Vision 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 fall open enrollment, effective January 1 of the following year. 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.
• Any other child who is under age 26, and
  • for whom the employee is the legal guardian or custodian, and
  • who resides in the employee’s home, and
  • 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 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, both pre-Medicare and Medicare-eligible, who meet the requirements described later in this summary.

• Retirees and spouse/partner/children
• LTD recipients and spouse/partner/children
• Surviving spouse/partner/children.

Eligibility for retirement from RIT is 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 vision coverage, you will not need to provide another copy of the verification document).
Generally, the approved documents are a marriage certificate for a spouse, 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 cancelled 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.

Vision Care Plan coverage is not automatic; you need to complete an enrollment form for coverage to take effect. On the form you indicate your election of vision care coverage, 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 dental coverage (e.g., you can have family medical and two person vision care).

Because vision coverage needs change from time to time, you have the opportunity once each year – effective as of January 1 - to make a change in your Vision Care Plan election. You can enroll in or cancel coverage or change your coverage level (e.g., change from individual to two person). Open enrollment changes are completed online through Oracle Employee Self-Service. If you do not make a change during an 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. You will find more details in the Mid-Year Benefits Enrollment Change Summary in the Other Resources section of the benefits website.

In general, once you have enrolled in the Plan, you cannot 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 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 a family contract to a single contract. 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.

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 medical plan

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).

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.
Changes in Coverage
If the coverage provided by the plan is significantly curtailed, you may revoke your prior election with regard to the plan.
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.

This is a voluntary plan, with the employee paying the full premium. The premium contribution is usually deducted on a pre-tax basis. However, 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. Your cost will be based on whether you choose individual, two person or family coverage. Eligible Retirees and Survivors are billed 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, 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 vision care 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 health 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.

Benefits are available under this plan if you receive services from a participating provider. You can find VSP providers on their website at www.vsp.com or by calling them at (800) 877-7195/v and (800) 428-4833/TTY Monday – Friday 8 a.m. to 10 p.m., Eastern Time. You can print a Member ID card from the VSP website.
You will not receive an ID card from VSP. And, when you go to a VSP provider, you simply let them know you are a VSP member and they will take care of the rest (no claim forms to file). The ID number will be your RIT University ID (UID) number.
If you or a covered family member receives coverage from a non-VSP provider, you should pay the provider’s full fee at the time of service and then submit an itemized bill to VSP for reimbursement according to the schedule of allowances. Discounts do not apply for vision care benefits obtained from non-VSP Providers, so your cost is likely to be higher if you receive services from a non-VSP Provider.
If you go to a VSP provider, the coverage is as follows:
Eye Exam: A routine eye exam is covered once per calendar year with a $15 copay. A diabetic eye exam has a $20 copay (see details below about the VSP Diabetic Eyecare Plus Program^SM.
Lenses: VSP’s standard lenses are covered in full, every calendar year, after a $20 copay, including glass or plastic single vision, bifocal, trifocal, progressive, or other more complex lenses necessary for the patient’s visual welfare. There is an additional cost for various coatings (e.g., anti-reflective, scratch, etc.), but VSP does provide a discount on these optional items.
Frames: $130 allowance toward frames, every calendar year. If you select a frame that costs more than $130, VSP offers a 20% discount off the amount over the retail allowance.
Contact Lenses: You may choose contacts instead of glasses (lenses and frame). There is a $130 allowance applied to the contact lens exam (fitting & evaluation) and the contact lenses. You also receive a 15% discount off the contact lens exam before the allowance is applied.

Some important notes:

• You can enroll in the RIT Vision Care Plan whether or not you have RIT medical coverage – they are two separate enrollments; you can have the Vision Care Plan without having RIT’s medical coverage;
• If you have RIT medical coverage, your coverage level under the RIT Vision Care Plan can be different (e.g., you can have family medical coverage and two person Vision Care coverage); this gives you flexibility if some family members don’t wear glasses. However, the employee needs to be covered under the Vision Care Plan in order to cover other family members.

