BARCLAYS BANK PLC AMENDED AND RESTATED RETIREE … · Plan by contacting the Barclays Benefits...

30
OHSUSA:766223108 BARCLAYS BANK PLC AMENDED AND RESTATED RETIREE MEDICAL, DENTAL AND LIFE INSURANCE PLAN SUMMARY PLAN DESCRIPTION AND PLAN DOCUMENT AMENDED AND RESTATED AS OF SEPTEMBER 1, 2016

Transcript of BARCLAYS BANK PLC AMENDED AND RESTATED RETIREE … · Plan by contacting the Barclays Benefits...

Page 1: BARCLAYS BANK PLC AMENDED AND RESTATED RETIREE … · Plan by contacting the Barclays Benefits Center at +1 (855) 538-7794. If I terminate my participation in the Plan, can I resume

OHSUSA:766223108

BARCLAYS BANK PLC

AMENDED AND RESTATED RETIREE MEDICAL, DENTAL AND LIFE INSURANCE PLAN

SUMMARY PLAN DESCRIPTION AND PLAN DOCUMENT

AMENDED AND RESTATED AS OF SEPTEMBER 1, 2016

Page 2: BARCLAYS BANK PLC AMENDED AND RESTATED RETIREE … · Plan by contacting the Barclays Benefits Center at +1 (855) 538-7794. If I terminate my participation in the Plan, can I resume

OHSUSA:766223108

PLAN DATA

PLAN NAME:

Barclays Bank PLC Retiree Medical, Dental and Life Insurance Plan

PLAN IDENTIFICATION NUMBER:

600

THE PLAN YEAR ENDS:

December 31

PLAN SPONSOR:

Barclays Bank PLC 745 Seventh Avenue, 18th Floor New York, NY 10019 PLAN ADMINISTRATOR AND NAMED FIDUCIARY:

Barclays Bank PLC except that each insurer is an ERISA fiduciary with respect to its insurance policy(ies) offered under the Plan and each third party administrator is an ERISA fiduciary to the extent Barclays Bank PLC has delegated ERISA fiduciary status to the third party administrator under an administrative services agreement.

PLAN SPONSOR TAX IDENTIFICATION NUMBER:

13-4942190

AGENT FOR SERVICE OF LEGAL PROCESS:

Barclays Bank PLC Attn: Human Resources/Benefits 745 Seventh Avenue, 18th Floor New York, NY 10019 TYPE OF PLAN:

Stand-alone retiree welfare benefits plan

PARTICIPATING EMPLOYERS:

Barclays Bank PLC and its ERISA affiliates

Page 3: BARCLAYS BANK PLC AMENDED AND RESTATED RETIREE … · Plan by contacting the Barclays Benefits Center at +1 (855) 538-7794. If I terminate my participation in the Plan, can I resume

II OHSUSA:766223108

TYPE OF ADMINISTRATION:

This Plan is administered in accordance with its terms and several component documents and insurance policies that more specifically describe the medical, prescription drug, dental and life insurance benefits offered under this Plan as well as the provisions of this official Plan documents and summary plan description. Medical, prescription drug and dental benefits are self-insured by Barclays and may be administered by a third-party administrator, including an insurance company.

If you have questions or want specific information regarding any of your retiree benefits, contact the Barclays Benefits Center at 1-855-538-7794.

Page 4: BARCLAYS BANK PLC AMENDED AND RESTATED RETIREE … · Plan by contacting the Barclays Benefits Center at +1 (855) 538-7794. If I terminate my participation in the Plan, can I resume

-i-

TABLE OF CONTENTS

1. Introduction ........................................................................................................................ 1

2. Definitions.......................................................................................................................... 1

3. Eligibility and Participation ............................................................................................... 3

4. Plan Benefits ...................................................................................................................... 5

5. Plan Administration ........................................................................................................... 8

6. HIPAA Privacy and Security ........................................................................................... 10

7. Statement of Your ERISA Rights .................................................................................... 12

SCHEDULE A – Retiree Benefits ............................................................................................... 15

SCHEDULE B– Contributions for Retiree Benefits ................................................................... 16

SCHEDULE C – Claims and Appeal Procedures........................................................................ 18

Page 5: BARCLAYS BANK PLC AMENDED AND RESTATED RETIREE … · Plan by contacting the Barclays Benefits Center at +1 (855) 538-7794. If I terminate my participation in the Plan, can I resume

1

OHSUSA:766223108

Barclays Bank PLC Retiree Medical, Dental and Life Insurance Plan and SPD

1. Introduction

Barclays Bank PLC (the “Company”) hereby amends and restates the Barclays Bank PLC Retiree Medical, Dental and Life Insurance Plan, originally established no later than April 1, 1988 (the “Plan”), for the benefit of Eligible Retirees and their Eligible Dependents. This Summary Plan Description (“SPD”) and Plan Document describes the provisions of the Plan in effect as of September 1, 2016 and supersedes all oral and previously written descriptions of the Plan. The Plan is a “stand-alone” retiree welfare plan for purposes of ERISA, the Affordable Care Act and HIPAA because less than two participants are current employees.

The Company does not provide vested welfare benefits and reserves the right to amend the Plan in any way and at any time or terminate the Plan at any time.

2. Definitions

“Affordable Care Act” means the Patient Protection and Affordable Care Act of 2010, as amended.

“COBRA” means the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended.

“Code” means the Internal Revenue Code of 1986, as amended.

“Company” means Barclays Bank PLC and any Participating Employer that has adopted the Plan for the benefit of its former employees. For purposes of the authority to administer, amend or terminate the Plan, Company means Barclays Bank PLC. Company also includes the predecessors and successors to Barclays Bank PLC and any Participating Employer.

“Dependent” means:

(a) An Eligible Retiree’s spouse or Domestic Partner;

(b) An Eligible Retiree’s or his spouse’s or Domestic Partner’s child until the end of the Plan Year in which he or she turns age 26;

(c) An Eligible Retiree’s or his spouse’s or Domestic Partner’s unmarried child who has turned age 26 as of the end of the Plan Year and is determined by the third party administrator or insurer of the covered benefit to have become totally and permanently disabled prior to age 26, provided that the third party administrator or insurer is given proof of such disability within 31 days after the later of the determination of total and permanent disability or the date the Eligible Retiree enrolls in the Plan;

(d) A person for whom the Eligible Retiree has a qualified medical child support order (as defined in ERISA Section 609);

Page 6: BARCLAYS BANK PLC AMENDED AND RESTATED RETIREE … · Plan by contacting the Barclays Benefits Center at +1 (855) 538-7794. If I terminate my participation in the Plan, can I resume

2 OHSUSA:766223108

(e) A person who has not attained age 27 as of the end of the Plan Year for whom the Eligible Retiree or the Eligible Retiree’s spouse or Domestic Partner is the court-appointed guardian (or was immediately before the person reached age 18); or

(f) Any person required to be covered under the Plan as a dependent of an Eligible Retiree by any applicable state or federal law.

