This Summary Plan Description describes the life insurance coverage available under the Franklin & Marshall College Group Insurance Plan and Flexible Spending Account (life insurance coverage is described herein as the "Group Life Insurance Plan" or the "Plan"), effective as of July 1, 2013. This is not part of your Certificate of Insurance. It is required by The Employee Retirement Income Security Act (ERISA) of 1974, as amended. The purpose of this Summary Plan Description is to acquaint employees, including retired College employees, with the provisions of the Plan, the way in which it is administered, and participants' rights under the federal law which applies to employee benefit plans. The Plan is established for the benefit of employees and their beneficiaries, and is administered impartially for the benefit of all eligible participants.
The insurer's Certificate of Insurance, which is provided at no cost to any participant or beneficiary, should be carefully read for specific policy provisions, eligibility requirements, and exclusions. Please contact the Plan Administrator, via the Franklin & Marshall Human Resources Office, for a copy of the Certificate of Insurance. The Certificate of Insurance includes important additional details about Plan benefits, limits, and exclusions, and should be carefully read by each participant.
Facts About the Plan
Plan Name: Franklin & Marshall College Group Insurance Plan and Flexible Spending Account
Plan Number: 501 - Plan 501 also includes the Shared Services Group Health Plan, the Franklin & Marshall College Group Dental Plan, and the Franklin & Marshall College Flexible Spending Accounts Plan which are each described in a separate Summary Plan Description.
Name, Address, and Telephone Number of Employer/Sponsor: Franklin & Marshall College, Lancaster, PA 17604-3003, (717) 291-3995. Employer shall also include the Lancaster City Alliance, EIN 71-0927742 (effective February 25, 2003).
Plan Sponsor's Employer Identification Number: 23-1352635
Plan Year: January 1 through December 31
Type of Plan: Welfare Plan (Group Term Life Insurance)
Plan Administrator: Franklin & Marshall College, P.O. Box 3003, Lancaster, PA, 17604.
Life Insurance Plan Benefits Provided By: CIGNA Group Insurance / Life Insurance Company of North America, 1777 Sentry Park West, Gwynedd Hall, Suite 100, Blue Bell, PA 19422, (215) 283-3947.
Plan Costs: Paid by Franklin & Marshall College
Agent for Service of Legal Process: Same as Plan Administrator
Funding: Premiums for group term life insurance coverage are paid by Franklin & Marshall College, through general employer assets.
Benefits are provided as listed in the Certificate of Insurance. A copy of the Certificate of Insurance, including the Schedule of Benefits, is available to each participating College employee upon enrollment in the Plan. Additional copies are available to any participant or beneficiary, at no charge, from Franklin & Marshall College, Human Resources, P.O. Box 3003, Lancaster, PA 17604-3003, (717) 291-3995. The Certificate of Insurance includes important details about benefits, including coverage levels, exclusions, and claims procedures. Plan participants are strongly encouraged to read their Certificate of Insurance.
Basic Term Life Insurance Coverage
An eligible, active College employee in coverage class 1 (see below) receives term life insurance coverage through this Plan equal to one and one-half (1.5) times his/her actual base annual salary, rounded to the nearest multiple of $1,000, up to a maximum life insurance coverage amount of $100,000. For coverage class 2, the coverage level is equal to one and one-half (1.5) times his/her actual base annual salary, rounded to the nearest multiple of $1,000, up to a maximum life insurance coverage amount of $400,000.
Effective on and after July 1, 2010, an active employee's and Officer’s term life insurance coverage and Accidental Death & Dismemberment coverage will reduce by fifty percent (50%) at age 75.
For coverage class 3, the coverage level equals twenty five percent (25%) of the retired College employee's life insurance coverage amount in effect the day prior to retirement or the day prior to the 50% age reduction, whichever is greater, up to a maximum of $18,750.
