BP group long-term care insurance plan

Transcription

1 BP group long-term care insurance plan IMS#65525

2 Table of Contents BP group long-term care insurance plan 1 Eligibility and participation 2 Who is not eligible 4 How to enroll 5 Paying for coverage 6 When coverage begins 7 When you can change coverage 8 When coverage ends 9 How the BP group long-term care plan works 10 What the plan pays 11 Statement of health 12 Offsetting benefits 13 Additional plan features 14 When eligibility for benefits end 16 Limitations and exclusions 17 How to file a claim 18 If coverage is denied 19 Process for formal claim for benefits 20 Process for formal claims relating to eligibility to participate 21 Leaving BP 22 Administrative information 23 Plan administrator 24 Power of attorney (POA) and anti-assignment matters 25 Governing plan documents 26 No right to employment 27 Future of the plan 28 Your ERISA rights 29

3 BP group long-term care insurance plan Long-term care helps with the normal activities of daily life should the need occur The BP Group Long-Term Care Insurance Plan offers you and your family financial protection in the event a covered participant requires longterm care services. Long-term care, often known as custodial care, provides help with the normal activities of daily living such as bathing, dressing and eating. This care can be provided at home, in a nursing home or at an adult day care facility. The plan is insured by John Hancock Life Insurance Company. Regardless of your specific circumstances, the plan offers a wide range of possible coverage levels. You have the flexibility to choose the type of care that best meets your needs. Note: Effective January 1, 2012, John Hancock has closed the long-term care plan to new enrollments. If you or your dependents are currently enrolled in coverage, John Hancock will continue to provide you with ongoing service for the policies in which you are enrolled. Note: Benefits may be subject to state-specific regulations; contact John Hancock for more information. Throughout this plan summary, you generally refers to: You (the eligible employee) when describing elections (e.g., how to enroll, how to change coverage). You or any eligible dependent when describing the provisions of the plan (e.g., what is covered and what is not). Because this document is intended as a summary of a BP benefits plan, it is not intended to describe each plan provision in full detail. More complete details are contained in the governing plan documents (including applicable insurance policies). While we intend to update this summary on a regular basis, it is possible that at any point this summary may be neither current nor complete. Further, differences between this summary and the applicable plan document are not intended. If, however, any differences are found to exist, the relevant provisions of the applicable plan document and not the summary will govern. BP reserves the right to amend or terminate a plan at any time without advance notice. 18/Jan/18 11:21 The most up-to-date information is available online at Page 1 of 31

4 Eligibility and participation Learn about the eligibility rules governing the long-term care plan Who is eligible You are eligible for long-term care coverage if you are classified as a full-time, part-time or temporary employee of a participating employer and are currently enrolled in the plan. Effective January 1, 2012, John Hancock has closed its long-term care plan to new enrollments. If you are currently enrolled in long-term care, your coverage can continue. Full-time employee: An employee assigned to a position that: Requires full-time service as determined by BP; Is established to fill regular and ordinary employment requirements; and Is expected to continue for an indefinite period of time. Part-time employee: An employee assigned to a position that is: Regular and ordinary in nature; Expected to continue for an indefinite period of time; and One in which the employee works a schedule that is less than that of a full-time employee but is at least 20 hours a week. Temporary employee: An employee assigned to a position that: Requires full-time or part-time (not occasional) service as determined by BP; Requires a regular schedule of hours; and Will continue for a specified period of time or until the occurrence of a specified event, such as the return to work of a regular employee or the completion of a special assignment or project. Interns and co-ops are considered occasional employees. Eligible family members Your eligible family members also may apply for the coverage even if you do not elect to insure yourself for coverage. Eligible family members must be age 18 or over on the date coverage is effective and include your: Spouse. Opposite-sex or same-sex domestic partner. Parents or parents-in-law. Some special rules apply if your spouse/domestic partner is also an eligible BP employee or retiree: Each of you may elect coverage for yourself. One of you may elect coverage for himself/herself, and the other can waive coverage. You cannot be insured under the plan more than once at any given time. 18/Jan/18 11:21 The most up-to-date information is available online at Page 2 of 31

