RIT
Human Resources

Medical Care Plan Summary

Important Information

The information in this document is a summary of the major provisions of this benefit plan, and constitutes the summary plan description as governed by the Employee Retirement Income Security Act of 1974 (ERISA). Benefits under the plan are determined by the terms of the underlying plan document and contracts. In the case of any inconsistency between this document and the plan document or contract, the plan document or contract will govern your rights and benefits.

RIT intends to continue the benefit plans indefinitely, but reserves the right to modify or terminate all or any portion of the employee benefits package at any time with or without notice. Such changes automatically will apply to you and your employment relationship at RIT. Participation in this plan is provided to eligible employees and does not constitute a guarantee of employment, requires continued employment and eligibility and is subject to the terms and conditions of the underlying plan document and insurance contracts.

Table of Contents

Plan Number: 501
Plan Year: 1/1 - 12/31
Plan Established: 05/02/1936

Introduction

By providing protection against unexpected and catastrophic medical care expenses, your RIT Medical Care Plan is one of your most important and valuable benefit programs. Your Medical Care Plan includes the following medical plan choices:

Medical Plans

This Plan is self-funded – that is, all benefits provided under the Plan are paid for by RIT from its general assets. RIT does not process the claims for Plan benefits. RIT has entered into a contract with Excellus BlueCross BlueShield (“Excellus”) to process these claims and to provide certain other services under the Plan. This contractual arrangement does not insure Plan benefits through Excellus. As a result, persons covered by the Plan do not have any insured or other contractual relationship with Excellus for benefit payments under the Plan.

This handbook addresses important topics such as eligibility, changing your election, and what happens when your coverage ends. These general medical care plan provisions apply to all of the medical plans. This document, together with the Medical Benefits Comparison Book, constitute the RIT Medical Care Plan’s summary plan description as required by the Employee Retirement Income Security Act of 1974 (ERISA).

General Information

Who is Covered and When

Regular full-time and extended part-time employees are eligible to participate in the Medical Plan. If you elect medical coverage, it can begin on the first day of the month on or after your date of employment. You need to enroll, however, and authorize the payroll deductions to pay your share of the cost before coverage can begin. If you are not at work on the day coverage is supposed to start, coverage will become effective on the day you return to active employment.

You also may obtain coverage for your spouse or domestic partner and/or eligible children by enrolling in two person or family coverage and authorizing payroll deductions to pay your share of the cost. You may not cover your spouse/domestic partner as a dependent if your spouse is enrolled for coverage as an employee. No dependent child may be covered by more than one employee in the plan. No dependent child can be covered as both an employee and a dependent.

Please refer to the Domestic Partner section of this handbook for more information on covering a domestic partner.

The eligibility rules for children are as follows:

The natural or adopted child of the employee or the employee’s opposite gender legal spouse

The natural or adopted child of the employee’s domestic partner or same gender spouse*

Any other child

Coverage for an unmarried dependent child who is physically or mentally disabled may be continued beyond the age limits of the Plan. Contact the Human Resources Department for further details.

Coverage for your dependents usually begins when your coverage begins. However, if your spouse/partner or a dependent child is confined in an institution or at home for medical reasons when coverage is supposed to begin, coverage will become effective on the first day the person is no longer confined.

A spouse/partner who is divorced from you is not eligible for coverage under the Plan. If you have an eligible dependent who is also an RIT employee, he or she may be covered either as an employee or as a dependent, but not both.

You Need to Enroll

Medical Plan coverage is not automatic; you need to complete an enrollment form for coverage to take effect. On the form you indicate your choice of medical plans and whether you want individual, two person, or family coverage.

It's important for you to return the completed enrollment form within 31 days after you first become eligible for coverage. If you wait beyond 31 days to enroll, you will not have another opportunity to enroll until the Plan's next open enrollment. If you have initially enrolled in one of the medical plans and wish to change to another plan, you may do so only at open enrollment.

Open Enrollment

Because medical care needs change from time to time, you have the opportunity once each year - effective as of January 1 - to make changes in your election. You can enroll in or cancel coverage, change plans, or change your coverage level (i.e., change from individual to two person). If you do not make a change during this open enrollment period, you will have to wait until the next open enrollment period to make a change unless you experience a qualified change in status that changes your medical care needs, described in the next section.

