DenTal Plan by jianglifang

VIEWS: 14 PAGES: 56

									The STanley BlaCK & DeCKeR

DenTal Plan
S u m m a R y P l a n D eS CR i PT i o n
	   	   	    																																									Effective	January	1,	2011
                                                                                                                         The Stanley Black & Decker Dental Plan                                      •1




TaBle of ConTenTS
Introduction ..............................................................................................................................................................................................2
Participation .............................................................................................................................................................................................3
The	Stanley	Black	&	Decker	Benefits	Center .................................................................................................................................... 15
Your	Dental	ID	Card .............................................................................................................................................................................. 16
How	the	Dental	Plan	Works................................................................................................................................................................. 17
Special	Benefits..................................................................................................................................................................................... 25
Filing	Claims ........................................................................................................................................................................................... 27
Claims	Review	Procedures .................................................................................................................................................................. 28
Coordination	of	Benefits...................................................................................................................................................................... 31
Continuing	Dental	Benefits	After	Plan	Coverage	Ends ................................................................................................................... 33
Other	Plan	Information ........................................................................................................................................................................ 37
ERISA	Rights	Statement ....................................................................................................................................................................... 46
Administrative	Information ................................................................................................................................................................. 48
Important	Plan	Details ......................................................................................................................................................................... 49
2 • The Stanley Black & Decker Dental Plan




inTRoDuCTion
The	Stanley	Black	&	Decker	Dental	Plan	(the	“Dental	Plan”	or	the	“Plan”)	offers	all	associates	two	options	for	
comprehensive	dental	coverage:
l  C
 			 IGNA	Dental	PPO	Basic	Preferred	Provider	Organization	(“Basic	PPO”)
l  C
 			 IGNA	Dental	PPO	Plus	Preferred	Provider	Organization	(“Plus	PPO”)
Both	Dental	Plan	options	allow	you	to	see	any	dentist	you	want.	If	you	see	a	dentist	who	is	a	CIGNA	Core	Network	PPO	
participating	dentist,	you	could	save	money	on	your	dental	costs	and	time	completing	paperwork.	
l  T
 			 he	Plus	PPO	Option	requires	you	to	pay	more	in	payroll	contributions	than	the	Basic	PPO	Option,	but	offers	higher	
   benefits	for	covered	services.	
l  T
 			 he	Basic	PPO	Option	costs	less	than	the	Plus	PPO	Option,	but	provides	a	lower	benefit	for	covered	services	and	
   does	not	cover	orthodontic	services.
For	more	dental	information,	including	dental	claim	forms,	visit	the	Forms	&	Resources	section	on	
www.benefits.stanleyblackanddecker.com.
                                                                          The Stanley Black & Decker Dental Plan          •3




PaRTiCiPaTion
eligiBiliTy
AssociAtes
You	are	eligible	for	coverage	under	the	Stanley	Black	&	Decker	Dental	Plan	if	you	meet	all	of	the	following	requirements:	
l  Y
 			 ou	work	for	Stanley	Black	&	Decker,	or	any	of	its	participating	subsidiaries	
l  Y
 			 ou	are	classified	by	Stanley	Black	&	Decker,	or	any	of	its	subsidiaries,	as	an	eligible	associate	regularly	scheduled	to	
   work	at	least	20	hours	per	week
l Y
 		 ou	work	in	the	United	States,	are	a	citizen	of	another	country	on	temporary	assignment	in	the	United	States	(and	
  receive	your	wages	through	one	of	the	Company’s	U.S.	payroll	systems),	or	you	are	on	assignment	outside	of	the	
  United	States	and	are	classified	as	an	Expatriate	for	payroll	purposes	
l  Y
 			 ou	are	actively	at	work	on	your	coverage	begin	date.	(If	the	day	your	coverage	would	normally	take	effect	is	not	a	
   regular	workday	for	you,	your	coverage	will	take	effect	on	that	day	if	you	are	able	to	do	your	regular	job.)	
Agency	workers,	temporary	associates,	leased	workers,	associates	not	eligible	for	benefits,	and	people	classified	by	
Stanley	Black	&	Decker	or	any	of	its	subsidiaries	as	temporary,	casual,	irregular,	and	independent	contractors	are	
not	eligible	to	participate	in	the	Dental	Plan.	Part-time	associates	working	less	than	20	hours	per	week	also	are	not	
eligible.	Associates,	who	work	under	a	formal	agreement	between	associate	representatives	and	Stanley	Black	&	
Decker,	receive	benefits	in	accordance	with	that	agreement.
Contact	The	Stanley	Black	&	Decker	Benefits	Center	if	you	have	any	questions	about	your	eligibility.

spouses & Domestic pArtners
Your	legal	spouse,	same-sex	domestic	partner	or	opposite-sex	domestic	partner	is	eligible	for	coverage	under	the	
Dental	Plan.	Divorced/ex-spouses	are	not	eligible	for	coverage	under	the	Dental	Plan;	the	only	option	for	divorced/
ex-spouses	is	COBRA.	Common-law	spouses	are	eligible	for	coverage	if	you	live	in	a	state	which	recognizes	common-
law	marriages.	You	are	required	to	submit	the	required	documentation	certifying	your	common-law	spouse	through	
The	Stanley	Black	and	Decker	Benefits	Center.	For	the	purposes	of	this	Summary	Plan	Description	(SPD),	the	term	
“spouse”	also	includes	domestic	partner.
To	be	considered	as	an	eligible	domestic	partner,	the	associate	and	the	domestic	partner	must	complete	and	return	
applicable	forms	and	must	meet	all	of	the	following	criteria:
l  B
 			 oth	are	at	least	18	years	of	age
l  B
 			 oth	are	competent	to	sign	a	contract	at	the	time	the	Affidavit	of	Domestic	Partnership	is	completed
l  N
 			 either	is	legally	married	to	any	person,	and	the	associate	and	the	domestic	partner	are	not	related	in	any	way	that	
   would	prohibit	marriage
l  E
 			 ach	is	the	other’s	sole	domestic	partner
l  T
 			 hey	are	in	an	exclusive,	committed	relationship	that	is	intended	to	be	permanent
l  T
 			 hey	share	a	mutual	obligation	of	support	and	responsibility	for	each	other’s	welfare
l  T
 			 hey	share	a	permanent	residence	and	intend	to	reside	together	indefinitely
To	elect	benefits	coverage	for	a	same-sex	or	opposite-sex	domestic	partner,	you	must	live	with	your	partner	in	a	
committed	relationship	(with	demonstrated	financial	ties).	Alternatively,	you	may	elect	coverage	for	your	domestic	
partner	if	you	have	entered	into	a	civil	union	or	have	registered	as	domestic	partners	in	a	state	or	municipality	that	
permits	such	registration.	
4 • The Stanley Black & Decker Dental Plan



To	enroll	a	domestic	partner,	you	must	complete	and	return	an	Affidavit	of	Domestic	Partnership	(if	applicable)	and	
a	Declaration	of	Tax	Status	within	31	days	of	electing	coverage	through	the	benefit	enrollment	website,	or	a	Stanley	
Black	&	Decker	Benefits	Center	Representative.	An	Affidavit	of	Domestic	Partnership	is	not	required	if	you	can	provide	
municipal	or	state	certification.	These	forms	will	be	mailed	to	you	after	initially	electing	coverage	for	your	domestic	
partner.	
If	you	do	not	enroll	the	partner	for	benefits	on	the	enrollment	website,	or	through	a	Stanley	Black	&	Decker	Benefits	
Center	Representative,	or	do	not	complete	the	required	forms	within	31	days	of	enrollment,	your	domestic	partner	
coverage	will	be	cancelled	effective	the	first	of	the	month	following	the	31	days	you	have	to	return	the	forms,	no	
premium	refund	will	be	issued,	and	you	will	not	be	able	to	enroll	a	domestic	partner	until	the	next	Annual	Benefits	
Enrollment	or	within	31	days	of	a	qualified	life	event.	Additionally,	you	will	have	to	reimburse	the	Plan	for	any	claims	
paid	in	error	on	behalf	of	your	domestic	partner	and	your	domestic	partner’s	children.	You	only	need	to	complete	the	
forms	once,	when	enrolling	the	domestic	partner.	If	the	domestic	partner’s	tax	status	changes,	you	may	file	a	new	
Declaration	of	Tax	Status	with	The	Stanley	Black	&	Decker	Benefits	Center.
You	must	notify	The	Stanley	Black	&	Decker	Benefits	Center	as	of	the	date	any	of	the	requirements	for	domestic	partner	
coverage	cease	to	apply.	If	you	do	not	do	so,	you	will	have	to	reimburse	the	Plan	for	any	claims	paid	in	error	on	behalf	
of	your	domestic	partner	and	your	domestic	partner’s	children	from	the	date	the	eligibility	requirements	cease	to	apply.	
To	elect	benefits	coverage	for	a	same-sex	or	opposite-sex	domestic	partner,	enroll	online	on	the	benefits	enrollment	
website	at	www.benefitsenrollment.stanleyblackanddecker.com.	If	you	have	questions,	contact	The	Stanley	Black	
&	Decker	Benefits	Center	at	1-800-795-3899	(9	a.m.	to	6	p.m.	Eastern	time,	Monday	through	Friday).	
For	more	information,	it	is	suggested	that	you	consult	with	a	tax	advisor.	You	should	also	review	Domestic Partner
Benefit Taxation	on	page	7	and	the	Domestic	Partner	Benefits	Policy	found	in	the	Forms	&	Resources	section	on	
www.benefits.stanleyblackanddecker.com,	or	contact	The	Stanley	Black	&	Decker	Benefits	Center	at	
1-800-795-3899.

chilDren
The	following	are	considered	eligible	dependents	for	the	Dental	Plan:
l  Y
 			 our	children	who	are	under	age	26	
l  Y
 			 our	children	at	any	age	if	they	are	permanently	and	continuously	completely	disabled,	as	long	as	they	became	
   permanently	and	continuously	completely	disabled	before	turning	age	26	and	they	have	been	permanently	and	
   continuously	completely	disabled	since	reaching	age	26	
Your	children	include:	
l  Y
 			 our	biological	children
l  Y
 			 our	legally	adopted	children	or	children	who	have	been	legally	placed	with	you	for	adoption
l  S
 			 tepchildren	
l  B
 			 iological	or	adopted	children	of	your	same-sex	or	opposite-sex	domestic	partner,	provided	your	domestic	partner	is	
   added	to	your	benefits	plan,	and	your	partner’s	children	meet	dependent	eligibility	requirements
l  O
 			 ther	children	for	whom	you	have	legal	guardianship	and	otherwise	meet	dependent	eligibility	requirements,	or	as	
   defined	by	a	court	order	
l  C
 			 hildren	who	must	be	covered	by	the	Plan	due	to	a	Qualified	Medical	Child	Support	Order	(QMSCO)
                                                                         The Stanley Black & Decker Dental Plan        •5



Please note the following:
l  I
 			f	your	child	under	age	26	is	married,	your	child’s	spouse	and	children	are	not	eligible	for	coverage.
l  Y
 			 ou	cannot	add	“other	children”	(for	example,	a	child	of	your	minor	dependent)	to	your	coverage	unless	the	child	
   meets	the	specifications	detailed	on	the	prior	page.	
l  Y
 			 ou	are	responsible	for	ensuring	that	your	dependents	meet	the	eligibility	requirements	of	the	Plan.	Stanley	
   Black	&	Decker	may	conduct	random	dependent	audits	to	confirm	eligibility.	If	your	enrolled	dependents	are	
   not	eligible	for	coverage	based	upon	the	criteria	outlined	above,	you	may	be	required	to	reimburse	the	Company	
   for	benefits	paid	on	behalf	of	the	ineligible	dependent,	and	you	may	also	be	subject	to	disciplinary	action,	up	to	
   and	including	termination	of	employment.	You	may	be	asked	to	provide	proof	of	dependent	eligibility	for	qualified	
   life	event	changes.
l  R
 			 egardless	of	the	financial	support	provided	or	income	tax	return	dependency,	an	associate	may	never	include	as	a	
   dependent	any	other	person	not	specified	above,	including	parents	and	siblings.
l  I
 			n	accordance	with	federal	regulations,	dependents	over	the	age	of	two	must	be	enrolled	with	a	Social	Security	
   number	(SSN).	If	you	enroll	a	newborn	without	an	SSN,	you	must	notify	The	Stanley	Black	&	Decker	Benefits	Center	
   (by	phone)	of	the	SSN	once	you	receive	it.

if You Are mArrieD to Another stAnleY BlAck & Decker AssociAte
If	your	spouse	or	domestic	partner	is	a	Stanley	Black	&	Decker	associate,	you	can	both	elect	coverage.	You	can	cover	
each	other	and	any	eligible	dependent	children,	or	one	of	you	can	elect	to	cover	all	eligible	family	members	while	the	
other	declines	coverage.	Duplication	of	coverage	is	allowed.	However,	you	should	consider	coordination	of	benefit	
rules	carefully	and	whether	duplication	of	coverage	is	cost-effective.

When you Can enRoll
If	you	are	a	newly	hired	or	newly	eligible	associate,	you	must	enroll	yourself	and	your	eligible	dependents	within	31	
days	from	the	date	you	become	eligible.	If	you	do	not	enroll	during	that	time,	then	you	must	wait	until	the	next	fall	for	
the	Annual	Benefits	Enrollment,	unless	you	have	a	qualified	life	event	(see	“Making	Changes	During	the	Year”).	
When	you	are	hired	or	become	eligible,	you	will	receive	a	package	of	enrollment	materials,	including	
instructions	on	how	to	enroll.	To	view	information	about	your	Dental	Plan	options,	visit	the	benefits	website	at	
www.benefits.stanleyblackanddecker.com.	To	make	your	enrollment	elections,	visit	the	enrollment	website	at	
www.benefitsenrollment.stanleyblackanddecker.com.	(Your	default	user	name	is	your	Social	Security	number,	
and	your	default	password	is	your	date	of	birth	[MMDDYY].)	If	you	do	not	have	Internet	access,	you	can	call	The	Stanley	
Black	&	Decker	Benefits	Center	at	1-800-795-3899.
In	addition	to	the	initial	opportunity	to	enroll	as	a	newly	hired	or	newly	eligible	associate,	all	associates	can	enroll,	
change,	or	end	coverage	every	fall	during	the	Annual	Benefits	Enrollment	period.	Changes	are	effective	on	January	1	
following	the	Annual	Benefits	Enrollment	period.	Each	year	you	will	receive	information,	including	instructions	on	how	
to	enroll,	change,	or	end	coverage	during	the	Annual	Benefits	Enrollment	period.	
6 • The Stanley Black & Decker Dental Plan



CoveRage levelS
When	you	enroll,	you	will	be	asked	to	choose	a	level	of	coverage,	which	indicates	who	you	are	covering:	
l   Employee only—If	you	are	single	and	have	no	dependents,	or	if	you	are	not	enrolling	your	spouse	or	any	eligible	
    dependents	in	Stanley	Black	&	Decker	coverage,	you	can	choose	to	cover	yourself	only
l   Employee plus one dependent—You	can	cover	yourself	and	one	eligible	dependent	(a	spouse,	domestic	partner,	
    or	a	child)
l   Employee plus two dependents—You	can	cover	yourself	and	two	eligible	dependents
l   Employee plus three or more dependents—You	can	cover	yourself	and	three	or	more	eligible	dependents
Once	you	choose	a	level	of	coverage,	you	cannot	change	it	until	the	next	Annual	Benefits	Enrollment	period,	unless	
you	experience	a	qualified	life	event	(see	“Making	Changes	During	the	Year”)	and	report	the	life	event	to	The	Stanley	
Black	&	Decker	Benefits	Center	(either	online	or	by	phone)	within	31	days.	If	you	choose	to	enroll	a	domestic	partner,	
you	must	first	add	them	as	a	same-sex	or	opposite-sex	domestic	partner	dependent	and	submit	proof	of	that	
partnership	(Affidavit	of	Domestic	Partnership,	if	applicable,	and	Declaration	of	Tax	Status	forms)	to	The	Stanley	
Black	&	Decker	Benefits	Center.	The	Benefits	Center	will	add	domestic	partner	coverage	for	your	domestic	partner	
dependents.	
Note: If	you	are	adding	a	dependent,	you	must	report	the	qualified	life	event	to	The	Stanley	Black	&	Decker	Benefits	
Center	(not	the	health	plan)	within	31	days,	even	if	it	is	not	changing	your	coverage	level.

CoST of CoveRage
You	and	the	Company	share	the	cost	of	your	Dental	Plan	coverage.	Stanley	Black	&	Decker	pays	a	large	percentage	of	
this	cost.	Your	Dental	Plan	option	and	your	dependent	coverage	level	determine	your	cost	of	coverage.	
Associate	contribution	rates	are	available	on	The	Stanley	Black	&	Decker	benefits	enrollment	website,	
www.benefitsenrollment.stanleyblackanddecker.com.	Contribution	rates	are	reviewed	annually	and	adjusted	
as	necessary.	

pre-tAx contriButions
Your	Dental	Plan	contributions	are	made	on	a	pre-tax	basis.	When	you	enroll	for	a	Dental	Plan,	you	are	authorizing	
the	Company	to	deduct	your	share	of	the	cost	from	your	pay	on	a	before-tax	basis,	meaning	contributions	for	dental	
coverage	are	taken	from	your	paycheck	before	your	pay	is	taxed,	so	you	do	not	pay	federal,	Social	Security,	or	in	most	
cases,	state	or	local	income	taxes	on	your	contributions.	Since	you	do	not	pay	Social	Security	tax	on	this	money,	your	
contributions	may	reduce	your	wages	reported	for	Social	Security	purposes	and	could	ultimately	reduce	your	future	
Social	Security	benefit	amount.	
In	exchange	for	lowering	your	taxable	income,	the	IRS	restricts	your	ability	to	terminate	or	change	your	coverage	during	
the	year	unless	you	have	a	qualified	life	event	(see	“Making	Changes	During	the	Year”).	This	rule	also	applies	to	after-
tax	deductions	for	domestic	partner	coverage.	Or,	you	may	change	your	coverage	during	Annual	Benefits	Enrollment.	
                                                                           The Stanley Black & Decker Dental Plan          •7



Domestic pArtner Benefit tAxAtion
Under	current	law,	domestic	partners	are	not	considered	eligible	dependents	for	federal,	and	most	states’	income	
tax	purposes.	As	a	result,	your	contributions	for	your	domestic	partner’s,	and	his	or	her	eligible	dependents’	dental	
coverage	will	ordinarily	be	withheld	on	an	after-tax	basis—rather	than	a	before-tax	basis—for	federal	tax	purposes.	
Also	per	IRS	regulations,	the	full	cost	of	Dental	Plan	coverage	for	domestic	partners	and	their	children,	if	they	are	not	
also	dependents	under	the	federal	tax	laws,	is	imputed	as	taxable	income	to	you.	This	cost,	if	applicable,	is	based	upon	
the	fair	market	value	of	domestic	partner	coverage.	The	fair	market	value	is	the	amount	that	the	Company	contributes	
to	the	Plan	to	cover	your	domestic	partner,	and	his	or	her	eligible	dependents.
To	impute	this	amount	as	taxable	income	to	you,	Stanley	Black	&	Decker	will	report	it	on	your	W-2.	Additionally,	Stanley	
Black	&	Decker	will	take	this	amount	into	account	in	determining	the	federal	income	taxes	and	the	Social	Security	taxes	
that	must	be	withheld	from	your	pay.	If	your	domestic	partner	qualifies	as	your	tax	dependent,	this	tax	treatment	would	
not	apply.	Review	the	Domestic	Partner	Policy	in	Forms	&	Resources	on	www.benefits.stanleyblackanddecker.com,	
or	contact	The	Stanley	Black	&	Decker	Benefits	Center	at	1-800-795-3899	for	more	information.

