RETIREE HEALTH CARE COMPANY CREDIT PROGRAM

Transcription

1 RETIREE HEALTH CARE COMPANY CREDIT PROGRAM Program Document and Summary Program Description January (Any changes to the SPD since this date are included in the applicable Benefits Bulletins.)

2 2 This page left intentionally blank.

3 TABLE OF CONTENTS Table of contents... 3 Introduction... 4 Summary of Benefits... 4 Eligibility to Earn Credits... 5 How to Receive a Credit... 5 How to Receive Benefits Under the Program... 6 Change in Employment Status... 6 Qualified Separation of Service... 6 Non-Qualified Separation of Service... 7 Rehires... 7 Treatment Upon Death... 7 Termination of Benefits... 7 Termination of Benefits... 7 Forfeitures... 8 How To Have A Claim Reviewed... 8 How to Request Review of a Denied Claim for Benefits... 8 General Provisions... 8 Program Sponsor... 8 Employer Identification Number (EIN)... 8 Program Year... 9 No Guarantee of Employment... 9 Reservation of Right to Amend or Terminate Program... 9 Assignment of Benefits... 9 Funding... 9 Program Administrator... 9 Limitations Period to Commence Legal Action Agent for Service of Legal Process

4 INTRODUCTION This document replaces the Summary Program Description (SPD) for the Nationwide Retiree Health Care Company Credit Program (Program). This document amends, replaces and supersedes all former Program documents and SPDs and is effective January 1, Many words used in this document have special meanings. These words appear in capital letters and are defined for you in the applicable subsection of this document. Nationwide Mutual Insurance Company is the sponsor of the Program. The Company has established the Program for the exclusive benefit of its Associates. The purpose of the Program is to encourage savings for future retirement costs, and to give Eligible Associates another vehicle in which they can save for future retiree health care costs. This will be accomplished through annual Credits capped at a lifetime maximum, which, when distributed on your behalf, can be used for health care costs following retirement. This Program shall be funded entirely by the Company and is paid out of the general assets of the Company. SUMMARY OF BENEFITS As an Eligible Associate, you may earn annual Credits under the Program each year based on your unmatched Nationwide Health Savings Account (HSA) contributions and/or after-tax contributions to the Nationwide Savings Plan (NSP). You may receive a credit of up to $1,000 each calendar year with a maximum potential lifetime credit of no more than $25,000 (the Credit ). We track these Credits in a notional account (the Account ) for you, meaning no actual money will go into the Account. Prior to January 1, 2018, you had the potential to accrue quarterly interest on your Account balance based on the interest rate in effect for the NSP at the time. Starting January 1, 2018, the Account will no longer accrue interest. However, any interest you accrued prior to January 1, 2018 will remain a part of your notional Account balance. Nationwide may provide you financial support toward your retiree medical costs when you make eligible contributions and if you leave the Company after reaching age 55 with at least 15 years of service. After your employment with Nationwide ends, if you have a Qualified Separation (see the Change in Employment Status section of this SPD for the definition of a Qualified Separation), you may be eligible to receive the accumulated Credits and, if applicable, any interest from your Account. Payment of the Credits is in the form of monthly deposits into a Nationwide Health Reimbursement Account ( HRA ). To be eligible, you must: (1) be at least age 55 (age 52 if you terminate employment due to a job elimination), (2) have been credited with at least 15 Years of Service; and (3) have a Qualified Separation. Monthly deposits to the HRA generally commence when you or an Eligible Spouse become eligible for Medicare. How benefits are paid under the Program is explained in more detail in the How to Receive Benefits under the Program section of this SPD. Once deposited into an HRA, you can use the money as you would use any other money in the HRA - for retiree health care premiums or qualifying medical care expenses for you or your Eligible Spouse (see the Nationwide Health Reimbursement Account Plan for Retirees and LTD Recipients Plan Document and Summary Plan Description for further details regarding reimbursable expenses). 4

