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Health Reimbursement Account for Retirees (HRA) – February 2016 of 32

MassMutual Health Reimbursement Account for Retirees (HRA)

Summary Plan Description for Retired Employees, Agents, General Agents and General

Managers; Disabled Former Employees and Agents; and Survivors

Effective January 1, 2016

This Summary Plan Description (SPD), published in February 2016, takes the place of any SPDs and

Summaries of Material Modifications (SMMs) previously issued to you describing your benefits.


Table of Contents

Disclaimer 3

Introduction 4

Contact Information 5

Eligibility for the HRA 6

Receiving HRA Credits 10

Credits to Your HRA 13

Tax Information 16

Non-U.S. Residents Eligible for the HRA 17

Eligible Expenses 18

Catastrophic Drug HRA 19

When Participation Ends 20

Reimbursement of Premiums and Expenses 21

Claims and Appeals Procedures 24

Administrative Information 27

Plan Information 29

ERISA Rights 31


Disclaimer

This Summary Plan Description (“SPD”) provides details of the MassMutual Health Reimbursement

Account for Retirees (the “HRA” or the “Plan”) available through the MassMutual Retired Employee

Welfare Benefits Plan (the “Retired Employee Plan”) or the MassMutual Retired Agents’ Welfare

Benefits Plan (the “Retired Agent Plan”). This SPD contains detailed and important information about the

Plan; every attempt has been made to communicate this information clearly and in easily understandable

terms.

Benefits are determined under the terms of the Plan in effect at the time you become eligible for specific

benefits. Benefits are based on current laws and regulations, which are subject to change. Massachusetts

Mutual Life Insurance Company (the “Company” or “MassMutual”) reserves the right to modify, revoke,

change, suspend or terminate any one or all plans, programs, policies, benefits or services described in

this SPD or the underlying Plan documents at any time and from time to time. This SPD does not

guarantee any particular benefit. Your receipt of this SPD describing the Plan does not mean that you are

eligible to participate in the Plan or receive HRA credits.

Because of the many detailed provisions of the Plan, no one other than the Plan Administrator and the

delegated representatives indicated in this SPD are authorized to advise you about your benefits. For this

reason, MassMutual cannot be bound by statements made by unauthorized personnel.

In the event of a discrepancy between descriptions in this SPD and information in the relevant Plan

documents, the applicable Plan document will govern. The Plans are subject to the provisions of the

Employee Retirement Income Security Act of 1974 (“ERISA”).


Introduction

This Summary Plan Description describes the MassMutual Health Reimbursement Account for Retirees

(HRA), which is offered under the Retired Employee Plan and Retired Agent Plan to eligible retired

employees, retired career contract agents, retired general agents, and retired general managers, as well as

to former disabled employees and the survivors of deceased participants in the MassMutual Welfare

Benefits Plan and the MassMutual Agents’ Welfare Benefits Plan (the “Active Plans”) (collectively

referred to as “Retirees”). The purpose of the HRA is to provide Retirees with a contribution to be used

for the reimbursement of eligible health expenses incurred by the Retiree and their eligible dependents.

The HRA also includes a Catastrophic Drug Benefit, which may be used for prescription drug expenses if

certain conditions are met.

The HRA is effective as of January 1, 2016 for eligible Retirees.1 To be eligible to receive HRA Credits,

you must generally enroll in health care coverage through the Aon Retiree Health ExchangeTM

, a private

health care exchange. If you live outside the United States (including U.S. territories, such as Puerto Rico)

or in a state in which no coverage is available to you through the Aon Retiree Health Exchange, you may

be eligible to receive HRA Credits by meeting other conditions as defined and determined by the Plan

Administrator and subject to change from time to time.

If, after reading this SPD, you have any questions about the HRA and how it works, contact the Aon

Retiree Health Exchange between 9 a.m. and 9 p.m. ET. You can also obtain information directly on the

Aon Retiree Health Exchange website.

1 Pre-Medicare-eligible Retirees use the Aon Retiree Health Exchange to shop for private-exchange coverage

through eHealth, an online marketplace that allows individuals to purchase health insurance products. In addition

to private-exchange coverage, you may also shop for public-exchange coverage through eHealth. You may enroll

in private-exchange coverage or public-exchange coverage, but not both. If you enroll in public-exchange

coverage, you may qualify for a public subsidy in the form of federal premium tax credits and/or cost-sharing

subsidies. In order to qualify for a public subsidy, you must opt out of MassMutual’s HRA by contacting

MassMutual. If you opt out of MassMutual’s HRA after Dec. 31, 2015, you will not be eligible for MassMutual’s

HRA in the future.


Contact Information

Resource Online Telephone

Aon Retiree Health Exchange https://retiree.aon.com/massmutual 844-335-9036

Aon Claims and Appeals Management (CAM)

P.O. Box 1407

Lincolnshire, IL 60069-1407

Fax: 847-554-1486

Retired Employees:

MassMutual Benefits

1295 State Street, F105 Springfield, MA 01111-0001

Email: [email protected]

866-662-6448, 10 a.m.-4 p.m. ET (business days)

Retired Agents:

Producer Services & Operations 1295 State Street, F210 Springfield, MA 01111-0001


800-767-1000, Ext. 48850, 8 a.m.-6 p.m. ET (business days)

Your Spending Account2 (Claims Administrator)

P.O. Box 785007

Orlando, FL 32878-5007

http://retiree.aon.com/massmutual

844-335-9036

Fax:

844-719-6834 (in the U.S.)

847-554-1409 (outside the U.S.)

2 Your Spending Account is a trademark of Hewitt Associates LLC.


Eligibility for the HRA

Who Is Eligible to Participate

Retired Employees

You are eligible for the HRA if you were a member of an Eligible Group and if you:

Retired prior to Jan. 1, 2010

Were eligible for medical coverage and were employed on January 1, 2010, and on January 1,

2010, either:

o You were at least age 50 with 10 or more years of service (as defined for pension vesting

purposes); or

o You have age and years of service equal to 75 or more with at least 10 years of service

(as defined for pension vesting purposes).

Began retiree medical benefits when you were either:

o Age 55 or older with at least 10 years of service on your retirement date; or

o A sunset participant in the MassMutual Employee Pension Plan who was age 50 or older

with at least 10 years of service, and age plus service equaled 65 or more on January 1,

2010.

Individuals who otherwise meet these requirements but are still working for MassMutual or who have

deferred retiree medical coverage are not eligible until the later of the date they retire or the date they

elect coverage to begin.

