NRECA Long-Term Disability Plan

Transcription

1 NRECA Lng-Term Disability Plan SUMMARY PLAN DESCRIPTION (BENEFITS BOOKLET) HOMEWORKS TRI-COUNTY ELEC EFFECTIVE DATE: January 1, 2016

2 Intrductin Summary Plan Descriptin This is a summary plan descriptin (SPD), als knwn as the Benefits Bklet. It describes the benefits prvided by the Natinal Rural Electric Cperative Assciatin (NRECA) Lng Term Disability Plan (the Plan) t participants. Yur Respnsibilities Yu are respnsible fr reading the SPD and related materials cmpletely and cmplying with the rules and Plan prvisins described herein. The prvisins applicable t the specific benefit ptins under this benefit Plan determine what services and supplies are eligible fr benefits; hwever, yu and yur prvider have the ultimate respnsibility fr determining what services yu will receive. While reading this material be aware that: The Plan is prvided as a benefit t persns wh are eligible t participate, as defined in the chapter titled Eligibility and Participatin Infrmatin. Plan participatin is nt a guarantee r cntract f emplyment with NRECA r with member cperatives. Plan benefits depend n cntinued eligibility. Frequently used and plan specific terms are defined in Appendix A: Key Terms. In case f a cnflict between this SPD (r any infrmatin prvided) and the fficial Plan dcument, the fficial Plan dcument gverns.

3 Table f Cntents Plan Infrmatin... 5 Chapter 1: Cntact Infrmatin... 7 Chapter 2: Lng-Term Disability Plan Highlights... 8 Chapter 3: Eligibility and Participatin Infrmatin... 9 Eligibility t Participate... 9 Eligibility Waiting Perid... 9 Additinal Eligibility Requirements... 9 When Cverage Begins (Participatin Date) Cst f Cverage Special Enrllment Opprtunity When Cverage Ends Chapter 4: Yur Benefits During a Leave f Absence General Infrmatin Cmpensated and Uncmpensated Leave f Absence Eligibility t Participate During Yur Leave f Absence Annual Benefits Enrllment Paying fr Benefits During Yur Leave f Absence Unifrmed Services Emplyment and Reemplyment Rights Act (USERRA) Chapter 5: Lng-term Disability Benefits Definitin f Disability When Benefits Begin Lng-term Disability Apprval and Other NRECA Benefits Maximum Benefit Perid fr Disability Benefits due t Mental/Nervus Cnditins r Substance Abuse When Benefits End Reductin f Mnthly Benefit Due t Other Surces f Incme Scial Security Disability and Wrkers Cmpensatin Benefits Rehabilitatin Prvisin Trial Wrk Perid Wrkplace Accmmdatin Lss f Earnings Prvisin... 20

4 Recurrent and New Disabilities Multiple Disabilities Exclusins Initial Prf f Disability Cntinuing Prf f Disability Chapter 6: Claims and Appeals General Infrmatin Claims and Appeals Cntacts Using an Authrized Representative The Disability Claim Filing Prcess The First-level Appeal Prcess The Vluntary Final Appeal Prcess Chapter 7: Imprtant Ntificatins and Disclsures Nt a Cntract f Emplyment Nn-assignment f Benefits Third-party Liability Right f Recvery f Overpayment Changing r Terminating the Plan Severability Additinal Prcedures Statement f ERISA Rights Appendix A: Key Terms... 32

5 Plan Infrmatin Plan Name The Natinal Rural Electric Cperative Assciatin s Grup Benefits Prgram Plan Identificatin Number: 501 Plan Type: Lng Term Disability Plan Year End: December 31 Plan Effective Date: January 1, 2016 Plan Funding Cverage under the Plan is self-insured and funded in whle r in part thrugh cntributins made by participating emplyers r participants t the: NRECA Grup Benefits Trust Natinal Rural Electric Cperative Assciatin 4301 Wilsn Bulevard Arlingtn, VA Plan Administratin Except where pre-empted by ERISA r ther U.S. laws, the validity f the Plan and any ther prvisins will be determined under the laws f the Cmmnwealth f Virginia. Plan Spnsr Natinal Rural Electric Cperative Assciatin 4301 Wilsn Bulevard Arlingtn, VA Plan Spnsr s Emplyer Identificatin Number: NRECA, as the Plan Spnsr, must abide by the rules f the Plan when making decisins abut hw the Plan perates and hw benefits are paid. Plan Administratr and Named Fiduciary Senir Vice-President, Insurance and Financial Services Natinal Rural Electric Cperative Assciatin 4301 Wilsn Bulevard, Mailstp IFS7-355 Arlingtn, VA Telephne number: Plan Administratr Emplyer Identificatin Number: The Plan Administratr has discretinary and final authrity t interpret and implement the terms f the Plan, reslve ambiguities and incnsistencies and make all decisins regarding eligibility and r entitlement t cverage r benefits. In additin t the Senir Vice-President f Insurance and Financial Services, the persn listed belw has Plan Administratr respnsibilities fr yur emplyer: Benefits Administratr HOMEWORKS TRI-COUNTY ELEC 7973 East Grand River Ave Prtland, MI Lng-Term Disability Prpsal #

6 Yur Emplyer s Emplyer Identificatin Number (EIN) Plan Trustee NRECA Grup Benefits Trust State Street Bank and Trust Cmpany 225 Franklin Street Bstn, MA Agent fr Service f Legal Prcess The agent f service f legal prcess is the Plan Administratr. The Plan Administratr receives all legal ntices n behalf f the Plan Spnsr regarding claims r suits filed with respect t this Plan. Such legal prcess may als be served upn the Plan Trustee. Claims Administratr Cperative Benefit Administratrs, Inc. (CBA) P.O. Bx 6249 Lincln, NE Lng-Term Disability Prpsal #

7 Chapter 1: Cntact Infrmatin Fr Infrmatin Abut Cntact Claims fr benefits Dcumentatin t supprt Prf f Lss Claims Administratr Cperative Benefit Administratrs, Inc. (CBA) P.O. Bx 6249 Lincln, NE General benefit questins Eligibility Enrllment When cverage begins r ends Cst f cverage Changing yur beneficiary Benefits Administratr HOMEWORKS TRI-COUNTY ELEC 7973 East Grand River Ave Prtland, MI Lng-Term Disability Prpsal #

