This document describes the Judge Rotenberg Educational Center Health Plan. The plan provides the following benefits to eligible employees: medical; prescription drug; dental; vision; life insurance; short term disability; long term disability; accidental death and dismemberment (AD&D); and educational assistance program (EAP).

Unless otherwise specified, in the event that this document conflicts with the actual plan documents, including the incorporated benefits booklets or insurance contracts, the plan documents will control to the extent that they comply with all applicable laws and regulations.

Additional information about each of these benefits is provided to you in the attached Supplements to this document. Those benefits booklets and certificates of insurance which are included in the attached Supplements, as well as the enrollment guide you receive each year, are incorporated into this document and, together with this document, form the summary plan description (“SPD”) for the plan.

If you have any questions about the plan, or to request a copy of a benefits booklet or a certificate of insurance, please contact your applicable benefits office at the number below:

The Judge Rotenberg Educational Center

Susan Brumbelow Benefits Administrator, 781-828-2202 ext. 4458

ELIGIBILITY TO PARTICIPATE IN PLAN

You are eligible to participate in the benefits offered under the plan if you are a full-time or part-time employee of The Judge Rotenberg Educational Center, Inc. (referred to as the “Employer”) regularly working at least a minimum number of hours per week as set forth below. See the chart below for more information on eligibility.

Individuals classified as Relief Staff are not eligible to participate in any of the benefit options under the plan.

Benefit Option

Eligible Employment Classifications

Medical, Prescription Drug, Dental, Vision

Employees regularly working at least 20 hours per week except employees classified by the employer as Relief Staff

Life Insurance, Short Term Disability, Long Term Disability, AD&D, and EAP

Full-time employees regularly working at least 30 hours per week except employees classified by the employer as Relief Staff

An employee changing his/her employment status from Relief to Regular shall be eligible for medical and dental benefits on the first day of the month following the effective date of the change when s/he has been employed for a minimum of 60 days of continuous service, and regularly works a minimum of 20 hours per week. Upon becoming eligible the employee must elect to participate and enroll within 30 days of the eligibility date, or during an annual open enrollment period, unless experiencing a qualified life event.

Also, upon changing from Relief to Regular employee status, the employee shall become eligible and automatically enrolled for life insurance coverage, long-term disability insurance coverage, short-term disability insurance coverage, accidental death and dismemberment insurance coverage, and employee assistant plan participation on the first date after working for a minimum of 30 hours per week for at least six (6) months following the change from Relief to Regular.

Please refer to the individual benefits booklet or certificate of insurance covering the underlying benefit options for additional eligibility requirements.

Waiver Bonus Program

Employees that are eligible to participate in the medical and prescription drug benefits are eligible to waive coverage under one or both benefits and receive a waiver bonus. Please see your open enrollment materials for more information on the waiver bonus.

Reclassification

If you are classified by the employer in one of the categories not eligible to participate in the plan, but the Employer is later required by the Internal Revenue Service, the U.S. Department of Labor or any other governmental agency, or by any court or other tribunal, to reclassify you as an eligible employee, you will not be eligible to participate in this plan until the time you are designated by the plan administrator as an eligible employee. Such designation shall only provide for eligibility prospectively from the time it is made.

Dependent Coverage

If you are an eligible employee, you may elect to cover your eligible dependents under the benefit options listed below, but only if you also elect coverage for yourself. Subject to the terms of the applicable benefits booklet or certificate of insurance, your eligible dependents generally include:

· Your legal spouse (for AD & D your spouse must be under age 70)

· For vision coverage only, your domestic partner of the same or opposite gender as determined under uniform rules established by the plan administrator

· For medical, prescription drug and dental coverage only, Your former spouse if a court judgment requires the employee to provide coverage, until the remarriage of the former spouse or until there is no longer a judgment requiring such coverage

· Your children, defined as:

Benefit Option	Definition of Children
Medical, Prescription Drug, Dental	Your biological children; adopted children; children legally placed for adoption; children of your eligible dependent child; children who are tax dependents for federal income tax purposes; and children recognized under a qualified medical child support order as having the right to enroll; up to the end of the month in which a child turns age 26. The age restriction may be waived for a disabled or handicapped child under terms and conditions set forth in the applicable Supplement. Please see the applicable Supplement for more information.
Vision	Your biological children, legally adopted children from the date of placement for adoption, or other child for whom a court or administrative agency holds you responsible; up to the calendar month in which the child obtains age 26. The age restriction may be waived for certain disabled or handicapped children under terms and conditions set forth in the applicable Supplement. Please see the applicable Supplement for more information.
Accidental Death and Dismemberment	A biological child; an adopted child beginning with any waiting period pending finalization of the child’s adoption; a stepchild who resides with you; a child for whom you are legal guardian, as long as the child resides with you and depends upon you for financial support (meaning that the child may be claimed by you as a dependent for federal and state income tax purposes); so long as the child is unmarried and up to the month in which the child attains age 19. A child who is unmarried and 19 or more years old but less than 25 years old and enrolled in a school as a full-time student and primarily supported by you, or a disabled or handicapped child over 19 years old under terms and conditions set forth in the applicable Supplement, is also eligible. Please see the applicable Supplement for additional details.

COMMENCING PARTICIPATION IN PLAN

For certain of the benefit options, you must elect to participate in the benefit option and must pay a portion of the cost of coverage. For other benefit options, you automatically are enrolled and your employer pays the cost of coverage.