Election Changes During the Plan Year

In general, once you have enrolled in the Plan, you cannot change your elections or withdraw from the Plan until the beginning of the next plan year. However, pursuant to federal regulations, you may be able to make mid-year election changes if you meet certain criteria, as explained in items one through six, below. Your requested election change must be consistent with the reason for the change. For example, it would be consistent for an employee with two-person coverage that adopts a child during the year to change his or her election to family coverage. It would not be consistent to move from a family contract to a single contract. Changes must be made within 31 days of the event that gives you the right to make a new election. The Administrator may require you to submit certain documentation related to your reason for making a mid-year election change. New elections will become effective as soon as administratively possible. NOTE: you cannot change plans mid-year.

Your benefit elections may be changed - consistent with the event - to reflect the following events:

  1. Qualified Change in Status


    The following events constitute a qualified change in status:
    • a change in legal marital status: for example, a marriage or divorce
    • a change in the number of dependents: for example, the birth of a child, an adoption, a death, and so on
    • a change in a dependent's eligibility: for example, a child reaches the maximum age under a medical plan or ceases to be a student or similarly is no longer entitled to be covered by an underlying plan
    • a change in your residence or that of your spouse or dependent: for example, a move out of a geographic area covered by an HMO or another medical plan
    • you, your spouse or your dependent become eligible for continued health coverage under federal law (COBRA) or similar state law
    • you, your spouse or your dependent become entitled to or lose Medicare or Medicaid coverage

  2. Change in Employment Status

    The following events constitute a change in employment status where they affect you or your spouse or dependent:
    • termination of employment
    • commencement of employment
    • commencement or return from an unpaid leave of absence
    • change in employment classification that makes the person either eligible or ineligible to participate in a plan (for example, a change from full-time to part-time status, or the reverse, if such a change changes one's eligibility to participate in a plan)

  3. Changes in Employee's Cost of Coverage

    With respect to your pre-tax premium contributions, you are permitted to make a mid-year election change if there is a significant increase in the cost of an underlying medical insurance plan. If there is an ordinary increase or decrease in premiums, your payroll deductions will be automatically adjusted to reflect this change. Any determination of what constitutes a "significant increase" will be made by RIT.

  4. Changes in Coverage

    1. Pre-tax Premium Contributions - You may make a change in your election regarding your pre-tax premium contributions consistent with the following changes in coverage in an underlying medical insurance plan:
      • If the coverage provided by an underlying plan is significantly curtailed, you may revoke your prior election with regard to that plan
      • If a new medical insurance option is added or an insurance option you have selected is eliminated, you may make a new election
    2. Dependent Care Flexible Spending Account - You may make a change in your elections under the Dependent Care Spending Account consistent with the following types of coverage changes:
      • If you obtain a new child care provider, you may change your election to reflect the cost of the new provider (who is not a family member)
      • If the number of hours worked by the child care provider changes, you may change your election to reflect the new number of hours (e.g. if less care is needed because the child starts school mid-year, a new election can be made to reflect the lower number of child care hours required.)

  5. Qualified Medical Child Support Orders (QMCSO)

    If a court ordered judgement requires you to provide medical coverage for a child or foster chid, or if the order requires someone else to provide coverage, which you were previously providing, you may make mid-year election changes consistent with the QMCSO.

  6. Health Insurance Portability and Accountability Act of 1996 (HIPAA)

    If you exercise special enrollment rights provided by HIPAA, you will be permitted to make a mid-year election change.

All changes in coverage must be consistent with your change in status. An example of a consistent change would be to change from individual coverage to two person coverage upon being married.

Who Pays For This Protection

You and RIT share the cost of your medical plan. Your share of the cost will be based on the plan you select and whether you choose individual, two person, one parent family or family coverage.

Rates for medical coverage are provided annually by the Human Resources Department. These rates are subject to change. You will be notified in the event of any change in rates.

