Page 8 - PWH 2018 Plan Documents

enrollment procedure listed in each component benefit program for additional information to fully
determine all of the participation requirements.

Your participation and the participation of your eligible family members in the Plan will terminate
on the same day you terminate employment. However, some benefits may continue until the
end of the month in which your employment terminates. Coverage may also terminate if you fail
to pay your share of an applicable premium, if your hours drop below any required hourly
threshold, if you submit false claims or for any other reason as set forth in the certificate of
insurance or other governing documents for the Plan.

Continuation of Coverage Under COBRA and USERRA:

If eligible coverage for you or your eligible family members ceases because of certain “qualifying
events” specified in COBRA, then you and your eligible family members may have the right to
purchase continuation of coverage for a temporary period of time. If you have any questions
about your COBRA rights, please read the benefit booklets as provided by the insurance
company. Please contact your Plan Administrator if you need another copy.

Continuation and reinstatement rights may also be available if you are absent for employment
due to service in the uniformed services pursuant to USERRA. More information about coverage
available pursuant to USERRA is included in the certificate of insurance.

Type of plan and administration:

The Plan provides welfare benefits consisting of group health benefits, life insurance benefits,
dental benefits, vision benefits, short & long term disability benefits. The Plan is administered by
David Weber & Deborah Kerlin.

Plan funding:

Medical, life, dental, vision, short term disability, long term disability, voluntary life benefits under
the Plan are funded by employee contributions made from the Employers General Fund,
pre-tax and post-tax employee contributions and insurance contracts. The Plan
Administrator provides a schedule of the applicable premiums during the initial and subsequent
open enrollment periods and upon request for each of the component benefit programs. The
Plan Administrator reserves the right to modify the amount employees have to contribute to
participate in the Plan at any time.

The plan is fully insured with respect to these benefits.

Claims Administrator / Insurance Company:

Medical
Anthem 1351 William Howard Taft Rd, Cincinnati, OH 45206 (513) 872-8100

Medical Health Reimbursement Arrangement
Custom Design Benefits 5589 Cheviot Rd, Cincinnati, OH 45247 (513) 598-2929

Dental
Dental Care Plus 100 Crowne Point Place Cincinnati, OH 45241 800-367-9466

Vision