Page 4 - HarborLight CU 2014-15 SPD
P. 4
enefits Provided...................................................................................................................13
Source of Payment ................................................................................................................13
Payment of Benefits...............................................................................................................13
Offset of Other Benefits..........................................................................................................14
Limitations and Exclusions.....................................................................................................14
Claims and Appeals ...............................................................................................................14
For More Information .............................................................................................................14
Your Employee Assistance Program (“EAP”) .......................................................................15
Participation ...........................................................................................................................15
Benefits Provided...................................................................................................................15
Source of Payment ................................................................................................................15
Plan Limitations and Exclusions.............................................................................................15
For More Information .............................................................................................................15
Administrative Information.....................................................................................................16
Plan Sponsor and Administrator.............................................................................................16
Plan Year ...............................................................................................................................17
Type of Plan...........................................................................................................................17
Identification Numbers ...........................................................................................................17
Plan Funding and Type of Administration ...............................................................................17
Insurers/Claims Administrators ..............................................................................................18
Agent for Service of Legal Process ........................................................................................19
No Obligation to Continue Employment .................................................................................19
Non-Alienation of Benefits......................................................................................................19
Severability ............................................................................................................................19
Payment of Benefits to Others ...............................................................................................20
Expenses ...............................................................................................................................20
Fraud .....................................................................................................................................20
Indemnity ...............................................................................................................................20
Compliance with State and Federal Mandates .......................................................................20
Refund of Premium Contributions ..........................................................................................20
Non-discrimination .................................................................................................................21
Future of the Plan ..................................................................................................................21
Claims Procedures/Coordination of Benefits .......................................................................22
Claims and Appeals ...............................................................................................................22
Exhaustion Required..............................................................................................................22
Non-Duplication of Benefits / Coordination of Benefits ...........................................................22
Subrogation and Reimbursement...........................................................................................23
Your Rights under ERISA .......................................................................................................24
Receive Information about Your Plan and Benefits ................................................................24
Continue Group Health Plan Coverage ..................................................................................24
Prudent Actions by Plan Fiduciaries.......................................................................................24
Enforce Your Rights ...............................................................................................................24
Assistance with Your Questions .............................................................................................25
Your HIPAA Rights ..................................................................................................................26
Health Insurance Portability and Accountability Act (HIPAA) ..................................................26
Certificate of Creditable Coverage .........................................................................................27
Your COBRA Continuation Coverage Rights ........................................................................28
Continuing Health Care Coverage through COBRA ...............................................................28
COBRA Qualifying Events and Length of Coverage...............................................................28
18-Month Continuation .......................................................................................................28
36-Month Continuation .......................................................................................................29
iv
Source of Payment ................................................................................................................13
Payment of Benefits...............................................................................................................13
Offset of Other Benefits..........................................................................................................14
Limitations and Exclusions.....................................................................................................14
Claims and Appeals ...............................................................................................................14
For More Information .............................................................................................................14
Your Employee Assistance Program (“EAP”) .......................................................................15
Participation ...........................................................................................................................15
Benefits Provided...................................................................................................................15
Source of Payment ................................................................................................................15
Plan Limitations and Exclusions.............................................................................................15
For More Information .............................................................................................................15
Administrative Information.....................................................................................................16
Plan Sponsor and Administrator.............................................................................................16
Plan Year ...............................................................................................................................17
Type of Plan...........................................................................................................................17
Identification Numbers ...........................................................................................................17
Plan Funding and Type of Administration ...............................................................................17
Insurers/Claims Administrators ..............................................................................................18
Agent for Service of Legal Process ........................................................................................19
No Obligation to Continue Employment .................................................................................19
Non-Alienation of Benefits......................................................................................................19
Severability ............................................................................................................................19
Payment of Benefits to Others ...............................................................................................20
Expenses ...............................................................................................................................20
Fraud .....................................................................................................................................20
Indemnity ...............................................................................................................................20
Compliance with State and Federal Mandates .......................................................................20
Refund of Premium Contributions ..........................................................................................20
Non-discrimination .................................................................................................................21
Future of the Plan ..................................................................................................................21
Claims Procedures/Coordination of Benefits .......................................................................22
Claims and Appeals ...............................................................................................................22
Exhaustion Required..............................................................................................................22
Non-Duplication of Benefits / Coordination of Benefits ...........................................................22
Subrogation and Reimbursement...........................................................................................23
Your Rights under ERISA .......................................................................................................24
Receive Information about Your Plan and Benefits ................................................................24
Continue Group Health Plan Coverage ..................................................................................24
Prudent Actions by Plan Fiduciaries.......................................................................................24
Enforce Your Rights ...............................................................................................................24
Assistance with Your Questions .............................................................................................25
Your HIPAA Rights ..................................................................................................................26
Health Insurance Portability and Accountability Act (HIPAA) ..................................................26
Certificate of Creditable Coverage .........................................................................................27
Your COBRA Continuation Coverage Rights ........................................................................28
Continuing Health Care Coverage through COBRA ...............................................................28
COBRA Qualifying Events and Length of Coverage...............................................................28
18-Month Continuation .......................................................................................................28
36-Month Continuation .......................................................................................................29
iv
