Please refer to this section for other important information for Plan Participants.
Notice of Privacy Practices
The SAG-AFTRA Health Plan is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to that information. The Plan understands that your health information is personal and we are committed to protecting it. This Notice of Privacy Practices gives you information on how the Plan protects your health information, when we may use and disclose it, your rights to access and request restrictions to the information, and the Plan’s obligation to notify you if there has been a breach of your health information.
“Health information” generally means information: (i) about your physical or mental health or condition, health care provided to you, or the payment of health care provided to you, whether past, present, or future; (ii) that is created, received, transmitted or maintained by the Plan; and (iii) that identified you or could be used to identify you.
A “breach” is any access, use or disclosure of your unsecured health information in a manner not permitted by the Privacy Rule that compromises the security or privacy of your health information.
Uses and Disclosures
In many instances, the Plan requires a court order or your written authorization to disclose your health information. However, the Plan is permitted by law to disclose your health information without your authorization or court order, as follows:
- Treatment: The Plan does not provide medical care or services; rather, it pays for such care and services that are covered under the terms of the Plan. The Plan may share your health information with doctors and other health care Providers for treatment purposes or for the coordination or management of your care. For example, if you are in the Hospital due to an accident or illness, the Plan may share your health information with all your health care Providers involved in your care and treatment.
- Payment: The Plan may use or disclose your health information for purposes of processing medical Claims, verifying your eligibility, determining Medical Necessity, utilization review and authorizing services. For example, your health information will be used in making a Claim determination.
In some circumstances it may be necessary for the Plan to disclose your health information, including your eligibility for health benefits and specific Claim information to other covered entities such as other health plans (in order for the Plan to coordinate benefits between this Plan and another plan under which you may have coverage).
The Plan may also disclose your health information and your Dependents’ health information, on Explanation of Benefit (EOB) forms and other payment-related correspondence, such as pre-certifications which are sent to you.
- Health care operations: The Plan may use or disclose your health information for purposes of Case Management, underwriting/premium rating, quality improvement and overall Plan operations. For example, the Plan periodically obtains proposals from health care companies in an effort to select appropriate Provider networks or insurance arrangements for Plan Participants. It may be necessary to provide the companies with certain health information, particularly in regard to catastrophic illnesses. The Plan is prohibited from using or disclosing health information that is your genetic information for purposes of: (i) determining your eligibility for benefits under the Plan; (ii) computing any premium or contribution amounts under the Plan; (iii) applying any pre-existing condition exclusion; and (iv) any other activities relating to the creation, renewal or replacement of a contract for health benefits. The Plan may, however, use genetic information for determining the medical appropriateness of providing a benefit you have requested under the Plan.
- Reminders: The Plan may use your health information to provide you with reminders. For example, the Plan may use your child’s date of birth to remind you that your Dependent, who would otherwise lose coverage under the Plan, may enroll in COBRA Continuation Coverage.
- Business associates: The Plan may disclose your health information to business associates. Business associates are entities retained or contracted by the Plan, such as Anthem Blue Cross, Beacon Health Options, Delta Dental, Express Scripts, UCLA Health and VSP to perform certain functions on our behalf or provide services to us that involve the use or disclosure of health information. The Plan has a contract with each business associate, whereby they agree to protect your health information and keep it confidential.
- Trustees, for purposes of fulfilling their fiduciary duties: The Plan may disclose your health information to the Plan’s Trustees who serve on the Appeals Committee in connection with appeals that you file following a denial of a benefit Claim or a partial payment. Trustees may also receive your health information if necessary for them to fulfill their fiduciary duties with respect to the Plan. Such disclosures will be the minimum necessary to achieve the purpose of the use of disclosure. In accordance with the Plan documents, such Trustees must agree not to use or disclose your health information with respect to any employment-related actions or decisions, or with respect to any other benefit plan maintained by the Trustees.
- Personal representatives: Unless you object, the Plan will disclose your health information to personal representatives appointed by you, and, in certain cases, a family member, close friend or other person in an emergency situation when you cannot give your authorization. The Plan will disclose only health information that is directly relevant to your health care or payment related to your health care, or as necessary for notification purposes.
- Workers’ Compensation: The Plan may disclose your health information to comply with laws relating to Workers’ Compensation or other similar programs that provide benefits for work-related injuries and illnesses.