8 Chapter 2: Lng-Term Disability Plan Highlights Benefit perid begins Disability mnthly benefit Maximum Benefit Perid After 26 weeks f Disability (see the chapter titled Yur Benefits During Leave f Absence) 66 2/3% f yur mnthly Earnings up t a maximum mnthly benefits payment f $15,000. Disability benefits will be paid mnthly fr as lng as yu qualify fr benefits under this Plan, but will nt exceed the Maximum Benefit Perid. The Maximum Benefit Perid is based n yur age when yur Disability ccurs and ends at age 65. Disabilities due t Mental/Nervus Cnditins r Substance Abuse may be subject t a 24-mnth limitatin n benefits. See the Definitin f Disability sectin in the Lng-term Disability Benefits chapter fr details abut this feature. Lng-Term Disability Prpsal #

9 Chapter 3: Eligibility and Participatin Infrmatin Eligibility t Participate Active Emplyees are eligible t participatin in the Plan unless they are excluded by their jb classificatin. The fllwing jb classificatins (r jb titles) f Emplyees are nt eligible t participate in this Plan: This Plan des nt have any excluded jb classificatins, psitins r titles. Eligibility Waiting Perid In rder t be eligible t participate in the Plan, yu must have satisfied yur Emplyer s Eligibility Waiting Perid. The Eligibility Waiting Perid is the length f time that yu must have wrked fr yur Emplyer befre yu can participate in the Plan. Yur Plan has the fllwing Eligibility Waiting Perid: An active emplyee is eligible t participate in the Plan after: 6 Mnths. T be eligible, yu must als cmplete and return an NRECA Emplyee Wrksheet t yur benefits administratr within 31 days f satisfying yur Emplyer s Eligibility Waiting Perid. Additinal Eligibility Requirements Part-time Emplyees must wrk 1,000 hurs befre they are eligible t participate in the Plan. In additin t meeting the Eligibility Waiting Perid requirements, full-time Emplyees must als: Be expected t wrk at least 1,000 hurs fr yur Emplyer as an active Emplyee during yur first 12 mnths f emplyment; Have wrked at least 1,000 hurs fr yur Emplyer each subsequent calendar year; r Have wrked at anther c-p within the past six mnths and met the hurs f service criteria nted in the bullets abve. A c-p means: Yur Emplyer; Any member c-p f NRECA (even if the c-p des nt participate in NRECA plans); An Emplyer that is an affiliate f a member c-p; An Emplyer that has since becme a member c-p f NRECA; r An Emplyer that has since merged with, been cnslidated with r been liquidated int a current member c-p f NRECA. Full-time Emplyees must als satisfy the Active Wrk requirement, als called the Actively at Wrk requirement. This means that an Emplyee must be present at wrk (at the business establishment f the Emplyer r at ther lcatins t which the Emplyer s business requires the Emplyee t travel) n a day that is ne f the Emplyer s scheduled wrk days and must be perfrming, in the usual way, all f the regular duties f the Emplyee s jb n a full-time basis n that day. An Emplyee will be deemed t be Actively at Wrk n a day that is nt ne f the Emplyer s regularly scheduled wrk days nly if the Emplyee was Actively at Wrk n the preceding scheduled wrk day. An Emplyee will be deemed t satisfy the Active Wrk requirement if he Lng-Term Disability Prpsal #

10 r she is n an Emplyer-apprved leave f absence (e.g., Family and Medical Leave Act (FMLA) absence, jury duty, bereavement leave, vacatin). This des nt include time ff as a result f Injury, Sickness r disciplinary suspensin. In n event will an Emplyee be deemed t be n an Emplyer-apprved leave f absence fr any absence that cntinues lnger than 12 weeks, except fr an FMLA leave f absence t care fr family members wh are injured while n active duty in the armed frces (including the Natinal Guard r Reserves) which prvides the emplyee with up t 26 weeks f leave. If an Emplyee is cnfined fr medical care r treatment in a Hspital, in any institutin r at hme n the date cverage wuld therwise becme effective, then the effective date f the Emplyee s eligibility t participate in the Plan will be pstpned until he r she receives final medical release frm the medical cnfinement and satisfies the Active Wrk requirement. When Cverage Begins (Participatin Date) Yu are cvered under this Plan effective n the later f: The effective date f the Plan, r The date yu meet the eligibility criteria (see the Eligibility t Participate and Eligibility Waiting Perid sectins in this chapter). Cst f Cverage The cst f yur cverage is subject t yur Emplyer s plicies and can change at any time. Yu and yur Emplyer share the cst f yur cverage as fllws: The emplyer pays 100% f the cst f yur cverage. Special Enrllment Opprtunity If yu decline cverage during yur initial enrllment perid, yu may qualify fr an additinal pprtunity t enrll as a late enrllee (subject t evidence f insurability) if yu experience ne f the fllwing events: Marriage, birth, adptin r placement fr adptin, if yu enrll prir t and within 31 days after the event date; Divrce r death f spuse r dependent child, if yu enrll within 31 days after the event date; Changes in emplyment status that wuld make yu eligible t participate in the Plan; r Annual enrllment, if ffered by yur Emplyer. Late enrllees must satisfy the Evidence f Insurability requirement. Yur benefits administratr will prvide yu with instructins fr satisfying this requirement. Yu can prvide evidence f insurability by cmpleting a Statement f Health (SOH) applicatin within 60 days f the effective date f electin. Cverage will be apprved r denied based n the evidence f insurability that yu prvide. When Cverage Ends Yur disability cverage ends n the earliest f the fllwing dates: Yur emplyment terminates r yu transfer t a jb classificatin (r title) that yur Emplyer des nt cver; Lng-Term Disability Prpsal #

11 Yu cease t be eligible fr participatin under the Plan; Yu cease t pay premiums required under the Plan; Yu retire frm yur Emplyer; The Plan is terminated, changed, r n lnger cvers yur jb classificatin (r title); r Yu take a leave f absence fr reasns ther than disability r an emplyer-apprved leave f absence, in which case cverage wuld terminate n the last day wrked. If yur grup Disability cverage under this Plan terminates fr any reasn it cannt be cnverted t an individual Disability plicy. Lng-Term Disability Prpsal #

