NRECA Business Travel Accident Insurance Plan Summary Plan Description For COAST ELECTRIC POWER ASSOCIATION 01-25028-001 Effective Date: February 1, 2011
To Our Employees and Directors In today s economy, you and your family need protection against the financial hardship that can happen when death or a serious injury occurs. That s why we have arranged for Business Travel Accident insurance through the National Rural Electric Cooperative Association (NRECA) Group Benefits Program. This document is a Summary Plan Description (SPD). It explains how the Business Travel Accident Insurance Plan works. It is important for you to read the entire SPD so that you know What benefits are available for you When you are eligible for benefits What policies and procedures you need to follow to receive your benefits Who you should contact for help or information about your benefits This SPD represents the Plan, but is not a replacement for the actual Plan documents. If there are any inconsistencies between what is written in this SPD and what is written in the master Plan document, the master Plan document will govern in all cases. Your employer reserves the right, in its sole discretion, to modify or terminate the Plan at any time. Any change will supersede the information contained in this SPD. You will be sent updates when necessary to describe any changes in the Plan. This SPD is not a contract and participation in this Plan does not guarantee employment by any participating employer or other entity. If you have any questions, please contact the benefits administrator at your employer, or call the NRECA Member Contact Center at 866.673.2299, Monday through Friday, from 7 a.m. to 7 p.m. Central Time.
Table of Contents YOUR BUSINESS TRAVEL ACCIDENT INSURANCE PLAN... 1 Questions?... 1 OVERVIEW OF YOUR BENEFITS... 2 Benefits at a Glance... 2 ELIGIBILITY... 3 WHO IS ELIGIBLE... 3 Employees... 3 Directors... 3 Retained Attorney... 3 Who is Not Covered... 3 WHEN COVERAGE BEGINS... 3 For Employees... 3 For Directors... 4 For Retained Attorney... 4 ENROLLING IN THE PLAN... 5 Don t Forget to Select Your Beneficiary... 5 WHEN COVERAGE ENDS... 5 YOUR BENEFITS... 5 How Your Business Travel Accident Insurance Benefit Works... 5 Covered Only for Business Travel... 6 Accidental Death... 7 Accidental Dismemberment... 7 Additional Benefits... 8 Exposure and Disappearance... 9 Maximum Payment... 10 When You Are Covered by More Than One Employer... 10 What is Not Covered... 10 APPLYING FOR BENEFITS... 12 FILING A CLAIM... 12 1. Notify Your Benefits Administrator... 12 2. NRECA Processes Your Eligibility for Coverage Request... 13 3. Complete Claim Forms for MetLife... 13 If Not Eligible for Benefits... 14 APPEALING YOUR CLAIM FOR ELIGIBILITY... 14 1. You Can Appeal the Decision Regarding Eligibility... 14 2. Your Appeal is Reviewed... 15 3. You May Use the Voluntary Final Appeal Process... 15 4. The Appeals Committee Reviews Your Final Appeal... 16 GENERAL INFORMATION... 17 PLAN INFORMATION... 17 Authority of Plan Fiduciaries... 18 YOUR ERISA RIGHTS... 19 Getting Information... 19 Fiduciary Responsibility... 19 NRECA ver. 01/11 i NRECA Business Travel Accident Insurance Plan
Enforcing Your Rights... 20 Questions?... 20 DEFINITIONS... 22 Please note The Definitions section lists the terms used in this booklet and explains how they are defined by the Plan. Refer to this section if you have any questions about the meaning of specific words or phrases. NRECA ver. 01/11 ii NRECA Business Travel Accident Insurance Plan
YOUR BUSINESS TRAVEL ACCIDENT INSURANCE PLAN You are covered by the NRECA Business Travel Accident Insurance Plan, a group term plan that is part of the NRECA Group Benefits Program. Group means you are covered for business travel accident insurance only while you are eligible to be part of the group in this case, the employees, directors and retained attorney at your employer. Term means that you are covered only for a specified term in this case, so long as you are employed by or serving as a director or retained attorney at your employer. Insured means that the NRECA Group Benefit Program has purchased the insurance coverage from MetLife. As the claims adjudicator, MetLife processes your claims and approves the payment of benefits to you or your beneficiary, based on your eligibility for benefits as determined by NRECA and your employer. Questions? If you have questions or need more information about your business travel accident insurance benefits 1. Contact the benefits administrator at your employer COAST ELECTRIC POWER ASSOCIATION P.O. BOX 2430 BAY SAINT LOUIS, MS 39521 2. Call the NRECA Member Contact Center at 866.673.2299, Monday through Friday, from 7 a.m. to 7 p.m. Central Time 3. Visit the NRECA Employee Benefits web site 24 hours a day, 7 days a week Log in to Cooperative.com Click NRECA Employee Benefits in the left-hand menu (or My Benefits under your name) NRECA ver. 01/11 1 NRECA Business Travel Accident Insurance Plan
