Scott & White Healthcare Short Term Disability Plan. Summary Plan Description

Transcription

1 Scott & White Healthcare Short Term Disability Plan Summary Plan Description Effective January 1, 2015

2 Short Term Disability Summary Plan Description Table of Contents SECTION PAGE NUMBER INTRODUCTION 1 YOUR DISABILITY BENEFITS IN BRIEF 2 ELIGIBLE CLASS(ES) FOR COVERAGE 2 ELIGIBILITY WAITING PERIOD FOR COVERAGE 2 COST OF COVERAGE 2 COVERAGE END DATE 3 AMOUNT OF BENEFIT DUE TO DISABILITY 3 TERMINATION OF BENEFITS 3 BENEFIT REDUCTIONS 4 MAXIMUM DISABILITY BENEFIT PERIOD 4 HOW THE CLAIMS PROCESS WORKS 5 CLAIM AND APPEAL PROCEDURES 6 GENERAL EXCLUSIONS 9 PLAN AMENDMENT AND TERMINATION 10 RIGHT OF REIMBURSEMENT 11 MISCELLANEOUS PLAN INFORMATION 12 DEFINITIONS 13 YOUR RIGHTS AND PROTECTIONS UNDER ERISA 15 ADDITIONAL PLAN INFORMATION 17

3 INTRODUCTION Scott & White Healthcare, (the Employer and Plan Sponsor ) a Texas nonprofit corporation sponsors and maintains, for the benefit of its Full-Time Staff Members and Part-Time Staff Members, the Scott & White Healthcare Short Term Disability Plan (the Plan ), which is a component of the Scott & White Healthcare Employee Welfare Benefits Plan (the Welfare Plan ). This document is intended to satisfy the summary plan description requirements of the Employee Retirement Income Security Act of 1974, as amended ( ERISA ). Together with the Welfare Plan document, this document contains the complete terms and conditions of this Plan. No other communication will supersede this document unless otherwise stated herein. The Plan Administrator shall be in charge of and responsible for the operation and administration of the Plan. The Plan Administrator has the absolute discretionary authority to determine eligibility for benefits and to interpret and enforce the terms of the Plan. The Plan Administrator also reserves the right to delegate duties and responsibilities hereunder. The Plan Sponsor has engaged Liberty Life Insurance Company of Boston to provide claims administration services for the Plan (the Claims Administrator ). This summary is not a contract and participation in the Plan does not guarantee or change any terms or conditions of employment. Scott & White Healthcare may amend, modify or terminate the Plan in whole or in part at any time, or from time to time, in its sole discretion. If You have any questions about Your benefits or the Plan, You may call Scott & White s Human Resources Service Center at or [email protected]. 1

4 YOUR DISABILITY BENEFITS IN BRIEF NOTE: The benefits described herein are those in effect as of January 1, 2015 unless specified otherwise. Eligible Class(es) for Coverage All Actively Employed Full-Time Staff Members or Part-Time Staff Members as follows: Class 1: All Practicing Physicians and Hillcrest Physicians. If You are in this class, You are automatically enrolled in the Plan and need not take any action to enroll. Class 2: All Directors, Executives and Administrative Physicians. If You are in this class, You must elect to enroll in order to be covered by the Plan. Class 3: Residents. If You are in this class, You must elect to enroll in order to be covered by the Plan. Class 4: All Other Staff Members. If You are in this class, You must elect to enroll in order to be covered by the Plan. You are not eligible for the Plan if you are (i) a PRN Staff Member, (ii) an individual who at the time of performing services is treated by an Employer as either a leased employee or an independent contractor for federal income tax purposes (regardless of any subsequent employment, retroactive reclassification or retroactive treatment of such individuals as employees), or (iii) an employee who is a member of a collective bargaining unit with which an Employer negotiates and with respect to whom no coverage hereunder has been provided by a collective bargaining agreement. Eligibility Waiting Period for Coverage Effective January 1, 2015 coverage for eligible Staff Members is as follows: Class 1: All Practicing Physicians and Hillcrest Physicians. Coverage under the Plan will begin on Your date of hire if You are eligible for the Plan on that date. If You are absent from work on the date Your coverage is scheduled to begin due to Injury or Illness, Your coverage will begin on the date You return to Active Employment under this class. Class 2: All Directors, Executives and Administrative Physicians. Coverage under the Plan will begin on Your date of hire if You are eligible for the Plan on that date. If You are absent from work on the date Your coverage is scheduled to begin due to Injury or Illness, Your coverage will begin on the date You return to Active Employment under this class. Class 3: Residents. Coverage under the Plan will begin on Your date of hire if You are eligible for the Plan on that date. If You are absent from work on the date Your coverage is scheduled to begin due to Injury or Illness, Your coverage will begin on the date You return to Active Employment under this class. Class 3: All Other Staff Members. Coverage under the Plan will begin on the 91st day following Your date of hire if You are eligible for the Plan on that date. If You are absent from work on the date Your coverage is scheduled to begin due to Injury or Illness, Your coverage will begin on the date You return to Active Employment under this class. 2