5 ELIGIBILITY TO EARN CREDITS Effective January 1, 2018, you are an Eligible Associate in the Program if you have an annual Base Pay of less than $100,000 as of the last pay of the calendar year. Base Pay is defined as your annual salary as shown on the Human Resource Information System (HRIS). If your employment ends during the calendar year due to retirement, death, or disability, Base Pay is determined as of your last day of active employment. Once an Associate is determined to be eligible to participate in the Program, certain requirements must be met to receive a Credit. Those requirements are discussed in more detail in the How to Receive a Credit section below. HOW TO RECEIVE A CREDIT In order to receive a Credit for a calendar year, you must: Participate in the HSA through payroll deduction during that year and contribute more than the amount matched by the Company; or You must make after-tax contributions to the NSP. The amount of the Credit the Company adds to your notional Account is based on your unmatched HSA contributions plus any after-tax contributions you make to the NSP during the calendar year. The Company adds the Credit to your Account during the first quarter of the following year. In order to receive the Credit for a calendar year, you must be either actively employed as of Contribute a total of at least $3,000 per year in unmatched HSA contributions, after-tax NSP contributions, or any combination of the two, to receive $1,000 Credit each year. December 31 of the calendar year or become deceased or retire during the calendar year. If you are receiving Long-Term Disability Income Benefits, you may be eligible for a Credit based on any eligible contributions to the HSA or NSP that you made during the calendar year in which you first begin receiving Long-Term Disability Income Benefits. A Credit equals one-third of: (i) your unmatched contributions made via payroll deduction to the HSA (including any catch-up contributions to the HSA); plus (ii) your total after-tax contribution to the NSP. The maximum Credit is $1,000 per year. A minimum annual contribution Credit will apply; only credits of $10 or more will be added to your Account. You can earn Credits for up to 25 Years of Service or $25,000, subject to the limitations explained in the next paragraph. The maximum lifetime Credit you can receive under the Program takes into account any years of Retiree Medical Cost-Sharing Service. The Retiree Medical Cost-Sharing Service is the number of months you received credit under the Nationwide Retiree Health Care Plan(s)) as of December 31, 2009 and have not since forfeited under the terms of the Company s prior cost-sharing program (the Prior Program ). For example, if, as of December 31, 2009, you have 15 years of Retiree Medical Cost-Sharing Service under the Prior Program, the most you can receive is 10 years of Credits in this program for a maximum lifetime Credit of $10,000. If you do not have any Retiree Medical Cost-Sharing Service under the Prior Program, you are eligible to receive the full $1,000 annual Credit for up to 25 years or $25,000 in Credits. This also means that if you forfeit the Retiree Medical Cost-Sharing Service that you earned under the Prior Program due to a break-in-service and you are subsequently rehired by the Company, you can earn up to the maximum Credit under the Program if you satisfy all other Program requirements. If you are a former Harleysville associate and eligible for company financial support towards retiree medical coverage under the former Harleysville retiree medical program (employed by Harleysville prior to 5