OVERVIEW OF YOUR BENEFITS Benefits at a Glance In the table below is an overview of the business travel accident insurance coverage offered by your employer. Detailed information on these benefits is provided in the Your Benefits section. Your employer pays the full cost of this benefit. There is no cost to you. There is no waiting period before you are eligible for coverage. See Who is Eligible to find out who is covered for business travel accident insurance, as well as any job classifications that are not covered. BENEFIT Accidental Death and Dismemberment COVERAGE Only covered if you are injured in an accident while traveling on business authorized by your employer If your death is due to an accident, your beneficiary will receive your accidental death benefit Accidental dismemberment benefits are paid if you lose a hand, foot, sight in your eye, hearing, speech or the thumb and index finger on the same hand and/or paralysis; how much you receive will depend on the loss Benefits paid by only one employer (see Maximum Payment section) A combined maximum of $5,000,000 paid to all individuals injured in a single accident that involves several people from one or more participating employers Seat Belt Benefit Air Bag Benefit Rehabilitation Benefit Home Alteration and Vehicle Modification Benefit Bereavement and Trauma Counseling Benefit Coma Benefit Personal Deviation $100,000 All full-time active employees Directors Retained attorney NRECA ver. 01/11 2 NRECA Business Travel Accident Insurance Plan
ELIGIBILITY WHO IS ELIGIBLE Employees You are eligible to participate in the Business Travel Accident Insurance Plan if you are an Active Employee who is in a covered job classification, and has worked, or expects to work, at least 1,000 hours during your first 12 months in a covered job classification, and continues to work at least 1,000 hours during subsequent calendar years, and is actively at work on the day your coverage begins, or has worked at another rural electric employer within the past 6 months and meets these conditions. Directors If you are a director, you are covered by the Plan during your term at a participating cooperative. Up to 3 directors emeritus can be covered by the Plan. Retained Attorney If you are an attorney retained by a participating cooperative, you are covered by the Plan while serving in this capacity. Only one retained attorney may be covered by a cooperative. Who is Not Covered The following job classifications (or titles) of employees are not eligible for coverage under the Plan: Intern (including student intern, work-study student) Part-time employee Seasonal worker Temporary employee Union employee WHEN COVERAGE BEGINS For Employees NRECA ver. 01/11 3 NRECA Business Travel Accident Insurance Plan
If you are an Active Employee, you are covered by the Plan after you have met all the eligibility requirements (see Who is Eligible). When you are a new hire, coverage is effective on the first day that you are eligible for coverage. Actively at Work If you are not Actively at Work on the day your coverage starts, then your coverage will begin on the day you return to work. Actively at Work (also referred to as the Active Work Requirement) means that you must be present to work at your employer s business location, or at other locations to which your employer requires you to travel, and be there on a day that is one of your employer s scheduled work days, and perform all of the regular duties of your job on a full-time basis on that day. You are considered Actively at Work on a day that is not one of your employer s regularly scheduled work days only if you were Actively at Work on the preceding scheduled work day. You also are Actively at Work if you are on an employer-approved leave of absence. However, if you are staying in a hospital, another institution or at home for medical care or treatment on the date your coverage otherwise would become effective, you are not Actively at Work. Your eligibility to participate in the Plan will be postponed until you receive a final medical release from the medical confinement and are Actively at Work. For Directors If you are a Director, you are covered by the Plan starting on the first day of your term as director. within 31 days of the date that you first attend a board meeting as director. For Retained Attorney If you are a Retained Attorney, you are covered by the Plan starting on the date of your appointment as a retained attorney by the cooperative. within 31 days of the date of your appointment. NRECA ver. 01/11 4 NRECA Business Travel Accident Insurance Plan
ENROLLING IN THE PLAN You automatically will be enrolled in any benefits that your employer is providing at no cost to you. Your employer is paying the full cost of those benefits. When you start working for your employer, your benefits administrator will review the accidental death & dismemberment options available to you during your initial benefits orientation. Don t Forget to Select Your Beneficiary Remember to select your beneficiary when you are enrolled. You may select anyone you choose. Your beneficiary is the person who will receive your benefit upon your death if your death is due to an accident which occurred while traveling on business. You may change your beneficiary at any time. Ask your benefits administrator for instructions on how to change your beneficiary. WHEN COVERAGE ENDS You are no longer eligible and your Business Travel Accident coverage ends on the day that You are no longer employed by your employer, or You are no longer in a covered job classification, or You are no longer serving as a director or the retained attorney for the cooperative, or You do not pay your share of the cost of your coverage, or You become disabled, or Your employer stops participating in the Plan. YOUR BENEFITS How Your Business Travel Accident Insurance Benefit Works Your Business Travel Accident Insurance coverage provides the following benefits if you are injured in an accident while you are traveling on business for your employer: accidental death benefit to your beneficiary if you die in an accident accidental dismemberment benefit to you if you suffer a loss due to an accidental injury NRECA ver. 01/11 5 NRECA Business Travel Accident Insurance Plan
