The information in this document is a summary of the major provisions of this benefit plan, and constitutes the summary plan description as governed by the Employee Retirement Income Security Act of 1974 (ERISA). Benefits under the plan are determined by the terms of the underlying plan document and contracts. In the case of any inconsistency between this document and the plan document or contract, the plan document or contract will govern your rights and benefits. \n\n RIT intends to continue the benefit plans indefinitely, but reserves the right to modify or terminate all or any portion of the employee benefits package at any time with or without notice. Such changes automatically will apply to you and your employment relationship at RIT. Participation in this plan is provided to eligible employees and does not constitute a guarantee of employment, requires continued employment and eligibility and is subject to the terms and conditions of the underlying plan document and insurance contracts.
Table of Contents
- Key Features of the Beneflex Plan
- General Information
- Election Changes During the Plan Year
- Pre-Tax Contributions for Medical and Dental Insurance Coverage
- Health Care and Dependent Care Spending Accounts
- Health Care Spending Account
- Continuation of Participation in the Health Care Spending Account under COBRA
- Dependent Care Spending Account
- Example: Advantage of Paying for Expenses Pretax Using a Flexible Spending Account
- Important Features of Your Flexible Spending Accounts
- Use the Flex Card to Pay Your Claims
- Claims for Benefit Payment
- Your Rights under ERISA
- Claim Procedures
- Additional Information
Plan Number: 506
Plan Year: 01/01 - 12/31
Plan Established: 01/01/1986
Key Features of the Beneflex Plan
Pretax Premium Contributions
Covered expenses include
- Your contributions to the RIT medical/prescription drug, vision and dental insurance plans are deducted from your pay on a pre-tax basis.
Health Care Spending Account
Contribute up to $5,000 per year, on a pretax basis, to the Health Care Spending Account. Receive tax-free reimbursement of eligible health care expenses such as:
- Medical and dental deductibles
- Medical and dental co-payments
- Vision and hearing expenses
- Prescription drug co-payments
- Other covered expenses that are tax-deductible
Dependent Care Spending Account
Contribute up to $5,000 per year, on a pretax basis, to the Dependent Care Spending Account. Receive tax-free reimbursement of eligible dependent care expenses that are necessary for both you and your spouse to work or attend school full-time. Expenses include:
- Child care centers
- Family day care providers
- Child care givers
- Nursery schools
- Caregivers for a disabled dependent
Care must be for a dependent child under age 13 or for a dependent who is disabled and incapable of self-support.
Under the Rochester Institute of Technology Beneflex Plan, you can use tax-free money to pay your portion of health care expenses not covered by your medical, vision, or dental plan, and/or to pay eligible dependent care expenses, such as day care for your dependent children. You can do this by enrolling in RIT’s Flexible Spending Accounts (FSA): the Health Care Spending Account (HCSA) and the Dependent Care Spending Account (DCSA).
If you participate in a Rochester Institute of Technology medical, vision, and/or dental insurance plan, you will also pay your share of the premiums with tax-free money.
Tax-free contributions to these plans mean you pay less in taxes and your spendable income increases by the amount of your tax savings.
This section of your handbook explains these special tax features.
Who is Covered and When
All regular full-time and extended part-time employees are eligible to participate in Beneflex. Participation can begin on the first day of the month on or after your date of hire.
You Need to Enroll
Participation in the pre-tax premiums for medical, vision and dental insurance coverage begins automatically when your participation in RIT medical, vision and/or dental insurance plan begins.
If you want to participate in the Health Care or Dependent Care Spending Accounts, you need to complete the enrollment form and return it to the Human Resources Department within 31 days of your date of employment.
It is important for you to return the completed enrollment form within 31 days of your employment. If you wait beyond the 31 days to enroll, you will not have another opportunity to enroll until the next open enrollment, or if you have a qualified change in status event (described in the Medical Care Plan section of this handbook).
If you do not enroll in Beneflex when you are first eligible, you will not have another opportunity to enroll until the next open enrollment period (unless you have a qualified change in status event). Open enrollment will be held once a year.
During open enrollment, all employees wanting to participate in the FSAs must enroll each year, even if you already are a Plan member. The contribution rates you selected for the prior year do not automatically stay at the same level for the following year.
When you re-enroll you may select the same contribution rate as for the previous year or you may change the amount you contribute to either or both accounts. Changes will not be allowed at any other time during the year unless you experience a qualified change in status event.