- Legal proceedings: The Plan may disclose your health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal. In addition, the Plan may disclose your health information under certain conditions in response to a subpoena, discovery request or other lawful process, in which case, reasonable efforts must be undertaken by the party seeking the health information to notify you and give you an opportunity to object to this disclosure.
- Secretary of Health and Human Services: The Plan will disclose your health information to the Secretary of Health and Human Services (HHS) or any other officer or employee of HHS to whom authority has been delegated for purposes of determining the Plan’s compliance with required privacy practices.
- Health care oversight: The Plan may disclose your health information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections and legal actions. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
- Military activity and national security: When the appropriate conditions apply, the Plan may use or disclose health information of individuals who are Armed Forces personnel for activities deemed necessary by military command authorities, or to a foreign military authority if you are a member of that foreign military service. The Plan may also disclose your health information to authorized federal officials conducting national security and intelligence activities including the protection of the President of the United States.
- Public health activities: The Plan may disclose your health information to a public health authority in connection with public health activities including, but not limited to: preventing or controlling disease, injury or disability; reporting disease or injury; reporting vital events such as births or deaths; conducting public health surveillance, public health investigations and public health interventions; at the direction of a public health authority, to an official of a foreign government agency acting in collaboration with a public health authority; or reporting child abuse or neglect.
- Coroners, funeral directors and organ donation: The Plan may disclose your health information to a coroner or medical examiner for identification purposes or other duties authorized by law. The Plan may also disclose your health information to a funeral director, as authorized by law, in order to permit the funeral director to carry out his or her duties. The Plan may disclose such information in reasonable anticipation of death. Your health information may be used and disclosed for cadaveric organ, eye or tissue donation and for transplant purposes.
- Disaster relief: The Plan may disclose your health information to any authorized public or private entities assisting in disaster relief efforts.
- Food and Drug Administration (FDA): The Plan may disclose your health information to a person or company subject to the jurisdiction of the FDA with respect to an FDA-regulated product or activity for which that person has responsibility, or for the purpose of activities related to the quality, safety or effectiveness of such FDA-regulated product or activity.
- Abuse or neglect: The Plan may disclose your health information to any public health authority authorized by law to receive reports of child abuse or neglect. In addition, if the Plan reasonably believes that you have been a victim of abuse, neglect or domestic violence we may disclose your health information to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.
- Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, the Plan may disclose your health information to the institution or law enforcement official if the health information is necessary for the institution to provide you with health care or protect the health and safety of you or others, or for the security of the correctional institution.
- Criminal activity: Consistent with applicable federal and state laws, the Plan may disclose your health information if it believes that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. The Plan may also disclose your health information if it is necessary for law enforcement authorities to identify or apprehend an individual.
- As required by law: The Plan will disclose your health information as required by law.
Use and Disclosure with Your Permission
The Plan may not use or disclose your health information for any purposes other than the ones outlined above without your written authorization. Types of uses and disclosures that require your written authorization include:
- Personal representatives: In situations where you wish to appoint a personal representative to act on your behalf or make medical decisions for you in situations where you are otherwise unable to do so, the Plan will require your written authorization before disclosing your health information to that individual. The Plan will recognize your previous written authorization designating such individual to act on your behalf and receive your health information until you revoke the authorization in writing.
- Trustee(s) as your representative: In some circumstances you may request that a Trustee receive your health information if you request the Trustee to assist you in your filing or perfecting of a Claim for benefits under the Plan. In these situations the Plan will first request that you complete a written authorization before disclosing the health information.
- Disclosure to others involved in your care or payment of your care: You may designate a manager, agent, accountant, personal assistant or other third party to receive EOBs and other written communications from the Plan with respect to you and your eligible Dependents. In such cases the Plan requires that you first file a written authorization with the Plan. The Plan will recognize your written authorization designating such individuals and will continue to send EOBs and other communications from the Plan to such parties. If you do not want the Plan to continue such communications, you must notify the Plan in writing to such effect and give us an alternate address or third party, if any, to whom you would like us to send your information.
- Psychotherapy notes: The Plan may not use or disclose the contents of psychotherapy notes without your written authorization.
- Marketing: Marketing means situations where the Plan receives financial compensation from a third party to communicate with you about a product or service and is only allowed if you give your written authorization. Marketing would include instances when an individual or entity tries to sell you something based on your health information. The Plan does not engage in marketing and will not use your health information for this purpose.
