Dental Care Summary Plan Description

Regular full-time and part-time employees scheduled to work nine or more months are eligible to participate in the plan 12 months per year; regular full-time and part-time employees scheduled to work less than nine months are eligible to participate in the plan when working as an RIT employee. Adjunct employees are eligible to participate in semesters in which they work at RIT. If you elect coverage, it can begin on the first day of the month on or after your date of employment. You need to enroll, however, and authorize the payroll deductions to pay your share of the cost before coverage can begin. If your contribution is too high to be deducted from your pay, we will set you up for billing by our outside billing administrator and you will pay with after-tax dollars. You must enroll within 31 days from your date of hire; otherwise, you cannot enroll until the dental open enrollment period. The dental enrollment is held every other year, in the fall, for coverage effective January 1 for the next two years (as long as you remain eligible). If you are not at work on the day coverage is supposed to start, coverage will become effective on the day you return to active employment.

You also may obtain coverage for your spouse or domestic partner and/or eligible children by enrolling in two person or family coverage and authorizing payroll deductions (or billing if your pay is too small) to pay your share of the cost. You may not cover your spouse/domestic partner as a dependent if your spouse is enrolled for coverage as an employee. No child can be covered as both an employee and a dependent.

Please refer to the separate summary on providing benefits for your Domestic Partner.

The eligibility rules for children are as follows:

• The child of the employee or the employee’s spouse who is under age 26.
• The child of the employee’s domestic partner who is under age 26 (NOTE: if the child is not claimed as a dependent on the employee’s federal income tax return, this benefit will be taxable).
• The foster child (under age 18) of the employee, defined as an individual who is placed with the employee by an authorized placement agency or by judgment decree, or other court order. Dental Care Plan 3 3/2022
• Any other child who is under age 26, and
  • o for whom the employee is the legal guardian or custodian, and
  • o who resides in the employee’s home, and
  • o who is claimed as a tax dependent on the employee’s federal income tax return

Coverage for your dependents usually begins when your coverage begins. However, if your spouse/partner or a child is confined in an institution or at home for medical reasons when coverage is supposed to begin, coverage will become effective on the first day the person is no longer confined.

A spouse/partner who is divorced from you is not eligible for coverage under the Plan (except under the provisions of COBRA, as described later in this summary), even if a court orders you to provide coverage for your former spouse. If you have an eligible dependent who is also an RIT employee, he or she may be covered either as an employee or as a dependent, but not both.

Also eligible for coverage under this Plan are those in the following categories who meet the eligibility requirements:

• Pre-Medicare retirees and pre-Medicare spouse/partner/children
• Pre-Medicare LTD recipients and pre-Medicare spouse/partner/children
• Pre-Medicare surviving spouse/partner/children.

Eligibility for Retirement

Eligibility for retirement from RIT are based on multiple factors. Detailed eligibility rules for retirement, that are applicable to all benefit plans that are available to RIT retirees, can be found in the Summary Plan Descriptions (SPDs) for RIT’s Group Health Insurance Plan and the RIT Retiree-Only Health Reimbursement Arrangement Plan. These SPDs are available on the RIT Human Resources-Benefits website, or a hard copy is available by request.

RIT has a family member verification (FMV) process to ensure that only those people who are eligible for benefits are covered and that the proper tax status is applied. It is important that RIT and employees are spending money as intended and that required taxes are paid.

The process is a simple one; copies of the eligibility verification documents only need to be provided once for an individual regardless of future benefit plan enrollments (e.g., if you cover your spouse only under dental and later add your spouse to your medical coverage, you will not need to provide another copy of the verification document).

Generally, the approved documents are a marriage certificate for a spouse and a birth certificate for a child, and an affidavit for your eligible domestic partner; refer to the benefits page of the HR website for more details on accepted documents. Copies of verification documents should be provided as follows:

• New Hires: a new employee must provide the eligibility verification documents before family members can be added to the various benefits coverage.
• Mid-Year Changes: generally, the employee must provide the eligibility verification documents before family members can be added to the various benefits coverage. In the case where the document is not available (e.g., birth certificate for a new baby), the family member will be added to the coverage but the employee must provide the required proof within 30 days, otherwise, coverage will be canceled for the family member.
• Open Enrollment Changes: the employee must provide eligibility verification documents by the end of the open enrollment period for any family members added to the coverage. If the documentation is not provided, the open enrollment change will not be processed and the family member will not be added to the coverage effective January 1.

