Med-Care Management (24 hours)  (800) 423-7781

Members Assistance Program (MAP) 24 hours (630) 416-2183

If your outpatient treatment for Mental or Nervous Disorders, chemical dependency, or substance abuse is not assessed or referred through MAP, the Plan will pay no benefits for such treatment.

Vision Benefits   NVA (National Vision Administration) (9-9 M-F EST and 9-5 Sat. EST)   (800) 672-7723

Podiatry Network AFAS hotline (800) 775-8829

Call the AFAS hotline for referrals in your area or to ask general questions.

To All Plan Participants and Their Eligible Dependents:

The Trustees of the I.B.E.W. Local No. 701 General Welfare Fund are pleased to present you with this revised Welfare Fund booklet which describes the eligibility rules and benefits available to you and your Eligible Dependents.

This Plan has been designed to assist you in meeting the present day cost of health care. Since the last booklet was printed, many changes and improvements have been made. Be sure to read the Schedule of Benefits on pages 1-11 to get an overview of your benefits.

Every effort has been made to make this booklet understandable. We urge you to read this booklet carefully so that you will be aware of the benefits available to you. If you have any questions about the Plan or about your eligibility for benefits, please contact the Welfare Fund Office. The Welfare Fund Office and the Board of Trustees will be happy to assist you.

Sincerely,

2a.  Eligibility Rules

• Definition of Credited Hour
• If You Are Currently Eligible
• If You Are a New Employee in the JATC Program or If You Are a Participant Who Has Lost Eligibility under
  the Jurisdiction of Local Union No. 701
• If You Are a New Employee Who is NOT in the JATC Program and Have Never Been Eligible under the
  Jurisdiction  of Local Union No. 701
• How Eligibility Continues
• When Eligibility Ends
• Self-Payment Provisions
• Family and Medical Leave Act (FMLA)
• How Eligibility Can Be Reinstated
• Reinstatement after Military Service
• How Eligibility May Be Continued during High Periods of Unemployment
• Reciprocal Agreements
• Employer Contributions for Work outside the Fund’s Jurisdiction
• Employer Contributions for Work outside the Bargaining Group

3a.  Life Insurance Coverage Provided by Union Labor Life Insurance Company

3b.  Accidental Death and Dismemberment Insurance Coverage Provided by Union Labor Life Insurance Company

3c.  Weekly Loss of Time Benefit

4a.  Supplemental Accident Expense Benefit

4b.  Physical Examination Benefit

4i.  Members Assistance Program

4k.  Subrogation

5.  Claims Filing and Review

6.  General Plan Provisions

Contributing Employer means any employer who, according to the terms of a collective bargaining agreement, agrees to contribute to the I.B.E.W. Local No. 701 Welfare Fund on your behalf.

Custodial Care means care designed mainly to help a person with daily living activities. It is not care primarily intended to help a person recover from an Injury or Illness.

Dependent means the following categories of individuals:

1. Your spouse;

2. Your unmarried Children who are less than 19 years of age and depend upon you for support and maintenance;

3. Your unmarried Children who are at least 19 years of age but less than 25 years of age and who are full-time students at an accredited school and depend upon you for support and maintenance (these individuals will be considered students for three full months after their last day of classes). If a Dependent child loses full-time student status because of a medical leave, he or she will be covered for the duration of the leave provided that he or she returns to full-time school status at the conclusion of the medical leave; and

4. Your unmarried Children of any age who are physically or mentally incapable of self-support and depend upon you for support and maintenance. The child must have become physically or mentally incapable of self-support before coverage under the Plan had ended. You must provide proof of your child’s incapacity at least 31 days before the child would otherwise cease to be eligible for Plan benefits and from time to time, thereafter, as requested by the Trustees.

Note: "Children" means children who are naturally born to you, who are legally adopted by you, who are your step-children, foster children or other children who live with you in a regular parent-child relationship and whom you claim as a federal income tax deduction. Children also means children who are listed in a Qualified Medical Child Support Order (QMCSO). "Legally adopted" means from the time the child is placed in your home for purposes of adoption.

The definition of Dependent will not include an individual who is covered as an Employee under this Plan.

Eligible Dependent means any Dependent who is eligible to receive benefits under this Plan in accordance with the eligibility rules beginning on page 18.

Eligible Employee means any actively employed individual who is eligible to receive Employee benefits under this Plan in accordance with the eligibility rules beginning on page 18. There are separate rules and benefits for active Employees and Maintenance D Employees.

Eligible Retired Employee means any individual who is eligible to receive Retired Employee benefits from this Welfare Fund.

Employee generally means any person who is covered by a collective bargaining agreement, or performs work that is covered under a collective bargaining agreement, between the Union and a ContributingEmployer, or any individual on whose behalf an employer is obligated to make contributions to the Fund, including non-bargained persons employed by the Union or the Fund.

Experimental or Investigative means any treatment, procedure, facility, equipment, drug, device, or supply which falls within any one of the following categories:

Home Health Care means services and supplies which are:

1. Ordered in writing by the covered person’s Physician; and

2. Provided in the covered person’s home by a Home Health Care Agency team.

The Home Health Care must be in place of a needed Hospital stay or a stay in a Skilled Nursing Facility. Also, it must be for the care or treatment of sick or injured persons. Home Health Care consists of the following services and supplies:

1. Part-time or intermittent home nursing care from, or supervised by, a registered nurse;

2. Part-time or intermittent home health aid services;

3. Physical therapy, occupational therapy, and speech therapy; and

4. Medical supplies, drugs and medications prescribed by a Physician, and lab services — but only to the extent that they would have been covered in a Hospital or Skilled Nursing Facility.

Home Health Care Agency means a public or private agency that:

1. Specializes in giving nursing or therapeutic services in the home;

2. Is licensed as a Home Health Care Agency; and

3. Operates within the scope of its license.

Each visit of four hours or less from a Home Health Care Agency team is considered a single visit.

Hospice means a facility, or part of one, which:

Hospital means a licensed institution, accredited by the Joint Commission on Accreditation of Health Care Organizations, other than a Skilled Nursing Facility, that provides inpatient medical care and treatment for sick and injured persons. Services provided by a Hospital must also include all of the following:

1. Facilities for diagnosis of Injury and Illness on its premises;

2. Full-time supervision by at least one Physician;

3. 24-hour nursing service by registered nurses;

4. Surgery or formal arrangements for available surgical facilities; and

5. Therapeutic care of patients who are convalescing from Injury or Illness.

An institution that is used primarily as a rest home, nursing home, convalescent home, a place for the aged, or a place for alcohol or substance abuse shall be excluded from this definition of Hospital.

Illness means any of the following conditions:

1. When the body’s organs do not function normally;

2. When a temporary ailment reduces the body’s ability to function normally; or

3. Pregnancy.

Injury means bodily harm which is caused by an accident. It includes all Injuries received in any one accident.

Medically Necessary means any service, supply or treatment which:

Mental and Nervous Disorder means all forms of illnesses in which psychological, intellectual, emotional, or behavioral disturbances are the dominating feature as manifested in maladaptive behavior or impaired functioning, whether caused by genetic, physical, chemical, biological, environmental, psychological, social, or cultural factors, meeting the criteria further described in the Diagnostic and Statistical Manual of Mental Disorders (Third Edition-Revised) and any subsequent revisions of the American Psychiatric Association, Axis I, supported by the enumeration of Axis II through Axis V therein, but excluding DSM IV R/V codes and developmental disorders.

Treatment for Mental and Nervous Disorders is only available through the Members Assistance Program (MAP) Benefit. See page 63 for details.

Physician means a person who is licensed to practice medicine by the governmental authority having jurisdiction over such licensure, and who is operating within the scope of this license. "Physician" shall include and be limited to: Doctors of Medicine, Chiropodists, Osteopaths, Podiatrists, Doctors of Dental Surgery, Chiropractors, Psychiatrists, Masters of Social Work (MSW), Licensed Clinical Social Workers (LCSW), Clinical Psychologists, Certified Addictions Counselors, and Naprapaths.

Reasonable and Customary Charges means charges within the 90th percentile of those charges determined by comparing the amount charged for medical services or supplies with prevailing charges made by a majority of medical service providers in the community.

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Skilled Nursing Facility means a licensed institution, other than a Hospital, which provides:

1. Inpatient medical care and treatment to convalescing patients;

2. Full-time supervision by at least one Physician or registered nurse;

3. 24-hour nursing service by licensed professional nurses;

4. Complete medical records for each patient; and

5. Utilization review plans for all patients.

NOTE: The exact text of these and other definitions are contained in Article II of the Rules and Regulations.

The benefits described in this booklet are for employees working under a collective bargaining agreement which requires their employer to make contributions on their behalf to the I.B.E.W. Local No. 701 General Welfare Fund. The following pages describe the eligibility rules for active Employees and their Eligible Dependents, Maintenance D Collective Bargaining Agreement Employees, and Retired Employees and their Eligible Dependents. (back)

Definition of Credited Hour

Credited Hour—A credited hour means work performed under the jurisdiction of Local Union No. 701 International Brotherhood of Electrical Workers for which a Contributing Employer makes the required hourly contribution to the Electrical Workers General Welfare Fund on behalf of the employee performing the work.

If You Are Currently Eligible

If you are currently eligible, you will remain eligible until you fail to meet the requirements described in the provisions of "How Eligibility Continues" on page 20.

If You Are a New Employee in the JATC Program or If You Are a Participant Who Has Lost Eligibility under the Jurisdiction of Local Union No. 701

If you are not currently eligible for benefits, you will become eligible on:

• the first day of the month following the month in which at least 300 credited hours are paid on your behalf by one or more Contributing Employers during any contribution quarter.

OR

You will be covered for the three-month coverage quarter, or the remainder of the coverage quarter, in which you become eligible for benefits (see table on page 21).

If you are not actively at work due to disability on the date your benefits would have become effective, you will be eligible for all benefits beginning on that date except the Weekly Loss of Time Benefit. The Weekly Loss of Time Benefit will become effective when you return to active work.

If you are not currently eligible for benefits, you will become eligible on the first day of the month following the month that one of the following requirements is met:

- 800 credited hours are paid on your behalf by one or more Contributing Employers during any six-consecutive-month period; or

- 1,200 credited hours are paid on your behalf by one or more Contributing Employers during any nine-consecutive-month period; or

- 1,500 credited hours are paid on your behalf by one or more Contributing Employers during any twelve-consecutive-month period.

