Note: The following notices are being provided as required by federal law.
Depending on your employment status, you may not be eligible for all benefits described; please refer to your 2001 Employee Benefits book to determine if you are eligible or call your Benefits Department.
MEDICAL AND SURGICAL BENEFITS AFTER A MASTECTOMY
Women receiving benefits from the Plan for a mastectomy may elect breast reconstruction in connection with the mastectomy in a manner determined in consultation with the patient and attending physician. Covered services include the following:
| All stages of reconstruction of the breast on which the mastectomy was performed. | |
| Surgery and reconstruction of the other breast to produce a symmetrical appearance. | |
| Prostheses and treatment of physical complications of all stages of mastectomy, including lymphedemas. |
These reconstructive benefits are subject to annual deductibles, copayments, and coinsurance provisions like other medical and surgical benefits covered under the medical plans.
MEDICAL CLAIM DETERMINATION & APPEAL
Post-Service Claims
Post-Service Claims are those claims that are filed for payment of benefits after medical care has been received. If your post-service claim is denied, you will receive a written notice from United HealthCare (UHC) within 30 days of receipt of the claim, as long as all needed information was provided with the claim. UHC will notify you within this 30-day period if additional information is needed to process the claim, and may request a one-time extension not longer than 15 days and pend your claim until all information is received.
Once notified of the extension you then have 45 days to provide this information. If all of the needed information is received within the 45-day time frame and the claim is denied, UHC will notify you of the denial within 15 days after the information is received. If you don’t provide the needed information within the 45-day period, your claim will be denied.
A denial notice will explain the reason for denial, refer to the part of the Plan on which the denial is based, and provide the claim appeal procedures.
Pre-Service Claims
Pre-service claims are those claims that require notification or approval prior to receiving medical care. If your claim was a pre-service claim, and was submitted properly with all needed information, you will receive written notice of the claim decision from United HealthCare (UHC) within 15 days of the claim.
If you filed a pre-service claim improperly, UHC will notify you of the improper filing and how to correct it within 5 days after the pre-service claim was received. If additional information is needed to process the pre-service claim, UHC will notify you of the information needed within 15 days after the claim was received, and may request a one time extension not longer than 15 days and pend your claim until all information is received.
Once notified of the extension you then have 45 days to provide this information. If all of the needed information is received within the 45- day timeframe, UHC will notify you of the determination within 15 days after the information is received. If you don’t provide the needed information within the 45 days period, your claim will be denied. A denial notice will explain the reason for denial, refer to the part of the Plan on which the denial is based, and provide the claim appeal procedures.
Urgent Claims that Require Immediate Action
Urgent claims are those claims that require notification or approval prior to receiving medical care, where a delay in treatment could seriously jeopardize your life or health or the ability to regain maximum function or, in the opinion of a physician with knowledge of your medical condition could cause severe pain. In these situations:
| You will receive notice of the benefit determination in writing or electronically within 72-hours after United HealthCare (UHC) receives all necessary information, taking into account the seriousness of your condition. | |
| Notice of denial may be oral with a written or electronic confirmation to follow within 3 days. |
If you filed an urgent claim improperly, UHC will notify you of the improper filing and how to correct it within 24 hours after the urgent claim was received. If additional information is needed to process the claim, UHC will notify you of the information needed within 24 hours after the claim was received. You then have 48 hours to provide the requested information. You will be notified of a determination no later than 48 hours after:
| UHC’s receipt of the requested information; or | |
| The end of the 48 hour period within which you were to provide the additional information, if the information is not received within that time. |
A denial notice will explain the reason for denial, refer to the part of the Plan on which the denial is based, and provide the claim appeal procedures.
Concurrent Care Claims
If an on-going course of treatment was previously approved for a specific period of time or number of treatments, and your request to extend the treatment is an urgent claim as defined above, your request will be decided within 24 hours, provided your request is made at least 24 hours prior to the end of the approved treatment. If your request for the extended treatment is not made at least 24 hours prior to the end of the approved treatment, the request will be treated as an urgent claim and decided according to the timeframes described above.