For purposes of this definition of “Dependent,” the term “child” includes the Eligible Retiree’s or his spouse’s or Domestic Partner’s biological child, a legally adopted child, a child who is lawfully placed for legal adoption, a step child or a foster child, but excludes any child of a Dependent child. The Eligible Retiree may be required by the Plan Administrator to provide documentation that a child qualifies as a Dependent under the Plan.

“Domestic Partner” means a person who meets and continues to meet all of the criteria detailed in the Barclays Domestic Partnership Employee Benefits Information Guide, provided that the domestic partnership has been internally registered with the Company. The term Domestic Partner shall also include a person in a civil union with an Eligible Retiree, as defined under the laws of a state that recognizes civil unions, provided that proof of the civil union has been filed with the Company.

“Eligible Dependent” means a Dependent of an Eligible Retiree who is eligible to participate in the Plan pursuant to Section 3.

“Eligible Retiree” means a former employee of the Company who is eligible to participate in the Plan pursuant to Section 3.

“ERISA” means the Employee Retirement Income Security Act of 1974, as amended.

“HIPAA” means the Health Insurance Portability and Accountability Act of 1996, as amended.

“Participating Employer” means an employer (and its predecessors or successors) that is an ERISA affiliate of Barclays Bank PLC and has adopted the Plan for its former employees.

“Plan” means the Barclays Bank PLC Retiree Medical, Dental and Life Insurance Plan, as amended.

“Plan Administrator” means Barclays Bank PLC and its predecessors and successors.

“Summary Plan Description” or “SPD” means this Summary Plan Description to the Plan which meets the requirements of ERISA. Together, this Plan document, SPD and any underlying component documents comprise the official “Plan document” as such term is defined in ERISA.

“Year of Service” for purposes of a former employee’s eligibility to participate in the Plan and the amount an Eligible Retiree is required to contribute for medical (including prescription drug) and/or dental coverage means the total number of years the former employee was employed by

Page 7: BARCLAYS BANK PLC AMENDED AND RESTATED RETIREE … · Plan by contacting the Barclays Benefits Center at +1 (855) 538-7794. If I terminate my participation in the Plan, can I resume

3 OHSUSA:766223108

the Company beginning on his or her U.S. hire date and ending on his or her termination of employment; except that the following service periods are excluded:

• Years of Service prior to a break in service if Years of Service before the break in service were less than or equal to the length of your break in service from the Company;

• Years of Service with an acquired company; • Years of Service during your rehire if you were rehired on or after January 1, 2010; • Years of Service following a transfer and localization into the U.S. if your transfer and

localization occurred on or after January 1, 2010; • Years of Service while an employee or former employee in receipt of a monthly long-

term disability benefit under a Company sponsored group long term disability policy or plan; and

• Years of Service after an employee or former employee is determined to be totally and permanently disabled by the Social Security Administration.

3. Eligibility and Participation

When am I eligible for coverage under the Plan?

Eligible Retirees include former full-time salaried employees who were employed by the Company in a state, territory or commonwealth of the United States. Eligible Retirees do not include any former hourly employees, leased employees within the meaning of Section 414(n)(2) of the Code, or persons treated by the Company as independent contractors, regardless of whether later or retroactively classified as employees by the Company.

You must meet the following criteria at termination of employment from the Company to be eligible for Plan coverage:

• You were hired on or before March 31, 1997 by the Company; and

• You terminated from the Company at or after attaining age 55 and at or prior to attaining age 64 with 10 or more Years of Service; or

• You terminated from the Company at or after attaining age 65 with 5 or more Years of Service; or

• You terminated from the Company prior to attaining age 55 due to job elimination and age plus your years of service (as defined under the Barclays Bank PLC USA Staff Pension Plan) were equal to or greater than 70; provided however that benefits under this Plan cannot commence until the attainment of age 55.

Your Plan coverage will terminate if:

• You or your Eligible Dependent(s) stop making required contributions for coverage, or do not make such required contributions on a timely basis. Your coverage will stop on the last day of the month in which the failure occurs.

Page 8: BARCLAYS BANK PLC AMENDED AND RESTATED RETIREE … · Plan by contacting the Barclays Benefits Center at +1 (855) 538-7794. If I terminate my participation in the Plan, can I resume

4 OHSUSA:766223108

• You notify the Plan Administrator that you no longer want coverage for yourself or an Eligible Dependent(s) under the Plan or your family notifies the Plan Administrator of your death. Your coverage will stop on the last day of the month in which the Plan Administrator receives your notice.

• You and/or an Eligible Dependent provide false information to the Plan. You and your Eligible Dependent(s)’ coverage will stop immediately under these circumstances.

Additional eligibility rules may be contained in the medical, prescription drug, dental and life insurance contracts or component documents under which each type of coverage is provided. If you have questions or want specific information regarding any of your retiree benefits, contact the Barclays Benefits Center at 1-855-538-7794.

Are there restrictions on when I can enroll in the Plan?

You must defer your enrollment in this Plan until you are no longer eligible to participate in any other group health plan, including a group health plan offered by your spouse’s employer. The term “group health plan” does not include Medicare or COBRA continuation coverage. Once you are no longer eligible for coverage under any other group health plan, you may enroll in this Plan by contacting the Barclays Benefits Center at +1 (855) 538-7794. If I terminate my participation in the Plan, can I resume my participation at a later date? No, once you terminate participation in the Plan for yourself and your Eligible Dependent(s), you and your Eligible Dependent(s) may not resume participation in the Plan at a later date. When are my dependents eligible for medical and/or dental coverage under the Plan?

When you first elect medical and/or dental coverage for yourself under this Plan, you also may elect medical and/or dental coverage for your Eligible Dependents. You may not elect to cover a Dependent at any time after you elect medical and/or dental coverage for yourself under this Plan Eligible Dependent whose participation under the Plan terminates may not later re-enter the Plan.

You must furnish to the Plan Administrator (in such form and at such time as the Plan Administrator prescribes) the names and ages of each Eligible Dependent and such other information pertaining to your Eligible Dependents as the Plan Administrator requests. You also must promptly notify the Plan Administrator of any changes in your marital status, the death of an Eligible Dependent, the change in status of an Eligible Dependent and such other information as the Plan Administrator requests.

What happens in the case of my death?

Your participation in the Plan will end on the last day of the month in which you die. Your spouse or Domestic Partner may remain a Plan participant for purposes of medical and/or dental coverage until his or her death. Your child who is not disabled may remain a participant for purposes of medical and/or dental coverage until the earlier of the date he or she is no longer an

Page 9: BARCLAYS BANK PLC AMENDED AND RESTATED RETIREE … · Plan by contacting the Barclays Benefits Center at +1 (855) 538-7794. If I terminate my participation in the Plan, can I resume

5 OHSUSA:766223108

Eligible Dependent, the death of your spouse or Domestic Partner who is an Eligible Dependent, or his or her death. Your child who is disabled may remain a participant for purposes of medical and dental coverage until the earlier of his or her eligibility for benefits under Medicare, the death of your spouse or Domestic Partner who is an Eligible Dependent, or his or her death.

