ALFRED UNIVERSITY
Employee Welfare Benefits Plan Summary
This summary, together with the relevant brochures provided by the insurance company,
plan sponsor, or third-party administrator and the enrollment package you receive each year,
describes various welfare benefits (in the aggregate, the “Employee Welfare Benefits Plan” or
“Plan”) provided to eligible employees of Alfred University and of related employers
(collectively, the “Employer”). The specific benefits offered under the Plan are listed in
Appendix A. As of the date this summary was prepared, the Plan includes medical, life,
disability, travel, and personal accident insurance, as well as flexible spending accounts. In
general, the brochures for each benefit describe the specific benefits that are provided by the
insurance company, plan sponsor, or third-party administrator, including any terms and
conditions associated with those benefits, the annual enrollment package describes eligibility,
cost sharing and other matters that relate to participation terms and conditions in a particular year
and this document describes supplemental information about the Employer, the class of
employees eligible to participate and certain legally-required statements about your benefits
rights. The aggregate information provided in the brochures, the enrollment package, and this
summary, are intended to constitute the summary plan description for the covered benefits. The
plan document, a copy of which may be obtained by contacting the Human Resources
Department, is the controlling legal document should any dispute arise over the terms and
conditions of this Plan.
Name of Plan Sponsor
Alfred University
1 Saxon Drive
Alfred, New York 14802
Employer Tax Identification Number: 16-0743900
Plan Administrator and Agent for Service of Legal Process
Alfred University
1 Saxon Drive
Alfred, New York 14802
Telephone Number: (607) 871-2118
The Plan Administrator determines, in its sole discretion, your eligibility to participate in
this Plan and its component parts, and, for benefits managed internally, if any, your eligibility for
benefits. For insured plans and plans managed by a third-party administrator, the insurer or third
party administrator determines eligibility for benefits under its policy or contract in its sole
discretion. The Plan Administrator has the discretion to administer and interpret all aspects of
the Plan not set forth in an insurance policy or third-party administration contract.
The Plan Administrator has the sole responsibility to determine whether a medical child
support order is “qualified” under the terms of ERISA. All such orders must be submitted to the
Plan Administrator (preferably in draft form before being sent to the court for signature to
minimize the chances of your having to return to court if the order is not qualified). The Plan
Administrator will respond within 90 days to all affected parties on whether the order qualifies
(or will qualify when signed by a court). You may obtain a copy of the procedures used for
processing an order, free of charge, from the Plan Administrator.
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-2Name and Plan Number of Benefits Covered by this Summary
Alfred University Employee Welfare Benefits Plan: Plan No. 501.
Type of Administration
The insured plans are insurer administered. The non-insured plans are administered
either by a third-party administrator or by the Employer.
Eligibility
Participation in the welfare benefits listed on the attached Appendix A which make up the
Alfred University Employee Welfare Benefits Plan are subject to certain eligibility requirements
set forth on the attached Exhibit B.
Participation is conditioned on completion of the relevant enrollment materials,
agreement to pay the employee-required portion, if any, of the plan’s cost and satisfying any
relevant terms and conditions imposed by the relevant carrier or third party administrator.
Dependents may also be eligible to be covered by some of the plans as described in the relevant
enrollment materials and the brochures prepared by the insurance company or third party
administrator.
Notwithstanding the above, the following persons are not eligible to participate: (1)
leased employees; (2) independent contractors (including persons treated by the Employer as
independent contractors) even if a court or agency should determine such persons to be
“employees;” and (3) contract employees.
Costs of Plan
Employees pay the share of any plan’s premiums and expenses as specified in the annual
enrollment materials. The Employer pays the balance of any premiums and administrative
expenses out of its general assets.
Plan Year
The calendar year.
Amendment and Termination
The Employer has discretion to amend or terminate any plan from time to time, and at
any time, including the discretion to change benefit levels or benefit availability and the cost
sharing between participants and the Employer. The Employer can change a policy with an
insurance company or a contract with a third-party administrator only with the consent of the
insurance company or third-party administrator. Insurance companies and third-party
administrators can generally change their policies and contracts from time to time and may
eliminate or reduce future coverage of certain benefits or change their procedures.
