2014-2015 Benefits Guide

TABLE OF CONTENTS
Welcome to the Infosys Limited Benefits Plan

Who Can Enroll

When You Can Enroll

How to Enroll

Medical and Prescription Drug Benefits

Dental Benefits

11

Aetnas Discount Programs

13

Vision Benefits

14

Health Savings Account

16

Dependent Care Flexible Spending Account

18

Disability Income Benefits and Basic Life and AD&D Insurance

20

Other Benefits

23

Employee Assistance Program

24

Retirement Benefits

24

Commuter Benefits

25

Group Auto and Home Insurance Program

26

Relocation and Mileage Reimbursement

27

Vacation, Holidays and Sick Time

28

OPEN ENROLLMENT
March 3 - 14, 2014

Web Tools

30

Contact Information

31

If your enrollment is not completed during the Open Enrollment period, you
may lose your benefits and you will have to wait until the next years Open
Enrollment to make elections.

Notices

33

Be sure to log on and record your beneficiary!

Disclaimer:
This brochure provides only a brief summary of the benefits available under Infosys Limiteds plans. In the
event of a discrepancy between this summary and the Plan Document, the Plan Document will prevail.
Infosys Limited retains the right to modify or eliminate these or any other benefits at any time and for
any reason. More detailed information on a particular benefit plan may be found in the Summary Plan
Description for that plan.

Your 2014 - 2015 Benefits Guide

Your 2014 - 2015 Benefits Guide

Please Note: This is the only time you will be allowed to change your benefit
elections without a qualifying life event.
View page 6 for more information on qualifying life events.

Annual Open Enrollment Elections for All Benefits Become Effective April 1, 2014.

WELCOME TO THE INFOSYS LIMITED BENEFITS PLAN

Infosys Limited offers you and your eligible family members a comprehensive array of
employee benefits to make sure you always have the benefits that best meet your needs.
Health Benefits We understand that a comprehensive health program is the key to

maintaining a healthy workforce. We offer comprehensive health coverage which

includes medical, dental and vision that you may choose separately.
Dependent Care Flexible Spending Account Our benefits plan allows you to participate in
a dependent care flexible spending account to pay for dependent daycare expenses with
pre-tax dollars, reducing your taxable income, resulting in a tax savings.
Life Insurance Benefits Our benefits program includes basic life and accidental death
& dismemberment insurance coverage to protect you and your family in the event of
accidental injury or death. You also have the opportunity to elect optional life coverage
on yourself, spouse and children.
Disability Insurance Benefits We provide you with long-term disability and the option
to purchase short-term disability income insurance benefits that would cover you in
the event of an accident or illness resulting in an extended absence from work.
Employee Assistance Program (EAP) Our EAP program is a company provided benefit
that helps you and your family balance the demands of work, home and life.
Retirement Benefits As a way of saving for retirement, eligible employees may
contribute pre-tax dollars to the Infosys Limited 401(k) plan.
Commuter Benefits You may enroll in the commuter benefits if you utilize the train,
the bus or pay parking costs for your commute to work.
Group Auto and Home Insurance Program To help you protect your property, MetLife
Auto & Home insurance is available to you at discounted rates.
Relocation Services and Mileage Reimbursement We provide reimbursement for eligible
moving expenses in the event you are required to relocate as a result of business reasons
and for mileage if you use your personal vehicle for business purposes.
Vacation, Holidays and Sick Time To help balance your work and personal life, we offer
a variety of programs and policies to meet your time-off needs. This includes vacation,
paid holidays and sick time.

Your 2014 - 2015 Benefits Guide

Your 2014 - 2015 Benefits Guide

WHO CAN ENROLL

You are eligible to enroll in the benefit plans described in this document if
you are a regular full-time employee working 30 hours or more per week,
unless otherwise indicated. Your newly elected benefits become effective
on April 1, 2014. If you are a new hire, your benefits become effective the
first day of regular full-time employment.
Short-term Assignments
If you are contracted for short-term assignments, you are eligible for the
following benefits:

Enrollment
Online!
It is recommended that you go online to
review, make changes, or waive your elections
during this Open Enrollment period to ensure
coverage for plan year 2014-2015. Enrollment in a
Flexible Spending Account (FSA) or Health Savings
Account (HSA) does not automatically extend from one
year to the next. If you wish to participate in a Health
Care and/or Dependent Care FSA for 2014-2015
or contribute to your HSA, you must enroll and
indicate the amount you wish to contribute.
If your enrollment is not completed
within the enrollment period, you
may lose coverage.

Your 2014 - 2015 Benefits Guide

Your 2014 - 2015 Benefits Guide

Medical Plans (Standard Plan with HSA or Plus Plan)

Basic Life and Accidental Death & Dismemberment Insurance
401(k) Plan
Dependent Coverage (Employee + 1 or Employee + Family)

Eligibility does not include:

Dental
Vision
Dependent Care FSA
Commuter Benefits

WHO CAN ENROLL

Eligible Dependents
Generally, for the purposes of Infosys Limiteds benefits programs,
dependents are defined as:
Legal spouse or registered domestic partner
Dependent children up to age 26 (disabled children up to any age),

regardless of student or marital status. Children include:

-- Your biological children
-- Your stepchildren
-- Your legally adopted children
-- Your foster children, including any children
placed with you for adoption
-- Any children for whom you are responsible under court order
-- Your grandchildren in your court-ordered custody
-- Any other child who lives with you in a parent-child relationship
-- Disabled children may be covered, regardless of age.
Coverage for disabled children requires completion and
submittal of a disabled child form, and approval by Aetna.
Documentation may be requested to support proof of dependent relationship.

Your 2014 - 2015 Benefits Guide

Your 2014 - 2015 Benefits Guide

WHEN YOU CAN ENROLL

Annual Open Enrollment
Our annual Open Enrollment will take place from March 3 - 14, 2014. The
choices you make will be effective from April 1, 2014 through
March 31, 2015. This is your one chance during the year to make changes
for the upcoming year, unless you have a qualifying life event.

Qualifying Life Events

You have 31 days from the date of the event to update your benefits or
your dependents benefit election in the web-based enrollment system.
For assistance with making changes due to your qualifying life event, call the
Benefits Desk at (855) 838-4072 or e-mail [email protected].

Your 2014 - 2015 Benefits Guide

Your 2014 - 2015 Benefits Guide

A qualifying life event, as defined by IRS regulations, allows you to make a

change to your benefit coverage if you experience any of the following:
Change In Life Status including but not limited to:
Marriage or divorce
Death of a dependent
Birth or adoption of a dependent (includes adoption assistance)
Loss of medical coverage associated with change in employment
status
Dependent satisfying or ceasing to satisfy plans eligibility
requirements
Loss of, or significant change to, your current coverage
Judgment, decree or court order
Enrollment/Ceasing to be enrolled in Medicare
The employees, spouses or dependents Medicaid or SCHIP coverage
is terminated as a result of loss of eligibility and the employee requests
coverage under the plan within 60 days after the termination; or the
employee, spouse, or dependent becomes eligible for a premium
assistance subsidy under Medicaid or SCHIP and the employee requests
coverage under the plan within 60 days after eligibility is determined
Family Medical Leave Act (FMLA) special requirements

HOW TO ENROLL
Web-Based Enrollment System Instructions
This year we changed our benefits administrator and are using a new online
enrollment system. Once you log in, you will find a powerful website with
interactive tools and videos to help you learn more about the company, your
benefits and other topics of interest. Follow these simple steps below to
enroll electronically in your benefits.
Please review your enrollment materials carefully, including reviewing this
guide and evaluate your needs before making elections.

Go to: https://infosysbenefits.hrintouch.com

Log-on to the benefits portal by selecting Register or Reset Your Account.

-- Employees will be asked to verify:
Social Security Number (SSN)
Last Name
Date of Birth
Code shown on screen

Create your username and password.

Select the Open Enrollment button.

Revise your completed benefits elections. You will receive an Enrollment

Confirmation.

Print and Retain a copy of the Employee Detail Report for your records.
-- Please take time to review this information.

Additional assistance is available if you have questions regarding the benefits

plans or how to enroll online. Contact the Benefits Desk at (855) 838-4072 or
by e-mail at [email protected]. Representatives are available to
answer your questions Monday through Friday between 8 a.m. to 8 p.m. EST.

Your 2014 - 2015 Benefits Guide

HELPFUL HINTS:
Review all of your personal information that has been pre-populated for
accuracy. It is your responsibility to review and notify the Benefits Help
Desk of any errors. Failure to do so could result in loss of benefits.
Your beneficiary selection has not been pre-populated please ensure
you complete this section.
You must complete the online enrollment process during Open
Enrollment or within 31 days of date of hire. Failure to do so could
result in loss of benefits.