Election Changes During the Plan Year
For information regarding election changes during the plan year please refer to the Medical Care Plan section of this handbook.
When Your Participation Ends
For medical, vision and dental insurance pretax premiums, your participation ends when your participation in the medical, vision, and/or dental insurance plan ends.
Your Beneflex participation ends
- On your termination date*;
- On your termination date under the RIT Severance Plan (coverage does not continue during the severance period, unless you elect coverage under COBRA-Health Care Spending Account only);
- On the date you retire;
- On the date you no longer meet the Plan’s eligibility requirements; this includes transfer to an employment category that is not eligible for coverage under the Plan, such as part-time employees and adjunct faculty;
- On the date you stop making required contributions;
- On the date you die; or
- On the date RIT discontinues the Plan.
* Special Note for 9½ month faculty:
- Participation will end on June 30 for a faculty member on a 9½-month contract , provided that the faculty member works until the end of the contract period, and the contract is not being renewed for the following academic year;
- Participation for a faculty member on a 9½-month contract will continue during the summer between the two academic years, provided that the contract is being renewed for the following academic year
IMPORTANT NOTE: If you cancel participation (change your contribution amount to zero) in a flexible spending account during the plan year, you will not be eligible for reimbursement for claims with dates of service after the cancellation date. For example, if you cancel participation (stop contributing to the plan) August 31, you would not be eligible for reimbursement for claims with dates of service between September 1 and December 31.
See the section "Continuation of Participation in the Health Care Spending Account Under COBRA" for details on extending Health Care Spending Account coverage after termination of employment.
Neither the contributions toward your health care coverage nor the dollars you set aside into your FSAs will be taxed for Social Security purposes. If your salary is at or below the Social Security taxable wage base, your Social Security wages for the year will be lower, which could result in slightly lower Social Security benefits in the future. For most people, though, the tax savings will more than outweigh any small reduction in Social Security benefits.
Your other salary-based benefits, such as retirement plan [403(b)] contributions and life insurance, will not be affected by this reduction in your taxable salary.
Pretax contributions toward your medical, vision and dental insurance coverages and reimbursement amounts paid from your FSAs cannot be claimed on your personal income tax return.
The tax-savings features of Beneflex are based on current federal tax laws. The Plan could be modified or terminated as a result of future action by Congress or the Internal Revenue Service.
Pre-Tax Contributions for Medical, Vision and Dental Insurance Coverage
If you elect medical, vision, and/or dental insurance coverage, you may be required to pay a portion of the cost. To help reduce the net amount you contribute, however, Beneflex has a special “pretax” payment feature. Here’s how it works:
Your contributions for medical, vision and dental insurance coverage are deducted from your pay on a pretax basis before income and FICA (Social Security and Medicare) taxes are figured.
This means you save taxes on the amount of your Medical, Vision and Dental plan contributions. Lower taxes mean more take-home pay for you.
Health Care and Dependent Care Spending Accounts
Through the flexible spending account feature of your employee benefit program, you can actually save money when paying for eligible health care and dependent care expenses. You may choose to open a Health Care Spending Accountand/or aDependent Care Spending Account.
Through these accounts, you select a certain amount of your earnings to be payroll deducted before taxesare calculated on your pay. This tax-free deducted amount is placed in your Health Care Account and/or Dependent Care Account and can be used to pay eligible health care and dependent care expenses. While you still pay these expenses with your money, you have saved taxes on these dollars and will have more spendable income than if the expenses were paid with savings or after-tax take-home pay.
It is important to estimate your health care and dependent care expenses carefully. Under Federal law, if you do not use all the money put into a health care or dependent care account by the end of any year, you will lose this money. But with thoughtful planning, you can minimize this risk.
Health Care Spending Account
Money in your Health Care Spending Account may be used to reimburse you for eligible health care expenses for those family members you report as dependents on your federal tax return.
You may be reimbursed for health care expenses that are not covered or are not fully reimbursed by RIT’s medical, vision, and dental plans, or other coverage you may have. Such expenses can include deductibles, co-payments and any expenses not covered or not reimbursed by your medical, vision, or dental plan; vision and hearing care expenses including routine exams, prescription glasses and sunglasses, contact lenses, and hearing aids; and any other expenses that would normally qualify as itemized deductions for purposes of federal income tax. By law, premiums you pay for coverage under medical, vision or dental programs are not eligible for reimbursement.
