Active Employee Schedule of Benefits

Retired  Employee Schedule of Benefits 

Summary Plan Description (SPD)

See SCHEDULE OF BENEFITS Section for CURRENT Benefit Levels

Summary of Changes in the IBEW Local 701 Welfare Fund Plan Description

To All Participants in the I.B.E.W. Local No. 701 Welfare Fund

Please read this notice carefully and keep it with your Summary Plan Description (SPD) for future reference.

     Change in Prescription Drug Manager   

SAV-RX TO ADMINISTER PRESCRIPTION DRUG PROGRAM

Sav-Rx will begin managing the Plan’s drug card program beginning November 1, 2003.  The Plan’s copays, and the types of covered and non-covered drugs, are not changing.   

To ease the transition from the current drug program to the new Sav-Rx program, the Trustees have arranged with the current prescription provider (ESI) to have all ongoing mail-order prescriptions transferred to Sav-Rx.  You should be able to order any remaining refills through the Sav-Rx mail-order pharmacy without getting a new written prescription from your doctor.

Before November 1, Sav-Rx will mail you a packet of information including new I.D. cards and a list of Sav-Rx participating pharmacies. 

Watch your mail for the Sav-Rx packet—it is important that you begin using your new prescription card and the new mail-order pharmacy November 1.  Please discard your old drug cards on November 1. 

Note:  To protect your identity and preserve your privacy, the member I.D. number on your new prescription drug card will not be your Social Security number.  

MSA for 2003

The Medical Savings Allowance (MSA) amount for 2003 will be $250.  All rules governing your MSA will continue to apply (see pages 54 and 55 in your SPD).

 Change in Vision Provider 

Beginning February 15, 2003, National Vision Administrators (NVA) will replace Cole Vision as the Fund’s vision service provider.  The benefits the Plan pays for vision care have not changed.  These benefits are described in your Summary Plan Description booklet (SPD) on page 5 (pages 9–10 for retirees).  Remember that the Plan pays higher benefits if you use a participating doctor. 

You will be receiving in the mail a welcome packet from NVA.  The packet will include a brochure explaining NVA’s program, ID cards for you and your family, a list of participating doctors, and other important information.  You can also find an NVA doctor in your area by calling 1-800-672-7723, or visiting www.e-nva.com. 

Your Rights Under ERISA

As a participant in the IBEW Local 701 Welfare Plan, you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA).  ERISA provides that all Plan participants shall be entitled to:

Receive Information About Your Plan and Benefits

• Examine, without charge, at the Fund Office and at other specified locations, such as worksites and union halls, all documents governing the Plan, including insurance contracts and collective bargaining agreements, 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 Pension and Welfare Benefit Administration.

• Obtain, upon written request to the Fund Office, copies of documents governing the operation of the Plan, including insurance contracts and collective bargaining agreements, and copies of the latest annual report (Form 5500 Series) and updated summary Plan description. The Fund Office  may make a reasonable charge for the copies.

• Receive a summary of the Plan's annual financial report.  The Plan is required by law to furnish each participant with a copy of this summary annual report.

Continue Group Health Plan Coverage

• Continue health care coverage for yourself, spouse or dependents if there is a loss of coverage under the Plan as a result of a qualifying event.  You or your dependents may have to pay for such coverage.  Review your Summary Plan Description and the documents governing the Plan on the rules governing your COBRA continuation coverage rights.

• You should be provided a certificate of creditable coverage, free of charge, from your group health Plan or health insurance issuer when you lose coverage under the Plan, when you become entitled to elect COBRA continuation coverage, when your COBRA continuation coverage ceases, if you request it before losing coverage, or if you request it up to 24 months after losing coverage.  Without evidence of creditable coverage, you may be subject to a preexisting condition exclusion for 12 months (18 months for late enrollees) after your enrollment date in your new coverage.

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, your union, or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a welfare benefit or exercising your rights under ERISA.

Enforce Your Rights—If your claim for a welfare 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 administrator.  If you have a claim for benefits which is denied or ignored, in whole or in part, you may file suit in a state or federal court. In addition, if you disagree with the Plan's decision or lack thereof concerning the qualified status of a medical child support order, you may file suit in Federal court.  If you believe that Plan fiduciaries misuse the Plan's money, or if you believe 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 you have any questions about your Plan, you should contact the Fund Office.

