Microsoft word - comprehensive plan spd exhibit c.doc
San Diego & Imperial County Schools Fringe Benefit s Consortium
The Legal Plan was established to provide personal legal services for eligible Company employees, their spouses
and dependent children. This summary provides general information about the Plan, who is eligible to receive
benefits under the Plan, what those benefits are, how to obtain benefits and what your rights under ERISA are. If
you have any questions that are not answered, please contact the Benefits Department.
Hyatt Legal Plans, Inc. has been selected to provide for legal plan benefits. The services will be provided through
a panel of carefully selected Participating Law Firms. Lawyers in this network are called Plan Attorneys. These
arrangements are described in detail in this summary. The actual provisions of the Plan are set out in a written
document maintained by your employer. All statements made in this booklet are subject to the provisions and
terms of that document, which control in the event of conflict with this summary. HOW TO GET LEGAL SERVICES
To use the Legal Plan visit the Hyatt Legal Plans’ Web Site at www.legalplans.com
. Once there, click on the
“Members Log in” icon at the top of the page. You will be taken to a secure page that will require you to enter
your Social Security Number. After you enter your Social Security Number you will jump to a page that is
specific for member services. On this page you can choose the following options:
¾ How Do I Use the Plan?
¾ Covered Services
¾ Attorney Locator
¾ Obtain Case Number
¾ Legal documents for Your Parents
¾ Law Guide
¾ Self-Help Document / Forms
¾ Contact Us Client Service Center
You may also use the Legal Plan by calling Hyatt Legal Plans' Client Service Center at 1-800-821-6400
– Thursday 8 a.m. to 7 p.m. and Friday 8 a.m. to 6 p.m., Eastern Time. Be prepared to give your Social Security
Number. If you are a spouse or an eligible dependent child of an eligible person, you will need the Social
Security Number of the employee through whom you are eligible. The Client Service Representative who
answers your call will:
¾ Verify your eligibility for services.
¾ Make an initial determination of whether and to what extent your case is covered (the Plan Attorney will make
¾ Give you a Case Number, which is similar to a claim number (you will need a new Case Number for each new
¾ Give you the telephone number of the Plan Attorney most convenient to you. ¾ Answer any questions you have about the Legal Plan.
You then call the Plan Attorney to schedule an appointment at a time convenient to you. Evening and Saturday appointments are available. If you choose, you may select your own attorney. Also, where there are no Participating Law Firms, you will be asked to select your own attorney. In both of these circumstances, Hyatt Legal Plans will reimburse you for these non-Plan attorneys' fees in accordance with a set fee schedule. For services to be covered, you or your eligible dependents must have obtained a Case Number, retained an attorney and the attorney must begin work on the covered legal matter while you are an eligible member of the legal plan.
WHAT SERVICES ARE COVERED
The Hyatt Group Legal Plan entitles you and your eligible dependents to receive certain personal legal services.
The available benefits are very comprehensive, but there are limitations and other conditions that must be met.
Please take time for yourself and your family to read the description of benefits carefully. All benefits are available to you and your spouse and dependents, unless otherwise noted.
ADVICE AND CONSULTATION
Office Consultation and Telephone Advice
This service provides the opportunity to discuss with an attorney any personal legal problems that are not
specifically excluded. The Plan Attorney will explain the Participant's rights, point out his or her options and
recommend a course of action. The Plan Attorney will identify any further coverage available under the Plan, and
will undertake representation if the Participant so requests. If representation is covered by the Plan, the
Participant will not be charged for the Plan Attorney's services. If representation is recommended, but is not
covered by the plan, the Plan Attorney will provide a written fee statement in advance. The Participant may
choose whether to retain the Plan Attorney at his or her own expense, seek outside counsel, or do nothing. There
are no restrictions on the number of times per year a Participant may use this service; however, for a non-covered
matter, this service is not intended to provide the Participant with continuing access to a Plan Attorney in order to
seek advice that would allow the Participant to undertake his or her own representation. CONSUMER PROTECTION
Consumer Protection Matters
This service covers the Participant as a plaintiff, for representation, including trial, in disputes over consumer
goods and services where the amount being contested exceeds the small claims court limit in that jurisdiction.
