How do I become eligible?

Initial eligibility begins when the Fund receives employer contributions in your behalf for at least 450 hours in a six- month period or less.  You will become initially eligible on the first day of the third month following the month in which the 450 hours has been accumulated.

 

Once an employee has satisfied the Initial Eligibility requirements, you will remain eligible for Benefits for the duration of that Benefit Period. Thereafter, to remain eligible an employee must be credited with at least 450 hours in a six- month period or 1,000 hours in twelve- month work period.  See the following chart for work and benefit periods.

 

To be eligible for coverage during the Benefit Period	You must have worked	During the work period
April 1 thru September 30	At least 450 hours or A least 1000 hours	August 1 – January 31 or February 1 – January 31
October 1 thru March 31	At least 450 hours or at least 1000 hours	February 1 – July 31 or August 1 – July 31

 

What do I do if I am injured or become ill and am unable to work?

If an active eligible employee becomes totally disabled from a sickness or accidental bodily injury which prevents the employee from engaging in any occupation or employment for wage or profit, the employee will receive credit for 30 hours worked per week for a maximum of 13 weeks. These disability credit hours may help continue your coverage for health care benefits. You must request a claim form from The Fund Office and have it completed by a Physician certifying the dates of disability. A new claim form is required for each new period of disability.  Disabled employees receiving Workman’s Compensation must submit proof of compensation.

 

What are the health care benefits?

The fund has contracted with Freedom Network Select to provide participants and the fund with discounts on medical services.  By choosing an in-network provider for your health care needs, you will save money for yourself and the fund.  The deductible is $300 per individual.  The benefit provided by using the in- network provider is 85% vs. the out- of- network benefit of 75%.  (For further details regarding the medical benefits available, please refer to the Summary Plan Description).

 

Covered Medical Expenses	In-PPO-Network	Out-of-Network
Major Medical Benefit (Hospital, ER, Doctor etc.)	Subject to the deductible & paid at 85%	Subject to the deductible & paid at 75%
Diagnostic X- ray and Lab Benefit	100% on first $100 per calendar year, Major Medical Benefits thereafter	100% on first $100 per calendar year, Major Medical Benefits thereafter
Supplemental Accident Expense Benefit	100% on first $200 per accident, Major Medical Benefits thereafter	100% on first $200 per accident, Major Medical Benefits thereafter
Maternity Benefit (Employee or Dependent Spouse Only)	Subject to deductible and paid at 85%	Subject to deductible and paid at 85%
Surgery – Second Surgical Opinion	100%	100%
Well Child Benefit (Eligible Dependents of Active Employees Only) See Benefit Description for Specific Limitations	85% No deductible	75% No deductible

 

Are Prescription Drugs Covered?

Prescription Drugs are covered through SAV-RX.  For generic drugs you pay $8.00, or the cost of the prescription, if less.  For brand name drugs (Formulary) you pay the greater of $13.00, or 25% of the cost of the prescription.  For brand named drugs (Non-Formulary) you pay the greater of $28.00 or 50% of the cost of the prescription (plus the difference in the ingredient cost if your prescription is for a brand name drug, when a generic is available).

 

An initial prescription for a maintenance medication may be filled at a retail pharmacy.  In addition, two refills for that medication may be obtained from the retail pharmacy.  Additional refills must then be filled through the mail order service.

 

 

What happens if I loose my eligibility because of a reduction in hours, termination of employment, or certain other events?

You will be notified by The Fund Office that your Health Care Coverage has terminated and will be given the opportunity to elect COBRA Continuation Coverage.

 

What is COBRA Continuation Coverage?

Federal law requires that sponsors of group health plans offer Covered Employees and their families

a temporary extension of their health care coverage under the Plan in exchange for self-contribution payments to the Plan. (Find detailed information regarding COBRA in the Summary Plan Description on page 16, letter A, Section One)

 

 

What Vision Benefits are available?

Vision care benefits under the plan are provided through a contract with Vision Service Plan (VSP) (optometrists, ophthalmologists, and dispensing opticians) who agree to provide services in exchange for contracted fees.  For further details, refer to the Summary Plan Description, Section 4.16 – Vision Care Benefit, page 36 & page 37.  If you need to locate a VSP participating doctor, call Vision Service Plan at (800) 877-7195 or visit the VSP website at www.vsp.com.

 

What Dental Benefits are available?

When a covered Person or Eligible Dependent incurs a covered Dental expense, the Plan will pay a percentage of all reasonable dental charges.  There is no deductible for dental or orthodontic treatment.  Dental and orthodontic benefits are paid at 80%, with a per person, calendar year maximum benefit of $750.00.  There are no frequency limitations under the dental and no age limit on orthodontic services.

 

What Routine Care Benefits are available?

Benefits are payable for routine physical examinations and preventative services and supplies up to a maximum payable of $300.00 per calendar year.  This Routine care benefit is not subject to a deductible, and is paid at 85% when using an In- Network provider.  The plan pays 75% when using an Out-of-Network provider. 

 

This benefit includes doctor services and supplies, such as well-baby examinations from birth to 5 years of age.  The routine benefit also includes lab and x-ray tests, including pap smears and mammograms for females and any other diagnostic test or procedures ordered by the examining doctor.

 

Immunizations and inoculations are also covered (Flu Shots are not covered).  Refer to the Summary Description Plan for further details.