This section contains certain general and technical information which you may need to know and which we are required by Federal Law to furnish you.

The Troup County Board of Commissioners Cafeteria Plan is the formal name of the plan.

Your employer has assigned Plan Number 501 to your plan.

The provisions of the plan became effective on October 1, 1992, which is called the Effective Date of the Plan.

Your Plan’s records are maintained on a twelve-month period of time. This is known as the Plan Year. The Plan Year begins on July 1st and ends on June 30th.

Employer Information

Your employer’s name, address and identification number is:

Troup County Board of Commissioners
100 Ridley Avenue
LaGrange, Georgia 30240


Plan Administrator Information

The name, address and business telephone number of your Plan’s Administrator is:

Human Resources Department
Troup County Board of Commissioners
100 Ridley Avenue
LaGrange, Georgia 30240

(706) 883-1630

The Administrator keeps the records for the Plan and is responsible for the administration of the Plan. The Administrator will also answer any questions you may have about the Plan.

Services of Legal Process

The name and address of the Plan’s agent for service of legal service is:

Troup County Board of Commissioners
100 Ridley Avenue
LaGrange, Georgia 30240

Claims Process

Claims for benefits that are insured will be reviewed in accordance with procedures contained in the policies. All other general claims or request should be directed to the Administrator of your Plan. If a non-insured claim under the Plan is denied in whole or in part, you or your beneficiary will receive written notification. The notification will include the reasons for the denial, with reference to the specific provisions of any additional information needed to process the claim and an explanation of the claims review procedure. If we fail to respond within 90 days, your claim is treated as denied. Within 60 days after denial, you or your beneficiary may submit a written request for reconsideration of the application to the Administrator.

Any such request should be accompanied by documents or records in support of your appeal. You or your beneficiary may review pertinent documents and submit issues and comments in writing. The Administrator will review the claim and provide, within 60 days, a written response to the appeal. (This period may be extended an additional 60 days under certain circumstances).

In response, the Administrator will explain the reason for the decision with specific references to the provisions of the Plan on which the decision is based. The Administrator has the exclusive right to interpret the appropriate Plan provisions. Decisions of the Administrator are conclusive and binding.

Type of Administration

The type of administration is “Insurer Administration”

The foregoing information on the various insured benefits is provided as an outline and summary.  For the exact specifications, provisions and limitations, refer to the actual policy or your individual certificate. If you have any questions, please contact the Administrator, or if you have specific questions regarding the insurance benefits contact:

Houze & Associates, Inc.
308 Church Street – Post Office Box 3070
LaGrange, Georgia 30241

Voice: (706) 882-2864 or (800) 523-7135
Fax:  (706) 883-6651 or (800) 523-5364