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Health Care Spending and Dependent Care Spending Program Detailed Table of Contents
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Table of Contents
Detailed Table of Contents
Index

Introduction

Who Is Eligible

General Information

If You Are Reemployed

For Employees of New Participating Subsidiaries and/or Participating Employers

Enrolling to Participate

General Information

Your Contributions

When Participation Begins

If You Are Not Actively at Work

If You Do Not Enroll by the Deadline

Qualified Status Changes

Annual Enrollment

A Few Words About Taxes

An Example of the Before-Tax Advantage

Using Tax Deductions Versus FSAs

How the Health Care FSA Works

Contribution Limits

Eligible Dependents

Eligible Covered Expenses

Ineligible Expenses

How to Receive Reimbursement From Your Health Care FSA

About Your Health Reimbursement Account (HRA)

How the Dependent Care FSA Works

Contribution Limits

Eligible Dependents

Eligible Covered Expenses

Ineligible Expenses

How to Receive Reimbursement From Your Dependent Care FSA

When Participation Ends

General Information

When Health Care FSA Benefits End

When Dependent Care FSA Benefits End

Special Extensions of Participation

General Information

During a Leave of Absence

Family Medical Leave of Absence

Your Legal Right to Continuation Coverage Under COBRA

General Information

Notification

Election Procedure

Payment

When Continuation Coverage Ends

Trade Act Implications

Claims and Appeal Procedures

General Information

Procedure for Filing a Claim

Defective Claims

Initial Claim Review

Initial Benefit Determination

Manner and Content of Notification of Denied Claim

Review of Initial Benefit Denial

Procedure for Filing an Appeal of a Denial

Review Procedures for Denials

Timing of Notification of Benefit Determination on Review

Manner and Content of Notification of Benefit Determination on Review

Legal Action

HIPAA Privacy Rule Notice

Permitted Uses and Disclosures of PHI

Additional Uses or Disclosures With Your Written Authorization

Your Rights

Revisions in the Programs’ Privacy Practices

Complaints

Further Information

Administrative and Contact Information

General Information

Type of Plan

Plan Sponsor

Employer Identification Number of Plan Sponsor

Plan Number

Plan Year End

Agent for Service of Legal Process

Benefits Committee and Plan Administrator

Eligibility Administration

Claims Administrator

Claims Administrator for Eligibility Claims

COBRA Administrator for Continuation Coverage

Allocation and Delegation of Fiduciary Responsibilities by the Benefits Committee

Self-Funded Benefits

Your ERISA Rights

General Information

Receive Information About the Health Care FSA and Benefits

Continue Group Health Plan Coverage

Prudent Actions by Plan Fiduciaries of the Health Care FSA

Enforce Your Rights

Assistance With Your Questions

Health Care Spending and Dependent Care Spending Program

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Introduction

The R.R. Donnelley & Sons Company (“RR Donnelley”) Health Care Flexible Spending Account and Dependent Care Flexible Spending Account provide a before-tax opportunity for you to fund contributions to:

The Health Care Flexible Spending Account (the “Health Care FSA”); and

The Dependent Care Flexible Spending Account (the “Dependent Care FSA,” and collectively with the Health Care FSA, the “FSAs”).

The FSAs are designed to help you save on certain eligible health and dependent day care-related expenses. Under the Health Care FSA, you can set aside money from your paycheck before taxes are taken out to reimburse eligible health care expenses not covered by either your medical or dental program. Under the Dependent Care FSA, you can set aside money before it is taxed to reimburse eligible dependent day care expenses. If you participate in the Health Choice or Health Value medical options under CIGNA, UnitedHealthCare (UHC/Definity), or Blue Cross and Blue Sheild (BCBS), you can use the Health Care FSA for eligible expenses only after you have met your coverage options’ deductible requirement. This is because these coverage options enable you to have a Health Savings Account (HSA), and under IRS regulations you cannot be reimbursed by the Health Care FSA until the deductible is satisfied. Please see www.irs.gov/publications/p969/ar02.html#d0e1580 for details. Also, if you participate in a Health Choice or Health Value medical option and you are eligible to direct RR Donnelley to make contributions to a HSA from your pay, then you may also be eligible to have RR Donnelley make matching contributions to your HSA. Separate materials are available that describe HSAs in detail.

If you have a balance in your 2005 Health Reimbursement Account (HRA), please see the “About Your Health Reimbursement Account (HRA)” section for details.

You decide how much tax-free income you want to contribute (between $200 and $5,000 annually) to each FSA. After you pay an eligible health care and/or dependent care expense, you must submit a claim for reimbursement to either the Health Care FSA or the Dependent Care FSA, as appropriate.

Because you do not have to pay taxes on the money you set aside, the Internal Revenue Service (IRS) requires that you forfeit any money that you do not use for the year in which you participate (“use it or lose it”). Keep this in mind when you decide how much to contribute.

This Summary Plan Description (SPD) explains the Health Care FSA and the Dependent Care FSA as of January 1, 2006 (unless noted otherwise). It details who is eligible to participate, how to enroll, when participation begins and ends, and which expenses are and are not eligible for reimbursement. It also describes how to submit a claim for reimbursement, as well as your rights under the FSAs. Please read this information to familiarize yourself with both FSAs.

You are eligible to participate in either one or both FSAs only if you are an employee of a participating employer or subsidiary. If you are an employee of an employer or subsidiary that does not participate in the FSAs, you are not eligible for the benefits described in this SPD. To find out if you are eligible for these benefits, contact the eligibility administrator.

This SPD and any supplemental information attempt to be as complete, accurate, and up-to-date a description as possible of the FSAs. However, since regulations change periodically, this document cannot adequately define every potentially reimbursable expense or exclusion. In the event of such circumstances, the claims administrator will make the determination of reimbursable expenses. If there is any discrepancy between this SPD and the Plan document, the actual Plan document always governs.

In addition, nothing in this SPD should be interpreted as an employment contract. This summary merely describes the Health Care FSA and the Dependent Care FSA offered to eligible employees as of January 1, 2006. RR Donnelley reserves the right to change or terminate the Plan or FSAs, in whole or in part, at any time.

This content contains a summary in English of your rights and benefits under the FSAs. If you have difficulty understanding any part of this content, call the RR Donnelley Benefits Center at 1-877-RRD-4BEN (1-877-773-4236). Benefits Center Representatives are available between the hours of 8 a.m. and 5 p.m. CT, Monday through Friday, except holidays.

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