EatonBenefits.com Summary Plan Description Effective August 1, 2008 Business Travel Accident Insurance Program
This booklet summarizes the main features of the Eaton Corporation Business Travel Accident Insurance Plan. Eaton Corporation is sometimes referred to as Eaton or the Company in this booklet. The Eaton Corporation Business Travel Accident Insurance Plan is sometimes referred to as the BTA plan or simply plan. The intent of this booklet is to satisfy the Employee Retirement Income Security Act of 1974 (ERISA) requirement for a Summary Plan Description (SPD). The entire plan and group policy, not only this SPD, will be determinative in all matters pertaining to rights and obligations with respect to the plan. As of the effective date of this booklet, the plan is insured under group policy number GTP 000911722827700-G issued to the Company by National Union Fire Insurance Company of Pittsburgh, PA. All insurance under the plan is term insurance. This plan and the coverage it is subject to all of the terms and conditions of the group policy. Although the Company's present intent is to continue this plan indefinitely, you should be aware that the Company retains the right to substitute other coverage, or to amend, change, modify or completely terminate the plan for any or all groups of participants at any time for any reason. The Company also retains the right to insure this plan with any insurance company. Neither this booklet nor any other writing regarding this plan grants or confers any vested or other rights to any employee, former employee, retiree, beneficiary, dependent, benefit recipient or any other person for future benefits beyond amounts payable for periods of time while the plan is in effect. If you have any questions about this plan, contact your local Human Resources Representative. The information in this booklet has been provided by Eaton and is the sole responsibility of Eaton.
Eaton Corporation Summary Plan Description Business Travel Accident Insurance Plan i Table of Contents INTRODUCTION AND OVERVIEW...1 ELIGIBILITY...1 AMOUNT OF INSURANCE...2 COVERED LOSSES...2 ADDITIONAL BENEFITS...4 BENEFICIARY DESIGNATION...8 ASSIGNMENT OF INSURANCE...8 BENEFIT LIMITATIONS AND EXCLUSIONS...9 COVERAGE DURING AND AFTER LEAVE OF ABSENCE OR DISABILITY...9 TERMINATION OF COVERAGE...9 CONVERSION...10 TAX LIABILITY...10 WHAT YOU SHOULD DO AND EXPECT IF YOU HAVE A CLAIM...10 MODIFIED PAYMENT OF CLAIMS...11 APPEAL PROCEDURE FOR DENIED CLAIMS...11 NOTICE OF DECISION ON APPEAL AND RIGHT TO LAWSUIT...12 PHYSICAL EXAMINATION AND AUTOPSY...13 LEGAL ACTION...13 NOTICE REGARDING THE OFFICE OF FOREIGN ASSETS CONTROL...13 ADMINISTRATION AND OTHER INFORMATION...14 STATEMENT OF ERISA RIGHTS...16 PLAN INTERPRETATION...17 COLLECTIVE BARGAINING AGREEMENT...17 GLOSSARY OF TERMS...18
Eaton Corporation Summary Plan Description Business Travel Accident Insurance Plan 1 INTRODUCTION AND OVERVIEW The Eaton Corporation Business Travel Accident Insurance Plan (called the "BTA plan or plan ) is designed to help protect employees, guests and non-employee Directors of the Company against financial disaster in the event a covered person dies or is severely injured in a covered accident while traveling on business for Eaton Corporation. The BTA plan is sponsored by Eaton Corporation (called "Eaton" or the "Company") and paid for by Eaton Corporation. The purpose of this Summary Plan Description (SPD) is to provide a general summary of the BTA plan, as in effect on August 1, 2008. The following table provides a brief overview of the plan. Type of Coverage Covered Persons Coverage Amount Business Travel Accident Coverage All full-time employees, except those represented by a collective bargaining agreement All spouses and dependent children of covered employees of the Company 5 times annual salary Minimum $100,000 Maximum $3,000,000 Spouse: $100,000 Children: $25,000 All guests of the Company $200,000 All non-employee Directors of the Company 5 times annual cash retainer from the Company Maximum $1,000,000 All benefits under the BTA plan are provided by and are subject to, the group insurance policy issued by National Union Fire Insurance Company of Pittsburgh, PA ( insurance company ) to Eaton Corporation. If there is any conflict between the group insurance policy and this SPD or any other plan documents for the BTA plan, the insurance policy will prevail. In other words, the extent of coverage for each covered person is governed at all times by the complete terms of the group insurance policy. You should refer to the glossary of terms at the end of this SPD for definitions of key terms used this SPD. If you have any questions regarding the information contained in this SPD, contact your local Human Resources Representative. ELIGIBILITY Employees You are eligible for the BTA plan if you are: Employed by Eaton or any other company who Eaton has named as a participating company; Classified in the Company Human Resources Information System as a full-time employee regularly scheduled to work at least 20 hours per week; and Not represented by a collective bargaining agent, or you are represented by a collective bargaining agent that has an agreement with the Employer Group that provides for your participation in the plan. You are not eligible for the plan if you are: A part-time, temporary, seasonal, casual or common law employee who is not classified in the Company Human Resources Information System as a full-time employee; An individual who has signed an agreement, or has otherwise agreed, to provide services to the Company as an independent contractor, regardless of the tax or other legal consequences of such an arrangement; or A leased employee compensated through a leasing entity, whether or not you fall within the definition of "leased employee" as defined in Section 414(n) of the Internal Revenue Code.