5 Cost of Coverage Class 1: All Practicing Physicians and Hillcrest Physicians. You are not required or permitted to make contributions to the Plan. The Plan benefits are unfunded and are paid directly by, and out of, the general assets of the Employer. Class 2: All Directors, Executives and Administrative Physicians. You must elect to participate in the Plan and are required to make contributions. Class 3: Residents. contributions. You must elect to participate in the Plan and are required to make Class 4: All Other Staff Members. You must elect to participate in the Plan and are required to make contributions. Coverage End Date Your coverage under the Plan will end on the earliest of: The date the Plan is cancelled. The date You are no longer an eligible regular Full-Time Staff Member or Part-Time Staff Member. The last day You are in Active Employment. If Your coverage ends during a period of Disability which began while You were covered, any benefits will be continued until benefit eligibility ends. Amount of Benefit Due to Disability The first seven continuous calendar days of Your Disability are considered to be Your Elimination Period. You must be continuously Disabled through Your Elimination Period. No benefits are payable for or during the Elimination Period and available PTO, Vacation and Sick Time must be used during the Elimination Period. Part or all of Your Elimination Period may be unpaid depending upon the availability of PTO, Vacation and Sick Time. After being continuously Disabled through Your Elimination Period, Your benefit is as follows: Class 1: All Practicing Physicians and Hillcrest Physicians. You are eligible to receive 100% of Your Regular Base Salary for the period from the eighth day through the 90th day of Your Disability, and 60% of Your Regular Base Salary for the period of the 91st day through the 180th day of Your Disability. Class 2: All Directors, Executives and Administrative Physicians. If You elect to participate in the Plan, You are eligible to receive 60% of Your Regular Base Salary for the period from the eighth day through the 180th day of Your Disability. The weekly maximum benefit is $3,000. Class 3: Residents. If You elect to participate in the Plan, You are eligible to receive 60% of Your Regular Base Salary for the period from the eighth day through the 180th day of Your Disability. The weekly maximum benefit is $3,000. Class 4: All Other Staff Members. If You elect to participate in the Plan, You are eligible to receive 60% of Your Regular Base Salary for the period from the eighth day through the 180th day of Your Disability. The weekly maximum benefit is $3,000. 3

