Summary Plan Description Vision IBEW Local 499, IBEW Local 109, IBEW Local 499-Fort Madison, USW Local 738 Administered by VSP Effective 1/1/2017
Effective 1/1/2017
About This Book This book is a summary plan description. It explains how your plan currently works, when you qualify for benefits and other information. If you have questions about the plan or any of the information in this book, contact the HR helpline at ext. 2999, (800-432- 8999), option 1, or hrhelpline@midamerican.com. This book is designed to help you understand the main features of the plan. It should not be considered as a substitute for the plan document, which governs the operation of the plans. That document sets forth all the details and provisions of the plans and is subject to amendment. If any questions arise that are not covered in this book or if this book appears to conflict with the official plan document, the text of the official plan document will govern your rights and benefits. Effective 1/1/2017
Effective 1/1/2017
TABLE OF CONTENTS Eligibility Eligibility 1 Enrollment Enrollment Process Date Your Coverage Takes Effect 1 1 1 Dependents 3 Schedule of Benefits How the Vision Plan Works 5 Schedule of Benefits 5 Covered Expenses 6 Exclusions and Limitations 6 How to File a Claim 7 Questions and Appeals 8 Termination of Coverage 8 Coordination of Benefits Benefits When You Have Coverage Under More Than One Plan 9 Order of Benefit Determination 10 Medicare Exception 12 Exchange of Information 12 Facility of Payment 12 Right of Recovery 12 Continuation Coverage under Federal Law (COBRA) Qualified Beneficiary 13 Qualifying Events 13 COBRA Notification 14 Length of COBRA Continuation Coverage 14 Cost 16 Plan Changes 16 Newly Acquired Dependents 16 Termination of COBRA Coverage 16 Family and Medical Leave Act (FMLA) Eligibility for FMLA Leave 17 Mandated Unpaid Leave 17 Benefits Continuation during FMLA 17 Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA) Benefits Continuation and Cost 19 Reinstatement of Benefits 19 General Provisions Plan Document 20 Amendments to the Plan 20 Legal Action 20 Time Limits 20 Right of Recovery 20 Statement of Employee Retirement Income Security Act of 1974 (ERISA) Rights Receive Information about Plans and Benefits 21 i
TABLE OF CONTENTS Continue Group Health Plan Coverage 21 Prudent Actions by Plan Fiduciaries 22 Enforce Your Rights 22 Assistance with Your Questions 22 Summary Plan Description ERISA required information 23 ii
Eligibility Eligibility Employees are eligible for this benefit if they are: Actively employed in the United States with MidAmerican Energy Company. Classified as either full time or part time. Are represented by IBEW Local 499, IBEW Local 109, IBEW Local 499-Fort Madison or USW Local 738 with the exception of seasonal employees. Enrollment You are initially eligible for coverage on the first day you satisfy the eligibility requirements stated above. Enrollment Process If you are eligible for coverage, you may enroll for such coverage by completing the enrollment process established by the Employer. The Vision benefits have an annual enrollment period established by the Employer. Subject to the rules of this plan, you may enroll for Vision benefits only when you are first eligible, during an annual enrollment period or if you have a qualifying event. You should contact the Employer for more information regarding the benefits plan. Date Your Coverage Takes Effect Enrollment When First Eligible If you complete the enrollment process within 30 days of becoming eligible for coverage, such coverage will take effect on the date you become eligible, provided you are actively at work on that date. If you are not actively at work on the date the coverage would otherwise take effect, the coverage will take effect on the day you resume active work. If You Do Not Enroll When First Eligible If you do not complete the enrollment process within 30 days of becoming eligible, you will not be able to enroll for coverage until the next annual enrollment period for Vision benefits, as determined by the Employer, following the date you first become eligible, or if you experience a Qualifying Event. At that time you will be able to enroll for coverage for which you are then eligible. 1
Your benefit elections and coverage levels remain in effect from Jan. 1 through Dec. 31, unless you experience a qualifying life event. Qualifying life events may allow you to add or drop coverage for eligible dependents during the year; however, in most cases, you cannot change your existing vision plan. Examples of qualifying life events are: Change in the employee s legal marital status. Change in the employee s number of eligible dependents. Change in the employee s or eligible dependent s employment status that affects benefits eligibility. Dependent satisfies or ceases to satisfy eligibility requirements. Change in residence that affects benefits eligibility. Commencement or termination of adoption proceedings. Eligibility for continuation coverage under COBRA. Judgments, decrees or court orders. Medicare, Medicaid or State s Children s Health Insurance Program. Significant cost or coverage changes for employee or eligible dependents. Significant curtailment that is a loss of coverage for employee or eligible dependents. Addition or improvement of a benefit package option for employee or eligible dependents. Leave under the Family and Medical Leave Act for employee. You may submit changes up to 30 days prior to the life event except for birth, adoption or placement for adoption of a child. For Medicare, Medicaid and SCHIP, you may submit changes up to 60 days