Benefit Option	Effective Date of Enrollment
Medical and Prescription Drug, Dental and Vision	You must elect to participate. You are eligible for coverage on the first day of the month coinciding with or next following 60 days of continuous service. You must enroll within 30 days of your eligibility date, or during an annual open enrollment period, unless you experience a Life Event as described below.
Life, Short Term Disability, Long Term Disability, AD&D and EAP	You are automatically enrolled coverage on the first date of active employment following completion of a six month active service waiting period.

For the benefits options that you must elect (i.e., the benefit options in which you are not automatically enrolled), if you do not elect coverage in a timely manner, you generally will have to wait until the next annual open enrollment period, unless you have a Life Event as described below.

Paying for Your Benefits

You must contribute toward the cost of your medical and prescription drug, dental and vision benefits Your Employer pays the cost of your basic life insurance, basic long term disability insurance, short term disability benefits, AD&D coverage and EAP.

Generally, any contributions you make to medical, prescription drug, dental or vision benefits will be paid through payroll deductions on a pre-tax basis. Contact your applicable benefits office for additional information on employee contributions to coverage. See page 1 for contact information.

The cost of your coverage is based on a number of factors, including which benefits you select and whether you elect to cover eligible dependents. The cost of coverage generally is set annually. Please refer to your enrollment materials for your contribution rates.

Life Events

You may make changes during the year only if you have a “life event.” The coverage change you wish to make must be consistent with your life event. Life events include:

§ A change in your marital status by reason of marriage, divorce, annulment or legal separation.

§ A change in the number of dependents due to birth, adoption or placement for adoption, legal custody or death.

§ You and/or your dependent gain or lose benefits coverage due to certain conditions like relocation, employment change, an increase or decrease in hours or loss of COBRA, CHIP or Medicaid benefits.

§ You become entitled to COBRA, Medicare or Medicaid.

If you wish to cover a new child, you must enroll a newborn within 31 days of birth and you must enroll an adopted child within 31 days of the date on which you or your spouse acquire the right to control the child’s health care. Coverage for the child will be retroactive to the date of birth or the date that you or your spouse acquire the right to control the child’s health care.

You must report all other changes in status events within 31 days of the event in order to make coverage changes for the current year. Otherwise, you must wait until the next annual open enrollment period to make any changes in coverage. Coverage will be effective prospectively from the after you notify your applicable benefits office.

For more information on Life Events, see page 1 for benefits office contact information.

Health Insurance Portability and Accountability Act (“HIPAA”) Special Enrollment

If you decline enrollment for yourself and your dependents (including your spouse) because of other health insurance coverage, you may in the future be able to enroll yourself or your dependents in health benefits under the plan, provided you request enrollment within 31 days after your other coverage ends. In addition, if you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be able to enroll yourself and your dependents, provided that you request enrollment within 31 days after marriage, birth, adoption or placement for adoption.

Children’s Health Insurance Program Reauthorization Act (“CHIPRA”) Special Enrollment)

You may request enrollment in health benefits under the plan upon either (i) termination of Medicaid or the state children’s health insurance program because of loss of eligibility or (ii) becoming eligible for premium assistance under a Medicaid or state children’s health insurance program. In order to be entitled to this special enrollment right, you must request coverage within 60 days of termination or the date the parent or child is determined to be eligible for assistance.

TERMINATION OF PARTICIPATION

Subject to any applicable COBRA election, and except as specified below under “Leave of Absence” or under the applicable Supplement, your coverage under the plan, or the applicable benefit option, ends on the earliest of the following:

· for medical, prescription, dental and vision, on the last day of the month that your employment terminates for any reason;

· for life insurance, long term disability insurance, short term disability insurance, AD&D insurance, and EAP, on the day that your employment terminates for any reason;

· termination of the plan or a specific benefit option; and

· the date you cease to meet the eligibility criteria.

Your coverage may also terminate for reasons set forth in the applicable Supplement such as insurance fraud or moving out of an HMO service area, and for other reasons set forth in this Summary, or as set forth in the official Plan document.

Spouse and Dependent Participation

Subject to any applicable COBRA election, coverage for your spouse or dependent ends when your coverage ends or on the date your spouse or dependent no longer meets the plan’s eligibility criteria. You are required to notify your applicable benefits office when an enrolled spouse or dependent no longer meets the eligibility criteria. See page 1 for contact information.

Leaves of Absence

You are entitled to continue coverage due to a leave of absence which qualifies under the Family and Medical Leave Act (FMLA) subject to payment of premiums. For a paid leave, premiums will continue to be paid on a pre-tax basis through payroll withholding. For an unpaid leave, you and the Employer must make arrangements for payment under a method which qualifies under the FMLA.

For leaves of absence that do not qualify for FMLA, please review your applicable Supplement for information regarding eligibility for continuation of coverage.

Notice Regarding Retroactive Cancellations of Coverage

The plan administrator, in his/her discretion, may retroactively cancel your coverage and your dependents’ coverage for the following reasons:

· Fraud or intentional misrepresentation of a material fact;

· Failure to timely pay premiums or required contributions; or

· Untimely notification of a divorce.

For this purpose, enrolling an ineligible individual or otherwise knowingly failing to comply with the plan’s eligibility requirements will constitute an intentional misrepresentation of fact and may trigger a retroactive cancellation of coverage.

If the retroactive cancellation is due to fraud or an intentional misrepresentation of a material fact, the plan will provide advance notice at least 30 days before the cancellation and you may appeal the termination. If coverage is retroactively terminated, then you may be liable for any benefits paid by the plan.

