Notices & Plan Documents

Under the Affordable Care Act, we are required to provide Summaries of Benefits & Coverage (SBC) that have simple and consistent information about health plan benefits and coverage. The SBCs will help employees better understand the coverage they have and allow them to easily compare different coverage options. It will summarize the key features of the plan or coverage, such as the covered benefits, cost-sharing provisions, and coverage limitations and exceptions.

2023 Medical Plans

• Cigna HSA (pdf)
• Cigna OAP (pdf)
• Cigna OAP 500 – AZ Only (pdf)
• Cigna HSA - UT Only (pdf)
• Cigna PPO - UT Only (pdf)
• Kaiser – Northern California (pdf)
• Kaiser – Southern California (pdf)

This section provides an overview of the major benefits programs that are offered to all employees regularly scheduled to work 20 or more hours per week.

Every effort has been made to describe the following benefit plans accurately and in simple language. The complete text of each plan is contained in the actual summary plan document (SPD). If there is any conflict between the on-line benefits information and the provisions of the PDF document, the plan document and contract between the carrier and NortonLifeLock will always take precedence. The following on-line documents replace all descriptions of benefit plans included in prior printed material.

Although NortonLifeLock expects to continue these benefits, the company does reserve the right to change or terminate any benefit for any reason without notice at any time.

Summary Annual Reports provide financial information on the benefits we have reported to the Federal Government which NortonLifeLock is required to do on an annual basis.

NortonLifeLock Corporation Section 401(k) Plan (pdf)
EIN 77-0181864, Plan No. 001, for period January 1, 2021 through December 31, 2021. The annual report has been filed with the Employee Benefits Security Administration, U.S. Department of Labor, as required under the Employee Retirement Income Security Act of 1974 (ERISA).

NortonLifeLock Corporation Group Welfare Benefit Plan (pdf)
EIN 77-0181864, Plan No. 501, for period January 1, 2021 through December 31, 2021. The annual report has been filed with the Employee Benefits Security Administration, U.S. Department of Labor, as required under the Employee Retirement Income Security Act of 1974 (ERISA).

COBRA—the Consolidated Omnibus Budget Reconciliation Act—requires group health plans to offer continuation coverage to covered employees, former employees, spouses, former spouses, and dependent children when group health coverage would otherwise be lost due to specific events called "qualifying events". In accordance with COBRA regulations, you and your eligible dependents have a right to continue your health care coverage if a qualifying event occurs and you or your dependents to lose coverage through NortonLifeLock Benefits.

The following are qualifying events for a covered employee if they cause the covered employee to lose coverage:

• Termination of the covered employee’s employment for any reason other than “gross misconduct”; or
• Reduction in the covered employee’s hours of employment.

The following are qualifying events for a spouse and dependent child of a covered employee if they cause the spouse or dependent child to lose coverage:

• Termination of the covered employee’s employment for any reason other than “gross misconduct”;
• Reduction in hours worked by the covered employee
• Covered employee becomes entitled to Medicare;
• Divorce or legal separation of the spouse from the covered employee; or
• Death of the covered employee.

In addition to the above, the following is a qualifying event for a dependent child of a covered employee if it causes the child to lose coverage:

• Loss of “dependent child” status under the plan rules. Under the Affordable Care Act, plans that offer coverage to children on their parents’ plan must make coverage available until the adult child reaches the age of 26.

In the event a COBRA "qualifying event" occurs with regard to you and/or your dependents' coverage, you will receive additional information, including enrollment details.

COBRA coverage is generally available for 18 months and an additional 18 months is available in certain circumstances. To receive COBRA coverage, you must pay certain premium payments. The required premium is equal to both the amount formerly paid by NortonLifeLock and your prior contribution amount, plus up to a 2 percent administration fee.

Note that while federal COBRA coverage provisions do not consider domestic partners or their children to be eligible dependents, NortonLifeLock extends the same continuation opportunities to these individuals.

For a more thorough explanation of COBRA rights under group health plans, please see the notice below.

COBRA Continuation (pdf)

The Patient Protection and Affordable Care Act (PPACA), commonly called Obamacare or the Affordable Care Act (ACA), is a United States federal statute that aims to increase the quality and affordability of health insurance, lower the uninsured rate by expanding public and private insurance coverage, and reduce the costs of health care for individuals and the government. It provides a number of mechanisms - including mandates, subsidies, and insurance exchanges to increase coverage and affordability.

Below, you will find a link to a detailed explanation of your coverage options through the Health Insurance Marketplace, where you can purchase health insurance not sponsored or made available by NortonLifeLock.

Health Care Reform notice (pdf)

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) gives individuals a fundamental right to be informed of the privacy practices of their health plans and of most of their health care providers. HIPAA includes provisions that protect the privacy of health plan participants and their Protected Health Information (PHI). These provisions govern how entities such as health insurance companies, plan administrators, medical professionals, and plan sponsors (e.g., NortonLifeLock) must handle PHI.