You will be covered for the three-month coverage quarter, or the remainder of the coverage quarter, in which you become eligible for benefits (see table on page 21).

If you are not actively at work due to disability on the date your benefits would have become effective, you will be eligible for all benefits beginning on that date except the Weekly Loss of Time Benefit. The Weekly Loss of Time Benefit will become effective when you return to active work.

How Eligibility Continues

If you do not receive 300 credited hours in a contribution quarter, you may remain eligible for benefits if 1,200 credited hours have been paid to the Fund on your behalf by a Contributing Employer over a twelve-month period in accordance with the following schedule:

When Eligibility Ends

Your eligibility will end on:

a. One of the four termination dates at the end of the coverage quarter for which you do not have the required credited hours, unless you make a correct and timely self-payment for COBRA Coverage as specified in "COBRA Continuation Coverage." The termination dates are:

December 31
March 31
June 30
September 30

Self-Payment Provisions

If you fall short of the continuing eligibility requirement of 300 credited hours in a contribution quarter, or 1,200 credited hours during the previous twelve-month period, you may make up to four quarters of self-payments without losing eligibility and having to meet the initial eligibility requirement again. Your self-payment will be an amount equal to the difference between 300 credited hours in a contribution quarter and the actual contribution hours for the most recent contribution quarter, or the difference between 1,200 credited hours and the actual contribution hours for the most recent twelve-month period, whichever is less. If, during this period, you work at least 300 credited hours in a single contribution quarter, you will be allowed to self-pay for an additional four quarters after that contribution quarter without having to meet the initial eligibility requirements.

You must make self-payments for consecutive coverage quarters so that there is no break in your eligibility and so your eligibility remains continuous. In the event that your eligibility terminates because you fail to make your self-contribution on time, you will lose the right to make future self-payments until you return to work and subsequently reinstate your eligibility by meeting the requirements outlined under the provisions of "If You Are a New Employee in the JATC Program or If You Are a Participant Who Has Lost Eligibility under the Jurisdiction of Local Union No. 701" beginning on page 19.

Self-payments must be received by the Welfare Fund Office prior to the first day of the month for which coverage is being paid. Payments received after this date will be returned to you and your coverage will end. You will have to meet the initial eligibility requirements to become covered again.

Your eligibility under the regular self-payment rule will end on the last day of the coverage quarter on which you last make self-payments or on the last day of the fourth consecutive coverage quarter for which you made self-payments.

Under no circumstances will you be allowed to make self-payments toward the establishment of initial eligibility.

Family and Medical Leave Act (FMLA)

The Family and Medical Leave Act of 1993 (FMLA) creates a new federal right for you to take up to 12 weeks of unpaid leave for your serious illness, after the birth or adoption of a child, or to care for your seriously ill spouse, parent or child, if you qualify. The Family and Medical Leave Act requires certain employers to maintain health care coverage during the leave period. If you qualify and take a family or medical leave, your benefits are protected. If you think that this law may apply to you, please contact the Welfare Fund Office.

How Eligibility Can Be Reinstated

If you lose eligibility for benefits because you do not have the required credited hours or you have not made the required self-payment, you may again become eligible as a new Employee as described beginning on page 19, unless the provisions governing reinstatement after military service described below apply.

Reinstatement after Military Service

If you leave covered employment to enter full-time military service, with re-employment rights protected under federal statute, your eligibility and any accumulated credited hours will be frozen during the period of your active duty. After your release from active duty, your eligibility will be reinstated on the date you return to work with a Contributing Employer, provided your return to work is within the time prescribed by federal law.

How Eligibility May Continue during Periods of High Unemployment

If you do not meet the 300- or 1,200-credited-hours continuing eligibility requirements due solely to a high level of unemployment in the industry, the Board of Trustees may grant you hours to continue eligibility. No hours will be granted until you have made a self-payment of at least 100 hours for a contribution quarter according to the provisions of "Self-Payment Provisions" and you have used up your Medical Savings Allowance Benefit. You may contact the Fund Administrator to see if you can be granted hours for the next contribution quarter. You will only be able to continue your eligibility in this manner for four consecutive quarters.

Reciprocal Agreements

Sometimes the Fund signs a Reciprocal Agreement with another Fund outside our jurisdiction. The purpose of this agreement is to help you establish or maintain eligibility for benefits based upon the combined credited hours submitted to all reciprocal funds. However, eligibility under the Electrical Workers General Welfare Fund will be withheld until the contributions from reciprocal funds are transferred to this Fund.

Employer Contributions for Work outside the Fund’s Jurisdiction

Employers may continue to contribute for you even though you are working outside the territorial jurisdiction of the Fund, provided the employer continues to be recognized as a Contributing Employer by the Trustees.

Employer Contributions for Work outside the Bargaining Group

If you work outside the bargaining group, your eligibility will be continued until the earliest of:

If you meet the eligibility requirements, your Dependents will be eligible for benefits under this Plan if they meet the definition of Dependent found on page 12 of this booklet. However, if a Dependent other than a newborn child is confined in a hospital or totally disabled on the date he or she would otherwise become eligible for benefit coverage, he or she will not become eligible until the date that total disability or hospital confinement ends. Adopted children are covered from the time they are placed in your home for adoption.

Continuing Eligibility

Your Dependent will be eligible for benefits as long as your eligibility is maintained in accordance with the Employee eligibility rules and any applicable continuation of coverage rules explained in the Plan.

New Dependents

If you acquire a Dependent while eligible for benefit coverage, that Dependent will automatically and immediately be eligible for benefits. However, if a Dependent other than a newborn child is confined in a hospital or totally disabled on the date he or she would otherwise become eligible for benefit coverage, he or she will not become eligible until the date that total disability or hospital confinement ends. Adopted children are covered from the time they are placed in your home for adoption.

If Both Parents Are Covered As Employees

If both you and your spouse are Eligible Employees under this Plan, your children may be covered as Dependents of either you or your spouse, but they cannot be covered as Dependents of both of you.

When Dependent Eligibility Ends

The eligibility of a Dependent will end on the earliest of any of the following dates:

If you are covered by the Maintenance D Collective Bargaining Agreement and meet the requirements below, you will be eligible for the medical benefits available under the Plan. You will not be eligible for Life or Accidental Death & Dismemberment Insurance, Weekly Loss of Time Benefit, Dental Benefit or Vision Benefit or the Prescription Drug Program. In addition, the medical benefits will only cover you — your dependents will not be covered.

When Eligibility Begins

Eligibility is determined by the total contributions made by Contributing Employers to the Fund on your behalf. Employer Contributions are due by the 15th day of the month following the month worked. Employer Contributions received by the Fund on your behalf will be credited to your Dollar Bank.

Initial Eligibility

To qualify for initial eligibility you must have at least $175.00* in your Dollar Bank. This amount can be accumulated over a twelve-consecutive-month period.

*This amount may change in the future.

You will become eligible for benefits on the first day of the month following the month in which you accumulated at least $175.00 in your Dollar Bank.

For example, your Employer(s) begin(s) to send contributions to the Fund on your behalf in February. The Fund receives:

February 75 hours X $1.30 = $ 97.50

March 50 hours X $1.30 = $ 65.00

April 100 hours X $1.30 = $130.00

Hours worked in February are received by the Welfare Fund Office on March 15. On that date you have $97.50 in your Dollar Bank. On April 15 the Welfare Fund Office receives contributions for the hours you worked in March, and you have $162.50 ($97.50 + $65.00) in your Dollar Bank. On May 15 the Fund receives the $130.00 contribution for the 100 hours worked in April. This Employer Contribution gives you a total of $292.50 in your Dollar Bank. The Fund will begin to cover you on June 1. At that time $175.00 will be deducted from your Dollar Bank. This will provide you with coverage for one calendar month and the remaining $117.50 will stay in your Dollar Bank.

How Eligibility Continues

Once you meet the initial eligibility requirement, you will continue to be eligible on a month-to-month basis as long as you have at least $175.00 in your Dollar Bank.

If you fall short of the continuing eligibility requirement of $175.00 in your Dollar Bank, you will be allowed to remain eligible by self-paying the difference between $175.00 and the amount in your Dollar Bank. You will be able to make partial or full self-payments for up to twelve months without having to meet the initial eligibility requirements again. If, during this period, your Employer(s) contribute(s) at least $175.00 to the Fund on your behalf during any one calendar month, you will be allowed to self-pay for another twelve months without having to meet the initial eligibility requirements.

When Eligibility Ends

You may elect continuation coverage as required under the Consolidated Omnibus Budget Reconciliation Act of 1986 ("COBRA") as an alternative to any other self-payment provisions provided under this Plan. If you choose COBRA Continuation Coverage (COBRA Coverage), you cannot elect any other self-pay option under this Plan. If you were making self-payments in accordance with the provisions on page 22, you can elect COBRA Continuation Coverage. However, your maximum coverage period of 18 months will begin in the month in which you first made a self-payment under the rules on page 22.

Qualifying Event/Maximum Coverage Period

You or your Dependent may continue health coverage for up to 18 months after Plan coverage would otherwise terminate due to one of the following events (called a "qualifying event"):

1. A reduction in the number of hours worked, as provided under the eligibility requirements of the General Welfare Fund;

2. Termination of employment for any reason other than gross misconduct; or

3. Your failure to return to work after a FMLA leave as explained on page 23.

If you or any of your Dependents are disabled as defined by Social Security for the purpose of Social Security disability benefits on the date of one of the qualifying events listed above, or if you or any of your Dependents becomes so disabled within 60 days after an 18-month COBRA period starts, the maximum coverage period will be 29 months for all members of your family who were covered under the Plan on the day before that qualifying event. The COBRA self-payment is higher for the extra 11 months of coverage.

Your Dependent may continue health coverage for up to 36 months after Plan coverage would otherwise terminate due to one of the following "qualifying events":

If You Are Entitled to Medicare

If you are entitled to Medicare when coverage would otherwise terminate due to termination of employment or a reduction in hours, your Dependents will be entitled to COBRA coverage for up to 36 months measured from the date of your Medicare entitlement or 18 months measured from the date coverage would otherwise terminate due to termination of your employment or a reduction in hours, whichever period is longer. Please advise the Welfare Fund Office when you become entitled to Medicare.

