Benefits|Caterpillar



INSTRUCTIONSAs more fully explained to you in communications that were mailed to your home, effective January 1, 2018, certain retirees who retired under the 2005 or later agreements between Caterpillar and the UAW are eligible to participate in the Caterpillar Inc. Retiree Benefit Program (“RBP”), the plan that currently provides retiree healthcare benefits to certain management and executive retirees.If you choose to opt out of eligibility for RBP:Complete the enclosed Opt-Out Form by printing your name on the line in the last paragraph, and then sign and date where indicated. Once complete, submit the Opt-Out Form by first class or certified U.S. mail, facsimile or email, to ensure receipt by October 6, 2017. OPT-OUT FORMS RECEIVED AFTER OCTOBER 6, 2017 WILL NOT BE HONORED. You will receive written confirmation from Caterpillar that your Opt-Out Form was received and processed within fourteen (14) days of receipt by the Caterpillar U.S. Benefits Administration Team. If you do not timely receive written confirmation, please contact Caterpillar’s UAW 2018 healthcare hotline at 309-675-1700.To submit by U.S. mail, send to: 100 NE Adams St., AB4400Peoria, IL 61629-4400To submit by facsimile, send to: 309-636-2595To submit by email, send to: 2018healthcare@ The Company reserves the right to amend, modify, or terminate retiree healthcare benefits at any time, whether the benefits are provided under RBP, the Caterpillar Inc. Retiree Group Insurance Plan, or any other Company plan or program.OPT-OUT FORMBy signing this form, you are OPTING OUT of participation in the Caterpillar Inc. Retiree Benefit Program (“RBP”), and your retiree healthcare benefits, if you have enrolled in such benefits, will be provided under the Caterpillar Inc. Retiree Group Insurance Plan (“RGIP”), the plan that you participate in today. You may be able to change your election and choose to participate in RBP during a subsequent annual enrollment period by filling out the form provided by the plan administrator.Please recognize that you are not vested in any Caterpillar-provided retiree healthcare benefits and you are not being promised or guaranteed any retiree healthcare benefits in the future. To the fullest extent permitted by law, Caterpillar may amend, modify or terminate the retiree healthcare benefits provided to retirees, whether the benefits are provided under RBP, RGIP, or any other Caterpillar plan or program.I, _____________________________________, acknowledge and agree that I have read and fully understand this Opt-Out Form and the communication mailed to my home regarding retiree healthcare changes effective January 1, 2018; and that I have had an opportunity to ask questions and to consult with my attorney. BY COMPLETING THIS FORM, I AM OPTING OUT OF PARTICIPATION IN RBP, AND I CHOOSE TO REMAIN ELIGIBLE FOR PARTICIPATION IN RGIP. AS A RESULT, ANY RETIREE HEALTHCARE BENEFITS WILL BE PROVIDED UNDER RGIP OR ITS SUCCESSOR, SUBJECT TO THE TERMS OF RGIP OR ITS SUCCESSOR.Signature: ________________________________Date:_______________________Full name:DOB:Last 4 digits of Social Security number:Complete address: ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download