INTERFACE, INC.
LONG-TERM CARE INSURANCE PLAN
ARTICLE I. ESTABLISHMENT AND INTERPRETATION OF THE PLAN
Section 1.1 ESTABLISHMENT. On December 14, 2005, Interface, Inc.
(the "Company") hereby amends and restates the Interface Fabrics Group, Inc.
Long-Term Care Insurance Plan and renames it as the Interface, Inc. Long-Term
Care Insurance Plan (the "Plan"), which is a welfare benefit plan providing
long-term care insurance for the exclusive benefit of Eligible Employees of the
Company and other entities that adopt the plan (the "Participating Companies")
and their Spouses (spousal coverage is at the expense of the Eligible Employee.)
As of the Effective Date, this Plan replaces and supersedes any and all similar
plans or programs sponsored or maintained by the Participating Companies, in
whole or in part, for the benefit of Eligible Employees.
Section 1.2 PURPOSE. The purpose of the Plan is to provide to
Eligible Employees and their Spouses certain welfare benefits described herein.
The Plan is intended to meet all applicable requirements of the Employee
Retirement Income Security Act of 1974, as amended and the Internal Revenue Code
of 1986, as amended. The long-term care insurance policies provided through the
Plan are intended to be qualified long-term care insurance contracts as defined
under Section 7702B(b) of the Internal Revenue Code of 1986, as amended.
ARTICLE II. DEFINITIONS, GENDER AND NUMBER
Section 2.1 DEFINITIONS. Whenever used in the Plan, the following
words and phrases shall have the meanings set forth below unless the context
plainly requires a different meaning, and when the defined meaning is intended,
the term is capitalized:
(a) "Affiliate" means any entity that is required to be
aggregated with the Company pursuant to Code section 414(b), (c), (m) or
(o).
(b) "Board" means the board of directors of the Company as
constituted at the relevant time.
(c) "Claims Administrator" means the Insurer or other entity
designated by the Plan Administrator as having responsibility for
determining claims and appeals for benefits under the Plan.
(d) "Committee" means the Long-Term Care Administrative
Committee as described in Article VII. The Company has designated that
the Committee perform various plan administrative duties on its behalf.
(e) "Company" means Interface, Inc., and its successors that
adopt the Plan.
(f) "Effective Date" means January 1, 2006, the effective
date of this amendment and restatement.
(g) "Eligible Employee" means a person who (i) receives
remuneration for performing services for a Participating Company in the
conduct of the Participating Company's regular business, (ii) is a
common law employee of the Participating Company and (iii) is a regular
full-time salaried employee for a Participating Company who is normally
scheduled to work 30 hours or more per week, provided that the employee
is on the U.S. payroll of the Participating Company. In addition, the
Committee may establish different tiers of coverage and benefits for
Eligible Employees, as described in the Summary Plan Descriptions for
those tiers.
(h) "ERISA" means the Employee Retirement Income Security
Act of 1974, as amended from time to time.
(i) "Insurer" means the insurance company or companies
issuing the policy or policies providing benefits under the Plan.
(j) "Internal Revenue Code" or "Code" means the Internal
Revenue Code of 1986, as amended from time to time, and any successor
statute. References to an Internal Revenue Code section shall be deemed
to be that section or to any successor to that section.
(k) "Participant" means an Eligible Employee or Spouse who
has satisfied the participation requirements of Article III.
(l) "Participating Company" means the Company, any
Affiliate, or other related company that participates in the Plan and is
designated by the Committee as a Participating Company. The
Participating Companies so designated by an authorized officer of the
Company are listed in Appendix A hereto, along with their effective date
of participation in the Plan.
(m) "Plan" means the Interface, Inc. Long-Term Care
Insurance Plan, as set forth herein and as may be amended or restated
from time to time.
(n) "Plan Administrator" means the Company, unless another
entity or person is appointed by the Company to administer the Plan
pursuant to Section 7.5. With respect to benefits that are provided on a
fully-insured basis, the Insurer or its designee shall act as Plan
Administrator.
(o) "Plan Year" means the twelve (12) consecutive month
period ending each December.
(p) "Policy" means the long-term care insurance policy or
policies issued by the Insurer and providing benefits to Participants.
(q) "Schedules" or Schedules of Benefits" means the
schedules set forth in the Summary Plan Description and other related
documents such as the Policy or other insurance contracts describing the
long-term care insurance benefits provided under the Plan, which
Schedules are incorporated by reference into the Plan.
2
(r) "Spouse" means the Eligible Employee's lawful spouse.
(s) "Summary Plan Description" means, collectively, the
summaries which, together with the Schedules, describe the long-term
care insurance benefits available under the Plan and which constitute
the "summary plan description" as defined in ERISA Section 102 for those
benefits. The Summary Plan Descriptions are incorporated by reference
into the Plan.
Section 2.2 GENDER AND NUMBER. Pronoun references in the Plan shall
be deemed to be of any gender relevant to the context, and words used in the
singular may also include the plural.
ARTICLE III. ELIGIBILITY AND PARTICIPATION
Section 3.1 ELIGIBILITY FOR CERTAIN BENEFITS. Based on such factors
as worker classification, an Eligible Employee and his or her Spouse will be
eligible to participate in certain benefits in accordance with the terms of the
Summary Plan Descriptions, subject to applicable underwriting requirements.