How RIT's Medical Benefits Contribution Methodology Works

RIT’s medical contribution methodology is what is commonly referred to as an “equal dollar contribution.” In addition, there are cost sharing levels for regular full-time employees, based on the employee’s annual base pay (extended part-time employees have one cost sharing schedule).

Effective January 1, 2010, regular full-time employees will pay for coverage based on their annual base pay as follows:

An equal dollar contribution means that RIT contributes the same amount to the cost of coverage for all employees and non-Medicare retirees in a cost sharing level who elect medical insurance through RIT, varied only by level of coverage – individual, two person or family – and by Medicare status. Equal dollar contribution is one of the most common ways that employers design their medical insurance contribution methodologies. It is based on the concept that RIT provides an equal level of support for everyone who has coverage in a cost sharing level, and keeps RIT neutral to any employee’s or retiree’s selection of a medical plan. As a result, employees and retirees pay more or less depending on the dollar difference between RIT’s equal dollar contribution and the actual plan premium charged by the insurance company.

Coordination of Benefits

If you have medical coverage under another group plan in addition to this one - through that of a spouse/partner, for example - the total benefits you are eligible to receive could be greater than your actual expenses. To help eliminate this duplicate spending, our Plan's coverage is coordinated with other group plans with which you have coverage. This means that when the RIT Plan pays second, benefits will be adjusted so that the total payments from both plans won't be more than 100% of total covered charges.

For your own claims and those of your spouse/partner, the plan that pays first is the one that covers you, your spouse or partner as an employee. If your children are covered by more than one plan, the plan of the parent whose birthday occurs earliest in the year will pay benefits first. However, if you are separated or divorced, the plan of the parent who has financial responsibility for the child's medical care expenses will pay first. If there is no court decree for medical care coverage, then the plan of the parent who has custody of the child will pay first. Where none of these situations apply, the plan that you're covered under the longest will pay first.

Other plans include any medical coverage available through:

When You Become Eligible For Medicare

When you or your spouse/partner reach age 65 while you are an active employee, your medical coverage may be continued as before, provided you continue to make your contributions for coverage. Medicare benefits also are available at age 65.

As explained under Coordination of Benefits, when you are eligible for coverage from two sources, coverage is coordinated. One plan will be designated the primary plan and will pay benefits first. The other plan will provide secondary coverage.

Under law, as an active employee, you have the right to elect one of the following options for yourself when you reach age 65 and for your spouse/partner when he or she reaches age 65:

Coverage at Retirement

Eligibility for Retirement

Age, years of service, and date of hire (or adjusted date of hire, if applicable) determines an employee's eligibility for retirement from RIT and, therefore, for continued access to medical insurance coverage from RIT. The eligibility rules are as follows (contribution rules are described later in this summary.

For employees hired prior to July 1, 1990:

For employees hired on or after July 1, 1990 but before January 1, 1995:

For employees hired on or after January 1, 1995:

Effective March 1, 2007, if

Then:

If the Assistant Vice President-Human Resources (AVP-HR) determines that the person is not a retiree for benefits purposes, then the individual will not be eligible to receive retiree benefits and privileges, effective as soon as administratively practicable on or after the date the determination has been made and communicated to the affected individual.

This is the case whether the willful misconduct occurs before or after the date that the individual retires from RIT - an employee may not elect to retire in advance of the conclusion of an audit or investigation's final report, with findings submitted to management, in order to avoid discharge and to preserve retiree benefits eligibility.

A committee appointed by the AVP-HR will review the circumstances of the case and provide counsel to the AVP-HR. The AVP-HR will be solely responsible for determining whether the person will be considered a retiree for benefits purposes.

The individual's eligibility to receive retirement income from the Basic and Voluntary Retirement Plans is not impacted by this determination.

Medical Insurance

Your age at the time of retirement determines the status of medical insurance for you and eligible family members. The definition of eligible family members is the same as that for active employees. You may enroll in or change among medical insurance carriers, without waiting periods, at the annual open enrollment period.

Adding a New Dependent After Retirement

RIT believes it is important to provide access to quality health care coverage. Any person who becomes an eligible dependent of a retiree on or after January 1, 2005 may be added to the retiree's health care coverage through RIT. However, the retiree will be required to pay the full difference in premium for the added individual(s).