HIPPA requires that an individual has a right to adequate notice of how a covered entity may use and disclose protected health information about the individual, as well the individual’s rights and the covered entity’s obligations with respect to that information. NortonLifeLock Corporation is required by law to periodically provide you with information about the privacy regulations under HIPAA.

NortonLifeLock maintains a Notice of Privacy Practices applicable to its self-funded health plans. The Notice provides information to individuals whose PHI will be used or maintained by ERISA. Please see the link below for a copy of NortonLifeLock HIPAA Notice of Privacy Practices.  

HIPAA Notice of Privacy Practices (pdf)

For employees working in Illinois, NortonLifeLock is required to provide a chart that compares which group health plan benefits are covered by the company to a list of Illinois essential health benefits. The chart is intended to help employees understand what is covered under the NortonLifeLock group health plan. You do not need to take any action other than reviewing the chart.

Illinois EHB Listing (pdf)

If you decline enrollment in a NortonLifeLock medical or health plan for you or your dependents - including your spouse - because of other health insurance or group health plan coverage, you or your dependents may be able to enroll in a NortonLifeLock health plan without waiting for the next open enrollment period if you:

• Lose other coverage. You must request enrollment within 31 days after the loss of other coverage.
• Gain a new dependent as a result of marriage, birth, adoption, or placement for adoption. You must request enrollment within 31 days after the marriage, birth, adoption, or placement for adoption.
• Lose Medicaid or Children's Health Insurance Program (CHIP) coverage because you are no longer eligible. You must request enrollment within 60 days after the loss of such coverage.

If you request a change due to a special enrollment event within the 31 day timeframe, coverage will be effective the date of birth, adoption or placement for adoption. For all other events, coverage will be effective the first of the month following your request for enrollment. In addition, you may enroll in NortonLifeLock's medical plan if you become eligible for a state premium assistance program under Medicaid or CHIP. You must request enrollment within 60 days after you gain eligibility for medical plan coverage. If you request this change, coverage will be effective the first of the month following your request for enrollment. Specific restrictions may apply, depending on federal and state law.

Note: If your dependent becomes eligible for a special enrollment rights, you may add the dependent to your current coverage or change to another health plan.

If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.

If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1­-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.

If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).

If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of July 31, 2020. Contact your State for more information on eligibility –

To see if any other states have added a premium assistance program since July 31, 2020, or for more information on special enrollment rights, contact either:

Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with NortonLifeLock and about your options under Medicare's prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.

There are two important things you need to know about your current coverage and Medicare's prescription drug coverage:

1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.


2. The prescription drug coverage sponsored by NortonLifeLock is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.

When can you join a Medicare drug plan?

You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15 to December 7.

However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.

What happens to your current coverage if you decide to join a Medicare drug plan?

If you decide to join a Medicare drug plan, your current NortonLifeLock coverage will not be affected. If you decide to enroll in a Medicare prescription drug plan and you are an active employee or family member of an active employee, you may also continue your employer coverage. In this case, the NortonLifeLock plan will continue to pay primary or secondary as it had before you enrolled in a Medicare prescription drug plan. See pages 7- 9 of the CMS Disclosure of Creditable Coverage To Medicare Part D Eligible Individuals Guidance (available at http://www.cms.hhs.gov/CreditableCoverage/), which outlines the prescription drug plan provisions/options that Medicare eligible individuals may have available to them when they become eligible for Medicare Part D).

If you do decide to join a Medicare drug plan and drop your current NortonLifeLock coverage, be aware that you and your dependents may not be able to get this coverage back without experiencing a qualifying life event.

When will you pay a higher premium (penalty) to join a Medicare drug plan?

You should also know that if you drop or lose your current coverage with NortonLifeLock and don't join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later.

If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go 19 months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.

For more information about this notice or your current prescription drug coverage:

Contact the benefits helpdesk listed below for further information. NOTE: You'll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through NortonLifeLock changes. You also may request a copy of this notice at any time.

For more information about your options under Medicare prescription drug coverage:

More detailed information about Medicare plans that offer prescription drug coverage is in the "Medicare & You" handbook. You'll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans.

For more information about Medicare prescription drug coverage:

Visit www.medicare.gov.  Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the "Medicare & You" handbook for their telephone number) for personalized help. Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).

Remember: Keep this Creditable Coverage notice (pdf). If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).

For more information about this notice or your prescription drug coverage, contact:

Benefits Helpdesk - NortonLifeLock Corporation
60 E. Rio Salado Pkwy, Suite 1000, Tempe, AZ 85281
1-800-457-1664

Provider-Choice Rights Notice

Kaiser Permanente’s Traditional HMO Plan generally requires the designation of a primary care provider. You have the right to designate any primary care provider who participates in our network and who is available to accept you or your family members.

For children, you may designate a pediatrician as the primary care provider.

You do not need prior authorization from Kaiser Permanente or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in our network who specializes in obstetrics or gynecology. The health care professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan, or procedures for making referrals.

For a list of participating health care professionals, contact Kaiser Permanente at 800-464-4000, open 7 days a week 24 hours a day. You can also visit Kaiser online at www.kp.org.