If an on-going course of treatment was previously approved for a specific period of time or number of treatments, and you request to extend treatment in a non-urgent circumstance, your request will be considered a new claim and decided according to post-service or pre-service timeframes, whichever applies.
How to Appeal a Claim Decision
If you disagree with a claim determination after following the above steps, you can contact United HealthCare (UHC) in writing to formally request an appeal. If the appeal relates to a claim for payment, your request should include:
| The patient’s name and the identification number from the ID card. | |
| The date(s) of medical service(s). | |
| The provider’s name. | |
| The reason you believe the claim should be paid. | |
| Any documentation or other written information to support your request for claim payment. |
Your first appeal request must be submitted to UHC within 180 days after your receive the claim denial.
Appeal Process
A qualified individual who was not involved in the decision being appealed will be appointed to decide the appeal. If your appeal is related to clinical matters, the review will be done in consultation with a health care professional with appropriate expertise in the field that was not involved in the prior determination. UHC may consult with, or seek the participation of, medical experts as part of the appeal resolution process. You consent to this referral and the sharing of pertinent medical claim information. Upon request and free of charge you have the right to reasonable access to and copies of, all documents, records, and other information relevant to your claim for benefits.
Appeal Determinations
You will be provided written or electronic notification of decision on your appeal as follows:
| For appeals of pre-service claims, the first level appeal will be conducted and you will be notified by UHC of the decision within 15 days from receipt of a request for appeal of a denied claim. A second level appeal will be conducted and you will be notified by UHC of the decision within 15 days from receipt of a request for review of the first level appeal decision. | |
| For appeals of post-service claims, the first level appeal will be conducted and you will be notified by UHC of the decision within 30 days from receipt of a request for appeal of a denied claim. A second level appeal will be conducted and you will be notified by UHC of the decision within 30 days from receipt of a request for review of the first level appeal decision. | |
| For urgent claims procedures, see "Urgent Claim Appeals That Require Immediate Action" below. | |
| For appeals of concurrent care claims, the appeal will be conducted under timeframes and procedures that are appropriate to the type of claim that was denied. Refer to either pre-service, post-service or urgent claims appeals. |
If you are not satisfied with the first level appeal decision of UHC, you have the right to request a second level appeal from UHC as the Plan Administrator. Your second level appeal request must be submitted to UHC within 60 days from receipt of first level appeal decision.
For pre-service and post-service claim appeals, Airborne Express has delegated to UHC the exclusive right to interpret and administer the provision of the Plan. UHC’s decisions are conclusive and binding. Please note that UHC’s decision is based only on whether or not benefits are available under the Plan for the treatment or procedure. The determination as to whether the health service is necessary or appropriate is between you and your Physician.
Urgent Claim Appeals that Require Immediate Action
Your appeal may require immediate action if a delay in treatment could significantly increase the risk to your health or the ability to regain maximum function or cause severe pain. In these urgent situations:
| The appeal does not need to be submitted in writing. You or your Physician should call UHC as soon as possible. UHC will provide you with a written or electronic determination within 72 hours following receipt of your request for review of the determination taking into account the seriousness of your condition. |
For urgent claim appeals, Airborne Express has delegated to UHC the exclusive right to interpret and administer the provisions of the Plan. UHC’s decisions are conclusive and binding.
DENTAL - CLAIM APPEALS
In the event a claim is denied in whole or in part, MetLife will notify you in writing within 30 days after your claim was filed (45 days under special circumstances). If an extension beyond 30 days is necessary to make a decision on your claim, you will receive a notice indicating the reason for the delay and the date you may expect a final decision.
MetLife’s notice of claim denial will include:
| The specific reason(s) for denial with reference to the Plan provisions on which the denial is based; | |
| A description of any additional material or information necessary to complete the claim and an explanation of why the material or information is necessary; and | |
| The steps to be taken if you wish to have the decision reviewed. |
How to Appeal a Claim Decision
If MetLife denies your claim, you may make two appeals of the initial determination. Upon your written request, MetLife will provide you free of charge with copies of documents, records and other information relevant to your claim.