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All claims for benefits under a Policy shall be submitted in accordance with the terms of
that Policy and shall be subject to the claims review procedure for that Policy. However, if the
particular issue on which a claim is based does not relate to any Policy or if the Policy lacks a
claims procedure that satisfies any then-applicable ERISA claims procedure requirements, the
relevant following claims procedures (health, disability, or other) shall apply:
≈ HEALTH PLAN CLAIMS PROCEDURES
If you submit a claim for health benefits provided under an insurance policy or
any other contract for health benefits administered by an outside provider, the claims
and appeals procedures set forth in the insurer’s or other third-party administrator’s
policy or contract must be followed. If the health benefit plan is administered by the
Employer or if an outside provider has failed to establish a claims and appeals
procedure, the following procedures must be followed:
A.
Special Definitions Applicable to Health Plan Claims Procedures
1.
Post-Service Claim means any claim for a benefit which is not a
Pre-Service Claim as defined below.
2.
Pre-Service Claim means any claim for benefits whereby the
terms of the plan condition receipt of the benefit, in whole or in part, on
approval of the benefit in advance of obtaining medical care.
3.
Urgent Care Claim means a claim for medical care or treatment
with respect to which the application of the time periods for making nonurgent care determinations:
a.
Could seriously jeopardize the claimant’s life or
health or the ability of the claimant to regain maximum function,
or
b.
In the opinion of a physician with knowledge of the
claimant’s medical condition, would subject the claimant to
severe pain that cannot be adequately managed without the care
or treatment that is the subject of the claim.
The determination of whether a claim involves Urgent Care will be made by
an individual acting on behalf of the Plan applying the judgment of a prudent
layperson who possesses an average knowledge of health and medicine,
except that a claim shall automatically be treated as an Urgent Care claim if a
physician with knowledge of the claimant’s medical condition determines
that the claim involves Urgent Care.
B.
Determination of Benefits
After you or your representative file a claim for benefits, the Plan
Administrator will respond within a certain period of time. The amount of time that
the Plan Administrator has to respond will depend upon the type of claim for benefits
being made.
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-41.
Post-Service Claims
The Plan Administrator will notify you of the benefits determination
within 30 days after receiving the claim. This period may be extended by the
Plan for up to 15 days, provided that the Plan Administrator both determines
that such an extension is necessary due to matters beyond the control of the
Plan and provides you with written notification prior to the expiration of the
initial 30-day period explaining the reason for the additional extension and
when the Plan expects to decide the claim. If the initial 30-day period of time
is extended due to your failure to submit information necessary to decide a
claim, the written notification will set forth the specific information required
and you will have at least 45 days to provide the requested information.
2.
Pre-Service Claims
The Plan Administrator will notify you of the Plan’s benefit
determination (whether adverse or not) within 15 days after receiving the
claim. This period may be extended by the Plan for up to 15 days, provided
that the Plan Administrator both determines that such an extension is
necessary due to matters beyond the control of the Plan and provides you with
written notification prior to the expiration of the initial 15-day period
explaining the reason for the additional extension and when the Plan expects
to decide the claim. If the initial 15-day period of time is extended due to your
failure to submit information necessary to decide a claim, the written
notification will set forth the specific information required and you will have
at least 45 days to provide the requested information.
In the event that you fail to follow proper Plan procedures in
submitting a claim, you will be notified within 5 days after the Plan initially
receives the claim so that proper adjustments can be made.
3.
Urgent Care Claims
The Plan Administrator will notify you of its benefit determination
(whether adverse or not), as soon as reasonably possible, taking into
consideration the medical circumstances involved. The Plan Administrator
will always respond to an Urgent Care Claim within 72 hours unless you fail
to submit information necessary to decide a claim. In this situation, you will
be informed within 24 hours after submitting the claim the specific
information necessary to complete your claim. You will be given at least 48
hours to provide the requested information. The Plan Administrator will
notify you of the benefit determination no later than 48 hours after the earlier
of the Plan’s receipt of the requested information or the end of the period
given to supply the additional information.
In the event that you fail to follow proper Plan procedures in
submitting a claim, you will be notified within 24 hours after the Plan initially
receives the claim so that proper adjustments can be made.
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-54.
