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NEW YORK DISTRICT COUNCIL OF CARPENTERS WELFARE FUND

NOTICE TO MEMBERS

December 15, 1998

In order to ensure the long-term health of the New York District Council of Carpenters Welfare Fund, the Trustees have made the following changes to the Fund's:

eligibility requirements

early retiree coverage

prescription drug coverage

dental coverage and

bulletlife insurance coverage

All changes become effective January 1, 1999.

This Notice details all the changes. Please read it carefully and share it with your family.

Eligibility Coverage Change top

Currently, the Fund offers two different health plans (i.e. one provided by Empire Blue Cross Blue Shield and the other provided by GHI) depending on the number of hours a member works. Further, the amount of hours necessary to gain coverage varies if the member works shop or outside.

Effective January 1, 1999, there will only be one health plan offered by the Fund (the Empire Blue Cross Blue Shield plan) and there will no longer be a differential in the

number of hours required for plan participation between shop and outside carpenters. As a result, medical coverage for "part-time" employment in the trade will no longer exist.

All hours worked in covered employment will be "banked" in an individual account. In order to qualify for a calendar quarter of coverage, a member must have 250 hours in his bank. Coverage includes medical and hospitalization from Empire Blue Cross and Blue Shield, dental, vision, hearing aids, life and accidental death insurance, and short term

disability coverage.

Hours are added to the bank four times each year at three-month intervals. If you do not have hours in your bank, but have' worked at least 250 hours during one of these periods, you will receive coverage on the date noted below: 

 

Accumulation Period Coverage Begins
August, September and October January 1
November, December, January April 1
February, March, April July 1
May, June, July October 1

Any additional hours worked above the 250 required may be added to the bank to be used for eligibility in a later quarter. No more than 750 hours may be in the bank at any time.

For example, assume a member has no beginning bank balance, but works 350 hours in February, March and April. Two hundred and fifty of those hours will be used to gain coverage for the calendar quarter beginning July 1. The remaining 100 not used for coverage will be placed in his bank to be used towards gaining coverage for the calendar quarter beginning October 1. However, he must work at least 150 hours in the period of May, June and July in order to have enough hours in his bank to qualify for coverage in that fourth quarter of the year.

If a member is found to be working in non-covered carpentry employment, his bank will be forfeited Additional rules regarding eligibility will be communicated to you after they are adopted by the Board of Trustee.

Eligibility for Calendar Quarter January 1, 1999 for Active Members

In order to ensure that no member currently covered by the Fund on December 1, 1998 loses coverage January 1, individual bank accounts will be established effective 1/1/99 in the following manner:

The member was covered by the Empire Blue Cross Blue Shield plan: 750 hours

The member was covered by the 6111 plan: 250 hours

Those hours will be used to provide coverage for the first quarter of 1999.

Someone who was not covered by the Fund on December 1, but has at least 250 hours during the period of August, September and October 1998 will also be covered by the Fund for at least one quarter with a bank of 250 hours on January 1, 1999.

Each member will be receiving identification cards from Empire Blue Cross Blue Shield shortly.

Eligibility for Disabled Members

If you currently are receiving short-term disability benefits and are covered by one of the health plans offered by the Fund on December 1, you will receive the same number of bank hours as an active participant. 

For each week you are receiving disability benefits, 20 hours will be added to your bank. The maximum number of weeks you can receive short-term disability benefits is 26 weeks. 

Eligibility for Retiree Health Coverage

No changes were made to the eligibility requirements for retiree health coverage.

Once you have retired, the Fund will no longer maintain an hours bank account for you. This is still true even if you work in covered employment, as long as you continue to receive a retirement benefit from the Pension Fund.

If you decide to return to active work, you must tell the Fund not to pay you your pension benefit. You will receive six months of your current retiree medical coverage, provided you continue to contribute towards the cost of that plan (see below for new retiree contributions). During that time, the Fund will once again accumulate your hours in a bank and you will become eligible for active coverage according to the same rules as any other active member. 

Dental Coverage top

A number of changes have been made to the dental plan effective January 1, 1999.

Specifically:

a per family member annual benefit maximum of $1,500 has been instituted for non- orthodontic services.

major restorative work, such as bridgework, dentures, etc. will only be replaced once every five years.

the deductible is waived for any preventive service such as exams and cleanings.

adults will no longer be eligible for orthodontia coverage; it will be limited to dependent children only.

It is hoped that by waiving the deductible for preventive services, more members and their dependents will visit the dentist regularly.

A further change is that Self-Insured Dental Services ("SIDS"), which currently provides the network of dentists to the Fund, will now also take over the payment of claims as well.

