employee benefit manual

EMPLOYEE BENEFITS GUIDE 2008 M A X I M I Z E Y O U R B E N E F I T S PA C K A G E 2008 O R I E N TAT I O N To All Employees, NBT Bancorp offers its employees a comprehensive benefits package. This package is a valuable part of the total compensation you receive from our company. Please carefully review this Employee Benefits Guide in making decisions to best meet your needs. Our benefits package includes health, dental, vision and life insurances as well as retirement plans and other important benefits. If you have benefits-related questions during the enrollment process or at any other time, please contact a member of our Human Resources Division. I would like to welcome new employees who are receiving this guide for the first time. Also, I want to thank those employees who have contributed to our success in this and previous years. Working together, we will lead our company into the future. Sincerely, Martin Dietrich President and Chief Executive Officer Table of Contents Summary This summary is been prepared exclusively for our employees This guide has intended to provide a brief overview of the benefits available through NBT Bancorp. and is a one-stop resource for all your benefits needs. SECTION 1 INTRODUCTION 3 4 5 6 7 Benefit Forms Available on NBT Bancorp’s Intranet Summary Observed Holidays Scheduled Pay Dates 2008 Benefit Rate Sheet SECTION 2 HEALTH BENEFITS MEDICAL INSURANCE 9 10 12 14 16 17 18 19 20 21 22 NBT Bancorp Medical Plans High-Deductible Health Plan Blue EPO Blue PPO Pharmacy Benefit Plan Dental Program Vision Program Flexible Spending Accounts Health/Dental/Vision FSA Dependent Care FSA BalanceWorks FLEXIBLE SPENDING ACCOUNTS (FSAs) EMPLOYEE ASSISTANCE PROGRAM SECTION 3 LIFE INSURANCE 24 25 Basic Life Insurance Business Travel Accident Insurance SECTION 4 DISABILITY BENEFITS 27 28 Short-Term Disability Benefits Long-Term Disability Benefits SECTION 5 RETIREMENT PLANS 30 31 Defined Benefit Pension Plan 401(k) Plan and Employee Stock Ownership Plan SECTION 6 VOLUNTARY BENEFITS GROUP VOLUNTARY BENEFITS 33 34 35 36 37 38 39 40 Optional Term Life Insurance – Employee Optional Term Life Insurance – Spouse and Child Accidental Death and Dismemberment Insurance Universal Life Insurance Auto and Homeowner’s Insurance AFLAC Cancer Plan Voluntary Short-Term Disability Insurance Long-Term-Care Insurance INDIVIDUAL VOLUNTARY BENEFITS SECTION 7 PLAN GUIDELINES 42 Employee Benefits Guide Plan Guidelines 1 2008 INTRODUCTION BENEFIT FORMS S UMM ARY H O L I D AY S PAY D AT E S 2 0 0 8 B E N E F I T R AT E S H E E T ■ Available Summary on NBT Bancorp’s Intranet Many benefit forms are easily accessible through the company’s intranet. This summary is intended to provide a brief overview of the benefits available through NBT Bancorp. 1 Commonly Used Benefits-Related Forms Available Online Excellus BlueCross BlueShield Enrollment Form Excellus BlueCross BlueShield Dependent Certification Form Dental Claim Form Davis Vision Out of Network Claim Form Flexible Spending Accounts Claim Form Defined Benefit Pension Plan Beneficiary Form 401(k) and Employee Stock Ownership Plan Beneficiary Form 401(k) and Employee Stock Ownership Plan Stock Dividend Election Form ACCESSING NBT BANCORP HUMAN RESOURCES FORMS 1 Double-click the Internet Explorer 2 3 icon on your Desktop. If you do not have an Internet Explorer icon, click Start, go to Programs and then highlight and click Internet Explorer. 2 Internet Explorer will begin to load on your computer. Once it has finished loading, locate the Address field near the top of the Internet Explorer window. Delete the current address in the Address field, then type in the following: 10.1.1.199. Then press the Enter key, or click the Go button to the right of the Address field. 3 4 The NBT Bancorp intranet page will now be displayed. Locate the References list, which will be in the upper-left-hand corner. Within that list, locate the Online Forms link and click it. displayed. In the right-hand column, at the top, are the various HR-related forms. The forms are all labeled individually and can be accessed by clicking them. 4 A list of forms should now be 5 5 Summary Plan Descriptions (SPDs) and other helpful benefit documents are also available online. Access these by clicking the Human Resources link in the box in the upper-right-hand corner of the NBT Bancorp intranet page. 6 SPDs and other benefit documents The mouse icon indicates that related information for this benefit is available online through the company’s intranet (http://10.1.1.199). are listed here. 6 Employee Benefits Guide 3 Summary This summary is intended to provide a brief overview of the benefits available through NBT Bancorp. Maximize Your Benefits Package. Enroll Now! Your Choice The NBT Bancorp benefits package lets you choose the benefits that you want and need. You decide which levels of coverage are best for you and your family. Make your elections carefully. Unless you have a change in family status, your elections cannot be changed until January 1, 2009. This Employee Benefits Guide is intended to provide a summary of the main features of the NBT Bancorp benefits package. It is much shorter and less technical than the legal documents and contracts that govern our benefits. NBT Bancorp has made every effort to make sure the information in this summary is accurate; however, in the case of any discrepancy, the provisions of the legal plan documents will govern. ELIGIBILITY You will be eligible to participate in the NBT Bancorp benefit plans if you are in one of the following employee categories: Full-time Employee (You are normally scheduled to work at least 35 hours per week) Part-time Employee (You are normally scheduled to work 30 or more hours per week) PARTICIPATION You will be covered by the following benefit plans on your date of hire: Business Travel Accident eni BalanceWorks You will be eligible to participate in the following benefit plans at the beginning of the plan year or on the first day of the month coinciding with or following your date of hire: Dental and Vision Insurance Flexible Spending Accounts (FSAs) Life Insurance Voluntary Benefit Plans You will be eligible to participate in the following retirement plans on the first day of the month following date of hire and attaining age 21: 401(k) and Employee Stock Ownership Plan (ESOP) Defined Benefit Pension Plan (must also complete one year of eligibility service) You will be eligible to participate in the following benefit plan at the beginning of the plan year or on the first day of the month following 60 days of continuous employment: Medical Insurance: • High-Deductible Health Plan (with HSA) • Blue EPO (including Pharmacy Benefit Plan) • Blue PPO (including Pharmacy Benefit Plan) Note The use of “biweekly” in this guide refers to every two weeks. Employee Benefits Guide 4 2008 Observed Holidays Summary This summary is intended to provide a brief overview of the benefits available through NBT Bancorp. Company-Paid Benefit Throughout the year, our 10 holidays and 2 sub-holidays give you an additional 12 paid days off. JANUARY S M T W T FEBRUARY F $ S S M T W T F $ S S M MARCH T W T F S New Year’s Day 1 6 7 8 2 3 4 5 3 4 5 6 7 $ 1 8 2 9 2 3 4 5 6 $ 1 7 8 9 10 11 12 $ 13 14 15 16 17 18 19 Martin Luther King Jr. Day 10 11 12 13 14 15 16 Presidents Day 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23⁄ 24⁄ 30 31 20 21 22 23 24 25 26 27 28 29 30 31 17 18 19 20 21 22 23 24 25 26 27 28 29 $ 25 26 27 28 29 APRIL S M T W T F S S M T MAY W T F S S M T JUNE W T F $ S 1 6 7 8 2 3 $ 4 5 4 5 6 7 1 $ 2 3 1 8 2 3 4 5 6 7 9 10 11 12 8 9 10 9 10 11 12 13 14 $ 13 14 15 16 17 18 19 $ 11 12 13 14 15 16 17 $ 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 20 21 22 23 24 25 26 27 28 29 30 18 19 20 21 22 23 24 Memorial Day 25 26 27 28 29 30 31 JULY S M T W T F S S M AUGUST T W T F $ S S M SEPTEMBER T W T F S Independence Day Labor Day 1 6 7 8 2 3 $ 4 5 3 4 5 6 7 $ 1 8 2 9 7 1 8 2 3 4 $ 5 6 9 10 11 12 $ 9 10 11 12 13 13 14 15 16 17 18 19 $ 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24⁄ 31 14 15 16 17 18 19 20 $ 20 21 22 23 24 25 26 27 28 29 30 31 21 22 23 24 25 26 27 28 29 30 $ 25 26 27 28 29 30 OCTOBER S M T W T F S S M NOVEMBER T W T F S S M DECEMBER T W T F S Holidays 5 6 7 Columbus Day 1 8 2 $ 3 4 $ 1 2 3 4 5 6 7 8 7 1 8 2 3 4 $ 5 6 9 10 11 9 10 11 12 13 $ Veterans Day Pay Dates 12 13 14 15 16 17 18 $ 9 10 11 12 13 14 15 $ 14 15 16 17 18 19 20 Christmas Day $ 19 20 21 22 23 24 25 26 27 28 29 30 31 Employee Benefits Guide 16 17 18 19 20 21 22 23⁄ 30 21 22 23 24 25 26 27 28 29 30 31 Thanksgiving Day 24 25 26 27 28 29 5 Scheduled Pay Dates Direct deposit makes it easy to keep track of your paychecks— and best of all, it’s free! Payroll Contact NBT Bancorp Payroll 607-337-6073 or 607-337-6358 payroll@nbtbci.com OUR 26 SCHEDULED BIWEEKLY PAY DATES IN 2008 # 1 2 3 4 5 6 7 8 9 10 11 12 13 PAY DATE January 4, 2008 January 18, 2008 February 1, 2008 February 15, 2008 February 29, 2008 March 14, 2008 March 28, 2008 April 11, 2008 April 25, 2008 May 9, 2008 May 23, 2008 June 6, 2008 June 20, 2008 July 3, 2008 July 18, 2008 August 1, 2008 August 15, 2008 August 29, 2008 September 12, 2008 September 26, 2008 October 10, 2008 October 24, 2008 November 7, 2008 November 21, 2008 December 5, 2008 December 19, 2008 FOR WEEKS ENDING December 22, 2007, and December 29, 2007 January 5, 2008, and January 12, 2008 January 19, 2008, and January 26, 2008 February 2, 2008, and February 9, 2008 February 16, 2008, and February 23, 2008 March 1, 2008, and March 8, 2008 March 15, 2008, and March 22, 2008 March 29, 2008, and April 5, 2008 April 12, 2008, and April 19, 2008 April 26, 2008, and May 3, 2008 May 10, 2008, and May 17, 2008 May 24, 2008, and May 31, 2008 June 7, 2008, and June 14, 2008 June 21, 2008, and June 28, 2008 July 5, 2008, and July 12, 2008 July 19, 2008, and July 26, 2008 August 2, 2008, and August 9, 2008 August 16, 2008, and August 23, 2008 August 30, 2008, and September 6, 2008 September 13, 2008, and September 20, 2008 September 27, 2008, and October 4, 2008 October 11, 2008, and October 18, 2008 October 25, 2008, and November 1, 2008 November 8, 2008, and November 15, 2008 November 22, 2008, and November 29, 2008 December 6, 2008, and December 13, 2008 Scheduled Pay Dates Paychecks are processed every two weeks (or biweekly). Your paycheck will be electronically deposited into your NBT Bank or Pennstar Bank account. ADP iPay Access your pay statements and W-2’s 24–7 through NBT Bancorp’s intranet: User name and password are case-sensitive Use information from your first pay statement to register iPay can be accessed from home at http:// paystatements.adp.com 14 15 16 17 18 19 20 21 22 iPay access and instructions are available online. Refer to page 3 for information on accessing the NBT Bancorp intranet. 