5 Domestic partners There are two alternative methods for qualifying your same-sex or opposite-sex domestic partner as an eligible dependent : Alternative A : Register your domestic partnership or civil union in accordance with registration requirements in the state in which you and your domestic partner or civil union partner reside. Your registration date is the first date you can enroll your partner as a domestic partner under the plan; or Alternative B : Satisfy each of the following requirements for at least six full months before signing a Domestic Partner Affidavit. The date you are first eligible to sign the affidavit is the date your partner will be considered your domestic partner for plan purposes. Be each other s sole domestic partner and intend to remain so indefinitely; Reside together in the same principal residence and intend to remain so indefinitely; Be emotionally committed to one another, share joint responsibilities for the partnership s common welfare and be financially interdependent; Be at least 18 years old, of legal age and mentally competent to enter into contracts; Not be related by blood closer than would bar marriage under applicable law where you live; and Not be legally married to, nor the domestic partner of, anyone else. Note: Under this plan, and pursuant to federal law, a civil union and a same-sex marriage must be treated the same as a domestic partnership. Your domestic partner will cease being an eligible dependent as of the date you cease to satisfy any of the above conditions. If your domestic partnership ends, call the BP HR & Benefits Center immediately. 18/Jan/18 11:21 The most up-to-date information is available online at Page 3 of 31

6 Who is not eligible Regardless of your employee classification, you are not eligible to participate in the BP Group Long-Term Care Insurance Plan if you are: An occasional employee. Not a U.S. resident. A member of a collective bargaining unit (union), unless your collective bargaining agreement provides that you are eligible to participate. Not classified as an employee on a participating employer s payroll, even if reclassified as a common-law employee by any third party. An employee on an unpaid leave of absence which has not been approved by BP. Note that if an employee is not eligible, the employee's family members are also not eligible. Occasional employee: For purposes of the plan, an "occasional employee" means an employee who is employed by BP for work that is irregular or infrequent in nature and which ordinarily should last no longer than four to six months, or an employee who works a regular schedule that is less than 20 hours per week and which is expected to continue for an indefinite period of time. An employee s classification in BP s payroll records controls eligibility regardless of whether the individual is later reclassified. An employee s classification is determined at the time of hire. If later changed, the new classification will only apply prospectively, regardless of the actual hours worked under the initial classification. 18/Jan/18 11:21 The most up-to-date information is available online at Page 4 of 31

7 How to enroll Effective January 1, 2012, John Hancock has closed the Group Long-Term Care Insurance Plan to new enrollments. If you or your dependents are currently enrolled in the plan and you have any questions about your coverage, you can reach John Hancock as follows: Online Name: bp Password: mybenefit By phone Within the U.S.: Outside the U.S.: Hearing impaired: All coverage under the BP Group Long-Term Care Insurance Plan is based on the truthfulness of statements made by you and your dependents. Coverage may be terminated, including retroactively, if such statements are found to be false, and intentional falsehoods will be considered a violation of the BP Code of Conduct, subjecting you to disciplinary actions, up to and including termination of employment. 18/Jan/18 11:21 The most up-to-date information is available online at Page 5 of 31

8 Paying for coverage You pay 100% of the cost of long-term care coverage for you and/or your spouse or domestic partner through payroll deductions on an aftertax basis. If your pay is not sufficient to take deductions for contributions (for example, if you are on an unpaid leave of absence), you will be billed directly by John Hancock. Other eligible family members also pay 100% of the cost of long-term care coverage and have the option of paying their premiums directly to John Hancock or through automatic withdrawal from their bank account. The monthly cost of long-term care coverage is based on: The insured person s issue age on the date John Hancock receives your application. The coverage options selected. Your state of residence. The younger the covered person is when long-term care coverage is purchased, the lower the rate will be for that person. Rates do not change because you age. 18/Jan/18 11:21 The most up-to-date information is available online at Page 6 of 31

9 When coverage begins If you enroll, long-term care coverage for: You begins the first of the month following John Hancock s approval of your application, if you are actively at work on that date. If you are not actively at work on that date, your coverage will not begin until the first of the month following the date you return to work at BP on a regular basis. Your eligible family members begins the first of the month after John Hancock approves his/her application. If a family member is disabled on the date his or her coverage would otherwise have become effective, his or her coverage becomes effective on the first day of the month following the date he or she is no longer disabled, if he or she is still eligible on that date. You and/or your eligible family member(s) must meet all eligibility requirements on the date the coverage is to become effective. 18/Jan/18 11:21 The most up-to-date information is available online at Page 7 of 31

