This bklet, tgether with the applicable insurance plicies, certificates f cverage r ther cmpnent plan benefit bklets serve as bth the fficial plan dcuments and as the summary plan descriptins fr the benefits prvided under the (Plan). reserves the right t amend, suspend r terminate the Plan r any f the benefits there under at any time and fr any reasn. Only, the Plan Administratr r the designated claims fiduciary is authrized t interpret the Plan and will d s nly in writing. Yu shuld nt rely n any representatin whether verbal r in writing that any ther individual may make cncerning Plan prvisins and yur entitlement t benefits under the Plan.
Table f Cntents Table f Cntents... i-ii IMPORTANT Infrmatin... 1 Plan Spnsr and Participating Emplyers... 1 Plan Administratin... 2 Plan Administratr... 2 Claims Administratr... 2 Discretinary Authrity f Plan Administratr and Plan Fiduciaries... 2 Plan Funding and Plan Expenses... 3 Self-Funded Benefits... 3 Insured Benefits... 3 Plan Expenses... 3 Plan Limitatins... 3 Plan Cntinuance and Amendment r Terminatin... 3 Plan Recrds... 4 Reimbursement, Recvery f Overpayment, and Subrgatin... 4 Agent f Service fr Legal Prcess... 4 Claims and Appeals Prcedures... 4 Yur Rights Under ERISA... 4 Yur Right t Receive Infrmatin Abut Yur Plan and Benefits... 4 Yur Right t Cntinue Grup Health Plan Cverage... 5 Yur Right t Prudent Actins by Plan Fiduciaries... 5 Hw t Enfrce Yur Rights... 5 Assistance with Yur Questins... 6 Summary Plan Infrmatin... 6 APPENDIX -- Emplyee Eligibility and Terminatin f Cverage... 10 A regular full-time LMU faculty member;... 10 A regular full-time Westchester staff member wrking at least 40 hurs a week;... 10 A regular full-time Lyla Law Schl faculty member;... 10 A regular full-time Lyla Law Schl staff member wrking at least 35 hurs a week; r... 10 A part-time regular faculty r staff member (defined as any psitin that is at least 50 percent full-time equivalent, 50 percent time and effrt r greater) wh has been previusly enrlled in the LMU plans as a full-time regular:... 10 Yur legal spuse;... 10 Yur registered dmestic partner;... 10 i
Yur unmarried dependent children under age 19 (under age 21 fr dependent life insurance)... 10 Fr yur medical plus dental/visin care, children thrugh age 25 whether r nt they are married r full-time students.... Errr! Bkmark nt defined. Yur unmarried disabled children (Each insurance cmpany has special rules fr children with disabilities. Onging prf f disability is required.)... 11 APPENDIX Change in Status... 12 APPENDIX Leaves f Absence... 14 Paid Leave f Absence... 14 Unpaid Leave f Absence... 14 Family and Medical Leave Act... 15 Military Leave (Health and Dental Plans)... 16 Reinstatement Upn Return Frm Leave... 17 APPENDIX -- QMCSO Prcedures... 18 APPENDIX -- COBRA Cntinuatin Cverage... 19 In General... 19 Qualifying Events... 19 Electing COBRA Cverage... 20 Length f Cntinuatin Cverage... 21 Cverage Optins, Cst, and Timing f Payments... 22 Eligibility and Ptential Cnversin Rights... 23 Early Terminatin f COBRA Cntinuatin Cverage... 24 Any Questins?... 25 APPENDIX Rules Regarding Use and Disclsure f Prtected Health Infrmatin... 26 Use and Disclsure f Prtected Health Infrmatin... 26 Use and Disclse PHI as Permitted by Authrizatin f the Participant r Beneficiary... 26 Disclsure t the Emplyer... 26 Adequate Separatin Between the Plan and the Emplyer Must Be Maintained... 27 APPENDIX Claims and Appeals Prcedures... 28 Applicatin... 28 Summary... 28 All Plans... 30 Filing Claims fr Benefits... 30 Changes in the Law... 30 APPENDIX Required Ntices (Grup Health Plans Only)... 30 Wmen s Health and Cancer Rights Act f 1998... 30 Newbrns and Mthers Health Prtectin Act f 1996... 31 Ntice f HIPAA Special Enrllment Rights... 31 Ntice fr Pre-existing Cnditin Exclusin Limitatin... 32 ii
IMPORTANT Infrmatin This bklet tgether with the applicable insurance plicies, certificates f cverage r ther cmpnent plan benefit bklets that yu receive serve bth as the fficial plan dcuments and as the summary plan descriptins fr the fllwing benefits prvided under the Plan and spnsred by ( LMU ): Medical Dental/Visin Lng-Term Disability (LTD) Insurance Accidental Death and Dismemberment (AD&D) Insurance Faculty/Staff Member and Dependent Life Insurance Lng-Term Care (LTC) Insurance Vluntary Benefits Flexible Spending Accunts (FSAs) Cmmuter Benefits Yu can als participate in the Emplyee Assistance Prgram (EAP), which is autmatically prvided yu d nt need t enrll. In the event f a cnflict between the benefits infrmatin in this bklet and the applicable insurance plicies, certificates f cverage r ther benefit bklets, the insurance plicy, certificate f cverage r ther benefit bklet will prevail. Additinal cpies f the insurance plicies, certificates f cverage and ther benefit bklets are available thrugh the Plan Administratr. This bklet includes infrmatin abut the administratin f the benefits under the Plan and yur rights under the Emplyee Retirement Incme Security Act f 1974, as amended (ERISA). Except as therwise prvided herein, this bklet and the applicable insurance plicies, certificates f cverage r ther cmpnent plan benefit bklets replace all summary plan descriptins previusly issued with regard t the benefits prvided under the Plan. Plan Spnsr and Participating Emplyers The Plan Spnsr fr the Plan is LMU. The Internal Revenue Service assigns every emplyer an Emplyer Identificatin Number (EIN). The Plan Spnsr s EIN is 95-1643334. If yu need t write t a gvernment agency abut a benefit plan, use this number alng with the Plan name, Plan identificatin number, and the Plan Spnsr s name. The term Emplyer as used herein refers t LMU and its participating affiliated entities that adpt the Plan with LMU s apprval. Participants and beneficiaries may receive frm the Plan Administratr, upn written request, infrmatin as t whether a particular Emplyer is a spnsr f the Plan and if the Emplyer is a plan spnsr, the spnsr s address. 1