23 24 25 26 Employee Benefits Guide 6 2008 Benefit Rate Sheet An employee’s annual cost share for 2008 benefits will be deducted equally over 26 biweekly pay periods. Provider Contact Health Insurance Excellus BlueCross BlueShield of CNY 800.734.4069 www.excellusbcbs.com EXCELLUS HIGH-DEDUCTIBLE HEALTH PLAN (HDHP) PREMIUMS COVERAGE Employee Employee Plus One Employee Plus Family TOTAL MONTHLY PREMIUM $ 243.10 $ 498.36 $ 687.63 EMPLOYEE’S BIWEEKLY COST SHARE (26 PAYS) 25% 30% 30% $ 28.05 $ 69.00 $ 95.21 EXCELLUS BLUE EPO PREMIUMS COVERAGE TOTAL MONTHLY PREMIUM $ 309.14 $ 633.10 $ 880.25 TIER 1 – BENEFITS BASE UP TO $50,000 EMPLOYEE’S BIWEEKLY COST SHARE (26 PAYS) 25% 30% 30% $ 35.67 $ 87.66 $ 121.88 TIER 2 – BENEFITS BASE $50,000 AND ABOVE EMPLOYEE’S BIWEEKLY COST SHARE (26 PAYS) 27% 32% 32% $ 38.52 $ 93.50 $ 130.01 Pharmacy Benefit Plan FLRx Pharmacy Help Desk 800.724.5033 Employee Employee Plus One Employee Plus Family EXCELLUS BLUE PPO PREMIUMS Dental EBS Benefit Solutions 800.803.5773 COVERAGE TIER 1 – BENEFITS BASE UP TO $50,000 TOTAL EMPLOYEE’S MONTHLY BIWEEKLY COST PREMIUM SHARE (26 PAYS) $ 361.24 $ 739.35 $ 1,033.03 25% 30% 30% $ 41.68 $ 102.37 $ 143.04 TIER 2 – BENEFITS BASE $50,000 AND ABOVE TOTAL EMPLOYEE’S MONTHLY BIWEEKLY COST PREMIUM SHARE (26 PAYS) $ 375.14 $ 767.78 $ 1,072.76 27% 32% 32% $ 46.75 $ 113.40 $ 158.44 Employee Employee Plus One Employee Plus Family Vision Davis Vision 800.999.5431 www.davisvision.com (client code: 7011) DENTAL PREMIUMS COVERAGE Employee Employee Plus One Employee Plus Family TOTAL MONTHLY PREMIUM $ 28.21 $ 60.41 $ 87.30 EMPLOYEE’S BIWEEKLY COST SHARE (26 PAYS) 30% 50% 50% $ 3.91 $ 13.94 $ 20.15 VISION PREMIUMS COVERAGE Employee Employee Plus One Employee Plus Family The mouse icon indicates that related forms for this benefit are available online through the company’s intranet (http://10.1.1.199). TOTAL MONTHLY PREMIUM $ 6.00 $ 10.79 $ 16.81 EMPLOYEE’S BIWEEKLY COST SHARE (26 PAYS) 30% 50% 50% $ 0.83 $ 2.49 $ 3.88 BENEFITS RATE CALCULATOR Please use the Benefits Rate Calculator to calculate your biweekly premium for: Employee Optional Life Spouse Optional Life Accidental Death and Dismemberment BENEFITS RATE CALCUATOR FOR LIFE INSURANCE (Click this box to access) Employee Benefits Guide 7 2008 H E A LT H B E N E F I T S H I G H - D E D U CT I B L E H E A LT H P L AN B L UE E P O B L UE P P O P H A R MA CY B E N E F I T P L A N D E N TA L P R O G R A M VISION PROGRAM F L E X I B L E S P E N D I N G ACCO UN T S ( F S As ) B A L AN C E W O R K S ■ NBT Bancorp Medical Plans Now, three plans to offer you more choices! The information on this page pertains to all three Excellus medical plans, unless otherwise noted. Human Resources Contact Diane Mohr NBT Bancorp Human Resources—Norwich 607.337.6412 dmohr@nbtbci.com Insured By Excellus BlueCross BlueShield of CNY Medical insurance is an important piece of NBT Bancorp’s benefits package. With the cost of medical care continuing to rise at a double-digit rate, it is critical for us to work together to control costs. We can slow the rate of increase by taking responsibility for our own health by: Adopting a healthy lifestyle, including a balanced diet, exercise, taking part in health screenings and having annual physicals Identifying health risks by taking a Health Risk Assessment (www.excellusbcbs.com) and addressing concerns early Taking advantage of wellness education opportunities Using preventive care services when appropriate NBT Bancorp’s medical plans are self-insured, and the company pays 71% of all employee medical and prescription claims. Being self-insured means the company pays the costs of actual claims. Premiums withheld from employees make up the balance (29%) of these costs. As a result, your health care decisions directly affect the costs of NBT Bancorp’s medical plans and, ultimately, the annual increases passed on to employees. IN-NETWORK By choosing an In-Network provider from a BlueCross BlueShield list of participating providers, you receive the highest level of reimbursement for covered health care service: • You file no claims. • You are responsible only for any deductibles, co-payments or coinsurance that may apply. There is no balance billing from participating providers. Provider Contact Excellus BlueCross BlueShield of Central New York 800.734.4069 www.excellusbcbs.com Cost-Shared Benefit Please refer to the 2008 Benefit Rate Sheet on page 7 of this guide for NBT Bancorp’s cost sharing. OUT-OF-NETWORK By choosing a provider who is not part of the BlueCross BlueShield network, you still receive reimbursement for covered services within the HighDeductible Health Plan and Blue PPO, but at a reduced level. (No coverage under the Blue EPO). • Health care is received from a provider who is not part of the BlueCross BlueShield network. • You may have to file the claim and are responsible for any deductibles, co-payments or coinsurance that may apply, as well as the difference between the total charge and the amount allowed. Pretax Premiums Employee premiums are withheld on a pretax basis.* *The portion of premium for domestic partner coverage is after-tax. ELIGIBLE DEPENDENTS Your spouse (unless you are legally separated, divorced or your marriage has been annulled). Documentation: A copy of your marriage license. Your unmarried children, legally adopted children and/or stepchildren who are under age 19 (or age 25 with proof of full-time student status) and who are chiefly dependent on you for financial support. Documentation: A copy of each dependent child’s birth certificate and a Dependent Certification for a full-time student age 19 or over. Your same-sex or opposite-sex domestic partner who is age 18 or older, unmarried and unrelated by marriage or blood. Documentation: Please print and fill out the Domestic Partner Affidavit from the online forms section of the NBT Bancorp intranet. Additional documentation will be required. Excellus Group Enrollment, Waiver of Coverage, Dependent Certification and Domestic Partner Affidavit forms are available online. Refer to page 3 for information on accessing all online forms. For information on midyear enrollment changes, refer to page 42. Important Information 9 Employee Benefits Guide High-Deductible Health Plan HSA Flex Credit The HSA Flex Credit will be direct-deposited to an eligible participant’s NBT Bank or Pennstar Bank HSA. ADMINISTERED BY Excellus BlueCross BlueShield of CNY The High-Deductible Health Plan (HDHP) allows participants to access any provider without a referral. The level of coverage is determined by whether your provider is in or out of the BlueCross BlueShield network. Benefits are paid after the individual or family deductible has been met. Preventive health care services are covered in full and are not subject to a deductible or coinsurance. The HDHP is intended to be paired with a Health Savings Account (HSA), such as that offered by NBT Bank and Pennstar Bank. The savings in premiums can be directed as a pretax deduction into the HSA to fund the annual deductible and to pay for out-of-pocket expenses, as defined in IRS Notice 2004-50. Funds in the HSA may accumulate year after year. FLEX CREDIT NBT Bancorp will contribute $20 per biweekly payroll (maximum of $520 per year) to your NBT Bank or Pennstar Bank HSA as your 2008 HSA Flex Credit to offset out-of-pocket expenses. In addition, NBT Bancorp will also match your biweekly HSA contribution up to $10 biweekly. HDHP BENEFITS SUMMARY BENEFITS SUMMARY Deductible Coinsurance Out-of-pocket maximum Lifetime maximum Full-time student coverage IN-NETWORK OUT-OF-NETWORK $1,300 Individual/$2,600 Family Full family deductible must be met before services are covered 20% 40% $3,000 Individual/$6,000 Family None To age 25 None To age 25 Adult routine physicals Adult immunizations Mammography Pap smear Routine gynecological exam Prostate cancer screening Covered in full — not subject to deductible or coinsurance After deductible, covered at 60% Diagnostic x-rays (MRI, PET and CAT scans)* Diagnostic laboratory and pathology Allergy tests and injections Chemotherapy and radiation Hospital care for mother (including delivery) Newborn nursery *Precertification required for this service. A penalty of $500 or 50%, whichever is less, will apply if precertification is not obtained. Employee Benefits Guide ▲ ▲ ▲ PREVENTIVE HEALTH CARE SERVICES Well-child visits PHYSICIAN OFFICE SERVICES Diagnostic office After deductible, covered at 80% After deductible, covered at 60% MATERNITY SERVICES After deductible, covered at 80% After deductible, covered at 60% Prenatal and postpartum care 10 High-Deductible Health Plan (continued) Health Savings Account (HSA) Contributions