- Sale of health information: The sale of an individual’s health information for financial compensation requires that individual’s written authorization. The Plan does not sell health information.
In situations where your written authorization is required in order for the Plan to use or disclose your health information, you may revoke that authorization, in writing, at any time, except to the extent that the Plan has already taken action based upon the authorization. Thereafter, the Plan will no longer use or disclose your health information for the reasons covered by your written authorization.
Your Rights Regarding Your Health Information
As a Participant, you have the following rights with regard to your personal health information:
- Right to inspect and copy – You have the right to review and copy health information that the Plan has about you in a designated record set for as long as the Plan maintains the information. You have the right to request a copy of your health information in electronic form, including in an unencrypted or unsecured form if you so desire. You have the right to request that a copy of your health information be provided to a third party. You must send a written request to the Plan’s Privacy Officer using the Plan’s access request form. You may obtain a copy of the Plan’s access form by contacting the Plan’s Privacy Officer using the telephone number, email address or mailing address listed below. The Plan may charge you a fee to provide you with copies of your health information. If the Plan will charge you a fee, it will notify you before it makes the copies. The Plan is allowed to charge only a reasonable, cost-based fee for the labor and supplies associated with making the copy, whether on paper or in electronic form. The Plan may deny your request to inspect and copy your health information in certain limited circumstances. If you are denied access to your health information, you will be provided written notice of the denial and may request the Plan to review the denial.
- Right to receive confidential communications – The Plan normally provides health information to Participants via U.S. mail. You may request that the Plan communicate your health information to you in a different way. Your request must be made in writing to the Plan’s Privacy Officer and explain the reasons for your request. In certain cases, the Plan may deny your request.
- Right to request consideration of restrictions – You may request additional restrictions on how your health information is used and disclosed. You may also request that any part of your health information not be disclosed to family members, friends or others who may be involved in your care or for notification purposes as described in this Notice. Your request must be made in writing to the Plan’s Privacy Officer and explain the reasons for your request. The Plan is not required to agree to the restrictions you request. If the Plan agrees, it must honor the restrictions you request.
- Right to amend –If you believe the health information the Plan maintains about you is incorrect, you have the right to request an amendment to it. Your request must be made in writing to the Plan’s Privacy Officer and explain the reasons for your request. In certain cases, the Plan may deny your request. If the Plan denies your request for amendment, you have the right to file a statement of disagreement with the decision.
- Right to receive an accounting of disclosures – You have the right to request a listing of the disclosures the Plan has made of your health information without your authorization for purposes other than treatment, payment of Claims and health care operations (subject to exceptions, restrictions, and limitations noted in the Privacy Rule). Your request must be made in writing to the Plan’s Privacy Officer and must specify the period for which you are requesting the disclosures (which cannot be for a period longer than six years prior to the date of your request). In certain cases, the Plan may charge a fee for this request. The Plan will notify you of the cost in advance and you may choose to withdraw or modify your request at that time.
- Right to notification in the event of breach – A breach occurs when there is an impermissible use or disclosure that compromises the security or privacy of your health information such that the use or disclosure poses a significant risk of financial, reputational or other harm to you. The Plan takes extensive measures to ensure the security of your health information; but in the event that a breach occurs, or if the Plan learns of a breach by a business associate, the Plan will promptly notify you of such breach.
- Right to obtain a paper copy of the Plan’s Privacy Notice – If you received this Notice electronically (via email or the internet), you have the right to request a paper copy at any time.
Genetic information is information about an individual’s genetic tests, the genetic tests of family members of the individual, the manifestation of a disease or disorder in family members of the individual, or any request for or receipt of genetic services by the individual or a family member of the individual. The term genetic information also includes, with respect to a pregnant woman (or a family member of a pregnant woman), genetic information about the fetus and, with respect to an individual using assisted reproductive technology, genetic information about the embryo.
Federal law prohibits the Plan and health insurance issuers from discriminating based on genetic information. To the extent that the Plan uses your health information for underwriting purposes, federal law also prohibits the Plan from disclosing any of your genetic information. The Plan will not use or disclose any of your genetic information for this purpose.
If you believe your privacy rights have been violated you have the right to file a formal complaint with the Plan’s Privacy Officer and/or with the Secretary of the U.S. Department of Health and Human Services. You cannot be retaliated against for filing a complaint.
