Summary Plan Description for: The Dow Chemical Company Texas Operations Hourly Total and Permanent Disability Plan

Transcription

1 Summary Plan Description for: The Dow Chemical Company Texas Operations Hourly Total and Permanent Disability Plan Amended and Restated Effective January 1, 2013 and thereafter until superseded This Summary Plan Description (SPD) supersedes all prior versions of this SPD Copies of this SPD can be found at the Dow Intranet, the Dow Friends website, or by requesting a copy from the Retiree Service Center, Employee Development Center, Midland, MI 48674, telephone or Summaries of material modifications may also be published from time to time. Content Steward: Dombek January 1, 2013 Lit #

2 Table of Contents OVERVIEW... 1 ELIGIBILITY... 1 TOTAL AND PERMANENT DISABILITY... 2 TOTAL AND PERMANENT DISABILITY STATUS AND OTHER DOW BENEFITS... 2 FRAUD AGAINST THE PLAN... 3 YOUR LEGAL RIGHTS UNDER ERISA... 4 PLAN ADMINISTRATOR S DISCRETION... 5 WELFARE BENEFITS... 5 AMENDMENT, MODIFICATION, OR TERMINATION OF PLAN... 5 DISPOSITION OF PLAN ASSETS IF THE PLANS ARE TERMINATED... 5 LITIGATION... 6 CLASS ACTION LAWSUITS... 7 UNCASHED CHECKS... 7 FOR MORE INFORMATION... 7 IMPORTANT NOTE... 8 ERISA INFORMATION... 9 CLAIMS PROCEDURES APPENDIX GLOSSARY APPENDIX i

3 Overview This booklet is the Summary Plan Description ( SPD ) for The Dow Chemical Company Texas Operations Hourly Total and Permanent Disability Plan (the Plan ). The Plan is a group disability income protection plan to help protect eligible Employees and their families in the event of Total and Permanent Disability. The Plan applies only to individuals who were receiving a benefit under the Plan prior to April 1, This SPD is a summary of the Plan Document. If there is an inconsistency between the SPD and the Plan Document, the Plan Document will govern. The Plan Document is available upon request from the Plan Administrator identified in the ERISA Information section of this SPD. The Dow Chemical Company reserves the right to amend, modify and terminate the Plan at any time in its sole discretion. The SPD and the Plan do not constitute a contract of employment. Words that are capitalized are either defined in the Glossary Appendix to this SPD or in the Plan Document. A pronoun or adjective in the masculine gender includes the feminine gender, and the singular includes the plural, unless the context clearly indicates otherwise. Eligibility You are eligible for coverage under this Plan on or after April 1, 1999 only if you were already approved for a benefit under this Plan before April 1, There are no new enrollments in the Plan after April 1, If you are currently receiving Plan benefits, your benefits under the Plan end on the earliest of the following dates to occur: 1. The date as of which you are determined by the Dow Medical Director to no longer be Totally and Permanently Disabled; 2. The end of the month in which you reach age 65, if your disability began on or before age 60; 3. After 60 consecutive months of payment, or you reach age 70, whichever is earlier, if your disability began between ages 60 and 69; 4. After twelve (12) consecutive months of payment, if your disability began between ages 70 and 74; 5. After six (6) consecutive months of payment, if your disability began on or after you reached age 75; 1