You must submit your appeal to MetLife at the address indicated on the claim form within 180 days of receiving MetLife's decision. Appeals must be in writing and must include at least the following information:
| Name of the patient | |
| Name of the Plan: Airborne Express Dental Plan, # 73862 | |
| Reference to the initial decision | |
| Whether the appeal is the first or second appeal of the initial determination | |
| An explanation why you are appealing the initial determination | |
| As part of each appeal, you may submit any written comments, documents, records, or other information relating to your claim |
Appeal Process
After MetLife receives your written request appealing the initial determination or the determination on the first appeal, MetLife will conduct a full and fair review of your claim. Deference will not be given to initial denials, and MetLife's review will look at the claim anew. The review on appeal will take into account all comments, documents, records, and other information that you submit relating to your claim without regard to whether such information was submitted or considered in the initial determination.
The person who reviews your appeal will not be the same person who made the initial decision to deny your claim. In addition, the person who is reviewing the appeal will not be a subordinate of the person who made the initial decision to deny your claim. If the initial denial is based in whole or in part on a medical judgment, MetLife will consult with a health care professional with appropriate training and experience in the field of dentistry involved in the judgment. This health care professional will not have consulted on the initial determination, and will not be a subordinate of any person who was consulted on the initial determination.
Appeal Determinations
MetLife will notify you in writing of its final decision within 30 days after MetLife's receipt of your written request for review, except that under special circumstances MetLife may have up to an additional 30 days to provide written notification of the final decision. If such an extension is required, MetLife will notify you prior to the expiration of the initial 30 day period, state the reason(s) why such an extension is needed, and state when MetLife will make its determination.
If MetLife denies the claim on appeal, MetLife will send you a final written decision that states the reason(s) why the claim you appealed is being denied and references any specific Plan provision(s) on which the denial is based. If an internal rule, protocol, guideline or other criterion was relied upon in denying the claim on appeal, the final written decision will state the rule, protocol, guideline or other criteria or indicate that such rule, protocol, guideline or other criteria was relied upon and that you may request a copy free of charge. Upon written request, MetLife will provide you free of charge with copies of documents, records and other information relevant to your claim.
VISION - CLAIM APPEALS
In the event a claim is denied in whole or in part, Cole Managed Vision will notify you in writing within 30 days after your claim was filed (45 days under special circumstances). If an extension beyond 30 days is necessary to make a decision on your claim, you will receive a notice from Cole Managed Vision indicating the reason for the delay and the date you may expect a final decision.
The notice of claim denial will include:
| The specific reason(s) for denial with reference to the Plan provisions on which the denial is based; | |
| A description of any additional material or information necessary to complete the claim and an explanation of why the material or information is necessary; and | |
| The steps to be taken if you wish to have the decision reviewed. |
How to Appeal a Claim Decision
If Cole denies your claim, you (or your authorized representative) may request a review of your claim and you may request free of charge copies of documents relevant to the claim. Your appeal should be sent to the attention of "Claims-Airborne Express Processing" at the address of the Cole Managed Vision Office on your claim form within 180 days after you receive notice of the denial of the claim. When requesting a review, at a minimum include the following information:
| Name of the patient | |
| Name of the Plan: Airborne Express Vision Plan, #40551 | |
| The reason you believe the claim was improperly denied | |
| Submit any data, questions, or comments you deem appropriate. |
All the information will be reevaluated by a qualified individual who was not involved in the decision being appealed. You will be informed of the decision in writing within 30 days after receipt of your written request for claims review. If special circumstances require an extension of time to review your claim, you will receive written notification of the final decision as soon as possible but not later than 60 days after your request for review. If such an extension is required, you will receive notice prior to the expiration of the initial 30 day period indicating the reason for the delay and the date you may expect a final decision.
Upon your written request, Cole Managed Vision will provide you free of charge with copies of documents, records and other information relevant to your claim.
LIFE & ACCIDENT INSURANCE CLAIMS APPEALS
Initial Determination
In the event a claim is denied in whole or in part, MetLife will notify you (or your beneficiary or your authorized representative) in writing within 90 days after receipt (180 days in special circumstances). If an extension beyond 90 days is necessary to make a decision on the claim, you (or your beneficiary or your authorized representative) will be notified in writing by MetLife indicating the reason for the delay and the timeframe for final decision.
