Attached files
file | filename |
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10-K - FORM 10-K - TRANSCAT INC | l40013e10vk.htm |
EX-32.1 - EX-32.1 - TRANSCAT INC | l40013exv32w1.htm |
EX-21.1 - EX-21.1 - TRANSCAT INC | l40013exv21w1.htm |
EX-31.2 - EX-31.2 - TRANSCAT INC | l40013exv31w2.htm |
EX-31.1 - EX-31.1 - TRANSCAT INC | l40013exv31w1.htm |
EX-23.1 - EX-23.1 - TRANSCAT INC | l40013exv23w1.htm |
EX-10.26 - EX-10.26 - TRANSCAT INC | l40013exv10w26.htm |
EX-10.25 - EX-10.25 - TRANSCAT INC | l40013exv10w25.htm |
Exhibit 10.24
Transcat Inc. Post-Retirement Benefit Plan
For Officers
For Officers
(Amended and Restated Effective January 1, 2010)
Introduction
The Transcat Inc. Post-Retirement Benefit Plan for Officers (the Plan) is a group health
plan that provides benefits to eligible retired Corporate Officers and their eligible spouses.
There are three kinds of benefits provided under the Plan: (i) long term care insurance coverage;
(ii) medical and dental insurance coverage; and (iii) medical premium reimbursement benefits. In
this document, Transcat Inc. is referred to as the Company.
This document, together with the subscriber contracts and coverage certificates issued by the
insurance carriers and health maintenance organizations (HMO) through which coverage is provided,
is the summary plan description of the Plan. This document, together with the subscriber contracts
and coverage certificates, is also considered the written instrument for the Plan for purposes of
Section 402(a)(1) of the Employee Retirement Income Security Act of 1974 (ERISA).
The original effective date of the Plan is December 23, 2006. This amendment and restatement is
effective January 1, 2010.
Eligibility Requirements
Corporate Officer Eligibility. Corporate Officers who retire from active employment
with the Company on or after December 23, 2006 at age 55 or older with 5 or more years of
Qualifying Service and who do not work in any full-time employment (as defined below) after
retirement are eligible to participate in the Plan. In this document, a Corporate Officer who
retires and is eligible to participate in the Plan may also be referred to as a Retiree.
For purposes of eligibility to participate in the Plan, an individual will be considered a
Corporate Officer if the individual has the title of Vice President or higher or is the Corporate
Controller.
Qualifying Service means an individuals most recent period of continuous, uninterrupted employment
with the Company on or after the date the individual reaches age 50. Service prior to age 50 does
not count as years of Qualifying Service for purposes of determining eligibility to participate in
the Plan. Service with a business acquired by the Company on or after December 23, 2006 (the
original effective date of the Plan) is not counted as Qualifying Service. An employee is
considered to be employed by the Company during any period of absence for which the employee is
paid his or her regular compensation or receives short-term disability benefits under a
Company-sponsored plan and during any other Company-authorized paid or unpaid leave of absence,
provided that the employee returns to active employment with the Company at the expiration of such
period of absence.
A Retiree will be considered to be working in full-time employment after retirement if the Retiree
regularly works 30 or more hours per week at a job at which the Retiree is eligible for medical
benefits. The Company, in its sole discretion, will determine whether an individual is working in
such full-time employment after retirement for purposes of determining eligibility to participate
in the Plan. As a condition to participating in the Plan, a Retiree is required to report to the
Company when the Retiree begins working in full-time employment (as defined above)
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after retirement. If the Company determines that a Retiree has commenced full-time employment
after retirement and has not reported such employment to the Company, the Retiree will cease to be
eligible to participate in the Plan and may be required to reimburse the Company for the cost of
any benefits (including premiums paid for long term care coverage, dental and medical coverage and
premium reimbursement payments) provided during the period the Retiree was working in full-time
employment.
Spousal Eligibility. A Retirees spouse is eligible for benefits under the Plan as
described in more detail below and subject to the following:
1) | the spouse and Retiree must be legally married under the law of the State in which they reside; |
2) | a spouse who becomes the spouse of a Retiree after the date the Retiree retires from the Company is not eligible for benefits under the Plan; |
3) | long term care coverage is not available to a spouse who is not the original spouse with respect to whom the Company provided long term care coverage on or after the date the Corporate Officer reached age 55 with 5 years of Qualifying Service; |
4) | long term care coverage is not available to a spouse who becomes the spouse of a Corporate Officer after the Corporate Officers long term care coverage began. |
A Retirees spouse who is eligible for benefits under the terms of the Plan is referred to as an
Eligible Spouse.
No Guarantee of Coverage. Eligibility for medical and dental coverage and for long term
care coverage is subject to the eligibility provisions contained in the subscriber contracts and
coverage certificates through which benefits are provided under the Plan. In the event that an
insurance carrier or HMO through which coverage is provided determines that a retiree or spouse is
not eligible for that coverage under a contract with the carrier or HMO, the individual shall not
be eligible for that coverage under the Plan. The Company does not guarantee that coverage will be
available to a Retiree or Eligible Spouse under any carrier or HMO contract, or that a Retiree or
Eligible Spouse will be eligible to obtain any individual coverage.
Description of Benefits
Long Term Care Insurance Coverage. During active employment, the Company provides long
term care insurance coverage for Corporate Officers who reach age 55 and have 5 years of Qualifying
Service. An actively employed eligible Corporate Officer may enroll the Officers spouse in long
term care insurance coverage on the date the Officer is first eligible for coverage. Once a
Corporate Officer has enrolled a spouse in long term care insurance coverage, no subsequent spouse
of that Corporate Officer may be enrolled in long term care insurance coverage through the Company.