Section 3.2 COMMENCEMENT OF PARTICIPATION. An Eligible Employee
shall become a Participant in the Plan as of the date designated by the
Committee, provided the Eligible Employee or Spouse satisfies all the conditions
set forth in Section 3.3, and as described in more detail in the appropriate
Summary Plan Description.
Section 3.3 PARTICIPATION CONDITIONS. As a condition to
participation and receipt of benefits under the Plan, an Eligible Employee or
Spouse agrees to:
(a) Furnish to the Insurer any required application to
participate provided for in Section 3.4 within the required time frame;
(b) Observe all rules and regulations implementing the Plan
and satisfy any requirements of an Insurer, including any underwriting
criteria, as a condition of issuing the Policy;
(c) Consent to inquiries by the Insurer as provided under
the Policy;
(d) Submit to the Company or such other agents as the
Company may designate, all reports, bills and other information which
the Company may reasonably require; and
(e) Agree to make any required contributions to the Plan as
described in Section 4.1.
Section 3.4 APPLICATION TO PARTICIPATE. Each Eligible Employee or
Spouse shall execute and deliver to the Insurer, if required, a written
application by which the Eligible Employee or Spouse applies to participate in
the Plan and supply any other pertinent information that the Insurer reasonably
requires.
3
Section 3.5 TERMINATION OF PARTICIPATION. In the event a Participant
terminates employment for whatever reason, or otherwise ceases to be an Eligible
Employee, the Participant shall cease to be a Participant in the Plan as of that
date consistent with the Policy. The former Participant may continue to receive
long-term care coverage by paying any required premium directly to the Insurer,
if so permitted under the terms of the Policy.
ARTICLE IV. FUNDING AND BENEFITS
Section 4.1 COMPANY AND EMPLOYEE CONTRIBUTIONS. The Participating
Company may bear the total cost of coverage for Eligible Employees under the
Plan, or the Eligible Employee may be required to share the cost of his or her
coverage under the Plan. (The Eligible Employee pays for any such applicable
costs for his or her own coverage under the Plan through after-tax payroll
deductions or other means approved by the Committee.) The Eligible Employee pays
the entire cost of coverage under the Plan for the Eligible Employee's Spouse
through after-tax payroll deductions or other means approved by the Committee.
Section 4.2 FUNDING. The premiums required under the Plan are funded
by Eligible Employee and Participating Company contributions. Benefits are
provided exclusively through Policies. A Participating Company shall pay to the
Insurer when due all premiums required to maintain such insurance in force,
including any required Participant contributions while the Eligible Employee is
a Participant in the Plan. Nothing herein requires a Participating Company or
the Plan Administrator to contribute to the Plan, or to maintain any fund or
segregate any amount for the benefit of any Participant, except to the extent
specifically required hereunder. No Participant shall have any rights to, or
interest in, the assets of a Participating Company. The Company reserves the
right, in its sole discretion, to change or terminate its contributions to the
Plan at any time.
ARTICLE V. BENEFITS
The Plan provides for long-term care benefits as described in the Policy
provided to the Participant, which Policy is incorporated herein by reference
and made a part hereof. Benefits to be provided hereunder will be provided
solely under such Policy. All benefits are subject to the terms and conditions
of the Policy.
ARTICLE VI. CLAIMS PROCEDURE
Section 6.1 WRITTEN CLAIM FOR INSURED BENEFITS. No benefit shall be
paid until the Insurer has received a claim for benefits that satisfies all
requirements set forth in the applicable Summary Plan Description.
Section 6.2 CLAIMS PROCEDURE FOR INSURED BENEFITS (POLICY CLAIMS).
If there is no claims procedure under the applicable Summary Plan Description,
the following shall apply: The Claims Administrator will process all claims for
benefits in a timely manner (generally within 30 days) after receipt by the
Claims Administrator. If necessary, and if the claimant is notified of the
extension, the Claims Administrator may take an additional 45 days to review a
claim for benefits. If the request for benefits is denied in whole or in part,
the Claims Administrator shall notify the claimant in writing setting forth, in
a manner calculated to be understood by the claimant, the specific reasons for
denial; specific reference to the pertinent
4
provisions of the Plan, the election form or other applicable documents upon
which the denial is based; a description of any additional material or
information necessary for the claimant to perfect the claim and an explanation
of why such material or information is necessary; and an explanation of the
provisions for review of the claim. If no decision is furnished as described
above, the claim shall be deemed denied and the claimant may appeal the claim as
described below.
Section 6.3 REVIEW PROCEDURE. If there is no review procedure under
the applicable Summary Plan Description, the following shall apply: Any
Participant believing that a benefit to which he or she is entitled under the
Plan has been improperly denied may file an appeal in writing with the Claims
Administrator within 60 days after receipt of the notice denying the claim. A
claimant who submits a timely written application for review shall be entitled
to review any and all documents in possession of the Claims Administrator
relevant to the claim and may submit issues and comments to the Claims
Administrator in writing. Not later than 45 days (90 days if special
circumstances exist) after receipt of a written application for review, the
Claims Administrator shall give the claimant written notice of the decision on
review, which written notice shall set forth, in a manner calculated to be
understood by the claimant, specific reasons for its decision and specific
references to the pertinent provisions of the Plan, the election form or other
applicable documents.
