ATU Local 1056 Benefits Fund
ATU LOCAL 1056 BENEFITS FUND
SUMMARY PLAN DESCRIPTION
ATU LOCAL 1056 BENEFITS FUND
PLAN AND SUMMARY PLAN DESCRIPTION
The ATU Local 1056 Benefits Fund (the “Fund”) provides benefits for Amalgamated Transit Union Local 1056 bargaining unit members, and for certain spouses, domestic partners, and eligible dependents of those members.
This ATU Local 1056 Benefits Plan (the “Plan”) is established to provide the health benefits funded by the Fund, and is intended to constitute a welfare benefit plan as amended from time to time.
The Plan is administered by a three-member Board of Trustees appointed by Amalgamated Transit Union Local 1056 (the “Board of Trustees”). Contact information for the Board of Trustees is listed in Article 9 of this document.
Interpretations of the terms of the Plan, including, without limitation, determinations of eligibility for participation in the Plan, are made by the Board of Trustees in its sole and absolute discretion. Any inquiry relative to interpretations or other such matters regarding the Plan should be referred to the Board of Trustees. The Board of Trustees is not obligated, bound, or responsible for opinions, information, or representations coming from other sources.
The Plan, or any of the benefits described in the Plan, may be amended, modified, or terminated by ATU Local 1056 in its sole and absolute discretion at any time and from time to time. The Plan is governed by the terms described in this Plan and Summary Plan Description and the Declaration of Trust of Amalgamated Transit Union Local 1056 (the “Fund Agreement”). For a complete understanding of the terms of the Plan, you may wish to review, in addition to this document, the Fund Agreement, and any applicable contract or arrangement between the Plan and a Benefit Provider.
Plan and Benefit Highlights
This section briefly describes the benefits provided under the Plan and certain eligibility terms. The benefits are described in greater detail in the accompanying benefit Program Documents. The terms of the Plan are set forth in sections that follow this Plan and Benefit Highlights section. Please read the Program Documents and Plan for additional information.
Benefits Provided Under the Plan
The following benefits are provided under the Plan.*
* If you are a member of ATU Local 1056 and enrolled in the Aetna CPOS II High Option Major Medical Plan, your dental benefits are provided through GHI Dental and are administered by the MTA. You may contact GHI Dental at 212-501-4444 or MTA Business Service Center at 646-376-0123, or go on the portal at mtabsc.info.
Who Is Eligible for benefits under the Plan?
The following individuals are eligible to participate in the Plan if they satisfy the eligibility provisions of the Plan, which are described in Article 2 of the Plan.
You may be required to provide proof that an individual qualifies as a Dependent. Please see Article 2 of the Plan and the Program Documents for more details about eligibility requirements.
When does your participation in the Plan end?
Your coverage under the Plan ends on the earliest of the following dates:
For Beneficiaries, coverage under the Plan ends on the earliest of the dates above or the date that you cease to be a Beneficiary for any reason, including without limitation, with respect to Dependents, the death of the Eligible Employee.
Please see Article 2 of the Plan for more details about termination of participation. Note that some programs may have earlier or later termination dates. Please review the Program Documents for more information.
Extensive Benefits, Inc.
P.O. Box 813546
Smyrna, Georgia 30081
Unless the context otherwise requires, the following terms shall have the meanings set forth below:
1.01 “Benefit Provider(s)” means those insurers, companies, and administrators with which the Board of Trustees contracts to provide benefits pursuant to the Program(s).
1.02 “Beneficiary” or “Beneficiaries” means any individual who is described in Section 2.01(b).
1.03 “Code” means the Internal Revenue Code of 1986, as amended from time to time.
1.04 “Board of Trustees” means the persons from time to time who are acting collectively as the Board of Trustees appointed to control and manage the operation and overall administration of the Plan.
1.05 “Dependent” means a spouse, domestic partner, or dependent child of an Eligible Employee as determined under the applicable Program.
1.06 “Eligible Employee” means any individual who is described in Section 2.01(a).
1.07 “Employer” means the New York City Transit Authority.
1.08 “Participant” means Eligible Employees and Beneficiaries described in Section 2.01 who satisfy the requirements for participation in the Plan and whose participation in the Plan has not, for any reason, terminated.
1.09 “Union” means the Amalgamated Transit Union Local 1056.