4 6. The date you fail to attend a medical examination as requested by the Plan Administrator; or 7. The date of your death. The Plan Administrator determines whether you may begin receiving benefits under the Plan, and when you will no longer receive benefits. If the Plan Administrator determines that you may receive benefits under the Plan, then you have Total and Permanent Disability status. The Plan may, at its option, require that you submit to periodic medical examinations or to provide such other medical evidence of continued Total and Permanent Disability as it may request in order to satisfy itself that you continue to be Totally and Permanently Disabled; such evidence may not be required more frequently than once every six months. Total and Permanent Disability Total and Permanent Disability means that because of a sickness or an injury: you cannot do your job; and you cannot do any other job for which you are reasonably fit by your education, your training or your experience including work with your Employer, self-employment or work with another employer. The Dow Medical Director determines whether you are Totally and Permanently Disabled. Total and Permanent Disability Status and Other Dow Benefits If you have Total and Permanent Disability status, you are no longer an active Employee of Dow. However, you may be eligible to continue coverage under certain employee benefit plans ( ancillary benefit plans ). Please note that these ancillary benefits are not provided under the Plan. Instead, the terms of the ancillary benefit plans may extend eligibility to you because of your status under the Plan. The following information is provided here only for your convenience. If there is any inconsistency between this information and the information in the summary plan description and other legal documents for the applicable ancillary benefit plan, the summary plan description and other legal documents for the applicable ancillary benefit plan will govern. While you are receiving the Plan benefits, the following provisions apply: Medical Coverage. You are eligible to continue coverage under either The Dow Chemical Company Retiree Medical Care Program or The Dow Chemical Company Insured Health Program for you and your eligible and covered dependents. Dow pays the full cost of this coverage. Your medical plan and coverage level is the plan and coverage level most comparable to the last plan and coverage level you had when you were an active Employee. 2

5 Dental Coverage. Coverage under the Dental Assistance Program or in the dental coverage provided under The Dow Chemical Company Insured Health Program may continue for you and for any qualified beneficiary for a period of eighteen (18) months after the Disability date, under the Consolidated Omnibus Reconciliation Act of 1985 (COBRA). You will be required to pay premiums equal to 102% of the full cost to insure. See the Summary Plan Description for dental coverage or contact the HR Service Center for details. Company-Paid Life Insurance. While you receive benefits under the Plan, you will continue to be eligible for the same Company-Paid Life Insurance coverage you were enrolled in as an active Employee, until the day before you reach age 65. Dow currently pays the full cost of this coverage. Voluntary Group Accident (VGA) Insurance coverage, Business Travel Accident (BTA) Insurance coverage, and Dependent Life Insurance coverage end when you have been approved for benefit payments under the Plan. Dow Employees Pension Plan (DEPP). If you have ten or more years of credited service before your last day of work, you will continue to earn credited service under the DEPP while you receive Plan benefits. You will earn one-half month of credited service under the DEPP for each month while you are on Total and Permanent Disability status, as specified under the DEPP until the date specified under the DEPP. Employees Savings Plan (ESP). If you are a participant of the Dow Employees Savings Plan ( ESP ), the ESP allows you to take distribution of the vested portion of your ESP account or defer receipt. If you defer, any investment earnings will continue to be reinvested in your account. While you are on Total and Permanent Disability status, you may not contribute to your ESP account. Health Care Reimbursement Account (HCRA) or Dependent Care Reimbursement Account (DCRA). If you are enrolled in HCRA or DCRA, eligible expenses you incurred through the last day on which you were actively employed may be submitted for reimbursement up to the amount you contributed to the account. If you elected to participate in HCRA or DCRA, you must submit your claims by April 30 of the following year. After that date, any remaining account balance will be forfeited. While on Total and Permanent Disability status, you may not make deposits into your Reimbursement Accounts. Retirement Health Care Assistance Plan (RHCAP). Any deductions under RHCAP cease on the last day you are on the payroll. Contact the HR Service Center to defer your Account. Fraud Against the Plan If you intentionally misrepresent information to the Plan, knowingly withhold relevant information from the Plan, or deceive or mislead the Plan, the Plan Administrator may (1) terminate your participation in the Plan, either retroactively to the date deemed appropriate 3