Example: Martha is retired from RIT and marries Sam in August, 2005. Martha is covered by Medicare Blue Choice and chooses to add Sam to her coverage. RIT will continue to pay the premium for Martha's own coverage, but Martha will pay the full premium for Sam's Medicare Blue Choice coverage.

Medical Plan Choices and Medicare

If You Retire Before You and Your Spouse are Eligible for Medicare

If you retire before you (and your spouse/partner) are eligible for Medicare (generally before age 65), you are eligible for the pre-Medicare plans that RIT offers active employees (some plans may not be available due to geographic restrictions).

Approximately three months prior to turning age 65, you should contact your local Social Security office and enroll in Medicare Part A (hospitalization) and Part B (medical). Please note that if you enroll late, you may have higher Part B premiums. You will also need to make a change at that time in your RIT coverage; RIT's administrator, Q&F Benefits Administration will send information directly to you about three months before you turn age 65. See the following section for details on your coverage once you become eligible for Medicare.

If You Retire When You and Your Spouse are Eligible for Medicare

When you (and your spouse/partner) are eligible for Medicare (generally after age 65), you are eligible for one of the RIT medical plans for those covered by Medicare (some plans may not be available due to geographic restrictions). The benefits coverage under these plans may be different from the plan you have prior to becoming eligible for Medicare.

If you enroll in retiree medical insurance coverage, Medicare will be your primary coverage; the RIT coverage will be your secondary coverage. How this coordination actually works will depend on the plan you choose. Please note that the primary and secondary coverage rules may be modified when the Medicare Prescription Drug Plan goes into effect.

If you retire after you (and your spouse/partner) are eligible for Medicare, Medicare should have automatically enrolled you in Medicare Part A (hospitalization) at age 65. Approximately three months prior to retirement, you should contact your local Social Security office and enroll in Medicare Part B (medical) effective the first of the month on or after your retirement date. Please note that if you enroll late, you may have higher Part B premiums. The Social Security Administration may require an RIT Human Resources representative to verify your coverage under an employer group plan so you can avoid paying late Part B premiums if your late enrollment is due to your working past your 65th birthday.

If you Retire When You OR Your Spouse is Eligible for Medicare But the Other is NOT

If either you OR your spouse is eligible for Medicare at retirement (one of you is under age 65 and the other is age 65 or older), the person who is not eligible for Medicare will continue to participate in the same coverage as he/she had prior to retirement (pre-Medicare plan) and the one who is eligible for Medicare will participate in one of the plans for Medicare eligible individuals. You will each have an individual policy under your own name and identification number. If you are still covering dependent children, they will be covered under the policy of the pre-Medicare individual and that person will have the appropriate level of coverage (two person, family or one parent family).

If Your Adjusted Date of Hire is Before January 1, 2004 and You Are Age 35 or Over on January 1, 2008

Contribution Rules

The retiree contribution toward the cost will change as the retiree's age changes, as follows:

If the retiree chooses a plan that costs more than the Benchmark Plan, the retiree will pay the difference. If the retiree chooses a plan that costs less than the Benchmark Plan, RIT will pay 100% of the premium for the plan (the retiree is responsible for deductibles, co-payments and the Medicare Part B premium).

Cost sharing when the spouse/partner is under age 65 and the retiree is over age 65: The total contribution amount will be based on two components: the contribution amount for the Medicare-eligible retiree under the Benchmark Plan rules plus the contribution amount for the pre-Medicare spouse/partner based on the pre-Medicare cost sharing rules (same amount active employees pay).

Cost sharing when the retiree is age 55 to 64 and the spouse is over age 65: The total contribution amount will be based on two components: the contribution amount for the Medicare-eligible spouse/partner under the Benchmark Plan rules plus the contribution amount for the pre-Medicare retiree based on the pre-Medicare cost sharing rules (same amount active employees pay).

