1 The Retiree Life Insurance Plan Summary Plan Description (A Component of the TECO Energy Group Voluntary Employees Beneficiary Association) The Summary Plan Description (SPD) for The Retiree Life Insurance Plan, A Component of the TECO Energy Group Voluntary Employees Beneficiary Association and any subsequent Summaries of Material Modifications (SMMs) are available for viewing online at Hard copies are available by request at or , ext Participating Companies TECO Energy, Inc. TECO Coal Corporation Tampa Electric Company Clintwood Elkhorn Mining Company Peoples Gas System, a division of Tampa Electric Gatliff Coal Company TECO Partners, Inc. Perry County Coal Corporation TECO Guatemala, Inc. Pike-Letcher Land Company TECO Transport Premier Elkhorn Coal Company Material contained in this booklet is current as of January 1, 2011
3 RETIREE LIFE INSURANCE PLAN TABLE OF CONTENTS RETIREE LIFE INSURANCE PLAN AT-A-GLANCE...1 HOW THE RETIREE LIFE INSURANCE PLAN WORKS...1 WHO IS ELIGIBLE... 1 Age-Years of Service-Total Points Requirements... 1 NAMING A BENEFICIARY... 2 RIGHTS OF ASSIGNMENT... 2 FILING A RETIREE LIFE INSURANCE CLAIM...3 FORMS OF PAYMENT... 3 PROOF OF LOSS... 3 Sending Proof of Loss... 4 Physical Examination and Autopsy... 4 Legal Action... 4 CLAIM DENIAL AND APPEAL... 4 Time Frame For Claim Determinations... 4 If You Receive an Adverse Benefit Determination... 5 Procedures for Appealing an Adverse Benefit Determination... 5 Legal Actions And Limitations... 6 UPDATING YOUR ADDRESS...6 PLAN ADMINISTRATION...6 PLAN DOCUMENT... 7 FUTURE OF THE PLAN...8 ERISA GUIDELINES AND YOUR RIGHTS...9 RECEIVE INFORMATION ABOUT YOUR PLAN AND BENEFITS... 9 PRUDENT ACTIONS BY PLAN FIDUCIARIES... 9 ENFORCE YOUR RIGHTS... 9 ASSISTANCE WITH YOUR QUESTIONS i
4 RETIREE LIFE INSURANCE PLAN AT-A-GLANCE BASIC INSURANCE: Full-time team members who retired on or after July 1, 2001 Part-time team members who retired on or after July 1, 2001 If you retired prior to July 1, 2001 PLAN FEATURES: Equal to 25% of your final base pay (rounded to the nearest $1,000) with a minimum coverage of $10,000 and a maximum coverage of $25,000 Equal to 25% of your final base pay (rounded to the nearest $1,000) with a minimum coverage amount of $1,000 and a maximum coverage of $25,000 Your coverage may be less. Contact the HR Service Desk at or , ext for your coverage amount. HOW THE RETIREE LIFE INSURANCE PLAN WORKS If you die, your retiree life insurance benefit is payable to the beneficiary(ies) you designate. WHO IS ELIGIBLE The retiree life insurance plan eligibility is based on the date of your retirement when you retired under TECO Energy s Retirement Plan and the Age Years of Service Total Points Requirements table listed below. Retirees must be citizens or legal residents of the United States to be eligible for the benefit. Age-Years of Service-Total Points Requirements COMPANY: TECO Energy, Inc.: Tampa Electric Company; Peoples Gas System, a division of Tampa Electric Company; TECO Partners, Inc.; TECO Guatemala, Inc., TECO Transport TECO Coal Corporation; Clintwood Elkhorn Mining Company; Gatliff Coal Company; Perry County Coal Corporation; Pike-Letcher Land Company; Premier Elkhorn Coal Company TECO Coal Corporation; Clintwood Elkhorn Mining Company; Gatliff Coal Company; Perry County Coal Corporation; Pike-Letcher Land Company; Premier Elkhorn Coal Company REQUIREMENTS: Minimum age 50 Minimum 5 years of service Minimum of 60 points which equals age plus years of service For employees who retired prior to January 1, 2008: Minimum age 50 Minimum 5 years of service Minimum of 60 points which equals age plus years of service For employees who retired on or after January 1, 2008: Minimum age 55 Minimum 10 years of service Minimum of 70 points which equals age plus years of service 1
5 As an eligible retiree, you will have basic coverage equal to 25% of your final base pay (rounded to the nearest $1,000) with a minimum coverage of $10,000 and a maximum coverage of $25,000. (Part-time team members who retire will have a minimum coverage amount of $1,000 and a maximum coverage of $25,000.) However, if you retired prior to July 1, 2001, your coverage may be less. Contact TECO Coal HR at (606) or the TECO Energy HR Service Desk in Tampa at or toll free at , ext , for your coverage amount. NAMING A BENEFICIARY You will name a beneficiary to receive your life insurance benefits. Benefits are payable at your death from any cause covered by the group policy, at any time or any place while you are insured. You can name anyone as your beneficiary. However, in certain states you are required to get your spouse s permission before naming someone other than your spouse as beneficiary. If you prefer, you can name more than one primary beneficiary and/or a contingent beneficiary (someone to receive your benefit if your primary beneficiary dies before you do). To do so, just indicate the percentage each person is to receive on the beneficiary designation form. If you do not specify a percentage, benefits will be equally divided among your beneficiaries. You may change your beneficiary at any time by completing the Retiree Group Life Insurance Beneficiary Designation form, available on the Human Resources Web site at and returning it to the Healthcare Department. Note: Events such as marriage, divorce, or death of a family member may call for a change in your beneficiary designation. This is why it s important to keep your beneficiary designation upto-date. Before naming a minor as your beneficiary, you should contact an attorney for legal advice. If you do not name a beneficiary, or if your beneficiary was not living at the time of your death, the life insurance carrier may distribute, at their option, your life insurance benefit in the following order: Your current spouse, if he or she is living Equally to your surviving children Equally to your surviving parents Equally to your surviving siblings Your estate RIGHTS OF ASSIGNMENT You have the right to absolutely assign your rights and interest under the life insurance policy including, but not limited to the following: the right to name and change a beneficiary. 2