HEALTH AND WELFARE BENEFIT DESCRIPTIONS

The following benefits booklets and certificates of insurance are part of the plan and incorporated in this summary document as Supplements.

The applicable Supplements listed below are included as part of this Summary Plan Description and are attached. In some cases, and for future updates, the applicable Supplements may be provided to you directly from the insurer or third party administrator.

Supplement	Benefit
I.	Medical and Prescription Drug · Blue Care Elect Enhanced Value (PPO) Schedule of Benefits and Subscriber Certificate · HMO Blue New England Enhanced Value (HMO) Schedule of Benefits and Subscriber Certificate · HMO Blue New England $1,000 Deductible (HMO) Schedule of Benefits and Subscriber Certificate
II.	Dental Dental Blue Program 2 Summary of Benefits and Subscriber Certificate
III.	Vision VSP Group Vision Care Plan
IV.	Life Insurance Group Life Insurance Certificate issued by Life Insurance Company of North America
V.	Short Term Disability Group Short Term Disability Insurance Certificate issued by Life Insurance Company of North America
VI.	Long Term Disability Group Long Term Disability Insurance Certificate issued by Life Insurance Company of North America
VII.	Accidental Death and Dismemberment (AD&D) Group Accident Insurance Certificate issued by Life Insurance Company of North America
VIII.	Employee Assistance Plan EAP Supplement

CLAIMS PROCEDURES

Claims Administrator

The plan administrator has contracted with the following companies to administer benefits and pay claims. You may contact the claims administrator directly, using the information listed below. All claims and appeals shall be made to the claims administrator below.

Benefit

Claims Administrators

Claims and Appeals Procedure

Medical and Prescription Drug	Blue Cross Blue Shield of Massachusetts Member Appeal and Grievance Program One Enterprise Drive, Quincy, MA 02171-2126 1-800-358-2227 www.bluecrossma.com	See Supplement I
Dental	Blue Cross Blue Shield of Massachusetts	See Supplement II
Vision	Massachusetts Vision Service Plan, Inc. 3333 Quality Drive Rancho Cordova, CA 95670 1-800-877-7195. www.VSP.com	See procedures set forth herein
Life, Short Term Disability, Long Term Disability, and AD&D	Life Insurance Company of North America 1601 Chestnut Street Philadelphia, PA 19192-2235 [Is there a phone number or website?]	See applicable Supplement IV, V, VI and VII.
EAP	CIGNA 1-800-538-3543	See procedures set forth herein
COBRA Administration
HR Total Solutions 111 Charles Street Manchester, NH 03101 603-647-1147

Claims Procedures General Information

To make a claim or file an appeal for benefits identified as having claims and appeals procedures described in booklets or certification of insurance, follow the procedures set forth in the benefits booklet or the certificate of insurance for the applicable benefit. Claims procedures for benefits identified as subject to these procedures are set forth below.

For all claims under the plan, you must go through the plan’s internal claims procedures before you can bring a case in court. This is sometimes called Exhaustion of Administrative Remedies. Read these carefully, as there are timeframes that have to be met or you will lose your rights.

Member Inquiries

General inquiries regarding your eligibility for coverage and benefits do not involve the filing of a claim, and should be made by directly contacting your applicable benefits office. See page 1 for contact information.

Failure to Follow Claims Procedures

In the case of the failure of the plan to follow the claims procedures, you shall be deemed to have exhausted the administrative remedies under the plan and shall be entitled to pursue any available remedies under section 502(a) of ERISA. This provision does not apply to the dependent care flexible spending account, as it is not subject to ERISA.

Further Proceedings

Notwithstanding anything in the underlying plan documents:

For all benefits under the plan, if your claim for benefits and appeal is finally denied in whole or in part, and provided that you timely complete the above procedures, you may file suit only in a state court located in Norfolk County, Massachusetts or in federal court in the District of Massachusetts. Again, before you may file suit in a state or federal court, you must exhaust the plan’s administrative claims procedures within the time frames set forth below. If any such judicial proceeding is undertaken, the evidence presented will be strictly limited to the evidence timely presented to the claims administrator. In addition, any such judicial proceeding must be filed within 6 months after the plan (or claims) administrator’s final decision or it will be forever barred.

Filing Benefit Claims: Claims Procedures for Group Health Plans

Applicable to Vision and EAP

For EAP, the following procedures apply only to the medical benefits available under the program, such as the limited counseling benefits. All claims under the EAP will be considered “post service claims”.

For claims for all other benefits, follow the claims procedure contained in the applicable Supplement.

Definitions

For purposes of these claims procedures, the following definitions apply:

Adverse Benefit Determination: A denial, reduction, termination of, or failure to provide or make payment (in whole or in part) for a benefit. Such adverse benefit determination may be based on:

o Your eligibility for coverage;

o The results of any utilization review activities;

o A determination that the service or supply is experimental or investigational; or

o A determination that the service or supply is not medically necessary.

Appeal: A written request to reconsider an adverse benefit determination.

Complaint: Any written expression of dissatisfaction about quality of care or the operation of the Plan.

Concurrent Care Claim Extension: A request to extend a previously approved course of treatment.

Concurrent Care Claim Reduction or Termination: A decision to reduce or terminate a previously approved course of treatment.

Pre-Service Claim: Any claim for medical care or treatment that requires approval before the medical care or treatment is received, but is not an “Urgent Care Claim”.

Post-Service Claim: Any claim that is not a “Pre-Service Claim” or an “Urgent Care Claim”.