can be made on a pretax or after-tax basis. Contributions can be made by an eligible individual’s employer, the individual or both. 2008 contribution limits are: • $2,900 for individual coverage • $5,800 for family coverage Open an HSA through NBT Bank or Pennstar Bank. HDHP BENEFITS SUMMARY BENEFITS SUMMARY ▲ ▲ ▲ ▲ ▲ INPATIENT HOSPITAL Hospital benefits* Physician inpatient visits* Inpatient physical rehab* Surgery* Anesthesia* EMERGENCY CARE Emergency room Freestanding urgent care (continued) IN-NETWORK OUT-OF-NETWORK After deductible, Covered at 80% After deductible, Covered at 60% Ambulance (for emergency transport only) Inpatient mental health care – After deductible, covered at 80% After deductible, After deductible, covered at 80% covered at 60% After deductible, covered at 80% MENTAL HEALTH AND CHEMICAL DEPENDENCE After deductible, After deductible, up to 30 days per calendar year* covered at 80% covered at 60% Outpatient mental health care – After deductible, covered at 50% up to 20 visits per calendar year Inpatient chemical dependence care – up to 7 days for detox and 30 days for rehab per calendar year* After deductible, covered at 80% After deductible, covered at 80% After deductible, covered at 60% After deductible, covered at 60% Outpatient chemical dependence care – up to 60 visits per calendar year OTHER SERVICES Home care – unlimited visits per calendar year* Hospice – unlimited visits Outpatient therapy – up to 45 visits for physical, speech, occupational and respiratory therapy combined External prosthetics – up to $15,000 maximum per calendar year After deductible, covered at 80% After deductible, covered at 60% Skilled nursing facility – up to 45 days per calendar year Diabetic insulin and supplies Durable medical equipment (DME)* Chiropractic Diagnostic hearing exams PRESCRIPTION DRUG After deductible, covered at 80% Prescription drug benefits are subject to the medical plan deductible and out-of-pocket maximum: Tier 1 – Generic: 10% coinsurance Tier 2 – Preferred Brand: 40% coinsurance Tier 3 – Non-Preferred Brand: 50% coinsurance 30-day supply at retail 90-day mail-order supply through Express Scripts. Coinsurance applies to each 30-day supply. Includes contraceptives. Not covered * Precertification required for this service. A penalty of $500 or 50%, whichever is less, will apply if precertification is not obtained. Employee Benefits Guide 11 Blue EPO In-Network Benefits Seek medical care from the National BlueCard network of participating providers with no referral. Administered By Excellus BlueCross BlueShield of CNY BLUE EPO BlueEPO is an Exclusive Provider Organization. It is a health plan that provides benefits from an established network of hospitals, physicians and other health care providers. The BlueCard network provides worldwide coverage through one of the largest provider networks in the nation. Through the BlueCard® program, your family can access a participating provider anywhere in the country. With more than 85% of all providers participating, chances are your family will find a doctor wherever they may be. Reimbursement of Out-of-Pocket Expenses Calculate and plan for your out-of-pocket expenses and take advantage of the tax savings by participating in the Health/Dental/Vision FSA. See pages 19–20 for more information. As a BlueEPO member, you will enjoy the convenience of no primary care physicians or referrals. There are no out-of-network benefits through this plan. BENEFITS SUMMARY Office co-pay Deductible (excludes co-pays) Coinsurance Out-of-pocket maximum (includes deductible and coinsurance; excludes co-pays) Full-time student coverage Lifetime maximum IN-NETWORK $25 $750 Individual/$2250 Family 20% $2,500 Individual/$7,500 Family Total In/Out of Network To age 25 Unlimited *Precertification required for this service. A penalty of $500 or 50%, whichever is less, will apply if precertification is not obtained. Employee Benefits Guide ▲ ▲ ▲ PREVENTIVE HEALTH CARE SERVICES Well-child visits and immunizations Routine cervical cancer screening Routine mammography screening Routine gynecological visits PHYSICIAN SERVICES Diagnostic office visits Routine physical exams Prostate cancer screenings Diagnostic x-rays (MRI, PET and CT scans)* Diagnostic laboratory and pathology Chemotherapy and radiation Hemodialysis Outpatient hospital and ambulatory surgery Allergy tests and injections MATERNITY SERVICES Covered in full Office Co-Pay Deductible/Coinsurance Office Co-Pay – Testing Covered in Full – Treatment Deductible/Coinsurance Coinsurance Maternity care Newborn nursery care 12 Blue EPO (continued) At www.excellusbcbs.com: Find a doctor using the Nationwide Provider Search – BlueCard. Take a Health Risk Assessment. Within moments of completing the assessment, you’ll receive your Personal Wellness Report and recommendations on how to make healthy changes. Visit the Healthwise Knowledgebase to research health topics, medications, tests and much more. Access brochures on common health issues such as allergies, heartburn prevention and treatment and migrane headaches. *Precertification required over $200. Employee Benefits Guide ▲ ▲ ▲ ▲ ▲ Online Tools for You BENEFITS SUMMARY IN-NETWORK HOSPITAL/FACILITY INPATIENT Preapproval is required in lieu of a $500 penalty for all inpatient admissions and home health care. Inpatient hospital services In-hospital physician visits Anesthesia Inpatient hospital surgery Second medical opinion EMERGENCY CARE Facility emergency room co-pay Freestanding urgent care center co-pay Ambulance (includes air) MENTAL HEALTH AND CHEMICAL DEPENDENCE Acute mental health – inpatient (30 days/calendar year) Deductible/Coinsurance Office Co-Pay $75 $25 Deductible/Coinsurance Chemical dependence and abuse rehab – inpatient (37 days/calendar year; 2 visits/lifetime) Deductible/Coinsurance Mental health care – outpatient (20 visits/calendar year) Office Co-Pay Deductible/Coinsurance $50 Deductible/Coinsurance Coinsurance Deductible/Coinsurance Chemical dependency – outpatient (60 visits; includes 20 family visits) OTHER SERVICES Home care Hospice Outpatient therapy (total of 45 visits/calendar year of physical, speech, occupational and respiratory) Skilled nursing facility (120 days) Durable medical equipment (DME)* Diabetic insulin and supplies Chiropractic Diagnostic hearing exams PRESCRIPTION DRUG Office Co-Pay 30-day supply at retail Tier 1 – Generic Tier 2 – Brand Tier 3 – Non-preferred brand $10 $30 $50 90-day supply through our mail-order vendor, Express Scripts, for two co-pays. Mail order Tier 1 – Generic Tier 2 – Brand Tier 3 – Non-preferred brand $20 $60 $100 13 Blue PPO ADMINISTERED BY Choice of Provider Blue PPO provides coverage both in and out of the BlueCross BlueShield network of participating providers. Excellus BlueCross BlueShield of CNY The Blue PPO Plan through Excellus BlueCross BlueShield of CNY is available to all eligible employees. Blue PPO allows freedom of choice. You may seek medical care from any provider you choose, without a referral. Your level of reimbursement is determined by whether your provider is In-Network or Out-of-Network. Please refer to the following table for more information. BLUE PPO BENEFITS SUMMARY Office co-pay Deductible (excludes co-pays) Coinsurance Out-of-pocket maximum (includes deductible and coinsurance; excludes co-pays) Full-time student coverage Lifetime maximum IN-NETWORK $20 OUT-OF-NETWORK None 40% $100 Individual/$300 Family 20% Total In/Out of Network $1,500 Individual/$4,500 Family To age 25 Unlimited Routine physical exams Prostate cancer screenings Diagnostic x-rays (MRI, PET and CT scans)* Diagnostic laboratory and pathology Chemotherapy and radiation Hemodialysis Outpatient hospital and ambulatory surgery Allergy tests and injections *Precertification required for this service. A penalty of $500 or 50%, whichever is less, will apply if precertification is not obtained. Employee Benefits Guide ▲ ▲ ▲ PREVENTIVE HEALTH CARE SERVICES Deductible/ Coinsurance Well-child visits and immunizations Routine cervical cancer screening Routine mammography screening Routine gynecological visits PHYSICIAN SERVICES Office Co-Pay Diagnostic office visits Covered in full Deductible/ Coinsurance Deductible/Coinsurance Office Co-Pay – Testing Covered in Full – Treatment Deductible/Coinsurance Coinsurance Deductible/ Coinsurance MATERNITY SERVICES Maternity care Newborn nursery care 14 Blue PPO (continued) BENEFITS SUMMARY ▲ Employee Benefits Guide IN-NETWORK OUT-OF-NETWORK HOSPITAL/FACILITY INPATIENT Preapproval is required in lieu of a $500 penalty for all inpatient admissions and home health care. Inpatient hospital services In-hospital physician visits Anesthesia Inpatient hospital surgery Second medical opinion Office Co-Pay $75 $25 Deductible/Coinsurance Deductible/Coinsurance Deductible/ Coinsurance Chemical dependence and abuse rehab – inpatient (37 days/calendar year; 2 visits/lifetime) *Precertification required over $200. ▲ ▲ ▲ ▲ EMERGENCY CARE Deductible/ Coinsurance Facility emergency room co-pay Freestanding urgent care center co-pay Ambulance (includes air) MENTAL HEALTH AND CHEMICAL DEPENDENCE Acute mental health – inpatient (30 days/calendar year) Deductible/Coinsurance Deductible/ Coinsurance Office Co-Pay Deductible/Coinsurance Mental health care – outpatient (20 visits/calendar year) Chemical dependency – outpatient (60 visits; includes 20 family visits) OTHER SERVICES $50 Deductible/Coinsurance Coinsurance Home care Hospice Outpatient therapy (total of 45 visits/calendar year of physical, speech, occupational and respiratory) Skilled nursing facility (unlimited) Durable medical equipment (DME)* Diabetic insulin and supplies Chiropractic Diagnostic hearing exams PRESCRIPTION DRUG 30-day supply at retail