If you are a locomotive engineer working on a railroad that participated in the Wage/Rules portion of the National Agreement dated December 16, 2003 (BNSF, NS and Amtrak did not participate in this Plan so this information does not apply to engineers working on these properties), your coverage under Part A (described below) of the BLET Short Term Disability Plan will automatically continue.

If you currently do not participate in Part B coverage(also described below), you may elect coverage during this enrollment period. If you currently participate and wish to opt out of Part B coverage, then you also can do so during this enrollment period.

Part A — NON-OCCUPATIONAL DISABILITIES

There will be no changes to Part A coverage:
• Your eligibility is based on the $40 premium submitted by the railroad on a monthly basis.
• Part A pays $402 per week for non-occupational disabilities only, up to 52 weeks.
• Occupational disabilities are not covered by Part A.
• Each eligible member is insured for $50,000 of Accidental Death and Dismemberment (AD&D) coverage.
• There is a 14-day waiting period.

Part B — OCCUPATIONAL DISABILITIES

If you currently participate in Part B coverage or are currently eligible for Part A and enroll for Part B during this open enrollment period, Part B will also cover non-occupational disabilities if you are demoted to train service and become ineligible for Part A coverage.

Part B is voluntary. Participation in this additional occupational coverage is not required.

• The weekly benefit for occupational disabilities is $402 per week, up to 52 weeks
• Each eligible member is insured for an additional $50,000 of AD&D coverage. When participating in both Part A and Part B there is a total $100,000 of AD&D coverage.
• The benefit is not subject to repayment upon receipt of a FELA settlement (no repayment after a personal injury settlement.
• The benefit is not considered taxable income.
• The Part B premium will be paid by means of an automatic monthly direct debit withdrawal authorization arranged with your banking/financial institution. The Part B premium is $18.00 per month.
• There is a 14-day waiting period.

IMPORTANT:

Be aware that your initial eligibility for Part B remains dependent on your eligibility for Part A. In order to be eligible for Part A, you must have seven (7) starts in a month with one (1) start as an engineer in the month prior to enrolling for coverage.

If you are enrolled in Part B, your Part B coverage will automatically cover you for both occupational and non-occupational disabilities until: (1) you again become eligible for Part A, (2) you elect to discontinue your direct debit payment for Part B coverage, or (3) you are no longer a locomotive engineer working on a railroad that participated in the Wage/Rules portion of the National Agreement dated December 16, 2003.

CHOICES THAT MUST BE MADE BY DECEMBER 15, 2015

If you currently DO NOT participate in Part B and choose to do nothing, you will continue to be eligible for Part A coverage only. If you are currently enrolled in Part B and paying your premium via the bank account direct debit, and wish to remain enrolled, then you are not required to take any action.

If you currently DO NOT participate in Part B (and are eligible for Part A coverage) you may sign-up for Part B coverage during this open enrollment period. A letter for this purpose containing current information about the program, and a form to complete and return to the BLET to authorize and start your monthly premium payments for Part B ($18.00 per month, effective January 1, 2016) is being sent by US mail to all locomotive engineers eligible for Part A coverage to their current mailing address as provided by MetLife. This letter also includes a postage-paid return address envelope for sending your completed form back to the BLET.

If you DO currently participate in Part B and would like to OPT-OUT of Part B coverage, please arrange to contact us using the telephone number, or email address, shown at the end of this document, and we will send you the form you will need to opt-out of Part B.

Members, who OPT-OUT of Part B coverage, will not be eligible to re-enroll for that coverage until the next annual enrollment period and must meet eligible requirements at that time. No exceptions will be made.

All elections to enroll will become effective on January 1, 2016.

The monthly direct debits will occur on the 15th of each month, starting on January 15, 2016 and continue until you opt-out.

FILING A CLAIM FOR BLET SHORT TERM DISABILITY

• Call 1-800-858-6506 – MetLife Claim Center.
• Tell them you would like to file a claim under “BLE-T Short Term Disability”.
• Provide information requested, including contact information for your attending physician(s).
• A Case Manager will be assigned and you will receive a file number, which you must keep available for future reference.
• Following the call, you will receive an authorization for release of medical information. Sign the document and return to MetLife.

DESIGNATION OF BENEFICIARY(IES)

You are able to designate your beneficiary(ies) for the AD&D coverage on-line. If you would prefer to submit a paper beneficiary form, it is available on MetLife’s website. A simple registration process is required the first time you access www.metlife.com/mybenefits. Designating your beneficiary(ies) will ensure that your benefit proceeds are paid according to your wishes. If you do not have a designation of beneficiary(ies) on file, proceeds will be paid according to the AD&D plan’s facility of payment clause. Beneficiary designation for this coverage will not impact beneficiary designations for any other Life Insurance or AD&D plans that you may have with MetLife.

QUESTIONS, and FORMS TO OPT-OUT OF PART B.

Questions regarding BLET Short Term Disability and forms to opt-out should contact Dave Ditzel, BLET Short Term Disability Liaison, at 216-241-2630 (ext. 205) or email at dditzel@ble-t.org.