What happens if I am rehired?

If you are rehired by the Company as a full-time employee and become eligible for medical, prescription drug and/or dental coverage under the Company’s welfare plan for active employees, your coverage under this Plan will cease. When you terminate employment from the Company after your rehire, you again will be eligible for medical, prescription drug and/or dental coverage under the Plan; provided you then meet the Plan’s eligibility requirements. If you are rehired by the Company and you are not eligible for coverage under the Company’s welfare plan for active employees, you will remain covered under this Plan.

If you were rehired by the Company on or prior to December 31, 2009, your Years of Service during your rehire will be counted for purposes of determining your eligibility under the Plan and the amount of your required contributions for retiree benefits. If you were rehired on or after January 1, 2010, your Years of Service during your rehire will not be counted for any purpose under this Plan.

What happens if I transferred into the US as a local employee?

If you transferred to the U.S. and were localized by the Company on or prior to December 31, 2009, your Years of Service following your transfer and localization will be counted for purposes of determining your eligibility under the Plan and the amount of your required contributions for retiree benefits. If you were transferred into the US and were localized by the Company on or after January 1, 2010, your Years of Service following your transfer and localization will not be counted for any purpose under this Plan.

How can a break in service impact the calculation of my Years of Service under the Plan?

• If your Years of Service before your break in service were greater than the length of your break in service from the Company, then your Years of Service prior to the break in service shall be counted.

• If your Years of Service before your break in service were less than or equal to your break in service from the Company, then your Years of Service prior to the break in service shall not be counted.

4. Plan Benefits

What Medical and Dental Benefits does the Plan provide and what will be my cost for coverage?

If you are eligible for and elect medical coverage (includes prescription drug coverage) for yourself, then you may also elect medical coverage for your Eligible Dependents. If you are eligible for and elect dental coverage for yourself, then you may elect dental coverage for your

Page 10: BARCLAYS BANK PLC AMENDED AND RESTATED RETIREE … · Plan by contacting the Barclays Benefits Center at +1 (855) 538-7794. If I terminate my participation in the Plan, can I resume

6 OHSUSA:766223108

Eligible Dependents. If you are eligible for both medical and dental coverage, then you may choose to elect either type of coverage, both types of coverage or no coverage. If you elect both medical and dental coverage, then coverage for your Eligible Dependents may be separately elected. You may not elect medical and/or dental coverage solely for your Eligible Dependents.

• Medical Coverage. Different medical coverage options are available to different groups of Eligible Retirees as described in Schedule A. Except as otherwise provided in this SPD and the applicable component document, you may not change the medical coverage offered to your coverage group. If you have questions or want specific information regarding any of your retiree medical benefits, contact the Barclays Benefits Center at 1-855-538-7794.

• Dental Coverage. If you are an Eligible Retiree who participated in the Restated Retirement Plan of BarclaysAmericanCorporation on or before December 31, 1995, or if you are a BARCAL Eligible Retiree (Barclays California), the dental coverage option available to you and your coverage group is the Dental PPO Plan. The dental coverage options are described in Schedule A. All other Eligible Retirees may not elect dental coverage under the Plan. You may not change the dental coverage option offered to your coverage group. If you have questions or want specific information regarding your dental retiree benefits, contact the Barclays Benefits Center at 1-855-538-7794.

• Medicare and Medicare Carve-out. When you or your Eligible Dependent attains age 65, you or your Eligible Dependent will be eligible for coverage under Medicare. When you reach age 65, medical coverage for you or your Eligible Dependents will be automatically converted into the applicable Post-65 plan. It is your responsibility to apply for Medicare. As a Medicare-Eligible Retiree or Dependent, your primary medical coverage will be through Medicare. This means that Medicare pays a benefit first, before any medical benefits are paid under this Plan. If you are a Medicare-Eligible Retiree or Dependent, claims for your non-Medicare-Eligible Dependents will be paid as primary. The rules relating to the election of Medicare and secondary Medicare coverage are complicated. You should contact Medicare directly at 1-800-MEDICARE (1-800-633-4227) or review the election and coverage information that is available on the Medicare website at http://www.medicare.gov.

• Prescription Drug Coverage. All Plan participants who are enrolled in medical coverage are automatically enrolled in prescription drug coverage offered under the Plan. The Company has determined that such prescription drug coverage is considered “creditable coverage” for purposes of Medicare Part D. Since your prescription drug coverage under this Plan is creditable coverage, upon becoming eligible for Medicare, or during the period beginning on November 15th and ending on December 31st in the years following your Medicare eligibility you may: (i) elect not to participate in Medicare Part D and keep your creditable coverage and not be subject to a higher premium or penalty if you subsequently choose to enroll in Medicare Part D; or (ii) elect to enroll in Medicare Part D and keep your creditable coverage and the Plan will coordinate with your Medicare Part D coverage; provided that you will be required to pay any premiums and associated out of pocket costs that

Page 11: BARCLAYS BANK PLC AMENDED AND RESTATED RETIREE … · Plan by contacting the Barclays Benefits Center at +1 (855) 538-7794. If I terminate my participation in the Plan, can I resume

7 OHSUSA:766223108

apply to the Medicare Part D plan that you elect. For a summary of the terms and benefits provided under your prescription drug coverage option, please refer to the summary plan description or component document provided to you by the Plan Administrator. To learn more about Medicare Part D coverage, you should contact Medicare directly at 1-800-MEDICARE (1-800-633-4227) or review the election and coverage information that is available on the Medicare website at http://www.medicare.gov.

You and/or your Eligible Dependents may be required to pay for your Plan coverage as further described in Schedule B. The amount of your required contributions depends on your retirement date and your Years of Service. Failure to make a required contribution may result in you and/or your Eligible Dependents losing coverage under the Plan as of the last day of the month in which the failure occurred.

What happens to my medical coverage when I turn age 65?

On the date you turn age 65, your medical coverage will be automatically converted into the applicable Post-65 Plan as further described in Schedule A. You must enroll in Medicare before submitting a claim under this Plan because Medicare becomes your primary coverage at age 65 and medical coverage under this Plan is secondary to Medicare coverage. Your Eligible Dependent(s) who are under age 65 will remain in the Pre-65 Plan.

If you are age 65 or over and you do not enroll in Medicare, any claims filed by you under this Plan will be reimbursed based on the insurance carrier’s estimate of what Medicare would have paid had you enrolled.

Please review the above Medicare and Medicare Carve-Out section for additional Medicare rules.

Does the Company Contribute towards the Cost of my Medical and Dental Benefits?

Yes. Company contributions vary among the different categories of Eligible Retirees.

Can I Change my Medical and/or Dental Benefit Elections?