Assistance With Your Questions—If you have any questions about this statement or about your rights under ERISA, or if you need assistance in obtaining documents from the Fund Office, you should contact the nearest office of the Pension and Welfare Benefits Administration, U.S. Department of Labor, listed in your telephone directory or the Division of Technical Assistance and Inquiries, Pension and Welfare Benefits 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 Pension and Welfare Benefits Administration.

How to Read or Get Plan Material—You can read the material listed in the previous section by making an appointment at the Fund Office during normal business hours.  This same information can be made available for your examination at certain locations other than Fund Office. The Fund Office will inform you of these locations and tell you how to make an appointment to examine this material at these locations.  Also, copies of the material will be mailed to you if you send a written request to the Fund Office.  There may be a small charge for copying some of the material. Before requesting material, call the Fund Office to find out the cost.  If a charge is made, your check must be attached to your written request for the material.  The Fund Office address and phone number are shown on the first page of this notice.

Annual Mastectomy Benefit Notice

The IBEW Local 701 Health Insurance Plan covers the following medical and surgical services  performed in connection with a mastectomy:  Reconstruction of the breast on which the mastectomy was performed; surgery and reconstruction of the other breast to produce a symmetrical appearance; and Prostheses and treatment of physical complications of all stages of mastectomy. 

The Board of Trustees have made the following changes to your Benefit Plan.  Please read this notice carefully and keep it with your Summary Plan Description (SPD) for future reference. 

Alternative Medicine  – Beginning June 1, 2002, the Plan is being amended to cover a larger variety of alternative medicine treatments and therapies.  The following types of therapies will now be included in this coverage category:

1.   Acupuncture treatments and therapies

2.      Naprapathic treatments and therapies

3.      Naturapathic treatments and Therapies

4.      Homeopathic treatments and therapies

5.      Massage therapy

6.      Chiropractic treatments and therapies 

A $2,600 calendar year maximum benefit per person will apply to alternative medicine, including chiropractic treatment.  There will no longer be a separate benefit for chiropractic treatments.  However, the maximum number of visits per calendar year for chiropractic treatment will remain the same (see page 8 of your SPD booklet). 

 Self-Inflicted Injuries  -  As stated in exclusion No. 8 on page 70 of your SPD, the Plan excludes all intentionally self-inflicted injuries or illnesses, or any injuries or illnesses caused by suicide or attempted suicide.  Effective June 1, 2002, the Plan will provide coverage for self-inflicted injuries or illnesses if the injury or illness resulted from a medical condition (including both physical and mental health conditions). 

Ø      Cosmetic Surgery  -  Effective June 1, 1997 the Plan has been amended to cover cosmetic surgery performed due to a non-occupational accidental injury, regardless of when the injury occurred, subject to the Plan’s eligibility rules at the time the services are performed.  Previously, these procedures were only covered if the injury occurred while the person was covered under the Plan. 

Ø      Weekly Loss of Time Benefits  -  Effective January 1, 2002 the following claim processing and appeal procedures will apply to the Weekly Loss of Time benefits: 

1.      Claim processing time limits  -  The Fund Office receives claims, Monday through Friday, during regular business hours.  If all information is provided to the Fund Office, your claim will usually be processed within 45 days.  If you send a claim to the Fund Office which can’t be processed because of missing information, you will receive a notice stating why the claim can’t be completed and what additional information is needed.  The notice about incomplete claim information will be sent to you within 45 days.  It is your responsibility to send the missing information to the Fund Office.

When all necessary information has been received, approval or denial of a claim will usually be made within 30 days.  An extension may be necessary due to matters beyond the control of the Plan.  You will be notified prior to the expiration of the normal approval/denial time period if an extension is needed.  If an extension is needed, it will not last more than 30 days.  A second 30 day extension may be needed in special circumstances beyond the Plan’s control. 