When CoveRage BeginS
Your	coverage	for	Dental	Plan	benefits	begins	the	first	day	of	the	month	following	your	date	of	hire	or	the	date	you	are	
newly	eligible	for	benefits.	If	you	are	hired	on	the	first	of	the	month,	your	benefits	begin	the	first	day	of	the	following	
month	(for	example,	if	you	are	hired	on	March	1,	your	benefits	begin	on	April	1).	
If	you	are	returning	from	a	layoff	before	your	benefits	are	cancelled,	your	benefits	are	automatically	reinstated	on	your	
first	day	back	to	work.	If	you	are	on	layoff	with	recall	rights	and	return	from	layoff	after	your	benefits	are	cancelled,	your	
benefits	begin	on	your	first	day	back	to	work,	provided	you	re-enroll.	
If	you	enroll	or	make	changes	during	Annual	Benefits	Enrollment,	your	coverage	begins	January	1	of	the	following	year.	
If	you	have	a	qualified	life	event	(see	“Making	Changes	During	the	Year”),	and	you	make	a	change	to	your	coverage	
within	31	days	of	the	event,	the	change	will	be	effective	as	of	the	date	of	the	event.	
If	your	company	is	acquired	by	Stanley	Black	&	Decker,	you	become	eligible	for	Stanley	Black	&	Decker	benefits	as	of	
the	benefits	effective	date	designated	by	Stanley	Black	&	Decker.	

if you aRe RehiReD
If	you	are	rehired	within	31	days	of	your	termination,	your	benefits	will	be	reinstated,	effective	immediately,	based	
upon	the	elections	you	had	in	place	prior	to	your	termination.	If	you	are	rehired	after	31	days,	you	will	be	treated	like	
a	new	hire	and	will	have	to	make	new	elections.	Your	dental	coverage	will	take	effect	the	first	of	the	month	on	or	after	
your	rehire	date.	
8 • The Stanley Black & Decker Dental Plan



When CoveRage enDS
If	your	employment	as	a	Stanley	Black	&	Decker	associate	ends,	or	if	your	hours	are	reduced	to	less	than	20	hours	
per	week,	coverage	for	yourself	and	your	dependents	ends	at	midnight	on	the	last	day	of	the	month	in	which	your	
employment	at	Stanley	Black	&	Decker	ended	or	your	hours	were	reduced.	
Note:	If	you	are	receiving	separation	pay,	benefits	(except	for	STD	and	LTD,	which	cease	on	the	last	day	worked)	end	at	
the	end	of	the	month	of	your	last	day	paid	(not	the	date	you	receive	your	last	separation	paycheck,	but	your	actual	last	
day	paid	based	on	the	number	of	weeks	of	separation	pay	from	your	last	day	worked).	Upon	layoff	with	recall,	benefits	
end	at	the	end	of	the	month	following	the	month	of	layoff.
Special note about divorced or legally separated spouses:	Coverage	for	your	spouse	ends	the	date	your	divorce	or	
legal	separation	is	final.	It	is	your	responsibility	to	notify	The	Stanley	Black	&	Decker	Benefits	Center,	via	phone	or	the	
web,	to	disenroll	your	spouse,	effective	with	the	date	of	divorce	or	legal	separation.	Failure	to	disenroll	your	spouse	
as	of	the	date	of	your	divorce	or	legal	separation	shall	be	considered	misrepresentation	of	Plan	eligibility	and	you	will	
be	responsible	to	reimburse	the	Plan	for	any	claims	paid	in	error	after	the	date	of	divorce	or	legal	separation.	If	your	
divorce	decree	or	legal	separation	mandates	you	continue	to	provide	health	coverage	for	your	ex-spouse,	this	does	
not	obligate	the	Plan	to	continue	coverage	for	your	ex-spouse.	Rather,	this	requires	you	to	provide	coverage	for	your	
ex-spouse	through	COBRA	or	an	individual	policy.	You	must	wait	until	the	divorce	or	legal	separation	is	final	before	
reporting	the	life	event.
Coverage	for	domestic	partners	and	their	eligible	dependents	ends	when	you	and	your	domestic	partner	are	no	longer	
living	together	in	a	committed	relationship.	
Special note about domestic partners:	It	is	your	responsibility	to	notify	The	Stanley	Black	&	Decker	Benefits	Center	
(via	phone	or	the	web),	to	disenroll	your	domestic	partner	and	their	eligible	dependents,	effective	with	the	date	on	
which	you	and	your	domestic	partner	are	no	longer	living	together	in	a	committed	relationship.	Failure	to	disenroll	your	
domestic	partner	and	their	eligible	dependents	as	of	the	date	on	which	your	domestic	partnership	terminates,	shall	be	
considered	misrepresentation	of	Plan	eligibility	and	you	will	be	responsible	to	reimburse	the	Plan	for	any	claims	paid	
in	error	after	the	date	on	which	your	domestic	partnership	ends.	As	a	reminder,	if	you	do	not	complete	an	Affidavit	of	
Domestic	Partnership	(if	applicable)	and	a	Declaration	of	Tax	Status	form	within	31	days	and	do	not	enroll	the	partner	
for	benefits	on	the	enrollment	website,	or	through	a	Stanley	Black	&	Decker	Benefits	Center	Representative,	you	will	not	
be	able	to	enroll	a	domestic	partner	until	the	next	Annual	Benefits	Enrollment,	or	within	31	days	of	a	qualifying	event,	
and	coverage	will	be	cancelled	effective	the	first	of	the	month	following	the	31	days	you	have	to	return	the	form,	and	
no	premium	refund	will	be	issued.
Coverage	for	any	dependent	children	or	stepchildren	ends	when	they	no	longer	meet	the	definition	of	a	dependent	
under	The	Stanley	Black	&	Decker	Dental	Plan.	Coverage	for	children	ends	at	the	end	of	the	month	in	which	they	turn	
age	26.	Coverage	for	a	permanently	and	continuously	completely	disabled	child	continues	as	long	as	the	child	qualifies	
as	a	disabled	dependent.	Coverage	for	children	for	whom	you	have	guardianship	ends	when	your	guardianship	status	
is	terminated.	
If	you	fail	to	make	the	required	contributions,	either	through	payroll	deductions	or	direct	billing	(if	applicable)	if	on	
leave,	your	coverage	will	end	on	the	last	day	of	the	period	covered	by	your	last	contribution.	
                                                                          The Stanley Black & Decker Dental Plan        •9




maKing ChangeS DuRing The yeaR
Once	you	enroll	for	dental	coverage,	you	cannot	change	your	coverage	level	until	the	next	Annual	Benefits	Enrollment,	
unless	you	have	a	qualified	life	event.
Qualified	life	events	include:
l  A
 			 dding	a	dependent	through	marriage,	birth,	adoption,	legal	guardianship,	or	qualifying	for	same-sex	or	
   opposite-sex	domestic	partnership
l  		
 			Losing	a	dependent	through	divorce,	legal	separation,	annulment,	placement	for	adoption,	or	death	of	a	
    dependent,	or	if	your	dependent	or	domestic	partner	(and	his	or	her	eligible	dependents)	no	longer	qualifies	for	
    coverage
l  C
 			 hange	in	employment	status	or	work	schedule	for	you	or	your	spouse	that	affects	benefit	eligibility,	such	as	a	strike	
   or	lockout,	or	a	commencement	of	or	return	from	an	unpaid	leave	of	absence
l  C
 			 hange	in	eligibility	of	a	covered	dependent,	such	as	a	change	in	age,	marital	status	or	a	dependent	gains	other	
   coverage	(i.e.,	through	another	employer	plan)
l  C
 			 hange	in	your,	your	spouse’s,	or	your	dependent’s	entitlement	to	COBRA,	Medicare,	or	Medicaid
l  I
 			ssuance	of	a	family	relations	judgment,	decree,	or	order	(e.g.,	Qualified	Medical	Child	Support	Order)
l  E
 			 lection	change	under	your	spouse’s	employer’s	plan;	for	example,	if	your	spouse’s	annual	benefits	enrollment	
   period	is	different	from	yours,	or	your	spouse	experiences	a	qualified	life	event
If	you	have	a	qualified	life	event,	you	have	31	days	from	the	date	of	the	event	to	make	changes	to	your	benefit	
elections.	You	cannot	make	qualified	life	event	changes	in	advance.	For	example,	if	you	are	getting	married,	you	have	
31	days	from	your	wedding	day	to	make	the	change	to	your	benefits	elections.	You	cannot	make	this	change	prior	to	
your	wedding	day.	
Depending	upon	the	life	event,	you	may	enroll	in	or	drop	coverage	because	of	a	life	event,	but	you	may	not	switch	
plans	because	of	a	life	event.	The	change	in	coverage	will	become	effective	the	date	of	the	event,	after	you	complete	
the	required	steps	for	making	the	change.	You	may	make	these	changes	online	on	the	benefits	enrollment	website	at	
www.benefitsenrollment.stanleyblackanddecker.com	or	by	calling	The	Stanley	Black	&	Decker	Benefits	Center.
Note:	Do	not	call	CIGNA	directly	to	make	a	life	event	change.	A	life	event	change	must	be	made	online	or	by	calling	The	
Stanley	Black	&	Decker	Benefits	Center	within	31	days	of	the	event	date.	If	a	newborn	is	not	enrolled	within	31	days	of	
birth,	they	will	not	have	coverage	until	you	add	them	during	the	next	Annual	Benefits	Enrollment	period.
In	addition	to	changing	your	benefit	elections	for	qualified	life	events,	you	will	have	a	special	enrollment	opportunity	if	
you	or	your	eligible	dependents	either:
l  L
 			 ose	Medicaid	or	coverage	under	the	Children’s	Health	Insurance	Program	(CHIP)	because	you	are	no	longer	eligible,	
   or
l  B
 			 ecome	eligible	for	a	state’s	premium	assistance	program	under	Medicaid	or	CHIP.
For	these	special	enrollment	opportunities,	you	have	60	days	from	the	date	of	the	Medicaid/CHIP	eligibility	change	
to	request	enrollment	in	the	Plan.	This	60-day	extension	does	not	apply	to	enrollment	opportunities	other	than	the	
Medicaid/CHIP	eligibility	change.
If	you	have	a	qualified	life	event	and	wish	to	change	your	dental	coverage,	log	on	at	www.benefitsenrollment.
stanleyblackanddecker.com	or	call	The	Stanley	Black	&	Decker	Benefits	Center	at	1-800-795-3899	to	request	
changes	within	31	days	of	the	event	date.	
10 • The Stanley Black & Decker Dental Plan



The	table	below	shows	what	changes	are	allowed	for	each	kind	of	qualified	life	event	that	is	listed.	

  EligiBlE lifE EvEnTS                    BEnEfiT ChangES allowED (wiThin 31 DayS of ThE EvEnT)
  Marriage                                l   A
                                            			 dd	coverage	to	your	current	plan	for	your	new	spouse	and/or	new	
                                              stepchild(ren)	
                                          l   D
                                            			 rop	your	own	Stanley	Black	&	Decker	coverage	to	join	your	spouse’s	plan
  Divorce,	legal	separation	              l   D
                                            			 rop	your	spouse	and/or	stepchild(ren)	from	Stanley	Black	&	Decker	
  or	annulment                                coverage
                                          l   A
                                            			 dd	coverage	for	yourself	and/or	your	child(ren)	covered	under	your	
                                              former	spouse’s	plan
  Birth,	adoption,	placement	for	         l   A
                                            			 dd	coverage	for	your	new	child	if	you	are	already	enrolled	(you	may	also	
  adoption,	or	becoming	legal	                add	coverage	for	your	spouse)
  guardian	of	dependent                   l   E
                                            			 nroll	yourself	and	your	new	child	if	you	are	not	already	enrolled	(you	
                                              may	also	enroll	your	spouse)
  Death	of	dependent                      l   D
                                            			 rop	the	dependent’s	coverage.	If	your	spouse	dies,	you	can	add	
                                              coverage	for	your	dependent	children.
  Loss	of	dependent’s	other	coverage      l   A
                                            			 dd	coverage	for	your	dependent	to	your	current	plan
  Dependent	no	longer	qualifies	          l   	
                                              D
                                            			 rop	coverage	for	your	dependent
  for	coverage
  Your	same-sex	or	opposite-sex	          l   A
                                            			 dd	coverage	to	your	current	plan	for	your	same-sex	or	opposite-sex	
  domestic	partner	qualifies	for	             domestic	partner	and/or	your	domestic	partner’s	eligible	children
  coverage
  Out	of	sync	annual	benefits	            l   A
                                            			 dd	coverage	to	your	current	plan	for	your	spouse/domestic	partner	
  enrollment	periods	(if	your	                and/or	dependent	child(ren)
  spouse’s	enrollment	period	is	          l   D
                                            			 rop	coverage
  different	from	yours)	
  Becoming	eligible	for	another	          l   D
                                            			 rop	coverage
  employer’s	plan
  Losing	eligibility	for	another	         l   A
                                            			 dd	coverage
  employer’s	plan
                                                                      The Stanley Black & Decker Dental Plan        • 11




if you TaKe leave
If	you	must	be	away	from	your	job	for	an	extended	period	of	time—such	as	for	a	personal	leave	of	absence,	military	
leave	of	absence,	disability,	work-related	injury	or	illness,	or	layoff—you	may	be	able	to	continue	dental	coverage	
while	you	are	away	from	work.	Associates	who	work	under	a	formal	agreement	between	associate	representatives	and	
Stanley	Black	&	Decker	receive	benefits	in	accordance	with	that	agreement.	

fAmilY AnD meDicAl leAve Act (fmlA)
This	leave	may	be	paid,	unpaid	or	a	combination	of	both.	If	you	take	an	approved	leave	under	FMLA,	you	may	be	
eligible	to	continue	certain	benefits,	as	described	below.	To	report	an	FMLA	claim,	review	the	FMLA	flyer	posted	on	
www.benefits.stanleyblackanddecker.com	and	then	contact	CIGNA	to	report	your	claim	at	1-800-243-3280.
Paid FMLA Leave
If	your	protected	leave	is	paid	because	you	are	on	Short-Term	Disability	or	vacation,	your	participation	will	continue	
under	all	benefit	plans.	Your	regular	contributions	will	continue	to	be	deducted	from	your	pay	if	you	are	receiving	pay	
from	Stanley	Black	&	Decker	or,	if	you	are	not	receiving	pay	from	Stanley	Black	&	Decker,	you	will	be	direct	billed	by	
CONEXIS.	If	your	coverage	is	suspended	due	to	non-payment,	you	may	reinstate	it	when	you	return	to	work	by	calling	
The	Stanley	Black	&	Decker	Benefits	Center.	
Unpaid FMLA Leave
The	following	chart	explains	what	happens	to	your	benefits	during	an	unpaid	FMLA	leave.

  BEnEfiT                                                      WhAt hAPPens DUring UnPAiD FMLA LeAve
  Medical,	Dental	and	Vision
  Basic	and	Voluntary	and	Dependent	Life	
  and	AD&D	Insurance                                           Coverage	continues	and	you	are	direct	billed	by	
                                                               CONEXIS	and	continue	to	pay	premiums	for	coverage
  Short-Term	and	Long-Term	Disability
  Group	Legal	Plan
  Health	FSA                                                   Participation	continues	and	contributions	are	
                                                               suspended.	When	you	return	to	active	service,	your	
                                                               contributions	will	be	automatically	recalculated	
                                                               based	on	the	number	of	pay	periods	left	in	the	
                                                               year	and	the	balance	required	to	meet	your	annual	
                                                               deduction	amount.	
  Dependent	Care	FSA                                           Participation	and	contributions	are	suspended	at	the	
                                                               end	of	the	month	in	which	the	leave	began
  Business	Travel	Accident	Insurance                           Coverage	is	suspended

You	must	pay	your	share	of	the	cost	for	the	benefits	you	continue	during	your	leave.	While	you	are	on	unpaid	leave,	you	
will	be	billed	directly	by	CONEXIS.	If	you	suspend	or	reduce	any	coverage,	you	may	reinstate	it	when	you	return	to	work	
by	calling	The	Stanley	Black	&	Decker	Benefits	Center.	Any	suspended	benefits	will	be	reinstated	upon	return	to	work.
12 • The Stanley Black & Decker Dental Plan



if You Become DisABleD
short-term and Long-term Disability
If	you	are	on	an	approved	leave	for	Short-Term	Disability	or	Long-Term	Disability,	certain	benefits	may	continue,	
provided	you	pay	the	required	premium,	as	shown	in	the	chart	below.	Keep	in	mind	that	a	portion	of	your	Short-Term	
Disability	may	run	concurrent	with	an	FMLA	leave,	described	in	the	previous	section.
If	you	are	on	an	approved	disability	leave,	coverage	ends	on	the	last	day	of	the	month	in	which	your	employment	
terminates,	which	is	the	lesser	of	one	year	or	your	length	of	service.

  BEnEfiT                                     whaT haPPEnS During DiSaBiliTy
  Medical,	Dental	and	Vision                  Coverage	continues	and	contributions	are	withheld	from	your	STD	
                                              payments	(salaried)	or,	if	you	are	not	receiving	a	Stanley	Black	&	Decker	
                                              paycheck,	you	are	direct	billed	by	CONEXIS	as	of	the	first	of	the	month	
                                              following	your	last	day	worked
  Health	FSA                                  Participation	continues	and	contributions	are	suspended.	When	
                                              you	return	to	active	service,	your	contributions	will	be	automatically	
                                              recalculated	based	on	the	number	of	pay	periods	left	in	the	year	and	
                                              the	balance	required	to	meet	your	annual	deduction	amount.	
  Dependent	Care	FSA                          Participation	and	contributions	are	suspended	at	the	end	of	the	month	
                                              in	which	the	leave	began
  Basic	Life	and	AD&D	Insurance               Coverage	continues
  Voluntary	and	Dependent	Life	               Coverage	continues	and	contributions	are	withheld	from	your	STD	
  and	AD&D	Insurance                          payments	(salaried)	or,	if	you	are	not	receiving	a	Stanley	Black	&	Decker	
                                              paycheck,	you	are	direct	billed	by	CONEXIS
  Business	Travel	and	Accident	Insurance      Coverage	is	suspended
  Short-Term	and	Long-Term	Disability         Coverage	continues	and	contributions	for	Long-Term	Disability	(LTD)	are	
                                              withheld	from	your	STD	payments	(salaried)	or,	if	you	are	not	receiving	
                                              a	Stanley	Black	&	Decker	paycheck,	you	are	direct	billed	by	CONEXIS.	
                                              Once	approved	for	LTD,	you	stop	paying	for	this	benefit
  Group	Legal	Plan                            Coverage	continues	and	contributions	are	withheld	from	your	STD	
                                              payments	(salaried)	or,	if	you	are	not	receiving	a	Stanley	Black	&	Decker	
                                              paycheck,	you	are	direct	billed	by	CONEXIS
                                                                      The Stanley Black & Decker Dental Plan         • 13



militArY leAve of ABsence
Under	the	Uniformed	Services	Employment	and	Reemployment	Rights	Act	of	1994	(USERRA),	associates	who	are	
absent	from	employment	due	to	service	in	the	uniformed	services	of	the	United	States	of	America	that	is	protected	by	
USERRA	are	entitled	to	a	leave	of	absence	for	military	service	with	reinstatement	rights	(Military	LOA).	The	Company	
will	comply	with	any	benefit	continuation	or	reinstatement	requirements	of	USERRA.	For	more	information	about	
USERRA,	visit	http://www.dol.gov/elaws/userra0.htm.	Here	is	how	your	benefits	will	be	affected	if	you	take	a	leave	
of	absence	for	military	service:

  tiMing               BEnEfiT
  Month	One           For	one	month	following	the	last	day	worked,	you	will	remain	Active.	Compensation	continues	
                      at	100%	and	payroll	benefit	deductions	continue.	Eligibility	for	STD	and	LTD	coverage	stops	
                      as	of	the	last	day	worked.	You	must	provide	military	orders	and	pay	grade/rate	information	to	
                      Human	Resources.
  Months              Beginning	with	the	second	month	of	absence,	your	status	will	change	to	Military	LOA.	Stanley	
  Two-to-Six          Black	&	Decker	pay	will	be	reduced	by	the	amount	of	the	military	pay	(for	up	to	five	months).	
                      During	this	period	you	are	obliged	to	keep	Stanley	Black	&	Decker	appraised	of	your	military	
                      pay	rate,	in	the	event	of	changes.	During	months	two-to-six,	medical/dental	deductions	(if	
                      applicable)	will	not	be	withheld	from	Stanley	Black	&	Decker	pay.	CONEXIS,	the	Stanley	Black	
                      &	Decker	direct	bill	vendor,	will	direct	bill	you	at	your	home	address	for	your	premium	only.	
                      If	timely	payments	are	not	received,	coverage	may	be	terminated	so	arrangements	may	be	
                      necessary	for	those	traveling	or	overseas.
  Month	Seven         Your	status	is	updated	to	a	Personal	LOA	(see	next	heading).	At	this	point	Stanley	Black	&	
                      Decker	pay	is	discontinued.	Direct	billing	for	benefits	continues	(if	applicable),	however	the	full	
                      (employee	+	employer)	premium	is	charged.
  Month	12	           After	12	months	you	will	be	terminated	from	employment.	All	pay	and	benefits	are	discontinued	
  and	beyond	         and	COBRA	will	apply,	if	necessary.