The VSP Diabetic Eyecare Plus Program^SM provides coverage of additional eyecare services specifically for members with diabetic eye disease, glaucoma or age-related macular degeneration (AMD). Eligible members can receive both routine and follow-up medical eyecare from their VSP doctor—the doctor who already knows their eyes best. A summary of the coverage is as follows:

• The VSP Diabetic Eyecare Plus Program^SM provides coverage of additional eyecare services specifically for members with diabetic eye disease, glaucoma or AMD, including:
  • medical follow-up exams,
  • visual field and acuity tests,
  • specialized screenings and diagnostic tests,
  • diagnostic imaging of the retina and optic nerve,
  • retinal screening for eligible members with diabetes.
• The program also provides supplemental¹ coverage for non-surgical medical eye conditions such as diabetic retinopathy, abnormal blood vessel growth on the eye (rubeosis), and diabetic macular edema.
• Members can self-refer², visit their VSP Provider as often as needed, and pay only a copay for services.

_{1 The VSP Diabetic Eyecare Plus Program pays secondary to other medical eye insurance coverage.
2 Unless referral by a primary care physician is required by the health plan.}

Low Vision Services are a plan benefit when specific benefit criteria are satisfied and when prescribed by the covered person’s VSP Preferred Provider. Professional services for severe visual problems not correctable with regular lenses are covered as follows:
Supplemental Test: Covered in full*
Supplemental Aids: 75% of VSP Preferred Provider’s fee, up to $1,000*
_{*maximum benefit for all Low Vision services and materials is $1,000 every two (2) years and a maximum of two supplemental tests within a two-year period.}

Some brands of spectacle frames may be unavailable for purchase as Plan Benefits, or may be subject to additional limitations. You may obtain details regarding frame availability from the VSP Member Doctor or by calling VSP’s Customer Care Division at (800) 877-7195.
Patient Options
This Plan is designed to cover visual needs rather than cosmetic materials. If you or a covered family member selects any of the following extras, the Plan will pay the basic cost of the allowed lenses, and you will pay the additional costs for the options.

• Optional cosmetic processes
• Anti-reflective coating
• Color coating
• Mirror coating
• Scratch coating
• Cosmetic lenses
• Laminated lenses
• Oversize lenses
• Photochromic lenses, tinted lenses except Pink #1 and Pink #2
• UV (ultraviolet) protected lenses
• Certain limitations on low vision care

Not Covered
There are no benefits for professional services or materials connected with:

• Orthoptics or vision training and any associated supplemental testing
• Plano lenses (less than a ±.50 diopter power)
• Two pair of glasses in lieu of bifocals
• Replacement of lenses and frames furnished under this plan that are lost or broken, except at the normal intervals when services are otherwise available
• Replacement of lost or damaged contact lenses, except at the normal intervals when services are otherwise available.
• Medical or surgical treatment of the eyes
• Local, state and/or federal taxes, except where VSP is required by law to pay
• Services associated with Corneal Refractive Therapy (CRT) or Orthokeratology
• Corrective vision treatment of an experimental nature, unless approved by an external appeal agent
• Plano contact lenses to change eye color cosmetically
• Artistically-painted contact lenses
• Contact lens insurance policies or service contracts
• Additional office visits associated with contact lens pathology
• Contact lens modification, polishing, or cleaning
• Costs for services and/or materials above Plan Benefit allowances
• Services or materials of a cosmetic nature
• Services and/or materials not indicated on this Schedule as covered Plan Benefits

Liability in Event of Non-Payment
In the event VSP fails to pay a VSP preferred provider, you will not be held liable for any sums owed by VSP other than those not covered by the plan.

Eligibility for retirement from RIT is 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 for RIT’s Group Health Insurance Plan and the RIT Retiree-Only Health Reimbursement Arrangement Plan.
If you are eligible for RIT retirement, you and your eligible family members are eligible to continue coverage under the Vision Care Plan and you will pay the full premium for the coverage. Refer to the information earlier in this summary which describes eligible family members and cost sharing.

