2016 BeneFlex Annual Enrollment Guide

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2016 BeneFlex Annual Enrollment Guide
GET READY
Do I Need to Enroll?
Your Enrollment
Checklist
BeneFlex Eligibility
GET INForMED
Medical Plan
How the Medical
Plan and HSA Works
Prescription Drug
Healthy Incentive
Credit Reward
Mental Health/
Chemical
Dependency
Treatment
Dental Plan
Vision Plan
FSAs
Life Insurance
Vacation Buying
GET EnrollED
CONTACTS &
Resources
Employees in Hawaii,
Puerto Rico or on
International Assignment
See the details for your 2016 medical
plan information in your DuPont
Benefits Enrollment Kit through
DuPont Connection at http://
resources.hewitt.com/dupont. Not all
of the plans and programs described in
this guide may apply to you.
Wednesday, November 4 – Tuesday, November 17, 2015
BeneFlex Annual Enrollment is your yearly opportunity to evaluate your options, decide if they meet
you and your family’s needs for the coming year, and make any necessary changes through
DuPont Connection — your personalized benefits website and service center. This guide provides the
information about your 2016 benefits options and how to enroll through DuPont Connection.
For more information about your 2016 benefits, before and during Annual Enrollment, link to your
DuPont Benefits Enrollment Kit, available from the home page once you log on to DuPont Connection
at http://resources.hewitt.com/dupont.
Welcome
page 2
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Do I Need to Enroll?
Your Enrollment
Checklist
BeneFlex Eligibility
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INFORMED
Do I Need to Enroll?
This year, take action with your coverage using DuPont Connection. For 2016, DuPont is offering you a choice between
two medical plan options: the Core option and the Premium Saver option. Both come with a Health Savings Account
(HSA) for eligible employees.
If you (and your covered dependents) are currently enrolled in the:
Standard PPO
Health Savings PPO
Make a new medical election on
DuPont Connection and open your HSA
Compare the medical plan options
to confirm your coverage for 2016
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Important!
Know What’s Changing
Refer to What’s Changing for 2016
in your online DuPont Benefits
Enrollment Kit through DuPont
Connection for details on specific
benefits changes.
If you are enrolled in the following coverage options and don’t make an election:
Standard PPO option:
• You (and any currently covered dependents) will be defaulted to the Core medical plan option; however, you must
use DuPont Connection during Annual Enrollment to validate that you are eligible to open an HSA and receive the
Company HSA contribution — otherwise you will not receive either; and
• Your Health Care Flexible Spending Account (FSA) amount will be set to $0 for 2016 since only the Limited
Purpose Health Care FSA will be offered.
Health Savings PPO option:
• You (and any currently covered dependents) will be defaulted to the Core medical plan option; and
• Both your HSA contribution amount and Limited Purpose Health Care FSA contribution amount will
carry forward.
Remember, if you have coverage today and no choice is made, you and your currently covered eligible dependents
will be automatically placed in the Core option at 2016 premium rates.
All of your other current coverage, elections, and covered dependents will also continue into 2016 at new premium
rates (if applicable).
Elections in place at the close of 2016 Annual Enrollment will be the benefits you have for all of 2016.
Tobacco User?
You will need to log on to DuPont
Connection during Annual Enrollment
and complete the enrollment process
to update your tobacco user status.
See Tobacco User Surcharge for more
information.
Welcome
page 3
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Do I Need to Enroll?
Your Enrollment
Checklist
BeneFlex Eligibility
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Your Enrollment Checklist
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ENROLLED
CONTACTS &
RESOURCES
Avoid the Surcharge
✔✔Complete the Healthy Incentive Credit reward requirements*. Complete the annual Healthy Incentive
Credit reward requirements through the Healthy Living Rewards website, administered by HealthFitness at
www.myhealth.dupont.com by October 30, 2015. This will reduce your 2016 medical premiums.
✔✔Consider your coverage needs. How did you and your family use your benefits during 2015? Will that change in
2016? Do you have access to coverage from another source, such as your spouse’s or parent’s medical plan? If so,
which plan offers you the best value?
✔✔Compare your medical options**. DuPont’s two 2016 medical options work similarly, but there are some differences.
Which one is right for you? Use the Health Plan Comparison Chart and ALEX® tools on DuPont Connection during
Annual Enrollment to feel confident about your choice.
✔✔Have your dependent information ready. If you are enrolling dependents for the first time, you will need their Social
Security numbers. After Annual Enrollment, you’ll be asked to submit proof of their eligibility, such as a birth or
marriage certificate.
✔✔Review your beneficiaries. Confirm your life insurance and HSA** beneficiaries through DuPont Connection, and
update them if necessary during the enrollment process.
✔✔Enroll! Beginning Wednesday, November 4, 2015, at 8:00 a.m. Eastern Time (ET), you can enroll in your
DuPont 2016 BeneFlex benefits through DuPont Connection at http://resources.hewitt.com/dupont or by calling
1-800-775-5955. Enrollment ends on November 17, 2015:
–– By phone through the DuPont Connection Service Center at 7:00 p.m., Eastern Time (ET); and
–– Online through the DuPont Connection website at 11:59 p.m., Central time (CT).
* Not applicable to employees in Hawaii or Puerto Rico.
**Not applicable to employees in Hawaii, Puerto Rico, or on International Assignment.
If you are a tobacco user, you must enroll
in the HealthFitness tobacco cessation
health coaching by December 1, and
complete your first health coaching
session by December 31, to waive the
tobacco user surcharge for 2016.
Visit the Healthy Living Rewards website
for information.
Welcome
page 4
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Your Enrollment
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BeneFlex Eligibility
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BeneFlex Eligibility
Who Is Eligible
You’re eligible for DuPont’s employee benefits if you are classified as a full-service regular employee (full- or part-time
regular). In the DuPont U.S. region, you must be working at least 20 hours per week.
You may choose to cover your family members in your DuPont medical, dental, and vision plans. Upon enrolling or
updating enrollment of a dependent into your BeneFlex plans, you will be required to certify the designated dependent
is eligible for coverage at the time of the enrollment. You must also provide Social Security number (SSN) information
for each of your dependents in order for them to be added to coverage.
Note: You do not need to provide SSN information immediately in order to add a newborn to your coverage. You will
have one year from the date you add your newborn to provide the SSN information.
Eligible dependents include the following:
Dependents
Eligibility
Spouse
Your dependent is eligible for coverage as a spouse if he or she is your
lawful spouse.
Child1
Your dependent qualifies as your child if he or she is your natural or adopted child,
stepchild, foster child, or a child for whom you have court-appointed permanent legal
guardianship, up to age 26.
You may continue to cover the child on your health care coverage beyond his or her
26th birthday provided the child is your federal tax dependent and has been certified as
disabled by your medical carrier prior to reaching age 26.
The age extension for disabled dependents does not apply to dependent life insurance
or accidental death insurance coverage.
1. Under your medical, dental and vision options, you may also elect coverage for a child for whom the court has issued a Qualified Medical Child Support Order (QMCSO) that
has been approved by the Company’s Legal Department.
The following are not eligible for dependent coverage:
• Grandchildren and stepchildren from a former marriage, even if they are your federal tax dependent; and
• Former spouses, even if you are ordered by the court to provide coverage.
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Enroll Only
Eligible Dependents
We appreciate your commitment
in helping DuPont maintain
compliance and manage health care
costs by ensuring that only eligible
dependents are enrolled. For newly
enrolled, dependents you will be asked
to provide their proof of eligibility, such
as with a birth or marriage certificate.
Ineligible dependents will be dropped
from your coverage.
Welcome
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Special Rules for DuPont Couples
If you and your spouse both work for DuPont, special rules apply to help you avoid purchasing unnecessary
duplicate coverage.
Medical, Dental, and Vision Care
Your Enrollment
Checklist
BeneFlex Eligibility
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You cannot be covered as a participant in the medical, dental, or vision plans under
your coverage at the same time as you are covered as a dependent under your spouse’s
coverage.
Eligible dependents cannot be covered by more than one employee.
Limited Purpose Health Care FSA
Each DuPont employee may contribute up to $2,550 each year to the Limited Purpose
Health Care FSA, regardless of marital status. Remember that your Limited Purpose
Health Care FSA can only be used for dental and vision expenses (your HSA can be
used for medical expenses).
Dependent Care FSA
For married couples, you and your spouse are each limited to the maximum contribution
allowed by your Dependent Care FSA plan. Also, in accordance with IRS rules:
•If you file a joint federal tax return, you and your spouse can contribute up to a
combined total of $5,000 per year.
•If you and your spouse file separate federal tax returns, you can each contribute up to
$2,500 per year.
