SUMMARY PLAN DESCRIPTION ARCHDIOCESE OF CINCINNATI CAFETERIA PLAN (as of January 1, 2010)
SUMMARY PLAN DESCRIPTION ARCHDIOCESE OF CINCINNATI CAFETERIA PLAN INTRODUCTION The Archdiocese of Cincinnati (the Archdiocese ) established the Archdiocese of Cincinnati Cafeteria Plan (the Plan ) for employees effective as of July 1, 2009 for the exclusive benefit of the Plan s participants and their dependents. The Plan permits you to tailor your own benefits package to meet your and your family s needs, and provides you with the opportunity to use salary reduction contributions, on a pre-tax basis, to pay for selected benefits. This booklet describes the basic features of the Plan, how the Plan can benefit you, and your rights under federal law. It is only a summary of the Plan. It is not a part of the official Plan document. In the event of a conflict between this booklet and the Plan document, the Plan document will govern. Copies of the Plan document are available for your inspection at the Archdiocese s office located at 100 East Eighth Street, Cincinnati, Ohio 45202. You may also obtain your own copies by writing to the Plan Administrator at this address. There may be a small charge for duplicating and postage. GENERAL INFORMATION ABOUT THE PLAN Name of the Plan. The name of the Plan is the Archdiocese of Cincinnati Cafeteria Plan. Plan Sponsor. The Archdiocese is the Plan sponsor. The Archdiocese s address is 100 East Eighth Street, Cincinnati, Ohio 45202. Identification Numbers. The Archdiocese s Employer Identification Number is 31-0538501. The Plan Number is 510. Type of Plan and Plan Benefits. The Plan consists of several component plans, some of which are welfare benefit plans. Generally, the Plan allows you to receive your full salary (less required tax withholding) for the plan year in cash or to have the Archdiocese apply a part of your earnings to the cost of certain benefits under the component plans. Name and Address of the Plan Administrator. The Archdiocese is the Plan Administrator, but it may delegate certain administration responsibilities to such person, or other entity as appropriate from time to time. The Plan Administrator s address is 100 East Eighth Street, Cincinnati, Ohio 45202 and its telephone number is (513) 421-3131. Agent for Service of Legal Process. The Archdiocese is the agent for service of process. Effective Date. The effective date of the Cafeteria Plan is July 1, 2009. The effective date of the Medical Reimbursement Plan and Dependent Care Plan is January 1, 2010.
Plan Year. The plan year of the Plan is the twelve-month period beginning on July 1 and ending on June 30. Since the Medical Reimbursement Plan and the Dependent Care Plan are not effective until January 1, 2010, the first Plan Year for those Plans will be a short plan year of January 1, 2010 to June 30, 2010. PARTICIPATION Eligibility and Date of Participation. As an employee of the Archdiocese, you become a Plan participant as you meet the eligibility requirements for the benefit programs included in the Plan. All employees who are maintained on the Archdiocese-wide payroll system and who are eligible for the Archdiocese s health care plan as of July 1, 2009 are eligible to participate in the Cafeteria Plan for purposes of paying Medical Plan premiums on a pre-tax basis. Each employee who later becomes eligible to participate in the health care plan shall be eligible to participate in the Cafeteria Plan on the first day of the month following the date of employment. Employees who work at locations that provide for participation in the plan, are on the Archdiocese-wide payroll system, and work 20 or more hours a week or teach 12 or more classroom hours per week are eligible to participate in the Medical Reimbursement Plan and the Dependent Care Plan on the later of January 1, 2010 or the first day of the month following the date of they meet the eligibility requirements. Employment at more than one location will be combined for determining hours a week worked. School employees are eligible if they meet the above stated hourly requirements for the period of time school is in session. Effective July 1, 2010, employees of St. Joseph Orphanage are permitted to participate in the Plan regardless of whether such employees are maintained on the Archdiocese-wide payroll system, but provided that such employee otherwise satisfies the requirements to participate in the Medical Plan, Medical Reimbursement Plan, or the Dependent Care Plan. Termination of Plan Participation. Your participation in the Plan will terminate on the earlier of: (a) (b) (c) the date the Plan is terminated; the date you cease to be an employee of the Archdiocese; or the date you no longer participate in any benefits offered under the Plan. PLAN BENEFITS Optional Benefits. Under the Plan you may elect to receive one or more of the following optional benefits: 2