6 Any absolute assignment made by you will be recognized, provided it is duly executed and a copy is acknowledged and on file. The Hartford and TECO Energy, Inc. assume no responsibility for the validity or effect of any assignment or to provide any assignee with notices. You do not have the right to collaterally assign your rights and interest under the policy. FILING A RETIREE LIFE INSURANCE CLAIM If you die while covered under the retiree life insurance plan, your beneficiary(ies) should contact the contact TECO Coal HR at (606) or the TECO Energy HR Service Desk at or , ext During the call, you will receive information on the benefits payable and forms of payment options. Following the call, the Healthcare Department will mail applicable form(s) to the beneficiary(ies). The beneficiary(ies) will be required to complete these form(s) and mail them directly to the life insurance carrier, along with the Certified Original Death Certificate. The Human Resources Department will notify the life insurance carrier of your death. This notification, along with the completed forms that the beneficiary(ies) submit(s) will initiate the filing of the life insurance benefit. After the claim has been processed by the life insurance carrier, your beneficiary will be notified in writing if any benefits are denied in whole or in part, or if any additional information is required. FORMS OF PAYMENT Usually, life insurance benefits are paid in a lump sum. However, your beneficiary can arrange to have the life insurance benefit paid out in two ways: Lump sum OR The money is put into a Safe Haven Account (an interest-bearing draft account). The life insurance carrier issues the beneficiary personalized drafts and the beneficiary may immediately utilize all or a portion of those funds by writing the drafts against that account. The funds in the account will earn interest at a competitive rate. PROOF OF LOSS The beneficiary must provide written notice of a claim within 30 days after the date of death. If notice cannot be given within that time, it must be given as soon as reasonably possible. Such notice must include the beneficiary s name, address and the policy number. The Healthcare Department will send forms to the beneficiary to provide proof of loss, within 15 days of receiving a beneficiary s notice of claim. If the forms are not returned to the life insurance carrier within 15 days, the beneficiary may submit any other written proof which fully describes the nature and extent of the claim. 3
7 To receive life insurance benefits, all proof of loss must prove satisfactory to the life insurance carrier. Proof of loss may include, but is not limited to, the following information: A completed claim form A certified copy of the death certificate (if applicable) Your enrollment form You beneficiary designation (if applicable) Documentation of the date of your disability began; the cause of your disability; and the prognosis of your disability Any and all medical information, including x-ray films and photocopies of medical records, including histories, physical, mental or diagnostic examinations and treatment notes The names and addresses of all physicians or other qualified medical professionals you have consulted; hospitals or other medical facilities in which you have been treated; and pharmacies which have filled your prescriptions within the past three years Any additional information required to adjudicate the claim. Sending Proof of Loss Written proof of loss should be sent within 90 days after the loss to the life insurance carrier. However, all claims should be submitted to the life insurance carrier no later than 90 days from the date coverage ends. If proof is not given by the time it is due, it will not affect the claim if it was not possible to give proof within the required time and the proof is provided as soon as possible or not later than one year after due unless the person who has the right to claim benefits is not legally competent. Physical Examination and Autopsy Where permitted by law, the life insurance carrier has the right to make a reasonable request for an autopsy to be performed if you or your covered dependent die. Requests for an autopsy will include the reasons why the life insurance carrier is making the request. Legal Action Legal action cannot be taken against the life insurance carrier sooner than 60 days after the date Proof of Loss is furnished or more than five years after the date Proof of Loss is required to be furnished according to the terms of the policy. CLAIM DENIAL AND APPEAL Time Frame For Claim Determinations If you receive an adverse benefit determination, the life insurance carrier will notify you of the adverse determination within a reasonable period of time, but not later than 90 days after receiving the claim. An adverse benefit determination is any denial, reduction or termination of benefit or a failure to provide or make a payment. This 90-day period may be extended for up to 4