6 by the Plan Administrator, or prospectively; (2) require you to reimburse the Plan for amounts it paid, including all costs of collection such as attorneys fees and court costs; and/or (3) prohibit you from enrolling in the Plan. In addition, the Plan and/or Dow may pursue civil and/or criminal action against you, or take other legal action. The Plan Administrator may determine that you are not eligible for coverage under the Program. Your Legal Rights Under ERISA As a participant in the Plan, you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA). This law requires that all Plan Participants must be able to: Examine, without charge, at the Plan Administrator s office and at other specified locations, the Plan Document and the latest annual report filed with the U.S. Department of Labor and available at the Public Disclosure Room of the Employee Benefits Security Administration. Obtain, upon written request to the Plan Administrator, copies of all documents governing the operation of the Plan, including insurance contracts, collective bargaining agreements (if applicable), and copies of the latest annual report, the Plan Document, and updated Summary Plan Description. The Plan Administrator may charge a reasonable fee for the copies. Receive a summary of the Plan s annual financial report. The Plan Administrator is required by law to furnish each Participant with a copy of this summary annual report. In addition to creating rights for you and all other Plan Participants, ERISA imposes duties on the people who are responsible for operating an employee benefit plan. The people who operate the Plan, called fiduciaries of the Plan, have a duty to act prudently and in the interest of you and other Plan Participants and beneficiaries. No one, including your employer or any other person, may discharge you or otherwise discriminate against you in any way, for pursuing a welfare benefit or for exercising your rights under ERISA. If you have a Claim for Plan Benefits that 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 schedules. Enforce your rights: Under ERISA, there are steps you can take to enforce the legal rights described above. For instance, if you request Plan materials and do not receive them within 30 days, you may file suit in a federal court. 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 the materials were not sent because of reasons beyond the control of the Plan Administrator. If you have a Claim for Plan Benefits that is denied or ignored, in whole or in part, you may file suit in state or Federal court. If it should happen that 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. The court will decide who should pay court costs and legal 4

7 fees. If you are successful the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees, for example, if it finds your claim is frivolous. Assistance with your questions: If you have any questions about the Plan, you should contact the Plan Administrator. If you have any questions about this statement or about your rights under ERISA, or if you need assistance in obtaining documents from the Plan Administrator, you should contact the nearest Employee Benefits Security Administration, U.S. Department of Labor, listed in your telephone directory or the Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, 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 Employee Benefits Security Administration at (866) Plan Administrator s Discretion The Plan Administrator is each of the Vice President, Human Resources Center of Expertise; the Global Benefits Director; the Associate Director of North America Benefits; the North America Health and Welfare Plans Leader; and such other person, group of persons, or entity which may be designated by the Plan Sponsor in accordance with Section 8.4 of the Plan Document as a named fiduciary with respect to administration of the Plan. Except for the duties reserved for the Claims Administrator, the Plan Administrator and any other person or committee designated by the Company to carry out these functions have the sole and absolute discretion to interpret the Plan Document, this SPD, and other relevant Plan documents, make findings of fact, and adopt rules and procedures applicable to matters within their jurisdiction. Their interpretations and determinations are conclusive and binding on all persons claiming benefits under, or otherwise having an interest in, the Plan, and if their interpretations or determinations are challenged in court, they shall not be overturned unless proven to be arbitrary and capricious. See Claims Procedures Appendix for information about the Claims Administrator s discretion.. Welfare Benefits Welfare benefits, such as those provided under the Plan, are not required to be guaranteed by a government agency. Amendment, Modification, or Termination of Plan The Company reserves the right to amend, modify, or terminate the Plan at any time at its sole discretion. The procedures for amending, modifying or terminating the Plan are contained in the Plan Document. Disposition of Plan Assets if the Plans are Terminated If the Dow Chemical Company terminates the Plan, the assets of the Plan, if any, shall not be used by The Dow Chemical Company, but may be used to: 5