Plan coverage is not automatic for a new employee; you need to complete an enrollment form for coverage to take effect. On the form you indicate your choice of dental plans and whether you want individual, two person, or family coverage.

It is important for you to return the completed enrollment form within 31 days after you first become eligible for coverage. If you wait beyond 31 days to enroll, you will not have another opportunity to enroll until the Plan’s next open enrollment.

You may have a different level of coverage than you do for your medical and/or vision coverage (e.g., you can have family medical and two person dental).

Because dental coverage needs change from time to time, you have the opportunity once each year – effective as of January 1 - to make changes in your election. You can enroll in or cancel coverage, change plans, or change your coverage level (e.g., change from individual to two person). If you do not make a change during this open enrollment period, you will have to wait until the next open enrollment period to make a change unless you experience a qualified change in status, described in the next section.

In general, once you have enrolled in the Plan, you cannot change plans, change your coverage level or cancel coverage until the beginning of the next plan year. However, pursuant to federal regulations, you may be able to make mid-year election changes if you meet certain criteria, as explained in items one through six, below. Your requested election change must be consistent with the reason for the change, as defined by the Internal Revenue Service. For example, it would be consistent for an employee with two-person coverage that adopts a child during the year to change his or her election to family coverage. It would not be consistent to move from family coverage to individual coverage. Changes must be made within 31 days of the event that gives you the right to make a new election. The Plan Administrator may require you to submit certain documentation related to your reason for making a mid-year election change. New elections will become effective on the qualifying event date.

Your dental benefit elections may be changed – consistent with the event - to reflect the following events:

1. Qualified Change in Status
   The following events constitute a qualified change in status:
   • a change in legal marital status: for example, a marriage or divorce
   • a change in the number of dependents: for example, the birth of a child, an adoption, a death, and so on
   • a change in a dependent’s eligibility: for example, a child reaches the maximum age under a dental plan
   • you, your spouse or your child become eligible for continued health coverage under federal law (COBRA) or similar state law
2. Change in Employment Status
   The following events constitute a change in employment status where they affect you or your spouse or child:
   • termination of employment
   • commencement of employment
   • commencement or return from an unpaid leave of absence
   • change in employment classification that makes the person either eligible or ineligible to participate in a plan (for example, a change from full-time to part-time status, or the reverse, if such a change affects one’s eligibility to participate in a plan).
3. Changes in Employee’s Cost of Coverage
   With respect to your pre-tax premium contributions, you are permitted to make a mid-year election change if there is a significant increase in the cost of the plan. If there is an ordinary increase or decrease in premiums, your payroll deductions will be automatically adjusted to reflect this change. Any determination of what constitutes a “significant increase” will be made by RIT.
4. Changes in Coverage
   You may make a change in your election regarding your pre-tax premium contributions consistent with the following changes in coverage in an underlying plan:
   • If the coverage provided by an underlying plan is significantly curtailed, you may revoke your prior election with regard to that plan
   • If a new dental care option is added or an option you have selected is eliminated, you may make a new election.
5. Qualified Medical Child Support Orders (QMCSO)
   If a court ordered judgment requires you to provide health care coverage for a child or foster child, or if the order requires someone else to provide coverage, which you were previously providing, you may make mid-year election changes consistent with the QMCSO.

You and RIT share the cost of your dental plan, with the employee contribution being deducted from your paycheck, usually on a pretax basis. However, if your elections are too high to be deducted from your pay, we will set you up for billing by our outside billing administrator and you will pay with after-tax dollars. Your share of the cost will be based on the plan you select and whether you choose individual, two person, or family coverage.

Contribution rates for dental coverage are provided annually by the Human Resources Department. These rates are subject to change. You will be notified in the event of any change in rates.

Pre-Medicare retirees and surviving family members covered by the Plan are billed monthly by our outside billing administrator. LTD recipients will have their contribution amount deducted from the insurance company’s LTD benefit payment unless the deduction is higher than the payment; if that occurs, LTD recipients will be billed monthly by our outside billing administrator. All payments are made on an after-tax basis.

Refer to the separate contribution summaries for the employee contribution amounts and retiree/LTD/survivor contribution amounts. These rates are subject to change.

If any benefit is paid in error to you or a provider (e.g., dentist), the Plan has the right to recover the amount overpaid. You, your dependent or legal representative shall, on request, provide the Plan with information, sign any documents, make repayment, and do whatever else the Plan says is necessary to recover an overpayment. Any failure to cooperate may result in the Plan’s seeking reimbursement directly from you, your dependent or your estate, through legal action.

