Summary Annual Report for
University of Pennsylvania
Health & Welfare Program
This is a summary of the annual report of the University of Pennsylvania Health & Welfare Program, Plan No. 503, sponsored by The Trustees of the University of Pennsylvania, EIN 23-1352685 for the period that began on July 1, 2004 and ended on June 30, 2005. The annual report has been filed with the Employee Benefits Security Administration as required under the Employee Retirement Income Security Act of 1974 (ERISA). Please note that not all employees are eligible to participate in all of the benefits available under the Plan. Please consult your Plan materials for specific eligibility information.
Medical, Prescription Drug, Dental and Long Term Disability Benefits
The University of Pennsylvania has committed itself to pay certain medical and prescription drug claims, dental benefits and long-term disability benefits incurred under the terms of the Plan on a self-insured basis.
The Plan also has contracts with Aetna, Inc. and Independence Blue Cross/Pennsylvania Blue Shield to pay medical claims incurred under the terms of the contracts. The total premiums paid for the plan year ending June 30, 2005 were $913,672.
Because some are so called “experience-rated” contracts, the premium costs are affected by, among other things, the number and size of claims. Of the total insurance premiums paid for the plan year ending June 30, 2005, the premiums paid under such “experience-rated” contracts were $833,020 and the total of all benefit claims paid under these experience-rated contracts during the plan year was $698,865.
The Plan has a contract with Highmark Blue Shield/Clarity Vision to pay vision claims incurred under the terms of the contract. The total premiums paid under this contract for the contract year ending December 31, 2004 were $509,722.
Because it is a so-called “experience-rated” contract, the premium costs are affected by, among other things, the number and size of claims. Of the total insurance premiums paid for the contract year ending December 31, 2004, the premiums paid under such “experience-rated” contract were $509,722 and the total of all benefit claims paid under the experience-rated contract during the plan year was $390,211.
Life Insurance Benefits
The Plan has a contract with Aetna Life Insurance Company to pay life insurance, dependent life insurance and accidental death and dismemberment claims incurred under the terms of the contract. The total premiums paid under this contract for the plan year ending June 30, 2005 were $3,305,654.
Your Rights to Additional Information
You have the right to receive a copy of the full annual report, or any part thereof, on request. Insurance information is included in this annual report.
To obtain a copy of the full annual report, or any part thereof, write or call the office of the Plan Administrator, c/o Joanne M. Blythe, Retirement Manager, University of Pennsylvania, 3401 Walnut Street, Suite 527A, Philadelphia, PA 19104-6228, (215) 898-9947. The charge to cover copying costs will be $5 for the full annual report or 25 cents per page for any part thereof.
You also have the legally protected right under ERISA to examine the annual report in the offices of the Employer at the address for the Plan Administrator, above, and at the U.S. Department of Labor in Washington, D.C., or to obtain a copy from the U.S. Department of Labor upon payment of copying costs. Requests to the Department should be addressed to: Public Disclosure Room, Room N-1513, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue, N.W., Washington, D.C. 20210.
—Division of Human Resources
Almanac, Vol. 52, No. 34, May 23, 2006
May 23, 2006
Volume 52 Number 34