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WHAT'S NEW

This Notice is a summary of important changes to the Medical Plan that will become effective July 1, 2014.


Modifications of Medical Benefit Program Effective July 1, 2014

1.         Modification for all Participants

            When a contributing Employer becomes delinquent in its contributions to the Plan, the payment of benefits to all Employees of such Employer and their Covered Family Members shall be suspended for all claims incurred 40 or more days after the date such contributions were due.  Such suspension shall remain in effect until payment of such delinquent contributions is received by the Fund Office.  

            Thus, effective July 1, 2014, instead of the Plan paying benefits during the first two months that an Employer’s contributions are delinquent, and suspending payment of such benefits for any claims incurred after such two month period, the Plan will now pay benefits for the first 40 days of such period of delinquency and suspend payment of any benefits incurred thereafter until such time as the Employer is no longer delinquent.

2.         Notice to be Sent to All Affected Participants

            The Trustees will send written notice to the Employees of a delinquent Employer within 10 days after the date the contributions in question were due, advising such Employees that payment of their benefits, and the benefits of their Covered Family Members, will be suspended in 30 days due to lack of payment of contributions by their Employer, unless the Employer pays all contributions due and owing within such 30 day period.  The notice will state the actual date of suspension of benefits.  Copies of the Notice will be sent to the Employer, applicable Contracting Officer, and DOL wage & hour area Director.


SUMMARY OF MATERIAL MODIFICATIONS TO YOUR MEDICAL BENEFITS EFFECTIVE JANUARY 1, 2014 

Introduction
            The ITPEU Health & Welfare Plan is in compliance with the Federal Affordable Care Act (“Obamacare”) and will continue to remain in compliance with that law. As part of that compliance:

            1.         The Fund provides medical coverage for your children up to the age of 26;

            2.         Effective January 1, 2012, the Fund pays 100% of the cost of all “Preventive Health Services” required by the Affordable Care Act, such as well-care baby visits, preventive care physical examinations for adults, and immunizations and screening tests for children and adults, so long as such services are provided by In-Network Healthcare Providers;

            3.         Effective January 1, 2014,there will no longer be a dollar cap on medical benefits paid on behalf of all eligible Participants and their covered family members per calendar year. 

            However, the additional costs to the Plan in order to remain in compliance with the requirements of the Affordable Care Act have been significant. Accordingly, in order to protect the substantial and expansive benefit program which the Plan provides to you, the Trustees have had to make the following modifications to the system of co-pays, deductibles and maximum out-of pockets per calendar year, Those modifications will become effective on January 1, 2014 and are summarized below. 


Modifications of Medical Benefits Effective January 1, 2014

1.        Modifications for Class III and IV Participants

            a.         Co-Pays

                        i.          The amount of the co-pay for Primary Care Physicians for Class III
and IV Participants with contribution rates of $4.25/hour or higher shall remain at $20.00;

                       ii.         The amount of the co-pay for Specialist Physicians for Class III and IV Participants with contribution rates of $4.25/hour or higher shall remain at $40.00;

                       iii.        The amount of the co-pay for Primary Care Physicians for Class III and IV Participants with Contribution Rates between $4.00/hour and $4.24/hour shall be increased to $25.00;

                       iv.        The amount of the co-pay for Specialist Physicians for Class III and IV Participants with Contribution Rates between $4.00/hour and $4.24/hour shall be increased to $50.00;

                       v.         Class III and IV Participants with contribution rates less than $4.00/hour shall not have Co-Pays and, accordingly, all of their physician’s visits, whether for Primary Care or Specialist Physicians, shall first be subject to their deductible, after which the Fund shall pay 75% of the charges for In-Network Physicians and 65% of the charges for Out-Of-Network Physicians.

             b.         Deductibles

                        i.          The amount of the Annual Calendar Year Deductible for Class III and IV Participants with Contribution Rates of $4.25/hour or higher shall remain at $240.00;

                        ii.         The amount of the Annual Calendar Year Deductible for Class III and IV Participants with Contribution Rates between $4.00/hour and $4.24/hour shall be increased to $300.00;

                        iii.        The amount of the Annual Calendar Year Deductible for Class III and IV Participants with Contribution Rates between $3.75/hour and $3.99/hour shall be increased to $360.00;

                        iv.        The amount of the Annual Calendar Year Deductible for Class III and IV Participants with Contribution Rates between $3.54/hour and $3.74/hour shall be increased to $420.00;

                        v.         The amount of the Annual Calendar Year Deductible for Class III and IV Participants with Contribution Rates between $2.70/hour and $3.73/hour shall be increased to $480.00.