If you have dental coverage under another group plan in addition to this one - through that of a spouse/partner, for example - the total benefits you are eligible to receive could be greater than your actual expenses. To help eliminate this duplicate spending, our Plan’s coverage is coordinated with other group plans with which you have coverage. This means that when the RIT Plan pays second, benefits will be adjusted so that the total payments from both plans won’t be more than 100% of total covered charges.

For your own claims and those of your spouse/partner, the plan that pays first is the one that covers you, your spouse or partner as an employee. If your children are covered by more than one plan, the plan of the parent whose birthday occurs earlier in the year will pay benefits first. However, if you are separated or divorced, the plan of the parent who has financial responsibility for the child’s health care expenses will pay first. If there is no court decree for medical care coverage, then the plan of the parent who has custody of the child will pay first. Where none of these situations apply, the plan that you’re covered under the longest will pay first.

If you retire before you (and your spouse/partner) are eligible for Medicare (generally before age 65), you are eligible for continuation of the same dental coverage you had as an active employee while you (and your spouse/partner) are pre-Medicare. The pre-Medicare retiree premium contribution is the full premium amount based on the coverage level. Retirees have the same enrollment rules as employees do.

When you and your spouse/partner are eligible for Medicare (generally after age 65), you are no longer eligible to be covered by this Plan. You would be eligible for coverage under the COBRA continuation option as well as through the private Medicare Exchange, Via Benefits (refer to information in the RIT’s Group Health Insurance Plan summary). Contact information for Via Benefits will be provided to you by RIT Human Resources, or is available on our website. COBRA participants have the same enrollment rules as employees do.

If either you OR your spouse/partner is eligible for Medicare at retirement (i.e., one of you is under age 65 and the other is age 65 or older), the person who is not eligible for Medicare is eligible for continuation of the same dental coverage you had as an active employee while pre-Medicare. The pre-Medicare premium contribution is the full premium amount based on the coverage level. Retirees/spouses/partners have the same enrollment rules as employees do.

The person who is eligible for Medicare would be eligible for coverage under the COBRA continuation options as well as the private Medicare Exchange, Via Benefits (refer to information in the RIT’s Group Health Insurance Plan summary). Contact information for Via Benefits will be provided to you by RIT Human Resources, or is available on our website. COBRA participants have the same enrollment rules as employees do. If you are still covering eligible pre-Medicare children, they will be covered under the policy of the preMedicare individual and that person will have the appropriate level of coverage (two person or family).

If you and your spouse/partner are eligible for Medicare at retirement and you have a pre-Medicare child, you would be eligible for coverage under the COBRA continuation options for you and your spouse. You would also be eligible for coverage through the private Medicare Exchange, Via Benefits (refer to information in the RIT’s Group Health Insurance Plan summary). The pre-Medicare child can continue with the same coverage you had prior to retirement under an individual policy; if you have more than one child, they will each have an individual Dental Care Plan 11 3/2022 pre-Medicare policy. The pre-Medicare premium contribution is the full premium amount for individual coverage. The pre-Medicare child has the same enrollment rules as employees do.

If your LTD effective date is prior to January 1, 2019, coverage will continue while approved for LTD. Coverage under this plan will end when RIT’s LTD insurance company determines that you are no longer eligible for LTD if you were not eligible for retirement from RIT on your LTD effective date.

When your LTD ends and you were eligible for RIT retirement on your LTD effective date, you (if you are preMedicare) and your eligible pre-Medicare family members would be eligible to continue coverage under this plan while pre-Medicare under the retiree rules described above.

If your LTD effective date is in 2019 or after, coverage will continue while approved for LTD for up to two years from the LTD effective date while pre-Medicare. Coverage under this plan will end before two years has elapsed when RIT’s LTD insurance company determines that you are no longer eligible for LTD if you were not eligible for retirement from RIT on your LTD effective date.

When you reach the two year benefits continuation maximum and you were eligible for RIT retirement on your LTD effective date, you (if you are pre-Medicare) and your eligible pre-Medicare family members would be eligible to continue coverage while pre-Medicare under the retiree rules described above.

If your LTD ends before the two year benefit continuation maximum and you were eligible for RIT retirement on your LTD effective date, you (if you are pre-Medicare) and your eligible pre-Medicare family members would be eligible to continue coverage while pre-Medicare under the retiree rules described above.

