Newspaper Guild of New York The New York Times
|
|
- Jack Newman
- 6 years ago
- Views:
Transcription
1 Newspaper Guild of New York The New York Times Benefits Fund Pension Plan Scholarship Fund TO: FROM: Guild-Times Benefits Fund Participants Robert A. Costello, Administrator DATE: February 10, 2011 RE: Annual Open Enrollment During the period February 15, 2011 through March 15, 2011, the Plan of benefits of the Newspaper Guild of New York-The New York Times Benefits Fund (the Plan ) will have its annual open enrollment period, to be effective April 1, During this time, you may elect to change your current health insurance plan and/or enroll your dependents. Active participants may elect to enroll in the voluntary disability and term life insurance program. If you do not want to make a change to your present election or cover an adult child, do nothing. However, if you are enrolling or continuing to cover any child who is age 19 or older, then you must complete and return to the Fund Office the Special Adult Child Enrollment Form at the end of this notice. Failure to complete this form for a child who is age 19 or older will result in loss of coverage for such child as of April 1, 2011 (if the child is currently covered) or in no coverage for such child (if the child is not currently covered). The Enrollment Period for the Flexible Benefits Plan for Employees under the Jurisdiction of the Newspaper Guild of New York is February 15 through March 31, Evergreen enrollment is in effect, which means your current elections, if available will remain in effect. There is nothing you need to do unless you would like to change your coverage level, sign up for the first time, or waive coverage. HMO s Please note the increase in the additional monthly contributions for the HMO plans listed below. Employees who are enrolled in a Health Maintenance Organization (HMO) available through the Plan are required to pay additional contributions, if their HMO carries a higher premium than the cost of the Choice I Hospital and Major Medical/EPO coverage. Please see the table below to determine if your HMO will cost more in employee contributions. You will, of course, be able to switch to a different HMO, or into the Choice I Hospital and Major Medical/EPO coverage, during the upcoming Open Enrollment period, in order to avoid any additional contributions required by the HMO. If you are considering such a switch, please be sure to review plan information carefully because each option provides different coverage. Services covered by your current HMO plan may not be covered by your new choice Broadway, Suite 1724 New York, NY Phone (646) Fax (212)
2 Name of HMO 1 Additional Monthly Contribution Individual Additional Monthly Contribution Family Oxford $42.89 $ Empire HMO-Region 1 2 $ $ Empire HMO-Region 2 3 $ $ CareFirst (Washington DC) $99.23 $ If your HMO is not listed above, there is no additional contribution required. Please note that HMO coverage is not available to retirees. Health Care Reform Changes Changes soon will be taking effect as a result of the new health care reform law, the Patient Protection and Affordable Care Act of 2010 (the Affordable Care Act ). Some of these changes are described below; others will be described in a future notice. Grandfathered Status Under the Affordable Care Act: The Board of Trustees believes that the Plan s Choice I Hospital and Major Medical/EPO coverage, the Empire HMO, and the HIP HMO are grandfathered health plans under the Affordable Care Act. As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that your plan may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits. Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the Fund Office at (646) You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at (866) or This website has a table summarizing which protections do and do not apply to grandfathered health plans. 1 Horizon and BlueShield of California are no longer available under the Plan. 2 Region 1 is Bronx, Brooklyn, Staten Island, Rockland County and New Jersey. 3 Region 2 is Manhattan, Queens and Long Island. 2
3 Coverage for Your Children up to Age 26: The Affordable Care Act requires the Plan to cover your eligible children up until the end of the month in which they attain age twenty-six (26). As a result, you are able to enroll your eligible children* during the period February 15, 2011 through March 15, 2011, for coverage to be effective April 1, *Children whose coverage ended, or who were denied coverage (or were not eligible for coverage), because the availability of dependent coverage of children ended before attainment of age 26 are eligible to enroll in the Plan. Participants may request enrollment for such children during the period February 15, 2011 through March 15, 2011, to be effective April 1, For more information contact the Fund Office at (646) Effective as of April 1, 2011, coverage for your eligible children is available whether a child is married or unmarried, regardless of student status, employment status, financial dependency on you (except noted below), or any other factor other than the relationship between yourself and the child. However, if you are enrolled in Choice I Hospital and Major Medical/EPO coverage, the Empire HMO or the HIP HMO, children who are age 19 or older (but below age 26) cannot have access 4 to health insurance coverage through an employer (besides that of another parent s employer). If a child is married, though, coverage will not be extended to the child s spouse or children. Also effective as of April 1, 2011, coverage for your domestic partner s eligible child(ren) is