            c.         Maximum Out-of-Pocket Per Calendar Year

                        i.          The Maximum Out-of-Pocket, plus deductible, for Class III and IV 
Participants with Contribution Rates of $4.25/hour or over shall be increased to 2,500.00;

                        ii.         The Maximum Out-of-Pocket, plus deductible, for Class III and IV 
Participants with Contribution Rates between $4.00/hour and $4.24/hour shall be increased to $3,500.00;

                        iii.        The Maximum Out-of-Pocket, plus deductible, for Class III and IV 
Participants with Contribution Rates between $3.75/hour and $3.99/hour shall be increased to $5,000.00;

                        iv.        The Maximum Out-Of-Pocket, plus deductible, for Class III and IV Participants with Contribution Rates between $3.54/hour and $3.74/hour shall be decreased to $5,500.00.

                        v.         The Maximum Out-Of-Pocket, plus deductible, for Class III and IV Participants with Contribution Rates between $2.70/hour and $3.53/hour shall be decreased to $5,500.00.

2.         Modifications for Class I and II Participants 

             a.         Co-Pays

                        i.          The amount of the Co-Pay for Primary Care Physicians for Class I and II Participants with Contribution Rates of $4.25/hour or higher shall remain at $25.00;

                        ii.         The amount of the Co-Pay for Specialist Physicians for Class I and II Participants with Contribution Rates of $4.25/hour or higher shall remain at $50.00;

                        iii.        Class I and II Participants with Contribution Rates less than $4.25 per hour shall not have Co-Pays, and, accordingly, all of their physician’s visits, whether for Primary Care or Specialist Physicians, shall first be subject to their Deductible, after which the Fund shall pay 75% of the charges for In-Network Physicians, and 65% of the charges for Out-Of-Network Physicians.

            b.         Deductibles

                        i.          The amount of the Annual Calendar Year Deductible for Class I and II Participants with Contribution Rates of $4.25/hour or higher shall remain at $300.00;

                        ii.         The amount of the Annual Calendar Year Deductible for Class I and II Participants with Contribution Rates between $4.00/hour and $4.24/hour shall be increased to $360.00;

                        iii.        The amount of the Annual Calendar Year Deductible for Class I and II Participants with Contribution Rates between $3.75/hour and $3.99/hour shall be increased to $420.00;

                        iv.        The amount of the Annual Calendar Year Deductible for Class I and II Participants with Contribution Rates between $3.54/hour and $3.74/hour shall be increased to $480.00;

                        v.         The amount of the Annual Calendar Year Deductible for Class I and II Participants with Contribution Rates between $2.70/hour and $3.53/hour shall be increased to $540.00.

            c.         Maximum Out-of-Pocket Per Calendar Year

                        i.          The Maximum Out-of-Pocket, plus deductible, for Class I and II 
Participants with Contribution Rates of $4.25/hour or over shall remain at $3,500.00;

                        ii.         The Maximum Out-of-Pocket, plus deductible, for Class I and II 
Participants with Contribution Rates between $4.00/hour and $4.24/hour shall be increased to $5,000.00;

                        iii.       The Maximum Out-Of-Pocket, plus deductible, for Class I and II Participants with Contribution Rates between $3.75/hour and $3.99/hour shall be decreased to $5,500.00.

                        iv.        The Maximum Out-Of-Pocket, plus deductible, for Class I and II Participants with Contribution Rates between $3.54/hour and $3.74/hour shall be decreased to $5,500.00.

                        v.         The Maximum Out-Of-Pocket, plus deductible, for Class I and II Participants with Contribution Rates between $2.70/hour and $3.53/hour shall be decreased to $5,500.00.
 
3.         All Other Benefits Provided by the Plan Remain Unchanged.



FOR YOUR CONVENIENCE WE HAVE ATTACHED A CHART WHICH SUMMARIZES THE MODIFICATIONS TO YOUR CO-PAYS, DEDUCTIBLES AND MAXIMUM OUT-OF-POCKET EFFECTIVE JANUARY 1, 2014. IF YOU ARE A CLASS III OR IV PARTICIPANT YOU SHOULD READ THE CHART FROM THE TOP DOWN. IF YOU ARE A CLASS I OR II PARTICIPANT, PLEASE READ THE CHART FROM THE BOTTOM UP.


 

 

Compliance with Affordable Care Act

The ITPEU Health & Welfare Plan is in compliance with the Federal Affordable Care Act and will continue to remain in compliance with the law. As part of that compliance:

1. The Funds provide medical coverage for your children up to the age of 26;

2. Effective January 1, 2012, the Fund pays 100% of the cost of all "Preventive Health Services" required
by the Affordable Care Act, such as well-care, baby visits, preventive care physical examinations for adults,
and immunizations and screening tests for children and adults, so long as such services are provided
by Network Healthcare Providers.
 


