CCP 12-13-2004 - Laserfiche WebLink

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Citv of Arden Hills Summary Plan Descriotion City Administrator by filing a petition for review with the City Administrator within 180 days after you . receive the notice issued by the Plan Administrator. Your petition should stale the specific reasons why you believe you are entitled to benefits, or greater or different benefits. You have the right to obtain from the Employer, on request and free of charge, reasonable access to and copies of all documents, records and other information relevant to your claim for benefits. You should make sure that your request for review includes all the information relevant to your claim. Within 60 days after the City Administrator receives the petition, City Administrator will give you a written decision of its review. The City Administrator may hold a hearing for the review of your claim if you request and it decides such a hearing is necessary. The City Administrator's written decision will state: (I) the specific reason or reasons for the adverse determination, (2) the specific Plan provisions and/or rule on which the benefit determination is based, (3) that you are entitled to receive, on request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to your claim for benefits, and (4) that you are entitled to bring an action under ERlSA. You may choose to have a representative represent you in the claims procedurc. If you do, the Employer may require proof that the individual is authorized to act on your behalf. Notc that you must follow this . claims procedure if you have a claim, and the failure to do so will prevent you from challenging an adverse decision in court. WHAT IF I NEED MORE INFORMATION?, This document is just a summary of the actual terms of the Plan. You may examine a copy of the actual Plan from the Assistant to the City Administrator at any time during regular working hours. You may also obtain a copy of the Plan by furnishing a written request for a copy to the Assistant to the City Administrator, at 1245 West Hwy 96, Arden Hills, MN 55112. There may be a charge for the expense of copying the Plan document. Since this document is only considered to be a summary, in case of any inconsistencies between this summary and the Plan, the Plan shall controL Also, certain information concerning the Plan may be filed with the Treasury Department and the Department of Labor. Should you wish to correspond with either agency about Ihis Plan, you must refer to Employer Identification Number 4 I -6008992 and Plan Number 50 I. The Plan Administrator has been designated as agent for the pUlpose of service of legal process. The address of the agent for service of process is the address of the Plan Administrator as shown on the preceding page. . SPD-18