12 Chapter 4: Yur Benefits During a Leave f Absence General Infrmatin Yur Emplyer ffers varius types f leaves f absence. A leave f absence means time away frm wrk, as permitted by yur Emplyer, fr reasns such as military duty, a medically certified health cnditin, family care r persnal needs. Depending n the type f leave, yu may remain eligible t participate in this Plan while yu are n leave f absence. Hw yu (r yur Emplyer) pay fr yur Plan premiums may vary. Remember that the specific Plan prvisins described in the individual chapters f this SPD cntinue t gvern the administratin f benefits during yur leave f absence. Yur leave f absence may be prtected under either the Family Medical Leave Act (FMLA) r the Unifrmed Services Emplyment and Reemplyment Rights Act f 1994 (USERRA). Please refer t the specific sectins describing each f these leave types fr applicable infrmatin. If yu have questins abut yur leave f absence, cntact yur benefits administratr. Cmpensated and Uncmpensated Leave f Absence Yur apprved leave f absence may be cmpensated r uncmpensated, and is based n the surces f incme yu receive during yur leave f absence. An apprved leave f absence des nt include a disciplinary suspensin. Cmpensated leave means the perid f time that yu are nt actively at wrk and yu are receiving ne r mre f the fllwing surces f incme: Base wages (pay) fr time wrked; Accrued, unused paid time ff (such as sick leave, vacatin leave r persnal leave); Hliday pay (including pay fr flating r variable hlidays); Pay by yur Emplyer fr ther time away frm wrk (fr example: bereavement, cmmunity service time, general electin vting, jury duty, weather clsings); Military supplement pay, r Salary cntinuatin prgrams and extended illness benefits. Uncmpensated leave means the perid f time that yu are nt actively at wrk and are nt receiving ne r mre f the surces f incme listed abve. Eligibility t Participate During Yur Leave f Absence If yur emplyment cntinues and yu are n an Emplyer-apprved cmpensated leave f absence, eligibility t participate in this plan cntinues as lng as the required applicable premium is paid. If yu are n an Emplyer-apprved uncmpensated leave f absence, yur eligibility t participate in this Plan terminates n the date yur uncmpensated leave begins. Lng-Term Disability Prpsal #

13 Annual Benefits Enrllment When yu are n a leave f absence and are eligible t cntinue t participate in this Plan, yu may generally make benefit electins (subject t all f the Plan s enrllment prvisins) during the annual benefits enrllment perid fr the upcming Plan year. Benefits elected during the annual benefits enrllment perid and crrespnding csts fr cverage becme effective January 1 f the fllwing year. Hwever, if during the annual benefits enrllment perid yu elect a benefit ptin with an Actively at Wrk requirement and then, n the fllwing January 1, yu are n a leave f absence, yur cverage effective date will be delayed until yu return t wrk in a benefits-eligible psitin. Paying fr Benefits During Yur Leave f Absence Yu r yur Emplyer must make the required premium payments fr yur benefits cverage while yu are n a leave f absence. If yur benefits cverage terminates due t nnpayment f premiums, reinstatement r reenrllment ptins will vary when yu return t wrk in a benefitseligible psitin immediately fllwing yur leave. Returning Frm a Leave f Absence If yur premiums were paid while yu were n a leave f absence and yu return t wrk in a benefits-eligible psitin immediately afterwards, then yur benefit electins will cntinue upn yur return. If yu return t wrk immediately fllwing the end f yur apprved leave, yu are autmatically re-enrlled in this Plan. Yur cverage is effective n the date yu return t wrk. Fr additinal infrmatin, cntact yur benefits administratr. Different requirements may apply when yu return frm a leave f absence that is prtected under FMLA r USERRA. Fr additinal infrmatin, see the sectins in this chapter abut FMLA and USERRA. If Yu Terminate Emplyment While n a Leave f Absence If yur emplyment ends either during r at the end f yur leave f absence and yur benefit cverage was nt terminated during the leave, yu r yur Emplyer must make any required premium payments that did nt ccur. If yu d nt pay fr all elected benefit cverages by the due date, yur cverage will end n the n the date f terminatin. Wrkers Cmpensatin Wrkers cmpensatin may be cmpensated r uncmpensated leave. If yur perid f Wrkers cmpensatin is cmpensated (see the sectin in this chapter titled Cmpensated and Uncmpensated Leave f Absence), then yu are eligible t cntinue yur benefits. If yu d nt receive cmpensatin during yur perid f wrkers cmpensatin, benefits will cntinue fr up t 90 days. Family Medical Leave Act (FMLA) Certain leaves f absence may be prtected under FMLA. If yur leave is prtected under FMLA, then when yu return t wrk yur Emplyer will cntinue t maintain yur benefits cverage and prvide fr applicable reinstatement f cverage t the extent required by FMLA. Lng-Term Disability Prpsal #

14 Basic Leave Entitlement FMLA requires cvered emplyers t prvide up t 12 weeks f unpaid, jb-prtected leave t eligible emplyees fr the fllwing reasns: Incapacity due t pregnancy, prenatal medical care r child birth; T care fr the emplyee s child after birth r placement fr adptin r fster care; T care fr the emplyee s spuse, sn, daughter r parent, wh has a serius health cnditin; r Fr a serius health cnditin that makes the emplyee unable t perfrm his r her jb. Military Family Leave Entitlements Eligible Emplyees whse spuse, sn, daughter r parent is n cvered active duty r called t cvered active duty status may use their 12-week leave entitlement t address certain qualifying exigencies. Examples f qualifying exigencies include attending certain military events, arranging fr alternative childcare, addressing certain financial and legal arrangements, attending certain cunseling sessins, and attending pst-deplyment reintegratin briefings. FMLA als includes a special leave entitlement that permits eligible Emplyees t take up t 26 weeks f leave t care fr a cvered service member during a single 12-mnth perid. A cvered service member is: A current member f the armed frces, including a member f the Natinal Guard r Reserves, wh is underging medical treatment, recuperatin r therapy, is therwise in utpatient status r is therwise n the temprary Disability retired list fr a serius Injury r illness; r A veteran wh was discharged r released under cnditins ther than dishnrable at any time during the five-year perid prir t the first date the eligible Emplyee takes FMLA leave t care fr the cvered veteran, and wh is underging medical treatment, recuperatin r therapy fr a serius Injury r illness. Fr mre infrmatin n FMLA and paying fr yur benefits during a leave, cntact yur benefits administratr. Unifrmed Services Emplyment and Reemplyment Rights Act (USERRA) Under USERRA, if yu g n active duty in the U.S. Armed Frces r the Natinal Guard f a state that is called t federal service, yu will have certain emplyment and Emplyee benefit rights upn cmpletin f duty, prvided yu were n an authrized military leave f absence. Military Leave f 31 r Fewer Days Cverage under this Plan is nt subject t USERRA. Cverage ends n yur last day f wrk. Military Leave Lnger Than 31 Days Cverage under this Plan is nt subject t USERRA. Cverage ends n yur last day f wrk. Lng-Term Disability Prpsal #

