Alcatel-Lucent Long-Term Disability Plan Summary Plan Description — Represented/Occupational Employees January 2015 Effective January 1, 2015 This summary plan description is intended for represented/occupational employees under the Alcatel-Lucent Long-Term Disability Plan. In the case of a discrepancy between this Summary Plan Description and the official plan document for the Alcatel-Lucent Long-Term Disability Plan, the official plan document shall control. Administrative Information Disclaimer This is a summary of the benefits offered to represented/occupational employees under the Alcatel-Lucent Long-Term Disability Plan (the “Long-Term Disability Plan” or the “Plan"). This summary is provided for informational purposes only and is intended to comply with Department of Labor requirements for Summary Plan Descriptions (“SPDs”). More detailed information about the Plan is provided in the official Long-Term Disability Plan document, a copy of which can be obtained by writing to the Plan Administrator (see Your Rights Under ERISA and Administrative Information). This summary is based on Long-Term Disability Plan provisions effective January 1, 2015. If there is any conflict between the information in this SPD and the Long-Term Disability Plan document, the Long-Term Disability Plan document will govern. Plan May Be Amended or Terminated The Company expects to continue the Long-Term Disability Plan but reserves the right to amend or terminate the Long-Term Disability Plan, in whole or in part, at any time by the resolution of the Board of Directors or its properly authorized designee, subject to the terms of applicable collective bargaining agreements. In addition, the Company does not guarantee the continuation of any long-term disability benefits during employment or at or during retirement nor does it guarantee any specific level of benefits or contributions, subject to the terms of any applicable bargaining agreement(s). Questions regarding your benefits should be addressed as indicated in this SPD (see Important Contacts). Because of the many detailed provisions of the Plan, no one other than the personnel or entities identified in this SPD (see Important Contacts) is authorized to advise you as to your benefits. Neither Alcatel-Lucent nor the Plan can be bound by statements made by unauthorized personnel or entities. In the event of a conflict between any verbal information provided to you by an authorized resource and information in the official Long-Term Disability Plan document, the Long-Term Disability Plan document will govern. Please note: Participation in the Plan is neither an offer of nor a guarantee of continued benefits or future employment. Effective January 1, 2015 This summary plan description is intended for represented/occupational employees under the Alcatel- Lucent Long-Term Disability Plan. In the case of a discrepancy between this Summary Plan Description and the official plan document for the Alcatel-Lucent Long-Term Disability Plan, the official plan document shall control. Administrative Information This document is a working summary of the terms of the LTD Plan as of January 1, 2015 applicable to represented/occupational employees, but is not the Plan itself. To the extent that anything in this summary may be contradicted by the terms of the Plan, the Plan terms are controlling. You may always request a copy of the full plan document from the Plan Administrator (see Administrative Information). Effective January 1, 2015 This summary plan description is intended for represented/occupational employees under the Alcatel- Lucent Long-Term Disability Plan. In the case of a discrepancy between this Summary Plan Description and the official plan document for the Alcatel-Lucent Long-Term Disability Plan, the official plan document shall control. YOUR BENEFIT PLAN Alcatel-Lucent USA Inc. Represented Employees Disability Income Insurance: Long Term Benefits Certificate Date: January 1, 2015 Alcatel-Lucent USA Inc. 600 Mountain Avenue, Room 2B410 Murray Hill, NJ 07974 TO OUR EMPLOYEES: All of us appreciate the protection and security insurance provides. This certificate describes the benefits that are available to you. We urge you to read it carefully. Alcatel-Lucent USA Inc. Metropolitan Life Insurance Company 200 Park Avenue, New York, New York 10166 CERTIFICATE OF INSURANCE Metropolitan Life Insurance Company (“MetLife”), a stock company, certifies that You are insured for the benefits described in this