6 Termination of Benefits Benefits will stop on the earliest of: The date You are determined to be no longer Disabled; The date You are able to work in Your Regular Occupation on a part-time basis and choose not to. The date You fail to provide requested medical information necessary to evaluate Your claim for benefits under the Plan (this could include submitting to an independent medical exam); The end of the Plan's maximum Disability benefit period; The date of Your death; or The date the Plan is terminated. Benefit Reductions Payments made under the Plan will be reduced by any federal or state income tax and payroll taxes that are required to be withheld. In addition, Your Plan benefits will be reduced for any other employer or federal, state or local government disability benefits You receive and for any earnings You receive from any form of employment. Any payments received while on Disability due to the HRA credit will not reduce the amount of payments under the Plan. For example, if Your benefit amount is calculated to be $1,000 and You also receive a $30 HRA credit, Your paid benefit will be $1,000 as opposed to $970 ($1,000 - $30). If You receive other disability income benefits or any information related to such benefits, You must provide such information to the Claims Administrator within five business days of receipt. If You do not do so, You may forfeit any remaining Plan Disability payments. You will be required to reimburse Scott & White Healthcare for all amounts of Plan Disability payments that exceed the benefit amounts You are entitled to under Plan provisions. See the Right of Reimbursement section. Maximum Disability Benefit Period The maximum Disability benefit period can include successive Disability periods caused by the same or related condition that begins within 14 calendar days after termination of a prior Disability period. This means that if You have returned to Your regularly scheduled work hours for less than 14 calendar days and have a second period of Disability related to the first, the initial maximum Disability benefit period still applies. If Your second Disability is unrelated to the first, or if You have returned to Your regularly scheduled work hours for more than 14 calendar days, the second period of Disability will be considered a separate claim and a new Elimination Period must be satisfied before benefits will be payable. Additionally, if You are released to return to work by Your attending Doctor, but You do not physically enter the work place due to a new Illness or Injury or pregnancy-related condition, the first period of Disability will remain in effect until You are released to return to work by the attending Doctor for the second Disability. A new Elimination Period is not required for the second Disability due to the continuation of Disability. 4

7 If You are Disabled for one diagnosis, and during that Disability You incur another diagnosis unrelated to the initial diagnosis, Your claim will be considered as one claim since You did not return to work. 5

8 HOW THE CLAIMS PROCESS WORKS You must promptly notify Your supervisor of Your inability to work due to Illness or Injury or pregnancy-related condition. As soon as You have reason to believe that Your Illness or Injury or pregnancy-related condition will keep You out of work beyond seven continuous calendar days, You or Your authorized representative must initiate Your claim over the phone by calling the Claims Administrator at or by visiting Notice of a claim must be given to the Claims Administrator within 30 days of the date of the loss on which the claim is based. If that is not possible, the Claim Administrator must be notified as soon as it is reasonably possible to do so. Such notice of a claim must be received in a form or format satisfactory to the Claim Administrator. Claims filed more than 30 days following the date of Your Disability will automatically be denied. If extenuating circumstances exist that You are unable to provide notification within the 30 day period, the Plan Administrator will, in its sole discretion, determine if the Disability claim should be submitted to the Claims Administrator for processing. You must provide certain basic information including Your Doctor's name and telephone number. The Claims Administrator will contact Your Doctor to request the medical information necessary to process and manage Your claim. You must provide timely and complete responses to requests from the Claims Administrator. Your Doctor s certification of Your Disability is important to Your claim. You are ultimately responsible for providing proof to the Claims Administrator that You are Disabled due to Illness or Injury and that You are under appropriate treatment and care of a Doctor. The Claims Administrator will tell You what is needed. Disability benefits will be suspended until this information is received and approved by the Claims Administrator. Disability benefits will commence only after the Claims Administrator has approved Your claim. You will be required to sign an authorization form so the Claims Administrator may receive the necessary medical information from Your Doctor. For benefits to continue after Your claim has been approved, You must be under the regular care of a Doctor qualified to treat the disabling Illness or Injury or pregnancy-related condition. The treatment plan must be approved by the Claims Administrator and You must adhere to the treatment plan. You are Disabled when You are unable to perform the Material and Substantial Duties of Your Regular Occupation due to Your Illness or Injury or pregnancy-related condition. The loss of a professional or occupational license or certification does not, in itself, constitute Disability. In order to receive benefits, You may be required to be examined by specified doctors, other medical practitioners or vocational experts. Your Employer will pay for these examinations. Examinations may be required as often as it is reasonable to do so. You may also be required to be interviewed by an authorized representative. Refusal to be examined, interviewed or otherwise provide requested information may result in denial or termination of Your claim. After Your claim has been initiated, the Claims Administrator will contact You periodically to check on the status of Your Disability and when You may be able to return to work. You or Your Doctor may be required to provide the Claims Administrator with periodic supporting documentation that Your Disability continues. You are responsible for keeping Your supervisor informed about the status of Your Disability while You are disabled. 6