prior to the life event. If you submit the request to begin employee or dependent coverage within 30 days prior to the life event, coverage will become effective the date of the event. For birth, adoption or placement for adoption of a child, if you submit the request within 60 days after the event, coverage will become effective the date of the event. For Medicare, Medicaid or SCHIP eligibility changes, if you submit the request to begin employee or dependent coverage within 60 days after the event, coverage will become effective the later of the date of notification of the event or the date of the event. For any other qualified life event, if you submit the request to begin employee or dependent coverage within 30 days after the event, coverage will become effective the later of the date of notification of the event or the date of the event. For any qualified life event, if you submit the request to drop employee or dependent coverage within 30 days before or after the event, medical, dental and vision coverage will terminate the last day of the month following the date of the event. Life insurance benefits terminate the date of the event. 2
From HR Self Service, select Life Events under the Benefits tab. Upon submitting the online Life Events Form, you will be instructed to enter benefits changes using the Benefits Enrollment page. If you fail to submit a life event or contact human resources within the specified time period following a qualified life event, you will not be able to change your benefits until the next open enrollment period. Dependents Dependents include your legal spouse, or an unmarried dependent child of you or your spouse. The term spouse means: A man or woman lawfully married to a covered member, excluding common law marriages and domestic partnerships. The term child includes any of the following: A natural child. A stepchild. A legally adopted child. A child placed for adoption. A child for whom legal guardianship has been awarded to the employee or the employee s spouse. The definition is subject to the following conditions and limitations: A dependent includes any unmarried dependent child under 19 years of age. A dependent includes an unmarried dependent child who is 19 years of age or older, but less than 25 years of age only if all of the following conditions are met: - The child must not be regularly employed on a full-time basis. - The child must be a full-time student. - The child must be primarily dependent upon the employee for support and maintenance. The plan administrator may require documentation proving that a dependent is eligible as defined above. A dependent also includes a child for whom health care coverage is required through a Qualified Medical Child Support Order or other court or administrative order. If both parents are eligible as members, only one is eligible to have coverage for their dependent children. Dependent children who are physically or mentally disabled 3
Coverage for an unmarried enrolled dependent child who is not able to be self-supporting because of a developmental disability or physical handicap will not end because the child has reached a certain age. Coverage will be extended for that child beyond the limiting age if both of the following are true regarding the enrolled dependent child: Is not able to be self-supporting because of a developmental disability or physical handicap. Depends mainly on the employee for support. 4
Schedule of Benefits How the Vision Plan Works There are two levels of vision benefits, which are based on the provider you select: 1) an innetwork provider, or 2) an out-of-network provider. When you use a VSP network provider, you pay the co-payment defined below when services are received. When you receive services from an out-of-network provider (a provider who does not participate with VSP) you will be reimbursed up to a specified amount. You pay the provider directly for all charges and submit your claim for reimbursement to VSP. Benefit Frequency Co-payment Coverage From a VSP Doctor Out-of-Network Reimbursement Eye Care Wellness Exam Once per calendar year $10 Covered in full Up to $45 allowance Diabetic Eyecare 1 As needed $20 Necessary services are covered 2 No coverage Prescription Eyewear You may choose between glasses or contacts. You are not eligible for both during the same calendar year. Lenses See below for additional lens option fees Once per calendar year Frames Once every 2 calendar years Contact Lenses Once per calendar year $25 (Applied to lenses and frame) 1 Also applies to those with glaucoma or age-related macular degeneration. 2 Limitations and coordination with medical coverage may apply. 3 Allowance applies to the cost of contact lens exam and contact lenses. Single vision, lined bifocal and lined trifocal lenses covered in full Single vision up to $45 allowance Lined bifocal up to $65 allowance Lined trifocal up to $85 allowance None Covered up to $130 allowance Up to $70 allowance None Covered up to $155 Up to $105 allowance 3 allowance Lens Options (fees based on single vision or lined-multifocal) Option Estimated Copay (participant responsibility) Polycarbonate Lenses Dependent Child $0 Adult $31 - $35 Anti-Reflective Coating $41 - $85 Photochromic Adaptive Lenses $70 - $82 Tinted (colored) Lenses $15 - $17 Progressive Lenses $55 - $175 Scratch-Resistant Coating $17 - $33 UV Protection $16 5