No. Once you are enrolled in the Plan, you may not add new Eligible Dependents or change benefit options.

Am I Eligible for Retiree Life Insurance under the Plan?

If you were hired on or before March 31, 1997, you may be eligible for retiree life insurance under the Plan. You shall not be provided with retiree life insurance until you are eligible for, and elect to receive, retiree medical benefits, except that, if you are a BAC Eligible Retiree who is a member of the grandfathered group as described in Schedule A, you shall be provided with retiree life insurance even though you are not eligible for retiree medical benefits. Your retiree life insurance shall be governed by the provisions of the applicable life insurance contract. Retiree life insurance premiums shall be paid by the Company. The amount of your retiree life insurance depends on your employment category. You should name a beneficiary to receive

Page 12: BARCLAYS BANK PLC AMENDED AND RESTATED RETIREE … · Plan by contacting the Barclays Benefits Center at +1 (855) 538-7794. If I terminate my participation in the Plan, can I resume

8 OHSUSA:766223108

your retiree life insurance benefits on such form and in such manner as the Plan Administrator may prescribe.

Can I convert my Retiree Life Insurance Benefits under the Plan to an Individual Life Insurance Policy?

You may elect to convert your retiree life insurance to an individual policy if your coverage is reduced or terminated subject to the terms of the insurance contract. The insurance company is solely responsible for determining your eligibility for conversion coverage. Conversion forms are available from the insurance company or the Plan Administrator.

Can I elect COBRA instead of this Plan?

If your retirement results in a loss of or reduction in health coverage, you and your Dependents who were covered under the Company’s welfare plan for active employees will be given the opportunity to elect COBRA.

However, your election of retiree benefits under this Plan constitutes a waiver of COBRA and no COBRA election will be offered when your retiree coverage under this Plan terminates, provided you have received at least 18 months of coverage under this Plan.

If applicable law requires that COBRA coverage be offered in a different manner, the Plan will comply and be administered in accordance with the minimum requirements of applicable law.

5. Plan Administration

Who Administers the Plan?

Barclays Bank PLC is the Plan Administrator as defined by ERISA and has the authority and discretion to manage the operation and administration of the Plan, except to the extent it has delegated such authority to a third party (the “Delegate”). Barclays Bank PLC has the exclusive authority and discretion to amend or terminate the Plan at any time. The authority of the Plan Administrator or its Delegate includes, without limitations the following authority and discretion:

• Subject to any limitations under the Plan or applicable law, to make and enforce such rules and regulations of the Plan and prescribe the use of such forms, procedures and administrative manuals as it shall deem necessary for the efficient administration of the Plan;

• To require any person to furnish such information as it may request as a condition to receiving any benefit under the Plan;

• To decide all questions of fact and law concerning the Plan and the eligibility of any former employee to participate in the Plan and any such decision or action shall be final and binding upon all persons; and

Page 13: BARCLAYS BANK PLC AMENDED AND RESTATED RETIREE … · Plan by contacting the Barclays Benefits Center at +1 (855) 538-7794. If I terminate my participation in the Plan, can I resume

9 OHSUSA:766223108

• To compute or have computed the amount of benefits payable to any Eligible Retiree or Eligible Dependent under the Plan.

Will the Plan follow a Qualified Medical Child Support Order?

Yes. The Plan will provide benefits in accordance with the applicable requirements of any qualified medical child support order (“QMCSO”). A QMCSO is an order, decree, judgment or administrative notice (including a settlement agreement) issued by a domestic relations court or other court of competent jurisdiction, or through an administrative process established under state law which has the force and effect of law in that state, which meets the requirements of Section 609 of ERISA. You may obtain a copy of the Plan’s QMCSO procedures from the Plan Administrator free of charge.

Will my Plan Benefits be provided forever?

No, your Plan benefits are not vested and Barclays Bank PLC may, in its exclusive discretion, amend or terminate the Plan at any time and amend or terminate any contract with any insurer or service provider at any time.

How does the Plan handle payments to minors and incompetents?

If the Plan Administrator determines at any time that a person entitled to payments under the Plan is a minor or is incompetent, the Plan Administrator shall have the power to cause the payments becoming due under the Plan to be paid, in the case of a minor, to such person’s parents, legal guardian or to a custodian for such person under the Uniform Gifts to Minors Act of the state of which the minor is a resident or, in the case of an incompetent, to such person’s spouse, parents or legal guardian, such payments to be used for such person’s benefit. The Plan Administrator shall not be obligated to inquire as to the actual use of the funds by the person to whom the payments are made under this provision, and any such payment shall operate as a complete discharge of the obligations of the Plan and the Plan Administrator.

What laws shall govern the provisions of this Plan?

This Plan shall be construed and enforced in accordance with ERISA, the Code, and all applicable federal laws and, to the extent it is not preempted by ERISA or the Code, with the laws of the State of New York.

How do I submit a claim for Plan Benefits? How do I appeal if my claim is denied?

In general, the Plan Administrator, insurance company or third party administrator (as applicable) will process claims for benefits and appeals of denied claims for Plan benefits in accordance with the provisions of all applicable federal, state and local laws. In addition, the Plan Administrator has established a claims procedure for the Plan in accordance with Section 503 of ERISA and regulations prescribed by the Secretary of Labor. The Plan’s claims and appeal procedures are described in detail in Scheduled C of the Plan and will apply only to the extent an applicable component document or insurance contract for a covered benefit does not apply at least as extensive procedures. If the claims and appeal procedures in Schedule C apply,

Page 14: BARCLAYS BANK PLC AMENDED AND RESTATED RETIREE … · Plan by contacting the Barclays Benefits Center at +1 (855) 538-7794. If I terminate my participation in the Plan, can I resume

10 OHSUSA:766223108

they will be construed and applied in a manner consistent with ERISA and applicable federal regulations as in effect on the date the claim is received.

Unless specifically provided otherwise in a component document, insurance contract or pursuant to applicable law, a claim for benefits under this Plan must be made within one year after the date the expense was incurred that gives rise to the claim. It is the responsibility of the Eligible Retiree or his or her designee to satisfy this requirement.

Unless specifically provided otherwise in a component document or pursuant to applicable law, a suit for benefits under this Plan must be brought within one year after the date of a final decision on the claim in accordance with the applicable claims procedures.