ARTICLE VII. ADMINISTRATION AND FINANCES
Section 7.1 NAMED FIDUCIARY. The Company and the Committee will be
the "named fiduciaries" of the Plan as described in ERISA Section 402, and as
such will have authority to control and manage the operation and administration
of the Plan; provided, that, to the extent benefits under the Plan are
fully-insured, the Insurer issuing such contract, and not the Company or
Committee, will be the "named fiduciary."
Section 7.2 COMMITTEE.
(a) Except as provided in Section 7.1 with respect to
insured benefits, the operation and administration of the Plan, the
exclusive power and discretion to interpret the Plan, and the
responsibility for carrying out the Plan's provisions are vested in the
Committee and its designees. The Committee may establish rules for
administration of the Plan and transaction of its business; provided, a
majority of the members of the Committee at any time will constitute a
quorum for the transaction of business and all resolutions or other
actions taken by the Committee will be by vote of a majority of those
present at a meeting of the Committee; or without a meeting by
instrument in writing signed by a majority of the members of the
Committee.
(b) Any member of the Committee may resign by written notice
to the Chief Executive Officer ("CEO") of the Company, and such
resignation will become effective at delivery or at any later date
specified therein. The CEO of the Company may remove a member of the
Committee at any time by written notice to such member, and the removal
will become effective at delivery or at any later date specified
therein. In the event of a vacancy on the Committee, the vacancy will be
filled by an individual selected by the CEO of the Company.
5
Section 7.3 POWERS AND DUTIES OF THE COMMITTEE. In addition to
powers and duties otherwise stated in the Plan, the Committee and its designees
shall have such duties and powers as may be necessary to discharge its
responsibilities under the Plan, including, but not limited to, the following:
(a) To establish and enforce such written rules, regulations
and procedures as it shall deem necessary or proper for the efficient
operation and administration of the Plan;
(b) To interpret and construe, in its sole discretion, the
Plan, and to decide all questions of eligibility of any person to
participate in the Plan or to receive benefits under it, and its
interpretation thereof in good faith shall be final and conclusive;
(c) To determine, in its sole discretion, the amount, manner
and time of payment of benefits which shall be payable to any
Participant, in accordance with the provisions of the Plan, and to
determine the person or persons to whom such benefits shall be paid;
(d) To authorize the payment of benefits and reasonable
expenses for administering the Plan;
(e) To prescribe written procedures to be followed in filing
applications for benefits;
(f) To prepare and distribute, in such manner as the
Committee determines to be appropriate and consistent with applicable
law, information describing or explaining the Plan;
(g) To decide all questions concerning the Plan;
(h) To furnish the Participating Company, upon request, and
government agencies as required, such reports with respect to the
administration of the Plan as are reasonable and appropriate; and (i) To
delegate its powers and duties pursuant to Section 7.5.
In the exercise of all of its functions, the Committee shall act in an impartial
and nondiscriminatory manner.
Section 7.4 COMMITTEE ACTIONS. The decisions of the Committee as to
interpretation and application of the Plan shall be final. A written
certification of acts and directives of the Committee with regard to the Plan
shall constitute complete proof to third parties dealing with the Committee of
the authenticity of such acts and directives.
Section 7.5 DELEGATION OF DUTIES. For purposes of operation and
administration of the Plan, the Committee may:
6
(a) Appoint one or more other committees or subcommittees
whose members need not be members of the Committee, and determine their
powers;
(b) Employ legal or other counsel and agents;
(c) Obtain clerical, accounting, claims administration and
actuarial assistance;
(d) Authorize one or more Committee members or any agent to
execute or to deliver any written instructions, requisitions, orders,
notices or any other instruments, or to make payments on its behalf;
(e) Allocate its fiduciary responsibilities among the
members of the Committee; and
(f) Delegate its fiduciary responsibilities to persons other
than members of the Committee.
Section 7.6 PLAN RECORDS. The Committee shall maintain, or cause to
be maintained, appropriate accounts and records relating to the operation and
administration of the Plan and shall keep records of all allocations and
delegations of fiduciary responsibilities that the Committee makes, including
terminations and modifications of such allocations and delegations.
Section 7.7 COSTS. Except as provided to the contrary, the costs of
administering the Plan shall be borne by the Participating Company.
Section 7.8 INDEMNIFICATION.
(a) To the extent permitted by law, the Company shall
indemnify each Committee member or former member, and others to whom the
Committee has duly delegated duties and authority pursuant to Section
7.5 who are either employees, officers, or directors of the Company
against any and all claims, losses, damages, expenses, and liabilities,
including (without limitation) attorneys' fees, arising from their
responsibilities in connection with the Plan which are not covered by
insurance (without recourse) paid for by the Company or the Plan or
both, unless due to willful misconduct; provided, however, this
provision shall not be construed to limit any other indemnity protection
afforded by the Company to any such Committee member or former member or
others to whom the Committee has duly delegated duties and authority
pursuant to Section 7.5.
(b) Promptly after receipt by an indemnified party under
this Section 7.8 of notice of the commencement of any action, such
indemnified party shall notify the Committee of the commencement
thereof.
