Drury University Tax Savings Plan

Summary Plan Description

This Plan allows eligible employees the choice of making employee contributions to the following benefits on a pre-tax basis: Premium Conversion Plan , (health and dental ) Health Care Reimbursement Plan (Health Care FSA), and Dependent Care Assistance Plan (Dependent Care FSA). Benefits under the plan also qualify as individual component plans. See individual insurance Summary Plan Descriptions for details about insured benefit information. The Plan Administrator has complete authority, responsibility and control over administration of this plan including the right to interpret provisions of the plan; determine questions of eligibility; apply rules and regulations uniformly as necessary to carry out provisions of the plan; and amend or terminate the plan at any time. This short benefit summary in conjunction with the Flexible Spending Accounts booklet explains your rights and benefits of the non-insured benefits under the Flexible Benefits Plan. If you do not understand the information or have additional questions, contact your Human Resources office for more information.

You are receiving this notice because you have recently become covered under a group health plan (the Plan). This notice contains important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This notice generally explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect the right to receive it. The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you when you would otherwise lose your group health coverage. It can also become available to other members of your family who are covered under the Plan when they would otherwise lose their group health coverage. For additional information about your rights and obligations under the Plan and under federal law, you should review the Plan’s Summary Plan Description or contact the Plan Administrator. COBRA continuation coverage is a continuation of Plan coverage when coverage would otherwise end because of a life event known as a “qualifying event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage. The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. When the qualifying event is the end of employment or reduction of hours of employment, death of the employee, or the employee's entitlement to Medicare benefits (under Part A, Part B, or both), the employer must notify the COBRA continuation benefits administrator of the qualifying event. The Health Care Flexible Spending Account (FSA) under this plan qualifies as a HIPAA welfare benefit. Health Care FSA participants losing coverage due to an eligibility change or termination will be offered COBRA continuation. If the participant chooses not to continue coverage under the COBRA option, only Health Care FSA services through the date of coverage loss will be eligible for reimbursement. There is no continuation coverage for the Dependent Care FSA, but participants are entitled to seek reimbursement for services received throughout the entire plan year, up to the account level as of the loss of coverage. If you are an employee, you will become a qualified beneficiary if you lose your coverage under the Plan because either one of the following qualifying events happens: (1) your hours of employment are reduced, or (2) your employment ends for any reason other than your gross misconduct. If you are the spouse of an employee, you will become a qualified beneficiary if you lose your coverage under the Plan because any of the following qualifying events happen: (1) your spouse dies; (2) your spouse’s hours of employment are reduced; (3) your spouse’s employment ends for any reason other than his or her gross misconduct; (4) your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or (5) you become divorced or legally separated from your spouse. Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because any of the following qualifying events happens: (1) the parent-employee dies; (2) the parent-employee’s hours of employment are reduced; (3) the parent-employee’s employment ends for any reason other than his or her gross misconduct; (4) the parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both); (5) the parents become divorced or legally separated; or (6) the child stops being eligible for coverage under the plan as a “dependent child.” You must notify the employer of qualifying events within 60 days of the event and you must provide notice to the COBRA continuation benefits administrator listed on the reverse side of this form. Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage of behalf of their children. COBRA continuation coverage is a temporary continuation of coverage. Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified on the back page of this notice. For more information about your rights under ERISA, including COBRA, the Health Insurance Portability and Accountability Act (HIPAA), and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit the EBSA website at www.dol.gov/ebsa . In order to protect your family’s rights, you should keep the Plan Administrator informed of any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator.

The Plan Administrator, by its Administrative Agent, must evaluate all claims for reimbursement under the Plan within a reasonable time not longer than 30 days after receipt. This period may be extended an additional 15 days for matters beyond control of the Administrative Agent, and you will be notified of any extension. The Plan may secure medical or other advice deemed necessary to decide your claim. If a claim is denied in whole or in part you will receive a written notice of adverse determination setting forth: the specific reason(s) for the denial; reference to the specific Plan provision on which the denial is based; a description of any additional material or information necessary for you to complete your claim and an explanation of why such material or information is necessary; and appropriate information as to the steps to be taken if you wish to appeal the determination, including your right to submit written comments and have them considered, your right to review (at no charge and upon your request) relevant documents and other information, and your right to file suit under ERISA with respect to any adverse determination after appeal of your claim.

If your claim is denied in whole or in part, you may appeal in writing for a review of the denied claim within 180 days of the Administrative Agent’s initial notice of adverse benefit determination. If you do not appeal on time, you will lose the right to appeal your denial and your right to file suit in court. Your written appeal should state the reasons that you feel your claim should have been reimbursed. It must include all additional facts and/or documents that you feel support your claim. You may also ask additional questions and make written comments, and you may review documents and other information relevant to your appeal. All written comments submitted with your appeal will be reviewed.

Your appeal will be reviewed and decided within a reasonable time not longer than 60 days after it is submitted and you will be provided with a written decision. The individual who decides your claim will not be the same individual who decided your initial claim denial nor their subordinate. If the decision on appeal affirms the initial denial of your claim, you will be furnished with a notice of adverse benefit determination on review setting forth: the specific reason(s) for the denial; the specific Plan provision(s) on which the denial is based; if an “internal rule, guideline, protocol, or other similar criterion” was relied on in making the decision, a description of the specific rule, guideline, protocol or other similar criterion or a statement that such information was relied on will be provided free of charge upon request; a statement of your right to review (at no charge upon request) relevant documents and other information; and a statement of your right to file suit under ERISA Section 502(a).

