The College of Wooster (the “Employer”) established The College of Wooster Health and Welfare Benefit Plan (the “Plan”) effective January 1, 2023. This summary is effective January 1, 2025, and describes the Plan and together with the incorporated documents, describes the benefits offered under the Plan (the “Included Benefits”).
This Summary Plan Description supersedes all previous Summary Plan Descriptions. Although the purpose of this document is to summarize the more significant provisions of the Plan, the Plan document and Included Benefit Documents will prevail in the event of any inconsistency.
1. The Plan’s name is The College of Wooster Health and Welfare Benefit Plan.
The Plan’s number is 510.
The Plan Year End is the 12-month period ending on December 31.
The Plan is an “employee welfare benefit plan” for purposes of ERISA that includes a group medical plan, a group dental plan, a group vision plan, a disability plan, a group life insurance plan, a health flexible spending account, a voluntary life insurance plan, a voluntary accidental death and disability insurance plan, and an employee assistance program.
2. The Plan Sponsor is the Employer.
1101 Bever Street
Wooster, Ohio 44691
Phone: 330-263-2000
Email: jenwilliams@wooster.com
Employer Identification Number: 34-0714654
3. The Plan Administrator is the Employer.
1101 Bever Street
Wooster, Ohio 44691
Phone: 330-263-2000
Email: jenwilliams@wooster.com
4. The agent for legal service is the Plan Administrator.
1101 Bever Street
Wooster, Ohio 44691
Phone: 330-263-2000
Service of legal process may also be made upon the Plan Administrator.
5. The Plan is not funded by a trust.
6. Funding
Certain benefits under the Plan, such as the medical and prescription drug benefits and the health flexible spending account benefits, are self-funded. Other benefits are provided through insurance contracts.
The cost of benefits offered under the Plan is either covered by contributions from the Company, contributions by you, or will be shared by you and the Company. Where you and the Company share the cost of coverage, the Company will contribute the difference between your contributions and the amount required to pay benefits under the Plan.
Any dividends, retroactive rate adjustments, rebates, or other refunds of any type that may become payable under any Included Benefit or in connection with an Included Benefit do not become assets of the Plan but are the property of, and will be retained by, the Company unless otherwise mandated by law.
7. The COBRA contact is the Plan Sponsor.
1101 Bever Street
Wooster, Ohio 44691
Phone: 330-263-2000
Subject to Plan and Company policies and procedures, you are eligible for medical benefits under the Plan if you are regularly scheduled to work at least 20 hours per week, except that if this eligibility provision would conflict with an eligibility provision in the Included Benefit Documents, then the Included Benefit Documents will prevail.
Your eligibility for participation and for other benefits under the Plan is described in the documents summarizing the Included Benefits. These documents are available from the Plan Administrator.
The Plan has a specific and first right of reimbursement from any payment, amount, or recovery you receive from a third party relating to expenses covered by the Plan. By accepting the benefits of the Plan, you agree to these rights of the Plan, which are described in the Plan document. Below is a summary of these rights. If the reimbursement provisions in this “Payments from Third Parties” provisions conflict with subrogation, right of recovery, or reimbursement provisions in an insurance contract or other document governing the Included Benefit at issue, the provisions in the other document will govern.
The Plan’s share of the recovery will not be reduced because the full damages or expenses claimed have not been reimbursed unless the Plan agrees in writing to the reduction. Further, the Plan’s right to reimbursement will not be affected or reduced by any equitable defenses that may affect the Plan’s right to reimbursement.
The Plan may enforce its rights by requiring you to assert a claim to any of the benefits to which you may be entitled. The Plan will not pay your attorneys’ fees or costs associated with the claim or lawsuit without express written authorization from the Company.
If the Plan should become aware that a Participant has received a third-party payment, amount or recovery and not reported such amount, the Plan, in its sole discretion, may suspend all further benefits payments related to the Participant and any covered dependents until the reimbursable portion is returned to the Plan or offset against amounts that would otherwise be paid to or on behalf of the Participant.
By participating in the Plan, you consent and agree:
- that a constructive trust, lien or an equitable lien by agreement in favor of the Plan exists with regard to any settlement or recovery from a third person or party.
- to cooperate with the Plan in reimbursing the Plan for costs and expenses.
- to notify the Plan if you have any reason to believe that the Plan may be entitled to recovery from any third party and to sign an agreement that confirms the prior acceptance of the Plan’s subrogation rights and the Plan’s right to be reimbursed for expenses arising from circumstances that entitle you payment, amount or recovery from a third party.
- to not assign your rights to settlement or recovery against a third person or party to any other party, including your attorney(s), without the Plan’s consent.
