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2016 Summary Plan Description

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New York State United Teachers Member Benefits Trust 800 Troy-Schenectady Road Latham, NY Summary Plan Description TRUSTEES Martin Messner, Chairperson Florence
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New York State United Teachers Member Benefits Trust 800 Troy-Schenectady Road Latham, NY Summary Plan Description TRUSTEES Martin Messner, Chairperson Florence McCue Roderick P. Sherman, Secretary Thomas McMahon Loretta Donlon Paul Pecorale Jeffrey Hartnett Arthur Pepper Matthew Hill Kevin Peterman PLAN ADMINISTRATOR Lynette A. Metz ATTORNEY Meyer, Suozzi, English & Klein, P.C Broadway, Suite 501 P.O. Box 822 New York, NY AUDITOR Buchbinder Tunick & Company LLP 6116 Executive Boulevard, Suite 201 Rockville, MD CONSULTANT The Segal Company 333 West 34 th Street New York, NY EMPLOYER IDENTIFICATION NUMBER PLAN NUMBER 503 2016 Summary Plan Description March 2016 Dear Participant: The NYSUT Member Benefits Trust (the Plan or MBT ) is pleased to provide you with this Summary Plan Description (SPD) of benefits, an overview of NYSUT Member Benefits Trust-endorsed Programs. The Member Benefits Trust was established to provide Participants and their Dependents with access to Benefit Programs endorsed by the Member Benefits Trust. This SPD is not a contract and does not guarantee any benefits. The actual terms and conditions of the endorsed Benefit Programs are contained in the Official Documents, which are incorporated by reference. This SPD, in conjunction with the Official Documents, together provide the details of your benefits. The NYSUT Member Benefits Trust does not claim that each Member Benefits Trust-endorsed Benefit Program is the lowest-cost product, but Member Benefits Trustees, Directors, staff, consultants, and advisors work tirelessly to obtain and maintain quality programs at competitive prices. Participants are also encouraged to shop and compare before utilizing any Member Benefitsendorsed Benefit Programs. Although some NYSUT Member Benefits Trust-endorsed Programs may provide legal or financial advice, Member Benefits itself does not offer investment, legal or tax advice. Participants are urged to consult their own investment, financial, tax, and legal advisers to help them with an evaluation of the Benefit Programs. The Benefit Programs described herein are provided by Benefit Providers. If you are looking for information on the group and voluntary Catastrophe Major Medical Plans, you should refer to the separate plan documents that apply to those benefits. This document is not to be considered a substitute for the Official Documents maintained by the Benefit Providers. If a discrepancy arises between this SPD and the Official Documents, the Official Documents will govern. We have made every effort to ensure that this information is as up-to-date and transparent as possible. If you would like to receive additional information on any NYSUT Member Benefits-endorsed Programs, please contact NYSUT Member Benefits at or visit memberbenefits.nysut.org. Sincerely, BOARD OF TRUSTEES OF NYSUT MEMBER BENEFITS TRUST IMPORTANT NOTICES Claims Procedures Procedures for any group health or disability claims must be provided to you automatically and without charge. Such procedures are included in the applicable Benefit Program Official Documents. Briefly, claims procedure information includes the following: Procedures for obtaining pre-authorizations, approvals or utilization review decisions in the case of group health plan services or benefits; Procedures for filing claim forms, providing notifications of benefit determinations, and reviewing determinations of any plan; and Applicable time-limits and remedies available under a Plan for the redress of claims, which are denied in whole or in part. Any questions regarding claims procedures should be directed towards the claims administrator of the applicable Benefit Program. Deadline for submitting claims for Benefits In order to receive the Benefits that you are entitled to, you must submit a claim for such Benefits to the relevant Benefit Provider before the deadline for filing such claims. The deadlines for submitting claims for different types of Benefits vary. Therefore, you should review the relevant Official Document in order to determine the applicable deadline. If you have any questions regarding a deadline, please contact the relevant Benefit Provider. Termination or Amendment of the Plan The Plan Sponsor has the right to modify or amend the Plan, in whole or in part, to change or discontinue any of the Benefit Programs, or to terminate the Plan at any time. Named Fiduciaries The named fiduciary for each of the Benefit Programs is listed in the description of each Benefit Program below. A plan fiduciary is a person or entity: (1) that is authorized by the plan to exercise discretionary authority or discretionary control respecting management of the plan or disposition of plan