Urgent Care Claim: Any claim in which a delay in treatment could:

o jeopardize your life or health;

o jeopardize your ability to regain maximum function;

o cause you to suffer severe pain that cannot be adequately managed without the requested medical care or treatment; or

o in the case of a pregnant woman, cause serious jeopardy to the health of the fetus.

Claim Determinations

Urgent Care Claims

The claims administrator will make notification of an urgent care claim determination as soon as possible but not more than 72 hours after the claim is made.

If more information is needed to make an urgent claim determination, the claims administrator will notify the claimant within 24 hours of receipt of the claim. The claimant has 48 hours after receiving such notice to provide the claims administrator with the additional information. The claims administrator will notify the claimant within 48 hours of the earlier of the receipt of the additional information or the end of the 48 hour period given the physician to provide the claims administrator with the information.

If the claimant fails to follow plan procedures for filing a claim, the claims administrator will notify the claimant within 24 hours following the failure to comply.

Pre-Service Claims

The claims administrator will make notification of a claim determination as soon as possible but not later than 15 calendar days after the pre-service claim is made. The claims administrator may determine that due to matters beyond its control an extension of this 15 calendar days claim determination period is required. Such an extension, of not longer than 15 additional calendar days, will be allowed if the claims administrator notifies you within the first 15 calendar days period. If this extension is needed because the claims administrator needs additional information to make a claim determination, the notice of the extension shall specifically describe the required information. You will have 45 calendar days, from the date of the notice, to provide the claims administrator with the required information.

Post-Service Claims

The claims administrator will make notification of a claim determination as soon as possible but not later than 30 calendar days after the post-service claim is made. The claims administrator may determine that due to matters beyond its control an extension of this 30 calendar day claim determination period is required. Such an extension, of not longer than 15 additional calendar days, will be allowed if the claims administrator notifies you within the first 30 calendar day period. If this extension is needed because the claims administrator needs additional information to make a claim determination, the notice of the extension shall specifically describe the required information. The patient will have 45 calendar days, from the date of the notice, to provide the claims administrator with the required information.

Concurrent Care Claim Extension

Following a request for a concurrent care claim extension, the claims administrator will make notification of a claim determination for emergency or urgent care as soon as possible but not later than 24 hours, with respect to emergency or urgent care provided the request is received at least 24 hours prior to the expiration of the approved course of treatment, and 15 calendar days with respect to all other care, following a request for a concurrent care claim extension.

Concurrent Care Claim Reduction or Termination

The claims administrator will make notification of a claim determination to reduce or terminate a previously approved course of treatment sufficiently in advance of such reduction or termination to permit you to file an appeal and obtain a determination on review before the benefit is reduced or terminated.

Change in Claim Type

The claim type is determined initially when the claim is filed. However, if the nature of the claim changes as it proceeds through these claims procedures, the claim may be re-characterized. For example, a claim may initially be an urgent care claim. If the urgency subsides, it may be re-characterized as a pre-service claim.

Questions About Claim Type

It is very important to follow the requirements that apply to your particular type of claim. If you have any questions regarding what type of claim and/or what claims procedure to follow, contact the claims administrator.

Appeals of Adverse Benefit Determinations

You may submit an appeal if the claims administrator gives notice of an adverse benefit determination.

You have 180 calendar days following the receipt of notice of an adverse benefit determination to request your appeal. You should contact the claims administrator to obtain any applicable forms. For an urgent care claim, the request for an expedited appeal may be submitted orally or in writing, and all necessary information, including the plan’s determination, shall be submitted by telephone, fax, or another expedited method.

You may also choose to have another person (an authorized representative) make the appeal on your behalf by providing written consent to the claims administrator.

Urgent care appeal

The claims administrator shall issue a decision within 72 hours of receipt of the request for an appeal.

Pre-Service appeals

The claims administrator shall issue a decision within 30 calendar days of receipt of the request for an appeal.

Post-Service appeals

The claims administrator shall issue a decision within 60 calendar days of receipt of the request for an appeal.

Exhaustion of Process

You must exhaust the plan’s applicable appeal procedure before you:

o for fully insured coverage, contact your state's Department of Insurance to request an investigation of a complaint or appeal; or

o for fully insured coverage, file a complaint or appeal with the your state's Department of Insurance; or

o establish any of the following regarding an alleged breach of the plan terms; or any matter within the scope of the Appeals Procedure:

- litigation;

- arbitration; or

- administrative proceeding.

Internal Claims and Appeals Processes and Notices

Upon request to the claims administrator, you may review, free of charge, all documents, records and other information relevant to the claim (as determined under ERISA regulations), that is the subject of your appeal and shall have the right to submit any written comments, documents, records, information, data or other material in support of your appeal.

A representative from the claims administrator will review the initial appeal. The representative will be a person who was not involved in any previous adverse benefit determination regarding the claim that is the subject of your appeal and will not be the subordinate of any individual that was involved in any previous adverse benefit determination regarding the claim that is the subject of your appeal.

In rendering a decision on your appeal, the claims administrator will take into account all comments, documents, records, and other information submitted by you without regard to whether such information was previously submitted to or considered by the claims administrator. The claims administrator will also afford no deference to any previous adverse benefit determination regarding the claim that is the subject of your appeal.

In rendering a decision on an appeal that is based, in whole or in part, on medical judgment, including a determination of whether a requested benefit is medically necessary and appropriate or experimental/investigative, the claims administrator will consult with a health care professional who has appropriate training and experience in the field of medicine involved in the medical judgment. The health care professional will be a person who was not involved in any previous adverse benefit determination regarding the claim that is the subject of your appeal, and will not be the subordinate of any person involved in a previous adverse benefit determination regarding the claim that is the subject of your appeal.