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The long term care insurance coverage benefit under this Plan consists of the continuation of the
Companys payment of the premium for the long term care insurance coverage that commenced at the
time the Officer first qualified for coverage. The Companys payment for coverage continues
through the end of the ten year period measured from the commencement of long term care insurance
coverage, provided that the Company may at any time elect to fully pay up a Retirees and/or
Eligible Spouses policy prior to the end of the ten year period. The long term care insurance
coverage will be provided under individual insurance policies owned by the Retiree and Eligible
Spouse. Such policies will be designed to be fully paid up policies after ten years of premium
payments. Eligibility for coverage under a policy is subject to the discretion of the insurance
carrier through which coverage is provided and the Company does not guarantee that any Retiree or
Eligible Spouse will qualify for coverage. In the event that a Retirees or Eligible Spouses long
term care insurance policy is terminated solely due to the Companys failure to pay the required
premium payments during the ten year period and, before the Company has acquired a comparable
replacement policy, the Retiree or Eligible Spouse incurs expenses that would have been covered
under the terminated policy, the Company will pay the benefits that would have been payable under
the terminated policy if it had remained in effect.
Example: Corporate Officer continues in active employment after reaching age 55 with 5 years of
Qualifying Service. Long term care coverage for the Officer and the Officers spouse begins during
active employment when the Officer reaches age 55. The Officer retires from the Company at age 58.
Long term care coverage commences immediately (continues) upon retirement under the Plan and,
subject to the terms of the Plan, the Company pays the premiums for the Officers and Eligible
Spouses coverage until the Officer reaches age 65, the end of the ten year period that began when
coverage commenced.
Medical and Dental Insurance Coverage. Company subsidized medical and dental insurance
coverage benefits are provided under the Plan to eligible Retirees and their Eligible Spouses
beginning when the Retiree reaches age 60. A Retiree who retires prior to reaching age 60 may
elect to purchase medical and dental coverage under this Plan for the Retiree and Eligible Spouse
until subsidized coverage begins at age 60 by paying 100% of the applicable premium for coverage,
subject to the insurance carriers determination that the Retiree and Eligible Spouse are eligible
for coverage. To the extent possible, medical and dental coverage under this Plan shall be provided
through the same insurance contract through which such coverage is provided to active employees of
the Company. Benefits are provided under contracts with insurance carriers and HMOs and are fully
described in the subscriber contract or coverage certificate issued to the Retiree and/or spouse
upon enrollment. The Company does not pay or otherwise guarantee any of the benefits under the
contracts with the insurance carriers or HMOs. The subscriber contracts or coverage certificates
are considered part of the summary plan description for the Plan.
A Retiree who retires prior to reaching age 60 and is not enrolled for medical and/or dental
benefits at the time the Retiree reaches age 60, must contact the Company at least 90 days in
advance of the Retirees 60th birthday to request enrollment material and must complete
and return the appropriate enrollment forms on a timely basis (as specified in the enrollment
information) in order for coverage to be effective on the first coverage entry date on or after the
Retirees 60th birthday (subject to the insurance carriers determination as to
eligibility and effective date of coverage). Subsidized coverage for an Eligible Spouse who
reaches age 60 prior to the date the Retiree reaches age 60 cannot begin until the Retiree reaches
age 60. An Eligible Spouse may not be enrolled for medical or dental insurance coverage under the
Plan
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unless the Retiree is enrolled for such coverage under the Plan or is eligible for medical premium
reimbursements, as described below.
Example: Corporate Officer retires from the Company immediately upon reaching age 55 with 5 years
of Qualifying Service. The Officer does not elect to purchase coverage under the Plan. The Officer
must notify the Company 90 days prior to the Officers 60th birthday that the Officer
wishes to enroll for medical and dental coverage under the Plan effective as of the Officers
60th birthday. If the Officer completes and returns the enrollment material in a timely
manner and the insurance carrier(s) and/or HMO(s) approve the enrollment, Company subsidized
medical and dental coverage will commence on the first coverage entry date on or after the
Officers 60th birthday. Even if the Officers Eligible Spouse reached age 60 prior to
the Officer reaching age 60, subsidized coverage for the Eligible Spouse would not begin until the
Officer reached age 60.
Subsidized medical insurance coverage for a Retiree under the Plan terminates when the Retiree
reaches age 65. Subsidized medical insurance coverage for the Eligible Spouse of a Retiree
terminates when the Eligible Spouse reaches age 65, provided, however, that if the Retiree reaches
age 65 before the Eligible Spouse reaches age 65, the amount of the Companys contribution toward
the cost of an Eligible Spouses subsidized medical insurance coverage will be reduced at the time
the Retiree reaches age 65, as described below.
Subsidized dental insurance coverage for a Retiree and Eligible Spouse continues after the date the
Retiree and Eligible Spouse reach age 65, subject to the terms of the Plan.
Example 1: Corporate Officer retires from the Company at age 60 with 10 years of Qualifying
Service. The Officers Eligible Spouse is age 63 at the time the Officer retires. Medical and
dental coverage for the Officer and Eligible Spouse begin immediately upon the Officers
retirement. The Eligible Spouses subsidized medical insurance coverage terminates on the Eligible
Spouses 65th birthday and the Eligible Spouse becomes eligible for medical insurance
premium reimbursements (described below). The Eligible Spouse is responsible for taking steps to
obtain individual medical insurance coverage. The Officers medical insurance coverage continues
until the Officer reaches age 65, subject to the terms of the Plan. The Officers and Eligible
Spouses subsidized dental insurance coverage continues subject to the terms of the Plan.