assets; (2) who has any authority or responsibility with respect to any monies or other properties of the plan; or (3) who has any discretionary authority or discretionary responsibility in the administration of the plan. A Named Fiduciary with regard to a plan benefit is a plan fiduciary with authority to make benefit determinations (claims decisions and/or decisions on claims appeals). No Guarantee of Income Tax Consequences Neither the Board of Trustees nor the Benefit Trust Fund Office makes any commitment or guarantee that any amounts paid to, or for the benefit of, a Participant under this Plan will be excludable from the Participant s gross income for Federal or State income tax purposes, or that any other Federal or State tax treatment will apply to or be available to any Participant. Special Enrollment Rights If you acquire a new Dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your Dependents in certain Benefit Programs outside of the usual open-enrollment timeframes, provided that you request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. You should review the Official Documents for detailed information regarding any special enrollment or open enrollment rights that may apply to you. These rights may also be available if you lose coverage under another group health plan or program. Omnibus Budget Reconciliation Act of 1993 (OBRA) OBRA 1993 requires that an eligible dependent child for purposes of medical coverage will include a child who is adopted or placed for adoption prior to age 18 and a child for whom the participant or covered dependent spouse is required to provide coverage due to a Qualified Medical Child Support Order (QMCSO) which is determined by the Plan Administrator to be a QMCSO. A QMCSO will also include a judgment, decree or order issued by a court of competent jurisdiction or through an administrative process established under state law and having the force and effect of law under state law and which satisfies the QMCSO requirements of ERISA. If a QMCSO is received, the Member Benefits Trust and applicable Benefit Providers will comply with it to the extent required by law. Notices You should send notices to Benefit Providers to their addresses, as specified in their brochures. You must provide notice to the applicable Benefit Provider in the event that you are divorced or legally separated, your domestic partner fails to qualify as a domestic partner, or if your dependent ceases to meet the eligibility requirements for being covered as a dependent under the applicable Benefit Program. TABLE OF CONTENTS ARTICLE TITLE 1 DEFINITIONS 2 GENERAL 3 ELIGIBILITY 4 GRANDFATHERED PROGRAMS VOLUNTARY PROGRAMS 5 LEVEL TERM LIFE INSURANCE PLAN 6 TERM LIFE INSURANCE PLAN 7 SENIOR TERM LIFE INSURANCE PLAN 8 WRAPPLAN II UNIVERSAL LIFE INSURANCE PLAN 9 WRAPPLAN TERM LIFE COORDINATION PROGRAM 10 PERSONAL PROPERTY AND LIABILITY INSURANCE PLAN 11 DISABILITY INSURANCE PLAN 12 DISABILITY INSURANCE PLAN II 13 LONG-TERM CARE INSURANCE PLAN (NYLTCB) 14 LONG-TERM CARE INSURANCE PLAN (METLIFE) 15 DENTAL PLAN 16 VISION PLAN 17 LEGAL SERVICE PLAN GROUP PROGRAMS 18 GROUP PROGRAM ELIGIBILITY 19 GROUP TERM LIFE INSURANCE PLAN 20 GROUP DISABILITY INSURANCE PLAN 21 GROUP LONG-TERM CARE INSURANCE PLAN 22 GROUP DENTAL PLAN 23 GROUP VISION CARE PLAN 24 HEALTH ADVOCATE TM 25 GROUP ACCESS LEGAL SERVICE PLAN 26 GROUP PREPAID LEGAL SERVICE PLAN 27 FLEXIBLE BENEFIT PLANS 28 HEALTH REIMBURSEMENT ARRANGEMENTS 29 COBRA CONTINUATION COVERAGE 30 STATEMENT OF ERISA RIGHTS 31 IMPORTANT INFORMATION ARTICLE 1 DEFINITIONS For the purposes of this Plan, the terms below are defined. However, in the event of a conflict between the definition specified in this document and the definition stated in an Official Document issued by the Benefit Provider, the definition used in the Official Document will govern. Thus, you should be aware of the definitions used in the Official Documents you receive. Section 1.01 Agency Fee Payer An Agency Fee Payer refers to an individual who pays the equivalent of membership dues for collective bargaining-related services and who receives a refund of the part of the fee that the Union uses for political and ideological purposes only incidentally related to the terms and conditions of employment. Section 1.02 Associate Member The term Associate Member refers to an individual who is currently covered by one or more NYSUT Member Benefits Trust-endorsed Programs and wishes to continue participation in such Program(s), but has no other means of maintaining NYSUT membership. This category is called Associate Member Continuing NYSUT Member Benefits Coverage, but is referred to as the shortened Associate Member throughout this Summary Plan Description. Section 1.03 Beneficiary A Beneficiary is a person designated by a Participant under the terms and conditions of a Benefit Program endorsed by this Plan. Section 1.04 Benefit Fund A Benefit Fund is a collectively-bargained Program designed to provide a plan of benefits to members of the bargaining unit and others as agreed. Section 