MEDICAL and PRESCRIPTION DRUG BENEFITS

Medical and Prescription Drug Plans

You may choose to enroll in the Standard Medical Plan which includes
a Health Savings Account (HSA) or the Plus Medical Plan. If you elect to
participate in one of the medical plans, you may also enroll your eligible
dependents. An overview comparison on the following page provides a
brief outline of the in-network and out-of-network benefits for each plan.
The Standard Medical Plan and Plus Medical Plan use the same network
of Aetna health care providers. However, if you are a Plus Medical Plan
member and live in an area serviced by Aetnas Aexcel network, you will
also be able to take advantage of no-referral access to Aexcel-designated
doctors in 12 selected categories of specialty care. As an Aexcel plan
member, youll generally pay the lowest out-of-pocket expense under the
terms of the plan when you visit an Aexcel-designated specialist.
All deductibles and out-of-pocket amounts accumulate on a plan year
(from date of enrollment through March 31st). Please refer to your SPD for a
complete list of benefits and any applicable limitations on the plan.

Your 2014 - 2015 Benefits Guide

Your 2014 - 2015 Benefits Guide

MEDICAL and PRESCRIPTION DRUG BENEFITS

Aetna Medical and Prescription Drug Plan
Group Number: 883499
Member Service Phone Number: (888) 219-9153
Web Site: www.aetnanavigator.com
Standard Plan
Plan Features

Plus Plan

In-Network

Out-of-Network

In-Network

Out-of-Network

Plan Year Deductible

$1,500 EE Only
$3,000 EE + 1 or more

$2,500 EE Only
$5,000 EE + 1 or more

$600 EE Only
$1,800 EE + 1 or more

$6,000 EE + 1 or more

Member Coinsurance

Aetna covers 80% after deductible

Aetna covers 50% after deductible

Aetna covers 80% after deductible

Aetna covers 50% after deductible

$2,500 EE Only
$5,000 EE + 1 or more

$3,500 EE Only
$7,000 EE + 1 or more

$1,750 EE Only
$5,250 EE + 1 or more

$10,500 EE + 1 or more

Yes
N/A

Yes
N/A

Yes
Yes

N/A

Included in the Medical Out-of-Pocket

Maximum

Not Covered

$6,350 EE Only
$12,700 EE + 1 or more

Not Covered

Yes
Yes

Not Covered

N/A
Yes

Not Covered

Medical Out-of-Pocket Maximum

Includes Deductible
Includes Copays
Pharmacy Out-of-Pocket Maximum
Includes Deductible
Includes Copays
Lifetime Maximum

$2,000 EE Only

$3,500 EE Only
Yes

Unlimited

Unlimited

Physician Office Visit

Primary Care Physician

You pay $20 copay

Covered 80% after deductible

Covered 50% after deductible

Preventive Care

Covered 100%; no deductible

Covered 50% after deductible

Covered 100%; no deductible

Covered 50% after deductible

Hospital Services

Covered 80% after deductible

Covered 50% after deductible

Covered 80% after deductible

Covered 50% after deductible

X-Ray and Lab

Covered 80% after deductible

Covered 50% after deductible

Covered 80% after deductible

Covered 50% after deductible

Designated Specialist
Non Designated Specialist

You pay $35 copay

Covered 50% after deductible

You pay $50 copay

Emergency Room (Emergency Care)

Covered 80% after deductible

$150 copay, then covered 80%; no deductible

Emergency Room (Non Emergency Care)

Covered 50% after deductible

Covered 50% after deductible

Urgent Care Clinics (Non Emergency Clinic)

Prescription Drugs
Retail - Up to 30 Day Supply

Covered 80% after deductible

After Deductible Is Met

Generic
Preferred Brand
Non-Preferred
Mail Order 31 to 90 day supply

Covered 50% after deductible

$10 copay
$20 copay
$35 copay

$20 copay
$40 copay
$70 copay

Covered 50% after deductible

No Deductible
Not Covered

After Deductible is Met

Generic
Preferred Brand
Non-Preferred Brand

$50 copay; no deductible

$20 copay
$40 copay
$75 copay

Not Covered

No Deductible
Not Covered

$40 copay
$80 copay
$150 copay

Not Covered

NOTES:
1. On the Standard Plan, if coverage is elected for one or more dependents, the entire family deductible ($3,000 in-network) must be met in full before any one member will receive coinsurance or prescription drug copayments under the plan. The EE + 1 or EE +
Family out-of-pocket maximum can be met with a combination of family members or any single individual within the family. Once met, the plan will pay 100% of the familys covered expenses for the rest of the plan year.
2. The Standard Plan medical deductible must be met before prescription drugs will be covered at the stated copays. Until the deductible is satisfied, members are responsible for all Rx costs.

Your 2014 - 2015 Benefits Guide

MEDICAL and PRESCRIPTION DRUG BENEFITS

Biweekly and Monthly Contribution Rates
Biweekly Standard Plan Contribution Rates

Monthly Standard Plan Contribution Rates

PL

EE

EE + 1

EE + Family

PL

EE

EE + 1

EE + Family

1&2

$15.37

$22.75

$26.44

1&2

$33.30

$49.29

$57.28

$48.33

$64.22

$72.17

$104.72

$139.15

$156.37

4&5

$51.43

$68.58

$75.43

4&5

$111.44

$148.58

$163.44

$70.05

$91.34

$101.98

$151.78

$197.90

$220.95

7 & up

$80.70

$107.30

$117.94

7 & up

$174.84

$232.48

$255.53

EE = Employee Only
EE + 1 = Employee + 1 Dependent
EE + Family = Employee + 2 or More Dependents

EE = Employee Only
EE + 1 = Employee + 1 Dependent
EE + Family = Employee + 2 or More Dependents

Biweekly Plus Plan Contribution Rates

Monthly Plus Plan Contribution Rates

PL

EE

EE + 1

EE + Family

PL

EE

EE + 1

EE + Family

1&2

$41.81

$51.03

$60.87

1&2

$90.58

$110.57

$131.88

$101.97

$129.11

$139.71

$220.93

$279.74

$302.70

4&5

$114.52

$142.64

$153.61

4&5

$248.13

$309.05

$332.82

$118.71

$216.43

$244.56

$257.20

$468.94

$529.88

7 & up

$118.71

$249.71

$296.89

7 & up

$257.20

$541.04

$643.27

EE = Employee Only
EE + 1 = Employee + 1 Dependent
EE + Family = Employee + 2 or More Dependents

Your 2014 - 2015 Benefits Guide

EE = Employee Only
EE + 1 = Employee + 1 Dependent
EE + Family = Employee + 2 or More Dependents

10

DENTAL BENEFITS
Dental Benefits
Infosys Limited offers you a choice to enroll in Aetnas Basic Dental PPO
Plan or the Premium Dental PPO Plan. If you elect to participate in the
dental plan, you may also enroll your eligible dependents.
Each plan includes Aetnas Dental PPO. As an Aetna Dental PPO participant,
you may visit any dentist you choose. However, if the dentist you choose is
out-of-network, you may experience higher out-of-pocket costs. If possible,
try to use a provider in the network. If you choose to visit a provider
outside the network, you may be charged more than the Aetna Recognized
Charge (ARC) amount; you are responsible for paying any amount incurred
above the ARC.
All deductibles and out-of-pocket amounts accumulate on a calendar year
(from January 1st through December 31st). An overview of dental benefits
is on the following page. Please refer to your SPD for a complete list of
benefits and any limitations to the plan.

Your 2014 - 2015 Benefits Guide

Your 2014 - 2015 Benefits Guide

11
11

DENTAL BENEFITS
Aetna Dental
Group Number: 883499
Member Service Phone Number: (877) 238-6200
Web Site: www.aetnanavigator.com
Plan Features

Basic Dental Plan PPO Plan

In-Network

Calendar Year Deductible

Premium Dental Plan PPO Plan

Out-of-Network

In-Network

Out-of-Network

$50 EE
$150 EE + 1 or more

$50 EE
$150 EE + 1 or more

$2,500

$3,000

Annual Maximum (per Individual)

Diagnostic & Preventive
(Type A Expenses)

Covered 100%; no deductible

100% covered up to *ARC, no deductible

100% covered; no deductible

100% covered up to *ARC; no deductible

Basic Services (Type B Expenses)

Covered 80% after deductible

Covered 80% up to *ARC, after deductible

Covered 90% after deductible

Covered 90% up to *ARC after deductible

Major Services (Type C Expenses)

Covered 60% after deductible

Covered 60% up to *ARC, after deductible

Covered 70% after deductible

Covered 70% up to *ARC after deductible

Orthodontic Expenses

Not Covered

Covered 50% up to $3,000 lifetime

NOTES
1. Unless otherwise indicated, any applicable deductible must be met before benefits are paid by the plan.
2. For more information refer to the carriers document for complete details, including plan exclusions and limitations.
*ARC is the maximum amount Aetna will pay for a covered expense from an out-of-network provider.