If the claim is denied, MetLife’s notice of claim denial will include:
| The specific reason(s) for denial with reference to the Plan provisions on which the denial is based; | |
| A description of any additional material or information necessary to complete the claim and an explanation of why the material or information is necessary; and | |
| The steps to be taken if you (or your beneficiary) wish to have the decision appealed. |
You (or your beneficiary or your authorized representative) may request, free of charge, a copy of pertinent documents related to the claim that were reviewed by the service representative in making its determination.
Appeal of the Initial Determination
If MetLife denies your claim, you (or your beneficiary or your authorized representative) may file an appeal in writing. Upon request, MetLife will provide you free of charge with copies of documents and information relevant to your claims.
You have 60 days after receiving notification of the claim denial to file a written appeal. You must submit your appeal to MetLife at the address indicated on the claim form. The appeal must be in writing and include at least the following information:
| Name of Employee | |
| Name of the Plan: Airborne Express Life Insurance Plan | |
| Reference to the initial decision | |
| An explanation of why you are appealing the initial determination | |
| As part of your appeal you may submit any written comments, documents, records, or other information relating to your claim. |
After MetLife receives your written request appealing the initial determination or the determination on the first appeal, MetLife will conduct a full and fair review of your claim. Deference will not be given to initial denials, and MetLife's review will look at the claim anew. The review on appeal will take into account all comments, documents, records, and other information that you submit relating to your claim without regard to whether such information was submitted or considered in the initial determination.
The person who reviews your appeal will not be the same person who made the initial decision to deny your claim. In addition, the person who is reviewing the appeal will not be a subordinate of the person who made the initial decision to deny your claim. If the initial denial is based in whole or in part on a medical judgment, MetLife will consult with a health care professional with appropriate training and experience in the field involved in the judgment. This health care professional will not have consulted on the initial determination, and will not be a subordinate of any person who was consulted on the initial determination.
MetLife will notify you (or your beneficiary or your authorized representative) of the decision in writing within 60 days after receipt of your written appeal. If special circumstances require an extension of time to review your claim, you (or your beneficiary or your authorized representative) will receive written notification of the final decision as soon as possible but not later than 120 days after your request for review.
SHORT & LONG TERM DISABILITY - CLAIM APPEALS
Initial Determination
The claims administrator will give you notice of the decision no later than 45 days after the claim is filed. This time period may be extended twice by 30 days if it is determined that such an extension is necessary due to matters beyond the control of the Program, and you will be notified of the circumstances requiring the extension of time and the date by which the administrator expects to render a decision.
If such an extension is necessary due to your failure to submit the information necessary to decide the claim, the notice of extension will specifically describe the required information, and you will be afforded at least 45 days from receipt of the notice within which to provide the specified information. If you deliver the requested information within the time specified, any 30 day extension period will begin after you have provided that information. If you fail to deliver the requested information within the time specified, your claim may be decided without that information.
If your claim for benefits is wholly or partially denied, any notice of adverse benefit determination under the Program will
Notice of the determination may be provided in written or electronic form. Electronic notices will be provided in a form that complies with any applicable legal requirements.
Appeal Procedures
You have 180 days from the receipt of notice of an adverse benefit determination to file an appeal. Requests for appeals should be sent to the address specified in the claim denial. A decision on review will be made not later than 45 days following receipt of the written request for review. If Unum determines that special circumstances require an extension of time for a decision on review, the review period may be extended by an additional 45 days (90 days in total). You will be notified in writing if an additional 45 day extension is needed.
If an extension is necessary due to your failure to submit the information necessary to decide the appeal, the notice of extension will specifically describe the required information, and you will be afforded at least 45 days from receipt of the notice to provide the specified information. If you deliver the requested information within the time specified, the 45 day extension of the appeal period will begin after you have provided that information. If you fail to deliver the requested information within the time specified, your appeal may be decided without that information.
You will have the opportunity to submit written comments, documents, or other information in support of your appeal. The review of the adverse benefit determination will take into account all new information, whether or not presented or available at the initial determination. No deference will be afforded to the initial determination.