benefits available under the Archdiocese s Medical (including dental and vision) Plans; benefits under the Archdiocese s Medical Reimbursement Plan; benefits under the Archdiocese s Dependent Care Plan. Each of the above benefits is described in more detail below. Benefit elections may be made with your salary reduction contributions. Medical Plan Coverage. If you are otherwise eligible to participate in any Archdiocesesponsored Medical Plans (including dental and vision plans), you may choose from among the coverages available under those plans and pay your share of the premium through this Plan with your salary reduction contributions. Medical Reimbursements. You may elect to receive reimbursement of some or all of your uninsured medical expenses through the Plan. The Archdiocese has established a related Medical Reimbursement Plan to provide a source of pre-tax funds to reimburse you for these expenses. If you elect this benefit, a Health Care Flexible Spending Account is established for you which you may fund with salary reduction contributions. The maximum amount of payments which you may receive from your Health Care Flexible Spending Account is $2400 for each plan year or such other amount as established by the Plan Administrator and communicated to you at the beginning of the plan year. The amount of salary reduction contributions which you elect to contribute to your Health Care Flexible Spending Account is credited to your account at the beginning of the plan year and is available for reimbursement of your out-of-pocket medical expenses at any time during the plan year, reduced by the amount of prior reimbursements you received during the year. The expenses which are eligible for reimbursement from your Health Care Flexible Spending Account include hospital bills, doctor and dental bills, drugs (including over-thecounter medications), and expenses for medical, dental and vision care which are not reimbursed or otherwise paid for through insurance or otherwise. No medical expenses that are contradictory to the beliefs of the Catholic Church (e.g., contraceptives) will be paid or reimbursed from this plan. Whether an expense is eligible to be paid or reimbursed from this plan will be in the sole discretion of the Plan Administrator. Reimbursable expenses must be incurred by you, your spouse, or an individual whom you may claim as a dependent for income tax purposes. However, if your spouse or dependent is enrolled in a Health Savings Account ( HSA ), their medical expenses are not payable or reimbursable expenses under this plan as long as they are eligible to contribute to the Health Savings Account. To receive a reimbursement you must submit a claim form provided by the Plan Administrator, together with documentation (e.g. receipts, canceled checks, invoices, etc.) 3
required under procedures established by the Plan Administrator. You may not be reimbursed for expenses arising before your participation in this benefit becomes effective, or for expenses incurred after the plan year ends. Claims must be submitted to the Plan Administrator for reimbursement on or before the September 30 th following the close of the plan year. If you use your electronic payment card program (debit card, credit card, or similar method) to pay expenses from your Health Care Flexible Spending Account, some expenses may be validated at the time the expense is incurred (like co-pays for medical care). For other expenses, the card payment is only conditional and you will still have to submit supporting documents. If any amount remains in your health care spending account after all reimbursements of eligible expenses for the plan year have been made, that balance will be forfeited and not be available to you for future use. Dependent Care Reimbursements. You may elect to receive reimbursement of some or all of your dependent care expenses through the Plan. The Archdiocese has established a related Dependent Care Plan to provide a source of pre-tax funds to reimburse you for these expenses. If you elect this benefit, a Dependent Care Flexible Spending Account is established for you which you may fund with salary reduction contributions. The maximum amount of payments which you may receive from your Dependent Care Flexible Spending Account in any plan year is $5,000 (this amount is $2,500 for the plan year ending June 30, 2010) or $2,500 in the case of a married participant filing a separate tax return (this amount is $1,250 for the plan year ending June 30, 2010), but not in excess of your earned income for the year, or if you are married, not in excess of the lesser of your or your spouse s earned income for the year. In the case of a spouse who is a full-time student at an educational institution or is physically or mentally incapable of caring for himself, such spouse shall be deemed to have earned income of not less than $250 per month if the Participant has one Dependent and $500 per month if the Participant has 2 or more Dependents. Eligible dependents for whom you may claim reimbursements include any individual in your family who is under age 13 whom you could claim as a dependent for income tax purposes, any dependent who is mentally or physically unable to care for himself or herself, or your spouse if he or she is likewise physically or mentally incapacitated. The expenses that are eligible for reimbursement are expenses incurred for the care of an eligible dependent to enable you to be gainfully employed. If the expenses are incurred for services outside your household, they must be incurred for the care of an eligible dependent who regularly spends at least 8 hours per day in your household. If the expenses are incurred for services provided by a dependent care center (i.e., a facility that provides care for more than 6 individuals not residing at the facility), the center must comply with all applicable state and local laws and regulations. In addition, to be eligible expenses, they must not be paid or payable to a child of yours who is under age 19 at the end of the year in which the expenses are incurred, to 4