Plan Administratin Plan Administratr is the Plan Administratr with respect t the Plan. Yu can cntact LMU at the fllwing address and telephne number: One LMU Drive, Suite 1900 Ls Angeles, CA 90045 (310) 338-2723 Claims Administratr LMU has delegated authrity under the Plan t the respective insurance cmpany r third party administratr t administer benefit claims under the applicable grup insurance cmpnent plans. LMU may designate different Claims Administratrs frm time t time, at LMU s discretin. The Claims Administratr fr each benefit is identified in the chart in the Summary Plan Infrmatin sectin belw. Discretinary Authrity f Plan Administratr and Plan Fiduciaries The Plan Administratr has the full and discretinary authrity and pwer t administer and cnstrue the Plan (and any cmpnent plans there under) except t the extent that such pwers have been delegated t the Claims Administratr. Withut limiting the generality f the freging, the Plan Administratr shall have the fllwing pwers and duties: Except as therwise prvided belw, t interpret and cnstrue the prvisins f the Plan and t decide any dispute which may arise regarding the rights f participants and beneficiaries under the Plan, which determinatins shall be final and cnclusive n all persns claiming benefits under the Plan; prvided, hwever, that if an insurance certificate sets frth a specific claims prcedure, such prvisins shall apply fr purpses f that cmpnent plan, cnsistent with the Claims and Appeals Prcedures sectin belw; and T make and enfrce such rules and regulatins as it may deem necessary r prper fr the efficient administratin f the Plan. Fr cmpnent plans prvided thrugh grup insurance, the insurance cmpany, nt LMU, is respnsible fr paying the actual cst f eligible claims yu and yur dependents incur. The insurance cmpany prviding such benefits has the full and final discretinary authrity t interpret the cmpnent plan terms, determine benefit eligibility and is respnsible fr ensuring that claims are paid accrding t the prvisins f the cmpnent plan. Such determinatins shall be final and cnclusive n all persns claiming such benefits. 2
Plan Funding and Plan Expenses The surce f cntributins fr the cst f cverage available under the Plan may be emplyer r emplyee cntributins, r a cmbinatin f bth, as determined by LMU and, in many cases, based n individual emplyee electins. Yu may be required t pay sme r all f the cst f cverage fr sme r all f the cmpnent plans under this Plan. The benefits may be funded in different ways, depending n the type f benefit, as described belw, and in the chart in the Summary Plan Infrmatin sectin belw. Self-Funded Benefits The fllwing benefits are self-funded frm LMU s general assets: Health Care flexible spending accunt and Dependent Care flexible spending accunt. Insured Benefits The Emplyer pays premiums t an insurance cmpany fr the insured cmpnent benefit prgrams under the Plan. Yu may be required t cntribute all r a prtin f the cst f these premiums thrugh payrll deductins. The insurance cmpany, nt the Emplyer, is respnsible fr paying the actual cst f eligible claims yu and yur dependents incur under the insured cmpnent prgrams. The health (HMO and PPO), dental (HMO and PPO), visin, life, AD&D and lng term disability benefits under the Plan are fully insured. Plan Expenses LMU has the ptin f paying certain expenses in cnnectin with the administratin f the Plan and reserves the right t allcate and reallcate administrative csts between LMU and participants in the Plan. Plan Limitatins Nthing cntained in the benefit dcuments r this bklet creates any emplyment cntract r in any way alters the Emplyer s plicy and practice f emplyment at will cntained in the Emplyer s emplyment applicatin, handbk and plicy manuals. Plan Cntinuance and Amendment r Terminatin LMU reserves the right at its discretin t amend r terminate the Plan, r any prvisin, benefit cverage r cntributin under any cmpnent plan, at any time, fr any reasn. Withut limiting any ther Plan prvisins fr the discntinuance f cverage, including but nt limited t the prvisins f any cmpnent plan as prvided in the applicable insurance plicy, certificate f cverage r ther cmpnent plan benefit bklet, yur cverage will terminate when LMU terminates the Plan, r when yu are n lnger eligible t receive benefits under the Plan, whichever ccurs first. Neither yu, yur dependents, yur beneficiaries nr any ther persn have r will have a vested r nn-frfeitable right t receive benefits under the Plan. 3
Plan Recrds The recrds f the Plan are kept n the basis f a plan year. Plan Year is the twelve-mnth perid which begins n January 1, and ends n the last day f the mnth f December. Reimbursement, Recvery f Overpayment, and Subrgatin As a cnditin fr receiving benefits under the Plan, yu agree t and grant the Plan the rights f reimbursement, recvery f verpayment and subrgatin. T the extent that a benefit bklet r insurance certificate als cntains prvisins regarding reimbursement, recvery f verpayment, and/r subrgatin, this sectin and the applicable prvisins f such bklet r certificate bth apply s as t grant the Plan the greatest pssible rights. Agent f Service fr Legal Prcess Any legal prcess against the Plan in the event f an unreslved dispute ver benefit plan prvisins shuld be served n the Plan Administratr. Claims and Appeals Prcedures If yu feel an errr has ccurred in yur recrds r in prcessing yur claim fr benefits, yu shuld knw that claims and appeals prcedures are available t every participant and beneficiary. Except as therwise prvided in the applicable cmpnent plan dcument, yur claim(s) fr benefits will be prcessed accrding t the prcedures set ut in the applicable Appendix t this bklet; prvided, hwever, that the claims will be prcessed in a time and manner n mre stringent than is described in this bklet, as required under ERISA. The claims and appeals prcedures fr each cmpnent plan are set ut in the insurance plicy, certificate f cverage, benefit bklet r ther cmpnent plan dcument fr that benefit. T the extent that a cmpnent plan prvides fr vluntary levels f appeal, the Plan agrees (i) t waive the right t assert that yu failed t exhaust yur administrative remedies by nt submitting the dispute t the vluntary level f appeal; (ii) that the statute f limitatin will be tlled during the time that such vluntary level f appeal is pending; and (iii) that yu may elect t submit the benefit dispute t the vluntary level f appeal nly after yu have exhausted the appeals permitted under Department f Labr regulatins. Yur Rights Under ERISA As a participant in the Plan yu are entitled t certain rights and prtectins under the Emplyee Retirement Incme Security Act f 1974 (ERISA). ERISA prvides that all plan participants shall be entitled t: Yur Right t Receive Infrmatin Abut Yur Plan and Benefits Examine, withut charge, at the Plan Administratr's ffice and at ther specified lcatins such as wrksites, all dcuments gverning the Plan, including insurance 4