If you fail or refuse to execute the required agreement, the Plan may deny payment of any benefits until the agreement is signed. Alternatively, if you fail or refuse to execute the required agreement and the Plan nevertheless pays benefits to you, your acceptance of such benefits shall constitute agreement to the Plan’s right to subrogation or reimbursement.
The Plan’s reimbursement will not be reduced by attorneys’ fees and expenses without express written authorization from the Plan.
These rights apply even after you are no longer a Participant in the Plan. The Plan Administrator has the authority and discretion to resolve all disputes regarding the Plan’s subrogation and reimbursement rights and to make determinations with respect to the subrogation amounts and reimbursements owed to the Plan.
CONTINUATION RIGHTS/COBRA NOTICE
The right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan, was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end. For more information about your rights and obligations under the Plan and under federal law, you should review, the documents describing the Included Benefits, this Summary Plan Description, or contact the Plan Administrator.
If you are participating in an Included Benefit subject to COBRA and the Company is not a small employer, then COBRA applies. A “small employer” is generally an employer that employs fewer than 20 employees, but you should contact the Plan Administrator who can inform you if the Company is a small employer not subject to COBRA and is not required to comply with these rules.
For health flexible spending accounts only – You, your spouse, and/or your dependent child(ren) generally do not have the right to elect COBRA continuation coverage if the cost of COBRA continuation coverage for the remainder of the Plan Year equals or exceeds the amount of reimbursement you have available under the Plan for the remainder of the Plan Year. You will be provided notice of your right to elect COBRA continuation coverage.
Should you become eligible for COBRA, you may also become eligible for other coverage options that may cost less than COBRA continuation coverage. You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees.
Except as set forth in an Included Benefit document, the following shall apply only to the Included Benefits subject to COBRA:
You have the right to continue your coverage under the Plan if any of the following events results in your loss of coverage under the Plan:
- termination of employment for any reason other than gross misconduct
- reduction in your hours of employment
Your spouse and dependent children (including children born to you or placed for adoption with you) have the right to continue coverage under the Plan if any of the following events results in their loss of coverage under the Plan:
- termination of your employment for any reason other than gross misconduct
- reduction in your hours of employment
- you become enrolled in Medicare
- you and your spouse divorce or are legally separated
- your death
- your dependent ceases to be a “dependent child” for purposes of COBRA
Persons entitled to continue coverage under COBRA are “Qualified Beneficiaries.”
You may continue the level of coverage you had in effect immediately preceding the Qualifying Event. However, if Plan benefits are modified for similarly situated active employees, then they will be modified for you and other Qualified Beneficiaries as well. You will be eligible to make a change in your benefit election with respect to the Plan upon the occurrence of any event that permits a similarly situated active employee to make a benefit election change during a Plan Year.
You, your spouse, or your dependent child(ren) must notify the Plan Administrator or its delegate in writing of a divorce, legal separation, or a child losing dependent status under the Plan within 60 days after the later of (1) the date of the Qualifying Event or (2) the date on which coverage is lost under the Plan because of the event. After receiving notice of a Qualifying Event, the Plan Administrator will provide Qualifying Beneficiaries with an election notice, which describes the right to COBRA continuation coverage and how to make an election. Notice to your spouse is deemed notice to your covered dependents that reside with the spouse.
You or your dependent(s) are responsible for notifying the Plan Administrator or its delegate if you or your dependent(s) become covered under another group health plan or entitled to Medicare.
Election Procedures and Deadlines
A Qualified Beneficiary may make an election for COBRA continuation coverage if he or she is not covered under the Plan as a result of another Qualified Beneficiary’s COBRA continuation election. To elect COBRA continuation coverage, you must complete the applicable election form within 60 days from the later of (1) the date the election notice was provided to you or (2) the date that the Qualified Beneficiary would otherwise lose coverage under the Plan due to the Qualifying Event and submit it to the Plan Administrator or its delegate. If the Qualified Beneficiary does not return the election form within the 60-day period, it will be considered a waiver of his or her COBRA continuation coverage rights.
Cost of COBRA Continuation Coverage
The cost of COBRA continuation coverage will not exceed 102% of the applicable premium for the period of continuation coverage.
When Continuation Coverage Ends
You may be able to continue coverage under the Plan until the end of the Plan Year (or 18 months, please contact the COBRA contact for further information on the length of COBRA coverage) in which the Qualifying Event occurs. However, COBRA continuation coverage may end earlier for any of the following reasons:
- You fail to make a required COBRA continuation coverage contribution;
- The date that you first become covered under another Plan;
- The date that you first become entitled to Medicare; or
- The date the Employer no longer provides a Plan to any of its employees.