The controversy must be evidenced by a written document such as a sales slip, contract, note or warranty. This
service does not include disputes over real estate, construction, insurance or collection activities after a judgment. Small Claims Assistance
This service covers counseling the Participant on prosecuting a small claims action; helping the Participant
prepare documents; advising the Participant on evidence, documentation and witnesses; and preparing the
Participant for trial. The service does not include the Plan Attorney's attendance or representation at the small
claims trial, collection activities after a judgment or any services relating to post-judgment actions. DEBT MATTERS
Debt Collection Defense
This benefit provides Participants with an attorney’s services for negotiation with creditors for a repayment
schedule and to limit creditor harassment, and representation in defense of any action for personal debt collection,
foreclosure, repossession or garnishment, up to and including trial if necessary. It does not include vacating a
judgment, counter, cross or third party claims, bankruptcy; any action arising out of family law matters; including
support and post-decree issues; or any matter where the creditor is affiliated with the sponsor or employer. Identity Theft Defense
This service provides the Participant with consultations with an attorney regarding potential creditor actions
resulting from identity theft and attorney services as needed to contact creditors, credit bureaus and financial
institutions. It also provides defense services for specific creditor actions over disputed accounts. The defense
services include limiting creditor harassment and representation in defense of any action that arises out of the
identity theft such as foreclosure, repossession or garnishment, up to and including trial if necessary. The service
also provides the Participant with online help and information about identity theft and prevention. It does not
include counter, cross, or third party claims, bankruptcy; any action arising out of family law matters, including
support and post decree issues; or any matter where the creditor is affiliated with the sponsor or Employer.
Personal Bankruptcy or Wage Earner Plan
This service covers the Employee and spouse in pre-bankruptcy planning, the preparation and filing of a personal
bankruptcy or Wage Earner petition, and representation at all court hearings and trials. This service is not
available if a creditor is affiliated with the Employer, even if the Employee or spouse chooses to reaffirm that
specific debt. Tax Audits
This service covers reviewing tax returns and answering questions the IRS or a state or local taxing authority has
concerning the Participant's tax return; negotiating with the agency; advising the Participant on necessary
documentation; and attending an IRS or a state or local taxing authority audit. The service does not include
prosecuting a claim for the return of overpaid taxes or the preparation of any tax returns
DEFENSE OF CIVIL LAWSUITS Administrative Hearing Representation
This service covers Participants in defense of civil proceedings before a municipal, county, state or federal
administrative board, agency or commission. It does not apply where services are available or are being provided
by virtue an insurance policy. It does not include divorce or post-decree matters, paternity, support or custody
matters or litigation of a job-related incident. Civil Litigation Defense
This service covers the Participant in defense of an arbitration proceeding or civil proceeding before a municipal,
county, state or federal administrative board, agency or commission, or in a trial court of general jurisdiction. It
does not apply where services are available or are being provided by virtue of an insurance policy. It does not
include divorce or post-decree matters, paternity, support or custody matters or litigation of a job-related incident.
Services do not include bringing counterclaims, third party or cross claims. Incompetency Defense
This service covers the Participant in the defense of any incompetency action, including court hearings when there
is a proceeding to find the Participant incompetent.
DOCUMENT PREPARATION Affidavits
This service covers preparation of any affidavit in which the Participant is the person making the statement. Deeds
This service covers the preparation of any deed for which the Participant is either the grantor or grantee Demand Letters
This service covers the preparation of letters that demand money, property or some other property interest of the
Participant, except an interest that is an excluded service. It also covers mailing them to the addressee and
forwarding and explaining any response to the Participant. Negotiations and representation in litigation are not
included. Document Review
This service covers the review of any personal legal document of the Participant, such as letters, leases or
purchase agreements. Mortgages
This service covers the preparation of any mortgage or deed of trust for which the Participant is the mortgagor.
This service does not include documents pertaining to business, commercial or rental property.
This service covers the preparation of any promissory note for which the Participant is the payor or payee.
This service covers advice and consultation, preparation of affidavits and powers of attorney, review of any
immigration documents and helping the Participant prepare for hearings.
FAMILY LAW Name Change
This service covers the Participant for all necessary pleadings and court hearings for a legal name change. Premarital Agreement
This benefit covers the preparation of an agreement by an Enrolled Employee and his or her fiancé (e) prior to
their marriage, outlining how property is to be divided in the event of separation, divorce or death of a spouse.