Bi-weekly and Monthly Contribution Rates

Basic Dental Plan PPO Plan Contribution Rates

Premium Dental Plan PPO Plan Contribution Rates

EE

EE + 1

EE + Family

EE

EE + 1

EE + Family

Bi-weekly Contribution

$4.64

$9.74

$13.92

Bi-weekly Contribution

$5.23

$10.98

$15.68

Monthly Contribution

$10.06

$21.10

$30.16

Monthly Contribution

$11.34

$23.78

$33.98

EE = Employee Only
EE+1 = Employee + 1 Dependent
EE + Family = Employee + 2 or More Dependents

Your 2014 - 2015 Benefits Guide

EE = Employee Only
EE+1 = Employee + 1 Dependent
EE + Family = Employee + 2 or More Dependents

12

AETNA DISCOUNT PROGRAMS

Aetna Discount Programs

Any member enrolled in an Aetna medical or dental plan is eligible for
Aetnas Discount Programs. Aetnas Discount Programs help you be well
and save you money on gym memberships, eyeglasses, contacts, weightloss programs, chiropractor visits and more.
Aetnas Discount Programs include:
Aetna VisionSM discount program
Aetna FitnessSM discount program
Aetna Natural Products and ServicesSM discount program
Aetna HearingSM discount program
Aetna Weight ManagementSM discount program
To learn more about Aetnas Discount Programs:
Log in to www.aetna.com
Choose Health Programs, then See the savings

Your 2014 - 2015 Benefits Guide

Your 2014 - 2015 Benefits Guide

13
13

VISION BENEFITS
Vision Plan
Infosys Limited offers you a choice to enroll in a voluntary vision plan
administered through VSP. If you elect to participate in the vision plan, you
may also enroll your eligible dependents.
Finding the right eyecare provider is important to your eye health and
overall wellness. Thats why you can see a VSP doctor, retail chain affiliate
provider or any other provider. However, if the provider you choose is outof-network, you may experience higher out-of-pocket costs.
The vision plan covers eye exams, frames, lenses and more. You can order
contact lenses online and have them delivered to your home. If you are
enrolled in the Standard Medical Plan with HSA, keep in mind that most
vision care expenses are eligible for reimbursement through a health
savings account.

Note: Any member enrolled in an Aetna medical or dental plan is eligible

for the Aetna Vision Discount Program at no additional cost. You do not
have to be enrolled in the VSP plan to be eligible for discounts.
The Aetna Vision Discount Program includes discounts on eye exams,
glasses, contact lenses, and Lasik surgery.
You can visit many doctors in private practice plus, these national
chains:* JCPenney Optical, LensCrafters, Target Optical, Sears
Optical and Pearle Vision.
The Aetna Vision Discount Program requires no claim forms, the
discount is given at the time of service.
Show your Aetna ID card to a participating vision provider for
immediate savings. A list of participating providers can be found on the
Aetna web site.

Using your VSP benefit is easy.

You can choose any eyecare provideryour local VSP doctor, a retail
chain affiliate, or any other provider. To find a VSP doctor or retail chain
affiliate, visit vsp.com or call (800) 877-7195.
Review your benefit information visit vsp.com to review your plan
coverage before your appointment.
At your appointment, tell your provider you have VSP. There are no ID
cards.
Thats it! VSP handles the rest there are no claim forms to complete
when you see a VSP doctor or retail chain affiliate.
An overview of vision benefits is on the following page. Please refer to your
SPD for a complete list of benefits and any limitations to the plan.

*EyeMed Select Network and Provider List, 1/12

Your 2014 - 2015 Benefits Guide

Your 2014 - 2015 Benefits Guide

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14

VISION BENEFITS
PLAN HIGHLIGHTS

VSP Vision
Group Number: 30020863
Member Service Phone Number: (800) 877-7195
Web Site: www.vsp.com

Discounts and coverage are available with VSP retail chain affiliate providers (includes
Costco). Contact VSP for details on your vision coverage and exclusive savings and
promotions for VSP members.

Benefit

Description of Your Coverage with VSP Doctors and Affiliate Providers*

Copay

Frequency

WellVision Exam

Focuses on your eyes and overall wellness

$0

Every 12 months

Prescription Glasses
Frame

$200 allowance for a wide selection of frames; 20% off amount over your allowance

$0

Every 12 months

Lenses

Single vision, lined bifocal, and lined trifocal lenses; polycarbonate lenses for dependent children

$0

Every 12 months

Lens Options

Progressive lenses; average 35-40% off other lens options

$0

Every 12 months

Contacts
(instead of glasses)

$200 allowance for contacts; contact lens exam (fitting and evaluation up to $60 copay )

Up to $60

Every 12 months

Primary Eyecare

Treatment and diagnosis of eye conditions like pink eye, vision loss and monitoring of cataracts, glaucoma, and diabetic retinopathy

$20

As needed

Computer Vision Care

Computer Vision Exam

Evaluates your needs related to computer use

$0

Every 12 months

Frame

$90 allowance for a wide selection of frames; 20% off amount over your allowance

$0

Every 12 months

Lenses

Single vision, lined bifocal, lined trifocal, and occupational lenses

$0

Every 12 months

*You coverage provides you access to the VSP Signature Doctor Network. Coverage with a retail chain affiliate may be different. Once your benefit is effective, visit vsp.com for details.
Coverage information is subject to change. In the event of a conflict between this information and your organizations contract with VSP, the terms of the contract will prevail.

Your Coverage with Other Providers

Exam up to $50

Single Vision Lenses up to $50

Lined Trifocal Lenses up to $100

Frame up to $70

Lined Bifocal Lenses up to $75

Progressive Lenses up to $75

Contacts up to $105

Visit vsp.com for details, if you plan to see a provider other than a VSP doctor.

Bi-weekly and Monthly Contribution Rates

EE Only

EE +1

EE + Family

Bi-weekly Contribution

$3.55

$7.09

$11.42

Monthly Contribution

$7.69

$15.36

$24.74

Your 2014 - 2015 Benefits Guide

Glasses and Sunglasses

30% off additional glasses and sunglasses, including lens options from the same
VSP doctor on the same day as your WellVision Exam, or get 20% off from any VSP
doctor within 12 months of your last WellVision Exam.
Retinal Screening
Guaranteed pricing on retinal screening as an enhancement to your WellVision Exam.

VSP Vision Plan Contribution Rates

EE = Employee Only
EE+1 = Employee + 1 Dependent
EE + Family = Employee + 2 or More Dependents

Extra Savings and Discounts Using the VSP Signature Network

Laser Vision Correction

On an average, receive 15% off the regular price or 5% off the promotional price;
discounts only available from contracted facilities.
After surgery, use your frame allowance (if eligible) for sunglasses from any VSP
doctor.

15

HEALTH SAVINGS ACCOUNT

Health Savings Account (HSA)
When enrolling in the Standard Medical Plan, you may have the option
of setting up a Health Savings Account (HSA) through JP Morgan Chase
(Aetnas HSA vendor partner) should you meet the eligibility requirements.
Eligibility requirements are as follows: you must be enrolled in a high
deductible health plan; you must not be covered by any other health plan;
you must not be enrolled in Medicare; and you must not be claimed as a
dependent on another individuals tax return.
An HSA is a special tax-advantaged account that you and your family
members can use to pay for qualified medical expenses ranging from
deductibles and co-insurance to pharmacy bills, dental care, vision care
and much more. You can make pre-tax contributions to your HSA via
payroll deduction. Once deposited, your money grows tax-free year after
year, much like an IRA. And its yours to keep, even if you change jobs.
Features of an HSA:
An HSA account is an individually owned account.
HSA contributions are made on a pre-tax basis and can be used for
future qualified medical expenses.
Funds you withdraw tax-free must be used to pay for qualified medical
expenses, as defined by Section 213(d) of the Internal Revenue Code
(Code).
Funds carry over year after year.
You can withdraw the money on a taxable basis for any purpose after
age 65 your unused HSA funds can help fund your retirement.
You can create a balanced HSA portfolio tailored to your specific needs
and risk preferences.

Your 2014 - 2015 Benefits Guide

Your 2014 - 2015 Benefits Guide

16
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HEALTH SAVINGS ACCOUNT

JP Morgan Chase Health Savings Account (HSA)
Member Services Phone Number: (866) 524-2483
Investments: (866) 774-7129
Web Site: www.chase.com/health-savings-account
IRS Annual Maximum Plan Year Contributions to Your HSA
Individual

$3,300

Family

$6,550

Over 55 catch up contributions

$1,000

Establishing Your HSA

When you enroll in the Standard Medical Plan you will receive a welcome kit
in the mail from JP Morgan Chase with instructions on how to set up your
HSA account and complete the enrollment process.