Will provide the identification of medical or vocational experts whose advice was obtained on behalf of the plan in connection with a claimant’s adverse determination, without regard to whether the advice was relied upon in making the benefit determination.

Written notification shall be provided to the claimant of the plan’s adverse decision on a claim or appeal and shall include the following, in a manner calculated to be understood by the claimant:

§ A statement of the specific reason(s) for the decision;

§ Reference(s) to the specific plan provision(s) on which the decision is based;

§ After denial of the initial claim, a description of any additional material or information necessary to perfect the claim and why such information is necessary;

§ A description of the plan procedures and time limits for appeal of the decision, and the right to obtain information about those procedures and, for a final appeal, the right to sue in federal or state court under Section 502 of ERISA;

§ A statement disclosing any internal rule, guidelines, protocol or similar criterion relied on in making the adverse decision (or a statement that such information will be provided free of charge upon request);

§ If the decision involves scientific or clinical judgment, either (a) an explanation of the scientific or clinical judgment applying the terms of the plan to the claimant’s medical circumstances, or (b) a statement that such explanation will be provided at no charge upon request; and

§ In the case of an urgent care claim, an explanation of the expedited review methods available for such claims.

Notification of the plan’s adverse decision on an urgent care claim may be provided orally, but written notification shall be furnished not later than three days after the oral notice.

Other Claims

Please note that the plan administrator still will make some determinations under the plan. These will be those matters that the claims administrator does not decide. Examples include basic determinations as to whether a particular person is eligible to be a plan participant. If you have a claim or appeal that is not handled by the claims administrator, it should be submitted to the plan administrator. The plan administrator will generally decide the claim or appeal using the procedures set forth above. The same appeal rights and time frames will apply, as well as the provisions regarding when you can sue and when you will lose your right to sue.

MISCELLANEOUS INFORMATION

Maternity Hospital Stay

Group health plans and health insurance issuers generally may not, under federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).

Women’s Health and Cancer Act Notice

As required by the Women’s Health and Cancer Rights Act of 1998, the plan provides benefits for mastectomy-related services including all stages of reconstruction of the breast on which the mastectomy was performed, surgery and reconstruction of the other breast to produce a symmetrical appearance and prostheses and treatment of physical complications of the mastectomy, including lymphedema.

Coordination of Benefits

This plan may or may not coordinate benefits with other plans. If you or your dependents are covered under more than one plan, refer to the component plans’ certificate of coverage, benefits booklet or plan description to determine how benefits payable under those plans will be coordinated. You should file all such claims with the appropriate plan administrator. Coverage under this plan plus another plan will not guarantee 100% total reimbursement.

Reimbursement and Subrogation

The purpose of this provision is to insure that the limited funds available to finance the benefits provided by the plan are not used to provide benefits where other Available Funds (defined below) may be available to pay the cost of the benefits provided by the plan.

For the purposes of this subsection the following definitions shall apply:

(1) The term "Participant" shall mean any participating employee or covered dependent.

(2) The term "Illness or Injury" shall mean any illness or injury of whatever kind or description, whether arising out of a work related cause or whether unrelated to the work of the Participant.

(3) The term "Available Funds" shall mean monies and/or compensation from any source whatsoever (whether called pain and suffering, weekly indemnity, workers compensation, damages, restitution, wage loss, medical treatment, out-of-pocket expenses, or any like or similar terms).

(4) The terms "Claim" or "Third Party Claim" or "Third Party Injury" shall mean any claim for monetary or non-monetary compensation of whatever kind or description whether made by petition (e.g., workers compensation petition), court complaint, insurance claim or written or oral demand as the result of an Illness or Injury caused (or allegedly caused) by another party to a Participant. It includes any payment, settlement, recovery, or judgment including, but not limited to, the following sources:

· Payments made by a Third Party or any insurance company on behalf of the Third Party;

· Any lawsuit settlements from payments made from any source;

· Any payments or awards under an uninsured or underinsured motorist coverage policy;

· Any workers' compensation or disability award or settlement;

· Any medical payments coverage under any: automobile policy; premises or homeowners' medical payments coverage; or premises or homeowners' insurance coverage (whether the Participant's or another's); and

· Any other payments from a responsible party, including any party responsible for payment of expenses associated with the care or treatment of Third Party Injuries, or another source intended to compensate the Participant for injuries resulting from an accident or alleged negligence.

(5) The term "Third Party" means any party that is, or may be, or is claimed to be responsible for Illness or Injuries to a Participant that are "Claims," "Third Party Injuries" or "Third Party Claims."

As a condition to the receipt of benefits, by any Participant from the plan, each Participant shall agree that in the event that the plan has made, does make, or is obligated to make payments to the Participant arising out of any Illness or Injury, then, as a condition for receiving benefits from the plan, the Participant (or where appropriate their representative) agrees:

· To notify the plan in writing, within 30 days of the time when notice is given to the Participant or any related party, of the intention to investigate or pursue a Claim, or that a Claim has been filed by the Participant against a Third Party seeking to recover damages or obtain compensation or Available Funds, relating to such Illness or Injury.

· To notify the plan in writing of the name and address of the Participant's attorney, provide said attorney with a copy of the agreement and require said attorney to comply with its terms. The agreement shall serve as authorization to the Participant's attorney to comply with its terms and to release all requested information about the Claims to the plan.

· To keep the plan informed in writing of the progress and/or settlement of his/her Third Party Claim.