10 When you can change coverage You can apply to increase your long-term care coverage amount once every 12 months by completing, signing and returning an application to John Hancock. Other than an inflation increase, a statement of health must accompany any application for an increase in coverage, and the increase in coverage is subject to approval by John Hancock. The application for increased coverage is available on John Hancock s website. You are not eligible to apply for an increase if you: Will be 85 or older on the date the increase would take effect. Have been certified for long-term care benefits in the six months before the increase effective date. Have exercised the reduced paid-up benefit (non-forfeiture benefit) option. Even if your application for increased coverage is denied, you will still be able to keep your original coverage. You can decrease your coverage at any time by writing to John Hancock and requesting the change. The change will take place the first of the following month. Changes due to a qualifying status change If you... Then... Get married Establish a domestic partnership Become legally separated Get a divorce or annulment End a domestic partnership Experience the death of a spouse/domestic partner Die You and your eligible family members may change your coverage at any time. A statement of health and approval by John Hancock is required for an increase in coverage. Additionally, John Hancock may request a statement from your doctor. The underwriting evaluation may also include an interview administered by a trained clinician. There is no charge to you for either the statement from your doctor or the interview. Long-term care coverage is portable. This means your legally separated spouse/former spouse/domestic partner can continue coverage on his/her own. Payroll deductions for your former spouse s/domestic partner s coverage will continue until you notify John Hancock to stop the deduction and offer direct billing to your former spouse/domestic partner. If your spouse/domestic partner had long-term care coverage at the time of his/her death, you will need to notify John Hancock to cancel coverage. In certain circumstances, your spouse s/domestic partner s estate may be eligible for a return of a portion of the premiums paid. A John Hancock representative will outline the requirements to request this benefit. See return of premium for more information. Long-term care coverage is portable. This means your surviving spouse/domestic partner can continue coverage on his/her own by notifying John Hancock, who will bill them directly. In certain circumstances, your estate may be eligible for a return of a portion of the premiums paid. A John Hancock representative will outline the requirements to request this benefit. 18/Jan/18 11:21 The most up-to-date information is available online at Page 8 of 31

11 When coverage ends Your long-term care coverage ends on the earliest of the: Premium due date, if you fail to pay your premium within 31 days after the premium due date. On the date through which your premiums are paid, when you terminate employment, unless you elect continuation coverage and pay the required premium directly to John Hancock when due. Date the lifetime maximum benefit is reached. Date the group policy is terminated. In this event, you may elect to continue your coverage under a replacement policy or under a conversion policy issued by John Hancock. Date you begin an unpaid leave of absence which has not been approved by BP. 18/Jan/18 11:21 The most up-to-date information is available online at Page 9 of 31

12 How the BP group long-term care plan works Important information about how the long-term care plan works Long-term care provides benefits that can help you manage the financial burden of long-term custodial care if you have a qualifying loss of functional capacity or cognitive impairment and have completed the qualification period requirement. You are considered to have a qualifying loss of functional capacity if you cannot perform at least two of the activities of daily living without substantial assistance by another person that is expected to last for at least 90 days. Activities of daily living are: Bathing Dressing Eating Maintaining continence Toileting Transferring A qualifying loss of functional capacity must be due to either physical incapacity resulting from illness, injury and the effects of aging or you may also qualify for benefits if you have a cognitive impairment that requires you to need substantial supervision for protection of yourself or others due to mental incapacity as a result of a diagnosed irreversible organic mental impairment, such as Alzheimer s disease. 18/Jan/18 11:21 The most up-to-date information is available online at Page 10 of 31