In addition, many over-the-counter (OTC) drugs can be paid for with pre-tax dollars through RIT's Beneflex Plan. This could be very beneficial to you, as you could save federal, state, and FICA taxes on your OTC expenses. OTC drugs include many drugs that used to be prescription drugs, such as Claritin and Advil, as well as items like cold or cough medicine, pain relievers, allergy medications, and antacids. OTC items that are merely beneficial to your general health are not be covered through Beneflex, and include vitamins, toiletries (toothpaste, mouthwash, etc.), cosmetics, and nutritional or dietary supplements.
If you decide to contribute to your Health Care Spending Account, you may contribute up to $5,000 of your pay each year. If your spouse is employed (including those employed at RIT), he or she can participate in his or her employer's health care flexible spending account program without the type of combined absolute maximum that applies to dependent care spending accounts (described below).
Before deciding how much to contribute to the Health Care Spending Account, you may want to first consider your health care expenses from last year. You can use last year's expenses as your guide for estimating this year's expenses. Consider your health and your family's health, and that some expenses incurred last year-like maternity or surgery-may not apply this year. Also, consider the coverage provided last year and this year by RIT’s medical, vision and dental plans or other coverage you may have.
Keep in mind that if you do not use all the money in your health care account for eligible expenses by the deadline, you will lose this money. Also, all expenses submitted for reimbursement must be incurred during your participation period – the date you joined the plan through the March 15 of the following calendar year (under the IRS grace period rules, described later in this summary).
For information on eligible health care expenses, contact the Beneflex administrator - EBS Benefit Solutions - or see Internal Revenue Service Publication 502, which is available on the IRS website: http://www.irs.gov/pub/irs-pdf/p502.pdf.
Continuation of Participation in the Health Care Spending Account under COBRA
You may not have incurred health care expenses at the time of your termination. In order to access the money, which you have contributed to the account, you may continue your participation in the Plan under the provisions of the Consolidated Omnibus Budget Reconciliation Act (COBRA). Under COBRA you could continue to contribute to the account with after-tax dollars for the remainder of the Plan year in which you terminated. This would allow you time in which to incur expenses that can be reimbursed from your account. See the Medical Care Plan section of this handbook for information on COBRA continuation of coverage.
Dependent Care Spending Account
You may open a Dependent Care Spending Account for:
- Children under 13 who you claim as dependents for federal income tax purposes
- Your spouse, children of any age or other dependents who are disabled, incapable of self-support (or who need full-time attention) and who are at home at least eight hours each day.
If you are married, you may have a dependent care spending account only if both you and your spouse work during the time your children receive care, unless your spouse is a full-time student or qualifies for dependent care because of a disability. You also may open a dependent care spending account if you are single with an eligible child.
A dependent care spending account will reimburse you for amounts spent on qualified expenses for the care of a dependent that allows you and your spouse (if applicable) to work or attend school full-time, including:
- Child care, in or out of your home;
- Approved day care centers;
- Home care specialists who care for the disabled; and
- Approved centers that care for the disabled.
Expenses paid to a provider who does not claim the payment as income may be determined ineligible for tax-free reimbursement by the IRS.
To estimate your qualified dependent care expenses, multiply your weekly qualified dependent care expenses by the number of weeks such care is required each year. The absolute maximum you may contribute to a dependent care account for any year, on a pretax basis, equals the lesser of
- The earned income of you or your spouse
- $2,500, if you and your spouse file separate tax returns.
By law, if your spouse participates in a dependent care flexible spending account through his or her employer (including RIT), your and your spouse's combined contributions cannot exceed the $5,000 or $2,500 absolute maximum described in the preceding paragraph.
It is important for you to know that, under current tax law, qualified dependent care expenses that you pay on an after-tax basis may qualify for a credit on your federal income tax return. Therefore, the tax savings for some people may be greater if they pay for dependent care on an after-tax basis rather than on a pretax basis under a dependent care account. For others, the tax savings will be greater under a dependent care account. For more information, you should check with a financial advisor or tax professional.
Keep in mind that if you do not use all the money put into a dependent care account by the end of any year, you will lose this money. Also, all expenses submitted for reimbursement must be incurred during that calendar year regardless of when the expense is billed or paid.
For information on eligible dependent care expenses, contact the Beneflex administrator - EBS Benefit Solutions - or see Internal Revenue Service Publication 503, which is available on the IRS website: http://www.irs.gov/pub/irs-pdf/p503.pdf.