Multiple Qualifying Events

If your Dependents are covered under an 18-month COBRA period due to termination of your employment or a reduction in hours, their COBRA coverage period may be extended as explained below if a second qualifying event (any of the following qualifying events) occurs during that 18-month period: your death, a child’s failure to meet the definition of a Dependent, or your divorce or legal separation from your spouse.

If any of these events occur, your spouse and children (or the child) are entitled to elect COBRA coverage for up to a maximum of 36 months minus the number of months of COBRA coverage already received under the 18-month continuation.

Only a person (spouse or child) who was your Dependent on the day before the occurrence of the first qualifying event (termination of your employment or a reduction in hours) is entitled to make an election for this extended coverage when a second qualifying event occurs except as follows: if a child is born to you (the Eligible Employee), adopted by you or placed with you for adoption during the first 18-month continuation period, that child will have the same election rights when a second qualifying event occurs as those of a person who was your Dependent on the day before the first qualifying event.

Notification and Benefits

It is your employer’s responsibility to notify the Welfare Fund Office of any other qualifying events that could cause loss of coverage. However, to make sure you are sent notification of your election rights as soon as possible, you or your Dependent should notify the Welfare Fund Office any time any type of qualifying event occurs.

You or your Dependent who is losing coverage will be required to pay the full monthly cost of health coverage as established by the Trustees. You or your Dependent will have the option to continue medical benefits only or to continue medical, dental and vision benefits.

The benefits provided under COBRA Coverage are the same health care benefits for which you or your Dependents were eligible on the day before the qualifying event, except that you will not be eligible for Life Insurance, Accidental Death and Dismemberment Insurance or Weekly Loss of Time Benefits.

A change in the benefits provided by the Plan or the cost of coverage will apply to you or your Dependent the same way it would if you were covered under the regular provisions of the Plan.

Electing COBRA Coverage

When the Welfare Fund Office is notified of a qualifying event, an election notice and election form will be sent to you and/or your Dependents who would lose coverage due to the event. The election notice tells you about your right to elect COBRA Continuation Coverage, the due dates, the amount of the self-payments, etc. The election form is the form you or your Dependent fills in and returns to the Welfare Fund Office if you want to elect COBRA Continuation Coverage.

The person electing COBRA Continuation Coverage has 60 days after he is sent the election notice or 60 days after his coverage would terminate, whichever is later, to return the completed election form. An election of COBRA Continuation Coverage is considered to be made on the date the election form is personally delivered or mailed back to the Fund. The postmark will govern the date of the mailing.

If the election form is not returned to the Welfare Fund Office within the allowable period, you and/or your Dependents will be considered to have waived your right to COBRA Continuation Coverage.

COBRA Self-payment Rules

1. COBRA self-payments must be made monthly.

2. The amount of the monthly self-payments are determined by the Trustees based on Federal regulations. The amounts are subject to change.

3. A person electing COBRA Continuation Coverage has 45 days after the signed election form is returned to the Welfare Fund Office to make the initial (first) self-payment for coverage provided between the date coverage would have terminated and the date of the payment. (If a person waits 45 days to make the initial payment, one or more monthly payments may also fall due within that period and must also be paid at that time.)

4. The due date for each following monthly self-payment is the first day of the month for which payment is made. A monthly self-payment will be considered on time if it is received within 30 days of the due date.

5. If a self-payment is not made within the time allowed, COBRA Continuation Coverage for all affected family members will terminate. You may not make up the payment or reinstate coverage by making future payments.

Additional COBRA Coverage Rules

Termination of COBRA Coverage

Normally COBRA Continuation Coverage for a covered person will terminate at the end of the last month of the applicable maximum coverage period to which the person was entitled and for which correct and on-time self-payments were made. However, COBRA Continuation Coverage for a covered person will terminate before the end of the applicable maximum coverage period when the first of the following events occurs:

1. A correct and on-time payment is not made to the Fund;

2. The person becomes entitled to Medicare benefits;

COBRA Coverage during Military Service

If you or a Dependent is in the Military Reserve and is called up to active duty for at least 30 days, the call-up is considered a qualifying event under COBRA. You or your Dependent is entitled to make COBRA self-payments for the coverage regardless of any coverage provided by the military or government. The Plan will pay primary benefits before the military/government pays except for service-related disabilities. (back)

If you are eligible but unable to perform work because of a certified disability, you will be credited with 25 disability hours for each full week of disability for the purpose of maintaining eligibility. A certified disability is one for which you are receiving Weekly Loss of Time benefits from the Fund.

Eligibility during Permanent and Total Disability

If you become totally disabled and are receiving Weekly Loss of Time benefits, you will continue to be eligible for active Employee coverage for a period of 26 weeks. After this period, if you are totally disabled, you will be eligible for an additional 26 weeks of coverage if proof of total disability is submitted.

If you continue to be disabled beyond 52 weeks, your and your Dependents’ eligibility under the Active Employees’ benefits will continue for up to 30 months following the initial date of your disability, provided that you are applying for or receiving a Social Security Disability Award.

Your eligibility for benefits will end sooner if:

1. You recover from your total disability and/or return to work.

2. You lose eligibility for Weekly Loss of Time benefits before receiving 26 weeks of benefits.

3. You fail to provide evidence of disability, such as a doctor’s statement (26th week to 52nd week of disability) or application for Social Security Disability Award (53rd week to 30th month of disability).

Your benefits will terminate on the last day of this 30-month period unless you qualify for Retired Employees’ benefits.

If you retire on or after December 1, 1981, you must meet the following requirements in order to qualify for retiree benefits under the I.B.E.W. Local No. 701 Welfare Fund:

1. You must be receiving an Early, Regular or Disability Pension from the Electrical Workers General Pension Fund;

2. You must have been eligible for benefits from this Plan for a minimum of ten years;

3. You must have been eligible for benefits from this Plan for at least three years out of the last five years immediately preceding your retirement.

Note: If you meet these requirements and later become eligible for Active Employee benefits, then your eligibility for Retired Employees’ benefits will end. You will again become eligible for Retired Employees’ benefits when you meet the above requirements, not including No. 3.

Example: Joe is eligible for retiree health coverage upon retirement. The current cost of coverage is $300 per month. Joe has earned a monthly HCP benefit of $150. Joe will turn over his HCP benefit to the Fund to pay for coverage. Since Joe has more than 45,000 lifetime hours, the Welfare Fund will pay $150 toward Joe’s retiree health care coverage in addition to his HCP benefit of $150.

If you remarry after you become eligible for retiree benefits, you may self-pay for Retired Employee benefits for your new Dependent spouse after one year of marriage. The initial self-payment will be due on the first day of the month after twelve months from the date of the marriage. The Dependent spouse’s initial eligibility will begin on the due date of the self-payment, provided such self-payment is made. If the Dependent spouse is eligible for Medicare, no self-payment is necessary.

Preretirement Surviving Spouse Pension

Surviving spouses receiving a Preretirement Surviving Spouse Pension from the Pension Fund may self-pay for Retired Employees’ benefits for themselves and for their Dependent children.

The Trustees will determine the self-payment amount and will notify you or your surviving spouse of such amount prior to January 1 of each year. The Welfare Fund Office will not accept late payments. Late payments will be returned and coverage will end if the Welfare Fund Office receives payment after the first day of the month.

Termination of Retired Employees’ Benefits

Your eligibility for Retired Employees’ benefits under this Plan will end:

1. On the day you reestablish eligibility for active benefits;

2. Six months after you return to active employment; or

3. The first day of the month that you fail to have the required self-payment at the Welfare Fund Office.

Your Dependent’s coverage will end:

1. On the day your coverage ends;

2. On the day he or she no longer meets the definition of a Dependent described on page 12;

3. The first day of the month that he or she fails to send the required self-payment to the Welfare Fund Office;

4. With respect to your surviving spouse, on the day he or she remarries; or

5. On the date your surviving spouse and/or your children become covered under another group plan.

Providing for you and your family in the event of your disability or death is an important part of your overall financial security. The Plan offers protection for you and your family if you should die or become seriously injured or disabled.

Life Insurance Benefits are provided only for active Eligible Employees, their spouse and each eligible dependent child.

If you die from any cause, your designated Beneficiary or Beneficiaries will receive the amount of the Life Insurance Benefit specified in the Schedule of Benefits.

Designating a Beneficiary

In order to designate your Beneficiary or Beneficiaries, you must file a written "Designation of Beneficiary" form supplied by the Welfare Fund Office. You can change your Beneficiary or Beneficiaries at any time, unless you make an irrevocable designation of Beneficiary. Beneficiary designations will be effective on the date you sign the form. The Welfare Fund Office is not responsible for any benefit payments made before a new Beneficiary designation is received.

If No Beneficiary Is Designated

If you don’t designate a Beneficiary or Beneficiaries, or if none of your designated Beneficiaries outlive you, the Death Benefit will be paid equally to the members of the first appropriate class, in the following order:

• your spouse;

• your children, including legally adopted children;

• your parents;

• your brothers and sisters; or

• your estate.

Note: Your Beneficiary must provide the Welfare Fund Office with proof of your death before the Death Benefit will be paid.

A Certificate of Insurance is on file in the Welfare Fund Office and is available on request. (back)

Accidental Death and Dismemberment Insurance is provided only for active Eligible Employees.

If you accidentally die or suffer the loss of sight in both your eyes, or the loss of two limbs, or the loss of one limb and sight of one eye, the benefit is payable as shown in the Schedule of Benefits. If you accidentally suffer the loss of one hand or foot or the sight of one eye, the benefit payable will be one-half of the amount shown in the Schedule of Benefits.

The Weekly Loss of Time Benefit will be payable if you are wholly and continuously disabled by an accidental bodily Injury or an Illness which prevents you from working at your occupation and which requires the regular care and attendance of a legally qualified Physician or surgeon.

Non-Occupational Disabilities

If your disability is due to a non-occupational cause, benefits will begin on the first day of a disability due to accidental bodily Injury and on the fourth day of a disability due to an Illness. Benefits will begin on the first day of confinement for disabilities caused by confinement in an alcoholism or substance abuse treatment program, or licensed and certified mental health facility or the mental health section of a Hospital, accredited by the Joint Commission on Accreditation of Health Care Organizations, if you are complying with a treatment program recommended by the Members Assistance Program (MAP). If your confinement for alcoholism or substance abuse is not recommended by MAP, the Weekly Loss of Time Benefit will not be payable.