2 Eaton Corporation Summary Plan Description Business Travel Accident Insurance Plan Other Individuals In addition to employees, the plan provides coverage for certain other individuals while traveling on business for Eaton Corporation as follows: Guests of Eaton (Traveling on Company Aircraft, only); Non-employee Directors of the Company; and Spouse and Dependent Children of: Employees; and Non-employee Directors of the Company. Employees and the other individuals listed above are automatically covered under the plan while traveling on business for Eaton Corporation. AMOUNT OF INSURANCE The "principal amount" of BTA insurance is based on your coverage classification as follows: Classification All full-time employees, except those represented by a collective bargaining agreement All non-employee Directors of the Company Principal Amount of BTA Insurance 5 times annual salary Minimum $100,000 Maximum $3,000,000 All guests of the Company $200,000 All spouses and dependent children of covered employees and non-employee Directors of the Company 5 times annual cash retainer from the Company Maximum $1,000,000 Spouse: $100,000 Children: $25,000 Aggregate Limit The maximum amount payable under this plan may be reduced if more than one covered person suffers a loss as a result of the same accident, and if amounts are payable for those losses under one or more of the following benefits provided by this plan: Permanent Total Disability Benefit, Paralysis Benefit, Coma Benefit. The maximum amount payable for all such losses for all covered persons under all those benefits combined will not exceed $30,000,000. If the combined maximum amount otherwise payable for all covered persons must be reduced to comply with this provision, the reduction will be taken by applying the same percentage of reduction to the individual maximum amount otherwise payable for each covered person for all such losses under all those benefits combined. COVERED LOSSES BTA benefits are payable if a covered person dies or suffers a loss solely from, and within 365 days after, a covered accident that occurs while the covered person is traveling on business for the Company or during a personal deviation. Business travel generally begins when a covered person leaves his or her residence or workplace for the purpose of starting an authorized business trip; and ends when the covered person returns to his or her residence or workplace following the trip. It also includes a personal deviation that may include activity before, during, or after business travel that is not reasonably related to Company business (e.g., a personal visit made enroute to an airport or Eaton business location). Business travel does not include travel to or from a work location where the covered person is expected to remain for more than 365 days. The following chart provides a high-level summary of the covered accidents applicable to each classification of coverage provided under the plan:
Eaton Corporation Summary Plan Description Business Travel Accident Insurance Plan 3 Classification All full-time employees, except those represented by a collective bargaining agreement All guests of the Company All non-employee Directors of the Company All spouse and dependent children of covered employees of the Company Type of Coverage Provided 24-hour business travel accident insurance Traveling on Company aircraft Traveling on Company aircraft 24-hour business travel accident insurance Traveling on Company aircraft 24-hour coverage while traveling for the purpose of a family relocation trip or accompanying an employee on a Company business trip Traveling on Company aircraft Certain non-employees of the Company have limited BTA benefits as follows: Spouse and dependent children: The spouse and dependent children of the employee and non-employee Directors of the Company are covered under the plan if they are: On a family relocation trip; or Accompanying the covered employee on a business trip or on his or her way to join the covered employee who is on a company business trip. Non-employee Directors of the Company: A non-employee Director of Eaton is covered under this plan while he/she is traveling to/from a location in which Eaton business will be or has been conducted. Guests: Persons traveling on Company aircraft are covered under the plan. This coverage also includes getting in or out of, or on or off of or by being struck or run down by a Company aircraft. The following table of losses describes the benefits payable under the BTA plan for a loss (each as defined in the Glossary) that is listed in the table. If a covered person sustains more than one covered loss as a result of the same covered accident, benefits will be paid for the covered loss for which the largest available benefit is payable. In no event will benefits from one accident exceed the principal amount of BTA insurance, except as summarized in Additional Benefits. For Loss of: Life Both hands or both feet Sight of both eyes One hand and one foot One hand and the sight of one eye One foot and the sight of one eye Speech and hearing in both ears Quadriplegia Percentage of Principal Sum Paraplegia 75% One hand or one foot Sight of one eye Speech or hearing in both ears Hemiplegia Thumb and Index finger of same hand Uniplegia 100% 50% 25%