Please	contact	your	Human	Resources	Representative	if	you	have	questions	about	benefits	continuation	during	a	
military	leave	of	absence.	Call	The	Stanley	Black	&	Decker	Benefits	Center	to	drop	Stanley	Black	&	Decker	coverage	if	
you	have	military	coverage.
14 • The Stanley Black & Decker Dental Plan



other unpAiD personAl leAves of ABsence
The	following	chart	explains	what	happens	to	your	benefits	during	an	authorized	unpaid	personal	leave	of	absence.	All	
changes	must	be	made	within	31	days	of	the	date	of	your	leave	by	calling	The	Stanley	Black	&	Decker	Benefits	Center.

  BEnEfiT                                    whaT haPPEnS During unPaiD lEavE
  Medical	and	Dental                         You	may	continue	or	suspend	your	participation;	you	will	be	direct	billed	
                                             by	CONEXIS	and	you	must	pay	100%	of	the	cost	after-tax
  Vision                                     You	may	continue	your	participation;	you	will	be	direct	billed	by	CONEXIS	
                                             and	you	must	pay	100%	of	the	cost	after-tax
  Health	FSA                                 Participation	continues	and	contributions	are	suspended.	When	you	return	
                                             to	active	service,	your	contributions	will	be	automatically	recalculated	
                                             based	on	the	number	of	pay	periods	left	in	the	year	and	the	balance	
                                             required	to	meet	your	annual	deduction	amount.
  Dependent	Care	FSA                         Participation	and	contributions	are	suspended	at	the	end	of	the	month	
                                             in	which	leave	the	began
  Basic	Life	and	AD&D	Insurance              Coverage	continues
  Voluntary	and	Dependent	Life	              You	may	continue	your	participation	or	reduce	your	coverage
  and	AD&D	Insurance
  Business	Travel	Accident	Insurance         Coverage	is	suspended
  Short-Term	and	Long-Term	Disability        Coverage	is	suspended	as	of	the	last	day	worked
  Group	Legal	Plan                           You	may	continue	or	suspend	your	participation

You	must	pay	100%	of	the	cost	(the	employee	and	employer	portions)	for	the	benefits	you	continue	during	your	personal	
leave	of	absence.	While	you	are	on	unpaid	personal	leave,	you	will	be	billed	directly	by	CONEXIS.	If	you	suspend	or	reduce	
any	coverage	during	your	leave,	you	may	elect	to	have	your	coverage	reinstated	within	31	days	of	your	return	to	work	by	
calling	The	Stanley	Black	&	Decker	Benefits	Center.	See	“Making	Changes	During	the	Year”	for	details.
If	you	suspend	your	Health	FSA,	expenses	incurred	during	your	leave	will	be	eligible	for	Health	FSA	reimbursement.	
When	you	return	to	active	service,	your	contributions	will	be	automatically	recalculated	based	on	the	number	of	
pay	periods	left	in	the	year	and	the	balance	required	to	meet	your	annual	deduction	amount.	If	you	want	to	resume	
coverage	at	a	reduced	annual	Health	FSA	contribution	amount,	you	must	notify	corporate	benefits	by	clicking	on	
“Contact”	on	www.benefits.stanleyblackanddecker.com.	You	may	not	reduce	your	coverage	amount	to	less	than	
what	you	have	already	contributed.	If	you	remain	on	leave	through	the	end	of	the	year,	no	further	deductions	will	be	
taken.	Additionally,	no	deductions	will	be	taken	in	the	next	calendar	year	for	the	amount	you	elected	in	the	prior	year.
lAYoff
If	you	experience	a	layoff,	coverage	will	continue	until	the	end	of	the	month	following	the	month	in	which	you	were	laid	
off.	You	may	be	able	to	continue	coverage	through	COBRA	after	your	coverage	ends.	

if you ReTiRe
Dental	coverage	cancels	at	the	end	of	the	month	of	your	last	day	worked.	You	cannot	continue	dental	coverage	unless	
you	elect	COBRA.

if you Die
If	you	die,	your	surviving	eligible	dependents’	coverage,	including	spouse	or	domestic	partner,	will	continue	until	
the	last	day	of	the	month	following	the	month	of	your	death	and	then	they	will	be	offered	COBRA	(see	“Continuing	
Coverage	through	COBRA”)	or	retiree	benefits,	if	you	qualified	for	retiree	benefits	at	the	time	of	your	death	(if	at	least	
55	years	old	with	10	or	more	years	of	service)	at	a	division/business	unit	offering	retiree	benefits.	
                                                                        The Stanley Black & Decker Dental Plan    • 15




The STanley BlaCK & DeCKeR BenefiTS CenTeR
The	Stanley	Black	&	Decker	Benefits	Center	can	help	you:
l  U
 			 nderstand	which	dependents	you	may	enroll	for	coverage	and	when	you	can	add	or	drop	them	from	coverage
l  G
 			 et	answers	to	general	questions	about	your	Health	&	Group	benefit	plans
l  	
   E
 			 nroll	for	Health	&	Group	benefits	or	make	qualified	life	event	changes
Customer	service	representatives,	dedicated	to	helping	Stanley	Black	&	Decker	associates,	are	available	to	answer	your	
questions	and	help	you	enroll	or	make	changes	to	your	benefits.
The	Stanley	Black	&	Decker	Benefits	Center	can	answer	general	Health	and	Group	benefit	questions	or	assist	with	
enrollment	and	urgent	eligibility	updates.	Stanley	Black	&	Decker	Benefits	Center	representatives	have	instant	access	to	
general	benefit	plan	information,	your	coverage,	and	personal	data.
There	are	three	ways	to	contact	The	Stanley	Black	&	Decker	Benefits	Center:
l  B
 			 y	phone,	1-800-795-3899	(9	a.m.	to	6	p.m.	Eastern	time,	Monday	through	Friday)
l  C
 			 hat	online	with	a	customer	service	representative,	www.benefitsenrollment.stanleyblackanddecker.com
l  V
 			 ia	email,	in	the	Contact	Us	section	of	the	benefits	enrollment	website,	
   www.benefitsenrollment.stanleyblackanddecker.com
Non-English	speaking	participants	can	use	the	Benefits	Center	Language	Line,	which	provides	immediate	access	to	
translators	for	over	170	languages.	Conversations	conducted	between	Benefits	Center	representatives,	the	Language	
Line,	and	participants	are	confidential.
If	you	have	detailed	benefit	or	coverage	questions,	call	CIGNA	directly	at	1-800-243-3280.
The	Stanley	Black	&	Decker	Benefits	Center	cannot	answer	payroll	questions	or	resolve	payroll	or	other	HR-related	
issues.
16 • The Stanley Black & Decker Dental Plan




youR DenTal iD CaRD
When	you	enroll	for	the	Dental	Plan,	you	will	receive	a	CIGNA	ID	card	in	the	mail.	Be	sure	to	show	your	ID	card	to	your	
provider	when	you	receive	services	or	bring	a	Stanley	Black	&	Decker	claim	form	with	you.	Claim	forms	are	available	in	
the	Forms	&	Resources	section	on	the	benefits	website,	www.benefits.stanleyblackanddecker.com.
Two	Dental	ID	cards	will	be	mailed	per	family,	both	with	the	associate’s	name.	Cards	with	each	family	member’s	name	
will	not	be	issued.	If	you	would	like	additional	ID	cards,	call	CIGNA	at	1-800-243-3280.	You	must	call	CIGNA—do	not	
contact	Corporate	Benefits,	The	Stanley	Black	&	Decker	Benefits	Center,	or	your	Human	Resources	representative	as	
they	cannot	order	ID	cards	for	you.
You	cannot	order	Dental	ID	cards	online.	However,	if	you	would	like	to	print	out	a	customized,	on-demand	Dental	ID	
card,	you	can	log	on	to	www.myCignA.com	and	print	one.	
                                                                       The Stanley Black & Decker Dental Plan        • 17




hoW The DenTal Plan WoRKS
You	can	use	any	dentist	you	choose;	however,	your	out-of-pocket	expenses	will	be	lower	if	you	see	a	dentist	who	
participates	in	the	CIGNA	Dental	PPO	Core	Network.	The	actual	benefit	you	receive	for	covered	services	will	depend	on	
whether	you	participate	in	a	Plus	PPO	Option	or	Basic	PPO	Option	(see	“Comparing	the	Options”	for	benefits	under	
each	option).	In	addition,	with	CIGNA’s	Dental	Wellness	Plan,	you	will	be	rewarded	for	using	preventive	care	benefits.

in-neTWoRK BenefiTS
If	you	go	to	a	CIGNA	Dental	PPO	Core	Network	dentist,	you	save	money	because	dentists	in	the	network	have	agreed	to	
charge	you	a	fixed	fee.	CIGNA	pays	the	dentist	a	percentage	of	the	fee.	You	pay	the	balance	of	the	CIGNA	approved	fee.	
There	are	no	claim	forms	to	file	because	your	dentist	submits	your	claims.
To	locate	a	CIGNA	Dental	PPO	Core	Network	dentist:	
l  I
 			f	you	are	a	prospective	member,	log	on	to	www.CignA.com/CignAproviderdirectory/sbd.
l  I
 			f	you	are	already	a	member,	log	on	to	www.myCignA.com	and	use	the	provider	search	feature.	Follow	the	
   directions	to	find	a	network	dentist	in	your	area.	CIGNA’s	website	will	provide	the	most	up-to-date	list	of	in-network	
   providers.	
l  C
 			 all	CIGNA	at	1-800-243-3280,	select	the	Dental	Plan	prompt,	and	speak	with	a	customer	service	representative.	
Note:	Stanley	Black	&	Decker	cannot	guarantee	that	there	will	be	an	in-network	provider	in	every	specialty,	in	every	
ZIP	Code.

ouT-of-neTWoRK BenefiTS
When	you	use	a	dentist	who	does	not	participate	in	the	CIGNA	Dental	PPO	Core	Network,	you	are	considered	to	be	
out-of-network.	
For	out-of-network	basic	and	major	restorative	care	and	TMJ	services	in	both	the	Plus	PPO	and	Basic	PPO	options	and	
orthodontia	services	in	the	Plus	PPO	Option,	you	must	first	meet	an	annual	deductible	before	either	option	will	pay	
benefits.	Then,	the	Dental	Plan	pays	a	percentage	of	the	cost	of	the	service,	up	to	the	maximum	reimbursable	charge,	
and	you	pay	the	remaining	percentage	(the	coinsurance),	plus	any	amount	above	the	maximum	reimbursable	charge.	
Note: Orthodontia services are not covered in the Basic PPO Option.
You	are	responsible	for	filing	claims	for	reimbursement	for	out-of-network	services	from	the	Dental	Plan	within	one	year	
of	the	date	of	service.	

DenTal PRevenTive CaRe
The	Plus	PPO	and	Basic	PPO	options	pay	100%	of	the	cost	of	two	annual	out-of-network	check-ups,	up	to	the	
maximum	reimbursable	charge.	If	you	receive	an	annual	dental	check-up,	your	annual	maximum	will	increase	the	
following	year.	See	CIGNA’s	Dental	WellnessPlus	for	more	information.
18 • The Stanley Black & Decker Dental Plan



WhAt is the mAximum reimBursABle chArge?
The	maximum	reimbursable	charge	is	the	lesser	of	the	provider’s	normal	charge	for	a	similar	service	or	supply	or	
the	90th	percentile	of	all	charges	made	by	the	providers	of	such	service	or	supply	in	the	geographic	area	where	it	is	
received.	
If	you	go	to	an	in-network	provider,	you	pay	less	for	covered	services	because	CIGNA	has	contracted	with	these	dentists	
to	charge	a	discounted	rate	for	expenses.	For	in-network	providers,	you	will	not	pay	any	amount	that	exceeds	the	
discounted	rates.	
If	you	go	to	an	out-of-network	provider,	your	dentist	can	charge	you	any	amount—you	must	meet	your	deductible,	pay	
your	coinsurance,	and	pay	any	amount	that	is	over	the	maximum	reimbursable	charge.	

annual maximum
The	Plus	PPO	Option	will	pay	an	annual	maximum	benefit	of	$2,000	per	person	per	year,	and	the	Basic	PPO	Option	
will	pay	an	annual	maximum	benefit	of	$1,000	per	person	per	year,	for	Class	I,	II,	and	III	services.	(See	“Comparing	the	
Options”	for	more	information	on	those	services.)	If	you	receive	an	annual	dental	check-up,	your	annual	maximum	will	
increase	the	following	year.	See	CIGNA’s	Dental	WellnessPlus	for	more	information.
Neither	the	Plus	PPO	Option	nor	the	Basic	PPO	Option	will	pay	any	benefits	after	you	reach	the	annual	maximum	
benefit.	
Orthodontic	benefits	paid	under	the	Plus	PPO	Option	do	not	count	toward	your	annual	maximum.	However,	there	is	a	
separate	orthodontic	maximum	of	$2,500	per	person	per	lifetime	(in-	and	out-of-network	combined).
                                                                                      The Stanley Black & Decker Dental Plan                • 19




ComPaRing The oPTionS
                                                      Plus PPO Option                                     Basic PPO Option
                                               In-Network       Out-of-Network                      In-Network      Out-of-Network

     Annual	Deductible1
     •	Employee	Only                       			$50                     $100                       $100                       $200
     •	Employee	+1                         $100                       $200                       $200                       $400
     •	Employee	+2                         $100                       $200                       $200                       $400
     •	Employee	+	3	or	more                $100                       $200	                      $200	                      $400

     Annual	Maximum2                       $2,000	per	person,	combined	                          $1,000	per	person,	combined	
                                           in-	and	out-of-network                                in-	and	out-of-network	
     Covered services                      Plan pays…                                            Plan pays…
     Class	I	Preventive	and	               100%4,	no	                 100%5,	no	                 100%4,	no	                 100%5,	no	
     Diagnostic	Services3                  deductible	                deductible	                deductible	                deductible	
     (some	limits	apply)
     Class	II	Basic	Restorations;	         90%4	after	                80%5	after	                80%4	after	                70%5	after	
     Endodontics;	Periodontics;	           deductible                 deductible	                deductible	                deductible	
     Prosthodontic	Maintenance;	
     Oral	Surgery	(includes	
     impacted	wisdom	teeth)
     Class	III	Major	Restorations	         60%4	after	                50%5	after	                50%4	after	                40%5	after	
     Crowns,	Dentures	                     deductible                 deductible                 deductible	                deductible	
     Bridgework	and	Implants

     Class	IV	Orthodontia	                 60%4	after	                50%5	after	                Orthodontia	not	covered
     (Available	for	children	              deductible,	               deductible,	
     and	adults)                           up	to	$2,500	              up	to	$2,500	
                                           lifetime	maximum	          lifetime	maximum	
                                           (combined	in-	and	         (combined	in-	and	
                                           out-of-network)            out-of-network)	

     Class	V—	TMJ	                         60%4	after	                50%5	after	                50%4	after	                40%5	after	
     (Appliances	only)                     deductible                 deductible                 deductible	                deductible	
1
    The annual deductible does not apply to Class I services. Both in- and out-of-network charges apply toward the annual deductible. Any amounts
    you pay towards reaching your in-network deductible also apply to reaching your out-of-network deductible. Similarly, amounts you pay towards
    reaching your out-of-network deductible apply towards reaching your in-network deductible.
2
    The annual maximum may be increased if you successfully participate in the WellnessPlus program. For details of the program see, “CIGNA’s
    Dental WellnessPlus.” Both in- and out-of-network charges apply toward the annual maximum.
3
    X-rays (complete series or panorex, but not both) are only allowed once every 36 consecutive months. For additional frequency limitations,
    see Class I Services under “What the Plan Covers” on the next page.
4
    The percentage of discounted fees the Dental Plan pays.
5
    The Dental Plan pays up to the indicated percentage of the maximum reimbursable charge.
20 • The Stanley Black & Decker Dental Plan



Cigna’S DenTal WellneSSPluS
Through	CIGNA’s	Dental	WellnessPlus	program,	if	you	have	one	annual	dental	check-up	during	the	calendar	year,	
an	additional	$50	will	be	added	to	your	calendar	year	maximum	for	the	next	year	(up	to	a	maximum	of	$150	after	
three	years).	
For	example,	if	you	have	your	annual	dental	check-up	during	the	current	calendar	year,	your	annual	maximum	benefit	
will	increase	$50	for	the	next	calendar	year.	Each	covered	individual—you	and	your	covered	dependents—is	eligible	to	
earn	$50	toward	the	out-of-pocket	maximum.	

