PART B: Information About Employer-Provided Health Coverage

BNY Mellon Benefits Guide

If you decide to complete an application for coverage in the Marketplace, you will be asked to provide information about the medical coverage offered by BNY Mellon. The information below can help you complete your application for Marketplace coverage.


GENERAL EMPLOYER INFORMATION
Employer name	The Bank of New York Mellon Corporation
Employer Identification Number (EIN)	13-2614959
Employer phone number	1-800-947-4748
Employer street address	500 Grant Street, Room 3118
Employer city	Pittsburgh
Employer state	PA
Employer ZIP code	15258
Contact about employee health coverage at this job	BNY Mellon Benefit Solutions Service Center
Phone number	1-800-947-4748, option 2

Here is some basic information about health coverage offered by BNY Mellon:

We offer a health plan to all benefits-eligible full-time and part-time employees who are regularly scheduled to work at least 20 hours per week.

With respect to dependents, we do offer coverage. Eligible dependents are: your spouse, your qualified domestic partner, your children up to age 26, your unmarried, dependent children older than age 26 who are mentally or physically disabled and incapable of self-support and who became disabled before age 19. Please see the summary plan description for a complete definition of eligible dependents.

You may be required to check a box indicating whether the BNY Mellon medical plan meets the minimum value standard. All of the BNY Mellon medical plan options meet the minimum value standard.

If you have medical coverage through a medical plan offered by BNY Mellon and Medicare while receiving LTD Plan benefits, and you or any of your covered dependents are receiving Social Security Disability benefits, Medicare becomes the primary coverage after 24 months of receiving Social Security Disability benefits. However, in the case of end-stage renal failure, Medicare becomes primary after the first 30 months. (As you approach either of these milestones, approximately 60 days prior to reaching 24 months of LTD, Alight will send you a notice advising you of your upcoming eligibility for Medicare.)

If you or your covered dependents are enrolled in both Medicare and a BNY Mellon group health plan, your employment status will determine whether the BNY Mellon medical plan or Medicare is the primary claims payer. Because you are classified as "inactive" status when approved for Long-term Disability (LTD), Medicare would be the primary coverage for any Medicare-eligible dependents.

LTD and Medicare Guidelines for Employees on BNY Mellon Medical Coverage:

Employer coverage can remain primary for up to 24 months after the effective date of Social Security Disability benefits (30 months in the case of end-stage renal failure). However, Medicare will become primary when the earliest of the following events occur:

Employees:

You are approved for Medicare based on your Social Security Disability status.

The 1st of the month in which you turn age 65.

Dependents:

Dependents turn age 65.

Dependents are already Medicare eligible or become Medicare eligible once the employee begins Long-Term Disability status.

To avoid paying the first 80 percent of Medicare Part B covered expenses, you must enroll in both Parts A & B of Medicare coverage once Medicare becomes primary. If you do not enroll in both Medicare Parts A & B, you may incur substantial out-of-pocket expenses because BNY Mellon medical coverage will pay secondary to Medicare and will not cover all of those expenses.

BNY Mellon medical plans will only pay eligible expenses as though you were enrolled in Medicare Part A and Part B. For this reason, you should make sure to enroll in both Part A and Part B. Exceptions may apply in certain cases of vocational rehabilitation and under certain HMOs. If you are currently part of a "grandfathered" group that is eligible to participate in a Medicare plan, that information will be reflected on the enclosed confirmation statement.

If you have questions about Medicare, please call 1-800-MEDICARE (1-800-633-4227 or TTY: 1-877-486-2048).

BNY Mellon's plans follow the non-duplication method when coordinating benefits. In cases where a BNY Mellon plan is determined to be the secondary coverage, the applicable plan will pay only the difference between the amount normally reimbursed by that plan and the amount reimbursed by the primary coverage. This means if you are covered under two plans, you may not necessarily receive more benefits than you would if the BNY Mellon plan was your only coverage.