4 Eaton Corporation Summary Plan Description Business Travel Accident Insurance Plan The BTA plan also provides coverage for exposure and disappearance as follows: Exposure: If a covered person is unavoidably exposed to the elements and as a result of such exposure suffers a loss for which a benefit is otherwise payable under the plan, the loss will be covered under the plan. Disappearance: If the body of a covered person has not been found within 365 days of the disappearance, forced landing, stranding, sinking or wrecking of a conveyance in which the person was an occupant while covered under the plan, then it will be deemed, subject to all other terms and provisions of the plan that the covered person has suffered accidental death within the meaning of the plan. ADDITIONAL BENEFITS The benefits summarized below are paid in addition to the other plan provisions and are available only when a loss is otherwise covered under the plan. Not all additional benefits apply to all classifications of covered persons. Bereavement and Trauma Counseling Benefit (For all classifications of covered persons) If a covered person suffers an accidental death for which an Accidental Death benefit is payable under the plan, or if he or she goes into a coma for which a Coma benefit is payable under the plan, the insurance company will pay certain covered bereavement and trauma counseling expenses that are due to his or her death or coma. The covered bereavement and trauma counseling expenses must be incurred within one year after the date of the accident causing such loss, up to a maximum of $100 per session for up to 10 sessions for the covered person and all of his or her immediate family members combined with respect to all such losses caused by the same accident. Children and Spouse Tuition Benefit (For all classifications of covered persons) If a covered person (other than a spouse or child) suffers accidental death such that an Accidental Death benefit is payable under the plan, the insurance company will pay the following benefit: For the Children The insurance company will pay a benefit to or on behalf of any child of the covered person who, on the date of the covered person s death: Is a full-time student in any institution of higher learning above grade 12; or Is in grade 12 and subsequently enrolls as a full-time student in an institution of higher learning within 365 days after the date of the covered person s death. The benefit will be paid for each year of the Child s continuous enrollment as a full-time student in an institution of higher learning, up to a maximum of four (4) consecutive years or the date the child reaches age 23, whichever comes first. The total amount of the benefit each year is equal to the least of: The actual tuition (exclusive of room and board) charged by that institution for enrollment during that year for that child; 5% of the covered person s principal sum on the date of the accident causing death; or $30,000. The applicable portion of the yearly benefit for each term of enrollment is payable upon receipt of proof of enrollment for that term.
Eaton Corporation Summary Plan Description Business Travel Accident Insurance Plan 5 A Child who ceases to be enrolled as a full-time student becomes permanently ineligible for the benefit, even if he or she reenrolls at a later date. The benefit is not payable for any term of enrollment as a full-time student that begins before the date of the covered person s death. For the Spouse The insurance company will pay a benefit to or on behalf of the spouse of the covered person who, for the purpose of obtaining an independent source of support or to enrich his or her ability to earn a living: Is enrolled in any institution of higher learning or professional or trade training program on the date of the covered person s death; or Subsequently enrolls in an institution of higher learning or professional or trade training program within 30 months after the date of the covered person s death. The benefit will be paid for each year of the spouse s continuous enrollment in an institution of higher learning or professional or trade training program, up to a maximum of four (4) consecutive years. The total amount of the benefit for all institutions and programs combined each year is equal to the least of: The total actual tuition (exclusive of room and board) charged by those institutions or programs for enrollment during that year for the spouse; 5% of the covered person s principal sum on the date of the accident causing death; or $30,000. The applicable portion of the yearly benefit for each term of enrollment is payable upon receipt of proof of enrollment for that term. A spouse who ceases to be enrolled as described above becomes permanently ineligible for the benefit, even if he or she reenrolls at a later date. The benefits not payable for any term of enrollment that begins before the date of the covered person s death. Coma Benefit (For all classifications of covered persons) If an accidental injury renders a covered person comatose within 90 days of the date of the accident that caused the injury, and if the coma continues for a period of 30 consecutive days, the insurance company will pay a monthly benefit of 1% of the principal sum. The benefit will begin after the coma has existed for 30 days (no benefit is provided for the first 30 days of coma). The benefit is payable monthly as long as the covered person remains comatose due to that injury, but ceases on the earliest of: The date the covered person ceases to be comatose due to that Injury; The date the covered person dies; or The date the total amount of monthly coma benefits paid for all injuries caused by the same accident equals 100% of the principal sum. The insurance company will pay benefits calculated by a rate of 1/30th of the monthly benefit for each day for which the insurance company is liable when the covered person is comatose for less than a full month. There is only one benefit provided for any one month of coma, regardless of the number of injuries causing the coma. The insurance company reserves the right, at the end of the first 30 consecutive days of coma and as often as it may reasonably require thereafter, to determine, on the bases of all the facts and circumstances, that the covered person is comatose, including, but not limited to, requiring an independent medical examination provided at the expense of the insurance company.