certificate, subject to the provisions of this certificate. This certificate is issued to You under the Group Policy and it includes the terms and provisions of the Group Policy that describe Your insurance. PLEASE READ THIS CERTIFICATE CAREFULLY. This certificate is part of the Group Policy. The Group Policy is a contract between MetLife and the Policyholder and may be changed or ended without Your consent or notice to You. Policyholder: Alcatel-Lucent USA Inc. Group Policy Number: 93587-4-G Type of Insurance: Disability Income Insurance: Long Term Benefits MetLife Toll Free Number(s): 1-800-300-4296 For Claim Information THIS CERTIFICATE ONLY DESCRIBES DISABILITY INSURANCE. THE BENEFITS OF THE POLICY PROVIDING YOU COVERAGE ARE GOVERNED PRIMARILY BY THE LAWS OF A STATE OTHER THAN FLORIDA. THE GROUP INSURANCE POLICY PROVIDING COVERAGE UNDER THIS CERTIFICATE WAS ISSUED IN A JURISDICTION OTHER THAN MARYLAND AND MAY NOT PROVIDE ALL THE BENEFITS REQUIRED BY MARYLAND LAW. WE ARE REQUIRED BY STATE LAW TO INCLUDE THE NOTICE(S) WHICH APPEAR ON THIS PAGE AND IN THE NOTICE(S) SECTION WHICH FOLLOWS THIS PAGE. PLEASE READ THE(SE) NOTICE(S) CAREFULLY. GCERT2000 fp 1 For Texas Residents: Para Residentes de Texas: IMPORTANT NOTICE AVISO IMPORTANTE To obtain information or make a complaint: Para obtener información o para someter una queja: You may call MetLife’s toll free telephone number Usted puede llamar al numero de teléfono gratis de for information or to make a complaint at MetLife para información o para someter una queja al 1-800-300-4296 1-800-300-4296 You may contact the Texas Department of Puede comunicarse con el Departamento de Seguros Insurance to obtain information on companies, de Texas para obtener información acerca de coverages, rights or complaints at compañías, coberturas, derechos o quejas al 1-800-252-3439 1-800-252-3439 You may write the Texas Department of Insurance Puede escribir al Departamento de Seguros de Texas P.O. Box 149104 P.O. Box 149104 Austin, TX 78714-9104 Austin, TX 78714-9104 Fax # (512) 475-1771 Fax # (512) 475-1771 Web: http://www.tdi.state.tx.us Web: http://www.tdi.state.tx.us Email: [email protected] Email: [email protected] PREMIUM OR CLAIM DISPUTES: Should You DISPUTAS SOBRE PRIMAS O RECLAMOS: Si have a dispute concerning Your premium or about tiene una disputa concerniente a su prima o a un a claim, You should contact MetLife first. If the reclamo, debe comunicarse con MetLife primero. Si dispute is not resolved, You may contact the Texas no se resuelve la disputa, puede entonces Department of Insurance. comunicarse con el departamento (TDI). ATTACH THIS NOTICE TO YOUR CERTIFICATE: UNA ESTE AVISO A SU CERTIFICADO: This notice is for information only and does not Este aviso es solo para propósito de información y no become a part or condition of the attached se convierte en parte o condición del documento document. adjunto. GCERT2000 notice/tx 2 NOTICE FOR RESIDENTS OF ALL STATES WORKERS’ COMPENSATION This certificate does not replace or affect any requirement for coverage by workers’ compensation insurance. MANDATORY DISABILITY INCOME BENEFIT LAWS For Residents of California, Hawaii, New Jersey, New York, Rhode Island and Puerto Rico This certificate does not affect any requirement for any government mandated temporary disability income benefits law. GCERT2000 3 notice/wc/nw NOTICE FOR RESIDENTS OF ARKANSAS If You have a question concerning Your coverage or a claim, first contact the Policyholder or group account administrator. If, after doing so, You still have a concern, You may call the toll free telephone number shown on the Certificate Face Page. If You are still concerned after contacting both the Policyholder and MetLife, You should feel free to contact: Arkansas Insurance Department Consumer Services Division 1200 West Third Street Little Rock, Arkansas 72201 (501) 371-2640 or (800) 852-5494 GCERT2000 notice/ar 4 NOTICE FOR RESIDENTS OF CALIFORNIA IMPORTANT NOTICE TO OBTAIN ADDITIONAL INFORMATION, OR TO MAKE A COMPLAINT, CONTACT THE POLICYHOLDER OR THE METLIFE CLAIM OFFICE SHOWN ON THE EXPLANATION OF BENEFITS YOU RECEIVE AFTER FILING A CLAIM. IF, AFTER CONTACTING THE POLICYHOLDER AND/OR METLIFE, YOU FEEL THAT A SATISFACTORY SOLUTION HAS NOT BEEN REACHED, YOU MAY FILE A COMPLAINT WITH THE CALIFORNIA INSURANCE DEPARTMENT AT: DEPARTMENT OF INSURANCE 300 SOUTH SPRING STREET LOS ANGELES, CA 90013 1 (800) 927-4357 GCERT2000 5 notice/ca
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