available under the same conditions as set forth in the SPD except that the child is eligible until the end of the month in which he or she attains age 26 (rather than age 23). As a result of these changes, as of April 1, 2011, verification of your child s reliance upon you for support will no longer be required by the Plan. However, such verification will continue to be required for children of your domestic partner. Also, you will be required to verify the eligibility of your children (e.g., by providing a birth certificate), just as you re required to verify the eligibility of your spouse. The extension of adult child coverage is not automatic. If you wish to participate in this extension, you must request enrollment by March 15, Enrollment will be effective April 1, To request enrollment of your eligible child who is age 19 or older, even if the child is already enrolled, you must complete the enclosed Special Adult Child Enrollment Form and submit it along with a copy of your child s birth certificate to: Guild Times Benefits Fund 1501 Broadway, Suite 1724 New York, New York (646) Access means that the child is eligible to enroll in, or purchase health coverage through an employer (regardless of the costs of that coverage or the benefits in provides). 3
4 If you fail to request enrollment by March 15, 2011, your adult children will not be eligible to enroll in the Plan until the next annual open enrollment period (unless a special exception to the annual open enrollment rules, described below, applies). In addition, failure to submit the form for any child age 19 or older who is currently covered under the Plan will result in that child s loss of coverage as of April 1, If you remain eligible under the Plan, coverage for your eligible child will generally be provided until the last day of the month of his or her 26 th birthday. General Annual Open Enrollment Information You may elect to cover or decline coverage for yourself and to cover all, some, or none of your dependents. The election choices you make at the annual open enrollment period cannot generally be changed until the next annual open enrollment period. You cannot choose to decline coverage for yourself but then elect coverage for a dependent under the Plan. An exception to the annual open enrollment rule will be made if you elect not to enroll in the Plan because you, your spouse or children had coverage under another plan, but you (or your dependents) then lose that coverage because employer contributions cease or because of a loss of eligibility resulting from a change in family status (i.e., legal separation, divorce, death of the employee, termination of employment, reduction in hours, exhaustion of COBRA, loss of dependent status such as children s aging out of coverage, or moving out of an HMO service area) other than a failure to pay participant premiums or termination of coverage for cause (such as fraud). In that event, you will be given the opportunity to enroll them and yourself provided that you notify the Fund Office in writing within 30 days of the change in family status. An exception may also be made if you acquire a new dependent through marriage, birth, adoption, or the placement of a child for adoption. In that event, you may add the new dependent to coverage by providing written notice to the Fund Office within 30 days of the marriage, birth, adoption or placement for adoption. If you provide this notice and pay the required premium on time, the coverage will become effective on the date of the event (in the case of birth, adoption or placement for adoption) or the first of the month following the notice (in the case of marriage). Again, if you do not want to make a change to your present election and are not covering children age 19 or older, do nothing. If you want to cover a child who is age 19 or older, you must complete the Special Adult Child Enrollment Form at the end of this notice and submit it to the Fund Office no later than March 15, If you wish to change your medical plan option to a different medical plan, add or remove dependents other than children age 19 or older, or if you need additional information, please contact the Fund Office at (646)
5 This Annual Open Enrollment notice constitutes a Summary of Material Modifications ( SMM ) intended to provide you with an easy to understand description of changes made to the Plan. You should share it with your family and file it with your copy of the Fund s summary plan description. While every effort has been made to make this description as complete and as accurate as possible, this SMM, of course, cannot contain a full restatement of the terms and provisions of the Plan. Except to the extent this SMM explicitly purports to amend the Plan, if any conflict should arise between this SMM and the Plan, or if any point is not discussed in this SMM or is only partially discussed, the terms of the Plan will govern in all cases. The Board of Trustees (or its duly authorized designee) reserves the right, in its sole and absolute discretion, to amend, modify or terminate the Plan, or any benefits provided under the Plan, in whole or in part, at any time and for any reason, in accordance with the applicable amendment procedures established under the Plan and the Agreement and Declaration of Trust establishing the Plan (the Trust Agreement ). The Trust Agreement and the full Plan documents are at the Fund Office and may be inspected by you free of charge during normal business hours. No individual other than the Board of Trustees (or its duly authorized designee) has any authority to interpret the Plan documents, make any promises to you about benefits under the Plan, or to change any provision of the Plan. Only the Board of Trustees (or its duly authorized designee) has the exclusive right and power, in its sole and absolute discretion, to interpret the terms of the Plan and decide all matters, legal and/or factual, arising under the Plan. 5
