SBF Summary Plan Handbook - CWA Local 1180

More documents

Recommendations

Info

SBF Summary Plan Description 06-11-12 The Fund will recognize certain individuals as personal representatives without completion of an Appointment of Personal Representative form. For example, the Fund will consider a parent or guardian as the personal representative of an unemancipated minor unless applicable state law requires otherwise. Unemancipated minors may, however, request that the Fund restrict information that goes to family members. Other documentation that may substitute for this form would include other official legal documentation that demonstrates that under relevant state law the representative is authorized to make health care decisions for you (e.g., appointment as a legal guardian, or a health care power of attorney.) ‣ Accounting: You have the right to request an "accounting of disclosures." An "accounting of disclosures" is a list of certain disclosures that the Fund has made of PHI about you other than disclosures you authorized and other than disclosures made for treatment, payment or administrative operations. The request must be in writing. The first request for an accounting that you make within a 12-month period is free; however, the Fund may charge you for additional requests within the same 12-month period. The Fund will notify you of the costs of the additional requests, and you may withdraw your request before incurring any costs. The Fund’s Duties Maintaining Your Privacy: The Fund is required by law to maintain the privacy of your PHI and to provide you and your eligible dependents with notice of its legal duties and privacy practices. Your Right to File a Complaint with the Fund or the HHS Secretary Complaints: If you believe your privacy rights have been violated, you may file a complaint with the Fund or with the U.S. Secretary of Health and Human Services. All complaints must be submitted in writing. The Fund will not penalize you for filing such a complaint. In order to exercise any of your rights as set forth in this Privacy Notice, to obtain forms, or if you have any questions, please write to: Dwight R. Kearns HIPAA Contact Officer CWA Local 1180 Security Benefits Fund 6 Harrison Street, 3rd Floor New York, NY 10013-2898 In addition to filing a complaint with the Contact Officer listed above, you may also file a complaint with: Secretary of the U.S. Department of Health and Human Services Hubert H. Humphrey Building 200 Independence Avenue, SW Washington, DC 20201 - 32 -
SBF Summary Plan Description 06-11-12 Y OUR LIFE & SUPPLEMENTAL HEALTH BENEFITS Dear Member: The life and supplemental health benefits described in this section are provided through the CWA Local 1180 Security Benefits Fund. This Fund is a trust, separate and distinct from the trust maintained for the Legal Benefits Fund, the Retirees Benefits Fund, the Education Fund, and the Members’ Annuity Fund. Sincerely, Board of Trustees CWA Local 1180 Security Benefits Fund 33
Page 1: COMMUNICATIONS WORKERS OF AMERICA
Page 4 and 5: CWA LOCAL 1180 SECURITY BENEFITS FU
Page 6 and 7: What If I Elect Coverage Under Anot
Page 8 and 9: What Happens When I Retire 86 How D
Page 10 and 11: SBF Summary Plan Description 06-11-
Page 90 and 91:
SBF Summary Plan Description 06-11-
Page 92 and 93:
Page 94 and 95:
Page 96 and 97:
Page 98 and 99:
Page 100 and 101:
Page 102 and 103:
Page 104 and 105:
Page 106 and 107:
Page 108 and 109:
Page 110 and 111:
Page 112 and 113:
Page 114 and 115:
Page 116 and 117:
Page 118 and 119:
Page 120 and 121:
show all

SBF Summary Plan Handbook - CWA Local 1180

Create successful ePaper yourself

Delete template?

Save as template?