The review will be conducted by the claims administrator and will be made by a person different from the person who made the initial determination and such person will not be the original decision maker's subordinate. In the case of a claim denied on the grounds of a medical judgment, the administrator will consult with a health professional with appropriate training and experience. The health care professional who is consulted on appeal will not be the individual who was consulted during the initial determination or a subordinate. If the advice of a medical or vocational expert was obtained by the Program in connection with the denial of your claim, you will be provided with the names of each such expert, regardless of whether the advice was relied upon.
A notice that your request on appeal is denied will contain the following information:
Notice of the determination may be provided in written or electronic form. Electronic notices will be provided in a form that complies with any applicable legal requirements. Unless there are special circumstances, this administrative appeal process must be completed before you begin any legal action regarding your claim.
COMPLIANCE WITH EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974 (ERISA)
The information furnished in the benefits book constitutes the Summary Plan Description required by Federal Law. To comply with the law, the following additional plan information is also furnished:
PLAN INFORMATION
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Plan Names |
Airborne Express Health and Disability Plan |
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Airborne Express Employee Group Benefits
Plan |
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Airborne Express Profit Sharing Plan |
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Airborne Express Capital Accumulation Plan
(CAP/401k) |
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Airborne Express Retirement Income Plan |
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Name and Address of |
ABX
Air, Inc. Wilmington, Ohio 45177
Airborne FTZ, Inc 145 Hunter Drive Wilmington, Ohio 45177 |
Aviation Fuel, Inc. 145 Hunter Drive Wilmington, Ohio 45177
Airborne Logistic Services Corp. 3435 Airborne Road Wilmington, Ohio 45177 |
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Employer ID. No. |
91-1091619 |
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Plan Sponsor: |
Airborne Express, Inc. |
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Type of Plan: |
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Plan Administrator – Health and Welfare Plans: |
Airborne Express, Inc. |
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Type of Administration - Health and Welfare Plans:
| Medical benefits for the PPO options described in the benefits book are paid by United HealthCare and funded through the Airborne Express Health and Disability Trust, a voluntary employee beneficiary association sponsored by Airborne Express, Inc. United HealthCare is responsible for reviewing claims and determining whether they are payable under the terms of the Plan; United HealthCare does not insure these benefits. | |
| Dental benefits are paid by Metropolitan Life Insurance Company (referred to as MetLife) and funded through the Airborne Express Health and Disability Trust, a voluntary employee beneficiary association sponsored by Airborne Express, Inc. MetLife is responsible for reviewing claims and determining whether they are payable under the terms of the Plan; MetLife does not insure these benefits. | |
| Vision benefits are paid by Cole Managed Vision and funded through the Airborne Express Health and Disability Trust, a voluntary employee beneficiary association sponsored by Airborne Express, Inc. Cole Managed Vision is responsible for reviewing claims and determining whether they are payable under the terms of the Plan; Cole Managed Vision does not insure these benefits. | |
| Life and Accidental Death and Dismemberment benefits are insured by, and claims paid by, Metropolitan Life Insurance Company (referred to as MetLife). | |
| Short Term Disability benefits are paid by Unum Life Insurance Company and funded through the Airborne Express Health and Disability Trust, a voluntary employee beneficiary association sponsored by Airborne Express, Inc. Unum is responsible for reviewing claims and determining whether they are payable under the terms of the Plan; Unum does not insure these benefits. | |
| Long Term Disability benefits are insured by, and claims paid by, Unum Life Insurance Company. | |
| Business Travel Accident benefits are insured by, and claims paid by, AIG Life Insurance Company. | |
| Dependent Care Spending Accounts are administered by Manley Administrative Services, a third-party administrator. | |
| Group Universal Life Insurance benefits are insured by, and claims paid by, Prudential Insurance Company of America, Newark, NJ. The program is administered by Marsh @WorkSolutions, a third-party administrator. The group insurance contract is held by a trust on behalf of the Plan. | |
| Voluntary Accident Insurance benefits are insured by, and claims paid by, AIG Life Insurance Company. |
See "Claims Procedure" sections in the Benefits book for appropriate addresses of the Claims Administrator.