6 GUILD-TIMES BENEFITS FUND SPECIAL ADULT CHILD ENROLLMENT FORM You must complete this form if you wish to enroll or continue the enrollment of any child who is at least age 19 and under age 26. Participant s Name & Address Participant s Social Security #: Participant s Telephone number By signing this form, the Participant certifies (1) that his or her child(ren) listed below is(are) currently at least 19 but less than 26 years of age and otherwise eligible under the Plan; (2) that such child(ren) is(are) not eligible for other employer health coverage (whether or not they actually elect it); and (3) that the Participant will notify the Fund Office immediately in writing if any child who is age 19 or older becomes eligible for other employer health coverage or if any other statement made on this form is no longer true or correct. PLEASE NOTE THAT COVERAGE UNDER THE PLAN WILL END ON THE LAST DAY OF THE MONTH THAT THE ADULT CHILD TURNS 26 YEARS OLD. PLEASE COMPLETE THIS SECTION TO CONTINUE OR OBTAIN COVERAGE FOR YOUR ADULT CHILD(REN): Child s Full Name Relationship Address Birth Date Soc Sec # Participant s Signature Date Please return this form and, for any child not currently enrolled in the Plan, a copy of the child s birth certificate to: Guild-Times Benefits Fund 1501 Broadway, Suite 1724 New York, New York
All Active Plan A, B, Flat Rate and R Participants and their Dependents, including COBRA Beneficiaries
June 20, 2011 CARPENTER FUNDS ADMINISTRATIVE OFFICE OF NORTHERN CALIFORNIA, INC. 265 Hegenberger Road, Suite 100 P.O. Box 2280 Oakland, California 94621-0180 Tel. (510) 633-0333 (888) 547-2054 Fax (510)
More informationLLNS Health and Welfare Benefit Plan for Retirees Summary Plan Description
LLNS Health and Welfare Benefit Plan for Retirees Summary Plan Description Effective October 1, 2007 IMPORTANT This Summary Plan Description (SPD) is intended to provide a summary of the principal features
More informationARTICLE 2. ELIGIBILITY FOR BENEFITS
basis must obtain Preadmission Review and Concurrent Review from the Professional Review Organization (PRO) under contract to the Fund as to the Medical Necessity of that confinement in order to receive
More informationHealthfirst Insurance Company, Inc. Participation & Eligibility Requirements
2017 Healthfirst Insurance Company, Inc. Participation & Eligibility Requirements Effective January 1, 2017 and applicable to Healthfirst s small group EPO plans Small Group 1 100 This material is intended
More informationARMSTRONG INTERNATIONAL, INC. THREE RIVERS MI
ARMSTRONG INTERNATIONAL, INC. THREE RIVERS MI Dental Booklet Revised 01-01-2016 BENEFITS ADMINISTERED BY Table of Contents INTRODUCTION... 3 PLAN INFORMATION... 4 SCHEDULE OF BENEFITS... 6 OUT-OF-POCKET
More informationELWOOD STAFFING SERVICES, INC. COLUMBUS IN
ELWOOD STAFFING SERVICES, INC. COLUMBUS IN Dental Benefit Summary Plan Description 7670-09-411299 Revised 01-01-2017 BENEFITS ADMINISTERED BY Table of Contents INTRODUCTION... 1 PLAN INFORMATION... 2 SCHEDULE
More informationGroup Benefits Package for Professional Employees Represented by SPEEA. Retiree Medical Plan Attachment B (Professional Unit) January 1, 2018
Group Benefits Package for Professional Employees Represented by SPEEA Retiree Medical Plan Attachment B (Professional Unit) January 1, 2018 ATTACHMENT B Attachment B Table of Contents ELIGIBILITY... 1
More informationDIXON PUBLIC SCHOOLS DISTRICT #170 All Other Staff (hired prior to July 1, 2013) Health Care Plan
DIXON PUBLIC SCHOOLS DISTRICT #170 All Other Staff (hired prior to July 1, 2013) Health Care Plan Benefit Booklet/Plan Document Effective September 1, 2006 Restated March 1, 2015 Table of Contents Page
More informationKern County HR County Administrative Office
Kern County HR County Administrative Office 1115 Truxtun Avenue, 1st Floor, Bakersfield, CA 93301 Telephone (661) 868-3182 Fax (661) 868-3110 Ryan Alsop County Administrative Officer Devin Brown Chief
More informationUS AIRWAYS, INC. HEALTH BENEFIT PLAN
US AIRWAYS, INC. HEALTH BENEFIT PLAN Updated November 1, 2012 Summary Plan Description Effective January 1, 2013 SUMMARY PLAN DESCRIPTION This document summarizes the main provisions of the US Airways,
More information» 2009 Benefits Summary. for U.S. Full-Time Hourly & Salaried Associates
» 2009 Benefits Summary for U.S. Full-Time Hourly & Salaried Associates What s inside 1 Life Events 12 Eligibility and Enrollment 27 Benefits for Same-sex Domestic Partners 34 Medical 114 California Medical
More informationOVERVIEW ACTIVE EMPLOYEE ELIGIBILITY POLICY
OVERVIEW ACTIVE EMPLOYEE ELIGIBILITY POLICY This document is an overview of the eligibility policy effective October 1, 2018. If you would like a complete copy of this policy please contact your district
More informationHFIC18_55. Small Group 1 100
Healthfirst Insurance Company, Inc. Participation & Eligibility Requirements Effective July 1, 2018 and applicable to Healthfirst s Small Group EPO plans Small Group 1 100 HFIC18_55 It is not intended
More informationOxford New York Small Group (1-100) Underwriting Requirements
Oxford New York Small Group (1-100) Underwriting Requirements ALL GROUPS OXFORD HEALTH INSURANCE, INC. (OHI) & OXFORD HEALTH PLANS (NY), INC. (OHP) The following underwriting requirements apply to all