Example 2: Corporate Officer retires from the Company at age 63 with 13 years of Qualifying
Service. The Officers Eligible Spouse is age 61 at the time the Officer retires. Medical and
dental coverage for the Officer and Eligible Spouse begin immediately upon the Officers
retirement. The Officers subsidized medical insurance coverage terminates on the Officers
65th birthday. The Eligible Spouse is age 63 on the Officers 65th birthday
and remains eligible for continued subsidized medical insurance coverage (at a reduced Company
contribution rate beginning on the date of the Officers 65th birthday, as described
below) until the Eligible Spouse reaches age 65, at which time the Eligible Spouses subsidized
medical insurance coverage terminates and the Eligible Spouse becomes eligible for medical
insurance premium reimbursements (described below). The Officers and Eligible Spouses subsidized
dental insurance coverage continues subject to the terms of the Plan.
The Company will contribute toward the cost of coverage up to a maximum capped amount determined
by the Company. The capped amount applicable to a Retiree or Eligible Spouse
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beginning in the first year in which the Retiree or Eligible Spouse is eligible for subsidized
medical and dental insurance coverage is based on the capped amount that was in effect for the year
in which the Retiree retired, or, in the case of an Officer who had satisfied the eligibility
requirements to participate in the Plan but died before retiring, the capped amount in effect for
the year in which the Officer died, increased by 3% each year beginning after the year in which the
Officer retired or died. The capped amount is equal to 72% of the applicable premium for
one-person or two-person coverage under a base coverage plan determined by the Company for the year
in which the Retiree retires. For Retirees who retire in 2007, the base plan used for determining
the Company contribution amount is the Preferred Care TriVantage plan for medical coverage and the
Business Council of New York State Dental Plan for dental coverage. For Retirees who retire in
2007, the maximum monthly Company contribution is equal to $230.48 for Retiree-only medical
insurance coverage, $518.57 for Retiree and Eligible Spouse medical insurance coverage, $20.28 for
Retiree-only dental insurance coverage and $58.14 for Retiree and Eligible Spouse dental insurance
coverage. The base plans selected by the Company for purposes of determining the Company
contribution amount may change from year to year in the discretion of the Company, but will be
plans that provide benefits at a substantially comparable level to the benefits provided under the
Preferred Care TriVantage plan and the Business Council of New York State Dental Plan. The
Companys contribution toward the cost of coverage for a Retiree and/or Eligible Spouse will
increase to reflect any increase in the cost of the base plan coverage, but the increase in the
Companys contribution for any year will not exceed 3%.
Example: Officer 1 is not married and retires from the Company in 2007 at age 63 with 13 years of
Qualifying Service. Medical and dental coverage for Officer 1 begins immediately and the Company
contribution toward the cost of coverage is equal to$230.48 per month for medical insurance
coverage and $20.28 per month for dental insurance coverage. The 2007 Company contribution amounts
represent 72% of $320.11, the monthly cost for one-person medical coverage under the base medical
plan and 72% of $28.17, the monthly cost for one-person coverage under the base dental plan.
Officer 2 is not married and retires from the Company in 2008 at age 63 with 13 years of Qualifying
Service. Medical and dental coverage for Officer 2 begins immediately. For 2008, assume that the
monthly cost for one-person coverage under the base medical plan is $400 and the monthly cost for
one-person coverage under the base dental plan is $45. For Officer 2, the Company contribution
toward the cost of coverage is equal to $288 per month for medical insurance coverage (72% of $400)
and $32.40 for dental insurance coverage (72% of $45). For Officer 1, the Company contribution
toward the cost of coverage for 2008 is equal to $237.39 for medical insurance coverage and $20.89
for dental insurance coverage. The reason for the difference in the Companys contribution toward
the cost of coverage for Officer 1 and Officer 2 in 2008 is that the increase in the Companys
contribution toward the cost of coverage for Officer 1 in 2008 is limited by the 3% cap on
increases.
In the event that an Eligible Spouse remains eligible for subsidized medical insurance coverage
after the date the Retiree reaches age 65 (see Example 2 above), the amount of the Companys
contribution toward the cost of medical insurance coverage for the Eligible Spouse will be reduced
beginning on the date the Retiree reaches age 65. The reduced contribution amount is an amount
equal to the maximum medical premium reimbursement the Retiree is eligible to receive, as described
below in the Medical Premium Reimbursements section.
5
The Retiree and/or Eligible Spouse are required to pay any additional cost of coverage over and
above the amount paid by the Company. If the coverage option selected costs less than the
applicable maximum monthly Company contribution, the Company contribution will be equal to the cost
of the coverage selected. The Company will not pay the Retiree or Eligible Spouse the difference
between the cost of coverage selected and the maximum monthly Company contribution. Nor will the
Company pay any amount to a Retiree or Eligible Spouse who is eligible for but does not elect
coverage under the Plan. The Retirees and/or Eligible Spouses contributions toward the cost of
coverage must be paid on a timely basis as specified by the Company. If required contributions are
not paid on a timely basis, coverage may be terminated.
