SSMC Employee Health Benefit Plan
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2. Continue Group Health Plan Coverage. Continue health plan coverage for yourself and/or your
Dependents if there is a loss of coverage under the plan as a result of a qualifying event. You and your
Dependents may have to pay for such coverage. You are entitled to review this summary plan description
and the documents governing the plan on the rules governing your COBRA continuation coverage rights.
You are entitled to reduction or elimination of exclusionary periods for pre-existing 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 m ay be subject to pre-existing
exclusions for up to 12 months (up to 18 months for Late Entrants) after your enrollment date, as imposed
by a health plan.
3. Prudent Actions by Plan Fiduciaries. In addition to creating rights for plan participants, ERISA imposes
duties upon the people who are responsible for the operation of employee benefit plans. 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, your union, or any other
person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a
(pension, welfare) benefit, or exercising your rights under ERISA.
4. Enforce your Rights. If your claim for a (pension, welfare) benefit is denied or ignored, in whole or in
part, you have a 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 that may be taken to enforce these rights. For instance, if you request
materials from the plan and do not receive them within 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
$110.00 a day until you receive the materials, unless the materials were not sent due to circumstances
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.
5. Assistance With Your Questions. If you have any questions about the 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 Pension and Welfare Benefits Administration, U.S. Department of Labor listed in your telephone
directory or contact the Division of Technical Assistance and Inquiries, Pension and Welfare Benefits
Administration, U. S. Department of Labor, 200 Constitution Ave. N.W., Washington, D.C. 20210. You
may also call the Department of Labor Toll-Free Participant and Compliance Assistance Number at 1-866-
275-7922 for assistance with your questions and to request certain PWBA publications.