More informationImportant Health Benefit Continuation Information
CHIEF EXECUTIVE OFFICE Risk Management Division Employee Benefits 1010 10 TH Street, Suite 5900, Modesto, CA 95354 Phone: 209.525.5717 Fax: 209.567.4367 Important Health Benefit Continuation Information
More informationMORRIS COUNTY PARK COMMISSION Policy and Procedure. Subject: Date: Resolution No
MORRIS COUNTY PARK COMMISSION Policy and Procedure Subject: Effective Date: 06-24-02 Resolution No.106-02 Date: 03-27-06 Resolution No. 71-06 Date: 12-11-06 Resolution No. 196-06 Health Benefits Date:
More informationModel COBRA Continuation Coverage Election Notice (For use by single-employer group health plans)
Model COBRA Continuation Coverage Election Notice (For use by single-employer group health plans) IMPORTANT INFORMATION: COBRA Continuation Coverage and other Health Coverage Alternatives Date of notice:
More informationThe Newspaper Guild of New York-The New York Times College Scholarship Fund. Summary Plan Description
The Newspaper Guild of New York-The New York Times College Scholarship Fund Summary Plan Description Effective July 1, 2018 INTRODUCTION The NewsGuild of New York ( Guild ) and The New York Times Company
More informationSUMMARY PLAN DESCRIPTION * FOR THE TUSCOLA COUNTY MEDICAL CARE FACILITY TUSCOLA COUNTY MEDICAL CARE FACILITY EMPLOYEE BENEFITS PLAN
[INSURED] SUMMARY PLAN DESCRIPTION * FOR THE TUSCOLA COUNTY MEDICAL CARE FACILITY TUSCOLA COUNTY MEDICAL CARE FACILITY EMPLOYEE BENEFITS PLAN EFFECTIVE APRIL 1, 2018 NON-UNION EMPLOYEES THIS DOCUMENT SHOULD
More informationSocial Security: With You Through Life s Journey. Produced at U.S. taxpayer expense
Social Security: With You Through Life s Journey Produced at U.S. taxpayer expense We re with you from Day 1. We re with you when you start work. We re with you for your wedding. We re With You If The
More informationGroup Health Plan For Insured Medical Programs
S U M M A R Y P L A N D E S C R I P T I O N L-3 Communications Corporation Group Health Plan For Insured Medical Programs Effective January 1, 2016 Table of Contents The L-3 Communications Group Health
More informationPOLICY AND REGULATIONS MANUAL HEALTH AND RELATED BENEFITS
Page Number: 1 of 24 TITLE: HEALTH AND RELATED BENEFITS PURPOSE: To provide an overview of the health and related benefits offered to Benefit Eligible Employees, Benefit Eligible Retirees, and their Benefit
More informationGeneral Information Book for active employees of the State of New York, their enrolled dependents, COBRA enrollees and Young Adult Option enrollees
2017 NY Active Employees New York State Health Insurance Program for active employees of the State of New York, their enrolled dependents, COBRA enrollees and Young Adult Option enrollees New York State
More informationOxford New York Small Group (1-100) Underwriting Requirements i
Oxford New York Small Group (1-100) Underwriting Requirements i ALL GROUPS OXFORD HEALTH INSURANCE, INC. (OHI) The following underwriting requirements apply to all applications or renewals of coverage
More informationFordham University Health and Welfare Plan
Fordham University Health and Welfare Plan SUMMARY PLAN DESCRIPTION Effective January 1, 2016 Contents INTRODUCTION... 1 ELIGIBILITY... 2 Employee Eligibility... 2 Individuals Not Eligible for Benefits...
More informationAMENDED AND RESTATED Nagel Farm Service SECTION 125 PREMIUM ONLY PLAN SUMMARY PLAN DESCRIPTION (SPD)
AMENDED AND RESTATED Nagel Farm Service SECTION 125 PREMIUM ONLY PLAN SUMMARY PLAN DESCRIPTION (SPD) RESTATED ORIGINAL PLAN 09/01/2015 1 INTRODUCTION Nagel Farm Service (the Company") maintains the Nagel
More informationSummary Plan Description for: Delta Dental Premier Basic Plan, Delta Dental PPO sm High Plan, Participating in:
Summary Plan Description for: Delta Dental Premier Basic Plan, Delta Dental PPO sm High Plan, Participating in: The Dow Chemical Company Dental Assistance Program (ERISA Plan #503) Amended and Restated
More information2018 GUIDE FOR SMALL GROUP PRODUCTS
2018 GUIDE FOR SMALL GROUP PRODUCTS Effective January 1, 2018 (This guide applies to coverage issued or renewed prior to January 1, 2019. Please visit the broker support library or contact your Empire
More informationFlexible Spending and Premium Cafeteria Plan Summary Plan Description And Plan Document
Flexible Spending and Premium Cafeteria Plan Summary Plan Description And Plan Document 7670-02-411309 Revised 01-01-2016 BENEFITS ADMINISTERED BY Table of Contents INTRODUCTION... 1 PLAN INFORMATION...
More informationCENTRAL MAINE HEALTHCARE CORPORATION LEWISTON ME
CENTRAL MAINE HEALTHCARE CORPORATION LEWISTON ME Flexible Spending Summary Plan Description 7670-03-150028 BENEFITS ADMINISTERED BY Amendment #1 CENTRAL MAINE HEALTHCARE CORPORATION January 1, 2008 The
More informationSocial Security: With You Through Life s Journey
Social Security: With You Through Life s Journey Takeya L. Haugabook, Public Affairs Specialist Produced at U.S. taxpayer expense Visit and share: youtube.com/socialsecurity History of Social Security
More informationMOTOROLA SOLUTIONS HEALTH AND WELFARE BENEFITS BOOK
MOTOROLA SOLUTIONS HEALTH AND WELFARE BENEFITS BOOK This U.S. Health and Welfare Benefits Book is effective January 1, 2017 CHI:2982335.2 ABOUT THIS MATERIAL This Health and Welfare Benefits Book represents
More informationNew York Small Group Employee Enrollment Application For Groups of (Medical/Vision) For Groups of 1 50 (Dental)
New York Small Employee Enrollment Application For s of 1 100 1 (Medical/Vision) For s of 1 50 () You, the employee, must complete this application. You are solely responsible for its accuracy and completeness.