Covered Expenses Subject to the exclusions and limitations, covered expenses include the following vision care services. Eye Examination Covered Expenses for an eye examination include the following procedures: Refractive care distance and near. Prescribing of eyeglasses. Contact lens fitting. Case history including eye and vision history and medical history. Distance and near acuities: habitual and/or uncorrected. External and internal ocular examination. Tonometry, when professionally indicated. Binocular coordination evaluation distance and near. Color vision testing as appropriate. Advice on matters pertaining to vision care. Eyewear You may select the following types of eyewear: Any frame from the selections displayed in each doctor s office. Any spectacle lens type. Contact lenses, in lieu of eyeglasses, including standard, soft daily-wear, disposable or planned replacement and other types that are available for most prescriptions. Exclusions and Limitations Benefits will not be paid for, and covered expenses will not include, the following: Examinations required by an employer as a condition of employment. Medical treatment of eye disease or injury. Visual therapy. Replacement of lost eyewear. Eyeglass lenses and contact lenses during the same benefit year. Lenses which do not provide vision correction. Sickness or injury covered by a workers compensation act or other similar legislation. Services or supplies furnished before or after the effective date of coverage. Expenses covered by any other group insurance, union welfare plan, governmental program or plan required by law. 6
How to File a Claim If You Receive Covered Services from a Vision Service Plan (VSP) Provider VSP pays providers directly for covered services. Filing a Claim for Benefits When services and/or materials are obtained from an open access provider, members have two reimbursement choices: 1. Members can ask an open access provider to submit a request for reimbursement on their behalf. This means members won t need to pay their entire bill up front and will only be responsible for paying applicable copays and any balance above their open access schedule. 2. Members can pay the open access provider directly and submit a request for reimbursement to VSP, using the following procedure: a. Pay the open access provider the full amount and request an itemized copy of the bill. The bill should separately detail the charges for the eye exam and materials, including lens type. b. Include the following information with the bill: The name, address, and phone number of the open access provide The covered member's ID number The covered member's name, address, and phone number The name of the group The patient's name, date of birth, address, and phone number The patient's relationship to the covered member (such as self, spouse, child, student, etc.). Members can write the information on the bill or use the printable form available when members sign on to view benefits information at vsp.com. Send a copy of the itemized bill(s) with the above information to VSP at: VSP P.O. Box 997105 Sacramento, CA 95899-7105 You must submit a request for payment of benefits within one year after the date of service. If this information is not provided to VSP within one year from the date of service, benefits for that service will be denied or reduced, at the discretion of the plan administrator. 7
Questions and Appeals If your question or concern is about a benefit determination, you should contact VSP at 800-877-7195. If VSP cannot resolve the issue to your satisfaction over the phone, you may submit your question in writing to VSP. Appeal Process A qualified individual who was not involved in the decision being appealed will be appointed to decide the appeal. VSP (first-level appeals) and the plan administrator (second-level appeals) may consult with, or seek the participation of, experts as part of the appeal resolution process. Appeals Determinations You will be provided written notification of the decision on your appeal. You have the right to request a second-level appeal. Your second-level appeal request must be submitted to the plan administrator in writing within 60 days from receipt of the first level appeal decision. The second-level appeal will be conducted and you will be notified of the decision within 30 days from receipt of a request for review of the first-level appeal decision. The plan administrator has the exclusive right to interpret and administer the plan and these decisions are conclusive and binding. Termination of Coverage Your vision benefits will automatically terminate at the end of the calendar month in which you cease to be actively employed. Typically, your pretax contributions will continue through your last regular payroll period. If coverage would otherwise end due to a qualifying event, as outlined in the COBRA laws, you and your covered spouse and dependents may be eligible to continue coverage under the plan on an after-tax basis, depending on the nature of the event. 8
Coordination of Benefits Benefits When You Have Coverage under More than One Plan This section describes how benefits under the plan will be coordinated with those of any other plan that provides benefits to you. Intent The intent of coordination of benefits is to provide that the sum of benefits paid under this plan, plus benefits paid under all other plans, will not exceed the actual cost charged for a treatment or service. Definitions As used in this section, the term This Plan will mean the benefits described in this book. The term Plan will mean This Plan and any benefits provided under: Any insured or non-insured group, service, prepayment, or other program arranged through an employer, trustee, union, or association. Any program required or established by state or federal law (including Medicare Parts A and B). Any program sponsored by, or arranged through, a