Deductible/Coinsurance Deductible/ Coinsurance Office Co-Pay Tier 1 – Generic $7 Tier 2 – Brand $25 Tier 3 – Non-preferred brand $50 90-day supply through our mail-order vendor, Express Scripts, for two co-pays. Tier 1 – Generic $14 Tier 2 – Brand $50 Tier 3 – Non-preferred brand $100 Not Covered Mail Order 15 Pharmacy Benefit Plan The FLRx Pharmacy Benefit Manager program enhances the overall quality of health care for our employees. Human Resources Contact Diane Mohr NBT Bancorp Human Resources—Norwich 607.337.6412 dmohr@nbtbci.com PHARMACY BENEFIT MANAGER FLRx This prescription coverage is included with the Blue PPO and Blue EPO plans. The FLRx Pharmacy Benefit Manager program enhances the overall quality of health care for our employees. The plan will cover only medications that require a prescription and have been approved by the U.S. Food and Drug Administration. RETAIL — PRESCRIPTION CO-PAYS (30-day supply at your local pharmacy) RX TIER Generic Brand Non-Preferred Brand Provider Contact FLRx Pharmacy Help Desk M-F: 9 a.m. – 12 a.m. Weekends: 10 a.m. – 6 p.m. 800.724.5033 Express Scripts Mail Order 877.603.8404 www.express-scripts.com BLUE EPO $10 $30 $50 BLUE PPO $7 $25 $50 COST-SAVING OPTIONS MAIL ORDER Pay two co-pays instead of three – Save 33% Receive a 90-day supply of your maintenance medications delivered to your home through our mail-order vendor, Express Scripts Some common types of maintenance medications are blood pressure, cholesterol, cardiovascular/heart, oral contraceptives and allergy HALF-TABLET INCENTIVE PROGRAM Certain medications may be eligible for the FLRx Half Tab Program. You reduce your co-payment by splitting a higherstrength tablet in half for your daily dose. Talk to your doctor to see if you could save up to 50% using this program. SAVE UP TO With the FLRx Half Tab Program 50% GENERICS Generic drugs are safe, effective and approved by the FDA. Experience has shown that more than 90% of all members who start on a generic medication will stay with it – and on average, generics are one-quarter of the price of the brand alternatives. Ask your doctor or pharmacist if generic drugs are right for you. The Three Tier Prescription Drug List is available online. Refer to page 3 for information on accessing all online forms. Employee Benefits Guide 16 Dental Program Dental coverage with any provider — no network restrictions. Human Resources Contact Diane Mohr NBT Bancorp Human Resources—Norwich 607.337.6412 dmohr@nbtbci.com DENTAL CLAIMS ADMINISTERED BY EBS Benefit Solutions The coverage for dental care allows you to visit any dentist. There are no network restrictions. PLAN YEAR – JANUARY 1 THROUGH DECEMBER 31 1. Company pays 100% of the first $150 of billed charges 2. Employee then pays a $75 deductible Provider Contact EBS Benefit Solutions 800.803.5773 3. Company then pays 70% of the next $500 of billed charges 4. Company then pays 40% of the next $1,250 of billed charges $1,000 maximum per person per year $2,000 maximum per family per year $1,250 lifetime non-adult orthodontic benefit included as part of the yearly maximums listed above (the $1,250 lifetime benefit applies to orthodontic work begun after January 1, 2005) Expenses are based on the plan year. Annual benefits are nonaccumulative (except orthodontics), and any unused portion will be forfeited upon termination of employment. Eligible family members include your spouse and your unmarried dependent children up to age 19 (or age 25 if they are full-time students). Cost-Shared Benefit Please refer to the 2008 Benefit Rate Sheet on page 7 of this guide for NBT Bancorp’s cost sharing. Pretax Premiums Employee premiums are withheld on a pretax basis. New for 2008 — more flexibility! Choose either dental or vision coverage, or both. The Dental Claim Form and Group Dental Plan Booklet are available online. Refer to page 3 for information on accessing all online forms. Employee Benefits Guide 17 Vision Program Human Resources Contact Diane Mohr NBT Bancorp Human Resources—Norwich 607.337.6412 dmohr@nbtbci.com VISION CARE PLAN ADMINISTERED BY Davis Vision If you enroll in the Davis Vision Plan, you and your enrolled family members are entitled to: A routine eye examination once every 12 months Lenses or contact lenses in lieu of eyeglasses once every 12 months Frames once every 24 months ▲ Provider Contact Davis Vision 800.999.5431 www.davisvision.com (control code: 7011) NETWORK BENEFITS A routine eye examination, including dilation as professionally indicated, with a $15 co-payment A choice of frames from Davis Vision’s Designer “Tower Collection” (located in most network provider offices) or a credit toward a network provider’s own frames Lenses, including your choice of the following, at no extra charge: Cost-Shared Benefit Please refer to the 2008 Benefit Rate Sheet on page 7 of this guide for NBT Bancorp’s cost sharing. • Glass or plastic single-vision, bifocal, trifocal or lenticular (post-cataract) lenses, in any prescription range • Fashion, sun or gradient-tinted plastic lenses • Oversize lenses • Ultraviolet (UV) lens coating • Photogrey Extra® (sun-sensitive) glass lenses • Blended invisible bifocal lenses • Free membership to Lens 123, an exclusive mail-order replacement contact lens service. ® Fixed, discounted charges for additional options for your lenses or frames, including polarized lenses and plastic photosensitive lenses Access to discounts for Laser Vision Correction Surgery through an approved network of Laser Vision Correction providers Pretax Premiums Employee premiums are withheld on a pretax basis. The Davis Vision Out of Network Claim Form and Indemnity Schedule are available online. Refer to page 3 for information on accessing all online forms. Out-of-network benefits are also available. Print the claim form from the NBT Bancorp intranet. Important Information Employee Benefits Guide 18 Flexible Spending Accounts (FSAs) Claim reimbursements will be processed weekly and direct-deposited into your NBT Bank or Pennstar Bank account. Human Resources Contact Diane Mohr NBT Bancorp Human Resources—Norwich 607.337.6412 dmohr@nbtbci.com CLAIMS ADMINISTERED BY NBT Bancorp Inc. THERE ARE TWO DIFFERENT TYPES OF REIMBURSEMENT ACCOUNTS Health/Dental/Vision FSA Dependent Care FSA Employee-Paid Benefit Participation requires annual enrollment. TAX TREATMENT Your pretax contributions to the FSAs are not subject to federal income tax, Social Security or Medicare taxes. Since this portion of compensation is not subject to the Social Security tax, it cannot be considered when Social Security benefits are calculated. Therefore, your eventual Social Security benefits may be reduced slightly if you participate in the pretax reimbursement accounts. FORFEITING CONTRIBUTIONS Claims for expenses that are incurred during a calendar year can be submitted until March 31 of the following year. Any money left in your FSAs as of that date cannot be returned to you and will be forfeited. BENEFITS OF USING PRETAX DOLLARS ANNUAL AMOUNT YOU CONTRIBUTE TO YOUR FSA $ $ 200 500 Pretax Dollars Employee contributions are withheld on a pretax basis. FSA Eligibility An employee contributing to a Health Savings Account (HSA) is ineligible to participate in the Health/ Dental/Vision FSA. TAX SAVINGS IN A 15% TAX BRACKET $ $ $ $ $ $ $ 45 113 227 340 453 680 906 TAX SAVINGS IN A 25% TAX BRACKET $ $ $ $ $ $ 65 163 327 490 653 980 $ 1,000 $ 1,500 $ 2,000 $ 3,000 $ 4,000 $ 5,000 $ 1,306 $ 1,633 $ 1,133 The Flexible Spending Accounts Claim Form is available online. Refer to page 3 for information on accessing all online forms. Set aside pretax dollars: • Up to $5,000 for Health/Dental/Vision FSA • Up to $5,000 for Dependent Care FSA Important Information Employee Benefits Guide 19 Flexible Spending Accounts (FSAs) Health/Dental/Vision FSA Employee-Paid Benefit Weekly reimbursement through direct deposit to your NBT Bank or Pennstar Bank account. YOUR OUT-OF-POCKET COSTS Without FSA, you pay 100% of your out-of-pocket costs. Out-of-Pocket Costs With FSA, you save 20% to 30% of your out-of-pocket costs. Out-of-Pocket Costs Pretax Dollars The Health/Dental/Vision FSA allows you to have from $130 to $5,000 a year deducted from your paycheck on a pretax basis. 20% to 30% Your Typical Tax Savings EXAMPLES OF ELIGIBLE MEDICAL EXPENSES Claims for the following must be processed through your medical, dental or vision insurance before they can be submitted through your Health/Dental/Vision FSA: Acupuncture Ambulance Services Artificial Limbs Braille Books Chiropractors Contact Lenses and Supplies Co-pays Crowns, Bridges and Dentures Crutches Deductibles Dental Cleanings Dermatologists Eye Examinations Fertility Treatments Glasses Home Health Care Home Improvements for Medical Purposes Hospital Bills Regulations require that you incur expenses before December 31 and submit your claim no later than March 31 of the following year. Laboratory Fees Lasik Eye Surgery Mammography Orthodontia Orthopedic Shoes and Braces Physical Therapy Prescription Co-pays Radial Kerototomy Select Over-the-Counter Drugs Sterilizations and Reversals Stop Smoking Program Substance Abuse Treatment Surgical Expenses Telephone Equipment for the Deaf Transportation for Medical Purposes Wheelchairs X-rays Documentation The best form of documentation to include with your Health/Dental/ Vision FSA claim is your insurance explanation of benefits (EOB). Employee Benefits Guide 20 Flexible Spending Accounts (FSAs) Dependent Care FSA Employee-Paid Benefit Weekly reimbursement through direct deposit to your NBT Bank or Pennstar Bank account. A Dependent Care FSA may cover the costs for care of the following dependents (the person receiving the care must qualify as your dependent for income tax purposes): Children age 12 