9 CLAIM AND APPEAL PROCEDURES Determination of Benefits Upon receipt of the required proof for Your claim, a decision will be made promptly by the Claims Administrator. The Claims Administrator shall notify You of the claim determination within 45 days of the receipt of Your claim. This period may be extended by 30 days if such an extension is necessary due to matters beyond the control of the Plan. A written notice of the extension, the reason for the extension and the date by which the Plan expects to decide Your claim, shall be furnished to You within the initial 45-day period. This period may be extended for an additional 30 days beyond the original 30-day extension if necessary due to matters beyond the control of the Plan. A written notice of the additional extension, the reason for the additional extension and the date by which the Plan expects to decide Your claim, shall be furnished to You within the first 30- day extension period if an additional extension of time is needed. However, if a period of time is extended due to Your failure to submit information necessary to decide the claim, the period for making the benefit determination by the Claims Administrator will be tolled from the date on which the notification of the extension is sent to You until the date on which You respond to the request for additional information. If an extension is required due to additional information being required, You will be given 45 days to submit such information. If Your claim for benefits is denied, in whole or in part, You or Your authorized representative will receive a written notice from the Claims Administrator of Your denial. The notice shall include: based, (a) (b) the specific reason(s) for the denial, references to the specific Plan provisions on which the benefit determination was (c) a description of any additional material or information necessary for You to perfect a claim and an explanation of why such information is necessary, (d) a description of the Plan s appeals procedures and applicable time limits, including a statement of Your right to bring a civil action under section 502(a) of ERISA following Your appeals, (e) if an adverse benefit determination is based on an internal rule, guideline, protocol or similar criterion, a copy of such rule, guideline, protocol, or other criterion will be provided free of charge upon request, and (f) if an adverse benefit determination is based on a medical necessity or experimental treatment or similar exclusion or limit, an explanation of the scientific or clinical judgment for the determination will be provided free of charge upon request. Appeals of Adverse Determination If Your claim for benefits is denied, You or Your representative may appeal Your denied claim in writing to the Claims Administrator within 180 days of the receipt of the written notice of denial. You may submit with Your appeal any written comments, documents, records and any other information relating to Your claim. Upon Your request, You will also have access to, and the right to obtain copies of, such documents, records and other information (other than legally privileged documents, records and other information) as are relevant to Your claim free of charge. A full review of the information in the claim file and any new information submitted to support the appeal will be conducted by the Claims Administrator. The appeal will be reviewed by individuals not involved in the initial benefit determination. This review will not afford any deference to the initial benefit determination. In deciding an appeal that is based in whole or in part on a medical 7

