SUMMARY PLAN DESCRIPTION FOR THE GROUP LIFE INSURANCE PLAN

Transcription

1 SUMMARY PLAN DESCRIPTION FOR THE GROUP LIFE INSURANCE PLAN

2 TABLE OF CONTENTS Page INTRODUCTION... 1 ELIGIBILITY... 1 When Can I Become a Participant in the Plan?... 1 What Are the Eligibility Requirements of Our Plan?... 1 When Is My Entry Date?... 1 Are There Any Employees Who Are Not Eligible?... 1 What Must I Do to Enroll in the Plan?... 1 When Does My Participation End in the Plan?... 1 THE PLAN'S BENEFITS... 1 What Benefits Are Available?... 1 BENEFIT PAYMENTS... 2 When Will Payments Be Received From This Plan?... 2 AMENDMENT OR TERMINATION OF THE PLAN... 2 NO CONTRACT OF EMPLOYMENT... 2 ADDITIONAL PLAN INFORMATION... 2 Your Rights Under ERISA... 2 Claims Process... 3 Family or Medical Leaves of Absence... 3 GENERAL INFORMATION ABOUT OUR PLAN... 3 General Plan Information... 4 Employer And Plan Sponsor Information... 4 Plan Administrator Information... 4 Carrier Information... 4 Service of Legal Process... 4 Type of Administration... 5 Funding Medium... 5 Important Disclaimer... 5 SUMMARY... 5

3 INTRODUCTION Playhouse Square Foundation (the "Employer") is pleased to announce that we continue to maintain a group life insurance plan for you and other eligible employees. This life insurance plan provides an important source of income for your beneficiaries in the event of your death. The benefits available are outlined in this Summary Plan Description. We will also tell you about other important information concerning the Plan, such as the laws that protect your rights. Read this Summary Plan Description carefully so that you understand the provisions our Plan and the benefits you will receive. We want you to be fully informed while you are a participant. You should direct any questions you have to the Administrator. This Summary Plan Description highlights the important features of the Plan. It is not intended to give all details of the Plan. The Plan, and not this Summary Plan Description, is the official document which control your rights, benefits and duties under the Plan. Any future revision of the Summary Plan Description shall completely replace and override this Summary Plan Description in all respects. There is a plan document on file that you may review if you desire. In the event there is a conflict between this Summary Plan Description and the Plan document, the Plan document will control. ELIGIBILITY WHEN CAN I BECOME A PARTICIPANT IN THE PLAN? Before you become a member or a "participant" in the Plan, there are certain rules that you must satisfy. First, you must meet the "eligibility requirements." After that, the next step is to actually join the Plan on the "entry date" that we have established for all employees. You will also be required to complete certain application forms before you can enroll in the Plan. WHAT ARE THE ELIGIBILITY REQUIREMENTS OF OUR PLAN? You will be eligible to join the Plan as detailed in the attached Certificate of Coverage provided by Unum Life Insurance Company of America. WHEN IS MY ENTRY DATE? You can join the Plan after you meet the eligibility requirements as provided for in the Certificate of Coverage. ARE THERE ANY EMPLOYEES WHO ARE NOT ELIGIBLE? Yes, there are certain employees who are not eligible to join the Plan. They are: Employees who are not eligible for coverage under our group life insurance plan as provided by the Employer's policy and as detailed in the Certificate of Coverage. WHAT MUST I DO TO ENROLL IN THE PLAN? Before you can join the Plan, you must complete an application to participate in the Plan. The Employer will provide you with that application at the appropriate time. WHEN DOES MY PARTICIPATION END IN THE PLAN? Your coverage under the Plan terminates as provided for in the Certificate of Coverage. THE PLAN'S BENEFITS WHAT BENEFITS ARE AVAILABLE?

4 This Plan provides a benefit to your beneficiaries upon your death as detailed in the Certificate of Coverage. The specific benefits available to you, including limitations and exclusions, are also detailed in that Certificate of Coverage. You must read the Certificate of Coverage to understand your benefits. BENEFIT PAYMENTS WHEN WILL PAYMENTS BE RECEIVED FROM THIS PLAN? Generally, your beneficiaries will receive payments from the Plan after the requirements set forth in the Certificate(s) of Coverage have been satisfied. Typically, these requirements entail providing proof of the Participant's death. AMENDMENT OR TERMINATION OF THE PLAN The Employer, as plan sponsor, has the right to amend or terminate the Plan at any time. If the Plan is terminated, your coverage under the Plan will end. NO CONTRACT OF EMPLOYMENT The Plan is not intended to be, and may not be construed as constituting, an employment contract or other arrangement between you and the Employer. ADDITIONAL PLAN INFORMATION YOUR RIGHTS UNDER ERISA As a Participant in the Plan, you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 ("ERISA"). ERISA assures that all Plan Participants shall be entitled to: Examine, without charge, at the Administrator's office all documents governing the Plan 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 Employee Benefits Security Administration. Obtain, upon the written request to the Administrator, copies of documents governing the operation of the Plan and copies of the latest annual report (Form 5500 Series) and updated Summary Plan Description. The Administrator may make 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 and beneficiaries. No one, including the 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. 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 times 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 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 Plan Administrator. If you have a claim for benefits that 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 2