Business Travel Accident Insurance is a group plan and covers you only while you are eligible for coverage from your employer. The benefit amount for either accidental death or accidental dismemberment is a flat dollar amount equal to $100,000. See Benefits at a Glance for the amount of your coverage. Covered Only for Business Travel You are covered only when you are authorized by your employer to travel or have a short stay o outside the city of your permanent assignment, and o on business for your employer. If you are a full-time employee, director or retained attorney, you are covered for all business travel away from your normal place of employment, or your residence. If you are a director, you are covered for all business travel for which you receive reimbursement of your travel expenses, or a daily allowance, or both reimbursement of travel expenses and a daily allowance. If you are a retained attorney, you are covered for travel to the final destination that occurs outside the system service area. Business travel begins when you start your trip from home, place of work or another place. Business travel ends when you arrive at your home or place of work, whichever happens first. If you are traveling on an airplane, you are covered only if you are riding as a passenger only, and you are not operating or learning to operate the aircraft or serving as a member of the crew, and the airplane is flown by a pilot duly licensed to operate such an aircraft, and the aircraft has a valid certificate of airworthiness, and the airplane is not being used for o crop dusting, spraying or seeding, or NRECA ver. 01/11 6 NRECA Business Travel Accident Insurance Plan
o fire fighting, or o sky writing, sky diving or hang gliding, or o pipeline or power line inspection, or o aerial photography or exploration, or o racing, endurance tests, stunt or acrobatic flying, or o any military purpose, or o testing or experimental purposes, or o any operation that requires a special permit from the FAA, even if it is granted (does not apply if the permit is required because of the territory flown over or landed on). You are not covered when you are commuting between your home and place of work, or travel while on a leave of absence, or travel while on vacation, or travel to another city and expect to remain there for more than 60 days; this is considered a change in your place of work. Accidental Death If you die due to an accident while traveling on business for your employer, your beneficiary will be paid the full benefit (100%) as an accidental death benefit. Your death must occur within one year after the date of the accident. For purposes of this benefit, it is presumed that you died if You are in a vehicle which disappears, sinks or is stranded or wrecked, on a trip covered by this benefit, and Your body is not found within one year of the accident. Accidental Dismemberment The full (100%) benefit is paid if you are injured in an accident and suffer one of the following within one year after the date of the accident: loss of both hands loss of both feet loss of sight in both eyes loss of hand and a foot loss of a hand and sight in one eye loss of a foot and sight in one eye loss of speech and hearing (both ears) quadriplegic (total paralysis both upper and lower limbs) NRECA ver. 01/11 7 NRECA Business Travel Accident Insurance Plan
Half (50%) of the accidental dismemberment benefit is paid if you are injured in an accident and suffer one of the following within one year after the date of the accident: loss of leg loss of arm loss of one hand loss of one foot loss of sight in one eye paraplegic (total paralysis both lower limbs) loss of speech or hearing One quarter (25%) of the accidental dismemberment benefit is paid if you are injured in an accident and suffer the loss of both your thumb and index finger on the same hand within one year after the date of the accident and/or paralysis of the arm and leg on either side of the body. Loss means hand permanently severed through or above the wrist foot permanently severed through or above the ankle eye with total and irrecoverable loss of sight index finger permanently severed through or above the metacarpophalangeal joint (the joints between the finger and the hand) thumb permanently severed through or above the metacarpophalangeal joint (the joints between the finger and the hand) Additional Benefits Seat Belt Benefit In addition to the standard schedule of benefits, an additional benefit equal to 10 percent of the full amount is paid if the loss of life results from injuries sustained while driving or riding in a private passenger car, and if your seat belt was properly fastened. The benefit is subject to a minimum of $1,000 per person and a maximum of 10 percent of the benefit not to exceed $10,000. Air Bag Benefit In addition to the standard schedule of benefits, an additional benefit equal to 10 percent of the full amount, not to exceed $5,000, will be paid if you are seated with a properly functioning air bag. NRECA ver. 01/11 8 NRECA Business Travel Accident Insurance Plan