6 January 1, 1993), your years of service under that program are included as part of the 25 years of service health care credit limit... Associates who had 25 or more years of Retiree Medical Cost-Sharing Service as of December 31, 2009, which are not forfeited, are not eligible to receive a Credit. Likewise, Associates who are credited with the maximum lifetime Credits available under the Program, or in combination between this Program and the Prior Program are not eligible to receive further Credits. Please note that there are limits to the amount you can contribute to an HSA, so you may have to make after-tax contributions to the NSP in order to receive the full $1,000 Credit each year. HOW TO RECEIVE BENEFITS UNDER THE PROGRAM Your Account is available to you only after your employment ends as a result of a Qualified Separation from the Company (see the Change in Employment Status section of this Program document for the definition of a Qualified Separation). If you terminate employment with the Company and it is not the result of a Qualified Separation, then you will forfeit your Account. The Company will begin making monthly deposits into your Nationwide HRA: If you have a Qualified Separation; and After you or your Eligible Spouse becomes Medicare eligible generally upon reaching age 65. An Eligible Spouse means an individual who is lawfully married to you at the time of your Qualified Separation. Once you meet the requirements above, the Company will make a monthly $100 deposit into your Nationwide HRA.. Once your Eligible Spouse meets the requirements above, the Company will make a monthly $100 deposit into your Nationwide HRA. Monthly deposits will cease when your Account has been exhausted. As contributions to your Nationwide HRA are made, the value of your Account will be reduced accordingly. Monthly deposits will commence on the 25th of the month in which you become Medicare eligible if your separation from the Company has been recorded on the Company s human resources information system (HRIS). Otherwise, monthly deposits will commence on the 25th day of the following month. Subsequent monthly deposits will be credited on the 25th day of each month until your account is exhausted. You can use the deposits into your HRA in the same manner as any other amounts contributed to an HRA. This means you can use the money to reimburse your retiree health care expenses such as premiums, co-payments, and medical expenses. Please refer to the Nationwide Health Reimbursement Account Plan for Retirees and LTD Recipients Plan Document and Summary Plan Description for further details regarding qualifying medical expenses. CHANGE IN EMPLOYMENT STATUS Qualified Separation of Service A Qualified Separation occurs if an Eligible Associate: Dies after having reached age 55 with at least 15 Years of Service; Terminates employment after having reached age 55 with at least 15 Years of Service; or 6

7 Terminates employment due solely to an Involuntary Termination due to a Job Elimination as defined in the Nationwide Severance Pay Plan, after having reached age 52 with at least 15 Years of Service. If an individual is receiving Long-Term Disability Income Benefits, a Qualified Separation occurs when Long-Term Disability Income Benefits end after reaching age 55 with at least 15 Years of Service. Years of Service means an Eligible Associate s years of continuous service calculated from the Eligible Associate s most recent hire date, as recorded in the Human Resource Information System (HRIS). Years of Service includes any period that the Eligible Associate is disabled and receiving Long-Term Disability Income Benefits. Non-Qualified Separation of Service A non-qualified separation is any termination of employment that is not a Qualified Separation, as described above. If your termination is considered a non-qualified separation, you will not be eligible to receive a Credit for the calendar year in which you terminate employment and your Account will be forfeited upon termination of employment. Rehires If you terminate employment with the Company and are later rehired, your Account that was previously forfeited will not be reinstated on the date of your rehire. However, if you are rehired and have an unforfeited Account balance due to a prior Qualified Separation from service, your Account will continue and you may be eligible to earn additional Credits. Treatment Upon Death If the death of an Associate is a Qualified Separation and there is an Eligible Spouse who is identified at the time of death, the Account continues on behalf of the Eligible Spouse. Monthly deposits to the Nationwide HRA begin when the Eligible Spouse becomes eligible for Medicare. If there is no Eligible Spouse identified, the Account will be forfeited. If you or an Eligible Spouse dies after monthly deposits to the Nationwide HRA have commenced and the Account has not been exhausted, monthly deposits on behalf of the deceased will end. Monthly deposits will continue to the HRA for you or any remaining Eligible Spouse, subject to continued Medicare eligibility of that individual, until the Account balance is zero, or until there are no eligible individuals surviving, whichever is sooner. TERMINATION OF BENEFITS Termination of Benefits Your monthly deposits will end on the earlier of: Your account balance is zero 7