school or other educational agency. The first-party medical expense provisions of any automobile policy issued under a no-fault insurance statute including the self-insured equivalent of any minimum benefits required by law. The term Plan will not include benefits provided under a student accident policy, nor will the term Plan include benefits provided under a state medical assistance program where eligibility is based on financial need. Also, the term Plan will apply separately to those parts of any program that contain provisions for coordination of benefits with other Plans and separately to those parts of any program which do not contain such provisions. The terms Primary Plan/Secondary Plan means the order of benefit determination rules which determine whether This Plan is a primary plan or a secondary plan when compared to another Plan covering the person. When This Plan is primary, its benefits are determined before those of any other Plan and without considering any other Plan s benefits. When This Plan is secondary, its benefits are determined after those of another Plan and may be reduced because of the primary plan s benefits. The term Allowable Expense will mean a vision care service or expense, including deductibles, co-payments, and coinsurance, if any, that is covered at least in part by any of the Plans covering the person for whom benefits are claimed. When a Plan provides benefits in the form of services, the reasonable cash value of each service will be considered an 9
allowable expense and a benefit paid. An expense or service that is not covered by any of the plans is not an allowable expense. The term Claim Determination Period will mean the part of a calendar year during which you or a dependent would receive benefit payments under This Plan if this section were not in force. Effect on Benefits Benefits otherwise payable under This Plan for Allowable Expenses during a Claim Determination Period may be reduced if: Benefits are payable under any other Plan for the same Allowable Expenses. The rules listed below provide that benefits payable under the other Plan are to be determined before the benefits payable under This Plan. The reduction will be the amount needed to provide that the sum of payments under This Plan, plus benefits payable under the other Plan(s), is not more than the total of Allowable Expenses. Each benefit that would be payable in the absence of this section will be reduced proportionately; such reduced amount will be charged against any applicable benefit limit of This Plan. For this purpose, benefits payable under other Plans will include the benefits that would have been paid had claim been made for them. Also, for any person covered by Medicare Part A, benefits payable will include benefits provided by Medicare Part B, whether or not the person is covered under that Part B. If the person is covered by Medicare Part A but not Medicare Part B, the amount that would have been payable by Medicare Part B had coverage been in effect will be estimated. Order of Benefit Determination Except as described under Medicare Exception below, the benefits payable by a Plan that does not have a coordination of benefits provision similar to the provision described in this section will be determined before the benefits payable by a Plan that does have such a provision. In all other instances, the order of determination will be: Nondependent/Dependent. The benefits of a Plan which covers the person for whom benefits are claimed as an employee, member, or subscriber (that is, other than as a dependent) are determined before the benefits of a Plan which covers the person as a dependent. Dependent Child Parents Not Separated or Divorced. When This Plan and another Plan covers the same child as a dependent of different persons called "parents", the benefits of the Plan of the parent whose birthday falls earlier in a calendar year are determined before those of the Plan of the parent whose birthday falls later in that year; but if both parents have 10
the same birthday, the benefits of the Plan which covered the parent longer are determined before those of the Plan which covered the other parent for a shorter period of time. However, if another Plan does not have the rule described above, but instead has a rule based on the gender of the parent, and if, as a result, the Plans do not agree on the order of benefits, the rule in the other Plan will determine the order of benefits. Dependent Child Separated or Divorced Parents. If two or more Plans cover a dependent child of divorced or separated parents, benefits for the child are determined in this order: First, the Plan of the parent with custody of the child; Then, the Plan of the spouse of the parent with custody of the child; and Finally, the Plan of the parent not having custody of the child. However, if the specific terms of a court decree state that one of the parents is responsible for the health care expenses of the child, and the entity obligated to pay or provide the benefits of the Plan of that parent has actual knowledge of those terms, the benefits of that Plan are determined first. This paragraph does not apply for any Claim Determination Period or plan year during which any benefits are actually paid or provided before the entity has that actual knowledge. Joint Custody. If the specific terms of a court decree state that the parents shall share joint custody, without stating that one of the parents is responsible for the health care expenses of the child, the Plans covering the child shall follow the order of benefit determination rules for dependent children of parents who are