The Weekly Loss of Time Benefit will be equal to 2.5% of your reported earnings for the last twelve consecutive months preceding the month in which your disability occurred, up to the maximum shown in the Schedule of Benefits.

Occupational Disabilities

If your disability is due to occupational causes, benefits will begin on the first day of a disability due to an accidental bodily Injury and the eighth day of a disability due to an Illness. The Weekly Loss of Time benefit for occupational causes is payable up to the maximum shown in the Schedule of Benefits.

Length of the Weekly Loss of Time Benefit

The maximum number of weeks payable for the Loss of Time Benefit for any one period of disability is stated in the Schedule of Benefits.

Successive periods of disability due to the same or related causes will be considered one period of disability unless you return to active employment for at least 30 days between such periods.

The Weekly Loss of Time Benefit is not payable for any disability during which you are not under the direct care of a legally qualified Physician or surgeon.

Benefits will be paid at a daily rate of one-fifth of the weekly benefit during partial weeks of disability. As required by federal law, the required amount of the employee’s share of FICA tax will be deducted from each disability benefit check.

If you continue to be disabled beyond 52 weeks, your eligibility for active Employee benefits will continue for up to 30 months following your original disability date provided you are receiving or have applied for a Social Security Disability Pension. (back)

For Retired Employees Only

If you die from any cause, your designated Beneficiary or Beneficiaries will receive the amount of the Death Benefit specified in the Schedule of Benefits.

In order to designate your Beneficiary or Beneficiaries, you must file a written "Designation of Beneficiary" form supplied by the Welfare Fund Office. You can change your Beneficiary or Beneficiaries at any time, unless you make an irrevocable designation of Beneficiary. Beneficiary designations will be effective on the date you sign the form. The Welfare Fund Office is not responsible for any benefit payments made before a new Beneficiary designation is received.

If No Beneficiary Is Designated

If you don’t designate a Beneficiary or Beneficiaries, or if none of your designated Beneficiaries outlive you, the Death Benefit will be paid equally to the members of the first appropriate class, in the following order:

• your spouse;

• your children, including legally adopted children;

• your parents;

• your brothers and sisters; or

• your estate.

Note: Your Beneficiary must provide the Welfare Fund Office with proof of your death before the Death Benefit will be paid.

Your health care benefits cover most reasonable health care expenses (with certain deductibles, copayments and limitations) that you and your family may have, whether treatment, services and supplies are received in or out of the Hospital. The following sections describe these benefits and explain how they work. (back)

For Active Employees and Their Dependents, and Retired Employees and Their Dependents

The Supplemental Accident Expense Benefit will pay the amount shown in the Schedule of Benefits for services and treatments you have within 90 days of an accident due to a non-occupational accidental Injury. Expenses beyond this amount are covered under the Comprehensive Major Medical Benefit subject to the deductible and copayment.

Any treatment or service must begin within ninety days after the date of the accident. Supplemental Accident Expense benefits are not payable for dental fees or charges for eye examinations.

"Accident" means an injury received solely through an occurrence which is sudden, violent and unexpected.

For Active Employees and Their Dependents, and Retired Employees and Their Dependents

If you or any member of your family have expenses for a routine physical exam or well-child care (including related x-ray and laboratory expenses) and this exam is performed by a Physician, the charges will be payable up to the amount of the maximum Physical Examination Benefit stated in the Schedule of Benefits.

Note: Well-child care will include routine in-Hospital visits, provided the visit is other than at the time of delivery.

Charges in excess of the maximum benefit will not be considered a covered charge under any other benefit of this Plan, including the Comprehensive Major Medical Benefit.

For Active Employees and Their Dependents, Active Employees Covered under the Maintenance D Collective Bargaining Agreement, and Retired Employees and Their Dependents

The Comprehensive Major Medical Benefit pays the majority of medical expenses that you or your Dependent may have for a non-occupational Illness or Injury which are not payable under the Supplemental Accident Expense Benefit up to the Reasonable and Customary Charge.

Individual Deductible

The individual deductible is the amount of covered charges which you or your Dependent must pay each Calendar Year before the Plan pays its share under the Comprehensive Major Medical Benefit. The amount of the deductible is $100 per individual.*

The deductible also has the following features:

1. Any expenses applied against the deductible in the last three months of a Calendar Year may also be applied against the deductible for the next Calendar Year; and

2. If two or more family members are injured in the same accident or contract the same contagious disease within a period of any 30 consecutive days, all covered charges resulting from the Injury or Illness may be combined and only one deductible charged against such expenses, regardless of the number of individuals involved.

* If you do not call Med-Care Management, the Plan’s Utilization Review (UR) organization at (800) 423-7781 for precertification of any inpatient or outpatient surgery, whether in or out of the PPO network, or any other inpatient Hospital stays when using a Hospital that is not in the Plan’s Preferred Provider Organization (PPO), the benefits normally payable on your claim will be reduced by $100. The Plan will pay no benefits for inpatient treatment of Mental and Nervous Disorders, chemical dependency, or substance abuse if you do not call Med-Care Management for precertification before receiving treatment. See "Precertification Procedures" on page 49 and "Preferred Provider Organization (PPO)" on page 47 for more information.

Certain covered charges have restrictions or limitations. See the Schedule of Benefits for details or call the Welfare Fund Office.

After you reach this maximum out-of-pocket expense, the Plan pays 100% of all Reasonable and Customary Charges for the remainder of that Calendar Year, subject to certain maximums or limitations.

Precertification Procedures

If your Physician recommends inpatient treatment for a Mental or Nervous Disorder, chemical dependency, or substance abuse, and you do not callMed-Care Management, the Plan’s utilization review (UR) organization, at (800) 423-7781 for precertification before beginning treatment, the Plan will pay no benefits for such treatment.

If your Physician recommends an inpatient Hospital stay and you choose to use a provider that is not in the PPO network, you must call Med-Care Management at (800) 423-7781 for precertification before hospitalization begins. If you do not, the benefits normally payable on your claim will be reduced by $100.

Any time you have any surgery, whether inpatient or outpatient, and whether provided in or out of the PPO network, you must call Med-Care Management at (800) 423-7781 for precertification. If you do not, the benefits normally payable on your claim will be reduced by $100.

If you use providers that are in the PPO network, no precertification by you is necessary, except for inpatient treatment of Mental or Nervous Disorders, chemical dependency, or substance abuse and any surgical procedures.

Covered charges are the Reasonable and Customary Charges for the following Medically Necessary services and supplies received for the treatment of a non-occupational Illness or Injury:

1. Room and board charges up to the Hospital’s regular daily semi-private rate, or for confinement in an Intensive Care Unit, up to the Hospital’s average charge for daily intensive care, or if a private room is certified as Medically Necessary by the attending Physician, up to the average Hospital private room rate.

2. Hospital services and supplies, other than room and board.

3. Professional services of a Physician or surgeon.

4. Professional services of an assistant surgeon when required by the attending surgeon due to the complexity of the procedure. The Plan will pay 10% of the Reasonable and Customary Charges for the surgery toward the services of a Certified Surgical Assistant.

5. Services of a legally licensed physiotherapist, licensed practical nurses and graduate registered nurses, provided such services are not rendered by a member of the individual’s immediate family (a spouse, child, brother, sister or parent of the individual or the individual’s spouse), or a resident in the individual’s home.

6. Chiropractic services, up to the maximums shown in the Schedule of Benefits for the following:

a. Office visits when the treatment performed by the chiropractor is within the scope of the chiropractor’s license and is required during treatment; and

b. Diagnostic x-rays and laboratory examinations as required by the chiropractor.

7. Drugs and medicines requiring a Physician’s prescription, or necessary supplies for diabetics or after any type of ostomy surgery (e.g. colostomy, ileostomy).

8. Surgical dressing, casts, splints, trusses, braces, crutches, artificial limbs and artificial eyes, including restoration or adjustment to prosthetic devices, or rental of a wheelchair, Hospital-type bed, or an artificial respirator.

9. X-ray and laboratory examinations and x-ray and radium and radioactive isotope therapy.

10. Anesthesia and its administration, blood, blood plasma, oxygen and rental of equipment for its administration.

11. Transportation to and from a Hospital when provided through a Hospital or licensed ambulance service, except service by railroad, ship, bus, airplane or any other common carrier.

12. Outpatient Hospital services and treatment.

13. Treatment provided in a Skilled Nursing Facility, up to the maximum number of days shown in the Schedule of Benefits. Confinement in a Skilled Nursing Facility is only covered if:

a. The confinement begins within 14 days of a Hospital confinement of at least 3 consecutive days;

b. The confinement is due to the to the same or related causes as the Hospital confinement; and

c. A Hospital confinement would otherwise be needed.

The maximum room and board rate is limited to 50% of the semi-private room rate at the Hospital at which the person had been a patient just prior to the Skilled Nursing Facility confinement.

14. Services of a dentist or dental surgeon to repair damage to the jaw and natural teeth, including replacement of such teeth, that is the direct result of an accident, provided such treatment is rendered within six months of the accident.

15. Prescription back braces, up to a maximum of two per year, up to the Reasonable and Customary Charges for the geographical area and type of service.

16. Speech therapy, when prescribed by a Physician and administered by a Hospital, speech therapy institute or by a licensed speech therapist or Physician to:

a. Correct a birth defect; or

b. Regain normal speech after an accident or Illness.

17. Hospice care furnished by a Hospice agency to a terminally ill patient, up to the maximum benefit shown in the Schedule of Benefits. A terminally ill patient is a patient who has been diagnosed by a Physician as having a life expectancy of six months or less.

18. The following Home Health Care services when furnished by a Home Health Care Agency, up to the maximum number of visits shown in the Schedule of Benefits:

a. Part-time or intermittent home nursing care from or supervised by a registered nurse;

b. Part-time or intermittent home health aid services;

c. Physical therapy, occupational therapy and speech therapy; and

d. Medical supplies, drugs and medications prescribed by a Physician, and laboratory services, but only to the extent that they would have been covered in a Hospital or Skilled Nursing Facility.

Each visit of four hours or less from a member of a Home Health Agency team is considered one visit.

