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Summary Plan Description
APPLYING FOR BENEFITS
MAKING APPLICATION (SECTION 7.01)
You must file a written application with the Board of Trustees on an application form that will be provided, upon request, by the Fund Office. Application for retirement should generally be filed during the month prior to the Effective Date on which you wish to have your pension payments begin. You are encouraged to file as soon as you decide on your intended retirement date. Early filing will avoid a delay in the processing of your application and the start of payment of benefits.
WHEN BENEFITS BEGIN (SECTION 7.05)
Your pension benefits will begin on the first day of the first month after you have met all requirements for entitlement to benefits. Remember, such requirements include filing a complete pension application in advance of the date you want your pension payments to begin. In some limited circumstances, your benefits may be paid as of a date that is earlier than when you have completed all of these detailed forms and requirements, provided your substantially complete application form was received by the Fund Office before the Effective Date. This is referred to as the “Retroactive Annuity Starting Date.” In no event can a Retroactive Annuity Starting Date be more than six (6) months prior to the date your benefit payments actually begin.
This special rule will help in circumstances like the following: You received your application including the information concerning your benefit payment options on January 1st and mailed your application which was received by the Fund Office on February 28th. The Fund Office discovers that you or your spouse forgot to sign the waiver of the Joint and Survivor Benefit Payment Form and sends it back to you but you are on vacation celebrating your retirement and you don’t get the additional form in until mid April. Your application was received before March 1st so that should be your pension effective date. However, under the law, the Joint and Survivor election must be made within 90 days of the date you received the information from the Plan about the choices available to you under the Plan. Under the old rule, the Plan would have had to send new information to you so that your election of a benefit payment option was made within 90 days of receiving the information about your choices and your pension would have been delayed.. Under the new rule, which was added when the law changed, you can complete the waiver form in April and elect the earlier or “retroactive” annuity starting date and receive your pension benefits for March and April
Remember, too, that you may not receive a pension for any month in which you have received Weekly Disability benefits from the National Automatic Sprinkler Industry Welfare Fund.
Special conditions may also apply for the Husband and Wife payment forms (see page XX).
Under Federal law, the Plan is generally required to provide you with information about your benefit payment options no sooner than 90 days and no less than 30 days before your pension payments begin. This means that the payment of your benefits generally cannot begin sooner than 30 days after the Fund Office has given you benefit election and spousal consent forms and provided you with information about your payment options. However, under the law, you may waive this requirement and have your benefits paid as early as eight (8) days after this information is provided to you.
ADJUSTMENTS FOR LATE RETIREMENT (SECTION 7.05)
If you retire after Normal Retirement Age (generally age 65), your pension is increased from your pension payable at Normal Retirement Age for each month your pension was delayed and in which you did not work in employment for which your benefit was suspended (page XX) after Normal Retirement Age.
MANDATORY BENEFIT COMMENCEMENT (SECTION 7.05, 7.17)
The plan will begin your pension as of the first of the month after you reach the age of 70 1/2, even if you do not apply. This rule applies whether or not you retire. You may notify the Plan to delay the commencement of your pension until April 1 of the calendar year following the calendar year in which you reach age 70˝. If you continue to work in Covered Employment past age 70 ˝, your benefit will be adjusted once every year to take into account the additional benefits you earned and the new pension amount will be payable beginning February 1 of the calendar year following the year the additional amount was earned.
APPEAL OF A DENIAL (SECTION 7.04)
After you file a claim for benefits, the Fund Office will generally notify you of its decision within 90 days after it receives the claim. However, if the Fund Office determines that special circumstances require an extension of time for processing the claim, the Fund Office will notify you, in writing and before the end of the initial 90-day period, that it will need additional time to decide the claim. The extension notice will indicate the special circumstances requiring an extension of time and the date by which the Fund Office expects to decide your claim. Such date will not exceed 90 days from the end of the initial 90-day period.