The effective date of this Notice of Privacy Practices is January 1, 2017. The Plan is required by law to abide by the terms of this Notice until replaced. The Plan reserves the right to make changes to this Notice and to make the new provisions effective for all health information the Plan maintains. If revised, a new Notice of Privacy Practices will be provided to all Participants eligible for or covered by the Plan at that time.
For Questions or Additional Information Regarding Privacy Practices and Complaints
To request additional copies of this Notice of Privacy Practices, to obtain further information regarding our privacy practices and your rights, or to file a complaint, please contact the Plan’s Privacy Officer.
SAG-AFTRA Health Plan
P.O. Box 7830
Burbank, CA 91510-7830
3601 West Olive Avenue Burbank, CA 91505
Email: [email protected]
Subrogation and Reimbursement
When benefits are paid by the Plan for the treatment of an illness or injury that is the result of an act or omission of a third party, certain special rules apply, as described in this section. Under such circumstances, if the Participant or Dependent pursues or has the right to pursue a recovery for such act or omission, the Plan will pay benefits for Covered Expenses related to such illness or injury only to the extent that the benefits for Covered Expenses are not paid by the third party and only after an appropriate written subrogation and reimbursement agreement is executed with the Plan.
The following are some examples of situations in which this provision may apply:
- You or your Dependent are injured in an automobile accident that you claim was caused by the act or omission of another person or other third party.
- You or your Dependent slip and fall or are otherwise injured under circumstances that you claim resulted from the act or omission of another person or third party.
- You or your Dependent suffer an illness or injury as a result of medical malpractice.
By accepting benefits related to such illness or injury, you – and, if applicable, your Dependent(s) – agree:
- To notify the Plan in writing whenever a claim against a third party is made for damages as a result of an injury, sickness or condition;
- That the Plan has established a lien on any recovery received by you or your Dependent(s), legal representative or agent;
- To notify any third party responsible for the illness or injury of the Plan’s right to reimbursement for any Claims paid by the Plan related to the illness or injury;
- To hold any reimbursement or recovery received by you or your Dependent(s), legal representative or agent in trust (and not commingled with other assets) on behalf of the Plan to cover all benefits paid by the Plan with respect to such illness or injury and to reimburse the Plan promptly for the benefits paid, even if you or your Dependent(s) are not fully compensated (“made whole”) for the loss;
- That the Plan has the right of first reimbursement (i.e. from the first dollar payable) against any recovery or other proceeds of any claim against the other person (whether or not the Participant or Dependent is made whole) and that the Plan’s claim has first priority over all other claims and rights (including, without limitation, attorneys’ fees);
- To reimburse the Plan in full up to the total amount of all benefits paid by the Plan in connection with the illness or injury from any recovery received from a third party, regardless of:
- Whether or not the recovery is specifically identified as a reimbursement of medical expenses;
- Any purported allocation or itemization of recovery to specific types of injuries; and
- The form of recovery (e.g. settlement, court judgment, arbitration award or otherwise).
- All recoveries from a third party, whether by lawsuit, settlement, insurance or otherwise, must be turned over to the Plan as reimbursement up to the full amount of the benefits paid by the Plan;
- That the Plan’s claim is not subject to reduction for attorney’s fees or costs under the Common Fund Doctrine* or otherwise;
- That, in the event that you or your Dependent(s), legal representative or agent elect not to pursue any claim(s) against a third party, the Plan shall be equitably subrogated to your right of recovery and may pursue claims on your behalf. (This means that the Plan may begin legal action against the third party seeking payment of damages related to the illness or injury);
- To assign, upon the Plan’s request, any right or cause of action to the Plan;
- Not to take or omit to take any action to prejudice the Plan’s ability to recover the benefits paid and to cooperate in doing what is reasonably necessary to assist the Plan in obtaining reimbursement;
- To cooperate in doing what is necessary to assist the Plan in recovering the benefits paid or in pursuing any recovery;
- To notify the Plan within 10 days of disbursement of any recovery by the third party and to forward such recovery to the Plan within that 10-day period; and
- To consent to the Plan’s entry of a judgment against you and, if applicable, your Dependent(s), in any court for the amount of benefits paid on your or your Dependent’s(s’) behalf with respect to the illness or injury to the extent of any recovery or proceeds that were not turned over as required and for the cost of collection, including but not limited to the Plan’s attorneys’ fees and costs.
