The Welfare Fund provides medical, dental, disability, and health spending benefits for the participants and their dependents.
To be eligible for any benefits from the Welfare Plan, including death benefits, you must maintain your eligibility with work hours or by making self-payments. You are eligible for all Welfare Plan benefits, except for death benefits and short-term disability, if you maintain your eligibility through COBRA.
If your eligibility lapses, you are not eligible for any benefits from the Welfare Plan.
Summary Plan Description
The Summaries of Material Modification (SMMs) are a part of the Summary Plan Description (SPD). The SPD and the SMMs should be read together as one document.
- Summary Plan Description
- New Coverage for Insulin Pumps-Continuous Glucose Monitors and Extension of Covid-19 Benefits SMM 2023
- Cologuard and Colonoscopy Coverage SMM 2022
- No Surprises Act SMM 2022
- ABA Therapy Coverage SMM 2021
- COVID Vaccine and LCPC and Naprapath Coverage SMM 2021
- Speech Therapy Limit Removal; Shingles and Pneumonia Vaccine Coverage SMM 2021
- Surviving Dependent Eligibility Extension SMM 2021
- COVID-19 Update 2020
- Flu Shot Coverage SMM 2020
- LASIK Coverage SMM 2020
- Midwife Coverage SMM 2020
Plan Documents
Forms
Medical Benefits
Prescription Drug Benefits
Frequently asked questions
What types of benefits are available from the Welfare Plan?
When do I first become eligible for coverage under the Welfare Plan?
How is my ongoing eligibility for Health Coverage determined?
You must work at least 250 hours during a “Contribution Quarter” to be eligible for health benefits during the “Corresponding Benefit Quarter”. The following chart shows Contribution Quarters and their Corresponding Benefit Quarters.
Contribution Quarter | Corresponding Benefit Quarter |
January, February, March | May, June, July |
April, May, June | August, September, October |
July, August, September | November, December, January |
October, November, December | February, March, April |
If you do not work at least 250 hours during a Contribution Quarter, we will automatically look at your work hours for which required employer contributions were made during the current and previous quarters. You will be eligible during Corresponding Benefit Quarter if you work at least:
- 500 hours in the current and prior Contribution Quarters combined, or
- 750 hours in the current and prior two Contribution Quarters combined, or
- 1000 hours in the current and prior three Contribution Quarters
Example
If you do not work at least 250 hours during a Contribution Quarter, and you do not meet the 500,750-, or 1000-hour requirements as described above, you are eligible to Self-Pay for the number of hours (up to 250) that you are short and maintain eligibility for the Corresponding Benefits Quarter.
Can I make a Self-Payment or a COBRA Payment with a Credit Card or Debit Card?
Is Cologuard a covered benefit from the Welfare Plan?
Effective May 1, 2022, Cologuard is a covered benefit for routine screening for ages 45+. A Cologuard test will be covered once every three years. Also, there is no longer a limiting top age for routine screening (it used to be age 75).
At what age can I get a colonoscopy for routine screening?
What type of disability benefits are available from the Welfare Plan?
Who is eligible for short-term disability benefits from the Welfare Plan?
If I am eligible, when will my short-term disability benefits begin?
What is the benefit amount paid for a short-term disability benefit?
The amount of the weekly disability benefit is:
- $600 a week for up to the first 26 weeks of a disability; and
- $400 a week for up to the next 26 weeks of disability.
The maximum weekly disability payment period is 52 weeks per disability or until you recover, if sooner. Separate periods of disability are considered one period of disability unless the second disability is caused by an illness or Injury totally unrelated to the first disability and you have met the active work requirements.
When will my short-term disability benefits end?
Your weekly disability benefits will end on the earliest of the date:
- You are no longer under the care of a physician for the disability; or
- You recover from your disability; or
- You retire; or
- You die; or
- You receive all disability payments for that period of disability; or
You receive 52 weeks of short-term disability payments.
Am I eligible for short-term disability benefits if I covered under COBRA or Plan C?
Participants and dependents are not eligible for weekly disability benefits.