1.10 “Plan” means the ATU Local 1056 Benefits Plan effective May 1, 2015.
1.11 “Plan Administrator” means the Board of Trustees of the ATU Local 1056 Benefits Plan. The Board of Trustees may delegate administrative functions to a third-party administrator from time to time.
1.12 “Plan Year” means January 1 through December 31.
1.13 “Program(s)” means the benefits described in the Appendix, as amended from time to time.
1.14 “Program Document” means (i) any summary plan description for the Plan that sets forth terms and conditions of any Program, and any supplements thereto, and (ii) all other plan documents, insurance policies, certificates of insurance, and other documents (each, if any) that set forth the terms and conditions of a Program, as may be amended from time to time. Any amendment to a Program Document will constitute automatically an amendment to the Plan.
1.15 “Summary Plan Description” means this booklet describing the terms and conditions of the Plan.
1.16 “Declaration of Trust” means the Declaration of Trust of Amalgamated Transit Union Local 1056 effective January 21, 2015, and as amended from time to time, which is intended to constitute a voluntary employees’ beneficiary association within the meaning of section 501(c)(9) of the Code.
1.17 “Trust” means the property maintained in trust pursuant to the Declaration of Trust.
1.18 “You” means a Participant or, if used in an Appendix, a Participant who is eligible for the particular Program described in the Appendix.
ELIGIBILITY AND PARTICIPATION; PARTICIPANT CONTRIBUTIONS
2.01 Eligibility for Participation in the Plan
You will become a Participant in the Plan if (i) you are an “Eligible Employee” or a “Beneficiary,” as each term is defined below, and (ii) you satisfy any additional requirements applicable to specific Program(s) for which you may be eligible:
The Plan Administrator – or as the case may be, a Benefit Provider – may require proof that an individual qualifies as a Dependent in accordance with rules that it or they may establish. You must provide the Plan Administrator with prompt written notice of any change in your family status, such as marriage, divorce, or a change in Beneficiary status. Participants will be held responsible for any costs of the Plan attributable to their failure to notify the Plan Administrator of a loss of Dependent status.
2.02 Eligibility and Enrollment for Specific Programs
Additional eligibility requirements may apply for participation in the Programs offered by the Plan. A list of the Programs offered by the Plan is set forth in Appendix A, and Program Documents are set forth in other Appendices.
2.03 When Does Participation End?
(a) Coverage under the Plan (including all of its Programs) will automatically end on the earliest to occur of the following dates:
(1) the date on which you cease to be an Eligible Employee;
(2) the date that either the Plan or the Program in which you participate terminates;
(3) the first day of the month for which any required Participant contribution is not received; or
(4) the first day of the month following the date on which the Participant or Beneficiary notifies the Plan Administrator that he or she wishes to terminate coverage in the Program.
(5) for Beneficiaries, the date on which the Dependent ceases to be a Beneficiary for any reason, including, without limitation, the death of the Eligible Employee.
(b) If a Program Document provides for an earlier or later termination date, such termination date shall apply.
2.04 Participant Contributions
You may be required to pay contributions to participate in any or all of the Programs offered by the Plan. ATU Local 1056, or its delegee, in its sole and absolute discretion, determines the amount of Participant contributions required to participate in any Program and may modify any Participant contributions that may be required to participate in any Program at any time and from time to time. Failure to pay timely Participant contributions may result in termination of your participation in the Plan and/or in the particular Program to which the contribution applies.
You are entitled to benefits to the extent determined by the Board of Trustees from time to time. Until changed by ATU Local 1056, the benefits shall be those offered under the Programs as set forth in the Appendices. Such benefits shall be subject to the provisions of the Program Document setting forth the terms and conditions pursuant to which such benefits are provided, and any condition or restriction imposed by a Benefit Provider or an administrator providing any benefit.
A description of the specific Plan benefits is set forth in the Appendices of this booklet.
3.02 Claims for Benefits
Rules for filing a claim for benefits vary with each particular Program: see the Program Documents for details.
Some or all of the benefits provided under the Plan may, at the discretion of the Board of Trustees, be provided by the purchase of insurance contracts issued by one or more insurance companies. Any refund, rebate, dividend, experience adjustment, retroactive rates, proceeds from demutualization, or other similar payment under any insurance contract or service contract or Program shall be the property of and retained by the Plan.