•Special limits may also apply if your spouse’s income is less than the above limits,
or if your spouse is a full-time student or incapable of self-care.
•If both you and your spouse contribute to the Dependent Care FSA plan, you can only
be reimbursed once for any eligible expense.
Accidental Death Insurance
•Each of you can elect spousal coverage, but the combined coverage cannot exceed
$500,000 per adult.
•Each of you can elect coverage for the same eligible child, but the combined coverage
cannot exceed $100,000 per child.
Dependent Life Insurance
•You and your spouse can cover each other under this plan.
•You and your spouse can each cover your dependent children under this plan. Your
combined maximum coverage for each child is $40,000.
Understand Primary and Secondary Coverage
In most cases, the DuPont plan is primary for employees and secondary for working spouses.
If you are covered under more than one medical or dental plan (such as through your spouse’s plan), one plan is
considered primary and the other is considered secondary. When your spouse has secondary coverage under your
DuPont medical or dental plan, DuPont provides additional coverage only if the DuPont medical or dental plan
benefit is greater than that of your spouse’s primary plan. This means that the DuPont medical or dental plan will never
pay a greater benefit than would have been received if there were no other plan involved.
If children are covered by both parents’ plans, the children’s primary plan is that of the parent whose birthday falls first
in the year. For more information, see your medical and dental SPDs on DuPont Connection.
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Welcome
Medical Plan
How the Medical
Plan and HSA Works
Compare the Plans
Prescription Drug
The medical plan premiums, deductibles, and out-of-pocket maximums vary based on the coverage level you choose.
More information about your medical plan options will be provided on DuPont Connection during Annual Enrollment.
Mental Health/
Chemical
Dependency
Treatment
Dental Plan
Vision Plan
FSAs
Life Insurance
Vacation Buying
CONTACTS &
RESOURCES
Medical Plan
For 2016, you can choose to be covered by one of two medical plan options1, both of which automatically come with
prescription drug and mental health/chemical dependency coverage. Both options also include a Health Savings Account
(HSA) if you certify on DuPont Connection during Annual Enrollment that you meet the eligibility requirements.
Healthy Incentive
Credit Reward
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Core Option
In-network
Premium Saver Option
Out-of-network
In-network
Out-of-network
Preventive care
(coverage follows the standard preventive care
guidelines of the Patient Protection and Affordable
Care Act; includes prescription drugs classified by the
guidelines as preventive)
100% paid; no deductible
100% paid; reasonable and
customary (R&C) as applicable;
no deductible
100% paid; no deductible
100% paid; reasonable and
customary (R&C) as applicable;
no deductible
Annual deductible
(applies to both medical and prescription drug
expenses combined)
$1,300 individual/$2,600 other
coverage levels
$2,500 individual/$4,000
other coverage levels
$2,500 individual/$5,000
other coverage levels
$3,500 individual/$6,000
other coverage levels
DuPont HSA contribution
(subject to eligibility)
Coinsurance for medical services
• Office visits (includes mental health visits approved
by ComPsych)
• Chiropractic care ($1,000 annual limit)
• Labs/X-Rays
• Hospitalization/Surgery
$600 Individual/
$1,200 Other coverage levels
You pay 20% after deductible
You pay 40% after deductible
$600 Individual/
$1,200 Other coverage levels
You pay 20% after deductible
You pay 40% after deductible
Prescription drugs 2
Generic
No charge
No charge
Preferred Brand
You pay 25% after deductible; $125 maximum
You pay 25% after deductible; $125 maximum
Non-Preferred Brand
You pay 45% after deductible; $250 maximum
You pay 45% after deductible; $250 maximum
Retail maintenance (after 2 fills at retail)
You pay 45% after deductible; no maximum
You pay 45% after deductible; no maximum
Out-of-pocket maximum (applies to both medical and prescription drug expenses combined)3
Individual
Other coverage levels
(combined family out-of-pocket maximum)
$5,000
$10,000 (limited to $5,000 for
any one family member)
$6,000
No limit
1.Not applicable to employees in Hawaii, Puerto Rico, or on International Assignment.
2.If you purchase a brand-name drug for which a generic equivalent is available, you will be responsible for paying the difference in costs between the
two drugs along with the normal coinsurance.
3.Infertility services are applied to the deductible but are not applied to the out-of-pocket maximum. The infertility lifetime maximum per family is
$15,000 for medical and $10,000 for prescription drugs.
$12,000 (limited to $6,000 for
any one family member)
No limit
page 7
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Medical Plan
How the Medical
Plan and HSA Works
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Welcome
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Monthly Medical Plan Premiums
Core Option
Premium Saver Option
Monthly Premiums (The amount deducted from your pay may vary depending on your pay frequency)
Coverage Levels
NOTE: Medical rates do not reflect the $50 tobacco
user surcharge
Without $40 Monthly Healthy
Incentive Credit Reward
With $40 Monthly Healthy
Incentive Credit Reward
Without $40 Monthly Healthy
Incentive Credit Reward
With $40 Monthly Healthy
Incentive Credit Reward
Prescription Drug
You only
$80
$40
$55
$15
Healthy Incentive
Credit Reward
You + Spouse
$160
$120
$110
$70
You + Child(ren)
$125
$85
$85
$45
You + Family
$195
$155
$150
$110
Mental Health/
Chemical
Dependency
Treatment
Dental Plan
Vision Plan
FSAs
Life Insurance
Vacation Buying
Tobacco User Surcharge
Supporting DuPont’s new global tobacco-free policy, a $50 monthly surcharge will be added to your 2016 medical
premiums if you are a tobacco user. Tobacco users are required to attest to their tobacco use status during Annual
Enrollment.
To avoid the surcharge, tobacco users must enroll in the HealthFitness tobacco cessation and health coaching program
before December 1, 2015 and complete at least one personal health coaching session with HealthFitness no later than
December 31, 2015. To enroll, call HealthFitness today at 1-888-211-2411. Special requirements apply for employees
on International Assignment.
Working Spouse Rule (If Other Coverage Is Available)
If your spouse is offered medical coverage through his/her own employer at a cost of less than $100 per month, he or she
must take that group coverage as primary in order to be eligible for secondary coverage under the DuPont medical plan.
If his or her employer does not provide medical coverage, or if the monthly premium for the lowest available coverage is
$100 or more per month in plan year 2016, your medical plan election can provide him or her with primary coverage.
HSA Eligibility
Due to the tax-savings features of an HSA, there are Internal Revenue Service (IRS) eligibility requirements that you
must meet. When you enroll, you will need to certify your eligibility for the HSA on DuPont Connection before your
HSA can be opened and before you can receive the Company contribution. If you are not eligible for the HSA, you
can still enroll in one of the DuPont medical options, but an HSA will not be opened for you. You can learn more in
How the Medical Plan and HSA Works.
You may participate in the HSA if you:
• Are not enrolled in Medicare;
• Are not enrolled in other health coverage, either as an individual or as a participant, unless that coverage is a qualifying
high deductible plan as defined by the IRS (your covered dependents may have other medical coverage); and
• Cannot be claimed as a dependent on someone else’s tax return.
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Medical Plan
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Find Network Providers
Always use in-network providers for the greatest cost savings.
Your Carrier:
Aetna
Go to:
•Go to www.aetna.com/docfind
How the Medical
Plan and HSA Works
•If you are searching for a specific provider, enter the provider’s name in the “Who or what are
you looking for?” field
Prescription Drug
•If you are looking for a list of providers for a specific specialty, choose from the list of options, or
type the specialty type in the “Who or what are you looking for?” field
Healthy Incentive
Credit Reward
•Enter the ZIP code (in the “Where?” field)
Mental Health/
Chemical
Dependency
Treatment
Dental Plan
Vision Plan
•Select “Aetna Choice POS II (Open Access)” as the network name from the “drop down” list
provided (this is the name of the Aetna network — not your DuPont medical plan option)
Highmark BCBS
•Go to www.highmarkbcbsde.com
•Click Find a Doctor or Rx
•Click Find a Doctor, Hospital or other Medical Provider
FSAs
•Enter the appropriate search criteria in the first three fields: Provider type, provider name (if
applicable) and ZIP code
Life Insurance
•At the “Search Your Network Using” radio button, choose “Member ID”
Vacation Buying
•Type “DUP” in the “Enter the First 3 Letters of Your Member ID” field
Each network services certain geographic areas. If your carrier changes for 2016, you will find that many of the doctors
you use today will be in-network with your new carrier. You can find your 2016 carrier network using the Find Your
Carrier tool in your DuPont Benefits Enrollment Kit through DuPont Connection.