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Health and Welfare Trustees: |
Carl Donaway Airborne Express, 3101 Western Avenue, Seattle, WA 98121 |
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Plan Administrator for the Retirement Plans: |
Plan Administrator for the Profit Sharing Plan is:
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For the Capital Accumulation Plan (CAP/401k) is:
For the Retirement Income Plan is:
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Retirement Plan Funding |
For the Retirement Income & Profit Sharing Plans, Trust Agreement with:
For the Capital Accumulation Plan (CAP/401k), Trust Agreement with:
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Insurance Policies: |
Life and AD&D Policy No.: 73862 (MetLife) |
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Long Term Disability Policy No.: 543781 (Unum) |
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Business Travel Accident Policy No.: GTP 803 76 58 (AIG) |
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Group Universal Life Insurance Policy No.: GL22199 (Prudential) |
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Voluntary Accident Insurance Policy No.: EAP 803 31 11 (AIG) |
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Agent for Service of |
For disputes arising under the Plan, service of legal process may be made on the Plan Administrator, a Plan Trustee or on the Secretary of the Corporation at Airborne Express. (See the "Plan Administrator" section for addresses.) |
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For disputes arising under the Life and AD&D insurance contracts, service of legal process may be made upon MetLife Insurance Company at one of its local offices, or upon the supervisory official of the Insurance Department in the state in which you reside. |
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For disputes arising under the Long Term Disability insurance contract, service of legal process may be made upon Unum Life Insurance Company of America at one of its local offices, or upon the supervisory official of the Insurance Department in the state in which you reside. |
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For disputes arising under the Business Travel Accident and Voluntary Accident insurance contracts, service of legal process may be made upon AIG Life Insurance Company at one of its local offices, or upon the supervisory official of the Insurance Department in the state in which you reside. |
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For disputes arising under the Group Universal Life Insurance contract, service of legal process may be made upon Prudential Insurance Company of America at one of its Home Offices, or upon the supervisory official of the Insurance Department in the state in which you reside. |
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Plan Year: |
The Health and Disability Plan’s fiscal records are kept on a plan year basis beginning January 1 and ending on the following December 31. |
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The Employee Group Benefits Plan’s fiscal records are kept on a calendar year basis beginning January 1 and ending on the following December 31. |
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The Profit Sharing Plan’s fiscal records are kept on a plan year basis beginning January 1 and ending on the following December 31. |
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The Capital Accumulation Plan’s (CAP/401k) fiscal records are kept on a plan year basis beginning January 1 and ending on the following December 31. |
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The Retirement Income Plan’s fiscal records are kept on a plan year basis beginning January 1 and ending on the following December 31. |
Details of the Plans:
The Benefits book contains details of the Plans regarding eligibility for participation, description of benefits, and disqualification, ineligibility, denial, loss, forfeiture or suspension of benefits. Although it is the Plan Sponsor’s intent to continue the Plans indefinitely, the Plan Sponsor reserves the right to amend or terminate any of the Plans at any date.
The benefits of these Plans are governed by official plan documents, which may be modified or terminated in accordance with each Plan’s amendment and termination procedures.
If a Plan is changed or terminated for any reason, you will receive adequate notice.
If a Plan is terminated, you will be paid for bonafide claims incurred prior to the date of Plan termination only.
STATEMENT OF ERISA RIGHTS
As a participant in these Plans, you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA). ERISA provides that all Plan participants shall be entitled to:
Examine, without charge, at the plan administrator’s office and at other specified locations, such as worksites and union halls, all documents governing the plan, including insurance contracts and collective bargaining agreements, and a copy of the latest annual report (Form 5500 Series) filed by the Plan with the U.S. Department of Labor and available at the Public Disclosure Room of the Pension and Welfare Benefit Administration.
Obtain, upon written request to the Plan Administrator, copies of documents governing the operation of the Plan, including insurance contracts and collective bargaining agreements, and copies of the latest annual report (Form 5500 Series) and updated summary plan description. The administrator may make a reasonable charge for the copies.