Rehabilitation Benefit This benefit covers rehabilitative expenses that are prescribed within 90 days and rendered within one year of the accident. A maximum of 10 percent of the full amount not to exceed $25,000 will be paid. Wheel chair Access Modification Benefit If you suffer an accidental dismemberment requiring permanent use of a wheelchair, a one-time additional benefit up to 10 percent of the full amount not to exceed $25,000 will be paid for wheelchair access modification. Therapeutic Counseling Benefit This benefit covers bereavement and trauma counseling for you or an immediate family member upon your death, dismemberment, paralysis or coma. There is a maximum benefit of $50 per session for up to 10 sessions with a maximum benefit of $500. Coma Benefit If you become comatose as a result of an accident, this benefit will pay at a rate of 1 percent of your principal sum per month after a 7-day waiting period, up to 60 months, recovery or death. Personal Deviation Benefits will be paid for any accident that occurs while on business travel 100 miles outside of your city of permanent assignment not longer than 3 days. Exposure and Disappearance Your coverage includes exposure to the elements, after the forced landing, stranding, sinking or wrecking of a vehicle in which are were traveling on business. Your beneficiary is paid the full (100%) Accidental Death benefit if You are in a vehicle which disappears, sinks or is stranded or wrecked, on a trip covered by this benefit, and Your body is not found within one year of the accident. You are paid either the full (100%) or half (50%) Accidental Dismemberment benefit if You are in a vehicle which disappears, sinks or is stranded or wrecked, on a trip covered by this benefit, and You are found within one year, and You suffer an injury due to this exposure that is covered by the Accidental Dismemberment benefit (see Accidental Dismemberment). NRECA ver. 01/11 9 NRECA Business Travel Accident Insurance Plan
Maximum Payment The maximum payment for all losses due to any one accident is the full amount of your Business Travel Accident benefit from one participating employer. ------------------------------ Example: John is severely injured in an accident, including the immediate loss of his left hand. He receives 50% of his AD&D benefit for accidental dismemberment. Six months later, John dies due to the injuries he received in the accident. His beneficiary will receive only the remaining 50% of John s AD&D benefit for accidental death because his death is due to the same accident as his dismemberment. ------------------------------ The maximum total benefit paid to all the employees, directors and/or retained attorneys injured in a single accident is $5,000,000. These people may be covered by one or more participating employers. If the benefits exceed $5,000,000, the benefits paid to each person covered by the Plan will be reduced in the same proportion so that the total paid to all is $5,000,000. When You Are Covered by More Than One Employer If you are covered by more than one participating employer during the same business trip, you will receive benefits through only one employer. What is Not Covered You are not covered for an accidental death or loss that is caused by or results from: a loss that occurs more than a year after the accident physical or mental illness, disease or bodily infirmity, or the diagnosis or treatment of such illness or infirmity any bacterial infection that was not caused by an accidental cut, wound or food poisoning suicide, attempted suicide an intentional, self-inflicted injury serving in the armed forces of any country or international authority, except the United States National Guard travel or flight in any spacecraft; or flight in any aircraft, except to the extent that this hazard is provided for by name in the policy participation in hazardous activities, such as: scuba diving, bungee jumping, sky diving, hang gliding, ballooning, drag racing, driving a car fit for competitive racing, aerial NRECA ver. 01/11 10 NRECA Business Travel Accident Insurance Plan
hunting, aerial skiing, or travel in an aircraft for the purpose of parachuting, or otherwise exiting an aircraft while in flight except for the purpose of self-preservation any incident related to an aircraft: o as a pilot, crew member, flight student or while acting in any capacity other than as a passenger o that is not flown by a pilot duly licensed to operate such an aircraft o that does not have a valid certificate of airworthiness o which is owned, leased, controlled or chartered by the policy holder o and parachuting or otherwise exiting from such aircraft while the aircraft is in flight except for the purpose of self-preservation o the aircraft is being used for crop dusting, spraying or seeding, or testing or experimental purposes, or by or for any military authority for military purposes, or for travel or designed for travel beyond the earth s atmosphere, or fire fighting, or sky writing, sky diving or hang gliding, or pipeline or power line inspection, or aerial photography or exploration, or racing, endurance tests, stunt or acrobatic flying, or any operation that requires a special permit from the FAA committing or attempting