The terms and conditions, including any limitations or restrictions, of each Program as set forth in the applicable Program Document are hereby incorporated by reference in this Plan document and constitute a part of the Plan.
CLAIMS AND SUBROGRATION; PARTICIPANT RESPONSIBILITIES
4.01 In General
The Board of Trustees is responsible for establishing rules and regulations under which the Plan operates. Plan interpretations and other matters relating to the operation of the Plan are the sole responsibility of the Board of Trustees. The Board of Trustees may delegate, however, the responsibility for any benefits determination to the Benefit Provider for the Program under which such benefit is made available under the Plan. The Board of Trustees or a Benefit Provider, as the case may be, has the discretion and authority to make factual findings regarding a claim and to interpret the terms of the Plan as they apply to the claim. The Board of Trustees will decide appeals of denials of claims by a third-party administrator or a Benefit Provider, as the case may be, or may delegate the responsibility for deciding appeals to a third party, including, without limitation, a Benefit Provider, in which case all references to the Board of Trustees shall be deemed to refer to its delegee in the provisions governing appeals.
4.02 Making a Claim for Benefits
Claims for Program benefits will be processed pursuant to the procedures established by the Board of Trustees or by one or more Benefit Providers, as the case may be, and described in the Program Document. You must submit claims for benefits in accordance the terms of the Program.
4.03 Limitations on Legal Actions
No legal action concerning a denial of benefits under the Plan may be commenced against the Plan, the Board of Trustees, or any representative of the Plan until the claimant has exhausted all of the administrative remedies set forth under the claims procedures for the applicable Program.
Any suit or legal action initiated by a person for benefits under a Program must be brought no later than two years following a final decision on the appeal of the claim for benefits by the person or entity described herein or in the applicable Program Document with the discretionary authority to determine appeals with respect to such claim unless a longer period of time is required under applicable law, in which case, such longer period shall apply. Notwithstanding the foregoing, if a Program provides for a shorter time period for suits or legal action to be brought following a final decision on the appeal of the claim for benefits, such shorter period shall apply instead of the two years period unless a longer period of time is required under applicable law, in which case, such longer period shall apply. In no case may a suit or legal action be brought if the claim for benefits was not made within any time period prescribed in the claims procedures of the applicable Program Document.
4.04 Participant’s Responsibilities
Each Participant shall be responsible for providing the Board of Trustees, or is delegee, with the Participant’s current address. Any notices required or permitted to be given hereunder shall be deemed given if directed to such address and mailed by regular United States mail. The Board of Trustees shall not have any obligation or duty to locate a Participant. In the event that a Participant becomes entitled to a payment under this Plan and such payment is delayed or cannot be made:
(a) because the current address according to Plan records is incorrect;
(b) because the Participant or Beneficiary fails to respond to the notice sent to the current address according to Plan records;
(c) because of conflicting claims to such payments; or
(d) because of any other reason
the amount of such payment, if and when made, shall be that determined under the provisions of this Plan without payment of any interest or earnings except to the extent required by law. If, after reasonable efforts, the Board of Trustees is unable to locate any Participant whose benefits under the Plan have become distributable, such benefits may be forfeited in accordance with the terms of the Plan. If the Participant subsequently applies for benefits, the amount so forfeited will be paid. Notwithstanding the forgoing, with respect to any benefit or arrangement that is underwritten by insurance, the terms of the insurance policy shall control to the extent such terms are inconsistent with this section.
4.05 Fraud or Misrepresentations
Subject to the Board of Trustees’ discretion, an individual who receives benefits under the Plan as a result of false, incomplete, or incorrect information or a misleading or fraudulent representation may be required to repay all amounts paid by the Plan and may be liable for all costs of collection, including attorney’s fees and court costs. False or misrepresented information could cause the Participant’s coverage to terminate irrevocably and retroactively to the extent permitted by law. Failure to provide timely notice of loss of eligibility will be considered intentional misrepresentation. The Board of Trustees reserves the right to ask for proof of eligibility for a Dependent, and any other information or proof as required by the Plan. Failure on the part of a Participant or Dependent to comply with a request by the Plan, for information or proof within a reasonable period of time is sufficient grounds for delay in the payment of any benefits that may be due under the Plan until such information or proof is received. The Plan may rely on any information furnished by a Participant or Dependent and this information will be conclusively binding upon the Participant or Dependent furnishing the evidence.
