Table of Contents
- Advice and Consultations
- Debt Matters
- Defense of Civil Lawsuits
- Document Preparation
- Document Review
- Family Law
- Real Estate Matters
- Wills and Estate Planning
- Other Special Rules
- Plan Confidentiality, Ethics and Independent Judgment
- Denial of Benefits and Appeal Procedures
- Your Rights under ERISA
- Your Rights under the Newborns' and Mothers' Health Protection Act
- Qualified Medical Child Support Orders ("QMCSOS")
- Claim Procedures
- Additional Information
Plan Number: 511
Plan Year: 01/01 - 12/31
Plan Established: 01/01/2000
The Hyatt Premier Legal Plan was established to provide personal legal services for eligible employees, their spouses and dependent children. If you choose to join the Legal Plan, the coverage available to you and your family through the Hyatt Premier Legal Plan can help you with many of your personal legal needs.
This summary provides general information about the Plan, who is eligible to receive benefits under the Plan, what those benefits are, and how to obtain benefits. Hyatt Legal Plans, Inc. has been selected as the provider for legal plan benefits. The services will be provided through a panel of carefully selected Participating Law Firms. Lawyers in this network are called Plan Attorneys. These arrangements are described in detail in this summary, which is provided directly by Hyatt Legal Plans, Inc. The actual provisions of the Plan are set out in a written document maintained by RIT. All statements made in this summary are subject to the provisions and terms of that document, which control in the event of conflict with this summary.
Regular full-time and extended part-time employees are eligible for legal services under the Hyatt Premier Legal Plan. You are eligible to enroll in the Legal Plan for yourself and, for some cases, your eligible dependents. Eligible dependents include your spouse and your unmarried child (or children) up to the age of 21 provided he or she depends on you for support.
During RIT's annual enrollment period, you can change or update your benefits selection. An eligible employee may choose to join or drop out of the Legal Plan at that time. If you become an eligible employee after the annual enrollment period, you can elect to participate in the Legal Plan by completing your election form within 31 days of employment. The Plan has a minimum participation period of one year.
Cost of The Plan
You pay the cost of the Plan through after-tax payroll deductions.
When Coverage Begins
Generally, Plan coverage becomes effective on the date of the following:
- The first day of the month in which RIT has agreed to provide the Plan, (typically January 1), for the elections you made during the previous enrollment period; or
- If you were hired after an enrollment period, the first day of the month after you submitted a properly completed Enrollment Form.
When Coverage Ends
Your ability to receive legal services under the Plan ends if you are no longer an eligible employee or if you choose not to enroll during future annual enrollment periods. If you cease to be eligible to participate in the plan or your employment with the Rochester Institute of Technology ends, the Plan will cover the legal fees for those covered services that were opened and pending during the period you were enrolled in the plan. of course, no new matters may be started after you become ineligible.
How To Get Legal Services
To use the Hyatt Premier Legal Plan, call Hyatt Legal Plans' Client Service Center at1-800-821-6400 between Monday: 8am - 8 pm; Tuesday - Thursday: 8am - 7pm; Friday: 8am - 6pm. All times are Eastern Time. Be prepared to identify yourself as a participant in the Hyatt Premier Legal Plan and to give your Social Security Number. If you are a spouse or a child of an eligible person, you will need the Social Security Number of the employee through whom you are eligible.
The Client Service Representative who answers your call will:
- verify your eligibility for services;
- make an initial determination of whether and to what extent your case is covered (the Plan Attorney will make the final determination of coverage);
- give you an Authorization Number which is similar to a claim number (you will need a new Authorization Number for each new case you have);
- give you the telephone number of the Plan Attorney most convenient to you; and
- answer any questions you have about the Hyatt Premier Legal Plan.
You then call the Plan Attorney to schedule an appointment at a time convenient to you. Evening and Saturday appointments are available.
If you wish, you may tell the Client Service Representative that you want to use your own attorney. Hyatt Legal Plans will reimburse you for these attorneys' fees in accordance with a set fee schedule. You must call Hyatt Legal Plans, as described above, prior to contacting any attorney. Plan benefits will be denied if you do not call first.