If you die while employed at RIT and are retirement-eligible at the time of your death, RIT continues coverage for your pre-Medicare spouse/partner (who was your spouse or partner at the time of your death) and any eligible pre-Medicare child (who was your eligible child at the time of your death) at the appropriate level of coverage. For the first six months, RIT will subsidize the premium so your survivors are paying the same amount an employee would have paid for the same level of coverage. After the first six months, your survivors would pay the full premium for the coverage. Coverage for your surviving spouse/partner will end if he/she becomes married/partnered. Coverage for your surviving child will end when he/she no longer meets the Plan’s eligibility requirements. Once eligible for Medicare, your suvivors would be eligible for coverage under the COBRA continuation option as well as through the private Medicare Exchange, Via Benefits (refer to information in the RIT’s Group Health Insurance Plan summary). Contact information for Via Benefits will be provided to you by RIT Human Resources, or is available on our website. Survivors and COBRA participants have the same enrollment rules as employees do.

If you die while on RIT long-term disability (LTD) and you were retirement-eligible at the time your LTD was effective, RIT continues coverage for your pre-Medicare spouse/partner (who was your spouse or partner at the time of your death) and any eligible pre-Medicare child (who was your eligible child at the time of your death) at Dental Care Plan 12 3/2022 the appropriate level of coverage. For the first six months, RIT will subsidize the premium so your survivors are paying the same amount an employee would have paid for the same level of coverage. After the first six months, your survivors would pay the full premium for the coverage. Coverage for your surviving spouse/partner will end if he/she becomes married/partnered. Coverage for your surviving child will end when he/she no longer meets the Plan’s eligibility requirements. Once eligible for Medicare, your survivors would be eligible for coverage under the COBRA continuation option as well as through the private Medicare Exchange, Via Benefits (refer to information in the RIT’s Group Health Insurance Plan summary). Contact information for Via Benefits will be provided to you by RIT Human Resources, or is available on our website. Survivors and COBRA participants have the same enrollment rules as employees do.

If you are retired at the time of your death, RIT continues coverage for your pre-Medicare spouse/partner (who was your spouse or partner at the time of your retirement from RIT) and any eligible pre-Medicare child (who was your eligible child at the time of your retirement from RIT) at the appropriate level of coverage. They would continue to pay the full premium for the coverage. Coverage for your surviving spouse/partner will end if he/she becomes married/partnered. Coverage for your surviving child will end when he/she no longer meets the Plan’s eligibility requirements. Once eligible for Medicare, your survivors would be eligible for coverage under the COBRA continuation option as well as through the private Medicare Exchange, Via Benefits (refer to information in the RIT’s Group Health Insurance Plan summary). Contact information for Via Benefits will be provided to you by RIT Human Resources, or is available on our website. COBRA participants have the same enrollment rules as employees do.

The following rules are in effect for the death of an individual who was not retirement eligible:

If you die while employed at RIT and are not retirement eligible at the time of your death, your eligible family members will be offered continuation of coverage under COBRA. If COBRA is elected, RIT will subsidize the COBRA premium for the first six months so the survivor is paying the same amount the employee would have paid for the same level of coverage.

If you die while on RIT long-term disability (LTD) and were not retirement-eligible at the time your LTD was effective, your eligible family members will be offered continuation of coverage under COBRA. If COBRA is elected, RIT will subsidize the COBRA premium for the first six months so the survivor is paying the same amount the employee would have paid for the same level of coverage.

COBRA participants have the same enrollment rules as employees do. Refer to the section in this summary titled “When You are Eligible for COBRA.”

If you are retired, your dental coverage under this plan ends the last day of the month

• before Medicare coverage is effective. Medicare is generally effective the first day of the month in which you reach age 65, but if your birthday is on the first of the month, it will be the first of the prior month. When you become eligible for Medicare, you would be eligible for coverage under the private Medicare Exchange, Via Benefits (see information in this summary for Medicare-eligible individuals);
• you stop making required contributions;
• you die; or
• RIT discontinues the Plan.

If you are a long-term disability recipient under RIT’s LTD plan and your LTD effective date was before January 1, 2019, your dental coverage under this plan ends the earliest of

• the last day of the month in which your LTD benefits end and you are not retirement eligible;
• you stop making required contributions;
• you die; or
• RIT discontinues the Plan.

If you are a long-term disability recipient under RIT’s LTD plan and your LTD effective date was on or after January 1, 2019, your dental coverage under this plan ends the earliest of

• the last day of the month that is two years from the date your LTD became effective;
• the last day of the month in which your LTD benefits end and you are not retirement eligible;
• you stop making required contributions;
• you die;
• RIT discontinues the Plan.