13 What the plan pays The following long-term care coverage options are available: Plan Coverage Option Daily Maximum Benefit Nursing Home Daily Maximum Benefit Alternate Care Facility Daily Maximum Benefit Home Health Adult Day Care Daily Maximum Benefit Informal Care* Daily Maximum Benefit Lifetime Maximum Benefit Comprehensive Option 1 $130 $130 $97.50 $78 $32.50 $237,250 5-year lifetime maximum benefit Option 2 $255 $255 $ $153 $63.75 $465,375 Option 3 $385 $385 $ $231 $96.25 $702,625 Enhanced Option 1 $130 $130 $97.50 $78 $32.50 $474, year lifetime maximum benefit Option 2 $255 $255 $ $153 $63.75 $930,750 Option 3 $385 $385 $ $231 $96.25 $1,405,250 * The total of benefits payable for all informal care received in any calendar year is 30 times the informal care daily maximum benefit. The benefits provided are subject to the daily maximum benefit and lifetime maximum benefit provided under the Comprehensive Plan or Enhanced Plan coverage option. The daily maximum benefit is the most the plan will pay for all covered services received on any one day. Each daily maximum benefit option has two corresponding lifetime maximum benefit options of which you will choose one. The lifetime maximum benefit (LMB) is the total pool of money payable for covered long-term care services received while you are insured. The lifetime maximum benefit for the Comprehensive Plan is based on a five-year benefit period, and the LMB for the Enhanced Plan is based on a 10-year benefit period. Care needed because of mental and emotional disorders without demonstrable organic disease is not covered. Long-term care providers must meet the qualifications specified in the Certificate of Insurance provided to you when coverage is approved. Services and supplies must be provided in accordance with a plan of care prescribed by a licensed health care practitioner. There is a 90-day waiting period from the date you are determined to be eligible for benefits before benefits may begin. You must continue to meet the eligibility requirement throughout this 90-day period. No benefits will be paid for charges incurred during this period. If you were receiving long-term care benefits, became decertified for benefits and then became certified for long-term care benefits again, you would have to satisfy a new 90-day waiting period before benefits would begin again. This requirement would not apply if the recertification of benefits occurred within 180 days after the date that the prior qualification period or benefit period ended. 18/Jan/18 11:21 The most up-to-date information is available online at Page 11 of 31

14 Statement of health John Hancock requires a statement of health before approving any increases in long-term care coverage. A statement of health provides proof of a person s physical condition and/or other factual information affecting his/her acceptance for insurance. You must provide a statement of health if you or an eligible family member apply to increase your coverage after you become insured. If a statement of health is required, complete the self-screening questionnaire. Please note that the self-screening questionnaire is for your information only, and you do not need to submit the questionnaire to John Hancock. John Hancock also may request a statement from your doctor. The underwriting evaluation may also include an interview administered by a trained clinician. There is no charge to you for either the statement from your doctor or the interview. 18/Jan/18 11:21 The most up-to-date information is available online at Page 12 of 31

15 Offsetting benefits To prevent duplication of benefits, the BP Group Long-Term Care Insurance Plan contains a coordination of benefits (COB) provision. When you receive benefits under another plan, COB may reduce or eliminate the benefits otherwise payable under the Group Long-Term Care Insurance Plan. The BP Group Long-Term Care Insurance Plan s coordination of benefits (COB) provision conforms to the NAIC Group Coordination of Benefits Regulations. Under these regulations, benefits received from other group plans such as group medical benefits and other employersponsored long-term care plans can reduce your benefits payable under this plan under the COB provision. Group Long-Term Care Insurance Plan benefits will not be reduced by any benefits you receive from Medicaid or individual long-term care policies. The plan does include a Medicare offset. 18/Jan/18 11:21 The most up-to-date information is available online at Page 13 of 31

16 Additional plan features In addition to the benefits provided under the Comprehensive Plan or Enhanced Plan coverage option elected, you and/or your eligible family members enrolled in the BP Long-Term Care Insurance Plan may be eligible for one or more of the following plan features. Waiver of premium Your premium payments will be waived if you: Are certified for long-term care benefits by a John Hancock patient advocate. Complete the 90-day qualification period. Incur at least 30 days of covered expenses for services other than informal care. The waiver will continue as long as you remain certified for benefits. Reduced paid-up benefit (non-forfeiture benefit) option In addition to choosing a coverage option, you may select a reduced paid-up benefit (non-forfeiture benefit) for an additional cost. If you elect this benefit, after you have paid premiums for at least three years, you may stop making premium payments and retain a reduced level of coverage. If you exercise this benefit, you retain the full daily maximum benefit amount, but the lifetime maximum benefit will be reduced. The reduced lifetime maximum benefit will equal the greater of: 30 times the nursing home daily maximum benefit. The sum of the premiums you have paid. This is a one-time option and is available only when you first apply for coverage. Return of premium at death benefit If you die before reaching age 70, this benefit pays a portion of the premiums paid for your coverage minus any benefits paid or payable. John Hancock will pay the return of premium benefit, if any, in a lump sum within 90 days after the date it receives due written proof of claim. The benefit will be paid to your estate; however, John Hancock may, at its option, pay the benefit to an alternative payee. Payment to an alternative payee may not exceed $2,000. The alternative payee must be a person John Hancock considers justly entitled to the benefit and must be related to you by blood or marriage. The portion of the premium payable to your estate is based on your age at the time of death: Age Percentage of Premium 65 or younger 100% 66 80% 67 60% 68 40% 69 20% 70 or older 0% The return of premium at death benefit will not apply if: You die after you reach age 70. You have exercised the reduced paid-up benefit (non-forfeiture benefit) option. 18/Jan/18 11:21 The most up-to-date information is available online at Page 14 of 31