WhaT The DenTal Plan CoveRS
The	Dental	Plan	will	pay	up	to	the	maximum	reimbursable	charges	for	those	services	or	supplies	that	are:	
l  C
 			 overed	in	full	or	partially	covered
l  L
 			 isted	in	the	Dental	Services	Schedule	below	
l  S
 			 tarted	and	completed	while	you	and/or	your	dependent(s)	are	covered	by	the	Dental	Plan	
l  P
 			 erformed	by	or	under	the	direction	of	a	dentist	
l  E
 			 ssential	for	the	necessary	care	of	the	teeth	

clAss i services—DiAgnostic AnD preventive
The	Dental	Plan	covers	the	following	diagnostic	and	preventive	services:	
l  	
   P
 			 eriodic	oral	examination	(two	per	person	per	calendar	year)	
l  P
 			 rophylaxis	and	periodontal	cleanings	(two	per	person	per	calendar	year)	
l  F
 			 ull	Mouth	X-rays	(one	complete	set	per	person	every	three	calendar	years)	
l  B
 			 itewing	X-rays	(two	per	person	per	calendar	year)
l  P
 			 anoramic	(Panorex)	X-ray	(one	per	person	every	three	calendar	years)	
l  T
 			 opical	application	of	acid	fluoride	phosphate	(limited	to	persons	less	than	19	years	old,	and	one	per	person	per	
   calendar	year)	
l  T
 			 opical	application	of	sealant	(limited	to	posterior	teeth	for	a	person	less	than	age	14;	one	treatment	per	tooth	every	
   three	calendar	years)	
l  S
 			 pace	maintainers,	fixed	unilateral	(limited	to	non-orthodontic	treatment)	
l  E
 			 mergency	treatment	to	relieve	dental	pain	when	no	other	definitive	dental	services	are	performed	(not	including	
   X-rays)	
                                                                         The Stanley Black & Decker Dental Plan       • 21



clAss ii services—BAsic restorAtions, enDoDontics, perioDontics,
prosthoDontic mAintenAnce, AnD orAl surgerY
The	Dental	Plan	covers	the	following	basic	restorative	services:	
l  A
 			 malgam	filling	for	primary	(baby)	or	permanent	teeth	
l  C
 			 omposite	acrylic	resin	filling	(all	teeth)	
l  R
 			 oot	canal	therapy—any	X-ray,	test,	lab	exam,	or	follow-up	care	is	part	of	the	allowance	for	root	canal	therapy	and	
   not	a	separate	dental	service	
l  O
 			 sseous	surgery—flap	entry	and	closure	is	part	of	the	allowance	for	osseous	surgery	and	osseous	graft	and	not	a	
   separate	dental	service	(if	more	than	one	periodontal	surgical	service	is	performed	per	quadrant,	only	the	one	with	
   the	largest	maximum	covered	expense	is	a	dental	service)	
l  P
 			 eriodontal	scaling	and	root	planing	(subject	to	review	and	limitations)	
l  A
 			 djustments	to	complete	denture	after	six	months	from	date	of	placement	(any	adjustment	or	repair	of	a	denture	
   within	six	months	of	its	placement	is	not	a	dental	service)	
l  R
 			 ecement	bridge	
l  S
 			 imple	extractions	
l  S
 			 urgical	extractions	(soft	tissue	impaction,	partial	bony	impaction,	complete	bony	impaction)	
l  L
 			 ocal	anesthetic,	analgesic,	and	routine	post-operative	care	for	extractions	and	other	oral	surgery	(including	
   impacted	wisdom	teeth)	are	part	of	the	allowance	for	each	dental	service	
l  G
 			 eneral	anesthetic	(the	administration	of	a	general	anesthetic	is	a	dental	service	covered	by	this	schedule	only	
   when	medically	necessary	in	conjunction	with	oral	or	dental	surgery;	and	if	the	anesthetic	agent	produces	a	state	of	
   unconsciousness	with	absence	of	pain	sensation	over	the	whole	body)	

clAss iii services—mAjor restorAtions, Dentures, AnD BriDgeWork
The	Dental	Plan	also	provides	benefits	for	the	following	major	restorations,	dentures,	and	bridgework:	
l  G
 			 old	restorations	or	crowns	are	covered	only	when	the	tooth,	as	a	result	of	extensive	caries	or	fracture,	cannot	be	
   restored	with	amalgam,	silicate,	acrylic,	or	plastic	restoration	
l  C
 			 rowns,	including,	but	not	limited	to,	porcelain	with	gold,	cast	gold	(full	or	three-fourths)	
l  F
 			 ixed	or	removable	appliances—complete	(full)	dentures,	upper,	or	lower	
l  P
 			 artial	dentures—acrylic	base	
l  L
 			 ower,	with	two	clasps	and	chrome	lingual	bar	
l  U
 			 pper,	with	two	clasps	and	chrome	palatal	bar	
l  B
 			 ridge	pontics—cast	gold	
l  B
 			 ridge	pontics—porcelain	fused	to	gold	
l  B
 			 ridge	pontics—plastic	processed	to	gold	
l  A
 			 butment	crowns—plastic	processed	to	gold	
l  A
 			 butment	crowns—porcelain	fused	to	gold	
l  A
 			 butment	crowns—full	cast	gold	
l  R
 			 eplacement	of	a	bridge,	crown,	or	denture
l  A
 			 	surgical	implant	of	any	type	including	any	prosthetic	device	attached	to	it	
22 • The Stanley Black & Decker Dental Plan



clAss iv services—orthoDontics (ppo plus option onlY)
For	the	PPO	Plus	Option,	the	Dental	Plan	provides	benefits	for	adults	and	children	for	the	following	orthodontic	
services	(a	lifetime	maximum	of	$2,500	applies,	and	each	month	of	active	treatment	counts	as	a	separate	dental	
service):
l  P
 			 reliminary	study,	including	X-rays,	diagnostic	casts,	and	treatment	plan	and	first	month	of	active	treatment	
   including	all	active	treatment	and	retention	appliance	
l  A
 			 ctive	treatment	per	month	after	the	first	month	
l  F
 			 ixed	or	cemented	appliances—only	one	appliance	arch	for	tooth	guidance	and	only	one	per	person	to	control	
   harmful	habits	
If	you	or	your	dependent	requires	full	banded	orthodontic	treatment,	benefits	will	be	paid	in	installments.	The	first	
payment	is	made	after	the	braces	are	applied.	Then,	payments	are	made	every	three	months.	Payments	are	made	for	
services	rendered	only	while	you	or	your	dependents	are	covered	by	the	Dental	Plan.	If	you	stop	your	dental	coverage,	
payments	will	be	made	only	for	charges	incurred	prior	to	termination,	up	to	the	month	your	coverage	terminates.	
Each	covered	participant	in	the	Plus	PPO	Option	is	eligible	to	receive	up	to	$2,500	in	orthodontia	care	if	he/she	
has	not	used	their	full	maximum	for	initial	treatment	and	he	or	she	later	needs	more	orthodontics	or	orthodontic	
services	(such	as	a	replacement	retainer).	The	participant	will	be	covered	up	to	the	balance	of	his/her	$2,500	lifetime	
orthodontic	maximum.	Eligible	participants	will	not	be	covered	for	orthodontia	services	that	exceed	their	lifetime	
orthodontic	maximum.	The	$2,500	lifetime	orthodontic	maximum	is	a	combined	benefit	(in-	and	out-of-network).
Note:	Any	lifetime	orthodontia	benefits	already	used	under	the	prior	Stanley	or	Black	&	Decker	dental	plans	will	
be	offset	against	the	lifetime	orthodontia	benefits	in	the	new	Stanley	Black	&	Decker	Dental	Plan.	For	example,	if	
your	former	Stanley	or	Black	&	Decker	Dental	Plan	had	already	paid	$1,000	in	lifetime	orthodontia	expenses,	and	
you	began	to	participate	in	the	Stanley	Black	&	Decker	Dental	Plan	Plus	PPO	Option,	which	has	a	$2,500	lifetime	
orthodontia	lifetime	maximum,	you	have	a	remaining	lifetime	orthodontia	benefit	of	$1,500	left	to	use	for	expenses	
incurred	while	you	are	enrolled	in	the	Dental	Plan	Plus	PPO	Option.

WhaT The DenTal Plan DoeS noT CoveR
The	Dental	Plan	does	not	cover,	or	provide	any	payment	for,	the	following:	
l  S
 			 ervices	performed	solely	for	cosmetic	reasons	
l  R
 			 eplacement	of	a	lost,	stolen	or	damaged	(due	to	patient	abuse,	misuse	or	neglect)	appliance
l  R
 			 eplacement	of	a	bridge	or	denture	within	five	years	following	the	date	of	its	original	installation
l  R
 			 eplacement	of	a	bridge	or	denture	which	can	be	made	useable	according	to	dental	standards
l  V
 			 eneers	of	porcelain	or	acrylic	materials	on	crowns	or	pontics	on	or	replacing	the	upper	and	lower	first,	second	and	
   third	molars
l  B
 			 ite	registrations,	precision	or	semi-precision	attachments,	or	splinting	
l  	
   I
 			nstruction	for	plaque	control,	oral	hygiene,	and	diet	
l  D
 			 ental	services	that	do	not	meet	common	dental	standards	
l  S
 			 ervices	that	are	deemed	to	be	medical	services	(i.e.,	oral	surgery,	such	as	impacted	wisdom	teeth,	and	related	
   anesthesia,	TMJ	surgery,	etc.)
l  S
 			 ervices	and	supplies	received	from	a	hospital,	including	any	associated	incremental	charges	for	dental	services	
   performed	in	a	hospital
                                                                         The Stanley Black & Decker Dental Plan          • 23



l  I
 			n	addition,	these	benefits	will	be	reduced	so	that	the	total	payment	will	not	be	more	than	100%	of	the	charge	made	
   for	the	Dental	Service	if	benefits	are	provided	for	that	service	under	this	plan	and	any	medical	expense	plan	
   or	prepaid	treatment	program	sponsored	or	made	available	by	Stanley	Black	&	Decker
l  A
 			 ny	injury	resulting	from,	or	in	the	course	of,	any	employment	for	wage	or	profit	
l  A
 			 ny	sickness	covered	under	any	Workers’	Compensation	or	similar	law	
l  R
 			 esin-bonded	retainers	and	associated	pontics
l  C
 			 ompletion	of	crowns,	bridgework,	dentures	or	root	canal	treatment	already	in	progress	on	the	effective	date	of	your	
   Stanley	Black	&	Decker	CIGNA	Dental	coverage
l  P
 			 rocedures	or	appliances	for	minor	tooth	guidance	or	to	control	harmful	habits
l  C
 			 harges	for	completing	claim	forms
l  C
 			 harges	which	would	not	have	been	made	if	person	had	no	insurance
l  C
 			 rowns	and	bridges	used	solely	for	splinting
l  D
 			 ental	grafting	when	done	on	the	same	day	as	an	extraction	except	when	done	in	conjunction	with	a	dental	implant
l  C
 			 onscious	oral	sedation	and	nitrous	oxide
l  P
 			 rescription	drugs
l  P
 			 rocedures,	appliances	and	restorations	if	the	main	purpose	is	to	restore	teeth	damaged	by	attrition,	abrasion,	
   erosion	and/or	abfraction
l  C
 			 harges	made	by	a	hospital	which	performs	service	for	the	U.S.	Government	if	the	charges	are	directly	related	to	a	
   condition	connected	to	a	military	service	
l  T
 			 o	the	extent	that	payment	is	unlawful	where	the	person	resides	when	the	expenses	are	incurred	
l  C
 			 harges	which	the	person	is	not	legally	required	to	pay	
l  T
 			 o	the	extent	that	the	charges	are	more	than	either	the	applicable	Contracted	Fee	or	maximum	reimbursable	charge
l  F
 			 or	charges	for	unnecessary	care,	treatment,	or	surgery	
l  T
 			 o	the	extent	that	you	or	any	of	your	dependents	are	in	any	way	paid	or	entitled	to	payment	for	those	expenses	by	or	
   through	a	public	program,	other	than	Medicaid	
l  F
 			 or,	or	in	connection	with,	experimental	procedures	or	treatment	methods	not	approved	by	the	American	Dental	
   Association	or	the	appropriate	dental	specialty	society	
l  C
 			 rowns,	including,	but	not	limited	to,	porcelain	with	gold	or	cast	gold	(full	or	three-fourths)	on	the	first,	second,	or	
   third	molar	teeth	on	both	primary	and	permanent	teeth	
l  I
 			f	you	or	your	dependents	replace	a	tooth	that	was	missing	when	you	enrolled	for	dental	coverage,	the	Dental	Plan	
   payment	will	be	half	the	amount	of	the	normal	benefit	during	the	first	24	months	of	coverage.	After	you	have	been	
   covered	by	the	Dental	Plan	for	at	least	two	years,	the	limit	will	not	apply.	Please	note,	this	does	not	apply	if	you	are	
   part	of	an	acquisition	that	is	joining	The	Stanley	Black	&	Decker	Dental	Plan	for	the	first	time.
l  I
 			f	you	or	your	dependents	receive	or	are	eligible	to	receive	benefits	from	the	mandatory	part	of	any	auto	insurance	
   policy	written	to	comply	with	any	state	or	federal	motor	vehicle	reparations	law	which	provides	for	the	payment	of	
   damages,	a	“no-fault”	insurance	law,	or	an	uninsured	motorist	insurance	law,	CIGNA	and	the	auto	insurance	policy	
   will	work	together	to	pay	up	to	100%	of	the	covered	expenses	
24 • The Stanley Black & Decker Dental Plan



A speciAl note ABout tmj
TMJ,	or	temporomandibular	joint	dysfunction,	is	a	disorder	of	the	jaw.	The	Stanley	Black	&	Decker	Medical	Plan	
covers	medically	necessary	treatment	of	TMJ,	including	surgery,	and	the	Dental	Plan	covers	related	appliances.	Prior	
authorization	is	recommended.	In	general,	the	Dental	Plan	covers	dental	services	related	to	TMJ	only	if	they	are	
deemed	to	be	true,	legitimate	dental	services.	

PReDeTeRminaTion of BenefiTS
Predetermination	of	Benefits	is	a	voluntary	review	of	a	dentist’s	proposed	treatment	plan	and	expected	charges.	It	is	
not	preauthorization	of	service	and	is	not	required.	However,	it	is	recommended	so	that	you	know	in	advance	what	the	
Stanley	Black	&	Decker	Dental	Plan	will	cover	and	how	much	you	will	need	to	pay.
The	treatment	plan	should	include	supporting	pre-operative	X-rays	and	other	diagnostic	materials	as	requested	by	
CIGNA’s	dental	consultant.	If	there	is	a	change	in	the	treatment	plan,	a	revised	plan	should	be	submitted,	CIGNA	will	
determine	covered	dental	expenses	for	the	proposed	treatment	plan.	If	there	is	no	Predetermination	of	Benefits,	CIGNA	
will	determine	covered	dental	expenses	when	it	receives	a	claim.	
Review	of	proposed	treatment	is	advised	whenever	extensive	dental	work	is	recommended	(when	charges	exceed	
$200).	Predetermination	of	Benefits	is	not	a	guarantee	of	a	set	payment.	Payment	is	based	on	the	services	that	are	
actually	delivered	and	the	coverage	in	force	at	the	time	services	are	completed.

DeTeRminaTion of BenefiTS
Sometimes,	more	than	one	dental	service	could	treat	your	condition,	based	on	common	dental	standards.	In	such	
cases,	CIGNA	will	decide	which	of	the	dental	services	will	be	the	basis	for	payment	under	the	alternate	benefit	
provisions.	CIGNA	will	also	determine	which	charges	will	be	included	as	covered	expenses.	A	temporary	dental	service	
is	included	in	the	allowance	for	the	final	dental	service	and	is	not	considered	a	separate	dental	service.

When DenTal SeRviCe BeginS
Dental	service	starts	when	the	actual	service	is	performed,	except	in	the	following	cases:	
l  F
 			 or	fixed	bridgework	and	full	or	partial	dentures,	service	starts	when	the	first	impressions	are	taken	and/or	abutment	
   teeth	are	fully	prepared	
l  F
 			 or	a	crown,	inlay,	or	onlay,	service	starts	on	the	first	date	of	preparation	of	the	tooth	involved	
l  F
 			 or	root	canal	therapy,	service	starts	when	the	pulp	chamber	of	the	tooth	is	opened	

When DenTal SeRviCe enDS
Normally,	dental	service	ends	when	the	procedure	is	complete.	However,	if	you	incur	charges	for	a	dental	service	that	is	
completed	after	your	benefits	have	stopped,	you	may	be	able	to	receive	payment	if:	
l  F
 			 or	fixed	bridgework	and	full	or	partial	dentures,	the	first	impressions	are	taken	and/or	abutment	teeth	are	fully	
   prepared	while	you	are	covered	and	the	bridgework	or	dentures	are	delivered	to	you	within	three	calendar	months	
   after	your	coverage	ends,	
l  F
 			 or	a	crown,	inlay,	or	onlay,	the	tooth	is	prepared	while	you	are	covered	and	the	crown,	inlay,	or	onlay	is	installed	
   within	three	calendar	months	after	your	coverage	ends,	or	
l  F
 			 or	root	canal	therapy,	the	pulp	chamber	of	the	tooth	is	opened	while	you	are	covered	and	the	treatment	is	
   completed	within	three	calendar	months	after	your	coverage	ends.	
There	is	no	extension	for	any	dental	service	except	as	described	above.	
                                                                      The Stanley Black & Decker Dental Plan      • 25




SPeCial BenefiTS
CIGNA	offers	a	CIGNA	Dental	Oral	Health	Integration	ProgramSM	for	eligible	members	with	both	CIGNA	medical	and	
dental	coverage.	Effective	January	1,	2011,	the	program	includes	the	following	conditions:
l  P
 			 regnancy
l  C
 			 adiovascular	disease	(heart)
l  C
 			 erebrovascular	disease	(stroke)
l  D
 			 iabetes
l  C
 			 hronic	kidney	disease
l  O
 			 rgan	transplants
l  H
 			 ead	and	neck	cancer	radiation
If	you	are	eligible,	CIGNA	reimburses	your	out-of-pocket	expenses	(coinsurance	and	copays)	for	certain	services,	
depending	on	the	condition.	Just	visit	your	regular	dentist	for	necessary	services	and	pay	the	applicable	coinsurance	
or	copay	amount	as	you	normally	would.	Then	submit	a	completed	CIGNA	Dental	Oral	Health	Integration	Program	
Reimbursement	Form	to	apply	for	reimbursement.	The	form	has	a	section	where	you	can	request	information	on	
prescription	and	non-prescription	dental	product	discounts	as	well	as	information	on	behavioral	conditions	affecting	
oral	health.
If	you	have	questions	or	need	a	reimbursement	form,	go	online	to	www.mycigna.com	or	call	CIGNA	at	
1-800-243-3280.