8 You are reemployed with the Company; or A death with no Eligible Spouse to receive the remainder of the Account. Forfeitures Generally, certain events may occur that result in the forfeiture of an Account. These events may include: Non-qualified separation; Death with no Eligible Spouse to receive the remainder of the Account; or Termination of Long-Term Disability income benefits without a return to work or Qualified Separation. HOW TO HAVE A CLAIM REVIEWED Under the Program, you can request in writing that the Associate Service Center ( ASC ) review your claim for benefits under the Program. You must submit the written request for review within 60 days of the adverse determination that you are challenging. If you submit a written request for review, the ASC will conduct a full and fair review of your request and notify you of the decision within 60 days, or 120 days if special circumstances apply. HOW TO REQUEST REVIEW OF A DENIED CLAIM FOR BENEFITS If the ASC denies your request, in whole or in part, you have a right to request a review of the denial by submitting a written application to the Program Administrator within 60 days after notification that the ASC denied your request. The Program Administrative Committee ( PAC ) is the Program Administrator. Upon receipt of your request, the PAC will conduct a full and fair review of your request and notify you of the decision within 60 days (120 days if special circumstances apply). That decision will be in writing and will include the specific reasons and the Program references on which the decision was based. GENERAL PROVISIONS Program Sponsor The Program Sponsor is Nationwide Mutual Insurance Company, with the principal home office located at One Nationwide Plaza, Columbus, OH Employer Identification Number (EIN) The employer identification number is

9 Program Year Each annual period beginning on January 1 and ending on December 31. No Guarantee of Employment Participation in the Program is provided as a benefit to Eligible Associates. Participation in the Program is not a promise or guarantee of future employment. The information contained in this document does not alter the employment-at-will relationship between Nationwide and you. Either you or Nationwide may terminate the employment relationship at any time and for any reason not prohibited by law. The information contained in this SPD does not constitute an express or implied contract of employment for any specific duration of time, or an express or implied contract concerning terms or conditions of employment. Reservation of Right to Amend or Terminate Program The Program Sponsor reserves the right to change or discontinue any of the philosophies, policies, procedures, and benefits in the future. Participation in this Program is provided as a benefit to Eligible Associates. If you are determined to be eligible to receive the Credit, your participation will not be a guarantee that you will continue to be eligible for the Credit. In addition to the Program Sponsor s general reservation of rights noted in the preceding sentences, the Program Sponsor reserves the right to change the timing and frequency of Credits, the amount of HRA deposits, and the amount it matches for Associate HSA contributions at its sole discretion. The Program is intended to be maintained for an indefinite period of time. However, the Program Sponsor reserves the right to amend, alter, or terminate the Program, or any portion thereof, at any time. If the Program is terminated, the Program Administrator will notify all affected Account holders that the Program is being terminated and that coverage under the Program will be terminated effective as of the selected date. Assignment of Benefits An individual s Account may not be assigned, transferred, or alienated in any manner whatsoever by the individual or her spouse. Funding The Program is not funded. A notional Account will be created on behalf of each associate who is eligible to participate in the Program and receive a Credit. Any Credits will be a book entry only and any contributions attributable to such Credits will be made into an HRA out of the Company s general assets. Program Administrator The Program Administrative Committee (PAC) is the Program Administrator and has the authority and discretion to interpret the Program. Their interpretation is final and binding. Among their duties, the PAC 9

10 will have the power to take all actions to carry out the provisions of the Program, to exercise discretion and authority to construe and interpret the provisions of the Program, to make and enforce rules under the Program, and to decide any questions or claims under the Program. The PAC can be reached at: Program Administrative Committee One Nationwide Plaza ( ) P.O. Box Columbus, OH Telephone: Limitations Period to Commence Legal Action No action shall be brought against the Program Administrator or the Company by an associate unless, as a condition precedent thereto, the associate for whom benefits are claimed shall have fully complied with all the terms and provisions of this Program, nor until the appeal with respect to such benefits has been denied in writing by the Program Administrator. Any legal action against the Program Sponsor must be filed in United States District Court, Southern District of Ohio, Eastern Division. Agent for Service of Legal Process The Agent for Service of Legal Process is: Nationwide Mutual Insurance Company Associate Vice President - Litigation-Discovery Unit Attn: Service of Process Team Three Nationwide Plaza ( ) Columbus, OH Telephone: Service of legal process may also be made upon the Program Administrator. 10

11 11 This page left intentionally blank.

12 Analysts from the Associate Service Center can answer your questions about the Program. Call the Associate Service Center at or G (1/18) 12