Health and Welfare

Summary Plan Description Table of Contents

  1. Important Contact Information
  2. Introduction
  3. Table of Contents
  4. Plan A Schedule of Benefits
  5. Plan B Schedule of Benefits
  6. Plan C Schedule of Benefits
  7. Plan 11 Schedule of Benefits
  8. Plan 11-C Schedule of Benefits
  9. Eligibility for Active Participants
  10. Eligibility for Retiree Coverage
  11. Insurance Coverage
  12. Weekly Loss of Time Benefit
  13. Medical Benefits
  14. Prescription Drug Program
  15. Medicare Part D Prescription Drug Plan (PDP) for Retirees
  16. Members Assistance Program (MAP)
  17. Dental Benefit
  18. Vision Benefit
  19. Hearing Benefit
  20. Special Fund Program
  21. General Plan Exclusions and Limitations
  22. Other Limitations on Your Benefits
  23. Definitions
  24. Claim and Appeal Procedures
  25. General Plan Provisions
  26. Information About the Plan
  27. Board of Trustees

Insurance Coverage

Life Insurance

Life Insurance benefits are governed by an insurance policy through Union Labor Life Insurance Company. This section is a summary of the policy provisions. If there is any discrepancy between the policy and this summary, the policy will govern.

Life Insurance benefits are provided for active eligible participants, their eligible dependents, and eligible retirees. These benefits are not payable for employees who are making self-payments for Plan B, or for employees and retirees who are making self-payments for COBRA coverage. Dependent Life Insurance is not provided for Class 11 participants.

Life Insurance for Employees and Retirees

If you die from any cause, your designated beneficiary or beneficiaries will receive the amount of the Life Insurance benefit specified in your 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 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 Fund Office is not responsible for any benefit payments made before a new beneficiary designation is received.

If you don’t designate a beneficiary or beneficiaries, or if none of your designated beneficiaries outlive you, your Life Insurance 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.

In the event of your death, your beneficiary must provide the Fund Office with proof of your death within 90 days.

Dependent Life Insurance (Active Participants Only)

In the event of the death of your eligible spouse or child, the amount of Dependent Life Insurance stated in your Schedule of Benefits will be paid to you, the active participant. You should provide proof of your loss to the Fund Office within 90 days of your dependent’s death.

If a dependent other than a newborn is hospitalized on the date the dependent would otherwise become insured for this benefit, the effective date of that person’s Dependent Life Insurance coverage will be postponed until the hospital discharge date.

Note: Dependent Life Insurance is not provided under Class 11.

ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE (ACTIVE PARTICIPANTS ONLY)

Accidental Death and Dismemberment (AD&D) Insurance is provided for active employees only. It is not provided to employees who are making self-payments for Plan B or COBRA.

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 your 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 your Schedule of Benefits.

The amount paid for accidental death (loss of life) is in addition to the amount of your Life Insurance benefit. If you suffer any combination of the losses as the result of one accident, only one amount (the largest) is payable for all losses. The amount payable for all losses resulting from any one accident cannot be more than the amount shown in your Schedule of Benefits.

The loss must occur within 90 days of an accidental injury which occurs while you are covered under the Plan and must result solely from that injury.

Your beneficiary for loss of life under this benefit is the same beneficiary as for your Life Insurance. If you change your beneficiary for your Life Insurance, you automatically change your beneficiary for this benefit.

AD&D claims must be submitted to the Fund Office within 90 days of your loss.

Exclusions and Limitations

  1. Benefits are not payable if you are 70 years of age or older.
  2. No payments will be made under this benefit for any loss which results directly or wholly from:

    1. Intentionally self-inflicted injury or suicide or attempted suicide, while sane or insane;
    2. Bodily or mental infirmity, ptomaines, bacterial infections, (except pyogenic infections occurring simultaneously with or through an accidental cut or wound) or any other disease;
    3. Committing an assault or a crime punishable as a felony; or
    4. Bodily injury or sickness caused by: war or any act of war, whether war is declared or undeclared; or participation in, or the result of participation in, a riot or insurrection or a civil commotion.