19. Occupational therapy to treat an Injury or Illness when prescribed by a Physician and provided by a person licensed to perform occupational therapy in a qualified medical facility.

20. Charges incurred for a voluntary sterilization operation, up to the maximum benefit shown in the Schedule of Benefits.

21. Tests and examinations to identify the cause or causes of infertility and the following treatments, up to the maximum benefit shown in the Schedule of Benefits:

a. Hormone treatment and fertility drugs, such as Clomid, Metrodin or Perganol;

b. Intrauterine insemination (IUI);

c. Surgery;

d. In vitro fertilization (IVF);

e. Gamete intrafallopian transfer (GIFT);

f. Zygote intrafallopian transfer (ZIFT); and

g. Intracytoplasmic sperm injection (ICSI).

22. Services, supplies, or appliances to treat temporomandibular joint syndrome (TMJ) up to the maximums shown in the Schedule of Benefits.

23. Services and supplies for radial keratotomy up to the maximum shown in the Schedule of Benefits.

24. Treatment for weight control, up to the maximum benefit shown in the Schedule of Benefits when under the direction of a Physician.

25. Charges made by an attending Physician or surgeon during a birth or delivery of a newborn if the charge is required by the Hospital.

26. Medically appropriate prenatal screening tests.

27. Organ donor expenses if the recipient is covered under the Plan.

28. Podiatry charges paid in accordance with the Schedule of Benefits and "The Preferred Podiatry Network (PPN)."

Important Note About Asbestosis Treatment

If you seek services and/or treatment for asbestosis, the Plan will cover your care as if it were not the result of a job-related exposure except that the Fund will be subrogated to any judgment settlement or payment based on a Workers’ Compensation claim or suit (see page 68).

The Preferred Podiatry Network (PPN)

The Preferred Podiatry Network includes providers affiliated with Associated Foot and Ankle Specialists (AFAS). AFAS is a network with over 120 locations in the Chicago area. They guarantee a PPN provider within 20 minutes of any Chicago-area participant, and, in most cases, appointments within 24 hours of your call. AFAS offers a 24-hour 800 line to handle questions or referrals, free foot screenings for Fund participants, year-round educational programs, and many other value-added services.

All benefits payable for podiatry will be paid according to the schedule below:

Plan copayment percentage

Level (after satisfaction of deductible)

Tier 1 - AFAS network 100%

Tier 2 - BCBSnetwork 90%

Tier 3 - Non-network 80%

Example: If you pick a provider in the AFAS network, a Tier 1 provider, your podiatry benefits will be paid at 100% after satisfaction of your Calendar Year deductible.

All benefits, including benefits paid for a provider in the AFAS network, paid for podiatry are subject to the Comprehensive Benefit Calendar Year deductible.

For general questions or for a referral to a PPN provider in your area, call the AFAS hotline at (800) 775-8829.

Extension of the Comprehensive Major Medical Benefit If You or Your Dependent Is Wholly and Continuously Disabled

Benefits will continue to be paid under the Plan after coverage would normally otherwise end if you or your Dependent is wholly and continuously disabled as a result of an Illness or Injury on or before the date coverage would have ended.

Benefits will only be paid for expenses related to this disability for up to one year after coverage is terminated. (back)

For Active Employees and Retired Employees

The Medical Savings Allowance is provided to help reduce out-of-pocket expenses for medical care. Each year, the Trustees may establish a tax-free predetermined allowance from which you may be reimbursed for eligible health care expenses that you or your Dependents have during the year.

Eligibility

If you were eligible for benefits for the entire previous Calendar Year and you are eligible on January 1st of the current Calendar Year, you will be eligible for the Medical Savings Allowance Benefit.

After you, or your Dependents if you are deceased, lose eligibility, the Medical Savings Allowance Benefit may continue to be used until the earlier of the following:

1. The amount of the Medical Savings Allowance has been used up; or

2. June 30th of the year following the year in which you have eligible expenses under the Medical Savings Allowance Benefit.

Amount of Your Medical Savings Allowance

In 1999, the Trustees credited each Eligible Employee with $500. This amount may vary from year to year. There may be some years when no allowance will be credited. The Trustees will notify you in advance of the amount of the Medical Savings Allowance for the following Calendar Year.

Expenses Your Medical Savings Allowance Can Be Used To Pay

You can use your Medical Savings Allowance to pay for certain eligible health care expenses you or your Dependents have during the year that are not reimbursed under any other benefit. Qualified expenses include:

1. Any expenses you or your Dependents must pay under the provisions of the Plan;

2. Services or supplies that are deductible as medical expenses under the Internal Revenue Code; and

3. Any self-payments you must make to maintain your eligibility for Plan benefits.

If you want to know if a certain expense is qualified for reimbursement under the Medical Savings Allowance Benefit, call the Welfare Fund Office.

You Must Use Your Medical Savings Allowance during One Calendar Year

Federal regulations require that you forfeit any amount of your Medical Savings Allowance that is not utilized to reimburse qualified expenses incurred in the Calendar Year in which it is provided. This requirement is often referred to as the "use it or lose it rule." However, you have until June 30 of the next year to submit claims for the current Calendar Year.

Using the Medical Savings Allowance Benefit

Once you have accumulated at least $25 in reimbursable medical expenses:

1. Fill out a request form, indicating which expenses you want reimbursed from your Medical Savings Allowance;

2. Submit, along with the form, originals or copies of your bills or copies of your explanation of benefits, receipts, cancelled checks or other such proof of payment; and

3. Send the items to the Welfare Fund Office.

Remember, you must submit claims by June 30 of the next year for claims incurred during the current Calendar Year. (back)

For Active Employees and Their Dependents and Retired Employees and Their Dependents

When you or any of your Dependents have expenses for covered dental charges, the Plan will pay a specific percentage of such covered charges up to the Calendar Year maximum shown in the Schedule of Benefits. Covered dental expenses are divided into four categories:

1. Coverage A – routine oral examination

2. Coverage B – basic dental care

3. Coverage C – gold restorations, crowns and prosthetics

4. Coverage D – orthodontic care

Routine oral examination includes:

1. Prophylaxis, or cleaning, which may be done by a dental hygienist twice per Calendar Year.

2. Oral examination and diagnosis which may be done twice per Calendar Year.

3. X-rays, if necessary (full mouth x-rays once in any Calendar Year).

4. Topical fluoride applications for Dependent children under age 19 once per Calendar Year.

Coverage B expenses are:

1. Emergency treatment for relief of pain.

2. Restorative services: amalgam, synthetic, porcelain and plastic restorations.

3. Endodontics: includes pulpal therapy and root canal filling.

4. Oral surgery: provides for extractions and other oral surgery, including pre- and post-operative care.

5. Periodontics, including treatment for disease of gums.

Coverage C expenses are:

1. Gold restorations when the teeth cannot be restored with another filling material.

2. Crowns, inlays, onlays and jackets when the teeth cannot be restored with a filling material.

3. Prosthetics: provides bridges, partial dentures and complete dentures.

Denture Replacement Benefit. In the event the replacement of a denture is professionally indicated, benefits are payable for allowable charges incurred for a replacement which is not the result of the theft or loss of your previous denture. Any charge for full denture replacement made less than five years after the immediately preceding denture placement or replacement was made under the program will not be payable.

Benefits are payable for necessary orthodontic treatment for Dependent adults and children if they are eligible under the Plan.

The combination of benefits payable for orthodontic care and all other Dental Benefits in any one year will not exceed the applicable maximum amount payable for Dental Benefits.

Extension of Dental Care Expense Benefits

Coverage B – If you or your Dependent is receiving root canal treatment in which the pulp has been opened and your coverage subsequently ends, coverage will continue under the Plan for an additional 30 days.

Coverage C – If impressions have been taken for crowns or dentures and coverage subsequently ends for you or your Dependent, coverage will be continued under the Plan for an additional 30 days.

Coverage D – If your Dependent child’s coverage ends while he or she is receiving Orthodontic Benefits, he or she will continue to receive Orthodontic Benefits for an additional 30 days. However, the maximum amount for this period will be the average of the previous quarterly payment made for orthodontic care, or, if your Dependent child was receiving benefits for orthodontic care for less than three months on the date of termination, the maximum amount will be $100.

Note: The Dental Benefits payable after coverage ends under the Plan for you or your Dependent are still subject to all the rules applicable to the Dental Care Expense Benefit.

1. Any treatment or service not prescribed by a Dentist or Oral Surgeon;

2. Services, supplies or appliances provided in connection with treatment to alter, correct, fix, improve, remove, replace, reposition, restore or treat the following, even if they are needed because of symptoms, illnesses or injuries which affect some other part or parts of the body or provided in connection with any examination or treatment of the teeth, gums, jaw or chewing muscles because of pain, injury, decay, malformation, disease or infection:

a. The jaw, any jaw implant or the joint of the jaw (the temporo-mandibular joint);

b. Teeth;

c. The gums and tissues around the teeth;

d. The parts of the upper or lower jaw which contain the teeth (the alveolar process and ridges);

e. The meeting of upper and lower teeth; and

g. The chewing muscles; and

3. Any treatment or service excluded under the provisions of "General Plan Exclusions and Limitations," beginning on page 70 of the Summary Plan Description Booklet. (back)

For Active Employees and Their Dependents and Retired Employees and Their Dependents

When you or any of your Dependents have expenses for covered vision care charges while eligible under the Plan, payment will be made as shown in the Schedule of Benefits.

Covered Vision Charges

Covered vision charges include the following:

1. Complete examinations by a licensed optometrist or ophthalmologist once per Calendar Year;

2. Frames – one pair every two Calendar Years;

3. Lenses or contact lenses prescribed by a licensed optometrist or ophthalmologist – one pair each Calendar Year; and

4. Safety glasses for you – one pair each Calendar Year.

Exclusions

No payments will be made for:

1. Sunglasses (unless prescribed to be worn substantially at all times);

2. Routine yearly examinations required for employment;

3. Special procedures (such as vision training) or special supplies;

4. Anti-reflective coatings;

5. Medical or surgical treatment of the eye; or

6. Two pairs of glasses instead of bifocals.

Extension of Vision Care Expense Benefit

Vision Care Expense Benefits will be continued under the Plan if you have ordered glasses, frames or lenses, and coverage subsequently ends, as long as these glasses, frames or lenses are picked up within 30 days after coverage ends.

