements.


Right to Amend JPMorgan Chase reserves the right to amend, modify (including cost of coverage), reduce or curtail benefits under, or terminate the expatriate benefit plan options at any time for any reason by act of the Compensation and Benefits Executive, other authorized officers, or the Board of Directors. In addition, the Expatriate Medical and Dental Plan Options do not represent a vested benefit. Neither this Guide nor the benefits described in this Guide create a contract of employment or a guarantee of employment between JPMorgan Chase and any employee.

If you have any questions about these options, contact the Benefits Call Center.

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