If, for any reason, any benefit under the Plan is erroneously paid or exceeds the amount appropriately payable under the Plan to a Participant, the Participant shall be responsible for refunding the overpayment to the Plan to the fullest extent permitted by law. In addition, if the Plan makes any payment that, according to the terms of the Plan, should not have been made, the Board of Trustees or an insurance company, as applicable, may, to the fullest extent permitted by law, recover that incorrect payment, whether or not it was made due to the Board of Trustees’ or insurance company’s own error, from the person to whom it was made or from any other appropriate party.
As may be permitted in the sole discretion of the Board of Trustees or insurance company, the refund or repayment may be made in one or a combination of the following methods: (a) as a single lump-sum payment, (b) as a reduction of the amount of future benefits otherwise payable under the Plan, or (c) any other method as may be required or permitted in the sole discretion of the Board of Trustees or the insurance company. The Plan may also seek recovery of the erroneous payment or benefit overpayment from any other appropriate party.
4.07 Right of Subrogation and Reimbursement
To the extent the subrogation and reimbursement provisions in this section are different than the subrogation and reimbursement provisions set forth under an applicable Program Document for an insured Program, the terms of that Program will control, except that if such terms of the Program do not comply with applicable law, the subrogation and reimbursement provisions in this section will control.
(a) If the Plan pays benefits to or for any Participant for any injury, illness, expense, or loss, the Plan will be subrogated for the full amount of such payments to all rights of the Participant, or any assignee of the Participant against any person, firm, corporation or other entity in connection with any claim related to the injury, illness, expense, or loss.
(b) If the Plan pays benefits to or for any Participant for any injury, illness, expense or loss caused, or alleged to be caused, by any person, and the Participant (or someone acting on behalf of the Participant) or any assignee of any of the Participant obtains any recovery from any source in connection with the injury, illness, expense or loss, whether by lawsuit, settlement or otherwise, including any recovery from the Participant’s insurance, and regardless of how the recovery is characterized or named, the Plan shall be entitled to full reimbursement from the Participant (or person acting on behalf of the Participant) or any assignee of any of the Participant to the full extent of the Plan’s payments.
(c) The Plan’s rights of subrogation and reimbursement under (a) and (b) above shall have first priority and shall not be reduced for any reason, including for attorney’s fees, the “fund” doctrine, the “common fund” doctrine, comparative or contributory negligence, “collateral source” rule, “attorney’s fund” doctrine, regulatory diligence or any other defenses or doctrines that may affect the Plan’s right to subrogation or reimbursement. Likewise, the Plan’s right to subrogation or reimbursement shall exist and be enforceable without regard to whether the Participant (or person acting on behalf of the Participant) is “made whole” for his or her loss. Notwithstanding the above, the Board of Trustees or the Board of Trustees’ delegee may determine, in the exercise of its sole discretion, to reduce the Plan’s recovery in appropriate circumstances, which may include, with respect to attorney’s fees, a condition that the attorney representing the Participant or assignee has agreed in advance to honor the rights of the Plan with respect to subrogation and reimbursement contained herein.
(d) Once a covered person has any reason to believe that he/she may be entitled to recovery from any source, the covered person must notify the Plan. Prior to payment by the Plan to or for a Participant (or someone acting on behalf of the Participant) for any injury, illness, expense, or loss caused, or alleged to have been caused, in circumstances that may support a recovery from any person, the Participant (or someone acting on behalf of the Participant) will be asked to execute a subrogation and reimbursement agreement consistent with the terms of this section. Failure to request or obtain such an agreement prior to the payment by the Plan shall not in any way diminish the Plan’s rights of subrogation and reimbursement herein. If a covered person fails or refuses to execute the required subrogation or reimbursement agreement, the Plan may deny payment of any benefits to the covered person until the agreement is signed. Alternatively, if a covered person fails or refuses to execute the required subrogation or reimbursement agreement and the Plan nevertheless pays benefits to or on behalf of the covered person, the covered person’s acceptance of such benefits shall constitute agreement to the Plan’s right to subrogation or reimbursement, and the covered person’s agreement to a constructive trust, lien and/or equitable lien by agreement in favor of the Plan on any payment, amount or recovery that the covered person recovers from any source.
