SSMC Employee Health Benefit Plan
1
INTRODUCTION
Sound Shore Medical Center of Westchester (also shown herein as SSMC) is pleased to give you a copy of the
Summary Plan Description for the SSMC Health Benefits Plan (also shown herein as Plan). This Plan provides
health expense benefits for eligible Employees and their Eligible Dependents. You should read this Summary
Plan Description (also shown herein as SPD) carefully to acquaint yourself with its provisions for eligibility,
coverage, filing a claim and other important information. Retirees are not eligible for benefits under this
Plan. Retiree coverage is provided separately under the SSMC Retiree Health Benefits Plan.
Plan Identification
Plan Name:
SSMC Employee Health Benefits Plan
Plan Administrator:
Sound Shore Medical Center of Westchester, 16 Guion Place, New Rochelle,
NY 10802, Tel.: (914) 632-5000
Plan Sponsor:
Sound Shore Medical Center of Westchester, 16 Guion Place, New Rochelle,
NY 10802, Tel.: (914) 632-5000
Administrative Manager:
The human resources manager of Sound Shore Medical Center of
Westchester, 16 Guion Place, New Rochelle, NY 10802, Tel.: (914) 632-
5000
Named Fiduciary:
The Plan Administrator, Sound Shore Medical Center of Westchester
Service of Legal Process:
Agent for Service of legal process is the Administrative Manager or any
officer of Sound Shore Medical Center of Westchester, 16 Guion Place, New
Rochelle, NY 10802, Tel.: (914) 632-5000
Plan Number:
502
Tax ID Number:
13-1740117
Plan Effective Date:
July 15, 1994
Plan Restatement Date:
January 1, 2003
Plan Year:
Twelve consecutive months beginning January 1 and ending December 31
Type of Plan:
This is a self-funded health plan providing benefits for covered medical and
dental expenses. Health benefits are provided from the general assets of the
Plan Sponsor, SSMC.
Claims Administrators:
Medical/Dental:
POMCO, 2425 James Street, P.O. Box 6329, Syracuse, New York 13217-
6329; Tel.: toll-free: 1-800-501-9536
Drugs:
Eckerd Health Services, 620 Epsilon Drive, Pittsburgh, PA 15238-2845, Tel.:
toll-free 1-888-645-9303
Please Note
The pronoun "you or your" means an eligible and enrolled Employee of SSMC. It also means a COBRA participant
whose social security number is used for Plan enrollment. Terms throughout this SPD have been capitalized and are
defined in Section X - Definitions to help you understand your Plan coverage and benefits. This SPD updates and
replaces previous publications showing coverage for the self-funded Plan formerly known as New Rochelle Hospital
Medical Center PHO Union-free Employee Health Benefit Plan and the Plan formerly known as New Rochelle Hospital
Medical Center Employee Benefit Plan. It is a restatement of Plan benefits showing provisions and benefits in effect as of
January 1, 2003.
This SPD is written in the English language to show your rights and coverage under this Plan. If you have any
difficulty understanding any part of this SPD, contact the SSMC Human Resources Department for assistance
and interpretation. You may phone the SSMC Human Resources Department at their local phone number (914)
632-5000 on normal business days between 9:00 A.M. and 5:00 P.M. (ET). You may also contact the Claim
Administrator (POMCO) for assistance by phoning their local number toll-free number 1-800-501-9536
Monday through Friday, during normal work hours from 8:00 A.M. to 4:30 P.M. (ET).