For class 4, the coverage level equals twenty five percent (25%) of the life insurance coverage amount in effect the day prior to retirement or the day prior to the 50% reduction at age 75, whichever is greater, up to a maximum of $25,000.
For coverage class 5, the coverage level equals the greater of twenty five percent (25%) of: the life insurance coverage amount in effect the day prior to retirement; what the life insurance coverage amount would have been the day prior to retirement if not reduced due to participation in the Phased Retirement Program or other similar approved program for faculty; or the coverage amount in effect the day prior to the 50% reduction at age 75 or older, up to a maximum of $25,000.
Base annual salary on which life insurance coverage is calculated excludes the following types of pay:
(a) employer contributions under the Retirement Plan or any other qualified plan of the College,
(b) the amount or value of any other fringe benefits (whether or not taxable) provided by the College,
(c) bonuses; shift differential payments; compensation paid for hours worked beyond regularly scheduled hours irrespective of whether it is paid as overtime; overtime pay; and other forms of additional remuneration,
(d) faculty summer pay; pay for teaching additional or night classes; faculty stipends and grants; and additional pay for acting as chair of a department,
(e) stipends/ wages provided for serving as a part-time athletic coach; pay for conducting a summer sports, recreation, and/or educational camp,
(f) the value of any housing and/or meals provided by the College, regardless of whether it is treated as taxable income,
(g) reimbursements, payment or stipends for the usage of automobiles, including mileage allowances, and
(h) the value of any accrued vacation benefit that, under the College's standard vacation policies, is paid to an eligible employee.
The value of a participant's term life insurance coverage, and the Accidental Death & Dismemberment benefit, will fluctuate (reduce or increase) as an employee's actual annual salary reduces or increases. A participant whose base salary reduces due to a reduction in work hours, sabbatical or leave of absence, change in job, or other circumstance will experience a reduction in his/her life insurance and AD&D coverage under this Plan.
The insurer will pay the basic term life insurance amount to the participant's beneficiary(ies) upon the death of a Plan participant and acceptance by the insurer of the claim for benefits, based on provisions outlined in the Certificate of Insurance.
The insurer may require evidence of insurability for coverage amounts in excess of $100,000 provided to those in coverage class 2.
Accidental Death & Dismemberment Benefit
If a Plan participant's death is the result of a covered accident, as defined in the Certificate of Insurance, an Accidental Death & Dismemberment (AD&D) benefit will be paid to the participant's beneficiary(ies), in addition to the basic term life insurance benefit. The AD&D benefit is equal to one and one-half (1.5) times the Plan participant's actual base annual salary as defined above, rounded to the nearest multiple of $1,000, up to a maximum of $100,000. For coverage class 2, coverage is as listed in the Certificate of Insurance.
Effective on and after July 1, 2010, an active employee's term life insurance coverage and Accidental Death & Dismemberment coverage will reduce by fifty percent (50%) at age 75.
Retired College employees (coverage classes 3, 4, and 5) are not eligible for the AD&D benefit.
Accelerated Death Benefit
The group insurance policy currently in effect offers an accelerated benefit to eligible Plan participants, under certain circumstances as outlined in the Certificate of Insurance.