1.05 Benefits Benefits are payments or services that you may be entitled to under a Benefit Program endorsed by this Plan. Section 1.06 Child or Children The terms Child and Children refer to natural children, stepchildren, lawfully-adopted children, and foster children, as determined by the Benefit Provider. Section 1.07 Dependent A Dependent is a legal spouse, domestic partner, or Child or such other individual eligible for Benefits as determined under the rules and requirements of a Benefit Program. Section 1.08 Local Association A Local Association is a group of Members who hold collective bargaining rights for classroom teachers, school-related personnel, private school employees, higher education faculty and professional staffs, and health care professionals or other non-supervisory employees at the school district or institutional level recognized by the NYSUT Board of Directors. Section 1.09 Member A Member is an individual represented by NYSUT or a local affiliate thereof, or who has otherwise satisfied NYSUT Membership requirements. Section 1.10 Official Document(s) Official Documents are the Master Insurance Policies, your Individual Insurance Policy, and other policies, certificates, contracts, or similar documents issued to you by the Benefit Providers that set forth the terms and conditions of the respective Benefit Programs. Section 1.11 Participant You are a Participant in this Plan if you are an in-service or retiree Member of New York State United Teachers (NYSUT), or you are an Agency Fee Payer or Associate Member. You are also considered a Participant if your Employer, Local Association or Benefit Fund has purchased or provides a Group Benefit Program and has included you as an individual eligible for coverage under that Group Benefit Program. Section 1.12 Union The Union is New York State United Teachers. ARTICLE 2 GENERAL Section 2.01 About this Plan The name of this Plan is the New York State United Teachers Member Benefits Trust referred to in this document as the Member Benefits Trust. The Member Benefits Trust is sponsored by the Union. The purpose of this Plan is to provide Participants and their Dependents with access to Benefit Programs endorsed by the Member Benefits Trust. Benefit Programs are provided by independent Benefit Providers who are solely responsible for the Program Contracts; eligibility determinations; coverage and exclusions; and for paying claims and resolving any disputes about Benefits. The Member Benefits Trust is a tax-exempt, not-for-profit Trust Fund established and maintained for the exclusive benefit of the Participants of the Trust and their Dependents. No Union dues monies are received from NYSUT to support the Member Benefit Trust s operation. The Member Benefits Trust has endorsement arrangements with the Benefit Providers. All payments to the Trust pursuant to such agreements are used solely to defray the costs of administering the Benefit Programs of the Member Benefits Trust, including compensation, rent, office expenses, and the cost of retaining consultants, auditors and attorneys to advise the Trustees and the Trust s staff. Where appropriate, Member Benefits Trust s revenue is also used to enhance the Benefit Programs for Participants. No monies are paid to NYSUT except reimbursement for use of facilities and for services and personnel provided by NYSUT to, and at the request of, the Member Benefits Trust (the reasonableness of which amounts is certified annually to the Trustees by the Member Benefits Trust s independent auditors). Section 2.02 About this Document This SPD provides an overview of all Member Benefits Trust-endorsed Benefit Programs. This Description is a brief summary of the provisions of the Member Benefits Trust-endorsed Benefit Programs. Official Documents provided to you by the respective Benefit Provider(s) set forth the details of all Benefits and provisions of the Benefit Programs. This SPD is not to be considered a substitute for the Official Documents. If a discrepancy arises between this SPD and the Official Documents, the Official Documents will govern. Except as otherwise required by the context, use of the masculine or feminine gender herein shall include both genders. Section 2.03 Plan Trustees The names and titles of the Plan s Trustees are listed on the front page of this SPD. For all Plan Trustees, their business address is NYSUT Member Benefits Trust, 800 Troy-Schenectady Road, Latham, NY Section 2.04 Plan Administrator and Service of Legal Process While the Board of Trustees is the Plan Administrator for purposes of ERISA, the Board has designated Lynette A. Metz as the Plan Administrator responsible for carrying out the Trustees decisions and for overseeing the daily operation of the Plan and the Fund Office. If you have any questions about the Plan, you may contact the Fund Office as follows: By writing: NYSUT Member Benefits Trust 800 Troy-Schenectady Road Latham, NY Or by calling: or The Trustees have designated the Plan Administrator as agent for service of legal process at the