MONTHLY HSA ACCOUNT FEES:

No fee to establish the HSA account
Monthly service charge of $3.75
A complete list of account fees will be included in the welcome kit and
posted on the web site

When you pay for qualified medical expenses with your HSA, the funds you
withdraw are tax-free, provided they:
Are qualified medical expenses as generally described in IRS publication
502 titled, Medical and Dental Expenses, Catalog Number 15002Q. You
can order the publication by calling (800) TAX-FORM or view it online at
www.irs.gov/pub/irs-pdf/p502.pdf .
Have not been compensated or reimbursed by insurance or otherwise.
Examples of Qualified Medical Expenses
Deductibles and coinsurance for medical and dental care
Prescription drugs (some over the counter drugs with a prescription)
Vision care, including glasses and Lasik eye surgery
Smoking cessation treatment and prescriptions
Some insurance premiums, such as long-term care, COBRA and health
care coverage premiums while receiving unemployment income
* For a detailed list, visit the IRS web site at: www.irs.gov/pub/irs-pdf/p502.pdf
Examples of Non-Qualified Medical Expenses
Air purifiers
Cosmetic surgery and related expenses
Health club dues (unless prescribed by a physician to treat illness)
Illegal operations and treatments
Massages for general well-being
Transportation, unless specifically for and essential to medical care
Toothpaste, cosmetics and toiletries
Vitamins and nutritional supplements
Weight loss programs (unless for a specific illness)
Please Note: For questions regarding your HSA, first call Aetnas medical
member services at (888) 219-9153 or log on to www.aetnanavigator.com.

Your 2014 - 2015 Benefits Guide

17

DEPENDENT CARE FLEXIBLE SPENDING ACCOUNT

Dependent Care Flexible Spending Account (FSA)
This account enables you to pay for out-of-pocket, work-related
dependent daycare cost with pre-tax dollars. Dependent care expenses
must be incurred during the coverage period so you (and your spouse, if
married) can work or look for work, or in some cases if your spouse is a fulltime student.
The care must be provided by a dependent care center or by an individual
who can provide a name, address, and taxpayer identification number.
Although you may not take the childcare tax credit if you choose this
option, you may save more depending on your income level.
The dependent care FSA should only be considered for anticipated
expenses. You should be conservative when estimating the amount to
contribute to your account. If you overestimate your expenses and have
money left in the account at the end of the year, it will be forfeited.

Your 2014 - 2015 Benefits Guide

Your 2014 - 2015 Benefits Guide

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18

DEPENDENT CARE FLEXIBLE SPENDING ACCOUNT

Flex-Plan Dependent Care Flexible Spending Account
Member Service Phone Number: (800) 669-3539
Web Site: www.flex-plan.com
Plan

Contribution

Dependent Care FSA

You may contribute between $900 (annual

minimum) and $5,000 (annual maximum).

Eligible dependent care facilities:

A dependent (day) care center, provided that if care is provided by the
facility for more than six individuals, the facility complies with applicable
state and local laws;
An educational institution for pre-school children. For older children, only
expenses for non-school care are eligible; and
An individual who provides care inside or outside your home. The
individual may not be a child of yours under age 19 or anyone you claim
as a dependent for federal tax purposes.
Eligible expenses must be for the care of:
A dependent child who is under age 13 and whom you claim as an
exemption on your income tax return.
A dependent child, elderly parent or relative who is physically or mentally
incapable of caring for him - or herself.
Eligible expenses include those to cover:
Licensed day care center
Nursery school
In-home care for dependents unable to care for themselves (children or
adults)
Daytime summer recreational camp
Adult day care center
Adult private sitter (nanny or home care companion)

Your 2014 - 2015 Benefits Guide

Use It Or Lose It Rule

The IRS mandates that any amount not spent in the
FSA plan year will be forfeited.
19

DISABILITY INCOME BENEFITS and BASIC LIFE and AD&D INSURANCE

Disability Income Benefits

You are eligible for short-term and long-term disability income benefits if
you are a regular full-time employee. In the event you become disabled
from a non work-related injury or sickness, disability income benefits are
provided as a source of income. Infosys Limited pays the full cost of longterm benefit there is no cost to you. You also have the opportunity to
elect optional short-term disability coverage on yourself.

Basic Life and Accidental Death & Dismemberment

(AD&D) Insurance
Regular, full-time employees are provided with company paid life insurance
and AD&D insurance. Eligible employees are automatically enrolled in life
insurance and AD&D insurance of $75,000. Infosys Limited pays the full cost
of this benefit there is no cost to you. You also have the opportunity to
elect optional life coverage on yourself, spouse and children.

Your 2014 - 2015 Benefits Guide

Your 2014 - 2015 Benefits Guide

20
20

DISABILITY INCOME BENEFITS and BASIC LIFE and AD&D INSURANCE

Disability Benefits
Aetna Disability Benefits
Member Service Phone Number: (866) 326-1380
Web Site: www.aetnadisability.com
Plan Features

Short-term Disability

Long-term Disability

Benefits Begin

On the 8th day of approved

claim for illness or injury

On the 91st day of approved claim

for illness of injury

Benefit Duration

Up to 13 weeks

Up to age 65 if totally disabled.

Limitations for specific conditions.

Percentage of
Income Replaced

66.67% of basic weekly

earnings

66.67% of basic monthly earnings

(minus other income benefits)

Maximum Benefit

$2,000 per week

$10,000 per month

Eligibility

Approved claim paperwork

1 year of US Infosys Limited employment

Employee Cost

Employee Paid

None - Infosys Limited pays all costs

Evidence of Insurability (EOI) is required unless you elect Short-term or Long-term disability
within 31 days of your benefit eligibility date.

Short-term Disability
Regular, full-time employees have the opportunity to purchase short-term
disability coverage. This coverage provides eligible employees with up to
66.67% of base pay in the event of a qualified disability which renders the
employee unable to work. Short-term disability payments are applicable for
up to 13 weeks, with a maximum of $2,000 per week. Short-term disability
payments are subject to a seven day waiting period.
Short-term Disability Premium
Your short-term disability premium cost is $.18 per month per $10 dollars
of weekly covered benefit. Below is an example of how a premium for an
employee with a $75,000 salary would be calculated:
$75,000 52 * 66.7% = $962
($962 * $.18) $10 = $17.31 (monthly premium)
($17.31 * 12) $26 = $7.99 (biweekly premium)
* 12) 26 = $7.99 (biweekly premium)

Your 2014 - 2015 Benefits Guide

Long-term Disability
Regular, full-time employees are provided with company paid long-term
disability coverage after one year of employment. This coverage provides
eligible employees with up to 66.67% of their base pay in the event of a
qualified disability which renders the employee unable to work as defined by
the summary plan documents. Long-term disability payments pay out at a
maximum of $10,000 per month and are subject to a 90 day waiting period.

IMPORTANT
Use the online
enrollment system to
record your beneficiary!

Basic Life and AD&D Insurance

Aetna Basic Life and AD&D Benefits
Member Service Phone Number: (800) 523-5065
Web Site: www.aetna.com/group/aetna_life_essentials
Plan Features
Life Benefit Amount

$75,000

AD&D Amount

Pays an additional one times the life insurance amount

should you die by accidental means

Age Reduction

Reduce by 50% at age 70

Accelerated Death
Benefit

Included up to $25,000 of your life benefit if you are

diagnosed with a terminal illness and have a life expectancy
of 12 months or less.

Conversion

Included - 31 days to convert to individual policy in most

cases

Employee Cost

None - Infosys Limited pays all costs

21

DISABILITY INCOME BENEFITS and BASIC LIFE and AD&D INSURANCE

Voluntary Life and AD&D Insurance

Voluntary Life Insurance Rates

You have opportunity to elect optional life and AD&D coverage on yourself. If
you elect coverage on yourself, you may also elect coverage on your spouse
and children. See the chart below for plan features.

Age Banded

Plan Features

Under 25

$0.05

Employee Life and AD&D

25 - 29

$0.06

Employee (Voluntary Life)

Spouse (Dependent Life)
Cost per $1,000 of Coverage

Benefit Increments

1x, 2x, 3x, 4x, 5x or 6x base annual earnings

30 - 34

$0.08

Benefit Maximum

$1,000,000

35 - 39

$0.09

Guarantee Issue Amount

3x annual earnings or $500,000

40 -44

$0.10

Age Reduction Schedule

50% at age 70

45 - 49

$0.15

50 -54

$0.26

Spouse Life and AD&D

Benefit Increments

$5,000

55 - 59

$0.52

Benefit Maximum

$250,000 or 50% of employee election

60 - 64

$1.04

Guarantee Issue Amount

$30,000

65 - 69

$1.84

Age Reduction Schedule

50% at age 70

70 - 74

$2.68

75+

$3.47

Dependent Child

$0.05

Child(ren) Life and AD&D

Benefit Increments

$5,000

Benefit Maximum

$10,000 or 50% of employee election

Please Note: Employees not currently enrolled in the Supplemental Life plan can elect 1x salary
with approval of EOI (Evidence of Insurability). Employees currently enrolled in the Supplemental
Life plan can elect an increase in coverage of 1x salary without EOI, however, this amount cannot
exceed the Guarantee Issue Amount. New hires can elect amount up to Guarantee Issue Amount
without EOI.
Employees not currently enrolled in the Dependent Life plan can elect $5,000 of coverage with
approval of EOI (Evidence of Insurability). Employees currently enrolled in the Dependent Life
plan can elect an increase in coverage of $5,000 without EOI, however, this amount cannot
exceed the Guarantee Issue Amount. New hires can elect up to Guarantee Issue Amount without
EOI.