What Services Are Covered
The Hyatt Premier Legal Plan entitles you and your eligible dependents to receive certain personal legal services. The available benefits are very comprehensive, but there are limitations and other conditions that must be met. Please take time for yourself and your family to read the description of benefits carefully. The following services are covered under the Plan:
Advice and Consultation
Office Consultation and Telephone Advice
This benefit provides the opportunity to discuss with an attorney any personal legal problems that are not specifically excluded or prohibited matters. During the consultation, the attorney will explain the Participant's rights, point out his or her options and, if needed, recommend a course of action. The Plan Attorney will identify any further coverage available under the Plan, and will undertake representation if the Participant so requests. If representation is covered by the Plan, the Participant will not be charged for the Plan Attorney's services. If representation is recommended, but is not covered by the Plan, the Plan Attorney will provide a written fee statement in advance. The Participant may choose whether to retain the Plan Attorney at his or her own expense; seek outside counsel; or do nothing. There are no restrictions on the number of times per year a Participant may use this service; however, for a non-covered matter, this service is not intended to provide the Participant with continuing access to a Plan Attorney in order to undertake his or her own representation.
Debt Collection Defense
This benefit provides participants with negotiation with creditors for a repayment schedule, limiting creditor harassment, and representation in defense of any action for personal debt collection, foreclosure, repossession or garnishment, up to and including trial if necessary. It does not include defense against a judgment, vacating a judgment, counter claims, cross claims, bankruptcy, any action arising out of divorce or post-decree matters, or any matter where the creditor is affiliated with the RIT.
Defense of Civil Lawsuits
Administrative Hearing Representation
This benefit covers participants in defense of civil proceedings before a municipal, county, state or federal administrative board agency or commission. It does not apply where services are available or are being provided by virtue of a homeowner or vehicle insurance policy. It does not include divorce or post-decree defense, paternity, support or custody matters or litigation of a job-related incident.
Civil Litigation Defense
This benefit covers the Participant for defense of civil proceedings in a trial court of general jurisdiction or before an administrative agency or a local, state, or federal agency. It does not apply where services are available or are being provided by virtue of a homeowner or vehicle insurance policy. It does not include divorce or post-decree defense, paternity matters or litigation of a job-related incident.
This benefit covers the Participant in the defense of any incompetency action, including court hearings when there is a proceeding to find the Participant incompetent.
This benefit includes the preparation of any deed for which the Participant is either the grantor or grantee.
This benefit covers the preparation of letters which demand money, property or some other property interest of the Participant, except an interest which is an excluded service, mailing them to the addressee and forwarding and explaining any response to the Participant. Negotiations and representation in litigation are not included.
This benefit includes the preparation of any mortgage for which the Participant is the mortgagor.
This benefit includes the preparation of any promissory note for which the Participant is the payor or payee.
Any personal legal document of the Participant will be reviewed by a Plan Attorney.
This benefit covers the Participant for all necessary pleadings and court hearings for a legal name change.
All uncontested governmental agency and stepparent adoptions are fully covered for the Employee and spouse. If an adoption becomes contested, the Employee or spouse must pay all additional legal fees.
Uncontested Guardianship or Conservatorship
This service covers establishing a guardianship or conservatorship over a person and his or her estate by the Employee or spouse. It includes obtaining a temporary guardianship or conservatorship if necessary, gathering any necessary medical evidence, preparing the paperwork and attending the hearing. If the proceeding becomes contested, the Employee or spouse must pay all additional legal fees. This benefit does not include representation of the person over whom guardianship or conservatorship is sought, or any proceedings involving annual accountings once guardianship or conservatorship has been established.
Identity Theft Defense
This benefit provides participants with consultations with an attorney regarding potential creditor actions resulting from identity theft, and attorney services as needed to contact creditors, credit bureaus and financial institutions. It also provides defense services for specific creditor actions over disputed accounts as set forth in the Debt Collection Defense coverage. In addition it provides participants with online help and information about Identity Theft and prevention.
This service covers advice and consultation, preparation of affidavits and powers of attorney, review of any immigration documents and helping the Participant prepare for hearings.