Example: Advantage of Paying for Expenses Pretax Using a Flexible Spending Account
|Annual Base Salary||$30,000||$30,000||$30,000||$30,000|
|HCSA/DCSA annual contribution||-$3,000||$0||-$5,000||$0|
|Federal income tax (estimated)||-$5,400||-$6,000||-$5,000||-$6,000|
|Social Security and Medicare tax (7.65%)||-$2,066||-$2,295||-$1,913||-$2,295|
|State income tax (estimated)||-$1,985||-$2,205||-$1,838||-$2,205|
Important Features of Your Flexible Spending Accounts
Once you select the amount you will be contributing to your accounts, you cannot change or stop the amount you are contributing during the plan year unless a change in family status occurs.
Other than for a qualified change in status, changes in your contribution amount may only be made once each yearduring the open enrollment. You elect each year, during the open enrollment, whether or not to participate and, if you participate, the amount you will contribute to each account. All open enrollment changes will take effect on January 1.
If you do not enroll each year during open enrollment, you will not be able to participate during the next year, even if you participated previously.
If you contribute to both accounts, you cannot use money from the health care account to pay for dependent care expenses, and vice versa. Money from the dependent care account can only be used for dependent care expenses and money from the health care account can only be used for health care expenses.
Your contributions to the FSAs will be payroll deducted, on a pretax basis, from each paycheck and will be credited to your account each pay period.
The maximum amount of reimbursement available at any time from the health care account will equal your annual elected contribution less any amounts already reimbursed. Of course, once you receive the maximum reimbursement, you would continue to have payroll deductions for the account for the rest of the plan year. However, you would not be eligible for any further reimbursement since you would have already received your entire election amount.
Expenses reimbursed through your health FSA cannot be claimed as a deduction on your income tax return or reimbursed later through a health care plan. Only the part of a bill not covered by any health insurance will be reimbursed.
The maximum amount of reimbursement available at any time from the dependent care account will equal your actual account balance at the time of reimbursement. If you request more than the amount in your account, you will be reimbursed up to the account balance, with remaining amounts being reimbursed as your contributions accumulate.
Remember, you cannot use both the Federal dependent care tax credit and dependent care FSA for the same dependent care expenses.
Use the Flex Card to Pay Your Claims
When you join Beneflex, EBS, the administrator, will automatically send you a “Flex Card.” The Flex Card is a convenient way for you to pay for your health care and dependent day care expenses. It automates the process of paying for your eligible expenses by paying your provider at the point of service. This way, you avoid having to pay cash for your service and waiting for your reimbursement check to arrive.
Instead, you simply use your Flex Card for eligible expenses wherever MasterCard is accepted, from physician and dental offices to pharmacies and vision care providers, as well as at certain dependent day care providers. Your contributions for these eligible expenses are first deducted from your paycheck and then added to your Beneflex account to fund your Flex Card. You may use your Flex Card as often as you like to pay for your eligible expenses.
How it works: When you seek eligible services (such as doctor’s office visit, prescription or over-the-counter drugs, eyeglasses or contacts), present your Flex Card and the charge will automatically be deducted from your pre-tax account after your card has been swiped. If requested, indicate that this is a credit card, and not a debit card. You do not need a PIN when you use your Flex Card, and you cannot withdraw cash with your card.
Here is some important information you need to know about using the Flex Card:
- The Flex Card is programmed to be used only at approved health care and dependent care providers. If you attempt to use it elsewhere, it will not be accepted.
- It is critical that you save your receipts and supporting detailed information from each Flex Card transaction, as your Beneflex claims are subject to review and audit, especially certain pharmacy and over-the-counter drug claims. EBS will conduct audits during the year, as required by the Internal Revenue Service.
- You should also save claim reimbursement documentation since EBS does not retain this beyond the current year.
- Be sure to use your Flex Card for eligible expenses only. If you are purchasing both allowable and non-allowable items, such as at the grocery store or pharmacy, please separate your items and use your Flex Card for allowable expenses only.
- If you inadvertently pay for a non-allowable expense with your Flex Card, you will be required to repay the non-allowable amount back to keep your account tax-free.
- Your Flex Card can be used only for the portion of the health care service or supply that is not being reimbursed from a health or dental plan. You will typically use it for copays, coinsurance and deductibles, and for items such as over-the-counter drugs that are not covered by health plans.
- You can submit a claim form for reimbursement if you do not have your Flex Card with you when you incur an eligible expense and pay for it. Reimbursements are typically processed weekly with a $30 minimum payment amount.