15 Chapter 5: Definitin f Disability Lng-term Disability Benefits T be cnsidered Disabled during the Benefit Waiting Perid (see Appendix A: Key Terms fr definitins) and fr the first 24 mnths f yur Disability benefits: Yu must be prevented frm perfrming any r all f the Material and Substantial Duties f yur Own Occupatin due t any Injury, Sickness, Mental/Nervus Cnditin r episde f Substance Abuse. Nte that disabilities due t Mental/Nervus Cnditin r Substance Abuse may be subject t a 24- mnth limitatin n benefits. See the sectin f this chapter titled Maximum Benefit Perid fr Disability Benefits due t Mental/Nervus Cnditins r Substance Abuse fr details; Yu have lst at least 20% f yur Pre-Disability Earnings (defined in Appendix A: Key Terms); and Yu have met all ther Plan requirements. After 24 mnths f Disability benefits (measured frm the end f the benefit waiting perid), yu will cntinue t be cnsidered Disabled if: Yu are unable t perfrm any r all f the Material and Substantial Duties f any Gainful Occupatin fr which yu are qualified based n educatin, training and experience due t any Injury, Sickness, Mental/Nervus Cnditin r episde f Substance Abuse; Yu have lst at least 40% f yur Pre-Disability Earnings; and Yu cntinue t meet all ther Plan requirements. Nte: the definitin f Disability als includes an Earnings-based cmpnent called Earnings While Disabled that allws yu t earn sme incme and still be cnsidered Disabled under the terms f the Plan. Yu must als meet these ther cnditins befre yu will receive any benefits under the Plan: The perid f Disability benefits must begin while yu are cvered under the Plan; and Yu must be receiving care frm a Physician that is apprpriate t the disabling cnditin, and such care must be administered as ften as necessary t achieve maximum medical imprvement. When Benefits Begin Yur Lng-term Disability benefits begin nce yu have met the Plan s eligibility requirements and yu are fund t be Disabled pursuant t the terms f the Plan. Yu may begin receiving Disability benefits after the Benefit Waiting Perid, which is 26 weeks f cnsecutive Disability. A return t Active Wrk fr 30 r fewer days (whether r nt they are cnsecutive), with yur Physician s apprval, is permitted during the Benefit Waiting Perid. Recvery guidelines allw 30 days f temprary recvery during the Benefit Waiting Perid when yu can return t wrk. Any time wrked n a single day will be treated as ne full day f wrk fr this purpse. This temprary recvery prvisin encurages Emplyees t attempt t return t wrk withut penalty during the Benefit Waiting Perid, if they are able. This perid f 30 days (r fewer) des nt cunt tward satisfying the Benefit Waiting Perid. If yu wrk mre than 30 days during the Benefit Waiting Perid, yu will be required t satisfy a new Benefit Waiting Perid. Lng-Term Disability Prpsal #

16 Lng-term Disability Apprval and Other NRECA Benefits Apprval fr Lng-term Disability benefits can have an impact n ther NRECA spnsred benefits, including but nt limited t medical, prescriptin drug, dental, visin, life, Retirement Security, 401(k) and accunt-based plans (e.g., health flexible spending accunt, dependent care, health reimbursement accunt). Yur age at the time f Disability apprval als has an impact n LTD benefits, particularly if yu are at r abve yur cp s nrmal retirement age. Please refer t ther SPDs r cnsult with yur benefits administratr t determine the impact f an award f Lng-term Disability benefits n yur ther benefits. Disability Benefit Amunt Yur mnthly benefit is 66 2/3% f yur basic mnthly Earnings, subject t the cmpensatin limit impsed by the Internal Revenue Cde (IRC) (discussed belw). If yur Earnings change while receiving a benefit under this Plan, yur mnthly benefit amunt will nt be adjusted until yu are eligible t receive a benefit again after yu return t wrk and satisfy the Active Wrk requirement. Benefits are based n a 30-day mnth and will be prrated accrdingly fr a partial mnth. Maximum Benefit Due t the cmpensatin limit impsed by the IRC, effective January 1, 1994, n mre than $265,000 (in 2016 and adjusted peridically fr inflatin) f annual Earnings may be cnsidered when the Plan calculates yur benefit. Hwever, a supplemental insurance plicy utside the NRECA Grup Benefits Trust has been established t prvide benefits t the extent an Emplyee s salary exceeds the cmpensatin limit. This supplemental insurance plicy is prvided under the NRECA Excess Lng-Term Disability Plan. The cmbined mnthly benefit maximum frm this Plan and the supplemental insurance plicy (under the NRECA Excess Lng-Term Disability Plan) is $15,000. Minimum Benefit The minimum mnthly benefit under this Plan is $65. Incme and FICA Tax Withhlding Federal Incme taxes will be withheld n any taxable Disability benefits. The default withhlding will be 25% f the taxable benefit, unless yu submit an IRS Frm W-4 t Cperative Benefit Administratrs (CBA) t change the withhlding amunt, in which case federal incme taxes will be withheld accrding t the instructins n yur IRS Frm W-4. State incme taxes will be withheld at the single rate with zer allwances frm all taxable Disability benefits, if the state yu reside in has state incme tax. If yu submit an IRS Frm W- 4 with federal withhlding instructins, the same instructins will be applied t state incme taxes. If yu want a different amunt withheld fr state taxes, yu must prvide a state specific withhlding frm. Federal Insurance Cntributins Act (FICA) taxes will be withheld frm taxable Disability benefit payments as applicable. Length f Disability Benefits Disability benefits will be paid mnthly as lng as yu qualify fr benefits under this Plan, but nt fr lnger than the Maximum Benefit Perid. Lng-Term Disability Prpsal #