10 judgment, a health care professional with appropriate training or experience in the field of medicine involved in the medical judgment will be consulted. The Claims Administrator shall make a determination on Your claim appeal within 45 days of the receipt of Your appeal request. This period may be extended by up to 45 days if the Claims Administrator determines that special circumstances require an extension of time. A written notice of the extension, the reason for the extension and the date that the Claims Administrator expects to render a decision shall be furnished to You within the initial 45-day period. However, if the period of time is extended due to Your failure to submit information necessary to decide the appeal, the period for making the benefit determination will be tolled from the date on which the notification of the extension is sent to You until the date on which You respond to the request for additional information. If the claim on appeal is denied in whole or in part, You will receive a written notification from the Claims Administrator of the denial. The notice will be written in a manner calculated to be understood by the applicant and shall include: (a) (b) the specific reason(s) for the adverse determination, references to the specific Plan provisions on which the determination was based, (c) a statement that You are entitled to receive, upon request and free of charge, reasonable access to and copies of all records, documents and other information relevant to Your benefit claim, (d) if an adverse benefit determination is based on an internal rule, guideline, protocol or similar criterion, a copy of such rule, guideline, protocol, or other criterion will be provided free of charge upon request, (e) if an adverse benefit determination is based on a medical necessity or experimental treatment or similar exclusion or limit, an explanation of the scientific or clinical judgment for the determination will be provided free of charge upon request, and (f) a statement describing any appeals procedures offered by the Plan and Your right to bring a civil suit under ERISA. If the appeal of Your benefit claim is denied, You or Your representative may make a second appeal of Your denial in writing to the Plan Administrator within 180 days of the receipt of the written notice of denial. You may submit with Your second appeal any written comments, documents, records and any other information relating to Your claim. Upon Your request, You will also have access to, and the right to obtain copies of, such documents, records and information (other than legally privileged documents, records and information) as are relevant to Your claim free of charge. The Plan Administrator may convene the Scott & White Benefit Plan Management Committee (the Committee ) to review and make a determination on Your second claim appeal. Upon receipt of a second appeal, the Plan Administrator will again conduct a full review of the claim file and any additional information submitted. The individuals deciding the second appeal would not have been involved in the initial benefit determination or in the first appeal. The Plan Administrator shall make a determination on Your second claim appeal within 45 days of the receipt of Your appeal request. This period may be extended by up to 45 days if the Plan Administrator determines that special circumstances require an extension of time. A written notice of the extension, the reason for the extension and the date by which the Plan Administrator expects to render a decision shall be furnished to You within the initial 45-day period. However, if the period of time is extended due to Your failure to submit information necessary to decide the appeal, the period for making the benefit determination will be tolled from the date on which the notification of the extension is sent to You until the date on which You respond to the request for additional information. 8

11 If the claim on appeal is denied in whole or in part for a second time, You will receive a written notification from the Plan Administrator of the denial. The notice will be written in a manner calculated to be understood by the applicant and shall include the same information that was included in the first adverse determination letter. The decision of the Plan Administrator is final and conclusive. You or Your authorized representative can only file legal action after You have exhausted these claim procedures. Any legal action to recover benefits under the Plan must be commenced within six months from the date for the notification from the Plan Administrator of the denial. Failure to Comply If the Claims Administrator fails to comply with any of the deadlines stated in this section or fails to adequately inform You of Your procedural rights, You may treat these procedures as having been completed, and file Your claim in court. You or Your authorized representative must file Your claim in court within six months of the date You knew, or should have known, of the Claims Administrator s material failure to comply with these procedures. 9

12 GENERAL EXCLUSIONS The Plan does not cover any Disability that is directly or indirectly caused by or results from: an intentionally self-inflicted injury; an occupational illness or occupational injury; criminal activity or an attempt to commit a crime; a war, declared or undeclared, or any act of war. A Plan payment will not be made for any period of Disability during which You are incarcerated as a result of a conviction. 10

13 PLAN AMENDMENT AND TERMINATION The Board of Trustees of Baylor Scott & White Holdings shall have the right and power at any time and from time to time to amend the Plan, in whole or in part, and at any time to terminate the Plan. The Chief Human Resources Officer of Baylor Scott & White Health shall also have the right and power at any time and from time to time to amend the Plan, in whole or in part, to the extent permitted by the Welfare Plan. 11

14 RIGHT OF REIMBURSEMENT If You have received Disability benefit payments under this Plan for an Injury or Illness and subsequently obtain a settlement from or a judgment against a third-party payer who, because of circumstances, is liable to You for such Injury or Illness, You are obligated to reimburse the Plan. The Plan is entitled to first reimbursement out of any and all amounts recovered up to the amount of Disability benefit payments made by the Plan. The Plan is also entitled to reimbursement for 100% of any Plan overpayment of Disability benefits. No Reduction of Reimbursement The Plan s reimbursement will not be reduced even if the recovery does not fully compensate You, You were not made whole for all losses sustained or alleged, or the recovery is not described as being related to disability income or care costs. The amount of the Plan s reimbursement will also not be reduced by legal fees or court costs incurred in seeking the recovery. 12

