2 TABLE of C ONTENT S INTRODUCTION ................................ ................................ ................................ ....................... 3 GENERAL TERMS AND CONDITIONS ................................ ................................ ......................... 3 PLAN INFORMATION ................................ ................................ ................................ ............... 4 PLAN ADMINISTRATION ................................ ................................ ................................ .......... 13 PLAN CONTACT INFORMATION ................................ ................................ ............................... 15 CLAIMS AND APPEALS ................................ ................................ ................................ ............ 17 MISCELLANEOUS RULES ................................ ................................ ................................ .......... 25 SECTION 125 PLAN ................................ ................................ ................................ .................. 28 ELIGIBILITY AND PARTICIPATION REQUIREMENTS ................................ ................................ ... 29 COBRA ................................ ................................ ................................ ................................ .... 32 BENEFIT PLAN PROVISIONS ................................ ................................ ................................ ..... 40 STATUTORY PROVISIONS ................................ ................................ ................................ ........ 40 BENEFIT CONTINUATION PROVISIONS FOR NON - STATUTORY LEAVE OF ABSENCE ................... 42 AMENDMENT OR TERMINATION OF THE PLAN ................................ ................................ ........ 43 HIPAA PRIVACY AND SECURITY STANDARDS ................................ ................................ ........... 44 HIPAA NOTICE OF SPECIAL ENROLLMENT RIGHTS ................................ ................................ .... 46 STATEMENT OF ERISA RIGHTS ................................ ................................ ................................ . 47 PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP) ................................ ................................ ................................ ................................ ..... 50 ENFORCE YOUR RIGHTS ................................ ................................ ................................ .......... 59 DEFINITIONS ................................ ................................ ................................ ........................... 60 ASSISTANCE WITH YOUR QUESTIONS ................................ ................................ ...................... 63 QUALIFIED MEDICAL CHILD SUPPORT ORDERS ................................ ................................ ........ 64