6. HIPAA Privacy and Security HIPAA Privacy Rule The Plan Administrator shall comply with the plan document requirements of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) privacy regulations (“Privacy Rule”) found at 45 CFR Section 164.504(f)(2) and all other aspects of HIPAA applicable to self-funded group health plans. This Section 6 of the Plan applies only to medical, prescription drug and dental benefits. Permitted and Required Uses of Protected Health Information The Plan shall use or disclose personal medical information (“Protected Health Information”) it receives as permitted or required by, and consistent with 45 CFR Part 164, Subpart A specifically for purposes related to Plan Administration, such as health care treatment, payment for health care and health care operations. Company Certification The Plan shall disclose Protected Health Information to the Company only upon receipt of a certification by the Company that the Plan documents have been amended to incorporate all the required provisions found at 45 CFR Section 164.504(f)(2)(ii)(A)-(J), as set forth in Section 10.1(d) below/ Company Agreement The Company agrees to:

• Not use or further disclose the Protected Health Information other than as permitted or required by the Plan documents and/or as required by law;

• Ensure that any business associates, agents or subcontractors, to whom it gives Protected Health Information received from the Plan, agree to the same restrictions and conditions that apply to the Company with respect to such Protected Health Information;

Page 15: BARCLAYS BANK PLC AMENDED AND RESTATED RETIREE … · Plan by contacting the Barclays Benefits Center at +1 (855) 538-7794. If I terminate my participation in the Plan, can I resume

11 OHSUSA:766223108

• Not use or disclose the Protected Health Information for employment-related actions and decisions in connection with any other benefit or employee benefit plan of the Company, unless that use or disclosure is permitted or required by law.

• Report to the Plan Administrator any use or disclosure of Protected Health Information that is inconsistent with the uses or disclosures provided for of which the Company becomes aware;

• Make available Protected Health Information in accordance with individuals’ rights to review their Protected Health Information pursuant to the HIPAA rules;

• Make available Protected Health Information for amendment and incorporate any amendments to Protected Health Information consistent with the HIPAA rules;

• Make available the information required to provide an accounting of disclosures in accordance with the HIPAA rules;

• Make its internal practices, books, and records relating to the use and disclosure of Protected Health Information received from the Plan available to the Secretary of Health and Human Services for purposes of determining compliance by the Plan; and

• If feasible, return or destroy all Protected Health Information received from the Plan that the Company still maintains in any form. The Company will retain no copies of Protected Health Information when no longer needed for the purpose for which disclosure was made. An exception may apply if such return or destruction is not feasible, but the Plan must limit further uses and disclosures to those purposes that make the return or destruction of the Protected Health Information infeasible.

Separation of the Company and the Plan The following employees or classes of employees or other persons under the control of the Employer involved in the day-to-day administration of the Plan, and including their support staff, shall be given access to Protected Health Information:

• Director/ Pension & Benefits • Vice President/ Pension & Benefits; • Assistant Vice President/ Pension & Benefits; • Human Resources Business Partners; and • Analysts/Pension & Benefits.

Restriction of Access to and Use of Protected Health Information The Company shall restrict the access to and use of Protected Health Information by the employees and other persons described above to the Plan administration functions that the Company performs for the Plan, including health care treatment, payment for health care and health care operations. HIPAA Security Rule The Company shall comply with the plan document requirements of the HIPAA security regulations found at 45 CFR Section 164.314(b).

Page 16: BARCLAYS BANK PLC AMENDED AND RESTATED RETIREE … · Plan by contacting the Barclays Benefits Center at +1 (855) 538-7794. If I terminate my participation in the Plan, can I resume

12 OHSUSA:766223108

Electronic Protected Health Information “Electronic Protected Health Information” means individually identifiable health information that is transmitted by electronic media or maintained in electronic media by the Plan. Company Agreement The Company agrees to:

• Implement administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of Electronic Protected Health Information that it creates, receives, maintains, or transmits on behalf of the Plan;

• Ensure that the adequate separation between the Plan and the Company as required by the Privacy Rule is supported by reasonable and appropriate security measures;

• Ensure that any agent, including a subcontractor, to whom it provides Electronic Protected Health Information agrees to implement reasonable and appropriate security measures to protect such Electronic Protected Health Information; and

• Report to the Plan Administrator any security incident of which it becomes aware.

7. Statement of Your ERISA Rights

As an Eligible Retiree covered by the Barclays Bank PLC Retiree Medical, Dental and Life Insurance Plan (the “Plan”), you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”). ERISA provides that covered individuals are entitled to: Receive Information About Your Plan Benefits

• Examine, without charge, at the Plan Administrator’s office and at other specified locations, such as worksites, all documents governing the Plan, including insurance contracts, and a copy of the latest annual report (Form 5500 Series) filed by the Plan with the U.S. Department of Labor and available at the Public Disclosure Room of the Pension and Welfare Benefit Administration.

• Obtain, upon written request to the Plan Administrator, copies of documents governing

the operation of the Plan, including insurance contracts 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.

Page 17: BARCLAYS BANK PLC AMENDED AND RESTATED RETIREE … · Plan by contacting the Barclays Benefits Center at +1 (855) 538-7794. If I terminate my participation in the Plan, can I resume

13 OHSUSA:766223108

Continue Group Health Plan Coverage You or your Eligible Dependents may have a right to continue health care coverage if there is a loss of coverage under the Plan as result of a qualifying event. You or your Eligible Dependents will have to pay for such coverage. Review the summary plan description provided to you by the Plan Administrator on the rules governing your continuation coverage rights under the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended (“COBRA”). Prudent Action 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 employee benefit 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 or any other person, may discriminate against you in any way to prevent you from obtaining a Plan benefit or exercising your rights under ERISA. Enforce Your Rights If your claim for a Plan 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 the Plan documents or the latest annual report from the Plan Administrator 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. In addition, if you disagree with the Plan’s decision or lack thereof concerning the qualified status of a medical child support order, you may file suite 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 that your claim is frivolous.

Page 18: BARCLAYS BANK PLC AMENDED AND RESTATED RETIREE … · Plan by contacting the Barclays Benefits Center at +1 (855) 538-7794. If I terminate my participation in the Plan, can I resume

14 OHSUSA:766223108

Assistance with Your Questions If you have any questions about the Plan, you should contact the Plan Administrator. If you have any questions about this statement or about your rights under ERISA, you should contact the nearest area 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 N.W., Washington, D.C. 20210. You may also obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the Pension and Welfare Benefits Administration.

Page 19: BARCLAYS BANK PLC AMENDED AND RESTATED RETIREE … · Plan by contacting the Barclays Benefits Center at +1 (855) 538-7794. If I terminate my participation in the Plan, can I resume

15 OHSUSA:766223108

SCHEDULE A

RETIREE BENEFITS

The terms, conditions and limitations of the retiree medical, prescription drug, dental and life insurance benefits under the Plan are further described in the component documents provided by insurance carriers or third party administrators and are incorporated into this Plan by reference. Component documents and third party administrators or insurers may change from time to time. The Company reserves the right to change or eliminate the benefits offered under the Plan in any way and at any time. If you have questions or want specific information regarding any of your retiree benefits, contact the Barclays Benefits Center at 1-855-538-7794.