17 The Maximum Benefit Perid is determined by yur age when yur Disability begins. The standard Maximum Benefit Perid ends at age 65 fr anyne wh becmes Disabled befre age 60. Benefits will be paid while yu remain Disabled up t the Maximum Benefit Perid shwn belw except fr disabilities due t Mental/Nervus Cnditins r Substance Abuse. See the sectin in this chapter titled Maximum Benefit Perid fr Disability Benefits due t Mental/Nervus Cnditins r Substance Abuse fr details. Age n the Date yur Disability Begins Maximum Benefit Perid Under 60 T age mnths mnths mnths mnths mnths mnths mnths mnths mnths 69 thrugh mnths 75 and lder 6 mnths Once yu reach the Maximum Benefit Perid, yur Disability benefits are n lnger payable even if yu remain Disabled. Maximum Benefit Perid fr Disability Benefits due t Mental/Nervus Cnditins r Substance Abuse When Disability is cntributed by (i.e., the claimant's physical cnditins alne d nt result in Disability), caused by r due t a Mental/Nervus Cnditin r Substance Abuse, an emplyee s Maximum Benefit Perid fr all such perids f Disability is limited t 24 mnths. This is nt a separate maximum fr each such cnditin r fr each perid f Disability due t a Mental/Nervus Cnditin r Substance Abuse, but rather a cmbined lifetime maximum fr all perids f Disability due t all these cnditins, either separate r cmbined. If at the end f the 24 mnths the emplyee is cnfined in a Hspital r ther facility qualified t prvide necessary care and treatment fr Mental/Nervus Cnditins r Substance Abuse, then the Maximum Benefit Perid may be extended t include the time during which the emplyee remains cnfined. When Benefits End Benefit payments under this Plan will terminate n the earliest f these events: Yu n lnger meet the definitin f Disabled, as determined by CBA; Yu fail t furnish written prf f yur cntinued Disability t CBA when and as required by CBA; Yu reach the end f the Maximum Benefit Perid; Lng-Term Disability Prpsal #

18 Yu refuse t participate in a Wrkplace Accmmdatin supprted and implemented by yur Emplyer and CBA; Yu refuse t participate in a Mandatry Rehabilitatin prgram designated by CBA; Yu refuse t submit t independent medical examinatin(s), functinal capacity evaluatin(s) r persnal interview(s) as required by CBA; Yu fail t prvide Prf f Lss t CBA when and as required by CBA; Yu refuse t receive nging care frm yur Physician that is apprpriate (in CBA s sle discretin) t yur disabling cnditin, r such care is nt administered as ften as necessary t achieve maximum medical imprvement during the perid f Disability, r bth; Yu becme cnfined t jail, prisn r ther huse f crrectin as a result f cnvictin fr a criminal r ther public ffense; r Yu die. Reductin f Mnthly Benefit Due t Other Surces f Incme The Plan will reduce yur mnthly Disability benefits by ther benefits r incme yu might receive after becming Disabled. These are called benefit ffsets. Examples f these benefit ffsets are: Wrkers cmpensatin benefits r benefits frm any similar gvernment plan r prgram. T the extent such benefits are paid in a lump sum settlement, the settlement will be characterized as lst wages ver the Maximum Benefit Perid fr purpses f determining the mnthly benefit ffset. Unemplyment benefits r benefits frm any similar gvernment plan r prgram. T the extent such benefits are paid in a lump sum settlement, the settlement will be characterized as lst wages ver the Maximum Benefit Perid fr purpses f determining the mnthly benefit ffset. Payments made pursuant t state, prvincial r federal laws f the United States r Canada including but nt limited t mtr vehicle insurance statutes r similar legislatin t the extent n fault lss f time cverage is required in plicies r cntracts t meet the requirement f such statute r legislatin. Distributins made under any defined benefit pensin plan, including but nt limited t the NRECA Retirement Security Plan and the Internatinal Brtherhd f Electrical Wrkers (IBEW) pensin plan. Other incme received as a retirement benefit frm a retirement plan that is whlly r partially funded by Emplyer cntributins unless: Yu began receiving regular peridic distributins prir t becming Disabled; r Yu immediately transfer r rll ver the payment r benefit t anther qualified retirement plan r t an individual retirement accunt (IRA) fr the funding f future retirement, and the balance f the transferee accunt r IRA at the end f each year des nt fall belw the amunt transferred as a result f any withdrawal by the Participant. Amunts withdrawn frm a qualified retirement plan r IRA attributable t amunts transferred r rlled ver frm a retirement plan that is whlly r partially funded by Emplyer cntributins. Disability benefits frm the Veteran s Administratin r any ther freign r dmestic gvernmental agency unless: The benefit began befre yu became Disabled; r If yu were receiving the benefit befre becming Disabled, nly the amunt f any increase in the benefit that is attributable t yur Disability will be a benefit ffset. Earnings while Disabled (defined in Appendix A: Key Terms). Disability benefits under any grup life insurance plicy. Disability payments frm any Emplyee benefit plan. Lng-Term Disability Prpsal #

