AETNA PPO PLAN - My Benefits Portfolio - Trinity Health

IMPORTANT INFORMATION ABOUT THE PLAN
Plan Sponsor Trinity Health
34605 Twelve Mile Road
Farmington Hills, MI 48331
Name of Plan and
Type of Plan
Plan Number 504
Employer Identification Number: 35-1443425
Phone Number: 248-324-8117
The Medical Program under component Plan 504 of the Trinity Health
Welfare Benefit Plan
This Plan is a welfare benefits plan providing medical benefits.
Plan Year The Plan Year begins on January 1st and ends on December 31st, and Plan
records are maintained on that basis.
Plan
Administrator and
Named Fiduciary
Type of Administration
and Fund
The Plan Administrator, named fiduciary and agent for service of legal
process is:
Trinity Health
34605 Twelve Mile Road
Farmington Hills, MI 48331
Benefits under the Plan are self-insured. The following entity is responsible
for the day-to-day administration of the Plan (Aetna PPO Health Care Plan
option) described in this SPD, including claims processing:
Aetna Life Insurance Company
151 Farmington Avenue
Hartford, CT 06156
The Aetna PPO health care plan option was effective as of January 1, 2008.
Cost of the Plan You and your Employer share the cost of providing Plan benefits for you and
your eligible Dependents.
Request for Plan
Information
The Plan is funded through the general assets of the Employer. In the event of
Plan termination, there are no specific assets set aside to use to pay claims
incurred prior to the date of such termination. If the Plan should be terminated,
only claims incurred prior to the date of such termination would be paid by the
Plan.
Requests to review Plan documents, requests for copies of Plan documents,
and questions regarding Plan operations should be directed to Plan
Administrator at the address and telephone number provided above.
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