6 Eaton Corporation Summary Plan Description Business Travel Accident Insurance Plan Day Care Benefit (For all classifications of covered persons) If a covered person (other than a spouse or child) suffers accidental death such that an Accidental Death benefit is payable under the plan, the insurance company will pay a benefit on behalf of any child of the covered person on the date of the accident who: Is enrolled in a day care center on the date of the covered person s death; or Enrolls in a day care center within 365 days after the covered person s death. The benefit is payable for each year of the child s enrollment in a day care center. The total amount of the benefit each year is equal to the least of: The actual cost of care for the child charged by the day care center for that year; 5% of the covered person s Principal Sum on the date of the accident causing death; or $5,000. The applicable portion of the yearly benefit for each period of enrollment is payable upon receipt of due proof of enrollment, but not more frequently that monthly. The benefit is not payable for any period of enrollment in a Day Care Center before the date of the accident that caused the covered person s death. The benefit is not payable for any period of enrollment after the earlier of: The date the child reaches 13 years of age; or The date four (4) years after the later of the date of the covered person s death or the date the Child first enrolls in a Day Care Center. Emergency Evacuation Benefit (For all classifications of covered persons) The insurance company will pay for covered emergency evacuation expenses reasonably incurred if the covered person suffers an injury or emergency sickness that warrants his or her emergency evacuation while he or she is outside a 100 mile radius from his or her current place of primary residence. The maximum benefit is $1,000,000 for all emergency evacuations due to all injuries from the same accident or for all emergency sicknesses from the same or related causes. The physician ordering the emergency evacuation must certify that the severity of the covered person s injury or emergency sickness warrants his or her emergency evacuation. All transportation arrangements made for the emergency evacuation must be by the most direct and economical conveyance and route possible. AIG Assist must make all arrangements and must authorize all expenses in advance for any benefits under this provision to be payable. The insurance company reserves the right to determine the benefit payable, including reduction, if it is not reasonably possible to contact AIG Assist in advance. Home Alteration and Vehicle Modification Benefit (For all classifications of covered persons) If a covered person suffers an accidental dismemberment or paralysis for which an Accidental Dismemberment and Paralysis benefit is payable under the plan, the insurance company may pay covered home alteration and vehicle modification expenses that are incurred within one year after the date of the accident causing such loss. To be eligible for the benefit, the covered person must not have, prior to the date of the accident causing such loss, required the use of a wheelchair to be ambulatory; and as a direct result of such loss is now required to use a wheelchair to be ambulatory. The maximum benefit under this provision is $50,000 for all such losses caused by the same accident.
Eaton Corporation Summary Plan Description Business Travel Accident Insurance Plan 7 Covered home alteration and vehicle modification expenses means one-time expenses that are charged for: Alterations to the covered person s residence that are necessary to make the residence accessible and habitable for a wheelchair-confined person; or Modifications to a motor vehicle owned or leased by the covered person or modifications to a motor vehicle newly purchased for the covered person that are necessary to make the vehicle accessible to and/or drivable by the covered person; and Do not include charges that would not have been made if no insurance existed; and Do not exceed the usual level of charges for similar alterations and modifications in the locality where the expense is incurred. The alterations to the covered person s residence and the modifications to his or her motor vehicles must be: Made on behalf of the covered person; Recommended by a nationally-recognized organization providing support and assistance to wheelchair users; Carried out by individuals experienced in such alterations and modifications; and In compliance with any applicable laws or requirements for approval by the appropriate government authorities. This benefit is not payable if the covered person is entitled to benefits under any Workers Compensation Act or similar law. Permanent Total Disability Benefit (Benefit not available for Covered Persons Age 80 or Older on the Date of the Accident, Spouse and Dependent Child(ren) of the Policyholder) If, as a result of an injury, the covered person is rendered permanently totally disabled within 365 days of the accident that caused the Injury, the insurance company will pay 100% of the principal sum at the end of 12 consecutive months of such permanent total disability. The Company reserves the right, at the end of the 12 consecutive months or permanent total disability to determine, on the basis of all the facts and circumstances that the covered person is permanently totally disabled, included, but not limited to, requiring an independent medical examination provided at the expense of the Company. Rehabilitation Benefit (For all classifications of covered persons) If a covered person suffers an accidental dismemberment or paralysis for which an Accidental Dismemberment and Paralysis benefit is payable under the plan, the insurance company will reimburse the covered person for covered rehabilitative expenses that are due to the injury causing the dismemberment or paralysis. The covered rehabilitative expenses must be incurred within two years after the date of the accident causing that injury, up to a maximum of $50,000 for all injuries caused by the same accident. Repatriation of Remains Benefit (For all classifications of covered persons) If a covered person suffers loss of life due to Injury while outside a 100 mile radius from his or her current place of primary residence, the insurance company will pay for covered expenses reasonably incurred to return his or her body to his or her current place of primary resident, up to a maximum of $1,000,000.