Your 2014 - 2015 Benefits Guide

Voluntary AD&D Insurance Rates

Employee (Voluntary AD&D)
Employee + 1 or more
(Dependent AD&D)

Cost per $1,000 of Coverage

Employee Only

$0.040

Employee + 1 or More

$0.050

22

OTHER BENEFITS

Your 2014 - 2015 Benefits Guide

Your 2014 - 2015 Benefits Guide

23
23

EMPLOYEE ASSISTANCE PROGRAM and RETIREMENT BENEFITS

Employee Assistance Program (EAP)

Retirement Benefits

Aetna EAP
Member Service Phone Number: (888) 238-6232
Web Site: www.aetnaeap.com
Company Code: EAP4INFY

Fidelity 401(k) Plan Benefits

Member Service Phone Number: (800) 294-4015
Web Site: www.fidelity.com

The EAP is a company paid benefit that is available to all eligible employees.
This program offers confidential telephonic counseling services around
the clock by licensed clinical staff to help you, members of your household
and your adult children up to age 26 balance the demands of work, life and
personal issues.

If you are an employee in Personal Level 6 or below and are not defined as a
Highly Compensated Employee (HCE) per IRS regulations, you may contribute
pre-tax dollars to the Infosys Limited 401(k) plan, exclusively through payroll.
Infosys Limited does not provide a matching contribution. The maximum
annual employee deferral in the 401(k) plan is governed by the IRS limits
specified for the plan year. You have a choice of investing your salary deferrals
in funds from different families of mutual funds. You may enroll in this plan
starting the first calendar month after date of hire.

The EAP can assist with topics such as:

Marital distress
Relationship issues
Substance abuse
Workplace conflict
Stress
Personal and family issues
Balancing the demands of work, home and life can lead to improved
productivity, increased employee satisfaction and better managed health
costs.

401(k) IRS Maximum Deferrals for 2014

Deferral Limit: $17,500
Catch-up Limit $5,500

Your 2014 - 2015 Benefits Guide

24

COMMUTER BENEFITS
Flexi-Commuter Benefits Plan
Member Service Phone Number: (800) 669-3539
Web Site: www.flex-plan.com
The Flexi-Commuter Benefit Plan enables you to use pre-tax dollars to pay for
transportation and parking expenses spent on your commute to work. You
may purchase tickets online every month for the following month. You can
save anywhere between 20-40% on these expenses depending on your tax
bracket.
Heres How it Works
Register on Flexi-Commuter Plan web site, and go through the three-step
ordering process. Your passes will be mailed to your home address.
Registration and orders must be completed via the Flexi-Commuter Plan
web site by the 8th of the month for the following month benefit access.
A minimum monthly contribution of $75 is required or a $3.50
administration fee will be assessed.
Purchases are made a month in advance for the following months transit.
Mass Transit Expenses (i.e. Train or Bus) are subject to a $245/month
maximum contribution.
Parking Expenses are subject to a $245/month maximum contribution.

Eligible Mass Transit & Parking Expenses

Bus vouchers and passes used to commute to and from work.
Vanpooling in a commuter highway vehicle to and from work as long
as 80% of the mileage is for transportation of employees between work/
home and the vehicle is at half the maximum adult seating.
Ferry passes used to commute to and from work.
Mass Transit FSA Non-Allowable Expenses
Mass transit costs not associated with the commute to work.
Mass transit costs from an employee bought voucher or bus pass when a
voucher system is already sponsored or available by the employer.
Parking FSA Eligible Expenses
Parking costs associated with a lot at or near the place of business.
Parking costs from a lot that is at or near the place of commute (i.e.
rideshare, carpool, vanpool).
Parking FSA Non-Allowable Expenses
Parking costs incurred at your residence.
Parking costs at a lot that is owned or sponsored by the employer.
Please Note: Parking lot fees arising from a company owned lot are not
eligible under the Parking Reimbursement Account. These costs are deducted
through the Parking Conversion Plan.

Your 2014 - 2015 Benefits Guide

25

GROUP AUTO and HOME INSURANCE PROGRAM

MetLife Auto & Home
Call MetLife Auto & Home at 800 GET-MET 8 ((800) 438-6388) for your FREE quote.
Web Site: www.metlife.com/mybenefits

MetLife Auto & Homes group insurance program is available to you as a

voluntary benefit made available by your employer. As part of the program
you will have access to value-added features and benefits, including special
group discounts on auto and home* insurance, as well as a variety of other
insurance policies including: condo, renters, motor home, motorcycle,
recreational vehicle, boat and personal excess liability policies.
You could also benefit from these program features:
24-hour claim reporting
Extended customer service hours, including weekday evenings and
Saturdays
Coverage you can take with you, should you retire or leave the company
for another reason
Enhanced product coverages that are built into every auto policy**
You can also choose from a variety of flexible and convenient payment
options to make paying for your insurance easier. You can choose an
automated payment option and receive added-savings or select direct bill as
your preferred payment option.

*Home insurance is not part of MetLife Auto & Homes benefit offering in Florida and
Massachusetts.

Since everyones insurance policies renew at different times during the year,
you may apply for group auto and home insurance at any time.

**See policy for restrictions.

Your 2014 - 2015 Benefits Guide

26

RELOCATION and MILEAGE REIMBURSEMENT

Relocation and Mileage Reimbursement

In the event that you are required to relocate as a result of business reasons
and with prior written approval by management, you may be eligible for
reimbursement under Infosys Limiteds relocation policy. Relocation is
defined as the transfer of work to a new location which is 50 miles or more
from the existing work location of the employee post joining or location as
captured in the application form for a new joinee.

All reimbursements will be based on actuals upon submission of bills.

You will be reimbursed for expenses against bill towards accommodation
(hotel expense) and conveyance for their initial stay. The entitlement towards
the reimbursement would be as per your Base Location and Personal Level.
You will be entitled for the reimbursement of Initial Settlement Expense of
USD.

Expenses for which you may be eligible for reimbursement include travel
to the new location for yourself and applicable family members (spouse
and children) via air, personal car or rental car, transportation of goods
and movement of one vehicle within the US. You will also be eligible for
reimbursement of Lease Breakage expenses due to relocation as per the
Policy on Relocation within USA or Policy on Reimbursement of Relocation
Expenses for Inter-Country Movements, whichever is applicable.

Please Note: The above mentioned Initial Settlement Expense eligibility

is applicable only for Bellevue, WA, USA. In case there is a change in your
location, please discuss Initial Settlement Expense eligibility with the
Recruitment Manager or the Human Resource Manager upon your joining.

Maximum allowable reimbursement towards the transportation of goods:

Up to $3,000 for relocations of less than or equal to 1,500 miles or $4,000
for relocations more than 1,500 miles.
All employees will be eligible for transportation of one vehicle and will
be reimbursed at actuals on submission of bills up to $1,000. This is
applicable only for domestic relocation i.e., within the US.

All transit expenses (bus, train, and airfare) will be reimbursed on submission
of bills and reimbursement is limited to economy fare only. For claims
purposes, please keep all original tickets and boarding passes.
Mileage Reimbursement
Employees who use their personal vehicles for business purposes may be
eligible for mileage reimbursement. For more information contact the Human
Resources Department.
Mileage Reimbursement Rates

Travel by personal car will be eligible for mileage reimbursement as per the
chart on the right. If a rental car is used, rental charges and fuel expenses
are reimbursable upon submission of bills up to a maximum limit of airfare
between the two locations; the exact amount applicable at a time can be
confirmed with the Human Resource Department. Driving options are
available only if airfare is not utilized.

Your 2014 - 2015 Benefits Guide

Particulars

Rate (per mile)

Business travel

56.5 cents

Using your own car for relocation purposes

24.0 cents

27

VACATION, HOLIDAYS
GENERAL AND
and FLOATING
SICK LEAVEHOLIDAYS, and SICK LEAVE
Vacation, Holidays and Sick Leave
HR Helpdesk: (888) 237-8763 Option 4
Web Site: AHD > HR Helpdesk

Vacation

Holidays

Infosys Limited provides paid vacation to regular, full-time employees.

Employees can accrue 10 days of paid vacation in the first year of employment
(the leave year runs from April 1st to March 31st). The amount of vacation
increases to 12 days per year after two years and to 15 days per year after five
years of employment. Additional, approved time-off will be treated as unpaid
leave.

All employees will be eligible for 10 paid holidays in a calendar year. The dates
of the holidays will depend on whether the employee is assigned to a client or
works out of an Infosys Limited location or another non-client location.

