2023 Annual CU Health & Welfare Benefits Plan Notice

The University is required to provide employees annually with the CU Health & Welfare Benefits Plan Notice. Please see the notice below to review the details.

This notice is also available in the Benefit Solver portal under the ‘Reference Center’ and on Human Resources webpage for Benefits Compliance. 

Please email clarksonhr@clarkson.edu with any questions.

Thank you,

Human Resources

SUMMARY ANNUAL REPORT For Clarkson University Health & Welfare Benefits Plan This is a summary of the annual report of the Clarkson University Health & Welfare Benefits Plan, EIN 15-0543659, Plan No. 502, for the period July 1, 2022, through June 30, 2023. The annual report has been filed with the Employee Benefits Security Administration, as required under the Employee Retirement Income Security Act of 1974 (ERISA). Clarkson University has committed itself to pay healthcare claims incurred under the terms of the plan. Insurance Information The plan has contracts with New York Life Group Insurance Company Of New York, Metropolitan Life Insurance Company, Federal Insurance Company, and Vision Service Plan to pay vision, life insurance, temporary disability, long-term disability, Critical Illness and Travel Accident claims incurred under the terms of the plan. The total premiums paid for the plan year ending June 30, 2023, were $423,487. 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: • insurance information, including sales commissions paid by insurance carriers. To obtain a copy of the full annual report, or any part thereof, write or call the office of Clarkson University in care of Traci Giffin who is the Plan Administrator at 8 Clarkson Ave CU Box 5542 is, Potsdam, NY 13699, or by telephone at (315) 268-6497. The charge to cover copying costs will be $3.00 for the full annual report, or $0.25 per page for any part thereof. 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 (Clarkson University, 8 Clarkson Ave CU Box 5542, Potsdam, NY 13699) 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. Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to

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(page 2) comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512. The public reporting burden for this collection of information is estimated to average less than one minute per notice (approximately 3 hours and 11 minutes per plan). Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Office of the Chief Information Officer, Attention: Departmental Clearance Officer, 200 Constitution Avenue, N.W., Room N-1301, Washington, DC 20210 or email DOL_PRA_PUBLIC@dol.gov and reference the OMB Control Number 1210-0040. OMB Control Number 1210-0040 (expires 03/31/2026)

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