If you’re currently in an active course of treatment for a medical condition (including pregnancy) with a network
provider who does not participate with your new carrier, you can inquire with your new carrier about your eligibility
for transition of care benefits.
Mental health and chemical dependency treatment is administered by ComPsych (see Mental Health/Chemical
Dependency Treatment for network details).
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RESOURCES
Welcome
page 9
GET
INFORMED
Medical Plan
How the Medical
Plan and HSA Works
Prescription Drug
Healthy Incentive
Credit Reward
Mental Health/
Chemical
Dependency
Treatment
Dental Plan
Vision Plan
FSAs
Life Insurance
Vacation Buying
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INFORMED
Stay Well During the Year
DuPont’s medical plan offers benefits to help you stay well, such as:
• Annual adult preventive exams covered at 100% every year — with no out-of-pocket costs whether you see an
in- or out-of-network doctor1;
• Well-baby/well-child preventive check-ups covered at 100%1;
• Six Employee Assistance Program (EAP) sessions per unique, short-term counseling need covered at 100%2; and
• Express Scripts preventive medications, such as certain beta-blockers, that are not subject to the deductible.
New for 2016: Teladoc
Teladoc is access to a national network of U.S. board-certified doctors by phone (and online
in certain locations), 24 hours per day, 7 days a week. The service is offered as part of your
medical coverage.
Starting after January 1, 2016, set up an account with Teladoc at www.teladoc.com and, after requesting
a consultation, a doctor can help virtually diagnose and recommend a course of treatment for nonemergency medical problems, such as for an ear infection, sinus problems, or flu symptoms. In many
locations, your Teladoc physician can even call in a prescription to your pharmacy if necessary.
Each visit with a Teladoc doctor is $40 — significantly less than urgent care and emergency room visits,
and the charges are applied to your medical plan deductible. Once you meet your medical deductible,
each appointment costs only $8.
1. Out-of-network services are subject to reasonable and customary (R&C) limits.
2. Services must be authorized by ComPsych in advance and received from a participating EAP network provider.
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Welcome
page 10
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Medical Plan
How the Medical
Plan and HSA Works
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How the Medical Plan and Health Savings
Account (HSA) Works
When you enroll in the medical plan (and certify that you meet the IRS eligibility criteria), a bank account will be
opened in your name through Bank of America called a Health Savings Account (HSA). You will own and control this
account for your health care expenses. Here’s how it works:
Prescription Drug
Healthy Incentive
Credit Reward
Contribute $
Grow $$
Use $$$
Vision Plan
DuPont contributes to your account by mid-January:
FSAs
•$600 (if you cover yourself)
Use the money for eligible health care expenses
now, or at any time in the future
Life Insurance
•$1,200 (if you cover more than yourself )
Your account earns
interest and once you
reach $1,000, you can
invest it in mutual funds
Money you don’t use rolls over each year
You contribute in tax-free deductions from your
paycheck up to:
Funds can be withdrawn
from investments for
eligible expenses at
any time without fees
or penalties
You don’t pay any taxes
on earnings
You don’t pay taxes on the money from the account
used to pay eligible health care expenses
Mental Health/
Chemical
Dependency
Treatment
Dental Plan
Vacation Buying
+
+
•$2,750 (if you cover yourself)
•$5,550 (if you cover yourself and others)
•An additional $1,000 if you are turning age 55
or older in 2016
You pay less in taxes from your paycheck now
= Triple-tax advantage
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CONTACTS &
RESOURCES
Your HSA and
the U.S. Patriot Act
Bank of America may request
information from you directly when
opening the HSA due to U.S. Patriot
Act requirements. Not providing the
information may result in the inability
to open your HSA.
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READY
Welcome
page 11
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INFORMED
Medical Plan
How the Medical
Plan and HSA Works
Prescription Drug
Healthy Incentive
Credit Reward
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INFORMED
GET
ENROLLED
CONTACTS &
RESOURCES
The Medical Plan and the HSA are Separate and Unique
Medical Plan
Health Savings Account (HSA)
•You receive comprehensive medical coverage and competitive
benefits, with a choice of Core or Premium Saver options.
•The HSA is a bank account with Bank of America that you own;
•You will need to attest to your eligibility during the Annual
Enrollment process to open an HSA for 2016 if you do not have
one currently — otherwise, it will not be opened for you and you
will not receive the Company contribution until you confirm your
eligibility;
•Preventive care (such as annual physicals) is covered at 100% and
is not subject to the annual deductible;
•For non-preventive care, you will pay full costs for your care until
you reach your deductible (you can pay for these costs with
money you receive from the Company in your HSA, your HSA
contributions, or your personal savings); and
•If you are currently enrolled in the HSA for 2015, your existing
HSA will remain open;
•For in-network care, you pay based on the network-negotiated rate.
Mental Health/
Chemical
Dependency
Treatment
+
•You choose a contribution amount from your paycheck — and
you can start, stop, or change the amount at any time through
DuPont Connection;
•The Company contributes to your account;
•Use the money to pay for your current health care expenses,
including the deductible and coinsurance, or save it for future
health care expenses;
Dental Plan
Vision Plan
•You can be reimbursed for expenses incurred by your tax-eligible
dependents — those who are not yet age 19 (or, if a student, not
yet age 24) at the end of the tax year, or is permanently and
totally disabled;
FSAs
Life Insurance
Vacation Buying
•The balance of the account rolls over from year to year, even if you
change plans or leave DuPont (DuPont’s contributions stop when
you leave the Company or retire); and
•After age 65 you can use the funds for health care expenses, including
Medicare premiums, and other expenses (subject to taxes).
How to Pay for Your HSA Eligible Expenses
There are three ways to access and use your funds:
Special Eligibility Rules
Apply to the HSA
• The Bank of America Visa debit card: Use your card at most pharmacies and physician’s offices (where Visa
is accepted) and select Credit or Debit at the register for automatic deduction;
• Health care provider payments: When you receive an invoice, use the Bank of America website to request that
your provider is paid directly from your account (similar to online bill payment — and once the claim is approved,
the provider will receive a check within 7-10 business days); and
• Reimbursement requests: If you pay out-of-pocket for health care services, you can request reimbursement for
yourself through the Bank of America website either electronically (direct to your personal checking or savings
account) or by receiving a check.
For information on how the HSA payment coordinates with the Limited Purpose Health Care FSA, see Flexible
Spending Accounts (FSAs).
If you will be covered in 2016 by
another health plan that does not
qualify as a high deductible health plan
or by Medicare, the IRS requires that
you decline the HSA. Medicare-eligible
employees (generally all employees
age 65 and older) should also
contact Medicare for information on
temporarily disenrolling while you are
participating in the BeneFlex medical
plan to maintain eligibility for an HSA.
Welcome
page 12
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INFORMED
Medical Plan
How the Medical
Plan and HSA Works
Prescription Drug
Healthy Incentive
Credit Reward
Mental Health/
Chemical
Dependency
Treatment
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INFORMED
GET
READY
GET
ENROLLED
CONTACTS &
RESOURCES
Put it All Together
Health Savings Account (HSA)
Company contributes:
$600/$1,200
+
You can contribute:
$2,750/$5,550
+
$1,000 extra if age 55 or older
+
any other HSA savings
accumulated from previous years
Core and Premium Saver Options
Plan provides 100% in-network preventive
care coverage and medications
You pay 100% of medical, prescription drug, and
mental health/chemical dependency expenses
until you reach your deductible
Dental Plan
Vision Plan
Deductible (varies by plan option)
FSAs
Life Insurance
Vacation Buying
You pay 20% for in-network medical expenses
until you reach your out-of-pocket maximum
(40% out-of-network) and varying amounts for
prescription drug coverage
Plan pays 80% of in-network medical expenses
(60% out-of-network) and varying amounts for
prescription drug coverage
Out-of-pocket maximum1
(varies by plan option; applies only to in-network coverage)
Plan pays 100% for the rest of the year
1.Does not apply to services not covered under the plan.
Welcome
page 13
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Medical Plan
How the Medical
Plan and HSA Works
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INFORMED
Prescription Drug Coverage1
If you elect BeneFlex medical plan coverage, you will be automatically enrolled in prescription drug coverage administered
through Express Scripts®. What you pay will vary depending on if you choose retail or mail-order, and the category of drug
according to the Express Scripts Preferred Drug List (formulary).
Prescription Drug
Visit the Express Scripts website at www.express-scripts.com/dupontactive for more information. Utilize the Open
Enrollment Information link to access the Savings Advisor tool. With this tool, you can research current medication
cost and savings opportunities by using a lower-cost alternative to discuss with your physician.
