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Qualified Status Changes Detailed Table of Contents
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Table of Contents
Detailed Table of Contents
Index

Introduction

IRS Rules

Consistency of Changes

Judicial Order

Entitlement to Medicare

Special Enrollment Rights

Eligibility Administrator

Benefits Changes You May Be Able to Make When You Report a Qualified Status Change

A Note About Medical Option Changes

A Note About Health Care and Dependent Care FSA Changes

About Dependent Care FSA Changes

A Note About Life Insurance Election Changes

Reporting a Qualified Status Change

How to Report a Qualified Status Change

Responsibility for Reporting Ineligible Dependents

Administrative and Contact Information

Eligibility Administration

Qualified Status Changes

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Introduction

Your employee benefits offered by R.R. Donnelley & Sons Company (“RR Donnelley”) are designed to address your needs. The options offered are designed to be flexible – to fit a wide range of lifestyles and employment situations. This flexibility enables you to personalize your benefits to maximize their value.

In most cases, because of Internal Revenue Service (IRS) rules, the benefits you elect each year remain in effect until the beginning of the next calendar year. However, when a significant change in your life occurs, you may be able to adjust your RR Donnelley benefits program choices to meet your changing needs.

The adjustments you make to your benefits program choices between Annual Enrollment periods are in response to specific situations called “Qualified Status Changes.” If you experience a Qualified Status Change, you can make limited changes to the following benefits program choices.

Under the Group Benefits Plan:

Group Health Program (including the CIGNA Group Health Program Medical Program options, the UnitedHealthcare (UHC) Group Health Program Medical Program options, the Blue Cross and Blue Shield (BCBS) Group Health Program Medical Program options, and the Prescription Drug Program);

The HMO Program;

Vision Care Program;

Dental Program;

Life and Accident Insurance Program; and

Disability Benefit Program.

Under the Flexible Benefits Plan:

Health Care Spending Program (Health Care Flexible Spending Account, or Health Care FSA);1

Dependent Care Spending Program (Dependent Care Spending Account, or Dependent Care FSA); and

Participant Contribution Program (this is the portion of the Flexible Benefits Plan that allows you to have your paycheck deductions contributed to the Group Benefits Plan on a before-tax basis).

This content contains a summary in English of your rights and benefits under the Group Benefits Plan and Flexible Benefits Plan. 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.

1 Separate materials describe how the Health Care FSA works in tandem with the Health Savings Account (available if you enroll in certain coverage options under the Group Health Program). Please see those materials for details.

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