19 Certain amunts withdrawn frm the 401(k) Pensin Plan (r ther qualified retirement plan) r IRA attributable t quasi-retirement transfers frm the Retirement Security Plan and rllvers frm the Retirement Security Plan (excluding any Emplyee cntributins). If a withdrawal causes the balance f such plan r IRA as f the end f each year t fall belw the amunt transferred, then yur Disability benefits will be reduced by the amunt that is the difference between yur ending balance and the amunt transferred r rlled ver. N reductin in yur Disability benefits will ccur if, at the end f each year, there have nt been any withdrawals, even if the ending balance is less than the amunt transferred (e.g., due t investment lsses). Payments frm any deferred cmpensatin plan, executive cmpensatin plan, tp hat plan r similar type f benefit arrangement. Scial Security benefits fr Disability (including dependent benefits) r retirement. This list is nt all-inclusive. If yu are nt sure abut a particular type f payment, cntact CBA. It is pssible that certain types f incme nt specifically mentined in the list abve will reduce yur Disability benefit payments. Any cst f living increases yu and yur family receive frm the abve surces will nt affect yur benefits. Any single lump sum payment yu receive will be cnsidered as a mnthly series f payments fr the purpse f this Plan. If yu receive a single lump sum payment and the crrespnding maximum mnthly payment can be determined by CBA, then the benefit ffset will be determined by prrating the single sum ver the time perid fr which the sum is paid. If the maximum mnthly payment cannt be determined by CBA, then the mnthly benefit ffset will be determined by dividing the lump sum payment ver the perid fr which payments wuld therwise be made. In the case f lump sum cash distributin(s) attributable t yur accrued benefit frm the NRECA Retirement Security Plan, the mnthly benefit ffset is determined using an actuarially determined mnthly annuity payment based n a 50% jint and survivr annuity fr married Emplyees and based n a life-nly annuity fr unmarried Emplyees. Entitlement t ther benefits may reduce yur mnthly benefit even if yu d nt apply fr and receive such benefits. If yu d nt apply fr ther benefits t which yu are entitled, CBA will reduce yur mnthly benefit by an estimate f what yu wuld have received if yu had applied fr the benefits. If yu subsequently receive such benefits, any necessary adjustments will be made t yur mnthly benefit. Scial Security Disability and Wrkers Cmpensatin Benefits CBA may, in its discretin, advance the full mnthly Disability benefit t yu withut reductin while yu are waiting fr payment f Scial Security Disability benefits, wrkers cmpensatin benefits r bth. Hwever, if CBA advances such benefits, yu will be required t prmise in writing that yu will repay the advance as sn as yu receive the ther expected benefits. If yu d nt repay the advance within 30 days after yu receive the ther benefits, CBA reserves the right t suspend yur Disability benefit, take legal actin t pursue repayment plus interest r bth. Interest n the principal amunt f the advance that is nt repaid within 30 days f yur receipt f the ther benefits will accrue at a rate equal t the prime rate plus 3%, cmpunded annually frm the date that is 30 days after yur receipt f the ther benefits. CBA may als recver frm yu reimbursement f CBA s csts and attrney s fees incurred t enfrce this repayment prvisin. Lng-Term Disability Prpsal #

20 Rehabilitatin Prvisin T help yu return t wrk, yur cverage has a Mandatry Rehabilitatin prvisin. Fr a particular Disability, CBA may determine that rehabilitatin is within the ability f a Disabled Emplyee wh is entitled t benefits under this Plan. This means that yur Disability is nt s severe that yu are nt able t learn new prductive skills and becme self-supprting. Rehabilitatin is mandatry. Yur Disability benefits may be terminated if yu refuse t participate in a rehabilitatin prgram that CBA has determined is apprpriate r fr which CBA has agreed t pay expenses up t $10,000. Trial Wrk Perid T help yu get back t wrk, yur cverage prvides fr a trial wrk perid during which yu can cntinue t receive Disability benefits and return t wrk fr the Emplyer in sme capacity, as yur Disability allws, fr up t three mnths. The trial wrk perid gives yu the pprtunity t determine hw much wrk yu can handle with yur medical cnditin(s) and t receive as much as 100% f yur Pre-Disability Earnings frm yur Emplyer and the Plan cmbined. If yu are interested in the trial wrk perid, yu must submit a written request t CBA in advance. The trial wrk perid must be apprved by CBA, the Emplyer and yur Physician. During the trial wrk perid, yur mnthly benefit will be calculated as yur Pre-Disability Earnings minus yur Earnings during the trial wrk perid and minus applicable ffsets. The three mnth trial wrk perid may be extended r renewed by CBA, in cnsultatin with the Emplyer and yur Physician, but nt fr mre than 3 mnths at a time. In n event may the trial wrk perid exceed 12 mnths. Yu may have nly ne trial wrk perid during any single perid f Disability due t the same r related causes. If yur Disability prevents yu frm cmpleting a trial wrk perid and yu cntinue t satisfy this Plan s definitin f Disability, yu will cntinue t receive yur Disability benefits and the full amunt f yur Disability benefit will be reinstated prspectively. Yu may be required t submit medical dcumentatin t cnfirm yur inability t cmplete the trial wrk perid. Wrkplace Accmmdatin If yu return t wrk as a result f a Wrkplace Accmmdatin made by the Emplyer, the Plan may reimburse yur Emplyer fr certain related expenses. Yur participatin by returning t wrk is mandatry if CBA deems accmmdatin necessary t ensure yur return t wrk and the Emplyer supprts it. Failure t participate may result in the terminatin f Disability benefits. Lss f Earnings Prvisin As a way t prvide pprtunity fr rehabilitatin and prductivity, Emplyees are allwed t wrk while Disabled and cntinue t receive a percentage f the Disability benefit in additin t their wrk Earnings While Disabled. The cmbinatin f the reduced Disability benefit and the Emplyee s wrk Earnings may nt exceed the standard Disability benefit. Yur Earnings While Disabled may cme frm yur Emplyer r frm anther Emplyer. Yur Disability benefit is calculated as the Disability benefit percentage multiplied by yur Pre-Disability Earnings minus yur Earnings while Disabled and any benefit ffsets. Lng-Term Disability Prpsal #

21 Fr the first 24 mnths f Disability yu may earn n mre than 80% f yur Pre-Disability Earnings. After 24 mnths f Disability yu can earn n mre than 60% f yur Pre-Disability Earnings. Recurrent and New Disabilities Fr purpses f satisfying the Benefit Waiting Perid, if yu have been actively at wrk fr fewer than 180 days, a recurring Disability resulting frm the same r similar cause r cnditin will be regarded as a cntinuatin f the prir Disability, and a new Benefit Waiting Perid is nt required. If yu have been actively at wrk fr at least 180 days, a recurring Disability resulting frm the same r similar cause r cnditin will be regarded as a new unrelated Disability, and a new Benefit Waiting Perid must be satisfied befre benefits can begin. If yu becme Disabled frm a cnditin unrelated t yur prir Disability after being actively at wrk fr yur Emplyer fr at least ne day, that successive Disability will be cnsidered a new Disability and a new Benefit Waiting Perid must be satisfied befre benefits can begin. In all cases, recurrent and new disabilities require this Plan t be in frce at the time f yur Disability. Multiple Disabilities If yu suffer frm tw r mre disabilities at the same time, whether related r unrelated, benefits will be paid as if the disabilities were caused by ne Injury r ne Sickness. In n event will yu be cnsidered t have mre than ne cntinuus perid f Disability at the same time. Exclusins General Exclusins N Disability benefit will be paid fr disabilities: Fr which yu are nt being treated r fr which yu are nt under the care f a Physician apprpriate (in CBA s sle discretin) t the disabling cnditin and nt receiving care that is administered as ften as necessary t reach maximum medical imprvement; Caused by r cntributed by service in the armed frces, Natinal Guard r military reserves f any cuntry r internatinal authrity (including active duty, active duty fr training purpses, undeclared war and resistance t armed aggressin) except a nn-service cnnected Injury r Sickness while n a temprary tur f duty f 31 r fewer days; Caused by r cntributed t an act f war, declared r undeclared, including resistance t armed aggressin; Resulting frm attempted suicide r intentinally self-inflicted Injury, while sane r insane; Caused by r cntributed t r resulting frm participatin in the cmmissin f an assault, felny, strike, civil disrder r rit; When yu are cnfined t jail, prisn r ther huse f crrectin as a result f cnvictin fr a criminal r ther public ffense; When yu fail t prvide acceptable Prf f Lss t CBA; r When yu d nt cperate with CBA in accrdance with the terms f the Plan, including but nt limited t the Mandatry Rehabilitatin prvisin, independent medical examinatin(s), functinal capacity evaluatin(s), persnal interview(s) r requests fr verificatin f yur financial status. Lng-Term Disability Prpsal #