Eligible Groups

You were a member of an eligible group if you were:

An employee of Connecticut Mutual and were a Participant in the Connecticut Mutual

Comprehensive Medical Plan as of December 31, 1999;

A non-grandfathered3 employee of Connecticut Mutual and retired on or after

January 1, 1993;

An employee of Antares Capital Corp. and retired on or after January 1, 2001;

An employee of Cornerstone Real Estate Advisers LLC who was hired by Cornerstone before

January 1, 1994;

An employee of Babson Capital Management LLC (formerly known as David L. Babson &

Company Inc.) who was a Springfield-based employee as of January 1, 2001, including

employees who transferred from Babson Capital Management LLC to Babson Capital Finance

3 You are considered grandfathered if, on December 31, 1992, you were:

Retired;

Eligible for early retirement;

Within five years of normal retirement;

A disabled employee who began receiving Group Long-Term Disability from GroupAmerica or

Connecticut Mutual on or before December 1, 1992; or

A surviving Spouse or Dependent of an active or a retired employee who died on or before

December 31, 1992.


LLC on or after June 30, 2013, except employees in the Restricted Stock or Stock Option plan or

successor plans who had not attained age 45 with at least 10 years of service as of January 1,

2001;

An employee of the Financial Products Division who was transferred from MassMutual to

Babson Capital Management LLC, effective January 1, 2008, including employees who

subsequently transferred from Babson Capital Management LLC to Babson Capital Finance LLC

on or after June 30, 2013;

An employee of Massachusetts Mutual Life Insurance Company;

An employee of MassMutual Benefits Management, Inc.;

An employee of MassMutual International LLC;

An employee of MML Investors Services, Inc.;

An employee of The MassMutual Trust Company, FSB;

A disabled former employee of MassMutual or one of its eligible subsidiaries as of your

retirement date; or

Otherwise subsidy eligible and retired as of Dec. 31, 2015, including those retirees who

previously deferred retiree health coverage.

Note: If you had prior service with Connecticut Mutual Life Insurance Company, your Connecticut

Mutual years of service will be taken into account only if you became employed by the Company

immediately following the end of your service with Connecticut Mutual as of March 1, 1996.

Retired Career Agents, General Agents and General Managers

To be eligible to participate in the HRA, you must: (1) have retired and not elected to defer retiree

coverage to a future date; and (2):

for career agents whose contract date is Jan. 1, 2000 or later, have terminated your active career

contract at age 60 or older with 10 or more continual years under a career contract immediately

prior to retirement.

for career agents whose contract date is prior to Jan. 1, 2000, have terminated your active career

contract at age 60 or older with 6 or more continual years under a career contract immediately

prior to retirement.

Note: Agents with contract dates on or after Jan. 1, 2009 who terminated their career contract at age 65

or older with 5 to 9 years of continual years under a career contract immediately prior to retirement are

not eligible for the HRA, but may access coverage through the Aon Retiree Health Exchange.

General Agent/Brokerage Director Note: Service includes service under a general agent contract or

brokerage director contract or similar management contract, as long as the retired agent was continually

under one of these qualifying contracts with or endorsed by the Company during this continuous service

period. Any general agent who attains at least 12 years of service as a general agent (up to two years of

which may be as a general manager) is eligible for retiree health coverage.


Disabled Former Employees and Former Career Agents, General Agents and General Managers

If you are a disabled former employee or disabled former career agent, general agent or general manager,

you are eligible to participate in the HRA if you are receiving Long-Term Disability benefits under one of

the Active Plans and, if you are a career agent, no longer have an active career contract.

Survivors

The Eligible Survivor of a deceased Active Plan participant is eligible for an HRA. You are an Eligible

Survivor if:

you are a surviving dependent of a deceased participant;

both you and the deceased participant were enrolled in an Active Plan at the time of the deceased

participant’s death;

the deceased participant had:

o died on or before December 31, 2013 and completed at least five (5) years of service

under the MassMutual Pension Plan (“Pension Plan”) prior to his death;

o died after December 31, 2013 and satisfied the requirements for retirement under the

Pension Plan as of the time of his death.

If the deceased participant has more than one dependent who meets the above requirements, the Eligible

Survivor will be the deceased participant’s spouse or domestic partner. If the deceased member had no

spouse or domestic partner, the Eligible Survivor will be the deceased participant’s oldest child who

meets the eligibility requirements for the HRA.

Dental HRA for Former Connecticut Mutual Agents

If you were a retiree and had dental coverage through Connecticut Mutual Life Insurance Company on

Nov. 30, 2003, or if you were a career agent or employee of Connecticut Mutual Life Insurance Company

who was eligible to retire or was within 5 years of normal retirement age on Dec. 31, 1992, you may be

eligible to participate and receive an HRA Credit to be used for the purchase of a retiree dental policy

even if you do not meet the eligibility requirements above for a general HRA Credit.

Dental HRA for Former Connecticut Mutual Employees

If you were a retiree or disabled employee and had dental coverage through Connecticut Mutual Life

Insurance Company on Dec. 31, 2002, or if you were an employee who was eligible to retire or was

within five years of your normal retirement date on Feb. 29, 1996, you may be provided with an HRA

Credit to be used for the purchase of a retiree dental policy. Such HRA Credit for dental coverage would

be provided in addition to any HRA Credit for which you may otherwise be eligible to use for a medical

policy.


Who Is Not Eligible to Participate

Not all Retirees are eligible for an HRA. You are not eligible for an HRA if you:

Reside in the United States and enroll in medical or prescription drug coverage through any

entity that is not the Aon Retiree Health Exchange

o Note: Coverage offered through eHealth as part of a public exchange is not part of the

Aon Retiree Health Exchange4

o This requirement does not apply to Pre-Medicare-eligible Retirees who reside in states

where the Aon Retiree Health Exchange is unavailable and purchase public-exchange

coverage through their state-based Exchange

Are eligible for the Retiree Health Reimbursement Arrangement under the Retired Employee

Plan;

Retired from a subsidiary that does not participate in the Retired Employee Plan or the Retired

Agent Plan;

Did not meet age and years of service requirements set forth in the Retired Employee Plan or the

Retired Agent Plan as of Dec. 31, 2015 as applicable; or

Were not or would not have been eligible for the company’s subsidized Retiree health coverage

prior to January 1, 2016.