not separated or divorced. Active/Inactive Employee. The benefits of a Plan that covers a person as an employee who is neither laid off nor retired, or as that employee's dependent, are determined before the benefits of a Plan that covers that person as a laid off or retired employee or as that employee's dependent. If the other Plan does not have this rule, and if, as a result, the Plans do not agree on the order of benefits, this rule will not apply. Continuation of Coverage. If coverage is provided for a person under a right of continuation according to federal or state law and the person is also covered under another Plan, the following will be the order of benefit determination: First, the benefits of a Plan covering the person as an employee, member or subscriber (or as that person's dependent); Second, the benefits under the continuation coverage. If the other Plan does not have the rule described above, and if, as a result, the Plans do not agree on the order of benefits, this rule will not apply. 11
Longer/Shorter Length of Coverage. If none of the above rules determine the order of benefits, the benefits of the Plan which covered an employee, member, or subscriber longer are determined before those of the Plan which covered that person for the shorter time. Medicare Exception Unless otherwise required by federal law, benefits payable under Medicare will be determined before the benefits payable under This Plan. Federal law will usually apply in such instances if: The benefits are applicable to an active (rather than a retired) member or to that member's spouse. The member's employer has 20 or more employees. Exchange of Information Any person who claims benefits under This Plan must, upon request, provide all information that is needed to coordinate benefits. In addition, all information that is needed to coordinate benefits may be exchanged with other companies, organizations, or persons. Facility of Payment Another Plan may be reimbursed if benefits were paid by that other Plan but should have been paid under This Plan in accordance with this section. In such instances, the reimbursement amounts will be considered benefits paid under This Plan and, to the extent of those amounts, will discharge This Plan from liability. Right of Recovery If it is determined that benefits paid under This Plan should have been paid by any other Plan, This Plan will have the right to recover those payments from the person to, or for whom, the benefits were paid and/or the other companies or organizations liable for the benefit payments 12
Continuation Coverage under Federal Law (COBRA) Much of the language in this section comes from the federal law that governs continuation coverage. The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to an employee when he or she would otherwise lose group health coverage. It can also become available to other members of the family who are covered under the plan when they would otherwise lose their group health coverage. Qualified Beneficiary COBRA continuation coverage must be offered to each person who is a qualified beneficiary. An employee, spouse or dependent child could become a qualified beneficiary if coverage under the plan is lost because of a qualifying event. Qualifying Events COBRA continuation coverage is a continuation of a plan s coverage when coverage would otherwise end because of a life event known as a qualifying event. An employee will become a qualified beneficiary if he or she loses coverage under the plan because one of the following qualifying events happens: Hours of employment are reduced. Employment ends for any reason other than your gross misconduct. The spouse of an employee will become a qualified beneficiary if he or she loses coverage under the plan because any of the following qualifying events happens: Employee dies. Employee s hours of employment are reduced. Employee s employment ends for any reason other than his or her gross misconduct. Employee becomes entitled to Medicare benefits (under Part A, Part B, or both). Spouse becomes divorced or legally separated from the employee. A dependent child will become a qualified beneficiary if he or she loses coverage under the plan because any of the following qualifying events happens: The parent-employee dies. The parent-employee s hours of employment are reduced. The parent-employee s employment ends for any reason other than his or her gross misconduct. The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both). 13
The parents become divorced or legally separated. The child stops being eligible for coverage under the plan as a dependent child. COBRA Notification The plan will offer COBRA continuation coverage to qualified beneficiaries only after the plan administrator has been notified that a qualifying event has occurred. The employer must notify the plan administrator of the following qualifying events. End of employment Reduction of hours Death of the employee Commencement of a proceeding in bankruptcy with respect to the employer. Employee s becoming entitled to Medicare benefits (under Part A, Part B, or both). The employee must notify the employer of the following qualifying events. Divorce or legal separation of the employee and spouse. A dependent child s losing eligibility for coverage as a dependent child. An employee must notify the employer within 60 days after the qualifying event occurs. The employee must provide this notice to the HR helpline at ext. 2999, (800-432-8999), option 1, or by e-mail at hrhelpline@midamerican.com. Length of COBRA Continuation Coverage Once the plan administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children. Continuation coverage up to a total of 18 months COBRA continuation coverage generally lasts for only up to a total of 18 months when the qualifying event is: The end of employment. Reduction of the employee s hours of employment. When the qualifying event is the end of employment or reduction of the employee s hours of employment, and the employee became entitled to Medicare benefits less than 18 months before the qualifying event, COBRA continuation coverage for qualified beneficiaries other than the employee lasts until 36 months after the date of Medicare entitlement. For example, if a covered employee becomes entitled to Medicare eight 14
