Administration of the Plan

On This Page...

What Are Your Basic Benefits Rights
What Are the Company's Rights
How Do You Appeal a Claim Denial

What Are Your Basic Benefits Rights

The Employee Retirement Income Security Act of 1974 (ERISA) protects employee rights under government-regulated benefit plans. This section describes your ERISA rights and protections. A benefits representative in the Vought Benefits Center can also explain plan provisions, and the nearest office of the U.S. Labor-Management Service Administration, Department of Labor can assist you and answer questions about your rights under ERISA.

As a participant in Managed Choice POS, you should know as much as possible about your benefits. Therefore, all supporting documents, including official plan texts, insurance contracts, annual reports and plan descriptions filed with the U.S. Department of Labor, are available for your examination without charge at the Vought Benefits Center, Dallas. You also can receive copies of all plan documents for a small fee upon written request to the plan administrator.

The plan administrator is also required by law to furnish each participant with an annual summary of the financial status of the plan. That summary describes what happens to the money contributed each year.

In addition to establishing rights for plan participants, ERISA imposes duties upon those responsible for the operation of the plan. The people who operate your plan, called fiduciaries, have a duty to do so prudently and in the interest of all plan participants and beneficiaries. No one may fire you or discriminate against you in any way to prevent you from obtaining a benefit or exercising your rights under ERISA.

If your claim for benefits is denied in whole or in part, you must receive a written explanation of the reason for the denial. You have the right to have the plan administrator review and reconsider your claim.

ERISA defines steps you can take to enforce your rights. For instance:

If you request materials from the plan administrator and do not receive them within 30 days, you may file suit in federal court. The court may require the plan administrator to provide the materials and pay you up to $100 a day until you receive them - unless the materials were not sent for reasons beyond the administrator's control.
If you have a claim for benefits that is denied or ignored, in whole or in part, you may file suit in a state or federal court.
If 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 file suit in federal court.

The court will decide who should pay court costs and legal fees. If you are successful, the court may order those you have sued to pay the 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).

What Are the Company's Rights

The benefits described in this booklet are provided as part of your total compensation package. They are not guaranteed to continue, however - and they do not guarantee your employment.

Although we intend to continue operating the plan indefinitely, future business conditions or other reasons could cause the company to discontinue it. The plan may also be changed, amended, or modified, including contributions, at any time, subject to collective bargaining. All changes will be communicated to plan participants.

The plan would end automatically if the company ceased to exist and no successor company continued the plan.

Why Do Your Benefits Not Guarantee Employment

Managed Choice POS is not an employment contract. Your benefits do not guarantee your employment with the company in any way. If you leave the company - or are discharged - you have no right to benefits unless specifically provided in the plan.

If benefits which are not covered by the plan are paid by mistake, the company that made the payment has the right to recover the overpayment from the person or organization that received the benefits.

How Do You Appeal a Claim Denial

If your claim for a benefit is denied in whole or in part, you must receive a written explanation of the reason for the denial. You have the right to have your claim reviewed and reconsidered.

You should be aware that benefits may not be payable under certain conditions. The exclusions are listed in this booklet. Some other conditions under which benefits will not be paid are:

When your dependents become ineligible due to age, marriage or divorce or
When you fail to provide the company with satisfactory claim information upon request.

What Steps Do You Follow

If a benefit claim is denied in whole or in part, or if you do not receive any response to your claim within 90 days after you filed it, follow these steps if you wish to appeal:

Review the claim denial notice. If your benefits under a plan are in question, discuss the matter with the Vought Benefits Center first. When a claim for benefits is denied, you will receive a written notice within 90 days. The notice will:
- Explain the reason for the denial,
- Refer to the specific plan provisions upon which the denial was based,
- Describe what additional information, if any, is necessary, and
- Explain the steps for an appeal.

Submit a written claim appeal to the Claim Appeal Committee in care of the Vought Benefits Center. If you disagree with a claim denial, you have 60 days to appeal from the time you were notified of the denial or received no response to your claim for 90 days. Normally, your appeal will be acknowledged within 10 days, and you will receive written notice of the decision and the reasons for it within 60 days. If a longer period is required, you will be notified in writing of the length of the delay and the reasons for it.

Legal action cannot begin until the claims review procedure has been exhausted.