When Eligibility Ends

Your eligibility to participate in the HRA will end:

On the date your coverage through the Aon Retiree Health Exchange is terminated for any

reason;

If you are eligible as a Spouse and divorce the Retiree, on the date your divorce is final;

If you are eligible as a Domestic Partner at the time of retirement and subsequently terminate

your domestic partnership, on the date your domestic partnership ends.

On the date you commit fraud against the Plan or make an intentional misrepresentation to the

Plan.

4

Pre-Medicare-eligible Retirees use the Aon Retiree Health Exchange to shop for private-exchange coverage

through eHealth, an online marketplace that allows individuals to purchase health insurance products. In addition

to private-exchange coverage, you may also shop for public-exchange coverage through eHealth. You may enroll

in private-exchange coverage or public-exchange coverage, but not both. If you enroll in public-exchange

coverage, you may qualify for a public subsidy in the form of federal premium tax credits and/or cost-sharing

subsidies. In order to qualify for a public subsidy, you must opt out of MassMutual’s HRA by contacting

MassMutual. If you opt out of MassMutual’s HRA after Dec. 31, 2015, you will not be eligible for MassMutual’s

HRA in the future.


Receiving HRA Credits

For You (Retiree, including an Eligible Survivor)

If you are eligible to participate in the HRA and enroll in individual medical or prescription drug

coverage through the Aon Retiree Health Exchange, an HRA account will be automatically established

for you. Aon’s Your Spending Account™ (“YSA”) administers the HRA through the Aon Retiree Health

Exchange.

Aon Retiree Health Exchange will send you enrollment information at the time of your retirement or, if

you previously chose to defer your retiree benefits, at the time you elect coverage. Because the medical

plans offered to Medicare-Eligible Retirees are individual medical or prescription drug policies, the open

enrollment period is defined by Medicare each year. For Pre-Medicare-Eligible participants, the open

enrollment period is established by the Patient Protection and Affordable Care Act (“Affordable Care

Act” or “ACA”).

If you reside outside the United States (as determined based on your legal mailing address as of the first

day of the plan year), you will not be required to obtain coverage through the Aon Retiree Health

Exchange to receive HRA Credits. If you resume residence in the United States during a plan year, you

will be subject to the coverage requirement to receive future HRA Credits beginning with the January 1 of

the year following the year in which you resume living in the United States.

If you live in a state within the United States that does not offer coverage for you, as determined by the

Plan Administrator, you will be eligible to receive HRA Credits if you obtain coverage through a state or

federal public health exchange. To receive HRA Credits, you must contact Aon and provide evidence of

your state or federal exchange coverage.

For Your Eligible Dependents

You may be eligible for additional HRA credits for your Eligible Dependents. Eligible Dependents

include:

Your current legal spouse.

Your eligible domestic partner, if he or she was enrolled in MassMutual medical coverage through

one of the Active Plans at the time you retired. A domestic partner is someone of the same or opposite

sex who:

o Lived together with you as a domestic partner for at least 12 consecutive months before he or she

was enrolled in coverage through the Active Plans and continued coverage without any break

through the date you became eligible for retiree medical coverage;

o Is at least 18 years old;

o Is not legally married to or separated from anyone else;

o Is not related in such a way that would make a marriage illegal in your state of residence;

o Is your sole domestic partner and intends to remain so indefinitely;

o Shares financial responsibilities and expenses with you; and

o Has resided together with you as if married and intends to do so indefinitely.

Note: You cannot add a domestic partner after you retire from MassMutual.


Your or your qualifying domestic partner’s Children, if they:

o Were covered as a dependent under your MassMutual coverage on your last day of participation

in coverage under an Active Plan;

o Are disabled as determined by the Social Security Administration and are Medicare-Eligible;

o Are considered your dependents for tax purposes; and

o Commence participating in the HRA at the time you first become eligible.

Participation is not available to any non-Medicare-Eligible Child, a Child’s Spouse or a Child’s

children. “Child” or “Children” means a disabled, Medicare-Eligible individual who was covered

under an Active Plan while you were still in active service, who is:

Your biological Child;

Your legally adopted Child;

Your stepchild;

Your eligible foster Child; and

A Child for whom you are the permanent legal guardian.

For more information about reporting your Child as a Dependent on your federal tax return, refer to

the section in this SPD titled “Tax Information.”

If there is any change to the status of your covered dependents (e.g., due to marriage, divorce, death, etc.),

you must notify MassMutual Benefits or Producer Services & Operations within 30 days of the date of

the event.

If you have an Eligible Dependent and wish to receive an HRA Credit to your Account for such Eligible

Dependent, they must also purchase an individual medical or prescription drug policy through the Aon

Retiree Health Exchange – provided you are also eligible for the HRA and are enrolled in an individual

medical or prescription drug policy through the Aon Retiree Health Exchange. Annual HRA Credits from

MassMutual for you and your Eligible Dependents are combined into one HRA that is set up under your

name.

If you marry while enrolled in coverage through the Aon Retiree Health Exchange and your new Spouse

meets the eligibility requirements set forth in the Retired Employee Plan or Retired Agent Plan, as

applicable, once he or she enrolls in coverage through the Aon Retiree Health Exchange, MassMutual

will provide HRA Credits to your Account for such Spouse.

You will not receive any HRA Credits for an ex-Spouse once your divorce is final.

If you are an Eligible Survivor and you remarry or enter into a new domestic partnership, you can

continue to receive HRA Credits as long as you continue to be enrolled in medical or prescription drug

coverage through the Aon Retiree Health Exchange. You will not receive HRA Credits for your new

spouse, domestic partner or their children.

If an Eligible Dependent resides outside the United States (as determined based on his or her legal

mailing address on the first day of the plan year), he or she will not be required to obtain coverage

through the Aon Retiree Health Exchange in order for you to receive HRA Credits. If he or she resumes

residence in the United States, he or she will be subject to the Aon Retiree Health Exchange coverage


requirement in order for you to receive future HRA Credits beginning with the January 1 of the year

following the year in which the Eligible Dependent resumes living in the United States.

If an Eligible Dependent lives in a state within the United States that does not offer coverage for him or

her, as determined by the Plan Administrator, you will be eligible to receive HRA Credits for such

Eligible Dependent if he or she obtains coverage through a state or federal health exchange. To receive

HRA Credits for a Dependent who is covered through a state or federal health exchange, you must contact

Aon and provide evidence of your state or federal exchange coverage. You must submit valid receipts to

YSA in order to be reimbursed for qualified expenses.