Real Estate Matters
Eviction and Tenant Problems (Tenant Only)
This service assists the Participant as a tenant with matters involving leases, security deposits or other disputes with a residential landlord. The benefit also covers eviction defense, up to and including trial, if necessary. It does not include representation as a plaintiff in a lawsuit against the landlord.
Sale, Purchase or Refinancing of Home
This benefit includes the review or preparation, by an attorney representing the Participant, of all relevant documents (including the mortgage, deed and documents pertaining to title, insurance, recordation and taxation), which are involved in the sale, purchase or refinancing of a Participant's primary residence. It does not include services provided by any attorney representing a lending institution or title company. The benefit does not include the sale, purchase or refinancing of a second home, vacation property, unimproved land, rental property or property held for business or investment. Home equity loans are not included under this benefit.
Traffic Ticket Defense
This service covers representation of the Participant in defense of any traffic ticket except driving under influence or vehicular homicide, including court hearings, negotiation with the prosecutor and trial.
Wills and Estate Planning
This benefit includes the preparation of living trusts for the Participant. It does not include tax planning.
This benefit covers the preparation of a living will for the Participant.
Powers of Attorney
This benefit includes the preparation of any power of attorney when the Participant is granting the power.
Wills and Codicils
This benefit covers the preparation of wills and codicils for the Participant. The creation of any testamentary trust is covered. It does not include tax planning.
Certain matters are excluded from coverage under the Plan. No services, not even a consultation, can be provided on the following matters:
- Payment made to a third party (someone other than the attorney) such as costs,
- witness fees, transcripts, recording fees, filing fees, fines, penalties, judgments or orders of restitution ordered by any court;
- Appeals, class actions, interventions, derivative actions and amicus curiae filings;
- Business, farm, commercial or rental property transactions, including any legal
- services which would ordinarily be deductible under the Internal Revenue Code as a necessary expense of doing business;
- Admiralty, patents, trademarks and copyrights;
- Tax return preparation;
- Disputes or proceedings involving RIT or any of its divisions or affiliated organizations;
- Disputes, claims or proceedings involving Hyatt Legal Plans, Inc., MetLife or any affiliates, any participating law firm or attorney, or the Plan;
- Matters for which you are or have been receiving legal services before you received an Authorization Number;
- Matters which Hyatt Legal Plans deems frivolous, non-meritorious or unethical;
- Services on behalf of a spouse or dependent where you are an adversary;
- Any employment-related matters. This includes, but is not limited to, disputes or proceedings involving RIT, any employee benefit or any agents, officers or employees of these groups, or claims for Workers' Compensation or Unemployment Compensation;
- Any bankruptcy or debt proceeding that would result in the discharge or collection delay of a debt owed to RIT, its subsidiaries or affiliates, or any benefit plan established, maintained or administered by RIT, its subsidiaries or affiliates.
Other Special Rules
In addition to the coverages and exclusions listed, there are certain rules for special situations. Please read this section carefully.
What if other coverage is available to you?
If you are entitled to receive legal representation provided by any other organization such as an insurance company or a government agency, or if you are entitled to legal services under any other legal plan, coverage will not be provided under this Plan. However, if you are eligible for legal aid or Public Defender services, you will still be eligible for benefits under this Plan, so long as you meet the eligibility requirements.
What if you are involved in a legal dispute with your dependents?
You may need legal help with a problem involving your spouse or your children. In some cases, both you and your child may need an attorney. If it would be improper for one attorney to represent both you and your dependent, only you will be entitled to representation by the plan attorney. Your dependent will not be covered under the Plan.
What if you are involved in a legal dispute with another employee?
If you or your dependents are involved in a dispute with another eligible employee or that employee's dependents, Hyatt Legal Plans will arrange for legal representation with independent and separate counsel for both parties.
What if the court awards attorneys' fees as part of a settlement?
If you are awarded attorneys' fees as a part of a court settlement, the Plan must be repaid from this award to the extent that it paid the fee for your attorney.