Vacation accruals are capped at 1.5 times an employees annual leave

entitlement. When the accrual cap is reached, an employee will not earn
additional vacation until the employee has taken enough vacation such that
the accrued amount falls below the cap.
In case an employee is moving across multiple locations in the US, the accrued
leave gets carried forward to each subsequent location. However, in case an
employee is required to relocate to another country, carry forward will not be
permissible and the leave balance in the USA would be compulsorily encashed.
Vacation encashment would be applicable at the time of separation /
termination from the organization.

Your 2014 - 2015 Benefits Guide

Holiday Policy Effective 1/1/13

All employees who are in the US from January 1st December 31st of each
year will get 10 holidays on January 1st to be applied as per the Infosys
Limited or client holiday calendar. Employees joining onsite for part of the
year will get holidays pro-rated based on the number of days at onsite for
that year. A year is based on the calendar year.
Employees working in Infosys Limited offices have to follow the Infosys
Limited holiday calendar. All 10 holidays are fixed and must be applied
through the leave system.
Employees working in client locations should follow the client holiday
calendar. Employees can only apply for holidays as per the list of holidays in
the Leave System.
All holidays, statutory or otherwise, need to be applied for through the
Leave System.
If an employee (either working in an Infosys Limited office or at a client
location) is unable to take a holiday as designated by Infosys Limited or the
client due to project requirements, he/she may take an alternate holiday
and apply for the same through the Leave System. Alternate holidays are
additional days designated in the Leave System in the same month in which
that holiday applies and are listed in the leave system.
Legacy Infosys Consultants (IC) employees, please note: All Legacy IC
employees need to continue to follow the current process to apply for
holiday leaves as you have been doing last year. If you have any specific
questions, you may reach out to your MCS HRBP.

28

VACATION, HOLIDAYS and SICK LEAVE

During Client Shutdowns:
Employees must either use their available holidays and apply for the leave
through the Leave System, or
They may work from home wherever possible, with their Managers
approval.
If working from home is not an option, the employee can create a task
in iTime for On duty or any other non-billable project code and enter 8
hours in their time sheet for every holiday that the client is closed and the
employee does not have sufficient leave to apply. In this circumstance,
employees are not required to use their vacation leave or LOP.

Your 2014 - 2015 Benefits Guide

Sick Leave
Infosys Limited offers paid sick leave to regular, full-time employees. Employees
accrue paid sick leave at a rate of six days per year. The leave year is April 1st to
March 31st. Half of the annual sick leave is credited twice per year in both April
and October respectively. In the first year of employment, sick leave will be
pro-rated for the half year (April or October) in which the employee has joined.
One day of accrued sick leave per year can be carried over to the next year and
must be utilized in the first quarter of the next fiscal year or it will lapse. Infosys
Limited does not pay employees for unused sick leave.

29

WEB TOOLS
Aetna Navigator - www.aetnanavigator.com
Its the one place to go for coverage, claims, costs and more.
Aetna Navigator is easy to use. Aetna Navigator is your secure web site for
planning and managing your health and health care. Its organized to help
you do what you want to do.
Register for Aetna Navigator to:
Check claim status
Find doctors, dentists, hospitals and pharmacies
View and print temporary ID cards
Request replacement Aetna member ID cards
Contact Aetna Member Services
Utilize tools to manage your health care:
-- Simple Steps Health and Wellness
-- Moms to Babies Program
-- Access expert sources of medical and dental health information
-- Review coverage details
-- Estimate health care costs
-- Find doctors, dentists, hospitals and pharmacies
Get explanation of benefits statements and much more...

INSURANCE ID CARDS

ID cards will be mailed to your home address within 30 days of

enrollment.
Providers will be able to verify your coverage with Aetna even if you
have not received your ID card.
You will be able to print a temporary ID card from the
Aetna Navigator site.
There are no ID cards issued for the VSP vision plan.

Your 2014 - 2015 Benefits Guide

Your 2014 - 2015 Benefits Guide

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30

CONTACT INFORMATION

Your 2014 - 2015 Benefits Guide

Your 2014 - 2015 Benefits Guide

31
31

CONTACT INFORMATION
Check with the plans administrator directly for specific information about the plan for 2014.

Carrier

Phone Number

Web Site

Aetna Medical and Prescription Drugs

(888) 219-9153

www.aetnanavigator.com

Aetna Dental

(877) 238-6200

www.aetnanavigator.com

Aetna Discount Vision Plan

(888) 219-9153

www.aetnanavigator.com

VSP Vision

(800) 877-7195

www.vsp.com

JP Morgan Chase HSA

(866) 524-2483

www.chase.com/health-savings-account

JP Morgan Chase HSA Investments

(866) 774-7129

www.chase.com/health-savings-account

(800) 669-3539

www.flex-plan.com

Aetna Disability Income (Short-term and Long-term)

(866) 326-1380

www.aetnadisability.com

Aetna Basic Life and AD&D

(800) 523-5065

www.aetna.com/group/aetna_life_essentials

Aetna Employee Assistance Program (EAP)

(888) 238-6232

www.aetnaeap.com

Fidelity 401(k) Plan a

(800) 294-4015

www.fidelity.com

Flexi-Commuter Plan

(800) 669-3539

www.flex-plan.com

MetLife Auto & Home

(800) 438-6388

www.metlife.com/mybenefits

Vacation, General and Floating Holidays, and Sick Leave

(888) 237-8763 Option 4

AHD > HR Helpdesk

Medical Benefits

Flexible Spending Account

Flex-Plan Dependent Care Flexible Spending Account
Insurance

Other Benefits

Still have questions about your benefits?

Go online to https://infosysbenefits.hrintouch.com
Call the Benefits Desk at (855) 838-4072. Representatives are available Monday through Friday
between 8 a.m. to 8 p.m. Eastern Time.
E-mail [email protected]
Call or visit a specific plan administrators web site

Your 2014 - 2015 Benefits Guide

32

NOTICES

Your 2014 - 2015 Benefits Guide

Your 2014 - 2015 Benefits Guide

33
33

NOTICES
MEDICAID AND THE CHILDRENS HEALTH INSURANCE PROGRAM (CHIP)

Medicaid and The Childrens Health Insurance Program (CHIP)

Offer Free or Low-Cost Health Coverage to Children and Families
If you are eligible for health coverage from your employer, but are unable to
afford the premiums, some States have premium assistance programs that
can help pay for coverage. These States use funds from their Medicaid or CHIP
programs to help people who are eligible for employer-sponsored health
coverage, but need assistance in paying their health premiums.

If you or your dependents are already enrolled in Medicaid or CHIP and you live
in a State listed below, you can contact your State Medicaid or CHIP office to
find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP,
and you think you or any of your dependents might be eligible for either of

these programs, you can contact your State Medicaid or CHIP office or dial
1-877-KIDS-NOW or www.insurekidsnow.gov to find out how to apply. If you
qualify, you can ask the State if it has a program that might help you pay the
premiums for an employer-sponsored plan.
Once it is determined that you or your dependents are eligible for premium
assistance under Medicaid or CHIP, your employers health plan is required to
permit you and your dependents to enroll in the plan as long as you and your
dependents are eligible, but not already enrolled in the employers plan. This
is called a special enrollment opportunity, and you must request coverage
within 60 days of being determined eligible for premium assistance.

If you live in one of the following States, you may be eligible for assistance paying your employer health plan premiums. The following list of States is
current as of April 16, 2010. You should contact your State for further information on eligibility.
ALABAMA Medicaid

ARIZONA CHIP

Web Site: http://www.medicaid.alabama.gov

Phone: 1-800-362-1504

Web Site: http://www.azahcccs.gov/applicants/default.aspx

Phone: 1-877-764-5437

ALASKA Medicaid

ARKANSAS CHIP

Web Site: http://health.hss.state.ak.us/dpa/programs/medicaid/

Phone (Outside of Anchorage): 1-888-318-8890
Phone (Anchorage): 907-269-6529

Web Site: http://www.arkidsfirst.com/

Phone: 1-888-474-8275

Your 2014 - 2015 Benefits Guide

34

NOTICES
CALIFORNIA Medicaid

KENTUCKY Medicaid

Web Site: http://www.dhcs.ca.gov/services/Pages/

TPLRD_CAU_cont.aspx
Phone: 1-866-298-8443

Web Site: http://chfs.ky.gov/dms/default.htm

Phone: 1-800-635-2570

COLORADO Medicaid and CHIP

LOUISIANA Medicaid

Medicaid Web Site: http://www.colorado.gov/

Medicaid Phone: 1-800-866-3513
CHIP Web Site: http:// www.CHPplus.org
CHIP Phone: 303-866-3243

