Page 4 - Salus Group Plan Doc SPD

Benefits Provided ................................................................................................................... 17
Source of Payment ................................................................................................................ 17
Plan Limitations and Exclusions ............................................................................................. 17
For More Information ............................................................................................................. 17
Your Voluntary Vision Plan Coverage ................................................................................... 18
Participation ........................................................................................................................... 18
Benefits Provided ................................................................................................................... 18
Source of Payment ................................................................................................................ 18
Plan Limitations and Exclusions ............................................................................................. 18
For More Information ............................................................................................................. 18
Administrative Information ..................................................................................................... 19
Plan Sponsor and Administrator ............................................................................................ 19
Plan Year ............................................................................................................................... 20
Type of Plan .......................................................................................................................... 20
Identification Numbers ........................................................................................................... 20
Plan Funding and Type of Administration ............................................................................... 20
Insurers/Claims Administrators .............................................................................................. 21
Agent for Service of Legal Process ........................................................................................ 22
No Obligation to Continue Employment ................................................................................. 22
Non-Alienation of Benefits ..................................................................................................... 22
Severability ............................................................................................................................ 22
Payment of Benefits to Others ............................................................................................... 22
Expenses ............................................................................................................................... 23
Fraud ..................................................................................................................................... 23
Indemnity ............................................................................................................................... 23
Compliance with State and Federal Mandates ....................................................................... 23
Non-discrimination ................................................................................................................. 23
Future of the Plan .................................................................................................................. 23
Claims Procedures/Coordination of Benefits ....................................................................... 24
Claims and Appeals ............................................................................................................... 24
Exhaustion Required.............................................................................................................. 24
Non-Duplication of Benefits / Coordination of Benefits ........................................................... 24
Health Care Coverage Coordination with Medicare ............................................................... 25
Subrogation and Reimbursement........................................................................................... 25
Your Rights under ERISA ....................................................................................................... 26
Receive Information about Your Plan and Benefits ................................................................ 26
Continue Group Health Plan Coverage .................................................................................. 26
Prudent Actions by Plan Fiduciaries ....................................................................................... 26
Enforce Your Rights ............................................................................................................... 26
Assistance with Your Questions ............................................................................................. 27
Your HIPAA Rights.................................................................................................................. 28
Health Insurance Portability and Accountability Act (HIPAA) .................................................. 28
Certificate of Creditable Coverage ......................................................................................... 29
Your COBRA Continuation Coverage Rights ........................................................................ 30
Continuing Health Care Coverage through COBRA ............................................................... 30
COBRA Qualifying Events and Length of Coverage .............................................................. 30
18-Month Continuation ....................................................................................................... 30

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