Example: Corporate Officer retires from the Company in 2007 at age 63 with 10 years of Qualifying
Service. Officers Eligible Spouse is age 58 at the time the Officer retires. The cap amounts
applicable for Officers who retire in 2007 are $230.48 for Retiree-only medical insurance coverage,
$518.57 for Retiree and Eligible Spouse medical insurance coverage, $20.28 for Retiree-only dental
insurance coverage and $58.14 for Retiree and Eligible Spouse dental insurance coverage. The
medical and dental coverage for the Officer and Eligible Spouse begin immediately upon the
Officers retirement and the Officer and Eligible Spouse are covered under two-person medical and
two-person dental coverage. The maximum Company monthly contribution toward the cost of their
coverage during 2007 is $518.57 for medical insurance coverage and $58.14 for dental insurance
coverage. Assume that for 2008 and 2009, the total cost of medical and dental insurance coverage
increases by 10% each year, so the amount of the increase in the Companys contribution for the
Officer and Spouse is 3% each year. For 2008, the maximum Company monthly contribution cap amounts
for the Officer and Eligible Spouse increase by 3% to $534.13 and $59.88 and increase by 3% again
for 2009 to $550.15 and $61.68. The Officer reaches age 65 in 2009. The Eligible Spouse is age 60
at that time.
The Officers subsidized medical insurance coverage terminates at age 65 and the Officer becomes
eligible for medical insurance premium reimbursements (described below). The Officer is
responsible for taking steps to obtain individual medical insurance coverage. The Eligible
Spouses subsidized medical insurance coverage may continue (at the reduced Company contribution
amount, which is equal to the amount of the Retirees premium reimbursement, as described below)
until the date the Eligible Spouse reaches age 65. When the Eligible Spouse reaches age 65, the
Eligible Spouses subsidized medical insurance coverage terminates and the Eligible Spouse becomes
eligible for medical insurance premium reimbursements. The Eligible Spouse is responsible for
taking steps to obtain individual medical insurance coverage.
Medical Premium Reimbursements. When a Retiree reaches age 65, the Retiree is eligible for
limited reimbursement from the Company of premiums paid by the Retiree for an individual policy of
medical insurance coverage purchased by the Retiree. Such medical premium reimbursements are
available to the Eligible Spouse of an age 60 or older Retiree when the Eligible Spouse reaches age
65. The Retiree and/or Eligible Spouse is responsible for obtaining such policies of individual
insurance.
Example 1: Corporate Officer retires from the Company at age 60 with more than 5 years of
Qualifying Service. The Officers Eligible Spouse is age 64 at the time the Officer retires.
Immediately upon retirement, medical and dental insurance coverage begins for the Officer and
Eligible Spouse. The Eligible Spouse reaches age 65 and the Eligible Spouses medical insurance
coverage under the Plan terminates. The Eligible Spouse is responsible for obtaining
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individual medical insurance coverage and the Eligible Spouse becomes eligible for medical premium
reimbursements (in the amount described below) for individual medical insurance coverage purchased
by the Eligible Spouse. The Officers medical insurance coverage under the Plan continues, subject
to the terms of the Plan, until the Officer reaches age 65, at which point the Officers medical
insurance coverage under the Plan terminates and the Officer becomes eligible for medical premium
reimbursements. Dental coverage continues subject to the terms of the Plan.
Example 2: Corporate Officer retires from the Company at age 62 with more than 5 years of
Qualifying Service. The Officers Eligible Spouse is age 54 at the time the Officer retires.
Immediately upon retirement, medical and dental insurance coverage begins for the Officer and
Eligible Spouse. When the Officer reaches age 65, the Officers medical insurance coverage under
the Plan terminates and the Officer is responsible for obtaining individual medical insurance
coverage and becomes eligible for medical premium reimbursements (in the amount described below)
for individual medical insurance coverage purchased by the Officer. The Eligible Spouse may
continue to receive subsidized medical insurance under the Plan (at the reduced Company
contribution amount beginning when the Officer reaches age 65) until the Eligible Spouse reaches
age 65. When the Eligible Spouse reaches age 65, the Eligible Spouses medical insurance coverage
terminates and the Eligible Spouse is responsible for obtaining individual medical insurance
coverage and becomes eligible for medical premium reimbursements (in the amount described below)
for individual medical insurance coverage purchased by the Eligible Spouse. As described above,
although the Eligible Spouses subsidized medical insurance coverage continues until the Eligible
Spouse reaches age 65 (subject to the terms of the Plan), the amount of the Companys contribution
toward the cost of the Eligible Spouses medical insurance coverage is reduced beginning on the
date the Officer reaches age 65. Dental coverage continues subject to the terms of the Plan.
The maximum amount of reimbursement available to a Retiree or Eligible Spouse for any month is a
capped amount determined by the Company. The capped amount applicable to a Retiree or Eligible
Spouse beginning in the year when the Retiree or Eligible Spouse reaches age 65 is based on the
capped amount that was in effect for the year in which the Retiree retired, or, in the case of an
Officer who had satisfied the eligibility requirements to participate in the Plan but died before
retiring, the capped amount in effect for the year in which the Officer died, increased by 3% each
year beginning after the year in which the Officer retired or died.
Example: Corporate Officer retires from the Company in 2007 at age 60 with 10 years of Qualifying
Service. In 2007, when the Officer retires, the capped amount for medical premium reimbursements
is $53.28 (as described below). Medical and dental coverage for the Officer begins immediately
upon the Officers retirement. When the Officer reaches age 65 in 2012, the Officers medical
insurance coverage terminates and the Officer is responsible for obtaining individual medical
insurance coverage and becomes eligible for medical insurance premium reimbursements. The maximum
monthly reimbursement amount for the Officer in 2012 is $61.78, determined by increasing the $53.28
capped amount 3% each year after 2007.
