Dental Program Index

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	Table of Contents

	Detailed Table of Contents

	Index

- A -

Adding Dependents 1

Administrative and Contact Information 1

Agent for Service of Legal Process 1

Alternate Dental Services 1

Annual Enrollment 1

Annual Maximum 1

Assignment 1

- B -

Basic Services 1

- C -

Child 1

Child QMCSO 1

CIGNA Dental PPO 1

Exclusions 1

What’s Covered 1

Claims Administrator

Eligibility Claims 1

Claims Administrators 1

Claims

Claims and Appeals Procedures 1

Concurrent Care 1

Dental Program 1

Filing 1, 2, 3

Initial Benefit Denial 1, 2

Initial Determination 1, 2, 3

Legal Action 1

Post-Service 1

Pre-Service 1

Procedure for Filing an Appeal of a Denial 1

Urgent Care 1

Class I

Preventive and Diagnostic Services 1

Class II

Basic Services 1

Class III

Major Services 1

COBRA Administrator 1

COBRA

Coverage Ends 1

Disability Extension 1

Election Procedure 1

Notification 1

Other Extension 1

Payment 1

Trade Act Implications 1

Coinsurance 1

Continue Coverage (COBRA) 1

Contract Amount 1

Contributions 1

Coordination of Benefits

Defined 1

Procedures 1

Coverage Begins 1

Coverage Ends

Extension of Benefits 1

General Information 1

Leave the Company 1

Retirement 1

Strike 1

Coverage Extensions 1

Covered Expenses 1

- D -

Deductibles 1

Defective Claims 1

Dental Program 1

Dentist 1

Disability Benefits 1

Domestic Partner 1

Duty to Notify 1

- E -

Effective Date 1

Eligibiilty

You 1

Eligibility Administration 1

Eligibility

Dependents 1

Disabled Children 1

Full-Time Student 1

New Subsidiaries and/or Participating Employers 1

Reemployed 1

Spouse 1

You 1

Employer Identification Number 1

Enrolling

General Information 1

Ineligible Person 1

Missed Deadline 1, 2

ERISA Rights 1, 2, 3, 4, 5, 6

- F -

Fiduciaries 1

- G -

General Information 1, 2, 3, 4, 5, 6

Glossary 1

CIGNA Dental PPO Options 1

- K -

Key Features 1, 2

- L -

Leave of Absence 1

Leave the Company 1

- M -

Major Services 1

Maximum Allowable Charge 1

- N -

Not Eligible 1

- O -

Orthodontic Lifetime Maximum 1

Orthodontic Services 1

- P -

Passive PPOs 1

Plan Administrator 1

Plan Changes 1

Plan Funding 1

Plan Name 1

Plan Number 1

Plan Sponsor 1

Plan Type 1

Plan Year End 1

Pretreatment Review 1

Preventive and Diagnostic Services 1

- Q -

Qualified Life Event Changes 1

Qualified Medical Child Support Order 1

- R -

Recovery 1

Requesting Benefits 1

Responsibilities 1

Retirement 1

Right of Reimbursement, Assignment of Rights and Duty to Notify 1

Right to Reimbursement 1

Rights 1

- S -

Significant Cost or Coverage Change 1

Situations Affecting Your Benefits 1

Sole Legal Guardian 1

Special Enrollment Opportunities 1

Spouse 1

Strike 1

Summary Chart

CIGNA Dental PPO Options 1

Summary Plan Description 1

- T -

Trust and Insurance 1, 2

Type of Plan 1

- U -

Uniformed Services Employment and Reemployment Rights Act 1

- W -

What’s Covered 1, 2, 3, 4

Dental Program

Special Extensions of Coverage

During a Leave of Absence

If you are granted a leave of absence pursuant to RR Donnelley’s Human Resources Core Policy 6-4, Leaves of Absence, or you are laid off pursuant to Human Resources Core Policy 6-8, Temporary Layoffs, your and your enrolled eligible dependents’ coverage will automatically continue during the approved leave period. This includes leaves:

For your own personal disability;

Covered by the Family and Medical Leave Act of 1993 (FMLA); and

Covered under the Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA).

If your unpaid leave is covered by FMLA or USERRA, you have a right to discontinue coverage when your unpaid leave begins. See the Qualified Status Changes SPD for additional information.

While you are on a leave of absence (excluding a military leave), RR Donnelley will advance on your behalf the required benefit contributions until you are able to return to work, you separate from employment, or you are reclassified as benefits-ineligible, whichever is earliest. Your election to authorize RR Donnelley to reduce your future wages on a before-tax basis for your required contributions includes an authorization to withhold amounts advanced to you by RR Donnelley during the time of your leave of absence. Therefore, if RR Donnelley advances contributions for you that remain unpaid at the end of the calendar year, provisions under the Program limiting your election to one calendar year will not apply.

Also, your authorization to withhold makes you responsible for repaying through payroll deductions any contributions advanced on your behalf during your leave of absence (excluding a military leave). The missed contributions will be recovered by taking one past deduction plus one current deduction, beginning with your first available pay upon your return to work. Deductions from your pay will continue until you repay your outstanding core benefit balance. If you separate from employment from the Company with an outstanding balance due, the remaining balance will be recovered from your final pay as permitted by law.