5 thereof concerning the qualified status of a domestic relations order, you may file a 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 form 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 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. If you have any questions about your Plan, you should contact the 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 Employee Benefits Security 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., You may also obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the Employee Benefits Security Administration. CLAIMS PROCESS Your beneficiaries should submit claims during the Plan Year to the Carrier as detailed in the attached Certificate of Coverage. Claims for benefits that are insured will be reviewed in accordance with procedures contained in that insurance policy. If you have followed the appropriate submission procedure for the benefits as outlined in the Certificate of Coverage and the Administrator denies all or part of your claim, you will be notified by the Administrator within 90 days (or an additional 90 days, if more time is required and you are provided with a notice of extension within the first 90 day period) of filing your claim. The Notification will state the following: (1) the reason your claim was denied, (2) specific references to the provisions of the Plan upon which the denial is based, (3) a description of any additional information or material necessary to review your claim and an explanation of why such material or information is necessary, and (4) the procedures you must take to submit your claim for review, including the applicable time limits. If you decide to appeal your claim, you must ask the Administrator in writing to review the denial of your claim within 60 days after receiving the written notice that your claim was denied. You will be given the opportunity to submit written comments, documents, records, and other information relating to the claim of benefits, and you shall be provided, upon request and free of charge, reasonable access to, and copies of all documents, records, and other information relevant to your claim for benefits. The review will take into account all comments, documents, records, and other information submitted by you relating to your claim, without regard to whether such information was submitted or considered in the initial benefit determination. Within 60 days after the Administrator receives your written appeal, you will be given a written notice of the Administrator's decision. The written response of the Administrator will include (1) the reasons for their decision and references to the Plan's provisions on which the decision is based, (2) a statement that you are entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to your claim for benefits, (3) a description of any voluntary appeal procedures offered by the Plan and your right to obtain information about such procedures, and (4) a statement of your right to bring action under section 502(a) of ERISA. You and your Plan may have other voluntary alternative dispute resolution opportunities, such as mediation. One way to find out what may be available is to contact the U. S. Department of Labor Office and your State insurance regulatory agency. The Administrator has the exclusive right to interpret and administer the Plan. The exhaustion of the claim appeal procedure is mandatory for resolving every claim and dispute arising under this Plan. FAMILY OR MEDICAL LEAVES OF ABSENCE A complete description of your rights while on an approved family or medical leave of absence with regard to the Plan can be found in the Certificate of Coverage. GENERAL INFORMATION ABOUT OUR PLAN This Section contains certain general information that you may need to know about the Plan. 3

6 GENERAL PLAN INFORMATION The Group Life Insurance Plan is the name of the Plan. The Plan Sponsor has assigned Plan Number 510 to your Plan. The provisions of your Plan become effective July 1, 2009, however, a life insurance plan has been in effect for many years. Your Plan's records are maintained on a twelve-month period of time. This is known as the Plan Year. The Plan Year begins on July 1 and ends on June 30. EMPLOYER AND PLAN SPONSOR INFORMATION The Employer and the Plan Sponsor's name, address and federal employer identification number are: Playhouse Square Foundation 1501 Euclid Avenue, Suite PLAN ADMINISTRATOR INFORMATION The name, address and business telephone number of your Plan's Administrator is: VP Human Resources 1501 Euclid Avenue, Suite 200 (216) The Administrator keeps the records for the Plan and is responsible for the administration of the Plan. The Employer establishes rules and regulations for the administration of the Plan. The decisions regarding any questions involving the Plan will be conclusive to the extent allowed by applicable law. The Administrator will also answer any questions you may have about our Plan. You may contact the Administrator for any further information about the Plan. CARRIER INFORMATION The name and address of the Plan's Carrier is: Unum Life Insurance Company of America 2211 Congress Street Portland, Maine SERVICE OF LEGAL PROCESS The name and address of the Plan's agent for service of legal process is: Patricia Gaul Senior Vice President, Business and General Counsel Playhouse Square Foundation 1501 Euclid Avenue, Suite 200 Service of process may also be made upon the Plan Administrator (if different than listed above). 4

7 TYPE OF ADMINISTRATION The type of Administration is by the Carrier as detailed in the attached Certificate of Coverage. FUNDING MEDIUM The Plan is fully insured. Benefits are provided under a group insurance contract entered into between the Employer and the Carrier. The Carrier is responsible for paying benefits. Insurance premiums for employees and their families are paid in part by the Employer and in part by employees. The Administrator maintains a schedule of all applicable premiums in full by the Employer. IMPORTANT DISCLAIMER The benefits of the Plan are provided solely pursuant to an insurance contract between the Employer and the Carrier. If the terms of this Summary Plan Description conflict with the terms of the insurance contract, then the terms of the insurance contract will control, unless superseded by applicable law. SUMMARY We hope this Summary Plan Description gives you an easy-to-understand explanation of the Group Life Insurance Plan. Please keep your copy for future reference. Remember, if any conflict should arise between this Summary Plan Description and the Plan document, the information in the actual Plan document will be used in all cases. 5

8 The Fedeli Group Name of Employer: Playhouse Square Foundation GROUP LIFE INSURANCE PLAN DOCUMENT AND SPD FORM Plan Name (from 5500): Name of Carrier Providing Coverage: The Group Life Insurance Plan Unum Life Insurance Company of America Plan Year: a. Begins July 1 b. Ends June 30 Will any affiliated employer be covered by this Plan? a. No X b. Yes. following names of affiliated employers: 1) 2) 3) 4) 5) Employer's Address and Telephone No.: 1501 Euclid Avenue, Suite 200 (216) Employer's Tax ID No: Plan No: 510 Plan Administrator shall be: a) Employer, using employer's address b) X Other, using following name, address and telephone no: VP, Human Resources 1501 Euclid Avenue, Suite 200 (216) Plan's Agent for service of legal process is: a) X Employer, using employer's address b) Other, using following name, address and telephone no: Service of process may also be made upon the Plan Administrator (if different than listed above).