For Active Employees and Their Dependents andRetired Employees and Their Dependents

When you or any of your Dependents have charges for a hearing examination recommended by a Physician and performed by an audiologist or certified hearing specialist, the Plan will pay up to the amount shown in the Schedule of Benefits.

When you or any of your Dependents have charges for a hearing aid instrument as a result of the related examination provided by an audiologist or by one who is certified to dispense hearing aids, the Plan will also pay up to the amount shown in the Schedule of Benefits.

Exclusions

No payment will be made for:

1. More than one examination in a two consecutive year period.

2. Hearing aids not prescribed by a Physician and provided by an audiologist or one certified to dispense hearing aids.

3. Hearing examinations or hearing aids required by an Employer in connection with the occupation of the person.

4. Services resulting from an accidental bodily injury arising out of and in the course of employment, or from a disease compensable under any Workers’ Compensation, occupational disease or similar law.

5. Services in a Hospital owned or operated by the federal government, or for any service furnished for which the person is not required to pay.

6. Charges made by a speech pathologist or any charges for speech therapy, speech readings or lessons in lip reading.

7. Charges for rental or purchase of amplifiers.

8. Replacement of a hearing aid due to theft, loss or any other reason within five consecutive years of purchasing and receiving the hearing aid. (back)

For Active Employees and Their Dependents and Retired Employees and Their Dependents

Your prescription drug program consists of two parts, the Drug Card Program and the Mail Order Program. The two parts of the Prescription Drug Program are administered by pharmacy benefit managers in accordance with contracts with the Trustees.

The Drug Card Program

This Program is for short-term or acute prescription drugs, such as antibiotics or pain relievers.

Your prescription drug card enables you to purchase covered prescription drugs at any participating pharmacy. You will pay:

- $0 per prescription or refill for generic drugs, or per prescription or refill for brand name drugs if your Physician does not authorize a generic substitution, or a generic equivalent is not available.

- $12.50 per prescription or refill for brand name drugs if you decline a generic substitution.

You pay only your $0 or $12.50  co-payment. The Comprehensive Benefit deductible does not apply.

You can purchase up to a 30-day supply from a participating pharmacy with the drug card. When prescription drugs need to be taken for more than 30 days, the drugs should be purchased through the Mail Order Program.

Call the Welfare Fund Office if you have any questions or if you need a list of pharmacies that participate in the Drug Card Program.

The Mail Order Program

This Program is for long-term or maintenance prescription drugs, the prescription medications you take on an on-going basis for chronic conditions such as high blood pressure, heart disease, diabetes, arthritis, etc.

When you have a prescription drug filled through the Mail Order Program, you pay:

- $0 per prescription or refill for generic drugs, or per prescription or refill for brand name drugs if your Physician does not authorize a generic substitution, or a generic equivalent is not available.

- $12.50 per prescription or refill for brand name drugs if you decline a generic substitution.

You pay only your $0 or $12.50  copayment. The Comprehensive Benefit deductible does not apply.

For each prescription refill, you can order the amount prescribed by your Physician up to a 90-day supply.

Call the Welfare Fund Office if you have any questions.

Exclusions and Limitations

Neither the Drug Card Program nor the Mail Order Program will cover the following, regardless of whether you or you Dependent has a physician’s prescription:

• Over-the-counter (non-prescription drugs),

• Experimental or Investigative drugs,

• Birth control,

• Drugs for the treatment of obesity,

• Drugs to aid in smoking cessation,

• Drugs for treatment of sexual dysfunction or growth disorders, or

• Any drug for the treatment of any condition, sickness, or injury that is excluded under the Plan, as specified on pages 70-73 of the Summary Plan Description Booklet.

When the Participant Chooses Not To Use the Prescription Drug Program

If you or your Dependents elect not to use the Prescription Drug Program, you may submit the claim for your prescription drugs to the prescription drug card pharmacy benefit manager. The pharmacy benefit manager will reprice the prescription and you may be reimbursed for a portion of the cost. Contact the Welfare Fund Office for more information.

When the Prescription Drug Program May Not Be Used

If your Dependent has coverage under a prescription drug program similar to this Plan’s Prescription Drug Program, this Plan will not pay prescription drug benefits for such Dependent. (back)

For Active Employees and Their Dependents and Retired Employees and Their Dependents

If you or your Dependent requires inpatient treatment for a Mental or Nervous Disorder or chemical dependency and substance abuse, YOU MUST CALL MED-CARE MANAGEMENT AT (800) 423-7781 FOR PRECERTIFICATION before any treatment is received in order to be eligible for Plan benefits. If you or a Dependent requires outpatient treatment for a Mental or Nervous Disorder or chemical dependency and substance abuse, you must call the Members Assistance Program at (630) 416-2183 or, in Illinois, (800) 540-0477 to seek an assessment or referral. All services are strictly confidential.

IMPORTANT! PLEASE NOTE!

Also, if you or a Dependent is receiving an inpatient or residential course of treatment, or intensive outpatient program through the Members Assistance Program, and you or your Dependent leaves prematurely against medical advice and MAP approval, the Plan copayment percentage of covered charges for this treatment period is reduced from 80% to 50%, even if the treatment has been properly precertified or referred.

For Eligible Employees and their Dependents in an alcohol and drug treatment program who complete the prescribed after-care following the completion of the initial levels of care, the Plan copayment percentage of covered charges for this treatment period will be increased from 80% to 90%. The care must be in accordance with a MAP-approved treatment plan. (back)

The total benefits payable to you or your Dependent under this Plan in a Calendar Year will be reduced so that the sum of the benefits payable by this Plan and any Other Plan will not exceed the maximum allowable benefits.

The term "Other Plan" includes:

1. Group blanket or franchise insurance coverage;

2. Group Blue Cross or group Blue Shield coverage, or other group hospital service prepayment plan, medical service prepayment plan, group practice or other prepayment coverage, except that for which the subscription charge or premium payment is made directly by the covered individual to the organization providing the coverage;

3. Any coverage under labor-management trust plans, union welfare plans, employer organization plans, employee benefits organization plans or any other arrangement of benefits for individuals of a group; and

4. Any coverage under a governmental program and any coverage required or provided by any statute.

Order of Payment

The plan which pays first is called the primary plan and the plan which pays second is called the secondary plan.

The following rules determine which plan’s benefits are payable first:

1. A plan which does not have a coordination of benefits rule is always primary and pays first.

2. A plan that covers an individual as an employee is primary and pays first.

3. If an individual is covered as an employee under two plans, the plan which has covered him or her longer is primary and pays first.

4. A plan covering the person as an employee, member, subscriber or retiree (or a Dependent of such person) will be primary over a plan covering the person because self-payments are being made by or on behalf of the person for COBRA Continuation Coverage.

5. The benefits of a plan covering a person as a laid-off or retired Employee, or as the Dependent of a laid-off or retired Employee, will be secondary to the benefits of any other plan covering such a person as an Employee, other than a laid-off or Retired Employee, or Dependent of such person. If the other plan does not have this provision regarding laid-off or Retired Employees which results in each plan determining its benefits after the other, then the provision above will not apply.

The rules below determine which plan’s benefits are payable first for a Dependent child:

1. If both you and your spouse are eligible Employees under this Plan, your children may be covered as Dependents of either you or your spouse, but they cannot be covered as Dependents of both of you.

2 If a Dependent child is covered under two or more Plans, the following provisions determine which Plan pays first:

a. If the parents are not divorced or separated, the plan that covers the parent whose date of birth occurs earlier in the of Calendar Year, excluding the year of birth, is primary and pays first. If the birthday of both parents occurs on the same date, the plan which has covered the parent for the longer period of time pays first. This does not apply if either plan does not have the rules of this paragraph. In such a case, the rules of the plan which does not have the rules of this paragraph will determine the order of benefit payments.

b. If the individual is a Dependent child of separated or divorced parents, the "order of payment" used to determine the primary plan is as follows:

(1) The plan of the natural parent with custody of the child pays first;

(2) The plan of the step-parent with custody of the child pays second; and

(3) The plan of the parent not having custody of the child pays third; or

(4) If a court order makes one parent financially responsible for the health care expenses of the child, that parent’s plan will pay first.

If the above rules do not determine which plan’s benefits are payable first, the plan which has covered the person for the longest time will pay benefits first.

The plan that is primary will pay benefits as if it were the only existing coverage without regard to the other plans. When this Plan is secondary, the benefits payable under this Plan will be reduced to the extent that the total amount of benefits paid by all plans will not exceed 100% of the Reasonable and Customary Charge for medical care or treatment that is covered at least in part by this Plan.

When this Plan pays reduced benefits due to these rules, only the reduced amount will be charged against the payment limits of the Plan.

If the other plan pays benefits that should have been reduced because of coordination of benefits, the amount by which the benefits should have been reduced may be paid to the other plan. Amounts so paid will be considered benefits under this Plan.

If a payment of any amount has been made that is in excess of that permitted by coordination of benefits, this Plan has the right to recover such amount from any party that has received such payment.

Right To Receive and Release Necessary Information

The Fund may, without the consent of or notice to any person, release to or obtain from any insurance company or other organization or person any information, with respect to any person, which the Fund deems to be necessary for such purposes of implementing these coordination of benefit rules. Any person claiming benefits under this Plan shall furnish to the Welfare Fund Office such information as may be necessary to implement these rules.

Coordination of Benefits with Medicare

Your Medicare coverage may affect Plan benefits. You should contact your local Social Security office for information about enrolling in Medicare before your or your spouse’s 65th birthday. This is very important because the Plan will pay benefits as if you are enrolled in Medicare, even if you are not. This could mean significant out-of-pocket expenses for you after you retire and Medicare becomes your primary coverage. Most workers age 65 and over do not have to pay for Medicare Part A (basic hospital insurance). Medicare Part B (supplementary medical insurance) may be purchased for a low monthly premium. Any Social Security office can give you more information on Medicare.

If you are an active Employee and you or your spouse is eligible for Medicare, you may elect Medicare as the primary payer by notifying the Welfare Fund Office. If no election is made, this Plan will have primary responsibility for expenses to an active Employee or his/her spouse who is eligible for Medicare.

If you are retired and neither your nor any of your Dependents are eligible under Medicare disability rules or as an End Stage Renal Disease beneficiary, you will have Medicare as your primary payer, provided that you are eligible for Medicare. If you have met the eligibility requirements for Retired Employees’ benefits, the Plan will have responsibility for secondary payment.

