North Community Counseling Centers, Inc. Page 1 of 9 TITLE: Employee Income Protection Plan

Transcription

1 North Community Counseling Centers, Inc. Page 1 of 9 Plan It is the Agency s policy to provide Short Term Disability Benefits for its employees. This document shall serve as the Plan Document and the Summary Plan Description ( SPD ) for the North Community Counseling Centers, Inc. Employee Income Protection Plan (the Plan ). The purpose of the Plan is to provide eligible employees of North Community Counseling Centers, Inc. ( Agency ) with income protection in the event that they are unable to work, have utilized all of their available paid leave, and must continue to be off the job. This Plan supplements the long term disability plan maintained by the Agency because it applies to an eligible employee for that period of time between the end of his paid leave status and the initiation of long term disability benefits. Benefits payable to eligible employees under the Plan shall be paid from the General Revenue Fund of the Agency. 1. Eligibility Requirements a. Initial Eligibility Each employee of the Agency, except for contract employees and independent contractors, is eligible to participate in the Plan on the first day of the month following the date on which he completes thirty (30) days of employment with the Agency. If an otherwise eligible employee incurs an illness or injury prior to completing 30 days of active employment with the Agency, he will not be eligible to participate in the Plan. b. Termination of Eligibility An eligible employee will cease to be eligible for benefits under the Plan upon the earliest occurrence of one or more of the following events: i. The date on which the employee s active employment with the Agency is terminated for any reason. An employee who utilizes vacation time for days prior to his last active day of employment with the Agency will cease his eligibility under the Plan on his last active day of employment. ii. The date on which an employee no longer satisfies Plan Eligibility requirements.

2 North Community Counseling Centers, Inc. Page 2 of 9 2. Benefits iii. The date on which coverage for a class of employees to which an individual belongs is no longer extended under the terms of the Plan. iv. The date on which the Plan is terminated. a. Eligibility for Benefits An eligible employee who is unable to work for the Agency because of an illness or injury shall be eligible to receive benefits under the Plan after he has completed the waiting period described in the Schedule of Benefits contained in Paragraph B of this Section 2. Benefits under the Plan shall be payable to an eligible employee during the period of time that he remains unable to work for the Agency; provided he is under the care of a physician during such period. Benefits for one period of disability will be paid at the bi-weekly benefit for each two-week period (or portion thereof) that the disability continues, but for no longer than the maximum benefit period, as contained in the Schedule of Benefits below. Benefits for any partial week of disability will be payable at 1/14 of the bi-weekly benefit for each day an eligible employee remains disabled. Successive periods of inability to work will be considered one period of inability to work unless: 1. Such periods are separated by at least two weeks of active employment with the Agency; or 2. Such periods are due to entirely unrelated causes and are separated by the eligible employee s return to active employment with the Agency for at least one full eight (8) hour work period. For purposes of receiving benefits under this Plan, an eligible employee will never be considered to be suffering from two or more disabilities at the same time. Eligible employees who are unable to work due to (1) pregnancy, including resulting childbirth, miscarriage or abortion, and any complications of pregnancy; or (2) acting as an organ/tissue donor, shall be paid benefits under this Plan in the same manner as any eligible employee who has suffered any other illness or injury.

3 North Community Counseling Centers, Inc. Page 3 of 9 b. Schedule of Benefits Bi-Weekly Income Benefits Waiting Period Maximum Benefit Period Minimum Bi-Weekly Income Benefit 50% of Bi-Weekly Basic Earnings Up to a Maximum of $1, per two-week period. 120 hours or full utilization of all paid leave benefits, whichever is greater. The waiting period shall be prorated for eligible part-time employees. 90 days from the date of illness or injury minus days of available paid leave. The greater of $100 or 10% of the bi-weekly benefit before deductions for other income benefits. c. Time of Benefit Payments Benefits will commence to be paid under the Plan to an eligible employee at the end of the waiting period after the Plan Administrator has received proof that the employee is unable to return to work due to illness or injury. For benefit payments to continue, the eligible employee must remain under the regular supervision of a physician. In addition, for benefit payments to commence, the eligible employee must have utilized all of his available paid leave from the Agency. d. Exclusions No benefits shall be payable from this Plan: a. During any period of time during which an eligible employee is not under the regular supervision of a physician; b. Due to any disability resulting from sickness or injury which arises from any occupation or employment for wage or profit, or for which the employee is entitled to benefits under any Workers Compensation or Occupational Disease Law;

