Volume 5 Issue 1 - Operating Engineers Local 520

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Page 8THE 520 HOISTERHEALTH & WELFARE, PENSION, ANNUITY, AND VACATION FUNDSBENEFIT REPORTAdministrative Manager – David GlastetterI am pleased to have this opportunity to provide an update on matters relating to your Health & Welfare, Pension, Annuity, and Vacation Funds.HEALTH & WELFARE FUND:The Health & Welfare Fund processed 47,258 claims (45,295-Medical and 1,963-Optical) during calendar year 2012 and paid benefits totaling $13,489,878.15($11,955,841.84-Medical, $1,185,068.83-Dental, and $348,967.48-Optical) compared to $13,345,117.56 that was paid out during 2011, an increase of$144,760.59 or 1%. Also, Death Benefits totaling $302,000 were paid to 44 eligible beneficiaries during 2012 as a result of the death of retired members or theirsurviving spouse. The Pharmacy Benefit program administered by CVS/Caremark processed 53,609 prescriptions during calendar year 2012 at a cost of$2,538,193.29, a decrease of $91,270.34 or 3.5% from the previous year.As of January 31, 2013, the Health & Welfare Fund had Total Assets of $32,613,103.23 compared to $34,737,987.46 as of January 31, 2012, adecrease of $2,124,884.23 or 6%. As of December 31, 2012, the Health & Welfare Fund had a Reserve Bank liability of approximately $11.9million covering 725 individuals. As of February 1, 2013, the Health & Welfare Fund was providing coverage to 1,519 families (893 Actives,444 Retirees, and 182 Widows) representing 3,367 individuals.You will find listed below a summary of Health & Welfare Plan benefit maximum limits and their corresponding coverage period at the presenttime. For other Plan limits and coverage periods, please refer to the Schedule of Benefits contained in the Summary Plan Descriptionand Plan Document or contact the Fund Office.Benefit Maximum Limit (PER PERSON) Coverage PeriodMedical $2,000,000 Annual (June-May)Dental $5,000 Two-year (6/1/11-5/31/13)Dental $25,000 LifetimeHearing Aid $4,000 Three-year (6/1/11-5/31/14)Prescription Drug $4,050 Annual (June-May)Optical $600 Two-year (6/1/12-5/31/14)Chiropractic $500 Annual (June-May)WORKER’S COMPENSATION MATTERS:No benefits are payable under the Plan for any expense covered by a Worker’s Compensation Act or similar legislation or any injury arising out of or in thecourse of any employment for wage or profit. Once you file a Claim Form with the Fund Office indicating your condition is the result of a work-related accidentor injury, the Health & Welfare Fund will not be in a position to consider any related medical expenses. Should your Worker’s CompensationClaim be denied, you must file an Appeal with the Industrial Commission for a final determination. If your claim is found not to bework-related, then the Health & Welfare Fund will be in a position to re-evaluate the submitted medical expenses.THIRD-PARTY LIABILITY MATTERS:The Health & Welfare Fund will be the secondary payer in those situations where the injury or illness of a covered individual (member ordependent) is the result of a negligent or wrongful act by a third party (automobile accident, etc.) who is primarily responsible for thepayment of medical expenses incurred by that covered individual. Once you notify the Fund Office your condition is the result of an injuryor illness caused by a liable third party, the Health & Welfare Fund will not be in a position to consider any related medical expenses for payment until the responsiblethird party or their insurer have paid up to the maximum limit of their liability in the matter. You should promptly notify the Fund Office of the name,address, and phone of the responsible third party, attorneys, and insurance companies involved in such matters, as well as keeping us informed when legal actionis instituted and the progress of that legal action. The Health & Welfare Fund, at your request, will notify medical providers that the Fund will be in a position toprocess all eligible claims in accordance with Plan Provisions after the maximum amount has been paid by the liable third party.COORDINATION OF BENEFITS WITH MEDICARE (CARVE-OUT):Benefits otherwise payable by the Plan after any deductible will be reduced by the amount paid by Medicare. In determining benefits payable under this Plan,benefits are limited to Medicare’s limiting charge. This Plan will also pay Medicare Part A and Part B deductibles, subject to satisfaction of the Plan’s deductibles.Medicare does not cover medical expenses incurred outside of the United States. You will owe an additional premium when traveling outside of the country.Please contact the Fund Office to determine the amount of your revised self-pay premium.If you are enrolled in Medicare at the time you retire, Part B coverage must be in place on your retirement date; otherwise, benefits will bereduced up to the amount Medicare would have paid if Part B should have been the primary payer. The cost of Medicare Part B premiumsis $104.90 per month in 2013, based on income. See p. 11 in the 2013 Medicare guide book, which is available in the Fund Office.Coordination of Benefits with Medicare Part DCurrently, the Plan’s existing prescription drug benefits are, on average for all Plan participants, expected to pay out as much as the standard Medicare PrescriptionDrug Coverage will pay, which means that the Plan’s prescription drug coverage is considered to be “creditable coverage.” Because current prescriptiondrug benefits under the Plan are, on average, more generous than Medicare standard coverage, you can choose to stay covered under the Plan and join a Medicareplan later and not be subject to higher premiums. You should review the annual notice sent to you by the Plan which informs you whether your Plan coverageconstitutes “creditable coverage.” The notice will help you determine whether or not to enroll in Medicare Part D coverage.