Cost sharing when the retiree is under age 55 and the spouse/partner is over age 65: The contribution amount will be the sum of the total premium for the pre-Medicare plan for the retiree plus the total premium for the Medicare plan that the spouse/partner has. When the retiree attains age 55, the total contribution amount will be based on two components: the contribution amount for the Medicare-eligible spouse under the Benchmark Plan rules plus the contribution amount for the pre-Medicare retiree based on the pre-Medicare cost sharing rules (same amount active employees pay).

Special Window Period: Special Window Period: There was a special “window period” for those employees eligible to retire and who were age 65 or older by June 30, 2005. If an employee in this category provided written notice to the manager by December 31, 2004 that he/she would retire on or before June 30, 2005, the retiree’s cost sharing is as though he/she retired prior to January 1, 2005 (i.e., the Benchmark Plan will not apply). If the employee’s spouse is under age 65 at the time of retirement, the spouse’s cost sharing will be under the Benchmark Plan rules when he/she becomes eligible for Medicare.

Upon Your Death

If you are retired, RIT continues coverage for your spouse/partner and dependent children at the appropriate level of coverage with the cost sharing rules in effect for retirees in your category. Coverage for your surviving spouse/partner will end if he/she becomes married. Coverage for your surviving children will end when they no longer meet the eligibility requirements for dependent children.

If you die while employed at RIT or while on LTD, RIT continues coverage for your spouse/partner and dependent children at the appropriate level of coverage with the cost sharing rules in effect for employees (or retirees if your spouse/partner is eligible for Medicare) in your category. Coverage for your surviving spouse/partner will end if he/she becomes married. Coverage for your surviving children will end when they no longer meet the eligibility requirements for dependent children.

If Your Adjusted Date of Hire is On or After January 1, 2004 OR Your Adjusted Date of Hire is Before January 1, 2004 AND You are Under Age 35 on January 1, 2008

Your retiree health care benefits will be provided through a "Retiree Medical Account," which we will refer to as an "RMA." An RMA is a lump sum account that will be made available to you when you retire. The RMA is funded entirely by RIT.

RMA Amount

How much will be in your account? That will depend on the year you retire. Each eligible employee who retires in a particular year will receive the same RMA beginning account balance.

How the RMA Works

During retirement, RIT will make one or more health care plans available to you at group rates. If you wish to participate in RIT health care benefits during your retirement, you will be responsible for paying the full premium for yourself, your spouse/partner, and any other dependents you cover. You may use the funds in the RMA to help pay for the premiums.

If you participate in another employer's plan during your retirement (for example, through your spouse's employer), the RMA funds can be used by you to reimburse yourself for all or a portion of the premiums for that plan, as long as the premiums have not been paid with pre-tax dollars (if your spouse is still employed), under current IRS rules. If you wish, you can use the RMA funds to reimburse yourself for Medicare premiums as well. The RMA cannot be used to pay for copays, deductibles or non-covered medical expenses - only for premiums paid on an after-tax basis.

You are responsible for managing the account over your lifetime. The RMA provides you with broad flexibility. You can use your account to pay premiums in whatever way best suits your needs. For example, you may decide that you don't need to access the account at all for the first five years after you retire because your spouse is still employed and you are able to obtain your health care coverage through his/her employer. After that time, you may begin using the account to pay all or a portion of your premiums. Another possibility is that you may decide to use the RMA to pay half your annual premium and pay the other half from your retirement plan income. Or, you may prefer to use the RMA to pay the full premium until it is used up. Once you have used your entire account, there will be no additional monies provided by RIT toward your retiree health care coverage. You can continue to participate in the RIT plans by paying the full premium.

The unused balance of your account will earn 3% interest each year, to help offset inflation. However, it is important for you to know that medical inflation historically has exceeded general inflation rates over time. This means that it is likely that you will need to supplement the RMA with other money to pay your premiums for your lifetime, and your spouse/partner's lifetime, if applicable.

You Need to Save, Too

In addition to premiums, you will have out of pocket medical expenses during retirement, such as copays, coinsurance, and deductibles, as is the case today. There are a number of potential tax-favored savings vehicles being discussed in Washington that could be used by employees to save for retiree medical expenses while they are working, and it is hoped that one or more of these will become available in the next several years. In the meantime, we encourage you to save as much as you are able to afford in the RIT Voluntary Retirement Plan (403(b) plan), because this money can be used to pay for your health care premiums, as well as your other living expenses, in retirement.