Concurrent Care Decisions
In certain situations, the Plan may approve an ongoing course of
treatment. For example, treatment provided over a period of time or approval
of a certain number of treatments. If the Plan reduces or terminates the course
of treatment before its completion, except in the case where the Plan is
amended or terminated in its entirety, this shall constitute an adverse benefit
determination. The Plan Administrator will notify you of this adverse benefit
determination within sufficient time to allow you to appeal the decision and
obtain a determination on review before the benefit is reduced or terminated.
If you request to extend the course of treatment and the claim involves
an Urgent Care situation, the Plan Administrator will notify you of the claim
determination (whether adverse or not) within 24 hours after an extension is
requested, provided that such claim is submitted at least 24 hours prior to the
expiration of the initial treatment period.
C.
Notification of Adverse Claim Determination
If a claim for benefits is denied, in whole or in part, you or your authorized
representative will receive a written notice of the denial. The notice will be written in
a manner calculated to be understood by you and will include:
1.
the specific reason(s) for the denial;
2.
references to the specific plan provisions on which the benefit
determination was based;
3.
a description of any additional material or information necessary
to perfect a claim and an explanation of why such information is
necessary;
4.
a description of the plan’s appeals procedures and applicable
time limits;
5.
a statement regarding the right to obtain upon request and free of
charge, a copy of internal rules or guidelines relied upon in
making this determination;
6.
if the adverse determination is based on medical necessity or
experimental treatment or a similar exclusion or limit, either an
explanation of the scientific or clinical judgment, applying the
terms of the plan to the particular medical circumstances, or a
statement that this will be provided free of charge upon request;
and
7.
in the case of an adverse determination involving urgent care, a
description of the expedited review process available to such
claims.
In order to expedite the process in a situation involving an Urgent Care Claim
you or your representative may initially be notified of an adverse claim determination
orally, but a written notification providing the information set forth above will follow
within three days.
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-6D.
Appeal of Adverse Claim Determination
If a claim for benefits is denied, you or your representative may appeal the
denied claim in writing to the Appeals Unit within 180 days after receiving the written
notice of denial. You may submit with this appeal any written comments, documents,
records and any other information relating to the claim. Upon request, you will also
have access to, and the right to obtain copies of, all documents, records and
information relevant to the claim free of charge.
If the situation involves an Urgent Care Claim, you can request an expedited
review process whereby you may submit your appeal orally or in writing, and all
necessary information, including the plan’s benefit determination on review, shall be
relayed to you or your representative by telephone, fax, or other similarly expeditious
method.
A full review of the information in the claim file and any new information
submitted to support the appeal will be conducted. The claim determination will be
made by the Appeals Unit of the plan. The Appeals Unit will not have been involved
in the initial benefit determination nor will any member of the Appeals Unit be the
subordinate of anyone involved in making the initial benefit determination. This
review will not afford any deference to the initial claim determination.
If the initial adverse decision was based in whole or in part on a medical
judgment the Appeals Unit will consult a healthcare professional who has appropriate
training and experience in the relevant field of medicine and who was not consulted in
the initial adverse benefit determination and is not a subordinate of the healthcare
professional who was consulted in the initial adverse benefit determination. If a
healthcare professional is contacted in connection with the appeal, you will have the
right to learn the identity of such individual.
E.
Notification of Decision on Appeal
After an appeal is filed, the Appeals Unit will respond within a certain period
of time. The amount of time that the Appeals Unit has to respond is based on the
underlying claim for benefits as set forth below:
Post-Service Claims:
60 days after receiving appeal request
Pre-Service Claims:
30 days after receiving appeal request
Urgent Care Claims:
72 hours after receiving appeal request
If the claim on appeal is denied in whole or in part, you will receive a written
notification of the denial. The notice will be written in a manner calculated to be
understood by you and will include:
R702792.1
1.
the specific reason(s) for the denial;
2.
to the specific plan provisions on which the benefit determination
was based;
3.
a statement that you are entitled to receive, upon request and free
of charge, reasonable access to, and copies of, all documents,
records, and other information relevant to the claim for benefits;
-74.
a description of the plan’s review procedures and applicable time
limits;
5.
a statement that you have the right to obtain upon request and free
of charge, a copy of internal rules or guidelines relied upon in
making this determination; and
6.
if the adverse determination is based on medical necessity or
experimental treatment or a similar exclusion or limit, either an
explanation of the scientific or clinical judgment, applying the
terms of the plan to you medical circumstances, or a statement
that this will be provided free of charge upon request.