or younger Disabled spouse or another disabled dependent Elderly parents who are physically or mentally unable to care for themselves Regulations require that you incur expenses before December 31 and submit claims no later than March 31 of the following year. Pretax Dollars This program is funded with pretax dollars. DEPENDENT CARE EXPENSES Eligible for Reimbursement Before- or after-school programs Day care Documentation Dependent Care FSA claim documentation must include: Provider’s name Provider’s tax ID number Dependent(s) cared for Dates care was provided Elder care Preschool/nursery school Summer day camp Ineligible for Reimbursement Educational expenses Payments to your child under age 19 for babysitting other siblings Payments for care of a child age 13 or over Placement fees for finding a provider MAXIMUM ELECTION You may have a maximum of $5,000 a year deducted pretax from your paycheck, in equal installments. If you are married and file a separate income tax return, you may have a maximum of $2,500 a year deducted. FEDERAL AND STATE DEPENDENT CARE TAX CREDITS The dependent care expenses that can be reimbursed through a Dependent Care FSA are the same as those eligible for the Child and Dependent Care credit on federal tax returns. Qualified dependent care expenses cannot be applied to both the reimbursement account and the tax credit. Therefore, you must decide which method is best for you. You may want to consult a tax advisor to help you evaluate this decision. Reimbursement will be made up to the amount of your deposits at the time your claim is received. Important Information Employee Benefits Guide 21 BalanceWorks eni’s work/life program provides a variety of information and support services to employers and employees. Human Resources Contact Karen Sastri NBT Bancorp Human Resources—Norwich 607.337.6410 ksastri@nbtbci.com ADMINISTERED BY eni BalanceWorks BalanceWorks, an enhanced work and family life Employee Assistance Program (EAP), is a prepaid and confidential service that combines traditional EAPs with work/life services. BalanceWorks is a one-stop resource for virtually any issue—personal or professional. ▲ BALANCEWORKS FEATURES Each participant is assigned his or her own Personal Assistant who provides access to specialized work/life services, referrals and information. Free online professional training – Educational materials and products are available in a variety of work/life topics, online self-help tools, videos and articles. Free 24-7 prepaid counseling – Toll-free access to a licensed professional for assessment, problem solving and up to five face-to-face, telephone or Internet counseling sessions. Other services available include: • Financial consultation and referral • Legal consultation and referral • Child and elder care resource/referral services Provider Contact eni BalanceWorks www.eniweb.com (web membership no.: NBT5845) 24-7 Toll-Free Intake Line 800.EAP.CALL (800.327.2255) VISIT YOUR EAP ONLINE AT WWW.ENIWEB.COM Step 1: To access eni’s website, go to: www.eniweb.com. Step 2: Select “Member Login.” Step 3: In the “Company ID” box in the “Company Login” area, enter NBT5845. Then, click the “Company Login” button. Step 4: You will now have access to a customized EAP web page. Up to fiv e confide ntial consulta tions per yea r at no char ge to the emp loyee. Employee Benefits Guide 22 2008 LIFE INSURANCE B A S I C L I F E I N S U R AN C E B U S I N E S S TR AV E L ACCI D E N T I N S UR AN C E ■ Basic Life Insurance Each employee is provided with group term life insurance. life insurance Human Resources Contact Diane Mohr NBT Bancorp Human Resources—Norwich 607.337.6412 dmohr@nbtbci.com INSURED BY Security Mutual Life Insurance Company of New York NBT Bancorp provides Group Term Basic Life Insurance coverage equal to your annual base salary (rounded to the next highest $1,000, if it is not already an even multiple of $1,000), subject to a maximum of $250,000. Your basic life coverage will be based on your annual base salary as of October 1 each year. On your 65th birthday, your group term life benefit will be reduced to 65% of your previous amount. On your 70th birthday, it will be reduced to 50% of your original amount. If you become disabled prior to age 60, coverage can be continued to age 65. Accelerated payment of benefits is available in the event of terminal illness. Company-Paid Benefit Basic life insurance is a company-paid benefit. Life insurance You will receive qual to coverage e company-paid life your annual base insurance equal to salary at no cost twice your base to you. salary. The Life and Accident Beneficiary Insurance Form is available online. Refer to page 3 for information on accessing all online forms. Employee Benefits Guide 24 Business Travel Accident Insurance Coverage provided while you travel on company business. Human Resources Contact Diane Mohr NBT Bancorp Human Resources—Norwich 607.337.6412 dmohr@nbtbci.com INSURED BY UnumProvident Corporation If you are required to travel on company business away from the premises where you are regularly assigned, UnumProvident will cover a loss incurred during the business trip. Coverage will begin from the actual start of a planned trip. You may leave from your place of work, home or another location. The coverage ends upon return to your place of work or home, whichever occurs first. UNUM does not cover commuting travel. Company-Paid Benefit Business travel accident insurance is a companypaid benefit. Air travel coverage is limited. Check the Summary Plan Description on the NBT Bancorp intranet for full details. BENEFIT This benefit provides four times your annual base salary, up to a maximum of $250,000. COVERED LOSS AND BENEFIT LOSS For loss of life BENEFIT 100% of Benefit 100% of Benefit 100% of Benefit 100% of Benefit 100% of Benefit 50% of Benefit 50% of Benefit 50% of Benefit 25% of Benefit One hand and one foot One hand or foot and sight in one eye Speech and hearing One hand or one foot Speech or hearing Sight in one eye Thumb and index finger of same hand The Life and Accident Beneficiary Insurance Form is available online. Refer to page 3 for information on accessing all online forms. Employees should notify Human Resources about any motor vehicle convictions. Employee Benefits Guide ▲ FOR LOSS OF Both hands or both feet or sight in both eyes Important Information 25 2008 DISABILITY BENEFITS S H O RT- T E R M B E N E F I T S LONG-TERM BENEFITS ■ Short-Term Disability Benefits Human Resources Contact Diane Mohr NBT Bancorp Human Resources—Norwich 607.337.6412 dmohr@nbtbci.com SELF-INSURED BY NBT Bancorp Inc. If you are absent from work due to an illness or injury, you may be eligible for short-term disability benefits. To qualify for short-term disability benefits, your disability must be certified by a physician. Disability benefits are payable for a nonwork-related injury or illness. A seven-calendar-day waiting period applies before benefits are effective. During this first week of absence, you will be required to use your available paid time off. Payment begins on the eighth consecutive day of disability. After the waiting period, you will receive one week of full pay for every completed year of service (up to 13 weeks), and then 60% of gross pay for the balance of your disability (up to the 26-week maximum) through NBT Bancorp’s Short-Term Disability Supplemental Benefit. You are required to provide adequate proof of disability upon request in order to remain eligible to receive short-term disability benefits. NBT Bancorp reserves the right to withhold disability payments pending the receipt of required documentation and/or the review and confirmation of the employee’s disability by our independent medical director. Additional Coverage Available Additional voluntary shortterm disability coverage is also available as an employee-paid benefit (see page 39). If your doctor excuses you from work for more than seven days, contact Human Resources. Employee Benefits Guide 27 Long-Term Disability Benefits Human Resources Contact Diane Mohr NBT Bancorp Human Resources—Norwich 607.337.6412 dmohr@nbtbci.com INSURED BY MetLife Employee-Paid Benefit Long-term disability (LTD) is an employee-paid benefit. The biweekly LTD flex credit will continue to reimburse eligible employees for the cost of the 40% LTD core benefit as a taxable benefit earning. TOTAL DISABILITY If you are totally disabled, you will receive a core benefit of 40% of your base salary up to a maximum benefit of $7,500 per month following 180 days of disability. Totally disabled means that for the first two years you are unable to perform the important duties of your own occupation because of an injury or sickness and are under a licensed physician’s care. Thereafter, you are considered to be totally disabled if you are unable to work in any occupation for which you are or may become suited by education, training or experience. BENEFITS Begin after 180 days of disability. Continue to age 65 if you are less than age 60 when you become disabled—and for a reduced duration if you are over age 60. Continue if you are released to return to work on a part-time basis. For the first 24 months, you will receive your full disability benefit unless your part-time earnings plus your benefit equal more than 100% of your pre-disability earnings. After 24 months, you will receive a partial benefit (the amount of which depends on your loss of earnings). Are integrated with any income you receive from other sources for the same disability, such as workers’ compensation, Social Security, etc. Are limited to 24 months for mental and nervous conditions. Exclusions may apply if you have not been covered under this or a previous plan for the past 12 months and have a preexisting