2013 XGS Office SPD.pdf - US Xpress

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For example, you may only want to have information sent by mail or to an address other than your home. For more information about exercising these rights, contact the office below. Right to Be Notified of a Breach You have the right to be notified in the event that the Plan or a Business Associate of the Plan discovers a breach involving your unsecured protected health information. Complaints If you believe that your privacy rights have been violated, you may file a written complaint without fear of reprisal. Direct your complaint to the office listed below under “Contacting Us” or to the Secretary of Health and Human Services, Hubert H. Humphrey Building, 200 Independence Avenue, SW, Washington, DC 20201. About this Notice The Plan is required by law to maintain the privacy of Protected Health Information and to provide individuals with notice of its legal duties and privacy practices with respect to Protected Health Information. The Plan is required to abide by the terms of this Notice. The Plan reserves the right to change the terms of this Notice and to make the new notice provisions effective for all Protected Health Information it maintains. If this Notice is changed, you will receive a new notice via mail. Contacting Us You may exercise the rights described in this notice by contacting the U.S. <strong>Xpress</strong> office identified below, which will provide you with additional information. The contact is: Amanda Thompson Sr. Director, Compensation & Benefits Human Resources Department (800) 251-6291 x 3491 NOTICE OF RIGHTS TO CONTINUE GROUP HEALTH COVERAGE This section of the Summary Plan Description is your notice of continuation coverage rights under the Consolidated Omnibus Budget Reconciliation Act of 1985 ("COBRA"). COBRA continuation coverage can become available to you and to your spouse and dependent children, if they are covered under the Plan when you would otherwise lose your group health coverage. Under the Plan, COBRA continuation coverage rights apply to medical (including prescription drug), vision and dental benefits and also apply on a limited basis to medical reimbursement benefits. COBRA continuation coverage is a continuation of Plan coverage when coverage would otherwise end because of a life event known as a "qualifying event." Specific qualifying events are listed later in this notice. COBRA continuation coverage must be offered to each person who is a "qualified beneficiary." A qualified beneficiary is someone who will lose coverage under the Plan because of a qualifying event. Depending on the type of qualifying event, employees, spouses of employees, and dependent children of employees may be qualified beneficiaries. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage. If you are an employee covered under the Plan, you have a right to choose this continuation coverage if you lose your group health coverage because of a reduction in your hours of employment or the termination of your employment (for reasons other than gross misconduct on your part). If you are the spouse of an employee covered by the Plan, you have the right to choose continuation coverage for yourself if you lose group health coverage under the Plan for any of the following four reasons: 1) The death of your spouse; 2) A termination of your spouse's employment (for reasons other than gross misconduct) or a reduction in your spouse's hours of employment; 3) Divorce or legal separation from your spouse; or 10
4) Your spouse becomes entitled to Medicare. In the case of a dependent child of an employee covered by the Plan, he or she has the right to continuation coverage if group health coverage under the Plan is lost for any of the following five reasons: 1) The death of a parent; 2) A termination of a parent's employment (for reasons other than gross misconduct) or reduction in a parent’s hours of employment; 3) Parent’s divorce or legal separation; 4) A parent becomes entitled to Medicare; or 5) The dependent child ceases to be a "dependent child" under the U.S. <strong>Xpress</strong> Inc. Employee Benefit Plan. Furthermore, a child born to, or placed for adoption with, the covered employee during the period of continuation coverage may also become covered as a qualified beneficiary. Under the law, the employee or a family member has the responsibility to inform the Plan Administrator of a divorce, legal separation, or a child losing dependent status under the Plan within 60 days of the date of the event or the date in which coverage would end under the Plan because of the event, whichever is later. The Company has the responsibility to notify the Plan Administrator of the employee's death, termination, and reduction in hours of employment or Medicare entitlement. When the Plan Administrator is notified that one of these events has happened, the Plan Administrator will in turn notify you that you have the right to choose continuation coverage. Under the law, you have at least 60 days from the date you would lose coverage because of one of the events described above, or the date notice of your election rights is sent to you, whichever is later, to inform the Plan Administrator that you want continuation coverage. If you do not choose continuation coverage, your group health insurance coverage will end. Also, if you do not become re-employed within 63 days of your termination of employment, and you have not chosen continuation coverage, you may lose prior coverage credit toward pre-existing condition limitation periods when you next become insured. If you choose continuation coverage, the Company is required to give you coverage which, as of the time coverage is being provided, is similar to the coverage provided under the plan to similarly situated employees or family members. The law requires that you be afforded the opportunity to maintain continuation coverage for 36 months unless you lost group health coverage because of a termination of employment or reduction in hours. In that case, the required continuation coverage period is 18 months. This18 months may be extended to 36 months if other events (such as a death, divorce, legal separation, or Medicare entitlement) occur during that 18-month period. If a second qualifying event occurs, you must make sure that the Plan Administrator is notified of the second qualifying event within 60 days of the second qualifying event. Continuation coverage for medical reimbursement benefits is only available through the end of the Plan Year in which the qualifying event occurs. The 18 months may be extended to 29 months for an individual, and his/her qualified dependents, if the individual is determined to be disabled (for Social Security disability purposes) at the time of the qualifying event or at any time during the first 60 days of continuation coverage, and the Plan Administrator is notified of that determination within 60 days of the date of the determination and before the end of the 18-month period. The affected individual must also notify the Plan Administrator within 30 days of any final determination that the individual is no longer disabled. In no event will continuation coverage last beyond 3 years from the date of the event that originally made a qualified beneficiary eligible to elect coverage. However, the law also provides that your continuation coverage may be terminated before the end of the maximum period for any of the following five reasons: 11
Page 1 and 2: Xpress Global Systems EMPLOYEE BENE
Page 3 and 4: The enrollment periods for the Plan
Page 5 and 6: copy of the certificate of insuranc
Page 7 and 8: 2. Significant Curtailment of Cover
Page 9: has reviewed the research proposal
Page 13 and 14: In addition, the Plan will make ben
Page 15 and 16: You may designate a representative
Page 17 and 18: Post-Service Claim If the denied cl
Page 19: Please contact the Benefits Departm
Page 29 and 30: OFFICE SHORT TERM DISABILITY • Up

2013 XGS Office SPD.pdf - US Xpress

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