SBF Summary Plan Handbook - CWA Local 1180

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SBF Summary Plan Description 06-11-12 Continuation of Coverage During Leave Under the Family and Medical Leave Act (FMLA) If your employer has 50 or more employees, you may be eligible for leave under the Family and Medical Leave Act (FMLA). If you take a FMLA leave, your employer must continue to contribute to the Fund on your behalf and certain health-related benefits through the Fund must continue. However, if you do not return to work after your FMLA leave ends, you may be required to repay the amount your employer paid toward your coverage during your leave unless you do not return because of a serious health condition of yourself or a family member other circumstances beyond your control. If you do not return to work after the end of your FMLA leave, you may be eligible for COBRA continuation coverage. Contact the Fund Administrator for more information about your rights and your dependents’ rights to continuation coverage. Keep the Fund Informed Of Address Changes In order to protect your family's rights, you should keep the Fund Administrator informed of any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Fund Administrator. - 26 -
SBF Summary Plan Description 06-11-12 Y OUR PRIVACY The Fund is required by The Health Insurance Portability and Accountability Act of 1996 (HIPAA), which was passed and adopted into federal law on December 28, 2000, to maintain the privacy of PHI about you, provide you with a notice of the Fund’s legal duties and privacy practices with respect to PHI, and to comply with the terms of the Fund's current notice of privacy practices. Privacy Notice THIS PRIVACY NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. This Privacy Notice, effective April 14, 2003, describes your rights concerning medical information, known as "Protected Health Information" (PHI), about you and/or your dependents. PHI is information that may identify you and that relates to your past, present, or future physical or mental health condition, or payment for your health care. The PHI includes information maintained by the Fund in oral, written or electronic form. The Fund is required by The Health Insurance Portability and Accountability Act of 1996 (HIPAA), which was passed and adopted into federal law on December 28, 2000, to maintain the privacy of PHI about you, provide you with a notice of the Fund’s legal duties and privacy practices with respect to PHI, and to comply with the terms of the Fund's current notice of privacy practices. The Fund reserves the right to change its privacy practices and this Privacy Notice. Any new Privacy Notice may be effective for all PHI that the Fund maintains about you, including PHI created or maintained in the past. Material changes to the Fund's privacy practices will require that the Fund mail copies of revised Privacy Notices to you and to all past and present participants and beneficiaries for whom the Fund still maintain PHI. Any other person, including dependents of named participants, may receive a copy upon request. Any revised version of this Privacy Notice will be distributed within 60 days of the effective date of any material change to the Fund's policies. Uses and Disclosures of Health Information Sections I and II contain the circumstances under which the Fund can provide PHI. SECTION I: Uses and Disclosures of PHI for Treatment, Payment or Administrative Operations Disclosure of PHI Generally Requires Your Written Authorization. Under the law, however, the Fund may disclose your PHI without your authorization or without giving you the opportunity to agree or object, in the following cases: - 27 -
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SBF Summary Plan Handbook - CWA Local 1180

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