8 Eaton Corporation Summary Plan Description Business Travel Accident Insurance Plan Covered expenses include, but are not limited to, expenses for: Embalming or cremation; The most economical coffins or receptacles adequate for transportation of the remains; and Transportation of the remains by the most direct and economical conveyance and route possible. AIG Assist must make all arrangements and must authorize all expenses in advance for this benefit to be payable. The insurance company reserves the right to determine the benefit payable, including and reductions, if it was not reasonably possible to contact AIG Assist in advance. Seat Belt and Air Bag Benefit (Not available for Guests of the Company) If a covered person suffers a covered accidental death while operating, or riding as a passenger in an automobile and wearing a properly functioning, original, factory-installed cover seat belt, a seat belt benefit of $50,000 may be available. If the seat belt benefit is determined payable, an additional air bag benefit may be payable if the covered person was positioned in a seat protected by a properly functioning, original, factory-installed supplemental restraint system that inflates on impact. Verification of the actual use of the seat belt, at the time of the accident, and that the supplemental restraint system inflated properly upon impact, must be a part of an official report of the accident or be certified, in writing, by the investigating officer(s). BENEFICIARY DESIGNATION You may designate a beneficiary under the plan, or you may change a previously designated beneficiary at any time. If you do not designate a beneficiary under the plan, benefits will be paid according to the beneficiary designation under the Eaton Life and Accidental Death and Dismemberment Insurance Plan. If there is no designated beneficiary for a covered person s coverage under the BTA Plan or the Eaton Life and Accidental Death and Dismemberment Insurance Plan, or no designated beneficiary under either of these plans is living after the covered person s death, benefits will be paid in equal shares to the survivors in the first surviving class of those that follow: Spouse; Children; Parents; Brothers and Sisters; or If no class has a survivor, the beneficiary is the covered person s estate. A new beneficiary designation will be effective as of the date you complete that designation. However, if the insurance company has taken any action or made any payment before the Company receives your designation, it will not go into effect. Changes in your family situation (such as marriage, divorce or new children) do not automatically alter or revoke your previous beneficiary designation. Therefore, you should occasionally review any beneficiary designation you have made for the Eaton Business Travel Accident Insurance Plan and the Eaton Life and Accidental Death and Dismemberment Insurance Plan. ASSIGNMENT OF INSURANCE Benefits under the plan are not assignable.
Eaton Corporation Summary Plan Description Business Travel Accident Insurance Plan 9 BENEFIT LIMITATIONS AND EXCLUSIONS BTA benefits are not payable if a loss results from or is caused by: Suicide or any attempt at suicide or intentionally self-inflicted injury or any attempt at selfinflicted injury or auto-eroticism. Declared or undeclared war, or any act of declared or undeclared war, unless such act of war occurs within the geographic limits or territorial waters of, or airspace above, a designated war risk territory. Sickness, disease, mental incapacity or bodily infirmity whether the loss results directly or indirectly from any of these. Infections of any kind regardless of how contracted, except bacterial infections that are directly caused by botulism, ptomaine poisoning or an accidental cut or wound independent and in the absence of any underlying sickness, disease or condition including but not limited to diabetes. Full-time duty in the armed forces, National Guard or organized reserve corps of any country or International authority. The covered person s commission of or attempt to commit a felony crime. The medical or surgical treatment of sickness, disease, mental incapacity or bodily infirmity whether the loss results directly or indirectly from the treatment. Stroke or cerebrovascular accident or event; cardiovascular accident or event; myocardial infarction or heart attack; coronary thrombosis; aneurysm. Flying in any aircraft used for specialized aviation activities. Flying in any aircraft chartered by Eaton. The maximum benefits (i.e., the aggregate limit) that the insurance company will pay for all losses incurred under this plan as the result of any single covered accident is $30,000,000. If, because of a single accident affecting more than one covered person, total benefits under this plan would exceed this aggregate limit, then the benefits that will be paid to each covered person will be reduced in the same proportion, so that the total amount the insurance company pays is not more than the aggregate limit under the plan. COVERAGE DURING AND AFTER LEAVE OF ABSENCE OR DISABILITY Your BTA coverage will terminate when you are no longer actively at work. If you return to the Company (as an eligible employee) after a leave of absence, you will be treated as a new employee, unless your leave was covered by the Family and Medical Leave Act ( FMLA ) or by the Uniformed Services Employment and Reemployment Rights Act ( USERRA ). If your coverage under the plan was terminated for any reason during a leave covered by FMLA or USERRA, your coverage will be reinstated when you return if the plan remains in effect. However, your reinstated coverage will not apply to any period during which your coverage was terminated. TERMINATION OF COVERAGE Your BTA coverage will terminate immediately on the earliest of: The date you no longer meet the eligibility requirements for coverage under the plan; The date on which you are no longer actively at work; The date your employment with the Company terminates; The date coverage for your employee group or class is discontinued; or The date the BTA plan or the applicable BTA insurance policy terminates. However, any termination of your BTA insurance will not affect your right to benefits due you for any covered loss from any covered accident that has already occurred.