8 1. provide benefits for Participants in accordance with the Plan; 2. pay third parties to provide such benefits; 3. pay expenses of the Plan and/or the Trust holding the Plan s assets; and/or 4. provide cash for Participants, as long as the cash is not provided disproportionately to officers, shareholders, or highly compensated employees. Litigation If you wish to file a lawsuit against the Plan (1) to recover benefits you believe are due to you under the terms of the Plan or any law; (2) to clarify your right to future benefits under the Plan; (3) to enforce your rights under the Plan; or (4) to seek a remedy, ruling or judgment of any kind against the Plan or the Plan fiduciaries or parties-in-interest (within the meaning of ERISA) that relates to the Plan, then under the terms of the Plan you must file the suit within the Applicable Limitations Period or your suit will be time-barred. The Applicable Limitations Period is the period ending 120 days after: 1. in the case of a claim or action to recover benefits allegedly due to you under the terms of the Plan or to clarify your right to future benefits under the terms of the Plan, the earliest of: (a) the date the first benefit payment was actually made, (b) the date the first benefit payment was allegedly due, or (c) the date the Plan first repudiated its alleged obligation to provide such benefits; 2. in the case of a claim or action to enforce an alleged right under the Plan (other than a claim for benefits), the date the Plan first denied your request to exercise such right; or 3. in the case of any other claim or action, the earliest date on which you knew or should have known of the material facts on which the claim or action is based, regardless of whether you were aware of the legal theory underlying the claim or action. A claim for benefits or an appeal of a complete or partial denial of a claim, as described in the claims and appeals sections, generally falls under (1) above. Please note, however, that if you have a timely claim pending before the Initial Claims Reviewer or a timely appeal pending before the Appeals Administrator when the Applicable Limitations Period would otherwise expire, the Applicable Limitations Period will be extended to the date that is 60 calendar days after the Appeals Administrator renders its final decision. The Applicable Limitations Period replaces and supersedes any limitations period that ends at a later time that otherwise might be deemed applicable under any state or federal law. The Applicable Limitations Period does not extend any limitations period under state or federal law. The Vice President of Human Resources of the Company may, in his discretion, extend the Applicable Limitations Period upon a showing of exceptional circumstances, but such an extension is at the sole discretion of the Vice President of Human Resources and is not subject to review. 6

9 Class Action Lawsuits Legal actions against the Plan must be filed in U.S. federal court. Class action lawsuits must be filed either (1) in the jurisdiction in which the Plan is principally administered (currently the Northern Division of the United States District Court for the Eastern District of Michigan) or (2) the jurisdiction in the United States of America where the largest number of putative members of the class action reside (or if that jurisdiction cannot be determined, the jurisdiction in which the largest number of class members is reasonably believed to reside). If any putative class action is filed in a jurisdiction other than one of those described above, or if any non-class action filed in such a jurisdiction is subsequently amended or altered to include class action allegations, then the Plan, all parties to such action that are related to the Plan (such as a Plan fiduciary, administrator, or party in interest) and all alleged Participants must take all necessary steps to have the action removed to, transferred to or re-filed in one of the jurisdictions described above. This forum selection provision is waived if no party invokes it within 120 days of the filing of a putative class action or the assertion of class action allegations. This provision does not waive the requirement to exhaust administrative remedies before initiating litigation. Uncashed Checks Uncashed checks for the payment of benefits shall not escheat to the state, but shall remain in the Company s general assets. The Plan and Claims Administrators are entitled to rely on the last address provided to the Plan by the Participant and have no obligation to search for or ascertain a Participant s whereabouts. If the applicable Administrator determines that there are no extenuating circumstances, after one (1) year of the date of the check, the Plan s obligation to pay the benefit underlying the uncashed check is extinguished, and the payment of benefits will be forfeited. For More Information If you have questions, contact the HR Service Center, Employee Development Center, Midland, Michigan or call

10 Important Note This booklet is the Summary Plan Description (SPD) for The Dow Chemical Company Texas Operations Hourly Total and Permanent Disability Plan (the Plan ). However, this booklet is not all-inclusive and it is not intended to take the place of the Plan s legal documents. The Dow Chemical Company reserves the right to amend, modify or terminate the Plan at any time in its sole discretion. The Plan Document can be made available for your review upon written request to the Plan Administrator. The SPD and the Plan do not constitute a contract of employment. Your employer retains the right to terminate your employment or otherwise deal with your employment as if this SPD and the Plan had never existed. 8