"SUMMARIES OF BENEFITS AND COVERAGE” (SBCs)

Under the Affordable Care Act, the ITPEU Health & Welfare Plan is required to publish Summaries of Benefits and Coverage explaining what the Plan covers and the cost of such coverage, depending on your Classification and the contribution rate which your employer contributes to the Plan on your behalf. The Health & Welfare Plan has published 8 SBCs covering the following Classifications and contribution rates:

            1.         Class I and II – Contribution Rate $2.50 to $3.54 per hour;
            2.         Class I and II – Contribution Rate $3.55 to $3.74 per hour; 
            3.         Class I and II – Contribution Rate $3.75 to $3.99 per hour;
            4.         Class I and II – Contribution Rate $4.00 an hour and over;
            5.         Class III and IV – Contribution Rate $2.50 to $3.54 per hour;
            6.         Class III and IV – Contribution Rate $3.55 to $3.74 per hour;
            7.         Class III and IV – Contribution Rate $3.75 to $3.99 per hour; and
            8.         Class III and IV – Contribution Rate $4.00 an hour and over. 

Among other things, these SBCs provide the following information:
  • Description and explanation regarding deductibles, out of pocket limits on your expenses and annual limits on payment of benefits;
  • Information regarding benefits for physician visits;
  • Description of covered services and excluded services;
  • Your right to continuation of coverage;
  • Your grievance and appeal rights; and Coverage examples

 

You may review the SBC covering your job classification and contribution rate by clicking on “Summaries of Benefits and Coverage


 
Important Notice regarding Grandfathered Status of ITPEU Health & Welfare Plan.
 
Effective July 1, 2012, the Trustees of the ITPEU Health & Welfare Plan believe that this Plan is no longer a “Grandfathered Health Plan” under the Patient Protection and Affordable Care Act (the Affordable Care Act). Accordingly, effective July 1, 2012, the Plan will provide the preventive health services mandated by the Affordable Care Act without any cost sharing by Participants. In addition, effective July 1, 2012, the Plan shall afford Participants an “External Appeal” process as a voluntary final step in connection with the review of denials of medical claims.
 
A description of the preventive health services provided by the Plan without any cost sharing as of July 1, 2012 is set forth in the Summary Plan Description, and at Section 9.03(c) of the ITPEU Health & Welfare Plan.

Questions regarding which protections apply and which protections do not apply to a Grandfathered Health Plan and what might cause a plan to change from Grandfathered health plan status can be directed to the Plan Administrator by calling 1-800-327-5926 or 1-912-352-7169, or writing to Board of Trustees, ITPEU Health & Welfare Fund, Attention Plan Administrator, P.O. Box 13817, Savannah, GA 31416. You may also contact the Employee Benefit Security Administration, at U.S. Department of Labor at 1-866-444-3272 or www.dol.gov\ebsa\healthreform. This website has a table summarizing which protections do and do not apply to Grandfathered Health Plans.

 

What To Do In Event of Interruption of Website Service.
We apologize for the recent interruption in your ability to obtain access to this website. Hopefully the problem has been corrected and there will be no recurrence of same. However, in the event such an interruption recurs in the future, we suggest that you obtain access to the website by entering the website address in the search bar at the top of your computer screen, as opposed to using a search engine such as Google.

 

ITPEU Health & Welfare Fund

 
When to Contact the Fund Office @ 1-800-327-5926
• Verify Coverage for Dental
• Verify Coverage for Vision
• Verify Coverage for Prescription Drugs
• Verify Coverage for Disability
• Verify Coverage for Death Benefits
• Request a Claim Form for Disability or Death

Also when you need to:
• Change Your Address***
• Change a Dependent(s)***

*** Note: You must fill out a New Enrollment Card When You Change Your Address, Add or Drop a Covered Family Member. You must include Birth Certificates, Adoption Papers, Marriage License or any required Court Documents. Make sure Your Union Representative has a Copy of Your Enrollment Card. 

Mail - Enrollment Cards and Documents, Dental, Vision, Prescription Drugs, Death and Disability Forms to:
ITPEU Health & Welfare Fund
P.O. Box 13817
Savannah, GA 31416

You can review your benefit program at www.itpeubenefits.com, and the Anthem Website is: www.anthem.com 

You can review your pharmacy benefit program at www.caremark.com 
Important Information for ITPEU Health & Welfare Fund Participants