4 North Community Counseling Centers, Inc. Page 4 of 9 c. For any disability resulting from war or any act or war, whether declared or undeclared, or acts of aggression by any country, or participation in a riot; d. For any disability resulting from any intentionally self-inflicted sickness or injury, while sane or insane; e. During any time for which an employee receives basic earnings from the Agency due to holiday, vacation or sick leave pay, or through any other arrangements; or f. For any disability incurred by an employee of the Agency who does not satisfy the eligibility requirements contained in Section Plan Administration a. Plan Administrator The Plan shall be administered by a Plan Administrator who shall be the President of the Agency. The Plan Administrator may be reached by mail at 4897 Karl Road, Columbus, Ohio 43229, or, by phone at (614) b. Duties of Plan Administrator The Plan Administrator is authorized to perform, in his discretion, all functions necessary to administer the Plan, including, without limitation, to determine the eligibility and qualification of employees for benefits under the Plan; to interpret and construe the terms of the Plan; to adopt rules, regulations and procedures consistent therewith and to decide all disputes with respect to the rights and obligations of eligible employees in the Plan. The Plan Administrator may employ one or more persons to render advice with regard to any responsibility he has under the Plan and may designate others to carry out any of his responsibilities.

5 North Community Counseling Centers, Inc. Page 5 of 9 4. Claims Procedure a. Initial Claim Within 15 days after an employee becomes eligible for benefits under the Plan, such employee should submit written proof of loss to the Plan Administrator. This written proof of loss must include: 1. The nature of his illness or injury; 2. The name, address and phone number of the employee s attending physician; and 3. A signed release of information allowing the Plan Administrator or his designee to have contact with the employee s attending physician. The Plan Administrator shall review an employee s written proof of loss, along with any other information that the Plan Administrator may require the employee to submit, and determine whether a benefit is due such employee under the Plan. In the event that an employee s claim is denied, in whole or in part, such employee will receive a written notice of denial, including: 1. The specific reasons for the denial; 2. The Plan provisions on which the denial is based; 3. Any additional information or material necessary to complete the claim along with an explanation of why it is needed; and 4. An explanation of the Plan s claim review procedures. The Plan Administrator will respond to an eligible employee s claim for benefits under the Plan within forty five (45) days after such claim is filed. In certain circumstances, this 45-day period may be extended by an additional thirty (30) days. If a claim for benefits is denied by the Plan Administrator, the eligible employee should begin the appeals procedure described in Paragraph B below. b. Appeals Procedure An eligible employee whose claim for benefits under the Plan is denied by the Plan Administrator shall have the right to have such benefit denial reviewed. When requesting

6 North Community Counseling Centers, Inc. Page 6 of 9 review, the employee must indicate the reason(s) for requesting the review and be prepared to submit any additional evidence to support his claim. Plan documents and other materials pertaining to the claim will be available for the employee s review. A request for review of a denied claim must be submitted, in writing, to the Plan Administrator within 180 days after the date the claim is denied. The individual or entity designated by the Plan Administrator will complete a review of an employee s appeal and send final written decision to such employee, within 45-days of the date on which the appeal is received. The decision will include the specific reasons for the decision with reference to the pertinent Plan provisions and other relevant information on which the decision is based. 5. Claims Procedure a. Non-Assignment of Benefits No employee, dependent or any other participant or beneficiary under this Plan has any right to assign benefits, rights, or privileges to which he is or may become entitled under this Plan. Any purported assignment shall be deemed by the Plan Administrator to be void. b. Facility of Payment of Benefits If an eligible employee becomes incapacitated and not competent to give valid receipt for payment of any benefits due him under the Plan, the Plan Administrator may direct payments to his duly appointed guardian or other legally appointed representative. If the Plan Administrator has not been notified of an employee s guardian or representative, the Plan Administrator will have the option of making payments to the person or institution appearing to him to have assumed the employee s custody or principal support. Any payment made by the Plan Administrator in accordance with the provisions of this Paragraph B shall fully discharge the Plan from any and all liability to the extent of such payment. c. Right of Recovery Whenever the Plan, as a result of oversight, lack of information or misrepresentation has paid benefits in excess of amounts that should have been paid, the Plan Administrator shall have the right to recover such overpayments(s) from the recipient.