Page 9 Volume 5, Issue 1If you are eligible for Medicare Part D coverage, you may want to compare your current coverage, including which medications arecovered, with the coverage and cost of the Medicare plans in your area. Remember that for most people there is a monthly premiumfor Medicare Prescription Drug Coverage.Eligible Active Employees and DependentsIf you are an active participant or the dependent of an active participant and are eligible for and enroll in Medicare Prescription DrugCoverage, you will continue to be eligible for the Plan’s prescription drug benefits. However, your benefits will be coordinated withMedicare, in accordance with the Plan’s and Medicare’s coordination provisions.Eligible Retired Employees and DependentsIf you are a Medicare-eligible Retired Employee or Medicare-eligible dependent of an eligible Retired Employee and enroll for Medicare Prescription Drug Coverage,you will no longer receive prescription drug benefits under the Plan. However, your monthly premium for coverage under the Plan will not be reduced.If you or your dependent enroll for Medicare Prescription Drug Coverage, lose Plan prescription drug benefits, and later decide to drop Medicare PrescriptionDrug Coverage, you will be given the opportunity to re-enroll for the Plan’s prescription drug benefits. Contact the Fund Office for more information.++ HEALTH AND WELFARE FUND CHANGES EFFECTIVE JUNE 1, 2013 ++Deductibles for Each Coverage Period (June-May)In-Network………….Out-of-Network…….$500 per individual/$1,000 per family$750 per individual/$1,500 per familyOut-of-Pocket Maximum for Each Coverage Period (June-May)In-Network………….Out-of-Network…….$2,000 per individual/$4,000 per family$4,000 per individual/$8,000 per familyAs of result of these changes to the Plan Deductibles and Out-of-Pocket maximums, there will be a number of other changes as a consequence of losing“Grandfathered Status” under the provisions of the Patient Protection and Affordable Care Act (PPACA). Listed below are some of the modifications that willneed to be made to the Health and Welfare Plan effective June 1, 2013, to be in compliance with federal regulations:‣ The Plan must cover dependent children to age 26, regardless of their employment status and regardless of whether they have coverage under theirown employer’s group health plan; however, such coverage will be subject to Coordination of Benefits.‣ The Plan must cover network preventive services without cost-sharing, including women’s health services, as prescribed by the ACA. Coverageguidelines are provided at http://www.hrsa.gov/womensguidelines/ and http://www.dol.gov/ebsa/faqs/faq-aca12.html and are summarized below:Well-woman visits: This includes an annual well-woman preventive care visit for adult women to obtain the recommended preventiveservices, and additional visits if women and their health care providers determine they are necessary.Gestational Diabetes screening: This screening is for women 24 to 28 weeks pregnant, and those at high risk of developing gestationaldiabetes.HPV DNA testing: Women who are 30 or older have access to high-risk human papillomavirus (HPV) DNA testing every three years,regardless of Pap smear results.STI counseling: Women have access to annual counseling on sexually transmitted infections (STIs).HIV screening and counseling: Women have access to annual counseling on HIV.Contraception and contraceptive counseling: Women with reproductive capacity have access to all Food and Drug Administration-approvedcontraceptive methods, sterilization procedures, and patient education and counseling, as prescribed by a health care provider.These recommendations do not include abortifacient drugs. Breastfeeding support, supplies, and counseling: Pregnant and postpartum women have access to comprehensive lactation supportand counseling from trained providers, as well as breastfeeding equipment. Interpersonal and domestic violence screening and counseling: Screening and counseling for interpersonal and domestic violencewill be covered for all adolescent and adult women.‣ The Plan must cover out-of-network Emergency Room services at the same coinsurance at which it covers network Emergency Room services.‣ The Plan must modify its internal review procedures and provide procedures for external review of adverse benefit determinations (claim denials),using Independent Review Organizations (IROs) with which the Fund needs to contract for such review services.‣ The Plan must notify Plan participants of material modifications to the terms of the Plan and Plan coverage that are reflected in the Summary ofBenefits and Coverage (SBC) at least 60 days prior to the date the modification becomes effective.If you are covered by the Health and Welfare Fund at the present time, you will receive a Summary of Material Modifications (SMM) from the Fund Officewithin the next few weeks explaining any changes that will take place effective June 1, 2013.PENSION FUND:As of January 31, 2013, the Pension Fund had Total Assets of $156,492,002 compared to $143,852,379 as of January 31, 2012, anincrease of $12,639,623 or 8.8% during that 12-month period. The Fund is currently paying benefits to 840 Retirees or their survivingBeneficiaries, such payments totaling $10,720,209 during calendar year 2012 or approximately $950,000 per month at thepresent time. During 2012, we had 59 members retire after having 40 members retire during calendar year 2011. If you plan toretire in the near future, you may want to contact me to request a draft of your Pension Quotation detailing the various benefitoptions that will be available to you at the time of your retirement. When you file your Application for Pension Benefits, you willneed to provide a copy of your Birth Certificate, your spouse’s Birth Certificate, and a copy of your Marriage license, if applicable,
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Volume 5 Issue 1 - Operating Engineers Local 520

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