17 Automatic benefit increase (ABI) option When you first enroll in the plan, you may select an ABI option for an additional cost. If you elect this option, your benefit amounts increase automatically each year. Each October 1, your daily maximum benefit amount will increase at an annual rate of 5% compounded, and your lifetime maximum benefit amount will increase in proportion to the increase in the Nursing Home daily maximum benefit. There will be no increase in your premium due to these annual increases. Daily maximum benefit amounts will automatically increase on each October 1 after your effective date of coverage by an amount equal to 5% of the daily maximum benefit amount then in effect. If your insurance becomes effective on October 1, no increase will apply on your effective date of coverage. The ABI benefit increases will continue to be made annually regardless of your age or whether you have met the benefit eligibility requirements under the policy. However, no increases will apply if you have exercised the reduced paid-up benefit (non-forfeiture benefit) option. Inflation adjustment If you do not elect the Automatic Benefit Increase option when you first enroll, every three years you will be offered additional amounts of coverage so your coverage can keep up with inflation. The amount of each adjustment will reflect a benefit increase of at least 5% compounded annually for the applicable period. Inflation adjustments are not available if you: Will be 85 or older on the date the increase would take effect. Have been certified for long-term care benefits in the six months before the increase effective date. Have exercised the reduced paid-up benefit (non-forfeiture benefit) option. If you are a resident of Connecticut, Delaware or Kansas, this provision varies slightly for you. See the John Hancock enrollment kit or call John Hancock for details. 18/Jan/18 11:21 The most up-to-date information is available online at Page 15 of 31

18 When eligibility for benefits end You are no longer qualified for benefits on the earliest of the date: The John Hancock patient advocate determines that you are no longer in need of long-term care services (the date you are decertified). You reach your lifetime maximum benefit. You die. 18/Jan/18 11:21 The most up-to-date information is available online at Page 16 of 31

19 Limitations and exclusions Some limitations and exclusions apply under the BP Group Long-Term Care Insurance Plan. Benefits are not paid for: Mental or emotional disorders without demonstrable organic disease. This includes, but is not limited to, neurosis, psychoneurosis, psychopathy and psychosis. This exclusion does not apply to Alzheimer s disease or other organically caused brain disorders. Intentionally self-inflicted injury. Home health care or adult day care provided by a person who ordinarily resides in the insured s home. Conditions caused by committing or attempting to commit a felony, engaging in an illegal occupation, or participating in a riot or insurrection. Care specifically provided for detoxification or rehabilitation for alcoholism or drug abuse. Conditions caused by war or any act of war, whether declared or not, or service in the armed forces or auxiliary units. Care or treatment provided outside the United States (the 50 states and the District of Columbia) or Puerto Rico. A service or supply furnished by or covered as a benefit under a program of any government or its subdivisions or agencies, except: A program established by the federal government for its civilian employees. Medicare. Medicaid (any state medical assistance program under Title XIX of the Social Security Act as amended from time to time). A service or supply furnished primarily to beautify. A service or supply for which a charge would not have been made in the absence of insurance. Any charge to the extent that a benefit is payable under Medicare, or would be payable under Medicare except for the deductible and coinsurance provisions under Medicare. Any charges incurred during the 90-day qualification period. These exclusions may not apply in all states and may vary, depending on the state in which you live. The Certificate of Insurance you receive outlines the exact exclusions for your state. If you move to another state, the guidelines of the state where the Certificate of Insurance was originally delivered to you will continue to apply. Long-term care providers must meet the qualifications specified in the Certificate of Insurance, and services and supplies must be provided in accordance with a plan of care prescribed by a licensed health care practitioner. 18/Jan/18 11:21 The most up-to-date information is available online at Page 17 of 31

20 How to file a claim Claims should be filed with the claims administrator To request benefits, contact John Hancock for a Certification Form. Complete the form and return it to John Hancock. You must be certified for benefits and meet the qualification period requirement before any benefits can be paid for covered services. You may receive long-term care benefits in a check mailed to your home, or you may have them deposited directly into your bank account. Alternatively, you may elect to have your benefits paid directly to your caregiver. 18/Jan/18 11:21 The most up-to-date information is available online at Page 18 of 31