11 ERISA Information The Dow Chemical Company Texas Operations Hourly Total and Permanent Disability Plan Plan Sponsor: The Dow Chemical Company Employee Development Center Midland, MI Plan Administrator: North America Health and Welfare Plans Leader The Dow Chemical Company Employee Development Center Midland, MI Type of Plan: Long-term disability benefit. Type of Plan Administration: Self-insured benefits. Employer Identification Number: Plan Number: 610 Claims Administrators: Initial Claims Reviewer: North America Health and Welfare Plans Leader The Dow Chemical Company Employee Development Center Midland, MI Attention: Initial Claims Reviewer for The Dow Chemical Company Texas Operations Hourly Total and Permanent Disability Plan To Serve Legal Process, File With: To Serve Legal Process: Appeals Administrator: Associate Director of North America Benefits The Dow Chemical Company Employee Development Center Midland, MI Attention: Appeals Administrator for The Dow Chemical Company Texas Operations Hourly Total and Permanent Disability Plan General Counsel The Dow Chemical Company Corporate Legal Department 2030 Dow Center Midland, MI General Counsel The Dow Chemical Company Corporate Legal Department 2030 Dow Center Midland, MI

12 Plan Year: Funding: The Plan s fiscal records are kept on a Plan year beginning January 1 and ending December 31. Dow pays the entire cost of the Plan from its general assets. 10

13 Claims Procedures Appendix You Must File a Claim in Accordance with these Claims Procedures A Claim is a written request by a claimant for a Plan benefit or an Eligibility Determination. There are two kinds of Claims: A Claim for Plan Benefits is a request for Plan benefits. An Eligibility Determination is a request for a determination as to whether a claimant is eligible to enroll in the Plan. You must follow the claims procedures for either Claims for Plan Benefits or Claims for an Eligibility Determination, whichever applies to your situation. See the section entitled CLAIMS FOR PLAN BENEFITS for the procedures regarding Claims for Plan Benefits. See the section entitled CLAIMS FOR AN ELIGIBILITY DETERMINATION for the procedures regarding Claims for Eligibility Determinations. Who Will Decide Whether to Approve or Deny My Claim? The Plan has more than one Claims Administrator. Each of the Claims Administrators is a named fiduciary of the Plan with respect to the respective types of claims that they process. The applicable Claims Administrator will make the decision as to whether to approve or deny your claim. The initial determination for a Claim is made by the Initial Claims Reviewer. The Initial Claims Reviewer for Claims for an Eligibility Determination and for Claims for Plan Benefits is the North America Health and Welfare Plans Leader. If you appeal, the appellate decision is made by the Appeals Administrator. The Associate Director of North America Benefits and the Global Benefits Director are the Appeals Administrators for appeals of denied Claims. Authority of Administrators and Your Rights Under ERISA The Claims Administrators have the full, complete, and final discretion to interpret the provisions of the Plan and to make findings of fact in order to carry out their respective Claims decision-making responsibilities. Interpretations and claims decisions by Claims Administrators are final and binding on Participants (except to the extent the Initial Claims Reviewer is subject to review by the Appeals Administrator). After you have appealed the initial determination, if you are not satisfied with the Appeals Administrator s final written decision, you may file a civil action against the Plan under section 502 of the Employee Retirement Income Security Act (ERISA) in a federal court. Please see the Litigation section for the deadline for filing a lawsuit. An Authorized Representative May Act on Your Behalf An Authorized Representative may submit a Claim on behalf of a Plan Participant. The Plan will recognize a person as a Plan Participant s Authorized Representative if such person submits a notarized writing signed by the Participant stating that the Authorized Representative 11