Eligibility and Enrollment
The following classes are eligible for coverage through this Group Life Insurance Plan:
· full-time, actively employed faculty and professional staff employees: Franklin & Marshall College employees who are scheduled to work at least 30 hours per week for wages on a regular basis, including visiting, tenured, non-tenured, and tenure-track faculty; full-time employees of the Lancaster City Alliance; the current, actively employed Spectrometer Technician; and full-time employees of the Centennial Conference who: (1) are regularly scheduled to work on the Franklin & Marshall College campus and (2) are paid through the College's payroll system, as long as otherwise eligible
· full-time faculty and professional staff employees who are scheduled to work at least 30 hours per week for wages on an approved 9, 10, or 11 month per year appointment
· faculty on an approved joint appointment: one full-time position shared by two College faculty members each working at least 1040 hours annually
· full-time faculty working a reduced schedule under an approved Phased Retirement Agreement or Pre-retirement Leave of Absence Program
· full-time faculty on an approved paid sabbatical, paid Junior Faculty Leave, or approved, unpaid research leave of absence of up to 12 months
· full-time faculty and professional staff employees on an approved paid or unpaid Family & Medical Leave as provided for in the Family & Medical Leave Act, or other approved paid leave of absence of up to 12 months which provides for continued coverage, per policies of the College and of the insurer as outlined in the Certificate of Insurance
· all College Senior Officers regularly working at least 30 hours per week, including: College President; Provost and Dean of the Faculty; vice presidents; Dean of the College; and Chief of Staff
· Retired employees who retired prior to May 1, 1999: full-time College employees who, on the date active employment was terminated, were at least 60 years of age and had completed at least 10 consecutive years of full-time employment with Franklin & Marshall College in a benefits-eligible class after the age of 50, and who retired prior to May 1, 1999
· Retired employees who retired on or after May 1, 1999: former full-time employees, including former Officers, former employees of the Higher Education Data Sharing Consortium, and former employees of the Lancaster City Alliance, who did not participate in the Phased Retirement Program or similar approved College program for faculty while employed, are eligible for term life insurance coverage during retirement if they meet the following requirements:
a) If age 55 or older by December 31, 2012, and employed by Franklin & Marshall in a full-time, benefits-eligible position as of December 31, 2012: Upon termination of employment, have completed at least 10 consecutive years of full-time employment after age 50 (at least age 60 upon employment termination).
b) If age 50 through 54 by December 31, 2012, and employed by Franklin & Marshall in a full-time, benefits-eligible position as of December 31, 2012: Upon termination of employment, have completed at least 15 continuous years of full-time employment with Franklin & Marshall after age 40 (at least age 55), or 10 consecutive years of full-time employment after age 50 (at least age 60), whichever comes first.
c) If under age 50 as of December 31, 2012, and employed by Franklin & Marshall in a full-time, benefits-eligible position as of December 31, 2012, or hired by Franklin & Marshall in a full-time, benefits-eligible position after December 31, 2012, regardless of age: Upon termination of employment, have completed at least 15 continuous years of full-time employment with Franklin & Marshall College after age 40 (at least age 55 when employment terminates).
· Retired members of the faculty who retired on or after May 1, 1999, and who participated in the Phased Retirement Program or similar approved College program for faculty. The age and service requirements above which apply to Class 4 also apply to Class 5.
Independent contractors, contracted employees, adjunct faculty, individuals who volunteer their services without compensation, students, and student employees are not eligible for coverage through the Plan.
Full-time College employees are eligible for life insurance coverage effective the first day of appointment to a full-time position in an eligible class. An active employee who is a member of an eligible class as described above must complete an enrollment form and elect, in writing, a beneficiary(ies) upon appointment to a regular full-time position. Eligible employees must obtain enrollment and beneficiary forms through the Plan Administrator (via the Human Resources office). Coverage is effective on the first day of employment in an eligible class.
Applying for Benefits
To apply for life insurance death benefits through this Plan, a representative for the deceased Plan participant must notify the Plan Administrator (via the Human Resources office) of the death and provide an original death certificate to the Plan Administrator. The application and death certificate will then be submitted by the Plan Administrator to the insurance carrier who will determine eligibility for benefits.
Continuation of Life Insurance Coverage during Total Disability
Basic term life insurance coverage through this Plan will continue during an approved long-term disability period, as outlined in the Certificate of Insurance, if:
(1) the College employee is eligible for group life insurance coverage through this Plan prior to when total disability begins,
(2) the employee is under age 60 when total disability begins,
(3) the period of total disability lasts for at least 180 consecutive days / the 6 month waiting period is satisfied,
(4) the disabled employee provides acceptable proof of disability to the life insurance carrier, and
(5) the life insurance carrier approves the application for continuation of life insurance coverage. This provision does not apply to Accidental Death & Dismemberment benefits. If approved, the life insurance benefit is provided until age 65. Retired employees are not eligible for this provision.