medical condition in the three months prior to your date of coverage and this condition is the cause of your disability. Your annual base salary as of October 1 of the current year will be used in determining your longterm disability insurance coverage and premium cost. EMPLOYEE OPTIONS You can choose to enhance the core benefit by selecting the buy-up option. Increase the monthly benefit to 60% (up to a maximum of $10,000 per month). Enhance the LTD Core Benefit with the buy-up option. Important Information Employee Benefits Guide 28 2008 RETIREMENT PLANS D E F I N E D B E N E F I T P E N S I O N P L AN 4 0 1 ( K ) A N D E M P L O Y E E S T O CK O W N E R S H I P P L AN ■ Defined Benefit Pension Plan Blue Preferred PPO Vested employees are eligible for retirement benefits from the plan as early as age 55. The Blue Preferred PPO Plan through BlueCross BlueShield of CNY is available to all eligible employees. Human Resources Contact Linda Zaczek NBT Bancorp Human Resources—Norwich 607.337.6158 lzaczek@nbtbci.com ELIGIBILITY Employees are enrolled in the plan on the first day of the month that coincides with or follows the date they have attained age 21 and completed a year of eligibility service (12 months and 1,000 hours). BENEFITS Benefits in this retirement plan accrue under an “ Account Balance” formula after you have become a participant in the plan. This formula provides: (1) a service credit of 5%* of your compensation earned at the end of each plan year in which you complete 1,000 hours of service and (2) an interest credit equal to the yield on 30-year Treasury notes* (in November of the prior plan year). If you are a participant in the plan and work less than 1,000 hours during a plan year, you will earn an interest credit but no service credit. (Employees covered under the Defined Benefit Pension Plan prior to January 1, 2000, and who did not elect the Account Balance formula, will receive benefits under the guidelines established for that plan at that time.) VESTING You will be able to receive a benefit from the plan only to the extent the benefit is vested. Your vesting service is earned in each year that you have worked 1,000 hours. Your accrued benefit will become vested under the following schedule. YEARS OF SERVICE Less than 3 years 3 years or more Company-Paid Benefit NBT Bancorp contributes 5%* of each eligible employee’s compensation to the pension plan on a calendar-year basis. VESTED PERCENTAGE 0% 100% NORMAL RETIREMENT AGE You are eligible to receive full retirement benefits after you have reached age 65. In-service commencement of benefits is available. EARLY RETIREMENT AGE You are eligible to receive early retirement (reduced) benefits after you have: (1) reached age 55; (2) become 100% vested; and (3) separated from active employment. SEPARATION FROM ACTIVE EMPLOYMENT If you accrue benefits under the Account Balance formula, you are eligible to receive your account balance after you have: (1) become 100% vested and (2) separated from active employment. The Defined Benefit Pension Plan Beneficiary Election Form and the Summary Plan Description (SPD) are available online. Refer to page 3 for information on accessing all online forms. *May change subject to regulations. Employee Benefits Guide 30 401(k) Plan and Employee Stock Ownership Plan with Automatic Enrollment Feature Human Resources Contact Linda Zaczek NBT Bancorp Human Resources—Norwich 607.337.6158 lzaczek@nbtbci.com To be prepared for a financially secure retirement, regardless of your age, you should begin saving now. NBT Bancorp’s 401(k) Plan and Employee Stock Ownership Plan (ESOP) offer you several features to help you maximize your retirement strategy. ELIGIBILITY First day of the month that coincides with or follows your date of hire, provided you have attained age 21 and are scheduled to work at least 1,000 hours annually. EMPLOYEE CONTRIBUTIONS Pretax contributions made through payroll deduction. Rollover contributions may be transferred from an existing qualified pretax retirement plan. Total annual payroll contribution limit for 2008: $15,500 (Employees age 50 and older may contribute additional contributions, called catch-up contributions, to a maximum of $5,000, for an annual maximum contribution of $20,500.) Recordkeeper Contact EPIC Advisors 800.716.3742 www.epic1st.com EMPLOYER CONTRIBUTIONS NBT Bancorp matches your contribution dollar-for-dollar up to 3% of compensation. NBT Bancorp may make discretionary 401(k) matching and ESOP contributions based on corporate profitability, if you contribute an average of 4% during the plan year. NBT Bancorp contributions are made in the form of NBT Bancorp stock. Employer contributions vest at the rate of 20% per year, with 100% vesting following five years of service. ▲ PLAN FEATURES Paperless self-enrollment through the NBT Bancorp intranet or voice response system (800-716-3742). A personal identification number (PIN) allows you easy access to set up your contribution percentage and investment options. Automatic enrollment makes your enrollment even easier. NBT Bancorp will automatically enroll all eligible employees at a contribution rate of 4% on the first of the month coinciding with or following 30 days from their date of hire or change to an eligible status. Contributions will be directed to the target-date retirement fund closest to your retirement date. You can adjust * your contribution rate percentage and investment options by using the plan’s online features. Investment advice provides assistance with selecting the best investment options for your individual situation. This is available through NBT Bank’s Trust and Investment Division. Online services allow you to perform the following functions on a 24-7 basis: • Access account balance information • Change deferral percentage or • Process fund-to-fund transactions investment elections • Rebalance your account • Gain access to fund information • Model/request a loan • Obtain investment guidance and education Available Online: • 401(k) and ESOP Beneficiary Form • Stock Dividend Election Form • Summary Plan Description • 401(k) Rollover Contribution Form To be eligible for NBT Bancorp’s 401(k) discretionary match contribution, you must contribute an average of 4% during the plan year. *Unless otherwise directed. Important Information Employee Benefits Guide 31 2008 V O L U N TA R Y B E N E F I T S O P T I O N A L T E R M L I F E I N S UR AN C E A C C I D E N TA L D E AT H A N D D I S ME M B E R ME N T I N S U R AN C E U N I V E R S AL L I F E I N S U R AN C E A U T O A N D H O ME O W N E R ’ S I N S UR AN C E A F L AC CAN C E R P L AN S H O RT- TE R M D I S AB I L I T Y I N S U R AN C E L O N G - T E R M - C AR E I N S UR AN C E ■ Optional Term Life Insurance – Employee Human Resources Contact Diane Mohr NBT Bancorp Human Resources—Norwich 607.337.6412 dmohr@nbtbci.com GROUP VOLUNTARY BENEFITS Group Voluntary Benefits can be elected on your Benefit Enrollment Form. INSURED BY MetLife Employee-Paid Benefit Optional term life insurance is an employee-paid benefit. EMPLOYEE OPTIONAL LIFE You may choose optional term life insurance coverage for yourself in multiples of one, two, three, four, five or six times your annual base salary—rounded to the next highest $1,000 if not already an even multiple of $1,000—to a maximum of $1,000,000. This coverage is available to you without medical evidence of insurability if your selected coverage amount does not exceed $300,000 and you have not been hospitalized within the last 90 days prior to enrollment. The definition of “hospitalized” includes: inpatient hospital care; hospice care; treatment in an intermediate- or long-term-care facility; and outpatient hospital care for receipt of chemotherapy, radiation therapy or dialysis treatment. The cost for optional term life insurance is based on the amount of coverage you select and your age as of January 1, 2008. Your annual base salary as of October 1 of each year will be used to determine your optional life insurance cost. ▲ Calculate Your Premium Click on the Benefits Calculator icon on NBT Bancorp’s intranet to determine your biweekly premium deductions. PLAN HIGHLIGHTS PORTABILITY Allows you to continue the employee optional term life coverage should you leave employment with NBT Bancorp or you are no longer part of an eligible class for coverage. Competitive group rates apply, and you will be billed directly by MetLife. Dependent term coverage on spouse and children is not portable. CONVERSION If your coverage is terminated, you may convert your dependent term life coverage to a MetLife individual permanent policy without evidence of insurability. Covered dependents may also convert. ACCELERATED BENEFITS The Life and Accident Beneficiary Insurance Form and Optional Life, Dependent Life and AD&D Insurance Plan Booklet are available online. Refer to page 3 for information on accessing all online forms. Allows a terminally ill participant with less than six months to live to receive up to 50% of his or her life insurance proceeds while still living (not to exceed $250,000). You can purchase term life insurance coverage up to six times your base salary (maximum coverage is $1,000,000). Important Information Employee Benefits Guide 33 Optional Term Life Insurance – Spouse and Child INSURED BY Human Resources Contact Diane Mohr NBT Bancorp Human Resources—Norwich 607.337.6412 dmohr@nbtbci.com MetLife SPOUSE OPTIONAL LIFE Term life insurance coverage is also available for your spouse without medical evidence of insurability if: The amount of coverage is $30,000 or less Your spouse has not been hospitalized within 90 days of enrollment Employee-Paid Benefit Spouse and Child Optional Term Life Insurance is an employee-paid benefit. Your spouse is able to