months before the date on which his employment terminates, COBRA continuation coverage for his spouse and children can last up to 36 months after the date of Medicare entitlement, which is equal to 28 months after the date of the qualifying event (36 months minus eight months). Disability extension of 18-month period of continuation coverage If an employee or anyone in his or her family covered under the plan is determined by the Social Security Administration to be disabled and the plan administrator is notified in a timely fashion, the employee and his or her entire family may be entitled to receive up to an additional 11 months of COBRA continuation coverage, for a total maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of continuation coverage. Second qualifying event extension of 18-month period of continuation coverage If a family experiences another qualifying event while receiving 18 months of COBRA continuation coverage, the spouse and dependent children in the family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if notice of the second qualifying event is properly given to the plan. This extension may be available to the spouse and any dependent children receiving continuation coverage if the employee or former employee dies, becomes entitled to Medicare benefits (under Part A, Part B, or both), or gets divorced or legally separated, or if the dependent child stops being eligible under the plan as a dependent child, but only if the event would have caused the spouse or dependent child to lose coverage under the plan had the first qualifying event not occurred. Continuation coverage up to a total of 36 months COBRA continuation coverage lasts for up to a total of 36 months when the qualifying event is: The death of the employee. The employee s becoming entitled to Medicare benefits (under Part A, Part B, or both). Divorce or legal separation. Dependent child s losing eligibility as a dependent child. 15
Cost Each qualified person may be required to pay the entire cost of continuation coverage. The amount a qualified person may be required to pay may not exceed 102 percent of the cost to the group health plan (including both employer and employee contributions). In the case of an extension of continuation coverage due to a disability, the amount a qualified beneficiary may be required to pay may not exceed 150 percent. Plan Changes Continued coverage will be subject to the same benefits and rate changes as the group coverage. Newly Acquired Dependents A qualified person may elect coverage for a dependent acquired during COBRA continuation. All enrollment requirements that apply to dependents of active members apply to dependents acquired by qualified persons during COBRA continuation. Coverage for a newly acquired dependent will end on the same dates as described for qualified persons above. Coverage for newly acquired dependents will not be extended as a result of a second qualifying event except for a dependent child who is born to or placed for adoption with the member. Termination of COBRA Coverage COBRA coverage ends the earliest of the following: The date the maximum continuation period ends. The date the qualified person enrolls in Medicare. The end of the last coverage period for which payment was made if payment is not made. The date the employer's group health coverage is terminated (and not replaced by another group health plan). The date the qualified person becomes covered by another group health plan and has satisfied any preexisting exclusion provisions under that plan. 16
Family and Medical Leave Act (FMLA) Federal law requires that eligible employees be provided a continuation period in accordance with the provisions of the Federal Family and Medical Leave Act (FMLA). This is a general summary of the FMLA. Contact human resources for details on FMLA. Eligibility for FMLA Leave An employee is eligible for FMLA if he or she is: Any active company employee who has been employed by the company for at least 12 months. Has at least 1,250 hours worked during the 12-month period immediately preceding commencement of the FMLA leave. Mandated Unpaid Leave An eligible employee may take FMLA for the following reasons: The birth or adoption of an infant or child by the employee. To care for a foster child of the employee. To care for the spouse, son, daughter or parent of the employee, if this individual has a serious health condition. A serious health condition that makes the employee unable to perform the functions of his/her position. An employee is entitled to a combined maximum of up to 12 weeks leave in a rolling 12- month period for one, or a combination of reason(s) listed above. Leave for birth, adoption or fostering a child is expected to be taken within 12 months of the event. When both spouses are employed by the company, employees are entitled to a combined leave of up to 12 weeks in a rolling 12-month period for birth, adoption, or fostering of a child. Each spouse may take 12 weeks for his or her own, or a family member's serious health condition. Additional leave at the conclusion of FMLA can be requested in accordance with the personal leave policy. Benefits Continuation during FMLA The company will continue to maintain the employee's same group health plan and benefits that the employee had prior to beginning the unpaid portion of his or her FMLA leave. The employee may be required to continue to pay his or her portion of those premiums in order to maintain such coverage during an unpaid leave. If the employee has 17