to commit a felony war or acts of war, whether or not declared insurrection, rebellion, riot or terrorist acts intoxication exclusion for drugs, alcohol, poison, gas, or fumes o the voluntary intake or use by means of: o any drug, medication, or sedative unless it is taken or used as prescribed by a physician or an over-the-counter drug, medication, or sedative taken as directed o alcohol in combination with any drug, medication or sedative, or o poison gas or fumes any nuclear reaction or release of nuclear energy. This includes the radioactive, toxic, explosive or other hazardous or contaminating properties or radioactive matter. the emission, discharge, dispersal, release or escape of any solid, liquid or gaseous chemical or biological agent. NRECA ver. 01/11 11 NRECA Business Travel Accident Insurance Plan
APPLYING FOR BENEFITS FILING A CLAIM NRECA only determines eligibility for coverage under the Business Travel Accident Insurance Plan. This means that NRECA reviews claims to determine if you are eligible to receive benefits under this Plan. MetLife, as the claims adjudicator, processes your claim for benefits and approves the payment of benefits to you or your beneficiary. 1. Notify Your Benefits Administrator For Death benefits Upon your death, your beneficiary must contact the benefits administrator at your employer (see Your Life and AD&D Insurance Plan), and provide any information necessary so that your benefits administrator can complete and submit the Notice of Death form. Your benefits administrator will send the form to the NRECA Employee Benefit Services Unit to confirm that you are eligible for benefits, and request the claim form that needs to be sent to MetLife. For Accidental Dismemberment When you suffer a loss covered by the Accidental Dismemberment benefit (see Accidental Dismemberment), you must contact the benefits administrator at your employer (see Your Life and AD&D Insurance Plan). Your benefits administrator will notify the NRECA Employee Benefit Services Unit to confirm that you are eligible for benefits, and request the claim form that needs to be sent to MetLife. The date that your claim request is considered to be filed is the date that NRECA receives the completed Notice of Death and/or any other eligibility for coverage claim form or notice. NRECA ver. 01/11 12 NRECA Business Travel Accident Insurance Plan
2. NRECA Processes Your Eligibility for Coverage Request NRECA has 90 days from the date your claim is filed to notify you, your beneficiary or your authorized representative that your eligibility for coverage request is approved or denied. In some cases, NRECA may need a 90-day extension. You will be notified that it needs more time to evaluate whether or not you are eligible for benefits before the initial 90-day period is over. If NRECA decides that you are not eligible for benefits and not covered by the Plan, the denial notice will state the specific reasons why the claim is denied refer to the specific Plan provisions on which the decision is based describe any additional information needed and why this information is needed explain the Plan s claims review and appeal procedures. 3. Complete Claim Forms for MetLife After the NRECA Employee Benefit Services Unit confirms that you are eligible for benefits, a claim form and instructions will be sent to you or the beneficiary. For death benefits, the beneficiary will be sent a Life Insurance Claim Form. For accidental dismemberment benefits, you will be sent the Life Insurance Claim Form. You or the beneficiary must ask your benefits administrator to complete the Employer section of the claim form, and ask the doctor to complete the physician s section for accidental dismemberment benefits, and complete your section of the claim form, and provide any documents requested, such as a death certificate, and send the claim form and any documents to METLIFE P.O. Box 6100 Scranton, PA 18505 No legal action may be brought less than 60 days nor more than 3 years (5 years in Kansas; 6 years in South Carolina) after written proof has been furnished. NRECA ver. 01/11 13 NRECA Business Travel Accident Insurance Plan
If Not Eligible for Benefits If you or the beneficiary disagree with the NRECA Employee Benefit Services Unit s decision that you are not covered by the Plan and is not eligible for benefits, please refer to the next section Appealing Your Claim for Eligibility. APPEALING YOUR CLAIM FOR ELIGIBILITY If a claim for benefits is denied because you are not eligible for coverage under the Plan, you may appeal this decision made by NRECA. Eligibility of coverage claims or appeals of adverse decisions may be filed by You Your beneficiary, or the beneficiary for your spouse or your child Your authorized representative. An authorized representative is a person you authorize in writing to act on your behalf. An authorized representative may not be a doctor or other health care provider. Please note: There are specific response time periods for your claims and appeals. Below is the process for reviewing claims and filing claims or appeals. If you need more information, please contact your benefits administrator. 1. You Can Appeal the Decision Regarding Eligibility You, your beneficiary or your authorized representative have 60 days from the date you receive the denial notice to request an appeal of NRECA s decision. To prepare your appeal for eligibility, you may request from the Plan, free of charge, copies of all documents, records and other information related to your eligibility for coverage claim. To submit your appeal: Put your request in writing Include any written comments, records, documents and other information to support your appeal, even if you have already submitted these materials Send to Appeals Administrator NRECA Attn: Life Insurance Product Advisor 4301 Wilson Blvd., Mailstop IFS7-333 Arlington, VA 22203 NRECA ver. 01/11 14 NRECA Business Travel Accident Insurance Plan