Healthy Incentive
Credit Reward
How the Prescription Drug Deductible Works
Mental Health/
Chemical
Dependency
Treatment
The following drugs are not subject to a deductible:
Prescription drug expenses are subject to your medical plan deductible. This means you will need to pay the full cost of
your prescription drugs until you reach your medical plan deductible.
Dental Plan
• Free preventive care medications, such as generic contraceptives and smoking cessation medications; and
Vision Plan
• Certain additional medications identified by the IRS as preventive (you’ll pay a coinsurance amount, which counts
toward your out-of-pocket maximum). These medications are prescribed 1) for a person who is at risk of having a
particular disease or condition but who doesn’t yet have any symptoms; and 2) to prevent a disease from returning in
someone recovered from it. Medications classified as preventive can be confirmed on the Express Scripts website at
www.express-scripts.com/dupontactive, utilizing the Savings Advisor tool within the Open Enrollment Information
link, or by utilizing the Price a Medication tool when logging on as a registered user.
FSAs
Life Insurance
Vacation Buying
For other prescription drugs, once you’ve met your deductible, the following coinsurance and per prescription maximums
will apply. There is no per prescription maximum for maintenance medications purchased at retail, except on the first two
30-day supplies purchased.
What You Pay for Prescription Drugs
Retail (up to 30 days) and Mail Order (up to 90 days) after medical deductible is met
(deductible does not apply to preventive medications)
You pay:
Generic
Drugs with the same active ingredients
and strength as brand-name
counterparts, according to the U.S. Food
and Drug Administration
No charge
Preferred Brand
Brand-name drugs available at a lower
cost than competing brand-name drugs
25% coinsurance after deductible;
$125 maximum
Non-Preferred Brand
Brand-name drugs with lower-cost
alternatives available
45% coinsurance after deductible;
$250 maximum
Maintenance medications filled more
than two times at retail pharmacies
Prescription drugs for long-term health
care needs
45% coinsurance after deductible;
no maximum
1.Employees in Hawaii, Puerto Rico, and on International Assignment are eligible for alternative coverage.
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ENROLLED
CONTACTS &
RESOURCES
Access the
Preferred List
Updates to the Express Scripts preferred
drugs for 2016 will be reflected on the
Express Scripts website at the start of
Annual Enrollment. Any impact to your
current prescriptions can be found by
searching your medications on
the website.
Special
Exceptions
• If you purchase a brand-name
medication when a generic equivalent
is available, you will be responsible for
paying the difference in cost between
the brand and generic medication,
along with the coinsurance amount.
• You may be responsible for higher
coinsurance if you continue to fill a
maintenance medication at a retail
pharmacy, after two initial fills. See
Mail Order for more information.
Welcome
page 14
GET
INFORMED
Medical Plan
How the Medical
Plan and HSA Works
Prescription Drug
Healthy Incentive
Credit Reward
Mental Health/
Chemical
Dependency
Treatment
Dental Plan
GET
READY
GET
INFORMED
Save Time and Money With Mail Order
Using mail-order for maintenance drugs (drugs you use on an ongoing basis) is required. If you fill a prescription for
a maintenance medication more than twice at a retail pharmacy, you’ll pay a 45% coinsurance (with no per-prescription
maximum) for the third and any subsequent retail fills.
Ask your doctor to write you a prescription for up to a 90-supply plus refills for up to one year. Once you sign up, the
Express Scripts Pharmacy will send up to a 90-day supply of your maintenance medications to your home with free
delivery. There may be a day supply limitation on some prescriptions, such as controlled medications, subject to state
and federal dispensing limitations.
Three Ways to Fill Your Mail-Order Prescription
1.
Order through www.express-scripts.com/dupontactive after registering on the website.
2.
Mail your prescription(s) with the Express Scripts Pharmacy order form and required coinsurance. You can order
mail-order forms by calling 1-800-793-8766, or through www.express-scripts.com/dupontactive.
3.
Ask your doctor to call 1-888-327-9791 for instructions on how to fax the prescription. Your doctor must have your
member ID number (which is on your DuPont prescription ID card) to fax your prescription.
Vision Plan
FSAs
Life Insurance
Vacation Buying
Specialty Medications
Specialty medications are drugs that are used to treat complex conditions, such as anemia, growth hormone deficiency,
hemophilia, hepatitis C, multiple sclerosis, and rheumatoid arthritis. Whether they’re administered by a health care
professional, self-injected, or taken by mouth, specialty medications require an enhanced level of service. These drugs
are both complex and expensive, and drug therapies may require frequent dosing adjustments and intensive clinical
monitoring.
Express Scripts manages specialty medications through Accredo. You may contact Accredo at 1-800-803-2523 to
confirm whether the medications you are taking are considered specialty medications. You will not be required to show
a separate ID card when purchasing specialty drugs. Your deductible, prescription drug coinsurance, and out-of-pocket
maximum apply.
Clinical Programs
DuPont and Express Scripts work together to monitor and evaluate how pharmacy benefits are utilized. This includes
DuPont’s participation in a number of clinical programs, such as Step Therapy, which is a protocol to utilize the most
cost-effective drug therapy for selected diagnoses. If you are impacted by these programs, you will be notified. These
programs help control plan costs and provide you with clinically appropriate coverage.
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ENROLLED
CONTACTS &
RESOURCES
A Word About
PCSK9 Inhibitors
PCSK9 Inhibitors are a new class
of drugs that have been shown to
significantly lower LDL cholesterol
levels. While this is a very high-cost
class of drugs, at the present time
Express Scripts will cover currently
available medications in this class for
those patients for whom such a drug
is clinically appropriate. Check the
Express Scripts website for the most
up-to-date coverage information on
PCSK9 Inhibitors.
Welcome
GET
INFORMED
GET
READY
page 15
Wondering How Your Prescription Might Be Covered?
GET
INFORMED
Here are the top 10 most frequently prescribed generic medications for DuPont participants, and how they’re covered
under the prescription drug plan:
Medical Plan
Generic drug name
Type of generic
What you pay
How the Medical
Plan and HSA Works
Amoxicillin
Regular
Free after you reach your deductible
Azithromycin
Regular
Free after you reach your deductible
Hydrocodone-Acetaminophen
Regular
Free after you reach your deductible
Atorvastatin Calcium
Preventive
Deductible waived, $0 copay
Prednisone
Regular
Free after you reach your deductible
Amox TR-Potassium Clavulanate
Regular
Free after you reach your deductible
Fluticasone Propionate
Regular
Free after you reach your deductible
Lisinopril
Preventive
Deductible waived, $0 copay
Omeprazole
Regular
Free after you reach your deductible
Simvastatin
Preventive
Deductible waived, $0 copay
Prescription Drug
Healthy Incentive
Credit Reward
Mental Health/
Chemical
Dependency
Treatment
Dental Plan
Vision Plan
FSAs
Life Insurance
Vacation Buying
GET
ENROLLED
CONTACTS &
RESOURCES
Welcome
page 16
GET
INFORMED
Medical Plan
How the Medical
Plan and HSA Works
GET
READY
GET
INFORMED
Get $480 With the Healthy Incentive
Credit Reward1
You can’t put a price on good health, but you can reduce what you pay to help you get there. In just a few simple steps,
you can receive a $480 ($40 per month) credit to reduce your 2016 medical premium costs.
Prescription Drug
This Healthy Incentive Credit reward is available to active, U.S. benefit-eligible employees (not spouses/dependents)
ages 18 and over, who enroll in the BeneFlex medical plan.
Healthy Incentive
Credit Reward
Earn the 2016 Healthy Incentive Credit reward when you take the following actions by October 30, 2015 to:
Mental Health/
Chemical
Dependency
Treatment
• Complete your Health Assessment on the Healthy Living Rewards website: Go to the Healthy Living Rewards
website, administered by HealthFitness, at www.myhealth.dupont.com to complete your assessment. It takes about
Dental Plan
Vision Plan
FSAs
Life Insurance
Vacation Buying
15 minutes to answer a few questions, and you’ll receive a personalized and confidential health report, including
recommendations for what you can do to define your goals and continue your journey toward a healthier life.
• Complete your health screening and health advising: Schedule your on-site screening today, as available, through
the Healthy Living Rewards website. Upon completion of your on-site screening, review your screening results with
a HealthFitness Health Advisor. He or she will help you learn more about the Healthy Living Rewards programs
and resources.
If you’re unable to attend an on-site event (or if one is not offered at your location), you must complete your
screening and advising with your own health care provider by using the Alternative Means Screening (AMS) form
available on the Healthy Living Rewards website. The AMS form must be received by HealthFitness no later than
October 30, 2015. You may also speak to a HealthFitness Health Advisor by calling 1-888-211-2411.