Web Site: http://www.la.hipp.dhh.louisiana.gov

Phone: 1-888-342-6207

FLORIDA Medicaid

MAINE Medicaid

Web Site: http://www.fdhc.state.fl.us/Medicaid/index.shtml

Phone: 1-866-762-2237

Web Site: http://www.maine.gov/dhhs/oms/

Phone: 1-800-321-5557

GEORGIA Medicaid

MASSACHUSETTS Medicaid and CHIP

Web Site: http://dch.georgia.gov/

Click on Programs, then Medicaid
Phone: 1-800-869-1150

Medicaid & CHIP Web Site: http://www.mass.gov/MassHealth

Medicaid & CHIP Phone: 1-800-462-1120

IDAHO Medicaid and CHIP

MINNESOTA Medicaid

Medicaid Web Site: www.accesstohealthinsurance.idaho.gov

Medicaid Phone: 1-800-926-2588
CHIP Web Site: www.medicaid.idaho.gov
CHIP Phone: 1-800-926-2588

Web Site: http://www.dhs.state.mn.us/

Click on Health Care, then Medical Assistance
Phone: 800-657-3739

INDIANA Medicaid

MISSOURI Medicaid

Web Site: http://www.in.gov/fssa/2408.htm

Phone: 1-877-438-4479

Web Site: http://www.dss.mo.gov/mhd/index.htm

Phone: 573-751-6944

IOWA Medicaid

MONTANA Medicaid

Web Site: www.dhs.state.ia.us/hipp/

Phone: 1-888-346-9562

Web Site: http://medicaidprovider.hhs.mt.gov/clientpages/clientindex.shtml

Telephone: 1-800-694-3084

KANSAS Medicaid

NEBRASKA Medicaid

Web Site: https://www.khpa.ks.gov

Phone: 800-766-9012

Web Site: http://www.dhhs.ne.gov/med/medindex.htm

Phone: 1-877-255-3092

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NOTICES
NEVADA Medicaid and CHIP

OREGON Medicaid and CHIP

Medicaid Web Site: http://dwss.nv.gov/

Medicaid Phone: 1-800-992-0900
CHIP Web Site: http://www.nevadacheckup.nv.org/
CHIP Phone: 1-877-543-7669

Medicaid & CHIP Web Site: http://www.oregonhealthykids.gov

Medicaid & CHIP Phone: 1-877-314-5678

NEW HAMPSHIRE Medicaid

PENNSYLVANIA Medicaid

Web Site: http://www.dhhs.state.nh.us/DHHS/MEDICAIDPROGRAM/default.htm

Phone: 1-800-852-3345 x 5254

Web Site: http://www.dpw.state.pa.us/partnersproviders/medicalassistance/

doingbusiness/003670053.htm
Phone: 1-800-644-7730

NEW JERSEY Medicaid and CHIP

RHODE ISLAND Medicaid

Medicaid Web Site: http://www.state.nj.us/humanservices/dmahs/clients/medicaid/

Medicaid Phone: 1-800-356-1561
CHIP Web Site: http://www.njfamilycare.org/index.html
CHIP Phone: 1-800-701-0710

Web Site: www.dhs.ri.gov

Phone: 401-462-5300

NEW MEXICO Medicaid and CHIP

SOUTH CAROLINA Medicaid

Web Site: http://www.nyhealth.gov/health_care/medicaid/

Phone: 1-800-541-2831

Web Site: http://www.scdhhs.gov

Phone: 1-888-549-0820

NEW YORK Medicaid

TEXAS Medicaid

Web Site: http://www.nyhealth.gov/health_care/medicaid/

Phone: 1-800-541-2831

Web Site: https://www.gethipptexas.com/

Phone: 1-800-440-0493

NORTH CAROLINA Medicaid

UTAH Medicaid

Web Site: http://www.nc.gov

Phone: 919-855-4100

Web Site: http://health.utah.gov/medicaid/

Phone: 1-866-435-7414

NORTH DAKOTA Medicaid

VERMONT Medicaid

Web Site: http://www.nd.gov/dhs/services/medicalserv/medicaid/

Phone: 1-800-755-2604

Web Site: http://ovha.vermont.gov/

Telephone: 1-800-250-8427

OKLAHOMA Medicaid

VIRGINIA Medicaid and CHIP

Web Site: http://www.insureoklahoma.org

Phone: 1-888-365-3742

Medicaid Web Site: http://www.dmas.virginia.gov/rcp-HIPP.htm

Medicaid Phone: 1-800-432-5924
CHIP Web Site: http://www.famis.org/
CHIP Phone: 1-866-873-2647

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NOTICES
WASHINGTON Medicaid

WISCONSIN Medicaid

Web Site: http://hrsa.dshs.wa.gov/premiumpymt/Apply.shtm

Phone: 1-877-543-7669

Web Site: http://dhs.wisconsin.gov/medicaid/publications/p-10095.htm

Phone: 1-800-362-3002

WEST VIRGINIA Medicaid

WYOMING Medicaid

Web Site: http://www.wvrecovery.com/hipp.htm

Phone: 304-342-1604

Web Site: http://www.health.wyo.gov/healthcarefin/index.html

Telephone: 307-777-7531

To see if any more States have added a premium assistance program since April 16, 2010, or for more information on special enrollment rights, you can contact
either:
U.S. Department of Labor
Employee Benefits Security Administration
www.dol.gov/ebsa
1-866-444-EBSA (3272)

Your 2014 - 2015 Benefits Guide

U.S. Department of Health and Human Services

Centers for Medicare & Medicaid Services
www.cms.hhs.gov
1-877-267-2323, Ext. 61565

37

NOTICES
MEDICAID AND THE CHILDRENS HEALTH INSURANCE PROGRAM (CHIP)

Notice of HIPAA Special Enrollment Rights

This notice is being provided to ensure that you understand your rights to
apply for group health insurance coverage. You should read this notice even if
you plan to waive coverage at this time.
Loss of Other Coverage
If you are declining enrollment for yourself or your dependents (including your
spouse) because of other health insurance or group health plan coverage, you
may be able to enroll yourself and your dependents in this plan if you or your
dependents lose eligibility for that other coverage (or if the employer stops
contributing toward your or your dependents other coverage). However, you
must request enrollment within 31 days or any longer period that applies
under the plan after your or your dependents other coverage ends (or after the
employer stops contributing toward the other coverage).

Medicaid or CHIP
If you or your dependents lose eligibility for coverage under Medicaid or the
Childrens Health Insurance Program (CHIP) or become eligible for a premium
assistance subsidy under Medicaid or CHIP, you may be able to enroll yourself
and your dependents. You must request enrollment within 60 days of the loss
of Medicaid or CHIP coverage or the determination of eligibility for a premium
assistance subsidy.
To request special enrollment or obtain more information, contact the Benefits
Desk at (855) 838-4072.

Marriage, Birth, or Adoption

In addition, if you have a new dependent as a result of marriage, birth,
adoption, or placement for adoption, you may be able to enroll yourself and
your dependents. However, you must request enrollment within 31 days or any
longer period that applies under the plan after the marriage, birth, adoption, or
placement for adoption.

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NOTICES
Medicare Part D Standard Plan and Plus Plan
Important Notice From Infosys Limited About Your Prescription Drug
Coverage and Medicare
Please read this notice carefully and keep it where you can find it. This notice
has information about your current prescription drug coverage with Infosys
Limited Health & Welfare Plan and about your options under Medicares
prescription drug coverage. This information can help you decide whether or
not you want to join a Medicare drug plan. If you are considering joining, you
should compare your current coverage, including which drugs are covered
at what cost, with the coverage and costs of the plans offering Medicare
prescription drug coverage in your area. Information about where you can get
help to make decisions about your prescription drug coverage is at the end of
this notice.
There are two important things you need to know about your current coverage
and Medicares prescription drug coverage:
1. Medicare prescription drug coverage became available in 2006 to
everyone with Medicare. You can get this coverage if you join a Medicare
Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO
or PPO) that offers prescription drug coverage. All Medicare drug plans
provide at least a standard level of coverage set by Medicare. Some
plans may also offer more coverage for a higher monthly premium.
2. Infosys Limited has determined that the prescription drug coverage
offered by the Standard Plan and Plus Plan is, on average for all
plan participants, expected to pay out as much as standard Medicare
prescription drug coverage pays and is therefore considered
Creditable Coverage. Because your existing coverage is Creditable
Coverage, you can keep this coverage and not pay a higher premium

Your 2014 - 2015 Benefits Guide

(a penalty) if you later decide to join a Medicare drug plan.

When Can You Join A Medicare Drug Plan?
You can join a Medicare drug plan when you first become eligible for Medicare
and each year from October 15th to December 7th.
However, if you lose your current creditable prescription drug coverage,
through no fault of your own, you will also be eligible for a two (2) month
Special Enrollment Period (SEP) to join a Medicare drug plan.
What Happens To Your Current Coverage If You Decide to Join A Medicare
Drug Plan?
If you decide to join a Medicare drug plan, your current Standard Plan and Plus
Plan coverage will not be affected. If you do decide to join a Medicare drug
plan and drop your current Infosys Limited coverage, be aware that you and
your dependents may be able to get this coverage back.
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?
You should also know that if you drop or lose your current coverage with
Standard Plan and Plus Plan and dont join a Medicare drug plan within
63 continuous days after your current coverage ends, you may pay a higher
premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous
days or longer without creditable prescription drug coverage, your monthly
premium may go up by at least 1% of the Medicare base beneficiary premium
per month for every month that you did not have that coverage. For example,
if you go nineteen months without creditable coverage, your premium
may consistently be at least 19% higher than the Medicare base beneficiary
premium. You may have to pay this higher premium (a penalty) as long as you
have Medicare prescription drug coverage. In addition, you may have to wait
until the following October to join.