ARTICLE VIII. AMENDMENTS AND TERMINATION
Section 8.1 AMENDMENTS. The Company shall have the right at any time
and from time to time, by action of the Board or if the Board so delegates, by
action of the Committee, to amend the Plan, in full or in part, including
changing eligibility requirements and the amount of
7
any Participant contributions, such amendment to be effective at the time stated
therein. The Board has delegated to the Committee the authority to amend the
Plan. Any action by the Board or Committee may be retroactive or prospective;
provided, no amendment, modification or other change shall alter the terms of
the Plan as applied to any claim incurred prior to the date of such amendment,
modification or other change.
Section 8.2 BENEFITS PROVIDED THROUGH THIRD PARTIES. In the case of
any benefit provided pursuant to an insurance policy or other contract with a
third party, the Company may amend the Plan by changing insurers, policies, or
contracts without changing the language of the Plan, provided that copies of the
contracts or policies are filed with the Plan documents and the Participants are
informed of the effects of any changes.
Section 8.3 TERMINATION. The Company expects the Plan to remain in
force, but necessarily must, and hereby does, reserve the right to terminate the
Plan at any time by action of the Board effective as of the date specified by
the Board. Upon termination of the Plan, neither the Company nor any of its
respective officers, directors or employees shall have any further financial
obligations under the Plan beyond paying the claims incurred (so long as such
claims are filed within 90 days of the date the Plan is terminated) and expenses
of the Plan incurred through the 90-day period in which claims may be filed.
Upon termination of the Plan, if so permitted under the terms of the Policies,
Participants may continue to receive long-term care coverage by paying any
required premium directly to the Insurer.
Section 8.4 ACTION IN WRITING. Any action taken by the Board or the
Committee under the Plan shall be reflected in writing and executed by any
person or persons duly authorized to take such action.
Section 8.5 CONSTRUCTION. Nothing in the Plan, or any other document
describing, interpreting or relating to the Plan shall be construed to provide
vested, nonforfeitable, nonterminable or nonchangeable benefits or rights
thereto. No communication, written or oral, may modify, supersede or void the
written terms of the Plan unless such communication constitutes a valid
amendment of the Plan executed by the Board or the Committee, as applicable.
Section 8.6 ADOPTION OF THE PLAN BY A PARTICIPATING COMPANY
(a) PROCEDURES FOR ADOPTION. Any Affiliate of the Company
may become a Participating Company and commence participation in the
Plan, subject to the provisions of this subsection. In order for a
company to become a Participating Company, the Committee must designate
the company as a Participating Company and specify the effective date of
such designation by action of an authorized member of the Committee. The
Committee may also specify such terms and conditions pertaining to the
adoption of the Plan by the Participating Company as it deems
appropriate. The name of each Participating Company, along with the
effective date of its participation, shall be recorded on Appendix A
hereto, which shall be appropriately modified each time a Participating
Company is added or deleted.
8
(b) AUTHORITY UNDER PLAN. As long as an Affiliate's
designation as a Participating Company remains in effect, the Affiliate
shall be bound by, and subject to, all provisions of the Plan. The
exclusive authority to amend the Plan shall be vested in the Company,
acting through the Board, the Committee or an authorized officer of the
Company, and no other Participating Company shall have the right to
amend the Plan. Any amendment to the Plan adopted by the Company will be
binding upon every Participating Company without further action by such
Participating Company.
(c) PROCEDURE FOR WITHDRAWAL FROM OR TERMINATION OF
PARTICIPATION. The Company (by action of an authorized officer of the
Company) or the Committee may terminate the designation of a
Participating Company, effective as of any date, by amendment of
Appendix A to the Plan. A Participating Company may withdraw from
participation in the Plan, provided such action is communicated in
writing to the Company and approved by the Company by action of its
authorized officer. The withdrawal of a Participating Company from the
Plan shall be effective as stated in the notice of withdrawal which is
received by the Company, unless the Company consents to a different
effective date by action of its authorized officer.
(d) EFFECT OF WITHDRAWAL FROM PLAN. Any Participating
Company which ceases to be a Participating Company shall be liable for
all costs and liabilities (whether imposed under the terms of the Plan,
the Code or ERISA) accrued through the effective date of its withdrawal
or termination, including such liabilities for incurred but unreported
claims as the Plan Administrator may establish.
(e) AUTOMATIC WITHDRAWAL. A Participating Company's
participation will automatically cease if it is no longer an Affiliate.
ARTICLE IX. MISCELLANEOUS
Section 9.1 NO GUARANTY OF EMPLOYMENT. The adoption and maintenance
of the Plan shall not be deemed to be a contract of employment between the
Participating Company and any Eligible Employee. Nothing contained herein shall
give any Participant the right to be retained in the employ of the Participating
Company or to interfere with the right of the Participating Company to discharge
any Eligible Employee at any time nor shall it give the Participating Company
the right to require any Eligible Employee to remain in its employ or to
interfere with the Eligible Employee's right to terminate his or her employment
at any time.
Section 9.2 LIMITATION ON LIABILITY. The Participating Company does
not guarantee benefits payable under any Policy, and any benefits payable
thereunder shall be the exclusive responsibility of the Insurer that is
obligated under the Policy.
Section 9.3 NONALIENATION. No benefit payable at any time under the
Plan shall be subject in any manner to alienation, sale, transfer, assignment,
pledge, levy, attachment, or encumbrance of any kind by any Participant or
beneficiary.
9
Section 9.4 APPLICABLE LAW. The Plan and all rights under it shall
be governed by and construed according to the laws of the State of Georgia,
except to the extent those laws are preempted by the laws of the United States
of America.