• Choose to participate in wellness activities throughout the year.2 DuPont offers a wide array of resources to support
your physical, emotional, and financial wellness. In 2016, the Healthy Living Rewards program will include activities
and rewards that enable you to stay engaged in healthy living habits throughout the year.
Hired on or after September 15, 2015?
You will not be required to complete the Healthy Incentive Credit reward steps to earn your credit in 2016.
1.If you’re an employee in Hawaii, you can take the online Health Assessment and get your health screening and health advising at any time during the year. The October 30
deadline does not apply to you since Hawaii participants are covered by a fully insured medical plan in order to comply with state insurance requirements and the credit is
automatically built into the premiums. If you’re an employee on expatriate assignment, you will need to complete the online Health Assessment by the October 30 deadline to
receive the Healthy Incentive Credit reward. The health screening and health advising can be completed at any time during the year utilizing the alternative method screening
(AMS) process. AMS information is available on the Healthy Living Rewards website. Puerto Rico employees are not eligible for the Healthy Living Rewards program.
2.Completion of wellness activities for this incentive eligibility period will not be tracked for purposes of earning the $40/month Healthy Incentive Credit reward; however, you
are strongly encouraged to take advantage of these resources.
GET
ENROLLED
CONTACTS &
RESOURCES
Welcome
page 17
GET
INFORMED
Medical Plan
How the Medical
Plan and HSA Works
GET
READY
GET
INFORMED
GET
ENROLLED
Year-Round Healthy Living Rewards Resources1
Teladoc
Castlight
Visit www.teladoc.com after January 1 to set up an account.
Log on to Castlight today! It’s an online tool that helps you compare the cost and
quality of health care providers and services.
Teladoc connects you with a doctor by phone (or online in certain states) to diagnose
and treat non-emergency issues — whether you’re at home or on the road. That makes it
even more convenient than an urgent care facility or a convenience clinic.
Prescription Drug
When searching for a doctor or hospital, always use Castlight. When you visit the Castlight
website at www.mycastlight.com/dupont, you can get help “shopping around” for the
most valued care in your area by comparing in-network providers, negotiated charges
agreed to, and how others rate them. (Don’t forget to add your own reviews!)
Castlight connects with your medical and prescription drug carriers to incorporate your
medical plan option, deductible, and out-of-pocket maximum so that you can estimate
your expenses.
Healthy Incentive
Credit Reward
Mental Health/
Chemical
Dependency
Treatment
Castlight and the carriers will not share any personal details about your health.
Dental Plan
Vision Plan
FSAs
Life Insurance
Vacation Buying
Health Action Guides
More than 40 Health Action Guides are available to help you improve different areas of
your health — step-by-step.
To access the guides, visit the Healthy Living Rewards website at www.myhealth.dupont.com,
and click Health Action Guides under the Tools and Resources section.
Provider Nurselines
Nurselines are intended to help you better work with your doctors — not to diagnose
illnesses or provide treatment.
When you use the nurseline through your medical plan, you will talk with a registered
nurse who can provide information on a variety of health related topics, coach you on
how to better describe your symptoms to your provider, tell you what questions to ask,
and provide information about procedure and treatment options. Contact your medical
plan for nurseline information.
1.Not all resources are available to employees in Hawaii, Puerto Rico, and on International Assignment.
CONTACTS &
RESOURCES
Welcome
page 18
GET
INFORMED
Medical Plan
GET
READY
GET
INFORMED
Mental Health and Chemical Dependency
Coverage and the Employee Assistance
Program (EAP)
GET
ENROLLED
CONTACTS &
RESOURCES
Contact ComPsych
Prescription Drug
DuPont has established the Employee Assistance Program to provide assessment, evaluation, and referral for mental
health and chemical dependency treatment for you and your covered dependents.
All participants can contact ComPsych in
2016 at 1-800-435-7266 or by visiting
www.guidanceresources.com.
Healthy Incentive
Credit Reward
When you call ComPsych, the EAP administrator, you will speak with an EAP consultant. The consultant will
confidentially assess your situation and, if necessary, refer you to an EAP network provider who will meet your needs.
Mental Health/
Chemical
Dependency
Treatment
Six free EAP counseling sessions apply to each unique situation that is assessed by the EAP as a short-term
counseling need.
The access code when you go online
or call is: DUPONTEAP.
How the Medical
Plan and HSA Works
Dental Plan
Vision Plan
FSAs
Life Insurance
If additional care is needed beyond the six free EAP sessions, you may be eligible to continue treatment under your
DuPont medical plan coverage. For 2016, ComPsych will be the administrator of mental health and chemical
dependency coverage for all eligible employees. All mental health and chemical dependency treatment must be
pre-certified by calling ComPsych. The ComPsych phone number will be found on your medical ID card.
All benefits-eligible employees and their dependents may receive the six free EAP counseling sessions per unique
short-term counseling need — including if you decline DuPont medical coverage.
Vacation Buying
ComPsych is New in 2016 for Some Employees
Mental health and chemical dependency coverage for BELCO, Coastal, Danisco, MECS, DuPont Pioneer
and Solae participants is currently provided through Highmark BCBS. If a covered participant is in an
active course of mental health and/or chemical dependency treatment today under Highmark BCBS that is
expected to continue into 2016, please contact ComPsych to confirm your providers’ network status and to
inquire about your eligibility for transitioning care.
Welcome
page 19
GET
INFORMED
Medical Plan
How the Medical
Plan and HSA Works
Prescription Drug
Healthy Incentive
Credit Reward
Mental Health/
Chemical
Dependency
Treatment
Dental Plan
Vision Plan
FSAs
Life Insurance
Vacation Buying
GET
READY
GET
INFORMED
GET
ENROLLED
CONTACTS &
RESOURCES
Dental Plan
You have the choice between two dental plan options administered by MetLife®. When you use benefits providers in
the MetLife Preferred Dental Program (PDP) network, you can limit your out-of-pocket costs. You can find PDP
dentists by visiting www.metlife.com/mybenefits, or by calling MetLife at 1-888-883-0052. Using network dentists is
recommended, but not required by the plan.
High Option
Standard Option
Coverage
Diagnostic and preventive care
•2 regular cleanings per year or 4 periodontal cleanings
with diagnosed condition (2 periodontal cleanings are in
lieu of the 2 regular cleanings)
•2 exams per year
•Dental X-rays:
–– Bitewing X-rays — One time per year;
–– Whole mouth X-rays — One time every 5 years
Plan pays 100%1
Plan pays 100% of R&C1
Restorative care
Includes bridges, crowns, fillings, and other covered dental
services
You pay approximately 25%2
You pay approximately 50%2
Annual benefit limit
$2,000/individual
$1,100/individual
Lifetime orthodontic limit3
$1,500 per covered individual, regardless of age
$1,200/child
(for children under age 19)
You only
$18
No premium cost (no deductions from your paycheck)
You + Spouse
$33
You + Child(ren)
$28
You + Family
$47
Monthly Premium4
1.
2.
3.
4.
For out-of-network claims, reasonable and customary (R&C) limits apply. R&C amounts are based on the 90th percentile, which means that 90% of providers in a geographic area charge no more than the R&C amount and 10% charge more.
The benefit for the preferred dental provider network dentist is determined on the network-negotiated amount, and the benefit for an out-of network dentist is based on a scheduled amount.
The lifetime orthodontic limit is a combined maximum for both options; however, the High Option provides an additional $300 of lifetime coverage.
Premiums shown are on a monthly basis. The amount deducted from your pay may vary depending on your pay frequency.
Welcome
page 20
GET
INFORMED
Medical Plan
How the Medical
Plan and HSA Works
Prescription Drug
GET
INFORMED
GET
READY
GET
ENROLLED
CONTACTS &
RESOURCES
Vision Plan
A vision plan with comprehensive coverage is offered through Vision Benefits of America (VBA).
To receive the highest level of coverage, you can choose a provider from the nationwide VBA network of more
than 14,000 vision care providers. You can use VBA or non-VBA providers; however, VBA providers offer the best
convenience, quality and value. Find a VBA provider by visiting www.visionbenefits.com/docsearch.aspx, or by
calling 1-800-432-4966.