Upon Your Death

If you are retired and your spouse/partner (who was your spouse or partner at the time of your retirement from RIT) or dependent child outlives you, then he/she will continue to have access to the remaining balance in your RMA to help pay for his/her health care premiums, under the same terms and conditions applicable to you had you lived. The RMA will be available to your surviving spouse/partner as long as he/she does not remarry, or to your dependent child until he/she reaches the health care plan's age limit.

A person who becomes your spouse/partner/dependent child after you retire from RIT, may be added to your RIT health care coverage but you may not use the RMA to pay toward that person's premiums. Upon your death, this survivor will not have the RMA balance available, but he/she will remain able to participate in the RIT health care plan by paying the full premium, unless he/she remarries (or reaches the health care plan's age limit in the case of a dependent child).

If you die while employed at RIT and are retirement-eligible at the time of your death, then your spouse/partner/dependent children will have access to your RMA to help pay for their health care premiums. The amount of the RMA will be the same as if you had retired in the year of your death. Your spouse/partner will continue to have access to the RMA as long as he/she does not remarry. Your dependent children will continue to have access to the RMA until they reach the age limit of the plan. Any unused portion of an RMA will revert to RIT upon the death of whomever is last to die (or reach the health care plan's age limit in the case of a dependent child) - you or your eligible spouse/partner/child.

If you die while employed at RIT and are not retirement-eligible at the time of your death, then your spouse/partner/dependent children will be able to continue participating in RIT health care plans, but the RMA will not be available. They will pay the regular employee contributions for up to three years following your death. After three years, they can continue to participate in RIT health care plans by paying the full premium. Your spouse/partner will remain eligible as long as he/she does not become married. Your eligible dependent children will continue to have coverage until they reach the age limit of the plan.

When Coverage Ends

Your medical coverage ends when

Generally, your dependent's coverage ends when your coverage ends. However, a dependent's coverage also will end on the last day of the month in which;

If you or a dependent submit a fraudulent claim under a medical or dental plan, you and all your dependents will be permanently ineligible for coverage under all RIT medical options and the RIT Dental Care Plan.

Coverage May Be Continued

In certain circumstances, your coverage and that of your dependents may be continued beyond the date it normally would end. Coverage may continue as shown below, provided you make any required premium contributions.

When You Are Eligible for COBRA

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 you when you would otherwise lose your group health coverage. It can also become available to other members of your family who are covered under the Plan when they would otherwise lose their group health coverage. For additional information about your rights and obligations under the Plan and under federal law, you should review the Plan's Summary Plan Description or contact the Plan Administrator.

COBRA Continuation Coverage

COBRA continuation coverage is a continuation of Plan coverage when coverage would otherwise end because of a life event known as a "qualifying event." Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a "qualified beneficiary." You, your spouse and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of a qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage.

If you are an employee, you will become a qualified beneficiary if you will lose your coverage under the Plan because one of the following qualifying events happens:

If you are the spouse of an employee, you will become a qualified beneficiary if you will lose your coverage under the Plan because any of the following qualifying events happens:

Your dependent children will become qualified beneficiaries if they will lose coverage under the Plan because any of the following qualifying events happens:

Sometimes, filing a proceeding in bankruptcy under title 11 of the United States Code can be a qualifying event. If a proceeding in bankruptcy is filed with respect to Rochester Institute of Technology, and that bankruptcy results in the loss of coverage of any retired employee covered under the Plan, the retired employee is a qualified beneficiary with respect to the bankruptcy. The retired employee's spouse, surviving spouse, and dependent children will also be qualified beneficiaries if bankruptcy results in the loss of their coverage under the Plan.

When is COBRA Coverage Available?

The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. When the qualifying event is the end of employment or loss of eligibility, death of the employee, commencement of a proceeding in bankruptcy with respect to the employer, or enrollment of the employee in Medicare (Part A, Part B, or both), the employer must notify the Plan Administrator of the qualifying event.