cntracts and a cpy f the latest annual reprt (Frm 5500 Series) filed by the Plan with the U.S. Department f Labr and available at the Public Disclsure Rm f the Emplyee Benefits Security Administratin. Obtain, upn written request t the Plan Administratr, cpies f dcuments gverning the peratin f the Plan, including insurance cntracts, and cpies f the latest annual reprt (Frm 5500 Series) and updated summary plan descriptins. The administratr may make a reasnable charge fr the cpies. If applicable, receive a summary f the Plan's annual financial reprt. Yur Right t Cntinue Grup Health Plan Cverage Under ERISA, yu are entitled t: Cntinue health care cverage fr yurself, spuse r dependents if there is a lss f cverage under the plan as a result f a qualifying event. Yu r yur dependents may have t pay fr such cverage. Review the Appendix entitled COBRA Cntinuatin Cverage and the dcuments gverning the plan n the rules gverning yur COBRA cntinuatin cverage rights. A reductin r eliminatin f exclusinary perids f cverage fr preexisting cnditins under yur grup health plan, if yu have creditable cverage frm anther plan. Yu shuld be prvided a certificate f creditable cverage, free f charge, frm yur grup health plan r health insurance issuer when yu lse cverage under the plan, when yu becme entitled t elect COBRA cntinuatin cverage, when yur COBRA cntinuatin cverage ceases, if yu request it befre lsing cverage, r if yu request it up t 24 mnths after lsing cverage. Withut evidence f creditable cverage, yu may be subject t preexisting cnditin exclusin fr 12 mnths (18 mnths fr late enrllees) after yur enrllment date in yur cverage. Yur Right t Prudent Actins by Plan Fiduciaries In additin t creating rights fr Plan participants, ERISA impses duties upn the peple wh are respnsible fr the peratin f the emplyee benefit plan. The peple wh perate yur Plan, called fiduciaries f the Plan, have a duty t d s prudently and in the interest f yu and ther Plan participants and beneficiaries. N ne, including yur emplyer r any ther persn, may fire yu r therwise discriminate against yu in any way t prevent yu frm btaining a welfare plan benefit r exercising yur rights under ERISA. Hw t Enfrce Yur Rights If yur claim fr a welfare benefit is denied r ignred, in whle r in part, yu have a right t knw why this was dne, t btain cpies f dcuments relating t the decisin withut charge, and t appeal any denial, all within certain time schedules. 5
Under ERISA, there are steps yu can take t enfrce the abve rights. Fr instance, if yu request a cpy f plan dcuments r the latest annual reprt frm the Plan and d nt receive them within 30 days, yu may file suit in a federal curt. In such a case, the curt may require the Plan Administratr t prvide the materials and pay yu up t $110 a day until yu receive the materials, unless the materials were nt sent because f reasns beynd the cntrl f the administratr. If yu have a claim fr benefits, which is denied r ignred in whle r in part, yu may file suit in a state r federal curt. In additin, if yu disagree with the plan's decisin r lack theref cncerning the qualified status f a medical child supprt rder, yu may file suit in federal curt. If it shuld happen that plan fiduciaries misuse the plan's mney, r if yu are discriminated against fr asserting yur rights, yu may seek assistance frm the U.S. Department f Labr, r yu may file suit in a federal curt. The curt will decide wh shuld pay curt csts and legal fees. If yu are successful the curt may rder the persn yu have sued t pay these csts and fees. If yu lse, the curt may rder yu t pay these csts and fees, fr example, if it finds yur claim is frivlus. Assistance with Yur Questins If yu have any questins abut yur Plan, yu shuld cntact the Plan Administratr. If yu have any questins abut this statement r abut yur rights under ERISA r if yu need assistance in btaining dcuments frm the Plan Administratr, yu shuld cntact the nearest ffice f the Emplyee Benefits Security Administratin, U.S. Department f Labr, listed in yur telephne directry r the Divisin f Technical Assistance and Inquiries, Emplyee Benefits Security Administratin, U.S. Department f Labr, 200 Cnstitutin Avenue N.W., Washingtn, D.C. 20210. Yu may als btain certain publicatins abut yur rights and respnsibilities under ERISA by calling the publicatins htline f the Emplyee Benefits Security Administratin. Summary Plan Infrmatin Official Plan Name: Plan Number: 001 Type f Plan: Welfare benefit plan grup health, dental, visin, life, AD&D, and lng-term disability 6
Cmpnent Plan Type f Benefit Funding and Carrier Infrmatin Claims Administratr Health, Dental and Visin Grup Health Plan Medical & Prescriptin Drug Expense Cverage Insured: Anthem Blue Crss PPO Grup # 175175 M001 Anthem Blue Crss HMO Grup # 175175 H001 Same as insurance carrier See Certificate f Insurance Kaiser Permanente HMO Grup # 100620-0000 Grup Dental Plan Dental Insured: Delta Dental PPO Grup # 4454-0001 DeltaCare USA HMO Grup # 6434-0001 Same as insurance carrier See Certificate f Insurance Grup Visin Plan Visin Insured: Visin Service Plan Grup # 12011288 Same as insurance carrier See Certificate f Insurance 7
Grup Life and AD&D Grup Life Insurance Life Insured: The Hartfrd Grup # GL-402280 (fr Life, Optinal Life) Same as insurance carrier See Certificate f Insurance AD & D Accident Insured: The Hartfrd Grup # GL-402280 See Certificate f Insurance Lng Term Disability Grup Lng Term Disability Insurance Disability Insured: The Hartfrd Grup # GL-402280 (fr Lng-Term Disability) Same as insurance carrier See Certificate f Insurance Health and Dependent Care Flexible Spending Accunt Flexible Spending Accunt Health and Dependent Care Self-funded: WageWrks 8
Cntact Infrmatin Benefit Plan Phne Number Website Anthem Blue Crss PPO (877) 800-7339 www.anthem.cm/ca Anthem Blue Crss HMO (877) 800-7339 www.anthem.cm/ca Kaiser Permanente HMO (800) 464-4000 http://my.kaiserpermanente.rg/ca/lmu Delta Dental PPO (800) 765-6003 www.deltadentalins.cm DeltaCare USA (HMO) (800) 422-4234 www.deltadentalins.cm Visin Service Plan (VSP) (800) 877-7195 www.vsp.cm WageWrks (FSAs) (877) 924-3967 www.wagewrks.cm The Hartfrd (Life Insurance) (800) 563-1124 www.thehartfrdatwrk.cm The Hartfrd (AD&D) (800) 563-1124 www.thehartfrdatwrk.cm The Hartfrd (LTD) (866) 945-7801 www.thehartfrdatwrk.cm Jhn Hancck (LTC) (866) 511-3087 http://lmu.jhancck.cm (user name: lmu; passwrd:mybenefit) MetLife (Vluntary Benefits) (800) GET-MET8 www.metlife.cm/mybenefits CmPsych GuidanceResurces (EAP) (800) 327-1850 www.guidanceresurces.cm Cmpany/rganizatin ID: LOYOLA Diversified (Retirement Planning) (888) 676-5512 www.divinvest.cm LMU Human Resurces Westchester Campus) (310) 338-2723 MYLMU (click n QuickLinks/Human Resurces ) LMU Human Resurces (Law Schl) (213) 736-1128 Law Schl intranet 9
