Member Rights FAQs
What are my rights as a member?
Where can I obtain a copy of the Summary Plan Description (SPD)?
What are the ERISA electronic distribution rules?
Where can I obtain a copy of the Summary Annual Report (SAR)?
What are my rights and protections against surprise medical bills?
WHAT ARE MY RIGHTS AS A MEMBER?
As a participant in the UABT you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA, 29 U.S.C. 1001 et seq.). ERISA specifies that all Plan Participants shall be entitled to:
- Examine, without charge, at the Plan Administrator’s office copies of the latest annual report (Form 5500 Series) filed by UABT with the U.S. Department of Labor and available at the Public Disclosure Room of the Employee Benefits Security Administration.
- Obtain, upon written request to the Plan Administrator, copies of documents governing the operation of the Plan, copies of the latest annual report (Form 5500 Series) and updated summary plan description. The Plan Administrator may set a reasonable charge for the copies.
- Receive a summary of the Plan's annual financial report. The Plan Administrator is required by law to furnish each participant with a copy of this Summary Annual Report.
Continue health care coverage for the Employee and eligible Dependents if there is a loss of coverage under UABT as a result of a Qualifying Event. You and/or your eligible dependent(s) may have to pay for such coverage. Review this SPD and the documents governing the Plan on the rules governing the Participant’s COBRA Continuation Coverage rights.
You have the right to appeal procedures for denied medical, prescription medication, dental or vision claims.
If a claim for benefits is denied in whole or in part or if there is an adverse determination of benefits, you, or a representative of your choice, may request a review of the decision within one hundred eighty (180) days of the date you receive the notice of denial or limitation by the UABT Appeals Committee
A request for review must be in writing, addressed to the UABT Appeals Committee, c/o United Agricultural Benefit Trust Claims, 54 Corporate Park, Irvine, CA 92606-5105, telephone 1(800)223.4590. You should state the reason you are requesting review and include any additional information that might help the Appeals Committee in evaluating your claim.
After the claim has been reviewed, if the denial is reversed, the disputed claim will be paid pursuant to plan provisions.
After the claim has been reviewed and the denial upheld, the UABT Appeals Committee will: (1) notify you in writing within seventy-two (72) hours for authorizations involving urgent care; fifteen (15) days for other authorizations; and, sixty (60) days for post-service health claims The denial notice will include a copy of the specific Plan provisions affecting the denial; and (3) let you know how to file an appeal to the Board of Trustees; provide you with new or additional evidence or rationale and a reasonable opportunity to respond to it before making a final decision on the claim. .
If you disagree with the conclusions reached by the UABT Appeals Committee, you may file a written appeal or request a formal hearing of the Board of Trustees within one hundred eighty (180) days of receipt of the results of the UABT Appeals Committee review. A written appeal should include: (1) your name, address and UABT Identification number, (2) the name of the patient, (3) the claim number and date of denial notice, (4) the specific facts upon which your appeal is being made; and, (5) all documents and evidence you have supporting those facts.
Any appeal should be addressed to the Board of Trustees, c/o United Agricultural Benefit Trust, 54 Corporate Park, Irvine, CA 92606-5105, to the attention of Trust Counsel.
Board of Trustees' consideration will be based on your written statement unless you request a formal hearing. If you request a hearing, it will be conducted at the next scheduled meeting of the Board of Trustees at the scheduled location of the meeting, upon 10 days written notice to all parties. Although not necessary, you may be represented by an attorney of your choice at the hearing.
The Board of Trustees has full discretionary authority to interpret the Plan, and to make decisions regarding eligibility and payment of claims. The Trustees will then conduct a full and fair evaluation of the appeal and shall base its decision on the information available at the time of consideration
The Board of Trustees, through UABT’s Legal Counsel, shall mail a written decision of the appeal to you within seventy-two (72) hours for authorizations involving urgent care (if applicable), fifteen (15) days for other authorizations and thirty (30) days for health claims after the appeal has been reviewed. The Trustees' final decision shall: (1) be written in a manner intended to be understood by the average person; (2) include the specific reason or reasons for the decision; and (3) contain a specific reference to the pertinent Plan provisions upon which the decision is based.
You must complete UABT’s claim process before filing an action in court challenging the denial of a claim (all administrative remedies must be exhausted). Any court challenge to a claim denial must be filed by the patient. The assignee of benefits is not eligible to initiate a court challenge to the denied claim.
