Administrative Information

Important Facts About Your Plan

This section contains descriptive information about your benefit plans.

COMPANY
As used in this Summary Plan Description (SPD), the terms “Company” or “employer” refer to Tufts Associated Health Plans, Inc. and any of its subsidiaries or affiliated companies that have adopted the applicable benefit plan(s) for their employees.

PLAN ADMINISTRATOR 
The Plan Administrator for all of your benefit plans is: 

Tufts Associated Health Plans, Inc.
705 Mount Auburn Street
Watertown, MA 02472-1508

Phone Number: 617-972-9400

VP of Human Resources on behalf of the Plan Administrator

PLAN SPONSOR
The Plan Sponsor for all of your benefit plans is: 

Tufts Associated Health Plans, Inc.
705 Mount Auburn Street
Watertown, MA 02472-1508 

EMPLOYER IDENTIFICATION NUMBER
The Employer Identification Number (EIN) for Tufts Associated Health Plans, Inc. is 04-2985923. 

AGENT FOR SERVICE OF LEGAL PROCESS
Legal process may be served on the Plan Administrator at the address shown above. Legal process may also be served on the insurance carrier for a plan (if applicable).

NOT A CONTRACT OF EMPLOYMENT
You should be aware that your participation in the benefit plan(s) described in this handbook does not mean that your employment with the Company is guaranteed for any length of time.

PLAN DOCUMENTS
This Summary Plan Description (SPD) summarizes the official plan documents for your benefit plans. You should refer to the official plan document for more information about the operation of or benefits provided under a specific plan or program. You can obtain a copy of the official plan document by contacting Human Resources. In the event of any conflict between the information summarized in this Summary Plan Description (SPD) and the official plan documents, the plan documents will always govern. The plan documents will also govern over any conflicting oral representations concerning the benefits provided under a specific plan or program.

PLAN CONTINUANCE
Tufts Associated Health Plans, Inc. reserves the right to change, amend or terminate the benefit plan(s) described in this Summary Plan Description (SPD) at any time. No participant has the right to any benefits from a plan following its termination, except that no amendment or termination may deprive you or an eligible dependent of any of the benefits to which you or an eligible dependent is entitled under a plan which have become due and payable under the terms of the plan through the date of such amendment or termination.

Any material amendment or termination of a plan will be adopted by formal action taken by the Tufts Associated Health Plans, Inc. Board of Directors in accordance with the Compensation Committee Charter. Administrative and regulatory changes are adopted by the Total Rewards Committee.

TYPE OF PLAN
Your Medical, Dental, Vision and BeWell Center Onsite Clinic plans are considered to be group health plans under current federal regulations.

Your Life Insurance, AD&D Insurance, Disability Insurance, Group Legal Plan, Adoption Assistance Plan,* Long-Term Care Insurance Plan,* and Employee Assistance Program (EAP) are considered to be welfare plans under current federal regulations.

*You should be aware that the Adoption Assistance and Long-Term Care Insurance Plans are not the type of plans that are covered by the Employee Retirement Income Security Act of 1974 (ERISA), and are therefore not subject to ERISA’s reporting and disclosure, fiduciary responsibility, and other rules. This also applies to the BeWell Center Onsite Clinic.

PLAN YEAR 
The Plan Year for each of the benefit plans described in this Summary Plan Description (SPD) is the same as the calendar year.

PLAN NAMES, PLAN NUMBERS, AND PLAN FUNDING
The official plan names, Plan Identification Numbers (PINs), and funding status for the benefit plans described in this Summary Plan Description (SPD) are as follows:

Plan Name Plan Number Funding Status Policy Number
(if applicable)

Tufts Associated Health Plans, Inc. 
Exclusive Provider Option
Your Choice Option

501

These plans are self-insured by the Company. These plans are funded in part by participant contributions, and in part by the Company.

16199

Tufts Associated Health Plans, Inc. Preferred Provider Option
Your Choice Option
Tufts HP Network Plan

501

45700

Tufts Associated Health Plans, Inc. Preferred Provider Option
Cigna Out of Area

501

45701

Granite Premier Choice EPO

501

17313

LifeSpan Premier Choice EPO

501

17311

Tufts Associated Health Plans, Inc. BeWell Center Onsite Clinic*

513

This plan is self-insured by the Company.