· To cooperate with the plan and its designees and do whatever is necessary to secure the plan's rights of subrogation and reimbursement, as described below.

· To include in all Claims a claim for benefits paid by the plan to and/or claimed from the plan by the Participant, plus interest accruing from the date of payment of such benefits.

· That the plan has the right to be reimbursed in full for the cost of any and all benefits that are provided by the plan to or on behalf of the Participant, plus interest accruing from the date of payment of such benefits, as the result of an Illness or Injury caused by another party. This process is called subrogation. The plan has this right of subrogation and by accepting the benefits under the plan, a Participant acknowledges this right of subrogation. The plan's right to subrogation applies to any Claim made by or on the Participant's behalf.

The plan's right of subrogation consists of both a right of a subrogation and a right of reimbursement.

Subrogation means the plan shall be subrogated to a Participant's right of recovery against any party to the extent of the full cost of all benefits provided by this plan. The plan may proceed against any party with or without the Participant's consent.

The plan's right of reimbursement attaches to any Claim received by a Participant or their representative from any party responsible for paying for expenses associated with the care or treatment of Third Party Injuries or any other Claim. By providing any benefit under this plan, the plan is granted an assignment of the proceeds of any Claim received by the Participant to the extent of the full cost of all benefits provided by this plan.

The plan's right of reimbursement is cumulative with and not exclusive of the plan's subrogation right and the plan may choose to exercise either or both rights of recovery.

The plan's subrogation right is a first priority right and the plan is entitled to reimbursement even if such reimbursement results in a recovery to the Participant that is insufficient to compensate the Participant in whole or in part for the Participant's damages from a Third Party Injury. The plan may recover the full cost of all benefits paid by this plan without regard to any claim of fault on the Participant's part, whether by comparative negligence or otherwise. No court costs or attorney's fees may be deducted from the plan's recovery, and the plan is not required to pay or contribute to paying court costs or attorney's fees for the attorney hired by the Participant to pursue their Claim without the prior express written consent of the plan.

The plan's subrogation right applies to all benefits under the plan, even if the underlying benefit booklets contain no language or different language on subrogation and reimbursement.

Certain other agreements, described below, are related to the plan's right of subrogation.

· To authorize any person or entity paying Available Funds to or on behalf of the Participant to pay over to the plan such monies as the plan is entitled to receive under the terms of the plan and the agreement, and the agreement shall constitute their warrant to do so. In case of any dispute over what monies are due the plan, Available Funds shall be escrowed pending resolution of such dispute.

This includes giving the plan a first-priority lien on any Claim or Available Funds to the extent of the full cost of all benefits associated with Third Party Injuries provided by this plan (regardless of whether specifically set forth in the recovery, settlement, judgment or compensation agreement).

This also includes an agreement to pay, as the first priority, from any Claim or Available Funds, any and all amounts due to the plan as reimbursement for the full cost of all benefits associated with Third Party Injuries paid by this plan (regardless of whether specifically set forth in the recovery, settlement, judgment or compensation agreement), unless otherwise agreed to by the plan in writing.

· To require and authorize his/her attorney, if any, to withhold from Available Funds any monies due the plan pursuant to the agreement and to forward them to the plan as required by the agreement. In case of any dispute over what monies are due the plan, Available Funds are to be escrowed pending resolution of such dispute.

· To do nothing to prejudice the plan's rights as set forth above. This includes, but is not limited to, refraining from making any settlement or recovery that specifically attempts to reduce or exclude the full cost of all benefits paid by the plan.

· To serve as a constructive trustee for the benefits of this plan over any Available Funds, including any settlement or recovery funds, received as a result of Third Party Injuries.

In the event that the Participant or the Participant's representative fails or refuses to comply with the provisions of the plan and the agreement, then the Participant shall be responsible for all benefits paid by this plan in addition to costs and attorney's fees incurred by the plan in obtaining repayment. The plan, in addition to any other rights to which the plan thereof might have, shall have the right to withhold from any payments due or which become due to the Participant or to third parties on behalf of the Participant from the plan any amount necessary until the plan is fully reimbursed for all benefits paid by this plan in addition to costs and attorney's fees incurred by the plan in obtaining repayment.

The Participant shall authorize the plan to record and/or use the agreement in any proceedings involving the Participant, including using the agreement in any Third Party Claims that the Participant may have.

Any Participant making a Claim on behalf of any minor child under the plan of benefits and who shall make the agreement on behalf of said minor child shall warrant that he/she is authorized to make the agreement on behalf of said minor child.

The provisions of this section supplement the provisions of any applicable benefits booklet or certificate of insurance including any and all Supplements, including the provisions of any plan summaries regarding the reimbursement of expenses.

No Guarantee of Employment

The plan shall not be deemed to constitute a contract of employment between the Employer and you.

Qualified Medical Child Support Orders

If a qualified medical child support order (also called a “QMCSO”) is issued by a court for your child, that child will be enrolled in medical, dental and vision benefits, as provided by the order, without regard to the annual enrollment and life event rules. You may obtain, without charge, a copy of the plan’s procedures for review and implementation of qualified medical child support orders by contacting your applicable benefits office. See page 1 for contact information.

Preventive Care

This plan provides all benefits, generally at no cost, that are obtained in-network, and that are “Covered Preventive Services,” meaning they fall within any of the following guidelines:

· Evidence-based items or services that have in effect a rating of “A” or “B” in the current recommendations of the United States Preventive Services Task Force (USPSTF) with respect to the individual involved;

· Immunizations for routine use in children, adolescents, and adults that have in effect a recommendation from the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) with respect to the individual involved;

· With respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA); and

· With respect to women, evidence-informed preventive care and screening provide for in comprehensive guidelines supported by HRSA, to the extent not already included in certain recommendations of the USPSTF.