insufficient earnings to pay for benefit deductions, the company may deduct such amounts from future wages. If the employee fails to return from the FMLA leave or returns for less than 30 calendar days unless excused by another company leave policy, the company may recover any premiums paid by the company on behalf of that employee during the leave. 18
Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA) Federal law requires that if an employee s coverage would otherwise end because an employee enters into active military duty, the employee may elect to continue coverage (including dependent coverage) in accordance with the provisions of Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA). Following is a general summary of USERRA and how it affects your group plan. Contact human resources for details on this continuation provision. Benefits Continuation and Cost If active employment ends because an employee enters active military duty, benefit coverage may be continued until the earliest of: If the leave will be less than 31 days, coverage will continue without interruption. The costs of benefits will continue as if the employee were at work. If the leave is expected to extend for more than 31 days, employees may elect to continue the company-sponsored group medical, dental and other health related insurance for up to 24 months, but will be required to pay the full cost plus 2 percent of the continued insurance benefits. Life insurance and long term disability insurance will terminate on the first day of leave. Reinstatement of Benefits Upon re-employment, the employee will be immediately eligible for coverage in the company-sponsored group medical, dental and other health related benefits. Life insurance and long term disability insurance will be reinstated, subject to acceptance by the then current insurance carrier. The reinstatement time period may be extended for an approved leave of absence taken in accordance with the provisions of the federal law regarding USERRA. 19
General Provisions Plan Document This summary plan description presents an overview of your benefits. In the event of any discrepancy between this summary plan description and the official plan document, the plan document shall govern. Amendments to the Plan MidAmerican Energy Company reserves the right to change, interpret, modify, withdraw or add benefits or terminate the plans. Plan amendments and riders are effective on the date specified. Any provision of the plans which, on its effective date, is in conflict with the requirements of federal statutes or regulations, or applicable state law provisions not otherwise pre-empted by ERISA (of the jurisdiction in which the plans are delivered) is hereby amended to conform to the minimum requirements of such statutes and regulations. Legal Action Legal action for a claim may not be started earlier than 90 calendar days after proof of loss is filed and before the appeal procedures have been exhausted. Further, no legal action may be started later than three years after proof is required to be filed. Time Limits All time limits listed in this section will be adjusted as required by law. Right of Recovery If it is determined that benefits paid under the plan document are in excess of benefits that should have been paid, the plan administrator will have the right to recover those payments from the person to or for whom the benefits were paid. 20
Statement of Employee Retirement Income Security Act of 1974 (ERISA) Rights As a participant in the MidAmerican Energy Company Welfare Benefit Plan you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA). ERISA provides that all plan participants shall be entitled to: Receive Information about your Plan and Benefits Examine, without charge, at the plan administrator's office and at other specified locations, such as worksites and union halls, all documents governing the plan, including insurance contracts and collective bargaining agreements, and a copy of the latest annual report (Form 5500 Series) filed by the plan with the U.S. Department of Labor and available at the Public Disclosure Room of the Employee Benefits Security Administration. Obtain, upon written request to the plan administrator, copies of documents governing the operation of the plan, including insurance contracts and collective bargaining agreements, and copies of the latest annual report (Form 5500 Series) and updated summary plan description. The administrator may make a reasonable charge 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. Continue Group Health Plan Coverage Continue health care coverage for yourself or your dependents if there is a loss of coverage under the plan as a result of a qualifying event. You or your dependents may have to pay for such coverage. Review this summary plan description and the documents governing the plan on the rules governing your COBRA continuation coverage rights. Reduction or elimination of exclusionary periods of coverage for pre-existing conditions under your group health plan, if you have creditable coverage from another plan. You should be provided a certificate of creditable coverage, free of charge, from your group health plan or health insurance issuer when you lose coverage under the plan, when you become entitled to elect COBRA continuation coverage, when your COBRA continuation coverage ceases, if you request it before losing coverage, or if you request it up to 24 months after losing coverage. Without evidence of creditable coverage, you may be subject to a pre-existing condition exclusion for 12 months (18 months for late enrollees) after your enrollment date in your coverage. 21