Credits to Your HRA

Amount of the Annual HRA Credit

If you are eligible to participate in the HRA and meet the requirements to receive HRA Credits for a Plan

Year, MassMutual will provide you with HRA Credits in each plan year as follows:

Pre-Medicare-Eligible Medicare-Eligible

Retired 1/1/2002 or earlier and met age and years of service requirements for subsidized Retiree medical coverage upon retirement

$5,700 per eligible retiree/eligible dependent


Retired on or after 1/2/2002 and met age and years of service requirements for subsidized Retiree medical coverage upon retirement



If eligible for dental HRA credits $300 per eligible retiree/eligible spouse

Annual HRA Credits are generally provided on January 1 each year as long as you remain eligible. If you

or an Eligible Dependent becomes eligible during the Plan Year, your HRA Credits will be prorated. See

“Proration Rules” below. Your HRA Credits will also be prorated in the year you or an Eligible

Dependent becomes eligible for Medicare.

HRA credits do not earn interest. You cannot contribute to your HRA and the account does not have any

investment options. You also cannot roll credits from your HRA into any other instrument, including

health savings accounts, health care flexible spending accounts or dependent care flexible spending

accounts.

Proration Rules

If you or an Eligible Dependent becomes eligible during the year, the following proration rules will apply

based on the effective date of your coverage through the Aon Retiree Health Exchange:

If you retire midyear, your first HRA Credit will be equal to 1/12 of the annual amount you are

eligible to receive multiplied by the number of complete months remaining in the year.

If your Eligible Dependent becomes eligible midyear, your HRA will be credited with an additional

amount equal to 1/12 of the annual amount you are eligible to receive for that eligible dependent

multiplied by the number of complete months remaining in the year.

If you are a Pre-Medicare-Eligible Retiree receiving an HRA Credit and you become eligible for

Medicare during the year, your HRA Credits will be prorated at the beginning of the year for the

Pre-Medicare-Eligible portion of the year only. When you enroll in Medicare and purchase a

Medicare-Eligible medical or prescription drug policy through the Aon Retiree Health Exchange, you

will then receive a second HRA Credit allocation for the period starting on the Medicare enrollment

date and continuing through the end of the year. Both allocations will go into one account. The same

pro-ration applies to the HRA Credit made for an Eligible Dependent in the year they become

Medicare-Eligible.


If you do not enroll in Medicare upon eligibility and you have a gap in coverage, your Medicare HRA

Credit will not be made until you have enrolled in Medicare coverage. It will be prorated for the

remainder of the year based on the number of complete months you will have Medicare-eligible

coverage through Aon for that Plan Year. The same pro-ration applies to the HRA Credit made for an

Eligible Dependent in the year they become Medicare-Eligible.

Other Rules

If you were previously enrolled in MassMutual’s Retiree health care coverage, were included in the

2015 transition special enrollment period, and you did not enroll in a medical or prescription drug

policy for 2016 through the Aon Retiree Health Exchange at that time, you will not be eligible for an

HRA or any HRA Credits in the future, except as noted in the “Non-U.S. Residents Eligible for the

HRA” section of this SPD.

If you become eligible after the start of the Plan Year, HRA Credits will be made to your account as

soon as administratively feasible after your eligibility date.

If coverage through the Aon Retiree Health Exchange is terminated for your eligible Dependent, any

HRA Credits already allocated to your HRA for your eligible Dependent will remain available in your

HRA account. However, you may only submit for reimbursement of services for that Dependent if the

services were incurred during the time your eligible Dependent was enrolled. You may continue to

use any remaining balance for your own or other eligible dependent’s expenses. However, no future

annual HRA Credits will be allocated to your account for a Dependent who terminates his or her Aon

Retiree Health Exchange coverage.

If your coverage is terminated for any reason (except your death), any HRA Credits already allocated

to your HRA will remain available for the reimbursement of services that were incurred during the

time you were enrolled. However, no future annual HRA Credits will be allocated for you or your

Eligible Dependent.

For more information about how the HRA Credit amount is determined, contact the Aon Retiree Health

Exchange.

MassMutual has the right to adjust the amount of the HRA Credit or discontinue the HRA Credit at any

time and for any reason.

Subsidy Considerations

Pre-Medicare-Eligible Retirees may wish to determine their eligibility for a government subsidy. During

the transition special enrollment period only (prior to March 1, 2016), if a Pre-Medicare-Eligible Retiree

enrolled in coverage through eHealth and decides to take the federal government subsidy instead of the

HRA Credits in 2016, the Retiree will be allowed a one-time deferral of the HRA Credits. However, once

the Retiree requests the HRA Credits and enrolls in coverage through the Aon Retire Health Exchange,

the Retiree cannot defer HRA participation. If the Retiree later decides to take the government subsidy

instead of HRA Credits, they are no longer eligible to receive the HRA Credits at any time in the future,

even if they become ineligible for a government subsidy at a later date.

Year-End Remaining HRA Balances

If you do not use all of your HRA Credits during the year for reimbursement of eligible health care

expenses, any unused remaining balance is automatically carried forward into your next year’s HRA – as


long as you continue to have coverage through the Aon Retiree Health Exchange in that year (unless an

exception applies) and you remain eligible for HRA Credits.

Forfeiting Your HRA Balance

HRA Credits will cease and be forfeited in the situations described below:

If you have an HRA balance when you die, and, as of the date of your death, you do not have an

Eligible Dependent enrolled in coverage through the Aon Retiree Health Exchange (unless an

exception applies), any amounts remaining in your HRA six months after your death will be forfeited.

(Note: Expenses may be submitted for reimbursement on behalf of your estate up to six months after

your date of death).

If you terminate your individual medical or prescription drug coverage purchased through the Aon

Retiree Health Exchange for any reason (including nonpayment of premiums), any HRA Credits

remaining after any eligible premium or health care expenses (incurred prior to the termination date)

have been reimbursed will be forfeited.

If your participation is terminated due to fraud or intentional misrepresentation, any HRA Credits will

be forfeited.

Account Statements

Each January, you will receive an HRA Balance Reminder confirming the amount of the annual HRA

Credit allocation made to your account for the Plan Year. You also will receive an HRA statement in the

fourth quarter of each year showing your available balance and amounts paid to date. Your available

balance and any HRA Credit or reimbursement history can be obtained at any time on the Aon Retiree

Health Exchange website (https://retiree.aon.com/massmutual) or by calling the Aon Retiree Health

Exchange.