Section 9.5 BENEFITS PROVIDED THROUGH INSURER. In the case of any
benefit provided under a fully-insured Policy, if there is any conflict or
inconsistency between the description of benefits contained in the Plan and the
Policy, the terms of the Policy shall control.
Section 9.6 CAPTIONS. Article and section headings and captions are
provided for purposes of reference and convenience only and shall not be relied
upon in any way to construe, define, modify, limit, or extend the scope of any
provision of the Plan.
IN WITNESS WHEREOF, the Company has caused this Plan to be executed by
its duly authorized officer.
INTERFACE, INC.
By: /s/ Raymond S. Willoch
-----------------------------
Its: Senior Vice President
-----------------------------
10
APPENDIX A
PARTICIPATING COMPANIES
NAME EFFECTIVE DATE
Interface, Inc. January 1, 2006
InterfaceFlor, Inc. January 1, 2006
Bentley Prince Street, Inc. January 1, 2006
Interface Flooring Systems, Inc. January 1, 2006
Interface Research Corporation January 1, 2006
Pandel, Inc. January 1, 2006
Re:Source Americas Enterprises, Inc. January 1, 2006
Interface Americas, Inc. January 1, 2006
Interface Fabrics, Inc. January 1, 2006
Interface Fabrics Guilford, Inc. January 1, 2006
Interface Teknit, Inc. January 1, 2006
Interface Fabrics Finishing, Inc. January 1, 2006
Interface Fabrics Elkin, Inc. January 1, 2006
Interface Fabrics Marketing, Inc. January 1, 2006
Strategic Flooring Services, Inc. January 1, 2006
11
INTERFACE, INC.
LONG-TERM CARE INSURANCE PLAN
SUMMARY PLAN DESCRIPTION
FOR
TIER 1 EMPLOYEES
Effective January 1, 2006
TABLE OF CONTENTS
PAGE
WHAT IS THE PURPOSE OF THE PLAN?...............................................1
WHEN AM I ELIGIBLE FOR COVERAGE?...............................................1
WHAT ARE THE BENEFITS UNDER THE PLAN?..........................................1
UNUM PROVIDENT COVERAGE......................................................2
LINCOLN LIFE INDIVIDUAL BENEFIT..............................................3
WHAT IS THE SOURCE OF FUNDING FOR THE PLAN?....................................3
WHAT IS THE COST OF THE PLAN TO ME?............................................3
WHEN DOES MY PARTICIPATION IN THE PLAN END?....................................3
WHAT IS THE CLAIMS PROCEDURE FOR BENEFITS UNDER THE PLAN?......................4
WHAT IF MY CLAIM IS DENIED?....................................................5
HOW DO I APPEAL A DENIED CLAIM?................................................6
MAY THE COMPANY AMEND OR TERMINATE THE PLAN?...................................6
WHO IS THE PLAN SPONSOR?.......................................................7
WHO IS THE PLAN ADMINISTRATOR?.................................................7
WHO ARE THE CLAIMS ADMINISTRATORS?.............................................7
WHAT IS THE PLAN YEAR?.........................................................8
WHAT IS THE TYPE OF PLAN ADMINISTRATION?.......................................8
WHAT IS THE FUNDING MEDIUM OF THE PLAN?........................................8
WHAT ARE THE PLAN NAME, PLAN NUMBER AND EMPLOYER IDENTIFICATION NUMBER?........8
WHO IS THE AGENT FOR SERVICE OF LEGAL PROCESS?.................................8
WHAT ARE MY RIGHTS UNDER ERISA?................................................8
Receive Information About Your Plan and Benefits.............................9
Prudent Actions by Plan Fiduciaries..........................................9
Enforce Your Rights..........................................................9
Assistance With Your Questions..............................................10
WHAT IF I NEED MORE INFORMATION?..............................................10
INTERFACE, INC. LONG-TERM CARE INSURANCE PLAN
SUMMARY PLAN DESCRIPTION
FOR TIER 1 EMPLOYEES
This document supplements the policy(ies) from UNUM Provident and, if
applicable, from Lincoln Benefit Life Company (collectively, the "Policies") and
is intended to explain Interface, Inc.'s Long-Term Care Insurance Plan (the
"Plan") in a manner that you can easily understand. Together, this document and
the Policies comprise the Summary Plan Description for the Plan. UNUM Provident
and Lincoln Benefit Life Company are referred to as the "Claims Administrators"
in this document. If you have any questions after reading this Summary Plan
Description, please call the Corporate Director of Benefits and Compensation at
770-437-6800. This Summary Plan Description describes benefits for your class of
participants. Other classes of participants who receive benefits under the Plan
are employees of Interface, Inc. (the "Company") and its subsidiaries who are
classified as Tier 2 and Tier 3 employees by the Long-Term Care Administrative
Committee.
WHAT IS THE PURPOSE OF THE PLAN?
To provide qualified long-term care insurance policies to you and, if you
desire, your spouse. These policies are intended to be qualified long-term care
insurance contracts as defined under section 7720B(b) of the Internal Revenue
Code of 1986, as amended.
WHEN AM I ELIGIBLE FOR COVERAGE?
You are eligible to participate in the Plan if you are designated as a "Tier 1"
employee by the Long-Term Care Administrative Committee.