15 MISCELLANEOUS PLAN INFORMATION Entire Representation This document is the entire description of the benefits provided under the Plan. It supersedes any previous or contemporary document, representation, negotiation, or agreement (whether written or oral), including, but not limited to, severance agreements and employment agreements. Acceptance and Cooperation If You accept benefits under this Plan, You are considered to have accepted its terms, and You agree to perform any act and to execute any documents which may be necessary or desirable to carry out the terms of this Plan. Governing Law The Plan is to be construed and enforced in accordance with the laws of the State of Texas, to the extent not preempted by federal law. Construction Words used in the masculine apply to the feminine where applicable. Wherever the context of the Plan dictates, the plural should be read as the singular, and the singular as the plural. Where any time period is given in days, the reference is to calendar days, unless otherwise specified. Non-Assignability of Rights No interest under the Plan is subject to assignment or alienation, whether voluntary or involuntary. Any attempt to assign or alienate any interest under the Plan will be void. Errors An error cannot give a benefit to You if You are not actually entitled to the benefit under the Plan. Severability The enforceability of any provision of the Plan will not affect the enforceability of the remaining provisions of the Plan. 13

16 DEFINITIONS Actively Employed or Active Employment means a Staff Member who is working for an Employer for earnings that are paid regularly and who is performing the Material and Substantial Duties of his or her regular occupation. You must be working at least the number of hours per week as required by Your Employer. Your worksite must be: Your Employer s usual place of business; an alternate work site at the direction of Your Employer other than Your home unless clear specific expectations and duties are documented; or a location to which Your job requires You to travel. Normal PTO, Vacation and Sick Time and any period of approved leave of absence are considered Active Employment. Individuals whose employment status is being continued under a severance or termination agreement will not be considered in Active Employment. Disability or Disabled means, with respect to a Staff Member, that due to an Illness or Injury or a pregnancy-related condition, such Staff Member cannot perform the Material and Substantial Duties of his or her Regular Occupation, and is under the regular care of a Doctor who is practicing within the scope of his or her license during the entire period of Disability. Disability must begin while You are Actively Employed and covered under the Plan. Doctor means a person who: is licensed to practice medicine and prescribe and administer drugs or to perform surgery; or has a doctoral degree in Psychology (Ph.D. or Psy.D.) whose primary practice is treating patients; or is a legally qualified medical practitioner according to the laws and regulations of the governing jurisdiction, and is not related to You in any way, including but not limited to You, Your spouse, or a child, brother, sister, or parent of You or Your spouse. Such individual will not be recognized as a Doctor for a claim that You submit. Elimination Period means a period of seven continuous calendar days which must be satisfied before You are eligible to receive benefits under the Plan. Employer means Scott & White Healthcare, Scott & White Memorial Hospital, Scott & White Clinic, Scott & White Hospital Brenham, Scott & White Hospital Taylor, Hillcrest Baptist Medical Center, and any other incorporated or unincorporated organization that may adopt this Plan with the approval of the President or Chief Human Resources Officer of Scott & White Healthcare. Baylor Scott & White Holdings and Baylor Scott & White Health are also participating Employers with respect to Staff Members who primarily perform their duties at a work location within the Central Texas Division. Full-Time Staff Member means a Staff Member who is designated as a full-time employee within the Human Resources information management system. 14