Tax Information

Except as noted below, generally neither HRA Credits nor any reimbursements paid through the HRA

will be considered part of your taxable income.

However, these amounts may be included in income and subject to tax if:

You are a retired general agent or the Eligible Dependent of a retired general agent: General agents

are not employees of MassMutual. For that reason, benefits cannot be provided on a tax-free basis.

You are a domestic partner or an Eligible Dependent of a domestic partner: Domestic partners and

their Dependent Children may not satisfy the definition of “Dependent” under federal tax laws.

If HRA Credits cannot be provided on a tax-free basis for you or your Eligible Dependent, MassMutual is

legally required to report the entire taxable value of your HRA as taxable income to you for income tax

purposes. The value that is reported is equal to the average HRA reimbursement for all similarly situated

individuals under the Retired Employee Plan or the Retired Agent Plan, whichever is applicable.

If your domestic partner and his or her Children meet the definition of a dependent under federal tax laws,

you may not be required to report the HRA Credits as income for income-tax purposes. You should

consult a tax advisor for advice on your specific situation.


Non-U.S. Residents Eligible for the HRA

If you are eligible for an HRA and live outside the United States (including U.S. territories, such as

Puerto Rico), you must submit eligible premiums and expenses to YSA for reimbursement from the HRA.

All receipts and other documentation must be submitted in English. You are responsible for any

translation services needed.


Eligible Expenses

Eligible expenses can be reimbursed from your HRA if the expenses are incurred during the time you

participate in the Aon Retiree Health Exchange (or are subject to an exception), provided such expenses

do not exceed your HRA balance.

The following after-tax expenses are eligible for reimbursement through your HRA:

Health care expenses allowed under IRS Publication 502, Internal Revenue Code section 213(d);

Medical premiums;

Dental premiums;

Vision premiums;

Prescription premiums;

Medicare Part B premiums; and

Medicare Part D premiums.

Note: Over-the counter (OTC) medication expenses, such as pain relievers and cold medications, will be

eligible for reimbursement only with your health care provider’s prescription or statement of medical

necessity.

Expenses are eligible only to the extent that they are not paid for by any health care coverage and have

not been paid by other programs; i.e., your health savings account balance or other insurance. Expenses

that exceed the balance in your HRA as of the date on which the claim is processed will not be

reimbursed. However, if your expenses carry over to the following year, they can be reimbursed once the

next year’s HRA Credit has been made to your HRA.

Expenses Not Covered

The following expenses are not reimbursable under the HRA:

Ineligible medical expenses not allowed under IRS Publication 502 (such as certain cosmetic

procedures or expenses paid through health coverage);

Premiums paid before-tax for group health plan coverage available through an employer; and

Premium expenses incurred while not eligible for the HRA.

List of Covered Expenses

For a complete list of expenses the IRS allows (and does not allow) to be reimbursed, and any special

requirements for a service or supply (including those in the list above) to be reimbursable under the HRA,

refer to Internal Revenue Service (IRS) Publication 502, available by calling 800-TAX-FORM

(800-829-3676). You can also access IRS Publication 502 by logging on to the IRS website at

http://www.IRS.gov.


Catastrophic Drug HRA

The Catastrophic Drug HRA is separate from your personal HRA and can be used to help pay for certain

prescription drug expenses only. All Medicare-Eligible Retirees are eligible for the Catastrophic Drug

HRA. You become eligible for the Catastrophic Drug HRA when you (or an Eligible Dependent):

Are Medicare-Eligible;

Use all of the HRA Credits in your HRA; and

Meet the $250 threshold after reaching the Medicare Part D “true annual out-of-pocket” limit that

qualifies you for the Catastrophic reimbursement level.

Reimbursement for Catastrophic Prescription Drug Expenses

If you are eligible for reimbursement of your catastrophic prescription drug expenses, the Catastrophic

Prescription Drug HRA will separately reimburse you for eligible prescription drug expenses that exceed

your annual Medicare true out-of-pocket limit, after the $250 threshold outlined above.

The Medicare Part D true out-of-pocket limit may change from year to year (for 2016 it is $4,850). A

prescription drug expense is only eligible for reimbursement from this Plan if it is an otherwise eligible

prescription drug expense under your Medicare Part D or Medicare Part C (Medicare Advantage, which

includes prescription drug) coverage.

For example, in 2016, an eligible drug expense is reimbursable from the Catastrophic Drug HRA after

you have paid $5,100 out of pocket for prescription drugs ($4,850 true out-of-pocket limit, plus $250

threshold). You will then be reimbursed for the copayments and 5% coinsurance not covered by Medicare

Part D.

There is a $1 million individual annual limit on Catastrophic Drug HRA benefits. This limit applies

independently to you and any Eligible Dependents.


When Participation Ends

Retirees

Your participation in the HRA ends on the earliest of the date on which:

You die;

You become ineligible for the HRA for any reason, including the amendment of the Plan’s eligibility

provisions;

You were participating in the HRA as a disabled employee, are no longer deemed to be disabled or

become eligible for retirement and are not eligible for retiree coverage under the HRA;

For any reason, you are no longer enrolled in a medical or prescription drug plan though the Aon

Retiree Health Exchange (unless you live outside the United States or in a state in which no coverage

is offered for you and you meet the requirements for an HRA Credit);

Your coverage through the Aon Retiree Health Exchange is terminated voluntarily or for nonpayment

of premiums (Note: If coverage is reinstated in the future, the HRA will not be reinstated.);

You again become a Career Agent; or

The Retired Employee Plan, Retired Agent Plan or the HRA under either Plan is terminated.

Spouse, Domestic Partner and Child

Your Eligible Dependent’s participation in the HRA ends on the earliest of the date on which:

Your Dependent dies;

Your Dependent no longer meets the HRA’s eligibility requirements for any reason, including the

amendment of the Plan’s eligibility provisions;

For a Spouse or domestic partner, you get divorced or your domestic partnership ends;

For an eligible Child, the Child is no longer disabled or eligible for Medicare;

Your coverage through the Aon Retiree Health Exchange is terminated for nonpayment of premiums;

You are no longer enrolled in a medical or prescription drug plan though the Aon Retiree Health

Exchange for any reason (unless you live outside the United States, or in a state in which no coverage

is offered for you, and you meet the requirements for an HRA Credit);

Your eligible Dependent is no longer enrolled in a medical or prescription drug plan through the Aon

Retiree Health Exchange (unless your Dependent lives outside the United States, or in a state in

which no coverage is offered for him or her, and he or she meets the requirements for an HRA

Credit); or

The Retired Employee Plan, Retired Agent Plan or the HRA under either Plan is terminated.