10 Eaton Corporation Summary Plan Description Business Travel Accident Insurance Plan CONVERSION Neither this plan nor your BTA Insurance gives you any right to convert your group BTA Insurance into an individual insurance policy. TAX LIABILITY Benefit payments under the BTA plan are not considered taxable income under current federal and state tax regulations. WHAT YOU SHOULD DO AND EXPECT IF YOU HAVE A CLAIM When you are eligible to receive benefits under the plan, you or your survivor (a "claimant") must request a claim form or obtain instructions for submitting a claim from the Manager of Claims at Eaton s World Headquarters. All claims a claimant submits must be on the claim form or in the electronic or telephonic format provided by the insurance company. A claimant must complete the claim according to directions provided by insurance company. If these forms or instructions are not available, a claimant must provide a written statement of proof of loss. After a claimant has completed the claim form or written statement, the claimant must submit it to the Manager of Claims at Eaton s World Headquarters, who will send it to insurance company for a decision. A claimant must notify the insurance company of a loss to a covered person within 90 days after the loss is suffered. The notice must include the name of the covered person and the BTA plan insurance policy number, which is currently GTP 0009117228. A written claim form (or other detailed proof of loss) must be sent to insurance company within the same 90-day period or as soon as reasonably possible after that, but no later than two years after the notice of loss was required, unless any further delay is due to the legal incapacity of the covered person. The Plan Administrator has appointed the insurance company as the named fiduciary for deciding claims for benefits under the plan, and for deciding any appeals of denied claims. The insurance company shall have the authority, in its discretion, to interpret the terms of the plan, to decide questions of eligibility for coverage or benefits under the plan, and to make any related findings of fact. All decisions made by the insurance company shall be final and binding on participants and beneficiaries to the full extent permitted by law. The insurance company has 45 days from the date it receives a claimant's claim for disability benefits, or 90 days from the date it receives a claim for any other benefit, to determine whether or not benefits are payable to the claimant in accordance with the terms and provisions of the BTA plan. If the insurance company finds that any request for plan benefits does not comply with this procedure, the insurance company shall promptly notify the claimant that the request does not comply with the procedure and what must be done to comply. The insurance company may require more time to review the claimant's claim if necessary due to circumstances beyond its control. If this should happen, the insurance company must notify the claimant in writing that its review period has been extended. The insurance may take up to two additional 30-day periods to review a claim for disability benefits or one additional period of 90 days for any other benefit. If an extension is made because the claimant must furnish additional information, the extension period will begin when the additional information is received. The claimant has up to 45 days to furnish the requested information. During the review period, the insurance company may (at its own expense) require a medical examination of the covered person; or additional information regarding the claim. If a medical examination is required, the insurance company will notify you of the date and time of the examination and the physician s name and location. It is important that you keep any appointments made since rescheduling examinations will delay the claim process. If additional information is required, the insurance company must notify the claimant, in writing, stating the information needed and explaining why it is needed.
Eaton Corporation Summary Plan Description Business Travel Accident Insurance Plan 11 If a claim is approved, the claimant will receive the appropriate benefit from the insurance company. If a claim is denied, in whole or in part, the claimant will receive a written notice from the insurance company within the review period (or by the end of any extended review period). The insurance company s written notice must include the following information: The specific reason(s) the claim was denied; Specific reference to each plan provision on which the denial was based; Any additional information required for the claim to be reconsidered, and the reason this information is necessary; In the case of any claim for a disability benefit, identification of any internal rule, guideline or protocol relied on in making the claim decision, and an explanation of any medically-related exclusion or limitation involved in the decision; A statement informing the claimant of his or her right to appeal the decision; and an explanation of the following appeal procedure, including the time limits that apply under that procedure; and A statement of the claimant's right to bring a suit under Section 502(a) of ERISA (as defined in the Glossary of Terms) or any other applicable law, if his or her appeal is denied after any review under the following appeal procedure. MODIFIED PAYMENT OF CLAIMS With respect to losses suffered by covered persons whose permanent, current place of primary residence is outside the United States of America or Canada, the insurance company will pay any benefits that may become payable under the plan to the policyholder, who: Will hold benefit payments in trust for the sole use and benefit of the covered person or his or her claimant or other person to whom such benefits are payable; Will transmit benefit payments in accordance with the provisions of the plan; Agrees that any benefits paid by the insurance company to the policyholder constitutes a full discharge of the insurance company s liability with respect to the claim for which payment is made; Will alone assume full responsibility for the proper application or distribution of such benefit payment; Will indemnify, defend and hold harmless the insurance company for any claims, demands, judgments, losses, costs, expenses, liabilities and damages whatsoever, including interest, penalties and legal fees, arising from or relating in any way to such payment or to the amount, application or distribution thereof; and With respect to any application or disbursement of such payment in foreign currency, will use the foreign exchange rate in effect at the policyholder s payor bank on the date the benefits become payable to convert United States of America dollar-denominated currency into foreign currency. APPEAL PROCEDURE FOR DENIED CLAIMS Whenever a claim is denied, the claimant has the right to appeal the decision. The claimant (or a duly authorized representative) must make a written request for appeal to the insurance company within 180 days from the date the claimant received the denial of a claim for disability benefits or 60 days from the date the claimant received the denial for any other type of claim. If a claimant does not make this request within that time, the claimant will have waived the right to appeal. Within 30 days after receipt by the insurance company of a request for appeal, it will appoint an individual or committee (a "reviewer") to promptly and completely review the request; and will provide the claimant (and his representative, if any):