2. Your Appeal is Reviewed The Appeals Administrator has 60 days from the date your appeal is received to review it and make a decision. He or she is not the person who made the original decision to deny your claim, nor is he or she directly supervised by the original decision-maker. The Appeals Administrator will conduct a full and fair review of all documents and evidence you submit to support your eligibility for coverage claim. He or she may consult with medical or vocational experts in order to make a decision. These medical or vocational experts are different than the experts consulted previously. In some cases, the Appeals Administrator may need a 60-day extension. You will be notified that he or she needs more time to evaluate your appeal before the initial 60-day period is over. If your appeal is denied, the denial notice will state the specific reasons why the appeal is denied refer to the specific Plan provisions on which the decision is based explain your rights under ERISA s claim and appeal rules explain your right to file a civil action under ERISA within 12 months You have now completed the Plan s appeal process. However, you may voluntarily take part in one more review process, called the Voluntary Final Appeal Process. If you do not choose to use the Voluntary Final Appeal Process, you may seek legal action. 3. You May Use the Voluntary Final Appeal Process You may use this option if you wish to have the Plan s Appeals Committee review your denied appeal of an eligibility of coverage claim. You have 60 days from the date you receive the notice that your appeal has been denied to request this review. Using this Voluntary Final Appeal Process has no effect on your rights to any other benefits under the Plan or your rights to legal review. Before you submit your request, please call 402.483.9200 if you have any questions or you want to request additional information about the Voluntary Final Appeal Process from the Appeals Committee. To prepare your appeal, you may request from the Plan, free of charge, copies of all documents, records and other information related to your eligibility of coverage claim and appeal. NRECA ver. 01/11 15 NRECA Business Travel Accident Insurance Plan
To submit your final appeal: Put your request in writing Include any written comments, records, documents and other information to support your appeal, even if you have already submitted these materials Send to Appeals Committee NRECA Attn: Principal of System Implementation 4301 Wilson Blvd., Mailstop IFS7-333 Arlington, VA 22203 4. The Appeals Committee Reviews Your Final Appeal The Appeals Committee has 60 days from the date your final appeal is received to review it and make a decision. The Appeals Committee is selected by the Vice-President, Insurance & Financial Services Administration, and has no financial or personal interest in the final appeal s result. The Appeals Committee will conduct a full and fair review of all documents and evidence you submit to support your eligibility for coverage claim. It may consult with medical or vocational experts in order to make a decision. These medical or vocational experts are different than the experts consulted previously. In some cases, the Appeals Committee may need a 60-day extension. You will be notified that it needs more time to evaluate your final appeal before the initial 60-day period is over. If your Voluntary Final Appeal is denied, the denial notice will state the specific reasons why the final appeal is denied refer to the specific Plan provisions on which the decision is based explain your rights under ERISA s claim and appeal rules explain your right to file a civil action under ERISA within 12 months NRECA ver. 01/11 16 NRECA Business Travel Accident Insurance Plan
GENERAL INFORMATION PLAN INFORMATION Plan Name: The NRECA Group Benefits Program Plan Number: 501 Policy Number: 145716 Year Ends: December 31 Business Travel Accident Insurance Underwritten by: Plan Sponsor: METLIFE P.O. Box 6100 Scranton, PA 18505 National Rural Electric Cooperative Association 4301 Wilson Boulevard Arlington, VA 22203-1860 Plan Sponsor Employer Identification Number: 53-0116145 The Insurance & Financial Services Department of the National Rural Electric Cooperative Association (NRECA) performs the general administrative duties. The names of persons who have the decision-making responsibilities are on file at the NRECA Insurance & Financial Services Department. Plan Administrator: Senior Vice-President Insurance & Financial Services National Rural Electric Cooperative Association 4301 Wilson Boulevard Arlington, VA 22203-1860 Telephone number 703.907.5500 Plan Administrator Employer Identification Number: 54-2072724 NRECA ver. 01/11 17 NRECA Business Travel Accident Insurance Plan