39

NOTICES
For More Information About This Notice Or Your Current Prescription Drug
Coverage
Contact the department listed below for further information. NOTE: You will
get a notice each year. You will also get it before the next period you can join a
Medicare drug plan, and if this coverage through Infosys Limited changes. You
also may request a copy of this notice at any time.
For More Information About Your Options Under Medicare Prescription Drug
Coverage
More detailed information about Medicare plans that offer prescription
drug coverage is in the Medicare & You handbook. Youll get a copy of the
handbook in the mail every year from Medicare. You may also be contacted
directly by Medicare drug plans.

Remember: Keep this Creditable Coverage notice. If you decide to join

one of the Medicare drug plans, you may be required to provide a copy
of this notice when you join to show whether or not you have maintained
creditable coverage and, therefore, whether or not you are required to pay a
higher premium (a penalty).
Date: April 1, 2014
Name of Entity/Sender:
Benefitfocus
Contact--Position/Office:
Benefits Desk
Address:
100 Benefitfocus Way
Charleston, SC 29492

Phone Number:
(855) 838-4072

For more information about Medicare prescription drug coverage:

Visit www.medicare.gov
Call your State Health Insurance Assistance Program (see the inside back
cover of your copy of the Medicare & You handbook for their telephone
number) for personalized help
Call 1-800-MEDICARE (1-800-633-4227). TTY users should call
1-877-486-2048.
If you have limited income and resources, extra help paying for Medicare
prescription drug coverage is available. For information about this extra help,
visit Social Security on the web at www.socialsecurity.gov, or call them at
1-800-772-1213 (TTY 1-800-325-0778).

Your 2014 - 2015 Benefits Guide

40

NOTICES
Notice Of Privacy Practices
This Notice Describes How Medical Information About You May Be
Used and Disclosed and How You Can Get Access to this Information.
Please Review It Carefully.
As a participant in the Infosys Limited Health and Welfare Plan (the Plan),
you are eligible for certain health care benefits. In the course of providing
these benefits to you, the Plan may receive and maintain some of your medical
information. Federal law requires that the Plan protect the privacy of, generally,
medical information that identifies you and relates to your past, present or
future health or condition, the provision of health care to you, or the payment
for health care received by you. The Plan may hire other companies (Business
Associates) to help provide health care benefits to you. These Business
Associates may also receive and maintain your medical information.
Federal law requires that the Plan provide you with this Notice about its privacy
practices and its legal duties regarding your medical information. The Plan is
required to abide by the terms of the Notice currently in effect.
The Plan may change its privacy practices and the terms of this Notice at any
time. Changes will be effective for all of your medical information received or
created by the Plan. If the Plan changes its policies regarding the protection
of your medical information, the Plan will mail you a new notice of privacy
practices that incorporates any changes within 60 days. The Plan will also will
post a new notice on its internet web site.
How the Plan May Use and Disclose Your Medical Information
The Plan may use and disclose your medical information without your written
permission for the following purposes:
For treatment. While the Plan does not directly participate in decisions

Your 2014 - 2015 Benefits Guide

regarding your health treatment, the Plan may disclose medical information
it has created or received for treatment purposes. For example, the Plan may
disclose your medical information to your doctor, at the doctors request, for his
or her treatment of you.
For payment. The Plan or one of its Business Associates may use or disclose
your medical information to pay claims for medical services provided to you
or to provide eligibility information to your doctor when you receive medical
treatment.
For health care operations. The Plan may provide your medical information to
our accountants, attorneys, consultants, and others in order to make sure we
are complying with federal law. Also, your medical information may be used or
disclosed to assess the quality of health care that you receive or to assist the
Plan in the management of its performance of administrative activities.
To you, your personal representative, or others involved in your healthcare.
The Plan may provide your medical information to you and your legal
representative. The Plan may also provide medical information to a person,
including family members, other relatives, friends or others identified by you
and acting on your behalf, so long as you do not object and the information
is directly relevant to such persons involvement in your health care. For this
purpose, a person acts on your behalf by being involved in the provision and/or
payment of your health care.
As required by law. For example, the Plan may disclose your medical
information to comply with workers compensation laws or other similar laws.
To Business Associates. The Plan may disclose your medical information to its
Business Associates so that they may perform the services that the Plan has

41

NOTICES
asked them to perform. The Plan requires that these entities appropriately
safeguard your medical information.
For health-related benefits. The Plan or one of its Business Associates may
contact you about treatment alternatives or other health benefits or services
that may be of interest to you.
For other uses and disclosures permitted by law such as:
To public health authorities for public health purposes (e.g. the reporting of

communicable diseases);
To state agencies handling cases of abuse, neglect, or domestic violence;
To a government agency authorized to oversee the health care system or
government programs (e.g. determining eligibility for public benefits);
To law enforcement officials for limited law enforcement purposes (e.g. to
locate a missing person or suspect);
To a coroner, medical examiner, or funeral director about a deceased person
(e.g. to identify a person);
To an organ procurement organization under limited circumstances;
For research purposes in limited circumstances (e.g. if identifying
information is removed or a research board has approved the use of the
information);
To avert a serious threat to your health or safety or the health or safety of
others;
To military authorities if you are a member of the armed forces or a veteran
of the armed forces;
To federal officials for lawful intelligence, counterintelligence, and other
national security purposes;
To an executor or administrator of your estate; and
To any other persons and/or entities authorized under law to receive
medical information.

Your 2014 - 2015 Benefits Guide

For any other use or disclosure of your medical information, the Plan must have
your written authorization. You may cancel your written authorization for the
use and disclosure of any or all of your medical information, unless the Plan has
taken action in reliance on your permission.
Your Rights
You may make a written request to the Plan to do one or more of the following
concerning your medical information received or created by the Plan and/or
the Plans Business Associates:
The right to request restrictions on certain uses and disclosures of medical

information; however, the Plan is not required to agree to such request.

The right to receive confidential communications of medical information by
alternative means or at alternative locations.
The right to inspect and copy medical information.
The right to amend medical information.
The right to receive an accounting of disclosures of medical information.
The right, even if you have agreed to receive this notice electronically, to
obtain a paper copy of this from the Plan upon request.
Although the Plan will utilize its best efforts to comply with your request, the
Plan may legally deny your request under certain circumstances. The Plan will
notify you of the reason for the denial and you will get a chance to respond.
The Plan may not deny a request to communicate with you in confidence by a
different means or location if the current means or location used by the Plan
endangers you. The Plan may, however, request payment for any additional
expenses it incurs to comply with your request. Your request to communicate
by a different means or location must be in writing, include a statement that
disclosure of all or part of the medical information by the current means could
endanger you, specifically state the different means or location by which you
would like the Plan to communicate with you, and continue to allow the Plan to
pay claims.

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NOTICES
Complaints
If you feel as if your privacy rights have been violated, you may file a written
complaint with:

Angie Reese, SPHR

Practice Lead Compensation & Benefits

Privacy Inquiries

6100 Tennyson Parkway

Suite 200

Plano, Texas 75024
You may also send a written or electronic complaint to the Secretary of the
Department of Health and Human Services. The complaint must state the
name of the entity that is the subject of the complaint and describe the act or
omissions believed to be in violation of law. A complaint must be filed within
180 days of when you knew or should have known that the act or omission
complained of occurred. The Plan may not retaliate against you if you file a
complaint.
More Information
If you would like more information about this Notice, please contact:

Angie Reese, SPHR

Practice Lead Compensation & Benefits

(469) 229-9530

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NOTICES
The Womens Health and Cancer Rights Act of 1998
If you have had or are going to have a mastectomy, you may be entitled to
certain benefits under the Womens 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.
This coverage will be provided in consultation with the attending physician
and the patient, and will be subject to the same annual deductibles and
coinsurance provisions which apply for the mastectomy. For deductibles and
coinsurance information applicable to the plan in which you enroll, please refer
to the summary plan description.
If you would like more information on WHCRA benefits, call your plan
administrators Benefits Desk at (855) 838-4072.

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NOTICES
Notice Regarding Electronic Disclosure
To: Infosys Limited Employees
From: Infosys Limited
Date: April 1, 2014
Re: Important Information About the Infosys Limited Employee Benefit Plan
(the Plan)
A Summary of Material Modification/revised Summary Plan Description
describes important changes in the benefits provided to you and/or your
dependents under the Plan.
It can be accessed electronically through the Infosys Americas portal at
http://usahrapp01/americas/.
You have a right to request and obtain a paper version of the document at no
charge. Contact the Benefits Desk at (855) 838-4072 or
[email protected] to request a paper version.

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