12 Eaton Corporation Summary Plan Description Business Travel Accident Insurance Plan An opportunity to present the claimant s position to the reviewer in writing, including the right to submit written comments, documents, records and other relevant information; Upon written request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant to the claimant s claim for benefits, with such relevance to be determined under applicable regulations of the U.S. Department of Labor; and Upon written request and free of charge, notice of the identity of the reviewer and any medical or vocational experts whose advice was obtained for the insurance company in connection with the claimant s adverse benefit determination, whether or not such advice was relied upon in such determination. This review will give no deference to the original claim decision, and will not be made by any individual who made the initial claim decision. During the review, the claimant (or a duly authorized representative) may also submit issues and comments that might affect the outcome of the review. The insurance company has 45 days from the date it receives a request regarding disability benefits or 60 days from the date it receives a request for any other benefit to review a claimant's appeal and notify the claimant of the reviewer's decision. Under special circumstances, a reviewer may require more time to review the appeal. If this should happen, the insurance company must notify the claimant, in writing that its review period has been extended for an additional 45 days (for disability appeals) or 60 days (for all other appeals). This could happen if an autopsy or physical examination is required. The reviewer's decision is final unless the claimant files a court action concerning the denied claim no later than 3 years after the date the claimant is required to send a written claim form (or other detailed proof of loss) to the insurance company. NOTICE OF DECISION ON APPEAL AND RIGHT TO LAWSUIT Once the review of a claimant's appeal is complete, the insurance company must notify the claimant, in writing, of the results of the review. If a reviewer makes an adverse decision on the benefits claimed in a request for appeal, the insurance company shall give the claimant a notice that shall state in writing, in a manner calculated to be understood by the claimant: Each specific reason for that decision; A specific reference to each provision of the plan on which the decision is based; A statement that the claimant is entitled to receive, upon request and free of charge; Reasonable access to, and copies of, all documents, records and other information relevant to the claimant s claim for benefits, with such relevance to be determined under applicable regulations of the U. S. Department of Labor; In the case of any claim for a disability benefit, identification of any internal rule, guideline or protocol relied on in making the claim decision, and an explanation of any medically-related exclusion or limitation involved in the decision; That the reviewer s decision is final unless the claimant files a court action concerning the denied claim within the period of time stated in the last paragraph of the preceding section; and The claimant s right to bring a suit, within the period of time stated in the last paragraph of the preceding section, to challenge any adverse decision on review, under ERISA Section 502(a) or any other applicable law.
Eaton Corporation Summary Plan Description Business Travel Accident Insurance Plan 13 PHYSICAL EXAMINATION AND AUTOPSY The insurance company, at its expense, has the right to examine any covered person and to perform an autopsy where not prohibited by law, at its expense. LEGAL ACTION A legal action on a claim may be brought against the plan only during a certain period. This period begins 60 days after the date proof of loss is submitted and ends three years after the date proof of loss was required to be submitted. NOTICE REGARDING THE OFFICE OF FOREIGN ASSETS CONTROL The Office of Foreign Assets Control (OFAC) is an office of the Department of the Treasury and acts under the presidential wartime and national emergency powers, as well as authority granted by specific legislation, to impose controls on transactions and freeze foreign assets under U.S. jurisdiction. OFAC administers and enforces economic embargoes and trade sanctions primarily against: Targeted foreign countries and their agents; Terrorism sponsoring agencies and organizations; and International narcotics traffickers. Prohibited Activity OFAC enforces certain embargoes and sanctions against certain designated countries. No U.S. business or person may enter into certain transactions in or connected to such designated sanctioned countries. OFAC maintains a directory known as the Specially Designated Nationals and Blocked Persons (SDNBP) list. No U.S. business or person may transact business with any person or entity named on the SDNBP list. Additional and more in-depth information on OFAC is available at the following website: http://www.ustreas.gov/offices/eotffc/ofac. Obligations Placed on the Insurance Company by OFAC If the insurance company determines that you or any insured, additional insured, loss payee, mortgagee, or claimant are on the SDNBP list or are connected to a sanctioned country as described in the regulations enforced by the OFAC, we must block or freeze property and payment of any funds, transfers or transactions and report all blocks to the OFAC within ten (10) days. Potential Actions by the Insurance Company 1. The insurance company may immediately cancel your coverage effective on the day that they determine that they have transacted business with an individual or entity associated with your policy on the SDNBP list or connected to a sanctioned country as described in the regulations enforced by OFAC. 2. If the insurance company cancels your coverage, you will not receive a return premium unless approved by OFAC. All funds will be placed in an interest bearing blocked account established on the books of a U.S. financial institution. 3. The insurance company will not pay a claim, accept premium or exchange monies or assets of any kind to or with individuals, entities or companies (including a bank) on the SDNBP list or connected to a sanctioned country as described in the regulations enforced by OFAC. And, they will not defend or provide any other benefits under your policy to individuals, entities or companies on the SDNBP list or connected to a sanctioned country as described in the regulations enforced by OFAC.