Reimbursement of Premiums and Expenses

Deadline for Claims for Reimbursement

There is no time limit to file claims for reimbursement, except that in the case of death, your estate must

file any claims for reimbursement from your HRA within six months following the date of your death.

See “Reimbursement After Your Death” for details.

How to Get Expenses Reimbursed

Aon Hewitt (the “Claims Administrator”) administers the HRA for MassMutual through Your Spending

Account (YSA). Reimbursements are issued from a YSA bank account operated by UMB Financial.

Auto-Reimbursement

If You Are Medicare-Eligible

In most cases, you are automatically enrolled in “auto-reimbursement” when you initially purchase an

individual medical or prescription drug policy through the Aon Retiree Health Exchange. (See note

below.) Once you have paid your premium, your premium will automatically be reimbursed to you from

your HRA – up to the current balance of your HRA Credits.

Note: Most individual medical or prescription drug policy providers offer the auto-reimbursement option.

If you enroll with a health care provider that does not offer this option, you will be responsible for

submitting claims for reimbursement of your premiums.

If you do not want the auto-reimbursement feature when you enroll in an individual medical or

prescription drug policy through the Aon Retiree Health Exchange, contact the Aon Retiree Health

Exchange.

If You Are Pre-Medicare-Eligible

Auto-reimbursement is available to Pre-Medicare-Eligible individuals; however, it is not automatic. If

you wish to elect auto-reimbursement, you must file an initial online or paper claim (or reimbursement

request) and provide documentation to YSA to initiate auto-reimbursement. YSA will reimburse the first

month and then set auto-reimbursement to recur for future months.

Note: It is your responsibility to contact YSA if you disenroll from a plan while you are receiving

automatic reimbursement.

Filing a Form for Reimbursement

When you have eligible expenses under the HRA that are not reimbursed through auto-reimbursement,

you can go online to the Aon Retiree Health Exchange and print and complete the Your Spending

Account Claim form. If you do not have online access, contact the Aon Retiree Health Exchange for a

paper form.


You may submit a request for reimbursement online, by mail or by fax. Reimbursement requests are

processed each business day. You may speed the processing of your claim by submitting your claim form

and receipts online or via fax rather than by submitting them by mail.

Via mail:

Aon Hewitt—Your Spending Account

P.O. Box 785007


Via Fax:

844-719-6834

Online:

https://retiree.aon.com/massmutual

You will be reimbursed by check. However, for faster reimbursement, you may sign up to have

reimbursements electronically deposited to your bank account via the Your Spending Account link from

the Exchange website (https://retiree.aon.com/massmutual).

Note: Banking laws do not permit electronic deposit (direct deposit) to international bank accounts.

(This does not apply to U.S. territories such as Puerto Rico.)

Information Required for Reimbursement

To make a claim for reimbursement, complete the Your Spending Account Claim form. You must sign

and date the form, verifying the expenses have not been reimbursed by another insurance policy or plan.

You need to include supporting documentation with your claim form, showing the following:

For premium reimbursements:

Premium amount(s) paid;

Coverage period start date, typically the first day of the month; and

Proof of payment, which may include:

o Bank statements;

o Copies of mailed checks; and

o Statements provided by your insurance carrier.

For reimbursement of other medical expenses:

Type of service;

Date of service;

Service provider;

Who service is for;

Receipt or other proof of payment; and

Requested reimbursement amount.

Note: Verbal or handwritten information for general merchandise, illegible receipts, credit card receipts,

and statements with a forwarding balance will not be accepted.




Receiving Reimbursements

You can only request and receive reimbursements for your own or your Eligible Dependent’s eligible

health care expenses, up to your current HRA balance.

Reimbursement After Your Death

If you die while participating in the HRA, reimbursement from your HRA will not be available for

expenses incurred after your death. However, your estate may request reimbursement on your behalf for

eligible health care expenses incurred before your death while you were participating in the HRA, as long

as a request for reimbursement is filed within six months following the date of your death and such

request does not exceed your remaining HRA Credits. Requests for reimbursements filed after the six-

month period will be denied and any remaining balance in your HRA will be forfeited. Your HRA

balance may be transferred to your surviving Eligible Dependent following your death (see below).

Surviving Spouse, Domestic Partner or Eligible Child

If you die while participating in the HRA and your Eligible Dependent is participating in the HRA at the

time of your death, your Eligible Dependent will become the HRA holder as long as he or she continues

to meet eligibility requirements. Your Eligible Dependent will receive your remaining HRA balance at

the time of your death and will continue to receive future HRA Credits (except for certain dental

participants – see below), if such Eligible Dependent continues to meet the eligibility requirements, until

the earlier of his or her death, the date he or she is no longer eligible for the HRA, or the termination of

the applicable Retired Employee or Retired Agent Plan. In the event you have multiple surviving eligible

Dependents, your spouse or domestic partner will become the HRA accountholder. If you do not have an

eligible spouse or domestic partner participating in the HRA at the time of your death, then your oldest

disabled child will become the HRA accountholder, if any.

If you were eligible for a dental HRA Credit, the dental HRA Credit will cease upon your death. If

eligible, your Dependent will only be eligible to receive the medical HRA Credit amount going forward

and will not receive future dental HRA Credits.


Claims and Appeals Procedures

For this section, any reference to “you” or “your” also refers to a representative or provider designated by

you to act on your behalf, unless otherwise noted.

If you file a claim for reimbursement and one or more of your expenses is not reimbursed, or if you

believe you have not been provided with the appropriate HRA Credit, you may file an appeal using the

following procedures. In this SPD, a claim for reimbursement from your HRA for eligible expenses

received by either you or your eligible Dependent is referred to as “your claim.” An “appeal” is a written

request for benefits. The “Appeals Reviewer” means the body responsible for reviewing and deciding

your claim.

General Appeal Procedure

Aon is the Appeals Reviewer for claims involving HRA reimbursements. The MassMutual Claims

Committee is the Appeals Reviewer for claims involving the amount of your HRA Credit. To initiate an

appeal, you must submit a request for an appeal in writing to the appropriate Appeals Reviewer within

180 days of receipt of a denial-to-reimburse notice. You should state the reason why you feel your appeal

should be approved and include any information supporting your appeal.