APPENDIX -- Emplyee Eligibility and Terminatin f Cverage Emplyee Eligibility In general, the insurance plicies, certificates f cverage r ther cmpnent plan benefit bklets describe wh is eligible t participate, as well as the requirements fr enrllment waiting perids, if any, and when cverage cmmences. Ntwithstanding any prvisins f thse bklets, t be eligible t participate in any cmpnent benefits under the Plan, at a minimum, yu must be: A regular full-time LMU faculty member; A regular full-time Westchester staff member wrking at least 40 hurs a week; A regular full-time Lyla Law Schl faculty member; A regular full-time Lyla Law Schl staff member wrking at least 35 hurs a week; r A part-time regular faculty r staff member (defined as any psitin that is at least 50 percent full-time equivalent, 50 percent time and effrt r greater) wh has been previusly enrlled in the LMU plans as a full-time regular: Staff member fr 12 mnths f cntinuus service immediately prir t changing status t part-time regular. Staff member fr 12 mnths f cntinuus service, fr which breaks between terms cunt tward the 12 mnths f cntinuus service (e.g., staff with 9-, 10-, and/r 11- mnth assignment). Faculty member fr ne cmplete academic year. Fr purpses f this plicy, fulltime regular faculty includes tenure, tenure-track, and clinical nly. Dependents eligible fr certain benefits include: Yur legal spuse; Yur registered dmestic partner; Yur dependent children under age 26, wh are nt eligible t enrll in a plan ffered by their wn emplyer (under age 21, r under age 25 if a full-time student, fr family AD&D insurance); 10
Yur unmarried disabled children (Each insurance cmpany has special rules fr children with disabilities. Onging prf f disability is required.) Fr mre infrmatin abut eligibility, cntact Human Resurces. Yu must als cmplete and submit the applicable enrllment materials and satisfy any ther enrllment requirements fr the cmpnent benefit. Yu are nt eligible fr cverage under any f the cmpnent plans under this Plan hwever, if yu are (A) nt reprted n the Emplyer s payrll recrds, r (B) classified by the Emplyer as (i) an n call, temprary, seasnal r per diem emplyee, (ii) an independent cntractr r ther self emplyed individual, even if a curt r administrative agency determines yu t be a cmmn law emplyee, (iii) a leased emplyee, r (iv) an emplyee included in a unit subject t cllective bargaining unless the applicable cllective bargaining agreement prvides therwise. An emplyee generally is cnsidered an active emplyee r actively at wrk fr purpses f administering the benefits plans (including making eligibility determinatins) referenced in this bklet if the emplyee is present and capable f carrying ut the assigned jb duties f the Emplyer. In additin, fr purpses f enrllment determinatins under a grup health plan (ther than the dental plan), emplyees wh are absent frm wrk due t a health factr will be cnsidered actively at wrk. Terminatin f Cverage The insurance plicies, certificates f cverage r ther cmpnent plan benefit dcuments describe when cverage terminates under the respective cmpnent benefit plans. Where applicable, hwever, yu may be eligible t cntinue yur cverage under COBRA r cnvert t individual cverage. In additin t the prvisins abve, yur cvered dependent s benefits terminate n the date that the persn n lnger meets the definitin f dependent, r such later date prvided under the applicable insurance plicies, certificates f cverage r ther cmpnent plan benefit bklets. The dependent may be eligible fr cntinuatin f cverage under COBRA r cnversin cverage, as applicable. If any f the plans are discntinued, cverage under the terminated plan will terminate n the date the terminatin is effective. If yu r yur dependent(s) engage in fraudulent cnduct r furnish LMU, a Claims Administratr r ther service prvider with fraudulent r misleading material infrmatin relating t claims r applicatin fr benefits, yur cverage and that f yur dependents may be adversely affected up t and including terminatin f yur benefits, effective n the date yu engaged in fraudulent cnduct r furnished fraudulent misleading material infrmatin, whichever is applicable. Yu shall be respnsible t pay LMU r the applicable carrier fr the cst f previusly received services, less any cpayments made r fees paid fr such services. 11
If yu permit the use f yur r any ther persn s identificatin card by any ther persn; use anther persn s card; r use an invalid card t btain services, yur cverage shall terminate immediately. Any persn r dependent invlved in the misuse f an identificatin card will be liable t and must reimburse the Emplyer r the applicable carrier fr the cst f services received thrugh such misuse. APPENDIX Change in Status While yu are a member f the Plan, yu usually will nly be allwed t make changes t yur electins during the annual Open Enrllment Perid, unless yu have a Change in Status. A Change in Status may allw yu t enrll, cancel yur membership in the Plan, r change the amunt f yur cntributin. Hwever, the change in yur electin must be cnsistent with the Change in Status. That is, the change must be n accunt f and crrespnd with a Change in Status that affects eligibility fr cverage under this Plan, r anther emplyer s plan. Change in Status Defined The fllwing events are cnsidered t be a Change in Status: A change in yur legal marital status which results in a lss r gain f eligibility fr cverage under this Plan r anther emplyer s plan, including: Marriage; Change in certified dmestic partnership status; Divrce; Legal separatin; Annulment; r Death f yur spuse A change in the number f yur dependents, including: Birth f yur child; Adptin; Legal guardianship; Placement f child with yur fr adptin r; Death f a dependent A change in emplyment status fr yu, yur spuse, certified dmestic partner r dependent which results in a lss r gain f eligibility fr cverage under this Plan r anther emplyer s plan including: Cmmencement f emplyment Terminatin f emplyment; A cmmencement f r return f unpaid leave f absence; r A change in wrk schedules (part-time r full-time t part-time) 12