≈ DISABILITY PLAN CLAIMS PROCEDURES
If you submit a claim for disability benefits provided under an insurance policy or
any other contract for disability benefits administered by an outside provider, the
claims and appeals procedures set forth in the insurer’s or other third-party
administrator’s policy or contract must be followed. If the disability benefit plan is
administered by the Employer or if an outside provider has failed to establish a claims
and appeals procedure, the following procedures must be followed:
A.
Determination of Benefits
The Plan Administrator will notify you of the claim determination within 45
days of the receipt of the claim. This period may be extended by 30 days if an
extension is necessary to process your claim due to matters beyond the control of the
plan. A written notice of the extension, the reason for the extension and when the
Plan expects to decide the claim, will be furnished to you within the initial 45-day
period. This period may be extended for an additional 30 days beyond the original
extension. A written notice of the additional extension, the reason for the additional
extension and when the plan expects to decide the claim, will be furnished within the
first 30-day extension period if an additional extension of time is needed. However,
if a period of time is extended due to your failure to submit information necessary to
decide the claim, the period for making the benefit determination by the Plan
Administrator will be tolled from the date on which the notification of the extension
is sent to you until the date on which you respond to the request for additional
information.
B.
Notification of Adverse Claim Determination
If your claim for benefits is denied, in whole or in part, you or your authorized
representative will receive a written notice of the denial. The notice will be written in
a manner calculated to be understood by you and will include:
R702792.1
1.
the specific reason(s) for the denial;
2.
references to the specific plan provisions on which the benefit
determination was based;
3.
a description of any additional material or information necessary to
perfect the claim and an explanation of why such information is
necessary;
-8-
C.
4.
a description of the plan’s appeals procedures and applicable time
limits; and
5.
a statement regarding the right to obtain upon request and free of
charge, a copy of internal rules or guidelines relied upon in making
this determination, and if the determination is based on medical
necessity or experimental treatment or similar exclusion or limit, an
explanation of the scientific or clinical judgment for the
determination, applying the terms of the plan to the medical
circumstances.
Appeal of Adverse Determination
If your claim for benefits is denied, you or your representative may appeal the
denied claim in writing to the Plan Administrator within 180 days of the receipt of the
written notice of denial. You may submit with the appeal any written comments,
documents, records and any other information relating to your claim. Upon request,
you will also have access to, and the right to obtain copies of, all documents, records
and information relevant your claim free of charge.
A full review of the information in the claim file and any new information
submitted to support the appeal will be conducted. The claim determination will be
made by the Appeals Unit of the plan. The Appeals Unit will not have been involved
in the initial benefit determination nor will any member of the Appeals Unit be the
subordinate of any individual involved in the initial claim for benefits. This review
will not afford any deference to the initial claim determination.
If the initial adverse decision was based in whole or in part on a medical
judgment, the Plan Administrator will consult with a healthcare professional who has
appropriate training and experience in the field of medicine involved in the medical
judgment, was not consulted in the initial adverse benefit determination and is not a
subordinate of the healthcare professional who was consulted in the initial adverse
benefit determination.
D.
Notification of Decision on Appeal
The Plan Administrator will make a determination on your claim appeal
within 45 days of the receipt of the appeal request. This period may be extended for
an additional 45 days if the Plan Administrator determines that special circumstances
require an extension of time. A written notice of the extension, the reason for the
extension and the date that the Plan Administrator expects to render a decision will be
furnished to you within the initial 45-day period. However, if the period of time is
extended due to your failure to submit information necessary to decide the appeal, the
period for making the benefit determination will be tolled from the date on which the
notification of the extension is sent to you until the date on which you respond to the
request for additional information.
If the claim on appeal is denied in whole or in part, you will receive a written
notification of the denial. The notice will be written in a manner calculated to be
understood by you and will include:
1.
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the specific reason(s) for the adverse determination;
-92.
references to the specific plan provisions on which the
determination was based;
3.
a statement that you are entitled to receive upon request and free
of charge reasonable access to, and make copies of, all records,
documents and other information relevant to your benefit claim
upon request;
4.
a description of the plan’s review procedures and applicable time
limits; and
5.
a statement that you have the right to obtain upon request and free
of charge, a copy of internal rules or guidelines relied upon in
making this determination, and if the determination is based on
medical necessity or experimental treatment or similar exclusion
or limit, an explanation of the scientific or clinical judgment for
the determination, applying the terms of the plan to your medical
circumstances.