21 If coverage is denied If coverage for you, your spouse/domestic partner or your parent or parent-in-law is denied due to a statement of health or insurance underwriting issues, John Hancock will send the applicant a notice of denial with the specific reason for the denial. If you do not agree with John Hancock s decision, you may file a written appeal, including supporting medical documentation, within 60 days from the date you receive the notice of denial. John Hancock will respond to your appeal when the review process is completed. Send your appeal to: John Hancock P.O. Box 111 Boston, MA You may discuss your appeal with John Hancock by calling /Jan/18 11:21 The most up-to-date information is available online at Page 19 of 31

22 Process for formal claim for benefits If you are not satisfied with a final benefits determination, you may file a formal claim. The formal claim must be in writing and must be filed with the claims administrator. If the formal claim for plan benefits is denied, you will be provided with a notice of denial, which will contain: The specific reason for the denial. The specific reference to the plan provisions on which the denial is based. Descriptions of any additional information that is necessary to perfect the formal claim and an explanation of why this information is necessary. An explanation of the review procedure. If your claim is denied in whole or in part, you will receive an adverse benefit determination within 90 days of the date your formal claim is received by the claims administrator unless special circumstances require an additional 90 days to process your claim. If an extension of time is required, you will be given written notice prior to the beginning of the extension period. The notice will indicate the special circumstances requiring an extension of time and the date by which the claims administrator expects the final decision to be rendered. Process for formal appeals relating to claim denials If your formal claim for benefits is denied in whole or in part, you may submit a written appeal of the decision to the same claims administrator within 60 days of the date you received the formal claims denial. In your written appeal, you may submit written comments, documents, records and other information relating to the claim, whether or not the materials or information was previously submitted in connection with the initial formal claim. You may also request that the claims administrator provide, free of charge, copies of all documents, records and relevant information relating to the claim. You will be notified of the decision on appeal not later than 60 days after the appeal is received by the claims administrator. If an extension of time is needed (up to an additional 60 days) you will be given written notice before the beginning of the extension period. The notice will indicate the special circumstances requiring the extension of time and the date by which the claims administrator expects the final decision to be rendered. The decision on your appeal will be in writing. It will include the reasons for the decision, a reference to the specific plan provision, as applicable, and other relevant information bearing on the decision. If you do not receive notice of the decision within 120 days after receipt of your appeal, it should be considered denied. The decision on the appeal is final, conclusive and not subject to further review. The applicable claims administrator has full and exclusive authority to determine the eligibility of any individual to participate in the plan and receive plan benefits; and to grant and deny claims under the plan, including the power to interpret the plan. If following exhaustion of the plan's appeal procedure, you still believe that you are entitled to a benefit under the plan, you may file a civil action under Section 502(a) of the Employee Retirement Income Security Act of 1974, as amended ("ERISA"). You may not file a civil action unless you have exhausted the plan s claims and appeals procedure. 18/Jan/18 11:21 The most up-to-date information is available online at Page 20 of 31

23 Process for formal claims relating to eligibility to participate You may make a verbal inquiry to the BP HR & Benefits Center if you have a claim related to such issues as: Eligibility to enroll in the plan; Enrollment elections; or Qualified status changes. In many cases, the inquiry will resolve your issue. If you believe that the response to your inquiry was based on inaccurate information or that additional information may clarify the issue, you may submit a written request for reconsideration to: Claims and Appeals Management BP P.O. Box 1407 Lincolnshire, IL You should receive a decision on your request for reconsideration within 30 days. If you are not satisfied with the reconsideration decision, you may file a formal claim with the claims administrator by submitting a claim to the claims administrator in care of: ERISA Claims and Appeals P.O. Box Houston, TX A formal claim related to eligibility cannot be filed with the claims administrator in care of ERISA Claims and Appeals until an inquiry and a request for reconsideration have been completed. If you file a formal claim with ERISA Claims and Appeals on behalf of the claims administrator, it will be reviewed subject to the same timeframes applicable to formal claims for benefits. The review will be subject to the same procedures, protocols and standards. If your claim is denied in whole or in part, you may appeal the adverse benefits determination by submitting an appeal to the claims administrator for appeals in care of ERISA Claims and Appeals. It will be reviewed subject to the same timeframes applicable to formal appeals for benefits. The review will be subject to the same procedures, protocols and standards. If following exhaustion of the plan's appeal procedure, you still believe that you are entitled to either participate in the plan or to a benefit under the plan, you may file a civil action under Section 502(a) of the Employee Retirement Income Security Act of 1974, as amended ("ERISA"). You may not file a civil action unless you have exhausted the plan s claims and appeals procedure. However, any such suit must be filed with a federal court of proper jurisdiction located in Harris County, Texas, no later than one (1) year following a final denial pursuant to the plan's appeal procedure. 18/Jan/18 11:21 The most up-to-date information is available online at Page 21 of 31

