SSMC Employee Health Benefit Plan
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c. You and/or your Dependent, or legal representative must provide, in writing, an assignment of
proceeds or a lien against such proceeds, in favor of the Plan in the amount of any benefits paid by
the Plan due to such Illness or Injury; such assignment to be valid against any judgment, settlement,
or recovery in any manner that is or will be received from such third party or such third party's
insurer or surety.
If you or your Dependent fail to tell this Plan that you or your Dependent has a claim against a third party; if
you or your Dependent fail to assign your claim against the third party to the Plan when required to do so (and
to cooperate with this Plan's subsequent recovery efforts); if you or your Dependent fail to require any
attorney subsequently retained to sign the Plan's lien forms; if you and/or your Dependent and/or authorized
representative or attorney fail to fully reimburse this Plan out of any payment obtained from the third party or
fail to fully reimburse the Plan, then you are personally liable to this Plan for the reimbursement owed this
Plan as the result of the third party payment or settlement. This Plan may then request reimbursement from
you and offset the amount you owe from any future benefit claims for any Covered Family Member or if
necessary, take legal action against you.
The Plan reserves the right to deny benefits for any charges that are or could be considered subject to the
Plan's right of subrogation in the case of failure by you and/or your Eligible Dependent or legal representative
to comply with the above conditions. The conditions shown above will not apply to benefits paid under
Medicare supplementary coverage nor to any payments made under any insurance policy, plan or certificate
issued to you or your Eligible Dependents.
H. Amendments or Cancellation of the Plan
The Plan Sponsor/Administrator intends to maintain this Plan indefinitely. However, in its sole discretion,
reserves the right to amend, reduce, revise or cancel any or all of the benefits, limitations, provisions,
inclusions or exclusions of the Plan. If the Plan cancels, coverage will end for all persons enrolled under the
Plan. Notice of Plan changes will be provided to the Plan participants within a reasonable time, but no later
than 90 days (60 days if change is a benefit reduction) after changes are effective.
I. Construction of Plan and Determination by Plan Administrator
The Plan Administrator, to the fullest extent allowed by law, shall have the discretion to determine all matters
relating to eligibility, coverage or benefits under the Plan and to determine all matters relating to the
interpretation and operation of the Plan. Any such determination, construction or judgment adopted by the
Plan Administrator in good faith shall be final and binding on all parties hereto and any Covered Persons
under the Plan. No decision of the Plan Administrator shall be reversed or overturned unless determined to
be arbitrary and capricious.
J. Named Fiduciary and Plan Administrator
A fiduciary is a person or entity that exercises discretionary authority or control over management of the Plan
or the disposition of its assets, renders advise to the Plan or has discretionary authority or responsibility in the
administration of the Plan. The named fiduciary for the Plan is the Plan Administrator, Sound Shore Medical
Center. The Plan Administrator may appoint others to carry out fiduciary responsibilities under the Plan.
These other persons or entities become fiduciaries themselves and are responsible for their acts under the Plan.
To the extent that the named fiduciary allocates its responsibility to others, the named fiduciary shall not be
liable for any act or omission of such person or entity unless either the named fiduciary has violated its stated
duties under ERISA in appointing the fiduciary; establishing the procedures to appoint the fiduciary or
continuing either appointment of the procedures; or the named fiduciary breached its fiduciary responsibility
under Section 405 (a) of ERISA. The agent for service of legal process is the human resources manager of
SSMC or any officer of SSMC at 16 Guion Place; New Rochelle, NY 10802.