an individual whom you or your spouse may claim as a dependent for income tax purposes, or for services at a camp. To receive a reimbursement you must submit a claim to the Plan Administrator on a claim form available to participants, together with documentation satisfactory to the Plan Administrator that you incurred the expense and that it is eligible for reimbursement. If your Dependent Care Flexible Spending Account balance is sufficient, you will be reimbursed for your claimed expenses as soon as administratively possible after it is submitted. Claims in excess of your account balance will not be paid until your balance becomes adequate. You may not be reimbursed for expenses arising before your participation in the plan becomes effective, or for any expenses incurred after the end of the plan year. Claims must be submitted for reimbursement on or before the September 30 th following the close of the plan year. If you use your electronic payment card program (debit card, credit card, or similar method) to pay expenses from your Dependent Care Flexible Spending Account, the card payment is only conditional and you will still have to submit supporting documents to substantiate your expense. If any amount remains in your dependent care spending account after all reimbursements of eligible expenses for the plan year have been made, that balance will be forfeited and not be available to you for future use. In addition, you may not claim any other tax benefit, such as the dependent care tax credit, relative to the tax-free amounts received by you under the dependent care plan. Therefore, you should consult your tax advisor on whether the dependent care tax credit would be more beneficial to you than the tax-free benefits under the dependent care plan. Tax Treatment. The Plan Administrator makes no commitment or guarantee that any amounts paid under the Plan to you or for your benefit will be excludable from your gross income for federal or state income tax purposes. It is your obligation to determine whether each payment you receive under the Medical Reimbursement Plan and/or Dependent Care Plan is excludable from your gross income for federal and state income tax purposes, and to notify the Plan Administrator if you have reason to believe that any such payment is not excludable. If the Archdiocese incurs any liability for failure to withhold federal and state income tax or social security tax with respect to any such payments or reimbursements which are not excludable from your gross income for tax purposes, you must indemnify and reimburse the Archdiocese for any such liability. ELECTION PROCEDURES Election Period. Prior to the commencement of each plan year, the Plan Administrator will provide you with a written election form whereby you make your benefit selections. A salary reduction agreement will also be included in the form whereby you agree to reduce your salary per pay period by any amount required to fund the benefits selected. Your election will go into effect the first day of the plan year, or, if later, the first day of the pay period following the 5
date you become a participant. If you wish to participate in the Plan, you must so specify on the election form and agree to a reduction in your pay. The amount of the reduction in your pay for the plan year will be equal to your share of the premium under the medical plan and the cost of the optional benefits you elect. Each election form must be completed and returned to the Plan Administrator on or before the date specified by the Plan Administrator. This date shall be no later than the beginning of the first pay period for which the compensation reduction agreement will apply. Failure to Elect. Unless otherwise provided in procedures established by the Plan Administrator, if you fail to return a completed election form to the Plan Administrator on or before the due date for the first plan year you are eligible, the Plan Administrator will deem that you have elected to receive your full compensation in cash; or if you fail to return a completed election form to the Plan Administrator during the open enrollment period for any subsequent plan year, the Plan Administrator will assume that you made the election to receive your full compensation in cash. However, any previous election to pay premiums on a pre-tax basis for the Medical Plan shall continue in effect each year until revoked. For employees who become eligible to participate in the Plan during a plan year, the election period will be such period as established by the Plan Administrator that begins with the date you accept the job or the day you become an eligible employee. The effective date of such election will not be earlier than the first pay period beginning after the election form is completed and returned to the Plan Administrator. Irrevocability of Election. Generally, elections made under the Plan will be irrevocable for the plan year. However, there are certain circumstances that you may revoke a benefit election for the balance of a plan year and file a new election, but only if both the revocation and the new election are consistent with the change in circumstance. You may revoke your Cafeteria Plan election, your Medical Reimbursement Plan election and/or your Dependent Care Plan election if you have a change in status. A change in status includes: (1) marriage, divorce, legal separation, or annulment; (2) change in the number of your dependents, including death of your