Page 44 - KCCU Health & Welfare SPD

notify the Plan Administrator of any address change as soon as possible. Failure on your part to do so will
result in delayed notifications or a loss of continuation coverage options.

Any Questions? - This notice is a summary of your potential future continuation coverage options only
and not a description of your actual health plan or full COBRA rights. For any health plan questions, you
should review the Plan’s Summary Plan Description or get a copy of the Plan Document from the Plan
Administrator. Should you have any continuation coverage questions regarding the information contained
in this or any future notice, you should contact the parties listed 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. Addresses and
phone numbers of Regional and District EBSA Offices are available through EBSA’s web site at
www.dol.gov/ebsa.

Plan and Continuation Coverage Contact Information –

Kent County Credit Union
1619 Plainfield NE
Grand Rapids, MI 49505
Attention: Human Resources
Phone: (616) 336-3490

Certain statutes, regulations, etc. may be amended or overruled following the mailing of this notice.
Revised 9/20/2012

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