These services are intended to prevent diseases (or injuries) rather than treat a symptom or complaint, or to treat or cure a disease after it is present. Any service or item that falls in the above categories will be covered at no cost, provided they are obtained in-network (unless there is no in-network provider of the particular preventive care service, in which case an out of network provider will be covered) and subject to certain reasonable medical management techniques. For example, these requirements do not prohibit the imposition of cost-sharing for separately billed office visits. You can obtain a schedule of all benefits there are “Covered Preventive Services” by contacting the medical and prescription drug claims administrator (See page 11 for phone number and website information).

In addition, this plan may cover certain additional preventive services (without cost if obtained in network) as set forth in the Medical Supplement.

NOTICE OF CONTINUATION COVERAGE RIGHTS UNDER COBRA

This notice contains important information about your right to COBRA continuation coverage, which is a temporary extension of coverage for certain benefits under the plan. This notice generally explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect the right to receive it.

The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (“COBRA”). COBRA continuation coverage can become available to you when you would otherwise lose your group health coverage. It can also become available to other members of your family who are covered under the plan when they would otherwise lose their group health coverage. For additional information about your rights and obligations under the plan and under federal law, you should contact the COBRA claims administrator.

You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees.

This notice is applicable to all benefits under the plan that qualify as “group health plans” under ERISA.

What is COBRA Continuation Coverage?

COBRA continuation coverage is a continuation of plan coverage when coverage would otherwise end because of a life event known as a “qualifying event.” Specific qualifying events are listed below. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse and your dependent children could become qualified beneficiaries if coverage under the plan is lost because of the qualifying event. Under the plan, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage.

If you are an employee, you will become a qualified beneficiary if you will lose your coverage under the plan because any of the following qualifying events happens:

§ Your hours of employment are reduced.

§ Your employment ends for any reason other than your gross misconduct.

If you are the spouse of an employee, you will become a qualified beneficiary if you lose your coverage under the plan because any of the following qualifying events happens:

§ Your spouse dies.

§ Your spouse’s hours of employment are reduced.

§ Your spouse’s employment ends for any reason other than his or her gross misconduct.

§ Your spouse becomes entitled to Medicare (Part A, Part B, or both).

§ You become divorced or legally separated from your spouse.

Your dependent children will become qualified beneficiaries if they will lose coverage under the plan because any of the following qualifying events happens:

§ The parent-employee dies.

§ The parent-employee’s hours of employment are reduced.

§ The parent-employee’s employment ends for any reason other than his or her gross misconduct.

§ The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both).

§ The parents become divorced or legally separated.

§ The child stops being eligible for coverage under the plan as a “dependent child.”

Sometimes, filing a proceeding in bankruptcy under title 11 of the United States Code can be a qualifying event. If a proceeding in bankruptcy is filed with respect to the Employer, and that bankruptcy results in the loss of coverage of any retired employee covered under the Plan, the retired employee will become a qualified beneficiary. The retired employee’s spouse, surviving spouse, and dependent children will also become qualified beneficiaries if bankruptcy results in the loss of their coverage under the Plan.

When is COBRA Coverage Available?

The plan will offer COBRA continuation coverage to qualified beneficiaries only after the COBRA administrator has been notified that a qualifying event has occurred. When the qualifying event is the end of employment or reduction of hours of employment, death of the employee or the employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both), or commencement of a proceeding in bankruptcy with respect to the employer, the employer must notify the COBRA administrator of the qualifying event.

You Must Give Notice of Some Qualifying Events

For the other qualifying events (divorce or legal separation of the employee and spouse, a dependent child’s losing eligibility for coverage as a dependent child), you must notify your applicable benefits office and the COBRA administrator within 60 days after the qualifying event occurs.

How is COBRA Coverage Provided?

Once the COBRA administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children.

COBRA continuation coverage is a temporary continuation of coverage. When the qualifying event is the death of the employee, the employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both), divorce or legal separation, or a dependent child’s losing eligibility as a dependent child, COBRA continuation coverage lasts for up to a total of 36 months. When the qualifying event is the end of employment or reduction of the employee’s hours of employment, and the employee became entitled to Medicare benefits less than 18 months before the qualifying event, COBRA continuation coverage for qualified beneficiaries other than the employee lasts until 36 months after the date of Medicare entitlement. For example, if a covered employee becomes entitled to Medicare 8 months before the date on which his employment terminates, COBRA continuation coverage for his spouse and children can last up to 36 months after the date of Medicare entitlement, which is equal to 28 months after the date of the qualifying event (36 months minus 8 months). Otherwise, when the qualifying event is the end of employment or reduction of the employee’s hours of employment, COBRA continuation coverage generally lasts for only up to a total of 18 months. There are two ways in which this 18-month period of COBRA continuation coverage can be extended.

Disability extension of 18-month period of continuation coverage

If you or anyone in your family covered under the plan is determined by the Social Security Administration to be disabled and you notify the COBRA administrator in a timely fashion, you and your entire family may be entitled to receive up to an additional 11 months of COBRA continuation coverage, for a total maximum of 29 months. The disability would have to have started at some time before the 60^th day of COBRA continuation coverage and must last at least until the end of the 18-month period of continuation coverage. You must notify the COBRA administrator of the Social Security
Administration’s determination within 60 days of the date of the determination and before the end of the 18-month period of COBRA continuation coverage. To do so, you must call the COBRA claims administrator.