22 Pre-existing Cnditin Exclusin N benefits will be payable under the Plan fr any Disability that is due t r results frm, in whle r in part, a Pre-Existing Cnditin, unless such Disability begins after the last day f 365 cnsecutive days during which yu have been cntinuusly cvered under this Plan. In the event that yur Disability is excluded as a Pre-Existing Cnditin, a recurring Disability resulting frm the same r similar cause r cnditin shall be excluded unless the Active Wrk requirement f 180 cnsecutive days is met befre the nset f the subsequent Disability can be treated as a new Disability. Initial Prf f Disability Yu must ntify CBA f yur Disability within 90 days f the nset f the Disability. Cntact yur benefits administratr fr a Lng-term Disability Claim Frm packet and instructins n hw t cmplete the frms. Yu, yur Emplyer and yur treating Physician each have sectins f the frms t cmplete. Once CBA has been ntified f the Disability, yu will be required t prvide Prf f Lss by sending CBA the cmpleted claim frms, which include: Emplyee applicatin; Emplyer s infrmatin; Attending Physician s Statement f Disability; Authrizatin t btain infrmatin; and Essential Jb Functins Statement. Prf f Lss must be furnished in writing t CBA nt mre than 90 days after the last day f yur Benefit Waiting Perid. If it is nt reasnably pssible t give initial ntice r Prf f Lss within the time limits, benefits may nt be invalidated r reduced as lng as CBA receives it as sn as reasnably pssible. N claim fr Disability shall in any event be apprved by CBA if ntificatin f Disability and applicatin are nt prvided t CBA within 12 mnths f the nset f the Disability. Cmpleted claim frms and dcumentatin supprting Prf f Lss shuld be sent t the CBA Claims Administratr at the address shwn in the Cntact Infrmatin chapter. If yu disagree with CBA s determinatin in whle r in part, yu may file an appeal (see the chapter titled Claims and Appeals). Cntinuing Prf f Disability Prf f cntinuing Disability indicating yu are under the regular care f a Physician may be required and must be prvided at yur expense upn request. In sme cases, yu may be required t give CBA authrizatin t btain additinal medical infrmatin and t prvide nnmedical infrmatin as part f the cntinuing prf f Disability. CBA may als require yu t be examined by CBA s Physician r persnally interviewed by CBA r its agents at such times and such frequency as CBA, in its sle discretin, deems necessary t establish Prf f Lss. The claim may be denied r benefits may end if the requested infrmatin is nt submitted. Lng-Term Disability Prpsal #

23 Chapter 6: Claims and Appeals General Infrmatin A claim is any request fr a Plan benefit made in accrdance with the prcedures described in this chapter. If yur claim is denied (als called an adverse benefit determinatin), yu r yur authrized representative have the right t appeal the decisin. This chapter describes the steps yu must take t file a claim r request an appeal. These steps are intended t cmply with applicable regulatins by prviding reasnable prcedures fr filing claims, ntifying participants f benefit decisins and appealing adverse benefit determinatins. Yu must fllw these prcedures fr all claims fr benefits under this Plan. An issue r dispute slely regarding yur eligibility fr cverage r participatin in the Plan is nt cnsidered a claim fr benefits and is nt gverned by the claims and appeals prcedures described in this chapter. Fr mre infrmatin, please cntact yur benefits administratr. Claims and Appeals Cntacts Purpse Authrizing a representative Filing a claim Filing an appeal Filing a vluntary final appeal Cntact NRECA Privacy Officer Natinal Rural Electric Cperative Assciatin 4301 Wilsn Bulevard Arlingtn, VA privacyfficer@nreca.cp Cperative Benefit Administratrs, Inc. Claims Administratr P.O. Bx 6249 Lincln, NE (fax) Cperative Benefit Administratrs, Inc. Appeals Administratr P.O. Bx 6249 Lincln, NE Appeals Cmmittee CBA 9284 P.O. Bx 6249 Lincln, NE Lng-Term Disability Prpsal #