Medical/Prescription Drug Coverage Pre-65 Eligible Retirees may enroll in the Barclays PPO Plan. Post-65 Eligible Retirees are offered either the Barclays Retiree PPO Plan or the Barclays Indemnity Plan, depending on their retirement date. Enrollment in medical coverage includes prescription drug benefit coverage Dental Coverage

Eligible Retirees who participated in the Restated Retirement Plan of BarclaysAmericanCorporation on or before December 31, 1995 and BARCAL Eligible Retirees are eligible for the Dental PPO Plan. Life Insurance Coverage

Barclays Bank PLC Eligible Retirees who retired before 1992 are eligible to receive a scheduled benefit amount of life insurance. Barclays Bank PLC Eligible Retirees who retired after1991 are eligible to receive a life insurance face amount of $1,000 per Year of Service with $30,000 maximum. Certain grandfathered BarclaysAmericanCorporation Eligible Retirees receive a scheduled amount of life insurance.

Page 20: BARCLAYS BANK PLC AMENDED AND RESTATED RETIREE … · Plan by contacting the Barclays Benefits Center at +1 (855) 538-7794. If I terminate my participation in the Plan, can I resume

16

OHSUSA:766223108

SCHEDULE B

CONTRIBUTIONS FOR RETIREE BENEFITS

This Plan provides certain retiree benefits to Eligible Retirees and their Eligible Dependents as determined by the Company, in its sole discretion. The Company has the authority to determine the cost to Eligible Retirees of retiree benefits offered under this Plan and the amount of Company contributions for such retiree benefits, if any. The Company reserves the right to change the amount of Eligible Retiree and Company contributions for retiree benefits at any time.

Medical/Prescription Drug Barclays Bank PLC Eligible Retirees who retired before January 1, 1991 currently do not make any contributions toward their retiree medical coverage. Barclays Bank PLC Eligible Retirees who retired on or after January 1, 1991 make contributions based on their Years of Service and the percentages in the table below. The percentages apply similarly to each coverage tier: Years of Service: Company Eligible Retiree 5 20% 80% 10 40% 60% 15 60% 40% 20 80% 20% 25 100% 0% Eligible Retiree contributions are ratably adjusted for intermediate years of service (e.g., after 11 years, the Retiree contribution is 56%). BarclaysAmericanCorporation Eligible Retirees make the following contributions for retiree medical coverage: Company Eligible Retiree Single Coverage 80% 20% Family Coverage Balance 20% of cost of single coverage plus 30% of the difference

between individual and family coverage

Dental BARCAL Eligible Retirees who terminated after 1991 pay 100% of the cost of dental coverage.

Page 21: BARCLAYS BANK PLC AMENDED AND RESTATED RETIREE … · Plan by contacting the Barclays Benefits Center at +1 (855) 538-7794. If I terminate my participation in the Plan, can I resume

17 OHSUSA:766223108

BAC Eligible Retirees make the following contributions for dental coverge: Company Eligible Retiree Single Coverage 80% 20% Family Coverage Balance 20% of cost of single coverage + 30% of difference between

individual and family coverage Life Insurance

The Company currently pays 100% of the cost of retiree life insurance for Eligible Retirees.

Page 22: BARCLAYS BANK PLC AMENDED AND RESTATED RETIREE … · Plan by contacting the Barclays Benefits Center at +1 (855) 538-7794. If I terminate my participation in the Plan, can I resume

18 OHSUSA:766223108

SCHEDULE C

CLAIMS AND APEALS PROCEDURES

I. Claims and Appeals

(a) Notice of Action

Any time a claim for benefits receives an adverse determination, the Claimant will be given written notice of such action within the “applicable period” after the claim is filed, unless special circumstances require an extension of time for processing. If there is an extension, the Claimant will be notified of the extension and the reason for the extension within the initial applicable period. If any urgent care or pre-service claim is approved, the Claimant will be notified of such approval and provided sufficient information to understand the importance of the approval.

An “adverse determination” means a denial, reduction or termination of, or failure to provide or make payment (in whole or in part) for a benefit, where the action is based on a determination of an individual’s eligibility, a determination that a benefit is not a covered benefit, the imposition of an exclusion or limitation, or a determination that a benefit is experimental, investigational or not medically necessary or appropriate.

(b) Categories of Claims, “Applicable Periods,” and Extensions

(1) “Urgent” Health Care Claims

Urgent health care claims are requests for verification or approval of coverage for health care or treatment where, if the request were not handled expeditiously the delay could jeopardize the life or health of the Claimant or the ability of the Claimant to regain maximum function, or in the opinion of a physician with knowledge of the Claimant’s medical condition, would subject the Claimant to severe pain that cannot be adequately managed without the care or treatment that is the subject of the claim. The “applicable period” for an urgent care claim is no longer than the period necessary to decide the matter (that is, “as soon as possible”), but in no event longer than 72 hours. Whether a claim involves “urgent care” (as defined in federal regulations) will be determined by the Claimant’s attending physician, and the Plan Administrator will defer to the judgment of the Claimant’s physician.

If the Plan cannot render a decision within this timeframe because the Claimant has not provided sufficient information to determine whether, or to what extent, benefits are covered or payable under the Plan, the Plan Administrator or its delegate must notify the Claimant within 24 hours of

Page 23: BARCLAYS BANK PLC AMENDED AND RESTATED RETIREE … · Plan by contacting the Barclays Benefits Center at +1 (855) 538-7794. If I terminate my participation in the Plan, can I resume

19 OHSUSA:766223108

the specific information needed to complete the claim. The Claimant must be given at least 48 hours to provide the required information. Within 48 hours after the earlier of (1) the Plan’s receiving the required information or (2) the expiration of the period afforded to the Claimant to provide the information, the Plan Administrator or its delegate must notify the Claimant of the Plan’s benefit determination. The Claimant may agree to extend these deadlines.

An appeal of an adverse determination regarding an urgent care claim (where the claim is still an urgent care claim) must be decided as soon as possible, but no later than 72 hours after the Plan receives the request for review or appeal.

(2) “Pre-Service” Health Care Claims

A pre-service health care claim is any request for approval of health care coverage for a service or item that under the terms of the Plan requires advance approval. The “applicable period” for a pre-service claim is 15 days after receipt of the claim by the Plan. The Plan Administrator may extend the review period for an additional 15 days if necessary due to circumstances beyond the control of the Plan. The Plan Administrator or its delegate must notify the Claimant within the timeframe of the reason for the extension and the date the Plan expects to render its decision.

If the Claimant has not followed the Plan’s procedures for filing a pre-service claim, the Plan must notify the Claimant within 5 days of the proper procedures to be followed in order to complete the claim. Further, if the Plan cannot render a decision within 15 days because the Claimant has not provided sufficient information to determine whether, or to what extent, benefits are covered or payable under the Plan, the notice of extension must describe the specific information needed to complete the claim; the Claimant must be given at least 45 days from receipt of the notice to provide the required information; and the Plan has 15 days from the date of receiving the Claimant’s information to render its decision. The Claimant may agree to extend these deadlines.

