Obtain, upon written request to the Plan administrator,
copies of documents governing the operation of the
Plan, including insurance contracts and collective
bargaining agreements, and copies of the latest
annual report (Form 5500 Series) and updated
summary plan description. The administrator
may make a reasonable charge for the copies.
Receive a summary of the Plan’s annual
financial report. The Plan administrator is
required by law to furnish each participant
with a copy of this summary annual report.
Continue health care Coverage for yourself, spouse
or Dependents if there is a loss of Coverage under
the Plan as a result of a qualifying event. You or your
Dependents may have to pay for such Coverage.
Review this summary plan description and the
documents governing the Plan on the rules governing
your COBRA continuation Coverage rights.
Prudent Actions by Plan Fiduciaries
In addition to creating rights for Plan participants, ERISA
imposes duties upon the people who are responsible
for the operation of the employee benefit plan. The
people who operate your Plan, called “fiduciaries” of the
Plan, have a duty to do so prudently and in the interest
of you and other Plan participants and beneficiaries.
No one, including your employer, your union, or any
other person, may fire you or otherwise discriminate
against you in any way to prevent you from obtaining a
welfare benefit or exercising your rights under ERISA.
Enforce Your Rights
If your claim for a welfare benefit is denied or ignored,
in whole or in part, you have a right to know why this
was done, to obtain copies of documents relating
to the decision without charge, and to appeal
any denial, all within certain time schedules.
Under ERISA, there are steps you can take to enforce
the above rights. For instance, if you request a copy of
Plan documents or the latest annual report from the
Plan and do not receive them within 30 days, you may
file suit in a Federal court. In such a case, the court may
require the Plan administrator to provide the materials
and pay you up to $110 a day until you receive the
materials, unless the materials were not sent because
of reasons beyond the control of the administrator.
If it should happen that Plan fiduciaries misuse the Plan’s
money, or if you are discriminated against for asserting
your rights, you may seek assistance from the U.S.
Department of Labor, or you may file suit in a Federal
court. The court will decide who should pay court costs
and legal fees. If you are successful the court may order
the person you have sued to pay these costs and fees.
If you lose, the court may order you to pay these costs
and fees, for example, if it finds your claim is frivolous.
Assistance with Your Questions
If you have any questions about your Plan, you should
contact the Plan administrator. If you have any questions
about this statement or about your rights under ERISA,
or if you need assistance in obtaining documents from
the Plan administrator, you should contact the nearest
office of the Employee Benefits Security Administration,
U.S. Department of Labor, listed in your telephone
directory or the Division of Technical Assistance and
Inquiries, Employee Benefits Security Administration,
U.S. Department of Labor, 200 Constitution Avenue N.W.,
Washington, D.C. 20210. You may also obtain certain
publications about your rights and responsibilities
under ERISA by calling the publications hotline of
the Employee Benefits Security Administration.
Your Plan is administered by your Plan administrator,
which has the authority to delegate the day-to-
day administrative duties to a third party. Here,
your Plan administrator has delegated such duties
to Blue Cross and Blue Shield of Vermont.
Blue Cross and Blue Shield of Vermont, as delegated by
your Plan administrator, shall have complete discretion to
interpret and construe the provisions of the Plan options,
programs and policies described in this Benefits Booklet,
to determine eligibility for participation and for benefits,
make findings of fact, correct errors and supply omissions.
All decisions and interpretations Blue Cross and Blue Shield
of Vermont made pursuant to the Plan options, programs
and policies described in this Benefits Booklet shall be
final, conclusive and binding on all persons and may not
be overturned unless found by a court to be arbitrary
and capricious, or unless found by an independent
medical review organization, after external review, to
be made in error. Your Plan administrator may delegate
this discretionary authority to select service providers.
If you have questions or comments regarding the
Plan’s administration, contact customer service
at Blue Cross and Blue Shield of Vermont.
Qualified Medical Child Support Orders (QMCSO)
The Omnibus Budget Reconciliation Act of 1993 (OBRA
‘93) mandates that group health plans provide benefits
according to qualified medical child support order
requirements. Contact your plan administrator to obtain,
without charge, a copy of the QMCSO procedures.