The Plan will only pay up to Medicare’s "limiting charge." Medicare’s "limiting charge" is the amount Physicians may charge Medicare patients (15% over Medicare’s allowable charge) and only applies to Physicians who are not paid directly by Medicare.

If you or any of your Dependents are totally disabled and eligible for Medicare under the Medicare disability rules, this Plan will usually pay its applicable benefits for that person before Medicare pays unless the Plan is legally permitted to pay second.

If you or any of your Dependents are an End Stage Renal Disease beneficiary under Medicare, this Plan will usually pay its benefits before Medicare pays for a period of up to 30 months unless the Plan is legally permitted to pay second. (back)

In the event the Fund pays or is obligated to pay benefits on behalf of a participant or his or her dependents for illness or injury to the participant or dependents, and the participant or dependents have the right to recover the amounts of such benefits from any other person, corporation, insurance carrier or governmental agency, including uninsured or underinsured insurance coverage, or any other first-party or third-party contract or claim, the Fund shall be subrogated to all of the participant’s or dependents’ right of recovery against such person, corporation, insurance carrier, governmental agency or uninsured or underinsured insurance coverage or any other first-party or third-party contact or claim, to the full extent of payments made by the Fund.

The participant or his or her dependents, or the participant acting on behalf of a minor dependent, shall execute and deliver such documents and papers (including but not limited to an assignment of the claim against the other party or parties, assignment to the minor child of any parental claim to recover medical expenses of the minor child, and/or a Subrogation Agreement) to the Fund as the Fund may require. The participant or dependents shall do whatever else is necessary to secure the rights of the Fund, including allowing the intervention by the Fund or the joinder of the Fund in any any claim or action against the responsible party or parties or any uninsured or underinsured insurance coverage or any other first-party or third-party contract or claim. The participant or dependents may not release or discharge any claim or responsible party, effect any settlement, nor dismiss any legal action against another source who may be responsible for paying damages or providing compensation, nor will such person effect satisfaction of any judgement resulting from any legal action without first notifying the Fund’s attorney and tendering to the Fund’s attorney the full amount of reimbursement due to the Fund.

If the participant or dependents do not attempt a recovery of the benefits paid by the Fund or for which the Fund may be obligated, the Fund shall, if in the Fund’s best interest and at its sole discretion, be entitled to institute legal action or claim against the responsible party or parties, against any uninsured or underinsured insurance coverage, or against any other first-party or third-party contract or claim in the name of the Fund or the Trustees in order that the Fund may recover all amounts paid to the participant or dependents or paid on their behalf.

In the event of any recovery by judgement or settlement against the responsible party or parties or by payment by any uninsured or underinsured insurance coverage or any other first-party or third-party contract or claim, the Fund’s attorney’s fees expended in the collection of the subrogation lien, if any, shall first be deducted. The Fund’s subrogation interest, to the full extent of benefits paid or due as a result of the occurrence causing the injury or illness, shall next be deducted. The remainder or balance of any recovery shall then be paid to the participant or dependents and their attorneys if applicable.

In the event of any failure or refusal by the participant or dependents to execute any document requested by the Fund or to take other action requested by the Fund to protect the interests of the Fund, the Fund may withhold payment of benefits or deduct the amount of any payments from future claims of the participants or dependents. After making a claim for benefits from the Fund, the participant or dependents shall take no action which might or could prejudice the rights of the Fund.

In the event the participant or dependents recover any amount by settlement or judgement from or against another party or by payment from or against another party or by payment from any uninsured or underinsured insurance coverage or any other first-party or third-party contract or claim, the Fund will request repayment of the full amount of benefits paid by the Fund. If the participant and/or dependents refuses or fails to repay such amount, then, in that event, the Fund shall be entitled to recover such amounts from the participants and/or dependents by instituting legal action against the participant and/or dependents and/or by deducting such amounts as may be due on future claims submitted by the participant and dependents. Once a settlement or judgement is reached on the claim, additional bills cannot be submitted with respect to the same injury.

The participant or dependents shall be required to pay their own legal fees and costs and to hire only attorneys who agree to waive the common fund doctrine and to remit the gross rather than the net proceeds from litigation. The Fund shall pay no legal costs or fees without receiving a recovery and then only within the terms of this provision. In the event that an attorney is hired by or on behalf of the participant or his dependents and the Plan is not given notice and an opportunity to pursue its own subrogation recovery, the Fund shall not be required to hire such attorney. If the attorney representing the Eligible Individual nevertheless wishes to proceed, and creates a common fund in which subrogation is specifically paid, the Fund may agree to pay up to 10% to include legal fees. Said 10% shall also include any prorated portion of the cost of recovery. If said attorney agrees to proceed, he will be considered to have waived the common fund doctrine.

The Fund’s right of subrogation is from the first dollar received by the participant or dependent and takes effect before the whole debt is paid to the participant or dependent.

(If you want more information about Subrogation, contact the Fund Office.) (back)

No benefits are provided for any of the following:

1. Any service, treatment or supply rendered before the individual was covered under the Plan.

2. Any charge for services, treatments or supplies in connection with Injuries or Illnesses sustained while the participant is not covered by the Plan.

3. Any charge for services, treatments or supplies after the maximum benefit has been paid or maximum limitation has been reached for that type of treatment or service on behalf of that individual.

4. Any treatment, service or supply not prescribed by a Physician for the treatment and diagnosis of an Illness or Injury.

5. Any treatment, service or supply furnished by a person residing within the individual’s home, or who is a member of the individual’s immediate family (a spouse, child, brother, sister or parent of the individual or spouse).

6. Any treatment or service due to an Illness that is covered by a Workers’ Compensation Act or other similar legislation, or due to any Injury arising out of or in the course of employment or profit, except for treatment or services for asbestosis.

7. Any treatment or service that is compensated for or furnished by the United States government or any agency thereof, unless the person is legally required to pay such charge.

8. Any treatment or service provided by a dentist or dental surgeon, except as specifically provided as a covered charges under the Comprehensive Major Medical Benefit and/or the Dental Care Expense Benefit.

9. Any treatment or service to treat a self-inflicted Injury or Illness or any Injury or Illness resulting from a suicide or an attempted suicide.

10. Hearing aids or the fitting thereof, except as specifically provided under the Hearing Care Expense Benefit.

11. Glasses or eye examinations for the correction of vision or fitting of glasses, except as specifically provided under the Vision Care Expense Benefit and for radial keratotomy under the Comprehensive Major Medical Benefit.

12. Any treatment or service resulting from war or any act of war, declared or undeclared.

13. Any treatment or service resulting from service in the Armed Forces, unless the person is legally required to pay such charge.

14. Any treatment, service or supply related to conception, artificial insemination, in vitro fertilization, embryo transfer, reversal of sterilization or genetic counseling, except as specifically provided under the Comprehensive Major Medical Benefit.

15. Any treatment, service, drug, implant or device designed to prevent pregnancy regardless of the use, except as specifically provided under the Comprehensive Major Medical Benefit.

16. Any charges for an abortion, except when the life of the mother would be endangered if the fetus were carried to term or when medical circumstances warrant an abortion.

17. Cosmetic surgery, except for:

(a) Treatment of injuries sustained in an accident while the person is eligible; and

(b) Breast reconstruction following a mastectomy, including surgery and reconstruction of the nonaffected breast in order to produce a symmetrical appearance, prosthesis and treatment of any physical complications of all stages of the mastectomy.

18. Custodial Care, which shall include services and supplies, including room and board and other institutional services that are provided to a person, whether disabled or not, primarily to assist him/her in activities of daily living except as specifically provided as Hospice Care under the Comprehensive Major Medical Benefit.

19. Any treatment or service for alcoholism or chemical dependency and substance abuse except as specifically provided through and monitored by the I.B.E.W. Local No. 701 Welfare Fund Members Assistance Program and provided under the Members Assistance Program Benefit.

20. Any treatment or service for organ transplants, except for the following:

(a) Coverage for the following transplants:
(1)Bone marrow, when for the treatment of acute leukemia, aplastic anemia and congenital immuno-deficiency syndrome;
(2) Cornea;
(3) Heart (not artificial heart or heart/lung simultaneously);
(4) Kidney; and
(5) Liver (not heart/lung/liver simultaneously); and
(b) Donor expenses, if the recipient is a covered person, not to exceed:
(1) $1,000 maximum for
tests for non-experimental transplants; and
(2) $50,000 lifetime maximum per donor.

21. Treatment for a Mental or Nervous Disorder, except as specifically provided under the Members Assistance Program Benefit.

22. Any treatment or services related to sexual dysfunction, including impotence or sex transferral.

23. Any charges for preventive inoculations and examinations that are not administered in treatment of an Illness, disease, Injury or condition (such as flu shots, shots necessary for travel or enrollment in school), except as specifically provided under the Physical Examination Benefit.

24. Services, supplies or appliances for the treatment of the temporomandibular joint, except as specifically provided under the Comprehensive Major Medical Benefit, or the gum and tissues around the teeth, except as specifically provided under the Dental Care Expense Benefit. However, the following will be covered if they are otherwise covered charges:

(a) Hospital room and board and other Hospital services while the covered person is confined;

(b) Treatment of tumors;

(c) Treatment of cysts which do not result from infection of the teeth and gums; and

(d) Surgery to the joint of the jaw.

25. Treatment for eating disorders, weight control, smoking clinics, etc., whether or not prescribed by a Physician, except as specifically provided under the Comprehensive Major Medical Benefit or through the Members Assistance Program Benefit.

26. Any routine charges incurred in the absence of a diagnosis, except as specifically provided under the Physical Examination Benefit.

27. Any expenses for treatment of enuresis (bed-wetting).

28. Any expenses for treatment of insomnia.

29. Any expenses for services or treatments that are Experimental or Investigative based on medical circumstances and/or the advanced stage of a covered person’s Illness or the likelihood that the service or treatment will measurably improve the covered person’s Illness or medical condition.