Second qualifying event extension of 18-month period of continuation coverage

If your family experiences another qualifying event while receiving 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if notice of the second qualifying event is properly given to the plan. This extension may be available to the spouse and any dependent children receiving continuation coverage if the employee or former employee dies, becomes entitled to Medicare benefits (under Part A, Part B, or both), or gets divorced or legally separated, or if the dependent child stops being eligible under the plan as a dependent child, but only if the event would have caused the spouse or dependent child to lose coverage under the plan had the first qualifying event not occurred. You must notify the COBRA administrator of the second qualifying event within 60 days of the second qualifying event.

Are there other coverage options besides COBRA Continuation Coverage?

Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov.

If You Have Questions

Questions concerning your plan or your COBRA continuation coverage rights should be directed to the COBRA claims administrator. For more information about your rights under ERISA, including COBRA, HIPAA and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (“EBSA”) in your area or visit the EBSA website at www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.)

Keep Your Plan Informed of Address Changes

In order to protect your family’s rights, you should keep your applicable benefits office informed of any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the benefits office or the COBRA administrator.

COBRA Administrator

HR Total Solutions

111 Charles Street

Manchester, NH 03101

603-647-1147

ADDITIONAL PLAN INFORMATION REQUIRED BY ERISA

This section contains additional information about the plan, including information that The Judge Rotenberg Educational Center, Inc. is required to provide to you under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”).

The Role of The Judge Rotenberg Educational Center, Inc.

The Judge Rotenberg Educational Center, Inc. (JRC) is the “plan sponsor” of the plan. JRC is the “plan administrator” of the Plan. JRC has the responsibility to administer and interpret the plan and make the final decision on such issues as eligibility and payment of benefits.

JRC has the exclusive discretionary right to interpret the terms and provisions of the plan and to determine any and all questions arising under the plan, including, without limitation, the right to remedy or resolve possible ambiguities, inconsistencies or omissions, by general rule or particular decision and to make findings of fact and conclusions of law.

Your Rights Under ERISA

As a participant in any of the ERISA-covered benefits under the plan, you are entitled to certain rights and protections under ERISA. ERISA provides that all plan participants shall be entitled to:

Receive Information About Your Plan and Benefits

§ Examine, without charge, at the plan administrator’s office and at other specified locations, such as worksites and union halls, all documents governing the plan, including insurance contracts and collective bargaining agreements, and a copy of the latest annual report (Form 5500 Series) files by the plan 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 all documents governing the operation of the plan, including insurance contracts and collective bargaining agreements, and copies of the latest annual report (Form 5500 Series) and updated summary plan description. The plan administrator may make 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 Group Health Plan Coverage

Continue health care coverage for yourself, spouse or dependents if there is a loss of coverage under the plan as a result of a qualifying event. You or your dependents may have to pay for such coverage. Review this summary plan description and the documents governing the plan on the rules governing your COBRA continuation rights.

Prudent Actions by Plan Fiduciaries

In addition to creating rights for plan participants, ERISA imposes duties upon the people who are responsible for the operation of the 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, your union, 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.

Enforce Your Rights

If your claim for a welfare benefit is denied or ignored, in whole or in part, you have a right to know why this was done, to obtain copies of documents relating to the decision without charge, and to appeal any denial, all within certain time schedules.

Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request a copy of plan documents or the latest annual report 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 plan 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 after exhaustion of the plan’s claims and appeal procedures. In addition, if you disagree with the plan’s decision or lack thereof concerning the qualified status of a domestic relations order or a medical child support order, you may file suit in 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 are successful the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees, for example, if it finds your claim is frivolous.

Assistance with Your Questions

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, or if you need assistance in obtaining documents from the plan administrator, you should contact the nearest office of the Employee Benefits Security Administration, U.S. Department of Labor, listed in your telephone directory or the Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue, NW, Washington, DC 20210. You may also obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the Employee Benefits Security Administration.

Future of Plan

The Judge Rotenberg Educational Center, Inc. has the right, in its sole discretion, to amend, modify, suspend or terminate any employee benefit it offers to employees, former employees and retirees at any time.

Name of Plan	The Judge Rotenberg Educational Center Health Plan
Plan Sponsor	The Judge Rotenberg Educational Center, Inc.
Plan Administrator	The Judge Rotenberg Educational Center, Inc.
Plan Sponsor’s Employer Identification Number	04-2489805
Plan Number	501
Type of Plan	Welfare plan comprised of group medical; dental; prescription drug; vision; life insurance; long term disability; short term disability; accidental death and dismemberment; and EAP.
Type of Administration/ Source of Contributions and Funding	Medical and Prescription Drug	Benefits are fully insured under one or more group insurance contracts administered by Blue Cross Blue Shield of Massachusetts
	Vision	Benefits are fully insured under one or more group contracts administered by Massachusetts Vision Service Plan, Incorporated
	Dental	Benefits are fully insured under one or more group contracts administered by Blue Cross Blue Shield of Massachusetts
	Life Short Term Disability Long Term Disability AD&D EAP	Benefits are fully insured under one or more group insurance contracts administered by Life Insurance Company of North America; EAP benefits are provided by CIGNA as part of the insurance arrangement with Life Insurance Company of North America.
Agent for Service of Legal Process	General Counsel The Judge Rotenberg Educational Center, Inc. 240 Turnpike Street Canton, MA 02021
Plan Year	January 1 to December 31