Prudent Actions by Plan Fiduciaries In addition to creating rights for plan participants, ERISA imposes duties upon the people who are responsible for the operation of the employee benefit plan. The people who operate your plan, called "fiduciaries" of the plan, have a duty to do so prudently and in the interest of you and other plan participants and beneficiaries. No one, including your employer, your union, or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a welfare benefit or exercising your rights under ERISA. If your claim for a welfare benefit is denied in whole or in part you must receive a written explanation of the reason for the denial. You have the right to have the plan review and reconsider your claim. Enforce Your Rights If your claim for a welfare benefit is denied or ignored, in whole or in part, you have a right to know why this was done, to obtain copies of documents relating to the decision without charge, and to appeal any denial, all within certain time schedules. Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request a copy of plan documents or the latest annual report from the plan 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 administrator. If you have a claim for benefits which is denied or ignored, in whole or in part, and you have exhausted the administrative remedies available under the plan, you may file suit in a state or federal court. In addition, if you disagree with the plan's decision or lack thereof concerning the qualified status of a domestic relations order or a medical child support order, you may file suit in 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 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 your 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 Area Office of the 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. 20210. You may also obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the Employee Benefits Security Administration. 22
Summary Plan Description The Employee Retirement Income Security Act (ERISA) requires that certain information be furnished to each participant in an employee benefit plan. This book is the summary plan description for purposes of ERISA. Name of plan: Plan number: 509 Plan type: Effective date of plan year: Name, address and telephone number of plan sponsor and named fiduciary: MidAmerican Energy Company Welfare Benefit Plan Vision EIN: 42-1425214 Name, address and telephone number of plan administrator Person designated as agent for service of legal process: Type of administration: Plan administration: January 1 through December 31 MidAmerican Energy Company 666 Grand Avenue P.O. Box 657 Des Moines, IA 50309-0657 515-242-4300 MEC Pension and Employee Benefits Plans Administrative Committee 666 Grand Avenue P.O. Box 657 Des Moines, IA 50309-0657 515-242-4300 Secretary MidAmerican Energy Company 666 Grand Avenue P.O. Box 657 Des Moines, IA 50309-0657 Plan document The plan sponsor, as plan administrator within the meaning of ERISA, has complete discretion to construe or interpret all provisions, to determine eligibility for benefits, and to determine the type and extent of benefits, if any, to be provided. The plan sponsor's decisions in such matters shall be controlling, binding, and final. In any action to review any such decision by the plan sponsor, the plan sponsor shall be deemed to have exercised its discretion properly unless it is proved duly that the plan sponsor has acted arbitrarily and capriciously. 23
Type of administration of the plan: Claims Administrator: Type of participants covered under the plan: Source of contributions under the plan: Method of calculating the amount of contribution: Date of the end of the year for purposes of maintaining plan's fiscal records: Determinations of qualified medical child support orders: The plan sponsor provides certain administrative services in connection with its plan. The plan sponsor may, from time to time in its sole discretion, contract with outside parties to arrange for the provision of other administrative services; claims processing services, including coordination of benefits and subrogation; utilization management and complaint resolution assistance. The company that provides certain administrative services for the plan. VSP P.O. Box 997105 Sacramento, CA 95889-7105 Employees of MidAmerican Energy Company or its subsidiaries as defined in this book. All benefits under the plan are paid by VSP. Any required employee contributions are used to partially reimburse the plan sponsor for benefits under the plan. Employee-required contributions to the plan sponsor are the employee's share of costs as determined by plan sponsor. From time to time, the plan sponsor will determine the required employee contributions for reimbursement to the plan sponsor and distribute a schedule of such required contributions to employees. Plan year shall be a twelve-month period ending December 31. The plan's procedures for handling qualified medical child support orders are available without charge upon request to the plan administrator. 24