In addition to the Senior Vice-President of the Insurance and Financial Services Department, the benefits administrator is the person with Plan Administrator responsibilities for your employer: COAST ELECTRIC POWER ASSOCIATION P.O. BOX 2430 BAY SAINT LOUIS, MS 39521 Your Employer s Employer Identification Number: 64-0169075 The agent for service of process receives all legal notices on behalf of the Plan Sponsor regarding claims or suits filed with respect to the Plans. Agent for service of process: Senior Vice-President Insurance & Financial Services Department National Rural Electric Cooperative Association In addition to the agent for service of legal process, service may also be made upon the Plan Trustee. Plan Trustee, NRECA Group Benefits Trust: Claim Adjudicator: State Street Bank and Trust Company 225 Franklin Street Boston, MA 02101 METLIFE P.O. Box 6100 Scranton, PA 18505 Authority of Plan Fiduciaries The NRECA Insurance and Financial Services Committee, the Plan Administrator and their delegates shall have the discretion and final authority to interpret and construe the terms of the Plan in carrying out their respective responsibilities under the Plan determine coverage and eligibility for benefits under the Plans adopt, amend and rescind rules, regulations and procedures pertaining to their duties under the Plan and the administration of the Plan make all other determinations that they believe are necessary or advisable for the discharge of their duties or the administration of the Plan This discretionary authority is final, absolute, conclusive and exclusive and binds all parties so long as exercised in good faith. NRECA, as Plan Sponsor, specifically intends that judicial NRECA ver. 01/11 18 NRECA Business Travel Accident Insurance Plan
review of any decision of the Committee, the Plan Administrator, MetLife as claims adjudicator, or their delegates be limited to the arbitrary and capricious standard of review. The express grant of any specific power to a party with respect to any duty assigned to it under the Plan should not be construed as limiting any power or authority of that party to discharge its duties. YOUR ERISA RIGHTS As a participant in the Plan, you have certain rights and protection under the Employee Retirement Income Security Act of 1974 (ERISA). Getting Information You have the right to: Receive information about the Plan and its benefits Examine, without charge, at the Plan Administrator s office or at other specified locations, such as worksites and union halls, all Plan documents, including insurance contracts and collective bargaining agreements, 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 copies of documents governing the Plan s operation, including insurance contracts, collective bargaining agreements, a copy of the latest annual report (Form 5500 series) and updated summary plan description, upon written request to the Plan Administrator. The Plan Administrator may make a reasonable charge for copies. Receive a summary of the Plan's annual financial report. The Plan Administrator is required by law to provide each participant with a copy of this Summary Annual Report. Fiduciary Responsibility In addition to creating rights for Plan participants, ERISA imposes duties on the people responsible for operating the Plan, called "fiduciaries." The fiduciaries have a responsibility to operate the Plan prudently and in the interest of all Plan participants and beneficiaries. No one, including your employer, your union or any other person, may fire you or discriminate against you in any way to prevent you from obtaining a benefit from this Plan or from otherwise exercising your rights under ERISA. NRECA ver. 01/11 19 NRECA Business Travel Accident Insurance Plan
If your claim for benefits is entirely or partially denied or ignored, you have a right within certain time schedules to Receive a written explanation of the reason why this was done Obtain copies of documents relating to the denial free of charge Appeal any denial Enforcing Your Rights Under ERISA, there are steps you can take to enforce your rights: If you request a copy of the Plan documents or the latest annual report from the Plan and you do not receive them within 30 days, you may file suit in Federal Court. In this case, the court may require the Plan Administrator to provide the documents and possibly pay you up to $110 a day until you receive the materials, unless the documents were not sent because of reasons beyond the control of the Plan Administrator. If you have a claim for benefits which is entirely or partially denied or ignored, you may file suit in a State or Federal Court after exhausting all mandatory appeals procedures under the Plan. In addition, if you disagree with the Plan s decision, or lack thereof, concerning the qualified status of a Medical Child Support Order, you may file suit in Federal Court after exhausting all mandatory appeals procedures under the Plan. If it should happen that the Plan's fiduciaries misuse the Plan's money, or if you are discriminated against for asserting your rights, you may get help 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 that you be paid these costs and fees. If you lose, the court may require you to pay these costs and fees (for example, if it finds your claim is frivolous). Please remember that you may not file a lawsuit in Federal or State court to enforce your rights until you have exercised and exhausted all administrative claim and appeals rights described in the Plan and in this document. Questions? If you have any questions about: NRECA ver. 01/11 20 NRECA Business Travel Accident Insurance Plan