As a part of your appeal, you can submit written comments, documents, records or other information

relating to your claim. In addition, you will be provided, upon written request and free or charge,

reasonable access to (and copies of) all documents, records and other information relevant to your claim.

The review will take into account all comments, documents, records and other information submitted

relating to the claim regardless of whether the information was submitted or considered in the initial

benefit determination. However, no consideration will be given to the initial denial of your claim during

the review of the claim or appeal. In addition, someone who was not involved in the initial decision and

who is not a subordinate or any individual who was involved in the initial decision will conduct the

review.

Responding to Your HRA Claim

If the Appeals Reviewer needs information to process your appeal, the Appeals Reviewer will notify you,

in writing, within 30 days after receiving your claim of the specific information required and the date

when you can expect a determination. You will have 45 days to provide the additional information. The

determination period to respond to your appeal will be suspended as of the date the Appeals Reviewer

sends the notice and will resume again once you have provided the additional information. This

determination date will be no later than 45 days after the date you filed your initial appeal.

If you do not provide the requested information within the specified timeframe, the Appeals Reviewer

will decide the appeal without the requested information.

If the Appeals Reviewer, due to reasons beyond its control, determines that extra time is required to

process your appeal, it will notify you in writing of the reasons for the extension and the new due date for

its response to your appeal. The Appeals Reviewer will notify you of the extension within 30 days after

its initial receipt of your appeal. The new due date will not be later than 45 days after the date you filed

your initial appeal.


Once you have filed an appeal, the Appeals Reviewer will notify you of its decision as soon as practical,

but no later than 30 days after receipt of your appeal. If you do not follow the required procedures for

filing an appeal, the Appeals Reviewer will notify you and explain the proper procedures to follow in

filing your appeal.

If Your Appeal Is Denied

If your appeal is denied, in whole or in part, the Appeals Reviewer will send you a written notice of its

decision, including:

The specific reason(s) for the denial of the appeal;

Reference to the specific Plan provision(s) on which the denial is based;

A description of additional material or information necessary to perfect the claim and an explanation

of why the material or information is necessary;

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 relevant information; and

A description of the HRA’s second-level appeal procedures and the time limits under those

procedures, including your right to bring a civil action under Section 502(a) of ERISA if your appeal

is denied.

Appealing Your Adverse Determination

If your appeal is denied, you will have 180 days following the receipt of the denial notice to file a written

second-level appeal. The Appeals Reviewer for a second-level appeal is the MassMutual Plan

Administrative Committee. The following procedures will apply in considering your second-level appeal.

You may submit your second-level appeal in writing or by fax to the appropriate Appeals Reviewer. The

Appeals Reviewer will review the facts, the reasons for the claim decision, and the information you have

provided. The Appeals Reviewer will respond in writing within 60 days following the receipt of your

second-level appeal.

You may submit written comments, documents, records, and other information relevant to your

appeal.

Upon request, you will be provided (free of charge) copies of all Appeals Reviewer’s documents,

records, and other information relevant to your appeal.

The review of your second-level appeal will consider all comments, documents, records, and other

information you submit on the second-level appeal and will not afford deference to the initial denial

of your appeal.

The Appeals Reviewer will notify you, in writing, of its decision of your second-level appeal as soon

as possible, but no later than 60 days after its receipt of your second-level appeal request. If the

Appeals Reviewer determines that an extension of time for processing the second-level appeal is

needed, it will notify you of the reasons for the extension and the extended due date before the end of

the 60-day period.

If Your Second-Level Appeal Is Denied

This Plan is governed by ERISA. You have the right to bring a civil action under ERISA Section 502(a) if

you are not satisfied with the outcome of the appeal process. In most instances, you may not initiate a

legal action against the Plan until you have completed the appeal process. If your appeal is expedited,


there is no need to complete the process before bringing legal action. No legal action may begin more

than one year after the date you have exhausted the Plan’s claim and appeal process.


Administrative Information

Discretionary Authority of the Plan Administrator

The Plan Administrator has responsibility for the interpretation and construction of the HRA and final

authority for the operation and administration of the HRA, including its day-to-day operation and

administration. The Plan Administrator has the power and the duty to take all actions and to make all

decisions necessary or proper to carry out its responsibilities, powers, and duties under the HRA. All

determinations of the Plan Administrator as to any question involving its responsibilities, powers, and

duties under the HRA, including interpretation of the HRA or as to any discretionary actions to be taken

under the HRA, are solely at the discretion of the Plan Administrator and are final, conclusive, and

binding on all persons claiming to have any right or interest in or under the HRA.

In addition to any implied powers and duties, the specific powers and duties of the Plan Administrator

include the power and duty to:

Determine the eligibility of any individual to participate in the HRA and the amount of HRA Credits,

if any, an individual is eligible for under the HRA;

Determine when, to whom, in what amount, and in what form reimbursements are to be made under

the HRA;

Construe and interpret the terms and provisions of the HRA and all documents that relate to the

HRA and to decide any and all matters arising thereunder, including the right to remedy possible

ambiguities, inconsistencies, or omissions;

Investigate and make such factual or other determinations as will be necessary or advisable for the

administration of the HRA or for the determination of benefits under the HRA;

Make and enforce such rules and regulations as it deems necessary or proper for the efficient

administration of the HRA;

Review benefit claims and approve or deny any such benefit claims;

Appoint such agents, counsel, accountants, Consultants, and other persons as may be required to

assist in administering the HRA; and

Allocate and delegate its responsibilities under the HRA and to designate other persons to carry out

any of its responsibilities under the Plan.

Clerical Error

A clerical error or other administrative error does not create benefits under the HRA. You are responsible

for the accuracy of information pertaining to your participation in the HRA, including, but not limited to,

your birthday, address, Social Security number, or dependent eligibility. It is your responsibility to

confirm the accuracy of statements made by MassMutual or its designees that are based on such

information and to promptly report errors to the Plan Administrator.

Plan Funding and Administration

No funding medium of any kind is used for the accumulation of HRA Credits, and no insurance company,

trust fund, or any other institution maintains a fund through which the HRA is funded or account

reimbursements are provided. Aon Hewitt (through its Your Spending Account program) acts as a third-

party Claims Administrator (the “TPA”) that MassMutual has hired to process claims. The activities of

the TPA may include receiving, processing, and evaluating your claim, billing MassMutual for the


amount due under your claim, and paying your claim. The TPA does not guarantee the payment of any

claims under the HRA in any contract or insurance policy. MassMutual is ultimately responsible for the

payment of your claims.