Representation is provided only to the Employee. The fiancé (e) must have separate counsel or must waive
This service covers all uncontested governmental agency and stepparent adoptions for the Employee and spouse.
If an adoption becomes contested, the Employee or spouse must pay all additional legal fees. Uncontested Guardianship or Conservatorship
This service covers establishing a guardianship or conservatorship over a person and his or her estate when the
Plan Member or spouse is appointed as guardian or conservator. It includes obtaining a guardianship or
conservatorship, gathering any necessary medical evidence, preparing the paperwork, attending the hearing and
preparing the initial accounting. This service does not include representation of the person over whom
guardianship or conservatorship is sought, or any annual accountings after the initial accounting. PERSONAL INJURY
Personal Injury (25% Network Maximum)
Subject to applicable law and court rules, Plan Attorneys will handle personal injury matters (where the
Participant is the plaintiff) at a maximum fee of 25% of the gross award. It is the Participant's responsibility to pay
this fee and all costs. REAL ESTATE MATTERS Eviction and Tenant Problems (Primary Residence – Tenant Only)
This service covers the Participant as a tenant for matters involving leases, security deposits or disputes with a
residential landlord. The service includes eviction defense, up to and including trial. It does not include
representation in disputes with other tenants or as a plaintiff in a lawsuit against the landlord, including an action
for return of a security deposit. Refinancing of Home (Primary Residence)
This service covers the review or preparation, by an attorney representing the Participant, of all relevant
documents (including the mortgage and deed, and documents pertaining to title, insurance, recordation and
taxation), which are involved in refinancing of or in obtaining a home equity loan on a Participant's primary
residence. This benefit includes obtaining a permanent mortgage on a newly constructed home. It does not
include services provided by any attorney representing a lending institution or title company. The benefit does
not include the refinancing of a second home, vacation property, rental property or property held for business or
Sale or Purchase of Home (Primary Residence)
This service covers the review or preparation, by an attorney representing the Participant, of all relevant
documents (including the construction documents for a new home, the purchase agreement, mortgage and deed,
and documents pertaining to title, insurance, recordation and taxation), which are involved in the purchase or sale
of a Participant's primary residence or of a vacant property to be used for building a primary residence. The
benefit also includes attendance of an attorney at closing. It does not include services provided by any attorney
representing a lending institution or title company. The benefit does not include the sale or purchase of a second
home, vacation property, rental property, property held for business or investment or leases with an option to buy. Home Equity Loans (Primary Residence)
This service covers the review or preparation of a home equity loan of the Participant’s primary residence.
TRAFFIC AND CRIMINAL MATTERS
Juvenile Court Defense
This service covers the defense of an Employee's dependent child in any juvenile court matter, provided there is
no conflict of interest with the Employee, in which case this service provides an attorney for the Employee only.
Traffic Ticket Defense (No DUI)
This service covers representation of the Participant in defense of any traffic ticket except driving under influence
or vehicular homicide, including court hearings, negotiation with the prosecutor and trial. Restoration of Driving Privileges
This service covers the Participant with representation in proceedings to restore the Participant’s driving license. WILLS AND ESTATE PLANNING Living Trusts
This service covers the preparation of a living trust for the Participant. It does not include tax planning or services
associated with funding the trust after it is created. Living Wills
This service covers the preparation of a living will for the Participant.
Powers of Attorney
This service covers the preparation of any power of attorney when the Participant is granting the power.
Probate (10% Network Discount)
Subject to applicable law and court rules, Plan Attorneys will handle probate matters at a fee 10% less than the
Plan Attorney’s normal fee. It is the Participant's responsibility to pay this reduced fee and all costs.
Wills and Codicils
This service covers the preparation of a will for the Participant. The creation of any testamentary trust is covered.
The benefit includes the preparation of codicils and will amendments. It does not include tax planning. Exclusions
Excluded services are those legal services that are not provided under the plan. No services, not even a
consultation, can be provided for the following matters:
• Employment-related matters, including company or statutory benefits • Matters involving the employer, MetLife® and affiliates, and plan attorneys • Matters in which there is a conflict of interest between the employee and spouse or dependents in
which case services are excluded for the spouse and dependents
• Appeals and class actions • Farm and business matters, including rental issues when the Participant is the landlord • Patent, trademark and copyright matters • Costs or fines • Frivolous or unethical matters • Matters for which an attorney-client relationship exists prior to the Participant becoming eligible for
To be eligible for legal services under The Legal Service Plan, you must have included the Plan in your benefits
selection. You are eligible to enroll in the Plan for yourself and, for some cases, your eligible dependents.