≈ OTHER CLAIMS FOR BENEFITS
The Plan Administrator shall maintain a procedure under which any
participant or beneficiary (or an authorized representative acting on behalf of a
participant or beneficiary) may assert a claim for benefits not covered by the claims
procedures for health or disability plans set forth above. Any such claim shall be
submitted to the Plan Administrator in writing. The Plan Administrator will generally
notify you of its decision within 90 days after it receives the claim. However, if the
Plan Administrator determines that special circumstances require an extension of time
to decide the claim, it may obtain an additional 90 days to decide the claim. Before
obtaining this extension, the Plan Administrator will notify you in writing, and before
the end of the initial 90-day period, of the special circumstances requiring the
extension and the date by which the Plan Administrator expects to render a decision.
If your claim is denied in whole or in part, the Plan Administrator will provide
you with a written notice which explains the reason or reasons for the decision,
includes specific references to plan provisions upon which the decision is based,
provides a description of any additional material or information which might be
helpful to decide the claim (including an explanation of why that information may be
necessary), and describes the appeals procedures and applicable filing deadlines.
If you disagree with the decision reached by the Plan Administrator, you may
submit a written appeal requesting a review of the decision. Your written appeal
must be submitted within 60 days of receiving the initial adverse decision. The
appeal should clearly state the reason or reasons why you disagree with the Plan
Administrator’s decision. You may submit written comments, documents, records
and other information relating to the claim even if such information was not
submitted in connection with the initial claim for benefits. Additionally, upon request
and free of charge, you may have reasonable access and copies of all documents,
records and other information relevant to the claim. The Plan Administrator will
R702792.1
- 10 generally notify you of its decision on appeal within 60 days after the appeal is
received.
Maternity and Newborn Infant Coverage Statement
Under Federal law, none of the insured group health plans offering maternity or newborn
infant coverage may 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 normal vaginal delivery, or less
than 96 hours following a cesarean section, or require that a provider obtain authorization from
the plan or the insurer for prescribing a length of stay not in excess of the above periods. This
requirement does not prevent an attending physician or other provider, in consultation with the
mother, from discharging the mother or newborn child prior to the expiration of the applicable
minimum period.
COBRA
Health benefits under this Plan are subject to COBRA continuation coverage. In the
event of a qualifying event, affected employees and their beneficiaries will be given a notice of
entitlement to elect continuation coverage for periods that can range up to 18, 29 or 36 months
depending on the qualifying event. An election to take continuation coverage must be made
within 60 days of this notice and persons making this election must pay the full amount of the
premiums plus a 2 percent administrative charge. The initial premium is due within 45 days of
returning a notice electing coverage and must cover the entire premiums due from the date your
coverage otherwise would have ceased. A participant or affected beneficiary must notify the
Plan Administrator within 60 days of divorce, legal separation or a dependent’s no longer
satisfying the age or other conditions of eligibility in order for the Employer to send out a
qualifying event notice and other materials to affected persons. More detailed information on
COBRA will be found in the brochures and in the COBRA qualifying event notice.
Women’s Health and Cancer Rights Act
All group health plans and their insurance companies or health maintenance
organizations that provide coverage for medical and surgical benefits with respect to a
mastectomy must also provide coverage for reconstructive surgery in a manner determined in
consultation with the attending physician and the patient. Coverage includes reconstruction of
the breast on which the mastectomy was performed, surgery and reconstruction of the other
breast to produce a symmetrical appearance, and prostheses and treatment of physical
complications at all stages of the mastectomy, including lymphedemas. Group health plans,
insurance companies, and HMOs may impose deductible or coinsurance requirements for
reconstructive surgery in connection with a mastectomy, but only if the deductible and
coinsurance are consistent with those established for other benefits under the plan or coverage.
Antiassignment Provision
Except for voluntary assignments to health care providers as may be required by law or
as may be provided in applicable policies, your right to receive benefits under any of the plans
covered by this summary may not be assigned, voluntarily or involuntarily, to any other person.