What is the Health Spending Account (HSA) and how does it work?
A Health Spending Account (HSA), sometimes referred to as a “Flex Account”, is available to you and your covered dependents. This benefit helps to pay for health care expenses that are not covered by the Welfare Plan. The maximum benefit is $2,500 per family each calendar year.
To be reimbursed for expenses you must file a claim with the Fund Office, no later than April 1st of the year following the expense. Any amount left in the HSA account at the end of the year will revert back to the Plan.
What kind of things are covered by the Health Spending Account (HSA)?
In general, the HSA covers health care expenses that are not covered by the Welfare Plan, or that are in excess of the amounts the Plan pays. To be eligible, expenses must be incurred while you are covered under the Welfare Plan.
Examples of the types of things that are covered under the HSA include, but are not limited to:
- Vision Care (Glasses, Contact Lenses)
- Prescription Drug Copayments
- Hearing Aides and Exams
- Orthodontic Treatment (for covered adults over age 19)
- Orthopedic Shoes
- Naprapath Services
What is the deadline to submit Health Spending Account (HSA) Claims?
The deadline for filing Health Spending Account (“Flex Account”) claims for the previous year is April 1st. We encourage you to submit these claims, with all receipts and completed claim forms, throughout the year. (2022 Flexible Spending claims are due no later than April 1, 2023.)
Is LASIK Eye surgery a Covered Benefit from the Welfare Plan?
The Board of Trustees of the Health and Welfare Fund made LASIK Eye surgery available to all covered participants and eligible dependents as of June 1, 2020. The Fund will cover LASIK Eye surgery, including Photo Refractive Keratectomy (PRK) surgeries, 100% up to a lifetime maximum of $4,500 per eligible covered participant.
Are there death benefits available from the Welfare Plan?
The Welfare Plan provides certain death benefits – employee, spouse, and child – to help protect your family against the effects of a sudden loss of income due to a death in the family.
What is the amount of death benefit(s) available from the Welfare Plan?
Employee Death Benefit
The amount of benefit payable depends on the employee’s years of service under this Plan at the time of death. If the employee has less than three years of service, the death benefit is $15,000. If the employee has three or more years of service, the death benefit is $30,000.
Spouse’s Death Benefit
If the covered spouse of an eligible employee dies, there is a $12,500 death benefit available to help with funeral and final expenses. This benefit will be paid to the employee or, if both the employee and spouse die at the same time, to the employee’s estate. The IRS treats this benefit as taxable income.
To be eligible for this benefit, you and your spouse must be eligible for Plan benefits at the time of your spouse’s death and not on COBRA or in Plan C, and you must have been married to your spouse for at least one year.
Child’s Death Benefit
If your covered child, under age 22, dies, a $12,500 death benefit is available to help with funeral and final expenses. This benefit will be paid to the employee or, if both the employee and child die at the same time, to the employee’s estate. The IRS treats this benefit as taxable income.
To be eligible for this benefit, you and your child must be eligible for Plan benefits at the time of your child’s death, and not on COBRA or in Plan C.
How can I designate a beneficiary to receive a death benefit, in the event of my death?
In the event of your death, the benefit amount is paid to your beneficiary. When you join the Plan, you complete a beneficiary designation form to name a beneficiary, who can be anyone you choose.
You can change your beneficiary at any time by completing and signing a new beneficiary designation form and submitting it to the Fund Office. You may name more than one beneficiary. If any of your designated beneficiaries dies before you do, your death benefit would be paid in equal shares to any remaining beneficiaries who survive you, unless you indicated otherwise
on the form.
If you don’t name a beneficiary, or no named beneficiary survives you, your benefit is paid to:
- Your spouse; or if none, then
- Your child(ren) in equal shares; or if none, then
- Your parents in equal shares; or if none, then
- Your siblings in equal shares; or if none, then
- Your estate.
You are the beneficiary for the spouse’s death and child’s death benefit.
COBRA and Plan C employees and their dependents are not eligible for death benefits.
Questions?
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