As a Plan participant you have certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA) entitling you to: 1) examine without charge at the Plan Administrator’s office or other specified location all plan documents governing the plan, including insurance contracts, and a copy of the latest annual report (Form 5500 Series) if any, filed by the plan with the U.S. Department of Labor; 2) obtain upon written request to the Plan Administrator, copies of documents governing plan operation, including insurance contracts and collective bargaining agreements, and copies of the latest annual report (Form 5500 Series) and updated summary plan description. The administrator may make a reasonable charge for the copies; and 3) receive a summary of the Plan’s annual financial report, if any is required by ERISA.

ERISA also imposes duties upon those responsible for the operation of the employee benefit plan, to do so prudently and in the interest of you and other participants and beneficiaries. No one, including your employer, your union, or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a plan benefit or exercising your rights under ERISA.

Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request materials from the plan and do not receive them within 30 days, you may file suit in a Federal court. In such a case, the court may require the PlanAdministrator to provide the materials and pay you up to $110 a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the Plan Administrator. If you have a claim for benefits, which is denied or ignored, in whole or in part, you may file suit in state or federal court. If it should happen that the plan fiduciaries misuse the plan's money or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in Federal court. The court will decide who will 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.

If you have questions about this statement or your rights under ERISA or HIPAA, or if you need assistance obtaining documents from the plan administrator, you should contact the nearest office of the Employee Benefits Security Administration, U.S. Department of Labor, listed in your telephone directory or the Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue N.W., Washington, D.C. 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.

 

 

NAME OF PLAN:

Drury University Flexible Benefits Plan and Drury University Premium Conversion Plan

PLAN SPONSOR and
PLAN ADMINISTRATOR:

Drury University
900 North Benton Avenue
Springfield, MO 65802

EMPLOYER ID NUMBER:
44-0552049
PLAN NUMBER:
503 and 504
AGENT FOR SERVICE
OF PROCESS:
Drury University
Scotti Siebert
900 N. Benton Avenue
Springfield, MO 65802
(417) 873-7527
ADMINISTRATIVE AGENT:
BMO Benefit Services
Flexible Benefits Department
P.O. Box 2517
Appleton, WI 54912-2517
COBRA CONTINUATION BENEFITS ADMINISTRATOR:
Infinisource 1 (800) 300-3838
15 E. Washington Street
P. O. Box 889
Coldwater, MI 49036
FSA PLAN YEAR:
January 1 - December 31
Run-off period closes 90 days after close of plan year
PREMIUM PLAN YEAR: June 1 – May 31
ELIGIBILITY/ENTRY/START
FOR PRE-TAX PREMIUMS:
Newly eligible employees must elect this benefit by completing a Premium Conversion Plan Election Form. Insurance premium deductions then continue as a pre-tax benefit in future plan years, unless a Section 125 pre-tax waiver is signed. Reference specific insurance benefit Summary Plan Descriptions for eligibility, entry and start dates.

ELIGIBILITY FOR FLEXIBLE SPENDING ACCOUNTS (FSA):

Who is eligible? Staff and faculty regularly scheduled to work at least 20 hours per week for nine months each year, or Transitional Retirees.
FSA ENTRY DATE:
When are you eligible? Eligible employees may elect coverage under the Flexible Spending Account (FSA) portion of the plan upon their first regularly scheduled work day. If an employee does not elect to participate in the Plan within thirty (30) days of his or her date of eligibility, he/she shall be eligible to participate upon a Qualified Change in Status or in future Plan Years. FSA benefits must be re-elected each Plan Year during open enrollment.
FSA COVERAGE EFFECTIVE DATE:
When is your coverage effective? FSA elections made during open enrollment prior to a new plan year are effective the first day of the new Plan Year. Mid-year elections for newly eligible participants are effective as of the first day of the month following the date the employee returns a properly completed election form. Qualified expenses are eligible for reimbursement as of the effective date.
COST TO PARTICIPANTS:
No administrative fee.
PLAN YEAR CONTRIBUTIONS:

Employee funded annual maximums:
Health Care $2,550
Dependent Care $5,000
Health Care Minimum: $ 200
Dependent Care Minimum: $200

MID-YEAR ELECTION CHANGE:

Benefit elections under this Plan are generally irrevocable for the Plan Year made. However, certain life or employment events may allow you to make a consistent benefit change within 30 days after the event. Contact the Benefits Department for more information and a form to complete. Mid-year elections for new participants due to a qualifying change event are effective the first day of the month following the date the benefit department receives your status change form.

FMLA and USERRA:
Family Medical Leave Act (FMLA) and Uniformed Services Employment and Reemployment Rights Act (USERRA) apply to the Health Care FSA. Participants should discuss various leave options with their Benefits Department prior to taking leave.
FSA LOSS OF COVERAGE:
Your coverage may be lost if you: do not make an election for the plan year; lose eligibility due to a position change; terminate employment; or if the Plan terminates. Only services received during your coverage period prior to the loss of coverage are eligible under the plan unless you qualify for health care COBRA continuation.
COBRA:
COBRA premiums must be mailed to the COBRA Continuation Benefits Administrator at the address listed above. For qualifying events other than termination of employment (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you must notify the Plan Administrator at the address listed within 60 days after the qualifying event occurs
PRIVACY RULES:
Your Plan Administrator and business associate(s) collect, transfer and store personal health information required to provide benefits under this plan in accordance to privacy right afforded you under HIPAA. Upon request, the Benefits Department will provide you with a “Notice of Privacy Practices.”