STATEMENT OF ERISA RIGHTS
Unless you are a participant of an ERISA exempt Plan, you are entitled to certain rights and protections under ERISA. The Act provides that all non-exempt Plan participants shall be entitled to:
- the Summary Plan Description, within ninety (90) days after you become a participant or within one hundred twenty (120) days after the Plan becomes subject to the reporting and disclosure provision of the Act;
- a summary of any change in the Plan Description or summary of a material modification in the terms of the Plan, within two hundred ten (210) days after the end of the Plan year in which the change is adopted;
- a summary of any reduction in benefits no later than sixty (60) days after the date of the adoption of the modification or change;
- an updated Summary Plan Description every five (5) years incorporating any amendments; and, if no amendments have been adopted, another Summary Plan Description every ten (10) years;
- a summary annual report, within two hundred tem (210) days after the close of the Plan's fiscal year;
- examine, without charge, at the Plan Administrator's office and at other specified locations, such as work sites and union halls, all Plan documents, including insurance contracts, collective bargaining agreements, and copies of all documents filed by the Plan with the U.S. Department of Labor, such as detailed annual reports and Plan descriptions; and
- obtain copies of all Plan documents and other Plan information upon written request to the Third Party Administrator. The Third Party Administrator may require you to pay a reasonable charge for the copies.
The Plan Administrator must furnish to you within thirty (30) days of your written request (except for reasons beyond the control of the Third Party Administrator) a copy of the following:
- the latest updated Schedule of Benefits;
- the Plan Description;
- the latest annual report;
- the documents under which the Plan was established or is operated; or
- terminal reports, if any.
The Plan Administrator may require you to pay a reasonable charge for the copies.
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. No one, including your Employer, your union, or any other person, may force you or otherwise discriminate against you in any way to prevent you from obtaining a welfare benefit or exercising your rights under ERISA.
RIGHT TO SUE: Depending on the circumstances, civil action under ERISA can be brought by the Secretary of Labor, fiduciaries, Third Party Administrators, Plan participants, and others.
Your right to bring a civil action includes the following:
- to compel a Plan Administrator to supply Plan documents requested in writing by you within thirty (30) days of the written request;
- to enforce rights under the Plan and to recover benefits due;
- for appropriate relief from breach of fiduciary duty;
- to enjoin any act or practice which violates any provision of Title I of ERISA, the terms of the Plan, or to obtain other equitable relief; or
- to obtain review of a final action of the Secretary of Labor, to restrain the Secretary from taking action contrary to ERISA, or to compel the Secretary to take action.
U.S. District Courts have exclusive jurisdiction over civil and criminal actions brought under Title I of ERISA except that cases pertaining to benefit recovery brought by participants may also be brought in State Courts. U.S. District Courts have jurisdiction to grant relief without respect to the amount in controversy or the citizenship of the parties. 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 frivolous.
LEGAL ACTION: Legal action to recover any lost benefits under this Plan may not be brought:
- until the Plan's appeal procedure, including utilization of a professional/peer review committee, has been exhausted per the terms of ERISA (see section on CLAIMS REVIEW AND APPEAL PROCEDURE); or
- later than one (1) year after the expense/disability was incurred. (The one (1)-year limitation in the prior sentence, however, does not apply to an action governed by 29 U.S.C. §1113.)
FURTHER INFORMATION: If you have any questions about your Plan, you should contact the Third Party Administrator.
If you have any questions about your rights under ERISA or HIPAA (Health Insurance Portability and Accountability Act of 1996),
you should contact the nearest office of the Employee Benefits Security Administration (EBSA), U.S. Department of Labor, 200 Constitution Ave. NW, Washington, DC 20216. Telephone (202) 219-8776.
(In the case of conflicting information, your Schedule of Benefits takes precedence.)
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