One Flex Card will automatically be provided to you when you enroll in Beneflex. If you wish to have an additional card for a spouse or eligible dependent, you may request one by completing the “Request Form for Issuance of EBS Flex Card to Dependent” found on the HR website, and mailing it to EBS at the address indicated on the form. It takes several weeks to receive additional cards, so be sure to do this as soon as possible once you have enrolled in Beneflex.
Claims for Benefit Payment
You are responsible for retaining records of all FSA expenses. EBS is not responsible for retaining copies of your receipts.
Beneflex claim forms are available on the RIT Human Resources web page, or at the Human Resources Department. You can submit claims only for eligible expenses that have been incurred after your Beneflex participation begins and before March 15 of the following calendar year. You have until this March 15 date because RIT has adopted the grace period allowed by the IRS.
If you sign up for Beneflex in a subsequent year and still have funds in your prior year account, any reimbursements will first come from the prior year account. For example, if you incur an eligible health care expense on January 30, 2007, your claim for that expense will be paid from your remaining 2006 account before the 2007 account.
If you cancel participation (change your contribution amount to zero) in a flexible spending account during the plan year, you will not be eligible for reimbursement for claims with dates of service after the cancellation date. For example, if you cancel participation (stop contributing to the plan) August 31, you would not be eligible for reimbursement for claims with dates of service between September 1 and the following March 15.
All claims for a calendar year must be submitted by April 30 of the following year. For example, claims for services during 2007 and through March 15, 2008 must be submitted by no later than April 30, 2008.
Health care expenses must be submitted first to any medical, dental, vision, prescription drug or other health plan in which you participate. Once that plan has paid its share, if any, the remainder can be submitted for reimbursement from your health care Beneflex account. When you file your Beneflex claim, you will need to attach the Explanation of Benefits (EOB) from your health plan showing how much that plan has paid and how much you are responsible for paying. If an eligible expense is not of a kind covered by any other plan (e.g. dental services if you do not have dental plan coverage), then you need to attach a written statement from the provider of the service (e.g. the dentist) which shows:
- the date, description and amount charged for the service
- the name and address of the provider
- the name, relationship and date of birth of the person for whom the service was rendered (you or your dependent).
Claims will be reimbursed bi-weekly. There is a $25.00 minimum reimbursement. If your claim is for less than $25.00, it will be held until another claim is submitted which brings the total to at least $25.00.
You can elect to have your Beneflex reimbursements directly deposited to your checking or savings account when you complete a manual claim form (this does not apply if you use the Flex Card). No more biweekly trips to the bank just to deposit your Beneflex reimbursement checks! And get your money back faster, too! To do so, simply complete a Beneflex Direct Deposit form (found on the HR website or available in HR) and mail the form to the address indicated with a voided check or deposit slip from your bank account. If you enroll in direct deposit then change your bank account at a later date, be sure to notify EBS at least 14 days in advance of closing your account to stop the direct deposit reimbursements from going to your old account.
If you do not wish to have your reimbursements directly deposited, you do not need to take any action (other than enrolling in Beneflex), and you will receive checks in the mail when your Beneflex claims are processed. You can change your mind - either way - at any time. And, once you have signed up for direct deposit for your Beneflex accounts, then direct deposit will automatically continue in future years - you don't have to do anything except enroll in Beneflex each year - remember your Beneflex election does not carry over from one year to another.
Information about your health care and dependent care flexible spending accounts is at your finger tips! Through a confidential web-site located at www.online-enrollment.com/excellus you can easily access information about your Beneflex (FSA) account(s). From this website, you will be able to:
- View your Beneflex claims activity (Detailed listing of claims you have submitted for reimbursement including the claim status);
- View your account activity (Deposits posted to your account and reimbursements made to you);
- Submit your claims online and receive an instant confirmation that EBS has received your claim. You then need to send supporting documentation (i.e., Explanation of Benefits-EOB, Statement, etc.) for your claim along with your confirmation number using one of three methods:
- E-mail attachment
- U.S. Mail
To supplement the information available to you through the EBS website, you will receive year-to-date statements quarterly by mail.
After your claim has been processed, you will receive a Beneflex Explanation of Benefits (EOB) showing the amount paid and any amount denied, along with your Beneflex balance for the year. If you have any questions about your EOB, contact BlueCross Blue Shield of the Rochester Area.
Your Rights under ERISA
[The U.S. Department of Labor requires that the following notice be included in all Summary Plan Descriptions.]