Your Plan or if you need to obtain documents from the Plan, contact the Plan Administrator Your rights under ERISA, contact the nearest area office of the o Employee Benefits Security Administration, U.S. Department of Labor, listed in your telephone directory, or o The Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue NW, Washington, DC 20210 You may also obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the Employee Benefits Security Administration NRECA ver. 01/11 21 NRECA Business Travel Accident Insurance Plan
DEFINITIONS Accident an accident is caused by an event that is sudden and unforeseen and occurred at an exact time and place. Actively at Work or Active Work Requirement A requirement that you must be present to work at your employer s business location, or at other locations to which your employer requires you to travel, and be there on a day that is one of your employer s scheduled work days, and perform all of the regular duties of your job on a full-time basis on that day. You are considered Actively at Work on a day that is not one of your employer s regularly scheduled work days only if you were Actively at Work on the preceding scheduled work day. You also are Actively at Work if you are on an employer-approved leave of absence. However, if you are staying in a hospital, another institution or at home for medical care or treatment on the date your coverage otherwise would become effective, you are not Actively at Work. Your eligibility to participate in the Plan will be postponed until you receive a final medical release from the medical confinement and are Actively at Work. Beneficiary The person or entity named, on a form and in a manner approved by NRECA, to receive benefits for loss of life. Benefit maximum A maximum dollar amount that is payable by the Plan for your insurance benefit. Board The Board of Directors of NRECA. Calendar year - The period of time that begins on January 1 and ends on the following December 31. When you first become eligible for coverage, the first calendar year begins on your effective date. Committee The NRECA Insurance and Financial Services Committee, appointed by the President of NRECA from the members of the Board. Contributory When you (the employee) pay all or part of the cost for your coverage. Deferment of effective date - If you are eligible to be covered under this Plan and are staying either in an institution or at home for medical care or treatment on the date any coverage, or change in coverage, would otherwise become effective, then your coverage or change in coverage will be deferred until you, your spouse or your child receive a final medical release. Director - An elected member of the board of directors of a cooperative. NRECA ver. 01/11 22 NRECA Business Travel Accident Insurance Plan
Doctor or Physician - A legally qualified medical doctor or practitioner who is licensed in the governing jurisdiction and practicing within the scope of his or her license. The physician or doctor must not be related to the participant by blood or marriage. Employee - A person who is actively at work for the employer, and receiving earnings. Employer - The organization, association, cooperative, system, entity, etc. from which you receive a salary for performing your job responsibilities and through which you receive the benefits under the Group Plan. Eligibility Waiting Period The length of time that an active employee must work before he or she is eligible to participate in the Plan. ERISA The Employee Retirement Income Security Act of 1974, as amended. Individual You (the employee) Injury bodily loss or harm Non-contributory When you (the employee) pay none of the cost of your coverage. Normal Retirement Age the age at which you are eligible for a full pension from your employer. For purposes of the life insurance premium waiver, if you are disabled before the Normal Retirement Age and your employer has a 30-year/age 62 retirement plan, the Normal Retirement Age is age 62, whether or not you have completed 30 years of participation. Participant An employee, director or retained attorney who is eligible for coverage and enrolls in, or chooses to participate, in the Plan. Personal Deviation An activity not related or incidental to your business or business trip. This is not at the expense of the policyholder and does not include charged vacation time. Physician or Doctor - A legally qualified medical doctor or practitioner who is licensed in the governing jurisdiction and practicing within the scope of his or her license. The physician or doctor must not be related to the participant by blood or marriage. Plan - A term used generally for the purpose of naming as a whole the benefits, provisions and exclusions for the Group Term Life and Accidental Death & Dismemberment Insurance Plan, as described in this Summary Plan Description. Plan year The calendar year. NRECA ver. 01/11 23 NRECA Business Travel Accident Insurance Plan
Premium The monthly amount your employer and/or you contribute to the cost of providing your benefits. You or Your The employee who is covered by the Plan and eligible for benefits. NRECA ver. 01/11 24 NRECA Business Travel Accident Insurance Plan