14 is authorized to act on behalf of such Participant. A court order stating that a person is authorized to submit Claims on behalf of a Participant will also be recognized by the Plan. CLAIMS FOR AN ELIGIBILITY DETERMINATION Information Required In Order to Be a Claim A Claim for an Eligibility Determination must be in writing and contain the following information: The name of the Employee The name of benefit plan for which the Eligibility Determination is being requested (The Dow Chemical Company Texas Operations Hourly Total and Permanent Disability Plan) Claims for Eligibility Determinations must be sent to: Initial Determination North America Health and Welfare Plans Leader The Dow Chemical Company Employee Development Center Midland, MI Attention: Initial Claims Reviewer for The Dow Chemical Company Texas Operations Hourly Total and Permanent Disability Plan If you submit a Claim for an Eligibility Determination, the Initial Claims Reviewer will review your Claim and notify you of its decision to approve or deny your Claim. Such notification will be provided to you in writing within a reasonable period, not to exceed 90 days after the date you submitted your claim; except that under special circumstances, the Initial Claims Reviewer may have up to an additional 90 days to provide you such written notification. If the Initial Claims Reviewer needs such an extension, it will notify you prior to the expiration of the initial 90-day period, state the reason why such an extension is needed, and state when it will make its determination. If the Initial Claims Reviewer denies the Claim, the written notification of the Claims decision will state the reason(s) why the Claim was denied and refer to the pertinent Plan provision(s). If the Claim was denied because you did not file a complete Claim or because the Initial Claims Reviewer needed additional material or information, the Claims decision will state that as the reason for denying the Claim and will explain why such information was necessary. Appealing the Initial Determination If the Initial Claims Reviewer has denied your Claim, you may appeal the decision. If you appeal the Initial Claims Reviewer s decision, you must do so in writing within 60 days of receipt of the Initial Claims Reviewer s determination, assuming that there are no extenuating circumstances, as determined by the Appeals Administrator. Your written appeal must include the following information: Employee s name 12

15 Name of the Plan (The Dow Chemical Company Texas Operations Hourly Total and Permanent Disability Plan) Reference to the Initial Determination Explanation of the reason why you are appealing the Initial Determination Appeals of Eligibility Determination Claims should be sent to: Associate Director of North America Benefits The Dow Chemical Company Employee Development Center Midland, MI Attention: Appeals Administrator for The Dow Chemical Company Texas Operations Hourly Total and Permanent Disability Plan You may submit any additional information to the Appeals Administrator when you submit your request for appeal. You may also request that the Appeals Administrator provide you copies of documents, records and other information that is relevant to your Claim, as determined by the Appeals Administrator in his/her sole discretion. Your request must be in writing. Such information will be provided at no cost to you. After the Appeals Administrator receives your written request to appeal the initial determination, the Appeals Administrator will review your Claim. Deference will not be given to the initial adverse decision, and the Appeals Administrator will look at the Claim anew. The Appeals Administrator is not the same person as the person who made the initial decision to deny the claim. In addition, the Appeals Administrator is not a subordinate who reports to the person who made the initial decision to deny the Claim. The Appeals Administrator will notify you in writing of its final decision. Such notification will be provided within a reasonable period, not to exceed 60 days after the written request for appellate review, except that under special circumstances, the Appeals Administrator may have up to an additional 60 days to provide written notification of the final decision. If the Appeals Administrator needs such an extension, s/he will notify you prior to the expiration of the initial 60-day period, state the reason why such an extension is needed, and indicate when s/he will make his or her determination. If an extension is needed because the Appeals Administrator determines that s/he does not have sufficient information to make a decision on the Claim, s/he will describe any additional material or information necessary to submit to the Plan, and provide you with the deadline for submitting such information. The period for deciding your Claim may, in the Appeals Administrator s sole discretion, be tolled until the date you respond to a request for information. If you do not provide the information by the deadline, the Appeals Administrator may decide the Claim without the additional information. If the Appeals Administrator has determined that its final decision is to deny your Claim, the written notification of the decision will state the reasons(s) for the denial and refer to the specific plan provisions on which the denial is based. 13