2.      Claim denials  -  If all or a part of your claim for Weekly Loss of Time benefits is denied after the Fund Office has received a completed claim form and all other necessary information from you, you will be sent a written notice giving you the reasons for the denial.  The notification will state:  (1) the specific reason for the determination with reference to the specific Plan provision(s) on which the determination was based;  (2) a description of any additional material or information necessary to perfect the claim, and the reason such information is necessary;  (3) a description of the review procedures and the applicable time limits for following the procedures, including a statement of your right to bring a civil action under section 502(a) of ERISA;  (4) the specific internal rule, guideline, protocol or similar criterion the administrator relied on to make the decision (if applicable); and (5) if the decision was based on medical necessity, either an explanation of the scientific or clinical judgment for the determination or a statement that such explanation will be provided free of charge upon request. 

3.      How to file a claim  -  If you want the Trustees to review your claim after a denial of Weekly Loss of Time benefits, request a claim appeal form from the Fund Office.  When you receive the form, fill it out completely, and attach any information that you think will help a favorable decision to be made on your claim.  Return the completed form within 180 days after the date the denial was mailed to you to:  Board of Trustees, IBEW Local 701 General Welfare Fund, 28600 Bella Vista Parkway, Suite 1110, Warrenville, IL 60555-1600. 

4.      Full and Fair Review – The Trustees will conduct a full and fair review of all the material submitted with your Loss of Time benefits claim, the action taken by the Fund Office, the additional information you have provided, and the reasons you believe the claim should be paid.  The review will:  (1) be conducted by an appropriate named fiduciary who is neither the party who made the initial adverse determination, nor the subordinate of such party;  (2) not afford deference to the initial adverse benefit determination; and (3) take into account all comments, documents, records and other information submitted by you, without regard to whether such information was previously submitted or relied upon in the initial determination.  You have the right, upon request and free of charge, to have copies of all documents, records and other information submitted by you, without regard to whether such information relevant to your claim for benefits.  With respect to a review of any determination based on a medical judgment, the Board of Trustees must consult with a health care professional with appropriate training and experience in the field of medicine involved in the medical judgment.  Such health care provider must be “independent,” which means the medical individual consulted must be an individual different from, and not subordinate to, any individual who was consulted in connection with the initial decision.  The Plan will not preclude an authorized representative (including a health care provider) from acting on your behalf, although the Trustees will verify that an individual has been so authorized. 

5.      Notification Following Review  -  A review and determination of your Weekly Loss of Time benefit claim will be made no later than the date of the Trustees meeting that immediately follows the Plan’s receipt of a request for review, unless the request for review is filed within 30 days preceding the date of such meeting.  In such cases, a determination may be made no later than the date of the second meeting.  If special circumstances (such as the need to hold a hearing) require a further extension of time for processing, a determination will be rendered not later than the third Trustees meeting.  Before the start of the extension, you will be notified in writing of the extension, including a description of the special circumstances and the date as of which the determination will be made.  After a decision has been made, you will be informed in writing of the Trustee’s decision, normally within 5 calendar days of the review.  When you receive the decision on your appeal, it will contain the reasons for the decision and specific references to the particular Plan provisions upon which the decision was based.  It will also contain a statement explaining that you are entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to your claim; a statement describing any voluntary appeal procedures offered by the Plan and your right to obtain the information about such procedures; and a statement of your right to bring an action under section 502(a) of ERISA.  If applicable, you will also be informed of the specific internal rule, protocol or similar criterion relied upon to make the decision.  If the decision was based on a medical judgment, you will receive an explanation of the determination or a statement that such explanation will be provided free of charge upon request.  If the Plan fails to make timely decisions or otherwise fails to comply with the applicable federal regulations, you may go to court to enforce your rights.

 Qualified Medical Child Support Orders (QMCSOs)  The Plan is sometimes presented with a court order to provide coverage for a child who would not otherwise be considered a covered dependent.  Court orders must meet certain conditions before the Plan may be obligated to provide such coverage.  Qualifying orders are called “Qualifying Medical Child Support Orders” (QMCSOs).  If you would like a copy of the Plan’s QMCSO procedures, please call or write the Fund Office.  If you are a responsible party in a court action involving a child, you should request a copy of the Plan’s procedures BEFORE the final order is entered.  

Call the Fund Office at (630) 393-1701 if you have any questions about these changes.