No benefits will be payable for charges and expenses which are excluded from coverage under any provision of the Plan. The Plan may enforce its right to reimbursement by filing a lawsuit, recouping the amount owed from a Participant’s or a covered Dependent’s future benefit payments, or any other remedy available to the Plan. The Plan may recoup from a Participant’s or a covered Dependent’s future benefit payments regardless of whether benefits have purportedly been assigned to the Physician, Hospital or other Provider since no rights under the Plan are assignable (see “Authorized Representatives”).
The Plan may permit you or your Dependent(s) to reimburse less than the full amount of benefits paid and recovered as it determines in its sole discretion. Any reduction of the Plan’s claim is subject to prior written approval by the Plan.
*The Common Fund Doctrine states generally that a litigant who creates, discovers, increases or preserves a fund to which others also have a claim is entitled to recover litigation costs and attorney’s fees from that fund.
Contribution and Dependent Verification Audits
Contribution Verification Audits
Periodically the Plan discovers that reported earnings are intentionally misrepresented in order to obtain Plan eligibility. In essence, signatory companies are fraudulently contributing on behalf of individuals who do not perform services covered by a SAG-AFTRA Collective Bargaining Agreement or misrepresenting the amount of compensation the individual received for covered services and the basis for the compensation reported. As an example, some companies are “buying” health coverage for individuals by contributing the minimum necessary to qualify for Earned Eligibility or otherwise misrepresenting the status of their company or their employees in order to participate in the Plan.
Companies and individuals who engage in this conduct are liable to the Plan for any overpaid benefits and administrative fees mistakenly or improperly paid by the Plan. The verification of contributions to the Plan is an important aspect of the Plan’s integrity, because fraudulently obtained benefits deplete the Plan’s assets and affect the benefits available to the rest of the Participants, and because the Plan is obligated to pay benefits only on behalf of the eligible Participants and beneficiaries of this Plan.
You should maintain and be prepared to supply, upon the Plan’s request, copies of employment contracts, proof of service, proof of payments, including payroll stubs, W-2 forms, income tax returns and bank records. You bear the burden of demonstrating that you provided services of the type covered by the Collective Bargaining Agreement, and the failure to provide access to such documents may be deemed by the Plan as the basis to disallow any contributions reported for your services.
Dependent Verification Audits
You may be selected for an audit to verify the eligibility of your Dependents under the Health Plan. Failure to comply with an audit request can lead to a loss of benefits for your Dependents.
By participating in the Plan, you agree to cooperate with the Plan’s reasonable efforts to audit the status of any Dependent. Providing information or documents within the established time periods is a condition of your Dependent’s eligibility for benefits; therefore, if the information or documents are not provided, the Plan, in its sole discretion, may determine that your Dependent does not qualify as a Dependent or loses continued eligibility as a Dependent. You may be held responsible for any overpayments made as a result of the failure to provide such information or documentation.
When you become eligible for benefits under the Plan, you must submit a completed Participant Information Form to the Plan. The Participant must sign this confidential legal document. If the Participant is under the age of 18, the parent or legal guardian must sign for the child.
In order to verify Dependent eligibility, the Plan performs routine audits. These audits are for your protection to assure that Plan benefits are reserved for eligible Participants and their eligible Dependents.
If you are selected for an audit, the Plan will send you an initial inquiry specifying the documents needed for Dependent verification. For example, the Plan may request a copy of a recorded marriage certificate to verify your spouse or a recorded birth certificate for a child. If you cannot locate a requested document, contact the Plan for assistance contacting the issuing agency. If the Plan does not receive a response to its initial request, a follow-up notice will be sent. The failure to respond will be deemed an admission of fraudulent conduct. If there is no response to our second request you will receive a Notice of Termination of Benefits for the unverified Dependents. Additionally, you will be responsible for paying back any health care expense paid by the Plan on behalf of nonqualified Dependents.
If you need to update the Plan’s records with respect to your Dependents, contact the Plan or obtain the proper form here.
The Plan has the right to recover any mistaken payment, overpayment or payment made to any individual who was not eligible for that payment. Together, these overpayments are referred to in this SPD simply as an overpayment. You will receive written notification if a reimbursement to the Plan is required.