8 an additional 90 days, if the life insurance carrier both determines that special circumstances require an extension of time for processing the claim and notifies you, before the initial 90-day period expires, of the special circumstances requiring the extension of time and the date by which the Plan expects to render a determination. In the event an extension is necessary due to your failure to submit necessary information, the Plan s time frame for making a benefit determination on review is stopped from the date the life insurance carrier sends you the extension notification until the date you respond to the request for additional information. If You Receive an Adverse Benefit Determination The life insurance carrier will provide you with a notification of any adverse benefit determination, which will include: The specific reason(s) for the adverse benefit determination References to the specific Plan provisions on which the benefit determination is based A description of any additional material or information needed to process the claim and an explanation of why that material or information is necessary A description of the Plan s appeal procedures and the time limits applicable to those procedures, including a statement of your right to bring a civil action under ERISA after an appeal of an adverse determination on appeal. Procedures for Appealing an Adverse Benefit Determination If you receive an adverse benefit determination, you may ask for a review. You (or your authorized representative) have 60 days following the receipt of a notification of an adverse benefit determination within which to appeal the determination. You have the right to: Submit written comments, documents, records and other information relating to the claim for benefits Request, free of charge, reasonable access to and copies of all documents, records and other information relevant to your claim for benefits. For this purpose, a document, record, or other information is treated as relevant to your claim if it: o o Was relied upon in making the benefit determination Was submitted, considered or generated in the course of making the benefit determination, regardless of whether such document, record or other information was relied upon in making the benefit determination o Demonstrates compliance with the administrative processes and safeguards required in making the benefit determination Request a review that takes into account all comments, documents, records and other information submitted by you relating to the claim, regardless of whether the information was submitted or considered in the initial benefit determination. The life insurance carrier will notify you of the Plan s benefit determination on review within a reasonable period of time, but not later than 60 days after receipt of your request for review by the Plan. This 60-day period may be extended for up to an additional 60 days, if the life 5
9 insurance carrier both determines that special circumstances require an extension of time for processing the claim and notifies you, before the initial 60-day period expires, of the special circumstances requiring the extension of time and the date by which the Plan expects to render a determination on review. In the event an extension is necessary due to your failure to submit necessary information, the Plan s time frame for making a benefit determination on review is stopped from the date the life insurance carrier sends you the extension notification until the date you respond to the request for additional information. The life insurance carrier s notice of an adverse benefit determination on appeal will contain all of the following information: The specific reason(s) for the adverse benefit determination. References to the specific Plan provisions on which the benefit determination is based. 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. A statement describing any voluntary appeal procedures offered by the Plan and your right to obtain the information about such procedures, and a statement of your right to bring an action under ERISA. Legal Actions And Limitations You must use and exhaust this Plan s administrative claims and appeals procedure before bringing a suit in either state or Federal court. Similarly, failure to follow the Plan s prescribed procedures in a timely manner will also cause you to lose your right to sue regarding an adverse benefit determination. No lawsuit with respect to plan documents may be brought after the expiration of the applicable limitations period stated in the plan documents. If no limitation is stated in the plan documents, then no such suit may be brought after the expiration of applicable limitations under applicable law. UPDATING YOUR ADDRESS Retirees are urged to keep the Human Resources Department advised of your current address. You can update your address by contacting TECO Coal HR at (606) or the TECO Energy HR Service Desk in Tampa at or toll free at , ext or by ing PLAN ADMINISTRATION This section was written to provide you with information to meet the disclosure requirements of a federal law called the Employee Retirement Income Security Act of 1974 (ERISA). ERISA is a 6
