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Vision Care Program Detailed Table of Contents
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Table of Contents
Detailed Table of Contents
Index

Introduction

Who Is Eligible

Glossary of Key Terms – Eligibility

General Information

Your Eligible Dependents

Extended Coverage for Full-Time Status Students Age 19 and Older

Extended Coverage for Disabled Children

Qualified Medical Child Support Order (QMCSO)

If You Are Reemployed

For Employees of New Participating Subsidiaries and/or Participating Employers

Enrolling for Coverage

General Information

Your Contributions

Enrolling Yourself and Your Eligible Dependents

When Coverage Begins

Adding Dependents

If You Are Not Actively at Work

If You Do Not Enroll by the Deadline

Qualified Status Changes

Special Enrollment Opportunities

Significant Cost or Coverage Change

Annual Enrollment

How the Program Works

General Information

Key Features

When Coverage Ends

General Information

If You Leave the Company, Retire, or Are No Longer Eligible for Coverage

If Your Employee Group Goes on Strike

Special Extensions of Coverage

General Information

During a Leave of Absence

Uniformed Services Employment and Reemployment Rights Act of 1994

If You Receive Disability Benefits

Your Legal Right to Continuation Coverage Under COBRA

General Information

Notification

Election Procedure

Disability Extension

Other Extension

Payment

When Continuation Coverage Ends

Trade Act Implications

Claims and Appeals Procedures

General Information

Procedure for Filing a Claim

Defective Claims

Initial Claim Review

Initial Benefit Determination

Post-Service Claim

Manner and Content of Notification of Denied Claim

Review of Initial Benefit Denial

Procedure for Filing an Appeal of a Denial

Review Procedures for Denials

Timing of Notification of Benefit Determination on Review

Manner and Content of Notification of Benefit Determination on Review

Situations Affecting Your Benefits

General Information

If the Group Benefits Plan Is Modified or Ended

Summary of Vision Plan

Administrative and Contact Information

General Information

Type of Plan

Plan Sponsor

Employer Identification Number of Plan Sponsor

Plan Name and Number

Plan Year End

Agent for Service of Legal Process

Benefits Committee and Plan Administrator

Eligibility Administration

Claims Administrator

Claims Administrator for Eligibility Claims

COBRA Administrator for Continuation Coverage

Allocation and Delegation of Fiduciary Responsibilities by the Benefits Committee

Trust and Insurance

Insured Benefits

Your ERISA Rights

General Information

Receive Information About Your Program and Benefits

Continue Group Health Plan Coverage

Prudent Actions by Plan Fiduciaries

Enforce Your Rights

Assistance With Your Questions

Vision Care Program

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Enrolling for Coverage

Enrolling Yourself and Your Eligible Dependents

Adding Dependents

Coverage for a new eligible dependent (gained through a Qualified Status Change as described in the “Qualified Status Changes” SPD) begins on the day of the qualifying event, provided you report the Qualified Status Change to the eligibility administrator within 30 days after the date of the event. However, coverage of your domestic partner or children of your domestic partner, who are eligible dependents, can begin at any time but will not start until the date you give your election change to the eligibility administrator. Payroll deductions begin as soon as administratively possible after you complete the enrollment process. Coverage takes effect on the date of the event, and payroll deductions are not retroactive to that date.

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