14 Eaton Corporation Summary Plan Description Business Travel Accident Insurance Plan Your Rights If funds are blocked or frozen by the insurance company in conjunction with the OFAC, you may complete an Application for the Release of Blocked Funds and apply for a specific license to request their release. Forms are available for download at the OFAC website. See http://www.treas.gov/offices/enforcement/ofac/forms/license.pdf. ADMINISTRATION AND OTHER INFORMATION Name and Type of Plan This booklet describes the Eaton Corporation Business Travel Accident Insurance (BTA) Plan, which is a fully insured welfare benefit plan. BTA insurance protection is provided by National Union Fire Insurance Company of Pittsburgh, PA, which processes claims and pays benefits to insured participants. Employer and Plan Sponsor The Employer and Plan Sponsor of the plan is: Eaton Corporation Eaton Center Cleveland, OH 44114-2584 Telephone Number: (216) 523-5000 Plan Administrator The Plan Administrator is: Eaton Corporation Health and Welfare Administrative Committee c/o Eaton Corporation Eaton Center Cleveland, OH 44114-2584 Telephone number: (216) 523-5000 Employer Identification Number and Plan Number The Employer Identification Number is 34-0196300. The Plan Number is 568. Agent for Service of Legal Process For disputes arising under the insurance policy, service of legal process may be made upon: National Union Fire Insurance Company of Pittsburgh, PA 70 Pine Street New York, NY 10270 Telephone: (212) 770-7000
Eaton Corporation Summary Plan Description Business Travel Accident Insurance Plan 15 Service of legal process may also be made on the Plan Administrator: Eaton Corporation Eaton Center Cleveland, OH 44114-2584 Attention: Secretary Telephone Number: (216) 523-5000 Plan Funding, Type of Administration and Premiums The plan is fully insured. Benefits are provided under a group insurance contract entered into between Eaton Corporation and National Union Fire Insurance Company of Pittsburgh, PA. National Union Fire Insurance Company is responsible for reviewing and paying claims. Premiums for the Business Travel Accident Insurance Plan are paid by the Company out of its general assets. No Contract of Employment The plan is not intended to be, and may not be construed as constituting, a contract or other arrangement between an employee and the Company to the effect that an employee will be employed for a specific period of time. Plan Amendment and Termination The Company may amend the provisions of the plan at any time by written action of an officer of the Company or any individual designated in writing by such an officer as authorized to take such action, which designees include (but are not limited to) the employees holding the following positions at the Company's World Headquarters: the Vice President, Compensation and Benefits and the Director of Benefits. Such amendment will be effective at the time designated in the amendment. The Company may discontinue or terminate the plan, in whole or in part, at any time for any reason by written action of an officer of the Company. Claim Administrator, Claim Fiduciary and Insurance Company The plan is insured under group policy number GTP 0009117228 issued to the Company by National Union Fire Insurance Company of Pittsburgh, PA. National Union Fire Insurance Company is also the claims administrator and claim fiduciary. Correspondence concerning the group insurance plan should be sent to the following addresses: Plan Year General Correspondence: American International Companies Accident and Health Claims Division P.O. Boxes 15701 Wilmington, DE 19850-5701 Claims and Appeals Correspondence: American International Companies Accident and Health Claims Division P.O. Boxes 15701 Wilmington, DE 19850-5701 All plan records are compiled on an annual basis from July 1 through June 30 the fiscal year. The plan year is referred to as the year or the fiscal year in this booklet.
16 Eaton Corporation Summary Plan Description Business Travel Accident Insurance Plan STATEMENT OF ERISA RIGHTS 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 provides that all plan participants will be entitled to: Receive Information About Your Plans and Benefits You are entitled to examine at no 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 applicable. You may also examine at no charge 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. You may obtain, upon written request to the Plan Administrator, copies of documents governing the operation of the plan, including insurance contracts; collective bargaining agreements, if applicable; 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. You are entitled to receive at no charge a summary of the plan s annual financial report. The Plan Administrator is required by law to furnish each participant with a copy of the 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 your 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, you can take steps to enforce the above rights. For example, you can file suit in a federal court if you: Request a copy of plan documents or the latest annual report from the plan and do not receive it within 30 days. 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. Exhaust the claims procedures described in this Summary Plan Description and your claim for benefits is denied or ignored, in whole or in part. (You may also file a claim in state court.) Disagree with the plan s decision or lack thereof concerning the qualified status of a domestic relations order or a medical child support order. Are discriminated against for asserting your rights. (You may also seek assistance from the U.S. Department of Labor.) You may also seek assistance from the U.S. Department of Labor or file suit in a federal court if it should happen that the plan fiduciaries misuse the plan s money. 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.