Summary Annual Report For Welfare
For Wabash Memorial Hospital
Health and Welfare Plan
This is a summary of the annual report of the Wabash
Memorial Hospital Association, 37-0806462 for the Health and Welfare
Plan for the year ended December 31, 2012. The annual report has
been filed with the Employee Benefits Security Administration as
required under the Employee Retirement Income Security Act of 1974 (ERISA).
Wabash Memorial Hospital Association has committed
itself to pay certain hospital, surgical and dental claims incurred
under the terms of the plan.
BASIC FINANCIAL STATEMENT
The value of plan assets, after subtracting liabilities
of the plan, was $6,688,784 as of December 31, 2012, compared to
$6,237,766 as of January 1, 2012. During the plan year, the plan
experienced an increase in its net assets of $451,018. This
increase includes unrealized appreciation or depreciation in the value
of plan assets; that is, the difference between the value of the plan's
assets at the end of the year and the value of the assets at the
beginning of the year or the cost of assets acquired during the year.
During the plan year, the plan had total income of $17,797,245.
This included employee contributions of $6,710,362, employer
contributions of $9,501,635 reimbursement payments of $901,832, income
from investments of $199,392, and unrealized gains on investments of
Plan expenses were $17,346,227. These expenses
included $1,778,454 in administrative expenses, $679,961 in clinic
operations, $14,191,402 in benefits paid to participants and
beneficiaries, and $696,410 for fees paid to preferred provider
YOUR RIGHTS TO ADDITIONAL INFORMATION
You have the right to receive a copy of the full annual
report, or any part thereof, on request. The items listed below
are included in that report:
1. An accountant's report
2. Assets held for investment
To obtain a copy of the full annual report, or any part
thereof, write or call the office of Wabash Memorial Hospital
Association, c/o Ms. Tamara Bivins, who is the plan administrator,
located at 1501 North Water Street, Decatur, Illinois 62526,
217-429-5246. A nominal fee to cover copying costs may be charged.
You also have the right to receive from the plan
administrator, on request and at no charge, a statement of the assets
and liabilities of the plan and accompanying notes, or a statement of
income and expenses of the plan and accompanying notes, or both.
If you request a copy of the full annual report from the plan
administrator, these two statements and accompanying notes will be
included as part of that report. The charge to cover copying costs
given above does not include a charge for the copying of these portions
of the report because these portions are furnished without charge.
You also have the legally protected right to examine the
annual report at the main office of the plan, 1501 North Water Street,
Decatur, Illinois 62526 and at the U.S. Department of Labor in
Washington, DC 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, DC 20210.
Newborn's and Mother's Health
Protection Act of 1996
Under Federal law, group health plans and
health insurance issuers offering group health insurance coverage
generally may not restrict benefits for any hospital length of stay in
connection with childbirth for the mother or newborn child to less than
48 hours following a vaginal delivery, or less than 96 hours following a
delivery by Cesarean section. However, the plan, or issuer may pay
for a shorter stay if the attending provider (e.g., your physician,
nurse, midwife, or physician assistant), after consultation with the
mother, discharges the mother or newborn earlier.
Also, under Federal law, plans and
issuers may not set the level of benefits or out-of-pocket costs so that
any later portion of the 48 hour (or 96 hour) stay is treated in a
manner less favorable to the mother or newborn than any earlier portion
of the stay.
In addition, a plan or issuer may not,
under Federal law, require that a physician or other health care
provider obtain authorization for prescribing a length of stay of up to
48 hours (or 96 hours). However, to use certain providers or
facilities, or to reduce your out-of-pocket costs, you may be required
to obtain pre-certification. For information or precertification,
contact your plan administrator.
Women's Health and Cancer Rights Act
Under the Women's Health and Cancer
Rights Act, members eligible for medical / surgical benefits relating to
mastectomies have coverage provided for reconstruction of the breast
operated on, and/or surgery/reconstruction of the other breast, and/or
prosthesis and treatment of physical complications at all stages of
Governing Law Notice
Many different laws apply to our Plan.
Some additional provisions may apply to your situation because the law
requires them. This can affect your rights and responsibilities
even if the laws are not included or explained in this document.
The principal law that applies is Title XVIII of the Social Security Act
by the Center for Medicare and Medicaid Services (CMS). In
addition, other Federal laws apply and, under certain circumstances, the
laws of the State (s) in which you reside may apply.
When we make decisions about employment
of staff, we do not discriminate based on a person's race, disability,
religion, sex, sexual orientation, health ethnicity, creed, age or
national origin. All organizations that provide Medicare Managed
Care Plans and Health Care Prepayment Plans, like Wabash Association,
must obey Federal laws against discrimination, including Title VI of the
Civil Rights Act of 1964, the Rehabilitation Act of 1973, the Age
Discrimination Act of 1975, the Americans with Disabilities Act, all
other laws that apply to organizations that receive Federal funding and
any other laws and rules that apply for any other reason.