WhY this progrAm is importAnt to You
According	to	the	U.S.	Surgeon	General’s	Report	in	2000,	our	mouths	speak	volumes	about	the	state	of	our	health.	
Many	of	the	diseases	associated	with	gum	disease	are	also	considered	to	be	systemic	inflammatory	disorders,	
including	cardiovascular	disease,	diabetes,	kidney	disease	and	even	certain	forms	of	cancer—suggesting	that	
inflammation	itself	may	be	the	basis	for	the	connection.	Clinical	research	has	shown	that	improving	the	health	of	your	
gums	may	have	a	positive	impact	on	your	overall	health,	making	it	more	critical	than	ever	to	maintain	periodontal	
health	in	order	to	achieve	overall	health	(Source:	www.perio.org).

oRal healTh maTeRniTy PRogRamSm
This	program	enhances	dental	benefits	for	expectant	mothers	with	both	CIGNA	medical	and	CIGNA	dental	coverage.	
Eligible	members	may	receive	100%	reimbursement	of	copay	or	coinsurance	for	these	covered	services	performed	
during	pregnancy:	
l  O
 			 ral	evaluation	
l  P
 			 eriodontal	scaling	and	root	planing	
l  P
 			 eriodontal	maintenance	
l  T
 			 reatment	of	inflamed	gums	around	wisdom	teeth	
l  F
 			 requency	limitation	for	cleanings	waived	to	include	an	additional	cleaning	
These	enhanced	benefits	are	subject	to	Plan	limitations.	
26 • The Stanley Black & Decker Dental Plan



oRal healTh DiaBeTeS PRogRam anD
oRal healTh CaRDiovaSCulaR PRogRam
These	programs	provide	enhanced	dental	benefits	for	members	with	both	CIGNA	medical	and	dental	coverage	who	
also	participate	in	the	CIGNA	Well	Aware	Program	for	Better	Health®	diabetes	or	heart	disease	programs.	Eligible	
members	may	receive	100%	reimbursement	of	their	out-of-pocket	payment	to	the	dentist	for	the	following	services:	
l  P
 			 eriodontal	root	scaling	and	planing—sometimes	referred	to	as	“deep	cleaning”	
l  P
 			 eriodontal	maintenance	
These	enhanced	benefits	are	subject	to	Plan	limitations	except	for	periodontal	maintenance	where	the	frequency	
limitation	has	been	increased	to	four	times	per	year.	Annual	maximums	and	out-of-network	maximum	reimbursable	
charges	may	apply.	

oRal healTh PRogRamS foR KiDney DiSeaSe,
oRgan TRanSPlanTS anD heaD anD neCK CanCeR
These	programs	provide	enhanced	dental	benefits	for	members	with	both	CIGNA	medical	and	dental	coverage	who	
also	participate	in	the	CIGNA	Well	Aware	Program	for	Better	Health®	kidney	disease,	organ	transplant	or	head	and	neck	
cancer	programs.	Eligible	members	may	receive	100%	reimbursement	of	their	out-of-pocket	payment	to	the	dentist	for	
the	following	services:	
l  T
 			 opical	application	of	fluoride	and	fluoride	varnish
l  S
 			 ealant	(one	per	tooth)
l  P
 			 eriodontal	root	scaling	and	planing—sometimes	referred	to	as	“deep	cleaning”	
l  P
 			 eriodontal	maintenance	
These	enhanced	benefits	are	subject	to	Plan	limitations	except	for	periodontal	maintenance	where	the	frequency	
limitation	has	been	increased	to	four	times	per	year.	Annual	maximums	and	out-of-network	maximum	reimbursable	
charges	may	apply.	
                                                                         The Stanley Black & Decker Dental Plan        • 27




filing ClaimS
When	you	go	to	an	in-network	dentist,	you	do	not	have	to	file	claims	for	services.	Your	dentist	will	automatically	file	
claims	for	you.	
When	you	go	to	an	out-of-network	dentist,	you	are	responsible	for	filing	claims	for	all	dental	services	within	one	year	
of	the	date	of	service.	You	and/or	your	dentist	will	need	to	send	a	Dental	Plan	Claim	Form	to	CIGNA.	Claim	forms	are	
available	in	the	Forms	&	Resources	section	of	www.benefits.stanleyblackanddecker.com,	or	your	dentist	can	
use	his	or	her	own	electronic	or	paper	standard	dental	claim	form	using	the	Stanley	Black	&	Decker	account	number,	
2498633.	Send	completed	dental	claims	to:	
  CIGNA	Dental	
  P.O.	Box	188037	
  Chattanooga,	TN	37422-8037
All	dental	benefits	are	payable	to	you.	However,	at	the	option	of	the	Dental	Plan,	all	or	any	part	of	payment	may	be	
made	directly	to	the	dentist.	If	you	should	die	before	expenses	are	reimbursed,	the	Dental	Plan	may	choose	to	make	
direct	payment	to	any	of	your	following	living	relatives:	spouse,	mother,	father,	child	or	children,	brothers	or	sisters,	or	
the	executors	or	administrators	of	your	estate.	
You	will	receive	an	Explanation	of	Benefits	(EOB),	which	shows	the	amount	of	covered	expenses	and	the	amount	of	
benefits	paid	by	the	Dental	Plan.	If	the	Plan	does	not	cover	all	of	the	expenses,	the	EOB	will	show	the	reasons	benefits	
were	not	paid.	If	you	sign	up	for	online	EOBs,	you	will	receive	an	email	notice.
When	you	file	a	claim	for	services,	CIGNA	will	periodically	request	other	insurance	information	from	you.	If	so,	you	will	
be	advised	that	the	other	insurance	information	(including	an	EOB	from	the	other	insurance	carrier)	is	required	before	
the	submitted	claim	will	be	processed	for	payment.	If	no	response	is	received	within	90	days,	the	claim	will	be	denied.	
If	the	claim	is	denied,	you	have	the	right	to	have	your	claim	reviewed	according	to	the	Dental	Plan’s	claims	review	
procedures.	
28 • The Stanley Black & Decker Dental Plan




ClaimS RevieW PRoCeDuReS
To	receive	dental	benefits,	you	must	follow	the	Plan’s	claims	procedures.	For	example,	you	must	submit	a	claim	for	out-
of-network	benefits	(as	explained	in	the	preceding	Filing	Claims	section).	Similarly,	CIGNA	and	the	Plan	Administrator	
must	follow	the	Plan’s	claims	procedures.	These	procedures	are	described	below.

When you have a ComPlainT
If	you	have	a	concern	regarding	a	person,	a	service,	the	quality	of	care,	or	contractual	benefits,	you	can	call	CIGNA	at	
1-800-243-3280	and	explain	your	concern	to	one	of	CIGNA’s	Member	Services	representatives.	You	can	also	express	
your	concern	by	writing	to	CIGNA:	
  CIGNA	Service	Center	
  P.O.	Box	188037	
  Chattanooga,	TN	37422-8037	
CIGNA	will	do	its	best	to	resolve	the	matter	on	your	initial	contact.	If	CIGNA	needs	more	time	to	review	or	investigate	
your	concern,	it	will	get	back	to	you	as	soon	as	possible,	but	in	any	case	within	30	days.	

PRoCeDuReS RegaRDing meDiCal neCeSSiTy DeTeRminaTionS
In	general,	health	services	and	benefits	must	be	medically	necessary	to	be	covered	under	the	Plan.	You	or	your	
authorized	representative	(typically,	your	health	care	provider)	must	request	medical	necessity	determinations	
according	to	the	procedures	described	below	(see	below	“Post-Service	Claim	Determinations”	section),	in	the	
Certificate,	and	in	your	provider’s	network	participation	documents	as	applicable.	When	services	or	benefits	are	
determined	to	be	not	medically	necessary,	you	or	your	representative	will	receive	a	written	description	of	the	adverse	
determination,	and	may	appeal	the	determination	(see	“Notice	of	Adverse	Determination”	section	on	the	next	page).	
Appeal	procedures	are	described	on	the	next	page	(see	“Appeals	Process”	section),	in	the	Certificate,	in	your	provider’s	
network	participation	documents,	and	in	the	determination	notices.
                                                                       The Stanley Black & Decker Dental Plan        • 29




PRoCeDuReS RegaRDing Claim PaymenT DeTeRminaTionS
post-service clAim DeterminAtions
When	you	or	your	representative	request	payment	for	services	that	have	been	rendered,	the	Claims	Administrator	will	
notify	you	or	your	representative	of	the	claim	determination	within	30	days	after	receiving	the	request.	However,	if	
more	time	is	needed	to	make	a	determination	due	to	matters	beyond	the	Claims	Administrator’s	control,	the	Claims	
Administrator	will	notify	you	or	your	representative	within	30	days	after	receiving	the	request.	This	notice	will	include	
the	date	a	determination	can	be	expected,	which	will	be	no	more	than	45	days	after	receipt	of	the	request.	If	more	time	
is	needed	because	necessary	information	is	missing	from	the	request,	the	notice	will	also	specify	what	information	
is	needed,	and	you	or	your	representative	must	provide	the	specified	information	within	45	days	after	receiving	the	
notice.	The	determination	period	will	be	suspended	on	the	date	the	Claims	Administrator	sends	such	a	notice	of	
missing	information	and	resume	on	the	date	you	or	your	representative	respond	to	the	notice.	

notice of ADverse DeterminAtion
Every	notice	of	an	adverse	benefit	determination	will	be	provided	in	writing	or	electronically,	and	will	include	all	
of	the	following	that	pertain	to	the	determination:	(1)	the	specific	reason	or	reasons	for	the	adverse	determination;	
(2)	reference	to	the	specific	Plan	provisions	on	which	the	determination	is	based;	(3)	a	description	of	any	additional	
material	or	information	necessary	to	perfect	the	claim	and	an	explanation	of	why	such	material	or	information	is	
necessary;	(4)	a	description	of	the	Plan’s	review	procedures	and	the	time	limits	applicable,	including	a	statement	of	a	
claimant’s	rights	to	bring	a	civil	action	under	section	502(a)	of	ERISA	following	an	adverse	benefit	determination	on	
appeal;	(5)	upon	request	and	free	of	charge,	a	copy	of	any	internal	rule,	guideline,	protocol,	or	other	similar	criterion	
that	was	relied	upon	in	making	the	adverse	determination	regarding	your	claim,	and	an	explanation	of	the	scientific	
or	clinical	judgment	for	a	determination	that	is	based	on	a	medical	necessity,	experimental	treatment,	or	other	similar	
exclusion	or	limit;	and	(6)	in	the	case	of	a	claim	involving	urgent	care,	a	description	of	the	expedited	review	process	
applicable	to	such	claim.	

AppeAls process
If	you	are	not	satisfied	with	the	decision	concerning	any	denial	of	a	claim	for	benefits,	you	can	start	the	appeals	
procedure.	The	Claims	Administrator	has	a	two-step	appeals	procedure	for	coverage	decisions.	To	initiate	an	appeal,	
you	must	submit	a	request	for	an	appeal	in	writing	to	the	Claims	Administrator	within	180	days	of	receipt	of	a	denial	
notice.	You	should	state	the	reason	why	you	feel	your	appeal	should	be	approved	and	include	any	information	
supporting	your	appeal.	If	you	are	unable	or	choose	not	to	write,	you	may	ask	the	Claims	Administrator	to	register	your	
appeal	by	calling	the	toll-free	number	on	your	Dental	ID	card.	
Level One Appeal
Your	appeal	will	be	reviewed	and	the	decision	made	by	someone	not	involved	in	the	initial	decision.	Appeals	involving	
medical	necessity	or	clinical	appropriateness	will	be	considered	by	a	health	care	professional.	
For	level	one	appeals,	CIGNA	will	respond	in	writing	with	a	decision	within	30	calendar	days	after	it	receives	an	appeal	
for	a	coverage	determination.	
30 • The Stanley Black & Decker Dental Plan



Level two Appeal
You	must	submit	your	second	level	of	appeal	in	writing	to	the	address	shown	on	the	level	one	denial	letter	within	
30	days	of	the	date	of	the	denial	letter.	
For	level	two	appeals	handled	by	Stanley	Black	&	Decker	(excluding	all	expedited/urgent	care	appeals),	you	should	
receive	a	letter	within	five	working	days	notifying	you	that	your	request	for	appeal	has	been	received.	For	pre-service	
and	concurrent	care	coverage	determinations,	the	review	will	be	completed,	and	you	will	be	notified	in	writing	of	the	
committee’s	decision,	within	15	calendar	days,	and	for	post-service	claims,	the	review	will	be	completed	within	30	
calendar	days.	If	the	appeal	is	denied,	the	decision	letter	will	include	the	specific	reason	or	reasons	for	the	adverse	
determination	and	reference	to	the	specific	Plan	provisions	on	which	the	benefit	determination	is	based.

notice of Benefit DeterminAtion on AppeAl
Every	notice	of	a	determination	on	appeal	will	be	provided	in	writing	or	electronically	and,	if	an	adverse	determination,	
will	include:	(1)	the	specific	reason	or	reasons	for	the	adverse	determination;	(2)	reference	to	the	specific	Plan	
provisions	on	which	the	determination	is	based;	(3)	a	statement	that	you	are	entitled	to	receive,	upon	request	and	free	
of	charge,	reasonable	access	to	and	copies	of	all	documents,	records,	and	other	relevant	information	as	defined	below;	
(4)	a	statement	describing	any	voluntary	appeal	procedures	offered	by	the	Plan	and	any	claimant’s	right	to	bring	an	
action	under	ERISA	Section	502(a);	(5)	upon	request	and	free	of	charge,	a	copy	of	any	internal	rule,	guideline,	protocol,	
or	other	similar	criterion	that	was	relied	upon	in	making	the	adverse	determination	regarding	your	appeal,	and	an	
explanation	of	the	scientific	or	clinical	judgment	for	a	determination	that	is	based	on	a	medical	necessity,	experimental	
treatment,	or	other	similar	exclusion	or	limit;	and	(6)	a	statement	that	you	or	your	Plan	may	have	other	voluntary	
alternative	dispute	resolution	options,	such	as	mediation,	and	that	one	way	to	find	out	what	may	be	available	is	to	
contact	your	local	U.S.	Department	of	Labor	office	and	your	state	insurance	regulatory	agency.	

relevAnt informAtion
Relevant	information	is	any	document,	record,	or	other	information	that	(a)	was	relied	upon	in	making	the	benefit	
determination;	(b)	was	submitted,	considered,	or	generated	in	the	course	of	making	the	benefit	determination,	without	
regard	to	whether	such	document,	record,	or	other	information	was	relied	upon	in	making	the	benefit	determination;	
(c)	demonstrates	compliance	with	the	administrative	processes	and	safeguards	required	by	federal	law	in	making	the	
benefit	determination;	or	(d)	constitutes	a	statement	of	policy	or	guidance	with	respect	to	the	Plan	concerning	the	
denied	treatment	option	or	benefit	for	the	claimant’s	diagnosis,	without	regard	to	whether	such	advice	or	statement	
was	relied	upon	in	making	the	benefit	determination.	

legAl Action
You	have	the	right	to	bring	a	civil	action	under	Section	502(a)	of	ERISA	if	you	are	not	satisfied	with	the	decision	on	
review.	In	most	instances,	you	may	not	initiate	legal	action	until	you	have	completed	the	level	one	and	level	two	appeal	
processes.	If	your	appeal	is	expedited,	there	is	no	need	to	complete	the	level	two	process	prior	to	bringing	legal	action.
                                                                        The Stanley Black & Decker Dental Plan        • 31




CooRDinaTion of BenefiTS
If	you	or	your	dependents	are	covered	under	The	Stanley	Black	&	Decker	Dental	Plan	and	another	dental	plan,	benefits	
payable	from	all	plans	are	coordinated	to	make	sure	there	is	no	duplicate	coverage.	All	of	the	plans	that	provide	
coverage	for	you	work	together	to	pay	benefits	up	to,	but	not	above,	the	level	of	benefits	available	in	The	Stanley	Black	
&	Decker	Dental	Plan.	Coverage	under	The	Stanley	Black	&	Decker	Dental	Plan	plus	another	benefit	plan	does	not	
guarantee	100%	total	reimbursement.
When	The	Stanley	Black	&	Decker	Dental	Plan	is	the	primary	plan,	benefits	are	paid	without	regard	to	any	other	plans.	
You	are	responsible	for	coordinating	any	benefits	by	submitting	the	Explanation	of	Benefits	and	an	itemized	bill	to	the	
secondary	plan.
The	following	example	shows	how	benefits	might	be	coordinated	when	the	Stanley	Black	&	Decker	Dental	Plan	is	the	
secondary	plan.	Assume	your	annual	deductible	has	already	been	met.


  Amount	charged	                                                                                              $105.00

  Amount	The	Stanley	Black	&	Decker	Dental	Plan	would	have	paid	as	primary	payer	(90%)	                        			$94.50

  Amount	paid	by	primary	carrier	(80%)	                                                                        –$84.00

  Amount	remaining,	to	be	paid	by	The	Stanley	Black	&	Decker	Dental	Plan	                                      			$21.00


DeTeRmining WhiCh Plan PayS fiRST
Stanley	Black	&	Decker	uses	the	following	guidelines	for	determining	whether	The	Stanley	Black	&	Decker	Dental	Plan	is	
the	primary	or	secondary	payer	for	associates	and	dependents.
AssociAtes
The	plan	that	covers	you	as	an	associate	pays	first	and	is	primary.	The	Plan	that	covers	you	as	a	dependent	pays	
second.
Your spouse, sAme-sex, or opposite-sex Domestic pArtner
The	Plan	that	covers	your	spouse	or	domestic	partner	as	an	employee	is	the	primary	payer	for	his	or	her	claims.	
If	you	have	elected	coverage	for	your	spouse,	same-sex,	or	opposite-sex	domestic	partner	as	a	dependent	and	your	
spouse	or	domestic	partner	has	coverage	through	another	employer,	The	Stanley	Black	&	Decker	Dental	Plan	is	the	
secondary	payer.	
Your DepenDent chilDren
Usually,	the	plan	of	the	parent	whose	birthday	occurs	first	in	the	calendar	year	is	the	primary	payer.	If	your	spouse’s	
plan	does	not	follow	this	“birthday	rule,”	then	the	“gender	rule”	applies.	That	is,	the	plan	covering	the	child’s	father	as	
an	employee	pays	first.
In	the	case	of	divorced	or	separated	parents,	benefits	are	determined	in	the	following	order:
   T
1.		 he	plan	of	the	parent	who	has	financial	responsibility	by	court	decree	
   T
2.		 he	plan	of	the	stepparent	who	is	the	spouse	of	the	parent	who	has	custody	of	the	child	
   T
3.		 he	plan	of	the	parent	who	does	not	have	custody	of	the	child
When	none	of	the	above	rules	establish	order,	benefits	are	paid	first	by	the	plan	that	has	covered	the	claimant	for	the	
longer	period	of	time,	except	that	a	plan	that	covers	a	terminated	or	retired	associate	is	secondary	after	a	plan	that	
covers	a	person	as	an	active	associate.
32 • The Stanley Black & Decker Dental Plan



ReleaSing anD oBTaining infoRmaTion
The	Plan	reserves	the	right	to	release	to,	or	obtain	from,	any	other	insurance	company	or	other	organization	or	person,	
any	information	that,	in	its	opinion,	it	needs	for	the	purpose	of	coordination	of	benefits.
                                                                       The Stanley Black & Decker Dental Plan       • 33




ConTinuing DenTal BenefiTS
afTeR Plan CoveRage enDS
ConTinuing CoveRage ThRough CoBRa
A	federal	law	called	the	Consolidated	Omnibus	Budget	Reconciliation	Act	(COBRA)	enables	you	or	your	dependent	to	
continue	health	coverage	if	coverage	ceases	due	to	a	reduction	of	your	work	hours	or	your	termination	of	employment.	
Federal	law	also	enables	your	dependents	to	continue	health	insurance	if	their	coverage	stops	due	to	your	death	or	
entitlement	to	Medicare,	divorce,	or	legal	separation,	or	when	your	child	no	longer	qualifies	as	an	eligible	dependent.	
You	must	elect	coverage	according	to	the	rules	of	The	Stanley	Black	&	Decker	Dental	Plan.	Continuation	is	subject	to	
federal	law,	regulations,	and	interpretations.
In	accordance	with	COBRA,	you	and	your	family	have	some	important	rights	concerning	the	continuation	of	your	group	
dental	benefits,	if	that	coverage	ceases.	For	COBRA	questions	or	enrollment,	contact	Stanley	Black	&	Decker’s	COBRA	
Administrator	CONEXIS	at	1-877-722-2667.
Although	COBRA	does	not	apply	to	domestic	partners,	The	Stanley	Black	&	Decker	Dental	Plan	extends	continuation	
coverage	that	mirrors	COBRA	coverage	to	domestic	partners.	For	simplicity,	these	continuation	rights	are	referred	to	as	
“COBRA”	throughout	this	section.