A dependent satisfies r ceases t satisfy eligibility requirements which result in a lss r gain f eligibility fr cverage under this Plan r anther emplyer s plan. Certain changes in cst r cverage. Any ther event that LMU, in its sle discretin, determines is a Change in Status cnsistent with IRS rules and regulatins and guidelines. Example 1: Yur spuse s emplyer adpts a new health care plan which is less expensive than the LMU plan. This is nt a qualified status change. Example 2: Yu get a divrce and lse cverage under yur ex-spuse s health plicy. Can yu btain cverage under the LMU health plan? What abut sme ptinal life insurance? Divrce is a qualified status change and LMU health cverage t replace the lst health cverage is cnsistent with the status change. But the acquisitin f ptinal life insurance is nt cnsistent unless it replaces insurance lst as a result f the divrce. Example 3: Prf A is returning frm an unpaid leave and Prf B is leaving fr an unpaid leave. Bth have qualified status changes which wuld allw them t mdify their electins. Cmpany Apprval and Determinatin f the Change in Status It is imprtant t remember that having a Change in Status des nt autmatically mean that yu may change yur electin. The IRS has strict guidelines abut when mid-year electin changes may be made. LMU, in its sle discretin, will determine if yu have had a Change in Status and if a requested electin change is cnsistent with the Change in Status and cnsistent with IRS rules, regulatins and guidelines. LMU reserves the right t deny any change request that LMU, in its sle discretin, determines is nt permitted r apprpriate under IRS rules and regulatins. If LMU determines that yu have had a Change in Status, but the electin change yu have requested is nt cnsistent with the Change in Status, yu will nt be allwed t change yur befre-tax electin until the next annual Open Enrllment Perid, r special enrllment event, even thugh yu have had a Change in Status. If yu anticipate that fr sme reasn yu may want t adjust yur cntributin amunt r cancel yur membership in the Plan during the next Plan Year, yu shuld cntact yur Human Resurces representative befre making yur electin t determine if yur situatin will qualify as a Change in Status. Hw t Make the Change Effective Once a Change in Status ccurs, yu will have an pprtunity t change yur befre-tax electin t make adjustments t yur membership that are cnsistent with the Change in Status. Yu must make the change by cmpleting and returning a signed enrllment/change frm t yur Human Resurces representative within 31 days frm the Change in Status. If yu are cvered under Healthy Family and lse cverage, yu will have 60 days t enrll frm the time yu lse cverage. 13
Remember, the change t yur electin must be cmpleted and returned within 31 days f yur Change in Status. If the change t yur electin is nt cmpleted and returned within 31 days f yur Change in Status, yu will nt be allwed t make the change until yur next annual Open Enrllment Perid. When the Change is Effective Fr infrmatin n when the change will be effective, refer t Human Resurces r the applicable underlying insurance and benefit bklets. APPENDIX Leaves f Absence Except as prvided in the underlying insurance and benefit bklets, this sectin describes hw yur cverage will be cntinued during certain leaves f absence. Thus, t knw whether yu will be eligible t cntinue cverage during a leave f absence, yu must review the terms f the applicable insurance plicies, certificates f cverage r cmpnent plan benefit bklets. If yu have any questins cntact Human Resurces. Paid Leave f Absence In additin t ther ptins that may be available, if yu take an apprved paid leave f absence, and cverage under ne r mre cmpnent benefits is cntinued, such as under the Family and Medical Leave Act ( FMLA ), yur scheduled payrll deductins will autmatically cntinue during yur leave. If yur paycheck des nt cver the amunt f any regularly scheduled cntributin during yur leave, yu may make an after-tax payment t make up the difference. If the full amunt f any regularly scheduled cntributin is nt made within thirty days after it was due, yur cverage under the applicable cmpnent benefit ptins under the Plan will be terminated fr the remaining perid f yur leave f absence, retractive t the last day fr which a required cntributin was made. If yu return t wrk frm yur leave f absence, yur cverage will be autmatically reinstated as described in the sectin Reinstatement Upn Return Frm Leave belw. Unpaid Leave f Absence If yu take an apprved unpaid leave f absence, including leave under the FMLA, yu may elect either t terminate yur cverage and t stp making required cntributins during yur leave, r t cntinue yur cverage and cntinue making yur required cntributins n an after-tax basis. If yu elect t cntinue yur Plan membership during yur leave, yur required after-tax cntributin payments are due at the same time yur payrll deductins wuld have been taken. If the full amunt f any regularly scheduled cntributin is nt made within thirty days after it was due, yur cverage under the applicable cmpnent benefit ptins under the Plan will be terminated fr the remaining perid f yur leave f absence, retractive t the last day fr which a required cntributin was made, and yu will nt be eligible fr reimbursement f any claims incurred while yur cverage was terminated. If yu return t wrk frm yur leave f absence, yur cverage will be autmatically reinstated as described in the sectin Reinstatement Upn Return Frm Leave belw. 14
Family and Medical Leave Act Ntwithstanding any ther prvisin f this Plan, if yu take an apprved leave f absence under the FMLA, cverage under the grup health plans (health and dental and flexible spending accunt benefits) under this Plan will cntinue t be made available during such leave perid t yu and yur cvered dependents under the same terms and cnditins that cverage was made available immediately prir t the cmmencement f the leave. Cntinuatin f cverage als may be available fr ther cmpnent benefits under the Plan. Cntact the Plan Administratr r Human Resurces fr mre infrmatin. If yu elect t cntinue yur cverage during such a leave perid, yu must cntinue t pay any required emplyee-prtin f the cst f the level f cverage elected. Upn returning frm an apprved FMLA leave, cverage under the Plan will immediately resume regardless f whether yu elected t cntinue cverage during the FMLA leave. LMU Cntributins. While yu are n an FMLA leave, LMU will cntinue t make the same cntributins tward the cst f cverage cntinued under the Plan that it wuld have made had yu nt taken such leave f absence. LMU will cntinue t d s until the earlier f the date that (a) yu fail t return t wrk n the expiratin f the FMLA leave, r (b) yu vluntarily give ntice f yur intent t terminate emplyment. Fr these purpses, yu are cnsidered t terminate emplyment when yu give ral r written ntice f yur intent nt t return t wrk due t reasns within yur cntrl. If yu vluntarily terminate yur emplyment due t reasns within yur cntrl at r befre the end f the FMLA leave, LMU shall have the right t be reimbursed by yu fr