Eligible dependents include your lawful spouse/domestic partner and your unmarried child (or children) up to the
age of 21 provided he or she depends on you for support.
During your employer's annual enrollment period, you can change or update your benefits selection. An eligible
employee may choose to join or drop out of the Plan at that time. If you become an eligible employee after the
annual enrollment period, you can elect to participate in the Legal Plan by completing your election form within
30 days of employment. The Plan has a minimum participation period of one year, and you must maintain the
coverage for the entire year.
WHEN COVERAGE BEGINS
Generally, Plan coverage becomes effective on the date of the following:
• The first day of the month in which your employer has agreed to provide the Plan, (typically January 1),
for the elections you made during the previous enrollment period;
• If you were hired after an enrollment period, the first day of the month after you submitted a properly
WHEN COVERAGE ENDS
Your ability to receive legal services under the Plan ends if you are no longer an eligible employee or if you
choose not to enroll during future annual enrollment periods.
If you cease to be eligible to participate in the plan or your employment with the Company ends, the Plan will
cover the legal fees for those covered services that were opened and pending during the period you were enrolled
in the plan. Of course, no new matters may be started after you become ineligible. AMENDMENT OR TERMINATION
While your employer expects to continue to offer participation in the Legal Service Plan, it reserves the right to
amend, or terminate the Plan at any time. If the Plan is terminated, all covered services then in process will be
handled to their conclusion under the Plan. ADMINISTRATION AND FUNDING
The Legal Service Plan is provided for and administered through a contract with Hyatt Legal Plans, Inc. Hyatt
Legal Plans makes all determinations regarding attorneys' fees and what constitutes covered services. All
contributions collected from employees electing this coverage are paid to Hyatt Legal Plans, Inc. COST OF THE PLAN
You pay the cost of the Plan through after-tax payroll deductions, based on your enrollment choice. PLAN CONFIDENTIALITY, ETHICS AND INDEPENDENT JUDGMENT
Your use of the Plan and the legal services is confidential. The Plan Attorney will maintain strict confidentiality
of the traditional lawyer-client relationship. Your employer will know nothing about your legal problems or the
services you use under the Plan. Plan administrators will have access only to limited statistical information needed
for orderly administration of the Plan.
No one will interfere with your Plan Attorney's independent exercise of professional judgment when representing
you. All attorneys' services provided under the Plan are subject to ethical rules established by the courts for
lawyers. The attorney will adhere to the rules of the Plan and he or she will not receive any further instructions,
direction or interference from anyone else connected with the Plan. The attorney's obligations are exclusively to
you. The attorney's relationship is exclusively with you. Hyatt Legal Plans, Inc., or the law firm providing
services under the Plan is responsible for all services provided by their attorneys.
You should understand that the Plan has no liability for the conduct of any Plan Attorney. You have the right to
file a complaint with the state bar concerning attorney conduct pursuant to the Plan. You have the right to retain
at your own expense any attorney authorized to practice law in this state.
Plan attorneys will refuse to provide services if the matter is clearly without merit, frivolous or for the purpose of
harassing another person. If you have a complaint about the legal services you have received or the conduct of an
attorney, call Hyatt Legal Plans at 1-800-821-6400
. Your complaint will be reviewed and you will receive a
response within two business days of your call.
You have the right to retain at your own expense any attorney authorized to practice law in the state. You have
the right to file a complaint with the state bar concerning attorney conduct pursuant to the plan.
OTHER SPECIAL RULES
In addition to the coverages and exclusions listed, there are certain rules for special situations. Please read this
section carefully. What if other coverage is available to you?
If you are entitled to receive legal representation provided by any
other organization such as an insurance company or government agency, or if you are entitled to legal services
under any other legal plan, coverage will not be provided under this Plan. However, if you are eligible for legal
aid or Public Defender services, you will still be eligible for benefits under this Plan, so long as you meet the
eligibility requirements. What if you are involved in a legal dispute with your dependents?