WHERE CAN I OBTAIN A COPY OF THE SUMMARY PLAN DESCRIPTION (SPD)?
Click here to download a current copy of the 2023 Summary Plan Description.
WHAT ARE THE ERISA ELECTRONIC DISTRIBUTION RULES?
SPDs must be provided to all plan participants within 90 days of becoming covered by the plan. Updated SPDs must be furnished every five years if changes were made to SPD information or if the plan was amended. Otherwise, SPDs must be furnished every 10 years. Rules governing Health Plan Documents, including SPDs are old and outdated, yet DOL has not updated them since 2002.
- Participants who can access electronic documents at their work location (whether on-site, in the office, at home or on the road), and for whom such access is an integral part of their work duties, may receive electronic materials automatically (i.e., without affirmatively consenting to electronic distribution).
- Participants who don't meet these access requirements (e.g. employees who don't use a computer as part of their jobs) must provide consent in a manner that shows they are able to receive SPDs electronically. Participants also have to be told that their consent can be withdrawn at any time and they can receive the paper document.
Under ERISA, employers must use delivery methods reasonably calculated to ensure actual receipt of this information by plan participants and beneficiaries.
- The delivery method must be chosen or designed to result in the actual receipt of the document
- Use the same style or format as the paper document
- Provide Notice that the participant can request a free paper copy at any time (this must be provided every time they access the document)
If you have any questions regarding the distribution rules or would like more information, please contact Jayson Welter, UnitedAg's General Counsel at email@example.com.
WHERE CAN I OBTAIN A COPY OF THE SUMMARY ANNUAL REPORT (SAR)?
Click here to download a current copy of the 2021 Summary Annual Report.
WHAT ARE MY PRIVACY RIGHTS?
The Participant has the following rights regarding PHI about him/her:
- Request Restrictions: The Participant has the right to request additional restrictions on the use or disclosure of PHI for treatment, payment, or health care operations. The Participant may request that the Plan restrict disclosures to family members, relatives, friends or other persons identified by him/her who are involved in his or her care or payment for his or her care. The Plan is not required to agree to these requested restrictions.
- Right to Receive Confidential Communication: The Participant has the right to request that he or she receive communications regarding PHI in a certain manner or at a certain location. The request must be made in writing and how the Participant would like to be contacted. The Plan will accommodate all reasonable requests.
- Right to Receive Notice of Privacy Practices: The Participant is entitled to receive a paper copy of the plan’s Notice of Privacy Practices at any time. To obtain a paper copy, contact the Privacy Officer.
- Accounting of Disclosures: The Participant has the right to request an accounting of disclosures the Plan has made of his or her PHI. The request must be made in writing and does not apply to disclosures for treatment, payment, health care operations, and certain other purposes. The Participant is entitled to such an accounting for the six years prior to his or her request. Except as provided below, for each disclosure, the accounting will include:
- the date of the disclosure, (b) the name of the entity or person who received the PHI and, if known, the address of such entity or person; (c) a description of the PHI disclosed, (d) a statement of the purpose of the disclosure that reasonably informs the Participant of the basis of the disclosure, and certain other information. If the Participant wishes to make a request, please contact the Privacy Officer.
- Access: The Participant has the right to request the opportunity to look at or get copies of PHI maintained by the Plan about him/her in certain records maintained by the Plan. If the Participant requests copies, he or she may be charged a fee to cover the costs of copying, mailing, and other supplies. If a Participant wants to inspect or copy PHI, or to have a copy of his or her PHI transmitted directly to another designated person, he or she should contact the Privacy Officer. A request to transmit PHI directly to another designated person must be in writing, signed by the Participant and the recipient must be clearly identified. The Plan must respond to the Participant’s request within 30 days (in some cases, the Plan can request a 30-day extension). In very limited circumstances, the Plan may deny the Participant’s request. If the Plan denies the request, the Participant may be entitled to a review of that denial.
- Amendment: The Participant has the right to request that the Plan change or amend his or her PHI. The Plan reserves the right to require this request be in writing. Submit the request to the Privacy Officer. The Plan may deny the Participant’s request in certain cases, including if it is not in writing or if he or she does not provide a reason for the request.
- Other uses and disclosures not described in this section can only be made with authorization from the Participant. The Participant may revoke this authorization at any time.
WHAT ARE RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLS?
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing. Click here for a summary of your rights and protections against surprise billing.