You Must Give Notice of Some Qualifying Events

For the other qualifying events (divorce or legal separation of the employee and spouse or a dependent child's losing eligibility for coverage as a dependent child), you must notify the Plan Administrator within 60 days after the qualifying event occurs. If notice is not received within that 60-day period, the dependent will not be entitled to choose continuation coverage. You must provide this notice to Rochester Institute of Technology Human Resources Department. If you do not choose continuation coverage within the 60-day election period, your group health coverage will end as of the date of the qualifying event.

How is COBRA Coverage Provided?

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.

COBRA continuation coverage is a temporary continuation of coverage. When the qualifying event is the death of the employee, enrollment of the employee in Medicare (part A, Part B, or both), your divorce or legal separation, or a dependent child's losing eligibility as a dependent child, COBRA continuation coverage lasts for up to a total of 36 months. When the qualifying event is the end of employment or the employee becoming ineligible for coverage, 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 8 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 8 months). Otherwise, when the qualifying event is the end of employment or reduction of the employee's hours of employment, COBRA continuation coverage generally lasts for only up to a total of 18 months. There are two ways in which this 18-month period of COBRA continuation coverage can be extended.

Disability extension of 18-month period of continuation coverage

If you or anyone in your family covered under the Plan is determined by the Social Security Administration to be disabled and you notify the Plan Administrator in a timely fashion, you and your 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. If you believe this extension pertains to you or anyone in your family, you must provide notice to the Rochester Institute of Technology Human Resources Department; 8 Lomb Memorial Drive; Rochester, NY 14623-5604 and complete any necessary forms to make this change.

Second qualifying event extension of 18-month period of continuation coverage

If your family experiences another qualifying event while receiving 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get 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 dependent children if the former employee dies, enrolls in Medicare (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.

If You Have Questions

Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. For more information about your rights under ERISA, including COBRA, the Health Insurance Portability and Accountability Act (HIPAA), and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor's Employee Benefits Security Administration (EBSA) in your area or visit the EBSA website at http://www.dol.gov/ebsa/. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA's website.)

Keep Your Plan Informed of Address Changes

In order to protect your family's rights, you should keep the Plan Administrator informed of any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator.

Plan Contact Information

If you have questions or require further information, please contact the Rochester Institute of Technology Human Resources Department; George Eastman Building; 8 Lomb Memorial Drive; Rochester, NY 14623-5604; (585) 475-2424 (voice).

How Long COBRA Coverage Will Continue

Converting to an Individual Policy

When your coverage here ends as a result of either termination of employment or the expiration of the continuation provision, you have the right to convert your medical to an individual insurance plan - or family plan, if you have had family coverage - without having to furnish medical statements. Also, if your spouse/partner or dependent children are no longer eligible for coverage, you can convert their coverage to individual insurance plans. The converted individual policy may provide lesser benefits than this Plan.

To obtain a conversion policy, you must apply for it - and pay the required insurance premium - within 31 days after your coverage ends. Check with your insurance carrier if you want additional information about the availability, cost and benefits of conversion policies.

Your Rights under ERISA

[The U.S. Department of Labor requires that the following notice be included in all Summary Plan Descriptions.]

As a participant in Rochester Institute of Technology benefit plans, 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, all documents governing the plan, including insurance contracts, 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 Pension and Welfare Benefit 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 report. The Plan Administrator is required by law to furnish each Participant with a copy of this summary financial report.

Continue Group Health Care Coverage

Continue health care coverage for yourself, spouse or 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 preexisting 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. [NOTE: None of the health insurance options presently offered by RIT include a pre-existing condition exclusion.]

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, 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.

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, 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 office of the Pension and Welfare Benefits Administration, U.S. Department of Labor, listed in your telephone directory or the Division of Technical Assistance and Inquiries, Pension and Welfare Benefits 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 Pension and Welfare Benefits Administration.

Your Rights under the Newborns' and Mothers' Health Protection Act

Group health plans and health insurance issuers generally may not, under federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother's or newborn's attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under federal law, require that a provider obtain authorization from the plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).

