Page 4 - Allied_Plan Doc SPD 0101214

Payment of Benefits ...............................................................................................................17
Offset of Other Benefits..........................................................................................................17
Limitations and Exclusions .....................................................................................................17
Claims and Appeals ...............................................................................................................17
For More Information .............................................................................................................18

Your Health Savings Account (“HSA”) ..................................................................................19
How the HSA Works ..............................................................................................................19
Catch-Up Contributions ..........................................................................................................20
Government Regulations and Your HSA ................................................................................20
How to File a Claim ................................................................................................................20
When Participation Ends - Health Savings Account ...............................................................20
If You Die ...............................................................................................................................21
Additional Information ............................................................................................................21

Administrative Information .....................................................................................................22
Plan Sponsor and Administrator .............................................................................................22
Plan Year ...............................................................................................................................23
Type of Plan ...........................................................................................................................23
Identification Numbers ...........................................................................................................23
Plan Funding and Type of Administration ...............................................................................23
Insurers/Claims Administrators ..............................................................................................24
Agent for Service of Legal Process ........................................................................................25
No Obligation to Continue Employment .................................................................................25
Non-Alienation of Benefits......................................................................................................26
Severability ............................................................................................................................26
Payment of Benefits to Others ...............................................................................................26
Expenses ...............................................................................................................................26
Fraud .....................................................................................................................................26
Indemnity ...............................................................................................................................26
Compliance with State and Federal Mandates .......................................................................26
Refund of Premium Contributions ..........................................................................................27
Non-discrimination .................................................................................................................27
Future of the Plan ..................................................................................................................27
Claims Procedures/Coordination of Benefits .......................................................................28
Claims and Appeals ...............................................................................................................28
Exhaustion Required..............................................................................................................28
Non-Duplication of Benefits / Coordination of Benefits ...........................................................29
Health Care Coverage Coordination with Medicare ...............................................................29
Subrogation and Reimbursement...........................................................................................29
Your Rights under ERISA .......................................................................................................30
Receive Information about Your Plan and Benefits ................................................................30
Continue Group Health Plan Coverage ..................................................................................30
Prudent Actions by Plan Fiduciaries .......................................................................................30
Enforce Your Rights ...............................................................................................................31

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