The capped amount is equal to 72% of the applicable premium for a base Medicare supplemental
coverage plan determined by the Company. For Retirees who retire in 2007, the maximum
reimbursement amount is $53.28 per month per individual, which is equal to 72% of $74, the 2007
monthly premium for the Excellus Medicare Blue Choice HMO Optimum Plan, the base
7
plan selected by the Company for 2007. The maximum monthly reimbursement amount will be adjusted
on an annual basis, but in no case will the amount of the maximum monthly reimbursement amount for
an individual increase by more than 3% over the preceding years maximum monthly reimbursement
amount. The base Medicare supplemental plan selected by the Company for purposes of determining
the maximum reimbursement amount may change from year to year in the discretion of the Company, but
will be a plan that provides benefits at a substantially comparable level to the benefits provided
under the Excellus Medicare Blue Choice HMO Optimum Plan.
If a Retiree or Eligible Spouse purchases coverage that costs more than the maximum reimbursement
amount available under the Plan, the Retiree or Eligible Spouse is responsible for paying the
additional cost of coverage over and above the maximum reimbursement amount. If the coverage
purchased by a Retiree or Eligible Spouse costs less than the applicable maximum monthly
reimbursement amount, the reimbursement from the Plan will be equal to the cost of the coverage.
The Plan will not reimburse the excess of the maximum monthly reimbursement over the actual cost of
coverage.
A Retiree or Eligible Spouse may claim reimbursement on an annual or periodic basis (not more
frequently than quarterly) for premiums paid by the individual for coverage. The individual
claiming reimbursement must provide the Company with adequate verification of the premium payments
for which he or she is claiming reimbursement.
Example: Corporate Officer retires from the Company in 2007 at age 60 with 10 years of Qualifying
Service. In 2007 when the Officer retires, the capped amount for medical premium reimbursements is
$53.28. The Officers Eligible Spouse is age 63 at the time the Officer retires. Medical and
dental coverage for the Officer and Eligible Spouse begin immediately upon the Officers
retirement. When the Eligible Spouse reaches age 65 in 2009, the Eligible Spouses medical
insurance coverage terminates and the Eligible Spouse is responsible for obtaining individual
medical insurance coverage and becomes eligible for medical insurance premium reimbursements. The
maximum monthly reimbursement amount for the Eligible Spouse in 2009 is $56.53.
Surviving Spouse Benefits
The surviving spouse of a Retiree or of an Officer who had satisfied the eligibility
requirements to participate in the Plan but died before retiring is eligible for surviving spouse
benefits as described below. An eligible surviving spouse is referred to as a Surviving Spouse.
Long Term Care Insurance Coverage. Long term care insurance coverage is available under
the Plan only to a spouse who was the Officers spouse on the date the Officer first becomes
eligible to enroll for long term care insurance coverage through the Company. If a Corporate
Officer who has satisfied the eligibility requirements to participate in the Plan but dies before
retirement or if a Retiree dies before the end of the period during which the Company pays for long
term care insurance coverage, the Company will continue to pay for long term care insurance
coverage for the Surviving Spouse through the end of the applicable ten year period for the
Surviving Spouses coverage (subject to the insurance carriers determination as to the Surviving
Spouses continued eligibility for coverage). A spouse who becomes the spouse of an
8
Officer after the date the Officer first becomes eligible to enroll for long term care insurance
through the Company is not eligible for long term care insurance coverage and is not eligible for
coverage as a surviving spouse after the Retirees death.
Example: Corporate Officer continues in active employment after reaching age 55 with 5 years of
Qualifying Service. Long term care coverage for the Officer and the Officers spouse begins during
active employment when the Officer reaches age 55. At that time, the Officers spouse is age 50.
The Officer retires from the Company at age 58. Long term care coverage commences immediately
(continues) upon retirement under the Plan and the Company pays the premiums for the Officers and
spouses coverage. The Officer dies at age 62. The Company pays the premiums for the Surviving
Spouses coverage until the Surviving Spouse reaches age 60, which is the end of the 10 year period
during which the Company pays for coverage.
Medical and Dental Insurance Coverage. The spouse of a Corporate Officer who was eligible
to retire but had not retired as of the date of his or her death is eligible for continued medical
and dental insurance coverage under the Plan. Medical insurance coverage for the Surviving Spouse
may continue through the date the Surviving Spouse reaches age 65, provided that the Companys
contribution toward the cost of the Surviving Spouses medical coverage is reduced on the date the
Corporate Officer would have reached age 65 to the amount of the maximum medical premium
reimbursement the Corporate Officer would have been eligible to receive at age 65, with such amount
determined as if the Corporate Officer had retired on the Corporate Officers date of death.
Dental insurance coverage continues subject to the terms of the Plan. When the Surviving Spouses
medical insurance coverage terminates on the date the Surviving Spouse reaches age 65, the
Surviving Spouse will be eligible for medical premium reimbursements as described below.
A spouse who was the Retirees spouse on the date the Retiree retired from the Company is eligible
for continued medical and dental insurance coverage under the Plan after the retirees death.
Medical insurance coverage continues through the date the Surviving Spouse reaches age 65, provided
that the Companys contribution toward the cost of the Surviving Spouses medical coverage is
reduced beginning on the date the Retiree would have reached age 65 to the amount of the maximum
medical premium reimbursement the Corporate Officer would have been eligible to receive at age 65.