spouse or child, birth, placement for adoption or adoption of a child; (3) you or your spouse incurring a termination or commencement of employment, a strike or lockout, commencement or return from an unpaid leave of absence, a change in your primary worksite, or any change in employment status that affects you or your spouse s eligibility for benefits; (4) your dependent satisfies or ceases to satisfy the requirements for coverage; or (5) a change in the place of your residence or your spouse or dependent s residence. A change in status will also include other events that the Plan Administrator determines the Internal Revenue Service will permit during a plan year under its rules and regulations. Additionally, you may change your Dependent Care Plan election in the middle of the year if your dependent ceases to meet the conditions to be eligible for dependent care (e.g., your child turns age 14). If the cost of a benefit under the Medical Plan (including the dental and vision plans) increases or decreases during a plan year, then the Archdiocese will automatically increase or decrease your salary reduction election. If the cost of the Medical Plan significantly increases (as determined by the Archdiocese), you are allowed to either increase your benefit election, 6
revoke your benefit election and elect another benefit option, or revoke your election entirely. You will also be permitted to make changes if either of the events occur to a medical plan offered by your spouse s employer. If the cost of your dependent care expenses significantly increases or decreases, you may make a corresponding election to the Dependent Care Plan (unless the cost change is imposed by a dependent care provider who is your relative). If the coverage under the Medical Plan (or a medical plan of your spouse s employer) is significantly curtailed or is no longer offered, you are allowed to revoke your elections and elect on a prospective basis coverage under another medical plan. Additionally, if the Archdiocese s or your spouse s employer adds a new benefit, you may change your election mid-year. The Plan Administrator will prescribe the effective date of any new election. This date will not be earlier than the first pay period beginning after the election form is completed and returned to the Plan Administrator. CLAIMS PROCEDURE Medical Plans. If you have a claim regarding the benefits under one of the Medical Plans, you must follow the claims procedures as outlined in the Medical Plan documents. Medical Reimbursement Plan and Dependent Care Plan. If you have a claim regarding the nonpayment of all or part of a Plan benefit under the Medical Reimbursement Plan or Dependent Care Plan, you or your duly authorized representative may mail or deliver a letter stating your complaint to the person or office responsible for the Archdiocese s employee benefits. The Plan Administrator or its delegate shall decide upon your claim and notify you of the decision within a reasonable period of time after receipt of the claim; provided however, that such period shall in no event exceed 30 days, unless special circumstances beyond the control of the Plan require an extension of time for processing. If such an extension of time for processing is required, then you shall, prior to the termination of the initial 30-day period, be furnished a written notice indicating such special circumstances and the date by which the Plan Administrator or its delegate expects to render a decision. In no event shall the extension exceed a period of 15 days from the end of the initial period. If such an extension is necessary due to your failure to submit the information necessary to decide the Claim, the notice of extension shall specifically describe the required information, and you shall be afforded at least 45 days from receipt of the notice to provide the specified information. If the Claim is wholly or partially denied, then the Plan Administrator or its delegate shall furnish to you, within the time limit applicable, a written notice setting forth the specific reason or reasons for such denial, specific reference to the pertinent Plan provisions on which the denial is based, a description of any additional material or information necessary for you to perfect your Claim and an explanation of why such material or information is necessary, appropriate information as to the steps to be taken if you wish to submit this Claim for review and if the 7
denial is based on a medical necessity or experimental treatment or similar exclusion or limit, an explanation of the scientific or clinical judgment for such denial that applies the terms of the Plan to your medical circumstances, or a statement that such explanation will be provided free of charge upon request. If your claim is denied you must submit a request for review within 180 days after you receive the initial claim denial. In deciding a request for review of a claim, the review shall not afford deference to the initial adverse benefit determination and shall be conducted by an appropriate named fiduciary of the Plan who is neither the individual who made the original adverse benefit determination that is the subject of the appeal, nor the subordinate of such individual. A decision on the Review shall be made within 60 days after receipt of the request for review. PLAN AMENDMENT OR TERMINATION The Archdiocese expects the Plan to be permanent but has the right to amend or terminate the Plan at any time. 2000506.4 8