any and all cntributins LMU has made n behalf f yu and yur cvered dependents during the leave. In this regard, LMU shall have the right t btain reimbursement frm any funds that LMU might therwise we yu fllwing yur vluntary terminatin, including (but nt limited t) (a) any regular r vertime wages, cmmissins, salary, r bnuses; (b) accrued vacatin pay r sick leave pay; r (c) ther surces. In additin, LMU shall have the right t pursue reimbursement in a curt f law. Regardless f whether r nt yu return frm an FMLA leave, LMU shall be entitled t recver frm yu any required emplyee cntributins LMU has made n behalf f yu and yur cvered dependents during the unpaid leave t ensure cntinuity f cverage. LMU may nt recver any f its regular LMU cntributins made n behalf f yu and yur cvered dependents fr the time yu had been n an FMLA leave if yur failure t return t emplyment at the expiratin r exhaustin f such leave is due t (a) the cntinuatin, recurrence, r nset f a serius health cnditin that wuld entitle yu t the FMLA leave; r (b) ther circumstances beynd yur cntrl (as set frth in LMU s plicies and prcedures). Cvered Emplyee. As sn as administratively feasible after yu qualify fr an FMLA leave, the Plan Administratr shall give yu the pprtunity t chse in writing between cntinued cverage during the leave f absence, r suspending cverage fr the leave s duratin. If yu chse nging cverage, yu must cntinue t make the same premium payments r cntributins that yu were making immediately befre the leave tk effect, as described abve. 15
The bligatin t prvide nging cverage under this Plan fr yu and yur cvered dependents n an FMLA leave, if any, ceases if yu are mre than thirty (30) days late n making a required premium payment; prvided, hwever, that LMU may at its ptin cver yur missed payments s that cverage will be uninterrupted. In this event, LMU s advances may be recvered in the event yu vluntarily terminate yur emplyment under circumstances within yur cntrl. Military Leave (Health and Dental Plans) LMU may grant a leave f absence t any emplyee due t military service in the Armed Frces f the United States in accrdance with the Unifrmed Services Emplyment and Reemplyment Rights Act f 1994, as amended (USERRA), and applicable state law. In general, during such a leave f absence under USERRA, yu may be eligible t elect t cntinue grup health plan cverage fr yurself and yur enrlled dependents (if any) fr up t 24 mnths. Mre specifically, if yu are absent frm wrk fr mre than 31 days in rder t fulfill a perid f duty cvered by USERRA, yu will be treated as having experienced a qualifying event, as that term is defined under the Plan s COBRA cntinuatin cverage prvisins, see belw, as f the first day f yur the absence fr such duty. This means that in additin t having the ptin t elect t cntinue cverage under COBRA, yu will becme eligible t elect cntinuatin cverage under USERRA using prcedures similar t thse required by COBRA. The Plan Administratr r its designee will furnish yu with a ntice f the right t elect cntinuatin cverage, which will include infrmatin abut the premiums yu will have t pay fr such cverage. This ntice will allw yu the pprtunity t elect such cverage fr up t 24 mnths (s lng as yu cntinue t be n a leave f absence under USERRA) beginning n the date yur USERRA leave cmmenced. Nthing in the Plan limits yur right t cntinue yur cverage under COBRA instead f under this sectin. If qualified t cntinue cverage pursuant t USERRA, yu may elect t cntinue cverage under the Plan by ntifying the Plan Administratr and prviding payment f any required cntributin fr the health cverage. The required cntributin may include the amunt we nrmally pay n yur behalf, unless the perid f cverage is fewer than 31 days. If yu d nt make an electin within 60 days f being prvided with the ntice mentined abve, yu will n lnger be eligible t cntinue cverage under the Plan, except as required by USERRA. If yu elect t cntinue cverage under USERRA, the perid f extended grup health plan cverage shall run cncurrently with the maximum cntinuatin cverage perid that may be available under COBRA. Regardless f whether yu cntinue yur health cverage, if yu return t yur psitin f emplyment in the time and manner required under USERRA, health cverage fr yu and yur enrlled dependents (if any) will be reinstated under the Plan as required under USERRA. N exclusins r waiting perid may be impsed n yu r yur enrlled dependents in cnnectin with this reinstatement unless a sickness r injury is determined by the Secretary f Veterans Affairs t have been incurred in, r aggravated during, the perfrmance f military service. 16
Reinstatement Upn Return Frm Leave Except as prvided abve, if yu elect t nt cntinue yur Plan membership during yur leave, r if yur Plan membership is terminated due t yur taking a leave f absence, and yu return t wrk when yur leave ends (during the same Plan Year as when yur leave cmmenced), yur membership in the Plan will be autmatically reinstated. 17
APPENDIX SPECIAL INFORMATION APPLYING TO GROUP HEALTH PLAN BENEFITS APPENDIX -- QMCSO Prcedures A QMCSO is a QUALIFIED MEDICAL CHILD SUPPORT ORDER that applies nly t grup health plans. ERISA requires that, as part f a divrce actin, a curt, dmestic relatins magistrate r administratr can enter an rder (a Medical Child Supprt Order r MCSO) which grants a child the right t receive health benefits under ne f his parent s grup health plans, regardless f whether the parent is the custdial parent f the child. Hwever, t be valid r qualified (a QMCSO ), the MCSO must meet certain statutry requirements which are identified belw. Upn receipt f a ntice f a MCSO and request fr cverage under the grup health plan fr ne r mre children f an emplyee r cvered spuse, the fllwing will ccur: The Plan Administratr will send a letter acknwledging receipt f the MCSO. The letter will be sent t the Plan participant (the emplyee) and t each child affected by the MCSO. The Plan Administratr will review the MCSO t make certain that it: was issued pursuant t a valid state dmestic relatins law; specifically prvides fr a dependent (r dependents) t receive benefits under the grup health cverage(s); prvides the name and last knwn mailing address f the emplyee (Plan participant) and each child cvered by the MCSO; prvides a reasnable descriptin f the cverage t be prvided by the Plan(s) r the manner in which the cverage can be determined. The MCSO cannt require a Plan t prvide any benefit r ptin that is nt therwise prvided. If it des, it is nt a qualified MCSO r QMCSO ; specifies the time perid t which the Order applies; names each grup health benefit t which the MCSO applies. Yu may be required t prvide necessary identifying infrmatin abut the child(ren), such as scial security number(s), s that the Plan Administratr can cmply with the requirements f the law. Upn cmpletin f its review, the Plan Administratr will send a letter t the Plan participant (emplyee) and each affected child advising whether r nt the MCSO has been determined t be a qualified MCSO (a QMCSO ). If the MCSO is determined t be qualified, each child affected is entitled t all reprting and disclsure requirements t which ther Plan participants are entitled under ERISA. Any child affected by the MCSO is als permitted t designate a representative t receive cpies f any ntices regarding this matter r any cverage r benefits matters. Any such designatin shuld be sent t the Plan Administratr. 18