7 North Community Counseling Centers, Inc. Page 7 of 9 d. Subrogation Upon the payment of any benefits under this Plan, the Plan shall be legally subrogated, to the extent of such payment, to all the eligible employee s rights of recovery against any person or organization. Upon the making of payment by the Plan, such rights will be assigned to the Plan by the eligible employee. The eligible employee shall agree to execute and deliver all necessary instruments and papers to cooperate fully with the Plan Administrator to secure such rights. The eligible employee shall do nothing to prejudice such rights. 6. General Information a. Plan Sponsor The Plan Sponsor Is North Community Counseling Centers, Inc. The Plan Sponsor s Employer ID Number is ; and its address is 4897 Karl Road, Columbus, Ohio b. Plan Year The records of the Plan shall be maintained on the calendar year. c. Named Fiduciary For purposes of the Plan, its named fiduciary shall be North Community Counseling Centers, Inc. d. Plan Amendments North Community Counseling Centers, Inc., in its sole discretion, may amend the Plan, or terminate the Plan completely, at any time without any prior notice to eligible employees. Any amendment to, or termination of the Plan, shall be accomplished by an action of the Agency s Board of Directors. e. Agent for Legal Process For purposes of the Plan, the agent for legal process shall be the President of North Community Counseling Centers, Inc. Such individual may be reached, by mail, at 4897 Karl Road, Columbus, Ohio

8 North Community Counseling Centers, Inc. Page 8 of 9 f. ERISA Rights Each employee who is eligible to participate in the Plan is entitled to certain rights and protections under the Employee Retirement Security Act of 1974, as amended (ERISA). An employee s rights under ERISA include the following: He may examine all Plan documents at no charge. These may include the annual financial reports, the Plan descriptions and all other official Plan documents filed with the United States Department of Labor. These documents are available for examination in the Agency s general offices. He may obtain copies of Plan documents and other Plan information by writing to the Plan Administrator. He may be charged a reasonable amount for these copies. He has a right to receive a written Plan summary of the Plan s annual financial reports. He may not be discharged or discriminated against to prevent him from obtaining a benefit or exercising his ERISA rights. If a claim for a benefit is denied in whole or in part, he will receive a written explanation from the Plan Administrator. He has the right to have the Plan Administrator review and reconsider his claim. Besides creating rights for Plan participants, ERISA also spells out certain responsibilities for people who operate the Plan. These people are called fiduciaries. The fiduciaries of the Plan must operate the Plan solely in the interest of Plan participants and beneficiaries. They must exercise prudence and good judgment in the performance of their Plan duties. Under ERISA, there are steps an eligible employee can take to enforce the rights described above. For example: o If he requests materials from the Plan Administrator and does not receive them within thirty (30) days, he may file suit in a federal court. In such a case, the court may require the Plan Administrator to provide the materials and pay the employee up to $110 a day until he receives the materials--unless the materials were not sent because of reasons beyond the control of the Plan Administrator.

9 North Community Counseling Centers, Inc. Page 9 of 9 o If his claim for benefits is denied after a final review or ignored in whole or in part, he may file suit in a state or federal court. o If the fiduciaries misuse Plan funds or if an employee is discriminated against for pursuing a benefit or exercising his ERISA rights, the employee may seek help from the United States Department of Labor or file suit in federal court. o If the employee files suit to enforce his rights, the court will decide who should pay costs and legal fees. If the employee wins the suit, the court may order the person he sued to pay the court costs and legal fees. o If the employee loses the suit, the court may order him to pay these costs and fees, for example, if the court finds his claim was frivolous. o If an employee has any questions about the Plan, he should contact the Plan Administrator. If an employee has any questions about this statement or about his ERISA rights, he should contact the nearest Area Office of the Pension and Welfare Benefit Administration, United States Department of Labor or the Division of Technical Assistance and Inquiries, Pension and Welfare Benefits Administrator, U.S. Department of Labor, 200 Constitution Avenue N.W., Washington, D.C You may also obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the Pension and Welfare Benefits Administration. David Kittredge President Judith A. Bryant Chair, Board of Directors Date Date Revised 4/3/08