More informationCOLBY COLLEGE STAFF HANDBOOK APPENDIX TABLE OF CONTENTS
COLBY COLLEGE STAFF HANDBOOK APPENDIX TABLE OF CONTENTS Appendix A (Benefit Plan Summary Plan Descriptions)...2 Life...2 Health...5 Long Term Disability...13 Medical Reimbursement...16 Retirement...19
More informationBuilding Service 32BJ PENSION FUND. 101 Avenue of the Americas, New York, NY Telephone
Building Service 32BJ PENSION FUND 101 Avenue of the Americas, New York, NY 10013-1991 Telephone 1-212-388-3500 The Building Service 32BJ Pension Fund is administered by a joint Board of Trustees consisting
More informationLafayette College. Health and Welfare Plan
Lafayette College Health and Welfare Plan And SUMMARY PLAN DESCRIPTION Amended and Restated Effective June 1, 2015 The following information is provided to you in accordance with the Employee Retirement
More informationSummary of Material Modifications and Summary Plan Description for the Retiree Dental Program
Summary of Material Modifications and Summary Plan Description for the Retiree Dental Program This notice serves as a Summary of Material Modifications (SMM) updating information in the 2011 Retiree Dental
More informationWELFARE BENEFITS PLAN
SUMMARY PLAN DESCRIPTION EFFECTIVE JULY 1, 2016 WELFARE BENEFITS PLAN SPONSORED BY THE STRUCTURAL IRON WORKERS LOCAL #1 WELFARE FUND TABLE OF CONTENTS PAGE ELIGIBILITY... 1 Initial Eligibility... 1 Deferred
More informationStep 1: Determining small group size. Group size. Effective January 1, Enroll groups 1-100* in three steps:
Effective January 1, 2017 (This guide applies to coverage issued or renewed prior to January 1, 2018. Please visit the broker support library or contact your Empire Sales representative for a current online
More informationFrequently Asked Questions - COBRA and How to Continue Your Healthcare Coverage
Frequently Asked Questions - COBRA and How to Continue Your Healthcare Coverage Many people have health insurance through their employer's group plan. When they no longer qualify for coverage through this
More informationAllergan Retiree Medical Access Plan Plan Summary
Allergan Retiree Medical Access Plan Plan Summary Plan Summary Amended as of October 1, 2018 The information below summarizes the eligibility requirements, enrollment information and coverage for the Allergan
More informationHealth Care Plans and COBRA
Health Care Plans and COBRA COBRA provides workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited
More informationPLAN DOCUMENT AND SUMMARY PLAN DESCRIPTION FOR NORTHWEST LABORERS EMPLOYERS HEALTH & SECURITY TRUST FUND REVISED EDITION APRIL 2010
PLAN DOCUMENT AND SUMMARY PLAN DESCRIPTION FOR NORTHWEST LABORERS EMPLOYERS HEALTH & SECURITY TRUST FUND REVISED EDITION APRIL 2010 1 NORTHWEST LABORERS-EMPLOYERS HEALTH & SECURITY TRUST FUND INTRODUCTION
More informationEIT Benefits. Table of Contents
EIT Benefits Electrical Insurance Trustees (EIT Benefit Funds) is pleased to provide you with this Summary Plan Description (SPD or handbook) describing the health care and welfare benefits available to
More informationPLUMBERS & PIPEFITTERS LOCAL 9 PENSION FUND PO Box 1028 Trenton, NJ Application For Benefits (Please Print or Type)
PLUMBERS & PIPEFITTERS LOCAL 9 PENSION FUND PO Box 1028 Trenton, NJ 08628-0230 INSTRUCTIONS: Application For Benefits (Please Print or Type) a. Read and complete all sections of this application. b. Both
More informationSocial Security: With You Through Life s Journey. Produced at U.S. taxpayer expense
Social Security: With You Through Life s Journey Produced at U.S. taxpayer expense We re With You From Day One Most Popular Baby Names A fun by-product of assigning Social Security numbers at birth is
More informationCONTINUATION OF HEALTH CARE BENEFITS. Summary of Continued Health Care Benefits and other Health Coverage Alternatives
CONTINUATION OF HEALTH CARE BENEFITS Summary of Continued Health Care Benefits and other Health Coverage Alternatives Date: Dear: This notice has important information about continuing your health care
More informationCAPITAL UNIVERSITY PREMIUM CONVERSION AND HEALTH SAVINGS ACCOUNT CONTRIBUTION PLAN SUMMARY PLAN DESCRIPTION
CAPITAL UNIVERSITY PREMIUM CONVERSION AND HEALTH SAVINGS ACCOUNT CONTRIBUTION PLAN SUMMARY PLAN DESCRIPTION 1 College Avenue V12072017 CAPITAL UNIVERSITY PREMIUM CONVERSION AND HEALTH SAVINGS ACCOUNT CONTRIBUTION
More informationHealth Care Benefits. Important!
Health Care Benefits The Major League Baseball Players Welfare Plan (referred to as the Welfare Plan in this section) provides comprehensive health care benefits for you and your eligible dependents. Whether
More informationKaiser Plus Medical Plan Kaiser Permanente Colorado
Kaiser Plus Medical Plan Kaiser Permanente Colorado Summary Plan Description Effective January 1, 2018 Introduction The Kaiser Plus plan is a high-deductible health maintenance organization (HMO) plan
More informationCaliber Holdings Corporation Employee Benefits Plan
Caliber Holdings Corporation Employee Benefits Plan SUMMARY PLAN DESCRIPTION Effective April 1, 2016 Contents INTRODUCTION... 1 ELIGIBILITY... 3 Eligibility for Benefits... 3 Individuals not eligible for
More informationWE VE GOT YOU COVERED
WE VE GOT YOU COVERED Your Verizon Benefits ANNUAL ENROLLMENT 2015 October 21 to vember 4, 2014 BenefitsConnection www.verizon.com/benefitsconnection Dear Verizon Employee: During Annual Enrollment, you
More informationThe University of Chicago Health Care Plans Summary Plan Description
The University of Chicago Health Care Plans Summary Plan Description Effective as of September 1, 2018 Table of Contents Introduction to the University of Chicago Health Care Plans Summary Plan Description...