24 Leaving BP What happens to benefits if you leave Continuing coverage For yourself and your spouse/domestic partner If you leave BP, your long-term care coverage is portable. This means you can continue your coverage when you leave BP for any reason. John Hancock will send you the information you need to do so after your termination of employment. You will continue to pay the same premium rate that is paid by active BP employees. John Hancock will bill you for the cost of your coverage (and for the cost of your spouse s/domestic partner s coverage, if elected), and you will pay your premiums directly to them. For your other eligible family members Your other eligible family members will continue to be billed by John Hancock and pay premiums directly to them. 18/Jan/18 11:21 The most up-to-date information is available online at Page 22 of 31

25 Administrative information Detailed information about plan administration and your rights Name of plan Type of plan BP Group Long-Term Care Plan, a component benefit program of the BP Corporation North America Inc. Consolidated Welfare Benefit Plan Welfare benefit insured. Plan number 504 Plan year April 1 March 31 Plan sponsor and identification number Plan administrator Sources of contributions BP Corporation North America Inc. 501 Westlake Park Blvd. Houston, TX Employer ID#: Director, Health & Welfare BP Corporation North America Inc. 501 Westlake Park Blvd. Houston, TX The BP Corporation North America Inc. Consolidated Welfare Benefit Plan is funded by participants and participating employers contributions and by investment earnings. Participant contributions are set by BP and may be adjusted from time to time. If participant contributions and investment earnings are insufficient to pay plan costs or expenses, the balance of the cost of the plan (if any) is paid by BP. VEBA trustee JPMorgan Chase Bank Worldwide Securities Services 4 New York Plaza New York, NY Benefits may be paid through the BP Welfare Benefits Trust-III ( VEBA ). Claims administrator/insurance company Agent for service of legal process John Hancock P.O. Box 111 Boston, MA For disputes arising from the plans, legal process may be served on: BP Legal BP Corporation North America Inc. P.O. Box Houston, TX Legal process may be made upon the plan administrator. 18/Jan/18 11:21 The most up-to-date information is available online at Page 23 of 31

26 Plan administrator The plan administrator has the authority to control and manage the operation and administration of the plan. In this capacity, the plan administrator (or his/her authorized delegates) generally has several rights, powers and duties, including: Selecting and contracting with a claims administrator and other service providers. Determining expenses that can be paid from plan assets. Determining, in his/her discretion, whether an individual is eligible for or entitled to benefits. Interpreting plan provisions. Establishing rules and procedures for plan administration. The plan administrator has designated John Hancock to manage the day-to-day operations of the plans, including processing and paying all claims for benefits. In addition to the rights and duties described above, the plan administrator has the authority to: Refuse payment or reimbursement for claims incurred by any covered person or other person who has engaged in improper conduct with respect to the BP Corporation North America Inc. Consolidated Welfare Benefit Plan. Terminate a covered person s participation in the plan if he/she has engaged in improper conduct. Once it has been determined that an individual has engaged in improper conduct, the plan administrator has the authority to take any actions he deems appropriate to remedy such violations, including pursuing legal or equitable remedies to recoup any payments made by the BP Corporation North America Inc. Consolidated Welfare Benefit Plan to any party, regardless of when such improper conduct was taken or discovered. Such action will not preclude the company from taking other appropriate action. If any individual loses any rights or coverage under the BP Corporation North America Inc. Consolidated Welfare Benefit Plan as a result of the plan administrator s determination of improper conduct, coverage will be retroactively terminated as of the date of the improper conduct. 18/Jan/18 11:21 The most up-to-date information is available online at Page 24 of 31