17 Illness means any disorder of Your body or mind, but not an Injury, pregnancy, abortion miscarriage or childbirth. Disability must begin while You are Actively Employed and covered under the Plan. Injury means a bodily injury that is the direct result of an accident and not related to any other cause. Disability must begin while You are Actively Employed and covered under the Plan. Material and Substantial Duties means duties that: are normally required for the performance of Your Regular Occupation; and cannot be reasonably omitted or modified, except for example, if You are required to work on average in excess of 30 hours per week, You will be considered able to perform that requirement if You are working or have the capacity to work 30 hours per week. Plan means this Scott & White Healthcare Short Term Disability Plan. Part-Time Staff Member means a Staff Member who is designated as a part-time employee within the Human Resources information management system. PRN Staff Member means a Staff Member who is designated as a PRN employee within the Human Resources information management system and works on an as needed basis. PTO, Vacation and Sick Time means continued payments to You by Your Employer of all or part of Your earnings during time away from work, as defined by Scott & White Healthcare policies. PTO, Vacation and Sick Time do not include compensation paid to You by Your Employer for work You actually perform after Your Disability begins. Regular Occupation means the occupation You are routinely performing when Your Disability begins. Your occupation will be looked at as it is normally performed instead of how the work tasks are performed for a specific employer or at a specific location. Regular Base Salary means annual base salary not including overtime, incentive, bonuses, shift differential pay or any other remuneration. Staff Member means a person who is classified by an Employer as a regular staff member. Weekly Earnings means the equivalent of Your Regular Base Salary divided by 52. You or Your means, or refers to, a person who satisfies all eligibility requirements for coverage under the Plan. 15

18 YOUR RIGHTS AND PROTECTIONS UNDER ERISA As a participant in this Plan, 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, all documents governing the Plan, including insurance contracts and collective bargaining agreements, if any, 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 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 Plan Administrator may make a reasonable charge for the copies. Receive a summary of the Plan s annual financial report. The Plan Administrator is required by law to furnish each participant with a copy of this summary annual report. 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, Your union, 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. 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 the 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 Employee Benefits Security Administration, U.S. Department of Labor, listed in Your telephone 16

19 directory or the Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue N.W., Washington, DC You may also obtain certain publications about Your rights and responsibilities under ERISA by calling the publications hotline of the Employee Benefits Security Administration. 17

20 ADDITIONAL PLAN INFORMATION This booklet is intended to comply with the disclosure requirements of the regulations issued by the U.S. Department of Labor under ERISA. ERISA requires that You be given a "Summary Plan Description" which describes the Plan and informs You of Your rights under it. This document is intended to meet that requirement, but also contains the complete terms and conditions of the Plan. Plan Name Scott & White Healthcare Short Term Disability Plan under the Scott & White Healthcare Employee Welfare Benefits Plan Plan Number 502 Type of Plan Welfare plan providing disability benefits and associated benefits to eligible employees Plan Sponsor Scott & White Healthcare 2401 South 31st Street MS Temple, TX Plan Sponsor s Employer Identification Number Plan Administrator Scott & White Healthcare 2401 South 31st Street MS Temple, TX (254) Agent for Service of Legal Process Scott & White Healthcare Director of Benefits 2401 South 31st Street MS Temple, TX Plan Year Ends Plan records are maintained on a calendar year basis. The Plan year ends on December 31. Name and Address of Participating Companies A list of participating companies is available from the Plan Administrator upon request. 18

21 Plan Administration The Plan Administrator has the sole discretion, authority and responsibility to interpret and construe the eligibility of employees and the benefits offered under the Plan and to determine all factual and legal questions. The Plan Administrator may delegate the authority to decide all initial claims and appeals for benefits to the Claims Administrator. This delegated authority includes, but is not limited to, determinations of entitlement to benefits and the amounts of the benefits to be paid. Claims Administrator Liberty Life Insurance Company of Boston, 100 Liberty Way, Dover NH Funding Scott & White Healthcare fully funds the Plan and benefits and pays benefits directly out of its general assets. Nothing in this document shall be construed (i) to provide nonforfeitable, nonterminal or nonchangeable benefits, (ii) to require an Employer to segregate any amount for the benefit of any Plan participant or other beneficiary, or (iii) to provide any Plan participant, other beneficiary or person any claim against, right to, or security or other interest in any fund, account or asset of an Employer from which any payment under the Plan may be made. 19