Receive a summary of the Plan’s annual financial report. The plan administrator is required by law to furnish each participant with a copy of this summary annual report.
Obtain a statement telling you whether you have a right to receive a pension at normal retirement age (age 65) and if so, what your benefits would be at normal retirement age if you stop working under the plan now. If you do not have a right to a pension, the statement will tell you how many more years you have to work to get a right to a pension. This statement must be requested in writing and is not required to be given more than once every twelve (12) months. The plan must provide the statement free of charge.
Continue health care coverage for yourself, spouse or dependents if there is a loss of coverage under the plan as a result of a qualifying event. You or your dependents may have to pay for such coverage. Review this summary plan description and the documents governing the plan on the rules governing your COBRA continuation coverage rights.
Reduction or elimination of exclusionary periods of coverage for preexisting conditions under your group health plan, if you have creditable coverage from another plan. You should be provided a certificate of creditable coverage, free of charge, from your group health plan or health insurance issuer when you lose coverage under the plan, when you become entitled to elect COBRA continuation coverage, when your COBRA continuation coverage ceases, if you request it before losing coverage, or if you request it up to 24 months after losing coverage. Without evidence of creditable coverage, you may be subject to a preexisting condition exclusion for 12 months (18 months for late enrollees) after your enrollment date in your coverage.
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 the interest of you and other plan participants and beneficiaries. No one, including your employer, your union, or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a pension or welfare benefit or exercising your rights under ERISA. If your claim for a pension or welfare benefit is denied in whole or in part you must receive a written explanation of the reason for the denial. You have the right to have the plan review and reconsider your claim.
If your claim for a welfare benefit is denied or ignored in whole or in part, you have a right to know why this was done, to obtain copies of documents relating to the decision without charge, and to appeal any denial, all within certain time schedules. Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request a copy of Plan documents or the latest annual report from the Plan and do not receive them within 30 days, you may file suit in a Federal court. In such a case, the court may require the plan administrator to provide the materials and pay you up to $110 a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the administrator. If you have a claim for benefits, which is denied or ignored, in whole or in part, you may file suit in a state or Federal court. In addition, if you disagree with the plan’s decision or lack thereof concerning the qualified status of a domestic relations order or a medical child support order, you may file suit in Federal court. If it should happen that plan fiduciaries misuse the plan’s money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a Federal court. The court will decide who should pay court costs and legal fees. If you are successful the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees, for example, if it finds your claim is frivolous.
If you have any questions about your plan, 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 Pension and Welfare Benefits Administration, U.S. Department of Labor, listed in your telephone directory or the Division of Technical Assistance and Inquiries, Pension and Welfare Benefits Administration, U.S. Department of Labor, 200 Constitution Avenue N.W., Washington, D.C. 20210. You may also obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the Pension and Welfare Benefits Administration.
AUTHORITY OF FIDUCIARIES
In carrying out their respective responsibilities under the Plans, the Plan Administrator, the Claims Administrator (i.e., those responsible for reviewing claims to determine eligibility for payment under the terms of the plan), the insurance companies, and other Plan fiduciaries shall have full and absolute discretionary authority to administer and interpret the terms of the Plans and to determine eligibility for and entitlement to Plan benefits. Benefits under this Plan will be paid only if the Plan Administrator, or its delegate, decides in its discretion that the applicant is entitled to them. Any interpretation or determination made under such discretionary authority will be given full force and effect and shall be binding on the participants, employees, their dependents and all interested parties, unless it can be shown that the interpretation or determination was arbitrary and capricious.
Note: The Life and AD&D benefits described in this summary plan description (SPD) are provided under insurance contracts with Metropolitan Life Insurance Company. The Long Term Disability benefits described in this SPD are provided under an insurance contract with Unum Life Insurance Company. The Business Travel Accident and Voluntary Accident Insurance benefits described in this SPD are provided under insurance contracts with AIG Life Insurance Company. The Group Universal Life Insurance benefits described in the SPD are provided under an insurance contract with Prudential Insurance Company of America. These insurance contracts are on file with the Plan Administrator and are available for your review. If the SPD and the insurance contracts conflict, the insurance contracts will govern plan administration and benefit payments.
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