You can be held individually liable for reimbursing the Plan for the amount of the overpayment if your eligibility was established because of fraud or intentional misrepresentation of material fact. In addition, the Plan has the right to collect the overpayment from you, your eligible Dependents (or any individual you have claimed to be your eligible Dependent), or your employer, or to pursue each or all of you for reimbursement. The Board of Trustees can take all actions as it determines appropriate, in its sole discretion, to recover the overpayment. Such actions may include:
- Reducing the amount owed to the Plan by applying the amount of contributions made by your employer on your behalf during the relevant period;
- Entering into written agreements for the repayment of overpaid benefits, with interest if applicable; and
- Requiring that the amount of overpayment be deducted from all future benefit payments for you and your eligible Dependents until the full amount is paid.
In addition, the Board of Trustees may in their discretion, seek payment of such amounts through filing a lawsuit or taking any other measure they deem necessary and appropriate. You, your eligible Dependent(s) (or any individual you have claimed to be your eligible Dependent), and your employer are also responsible for paying the Plan all expenses incurred collecting the overpayment, audit fees, attorneys’ fees and interest calculated from the date of the initial overpayment.
False or Fraudulent Claims
Anyone who submits any false or fraudulent Claim or information to the Plan may be subject to criminal penalties – including a fine, imprisonment or both – as well as damages in a civil action under applicable state or federal law. Furthermore, the Board of Trustees reserves the right to impose such restrictions upon the payment of further benefits to any such Participant or Dependent as may be necessary to protect the Plan, including the deduction from such future benefits of amounts owed to the Plan because of the payment of any false or fraudulent Claim. The Participant, Dependent or any individual you have claimed to be your eligible Dependent must pay the Plan for all its legal and collection costs as well as benefit payments made (with interest).
If it is determined that an individual became eligible for Plan benefits as a result of earnings which are determined to be non-Covered Earnings, the individual’s coverage could be cancelled 30 days after the Plan provides the individual with notice of cancellation. If the coverage is cancelled as a result of fraud or intentional misrepresentation, the individual’s coverage may be rescinded retroactively. Also, to the extent permitted by law, the individual may be obligated to refund all benefits received in excess of contributions by the individual’s employer to the Plan on the individual’s behalf.
Termination of eligibility as a result of a contribution or Dependent verification audit does not constitute a qualifying event for COBRA Continuation Coverage.
If the Trustees believe that fraud has been perpetrated against the Plan, the Trustees may require a Participant to provide certain documentation or information to determine if benefits were properly paid. If such documentation (or an explanation as to why the documents or information cannot be provided) is not received by the Plan, then the Trustees reserve the right to terminate any future benefits for the Participant and his or her covered Dependents.
Your Rights Under ERISA
As a Participant in the Plan, you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA), as outlined in this section.
Rights to Receive Information About Your Plan and Benefits
You have the right to examine, at the Plan offices and free of charge, all Plan documents, including insurance contracts and Collective Bargaining Agreements and a copy of the latest annual report (Form 5500 Series) filed by the Plan with the U.S. Department of Labor and available at the Public Disclosure Room of the Employee Benefits Security Administration.
You have the right to 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 SPD. The Plan administrator may make a reasonable charge for the copies.
You have the right to receive a summary of the Plan’s annual financial report. The Plan is required by law to furnish each Participant with a copy of this summary annual report.
Rights to Continue Group Health Plan Coverage
You have the right to continue health care coverage for yourself, your 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 SPD and the documents governing the Plan on the rules governing your COBRA Continuation Coverage rights.
Prudent Actions Required of Plan Fiduciaries
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 benefits under the Plan or exercising your rights under ERISA.
Enforcing Your ERISA Rights
If your Claim for a benefit under the Plan 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 federal court. In such a case, the court may require the Plan administrator to provide the materials and pay you up to $110 a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the Plan administrator.
If Plan fiduciaries are misusing 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 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 frivolous.
If you have any questions about your Plan, you should contact the Plan administrator. If you have any questions about this statement or your rights under ERISA, or if you need assistance in obtaining documents from the Plan, you should contact the nearest office of the Employee Benefits Security Administration, U.S. Department of Labor, listed in your telephone directory or the Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue N.W., Washington D.C. 20210. You may also obtain certain publications about your rights and responsibilities under ERISA by calling the publication hotline of the Employee Benefits Security Administration.