More informationSUMMARY PLAN DESCRIPTION for the Verso Corporation Health and Welfare Benefit Plan
SUMMARY PLAN DESCRIPTION for the Verso Corporation Health and Welfare Benefit Plan Represented Employees 2018 This document, together with the benefit booklets listed in the section entitled Benefit Programs
More informationCOBRA INITIAL/GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS **CONTINUATION COVERAGE RIGHTS UNDER COBRA** C&A Industries, Inc.
Initial Notice of COBRA Rights COBRA INITIAL/GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS Introduction **CONTINUATION COVERAGE RIGHTS UNDER COBRA** C&A Industries, Inc. C&A Industires, Inc. Benefits
More informationTwyla Flaws County Road 3 Merrifield, MN 56465
FLEXIBLE BENEFITS PLAN SUMMARY PLAN DESCRIPTION PLAN INFORMATION SUMMARY The Employer named below establishes a Flexible Benefits Plan (the "Plan") as set forth in this Summary Plan Description ("SPD")
More informationCareFirst BlueChoice, Inc.
CareFirst BlueChoice, Inc. 840 First Street, NE Washington, DC 20065 202-479-8000 An independent licensee of the Blue Cross and Blue Shield Association GROUP CONTRACT APPLICATION If this Application is
More informationInitial COBRA Notification Continuation Rights Under COBRA
Introduction Initial COBRA Notification Continuation Rights Under COBRA Below is the Group Health Continuation under COBRA - notice. The purpose of this initial notice is to acquaint you with the COBRA
More informationModel COBRA Continuation Coverage Election Notice (For use by single-employer group health plans)
Model COBRA Continuation Coverage Election Notice (For use by single-employer group health plans) [Enter date of notice] Dear : [Identify the qualified beneficiary(ies), by name or status] This notice
More informationI.B.E.W. LOCAL 269 PENSION FUND C/O I.E. SHAFFER & CO. P.O. BOX 1028 TRENTON, NJ PHONE (800) FAX (609)
I.B.E.W. LOCAL 269 PENSION FUND C/O I.E. SHAFFER & CO. P.O. BOX 1028 TRENTON, NJ 08628-0230 PHONE (800) 792-3666 FAX (609) 883-7580 INSTRUCTIONS: Application For Benefits (Please Print or Type) a. Read
More informationModel COBRA Continuation Coverage Election Notice Instructions
Model COBRA Continuation Coverage Election Notice Instructions The Department of Labor has developed a model Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) continuation coverage election
More informationVAN WERT HOSPITAL FLEXIBLE BENEFITS PLAN
VAN WERT HOSPITAL FLEXIBLE BENEFITS PLAN Medical Mutual Services, LLC does not provide legal or tax advice. This document is a model and is being provided to the Employer for its own use. The Employer
More informationSarasota County Government. Cafeteria Plan as Amended and Restated Effective January 1, 2016
Sarasota County Government Cafeteria Plan as Amended and Restated Effective January 1, 2016 PREAMBLE AND EXECUTION The Section 125 arrangement affecting the employees of Sarasota County Government shall
More informationINTRODUCTION OVERVIEW OF BENEFITS...
Summary Plan Description Swift Transportation Company Medical, Dental and Vision Plan Effective January 1, 2015 Table of Contents INTRODUCTION... - 1 - OVERVIEW OF BENEFITS... - 1 - Medical & Prescription...
More informationTHE JOHNS HOPKINS UNIVERSITY SUPPORT STAFF PENSION PLAN
THE JOHNS HOPKINS UNIVERSITY SUPPORT STAFF PENSION PLAN SUMMARY PLAN DESCRIPTION FOR SUPPORT STAFF EMPLOYEES Amended and Restated, Effective July 1, 2016 The Johns Hopkins University Support Staff Pension
More informationOFFICE OF LABOR RELATIONS EMPLOYEE BENEFITS PROGRAM 40 Rector Street, 3 RD Floor, New York, N.Y nyc.gov/olr
OFFICE OF LABOR RELATIONS EMPLOYEE BENEFITS PROGRAM 40 Rector Street, 3 RD Floor, New York, N.Y. 10006 nyc.gov/olr ROBERT W. LINN Commissioner RENEE CAMPION First Deputy Commissioner GEORGETTE GESTELY
More informationSUMMARY PLAN DESCRIPTION. UNITE HERE Local 25 and Hotel Association of Washington, D.C.
