Page 3 - Allied_Plan Doc SPD 0101214

Table of Contents

Introduction .............................................................................................................................. 2

Table of Contents ..................................................................................................................... 3
Plan Overview .......................................................................................................................... 6
Your Eligibility ......................................................................................................................... 6
Eligible Dependents ................................................................................................................ 6
When Coverage Begins .......................................................................................................... 7
Proof of Dependent Eligibility .................................................................................................. 7
Your Contribution for Coverage ............................................................................................... 7
Enrolling for Coverage ............................................................................................................ 8
New Hire Enrollment ............................................................................................................ 8
Late Entrant ......................................................................................................................... 8
Annual Open Enrollment Period .............................................................................................. 8
Effect of Section 125 Tax Regulations on this Plan ................................................................. 9
Qualifying Change in Status .................................................................................................... 9
Special Enrollment Rights ......................................................................................................10
When Coverage Ends ............................................................................................................10
Cancellation of Coverage .......................................................................................................10
Rescission of Coverage ......................................................................................................... 11
Coverage While Not at Work .................................................................................................. 11
If You Take a Leave of Absence (FMLA) ................................................................................ 11
If You Take a Military Leave of Absence ................................................................................. 11

Your Health Care Coverage ....................................................................................................12
Participation ...........................................................................................................................12
Benefits Provided ...................................................................................................................12
Source of Payments ...............................................................................................................13
Opt-Out Credits ......................................................................................................................13
Limitations and Exclusions .....................................................................................................13
Continuation of Health Care Coverage through COBRA ........................................................13
For More Information .............................................................................................................13
Your Life and Accidental Death & Dismemberment (“AD&D”) Coverage ............................14
Participation ...........................................................................................................................14
Benefits Provided ...................................................................................................................14
Source of Payment ................................................................................................................14
Plan Limitations and Exclusions .............................................................................................14
Coverage Continuation ..........................................................................................................14
For More Information .............................................................................................................15
Your Disability Benefits ..........................................................................................................16

Participation ...........................................................................................................................16
Benefits Provided ...................................................................................................................16
Source of Payment ................................................................................................................17

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