Special rules apply to pension claims if your claim depends on whether you are or were disabled. If your claim involves a disability question, the Fund Office will generally notify you of its decision within 45 days after it receives the claim. The Fund Office will seek extensions beyond the 45-day period only for circumstances that are beyond the control of the Fund Office. If the Fund Office determines that an extension is appropriate, the initial 45-day period may be extended by an additional 30 days, provided that the Fund Office notifies you of the extension prior to the expiration of the initial 45-day period. The extension notice will:
If your claim involves a disability question and the Fund Office decides that it is unable to decide your claim during the first 30-day extension due to matters beyond its control, a second 30-day extension is possible. In the event that a second 30-day extension is required, the Fund Office will notify you of the extension prior to the expiration of the initial 30-day extension period and the notification will contain the same type of information required to be included in the first notice.
If your application for benefits is denied in whole or in part, the Fund Office will provide you with a written or electronic notice that sets forth:
If your claim is denied, or if you disagree with a policy, determination or action of the Fund, you may submit a written appeal to the Trustees, requesting that the Trustees review your benefit denial or the Fund policy, determination or action with which you disagree. Your written appeal must be submitted within 180 days of receiving the notice of denial of benefits, or within 60 days after you learn of a Fund policy, determination or action with which you disagree and which is not a benefits denial.
Your written appeal should state the reason for your appeal. This does not mean that you are required to cite all applicable Plan provisions or to make “legal” arguments; however, you should state clearly why you believe you are entitled to the benefit you claim, or why you disagree with a Fund policy, determination or action. You are permitted to submit written comments, documents, records and other information relating to your claim even if such information was not submitted in connection with your initial claim for benefits. The Trustees can best consider your position if they clearly understand your claims, reasons and/or objections. Your appeal should be sent to:
Board of Trustees
National Automatic Sprinkler Industry Pension Fund
8000 Corporate Drive
Landover, MD 20785
The Trustees, or a designated Appeals Committee of the Trustees, will review your appeal at their quarterly meeting immediately following receipt of your appeal, unless the Fund Office received your appeal within 30 days of the date of the meeting. In that case, your appeal would be reviewed by the second quarterly meeting following receipt of the appeal. You may wish to contact the Fund Office concerning the date of the next meeting, so that you may submit your appeal in time to be heard at that meeting. If special circumstances require an extension of time for reviewing your claim, you will be notified in writing of the need for the extension. The notice will be provided prior to the commencement of the extension, describe the special circumstances requiring the extension and set forth the date the Trustees will decide your appeal. Such date will not be later than the third meeting of the Trustees or Committee following the Fund Office’s receipt of your appeal.
For benefit claims involving disability questions, the Trustees, or the designated Appeals Committee, will give no deference to the initial claim denial. Additionally, if the initial denial was based, in whole or in part, on a medical judgment, the Trustees will consult with a medical professional who has appropriate training and experience in the relevant field of medicine relating to the appeal. The medical professional will not be an individual who was consulted, or a subordinate of any professional consulted, in connection with the initial denial. You have the right to learn the identity of any health care professional contacted in connection with your claim.
Once your claim has been reviewed and a benefit determination has been made, you will receive written or electronic notice of the decision within 5 days. The notice will explain the reasons for the decision, include specific references to Plan provision, internal rule, guideline, protocol or other criterion on which the decision is based, indicate that you are entitled to request free access to and copies of documents, records, and other information relevant to your claim for benefits, and may state whether additional information may help your claim.
You may renew your appeal if you have any additional information or arguments to present. A renewed appeal must be submitted in writing, and the rules and limits stated above apply. In connection with an appeal or a renewed appeal, you may review pertinent documents in the Fund Office after making appropriate arrangements, or you may request that documents be provided to you. Such information will be provided free of charge. The special claims and appeal rules set forth above for questions relating to a disability do not apply if your rights under the Plan are conditioned upon a finding of the Social Security Administration that you are disabled.