Qualified Medical Child Support Orders ("QMCSOS")

A medical child support order shall be filed with the plan administrator as soon as reasonably possible after it has been filed promptly upon the receipt of such order, the plan administrator shall notify the participant and each person eligible to receive benefits under the terms of the order ("alternate recipients") of its receipt and of the procedures set forth in this section 14.04.

The Participant and the alternate recipients may provide comments to the Plan Administrator with respect to the order during the 30 day period commencing as of the date the Plan Administrator sends them notice of receipt of the order. The Plan Administrator shall, within the 60 day period commencing as of the expiration of the 30 day comment period specified in the preceding sentence, determine whether the order is qualified and shall so notify the participant and the alternate recipients in writing of its decision. The parties may waive the 30 day comment period. If they do so, the 60 day period shall commence as of the date all parties have waived their rights to submit comments. The Plan Administrator's determination on the qualified status of an order is final. As soon as reasonably practicable following its notification that an order is "qualified," the Plan Administrator shall take such steps it deems appropriate to implement the order.

The Plan Administrator encourages parties to submit draft orders for "pre-approval" of their qualified status prior to their being submitted to a court for signature as such pre-approval will expedite approval procedures.

An alternate recipient may designate a representative for receipt of copies of notices that are sent to an alternate recipient with respect to a medical child support order.

Claim Procedures

  1. Claims for Benefits - An Employee wishing to present a claim for benefits for himself or his Dependents should obtain a claim form or forms from his Employer or Plan Administrator. The applicable section of such form or forms should be completed by (1) Employee, (2) Employer or Plan Administrator, and (3) attending Physician or Hospital. Claims will only be processed if received within a reasonable time following the date the expense to which the claim relates arises.

    Following completion, the claim form or forms should be submitted to the Plan's representative as indicated on the reverse side of the Employee's Benefit Plan Identification Card. The organization that is authorized by the Plan to process and pay claims (the Plan's Claims Administrator) will compute benefits due, and cause proper claims to be paid. Unless the Employee assigns benefits to a doctor or to a Hospital, draft(s) will be made payable to the Employee.

    A decision will be made by the Claims Administrator no more than ninety (90) days after receipt of due proof of loss, except in special circumstances (such as the need to obtain further information), but in no case more than one hundred eighty (180) days after the due proof of loss is received. The written decision will include specific reasons for the decisions and specific references to the Plan provisions on which the decision is based.

  2. Appealing Denial of Claims - If a claim for benefits is wholly or partially denied, notice of the decision shall be furnished to the Employee. This written decision will:
    1. Give the specific reason or reasons for denial;
    2. Make specific reference to the Plan provisions on which the denial is based;
    3. Provide a description of any additional information necessary to perfect the claim, if possible, and an explanation of why it is necessary; and
    4. Provide an explanation of the review procedure.
    On any denied claim an Employee or his representative may appeal to the Plan Administrator for a full and fair review. The claimant may:
    1. Request a review upon written application within sixty (60) days of receipt of claim denial;
    2. Review pertinent documents; and
    3. Submit issues and comments in writing.

A decision will be made by the Plan Administrator no more than sixty (60) days after receipt of the request for review, except in special circumstances (such as the need to hold a hearing), but in no case more than one hundred twenty (120) days after the request for review is received. The written decision will include specific reasons for the decision and specific references to the Plan provisions on which the decision is based.

Additional information about claims submitted and review procedures may be obtained by contacting the Plan Administrator.

If you have any questions about your Plan, you should contact the Human Resources Department. If you have any questions about this statement or about your rights under ERISA, you should contact the nearest Area Office of the U.S. Labor Management Services Administration, Department of Labor.

Additional Information

Employer
Rochester Institute of Technology

Employer Identification Number
16-0743140

Plan Sponsor
Rochester Institute of Technology
8 Lomb Memorial Drive
Rochester, NY 14623-5604

Plan Administrator
Rochester Institute of Technology
8 Lomb Memorial Drive
Rochester, NY 14623-5604

Business Telephone Number
(585) 475-2424 (voice)

Agent for Service of Legal Process
Associate Director of Human Resources, Benefits, Health and Wellness
Rochester Institute of Technology
8 Lomb Memorial Drive
Rochester, NY 14623-5604