The administration of this plan and onsite clinic operation is funded entirely by the Company. Participants’ costs are limited to any applicable charges for services and/or copayments.

N/A

Delta Dental Plan of Massachusetts PPO Plus Premier

504

This plan is self-insured by the Company. This plan is funded in part by participant contributions, and in part by the Company.

009666

EyeMed Vision Care Plan

 

 

506

This plan is insured through a group policy issued by:

Combined Insurance Company of America
5050 Broadway
Chicago, IL 60640

Administrative Office:
4000 Luxottica Place
Mason, OH 45040

This plan is funded entirely by participant contributions.

9798760

Tufts Associated Health Plans, Inc. Group Long-Term Care Insurance Plan*
(applies only to employees enrolled in the plan prior to 12/31/2011)

N/A

This plan is insured through a group policy issued by:

John Hancock Life Insurance Company (U.S.A.)
Group Long-Term Care
PO Box 111
Boston, MA 02117
Attn: Long-Term Care Claims 

This plan is funded entirely by participant contributions.

189747-LTC

Tufts Associated Health Plans, Inc. Short and Long-Term Disability Coverage for All Employees Classified as Full-Time other than Senior Management

503

These plans are insured through a group policy issued by:

Life Insurance Company of North America
601 Chestnut St
Philadelphia, PA 19192-2235 

These plans are funded in part by participant contributions, and in part by the Company.

Short-Term Disability Plan:
FLK-960439

 

Long-Term Disability Plan:
FLK-960440

Tufts Associated Health Plans, Inc. Short-Term Disability Coverage for All Employees Classified as Part-Time employees

503

Tufts Associated Health Plans, Inc. Short and Long-Term Disability Coverage for All Employees Classified as Directors

503

Tufts Associated Health Plans, Inc. Long-Term Disability Coverage for All Employees Classified as Senior Management (AVP and Above)

503

Tufts Associated Health Plans, Inc. Salary Continuance Plan for All Employees Classified as Senior Management (AVP and Above)

N/A

This plan is self-insured by the Company combined with an ASO Agreement with Cigna Insurance Company.

This plan is funded entirely by the Company.

SHD 961719

Employee Basic and Optional Term Life and Dependents Term Life Coverage for All Full-Time and Part-Time Employees of Tufts Associated Health Plans, Inc.

502

This plan is insured through a group policy issued by:

Life Insurance Company of North America
1601 Chestnut St
Philadelphia, PA 19192-2235

This plan is funded in part by participant contributions, and in part by the Company.

FLX-963123

Group Basic and Voluntary Accidental Death & Dismemberment Insurance for all Full-Time and Part-Time Employees of Tufts Associated Health Plans, Inc.

502

This plan is insured through a group policy issued by:

Life Insurance Company of North America
1601 Chestnut St
Philadelphia, PA 19192-2235

This plan is funded in part by participant contributions, and in part by the Company.

OK964778

Tufts Associated Health Plans, Inc. Flexible Spending Account Plan

508

This plan is administered by:

ADP Benefit Services
2575 Westside Parkway, Suite 500
Alpharetta, GA 30004-3852

This plan is funded entirely by participant contributions.

N/A

Group Legal Expense Insurance Policy

511

This plan is insured through a group policy issued by:

ARAG Group
400 Locust Street, Suite 480
Des Moines, IA 50309

This plan is funded entirely by participant contributions.

13400

Employee Assistance Program

509

This plan is administered by:

E4 Health
55 Cedar Street #100
Providence, RI 02903

This plan is funded entirely by the Plan Sponsor.

N/A

Tufts Health Plan Adoption Assistance Plan*

514

This plan is administered by:

Tufts Health Plan
705 Mount Auburn Street
Watertown, MA 02472

This plan is funded entirely by the Plan Sponsor.

N/A

*You should be aware that the Adoption Assistance and Long-Term Care Insurance Plans are not the type of plans that are covered by the Employee Retirement Income Security Act of 1974 (ERISA), and are therefore not subject to ERISA’s reporting and disclosure, fiduciary responsibility, and other rules.