ÌÇÐÄ´«Ã½

I. Introduction

The ÌÇÐÄ´«Ã½ Health Reimbursement Arrangement (the “Plan"), effective July 1, 2019, is established to provide Qualified Medical Care benefits to certain Retirees of ÌÇÐÄ´«Ã½. This Summary Plan Description ("SPD") is intended to provide you with a general description of the material terms of the Plan written in non-technical terms. It does not describe in detail every aspect of the Plan and is not the official Plan. The Plan, which consists of the Plan Document and the Adoption Agreement, is the only official statement of the benefits, rights, and features provided by this Plan. You may obtain a copy of the Plan Document and the Adoption Agreement if you request it from the Office of Human Resources. If there is any conflict between the terms of this SPD and those of the Plan, the Plan will control.

II. Eligibility

ÌÇÐÄ´«Ã½ (W&L) employees are eligible for the plan if they meet the following criteria:

• Hired full-time before April 1, 2003, and
• Meet eligibility requirements to retire from W&L
  • Ten consecutive years of full-time service
  • Have reached age 59.5 when full-time employment ends, and
• Have reached age 65 
• Have become Medicare eligible.

Spouses and domestic partners are eligible for their own plan if they meet the following criteria:

• Married to or the domestic partner of an eligible employee at the time of their retirement
• Have reached the age of 65
• Have become Medicare eligible.

If a spouse or domestic partner is eligible for the Health Reimbursement Arrangement (HRA), and that spouse or domestic partner is also a retired Washington and Lee employee eligible for the Retiree Health Plan (RHP), they may choose which benefit they prefer but will not receive both.

III. When May I Begin to Receive Benefits?

Accounts will be issued and activated for eligible members:

For retired employees:

• The first of the month after employee retires and has reached age 65, or
• The month a retired employee reaches age 65

For eligible spouses and domestic partners:

• If age 65, the month after the employee retires, or
• The month the retiree spouse/domestic partner turns 65

Entitlement letters are sent to member’s home address or email address upon enrollment.

IV: How Is the Plan Funded

Accounts are funded annually by ÌÇÐÄ´«Ã½. Annual contribution amounts are set by Human Resources and the Treasurer’s Office. Annual contributions are made each year in January.  

A member enrolling mid-year will receive a prorated portion of the current year’s annual contribution. Funds may only be used for expenses that are incurred on or after the enrollment date.  

V: How Can the Funds Be Used

Funds in accounts can be used as reimbursement for Qualifying Medical Care expenses, including (but not limited to):

• Medicare related expenses including premiums
• Out of pocket medical, dental and vision expenses
• Prescription and over the counter medications
• Other insurance premiums (vision and dental)

Funds in member account may only be used for the member, and not for dependents (including spouses and domestic partners).

VI: How Are Claims Processed

Funds in the accounts are held with TIAA. Optum Financial approves and pays out claims. Members have access to TIAA and Optum online to manage the account and can submit claims via the web, Optum mobile app, or paper claims forms via fax or mail. Members are also issued a debit card that may be used to pay for qualifying expenses.

VII: Cessation of Membership

Member accounts are closed in the following circumstances:

• Lifetime maximum benefit is reached ($35,000 contribution for the University) and funds have been exhausted
• Member passes away
• Member’s estate has 90 days to submit claims on or before date of death
• Member is no longer eligible as a spouse/domestic partner of a retiree if
• Divorce, or
• Domestic partnership is no longer in effect.

Member accounts are frozen in the following circumstances:

• Retiree is rehired by the University 
• Dependent account is closed as well
• Account(s) are reopened upon termination of employment
• Dependent is hired by the university
• Account reopened upon termination of employment

VIII: Unused Funds

Unused funds in each calendar year will rollover to the next.  

In the event of member death, benefits would be payable only for claims arising on or before the date of death. After those claims are paid, the remaining Account balance would be forfeited. There is a 90-day window following member date of death for the family or estate to submit claims for previous expenses.  

IX. What Are the Federal Tax Consequences of Contributions and Payments Under the Plan?

1. Employer contributions paid to your account on your behalf are not taxable.
2. Any growth in your accumulation attributable to investment earnings or credited interest is not subject to taxation.
3. Generally, all amounts paid to you for Qualified Medical Expenses from the Plan will not be taxed to you. 
4. You should consult your tax advisor for further information about the federal and state tax treatment of the contributions and payments under the Plan.
    