(3) “Concurrent” Health Care Claims

A concurrent health care claim may be either an urgent care claim or a pre-service claim. Generally, it is a claim for an ongoing course of health care treatment to be provided over a period of time or number of treatments. An adverse determination involving concurrent care must be made sufficiently in advance of any reduction or termination in treatment to allow the Covered Person to appeal the adverse determination. If a course of treatment involves urgent care, a request by the Claimant to extend the course of treatment must be decided as soon as possible, but not

Page 24: BARCLAYS BANK PLC AMENDED AND RESTATED RETIREE … · Plan by contacting the Barclays Benefits Center at +1 (855) 538-7794. If I terminate my participation in the Plan, can I resume

20 OHSUSA:766223108

later than 24 hours after receipt of the request by the Plan, provided that the request is made at least 24 hours prior to the expiration of treatment.

Expiration of an approved course of treatment is not an adverse determination under these rules. However, any reduction or termination by the Plan of the course of treatment (other than by Plan amendment or termination) before the end of the period of time or number of treatments originally prescribed is an adverse determination and may be appealed. Notice must be provided a reasonable time before the treatments will stop; however, the Plan is not required to allow the Claimant the 180 days to appeal the Plan’s decision, before the Plan may terminate the treatment. Coverage must continue during the pendency of an appeal of an adverse determination involving a concurrent care claim to the extent required by, and in accordance with, applicable federal law.

(4) “Post-Service” Health Care Claim

A post-service health care claim is a claim that is not an urgent care, pre-service or concurrent care claim. The “applicable period” for a post-service claim is 30 days after receipt of the claim by the Plan. The Plan Administrator may extend the review period for an additional 15 days if necessary due to circumstances beyond the control of the Plan. The Plan Administrator or its delegate must notify the Claimant within the timeframe of the reason for the extension and the date by which the Plan expects to render its decision.

If the Plan cannot render a decision within 30 days because the Claimant has not provided sufficient information to determine whether, or to what extent, benefits are covered or payable under the Plan, the notice of extension must describe the specific information needed to complete the claim. The Claimant must be given at least 45 days from receipt of the notice to provide the required information. The Plan has 30 days from the date of receiving the Claimant’s information to render its decision. The Claimant may agree to extend these deadlines.

(5) Disability Benefit Claim

The “applicable period” for a disability benefit claim is 45 days after receipt of the claim by the Plan. If the Plan requires additional time to process the claim, it may extend the applicable period by up to two (2) thirty-day extensions, but the Plan Administrator or its delegate will notify the Claimant of the need for the extension prior to the beginning of any such extension period.

(6) Special Rule for Retroactive Health Care Coverage Rescissions

Where health care coverage subject to the Affordable Care Act is rescinded retroactively (for reasons other than failure to pay premiums or

Page 25: BARCLAYS BANK PLC AMENDED AND RESTATED RETIREE … · Plan by contacting the Barclays Benefits Center at +1 (855) 538-7794. If I terminate my participation in the Plan, can I resume

21 OHSUSA:766223108

due to routine administrative delays in processing coverage additions and deletions), the Plan will supply written notice of the rescission to each affected participant not fewer than 30 days prior to the effective date of the rescission, in addition to any other notice that may be required by these provisions.

(7) Other Claims

The “applicable period” for a benefit claim not described in subsections (1) to (5) above is 90 days after receipt of the claim by the Plan. If the Plan requires additional time to process the claim, it may extend the applicable period by up to 90 days, but the Plan Administrator or its delegate must notify the Claimant of the need for the extension prior to the beginning of any such extension period.

(c) Form and Content of Notice of Adverse Determination on Claims

If a claim is denied in whole or in part, notice of such adverse determination must be provided to the Claimant. Notice must be written or electronic; oral notice is permitted with respect to urgent care claims, but only if written or electronic confirmation is furnished to the Claimant within three (3) days after the oral notice is provided.

The notice must include the following:

• the specific reason or reasons for the adverse determination;

• reference to the specific Plan provisions on which the determination is based;

• if applicable, a description of any additional information needed for the Claimant to perfect the claim and an explanation of why such information is needed;

• a description of the Plan’s review procedures, including the Claimant’s right to bring a civil action under Section 502(a) of ERISA;

• (for health care and disability claims) a copy of any internal rule, guideline, protocol or other similar criteria relied on in making the adverse determination or a statement that it will be provided without charge upon request;

• (for health care and disability claims) if the adverse determination is based on medical necessity or experimental treatment or a similar exclusion or limit, either an explanation of the scientific or clinical judgment, applying the terms of the Plan to the Claimant’s medical circumstances, or a statement that this will be provided without charge upon request; and

Page 26: BARCLAYS BANK PLC AMENDED AND RESTATED RETIREE … · Plan by contacting the Barclays Benefits Center at +1 (855) 538-7794. If I terminate my participation in the Plan, can I resume

22 OHSUSA:766223108

• in the case of an adverse determination involving urgent care, a description of the expedited review process available to such claims.

(d) Right to Request Review

Any Claimant who has had a claim for benefits denied in whole or in part by the Plan Administrator or its delegate, or is otherwise adversely affected by action of the Plan Administrator or its delegate, will have the right to request review by the Plan Administrator. Such request must be in writing, and must be made within 180 days (for health care and disability benefit claims) or 60 days (for other claims) after such person is advised of the Plan Administrator’s (or its delegate’s) action. If written request for review is not made within such 180-day (or 60-day, as the case may be) period, the Claimant will forfeit his or her right to review. The Claimant or a duly authorized representative of the Claimant may review all pertinent documents and submit issues and comments in writing. The Plan Administrator may prescribe a reasonable procedure under which a Claimant may designate an authorized representative.

(e) Review of Claim

The Plan Administrator or its delegate will then review the claim. If in the case of a health care or disability claim the adverse determination was based on medical judgment, the person handling the appeal must consult with a health care professional with an appropriate level of training and expertise in the field of medicine involved, and such professional may not be the same professional who was consulted with respect to the initial action on the claim.

The person or entity deciding the appeal may hold a hearing if it deems it necessary and will issue a written or electronically disseminated decision reaffirming, modifying or setting aside its former action. The decision on appeal must be made within 72 hours for a claim involving urgent health care, 30 days for a pre-service health care claim, 45 days for a disability claim, or 60 days for a post-service health care claim or claim for a benefit other than a health care or disability benefit; the time period begins to run on the date the appeal is received by the Plan. The Claimant may agree to extend these deadlines.

The decision on review may be delayed for up to 45 days (in the case of a disability benefit claim) or 60 days (in the case of a claim other than for a disability benefit) where special circumstances require the delay, and such delay is permitted by federal regulations. The Plan Administrator or its delegate will provide notice of the extension, and the reason therefor, to the Claimant prior to the end of the initial review period.