30. Any expenses over the 90th percentile of Reasonable and Customary Charges for the geographic area.

No Medical Examination Required

No medical examination is required in order to become eligible for benefits under this Plan. (back)

Claim forms may be obtained from the Welfare Fund Office:

I.B.E.W. Local No. 701

Fringe Benefits Administration Office

28600 Bella Vista Parkway

Warrenville, Illinois 60555-1600

(630) 393-1701

You must provide written notice to the Welfare Fund Office of any Injury or Illness upon which a claim may be based within 90 days of the date of the beginning of the first loss for which benefits may be claimed. Notice given by or on behalf of the claimant to the Welfare Fund Office with particulars sufficient to identify the individual will be considered to be sufficient notice to the Fund.

Payment of Benefits

Death benefits will be paid to your designated beneficiary. If your designated beneficiary does not survive you, death benefits will be paid to the person(s) specified in your life insurance policies or to your estate.

Benefits provided under this Plan will be paid directly to the Physician or Hospital unless you can provide proof that you already paid the bill.

If you use a Blue Cross Blue Shield PPO provider, after you pay your visit copayment, if applicable, you are not required to pay for ANY service before your claim is processed.

Benefits for Loss of Time will be paid each week during any period for which benefits are payable. Any balance remaining unpaid at the termination of such period will be paid immediately upon receipt of due proof.

You may not assign your benefit claim to a third party for payment or collection.

Claim Denials

1. States the specific reason or reasons for the denial;

2. Refers to provisions of the Plan on which the denial is based;

3. Describes and explains the need for any additional material or information that you must supply in order to make your claim valid; and

4. Explains what steps you must take to ask for a review of your claim denial.

Claim Review Procedure

How To Request a Review of a Denied Claim

If you want your denied claim to be reconsidered, you should send a written request for a review of the claim denial to the Welfare Fund Office at the address shown on the front inside booklet cover no later than 60 days after the date the claim is denied. You may include a written explanation of the issues and your comments on those issues with your request for a review. You may review all pertinent Plan documents when preparing your request.

Decision on Review

The Board of Trustees will review the denied claim according to the terms and conditions of the Plan.

Time of Decision

You will receive a written decision on the review of a denied claim within 60 days of the date the Welfare Fund Office receives your request for review or, if special circumstances require a delay in the decision you will receive a notice of the reasons for the delay within the same period. A delayed decision will be issued no later than 120 days after the date the Welfare Fund Office receives your request for review. The written decision will explain the reasons for the decision and will refer to the provisions of the Plan on which it is based. If, for any reason, you do not receive a written decision within the time limits just described, you may assume that your claim has been denied on review.

If you are dissatisfied with the written decision of the Board of Trustees on review, you will have the right to appeal the matter to arbitration. Please contact the Welfare Fund Office for more information. (back)

The Trustees or persons acting for them, such as a claims appeal committee, have sole authority to make final determinations regarding any application for benefits and the interpretation of the Plan of Benefits, the Trust Agreement and any other regulations, procedures or administrative rules adopted by the Trustees. Decisions of the Trustees (or, where appropriate, decisions of those acting for the Trustees) in such matters are final and binding on all persons dealing with the Plan or claiming a benefit from the Plan. If a decision of the Trustees or those acting for the Trustees is challenged in court, it is the intention of the parties to the Trust that such decision is to be upheld unless it is determined to be arbitrary or capricious.

All benefits under the Plan are subject to the Trustees’ authority to change them. The Trustees have the authority to increase, decrease, change, amend, or terminate benefits, eligibility rules, or other provisions of the Plan of Benefits as they may determine to be in the best interests of the Plan participants and beneficiaries.

The Plan is maintained for the exclusive benefit of the Plan’s participants and their Dependents.  All rights and benefits granted to a participant under the Plan are legally enforceable.

The right to change or eliminate any and all aspects of benefits provided for Retired Employees is a right specifically reserved to the Trustees, since coverage for Retired Employees is not an "accrued" or "vested" benefit. The Trustees have the authority to amend or terminate such benefits and to increase self-payments for the coverage at any time. Any such change shall be effective even though an employee has already become a Retired Employee.

Plan Discontinuation or Termination

This Plan of Benefits may be discontinued or terminated under certain circumstances, for example if future collective bargaining agreements and participation agreements don’t require employer contributions to the Fund. In such event, benefits for covered charges incurred before the termination date will be paid on behalf of eligible family members as long as the Plan’s assets are more than the Plan’s liabilities. Full benefits may not be paid if the Plan’s liabilities are more than its assets, and benefit payments will be limited to the funds available in the trust fund for such purposes. The Trustees will not be liable for the adequacy or inadequacy of such funds.

Length of Maternity Stay

The Plan will provide benefits for the covered charges incurred by an individual eligible for maternity benefits during the prescribed time periods (48 hours or 96 hours), subject to all applicable Plan eligibility and benefit payment provisions and limitations as set forth in this Summary Plan Description booklet.

Important Information about the Plan

1. Name of Plan. This Plan is known as the I.B.E.W. Local No. 701 Welfare Fund.

2. Board of Trustees. A Board of Trustees is responsible for the operation of this Plan. The Board of Trustees consists of an equal number of Employer and Union representatives, selected by the Employers and the Union which have entered into collective bargaining agreements which relate to this Plan. If you wish to contact the Board of Trustees, you may do so by calling or writing the Welfare Fund Office at the address below:

I.B.E.W. Local No. 701

Fringe Benefits Administration Office

Cathy Wenskus, Administrator

28600 Bella Vista Parkway, Suite 1110

Warrenville, IL 60555-1600

(630) 393-1701

3. Plan Sponsor and Administrator. The Board of Trustees is both the Plan Sponsor and Plan Administrator.

4. Identification Numbers. The number assigned to this Plan by the Board of Trustees pursuant to instructions of the Internal Revenue Service is 501.

The number assigned to the Board of Trustees by the Internal Revenue Service is 36-2951116.

5. Agent for Service of Legal Process. The Fund Counsel to the Board of Trustees is the Plan’s agent for service of legal process. Accordingly, if legal disputes involving the Plan arise, any legal documents should be served upon Fund Counsel at the address shown on the inside front booklet cover.

6. Source of Contributions. All contributions to the Plan are made by employers in accordance with their collective bargaining agreements with the International Brotherhood of Electrical Workers, Local No. 701. The Welfare Fund Office will provide you, upon written request, information as to whether a particular employer is contributing to this Plan on behalf of participants working under the collective bargaining agreements. An employee whose eligibility is about to terminate will be allowed, under certain circumstances, to continue coverage by making self-payments directly to the Fund. See page 22 for the rules governing self-payment.

7. Identification of Insurance Company. Life and Accidental Death and Dismemberment Insurance coverage is provided by the Union Labor Life Insurance Company, 111 Massachusetts Avenue, N.W., Washington, D.C., 20001. The complete terms of these benefits are set forth in the group insurance policies or contracts with the insurance company. All Health and Welfare, Medical, Dental and Vision Care benefits are on a self-funded basis. The complete terms of the self-insured benefits are set forth in this booklet.

8. Trust Fund. Benefits are provided from the Fund’s assets which are accumulated under the provisions of the collective bargaining agreement and the Trust Agreement and held in a trust fund for the purpose of providing benefits to covered participants and defraying reasonable administrative expenses. The Fund’s assets and reserves are invested appropriately.

The Life and Accidental Death and Dismemberment Insurance benefits are provided through insurance policies for which insurance premiums are paid from the trust fund. Self-funded benefits are paid directly from the trust fund.

9. Plan Year. The records of the Plan are kept separately for each plan year. The plan year begins June 1 and ends on May 31.

10. Type of Plan. This Plan is maintained for the purpose of providing life and medical benefits in the event of death, sickness or accident. The Plan benefits are shown in the Schedule of Benefits on pages 1-11 of this booklet.

11. Eligibility/Plan Participation. The Plan’s requirements with respect to eligibility as well as circumstances that may result in disqualification, ineligibility, or denial or loss of any benefits are fully described on pages 18-36 of this booklet.

12. Claim Procedures. The general procedures to follow for filing a claim for benefits are set forth beginning on page 74 of this booklet. If all or any part of your claim is denied, you may appeal that decision. See page 76 for an explanation of the procedures for appealing claim decisions. (back)

As someone who is eligible for benefits from this Plan, be aware of the fact that the benefits are paid in accordance with Plan provisions out of a trust fund which is used solely for that purpose. If you have any questions or problems with respect to benefit payments, you have the right to get answers from the Trustees who administer the Plan.

The same basic rights have now been incorporated in the Employee Retirement Income Security Act (ERISA) which Congress adopted in 1974, for application to all benefit plans.

As a participant in the I.B.E.W. Local No. 701 Welfare Fund, you are entitled to these rights and protections under ERISA. ERISA provides that all Plan participants shall be entitled to:

Examine, without charge, at the Plan Administrator’s office and at other specified locations, such as union halls and worksites at which at least 50 participants covered under the Plan customarily work, all Plan documents, including insurance contracts, collective bargaining agreements and copies of all documents filed by the Plan with the U. S. Department of Labor, such as detailed annual reports and Plan descriptions.

Obtain copies of all Plan documents and other Plan information upon written request to the Plan Administrator. The Administrator may make a reasonable charge for the copies.

Receive a summary of the Plan’s annual financial report. The Plan Administrator is required by law to furnish each covered person with a copy of this summary annual report.

In addition to creating rights for covered persons, ERISA imposes duties upon the people who are responsible for the operation of the Employee Benefits 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 benefit or exercising your rights under ERISA. If your claim for a benefit is denied in whole or in part, you must receive a written explanation of the reason for the denial. You have the right to have the Plan review and reconsider your claim.

Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request materials 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 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. If you believe that Plan fiduciaries have misused the Plan’s money, or if you believe that you have been discriminated against for asserting your rights, you may seek assistance from the U. S. Department of Labor or you may file suit in federal court. The court will decide if one party should pay the court costs and legal fees of the other party. The court may order the person you have sued to pay your costs and fees or it may order you to pay the costs and fees of the person you have sued.

If you have any questions about your Plan, you should contact the Plan Administrator. If you have any questions about this statement or about your rights under ERISA, you should contact the Pension and Welfare Benefits Administration, U.S. Department of Labor, 200 Constitution Avenue, N.W., Washington D.C., 20210.

Nothing in this statement is meant to interpret or extend or change in any way the provisions expressed in the Plan or insurance policies. The Trustees reserve the right to amend, modify or discontinue all or part of this Plan whenever, in their judgment, conditions so warrant.