(e) By participating in the Plan, each covered person consents and agrees that, once Plan benefits are paid, a constructive trust, lien, or an equitable lien by agreement in favor of the Plan exists with regard to any payment, settlement, or recovery relating to an injury, illness, expense, or loss for which the Plan has provided benefits. In accordance with that constructive trust, lien, or equitable lien by agreement, each covered person agrees to cooperate with the Plan by reimbursing it for Plan benefits received.
(f) The Participant shall do nothing to prejudice the Plan’s rights under this section and shall promptly inform the Plan of the name and address of any attorney representing the Participant or assignee. The Participant shall assist the Plan upon request, including instituting legal proceedings against any appropriate persons, firms, corporations, or entities.
(g) In the event that the Plan is not fully reimbursed as set out in this section, the Plan shall have the right, as the Board of Trustees or the Board of Trustees’ delegee may determine, in the exercise of its sole discretion, to reduce any future benefits to which the Participant or assignee is or may become entitled, by the amount not reimbursed or recovered by the Plan.
ADMINISTRATIVE AND FIDUCIARY PROVISIONS
Except as may otherwise be provided in the Appendix with respect to any particular Program, the Board of Trustees is responsible for administration of the Plan. The Board of Trustees, however, may delegate in writing any of its powers or duties under the Plan to any person or entity. The delegate shall become the fiduciary for only that part of the administration which has been delegated by the Board and any references to the Board of Trustees shall instead apply to the delegee.
5.02 Discretionary Authority
The Board of Trustees, or, where applicable, its authorized delegee, shall have the exclusive authority, in its sole and absolute discretion, to administer and interpret the Plan, to establish rules governing the operation of the Plan and the transaction of its business, to decide all matters arising in connection with the operation or administration of the Plan, and to take such actions as are described in Article 5 of the Plan. The determination of the Board, or its authorized delegee, as to any disputed question shall be conclusive. Subject to the requirements of the law, the Board of Trustees, or its authorized delegee, shall be the sole judge of the standard of proof required in any case and the application and interpretation of this booklet, and the decisions of the Board of Trustees shall be final and binding on all parties. Furthermore, benefits under this Plan will be paid only if the Board of Trustees, or its authorized delegee, decides in its discretion that the applicant is entitled to them under the terms of the Plan. Accordingly, it is intended that any review of an exercise of discretionary authority by the Board of Trustees, or its authorized delegee, by a court or an arbitrator is to be limited to whether the decision of the Board of Trustees, or its authorized delegee, was a clear abuse of its discretion.
5.03 Powers and Duties of the Board of Trustees
The Board of Trustees shall have full authority to administer, operate, and interpret the Plan, including, without limitation, as follows:
5.04 Facility of Payments
If the Board of Trustees finds that any person to whom an amount is payable under the Plan is unable to care for his or her affairs because of physical or mental illness or accident, or is a minor, or has died, then any payment due him or her, or his or her estate (unless a prior claim has been made by a duly appointed legal representative) may be paid to his or her spouse or domestic partner, a child (in accordance with the Uniform Gifts to Minors Act or State “gifts to minors” act, if applicable), a relative, an institution maintaining or having custody of such person, or any other person deemed by the Board of Trustees to be a proper recipient on behalf of such person otherwise entitled to payment. Any such payment shall constitute a complete discharge of the liability of the Plan and the Board of Trustees.
6.01 Benefits Not Transferable
Except as required by applicable law, benefit payments hereunder shall not in any way be subject to the debts or other obligations of the persons entitled thereto and may not be voluntarily or involuntarily sold, anticipated, alienated, encumbered, pledged, transferred or assigned.
6.02 Compliance with Legal Requirements
In addition to the powers of the Board of Trustees expressly set forth herein, the Board of Trustees shall have the power and authority to take any action required to cause the Plan and the Fund to be in compliance with applicable provisions of law.
6.03 Factual Determinations
Any misstatement or other mistake of fact in any certificate, notice, or other document filed with or issued by the Board shall be corrected when it becomes known. The Board of Trustees shall not be liable in any manner for any determination of fact made in good faith.