Who iS eligiBle foR CoBRa
l  A
 			 	covered	associate	who	loses	coverage	due	to	termination	or	reduction	in	work	hours.	Termination	includes	
   voluntary	and	involuntary	terminations,	layoff,	and	lack	of	work	due	to	plant	closure.	
l  T
 			 he	spouse	or	domestic	partner	and/or	dependent	children	of	a	covered	associate	(including	children	of	your	same-
   sex	or	opposite-sex	domestic	partner)	who	are	covered	under	the	Plan	and	who	lose	coverage	as	a	result	of	any	of	
   the	following	qualifying	events:
    —	The	death	of	a	covered	associate,	
      T
    —		 he	reduction	in	work	hours	or	termination	of	a	covered	associate,	
      T
    —		 he	divorce	or	legal	separation	of	the	covered	associate	from	his	or	her	spouse,	or	the	end	of	a	domestic	partner	
      relationship	(you	are	no	longer	living	together	in	a	committed	relationship),
    —	A	dependent	ceasing	to	qualify	as	a	“dependent	child”	under	the	terms	of	the	Plan,	or	
    —	The	covered	associate	becoming	entitled	to	Medicare	benefits.
If	a	covered	associate	elects	COBRA	coverage	and	then	has	a	child,	by	birth	or	adoption,	the	new	child	is	eligible	for	
continuation	coverage.
34 • The Stanley Black & Decker Dental Plan



hoW To ConTinue CoveRage ThRough CoBRa
If	you	lose	Stanley	Black	&	Decker	health	care	coverage	because	your	employment	status	changes,	you	will	
automatically	receive	more	information	about	COBRA	coverage.	If	you	die,	or	your	employment	status	changes,	
your	spouse	or	domestic	partner	and/or	dependents	will	automatically	receive	information	about	the	right	to	elect	
COBRA	coverage.	
If	your	spouse	or	domestic	partner	and/or	dependents	lose	coverage	as	a	result	of	divorce,	legal	separation,	
or	the	ineligibility	of	a	dependent	child,	you	or	a	family	member	must	notify	The	Stanley	Black	&	Decker	Benefits	
Center.	(Initiate	a	life	event	change	online	at	www.benefitsenrollment.stanleyblackanddecker.com	or	call	
1-800-795-3899.)	In	order	to	have	a	right	to	elect	COBRA	coverage,	notification	must	be	made	within	60	days	from	
the	latest	of:	the	date	of	the	divorce,	legal	separation,	end	of	a	domestic	partner	relationship,	or	loss	of	dependent	
status;	the	date	coverage	is	lost	because	of	the	event;	or	the	date	on	which	you	were	informed	of	the	responsibility	to	
provide	notice	and	Stanley	Black	&	Decker’s	procedures	for	providing	notice.	The	notification	must	include	information	
about	the	associate,	spouse,	or	dependent	requesting	COBRA	coverage	and	the	event	that	gave	rise	to	the	individual’s	
eligibility	for	COBRA	coverage.	
Each	eligible	person	may	make	an	independent	election.	For	example,	your	spouse	or	dependent	child	is	entitled	
to	elect	COBRA	continuation	even	if	you	do	not	make	that	election.	However,	you	or	your	spouse	can	elect	COBRA	
coverage	on	behalf	of	other	eligible	family	members,	and	a	parent	or	legal	guardian	may	elect	COBRA	coverage	on	
behalf	of	a	minor	child.	
Once	you	elect	COBRA	coverage,	you	cannot	change	your	COBRA	elections	except	during	Annual	Benefits	Enrollment	
or	if	you	have	a	child,	get	married,	or	enter	into	a	domestic	partner	relationship,	or	if	your	spouse	or	domestic	partner	
loses	eligibility	for	another	employer’s	plan.	Note:	If	you	drop	a	dependent	during	Annual	Benefits	Enrollment,	it	is	not	
considered	a	COBRA	event.	
If	you	elect	COBRA	coverage	and	then	have	a	child,	by	birth	or	adoption,	the	new	child	can	be	added	to	COBRA	
coverage	by	notifying	CONEXIS,	Stanley	Black	&	Decker’s	COBRA	Administrator,	of	the	new	child’s	birth,	adoption,	or	
placement	for	adoption	within	31	days	after	the	event.	If	you	add	your	new	child	to	COBRA	coverage,	you	may	also	add	
your	spouse	to	your	COBRA	coverage.
Similarly,	if	you	elect	COBRA	coverage	and	then	get	married	or	enter	into	a	domestic	partner	relationship,	your	spouse	
or	domestic	partner	and	any	new	stepchildren	can	be	added	to	COBRA	coverage	by	notifying	CONEXIS,	the	COBRA	
administrator.	

hoW long CoBRa CoveRage may laST
COBRA	coverage	begins	on	the	date	of	the	qualifying	event	and	ends	upon	the	earliest	of	the	following:	
l  	
   1
 			 8	months	in	the	case	of	termination	of	employment,	layoff,	reduction	of	hours,	or	workforce	reduction,	
l  	
   3
 			 6	months	in	the	event	of	legal	separation,	divorce,	end	of	a	domestic	partner	relationship,	or	death	of	the	
   associate,	
l  	
   3
 			 6	months	in	the	event	of	all	other	qualifying	events,	
l  	
   F
 			 ailure	to	pay	any	required	premium	when	due*,	
l  	
   T
 			 he	date	you,	under	the	COBRA	continuation	program,	become	eligible	to	be	covered	under	another	group	plan	or	
   Medicare,	or	
l  	
   T
 			 he	date	that	Stanley	Black	&	Decker	no	longer	provides	a	group	dental	plan	to	any	of	its	associates.	
*If your COBRA coverage is cancelled due to untimely or non-payment of premium, coverage is cancelled retroactively and cannot be reinstated.
                                                                      The Stanley Black & Decker Dental Plan        • 35



The	following	table	summarizes	COBRA	benefits	under	The	Stanley	Black	&	Decker	Dental	Plan:	

                                   gETTing                      who Can                   how long CovEragE
  ThE SiTuaTion                    inFOrMAtiOn                  BE CovErED                Can laST
  Your	employment	with	            It	will	be	sent	to	you	      You	and	your	             18	months	
  Stanley	Black	&	Decker	is	       automatically		              covered	dependents	
  terminated		
  There	is	a	reduction	in	your	    It	will	be	sent	to	you	      You	and	your	             18	months	
  work	hours	to	the	point	         automatically		              covered	dependents	
  where	you	no	longer	qualify	
  for	benefits	coverage		
  You	die		                        It	will	be	sent	to	your	     Your	covered	             36	months	
                                   covered	dependents	          dependents		
                                   automatically		
  You	become	divorced	             You	must	notify	The	         Your	spouse/domestic	     36	months	
  or	legally	separated	or	your	    Stanley	Black	&	Decker	      partner	(provided	your	
  domestic	partnership	ends		      Benefits	Center	(online	     spouse/domestic	
                                   or	by	phone)	within	         partner	was	covered	
                                   60	days	of	your	divorce	     under	the	Plan	prior	
                                   or	separation		              to	your	divorce,	legal	
                                                                separation	or	the	
                                                                end	of	your	domestic	
                                                                partnership)			
  You	become	entitled	             If	you	enroll	in	Medicare	 You	and	your	               You—18	months	from	your	
  to	Medicare		                    before	your	employment	 covered	dependents		           termination	of	employment	
                                   ends,	it	will	be	sent	to	                              (although	Medicare	is	primary	
                                   you	automatically	when	                                payor)
                                   your	employment	ends
                                                                                          Your	covered	dependents—
                                                                                          the	longer	of	36	months	from	
                                                                                          the	date	of	your	Medicare	
                                                                                          eligibility	or	18	months	
                                                                                          from	your	termination	of	
                                                                                          employment

  Your	covered	dependent	          It	will	be	sent	to	you	      Your	covered	             36	months	
  reaches	age	26		                 automatically		              dependent		
  Your	covered	child	loses	        You	must	notify	The	         Your	covered	child		      36	months
  eligibility	status		             Stanley	Black	&	Decker	
                                   Benefits	Center	(online	
                                   or	by	phone)	within	
                                   60	days	of	loss		

If	one	of	the	36-month	qualifying	events	listed	above,	with	the	exception	of	becoming	eligible	for	Medicare,	
occurs	while	your	spouse/domestic	partner	and/or	dependent	is	covered	under	COBRA	(due	to	your	termination	of	
employment	or	reduction	in	hours),	then	COBRA	coverage	may	be	extended	for	up	to	36	months	from	the	date	of	the	
first	COBRA	event.	If	you	become	eligible	for	Medicare	while	your	spouse	and	dependents	are	covered	by	COBRA,	they	
will	not	be	able	to	extend	COBRA	coverage.	To	be	eligible	to	extend	the	COBRA	coverage	period	from	18	months	to	
36	months,	you	or	a	family	member	must	notify	the	COBRA	Administrator,	CONEXIS,	within	60	days	from	the	latest	of	
the	date	of	the	second	qualifying	event,	or	the	date	on	which	the	qualified	beneficiary	is	informed	of	the	responsibility	
to	provide	the	notice.	
36 • The Stanley Black & Decker Dental Plan



If	you	or	your	covered	dependent	elect	COBRA	coverage	under	the	circumstances	identified	in	the	COBRA	section	
on	the	previous	page,	and	one	of	you	is	deemed	disabled	under	the	federal	Social	Security	Act	before,	on,	or	within	
60	days	of	the	date	the	COBRA	coverage	became	effective,	you	and	your	covered	dependents	may	be	eligible	for	up	
to	an	additional	11	months	of	COBRA	coverage,	for	a	total	of	29	months	of	COBRA	coverage. You will be charged
the Plan’s full cost of providing continued coverage, plus an additional 50% administrative fee.	You	must	
notify	CONEXIS	within	60	days	of	the	date	of	the	Social	Security	disability	determination	and	before	the	end	of	the	
initial	18-month	COBRA	period.	You	must	also	notify	CONEXIS	within	30	days	if	the	Social	Security	Administration	
determines	that	you	or	your	dependent	are	no	longer	disabled.	If	the	individual	entitled	to	the	disability	extension	has	
non-disabled	family	members	who	have	COBRA	coverage	due	to	the	same	qualifying	event,	those	non-disabled	family	
members	will	also	be	entitled	to	this	11-month	disability	extension.	If	a	child	is	born	to	or	placed	for	adoption	with	
you	while	you	are	continuing	coverage	and	the	child	is	determined	to	be	disabled	within	the	first	60	days	of	COBRA	
coverage,	the	child	and	all	family	members	with	continuation	coverage	arising	from	the	same	qualifying	event	may	be	
eligible	for	a	total	of	up	to	29	months	of	continuation	coverage.	
Continuation	for	up	to	24	months	and	reinstatement	rights	may	also	be	available	if	you	are	absent	from	employment	
due	to	service	in	the	uniformed	services	pursuant	to	the	Uniform	Services	Employment	and	Reemployment	Rights	
Act	of	1994	(USERRA).	More	information	about	coverage	under	USERRA	is	available	from	your	Human	Resources	
representative.	
Note:	Once	COBRA	coverage	ends,	there	is	no	conversion	coverage	option	available.

ApplYing for coBrA coverAge
You	must	apply	for	COBRA	coverage	within	60	days	from	the	date	your	Stanley	Black	&	Decker	dental	coverage	
terminates	or	the	date	of	notification,	whichever	is	later.	Your	initial	premium	payment(s)	must	be	USPS	postmarked	
no	later	than	45	days	from	the	postmark	date	of	your	election	and	received	by	CONEXIS.	Your	initial	payment	must	
include	all	premiums	back	to	the	date	you	would	have	lost	Plan	coverage.	You will be charged the Plan’s full cost
of providing continued coverage, plus an additional 2% administrative fee.	If	you	want	to	continue	coverage	
through	COBRA,	please	contact	the	number	indicated	on	your	notification	letter	or	visit	https://mybenefits.
ConExiS.com.	You	must	notify	CONEXIS	within	60	days	from:	the	latest	of	the	date	of	the	divorce,	legal	separation,	
end	of	domestic	partnership,	or	loss	of	dependent	status;	the	date	coverage	is	lost	because	of	the	event;	or	the	
date	on	which	you	were	informed	of	the	responsibility	to	provide	notice	and	Stanley	Black	&	Decker’s	procedures	for	
providing	notice.
Remember:	Make	sure	you	apply	for	continuation	of	coverage	under	COBRA	within	60	days	after	you	receive	your	
COBRA	notification	and	enrollment	information.	Once	you	have	your	initial	premium	payment,	subsequent	payments	
are	due	on	the	first	of	the	month	and	will	be	returned	if	not	USPS	postmarked	within	30	days	of	the	due	date.
If	you	have	any	questions	about	COBRA	coverage	or	the	application	of	the	law,	contact	the	COBRA	Administrator,	
CONEXIS,	at	the	address	listed	below.	
All	notices	and	other	communications	regarding	COBRA	coverage	and	the	Stanley	Black	&	Decker	sponsored	group	
health	Plan	should	be	directed	to	CONEXIS.	If	you	have	to	report	any	changes	or	qualified	life	events	once	you	are	on	
COBRA	coverage,	contact	CONEXIS	at:
  CONEXIS
  P.O.	Box	226101
  Dallas,	TX	75222-6101
  1-877-722-2667
  www.CONEXIS.com
                                                                         The Stanley Black & Decker Dental Plan         • 37




oTheR Plan infoRmaTion
hiPaa PRivaCy noTiCe
The	Health	Insurance	Portability	and	Accountability	Act	of	1996	(HIPAA)	imposes	numerous	requirements	on	the	use	
and	disclosure	of	individual	health	information	by	Stanley	Black	&	Decker	health	plans.	This	information,	known	as	
protected	health	information,	includes	almost	all	individually	identifiable	health	information	held	by	a	plan—whether	
received	in	writing,	in	an	electronic	medium,	or	as	an	oral	communication.	The	plans	covered	by	this	notice	may	
share	health	information	with	each	other	to	carry	out	treatment,	payment,	or	health	care	operations.	These	plans	are	
collectively	referred	to	as	the	Plan	in	this	notice,	unless	specified	otherwise.

the plAn’s Duties With respect to heAlth informAtion ABout You
The	Plan	is	required	by	law	to	maintain	the	privacy	of	your	health	information	and	to	provide	you	with	this	notice	of	
the	Plan’s	legal	duties	and	privacy	practices	with	respect	to	your	health	information.	If	you	participate	in	an	insured	
Plan	option,	you	will	receive	a	notice	directly	from	the	Insurer.	It’s	important	to	note	that	these	rules	apply	to	the	Plan,	
not	Stanley Black & Decker	as	an	employer—that’s	the	way	the	HIPAA	rules	work.	Different	policies	may	apply	to	other	
Stanley	Black	&	Decker	programs	or	to	data	unrelated	to	the	Plan.

hoW the plAn mAY use or Disclose Your heAlth informAtion
The	privacy	rules	generally	allow	the	use	and	disclosure	of	your	health	information	without	your	permission	(known	as	
an	authorization)	for	purposes	of	health	care	treatment,	payment	activities,	and	health	care	operations.	Here	are	some	
examples	of	what	that	might	entail:
l   treatment	includes	providing,	coordinating,	or	managing	health	care	by	one	or	more	health	care	providers	or	
    doctors.	Treatment	can	also	include	coordination	or	management	of	care	between	a	provider	and	a	third	party,	
    and	consultation	and	referrals	between	providers.	For example, the Plan may share your health information with
    physicians who are treating you.
l   Payment	includes	activities	by	this	Plan,	other	plans,	or	providers	to	obtain	premiums,	make	coverage	
    determinations,	and	provide	reimbursement	for	health	care.	This	can	include	eligibility	determinations,	reviewing	
    services	for	medical	necessity	or	appropriateness,	utilization	management	activities,	claims	management,	and	
    billing;	as	well	as	“behind	the	scenes”	Plan	functions	such	as	risk	adjustment,	collection,	or	reinsurance.	For
    example, the Plan may share information about your coverage or the expenses you have incurred with another health
    plan in order to coordinate payment of benefits.
l   health care operations	include	activities	by	this	Plan	(and	in	limited	circumstances	other	plans	or	providers)	
    such	as	wellness	and	risk	assessment	programs,	quality	assessment	and	improvement	activities,	customer	service,	
    and	internal	grievance	resolution.	Health	care	operations	also	include	vendor	evaluations,	credentialing,	training,	
    accreditation	activities,	underwriting,	premium	rating,	arranging	for	medical	review	and	audit	activities,	and	business	
    planning	and	development.	For example, the Plan may use information about your claims to audit the third parties
    that approve payment for Plan benefits.
The	amount	of	health	information	used,	disclosed	or	requested	will	be	limited	and,	when	needed,	restricted	to	the	
minimum	necessary	to	accomplish	the	intended	purposes,	as	defined	under	the	HIPAA	rules.	If	the	Plan	uses	or	
discloses	PHI	for	underwriting	purposes,	the	Plan	will	not	use	or	disclose	PHI	that	is	your	genetic	information	for	such	
purposes.	The	Plan	may	contact	you	to	provide	appointment	reminders	or	information	about	treatment	alternatives	or	
other	health-related	benefits	and	services	that	may	be	of	interest	to	you,	as	permitted	by	law.
38 • The Stanley Black & Decker Dental Plan



hoW the plAn mAY shAre Your heAlth informAtion With stAnleY BlAck & Decker
The	Plan,	or	its	health	insurer	or	HMO,	may	disclose	your	health	information	without	your	written	authorization	to	
Stanley	Black	&	Decker	for	Plan	administration	purposes.	Stanley	Black	&	Decker	may	need	your	health	information	to	
administer	benefits	under	the	Plan.	Stanley	Black	&	Decker	agrees	not	to	use	or	disclose	your	health	information	other	
than	as	permitted	or	required	by	the	Plan	documents	and	by	law.	Benefits	and	HR	staff	are	the	only	Stanley	Black	&	
Decker	employees	who	will	have	access	to	your	health	information	for	Plan	administration	functions.
Here’s	how	additional	information	may	be	shared	between	the	Plan	and	Stanley	Black	&	Decker,	as	allowed	under	the	
HIPAA	rules:
l  T
 			 he	Plan,	or	its	insurer	or	HMO,	may	disclose	“summary	health	information”	to	Stanley	Black	&	Decker,	if	requested,	
   for	purposes	of	obtaining	premium	bids	to	provide	coverage	under	the	Plan,	or	for	modifying,	amending,	or	
   terminating	the	Plan.	Summary	health	information	is	information	that	summarizes	participants’	claims	information,	
   from	which	names	and	other	identifying	information	have	been	removed.
l  T
 			 he	Plan,	or	its	insurer	or	HMO,	may	disclose	to	Stanley	Black	&	Decker	information	on	whether	an	individual	is	
   participating	in	the	Plan	or	has	enrolled	or	disenrolled	in	an	insurance	option	or	HMO	offered	by	the	Plan.
In	addition,	you	should	know	that	Stanley	Black	&	Decker	cannot	and	will	not	use	health	information	obtained	from	
the	Plan	for	any	employment-related	actions.	However,	health	information	collected	by	Stanley	Black	&	Decker	from	
other	sources,	for	example	under	the	Family	and	Medical	Leave	Act,	Americans	with	Disabilities	Act,	or	Workers’	
Compensation	is	not	protected	under	HIPAA	(although	this	type	of	information	may	be	protected	under	other	federal	
or	state	laws).

other AlloWABle uses or Disclosures of Your heAlth informAtion
In	certain	cases,	your	health	information	can	be	disclosed	without	authorization	to	a	family	member,	close	friend,	
or	other	person	you	identify	who	is	involved	in	your	care	or	payment	for	your	care.	Information	about	your	location,	
general	condition,	or	death	may	be	provided	to	a	similar	person	(or	to	a	public	or	private	entity	authorized	to	assist	in	
disaster	relief	efforts).	You’ll	generally	be	given	the	chance	to	agree	or	object	to	these	disclosures	(although	exceptions	
may	be	made—for	example,	if	you’re	not	present	or	if	you’re	incapacitated).	In	addition,	your	health	information	may	
be	disclosed	without	authorization	to	your	legal	representative.
                                                                       The Stanley Black & Decker Dental Plan        • 39



The	Plan	is	allowed	to	use	or	disclose	your	health	information	without	your	written	authorization	for	these	activities:

  Workers’                 Disclosures	to	Workers’	Compensation	or	similar	legal	programs	that	provide	benefits	for	
  Compensation             work-related	injuries	or	illness	without	regard	to	fault,	as	authorized	by	and	necessary	to	
                           comply	with	the	laws
  necessary to             Disclosures	made	in	the	good-faith	belief	that	releasing	your	health	information	is	necessary	
  prevent serious          to	prevent	or	lessen	a	serious	and	imminent	threat	to	public	or	personal	health	or	safety,	
  threat to health         if	made	to	someone	reasonably	able	to	prevent	or	lessen	the	threat	(or	to	the	target	of	
  or safety                the	threat);	includes	disclosures	to	help	law	enforcement	officials	identify	or	apprehend	
                           an	individual	who	has	admitted	participation	in	a	violent	crime	that	the	Plan	reasonably	
                           believes	may	have	caused	serious	physical	harm	to	a	victim,	or	where	it	appears	the	
                           individual	has	escaped	from	prison	or	from	lawful	custody
  Public health            Disclosures	authorized	by	law	to	persons	who	may	be	at	risk	of	contracting	or	spreading	a	
  activities               disease	or	condition;	disclosures	to	public	health	authorities	to	prevent	or	control	disease	
                           or	report	child	abuse	or	neglect;	and	disclosures	to	the	Food	and	Drug	Administration	to	
                           collect	or	report	adverse	events	or	product	defects
  victims of abuse,        Disclosures	to	government	authorities,	including	social	services	or	protected	services	
  neglect, or              agencies	authorized	by	law	to	receive	reports	of	abuse,	neglect,	or	domestic	violence,	as	
  domestic violence        required	by	law	or	if	you	agree	or	the	Plan	believes	that	disclosure	is	necessary	to	prevent	
                           serious	harm	to	you	or	potential	victims	(you’ll	be	notified	of	the	Plan’s	disclosure	if	
                           informing	you	won’t	put	you	at	further	risk)
  Judicial and             Disclosures	in	response	to	a	court	or	administrative	order,	subpoena,	discovery	request,	
  administrative           or	other	lawful	process	(the	Plan	may	be	required	to	notify	you	of	the	request	or	receive	
  proceedings              satisfactory	assurance	from	the	party	seeking	your	health	information	that	efforts	were	
                           made	to	notify	you	or	to	obtain	a	qualified	protective	order	concerning	the	information)
  Law enforcement          Disclosures	to	law	enforcement	officials	required	by	law	or	legal	process,	or	to	identify	a	
  purposes                 suspect,	fugitive,	witness,	or	missing	person;	disclosures	about	a	crime	victim	if	you	agree,	
                           or	if	disclosure	is	necessary	for	immediate	law	enforcement	activity;	disclosure	about	a	
                           death	that	may	have	resulted	from	criminal	conduct;	and	disclosure	to	provide	evidence	of	
                           criminal	conduct	on	the	Plan’s	premises
  Decedents                Disclosures	to	a	coroner	or	medical	examiner	to	identify	the	deceased	or	determine	cause	
                           of	death;	and	to	funeral	directors	to	carry	out	their	duties
  Organ, eye, or           Disclosures	to	organ	procurement	organizations	or	other	entities	to	facilitate	organ,	eye,	
  tissue donation          or	tissue	donation	and	transplantation	after	death
  research purposes        Disclosures	subject	to	approval	by	institutional	or	private	privacy	review	boards,	subject	to	
                           certain	assurances	and	representations	by	researchers	about	the	necessity	of	using	your	
                           health	information	and	the	treatment	of	the	information	during	a	research	project
  health oversight         Disclosures	to	health	agencies	for	activities	authorized	by	law	(audits,	inspections,	
  activities               investigations,	or	licensing	actions)	for	oversight	of	the	health	care	system,	government	
                           benefits	programs	for	which	health	information	is	relevant	to	beneficiary	eligibility,	and	
                           compliance	with	regulatory	programs	or	civil	rights	laws
  specialized              Disclosures	about	individuals	who	are	Armed	Forces	personnel	or	foreign	military	personnel	
  government               under	appropriate	military	command;	disclosures	to	authorized	federal	officials	for	national	
  functions                security	or	intelligence	activities;	and	disclosures	to	correctional	facilities	or	custodial	law	
                           enforcement	officials	about	inmates
  hhs investigations       Disclosures	of	your	health	information	to	the	Department	of	Health	and	Human	Services	to	
                           investigate	or	determine	the	Plan’s	compliance	with	the	HIPAA	privacy	rule
40 • The Stanley Black & Decker Dental Plan



Except	as	described	in	this	notice,	other	uses	and	disclosures	will	be	made	only	with	your	written	authorization.	You	
may	revoke	your	authorization	as	allowed	under	the	HIPAA	rules.	However,	you	can’t	revoke	your	authorization	with	
respect	to	disclosures	the	Plan	has	already	made.	You	will	be	notified	of	any	unauthorized	access,	use	or	disclosure	of	
your	unsecured	health	information	as	required	by	law.

Your inDiviDuAl rights
You	have	the	following	rights	with	respect	to	your	health	information	the	Plan	maintains.	These	rights	are	subject	to	
certain	limitations,	as	discussed	below.	This	section	of	the	notice	describes	how	you	may	exercise	each	individual	right.
right to request restrictions on certain uses and disclosures of your health information and the Plan’s right
to refuse
You	have	the	right	to	ask	the	Plan	to	restrict	the	use	and	disclosure	of	your	health	information	for	treatment,	payment,	
or	health	care	operations,	except	for	uses	or	disclosures	required	by	law.	You	have	the	right	to	ask	the	Plan	to	restrict	
the	use	and	disclosure	of	your	health	information	to	family	members,	close	friends,	or	other	persons	you	identify	
as	being	involved	in	your	care	or	payment	for	your	care.	You	also	have	the	right	to	ask	the	Plan	to	restrict	use	and	
disclosure	of	health	information	to	notify	those	persons	of	your	location,	general	condition,	or	death—or	to	coordinate	
those	efforts	with	entities	assisting	in	disaster	relief	efforts.	If	you	want	to	exercise	this	right,	your	request	to	the	Plan	
must	be	in	writing.
The	Plan	is	not	required	to	agree	to	a	requested	restriction.	If	the	Plan	does	agree,	a	restriction	may	later	be	terminated	
by	your	written	request,	by	agreement	between	you	and	the	Plan	(including	an	oral	agreement),	or	unilaterally	by	the	
Plan	for	health	information	created	or	received	after	you’re	notified	that	the	Plan	has	removed	the	restrictions.	The	
Plan	may	also	disclose	health	information	about	you	if	you	need	emergency	treatment,	even	if	the	Plan	has	agreed	to	a	
restriction.
Effective	February	17,	2010,	an	entity	covered	by	these	HIPAA	rules	(such	as	your	health	care	provider)	or	its	business	
associate	must	comply	with	your	request	that	health	information	regarding	a	specific	health	care	item	or	service	not	be	
disclosed	to	the	Plan	for	purposes	of	payment	or	health	care	operations	if	you	have	paid	for	the	item	or	service,	in	full	
out-of-pocket.
right to receive confidential communications of your health information
If	you	think	that	disclosure	of	your	health	information	by	the	usual	means	could	endanger	you	in	some	way,	the	Plan	
will	accommodate	reasonable	requests	to	receive	communications	of	health	information	from	the	Plan	by	alternative	
means	or	at	alternative	locations.
If	you	want	to	exercise	this	right,	your	request	to	the	Plan	must	be	in	writing	and	you	must	include	a	statement	that	
disclosure	of	all	or	part	of	the	information	could	endanger	you.
                                                                        The Stanley Black & Decker Dental Plan        • 41



right to inspect and copy your health information
With	certain	exceptions,	you	have	the	right	to	inspect	or	obtain	a	copy	of	your	health	information	in	a	“designated	
record	set.”	This	may	include	medical	and	billing	records	maintained	for	a	health	care	provider;	enrollment,	payment,	
claims	adjudication,	and	case	or	medical	management	record	systems	maintained	by	a	plan;	or	a	group	of	records	
the	Plan	uses	to	make	decisions	about	individuals.	However,	you	do	not	have	a	right	to	inspect	or	obtain	copies	of	
psychotherapy	notes	or	information	compiled	for	civil,	criminal,	or	administrative	proceedings.	The	Plan	may	deny	your	
right	to	access,	although	in	certain	circumstances	you	may	request	a	review	of	the	denial.
If	you	want	to	exercise	this	right,	your	request	to	the	Plan	must	be	in	writing.	Within	30	days	of	receipt	of	your	request	
(60	days	if	the	health	information	is	not	accessible	onsite),	the	Plan	will	provide	you	with:
l  T
 			 he	access	or	copies	you	requested;
l  A
 			 	written	denial	that	explains	why	your	request	was	denied	and	any	rights	you	may	have	to	have	the	denial	reviewed	
   or	file	a	complaint;	or
l  A
 			 	written	statement	that	the	time	period	for	reviewing	your	request	will	be	extended	for	no	more	than	30	more	days,	
   along	with	the	reasons	for	the	delay	and	the	date	by	which	the	Plan	expects	to	address	your	request.
The	Plan	may	provide	you	with	a	summary	or	explanation	of	the	information	instead	of	access	to	or	copies	of	your	
health	information,	if	you	agree	in	advance	and	pay	any	applicable	fees.	The	Plan	also	may	charge	reasonable	fees	for	
copies	or	postage.	If	the	Plan	doesn’t	maintain	the	health	information	but	knows	where	it	is	maintained,	you	will	be	
informed	of	where	to	direct	your	request.	
Effective	February	17,	2010,	you	may	request	an	electronic	copy	of	your	health	information	if	it	is	maintained	in	an	
Electronic	Health	Record.	You	may	also	request	that	such	electronic	health	information	be	sent	to	another	entity	or	
person,	so	long	as	that	request	is	clear,	conspicuous	and	specific.	Any	charge	that	is	assessed	to	you	for	these	copies,	
if	any,	must	be	reasonable	and	based	on	the	Plan’s	cost.
right to amend your health information that is inaccurate or incomplete
With	certain	exceptions,	you	have	a	right	to	request	that	the	Plan	amend	your	health	information	in	a	designated	
record	set.	The	Plan	may	deny	your	request	for	a	number	of	reasons.	For	example,	your	request	may	be	denied	if	the	
health	information	is	accurate	and	complete,	was	not	created	by	the	Plan	(unless	the	person	or	entity	that	created	
the	information	is	no	longer	available),	is	not	part	of	the	designated	record	set,	or	is	not	available	for	inspection	
(e.g.,	psychotherapy	notes	or	information	compiled	for	civil,	criminal,	or	administrative	proceedings).	
If	you	want	to	exercise	this	right,	your	request	to	the	Plan	must	be	in	writing,	and	you	must	include	a	statement	to	
support	the	requested	amendment.	Within	60	days	of	receipt	of	your	request,	the	Plan	will:
l  M
 			 ake	the	amendment	as	requested;
l  P
 			 rovide	a	written	denial	that	explains	why	your	request	was	denied	and	any	rights	you	may	have	to	disagree	or	file	a	
   complaint;	or
l  P
 			 rovide	a	written	statement	that	the	time	period	for	reviewing	your	request	will	be	extended	for	no	more	than	30	
   more	days,	along	with	the	reasons	for	the	delay	and	the	date	by	which	the	Plan	expects	to	address	your	request.
42 • The Stanley Black & Decker Dental Plan



right to receive an accounting of disclosures of your health information
You	have	the	right	to	a	list	of	certain	disclosures	of	your	health	information	the	Plan	has	made.	This	is	often	referred	
to	as	an	“accounting	of	disclosures.”	You	generally	may	receive	this	accounting	if	the	disclosure	is	required	by	law,	in	
connection	with	public	health	activities,	or	in	similar	situations	listed	in	the	table	earlier	in	this	notice,	unless	otherwise	
indicated	below.	
You	may	receive	information	on	disclosures	of	your	health	information	for	up	to	six	years	before	the	date	of	your	
request.	You	do	not	have	a	right	to	receive	an	accounting	of	any	disclosures	made:
l  F
 			 or	treatment,	payment,	or	health	care	operations;
l  T
 			 o	you	about	your	own	health	information;
l  I
 			ncidental	to	other	permitted	or	required	disclosures;
l  W
 			 here	authorization	was	provided;
l  T
 			 o	family	members	or	friends	involved	in	your	care	(where	disclosure	is	permitted	without	authorization);
l  F
 			 or	national	security	or	intelligence	purposes	or	to	correctional	institutions	or	law	enforcement	officials	in	certain	
   circumstances;	or
l  A
 			 s	part	of	a	“limited	data	set”	(health	information	that	excludes	certain	identifying	information).
In	addition,	your	right	to	an	accounting	of	disclosures	to	a	health	oversight	agency	or	law	enforcement	official	may	be	
suspended	at	the	request	of	the	agency	or	official.
If	you	want	to	exercise	this	right,	your	request	to	the	Plan	must	be	in	writing.	Within	60	days	of	the	request,	the	Plan	
will	provide	you	with	the	list	of	disclosures	or	a	written	statement	that	the	time	period	for	providing	this	list	will	be	
extended	for	no	more	than	30	more	days,	along	with	the	reasons	for	the	delay	and	the	date	by	which	the	Plan	expects	
to	address	your	request.	You	may	make	one	request	in	any	12-month	period	at	no	cost	to	you,	but	the	Plan	may	charge	
a	fee	for	subsequent	requests.	You’ll	be	notified	of	the	fee	in	advance	and	have	the	opportunity	to	change	or	revoke	
your	request.
right to obtain a paper copy of this notice from the Plan upon request
You	have	the	right	to	obtain	a	paper	copy	of	this	privacy	notice	upon	request.	Even	individuals	who	agreed	to	receive	
this	notice	electronically	may	request	a	paper	copy	at	any	time.

chAnges to the informAtion in this notice
The	Plan	must	abide	by	the	terms	of	the	privacy	notice	currently	in	effect.	This	notice	went	into	effect	on	October	1,	
2010.	However,	the	Plan	reserves	the	right	to	change	the	terms	of	its	privacy	policies,	as	described	in	this	notice,	at	
any	time	and	to	make	new	provisions	effective	for	all	health	information	that	the	Plan	maintains.	This	includes	health	
information	that	was	previously	created	or	received,	not	just	health	information	created	or	received	after	the	policy	is	
changed.	If	changes	are	made	to	the	Plan’s	privacy	policies	described	in	this	notice,	you	will	be	provided	with	a	revised	
privacy	notice	via	mail	to	your	home.
                                                                       The Stanley Black & Decker Dental Plan        • 43



complAints
If	you	believe	your	privacy	rights	have	been	violated	or	your	Plan	has	not	followed	its	legal	obligations	under	HIPAA,	
you	may	complain	to	the	Plan	or	to	the	Federal	Office	of	Civil	Rights	(OCR)	within	the	Department	of	Health	and	Human	
Services.	You	won’t	be	retaliated	against	for	filing	a	complaint.	To	file	a	complaint	with	the	Plan,	contact	the	Privacy	
Officer	at	1-860-438-3421.	To	file	a	complaint	with	OCR,	go	to	www.hhs.gov/ocr/privacy/hipaa/complaints/
index.html or	contact	the	OCR	officer	in	the	region	where	you	live.

contAct
For	more	information	on	the	Plan’s	privacy	policies	or	your	rights	under	HIPAA,	contact	the	Privacy	Officer	at	
1-860-438-3421.

PRoCeDuReS goveRning QualifieD meDiCal ChilD SuPPoRT oRDeRS
A	Qualified	Medical	Child	Support	Order	(QMCSO)	is	a	court	order	requiring	a	parent	to	provide	health	care	benefits	to	
one	or	more	children.	Upon	the	Plan’s	receipt	of	any	Medical	Child	Support	Order,	the	Plan	Administrator	shall	promptly	
send	a	copy	of	that	order,	along	with	a	copy	of	the	Plan’s	procedures	for	determining	whether	the	order	is	a	“Qualified”	
Medical	Child	Support	Order	within	the	meaning	of	ERISA	Section	609,	to	the	member	and	any	other	person	affected	
by	that	order,	including	any	representative	of	the	child	named	in	the	order.
The	receipt	of	the	order	by	the	Plan	Administrator	will	be	treated	as	a	claim	for	benefits	and	the	member	and	all	
other	persons	affected	by	that	order	will	be	deemed	to	be	claimants.	The	Plan	Administrator	will	make	an	initial	
determination	as	to	whether	the	order	is	a	Qualified	Medical	Child	Support	Order	as	soon	as	possible,	but	within	
15	days	after	the	order’s	receipt.	In	general,	a	Medical	Child	Support	Order	is	“qualified”	if	(i)	the	order	creates	or	
recognizes	the	existence	of	an	alternate	recipient’s	right	to,	or	assigns	to	an	alternate	recipient	the	right	to,	receive	
benefits	under	the	Plan;	(ii)	the	order	clearly	specifies	(A)	the	name	and	last	known	mailing	address	(if	any)	of	the	
member	and	the	name	and	mailing	address	of	each	alternate	recipient	covered	by	the	order,	(B)	a	reasonable	
description	of	the	type	of	coverage	to	be	provided	by	the	Plan	to	such	alternate	recipient,	or	the	manner	in	which	such	
type	of	coverage	is	to	be	determined,	(C)	the	period	to	which	such	order	applies,	and	(D)	each	plan	to	which	such	order	
applies;	and	(iii)	does	not	require	the	Plan	to	provide	any	type	or	form	of	benefit,	or	any	option,	not	otherwise	provided	
under	the	Plan,	except	to	the	extent	necessary	to	meet	the	requirements	of	a	state	law	relating	to	medical	child	support	
that	is	described	in	Section	1909	of	the	Social	Security	Act.
Any	claimant	may	request	a	reconsideration	of	the	Plan	Administrator’s	initial	decision	pursuant	to	the	Plan’s	claims	
review	procedures.	If	none	of	the	claimants	request	reconsideration,	the	Plan	Administrator’s	initial	determination	will	
become	final	in	180	days	after	the	notice	of	initial	decision	is	given.	In	either	case,	notice	of	the	Plan	Administrator’s	
final	decision	is	to	be	given	promptly	to	all	claimants	in	accordance	with	the	Plan’s	Claims	Review	Procedures.
In	the	event	that	a	final	determination	is	made	that	an	order	is	a	Qualified	Medical	Child	Support	Order,	the	following	
provisions	shall	apply	and	shall	supersede	any	other	Plan	provision	to	the	contrary	for	the	period	that	the	Qualified	
Medical	Child	Support	Order	is	in	effect.
l  T
 			 he	alternate	recipient	shall	be	enrolled	in	the	Plan	as	an	eligible	dependent	following	the	filing	of	the	required	
   enrollment	forms	with	the	Plan	Administrator	by	the	member,	the	alternate	recipient’s	other	parent	or	by	the	state	
   agency	administering	Medicaid	if	the	parents	fail	to	make	application	for	enrollment	of	the	alternate	recipient,	
   regardless	of	any	provisions	of	the	Plan	restricting	the	time	during	which	eligible	dependents	may	be	enrolled	in	the	
   Plan.	The	alternate	recipient	may	be	enrolled	as	an	eligible	dependent	in	the	Plan	even	if	the	alternate	recipient	is	
   not	claimed	as	a	dependent	on	the	member’s	federal	income	tax	return	or	does	not	reside	with	the	member.	
44 • The Stanley Black & Decker Dental Plan


l  T
 			 he	alternate	recipient	shall	not	be	disenrolled	from	the	Plan	unless:	(i)	the	Plan	Administrator	is	provided	
   satisfactory	written	evidence	that	the	Qualified	Medical	Child	Support	Order	is	no	longer	in	effect	or	that	the	
   alternate	recipient	is	or	will	be	entitled	to	comparable	health	coverage	through	another	insurer	or	group	health	plan	
   no	later	than	the	effective	date	of	the	disenrollment;	or	(ii)	coverage	for	eligible	dependents	has	been	eliminated	for	
   all	associates	of	the	employer.	
l  T
 			 he	Plan	Administrator	shall	withhold	from	the	member’s	compensation,	the	participant’s	share	of	the	cost	of	
   the	coverage	provided	to	the	alternate	recipient	pursuant	to	the	order,	but	not	exceeding	the	maximum	amount	
   permitted	to	be	withheld	under	Section	303(b)	of	the	Consumer	Credit	Protection	Act	or	any	other	applicable	law.	
l  I
 			f	the	member	is	the	non-custodial	parent	of	the	alternate	recipient,	the	custodial	parent	shall	be	provided	all	
   information	that	is	needed	in	order	for	the	alternate	recipient	to	obtain	benefits	under	the	Plan,	the	custodial	parent	
   may	submit	claims	for	covered	expenses	without	the	approval	of	the	member.	All	claims	shall	be	paid	directly	to	the	
   alternate	recipient	or	his	or	her	legal	guardian,	the	health	care	provider	or	the	state	Medicaid	agency,	if	applicable.
For	more	information	on	the	Plan’s	Qualified	Medical	Child	Support	Order	procedures,	call	1-866-827-3531	or	mail	
information	to:
    Stanley	Black	&	Decker
    QMCSO	Coordinator
    1000	Stanley	Drive
    New	Britain,	CT	06053