Plan Confidentiality, Ethics and Independent Judgment
Your use of the Plan and the legal services is confidential. The Plan Attorney will maintain strict confidentiality of the traditional lawyer-client relationship. RIT will know nothing about your legal problems or the services you use under the Plan. Plan administrators will have access only to limited statistical information needed for orderly administration of the Plan. No one will interfere with your Plan Attorney's independent exercise of professional judgment when representing you. All attorneys' services provided under the Plan are subject to ethical rules established by the courts for lawyers. The attorney will adhere to the rules of the Plan and he or she will not receive any further instructions, direction or interference from anyone else connected with the Plan.
The attorney's obligations are exclusively to you. The attorney's relationship is exclusively with you. Hyatt Legal Plans, Inc., or the law firm providing services under the Plan is responsible for all services provided by their attorneys. You should understand that the Plan has no liability for the conduct of any Plan Attorney.
Plan attorneys will refuse to provide services if the matter is clearly without merit, frivolous or for the purpose of harassing another person.
If you have a complaint about the legal services you have received or the conduct of an attorney, call Hyatt Legal Plans at 1-800-821-6400. Your complaint will be reviewed and you will receive a response within two business days of your call.
Amendment or Termination
While RIT expects to continue to offer participation in the Hyatt Premier Legal Plan, it reserves the right to amend, or terminate the Plan at any time. If the Plan is terminated, all covered services then in process will be handled to their conclusion under the Plan.
Administration and Funding
The Legal Plan is provided for and administered through a contract with Hyatt Legal Plans, Inc. Hyatt Legal Plans makes all determinations regarding attorneys' fees and what constitutes covered services. All contributions collected from employees electing this coverage are paid to Hyatt Legal Plans, Inc.
Denial of Benefits and Appeal Procedures
Denials of Eligibility
Hyatt verifies eligibility using information provided by RIT. When you call for services, you will be advised if you are ineligible and Hyatt Legal Plans will contact RIT for assistance. If you are not satisfied with the final determination of eligibility, you have the right to a formal review and appeal. See the procedures outlined in the next section.
Denials of Coverage
If you are denied coverage by Hyatt Legal Plans or by any Plan Attorney, you may appeal by sending a letter to:
Hyatt Legal Plans, Inc.
1111 Superior Avenue, Suite 800
Cleveland, Ohio 44114-2507
The Director will issue Hyatt Legal Plans' final determination within 30 days of receiving your letter. This determination will include the reasons for the denial with reference to the specific Plan provisions on which the denial is based and a description of any additional information that might cause Hyatt Legal Plans to reconsider the decision, and an explanation of the review procedure.
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.
Your Rights under the Newborns' and Mothers' Health Protection Act
Group health plans and health insurance issuers generally may not, under federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother's or newborn's attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under federal law, require that a provider obtain authorization from the plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).
Qualified Medical Child Support Orders ("QMCSOS")
A medical child support order shall be filed with the plan administrator as soon as reasonably possible after it has been filed promptly upon the receipt of such order, the plan administrator shall notify the participant and each person eligible to receive benefits under the terms of the order ("alternate recipients") of its receipt and of the procedures set forth in this section 14.04.
The Participant and the alternate recipients may provide comments to the Plan Administrator with respect to the order during the 30 day period commencing as of the date the Plan Administrator sends them notice of receipt of the order. The Plan Administrator shall, within the 60 day period commencing as of the expiration of the 30 day comment period specified in the preceding sentence, determine whether the order is qualified and shall so notify the participant and the alternate recipients in writing of its decision. The parties may waive the 30 day comment period. If they do so, the 60 day period shall commence as of the date all parties have waived their rights to submit comments. The Plan Administrator's determination on the qualified status of an order is final. As soon as reasonably practicable following its notification that an order is "qualified," the Plan Administrator shall take such steps it deems appropriate to implement the order.
The Plan Administrator encourages parties to submit draft orders for "pre-approval" of their qualified status prior to their being submitted to a court for signature as such pre-approval will expedite approval procedures.
An alternate recipient may designate a representative for receipt of copies of notices that are sent to an alternate recipient with respect to a medical child support order.
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)
(585) 475-2420 (TTY)
Agent for Service of Legal Process
Associate Director of Human Resources, Benefits
Rochester Institute of Technology
8 Lomb Memorial Drive
Rochester, NY 14623-5604