6.04 Proof of Claims
As a condition of receiving Benefits under the Plan, any person may be required to submit whatever proof the Board of Trustees may require either directly to the Board of Trustees or to any person delegated by it. Failure on the part of a claimant to comply with such request promptly, accurately, and in good faith shall be sufficient grounds for denying, postponing, or discontinuing benefits from the Plan to such person.
6.05 Title to Trust
Except with respect to the right to receive benefits for which a Participant qualifies under the Plan, no individual shall have any right, title, or interest in and to the assets of the Fund or to the contributions thereto, such contributions being made and held in the Fund for the sole purpose of providing benefits under the Plan in accordance with its terms. The Board of Trustees does not in any way guarantee the Fund from any loss or depreciation, or guarantee payment of any benefit which may become due to any person under the Plan. The Plan’s obligation to pay benefits is conditioned on the availability of cash in the Fund and no plan fiduciary or other person shall be required to liquidate any asset of the Fund to generate cash to pay benefits. Further, the liability for payment of Benefits under a Program described in the Appendix of this booklet as of any date is limited solely to the terms of such Program and, where applicable, the Benefit Provider’s obligation pursuant to such Program.
6.06 Limitation of Rights
Neither the establishment nor the existence of the Plan nor any modification thereof shall operate or be construed so as to:
(a) give any person any legal or equitable right against the Plan, Board of Trustees, Employer, or Union, except as expressly provided herein or required by law; or
(b) create a contract of employment with any Employee, obligate the Employer to continue the service of any Employee, or affect or modify the terms of an Employee’s employment in any way.
All fees and expenses incurred in connection with the operation and administration of the Plan, including, without limitation, legal, accounting, actuarial, investment, management, and administrative fees and expenses may be paid out of any Plan asset to the extent that it is legally permissible for these fees and expenses to be so paid.
In the event that the provisions of any Program conflicts with or contradicts the provisions of this document or any other Program, the Board of Trustees shall use its discretion to interpret the terms and purpose of the Plan so as to resolve any conflict or contradiction. However, the terms of this document may not enlarge the rights of a Participant to benefits available under any Program.
6.09 Right of Recovery
The Board of Trustees shall have the right to recover any payment it made but should not have made or made to an individual or organization not entitled to payment, from the individual or organization or anyone else benefiting from the improper payment.
Except where otherwise indicated by the context, any masculine terminology used herein shall also include the feminine and vice versa, and the definition of any term herein in the singular shall also include the plural, and vice versa.
6.11 Governing Law
Except to the extent that state law is preempted by federal law, the Plan shall be administered and construed to be in accordance with the laws of the State of New York.
6.12 References to the Internal Revenue Code
Any reference to a section of the Internal Revenue Code shall include a reference to any successor provision of the Internal Revenue Code.
6.13 No Contract
Neither the Plan nor any portion thereof shall be deemed to constitute a contract between the Board of Trustees and any Participant.
7.01 Continuation Coverage
A Participant or Beneficiary may continue coverage for benefits under the Plan as described in the applicable Program Document.
AMENDMENT AND TERMINATION
The Plan, including any Programs maintained pursuant to the Plan with respect to any group of Participants, may be amended by ATU Local 1056, by written instrument, at any time and from time to time in its sole and absolute discretion.
The Plan, including any Programs maintained pursuant to the Plan with respect to any groups of Participants, may be terminated at any time by ATU Local 1056, by written instrument, in its sole and absolute discretion.
8.03 No Reversion or Inurement
Under no circumstances may any assets of the Fund revert or inure to the benefit of the Employer, Union, Board of Trustees, or their respective successors.
9.01 Board of Trustees
The Board of Trustees, as originally constituted, consists of the following three individuals:
The Board of Trustees may be reached at:
ATU Local 1056 Benefits Fund
c/o Extensive Benefits, Inc.
P.O. Box 813546
Smyrna, Georgia 30081
ATU Local 1056
211-12 Union Turnpike
Oakland Gardens, New York 11364
9.02 Service of Legal Process
Legal process may be served on the Board of Trustees at the addresses set forth in Section 9.01.
Addendum – Privacy Notice
ATU Local 1056 Benefits Fund
c/o Extensive Benefits, Inc.
P.O. Box 813546
Smyrna, Georgia 30081
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Please note that the information that the Plan has on file pertains only to your enrollment and eligibility to receive benefits from the Plan.