APPENDIX SPECIAL INFORMATION APPLYING TO GROUP HEALTH PLAN BENEFITS APPENDIX -- COBRA Cntinuatin Cverage In General It is imprtant that all cvered individuals take the time t read this infrmatin carefully and be familiar with its cntents. If there is a cvered dependent whse legal residence is nt yurs, please prvide the cvered dependent s name and address t the Human Resurces Department s a ntice can be sent t him r her as well. Under federal COBRA law, mst emplyers are required t ffer cvered emplyees and cvered family members the pprtunity fr a temprary extensin f health cverage (called Cntinuatin Cverage ) at grup rates when cverage under the health plan wuld therwise end due t certain qualifying events. This sectin is intended t infrm yu (and yur cvered dependents, if any), in a summary fashin f yur ptential future ptins and bligatins under the Cntinuatin Cverage prvisins f the COBRA law. Shuld an actual qualifying event ccur in the future, the Plan Administratr will send yu additinal infrmatin and the apprpriate electin ntice at that time. The infrmatin described in this sectin replaces any discussin f COBRA cntinuatin cverage cntained in the insurance certificate r benefit bklet and is nly intended t prvide COBRA cntinuatin cverage t the extent required by law; prvided hwever that if the plan prvides cverage fr certified dmestic partners r same sex spuses, COBRA Cntinuatin Cverage will be prvided t the extent prvided under the terms in the insurance certificate r benefit bklet. Qualifying Events Qualifying Events fr Cvered Emplyee* If yu are the cvered emplyee, yu may have the right t elect COBRA Cntinuatin Cverage if yu lse yur grup health cverage because f a terminatin f yur emplyment (fr reasns ther than grss miscnduct n yur part) r a reductin in yur hurs f emplyment. Qualifying Events fr Cvered Spuse* If yu are the cvered spuse f a cvered emplyee, yu may have the right t elect COBRA Cntinuatin Cverage fr yurself if yu lse grup health cverage under yur spuse s emplyer s grup health plan(s) because f any f the fllwing reasns: A terminatin f yur spuse s emplyment (fr reasns ther than grss miscnduct) r reductin in his r her hurs f emplyment with his emplyer. The death f yur spuse. Divrce r, if applicable, legal separatin frm yur spuse. Yur spuse becmes entitled t Medicare. Qualifying Events fr Cvered Dependent Children* If yu are the cvered dependent child f a cvered emplyee, yu may have the right t elect Cntinuatin Cverage fr yurself if yu lse grup health cverage under yur parent s grup health plan because f any f the fllwing reasns: 19
APPENDIX SPECIAL INFORMATION APPLYING TO GROUP HEALTH PLAN BENEFITS A terminatin f yur parent s emplyment (fr reasns ther than grss miscnduct) r reductin in his r her hurs f emplyment with his emplyer. The death f yur parent (the cvered emplyee). Yur parents divrce r, if applicable, legally separate. Yur parent (the cvered emplyee) becmes entitled t Medicare. Yu cease t be a cvered dependent under the terms f the Plan. * Imprtant Required Emplyee, Spuse, and Dependent Ntificatins. Under the law, cvered individuals, including the emplyee, spuse, r ther family member, have the respnsibility t ntify the Plan Administratr f a divrce, legal separatin, r a child lsing dependent status. This ntificatin must be made within 60 days after the later f the date n which the qualifying event ccurs r the date n which a qualified beneficiary lses r wuld lse cverage as a result f the qualifying event. Yu must prvide this ntice by mail r persnal delivery t, Attentin Plan Administratr, One LMU Drive, Suite 1900, Ls Angeles, CA 90045. This ntice must identify: (i) qualified beneficiaries and their respective addresses, phne numbers and dates f birth, (ii) the qualifying event, (iii) the date the qualifying event ccurred, (iv) include evidence supprting the ccurrence f the qualifying event acceptable t the COBRA Administratr; and (v) the name f the plan under which yu are lsing cverage and the level f cverage at the time f the event. Fr example, in the case f a Scial Security Disability, the ntice must include a cpy f the Scial Security Administratr s determinatin f disability. If ntificatin is nt cmpleted accrding t the Plan Administratr s prcedures and within the required 60-day ntificatin perid, then rights t Cntinuatin Cverage will be frfeited. Carefully read the applicable dependent eligibility rules s yu are familiar with when a dependent ceases t be a cvered dependent under the terms f the applicable benefit. Electing COBRA Cverage Electin Perid and Cverage. Once LMU learns f a qualifying event, LMU will ntify WageWrks the COBRA Administratr which will ntify cvered individuals (als knwn as qualified beneficiaries) f their rights t elect COBRA Cntinuatin Cverage. Each qualified beneficiary has independent COBRA electin rights and will have 60 days t elect Cntinuatin Cverage. The 60-day electin windw is measured frm the later f the date f COBRA ntificatin n r after the qualifying event r the date cverage is lst. This is the maximum perid allwed t elect COBRA. If a qualified beneficiary des nt elect Cntinuatin Cverage within this electin perid, then rights t cntinue cverage under the applicable Plan will end and he r she ceases t be a qualified beneficiary. T elect Cntinuatin Cverage, yu must cmplete the applicable electin frm and furnish it accrding t the directins n the frm. Each qualified beneficiary has a separate right t elect Cntinuatin Cverage. Fr example, the cvered emplyee s spuse may elect Cntinuatin Cverage even if the cvered emplyee des nt. Cntinuatin Cverage may be elected fr nly ne, several, r fr all cvered dependent children wh are qualified beneficiaries. A parent may elect t cntinue cverage n behalf f any cvered dependent children. The cvered emplyee r his r her spuse can elect Cntinuatin Cverage n behalf f all f the qualified beneficiaries. 20