27 Power of attorney (POA) and anti-assignment matters Power of attorney (POA) Occasionally participants need assistance from a third party (agent) with benefits matters. If you wish to designate an agent to act on your behalf for your BP health and protection benefits, please contact the BP HR & Benefits Center for copies of the POA Notice (submission guide) for health and protection matters and related POA form or print copies from the LifeBenefits website Forms or Policies and programs links. The POA Notice also explains the submission process for individually designated POAs, court orders and guardianships. Third parties may request a copy of the POA Notice by calling the BP HR & Benefits Center at Please note that generally only one person or institution at a time can be recognized to act on behalf of a participant through submission of a POA, court order or guardianship. The BP HR & Benefits Center will not process a transaction if there is a reason to believe that the person making the transaction is not the plan participant, the participant's agent under a POA or court-appointed conservator or guardian. Anti-assignment The rights or benefits under this plan may not be assigned by a participant or beneficiary. 18/Jan/18 11:21 The most up-to-date information is available online at Page 25 of 31

28 Governing plan documents In the preparation of this plan summary, effort was made to provide a clear, concise description of your benefits and to avoid contract and legal terms wherever possible. The aim has been to present a simplified overview of essential information about your benefits in words that are not obscure or likely to be misunderstood. As highlighted earlier in this summary, in the event of an inconsistency between this summary and the plan document (including insurance policies as applicable), the plan document will govern. Employees covered by collective bargaining agreements are subject to this summary to the extent consistent with the terms of BP s benefit programs, the applicable collective bargaining agreement and any applicable legal guidelines. 18/Jan/18 11:21 The most up-to-date information is available online at Page 26 of 31

29 No right to employment Your eligibility for or your right to benefits under BP s benefit plans is not a guarantee of continued employment. BP s employment practices are determined without regard to the benefits offered as part of your total compensation package. In addition, and subject to legal and contractual considerations, BP reserves the right to terminate your employment at any time or for any reason. 18/Jan/18 11:21 The most up-to-date information is available online at Page 27 of 31

30 Future of the plan The company reserves the right to change or end a plan at any time without advance notice. The decision to do so may be the result of changes in federal or state laws governing benefits, or any other factor. 18/Jan/18 11:21 The most up-to-date information is available online at Page 28 of 31

31 Your ERISA rights As a participant in a BP benefit plan, you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA). ERISA provides that all plan participants have the right to: Examine, without charge, at the plan administrator s office, 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. Obtain, upon written request to the BP HR & Benefits Center, copies of governing plan documents. A reasonable fee for copying may be assessed. The address to be used to request plan documents is: BP HR & Benefits Center P.O. Box Charlotte, NC Participants may also download a copy of the summary plan description at no cost from the Benefits handbook tab on the LifeBenefits website at Receive a summary of the plan s annual financial report at no charge. Each participant is automatically provided with a copy of this summary annual report. In addition to creating rights for plan participants, ERISA imposes duties upon the people who are responsible for the operation of the plan. The people who operate your plans are called fiduciaries and have a duty to operate the plans prudently and in the interest of you and other plan participants and beneficiaries. No one, including your employer or any other person, may fire you or discriminate against you in any way to prevent you from obtaining benefits under the plan or exercising your rights under ERISA. If your claim for a 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 limits. Under ERISA, there are steps you can take to enforce these rights. For instance, if you request materials from the plan and do not receive them within 30 days, you may file suit in a federal court within Harris County, Texas. 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 they were not sent because of reasons beyond the plan administrator s control. The only proper venue for a lawsuit seeking enforcement of your rights under this plan is in federal court in Harris County, Texas. If you have a claim for benefits that is denied or ignored, in whole or in part, or if you disagree with the plan s decision or lack thereof concerning the qualified status of a Domestic Relations Order (DRO), you may file suit in a state or federal court located in Harris County, Texas. (You can file suit only after you have exhausted the plan s claims and appeals procedures.) If the 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 in Harris County, Texas. The court will decide who should pay court costs and legal fees. If you re successful, the court may order the person you have sued to pay these costs and fees. If you lose for example, if the court finds your claim is frivolous the court may order you to pay these costs and fees. If you have any questions about your health and protection plans, you should contact the BP HR & Benefits Center. If you have any questions about this statement or about your rights under ERISA, you should contact the nearest office of the Employee Benefits Security Administration, U.S. Department of Labor, listed in your telephone directory, or contact: Division of Technical Assistance and Inquiries Employee Benefits Security Administration U.S. Department of Labor 200 Constitution Avenue N.W. 18/Jan/18 11:21 The most up-to-date information is available online at Page 29 of 31

32 Washington, DC /Jan/18 11:21 The most up-to-date information is available online at Page 30 of 31

33 18/Jan/18 11:21 The most up-to-date information is available online at Page 31 of 31