24 Using an Authrized Representative Either yu r yur authrized representative may file claims fr Plan benefits and appeal adverse claim decisins. An authrized representative is an individual wh yu have authrized in writing t act n yur behalf. An authrized representative may nt be a dctr r ther health prvider. If yu use an authrized representative, yu must cmplete the frm Authrizatin t Use and Disclse Prtected Health Infrmatin. Ask yur benefits administratr fr the frm. Befre yu submit the frm t NRECA, yu may cntact the Plan s Privacy Officer t ask questins abut the use and disclsure f yur health infrmatin, using the cntact infrmatin fr the Privacy Officer in the Claims and Appeals Cntacts sectin at the start f this chapter. The Disability Claim Filing Prcess Claim Filing Time Limits Yu must ntify CBA f yur Disability nt later than 90 days frm the nset f yur Disability. Yu must file Prf f Lss nt later than 90 days frm the last day f yur Benefit Waiting Perid. Where t Send Yur Claim Send yur claim t the Claims Administratr, CBA, at the address in the Claims and Appeals Cntacts sectin f this chapter. Yur claim is cnsidered filed n the date CBA receives yur cmpleted claim in writing. CBA Evaluates Yur Claim CBA will ntify yu that yur claim is either apprved r denied nt later than 45 days after receipt f claim by the Plan. If circumstances warrant, CBA may require tw extensins f up t 30 days each. CBA will ntify yu within the initial 45-day perid if an extensin is required. If CBA needs the initial 30- day extensin because yu did nt prvide all f the infrmatin needed t prcess yur claim, CBA will tell yu what infrmatin is missing. If an additinal 30-day extensin is needed, CBA will ntify yu befre the end f the first 30-day extensin. If Yur Claim is Incmplete Yu must submit additinal infrmatin requested by CBA within 45 days frm the date CBA sends yu the ntice t tell yu that yur claim is missing infrmatin. Nte: The time perid t decide yur claim is suspended frm the date CBA ntifies yu that yur claim is incmplete until the date yu prvide CBA with the requested infrmatin, nt t exceed 45 days. CBA may then use the remainder f the review perid t cmplete its evaluatin f the claim. If Yur Claim is Denied CBA will prvide yu a ntice that cntains: Specific reasn(s) fr the benefit denial; Reference t specific Plan prvisins n which denial is based; A descriptin f any additinal infrmatin needed t perfect the claim and an explanatin f why such infrmatin is needed; Lng-Term Disability Prpsal #

25 A descriptin f the Plan s review prcedures and time limits that apply t them; An explanatin f yur rights under ERISA s claim and appeals rules; and A cpy f any internal rule, guideline, prtcl r similar criterin used in the decisin r a statement that the material is available upn request fr free. The First-level Appeal Prcess Time Perid t Request an Appeal Yu r yur authrized representative must request an appeal nt later than 180 days frm the date yu receive the ntice that yur claim is denied. Yu may request cpies f all dcuments, recrds, and ther infrmatin related t yur denied claim frm the Plan, free f charge. Yu als have the right t submit with yur appeal written cmments, recrds, dcuments and ther infrmatin t supprt yur appeal, whether r nt yu already submitted these items. Where t Submit Yur Appeal Send yur appeal request t the Appeals Administratr (CBA) at the address in the Claims and Appeals Cntacts sectin at the start f this chapter. The Appeals Administratr wh reviews yur appeal will nt be the persn wh made the riginal decisin t deny yur claim nr will that reviewer be smene directly supervised by the riginal decisin maker. The Appeals Administratr will cnduct a full and fair review f all dcuments and evidence t supprt yur claim fr benefits and may cnsult with medical r vcatinal experts in rder t make a decisin abut yur appeal. These medical r vcatinal experts will be different frm the nes previusly cnsulted. Appeal Review Time Perid Yur appeal will be reviewed nt later than 45 days frm the date the Appeals Administratr receives yur appeal. The Appeals Administratr may request ne 45-day extensin and will ntify yu during the initial 45-day perid if the extensin is required. If Yur Appeal is Denied The Appeals Administratr will prvide yu with a ntice that cntains: Specific reasn(s) fr the benefit denial; Reference t specific Plan prvisins n which denial is based; A descriptin f any additinal infrmatin needed t perfect the claim and an explanatin f why such infrmatin is needed; A descriptin f the Plan s appeal prcedures and time limits that apply t them; An explanatin f yur rights under ERISA s claims and appeals rules; and A cpy f any internal rule, guideline, prtcl r similar criterin used t make the determinatin (r a statement that the material is available upn request fr free). If yu cmplete the Plan s appeal prcess and yur appeal is denied, yu may vluntarily take part in ne additinal review f yur denied appeal called the Vluntary Final Appeal Prcess. If yu d nt chse t use the Vluntary Final Appeal Prcess, yu may seek legal actin by filing suit under ERISA within ne year frm the date yur appeal was denied. Lng-Term Disability Prpsal #

26 The Vluntary Final Appeal Prcess Yu may use this ptin if yu wish t have the Plan s Appeals Cmmittee review yur denied appeal. Using this Vluntary Final Appeal Prcess has n effect n yur rights t any ther benefits under the Plan r yur rights t legal actin. Befre yu submit yur written request, yu may request additinal infrmatin abut the Vluntary Final Appeal Prcess by calling Time Perid t File a Vluntary Final Appeal Yu must request a Vluntary Final Appeal nt later than 60 days frm the date yu receive the ntice that yur appeal is denied by the Appeals Administratr. Yu may request cpies f all dcuments, recrds, and ther infrmatin related t yur denied claim frm the Plan, free f charge. Yu als have the right t submit with yur appeal written cmments, recrds, dcuments, and ther infrmatin t supprt yur appeal, whether r nt yu already submitted these items. Where t Submit yur Vluntary Final Appeal Send yur request t the Appeals Cmmittee at the address listed in the Claims and Appeals Cntacts sectin at the start f this chapter. The Appeals Cmmittee is selected by the Plan Administratr and was nt invlved in the riginal decisin t deny yur claim r t deny yur appeal. The Appeals Cmmittee will cnduct a full and fair review f all dcuments and evidence t supprt yur claim fr benefits and may cnsult with medical r vcatinal experts in rder t make a decisin abut yur appeal. These medical r vcatinal experts are different persns than the nes wh were previusly cnsulted. Review Time Perid Yur appeal will be reviewed nt later than 60 days frm the date the Appeals Cmmittee receives it. If circumstances warrant, the Appeals Cmmittee may require an extensin f up t 60 days. CBA will ntify yu within the initial 60-day perid if an extensin is required. The Appeals Cmmittee will cnduct a full and fair review f all dcuments and evidence submitted t supprt yur claims fr benefits and may cnsult with medical r vcatinal experts in rder t make a decisin abut yur appeal. These medical r vcatinal experts are different persns than the nes cnsulted previusly. If Yur Vluntary Final Appeal is Denied The Appeals Cmmittee will prvide t yu with a ntice cntaining: Specific reasn(s) fr the benefit denial; Reference t specific Plan prvisins n which denial is based; A descriptin f any additinal infrmatin needed t perfect the claim and explanatin f why such infrmatin is needed; An explanatin f yur rights under ERISA s claims and appeals rules; and A cpy f any internal rule, guideline, prtcl r similar criterin used t make the determinatin (r a statement that the material is available upn request fr free). Lng-Term Disability Prpsal #