10 comprehensive law that sets standards and procedures for certain benefit plans. This document provides administrative information for the health plan program, which is an ERISA covered plan. ERISA established guidelines for communicating benefits to you so that you have a good understanding of the features of your benefits, such as: When you are eligible to participate How the plans work Your rights and the steps you must take to receive benefits Refer to the topic ERISA Guidelines and Your Rights for more information. PLAN DOCUMENT This detailed summary was written from legal documents that determine how the plan operates. As a result, this summary should not be considered as a substitute for the official plan documents, which govern the operation of the program. Although every attempt has been made to ensure this document is accurate, the legal documents will settle any confusion over wording, if that should ever become necessary. In other words, the official plan documents will always be used in cases requiring a legal interpretation of the program. In addition, the official documents govern your rights under the program at all times. If you have questions about any of the benefits highlighted in this document, contact TECO Coal HR at (606) or the TECO Energy HR Service Desk in Tampa at or toll-free , ext PLAN SPONSOR AND PLAN ADMINISTRATOR TECO Energy, Inc. 702 North Franklin Street Tampa, Florida (813) To the fullest extent permitted by law, the Plan administrator will have the discretion to determine all matters relating to eligibility, coverage and benefits under this program. The Plan administrator will also have the discretion to determine all matters relating to interpretation and operation of the Plan. Decisions by the Plan administrator, or any authorized delegate, will be final and binding on all parties. AGENT FOR LEGAL SERVICE General Counsel TECO Energy, Inc. 702 North Franklin Street Tampa, FL Legal process also can be served on the Plan Administrator. 7
11 EMPLOYER IDENTIFICATION NUMBER AND PLAN NUMBER The employer identification number assigned to TECO Energy, Inc. by the IRS is: The TECO Energy Group Voluntary Employees Beneficiary Association (which includes the Retiree Life Insurance Plan) number is 504. Refer to these numbers to obtain Plan information from the U.S. Department of Labor or the Internal Revenue Service. PROGRAM YEAR All plans are maintained on a calendar-year basis from January 1 through December 31. The chart below shows administrative information that is required by ERISA, including the agent for service of legal process for this plan. Please note, however, that legal process may also be served on the plan trustee. PLAN NAME AGENT FOR LEGAL PROCESS PLAN TRUSTEE AND/OR INSURER TYPE OF ADMINISTATION PLAN NO. DOCUMENT Life Insurance Plans General Counsel: TECO Energy, Inc. 702 N. Franklin St. Tampa, FL (813) Plan Administrator (PA): TECO Energy, Inc. 702 N. Franklin St. Tampa, FL (813) Claims Administrator (CA): Hartford Life and Accident Insurance Company 200 Hopmeadow St. Simsbury, CT Welfare benefit plans for purposes of ERISA; selfinsured; funded by direct benefit payments from the general assets of the employer 504 TECO Energy Group Voluntary Employees Beneficiary Association TECO Energy, Inc. Group Life Insurance Plan (Group Policy No ), Basic Life Insurance Plan FUTURE OF THE PLAN Although the company expects to continue your retiree life insurance benefit, the Board of Directors reserves the right to amend, modify, suspend or terminate any or all of the benefits described in this document in whole or in part. The company s decision to change or end a plan may be due to changes in federal or state laws governing retirement or welfare benefits, the requirements of the Internal Revenue Code or ERISA, the provisions of an insurance policy or contract, or any other reason. A plan change may transfer plan assets and debts to another plan or split this plan into two or more parts. If the company does make a change or ends the plan, it may decide to set up a different plan providing similar or identical benefits. Any such action would be taken in writing and maintained with the records of the respective plans. 8
12 ERISA GUIDELINES AND YOUR RIGHTS As a participant in the TECO Energy Group Health 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, such as work sites, all documents governing the Plan, including insurance contracts 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 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. To arrange an appointment to review any documents, you may call the HR Service Desk during normal business hours. 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, or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a Plan benefit or exercising your rights under ERISA. ENFORCE YOUR RIGHTS If a claim for a Plan 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 Plan administrator. If you have a claim for benefits that is denied or ignored, in whole or in part, you may file a suit in a state or Federal court, but only after you have exhausted the Plan s claims and appeals procedure, as described in the Claim Denial and Appeal section. 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 9
13 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 your 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 Employee Benefits Security Administration (EBSA), U.S. Department of Labor, listed in your telephone 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 at EBSA, logging on to or contacting the EBSA field office nearest you. After reading this notice, you may contact the HR Service Desk at or toll-free at , ext for answers to any questions you might have. 10
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