Dental insurance coverage continues subject to the terms of the Plan. When the Surviving Spouses
medical insurance coverage terminates on the date the Surviving Spouse reaches age 65, the
Surviving Spouse will be eligible for medical premium reimbursements as described below.
A spouse who was not the Retirees spouse on the date the Retiree retired from the Company is not
eligible for medical and dental insurance coverage after the Retirees death. A Surviving Spouse
who is eligible for coverage is eligible only for self-only coverage under the Plan.
Medical Premium Reimbursements. A spouse who was the Retirees spouse on the date the
Retiree retired from the Company or who is the spouse of a Corporate Officer who was eligible to
retire but had not retired as of the date of his or her death is eligible for continued
reimbursements for premiums paid by the Surviving Spouse for an individual policy of medical
insurance purchased by the Surviving Spouse after the date the Surviving Spouse reaches age 65.
The maximum amount of reimbursements available and the requirements for obtaining such
reimbursements are as set forth in this Plan. A spouse who was not the Retirees spouse on the
9
date the Retiree retired from the Company is not eligible for medical premium reimbursements after
the Retirees death. A Surviving Spouse is eligible only for reimbursement for self-only coverage
purchased by the Surviving Spouse.
Provisions Applicable to Medical and Dental Insurance Coverage
The following provisions are applicable to the medical and dental insurance coverage provided
through the Plan to Retirees and Eligible Spouses. These provisions are not applicable to long
term care insurance coverage or to the individual policies of medical insurance purchased by a
Retiree or Eligible Spouse when the Retiree or Eligible Spouse is eligible for medical premium
reimbursement benefits under the Plan.
Annual Enrollment Period. If there is more than one subsidized coverage option available
in a Retirees/Eligible Spouses geographic area, before the beginning of each plan year, the
Retiree/Eligible Spouse will be given the opportunity to change coverage options under the Plan.
If there is more than one coverage option available in the Retirees/Eligible Spouses geographic
area, more detailed coverage, cost and election material will be furnished each year during the
annual open enrollment period.
Certificate of Creditable Coverage. A certificate of creditable coverage is a document
that reports the period of time that a Retiree or Eligible Spouse has had medical benefits coverage
under the Plan without a 63-day break in coverage. This information may be helpful if the Retiree
or Eligible Spouse becomes covered under a group health plan other than the Plan and that other
group health plan contains a preexisting condition limitation. Under Federal law, the Retirees or
Eligible Spouses coverage under the Plan may reduce or eliminate the application of the other
plans preexisting condition limitation.
A certificate of creditable coverage will be provided automatically when a Retirees or Eligible
Spouses coverage under the Plan terminates. A Retiree or Eligible Spouse also has the right to
request a certificate of creditable coverage from the Plan at any time, as long as the request is
made within 24 months after their coverage under the Plan terminates. Requests should be directed
to the insurance carrier or HMO through which the coverage was provided.
Medicaid-Eligible Individuals. In determining whether an individual is eligible for
coverage and in making benefit payments, the Plan will not take into account the fact that an
individual is eligible for or is covered by Medicaid. In addition, the Plan will make benefit
payments in accordance with any assignment of rights made by or on behalf of an individual as
required by a state Medicaid Plan and in accordance with any state law, which provides that the
state has acquired rights to payment with respect to a participant.
Mastectomy Benefit Coverage. Under Federal law, group health plans, insurance companies,
and health maintenance organizations (HMOs) that provide coverage for medical and surgical benefits
for mastectomy must also provide coverage for reconstructive surgery in a manner determined in
consultation with the attending physician and the patient. Required 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.
10
These benefits are subject to the normal deductible and coinsurance provisions that apply to other
benefits under the individuals coverage.
Minimum Stay for Mothers and Newborns. Group health plans and health insurance issuers
generally may not, under Federal law, 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
vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law
generally does not prohibit the mothers or newborns attending provider, after consulting with the
mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as
applicable). In any case, plans and issuers may not, under Federal law, require that a provider
obtain authorization form the plan or the insurance issuer for proscribing a length of stay not in
excess of 48 hours (or 96 hours).
COBRA Continuation Coverage for Spouses. A Retirees spouse will be eligible to purchase
temporary continuation of medical and/or dental coverage under the Plan if the spouse loses medical
and/or dental insurance coverage under the Plan as a result of divorce from the retiree or the
retirees death. In the event of the Retirees death, the spouse may be eligible for surviving
spouse benefits as described above and may choose either surviving spouse coverage or to purchase
temporary COBRA continuation coverage. COBRA continuation coverage may be purchased for a maximum
of 36 months from the date of death or divorce.
A spouse is required to notify the Company in writing not later than 60 days after a divorce from
the Retiree. If written notice is not provided to the Company on a timely basis, the spouse will
not be eligible for COBRA continuation coverage.
A spouse who is eligible to purchase COBRA continuation coverage must make written election for
continuation coverage no later than the date that is 60 days after the later of the date coverage
would otherwise end or the date the Company provides written notice of the right to purchase
continuation coverage. The election form must be hand-delivered to the Company or postmarked on or
before the 60th day or the spouse will not be permitted to purchase continuation
coverage.
In considering whether to elect continuation coverage, a spouse should take into account that a
failure to continue group health coverage will affect the spouses future rights under Federal law.