Regular full-time employees who are approved for long-term disability by RIT’s insurance company are eligible for vision care coverage under this plan as outlined below. Refer to the information earlier in this summary which describes eligible family members and cost sharing.
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 and your eligible family members would be eligible to continue coverage under this plan 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. 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 and your eligible family members would be eligible to continue coverage 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 and your eligible family members would be eligible to continue coverage under the retiree rules described above.

Coverage continuation for your eligible survivors is based on multiple factors and is described below.

Upon Your Death if You are Retired or an Employee or LTD Recipient Who is Eligible to Retire

If you are retired at the time of your death, RIT continues coverage for your spouse/partner (who was your spouse or partner at the time of your retirement from RIT) and any eligible child (who was your eligible child at the time of your retirement from RIT) at the appropriate level of coverage with the cost sharing rules in effect for retirees in your category. 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.
If you die while employed at RIT and are retirement-eligible at the time of your death, RIT continues coverage for your spouse/partner (who was your spouse or partner at the time of your death) and any eligible child (who was your eligible child at the time of your death) at the appropriate level of coverage with the cost sharing rules in effect for retirees in your category. 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.
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 spouse/partner (who was your spouse or partner at the time of your death) and any eligible child (who was your eligible child at the time of your death) at the appropriate level of coverage with the cost sharing rules in effect for retirees in your category. 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.

Upon Your Death if You are Not Eligible to Retire

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.
Refer to the section in this summary titled “When You are Eligible for COBRA.”

Cancelling Coverage for Non-Payment

RIT’s outside administrator, Lifetime Benefit Solutions (LBS), bills employees who are on an unpaid leave of absence or whose pay is too small to take payroll deductions, LTD recipients whose LTD payment is too small to take the deduction, and retirees/spouses/partners/survivors, for the applicable contributions.
There is a grace period before coverage is cancelled for non-payment. If LBS does not receive the full premium amount by the last day of the second month, coverage will be cancelled as of the last day of the second month. For example:

The first time coverage is cancelled for non-payment, there is a three-month waiting period before you can re-enroll in coverage; coverage will not be retroactive. Before you can re-enroll, you must pay the outstanding balance owed as well as the premium for the first month’s coverage. Payment must be with a cashier’s or bank check, electronic funds transfer (EFT) from your bank account, money order, or credit card.
If coverage is cancelled again for non-payment, there is a six-month waiting period before you can re-enroll in coverage; coverage will not be retroactive. Before you can re-enroll, you must pay the outstanding balance owed as well as the premium for the first month’s coverage. Payment must be with a cashier’s or bank check, electronic funds transfer (EFT) from your bank account, money order, or credit card.

Your employee vision care coverage under this plan ends the last day of the month in which

• Your employment ends*;
• You are an adjunct employee and you are not working for RIT;
• You are a less than 9-month employee and you are not working for RIT;
• Your employment ends under the RIT Severance Plan (coverage does not continue during the severance period, unless you elect coverage under COBRA);
• 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;
• You stop making required contributions;
• You die; or
• RIT discontinues the Plan.

* Special Note for 9-month faculty:

• Coverage will end on June 30 for a faculty member on a 9-month contract, provided that the faculty member works until the end of the contract period, and the contract is not being renewed for the following academic year;
• Coverage for a faculty member on a 9-month contract will continue during the summer between the two academic years, provided that the contract is being renewed for the following academic year.

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

• 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 vision care 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 vision care 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.

Generally, your dependent’s coverage ends when your coverage ends. However, a child’s coverage would also end on the last day of the month in which he or she no longer meets the Plan’s eligibility.

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

• 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.

If it is determined that you or an eligible family member has submitted a fraudulent claim or fraudulent proof of eligibility, or has intentionally misrepresented any facts under a medical, prescription drug, vision or dental plan, you and all your dependents will be permanently ineligible for coverage under the RIT Medical and Prescription Drug Plan, the RIT Retiree-Only Health Reimbursement Arrangement Plan, the RIT Vision Care Plan, and the RIT Dental Care Plan.

Coverage May Be Continued

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.
• 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.

The following page contains important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This information 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.

Learn More

Examine, without charge, at the Plan Administrator’s office and at other specified locations, such as other work-sites, 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 pre-existing 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.