A monthly benefit will become payable once all of the requirements described in
the Policies are met.
WHAT ARE THE BENEFITS UNDER THE PLAN?
The Plan is designed to provide long-term care benefits for you (and your
spouse, if you so elect and your spouse qualifies). Long-term care benefits are
paid for many different types of care and support for people who need assistance
with basic "Activities of Daily Living" for an extended period due to an
accident, illness, or other chronic condition. These services may be provided in
a variety of settings, including a person's home, an assisted living facility,
or in a nursing home. Benefits covered by the Plan include treatment,
rehabilitation, and maintenance or personal care services. The Policies pay an
indemnity benefit, meaning that you receive the full daily benefit, regardless
of actual expenses.
The Plan provides long-term care benefits through the
following two insurance policies:
1) UNUM PROVIDENT-INSURED COVERAGE
o A plan with a maximum benefit amount of $432,000, or
o A plan with unlimited benefits (subject to daily benefit
amounts, as described in more detail below), provided
that you meet the medical underwriting standard.
2) LINCOLN BENEFIT LIFE-INSURED COVERAGE (provided you meet the
medical underwriting standard).
This coverage is an individual insurance contract that provides
long-term care benefits in addition to the benefits provided by
UNUM. This contract also has a 10-year pay design - once the
premiums have been paid for 10 years, the contract will be
considered "paid up" and no additional premium will be due for
the lifetime of the insured.
Both of these coverages are fully-insured insurance policies and
are portable. That is, if you leave the Company, you can
continue to maintain your coverages, if you pay the applicable
premiums for these policies. While your long-term care insurance
policies describe in detail the long-term care benefits you may
receive, the following is a brief summary of these benefits:
UNUM PROVIDENT COVERAGE
BENEFIT INFORMATION
BENEFIT DAILY BENEFIT AMOUNT MAXIMUM AMOUNT
Nursing Care: $200/day* $432,000**
Assisted Living Facility: $120/day* $432,000**
Home Care: $100/day* $432,000**
* Benefits will be paid on a 30 day month.
**$432,000 is the combined Maximum Amount for Nursing Care, Assisted Living
Facility and Home Care. If you qualify and elect additional coverage, the
Maximum Amount is unlimited.
This coverage pays benefits for a six-year period (or an unlimited duration if
you qualify and elect the additional coverage). In addition, the benefit
maximums are adjusted for inflation on an annual basis at a rate of 5% simple
interest per year (the annual increase is based on the original daily benefit),
subject to a cap of two times the benefit maximums stated above. There is a
90-day "elimination period" before the benefits are paid under this coverage.
Please refer to the Policies for additional details about the long-term care
insurance available from UNUM Provident.
2
LINCOLN BENEFIT COVERAGE
BENEFIT INFORMATION
BENEFIT DAILY BENEFIT AMOUNT MAXIMUM AMOUNT
Nursing Care: $150/day Unlimited
Community Care: $150/day Unlimited
Home Care: $150/day Unlimited
There is no maximum lifetime benefit amount under this Policy. This coverage
pays for benefits for an unlimited duration with no cap on the aggregate amount
paid. In addition, the benefit maximums are adjusted annually for inflation at a
rate of 5%, compounded annually (the increase is 5% of the previous year's
benefit). There is a 60-day "elimination period" before benefits are paid under
this coverage.
You must meet the medical underwriting standard to be eligible for this
coverage. Please refer to the Policies for additional details about the
long-term care insurance available from Lincoln Life.
WHAT IS THE SOURCE OF FUNDING FOR THE PLAN?
The Plan is funded through qualified long-term care insurance policies. The
policies for employees are paid for by Company contributions. You will also have
the option to obtain coverage for your qualifying spouse at your expense.
WHAT IS THE COST OF THE PLAN TO ME?
The Company pays the entire cost of the Plan for employees. If you decide to
obtain coverage for your spouse, you will pay for the premiums for your spouse
through after-tax payroll deductions.
WHEN DOES MY PARTICIPATION IN THE PLAN END?
Your participation in the Plan will terminate on the earliest of:
(a) the end of the period for which required premiums were last paid
for your coverage;
(b) the date your election to participate terminates; or
(c) the last day that you are employed by the Company as an
employee.
Also, if the Plan is terminated, all employees' participation in the Plan will
cease on the date of termination. However, claims will continue to be paid under
the terms of the Plan or as required by law. As mentioned above, the benefits
under the Plan are provided through fully-insured insurance
3
policies, and are portable. That is, if you leave the Company or the Plan is
terminated, you can continue to maintain your coverages, if you pay the
applicable premiums for these policies.
WHAT IS THE CLAIMS PROCEDURE FOR BENEFITS UNDER THE PLAN?
You must give the Claims Administrator written notice of claim within thirty
(30) days of the date you become disabled. If it is not possible for you to give
the Claims Administrator notice within this time period, it must be given as
soon as reasonably possible. If you do not have a "long-term care notice of
claim form," you can get one from the Plan Administrator or your policy
representative. You can also notify the Claims Administrator in writing that you
want to make a claim. The notice must give the Claims Administrator sufficient
information to identify you. If you do not receive the form from the Claims
Administrator within 15 days for UNUM claims (10 days for Lincoln claims) after
writing, send the Claims Administrator proof of the claim without the form.