Termination of Coverage
Group life insurance coverage under this Plan will be discontinued as of the last actual working day prior to:
1) termination of employment, except an eligible retirement,
2) commencement of an unpaid leave of absence, except an approved Family & Medical Leave or approved faculty research leave,
3) a change from full-time employment status to part-time status, or
4) any other change in status that leads to loss of eligibility under the group policy
Coverage will also end if Franklin & Marshall College fails to pay the required premium or terminates the Plan.
If life insurance coverage through the group insurance policy terminates or is reduced due to employment termination, including a personal, unpaid leave of absence or retirement, or change in employment status causing an employee to no longer be a member of an eligible class, the employee/former employee may apply for an individual life insurance policy, in accordance with the group policy conversion privilege outlined in the insurer's Certificate of Insurance. Upon termination of group life insurance coverage, or a reduction in coverage, an employee / former employee interested in this conversion privilege must apply in writing to the group life insurance carrier, as outlined in the Certificate of Insurance, and pay the required premium, within 31 calendar days of loss of group coverage.
Life Insurance Coverage During Retirement
A Franklin & Marshall employee who, when active employment terminates, has completed at least 10 consecutive full years of full-time employment with the College after the age of 50 and is at least age 60, is eligible for basic term life insurance coverage upon retirement. At retirement, a participant's term life insurance coverage will equal twenty-five percent (25%) of the basic term life insurance coverage in effect the day prior to retirement, except as noted above in the “Plan Benefits” section. The maximum life insurance coverage during retirement will be $18,750 for retired participants in coverage Class 3 (those who retired prior to May 1, 1999), and $25,000 for retired participants in coverage Class 4 and Class 5 (those who retired on or after May 1, 1999). Coverage is not subject to further reductions during retirement. Retired participants do not retain Accidental Death & Dismemberment coverage.
Benefit Denials and Claims Procedures
Benefit Denials-- The Plan's procedures for filing claims, making benefit determinations, and reviewing appeals of denied claims are available to Plan participants and beneficiaries, at no cost. Such information is provided with the Certificate of Insurance, which is furnished automatically to all Participants, and is also available upon request from the Plan Administrator or the insurance carrier. Plan participants must follow the procedures described in the Certificate of Insurance to appeal denial of a claim for benefits.
Adverse Eligibility / Coverage Determinations-- The Plan Administrator shall have the responsibility and authority, in its sole discretion, to decide eligibility for coverage through this Plan. If the Administrator denies a claim for coverage through this Plan, the Administrator promptly and in writing shall notify the individual of such denial. The notification of denial will be made not later than within thirty (30) days of receipt of the individual's claim. This 30 day period may be extended for an additional 15 days due to circumstances beyond the control of the Plan Administrator, including cases in which a claim is incomplete. The individual will receive written notice of any such extension, including the reason for the extension and the date by which a decision by the Administrator can be expected. The Plan Administrator may secure independent information or other advice and require such other evidence as deemed necessary to decide a claim. A written notice of adverse benefit determination will be provided to the individual, and will include: (1) the specific reason(s) for the denial of benefits, (2) the specific Plan provision on which the denial is based, (3) a description of any additional material or information necessary for the individual to complete a claim and an explanation of why such information is necessary, and (4) an explanation of the right of appeal and the process to appeal the adverse benefit determination, including an explanation of the individual's right to review relevant documents and information, and his/her right to file suit under the Employee Retirement Income Security Act (ERISA) with respect to any adverse determination after appeal of a claim.