Electronic Media

The Plan Administrator may use electronic media in accordance with ERISA to satisfy all disclosure and

recordkeeping obligations imposed on the HRAs under Title I of ERISA.

Future of the HRA

MassMutual reserves the right to terminate, modify, amend or suspend the HRA, in whole or in part, at

any time and from time to time. If the HRA is terminated, you will not be reimbursed for any expenses

incurred on or after the HRA termination date, and you will need to file requests for reimbursement for

expenses incurred before the termination date by the filing deadline established by the Plan

Administrator. The Claims Administrator will not accept reimbursement requests filed after the deadline.

Any remaining HRA Credits, after timely filed requests for reimbursement have been processed, will be

the sole property of MassMutual.

Indemnification

MassMutual indemnifies and holds harmless the Plan Administrator, members of the Claims Review

Committee, members of the Plan Administrative Committee (PAC), and any employee of MassMutual to

whom fiduciary responsibilities have been delegated from and against any liability, damage, cost, and

expense (including attorneys’ fees and amounts paid in settlement of any claim approved by MassMutual)

incurred by or asserted against him or her by reason of his or her occupying or having occupied fiduciary

positions in connection with the HRA. However, no indemnification is provided if the Plan

Administrator, members of the Claims Review Committee, members of the PAC, or any employee of

MassMutual personally profited from any act or transaction in respect of which indemnification is sought.

Nonassignment of Benefits

Assignment or alienation of any reimbursements provided by the Plan will not be permitted or recognized

except as otherwise required by applicable law. This means that, except as required by applicable law,

reimbursements provided under the HRA are not subject to sale, assignment, anticipation, alienation,

attachment, garnishment, levy, execution, or any other form of transfer. Generally, state and local laws

will not be recognized unless permitted by or under an applicable federal law, such as ERISA.


Plan Information

Plan Name

MassMutual Retired Employee Welfare Benefits Plan, 545

MassMutual Retired Agents’ Welfare Benefits Plan, 546

Plan Sponsor

Massachusetts Mutual Life Insurance Company

1295 State Street, F105

Springfield, MA 01111

Phone: 866-662-6448


Plan Administrator

The Plan Administrator is the Plan Administrative Committee (PAC), which is appointed by

MassMutual’s Chief Executive Officer. The PAC has the authority to control and manage the operations

and administration of the Plan. You can reach the PAC at:

Massachusetts Mutual Life Insurance Company

MassMutual Benefits


Springfield, MA 01111-0001

Phone: 866-662-6448


Claims Administrator

Generally:

Aon Hewitt

Your Spending Account

P.O. Box 785007


844-335-9036

Fax: 844-719-6834

Amount of HRA Credit Only:

Claims Review Committee

MassMutual Benefits



Phone: 866-662-6448



Plan Year

The Plan Year is January 1 through December 31.

Employer Identification Number

The EIN of Massachusetts Mutual Life Insurance Company is 04-1590850

Plan Type and Funding

The HRA is an option offered as a part of a welfare plan reimbursement arrangement providing

reimbursement for certain qualified expenses. Your benefits are based on the credits in your account,

which are credited by the Company. The HRA is unfunded.

Agent for Service of Legal Process

General Counsel of Massachusetts Mutual Life Insurance Company

1295 State Street


If legal action is necessary to settle a claim, any action may also be served upon the Plan Administrator.

Claims Administrator

Generally, the claims administrator for reimbursement claims is Aon Hewitt and the claims administrator

for claims involving the amount of a Retiree or Dependent’s HRA Credit is the MassMutual Claims

Committee. The claims administrator for all second-level appeals is the MassMutual Plan Administrative

Committee. The Claims Administrator has full discretion and authority to determine claims and appeals

arising under this Plan. See the Appeals section of this SPD for details about appeals. See the Contact

Section for contact information.

Continuation of the Plan

At this time, the Company expects to continue sponsoring the Plan. However, the Company reserves the

rights to terminate, modify, amend or suspend the benefits plans, in whole or in part, at any time and from

time to time. This may result in modification or termination of benefits to Participants. You will be

notified in writing of any change or if benefits end.


ERISA Rights

As a Plan Participant, you are entitled to certain rights and protections under the Employee Retirement

Income Security Act (ERISA) of 1974, as amended. ERISA provides that you are entitled to the rights

described in this section.

Receive Information about Plan and Benefits

You have the right to:

Examine, without charge, at the Plan Administrator’s office or other specified locations, such as

worksites, all documents governing the Plan. These include any insurance contracts and copies of the

latest annual report (Form 5500 series) filed by the Plan with the U.S. Department of Labor and

available at the Public Disclosure Room of the Employee Benefits Security Administration (EBSA).

Obtain, upon written request, copies of documents governing the operation of the Plan. These include

any insurance contracts and copies of the latest annual report (Form 5500 series) and current

Summary Plan Description. A reasonable charge may be required for the copies.

Continue Group Health Plan Coverage

You have the right to continue health care coverage for yourself and your dependents if there is a loss of

coverage as a result of a qualifying event. You or your dependents may have to pay for this coverage.

You will be provided with more information regarding your COBRA coverage rights.

Prudent Actions 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 Plan. The people who operate the Plan, called Plan fiduciaries, have a

duty to do so prudently and in the interest of you and other Plan Participants and beneficiaries. No one,

including the Company or any other person, may 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 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. However, you may not begin any legal action, including proceedings

before administrative agencies, until you have followed and exhausted the Plan’s claims and appeals

procedures.

Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request a copy

of a Plan document and do not receive it 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 Plan

Administrator’s control.

If you have a claim that is denied or ignored, in whole or in part, you may file suit in a state or federal

court. If you believe that Plan fiduciaries have misused the Plan’s money or if you believe that you have


been 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 if, for example, it finds your claim is frivolous.

Assistance with Questions

If you have any questions about the Plan, you should contact the Plan Administrator. If you have any

questions about your rights under ERISA or if you need assistance in getting documents from the Plan

Administrator, you should contact the nearest EBSA office or the national office at:

Division of Technical Assistance and Inquiries

Employee Benefits Security Administration

U.S. Department of Labor

200 Constitution Avenue NW

Washington, DC 20210

866-444-3272

For more information about your rights and responsibilities under ERISA or for a list of EBSA offices,

contact EBSA by visiting their website at www.dol.gov/ebsa.

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