The Company intends to continue the Plan indefinitely, but reserves the right to amend or terminate the Plan or an Included Benefit, in whole or in part, at any time and for any reason. No participant or beneficiary has a vested right in or to any future Plan benefits.
INCLUDED BENEFIT DOCUMENTS INCORPORATED BY REFERENCE
This Plan incorporates the terms of all welfare benefit plans subject to ERISA sponsored by Employer and any affiliate who has adopted the Plan (“Included Benefits”). Certain documents describing these Included Benefits include information about eligibility, benefits, and employee/employer contributions for each of the separate Included Benefits, which are incorporated by reference into this Summary Plan Description. These documents may include summary plan descriptions for the Included Benefits, as well as summary benefit booklets, certificates of coverage, enrollment materials, etc. These documents, together with this document, constitute the entire Summary Plan Description for the Plan.
You must immediately repay any excess payments/reimbursements. You must reimburse the Company for any liability the Company may incur for making such payments, including but not limited to, failure to withhold or pay payroll or withholding taxes from such payments or reimbursements. If you fail to timely repay an excess amount and/or make adequate indemnification, the Plan Administrator may: (i) to the extent permitted by applicable law, offset your salary or wages, and/or (ii) offset other benefits payable under this Plan.
If you serve in the United States Armed Forces and must miss work as a result of such service, you may be eligible to continue to receive benefits with respect to any qualified military service.
As a participant, you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA). This federal law provides that you have the right to:
- Examine, without charge, at the Plan Administrator’s office and at other specified locations, such as worksites and union halls, all documents governing the Plan, including insurance contracts and 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 Benefits Security Administration.
- Obtain, upon written request to the Plan Administrator, copies of documents governing the operation of the Plan, including insurance contracts and collective bargaining agreements, and copies of the latest annual report (Form 5500 Series) and updated summary plan description. The Plan Administrator may make a reasonable charge for the copies.
- Receive a summary of the Plan’s annual financial report. 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 dependents 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 on the rules governing your COBRA continuation coverage rights.
In addition to creating rights for plan participants, ERISA imposes duties upon the people who are responsible for the operation of the Plan. The people who operate the 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 your benefits or exercising your rights under ERISA.
If your claim for a 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 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 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 a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the Plan 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 medical child support order, you may file suit in Federal court. If it should happen that 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 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 Employee Benefits 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 publications hotline of the Employee Benefits Security Administration.
QUALIFIED MEDICAL CHILD SUPPORT ORDERS
In certain circumstances you may be able to enroll a child in the Plan if the Plan receives a Qualified Medical Child Support Order (QMCSO). You may obtain a copy of the QMCSO procedures from the Plan Administrator, free of charge.
WOMEN’S HEALTH AND CANCER RIGHTS ACT
To the extent required by the Women’s Health and Cancer Rights Act (WHCRA) of 1998, this Plan provides coverage for all stages of reconstruction of the breast on which the mastectomy has been performed, surgery and reconstruction of the other breast to produce a symmetrical appearance, and prostheses and physical complications of mastectomy, including lymphedemas, in a manner determined in consultation with the attending physician and the patient.
Such coverage may be subject to annual deductibles and coinsurance provisions as may be deemed appropriate and are consistent with those established for other benefits under the Plan or coverage. Written notice of the availability of such coverage shall be delivered to Participants upon enrollment and annually thereafter. Contact the Plan Administrator for more information.
NEWBORNS’ AND MOTHERS’ HEALTH PROTECTION ACT
Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).
You may lose all or part of any payment due to you if we cannot locate you when your benefit becomes payable to you.
You may not alienate, anticipate, commute, pledge, encumber, or assign any of the benefits or payments which you may expect to receive, contingently or otherwise, under the Plan, except that you may designate a Beneficiary as permitted under any Included Benefit.
The Plan Administrator has the authority to make factual determinations, to construe and interpret the provisions of the Plan, to correct defects and resolve ambiguities in the Plan and to supply omissions to the Plan. Any construction, interpretation, or application of the Plan by the Plan Administrator is final, conclusive, and binding on all parties.
The Medical and Prescription Drug Plan for Employees of the College of Wooster:
- Anthem PPO Plan Benefits
- Anthem HDHP Plan Benefits
- ESI/RxBenefits Prescription Drug Benefits
- Group Insurance Plan for Employees of the College of Wooster
The College Of Wooster Dental Plan
Long-Term Disability for Faculty and Administrative Staff at the College Of Wooster
The College of Wooster Section 125 Flexible Benefit Plan
The College Of Wooster Vision Plan
Accidental Death and Dismemberment Plan for the Employees of the College Of Wooster
Voluntary Life Insurance Plan for Employees of the College of Wooster
The College of Wooster Employee Assistance Plan