16 CLAIMS FOR PLAN BENEFITS A Claim for Plan Benefits must be in writing and contain the following information: The name of the Employee A description of the benefit that is being requested A Claim for Plan Benefits must be sent to: Initial Determination North America Health and Welfare Plans Leader The Dow Chemical Company Employee Development Center Midland, MI Attention: Initial Claims Reviewer for The Dow Chemical Company Texas Operations Hourly Total and Permanent Disability Plan The Initial Claims Reviewer will review your Claim and notify you of its decision to approve or deny your Claim. Such notification will be provided to you within a reasonable period, not to exceed 45 days after the date you submitted your claim; except for situations requiring an extension of time because of matters beyond the control of the Plan, in which case the Initial Claims Reviewer may have up to two (2) additional extensions of 30 days each (totaling 60 days) to provide you such notification. If the Initial Claims Reviewer needs such extensions, it will notify you prior to the expiration of the initial 45-day period (or the first 30-day extension period if a second 30-day extension period is needed), state the reason why such an extension is needed, and state when it will make its determination. If an extension is needed because you did not provide sufficient information or filed an incomplete Claim, the period for deciding your claim may, in the Initial Claims Reviewer s sole discretion, be tolled from the date on which the notification of extension is sent to you until the date on which you respond to the request for additional information. If you do not provide the additional information within 45 days, the Initial Claims Reviewer will decide the claim without the additional information. If the Initial Claims Reviewer denies the Claim, the written notification of the Claim decision will include: The specific reason or reasons for denial of the claim; References to the specific Plan provisions upon which such denial is based; A description of any additional material or information necessary to perfect the claim, and an explanation of why such material or information is necessary; If applicable, any internal rule, protocol, guideline or other similar criterion relied upon in making the decision, or a statement that such rule, guideline, protocol, or other similar criterion was relied upon and a copy will be provided free of charge upon request; 14

17 If the decision was based on a medical necessity, experimental treatment, or similar exclusion or limit, an explanation of the scientific or clinical judgment for the adverse decision, or a statement that such explanation will be provided free of charge upon request; An explanation of the Plan s appeal procedures and the applicable time limits; and A statement of your right to bring a civil action under section 502(a) of ERISA, if your claim is denied upon review. Appealing the Initial Determination If the Initial Claims Reviewer has denied your Claim, you may appeal the decision. In addition, if you were being paid benefits and you have been notified that these benefits will be terminated, you may also appeal the decision to terminate your benefits. You must file a written appeal within 180 days of the Initial Claims Reviewer s notice of denial, assuming that there are not extenuating circumstances, as determined by the Appeals Administrator, in which case the time to file the appeal may be more than 180 days. Appeals must be in writing and must include the following information: Name of Employee Name of the Plan Reference to the Initial Determination Explanation of the reason why you are appealing the Initial Determination Send your appeal to: Associate Director of North America Benefits The Dow Chemical Company Employee Development Center Midland, MI Attention: Appeals Administrator for The Dow Chemical Company Texas Operations Hourly Total and Permanent Disability Plan You may submit any additional information to the Appeals Administrator when you submit your request for appeal. You may also request that the Appeals Administrator provide you copies of documents, records and other information that is relevant to your Claim, as determined by the Appeals Administrator under applicable federal regulations. Your request must be in writing. Such information will be provided at no cost to you. After the Appeals Administrator receives your written request to appeal the initial determination, the Appeals Administrator will review your Claim. Deference will not be given to the initial adverse decision, and the Appeals Administrator will look at the Claim anew. The Appeals Administrator will take into account all comments, documents, records, etc. submitted to the Appeals Administrator that is related to the Claim without regard to whether such information was submitted or considered in the initial determination. The Appeals Administrator will not be the same person as, or a subordinate who reports to, the person who made the initial decision to 15