SUMMARY PLAN DESCRIPTION UNITE HERE Local 25 and Hotel Association of Washington, D.C. HEALTH and welfare fund FEBRUARY 2012 TABLE OF CONTENTS Dear Participant... 1 Notice No Fund Liability... 2 Facts
More informationWASHINGTON AND LEE UNIVERSITY EMPLOYEE HEALTH AND WELFARE PLAN PLAN DOCUMENT AND SUMMARY PLAN DESCRIPTION
WASHINGTON AND LEE UNIVERSITY EMPLOYEE HEALTH AND WELFARE PLAN PLAN DOCUMENT AND SUMMARY PLAN DESCRIPTION This document is provided for informational purposes and to comply with certain requirements of
More informationPennsylvania Employees Benefit Trust Fund (PEBTF)
Pennsylvania Employees Benefit Trust Fund (PEBTF) April 2018 This Summary Plan Description (SPD) summarizes the main terms of the benefits provided to Members and their eligible Dependents under the Pennsylvania
More informationYour Benefit Program. Highlights
Your Benefit Program Highlights At Turner, we value your hard work, and we believe you deserve a high-quality, comprehensive benefit program. Turner Benefits offers you and your family the opportunity
More informationPUBLIC EMPLOYEE RETIRMENT SYSTEM (PERS) Pension and Health Benefits at Retirement
PUBLIC EMPLOYEE RETIRMENT SYSTEM (PERS) Pension and Health Benefits at Retirement TABLE OF CONTENTS Considering Retirement Before You Apply Retirement Timeline Tiers Types of Retirement Early Retirement
More informationSHAKER HEIGHTS CITY SCHOOL DISTRICT FLEXIBLE BENEFITS PLAN
SHAKER HEIGHTS CITY SCHOOL DISTRICT FLEXIBLE BENEFITS PLAN Medical Mutual Services, LLC does not provide legal or tax advice. This document is a model and is being provided to the Employer for its own
More informationBOX ELDER COUNTY CAFETERIA PLAN SUMMARY PLAN DESCRIPTION
BOX ELDER COUNTY CAFETERIA PLAN SUMMARY PLAN DESCRIPTION Restatement TABLE OF CONTENTS I ELIGIBILITY 1. When can I become a participant in the Plan?... 1 2. What are the eligibility requirements for our
More informationMEDICAL MUTUAL OF OHIO GROUP CONTRACT
MEDICAL MUTUAL OF OHIO GROUP CONTRACT This Contract is entered into between (called the Group or Employer) and Medical Mutual of Ohio ( Medical Mutual ). This Contract supersedes any contracts previously
More informationChapter 1: Eligibility, Enrollment, and More. Eligibility, Enrollment, and More. Contents
Chapter 1: Eligibility, Enrollment, and More Chapter 1: Eligibility, Enrollment, and More Contents Contacts... 1-2 The basics... 1-3 Summary Plan Descriptions... 1-3 Benefit plan options... 1-3 Who s eligible
More informationInitial Notice Form COBRA Notice Upon Enrollment in a Group Health Plan
Initial Notice Form COBRA Notice Upon Enrollment in a Group Health Plan VERY IMPORTANT NOTICE If a qualifying event occurs that causes you or your spouse or dependent children to lose coverage under group
More informationINITIAL NOTICE OF CONTINUATION COVERAGE UNDER THE HEALTH PLAN OF KINDER MORGAN. Very Important Notice
INITIAL NOTICE OF CONTINUATION COVERAGE UNDER THE HEALTH PLAN OF KINDER MORGAN Very Important Notice January 1, 2010 Dear Employee (and Spouse, if applicable): IT IS IMPORTANT THAT ALL COVERED INDIVIDUALS
More informationHIPAA Special Enrollment Rights Legislative Alert June 9, 2015
Provided by BB&T Insurance Services, Inc., McGriff, Seibels & Williams, Inc., BB&T Insurance Services of California, Inc., and Precept Insurance Solutions, LLC HIPAA Special Enrollment Rights Legislative
More information2017 Benefits Summary Plan Description. For Campus Retirees
2017 Benefits Summary Plan Description For Campus Retirees ii 2017 BENEFITS SUMMARY PLAN DESCRIPTION FOR CAMPUS RETIREES TABLE OF CONTENTS CALTECH RETIREE HEALTH AND LIFE BENEFITS PROGRAM... 1 ABOUT THIS
More informationSupporting Documentation Dependent Verification
Supporting Documentation Dependent Verification CalPERS is required under the Affordable Care Act (ACA) to report to the IRS who is enrolled in their health plans. As such, CalPERS requires the employer
More informationOFFICE OF LABOR RELATIONS EMPLOYEE BENEFITS PROGRAM
OFFICE OF LABOR RELATIONS EMPLOYEE BENEFITS PROGRAM 40 Rector Street, 3 RD Floor, New York, N.Y. 10006 nyc.gov/olr ROBERT W. LINN Commissioner RENEE CAMPION First Deputy Commissioner GEORGETTE GESTELY
More informationROCHESTER INSTITUTE OF TECHNOLOGY Retirement Information for Calendar Year 2018
ROCHESTER INSTITUTE OF TECHNOLOGY Retirement Information for Calendar Year 2018 The following information is applicable for calendar year 2018 only. We will publish a 2019 version when it is available.
