Page 4 - 2013 Adv1FCU Health and Welfare SPD

Participation ........................................................................................................................... 19
Benefits Provided ................................................................................................................... 19
Source of Payment ................................................................................................................ 19
Payment of Benefits ............................................................................................................... 19
Offset of Other Benefits.......................................................................................................... 20
Limitations and Exclusions ..................................................................................................... 20
Claims and Appeals ............................................................................................................... 20
For More Information ............................................................................................................. 20
Administrative Information ..................................................................................................... 21
Plan Sponsor and Administrator ............................................................................................. 21
Plan Year ............................................................................................................................... 22
Type of Plan ........................................................................................................................... 22
Identification Numbers ........................................................................................................... 22
Plan Funding and Type of Administration ............................................................................... 22
Insurers/Claims Administrators .............................................................................................. 23
Agent for Service of Legal Process ........................................................................................ 24
No Obligation to Continue Employment ................................................................................. 25
Non-Alienation of Benefits...................................................................................................... 25
Severability ............................................................................................................................ 25
Payment of Benefits to Others ............................................................................................... 25
Expenses ............................................................................................................................... 25
Fraud ..................................................................................................................................... 25
Indemnity ............................................................................................................................... 25
Compliance with State and Federal Mandates ....................................................................... 25
Refund of Premium Contributions .......................................................................................... 26
Non-discrimination ................................................................................................................. 26
Future of the Plan .................................................................................................................. 26
Claims Procedures/Coordination of Benefits ....................................................................... 27
Claims and Appeals ............................................................................................................... 27
Exhaustion Required.............................................................................................................. 27
Non-Duplication of Benefits / Coordination of Benefits ........................................................... 28
Health Care Coverage Coordination with Medicare ............................................................... 28
Subrogation and Reimbursement........................................................................................... 28
Your Rights under ERISA ....................................................................................................... 29
Receive Information about Your Plan and Benefits ................................................................ 29
Continue Group Health Plan Coverage .................................................................................. 29
Prudent Actions by Plan Fiduciaries ....................................................................................... 29
Enforce Your Rights ............................................................................................................... 29
Assistance with Your Questions ............................................................................................. 30
Your HIPAA Rights .................................................................................................................. 31
Health Insurance Portability and Accountability Act (HIPAA) .................................................. 31
Certificate of Creditable Coverage ......................................................................................... 32
Your COBRA Continuation Coverage Rights ........................................................................ 33
Continuing Health Care Coverage through COBRA ............................................................... 33
COBRA Qualifying Events and Length of Coverage ............................................................... 33

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