ERISA Rights Statement
R702792.1
- 11 Participants in the plans covered by this summary have certain legal rights under Federal
law. The Department of Labor requires the Employer to inform you of these rights in the
following form:
As a participant in the plans you are entitled to certain rights and protections
under the Employee Retirement Income Security Act of 1974 (ERISA). ERISA
provides that all plan participants shall be entitled to:
≈ Receive Information About Your Plan and Benefits
Examine, without charge, at the plan administrator’s office and at other
specified locations, such as worksites and union halls, all plan documents,
including insurance contracts, 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.
Obtain upon written request to the plan administrator copies of documents
governing the administration 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
administrator may make a reasonable charge for the copies.
Obtain a statement of your right to 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.
Continue health care coverage for yourself, spouse or dependent 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 rights.
Reduction or elimination of exclusionary periods of coverage for preexisting
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 may be subject to preexisting condition exclusion for 12
months (18 months for late enrollees) after your enrollment date in your
coverage.
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.
R702792.1
- 12 -
≈ 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 the employee
benefit plan. 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 welfare benefit or
exercising your rights under ERISA.
≈ Enforce Your Rights
If your claim for a welfare benefit is denied in whole or in part you must
receive a written explanation of the reason for the denial. You have the
right to have the plan review and reconsider your claim. Under ERISA,
there are steps you can take to enforce the above 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 a day
until you receive the materials, unless the materials were not sent because of
reasons 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. 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 Your Questions
If you have any questions about your plan, you should contact the plan
administrator. If you have any questions about this statement or about your
rights under ERISA, you should contact the nearest office of the Pension
and Welfare Benefits Administration, U.S. Department of Labor, listed in
your telephone directory or the Division of Technical Assistance and
Inquiries, Pension and Welfare Benefits 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 Pension and Welfare
Benefits Administration.
R702792.1
APPENDIX A
A.
Medical Plans:
Alfred University Group Medical Insurance

Blue Cross & Blue Shield of Western New York
1901 Main Street
P.O. Box 159
Buffalo, NY 14240-0159

Assurant Employee Benefits (Dental Insurance)
23233 Grand Boulevard
Kansas City MO 64108-2670

Vision Service Plan (V.S.P.)
3333 Quality Drive
Rancho Cordova, CA 95670
B.
Life Insurance Plans:

Non-Contributory Basic Term Life Insurance (Includes Accidental Death and
Dismemberment and Dependent Coverage)
Sun Life Insurance Company
Sun Life Insurance and Annuity Company of New York
122 East 42nd Street
Suite 1900
New York, NY 10017

Contributory Term Life Insurance
Sun Life Insurance Company
Sun Life Insurance and Annuity Company of New York
122 East 42nd Street
Suite 1900
New York, NY 10017
C.
Disability Insurance Plans:

Long Term Disability Insurance
Sun Life Insurance Company
Sun Life Insurance and Annuity Company of New York
122 East 42nd Street
Suite 1900
New York, NY 10017
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- 14 D.
Other:

Personal Accident Insurance
INA-Cigna Group Insurance
Three Newton Executive Park
2223 Washington Street, Suite 200
Newton, MA 02462

Travel Accident Insurance
INA-Cigna Group Insurance
Three Newton Executive Park
2223 Washington Street, Suite 200
Newton, MA 02462

Alfred University Flexible Spending Account Plan
Benefit Resource, Inc.
2320 Brighton-Henrietta Townline Road
Rochester, NY 14623-2782
R702792.1
- 15 APPENDIX B
1. Medical Insurance Plan – All regular and temporary employees working at least 35
hours per week for at least 9 months are eligible to participate in the Medical
Insurance Plan.
2. Non-Contributory Basic Term Life Insurance & Contributory Term Life Insurance
Plans – All regular non-temporary employees working at least 35 hours per week for
no less than a 9 month period are eligible to participate in the Non-Contributory Basic
Term Life Insurance and Contributory Term Life Insurance Plans.
3. Long Term Disability Insurance, Personal Accident Insurance, Travel Accident
Insurance, and Flexible Spending Accounts – All regular non-temporary employees
working at least 35 hours per week for a minimum of 9 months per year are eligible
to participate in the Long Term Disability Insurance, Personal Accident Insurance,
Travel Accident Insurance, and Flexible Spending Account Plans.
R702792.1