If a claim is denied in whole or in part, the individual may appeal to the Plan Administrator for review of the claim. The appeal must be made within one hundred, eighty (180) days of the Plan Administrator's initial notice of adverse benefit determination. If the appeal is not made within 180 days, the individual will lose his/her right to appeal and to file suit in court. The individual's written appeal should state the reasons that he/she believes the claim should not have been denied. It should include any relevant facts and/or documents to support the claim. The individual may ask additional questions of the Plan Administrator, make written comments, and may review (on request and at no charge) documents and other information relevant to the appeal. The Plan Administrator will review and decide the individual's appeal within a reasonable time and, within sixty (60) days after receiving the written appeal, shall render, in writing, a decision. The individual who reviews and decides the appeal will not be the same individual who originally denied the claim for benefits, or that individual's subordinate. The Plan Administrator may require additional relevant information to decide the claim. If the decision on appeal affirms the initial denial of the individual's claim for benefits under the Plan, he/she will be furnished with a notice of adverse benefit determination on review, which includes the following:
(1) the specific reason(s) for the denial,
(2) the specific Plan provision(s) on which the denial is based,
(3) a statement of the individual's right to review (on request and at no charge) relevant documents and other information,
(4) a description of any internal rule, guideline, or protocol, if applicable, used to make the benefit determination and a statement that such rule, guideline, or protocol will be provided to the claimant upon request at no charge, and
(5) a statement of the individual's right to bring suit under ERISA.
Claims and appeals of adverse benefit determinations are to be addressed to Human Resources, Franklin & Marshall College, P.O. Box 3003, Lancaster, PA 17604-3003.
Plan Amendment, Modification, and Termination
This Plan may be amended or terminated by Franklin & Marshall College at any time. The Group Policy which provides benefits for this Plan may be amended or terminated by the Policyholder (Franklin & Marshall College) at any time with prior written notice to the insurer. Termination will also occur if the Policyholder fails to pay the required premiums. The insurer may terminate the Group Policy on any premium due date if the number of persons insured is less than the required minimum, or if the insurer believes the Policyholder has failed to carry out its obligations relating to the Group Policy. No consent of any participant or beneficiary is required to terminate, modify, amend, or change the Plan.
Statement of ERISA Rights
Participants in the Plan are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974, as amended (ERISA). ERISA provides that all Plan participants are entitled to the following rights:
Receive information about the Plan and benefits-- Examine, without charge, at the Plan Administrator's office and at other specified locations, all documents governing the Plan (including, if applicable, insurance contracts and collective bargaining agreements), and a copy of the latest annual report (Form 5500 Series) filed by the Plan, if the Plan is required to do so, 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, if applicable, insurance contracts and collective bargaining agreements), and copies of the latest annual report (Form 5500 Series), if the Plan is required to file such form, 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, if the Plan is required to prepare such a report-- The Plan Administrator is required by law to furnish each participant with a copy of any summary annual report.
Prudent action by Plan Fiduciaries-- In addition to creating rights for Plan participants, ERISA imposes duties upon the people who are responsible for the operation of an employee benefit plan. The people who operate this 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 terminate your employment or otherwise discriminate against you in any way to prevent you from obtaining a welfare benefit or exercising your rights under ERISA.
Enforce your rights-- If a claim for a 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 participants can take to enforce the above rights. For instance, if you request a copy of the Plan documents or the latest annual report (if applicable) 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 domestic relations order or 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.
Assistance with Questions
If you have any questions about the Plan, you should contact the Plan Administrator, via Franklin & Marshall College's Human Resources department. 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.
In no case will a Plan participant, or anyone acting on a participant's behalf, be entitled to challenge a decision of the Plan Administrator in court or in any other administrative proceeding unless and until the claim and appeal procedures described in this Summary Plan Description and the Certificate of Insurance have been complied with and exhausted.
Please visit the Human Resources public eDisk folder ("Life Insurance / Business Travel Insurance") to view the Certificate of Insurance, and for a summary of additional services currently provided by the insurer.
Download the Life Insurance Beneficiary Form.