First, the spouse can lose the right to avoid having pre-existing condition exclusions applied to
the spouse by other group health plans if the spouse has more than a 63-day gap in health coverage,
and election of continuation coverage may help the spouse not have such a gap. Second, a spouse
will lose the guaranteed right to purchase individual health insurance policies that do not impose
such pre-existing condition exclusions if the spouse does not get continuation coverage for the
maximum time available. Finally, a spouse has the right to request special enrollment in another
group health plan for which the spouse is otherwise eligible (such as a plan sponsored by the
spouses employer) within 30 days after their group health coverage ends because of a qualifying
event listed above. The spouse will also have the same special enrollment right at the end of
continuation coverage if the spouse gets continuation coverage for the maximum time available.
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COBRA continuation coverage will end as of the date any of the following occurs:
1) | The required premiums are not paid on a timely basis. |
2) | The maximum 36 month continuation coverage period expires. |
3) | The Company ceases to provide any group health coverage to any employees. |
4) | The date the spouse becomes covered under another group health plan that does not contain any exclusion or limitation with respect to a preexisting condition of the spouse. |
5) | The date the spouse becomes entitled to Medicare. |
Termination of Participation
A Retirees participation in the Plan (or a specific benefit under the Plan) will terminate on
the earliest of the following dates:
1) | all participation for the Retiree terminates on the date the Retiree dies; |
2) | with respect to medical and/or dental insurance coverage under the Plan, coverage terminates on the last day of the period for which the Retiree has paid the required contribution for coverage, if the Retiree fails to timely make a required contribution (the Company shall establish a policy regarding the payment of required contributions, which policy shall provide a 60 day grace period following notification to the Retiree before coverage is terminated); |
3) | with respect to the Companys continued payment of long term care premiums, the Companys payment of such premiums terminates on the date the Retiree begins to work in full-time employment after retirement from the Company; or |
4) | with respect to subsidized medical and dental coverage and medical premium reimbursements under the Plan, benefits terminate on the date the Retiree begins to work in full-time employment at which the Retiree is eligible for medical benefits after retirement from the Company. |
A Retirees Eligible Spouse will cease to participate in the Plan (or a specific benefit under the
Plan) on the earliest of the following dates:
1) | the date the Retiree ceases to participate in the Plan, unless the Retirees participation ceases due to the Retirees death and the Eligible Spouse is eligible for surviving spouse benefits; |
2) | in the case of an Eligible Spouses medical and/or dental insurance coverage, coverage terminates on the last day of the period for which the Eligible |
12
Spouse has paid the required contribution for coverage, if the Eligible Spouse fails to timely make a required contribution (the Company shall establish a policy regarding the payment of required contributions, which policy shall provide a 60 day grace period following notification to the Eligible Spouse before coverage is terminated); |
3) | in the case of a surviving spouses coverage, the date the surviving spouse remarries; |
4) | all participation for the Eligible Spouse terminates on the date the Eligible Spouse dies or is divorced from the Retiree. |
A Retirees or Eligible Spouses long term care insurance coverage and/or medical and dental
insurance coverage under the Plan may terminate prior to the date the Retirees or Eligible
Spouses participation in the Plan terminates in the event that the insurance carrier or HMO
determines that the individual ceases to be eligible for coverage under the applicable insurance
contract.
A Retiree may at the time of retirement elect to delay the commencement of medical and dental
insurance coverage under the Plan for the Retiree and/or the Retirees Eligible Spouse. A Retiree
who elects to delay commencement of medical and dental insurance coverage under the Plan must
notify the Company when the Retiree and/or Eligible Spouse desires to later enroll in medical and
dental insurance coverage and such coverage will become effective as soon as administratively
practicable after such notice is provided, subject to the insurance carriers/HMOs agreement to make
such coverage available to the Retiree and/or Eligible Spouse. Delayed enrollment in medical and
dental insurance coverage does not extend the time period during which a Retiree and/or Eligible
Spouse is eligible for such coverage under the Plan. A Retiree or Eligible Spouse whose medical
and/or dental insurance coverage under the Plan terminates after having become effective
(regardless of the reason for such termination) are not eligible to later re-enroll for medical or
dental insurance coverage and are not eligible for medical premium reimbursements.
Amendment or Termination of Plan
Except for Corporate Officers who have attained age 55 with 5 years of Qualifying Service and
Retirees who have retired from the Company and qualified for benefits, no Corporate Officer or
spouse has a vested right to benefits under the Plan. This means that Corporate Officers who have
not attained age 55 with 5 years of Qualifying Service (and their spouses) do not have a
non-forfeitable right to qualify for coverage under the Plan and the Company reserves the right to
amend the Plan at any time to change or terminate the Plan with respect to such Corporate Officers
and their spouses. If the Plan is so amended, any Corporate Officer (and spouse) who is not age 55
with 5 years of Qualifying Service at the time of the amendment may be ineligible for benefits
under the Plan or may be eligible for reduced or changed benefits under the Plan. Such an
amendment to the Plan may change the benefits under the Plan in a way that changes, reduces or
increases benefits or reduces or increases the amount that retirees and spouses pay for benefits,
either as a share of the premium cost or as deductibles, co-payments, co-insurance or other
cost-sharing provisions. The Plan may not be terminated or modified in a manner that
13
reduces benefits for any Retiree or Corporate Officer who has attained age 55 with 5 years of
Qualifying Service.
Claim Procedures
Claims for the payment of medical, dental or long term care insurance benefits are subject to
the claim procedures contained in the insurance contract through which such coverage is provided
and are not the responsibility of the Company.