A copy of the decision will be furnished to the Claimant. The decision will set forth:

• the specific reason or reasons for the adverse determination;

Page 27: BARCLAYS BANK PLC AMENDED AND RESTATED RETIREE … · Plan by contacting the Barclays Benefits Center at +1 (855) 538-7794. If I terminate my participation in the Plan, can I resume

23 OHSUSA:766223108

• reference to the specific Plan provisions on which the determination is based;

• a statement that the Claimant is entitled to receive without charge reasonable access to any document (1) relied on in making the determination; (2) submitted, considered or generated in the course of making the benefit determination; (3) that demonstrates compliance with the administrative processes and safeguards required in making the determination; or (4) in the case of a group health Plan or disability Plan, constitutes a statement of policy or guidance with respect to the Plan concerning the denied treatment without regard to whether the statement was relied on;

• a statement of any voluntary appeals procedures and the Claimant’s right to receive information about the procedures as well as the Claimant’s right to bring a civil action under Section 502(a) of ERISA;

• a copy of any internal rule, guideline, protocol or other similar criteria relied on in making the adverse determination or a statement that it will be provided without charge upon request;

• if the adverse determination is based on medical necessity or experimental treatment or a similar exclusion or limit, either an explanation of the scientific or clinical judgment, applying the terms of the Plan to the Claimant’s medical circumstances, or a statement that this will be provided without charge upon request; and

• the following statement: “You and your Plan may have other voluntary alternative dispute resolution options, such as mediation. One way to find out what may be available is to contact your local U.S. Department of Labor Office and your State insurance regulatory agency.” (However, this latter statement is not required if there is no alternative dispute resolution process (e.g., arbitration).

The decision will be final and binding upon the Claimant and all other persons involved, except to the extent otherwise provided under applicable law.

II. Additional Requirements for Non-Grandfathered Health Care Coverage under the Affordable Care Act

The rules that govern processing of claims, and appeals of claims that are denied in whole or in part, differ depending on a number of factors including the nature of the benefits involved and whether the coverage, if it is subject to the Affordable Care Act rules, is considered “grandfathered.” None of the health coverages under the Plan are grandfathered under the Affordable Care Act, and the following additional rules apply to health care claims:

Page 28: BARCLAYS BANK PLC AMENDED AND RESTATED RETIREE … · Plan by contacting the Barclays Benefits Center at +1 (855) 538-7794. If I terminate my participation in the Plan, can I resume

24 OHSUSA:766223108

(a) Additional Requirements for Notice of Initial Adverse Determination and Notice of Final Action on Internal Appeal

Any notice of initial adverse determination or notice of final action on an internal review of an adverse determination must include the following additional information:

• the date of service, the health care provider, the claim amount (if applicable), and a statement describing the availability, upon request, of the diagnosis code and the treatment code and their corresponding meanings (the Plan will supply this information related to the diagnosis and treatment codes as soon as practicable following such a request, and will consider such request to be a request for an internal appeal or, as applicable, external review);

• the standard, if any, used in denying the claim in whole or in part (i.e., a discussion of an applied “medical necessity” standard);

• a description of the available internal and external appeals procedures, including information about how to initiate an appeal; and

• the availability of—and contact information for—any applicable office of health insurance consumer assistance or ombudsman established under the Act to assist individuals with the internal claims and appeals and external review procedures.

The notices described above must be supplied in a “culturally and linguistically appropriate” manner, pursuant to and to the extent required by applicable federal regulations.

(b) Additional Requirements Related to Access to Information Pending Decision on Appeal

In connection with any appeal of an adverse determination, the Claimant or a duly authorized representative of the Claimant will have the right to examine the Claimant’s claim file, and to present evidence and testimony as part of the review process. The Claimant will receive, free of charge, any new or additional evidence considered, relied upon or generated by the Plan in connection with its review of an appeal of an adverse determination, and any new or additional rationale the Plan intends to rely upon in deciding the internal appeal, sufficiently in advance of the final decision on the internal appeal to allow the Claimant an opportunity to respond prior to the decision.

(c) Additional Requirements Related to External Review of Final Action on Internal Appeal

Different external review rules apply depending on whether the relevant health care coverage is subject to a state insurance law external review requirement that

Page 29: BARCLAYS BANK PLC AMENDED AND RESTATED RETIREE … · Plan by contacting the Barclays Benefits Center at +1 (855) 538-7794. If I terminate my participation in the Plan, can I resume

25 OHSUSA:766223108

meets standards specified in federal regulations, or whether the coverage is not subject to such a state law.

Where the relevant health care coverage is subject to a state standard that complies with applicable federal regulations (or is deemed to comply during any transition period under such regulations), such state standard will apply to the insurer (where the coverage is insured) or the Plan (where the coverage is self-insured). Where the relevant health care coverage is not subject to a state standard, or subject to a state standard that does not meet federal regulatory requirements (taking into account any period of deemed compliance during a transition period provided for under federal regulations), then the following rules apply to the Plan to the extent and as of the date required by applicable federal regulations:

(1) A Claimant may file a request for external review within 4 months of receipt of notice of an adverse determination (to the extent permitted by applicable law, however, the Plan may require the Claimant to exhaust any reasonable internal appeal process); for this purpose, and to the extent permitted by applicable federal regulations, an “adverse determination” means an adverse determination as defined elsewhere in these provisions, but only to the extent it involves medical judgment or a retroactive recession of coverage.

(2) Within 5 business days following receipt of the request for external review, the Plan will determine whether:

• the Claimant was covered under Plan and applicable health care coverage when the health care item or service was requested (or provided, where the review is a for a post-service claim);

• the adverse determination was not due to ineligibility of the Claimant;

• the Claimant exhausted any required internal appeal process; and

• the Claimant has provided all information required.

(3) The Plan will issue notice to the Claimant within one business day after the Plan’s preliminary review of the request for external review. If the Claimant is not eligible for external review, the notice must include reasons for ineligibility and contact information for the Employee Benefit Security Administration. If the request for external review is not complete, the notice must describe information that is needed and allow the claimant to complete or perfect his request within the four-month filing period described above or 48 hours, whichever is later.

(4) If the request for external review is appropriate, the Plan will refer the appeal to an Independent Review Organization (IRO), with which the Plan has contracted in accordance with applicable federal regulations. The IRO

Page 30: BARCLAYS BANK PLC AMENDED AND RESTATED RETIREE … · Plan by contacting the Barclays Benefits Center at +1 (855) 538-7794. If I terminate my participation in the Plan, can I resume

26 OHSUSA:766223108

will conduct its review and supply appropriate notices in accordance with applicable federal standards. If the IRO reverses the Plan’s decision, the Plan will provide coverage or payment upon receipt of notice of the IRO’s decision, without delay and without regard to the Plan’s intention to seek judicial review.

(5) The Plan will make available, to the extent required by and in accordance with applicable federal law, an expedited external review process where a Claimant receives an adverse determination or final internal adverse determination and where completion of an expedited internal appeal or standard external review would seriously jeopardize the life or health of the Claimant.

(d) No Conflicts of Interest

The Plan Administrator, or its delegate will adjudicate claims in a manner ensuring the independence and impartiality of those involved in decision-making.