You must send the Claims Administrator proof of claim for long term care
payments no later than 90 days after the date you become disabled. If you cannot
send the Claims Administrator proof within this 90-day period, you must send the
Claims Administrator proof as soon as it is reasonably possible to do so, but in
no event more than one year for UNUM claims (15 months for Lincoln claims) after
the time this proof is required.
Your proof of claim must include:
o the date your disability occurred;
o the cause of your disability;
o the extent of your disability;
o certification by a physician that you are unable to perform
(without substantial assistance from another individual) two or
more activities of daily living ("ADLs") for at least 90 days,
or that you require substantial supervision by another
individual to protect yourself and others from threats to health
and safety due to severe cognitive impairment; ADLs are defined
as:
o BATHING - washing oneself by sponge bath; or either a
tub or shower, including the task of getting in or out
of the tub or shower with or without equipment or
adaptive devices;
o DRESSING - putting on and taking off all items of
clothing and necessary braces, fasteners, or artificial
limbs;
o TOILETING - getting to and from the toilet, getting on
and off the toilet, and performing associated personal
hygiene;
o TRANSFERRING - moving into or out of a bed, chair, or
wheelchair with or without equipment such as canes, quad
canes, walkers, crutches or grab bars, or other
supportive devices including mechanical or motorized
devices;
4
o CONTINENCE - the ability to maintain control of bowel or
bladder function; or, when unable to maintain control of
bowel or bladder functions, the ability to perform
associated personal hygiene (including caring for
catheter or colostomy bag); and
o EATING - feeding oneself by getting food into the body
from a receptacle (such as a plate, cup, or table) or by
a feeding tube or intravenously.
o your written plan of care, developed by a licensed health care
practitioner; and
o such other proof as the Claims Administrator may deem necessary.
You must give the Claims Administrator proof of continued disability at
intervals requested by the Claims Administrator. Such proof must be given within
30 days of the Claims Administrator's request. If it is not possible for you to
give the Claims Administrator proof of continued disability within this 30-day
period, it must be given as soon as possible. However, proof of continued
disability must be given no later than one year after the time proof is
otherwise requested. Claims for a professional home care services monthly
benefit must also include proof of the number of days these services were
provided to you. The Claims Administrator may also require a claims assessment
as part of the proof of claim. A claims assessment means a review done by the
Claims Administrator or its designated representative to help in evaluating the
disability. It may include a face-to-face interview with you at a location
selected by the Claims Administrator or its designated representative.
You must fill out a long-term care claim form and send it to the Claims
Administrator. The claim form must be submitted when all information is
available. After you have filed a claim, the Claims Administrator may also
require you to be examined by a physician or other medical practitioner of the
Claims Administrator's choice. The Claims Administrator will pay for the
examination. The Claims Administrator can require an examination as often as it
is reasonable to do so. The Claims Administrator may require you or your
authorized representative to give authorization to obtain additional medical and
nonmedical information as part of the proof of claim.
You or your authorized representative may not start legal action on your claim
before 60 days after proof of loss has been given to the Claims Administrator or
more than 3 years from the time proof of loss was required.
The Claims Administrator has the right to recover any overpayments made because
of any error the Claims Administrator makes in processing your claim.
WHAT IF MY CLAIM IS DENIED?
In the event that your claim is denied, either in full or in part, the Claims
Administrator will notify you in writing within 90 days after your UNUM claim
form was filed. (The Claims Administrator will notify you within 15 days after
your Lincoln claim form was filed. Interest equal to 18% per annum on the
benefits due will be paid if Lincoln does not comply with this provision.) Under
special circumstances, the Claims Administrator is allowed an additional
5
period of not more than 90 days (180 days in total) within which to notify you
of its decision. If such an extension is required, you will receive a written
notice from the Claims Administrator indicating the reason for the delay and the
date you may expect a final decision. The Claim Administrator's notice of denial
shall include the following:
1. The specific reason(s) for the adverse determination;
2. Reference to the specific Plan provision(s) on which the denial
is based;
3. A description of any additional material or information
necessary for the participant to perfect the claim and an
explanation of why such material or information is necessary;
and
4. An explanation of the Plan's claim review procedure describing
the steps to be taken by a participant who wishes to submit his
or her claim for review.
Please note that if the Claims Administrator does not respond to your claim
within the time limits set forth above, you should automatically assume that
your claim has been denied and you should begin the appeal process at that time.
HOW DO I APPEAL A DENIED CLAIM?
If you or your authorized representative appeal a denied claim, it must be
submitted within 90 days after you receive the Claim Administrator's notice of
denial.
You have the right to:
1. submit a request for review, in writing, to the Claims
Administrator;
2. review pertinent documents; and
3. submit issues and comments in writing to the Claims
Administrator.
The Claims Administrator will make a full and fair review of the claim and may
require additional documents as it deems necessary or desirable in making such a
review. A final decision on the review shall be made not later than 60 days for
UNUM claims (30 days for Lincoln claims) following receipt of the written
request for review. If special circumstances require an extension of time for
processing, you will be notified of the reasons for the extension, and a
decision shall be made not later than 120 days following receipt of the request
for review. The final decision on review shall be furnished in writing and shall
include the reasons for the decision with reference, again, to those Plan
provisions upon which the final decision is based.
MAY THE COMPANY AMEND OR TERMINATE THE PLAN?