You may need legal help with a problem
involving your spouse or your children. In some cases, both you and your child may need an attorney. If it would
be improper for one attorney to represent both you and your dependent, only you will be entitled to representation
by the plan attorney. Your dependent will not be covered under the Plan. What if you are involved in a legal dispute with another employee?
If you or your dependents are involved in
a dispute with another eligible employee or that employee's dependents, Hyatt Legal Plans will arrange for legal
representation with independent and separate counsel for both parties. What if the court awards attorneys' fees as part of a settlement?
If you are awarded attorneys' fees as a part
of a court settlement, the Plan must be repaid from this award to the extent that it paid the fee for your attorney.
DENIAL OF BENEFITS AND APPEAL PROCEDURES
Denials of Eligibility
Hyatt verifies eligibility using information provided by your employer. When you call for services, you will be
advised if you are ineligible and Hyatt Legal Plans will contact the San Diego & Imperial County Schools Fringe
Benefits Consortium for assistance. If you are not satisfied with the final determination of eligibility, you have
the right to a formal review and appeal. Send a letter within 60 days to your employer explaining why you
believe you are eligible. Denials of Coverage
If you are denied coverage by Hyatt Legal Plans or by any Plan Attorney, you may appeal by sending a letter to:
Hyatt Legal Plans, Inc.
Director of Administration
Eaton Center 1111 Superior Avenue
Cleveland, Ohio 44114-2507
The Director will issue Hyatt Legal Plans' final determination within 30 days of receiving your letter. This
determination will include the reasons for the denial with reference to the specific Plan provisions on which the
denial is based and a description of any additional information that might cause Hyatt Legal Plans to reconsider
the decision, an explanation of the review procedure and notice of the right to bring a civil action under Section
502(a) of ERISA.
YOUR ERISA RIGHTS
Congress enacted the Employee Retirement Income Security Act (ERISA) to safeguard your interests and those of
your beneficiaries under your employee benefit plans. As a participant in The Legal 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 shall be entitled to: ¾ Examine, without charge, at the Plan Administrator's office and at other specified locations, all Plan
documents, including collective bargaining agreements and copies of all documents filed by the Plan with U.S. Department of Labor such as detailed annual reports and Plan descriptions.
¾ Obtain copies of all Plan documents and other Plan information upon written request to the Plan Administrator.
The Administrator may make a reasonable charge for the copies.
¾ Receive a summary of the Plan's annual financial report from the Plan Administrator who is required by law to
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. If your claim for a welfare
benefit is denied in whole or in part, you must receive a written explanation of the reason for the denial. You
have the right to have the Plan review and consider your claim. Under ERISA, there are steps you can take to
enforce the above rights. If you request materials 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 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. If it should happen that Plan fiduciaries misuse the
Plan's 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 lose, the court may order you to pay these costs and fees, for example if it finds your claim
is frivolous. 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, you should contact the nearest area office of
the Pension and Welfare Benefits Administration or the Division of Technical Assistance, U.S. Department of
Labor, listed in your telephone directory, or at 200 Constitution Avenue, NW, Washington. D.C. 20210 or you
can call the publications hotline of the Pension and Welfare Benefits Administration.
FOR YOUR INFORMATION:
Name of Plan
Type of Plan
Welfare Benefit Plan for pre-paid legal services
Agent for Service of Legal Process
Provider of Benefits
If you are having any concerns about this plan, please call Hyatt Legal Plans at 1-800-821-6400. A Hyatt
Legal Plans representative will help you resolve the issue to your satisfaction.
Effective January 1, 2013 2013 EMPIRE PLAN FLEXIBLE FORMULARY Administered by UnitedHealthcare The following is a list of the most commonly prescribed generic and brand-name drugs included on the 2013 Empire Plan Flexible Formulary. This is not a complete list of all prescription drugs on the flexible formulary or covered under The Empire Plan. This list and excluded medication
Adventist Health Balance and Mobility Center 10201 SE Main Street Suite 4 Appointment Date:____________________________ Insurance:___________________________________ Portland OR 97216 (503) 251-6350 TIME IN:_______________ TIME OUT:_____________ Patient Questionaire Instructions : Please complete the questions as best as you can and bring with you on the day of your appoi