Page 3 - HarborLight CU 2014-15 SPD
P. 3
le of Contents
Introduction.............................................................................................................................. ii
Table of Contents .....................................................................................................................iii
Plan Overview .......................................................................................................................... 1
Your Eligibility ......................................................................................................................... 1
Eligible Dependents ................................................................................................................ 1
When Coverage Begins .......................................................................................................... 2
Proof of Dependent Eligibility .................................................................................................. 2
Your Contribution for Coverage............................................................................................... 2
Enrolling for Coverage ............................................................................................................ 3
New Hire Enrollment............................................................................................................ 3
Late Entrant......................................................................................................................... 3
Annual Open Enrollment Period.............................................................................................. 3
Effect of Section 125 Tax Regulations on this Plan ................................................................. 3
Qualifying Change in Status.................................................................................................... 4
Special Enrollment Rights ....................................................................................................... 4
When Coverage Ends............................................................................................................. 5
Cancellation of Coverage........................................................................................................ 5
Rescission of Coverage .......................................................................................................... 5
Coverage While Not at Work................................................................................................... 5
If You Take a Leave of Absence (FMLA) ................................................................................. 6
If You Take a Military Leave of Absence .................................................................................. 6
Your Health Care Coverage ..................................................................................................... 7
Participation............................................................................................................................ 7
Benefits Provided.................................................................................................................... 7
Source of Payments................................................................................................................ 8
Opt-Out Credits....................................................................................................................... 8
Limitations and Exclusions...................................................................................................... 8
Continuation of Health Care Coverage through COBRA ......................................................... 8
For More Information .............................................................................................................. 8
Your Health Reimbursement Arrangement (“HRA”) .............................................................. 9
How the HRA Works ............................................................................................................... 9
How to File a Claim................................................................................................................. 9
Benefit Payment ..................................................................................................................... 9
Maintaining Records ..............................................................................................................10
Ineligible Claims.....................................................................................................................10
Changes in Coverage ............................................................................................................10
When Participation Ends........................................................................................................10
Health Care Flexible Spending Account and HRA..................................................................11
For More Information .............................................................................................................11
Your Life and Accidental Death & Dismemberment (“AD&D”) Coverage............................12
Participation ...........................................................................................................................12
Benefits Provided...................................................................................................................12
Source of Payment ................................................................................................................12
Plan Limitations and Exclusions.............................................................................................12
Coverage Continuation ..........................................................................................................12
For More Information .............................................................................................................12
Your Disability Benefits ..........................................................................................................13
Participation ...........................................................................................................................13
iii
Introduction.............................................................................................................................. ii
Table of Contents .....................................................................................................................iii
Plan Overview .......................................................................................................................... 1
Your Eligibility ......................................................................................................................... 1
Eligible Dependents ................................................................................................................ 1
When Coverage Begins .......................................................................................................... 2
Proof of Dependent Eligibility .................................................................................................. 2
Your Contribution for Coverage............................................................................................... 2
Enrolling for Coverage ............................................................................................................ 3
New Hire Enrollment............................................................................................................ 3
Late Entrant......................................................................................................................... 3
Annual Open Enrollment Period.............................................................................................. 3
Effect of Section 125 Tax Regulations on this Plan ................................................................. 3
Qualifying Change in Status.................................................................................................... 4
Special Enrollment Rights ....................................................................................................... 4
When Coverage Ends............................................................................................................. 5
Cancellation of Coverage........................................................................................................ 5
Rescission of Coverage .......................................................................................................... 5
Coverage While Not at Work................................................................................................... 5
If You Take a Leave of Absence (FMLA) ................................................................................. 6
If You Take a Military Leave of Absence .................................................................................. 6
Your Health Care Coverage ..................................................................................................... 7
Participation............................................................................................................................ 7
Benefits Provided.................................................................................................................... 7
Source of Payments................................................................................................................ 8
Opt-Out Credits....................................................................................................................... 8
Limitations and Exclusions...................................................................................................... 8
Continuation of Health Care Coverage through COBRA ......................................................... 8
For More Information .............................................................................................................. 8
Your Health Reimbursement Arrangement (“HRA”) .............................................................. 9
How the HRA Works ............................................................................................................... 9
How to File a Claim................................................................................................................. 9
Benefit Payment ..................................................................................................................... 9
Maintaining Records ..............................................................................................................10
Ineligible Claims.....................................................................................................................10
Changes in Coverage ............................................................................................................10
When Participation Ends........................................................................................................10
Health Care Flexible Spending Account and HRA..................................................................11
For More Information .............................................................................................................11
Your Life and Accidental Death & Dismemberment (“AD&D”) Coverage............................12
Participation ...........................................................................................................................12
Benefits Provided...................................................................................................................12
Source of Payment ................................................................................................................12
Plan Limitations and Exclusions.............................................................................................12
Coverage Continuation ..........................................................................................................12
For More Information .............................................................................................................12
Your Disability Benefits ..........................................................................................................13
Participation ...........................................................................................................................13
iii