18 deny the Claim. If the adverse decision is based on medical judgment, the Appeals Administrator will consult a health care professional with appropriate training and experience in the field of medicine involved in the medical judgment. This health care professional may not be the same person consulted for the initial determination, and may not be a subordinate who reports to the person who was consulted for the initial determination. The Appeals Administrator will notify you in writing of its final decision. Such notification will be provided within a reasonable period, not to exceed 45 days of the written request for appellate review, except that under special circumstances, the Appeals Administrator may have up to an additional 45 days to provide written notification of the final decision. If the Appeals Administrator needs such an extension, it will notify you prior to the expiration of the initial 45- day period, state the reason(s) why such an extension is needed, and state when it will make its determination. If an extension is needed because you did not provide sufficient information, the period for deciding your Claim may, in the Appeals Administrator s sole discretion, be tolled from the date on which the notification of extension is sent to you until the date on which you respond to the request for additional information. If you do not provide the additional information within 45 days, the Appeals Administrator will decide the Claim. If the Appeals Administrator denies the Claim on appeal, the Appeals Administrator will send you a final written decision that includes: The specific reason(s) why the Claim you appealed is being denied; References to the specific Plan provisions on which the denial is based; A statement that you are entitled to receive, upon request and free of charge, reasonable access to, and copies of all documents, records, and other information relevant to your claim; If an adverse decision is based on advice of medical or vocational experts, a statement that you may, upon request and free of charge, obtain the identity of the expert whose advice was obtained, without regard to whether the advice was relied upon in making the adverse decision; If applicable, any internal rule, protocol, guideline or other similar criterion relied upon in making the decision, or a statement that such rule, guideline, protocol, or other similar criterion was relied upon and a copy will be provided free of charge upon request; If the decision was based on a medical necessity, experimental treatment, or similar exclusion or limit, an explanation of the scientific or clinical judgment for the adverse decision, or a statement that such explanation will be provided free of charge upon request; A statement that You and your plan may have other voluntary alternative dispute resolution options, such as mediation. One way to find out what may be available is to contact your local U.S. Department of Labor Office and your state insurance regulatory agency ; and A statement of your right to bring a civil action under section 502(a) of ERISA. 16

19 Glossary Appendix Additional terms may be defined in the Plan Document. Appeals Administrator: With respect to either a Claim for Plan Benefits or a Claim for an Eligibility Determination, the Appeals Administrators are the Global Benefits Director and the Associate Director of North America Benefits. Bargained-for: A Bargained-for individual means an individual who is represented by a collective bargaining unit that is recognized by the Company. Claim: A written request by a claimant for Plan benefits or for an eligibility determination that contains, at a minimum, the information described in the Claims Procedures Appendix of this SPD. Claim for an Eligibility Determination: A Claim requesting a determination as to whether a claimant is eligible to be a Participant under the Plan. Claim for Plan Benefits: A Claim requesting that the Plan pay for benefits covered under the Plan. Claims Administrator: Either the Initial Claims Reviewer or the Appeals Administrator, depending on the context of the sentence in which the term is used. Company: The Dow Chemical Company. Initial Claims Reviewer: With respect to either a Claim for Plan Benefits or a Claim for an Eligibility Determination, the Initial Claims Reviewer is the North America Health and Welfare Plans Leader. Participant: An Employee who is both eligible to participate in the Plan and is enrolled in the Plan. Plan: The Dow Chemical Company Texas Operations Hourly Total and Permanent Disability Plan. Plan Administrator: Each of the Vice President, HR Center of Expertise; Global Benefits Director; Associate Director of North America Benefits; and North America Health and Welfare Plans Leader; and such other person, group of persons or entity which may be designated by The Dow Chemical Company in accordance with the Plan Document. Plan Document: The plan document for the Plan. The Summary Plan Description is an integral part of the Plan Document. Plan Sponsor: The Dow Chemical Company. Plan Year: The 12-consecutive-month period ending each December

20 Summary Plan Description ( SPD ): The summary plan description for the Plan. The SPD is an integral part of the Plan Document. Total and Permanent Disability: Total and Permanent Disability has the meaning given to this term in Total and Permanent Disability. 18