X. How Do I File a Claim When Benefits are Denied?

1. If a request for a benefit is denied, you can file a claim in writing with the Plan Administrator. The claim should explain the reasons that you are entitled to the benefit. The Plan Administrator has unfettered discretionary authority to investigate and to determine the merits of the claim.
2. If the claim is fully or partially denied, the Plan Administrator will provide you or your Beneficiary with a written explanation within 90 days stating:
   
   1. the reason for the denial;
   2. the Plan provisions upon which the denial is based;
   3. any additional information that would be needed to grant the claim and why it is needed; and
   4. the procedure for appealing the denial.
3. If the written claim is denied, you or your Beneficiary may request a second review by the Plan Administrator within 60 days.
4. Within 60 days following your request for review, the Plan Administrator will render its final decision in writing to you stating specific reasons for its decision. If special circumstances require an extension of the review period, the Plan Administrator’s decision will be rendered as soon as possible but in no event later than 120 days after receipt of the request for review.
5. If the review is denied on appeal, you have the ERISA rights set out below.

XI. How is the Plan Administered?

1. The Plan Administrator has the authority to manage the operation of the Plan. Factual determinations and interpretations of the Plan provisions by the Plan Administrator shall be final and binding on all members and their dependents.
2. The Plan Administrator may delegate responsibilities of managing the Plan to other people or entities. Any such delegation will be in writing.
3. The Plan Administrator may adopt rules and procedures to administer the Plan.
4. Plan expenses and fees may be paid from Plan assets subject to the terms of the Trust. Fees that are related to the administration of your individual account may be assessed against your account but will be paid by Employer.
5. While this Plan was adopted with the expectation that it would continue indefinitely, the Employer has no obligation to maintain it for any length of time and may discontinue contributions, amend, or terminate it at any time.
6. Your accumulation under the Plan is not subject to the claims of your creditors or your Dependents’ creditors. You and your Dependent(s) may not have the right to sell, assign, transfer, or otherwise convey the right to receive any payments or any interest under the Plan.
7. Nothing in this Plan should be considered as giving you any right to continued employment.
8. This Plan was drafted to comply with the provisions of the Internal Revenue Code and will be interpreted in a manner consistent with applicable sections of the Internal Revenue Code and ERISA.

XII. Do I Have Rights Under ERISA?

As a Member under the Plan, you are entitled to certain rights and protections under ERISA.

1. ERISA provides that all Plan Members are entitled to:
   
   1. Examine, without charge, at the Plan Administrator’s office, all documents governing the Plan, including the Trust Agreement.
   2. Obtain upon written request copies of documents governing the Plan, including the Trust Agreement and an updated SPD. The Plan Administrator may charge a reasonable cost for the copies.
   3. Receive a summary of the Plan’s annual financial report, which the Plan Administrator will provide to each Member.
2. 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 interests of you and other Plan Members and their Beneficiaries. No one, including the Employer or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a Plan benefit or exercising your rights under ERISA.
3. If your claim for a benefit under this Plan is denied in whole or in part, you have a right to receive an explanation of why and to obtain copies of documents relating to the decision without charge, and to appeal the denial to the Plan Administrator. Under ERISA, there are steps you can take to enforce your rights. For example, if you request a copy of documents 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 them, unless they were not sent because of reasons beyond the Plan Administrator’ s control. In addition, if you disagree with the Plan’ s decision on a claim for benefits, you may file suit in Federal Court. If it should happen that Plan fiduciaries misuse the Plan’ s money, or 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.
4. If you have any questions about this Plan, you should contact the Plan Administrator at the following:
   
   1. Office of Human Resources
      ÌÇÐÄ´«Ã½
      204 W. Washington Street
      Lexington, VA 24450

You can also contact the nearest office of the Employee Benefits Security Administration, U.S. Department of Labor, or the Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, 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 or going to the .

XIII. What other Relationships exist between the Parties to this Agreement?

1. Teachers Insurance and Annuity Association of American ("TIAA”) is the third-party administrator and record keeper of the Plan.
2. TIAA has a relationship with Optum Financial to administer all claims under this Plan.