VBA Provider
Healthy Incentive
Credit Reward
Non-VBA Provider
Non-VBA Provider if No VBA Provider
Within 35-Mile Radius
Mental Health/
Chemical
Dependency
Treatment
Vision Care Service
Eye exam
Plan pays 100%
Plan pays up to $40
Plan pays 100%
Dental Plan
Eyeglass lenses and/or frames (one
time per year) — includes polycarbonate
lenses, scratch-resistant coatings, solid
and gradient tints, blended bifocals,
progressive lenses (except digital), UV
coatings, and trifocal lenticular
Plan pays 100% after $20 copay
(the $20 copay applies to lenses or frames
but not both; the frames are covered with a
wholesale value of up to $60 (approximately
$150-$180 retail))
Plan pays:
•Single vision: up to $40
•Bifocal: up to $50
•Trifocal: up to $75
•Progressive: up to $75
•Lenticular: up to $100
•Frames: up to $50
•Plan pays 100% after $20 copay per
person for the materials
•Frames will be reimbursed up to $130
•Additional Lens Options such as: 1 Yr.
Scratch, UV Coatings, Polycarbonate
Lenses, Progressives (except Digital) and
Tints will be reimbursed in full
Cosmetic contact lenses (in lieu of glasses,
including exam)
Plan pays up to $175 allowance toward the
total cost
Plan pays up to $175 allowance toward the
total cost
Plan pays up to $175 allowance toward the
total cost
VBA-approved, medically necessary
contact lenses (in lieu of glasses,
including exam)
Plan pays 100% of R&C
Plan pays up to $300
100% R&C
Vision Plan
FSAs
Life Insurance
Vacation Buying
Monthly Premiums1
You only
$8.46
You + Spouse
$14.70
You + Child(ren)
$14.70
You + Family
$21.78
1. Premiums shown are on a monthly basis. The amount deducted from your pay may vary depending on your pay frequency.
GET
READY
Welcome
page 21
GET
INFORMED
GET
INFORMED
Flexible Spending Accounts (FSAs)
Limited Purpose Health Care FSA
Medical Plan
With a Limited Purpose Health Care FSA, you make a minimum contribution from your paycheck on a before-tax
basis — $120 per year — up to a maximum contribution of $2,550 per year.
How the Medical
Plan and HSA Works
The Limited Purpose Health Care FSA can be used to pay for dental and vision expenses only.
Prescription Drug
Healthy Incentive
Credit Reward
Mental Health/
Chemical
Dependency
Treatment
Dental Plan
Vision Plan
FSAs
Life Insurance
Vacation Buying
Because of the FSA “use it or lose it” rule, consider contributing the maximum amount to the HSA prior to
contributing to the Limited Purpose Health Care FSA. Unused HSA money rolls over to the next year for future
expenses. Leftover money in your Limited Purpose Health Care FSA at the end of the year is forfeited.
Eligible Limited Purpose Health Care FSA expenses include:
• Prescribed dental and vision products;
• Non-cosmetic dental care, orthodontia, eyeglasses, contact lenses and laser eye surgery; and
• Copays, coinsurance, and deductibles under dental and vision plans.
Dependent Care FSA
With a Dependent Care FSA, set aside tax-free money to pay for day care for your child who is under the age of 13
or for a spouse/dependent age 13 or over who is not able to take care of him/herself. The day care expenses must be
necessary for you to work. If you are married, the expenses must also be necessary for your spouse to either work or
attend school full-time.
Based On Your Tax Status…
You Can Set Aside...
If single or married filing jointly
Up to $5,000
If married filing jointly and your spouse’s employer offers a
dependent care account
Up to $5,000 in total between the two accounts
If your spouse earns less than $5,000 per year
Up to the amount of your spouse’s earned income
(special income limits may apply if your spouse is a
full-time student or unable to care for self )
If married filing separate returns
Up to $2,500
If you are considered a highly compensated employee, your contributions to this account may be limited.
GET
ENROLLED
CONTACTS &
RESOURCES
How You Pay If You Have
an HSA and Limited
Purpose Health Care FSA
When you have both the HSA and
Limited Purpose Health Care FSA and
use your Bank of America debit card
to pay for eligible expenses, those
expenses qualified for reimbursement
under the Limited Purpose Health
Care FSA will automatically deduct
from that account.
If you prefer to pay for qualified dental
and vision expenses using your HSA,
you can pay out-of-pocket for the
services and reimburse yourself using
the Bank of America website. Or, have
a check sent directly to the provider
from your Bank of America HSA.
Welcome
page 22
GET
INFORMED
Medical Plan
How the Medical
Plan and HSA Works
Prescription Drug
Healthy Incentive
Credit Reward
Mental Health/
Chemical
Dependency
Treatment
Dental Plan
Vision Plan
FSAs
Life Insurance
Vacation Buying
GET
READY
GET
INFORMED
FSA Details—Other Things You Need to Know
• If you have both an HSA and a Limited Purpose Health Care FSA, you will receive only one Bank of America debit card
— access your funds using the same card. If you are enrolled in the HSA and/or an FSA today and remain enrolled in a
GET
ENROLLED
CONTACTS &
RESOURCES
Substantiating Your
Expenses
tax-advantaged account for 2016, you will not receive a new Bank of America debit card for 2016.
• You may need to submit receipts to Bank of America to validate any FSA claims. Claims may not be
automatically processed.
• Be sure to plan your contributions carefully. You cannot change your Limited Purpose Health Care FSA or
Dependent Care FSA contribution amount during the year unless you experience a qualifying life event that
permits the change.
• The minimum contribution you can make from your paycheck on a before-tax basis is $120 per year. The maximum
contribution you can make to your Limited Purpose Health Care FSA is $2,550 per year. The maximum contribution
you can make to your Dependent Care FSA is $5,000 per year, depending on your tax status. Contributions and expenses
cannot be transferred between your Limited Purpose Health Care FSA and your Dependent Care FSA, and vice versa.
• Your FSA balances are available to reimburse eligible expenses you incur only between January 1 and
December 31. FSA balances are based on a calendar year. Any money left in your 2016 account at the end of the
year and not claimed by April 15, 2017, will be forfeited according to IRS regulations (“use it or lose it”). For all
claims, the minimum claim submission is $50, except at plan year closeout.
• For a complete list of eligible expenses, visit DuPont Connection, or review Publication 502 (Medical and Dental
Expenses)1 or Publication 503 (Child and Dependent Care Expenses) on the IRS website at http://www.irs.gov.
1.Only dental and vision expenses are eligible under the Limited Purpose Health Care FSA.
Substantiation is proof that an expense
is eligible. In many cases, such as
certain debit card transactions, no
additional documentation may be
required. However, in other cases,
you may need to submit additional
documentation — either electronically
or through the mail.
If an expense requires substantiation,
you will be notified by Bank of America.
That’s why it’s important to keep
your receipts.
Welcome
page 23
GET
INFORMED
Medical Plan
How the Medical
Plan and HSA Works
Prescription Drug
Healthy Incentive
Credit Reward
GET
INFORMED
GET
READY
CONTACTS &
RESOURCES
Life Insurance
Employee Life Insurance
DuPont automatically provides you with basic life insurance coverage equal to your annual pay. You don’t pay anything
for this coverage, and you don’t have to enroll to receive it. (Company-paid coverage over $50,000 is subject to
imputed income taxes.)
During this Annual Enrollment, you can make changes to your current life insurance coverage:
• More coverage than what you have now: You can buy additional life insurance coverage for yourself on an after-tax
basis (subject to evidence of insurability), up to 8x your annual pay (including 1x your annual pay provided by
DuPont); or
Mental Health/
Chemical
Dependency
Treatment
• Less coverage than what you have now: You can purchase coverage equal to $10,000 or $50,000 and receive
Dental Plan
Employee Life Insurance Amounts
Vision Plan
GET
ENROLLED
Employee Life Insurance (ELI) Cash in your paycheck.
$10,000
$50,000
1 x annual pay
2 x annual pay
3 x annual pay
4 x annual pay
5 x annual pay
6 x annual pay
7 x annual pay
8 x annual pay
FSAs
Life Insurance
Employee Life Insurance
(ELI) 2016 Details
What You Will Pay
Vacation Buying
Employee Life Insurance Rates
Monthly premiums per $1,000 of coverage
Age at 12/31/16
Premium
Age at 12/31/16
Premium
Under 25
$0.015
50-54
$0.170
25-29
$0.018
55-59
$0.281
30-34
$0.027
60-64
$0.439
35-39
$0.041
65-69
$0.788
40-44
$0.055
70-74
$1.369
45-49
$0.098
75+
$2.042
Evidence of Insurability
If you increase your coverage level higher than your 2015 coverage amount, you will be asked to provide evidence of
insurability (health information) during the enrollment process. Your increased coverage will go into effect once your
health information is approved by the Securian Life Insurance Company, the life insurance administrator.