More informationCOBRA Procedures and Basic Compliance Rules for Employers
COBRA Procedures and Basic Compliance Rules for Employers Allied National is pleased to provide your group with medical and/or dental benefits. This guide is intended to assist you with managing your COBRA
More informationSample COBRA Notice. ABC Company c/o The COBRA Administrator s Name 1234 South St City, State and Zip 06/10/2008
ABC Company c/o The COBRA Administrator s Name 06/10/2008 PQB Name: Spouse Name: Street Address Street Address This notice contains important information about your right to continue your health care coverage
More informationLOS ANGELES POLICE RELIEF ASSOCIATION, INC. HEALTH CARE BENEFITS ELIGIBILITY BOOKLET FOR ACTIVE MEMBERS
LOS ANGELES POLICE RELIEF ASSOCIATION, INC. HEALTH CARE BENEFITS ELIGIBILITY BOOKLET FOR ACTIVE MEMBERS Updated as of April 1, 2017 TABLE OF CONTENTS 1. INTRODUCTION... 1 2. ACTIVE MEMBER ELIGIBILITY...
More informationICUBA: Nova Southeastern University PO Box 7127 Atlanta, Georgia
ICUBA: Nova Southeastern University PO Box 7127 Atlanta, Georgia 30357-7127 1-877-747-4141 cobra@csllc.com PARTICIPANT AND DEPENDENT NAME PARTICIPANT ADDRESS Dear Participant and dependent(s): This notice
More informationEL PASO COUNTY CAFETERIA PLAN SUMMARY PLAN DESCRIPTION
EL PASO COUNTY CAFETERIA PLAN SUMMARY PLAN DESCRIPTION TABLE OF CONTENTS I ELIGIBILITY 1. When can I become a participant in the Plan?...1 2. What are the eligibility requirements for our Plan?...2 3.
More informationEPK & Associates, Inc. BIAW Health Insurance Trust Administrative Manual Regence. BIAW HEALTH INSURANCE TRUST Administrative Manual
EPK & Associates, Inc. BIAW Health Insurance Trust Administrative Manual BIAW HEALTH INSURANCE TRUST Administrative Manual Key Contacts For answers to questions about benefits issues and for help with
More informationBuilding Service 32BJ. 101 Avenue of the Americas, New York, NY Telephone
Building Service 32BJ Pension Fund 101 Avenue of the Americas, New York, NY 10013-1991 Telephone 1-212-388-3500 The Building Service 32BJ Pension Fund is administered by a joint Board of Trustees consisting
More informationEmployees Group Life Insurance Plan of Progress Energy Florida, Inc.
Document title: AUTHORIZED COPY Employees Group Life Insurance Plan of Progress Energy Florida, Inc. Document number: HRI-PGNF-00007 Applies to: Keywords: Progress Energy Florida, Inc. (bargaining unit
More informationCOBRA ELECTION NOTICE
COBRA ELECTION NOTICE Date of Notice: DATE NAME ADDRESS CITY STATE ZIP NOTICE OF RIGHT TO ELECT COBRA CONTINUATION COVERAGE This notice contains important information about your right to continue your
More informationSummary Plan Description. Important Benefits Information. Please keep this SPD for future reference. DISTRIBUTION
Summary Plan Description Important Benefits Information Cingular Wireless Vision Program This summary plan description (SPD) is a guide for using the Cingular Wireless Vision Program (Program), a component
More informationAdministrator Checklist
Administrator Guide Administrator Checklist For your convenience, here s a list of things health plan administrators are responsible for: Letting employees know if they re eligible to enroll in a timely
More informationIllinois Insurance Facts Illinois Department of Insurance Health Insurance Continuation Rights Illinois Spousal Law
Illinois Insurance Facts Illinois Department of Insurance Health Insurance Continuation Rights Illinois Spousal Law Revised July 2014 Note: This information was developed to provide consumers with general
More informationRetiree Health Reimbursement Arrangement Plan
Harvey Mudd College Retiree Health Reimbursement Arrangement Plan Plan Summary Plan Administrator: SelectAccount 1. INTRODUCTION...1 2. DETAILS REGARDING THE HRA...1 3. ELIGIBLE RETIRED AND FORMER EMPLOYEES...1
More informationUSD 267 RENWICK WELFARE BENEFIT PLAN
USD 267 RENWICK WELFARE BENEFIT PLAN Summary Plan Description USD 267 RENWICK WELFARE BENEFIT PLAN SUMMARY PLAN DESCRIPTION TABLE OF CONTENTS 1. General Information... 1 2. Participation in the Plan...
More informationChild Resident Street Address (required - a PO Box will not be accepted) City County State Zip. Mailing address (if different) City County State Zip
PO Box 339 400 Warren Avenue Bremerton, WA 98337 APPLICATION FOR INDIVIDUAL/FAMILY PLAN COVERAGE KPS is a health care service contractor licensed and marketing in all of Washington State Please review
More informationANDOVER USD 385 WELFARE BENEFIT PLAN
ANDOVER USD 385 WELFARE BENEFIT PLAN Summary Plan Description ANDOVER USD 385 WELFARE BENEFIT PLAN SUMMARY PLAN DESCRIPTION TABLE OF CONTENTS 1. General Information... 1 2. Participation in the Plan...
More informationBENEFIT APPLICATION FORM
BENEFIT APPLICATION FORM NAME OF APPLICANT PHONE NO. ( ) ADDRESS SOC. SEC. NO. NAME OF PARTICIPANT (If different from applicant) DATE OF BIRTH SOC. SEC. NO. Under and subject to the provisions of the HAWAII
More informationFilice Insurance Welfare Benefit Plan. Plan Document & Summary Plan Description Wrap Document
Filice Insurance Welfare Benefit Plan Plan Document & Summary Plan Description Wrap Document This booklet contains a summary in English of your plan rights and benefits under Filice Insurance Welfare Benefit
More information