As a participant in Rochester Institute of Technology benefit plans, you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA). ERISA provides that all plan participants shall be entitled to:
Receive Information About Your Plan and Benefits
Examine, without charge, at the plan administrator's office and at other specified locations, such as worksites, all documents governing the plan, including insurance contracts, and a copy of the latest annual report (Form 5500 Series) filed by the plan with the U.S. Department of Labor and available at the Public Disclosure Room of the Pension and Welfare Benefit Administration.
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 report. The Plan Administrator is required by law to furnish each Participant with a copy of this summary financial report.
Continue Group Health Care Coverage
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.
Reduction or elimination of exclusionary periods of coverage for preexisting conditions under your group health plan, if you have creditable coverage from another plan. You should be provided a certificate of creditable coverage, free of charge, from your group health plan or health insurance issuer when you lose coverage under the plan, when you become entitled to elect COBRA continuation coverage, when your COBRA continuation coverage ceases, if you request it before losing coverage, or if you request it up to 24 months after losing coverage. Without evidence of creditable coverage, you may be subject to a pre-existing condition exclusion for 12 months (18 months for late enrollees) after your enrollment date in your coverage. [NOTE: None of the health insurance options presently offered by RIT include a pre-existing condition exclusion.]
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, 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 you have a claim for benefits which is denied or ignored, in whole or in part, you may file suit in a state or Federal court. In addition, if you disagree with the plan's decision or lack thereof concerning the qualified status of a domestic relations order or a medical child support order, you may file suit in Federal court. 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 Pension and Welfare Benefits Administration, U.S. Department of Labor, listed in your telephone directory or the Division of Technical Assistance and Inquiries, Pension and Welfare Benefits 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 Pension and Welfare Benefits Administration.
Claims for Benefits - An Employee wishing to present a claim for benefits for himself or his Dependents should obtain a claim form or forms from his Employer or Plan Administrator. The applicable section of such form or forms should be completed by (1) Employee, (2) Employer or Plan Administrator, and (3) attending Physician or Hospital. Claims will only be processed if received within a reasonable time following the date the expense to which the claim relates arises.
Following completion, the claim form or forms should be submitted to the Plan's representative as indicated on the reverse side of the Employee's Benefit Plan Identification Card. The organization that is authorized by the Plan to process and pay claims (the Plan's Claims Administrator) will compute benefits due, and cause proper claims to be paid. Unless the Employee assigns benefits to a doctor or to a Hospital, draft(s) will be made payable to the Employee.
A decision will be made by the Claims Administrator no more than ninety (90) days after receipt of due proof of loss, except in special circumstances (such as the need to obtain further information), but in no case more than one hundred eighty (180) days after the due proof of loss is received. The written decision will include specific reasons for the decisions and specific references to the Plan provisions on which the decision is based.
- Appealing Denial of Claims - If a claim for benefits is wholly or partially denied, notice of the decision shall be furnished to the Employee. This written decision will:
- Give the specific reason or reasons for denial;
- Make specific reference to the Plan provisions on which the denial is based;
- Provide a description of any additional information necessary to perfect the claim, if possible, and an explanation of why it is necessary; and
- Provide an explanation of the review procedure.
- Request a review upon written application within sixty (60) days of receipt of claim denial;
- Review pertinent documents; and
- Submit issues and comments in writing.
A decision will be made by the Plan Administrator no more than sixty (60) days after receipt of the request for review, except in special circumstances (such as the need to hold a hearing), but in no case more than one hundred twenty (120) days after the request for review is received. The written decision will include specific reasons for the decision and specific references to the Plan provisions on which the decision is based.
Additional information about claims submitted and review procedures may be obtained by contacting the Plan Administrator.
If you have any questions about your Plan, you should contact the Human Resources Department. If you have any questions about this statement or about your rights under ERISA, you should contact the nearest Area Office of the U.S. Labor Management Services Administration, Department of Labor.
Rochester Institute of Technology
Employer Identification Number
Rochester Institute of Technology
8 Lomb Memorial Drive
Rochester, NY 14623-5604
Rochester Institute of Technology
8 Lomb Memorial Drive
Rochester, NY 14623-5604
Business Telephone Number
(585) 475-2424 (voice)
Agent for Service of Legal Process
Associate Director of Human Resources, Benefits, Health and Wellness
Rochester Institute of Technology
8 Lomb Memorial Drive
Rochester, NY 14623-5604