What’s Not Changing
•The Company provides 1x your annual
pay in coverage at no cost to you
•Age-related rates for supplemental
coverage
What’s Changing
•ELI Cash or Employee Life Credit
(EE Life Credit) for Companyprovided coverage will not appear
on your paystub if you are enrolled
in coverage of at least 1x your
annual pay
•ELI Cash or Employee Life Credit will
appear only if you are enrolled in a
coverage amount of less than 1x your
annual pay
•ELI premiums will be deducted on an
after-tax basis only
GET
READY
Welcome
page 24
GET
INFORMED
GET
INFORMED
GET
ENROLLED
CONTACTS &
RESOURCES
Spouse Life Insurance
You can choose from these life insurance coverage amounts for your spouse:
$10,000
$25,000
$50,000
$100,000
$150,000
$200,000
$250,000
$300,000
$350,000
$400,000
Medical Plan
Spouse Life Insurance Rates
Monthly premiums per $1,000 of coverage
How the Medical
Plan and HSA Works
Age at 12/31/16
Prescription Drug
Healthy Incentive
Credit Reward
Mental Health/
Chemical
Dependency
Treatment
Dental Plan
Vision Plan
FSAs
Life Insurance
Vacation Buying
Age at 12/31/16
Under 25
$0.017
50-54
$0.187
25-29
$0.020
55-59
$0.312
30-34
$0.029
60-64
$0.487
35-39
$0.045
65-69
$0.874
40-44
$0.061
70-74
$1.519
45-49
$0.107
75+
$2.060
Evidence of Insurability
If you elect a level of coverage that is greater than your 2015 coverage amount, your spouse will need to provide
evidence of insurability (health information) during the enrollment process through DuPont Connection. Coverage
will take effect once the health information is approved by the Securian Life Insurance Company.
Not Sure How Much Coverage You Need?
Visit the Securian Life Insurance Company’s life insurance estimating calculator tool at
www.lifebenefits.com/insuranceneeds. No user ID or password is required.
page 25
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Medical Plan
How the Medical
Plan and HSA Works
Child Life Insurance
You can elect dependent life insurance for your eligible children in these amounts: $5,000, $10,000, or $20,000 per
child. The coverage amount you select covers each of your eligible children for that amount — regardless of the number
of children you have.
There is no waiting period for newborn life insurance. Your firstborn child will be automatically covered for $5,000 for
the first 31 days following live birth. Additionally, dual DuPont couples may both cover children up to a maximum of
$40,000 (up to $20,000 of coverage per child is available to each employee).
Prescription Drug
Child Life Insurance Rates
Monthly premiums per $1,000 of coverage
Healthy Incentive
Credit Reward
Mental Health/
Chemical
Dependency
Treatment
Dental Plan
Vision Plan
FSAs
Life Insurance
Vacation Buying
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Child(ren)
$0.031
Accidental Death Insurance
No one can predict an accident, so DuPont helps you protect yourself and your family from the financial hardships a
serious accident can cause. You automatically have Company-paid accidental death insurance coverage equal to
1x your annual pay. This coverage is in addition to your Employee Life Insurance benefit and pays a benefits to your
beneficiaries if you die in an accident. Also, if you are permanently injured in an accident, a percentage is paid for
specific losses, such as a limb or eyesight.
Additional Accidental Death Insurance
Naming a Beneficiary
When you first enroll, you should
designate a beneficiary. Annual
Enrollment is also a good time each
year to review your beneficiaries and
ensure they are up to date.
You can change your beneficiary
designation at any time by entering
the update on DuPont Connection at
http://resources.hewitt.com/dupont.
If you need help, call the DuPont
Connection Service Center at
1-800-775-5955.
If you die without a valid beneficiary,
benefits are paid in the following order:
• Your children (in equal shares);
Coverage Amounts
Option A
CONTACTS &
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• Your spouse;
You can also purchase coverage for your spouse and eligible children.
Coverage For:
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Option B
Option C
Option D
• Your parents (in equal shares);
You only
$500,000
$250,000
$100,000
$50,000
• Your siblings (in equal shares); then
You / your spouse
$500,000/
$250,000/
$100,000/
$50,000/
• Your estate.
$300,000
$150,000
$50,000
$25,000
$500,000/
$250,000/
$100,000/
$50,000/
$100,000
$50,000
$25,000
$10,000
$500,000/
$250,000/
$100,000/
$50,000/
$300,000/
$150,000/
$50,000/
$25,000/
$100,000
$50,000
$25,000
$10,000
You /each eligible child
You / your spouse /
each eligible child
Accidental Death Life Insurance Rates
Coverage For:
Option A
Option B
Option C
Option D
You only
$8.50
$4.25
$1.70
$0.85
You + Spouse
$13.60
$6.80
$2.55
$1.28
You + Child(ren)
$11.70
$5.85
$2.50
$1.17
You + Family
$16.80
$8.40
$3.35
$1.60
For dependent life insurance, you are
automatically the beneficiary.
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page 26
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Medical Plan
How the Medical
Plan and HSA Works
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BeneFlex Vacation Buying Plan
With the BeneFlex Vacation Buying plan, you can buy extra hours of vacation on a before-tax basis. You can purchase
up to the number of hours in your normal work week or 40 hours, whichever is less. Your personalized cost will be
available on DuPont Connection starting November 4, 2015.
Prescription Drug
Before you purchase extra vacation hours, consider your time off needs carefully and buy only the vacation you need.
Purchased vacation can be used only after you have used all of your carryover and current year vacation. Any negotiated
paid time off you may be eligible for is available only after using purchased vacation.
Healthy Incentive
Credit Reward
Don’t Miss the Cashout Deadline!
Mental Health/
Chemical
Dependency
Treatment
If you purchased vacation in 2015, be sure to use it or cash it out. If you’ll have a vacation balance left over at the end of
the year, you’ll lose it if you don’t take action.
Dental Plan
You will not be able to stop your monthly Vacation Buying deduction, but you will receive a taxable refund for your
remaining contributions in your final December paycheck.
Vision Plan
FSAs
Life Insurance
Vacation Buying
To cash out your 2015 purchased vacation use DuPont Connection by November 30, 2015.
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page 27
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enrolled
Decision Points
Enroll
Useful Tools
What to Expect After
You Enroll
Changing Your
Coverage During
the Year
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Decision Points1
✔✔Medical:
If you’re currently enrolled in the Standard PPO, you will need to elect one of the two medical options for 2016.
If you do not, you will be enrolled in the Core option (with your currently covered dependents), but you will not
have an HSA opened for you and will not receive the Company contribution until you certify your HSA eligibility
with DuPont Connection. If you’re in the Standard PPO, any Limited Purpose Health Care FSA elections for you
will also be set to $0.
The Premium Saver option has lower premiums, and a higher deductible and out-of-pocket maximum than the Core
option. If you’re expecting few health care needs in the new year, you may want to consider the Premium Saver option.
✔✔Limited Purpose Health Care FSA:
You should consider the Limited Purpose Health Care FSA only if you’re already contributing the maximum
amount to your HSA, and expect to need even more savings to pay for dental and vision expenses in 2016.
✔✔Tobacco users:
You should certify during Annual Enrollment using DuPont Connection that you have used tobacco within the
past three months. You’ll also want to take action and follow the steps to avoid the tobacco user surcharge by the
deadline dates.
✔✔Vacation, Holidays, Disability, and Other Benefits:
This guide is designed to provide you with an overview of the options that may be available to you during Annual
Enrollment. If you need more information about these 2016 benefits, visit DuPont Connection at http://resources.
hewitt.com/dupont starting November 4, 2015.
For information on other 2016 DuPont benefits that you may be eligible for, such as short- and long-term disability,
you should also review DuPont Connection during Annual Enrollment.
1.Not applicable to employees in Hawaii, Puerto Rico, or on International Assignment.
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Welcome
page 28
GET
enrolled
Decision Points
Enroll
Useful Tools
What to Expect After
You Enroll
Changing Your
Coverage During
the Year
GET
READY
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INFORMED
Enroll
How to Enroll
Beginning Wednesday, November 4, 2015, at 8:00 a.m. Eastern Time (ET), you can review
and enroll in your DuPont 2016 BeneFlex coverage through DuPont Connection.
Online: http://resources.hewitt.com/dupont
Take action with your health and insurance benefits using this personalized website. It
gives you the benefits information you need and makes enrollment easy and quick.
Once you’re logged on, follow the instructions that pop up on your screen to enroll. If
you experience any problems enrolling through the website, call DuPont Connection.
By Phone: 1-800-775-5955
Call DuPont Connection and a representative will guide you through the enrollment
process and take your elections by phone.
Representatives will be available Monday through Friday from 8:00 a.m. to
7:00 p.m., ET during Annual Enrollment. When you call, say “Annual Enrollment”
for enrollment assistance. You’ll be asked to enter the last four digits of your Social
Security number and your date of birth to confirm your identity and connect to a
representative. Language assistance is available.