perform “normal activities” Normal activities means that the spouse is not confined at home under the care of a physician due to sickness or injury and is not receiving or is not entitled to receive any disability income from any source due to his or her own sickness or injury. Coverage on the life of your spouse is available in $10,000 increments, up to a maximum of $100,000, provided that you participate in the Employee Optional Life program and that the amount of coverage on your spouse does not exceed 100% of your Employee Optional Life amount. The cost for spouse coverage is based on his or her age as of January 1 of the upcoming year and the amount of coverage selected. Coverage ends on the spouse’s 70th birthday. Spouse Life Spouse coverage is available up to $100,000 (in $10,000 increments). Calculate Your Premium Click on the Benefits Calculator icon on NBT Bancorp’s intranet to determine your biweekly premium deductions. CHILD OPTIONAL LIFE Coverage is also available in the amount of $10,000 for each dependent child age 15 days to 19 years (25 years if full-time student), provided that you participate in the Employee Optional Life program. The cost of covering your children is a flat biweekly rate regardless of the number of children enrolled. Child optional life coverage can give you peace of mind. Employee Benefits Guide 34 Accidental Death and Dismemberment Insurance Human Resources Contact Diane Mohr NBT Bancorp Human Resources—Norwich 607.337.6412 dmohr@nbtbci.com INSURED BY MetLife You may choose Voluntary Accidental Death and Dismemberment (AD&D) coverage regardless of whether or not you purchase optional life insurance coverage. AD&D is available in multiples of one, two or three times your annual base salary rounded to the next highest $1,000, if it is not already an even multiple of $1,000, to a maximum of $1,000,000. If you are enrolled in AD&D coverage, you may also choose AD&D coverage for your dependents. Unmarried dependent children are covered up to age 19 (or age 25 if they are full-time students). The amount of insurance applicable to your family members is expressed as a percentage of the amount you select for yourself on the following basis: Spouse and Eligible Child or Children • Spouse: 40% of employee amount • Each Child: 10% of employee amount Spouse and No Eligible Child or Children • Spouse: 50% of employee amount No Spouse but Eligible Child or Children • Each Child: 15% of employee amount Employee-Paid Benefit Voluntary Accidental Death and Dismemberment Insurance is an employeepaid benefit. Calculate Your Premium Click on the Benefits Calculator icon on NBT Bancorp’s intranet to determine your biweekly premium deductions. COMMON DISASTER BENEFIT Your spouse percentage (40% or 50%) of your coverage will be increased to 100% if you and your spouse die within one year of sustaining bodily injuries in the same accident or in separate accidents occurring within the same 24-hour period. Your annual base salary as of October 1 of the current year will be used in determining your AD&D insurance premium cost. The Life and Accident Beneficiary Insurance Form and Optional Life, Dependent Life and AD&D Insurance Plan Booklet are available online. Refer to page 3 for information on accessing all online forms. You can purchase AD&D coverage up to three times your base salary (maximum coverage is $1,000,000). Important Information Employee Benefits Guide 35 Universal Life Insurance An easy and affordable way to purchase life insurance for you and your family. Policy Contact NBT Financial Services 607.337.6011 financialservices@nbtbank.com INDIVIDUAL VOLUNTARY BENEFITS Individual Voluntary Benefits are elected through the policy contact (listed at left) and may be paid through payroll deduction. Individual benefits may be kept after termination through direct billing by the carrier. INSURED BY Security Mutual Life Insurance Company of New York Employee-Paid Benefit Universal Life Insurance is an employee-paid benefit. Security Mutual’s LifePlan offers an easy and affordable way for you to purchase life insurance in order to assist you in safeguarding your family’s future. In addition to providing death benefits to your family, your policy builds cash value that may be available to help you with other financial needs. ▲ EXPLORING YOUR OPTIONS PERSONAL You may pick and choose whom you wish to cover. You can provide coverage for yourself, a spouse, dependent children and even grandchildren. There is no requirement that you have to be covered in order to cover family members. PORTABLE Should you leave employment with NBT Bancorp, you can take the coverage with you. The only change will be the method in which you pay the premiums. All rates stay the same. PERMANENT Once the plan is established, the amount of coverage is stable. As long as the necessary premiums are paid, protection can be provided for your entire life. PROTECTION This is life insurance. Although it does gain cash value, it is not intended as an investment vehicle. • Simple application process—no physicals or medical exams • Family coverage available • Tax-free death benefit • 100% portable Important Information Employee Benefits Guide 36 Auto and Homeowner’s Insurance Purchase coverage and add convenience to the process. Provider Contact Mang Insurance Agency 800.965.6264, ext. 4424 www.manginsurance.com OFFERED BY Mang Insurance Agency The auto and homeowner’s insurance benefit allows you to conveniently purchase this coverage through work. With access to professional insurance consultants, you will also have an opportunity for a comprehensive review of your coverage. The advantages of this benefit include: Payroll-deducted premiums Employee-Paid Benefit Auto and homeowner’s insurance is an employeepaid benefit. Multiple companies to choose from No down payments, interest or finance charges Quality products that are fully portable Completely customized and flexible products TO RECEIVE A COMPARATIVE QUOTE OR FOR AN INSURANCE REVIEW, CONTACT Teri Schunk Mang Insurance 800.965.6264, ext. 4424 teri.schunk@manginsurance.com Use payroll deduction to pay your auto and homeowner’s insurance premiums. Employee Benefits Guide 37 AFLAC Cancer Plan The Personal Lifestyle Protector Cancer Plan provides cash paid directly to the policy-holder to meet out-of-pocket expenses associated with the treatment of cancer. INSURED BY Policy Contact NBT Financial Services 607.337.6011 financialservices@nbtbank.com AFLAC (American Family Life Assurance Company of New York) Mail or Fax Wellness Benefits Claims to: (NY Employees) AFLAC New York 1 Marcus Boulevard Albany, NY 12205 Fax: 518.438.0896 (PA Employees) AFLAC Worldwide Headquarters 1932 Winnton Road Columbus, GA 31999 Fax: 877.442.3522 Attach receipt and include policy number. The American Cancer Society estimates that over 115 million Americans—about four in ten— will eventually have cancer. Current trends indicate that approximately 1.4 million new cases will be diagnosed annually. Of these new cases, nearly 9,000 will include children. Over 7.4 million Americans alive today have a history of cancer. Most important, 115,000 more lives could be saved each year with early detection and treatment. But cancer treatment is expensive. Even if you have health insurance, it probably will not cover 100% of the medical costs of cancer, much less the multitude of nonmedical expenses usually incurred with a serious cancer illness. ▲ PLAN BENEFITS The Personal Lifestyle Protector Cancer Plan provides cash paid directly to the policyholder to meet out-of-pocket expenses associated with the treatment of cancer. For example: First-occurrence benefits of $1,500 to $5,000, if diagnosed Hospital-confinement benefits of $200 to $300 per day Radiation and chemotherapy benefits of $200 to $300 per day Surgery benefits of $100 to $5,000 per day (depending on the type of surgery) Cancer-screening benefit of $40 or $75 per calendar year (depending on the plan level selected) ▲ POLICY FEATURES Family coverage is available Premiums are deducted on a pretax basis Cash benefits are paid directly to the insured, unless assigned Cash benefits are paid regardless of other insurance Employee-Paid Benefit The AFLAC cancer plan is an employee-paid benefit. Fully portable at payroll rates Coverage is guaranteed renewable for life under the guidelines of the plan Plans offer various levels with different cash payouts. Pretax Dollars This program is funded with pretax dollars. Cash benefits from this plan are paid directly to you (unless otherwise assigned), regardless of any other insurance you may have; you can use these cash benefits however you want. Important Information Employee Benefits Guide 38 Short-Term Disability Insurance Supplement your company-provided short-term disability benefits. Provider Contact Teri Schunk Mang Insurance Agency 800.965.6264, ext. 4424 teri.schunk@manginsurance.com INSURED BY First Unum Life Insurance Company One out of three people will suffer a disability that lasts at least 90 days. One out of ten will be permanently disabled before age 65. Disability insurance, then, is an important consideration. If a serious accident or illness suddenly stopped your income, would you be able to cover everyday living expenses? OFFERED BY Mang Insurance Agency Short-term disability coverage provides a monthly benefit when you are sick or injured and unable to work. Benefits under this program would be paid in addition to any other disability or workers’ compensation benefits you receive. ▲ Employee-Paid Benefit Voluntary short-term disability is an employeepaid benefit. PRODUCT FEATURES Available monthly benefits of $300 to $3,000 per month Benefit-period options of 6 or 12 months Waiting-period options of 7 or 30 days Premiums do