You have the right to:
You have some choices in the way that we use and share information as we:
Our Uses and Disclosures
We may use and share your information as we:
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you. Please note that the information that the Plan has on file pertains only to your enrollment and eligibility to receive benefits from the Plan.
Get a copy of health and claims records
Ask us to correct health and claims records
Request confidential communications
Ask us to limit what we use or share
Get a list of those with whom we’ve shared information
Get a copy of this privacy notice
Choose someone to act for you
File a complaint if you feel your rights are violated
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions. In these cases, you have both the right and choice to tell us to:
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases we never share your information unless you give us written permission:
Our Uses and Disclosures
How do we typically use or share your health information?
We typically use or share your health information in the following ways.
Help manage the health care treatment you receive.
As noted above, the Plan has information that pertains only to your enrollment and eligibility to receive benefits from the Plan.
If applicable, we could use your health information and share it with professionals who are treating you.
Example: A doctor sends us information about your diagnosis and treatment plan so we can arrange additional services.
Run our organization
Example: We use health information about you to develop better services for you.
Pay for your health services
If applicable, we could use and disclose your health information as we pay for your health services.
Example: We share information about you to coordinate payment for your medical expenses.
Administer your plan
We may disclose your health information to your health plan sponsor for plan administration.
Example: Certain statistics could be provided to evaluate the benefits provided by the Plan.
How else can we use or share your health information?
As noted above, the Plan has information that pertains only to your enrollment and eligibility to receive benefits from the Plan. We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Help with public health and safety issues
We can share health information about you for certain situations such as:
We can use or share your information for health research.
Comply with the law
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
Respond to organ and tissue donation requests and work with a medical examiner or funeral director
Address workers’ compensation, law enforcement, and other government requests
We can use or share health information about you:
Respond to lawsuits and legal actions
We can share health information about you in response to a court or administrative order, or in response to a subpoena.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Changes to the Terms of this Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request and we will mail a copy to you.
Effective Date of this Notice – May 1, 2015
ATU Local 1056 Benefits Plan
Extensive Benefits, Inc.
P.O. Box 813546
Smyrna, Georgia 30081
Addendum – COBRA General Notice
** Continuation Coverage Rights Under COBRA**
You’re getting this notice because you recently gained coverage under a group health plan (the Plan).This notice has important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan.This notice explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect your right to get it.When you become eligible for COBRA, you may also become eligible for other coverage options that may cost less than COBRA continuation coverage.
The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA).COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end.For more information about your rights and obligations under the Plan and under federal law, you should review the Plan’s Summary Plan Description or contact the Plan Administrator.
You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees.
What is COBRA continuation coverage?
COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event. This is also called a “qualifying event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage.
If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events:
If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events:
Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying events:
When is COBRA continuation coverage available?
The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. The employer must notify the Plan Administrator of the following qualifying events:
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you must notify the Plan Administrator within 60 days after the qualifying event occurs. You must provide this notice to: Extensive Benefits, Inc., P.O. Box 813546, Smyrna, Georgia 30081.
How is COBRA continuation coverage provided?
Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children.
COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage.
There are also ways in which this 18-month period of COBRA continuation coverage can be extended:
Disability extension of 18-month period of COBRA continuation coverage
If you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage, for a maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage.
Second qualifying event extension of 18-month period of continuation coverage
If your family experiences another qualifying event during the 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if the Plan is properly notified about the second qualifying event. This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies; becomes entitled to Medicare benefits (under Part A, Part B, or both); gets divorced or legally separated; or if the dependent child stops being eligible under the Plan as a dependent child. This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred.
Are there other coverage options besides COBRA Continuation Coverage?
Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov.
If you have questions
Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. For more information about your rights under the Employee Retirement Income Security Act (ERISA), including COBRA, the Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.) For more information about the Marketplace, visit www.HealthCare.gov.
Keep your Plan informed of address changes
To protect your family’s rights, let the Plan Administrator know about any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator.
Plan contact information
ATU Local 1056 Benefits Plan
Extensive Benefits, Inc.
P.O. Box 813546
Smyrna, Georgia 30081
Programs Offered Under the Plan
The following Programs shall be incorporated by reference into and made a part of this Plan as of January 1, 2018, or the Program’s effective date, if later:
Page Last Updated: Mar 08, 2020 (05:37:50)