Using DuPont Connection for the First Time
If you are using DuPont Connection for the first time, you will need to create a user ID and password. Here’s how:
• Go to DuPont Connection at http://resources.hewitt.com/dupont; and
• At the log on page, simply click on the “Are you a new user?” link.
• You will be asked to provide the last four digits of your Social Security number and your date of birth (mmddyyyy)
to establish your user ID and password.
• Once you’re logged on, click “Make Your Annual Enrollment Choices” in the message box that pops up on
your screen.
If you haven’t set up your password online, enter your home ZIP code. You’ll also be prompted to create a password.
You’ll use this password anytime you log on to or call DuPont Connection. (If you have trouble creating a password,
you can still speak to a representative who will help you create it.)
Hint: Use Web Chat!
The Web Chat feature on DuPont Connection connects you directly with a Service Center representative
online who can help you with any enrollment questions you might have while you’re on the website.
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Welcome
page 29
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Decision Points
Enroll
Useful Tools
What to Expect After
You Enroll
Changing Your
Coverage During
the Year
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Choose Well With Useful Tools1
In addition to viewing and managing your benefits, a variety of easy-to-use tools will be available on DuPont Connection
during Annual Enrollment to help you choose the benefits right for you and your family next year, including:
• DuPont Benefits Enrollment Kit — Connect to your online benefits enrollment kit through DuPont Connection,
and find videos, newsletters, and other resources to help you understand your benefits for 2016.
• Health Plan Comparison Chart — View a side-by- side comparison of key plan provisions — such as coinsurance,
deductibles, out-of-pocket maximums and prescription drug coverage.
• Medical Expense Estimator — Estimate your total annual expenses under each medical option — including both
the out-of-pocket costs you pay when you receive care and your monthly premiums.
• Alex® — Get a personalized medical plan option suggestion from this interactive medical plan comparison tool. Just
answer a few easy questions and in about ten minutes, this tool suggests a specific medical plan option for you
to consider.
What to Expect After You Enroll
If you…
You will receive...
Enroll online and have an email address on file
An email confirmation of completing your enrollment on
DuPont Connection. The email will confirm that you completed
your enrollment, and your elections.
Do not have Internet access and need to enroll using
DuPont Connection by phone
A confirmation statement in the mail with your elections.
Enroll in medical coverage
New ID cards in the mail for medical benefits.
Participate for the first time in 2016 in either or both of the
following accounts through Bank of America:
•Health Savings Account (HSA)
•Limited Purpose Health Care Flexible Spending Account (FSA)
A welcome letter and new debit card in the mail from Bank of
America. You will receive and need only one card if you have
both the HSA and Limited Purpose Health Care FSA for 2016 —
you can use the same card to access funds in both accounts.
1. For employees in Hawaii, Puerto Rico, and on International Assignment, not all of the tools and information described on this page apply to you.
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page 30
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Changing Your Coverage During the Year:
Qualifying Life Events
Useful Tools
IRS rules provide that you cannot change the coverage you elect until the next Annual Enrollment period. The only
exception is if you have a “qualifying life event” like marriage, divorce, a change in job status, birth or adoption, or the
gain or loss of coverage.
What to Expect After
You Enroll
If you have a qualifying life event, you can enroll in or change your benefits during the year. The change must be
consistent with the type of life event you are experiencing.
Changing Your
Coverage During
the Year
Because your premiums for many benefits come out of your paycheck before taxes, the IRS defines the events that let
you change your benefits during the year. Here are some examples:
Decision Points
Enroll
• Marriage or divorce
• Death of a spouse
• Birth or adoption of a child, or a child placed with you for legal guardianship or foster care
• Death of a child or child’s loss of eligibility for benefits
• A significant change in your spouse’s medical coverage
• The start of or return from a military leave of absence when an employee is called up to active duty
• Change in the cost of day care (for the Dependent Care FSA only)
• Change in your or your spouse’s employment status that affects eligibility for benefits, including:
–– A switch from part-time to full-time status, or vice versa
–– Start or end of employment
–– Start of or return from an unpaid leave
–– Retirement
–– An unpaid leave of absence by you or your spouse
To make a benefit change due to a qualifying life event, you need to update your information on DuPont Connection
within 31 days of the event.
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For Example
If you get married or have a baby, you’re
allowed to add your new dependent
to your current medical elections and
enroll in dependent life insurance. You
can’t change medical options if you are
adding a new dependent or removing a
dependent.
Welcome
page 31
CONTACTS &
Resources
Resources
Other Important
Plan Information
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Resources
Your 2016 BeneFlex Resource Contact List
If You Need Information About:
For 2016, Contact:
Your BeneFlex benefits, including enrolling in, confirming, or
making changes to your 2016 health and insurance elections
DuPont Connection
1-800-775-5955
http://resources.hewitt.com/dupont
Core and Premium Saver option medical plan carriers
Aetna
1-800-938-7668
www.aetna.com
Highmark BCBS
1-888-431-4650
www.highmarkbcbsde.com
Prescription drug benefits
Express Scripts
1-800-RxDUPONT
(1-800-793-8766)
www.express-scripts.com/dupontactive
Coverage for specialty medications
Accredo
1-800-803-2523
Health Savings Account (HSA)
Bank of America
1-866-791-0250
www.bankofamerica.com/benefitslogin
Limited Purpose Health Care and
Dependent Care Flexible Spending Accounts (FSAs)
Dental benefits
MetLife
1-888-883-0052
www.metlife.com/mybenefits
Vision benefits
Vision Benefits of America
1-800-432-4966, Option 5
www.visionbenefits.com
Life insurance and accidental death insurance
The Securian Life Insurance Company
www.LifeBenefits.com
Healthy Living Rewards Program
Healthy Living Rewards website, administered by HealthFitness,
at www.myhealth.dupont.com
HealthFitness®
1-888-211-2411
Castlight
https://mycastlight.com/dupont
Employee Assistance Program (EAP) and
Mental Health and Chemical Dependency Treatment
ComPsych Employee Assistance Program (EAP)
www.guidanceresources.com
Access Code: DUPONTEAP
1-800-435-7266
Teladoc
(starting January 1, 2016)
Teladoc
Phone number on back of 2016 medical plan ID card
www.teladoc.com
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Welcome
page 32
CONTACTS &
Resources
Resources
Other Important
Plan Information
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Other Important Plan Information
Summaries of Benefits and Coverage
The federal government now requires all employers and insurers to provide a Summary of Benefits and Coverage
(SBC) for each medical plan option. All employee medical plans across the country must produce an SBC using
identical format, wording, and coverage examples. This allows you to compare the DuPont medical plan options with
other employer and individual medical plans that may be available to you. For more information on the benefit plan
options offered by DuPont, please refer to the Enrollment Guide and Summary Plan Descriptions on the DuPont
Connection website.
Any inconsistency between the SBC and the Plan Documents will be governed by the Plan Documents. Visit DuPont
Connection at http://resources.hewitt.com/dupont for the applicable DuPont SBCs. You may also receive paper
copies, free of charge, by calling DuPont Connection at 1-800-775-5955.
Newborns’ and Mothers’ Health Protection Act of 1996 (Newborns’ Act)
Group health plans and health insurance issuers generally may not, under federal law, restrict benefits for any hospital
length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a
vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit
the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her
newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under federal law,
require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in
excess of 48 hours (or 96 hours).
Women’s Health and Cancer Rights Act of 1998 (WHCRA)
If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health
and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be
provided in a manner determined in consultation with the attending physician and the patient, for:
• All stages of reconstruction of the breast on which the mastectomy was performed;
• Surgery and reconstruction of the other breast to produce a symmetrical appearance;
• Prostheses; and
• Treatment of physical complications of the mastectomy, including lymphedema.
These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and
surgical benefits provided under this plan. Therefore, deductibles and coinsurance apply. If you would like more
information on WHCRA benefits, call your medical carrier.
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page 33
This guide provides a quick, easy-to-understand outline of your Plan options. DuPont has made every effort to ensure that
this guide accurately reflects the plan documents and contracts. However, if there is any conflict or inconsistency between
this guide and those documents or contracts, the documents or contracts will govern. DuPont reserves the right to change,
modify, or discontinue at its discretion any of the plans, programs, or services described in this guide. If you are in a
collective bargaining unit, the benefits described are subject to existing provisions in the collective bargaining agreements
and subject to meeting any bargaining obligations.
Copyright © 2015 DuPont. The DuPont Oval Logo is a registered trademark of E. I. du Pont de Nemours and
Company. All rights reserved.
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