For medical premium reimbursements under the Plan, if you disagree with the amount of a medical
premium reimbursement, you have the right to appeal to the Company. All appeals must be made in
writing within 180 days after the date the reimbursement in question was paid. Appeals should be
addressed to the Company at the address specified below. You may submit written comments,
documents, records and other information relating to your claim and you will be provided, upon
request and free of charge, reasonable access to, and copies of, all documents, records and other
information relevant to your claim for benefits. The review of your appeal will take into account
all comments, documents, records and other information you submit, without regard to whether such
information was considered in the initial benefit determination.
You will be notified in writing of the Companys decision on your appeal not later than 60 days
after the Company receives your request for review. If the decision is adverse, the notification
will set forth: (1) the specific reason or reasons for the adverse determination; (2) reference to
the specific plan provisions on which the determination is 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 your claim; and (4) a statement of your right
to bring an action under section 502(a) of ERISA. Please refer to the claim section of your
subscriber contract or coverage certificate for a description of the specific claim procedures
applicable to your claims for benefits.
Discretionary Authority
The insurance carriers and HMOs through which coverage is provided under the Plan have full
discretionary authority to interpret the terms of the subscriber contracts and coverage
certificates that they issue and to determine eligibility for benefits in accordance with the terms
of such subscriber contracts and coverage certificates. In carrying out its responsibilities under
the Plan as the plan administrator, the Company has full discretionary authority to interpret the
terms of the Plan. Any interpretation or determination made by an insurance carrier or HMO, or by
the Company pursuant to such discretionary authority shall be given full force and effect unless
found by a court of competent jurisdiction to be arbitrary and capricious.
Statement of Rights
As a participant in the Plan, you are entitled to certain rights and protections under the
Employee Retirement Income Security Act of 1974 (ERISA). ERISA provides that all Plan participants
be entitled to:
14
Receive Information About Your Plan and Benefits
Examine, without charge, at the plan administrators corporate office all documents
governing the Plan including insurance contracts.
Obtain upon written request to the plan administrator, copies of documents governing the operation
of the Plan, including insurance contracts and updated summary plan description. The plan
administrator may make a reasonable charge for the copies.
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 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 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 or ignored, 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.
Under ERISA, there are steps you can take to enforce the above rights. For instance, if you
request a copy of Plan documents or the latest annual report 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 Plan
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, provided that you have exhausted all your
administrative appeal rights. If it should happen that Plan fiduciaries misuse the Plans 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, or if you need assistance in
obtaining documents from the plan administrator, you should contact the nearest Area Office of the
Employee Benefits Security Administration, U.S. Department of Labor, listed in your telephone
directory or the Division of Technical Assistance and Inquiries, Employee Benefits Security
Administration, U.S. Department of Labor, 200 Constitution Avenue N.W.,
15
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.
In order to protect your familys rights, you should keep the plan administrator
informed of any charges in the addresses of family members. You should also keep a copy, for
your records, of any notices you send to the plan administrator.
Plan Name
The legal name of the Plan is the Transcat Inc. Post-Retirement Benefit Plan for Officers.
Plan Number
511
Employer
Transcat Inc.
35 Vantage Point Drive
Rochester, New York 14624
(585) 352-7777
35 Vantage Point Drive
Rochester, New York 14624
(585) 352-7777
Employer Identification Number
16-0874418
Type of Plan
The Plan is a welfare benefit plan that provides medical, dental and long term care insurance
benefits through contracts issued by insurance carriers and health maintenance organizations. A
list of the carriers and health maintenance organizations that provide coverage under the Plan is
attached to the end of this document. The Plan also provides limited reimbursement of premiums
paid by Retirees and spouses for individual medical and dental insurance coverage obtained by the
Retiree and/or spouse.
Plan Administrator
Transcat Inc.
35 Vantage Point Drive
Rochester, New York 14624
(585) 352-7777
35 Vantage Point Drive
Rochester, New York 14624
(585) 352-7777
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Type of Administration
The Plan is administered by Transcat Inc. The insurance carriers and health maintenance
organizations through which benefits are provided administer claims under the contracts through
which such benefits are provided.
Agent for Service of Legal Process
Transcat Inc.
35 Vantage Point Drive
Rochester, New York 14624
(585) 352-7777
35 Vantage Point Drive
Rochester, New York 14624
(585) 352-7777
Contributions/Funding
The Company and participants contribute toward the cost of coverage under the Plan.
Plan Year
The plan year for the Plan is the calendar year.
17
Insurance Carriers and Health Maintenance Organizations
Providing Medical and Dental Insurance Coverage
(Excluding Carriers/HMOs providing individual coverage)
Providing Medical and Dental Insurance Coverage
(Excluding Carriers/HMOs providing individual coverage)
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Acknowledgment of Receipt
By signing below, the authorized representative of the Company certifies that a copy of this
summary plan description/plan document for the Transcat Inc. Post-Retirement Benefit Plan for
Officers was provided to the below-named Corporate Officer and Eligible Spouse (if any), and the
Corporate Officer and Eligible Spouse (if any) acknowledge that the Company provided the Corporate
Officer and Eligible Spouse with a copy of this summary plan description/plan document for the
Transcat Inc. Post-Retirement Benefit Plan for Officers.
Transcat Inc.
By: |
||||
Date | ||||
Signature of Retiree | Date | |||
Print Name of Retiree | ||||
Signature of Eligible Spouse | Date | |||
Print Name of Eligible Spouse |
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