not increase due to age Benefits are paid directly to you Coverage is portable New York State Statutory Disability equals 50% of your gross salary, up to a maximum of $170 per week. NBT Bancorp’s Short-Term Disability Supplemental Benefit is based on years of service (see page 27 for more information). Voluntary Short-Term Disability Insurance can help fill the gap if you become disabled. NYS Statutory Disability NBT Bancorp Short-Term Disability Supplemental Benefit Voluntary Short-Term Disability Insurance Employee Benefits Guide 39 Long-Term-Care Insurance A voluntary, discounted program for employees, retirees and their families. Policy Contact NBT Financial Services 607.337.6011 financialservices@nbtbank.com INSURED BY John Hancock Long-term care (LTC) generally involves providing care and services when a person is unable to perform the normal activities of daily living (examples: toileting, bathing, dressing, eating, maintaining continence or having a severe cognitive impairment, such as Alzheimer’s disease). LTC is usually custodial—not skilled—care and so is usually not covered by your medical insurance. ▲ ▲ Employee-Paid Benefit Long-term-care insurance is an employee-paid benefit. PLAN BENEFITS Private LTC insurance can help you: Stay at home when you need care Maintain your independence Protect your income and assets Avoid dependence on family members Access high-quality care POLICY FEATURES Two plans are available—traditional and New York State Partnership. The features of these plans include: Benefits are payable for care at home, in an assisted-living facility, adult day care center or a nursing home Discounts are available to employees, retirees, extended family (spouses, parents, grandparents, children, in-laws and domestic partners) Discounts are portable for life and are in addition to good health and marital discounts Coverage is customized to your situation Premiums are based on age and should remain level for life. You can lock in a more affordable rate when you are younger. Important Information 40 2008 PLAN GUIDELINES D E FA U LT C O V E R AG E | E N R O L L M E N T CH AN G E S T E R M I N AT I O N OF C O V E R AG E | C O B R A CO V E R AG E C L A I M - F I L I N G P R O CE D UR E S N O TI C E O F C L A I M D E N I A L | R E Q U E S T F O R R E V I E W O F CL AI M D E N I AL Y O U R E R I S A R I G H T S AS A PA RT I C I PA N T ■ Plan Guidelines Additional information on benefits-related provisions and procedures. Enrollment Changes Enrollment changes due to qualified family status events must be made within 30 days after the date of the event. DEFAULT COVERAGE If you miss the enrollment deadline at the time of open enrollment or at the time of hire, you will be required to wait until the next open-enrollment date. In the meantime, you will be provided with the following benefits: Business Travel Accident Insurance eni BalanceWorks Basic Life Insurance Long-Term Disability Insurance (core benefit of 40%) Documentation Proof of a qualifying event will be required to make an enrollment change. ENROLLMENT CHANGES You may change your election only during the open-enrollment period that takes place in the fall of each year. Federal law permits exceptions to this rule only if the change is due to and consistent with a “qualified family status event.” These events include the following: Legal marital status (marriage, death of spouse, divorce, legal separation and annulment) Number of dependents (events that change the number – birth, death, adoption and placement for adoption) Termination or commencement of employment, strike or lockout, commencement of or return from unpaid leave of absence or change in work site Change in employment status that affects plan eligibility, such as a change from a nonbenefits-eligible status to a benefits-eligible status (changes regarding the employee, the employee’s spouse or the employee’s dependent) Dependent satisfies or ceases to satisfy eligibility requirements Change in domestic partner status TERMINATION OF COVERAGE Your coverage under the company benefit plan will terminate at the end of the month in which one or more of the following events occur (unless otherwise specified): You terminate employment The plan terminates You cease to be eligible Your required contribution is due but not paid after any waiting period The date your dependent or domestic partner ceases to be classified as a “dependent” under the definition of the insurance contracts or plan COBRA COVERAGE Employees or dependents other than domestic partners may elect to continue plan coverage that would otherwise end because of one or more COBRA-qualifying events. Complete details on COBRA continuation coverage are included in the insurance contracts and booklets that govern each benefit. In addition, the COBRA policy is discussed in the Human Resources Policy and Procedures Manual and in the Employee Information Guide. Employee Benefits Guide 42 Plan Guidelines (continued) Claim-Filing Procedures A claim for insured medical, life, accidental death and dismemberment, cancer, auto and homeowner’s and voluntary short-term disability benefits should be filed with the company that insures the benefit you are claiming. CLAIM-FILING PROCEDURES FOR INSURED BENEFITS A claim for insured medical, life, accidental death and dismemberment, cancer, auto and homeowner’s and voluntary short-term disability benefits should be filed with the company that insures the benefit you are claiming. The respective group insurance contracts for these benefits describe the procedures for filing claims and for requesting a review of denied claims. CLAIM-FILING PROCEDURES FOR DENTAL AND VISION BENEFITS DENTAL Before any services are provided, you should obtain a claim form through NBT Bancorp’s intranet or from Human Resources. To file a claim, complete and sign the claim form, include documentation of the covered expense and send the claim to: EBS Solutions PO Box 4863 Syracuse, NY 13221 800.803.5773 VISION Services received from a Davis Vision network provider require no claim forms. When using an out-of-network provider, you may obtain a claim form through NBT Bancorp’s intranet or from Human Resources. To file a claim, complete and sign the claim form, include documentation of the covered expense and send the claim to: Vision Care Processing Unit PO Box 1525 Latham, NY 12110 1-800-999-5431 CLAIM-FILING PROCEDURES FOR HEALTH/DENTAL/VISION AND DEPENDENT CARE FLEXIBLE SPENDING ACCOUNTS To file a claim, you must first obtain a claim form through NBT Bancorp’s intranet or from Human Resources. Complete and sign the claim form, include documentation of the covered health/dental/vision and/or dependent care expenses—as well as applicable explanations of benefits (EOB) from your medical insurance provider—and send to: Flexible Spending Account Claims NBT Bancorp Inc. Human Reszes Division 52 South Broad Street Norwich, NY 13815 Related forms for these benefits are available online. Refer to page 3 for information on accessing all online forms. 607.337.6412 HumanResources@nbtbank.com Employee Benefits Guide 43 Plan Guidelines (continued) NOTICE OF CLAIM DENIAL If a claim for benefits is turned down, wholly or partially, you will be notified by the insurer within 90 days after the claim has been filed. The notice of denial will be in clear, understandable language and will give the reasons why the claim was turned down. The notice will describe the plan provisions on which the decision was based and will request any additional information or material that is needed to support the claim. REQUEST FOR REVIEW OF CLAIM DENIAL A written appeal of any claim denial may be submitted to the claims administrator within 60 days of receipt of the denial. Reasons and evidence for contesting the claim should be included with the appeal. The final written decision will be delivered within 60 days of the receipt of the appeal. This period may be extended if circumstances make it necessary. YOUR ERISA RIGHTS AS A PARTICIPANT As a participant in the employee benefit 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 are entitled to: Examine, without charge, at the plan administrator’s office all plan documents, including copies of all documents that the plan has filed with the U.S. Department of Labor; these documents include detailed annual reports and plan descriptions. Obtain copies of all plan documents and other plan information upon written request to the plan administrator. The plan administrator may charge a reasonable fee for the copies. Receive a summary of the plan’s annual financial report. In addition to creating rights for plan participants, ERISA imposes duties upon the people who are responsible for the operation of the employee benefit plan. The people who operate your plan, called “fiduciaries” of the plan, have a duty to do so prudently and in your interest and in the interest of other plan participants as well as beneficiaries. No one, including your employer, may discriminate against you in any way to prevent you from obtaining the plan benefits or exercising your rights under ERISA. If you have any questions about your benefits, you should contact the plan administrator. If you have any questions about this statement or about your rights under ERISA, you should contact the nearest office of the Employee Benefits Security Administration (formerly the Pension and Welfare Benefits Administration), U.S. Department of Labor, listed in your telephone directory. You may also contact the Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue, NW, Washington, DC 20210. Summary Plan Descriptions (SPDs) and other helpful benefit documents are available online. Refer to page 3 for information on accessing all online forms. Employee Benefits Guide 44