ReCoveRy RighTS
Stanley	Black	&	Decker	has	a	right	to	recover,	by	way	of	subrogation	or	right	of	reimbursement,	any	expenses	paid	on	
your	or	your	dependents’	behalf	for	which	another	policy	or	individual	is	legally	responsible.	‘You’	includes	any	person	
receiving	benefits	under	the	Plan	including	all	dependents.	
The	Plan	has	the	right	to	recover	any	payments	you	receive	from	any	third	party’s	liability,	including	but	not	limited	to	
any	person	alleged	to	have	caused	you	to	suffer	injuries	or	damages,	or	other	insurance	covering	the	third	party,	as	
well	as	any	first	party	coverage	including	but	not	limited	to	any	payments	you	receive	from	your	own	personal	injury	
protection	(PIP),	med-pay,	uninsured	motorist	insurance,	underinsured	motorist	insurance,	no-fault	insurance,	or	
school	insurance,	Workers’	Compensation	insurance	or	whether	by	lawsuit,	settlement	or	otherwise.	Regardless	of	how	
you	or	your	representative	or	any	agreements	characterize	the	money	you	receive	as	a	Recovery,	it	shall	be	subject	
to	these	provisions.	The	benefits	under	this	Plan	are	secondary	to	any	coverage	under	no-fault	or	similar	insurance.	
The	Plan’s	right	to	recover	(whether	by	subrogation	or	reimbursement)	shall	apply	to	the	settlement	or	recoveries	of	
decedents,	minors,	and	incompetent	or	disabled	persons.	
You	agree	as	follows:
l  T
 			 o	assign	to	Stanley	Black	&	Decker	all	rights	of	recovery	against	third	parties,	to	the	extent	of	the	reasonable	value	
   of	services	and	benefits	provided,	plus	reasonable	costs	of	collection.
l  T
 			 o	cooperate	with	Stanley	Black	&	Decker	or	its	designated	vendor(s)	in	protecting	its	legal	rights	to	subrogation	and	
   reimbursement.	
l  T
 			 hat	Stanley	Black	&	Decker’s	rights	will	be	considered	as	the	first	priority	claim	against	third	parties,	to	be	paid	
   before	any	other	of	your	claims	are	paid.	
l  T
 			 hat	you	will	do	nothing	to	prejudice	Stanley	Black	&	Decker’s	rights	under	this	provision,	either	before	or	after	the	
   need	for	services	or	benefits	under	the	Plan.	
                                                                       The Stanley Black & Decker Dental Plan          • 45



l  T
 			 hat	Stanley	Black	&	Decker	may,	at	its	option,	take	necessary	and	appropriate	action	to	preserve	its	rights	under	
   these	subrogation	provisions,	including	filing	suit	in	your	name.
l  T
 			 he	Plan’s	right	of	recovery	shall	be	a	prior	lien	against	any	proceeds	recovered	by	you	or	your	dependents,	which	
   right	shall	neither	be	defeated	nor	reduced	by	the	application	of	any	so-called	“Made-Whole	Doctrine,”	“Rimes	
   Doctrine,”	or	any	other	such	doctrine	purporting	to	defeat	the	Plan’s	recovery	rights	by	allocating	the	proceeds	
   exclusively	to	non-medical	expense	damages.	Neither	you	nor	your	dependents	are	authorized	to	incur	any	
   expenses	on	behalf	of	the	Plan	in	pursuit	of	the	Plan’s	rights	of	subrogation	or	reimbursement.	Specifically,	no	
   court	costs,	attorneys’	fees	or	other	expenses	you	incur	with	any	claim	or	lawsuit	may	be	deducted	from	the	Plan’s	
   recovery	without	the	prior	express	written	consent	of	the	Plan.	This	right	shall	not	be	defeated	by	any	so-called	“Fund	
   Doctrine,”	or	“Common	Fund	Doctrine,”	or	“Attorney’s	Fund	Doctrine.”
l  T
 			 o	hold	in	trust	for	Stanley	Black	&	Decker’s	benefit	under	these	subrogation	provisions	any	proceeds	of	settlement	
   or	judgment.
l  T
 			 hat	Stanley	Black	&	Decker	shall	be	entitled	to	recover	reasonable	attorney	fees	from	you	incurred	in	collecting	
   proceeds	held	by	you.	
l  T
 			 hat	you	will	not	accept	any	settlement	that	does	not	fully	compensate	or	reimburse	Stanley	Black	&	Decker	without	
   Stanley	Black	&	Decker’s	written	approval.
l  T
 			 o	execute	and	deliver	such	documents	(including	a	written	confirmation	of	assignment,	and	consent	to	release	
   medical	records),	and	provide	such	help	(including	responding	to	requests	for	information	about	any	accident	or	
   injuries	and	making	court	appearances)	as	Stanley	Black	&	Decker	may	reasonably	request	from	you.
l  I
 			f	you	fail	to	repay	the	Plan,	the	Plan	shall	be	entitled	to	deduct	any	of	the	unsatisfied	portion	of	the	amount	of	
   benefits	the	Plan	has	paid	or	the	amount	of	your	Recovery	whichever	is	less,	from	any	future	benefit	under	the	Plan.	
       I
    1.		f	the	amount	the	Plan	paid	on	your	behalf	is	not	repaid	or	otherwise	recovered	by	the	Plan;	or
    2.	You	fail	to	cooperate.
l  I
 			n	the	event	that	you	fail	to	disclose	the	amount	of	your	settlement	to	the	Plan,	the	Plan	shall	be	entitled	to	deduct	
   the	amount	of	the	Plan’s	lien	from	any	future	benefit	under	the	Plan.
l  T
 			 he	Plan	shall	also	be	entitled	to	recover	any	of	the	unsatisfied	portion	of	the	amount	the	Plan	has	paid	or	the	
   amount	of	your	Recovery,	whichever	is	less,	directly	from	the	Providers	to	whom	the	Plan	has	made	payments	on	
   your	behalf.	In	such	a	circumstance,	it	may	then	be	your	obligation	to	pay	the	Provider	the	full	billed	amount,	and	the	
   Plan	will	not	have	any	obligation	to	pay	the	Provider	or	reimburse	you.
Stanley	Black	&	Decker	will	not	pay	fees,	costs,	or	expenses	you	incur	with	any	claim	or	lawsuit,	without	our	prior	
written	consent.
46 • The Stanley Black & Decker Dental Plan




eRiSa RighTS STaTemenT
As	a	participant	in	The	Stanley	Black	&	Decker	Dental	Plan,	you	are	entitled	to	certain	rights	and	protections	under	
the	Employee	Retirement	Income	Security	Act	of	1974	(ERISA).	ERISA	provides	that	all	Plan	participants	shall	be	
entitled	to:
l  R
 			 eceive	information	about	the	Plans	and	benefits	
l  P
 			 rudent	actions	by	Plan	fiduciaries	
l  E
 			 nforce	your	rights	
l  A
 			 ssistance	with	your	questions

ReCeive infoRmaTion aBouT youR Plan anD BenefiTS
You	have	the	right	to:
l  E
 			 xamine,	without	charge,	at	the	Plan	Administrator’s	office	and	at	other	specified	locations,	such	as	worksites	and	
   union	halls,	all	documents	governing	the	Plan,	including	insurance	contracts	and	collective	bargaining	agreements,	
   and	a	copy	of	the	latest	annual	report	(Form	5500	series)	filed	by	the	Plan	with	the	U.S.	Department	of	Labor	and	
   available	at	the	Public	Disclosure	Room	of	the	Employee	Benefits	Security	Administration.	
l  O
 			 btain,	upon	written	request	to	the	Plan	Administrator,	copies	of	documents	governing	the	operation	of	the	Plan,	
   including	insurance	contracts	and	collective	bargaining	agreements,	and	copies	of	the	latest	annual	report	(Form	
   5500	series)	and	the	updated	Summary	Plan	Description.	The	Plan	Administrator	may	make	a	reasonable	charge	for	
   the	copies.	
l  R
 			 eceive	a	summary	of	the	Plan’s	annual	financial	report.	The	Plan	Administrator	is	required	by	law	to	furnish	each	
   participant	with	a	copy	of	this	summary	annual	report.

PRuDenT aCTionS By Plan fiDuCiaRieS
In	addition	to	creating	rights	for	Plan	participants,	ERISA	imposes	duties	upon	the	people	who	are	responsible	for	the	
operation	of	the	associate	benefit	plan.	The	people	who	operate	your	Plans,	called	“fiduciaries”	of	the	Plans,	have	a	
duty	to	do	so	prudently	and	in	the	interest	of	you	and	other	Plan	participants	and	beneficiaries.	No	one,	including	your	
employer,	your	union,	or	any	other	person,	may	fire	you	or	otherwise	discriminate	against	you	in	any	way	to	prevent	
you	from	obtaining	a	Plan	benefit	or	exercising	your	rights	under	ERISA.
                                                                        The Stanley Black & Decker Dental Plan         • 47




enfoRCe youR RighTS
If	your	claim	for	a	Plan	benefit	is	denied	or	ignored	in	whole	or	in	part,	you	have	a	right	to	know	why	this	was	done,	to	
obtain	copies	of	documents	relating	to	the	decision	without	charge,	and	to	appeal	any	denial,	all	within	certain	time	
schedules.	
Under	ERISA,	there	are	steps	you	can	take	to	enforce	the	above	rights.	For	instance,	if	you	request	a	copy	of	Plan	
documents	or	the	latest	annual	report	from	the	Plan	and	do	not	receive	them	within	30	days,	you	may	file	suit	in	a	
federal	court.	In	such	a	case,	the	court	may	require	the	Plan	Administrator	to	provide	the	materials	and	pay	you	up	to	
$110	a	day	until	you	receive	the	materials,	unless	the	materials	were	not	sent	because	of	reasons	beyond	the	control	
of	the	Plan	Administrator.	If	you	have	a	claim	for	benefits	that	is	denied	or	ignored,	in	whole	or	in	part,	you	may	file	suit	
in	a	state	or	federal	court.	
In	addition,	if	you	disagree	with	the	Plan’s	decision	or	lack	thereof	concerning	the	qualified	status	of	a	medical	child	
support	order,	you	may	file	suit	in	a	federal	court.	If	it	should	happen	that	fiduciaries	misuse	the	Plan’s	money,	or	if	you	
are	discriminated	against	for	asserting	your	rights,	you	may	seek	assistance	from	the	U.S.	Department	of	Labor,	or	you	
may	file	suit	in	a	federal	court.	The	court	will	decide	who	should	pay	court	costs	and	legal	fees.	If	you	are	successful,	
the	court	may	order	the	person	you	have	sued	to	pay	these	costs	and	fees.	If	you	lose,	the	court	may	order	you	to	pay	
these	costs	and	fees,	for	example,	if	it	finds	your	claim	is	frivolous.

aSSiSTanCe WiTh youR QueSTionS
If	you	have	any	questions	about	your	Plans,	you	should	contact	the	Plan	Administrator.	If	you	have	any	questions	
about	this	statement	or	about	your	rights	under	ERISA,	or	if	you	need	assistance	in	obtaining	documents	from	the	Plan	
Administrator,	you	should	contact	the	nearest	office	of	the	Employee	Benefits	Security	Administration,	U.S.	Department	
of	Labor,	listed	in	your	telephone	directory	or	the	Division	of	Technical	Assistance	and	Inquiries,	Employee	Benefits	
Security	Administration,	U.S.	Department	of	Labor,	200	Constitution	Avenue,	N.W.,	Washington,	D.C.	20210.	You	may	
also	obtain	certain	publications	about	your	rights	and	responsibilities	under	ERISA	by	calling	the	publications	hotline	
of	the	Employee	Benefits	Security	Administration.	

ConTinue gRouP healTh Plan CoveRage
You	have	the	right	to:
l  	
   C
 			 ontinue	health	care	coverage	for	yourself,	your	spouse,	or	your	dependents	if	there	is	a	loss	of	coverage	under	the	
   plan	as	a	result	of	a	qualifying	event.	You	or	your	dependents	may	have	to	pay	for	such	coverage.	
l  	
   R
 			 eview	this	summary	plan	description	and	the	documents	governing	the	Plan	on	the	rules	governing	your	COBRA	
   continuation	coverage	rights.	
l  	
   A
 			 	reduction	or	elimination	of	exclusionary	periods	of	coverage	for	pre-existing	conditions	under	your	group	health	
   plan,	if	you	have	creditable	coverage	from	another	plan.	You	should	be	provided	a	certificate	of	creditable	coverage,	
   free	of	charge,	from	your	group	health	plan	or	health	insurance	issuer	when	you	lose	coverage	under	the	plan,	when	
   you	become	entitled	to	elect	COBRA	continuation	coverage,	when	your	COBRA	continuation	coverage	ceases,	if	you	
   request	it	before	losing	coverage,	or	if	you	request	it	up	to	24	months	after	losing	coverage.	Without	evidence	of	
   creditable	coverage,	you	may	be	subject	to	a	pre-existing	condition	exclusion	for	12	months	(18	months	for	late	
   enrollees)	after	your	enrollment	date	in	your	coverage.
48 • The Stanley Black & Decker Dental Plan




aDminiSTRaTive infoRmaTion
This	section	describes	how	this	Stanley	Black	&	Decker	Dental	Plan	is	administered.	

Plan DoCumenTS
In	this	SPD,	we	have	attempted	to	explain	the	benefits	available	to	you	as	briefly	and	clearly	as	possible.	Specific	terms	
and	conditions	governing	these	benefits	are	set	forth	in	the	provisions	of	the	official	Plan	documents.	Since	these	
documents	are	complete	in	detail,	they	govern	the	final	interpretation	of	any	specific	provision.	

Changing The PlanS
Each	employer	who	participates	in	this	Plan	reserves	the	right	to	terminate	the	Plan	at	any	time	as	to	its	current	
associates,	former	or	retired	associates,	and	their	dependents.	Participating	employers	can	modify,	reduce,	or	
eliminate	the	benefits	provided	under	this	Plan	at	any	time.	Benefits	under	this	Plan	are	not	vested	in	any	current	
associates,	former	or	retired	associates,	or	their	dependents.	Nothing	in	this	book	should	be	construed—either	now	or	
in	the	future—to	vest	any	benefits	in	any	current	associate,	former	or	retired	associate,	or	his	or	her	dependents.	

Plan amenDmenT oR TeRminaTion
Stanley	Black	&	Decker,	Inc.,	the	Plan	sponsor,	expects	to	continue	its	benefit	plans	indefinitely	for	eligible	associates	
but	reserves	the	right,	in	its	sole	discretion,	under	authority	of	the	Board	of	Directors,	to	amend,	modify,	increase	
the	cost	of,	or	terminate	the	Plan	at	any	time	to	any	extent	that	it	may	deem	advisable.	The	Company’s	decision	
to	terminate	or	amend	the	Plan	may	be	due	to	changes	in	federal	or	state	laws,	the	requirements	of	the	Internal	
Revenue	Code	or	ERISA,	or	any	other	reason.	The	Plan	provisions,	including	covered	expenses,	contribution	levels	for	
participants	or	participating	employers,	levels	of	benefit	reimbursement,	claim	administrators,	health	care	managers,	
and	all	other	Plan	design	features	may	be	modified	by	the	Plan	sponsor	at	any	time,	with	or	without	advance	notice,	
to	those	who	participate	in	this	Plan.	Stanley	Black	&	Decker	regularly	reviews	benefits	and	makes	changes	to	meet	
industry	standards,	practice	patterns	or	cost-control	needs.	Any	Plan	design	changes	may	apply	to	both	active	and	
retiree	plans.

inTeRPReTaTion of The Plan
The	responsibility	of	interpreting	this	Plan,	including	resolving	issues	concerning	eligibility	to	participate,	eligibility	to	
receive	benefits,	and	determining	the	amount	of	any	benefit	payable	to	any	person	rests	with	the	Plan	Manager.	The	
power	to	interpret	the	Plan	shall	be	exercised	by	the	Plan	Manager	in	his	sole	and	absolute	discretion.	

non-guaRanTee of emPloymenT
Participation	in	this	Plan	should	not	be	construed	as	a	contract	of	employment	with	any	participating	employer.	
Participation	in	this	Plan	shall	not	give	any	person	the	right	to	continue	in	the	employ	of	a	participating	employer	or	
limit	the	right	of	a	participating	employer	to	discharge	any	associate	at	any	time.	
                                                                       The Stanley Black & Decker Dental Plan        • 49




imPoRTanT Plan DeTailS
Important	administrative	facts	for	this	Plan	are	shown	below.	
Plan Name:
The	Stanley	Black	&	Decker	Health	and	Welfare	Program	
The	Stanley	Black	&	Decker	Dental	Plan	is	one	of	several	health	and	welfare	benefits	provided	under	The	Stanley	
Black	&	Decker	Health	and	Welfare	Program.
Type of Plan:
Group	health	plan	
Plan Sponsor:
Stanley	Black	&	Decker,	Inc.
1000	Stanley	Drive
New	Britain,	CT	06053	
Plan Sponsor Employer Identification Number:
06-0548860	
Participating Employers:
The	following	employers	have	adopted	this	Plan	for	their	eligible	associates.	A	complete	list	of	the	employers	
participating	in	the	Plan	may	be	obtained	by	participants	and	beneficiaries	upon	written	request	to	the	Plan	
Administrator,	and	is	available	for	examination	by	participants	and	beneficiaries	at	the	principal	office	of	the	Plan	
Administrator	and	at	each	principal	work	location.	
Associates	in	units	covered	by	a	collective	bargaining	agreement	are	not	eligible	to	participate	in	this	Plan	unless	their	
Collective	Bargaining	Agreement	expressly	provides	for	participation.	
Stanley	Black	&	Decker,	Inc.	and	all	participating	subsidiaries.	
EIN	06-0548860	
Plan Administrator:
Stanley	Black	&	Decker,	Inc.
1000	Stanley	Drive
New	Britain,	CT	06053	
Attn:	Raymond	J.	Brusca	
VP	Benefits	&	Compensation
Plan Manager:
The	Plan	Manager	is	designated	by	the	Plan	Administrator	and	is	responsible	for	the	design	and	modification	of	Plan	
benefits,	selection	and	termination	of	Plan	vendors,	interpretation	of	Plan	benefits,	establishing	Plan	funding	costs,	
and	all	other	Plan	activities	(excluding	the	termination	of	the	Plan)	not	specifically	reserved	by	the	Plan	Administrator.	
The	Plan	Manager	for	The	Stanley	Black	&	Decker	Dental	Plan	is:	
Stanley	Black	&	Decker,	Inc.	
1000	Stanley	Drive	
New	Britain,	CT	06053
Raymond	J.	Brusca	
VP	Benefits	&	Compensation
1-860-225-5111
50 • The Stanley Black & Decker Dental Plan



Plan Number:
550
Agent for Service of Legal Process:
Legal	process	may	be	served	on	the	Plan	Administrator	at	the	address	specified	on	the	previous	page.	
Plan Year:
January	1	through	December	31	
Funding:
The	cost	of	The	Stanley	Black	&	Decker	Dental	Plan	is	shared	between	Stanley	Black	&	Decker	and	associates.	
Associates	must	make	contributions	to	be	covered	for	benefits.	Associate	contributions	will	generally	be	made	on	a	
before-tax	basis	so	that	the	contribution	amount	will	generally	not	be	subject	to	income	taxes.	If	you	cover	a	domestic	
partner,	special	tax	rules	apply.	See	the	“Pre-Tax	Contributions”	section	for	more	information.
Claims Administrators and Vendors:
CIGNA	
P.O.	Box	188037	
Chattanooga,	TN	37422-8037
COBRA	Administrator
CONEXIS
P.O.	Box	226101
Dallas	TX	75222-6101
The Stanley Black & Decker Dental Plan   • 51
52 • The Stanley Black & Decker Dental Plan
Uniform	Dental
2011

								
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