The network has been expanded to provide stronger access to the membership. With SIDS responsible for both the claims and network, there will be greater integration in the program and better service for everyone.

SIDS will be sending out directories and identification cards in late December.

All dental claims, regardless of when the services are incurred, should be sent to SIDS at the following address:

Self-Insured Dental Services

P.O. Box Dept. 95

Valley Stream, New York 11582

If you visit a participating dentist, you do not need to file a claim form. The doctor will file the form and accept the fee from SIDS as payment in full. You may also have a non-participating dentist receive payment from SIDS, but the doctor is under no obligation to accept the fee as payment in full. In that case, you may receive a bill for the balance from the dentist.

You can call SIDS with any questions at: (516)396-5500 or (718)204-7172.

 

Prescription Drug Coverage top

We have changed the prescription drug vendor to CareMark. CareMark offers a large network to all of our members. Directories and identification cards will be arriving during the month of December.

Further, some changes have been made to the copayments as well.

Active Members

An active member filling a prescription at a participating local pharmacy will be covered at 100% after a $6 copay for a brand name drug and $0 for a generic. Generally, this covers short-term, one-time prescriptions, such as antibiotics for an ear infection, for example.

For medications taken for a chronic condition (for example, high blood pressure or heart medication), an active member who uses the mail order feature will be covered at 100% after a $6 copay for a brand name drug or $0 copay for a generic drug. These prescriptions can be filled by mail for up to a ninety day supply and the member only has to pay the copay once.

Retired Members

If you are a retired member of the Fund and receive health coverage, you will continue to have coverage for prescription drugs.

A retired member filling a prescription at a local pharmacy will be covered 100% after a $10 copay for a brand name drug and a $5 copay for a generic drug.

For mail order prescriptions, the benefit will be 100% after a $10 copay for brand and a $5 copay for generic drugs. Keep in mind, that these copays cover up to a ninety day supply.

To receive a mail order drug form, please call the Fund Office. 

Early Retiree Coverage top

The Fund provides health care to our members who retire at age 55. Currently, these members are offered a limited benefits health plan from GHI. Effective January 1, 1999, the health plan provided to early retirees will be issued from Empire Blue Cross Blue Shield.

The new plan offers an enhanced level of benefits, with a broader network. Further, retirees who move out of the New York metropolitan area, will continue to have access to a network of providers through the Blue Cross Blue Shield association. 

Another change is that any member who has retired and is covered under the GHI plan or who retires between the ages of 55 and 65 after January 1, 1999, will be covered under the new Blue Cross Blue Shield plan for retirees under age 65, and will not change health plans until they reach age 65 and become eligible for Medicare. As a result, there will be no vision or dental coverage for any current GHI covered early retiree or any future retirees.

A summary of the new Blue Cross Blue Shield under 65 retiree plan of benefits is attached.

Retiree Contributions

Effective January 1, 1999, all retired members who elect to receive coverage under the Health and Welfare Fund will pay a portion of the cost of the plan.

For retirees under the age of 65, the contribution will be 37.5% of the total cost. For retirees age 65 and older, the contribution will be 18.75% of the total cost.

If you would like to continue your health coverage, you must sign the attached authorization form permitting the plan administrator to deduct the cost of coverage, as shown, from your pension check. As an alternative, you can elect to be billed directly on a quarterly basis. If you later decide you no longer want coverage, you can notify the administrator in writing. However, once you terminate your coverage, you cannot rejoin the plan at a later date

If you or your family members currently have other health coverage, you may choose not to elect coverage now. When you and/or they lose coverage, you may add them to this plan at that time.

Contribution amounts will change annually. 

Life Insurance top

The life insurance maximum benefit has been increased from $45,000 to $50,000 for active members. The life insurance benefit formula is one times the highest 24 of the last 30 months of earnings immediately preceding death.

For retired members, the life insurance benefit has been increased from $7,500 ($3,500 from the Pension Fund and $4,000 from the Welfare Fund) to $8,000 all of which will be insured by the Welfare Fund. 

Reconstructive Surgery Following a Mastectomy

A new federal law has been enacted requiring plans to cover certain reconstructive surgery following a mastectomy. Effective on January 1, 1999, the Welfare Fund will cover expenses associated with reconstructive surgery following a mastectomy, expenses for reconstructive surgery on the other breast to achieve symmetry, the cost of prostheses and the costs for treatment of physical complications at any stage of the mastectomy including lymphedemas. Some of these expenses were already covered by the Fund. Normal Fund deductibles and coinsurance will continue to apply.