above address. Service of legal process upon Lynette A. Metz will be deemed to be service upon the Trustees in their capacity as Trustees. However, service of legal process may also be made upon any Trustee. Section 2.05 Plan Year The Plan Year begins on September 1 and ends on August 31. Section 2.06 How Benefits are Provided This Plan has entered into agreements with the Benefit Providers and certain Third-Party Administrators, herein referred to as Benefit Providers, to provide the Benefit Programs described below. The Benefit Providers, Third-Party Administrators and Benefit Programs are: Davis Vision provides the Vision and Group Vision Care Plans. The mailing address for Davis Vision is 700 Troy-Schenectady Road, Suite 301, Latham, NY Delta Dental of New York provides the Group Dental Plan. The mailing address for Delta Dental is One Delta Drive, Mechanicsburg, PA First Unum Life Insurance Company provides the Group Term Life Insurance, Group Disability Insurance and grandfathered Group Long-Term Care Plans. The mailing address for First Unum is 666 Third Avenue, Suite 301, New York, NY Health Advocate TM provides the Health Advocate benefit. The mailing address for Health Advocate TM is 3043 Walton Road, Suite 150, Plymouth Meeting, PA Mercer Consumer (formerly known as Marsh U.S. Consumer) administers the Disability Insurance Plan, grandfathered Disability Insurance Plan II, Term Life Insurance Plan, Level Term Life Insurance Plan, and grandfathered Senior Term Life Insurance Plan. The mailing address for Mercer Consumer is P.O. Box 9186, Des Moines, IA MetLife Auto & Home provides the Personal Property and Liability Insurance Plan. The mailing address for MetLife Auto & Home is P.O. Box 671, Warwick, RI Metropolitan Life Insurance Company provides the grandfathered Long- Term Care Insurance Plan. The mailing address for Metropolitan Life is P.O. Box , Hartford, CT Metropolitan Life Insurance Company provides the Dental Plan. The mailing address for Metropolitan is P.O. Box 3019, Utica, NY New York Long-Term Care Brokers provides the Long-Term Care Insurance Program. The mailing address for NYLTCB is 11 Executive Park Drive, Clifton Park, NY The National Legal Office of Feldman, Kramer & Monaco, P.C. provides the Legal Service Plan, Group Access Legal Service Plan and Group Prepaid Legal Service Plan. The mailing address for Feldman, Kramer & Monaco is 330 Vanderbilt Motor Parkway, Hauppauge, NY P & A Administrative Services, Inc. administers the Dental Plan and is one of the administrators of the Flexible Benefits Plans and Health Reimbursement Arrangements. The mailing address for P & A is 17 Court Street, Suite 500, Buffalo, NY The Preferred Group Plans, Inc. is one of the administrators of the Flexible Benefits Plans and Health Reimbursement Arrangements. The mailing address for The Preferred Group Plans is 19 British-American Boulevard West, Latham, NY Transamerica Financial Life Insurance Company provides the WrapPlan II Universal Life Insurance Plan and grandfathered WrapPlan Term Life Coordination Program. The mailing address for Transamerica is 440 Mamaroneck Avenue, Harrison, NY Unimerica Life Insurance Company of New York provides the Disability Insurance Plan and grandfathered Disability Insurance Plan II. The mailing address for Unimerica is One Penn Plaza, 8 th Floor, New York, NY USI Affinity administers the WrapPlan II Universal Life Insurance Plan and grandfathered WrapPlan Term Life Coordination Program. The mailing address for USI Affinity is 14 Cliffwood Avenue, Suite 310, Matawan, NJ The United States Life Insurance Company in the City of New York provides the Term Life Insurance Plan, Level Term Life Insurance Plan and grandfathered Senior Term Life Insurance Plan. The mailing address for United States Life is 1 World Financial Center, 200 Liberty Street, New York, NY Section 2.07 Member Benefits Trust and the Benefit Providers? The Member Benefits Trust has endorsement arrangements with the Benefit Providers. The details of each endorsement arrangement are included in this SPD. All payments to Member Benefits pursuant to such arrangements are used solely to defray the costs of administering its various endorsed Programs and, where appropriate, to enhance them for Participants. For the following Benefit Programs, the insurer pools (or, in the case of the Group Vision Care Plan, insured group vision plans pool) the premiums of Member Benefits Participants who are insured for the purposes of determining premium rates and accounting Term Life Insurance Plan, grandfathered Senior Term Life Insurance Plan, Disability Insurance Plan, grandfathered Disability Insurance Plan II, grandfathered Long-Term Care Insurance Plan, Group Term Life Insurance Plan, Group Disability Insurance Plan, Group Dental Plan, and Group Vision Care Plan. Coverage outside of these plans may have rates and terms that are not the same as those obtainable through Member Benefits. The Insurer or Member Benefits may hold premium reserv
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