If you are a surviving spouse/partner/child, your dental coverage under this plan ends the earliest of

• the last day of the month before Medicare coverage is effective;
• you stop making required contributions;
• you remarry/re-partner (for the spouse/partner);
• you reach the age limit of the plan (for a child);
• you die;
• RIT discontinues the Plan.

In certain circumstances, your coverage and that of your dependents may be continued beyond the date it normally would end. Coverage may continue as shown below, provided you make any required premium contributions.

• For a Disabled Child - Coverage for an unmarried child who is physically or mentally incapable of self support and who reached age 26 prior to 2019 may be continued beyond the age limit of the plan provided the disability occurred before that age and family coverage under this plan was in effect before the disability occurred. For a child reaching age 26 in 2019 or after, benefits will end the last day of the month in which the child reaches age 26.
• For a Personal Leave of Absence – Coverage may continue while on a personal leave of absence of up to four months. For personal leaves of absence beyond four months, coverage is not continued. Dental Care Plan 15 3/2022
• For a Professional Leave of Absence - Coverage is continued for up to two years while on an approved professional leave of absence, including a sabbatical. For professional leaves of absence beyond two years, coverage is not continued.

COBRA continuation coverage is a continuation of the coverage when coverage would otherwise end because of a life event known as a “qualifying event.” Specific qualifying events are listed later in this section. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your eligible 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.

If you are an employee, spouse, or eligible child, you will become a qualified beneficiary if an employee loses coverage. An eligible employee, covered spouse or covered eligible child are entitled to an additional 18 months of coverage under the Plan because one of the following qualifying events happen:

• You no longer meet the Plan’s eligibility requirements; this includes transfer to an employment category that is not eligible for coverage under the Plan;
• Your approved leave of absence ends (personal, professional, Family and Medical Leave Act, New York State Paid Family Leave) and you do not return to work; or
• Your approved leave of absence continues, but the maximum benefits continuation period is reached (i.e., coverage ends); or
• 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. You are entitled to an additional 36 months of coverage under the Plan because any of the following qualifying events happen:

• Your spouse dies;
• Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or
• You become divorced or legally separated from your spouse.

Your eligible children will become qualified beneficiaries if they lose coverage. They are entitled to an additional 36 months of coverage under the Plan because any of the following qualifying events happen:

• The parent-employee dies;
• The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both);
• The parents become divorced or legally separated; or
• The child stops being eligible for coverage under the Plan as an eligible child.

Note regarding domestic partners and their children: Under federal law, the domestic partner and/or children of a domestic partner are not considered qualified beneficiaries. However, RIT does extend continuing coverage to these individuals as though they were COBRA-eligible.

The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan’s COBRA Administrator has been notified that a qualifying event has occurred. The employer must notify the COBRA administrator of the following qualifying events:

• the end of employment or change in employment or benefits eligibility;
• death of the employee; or
• the employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both).

For all other qualifying events (divorce or legal separation of the employee and spouse or an eligible child’s losing eligibility for coverage as an eligible child), you must notify RIT Human Resources in writing within 60 days after the qualifying event occurs. The employee or family member can provide notice on behalf of themselves, as well as other family members affected by the qualifying event. Written notice of the qualifying event should be sent to RIT Human Resources, at the address provided at the end of this summary, and should include the following information:

• Request Date (month/day/year)
• Employee Name
• Employee ID Number
• Name of person losing coverage
• Relationship to employee
• Address for person losing coverage
• Reason for loss of coverage (additional documentation may be requested)
• Date coverage was lost (month/day/year)

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 on behalf of their children.

COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or the employee becoming ineligible for coverage. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage; these events include the death of the employee, the employee's becoming entitled to Medicare benefits (under Part A, Part B, or both), your divorce or legal separation, or an eligible child's losing eligibility as an eligible child.

There are also ways in which this 18-month period of COBRA continuation coverage can be extended.

Disability extension of 18-month period of continuation coverage

If you or anyone in your family covered under the Plan is determined by the Social Security Administration to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to receive up to an additional 11 months of COBRA continuation coverage, for a total maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of continuation coverage.

Second qualifying event extension of 18-month period of continuation coverage

If your family experiences another qualifying event during the 18 months of COBRA continuation coverage, the spouse and eligible children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if notice of the second qualifying event is properly given to the Plan. This extension may be available to the spouse and any eligible children receiving continuation coverage if the employee or former employee dies, becomes entitled to Medicare benefits (under Part A, Part B, or both), or gets divorced or legally separated, or if the eligible child stops being eligible under the Plan as an eligible child. This extension is only available if the second qualifying event would have caused the spouse or eligible child to lose coverage under the Plan had the first qualifying event not occurred.

Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov.

You do not have to show that you are insurable to choose COBRA continuation coverage. However, under the law, you may have to pay all or part of the premium for your continuation coverage. Your employer reserves the right to charge an additional 2% administration fee in addition to the regular premium.

For disability extensions up to 29 months if an individual is determined to be disabled (for Social Security disability purposes) Rochester Institute of Technology reserves the right to charge an additional 50% of the regular premium. There is a grace period of at least 30 days for payment of the regularly scheduled premium. The law also says, that at the end of the 18 month or 3 year continuation coverage period, you must be allowed to enroll in an individual conversion health plan provided under your insurance carrier.

Although monthly payments are due on the first day of each month of COBRA coverage, COBRA participants will be given a grace period of 30 days to make each monthly payment. COBRA coverage will be provided for each month as long as payment is made before the end of the grace period for that payment, but coverage is subject to being suspended as explained below.

If payment is made after the due date but before the end of the 30-day grace period for that month, health coverage may be suspended as of the first day of the month when payment was due. Coverage will be retroactively reinstated (going back to the first day of the month) when the payment for that month is received. Any claim(s) submitted for reimbursement while coverage is suspended may be denied and may have to be resubmitted once coverage is reinstated.

The law also provides that your continuation coverage may be terminated for any of the following five reasons:

1. Rochester Institute of Technology no longer provides group dental coverage to any of its employees;
2. The premium for your continuation coverage is not paid on time;
3. You become covered by another group plan, unless the plan contains any exclusions or limitations with respect to any pre-existing condition you or your covered dependents may have Rochester Institute of Technology must limit pre-existing exclusion period to no more than 12 months (18 for a late entrant)). A plan’s pre-existing conditions exclusion period will be reduced by each month that you and your family had continuous health coverage (including COBRA continuation coverage) with no break in coverage greater than 63 days. Please note that exclusions and limitations with respect to pre-existing condition requirements have been eliminated for children 19 years of age and under through the Patient Protection and Affordable Care Act (also known as Health Care Reform). Pre-existing conditions exclusions and limitations will no longer apply after 2014;
4. You become entitled to Medicare;
5. You extend coverage for up to 29 months due to your disability and there has been a final determination that you are no longer disabled.

Examine, without charge, at the Plan Administrator’s office and at other specified locations, such as other worksites, all documents governing the plan, including insurance contracts, 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 Benefit Security Administration.

Receive a summary of the plan’s annual financial report, if any. The Plan Administrator is required by law to furnish each participant with a copy of this summary annual report.

Continue health care coverage for yourself, spouse or eligible children if there is a loss of coverage under the plan as a result of a qualifying event. You or your dependents may have to pay for such coverage. Review this summary plan description and the documents governing the plan of the rules governing your COBRA continuation coverage rights.

You are entitled to a reduction or elimination of exclusionary periods of coverage for preexisting conditions under your group health plan, if you have creditable coverage from another plan. You should be provided a certificate of creditable coverage, free of charge, from your group health plan or health insurance issuer when you lose coverage under the plan, when you become entitled to elect COBRA continuation coverage, when your COBRA continuation coverage ceases, if you request it before losing coverage, or if you request it up to 24 months after losing coverage. Without evidence of creditable coverage, you may be subject to a preexisting condition exclusion for 12 months (18 months for late enrollees) after your enrollment date in your coverage.

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 or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a welfare benefit or exercising your rights under ERISA.

If your claim for a welfare benefit is denied or ignored, in whole or in part, you have 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, there are steps you can take to enforce the above rights. For instance, if you request a copy of plan documents or the latest annual report from the plan and do not receive them in 30 days, you may file suit in a Federal court. 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 administrator. If you have a claim for benefits which is denied or ignored, in whole or in part, you may file suit in a state or federal court. In addition, if you disagree with the plan’s decision or lack thereof concerning the qualified status of a domestic relations order or a medical child support order, you may file suit in 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 a federal court. 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.

If you have any questions about your Plan, you should contact the Plan Administrator. If you have any questions about this statement or about your rights under ERISA, or if you need assistance in obtaining documents from the Plan Administrator, you should contact the nearest office of the Employee Benefit 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 publication’s hotline of the Employee Benefits Security Administration.