Although the Company intends to continue the Plan, it reserves the right to
amend or discontinue the Plan at any time. If the Plan is terminated, all of
your rights under the Plan will immediately end
6
(except for claims that arise prior to termination and which are specifically
covered under the applicable policy upon termination). However, as mentioned
above, the benefits under the Plan are provided through fully-insured insurance
policies, and are portable. That is, if you leave the Company or the Plan is
terminated, you can continue to maintain your coverages, if you pay the
applicable premiums for these policies.
The Plan is a program established and maintained by the Company for the
exclusive benefit of employees and their spouses. However, the Plan is not an
employment contract between the Company and any employee and does not affect the
right of the Company to conduct its business affairs, including laying off or
terminating the employment of any employee.
WHO IS THE PLAN SPONSOR?
Interface, Inc.
Attention: Long-Term Care Administrative Committee
2859 Paces Ferry Road
Atlanta, Georgia 30339
WHO IS THE PLAN ADMINISTRATOR?
Interface, Inc.
Attention: Long-Term Care Administrative Committee
2859 Paces Ferry Road
Atlanta, Georgia 30339
Interface, Inc. is the Plan Administrator and named fiduciary of the Plan, with
authority to delegate its duties. Interface has delegated its duties for claims
administration to the Claims Administrators, who are named fiduciaries of the
Plan.
WHO ARE THE CLAIMS ADMINISTRATORS?
UNUM Life Insurance Company of America is the Claims Administrator for the
benefits insured by UNUM Life Insurance Company of America.
UNUM Life Insurance Company of America
2211 Congress Street
Portland, ME 04122
Claims: (800)693-4988
Customer Service: (800)227-4165
Lincoln Benefit Life Company is the Claims Administrator for the benefits
insured by Lincoln Benefit Life Company.
7
Lincoln Benefit Life Company
Home Office: Lincoln, Nebraska
Long-Term Care Administrative Office
P.O. Box 4243
Woodland Hills, CA 91365-4243
(888)503-8110
WHAT IS THE PLAN YEAR?
The Plan is administered on a calendar year basis.
WHAT IS THE TYPE OF PLAN ADMINISTRATION?
Benefits are provided through insurance policies issued by the Claims
Administrators. As the Plan Administrator, the Company has the discretionary
authority to interpret and construe any terms of the Plan, to make eligibility
determinations, and to delegate any determinations. The Company has delegated
certain of its authority to the Claims Administrators. The Company's role under
the Plan is limited to determining eligibility to participate and administer
premium payments. The Claims Administrators serve as the named claims
fiduciaries. Claims for benefits are sent to the Claims Administrators. The
Claims Administrators, not the Company, are responsible for determining the
amount of any benefits payable under the Policies.
WHAT IS THE FUNDING MEDIUM OF THE PLAN?
The Plan is a fully-insured long-term care insurance plan consisting of group
and individual policies issued to participants. The Claims Administrators
provide all benefits.
WHAT ARE THE PLAN NAME, PLAN NUMBER AND EMPLOYER IDENTIFICATION NUMBER?
The Plan Name is Interface, Inc. Long-Term Care Insurance Plan. The Plan Number
is 515. The Employer Identification Number is 58-1451243.
WHO IS THE AGENT FOR SERVICE OF LEGAL PROCESS?
Interface, Inc.
Attention: General Counsel
2859 Paces Ferry Road
Atlanta, Georgia 30339
WHAT ARE MY RIGHTS UNDER ERISA?
As a participant in the Plan, you are entitled to certain rights and protection
under the Employee Retirement Income Security Act of 1974 (ERISA). ERISA
provides that all Plan participants shall be entitled to:
8
RECEIVE INFORMATION ABOUT YOUR PLAN AND BENEFITS
o Examine, without charge, at the Plan Administrator's office and
at other specified locations, 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 Employee Benefits Security Administration.
o 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.
o 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.
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 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 fire you
or otherwise discriminate against you in any way to prevent you from obtaining a
benefit or exercising your rights under ERISA.
ENFORCE YOUR RIGHTS
If your claim for a 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 that is denied or ignored, in whole or in part,
you may file suit in a state or 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 if, for example, it finds your claim is
frivolous.
9
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, 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 Employee Benefits Security Administration.
WHAT IF I NEED MORE INFORMATION?
If you have questions about eligibility to participate or general questions
about the Plan, please contact the Plan Administrator. If you have questions
about eligibility for or the amount of any benefit payable under the policy,
please contact the Claims Administrators. If you did not receive copies of the
Policies or need another copy of the Policies or this document, please contact
the Corporate Director of Benefits and Compensation at 770-437-6800.
THIS BOOKLET AND THE POLICIES ARE THE SUMMARY PLAN DESCRIPTION AND ARE
INCORPORATED INTO THE FORMAL PLAN DOCUMENT. COLLECTIVELY, THE DOCUMENTS CONTROL
THE OPERATION OF THIS BENEFIT. IF THERE IS A CONFLICT BETWEEN THIS DOCUMENT AND
THE POLICIES, THE POLICIES CONTROL. IF YOU WOULD LIKE A COPY OF THE FORMAL PLAN
DOCUMENT, PLEASE CONTACT THE CORPORATE DIRECTOR OF BENEFITS AND COMPENSATION AT
770-437-6800.
10