APPENDIX SPECIAL INFORMATION APPLYING TO GROUP HEALTH PLAN BENEFITS In cnsidering whether t elect Cntinuatin Cverage, yu shuld take int accunt that a failure t cntinue yur grup health cverage will affect yur future rights under federal law. First, yu can lse the right t avid having pre-existing cnditin exclusins applied t yu by ther grup health plans if yu have mre than a 63-day gap in health cverage, and electin f Cntinuatin Cverage may help yu nt have such a gap. Secnd, yu will lse the guaranteed right t purchase individual health insurance plicies that d nt impse such pre-existing cnditin exclusins if yu d nt get Cntinuatin Cverage fr the maximum time available t yu. Finally, yu shuld take int accunt that yu have special enrllment rights under federal law. Yu have the right t request special enrllment in anther grup health plan fr which yu are therwise eligible (such as a plan spnsred by yur spuse s emplyer) within 30 days after yur grup health cverage ends because f the qualifying event listed abve. Yu will als have the same special enrllment right at the end f Cntinuatin Cverage if yu get Cntinuatin Cverage fr the maximum time available t yu. If, during the electin perid, a qualified beneficiary waives Cntinuatin Cverage, the waiver can be revked at any time befre the end f the electin perid. Revcatin f the waiver is an electin f Cntinuatin Cverage. Hwever, if a waiver is later revked, cverage need nt be prvided retractively (that is, frm the date f the lss f cverage until the waiver is revked). Waivers and revcatins f waivers are cnsidered made n the date that they are sent t the Plan Administratr, r its designee fr COBRA administratin. Length f Cntinuatin Cverage 18 Mnths. If the event causing the lss f cverage is a terminatin f emplyment (ther than fr reasns f grss miscnduct) r a reductin in wrk hurs, then each qualified beneficiary will have the pprtunity t cntinue cverage fr 18 mnths frm the date f the qualifying event. Extensin fr Scial Security Disability. The 18-mnth cverage perid described abve may be extended fr 11 mnths if yu r anyne in yur family cvered under the Plan is determined by the Scial Security Administratin t be disabled and yu ntify the Plan Administratr in a timely fashin. The disability wuld have t have started at sme time befre the 60th day f COBRA Cntinuatin Cverage and must last at least until the end f the 18-mnth perid f Cntinuatin Cverage. T receive this extensin, yu must ntify the Plan Administratr f the disability determinatin within 60 days after the latest f the fllwing events: (i) the date f the Scial Security Administratin s disability determinatin; (ii) the date n which the qualifying event ccurs; r (iii) the date cverage is r wuld be lst as a result f the qualifying event; prvided the ntice is nt made later than yur initial 18-mnth perid f Cntinuatin Cverage. Yu must prvide this ntice by mail r persnal delivery t the COBRA Plan Administratr, WageWrks, P.O. Bx 14055 Lexingtn, KY 40512-4055; Fax (877) 220-3249, and that ntice must include all f the infrmatin, as applicable, described abve in the paragraph entitled, Imprtant Required Emplyee, Spuse, and Dependent Ntificatins under the Qualifying Events Sectin. This extensin applies separately t each qualified beneficiary. If the disabled qualified beneficiary chses nt t cntinue cverage, all ther qualified beneficiaries are still eligible fr the extensin. 21
APPENDIX SPECIAL INFORMATION APPLYING TO GROUP HEALTH PLAN BENEFITS Nte, it is als the qualified beneficiaries' respnsibility t ntify the Plan Administratr within 30 days if a final determinatin has been made that they are n lnger disabled. In this case, yu are required t ntify the Plan Administratr f this change in disability status in the manner described abve. Extensin fr Secndary Events. Anther extensin f the 18-mnth r abve mentined 29-mnth cntinuatin perid can ccur, if during the 18 r 29 mnths f Cntinuatin Cverage, a secnd event takes place (divrce, legal separatin, death, Medicare entitlement, r a dependent child ceasing t be a Cvered Dependent). If a secnd event ccurs, then the riginal 18 r 29 mnths f Cntinuatin Cverage can be extended t 36 mnths frm the date f the riginal qualifying event date fr eligible dependent qualified beneficiaries. If a secnd event ccurs, it is the qualified beneficiaries respnsibility t ntify the Plan Administratr r its designee in writing by mail r persnal delivery within 60 days f the secnd event and within the riginal 18 r 29-mnth COBRA timeline. Yu must prvide this ntice by mail r persnal delivery t COBRA Plan Administratr WageWrks, P.O. Bx 14055, Lexingtn, KY 40512-4055, Fax: (877) 220-3249, and that ntice must include all f the infrmatin, as applicable, described abve in the paragraph entitled, Imprtant Required Emplyee, Spuse, and Dependent Ntificatins under the Qualifying Events Sectin. In n event, hwever, will Cntinuatin Cverage last beynd 36 mnths frm the date f the event that riginally made the qualified beneficiary eligible fr Cntinuatin Cverage. A reductin in hurs fllwed by a terminatin in emplyment is nt cnsidered a secnd event fr COBRA purpses. 36 Mnths. If the riginal event causing the lss f cverage was the death f the cvered emplyee, divrce, legal separatin, Medicare entitlement, r a dependent child ceasing t be a cvered dependent child under the Plan, then each qualified beneficiary will have the pprtunity t cntinue cverage fr 36 mnths frm the date f the qualifying event. The maximum cverage perid fr a qualified beneficiary wh is the spuse r dependent child f the retired cvered emplyee ends 36 mnths after the death f the retired cvered emplyee. CAL-COBRA If yu are a Califrnia resident and yur cverage is less than 36 mnths, yu may be eligible fr Cal-COBRA cverage. Yu generally will be ntified if yu qualify r cntact the insurance carrier directly. Cverage Optins, Cst, and Timing f Payments An Emplyer is required t prvide the qualified beneficiary with cverage that is identical t the cverage prvided under the Plan t similarly situated nn-cobra cvered individuals. Shuld cverage change r be mdified fr nn-cobra cvered individuals, then the change and/r mdificatin will be made t yur cverage as well. If a qualified beneficiary elects Cntinuatin Cverage, he r she will be required t pay the entire cst fr the cverage, plus a 2% administratin fee. Nte that the cst fr Cntinuatin Cverage prvided during the disability extensin will increase t 150%. If yu 22