WELFARE TRUST FUND
VOL. 19, No. 1
You Need to Do If You Are Called to
With all that is going on in the world today, it is likely that
some of our participants will be called to serve our country. It
is important that you contact the Fund Office as soon as possible
when you are called to military service. The Fund Office will explain
how you can continue coverage for yourself and/or your dependents
and will help you through the process. For more information, active
participants can refer to page 14 of the 2003 Edition of your Summary
Plan Description (SPD).
care costs and spending continue to increase, the Fund continues
to look for ways to increase income to cover these costs. One
way to do this is by increasing the contribution rate that employers
pay for each hour that active employees work. Since employer
contributions are the biggest source of income to the Fund, effective
June 1, 2003, the hourly contribution rate will increase to $4.65
of income to the Fund, used to pay health care expenses include
self-payments made by retirees for coverage and COBRA coverage self-payments.
The monthly self-pay rate for each type of coverage is based on the cost of
providing that coverage. Unfortunately as the cost of health
care increases, so does the
cost of providing coverage.
Self-Pay Rates Increasing
Retiree Monthly Self-Pay Rates Effective June 1, 2003
Age of Retirement
Jan. 1, 2002
Jan. 1, 2002
62 to 65*
65 and Over
| *When the Employee becomes eligible for Medicare, age 65 and over rate applies.
COBRA Coverage Self Pay Rates Increasing
Under certain circumstances, you may be eligible to continue
coverage on a self-pay basis as required under federal law, referred
to as COBRA coverage. Effective June 1, 2003, monthly self-pay
rates for COBRA coverage are as follows.
Cobra Coverage Monthly Self-Pay Rates Effective June 1, 2003
Dental and Vision
information about COBRA coverage, active participants can refer
to pages 16-17 of the 2003 Edition of your SPD.
Comprehensive Major Medical Benefit Changes
Effective June 1, 2003
care costs paid by the Plan continue to rise at levels beyond
amount of income to the Plan, including the increased
income described previously, the Fund needed to make additional
changes to try to bring health care spending in line with Fund
income. Therefore, effective June 1, 2003, two changes will be
made to the Fund’s comprehensive major medical program.
Annual Deductible Changing
This applies to all participants. However, since there is no deductible for
in-network care provided in the state of Alabama, this does not apply to
in-network services rendered in Alabama.
Each year (from January 1 through December 31), you are responsible
for meeting the annual deductible before the Plan begins paying
benefits. Effective June 1, 2003, the amount of annual deductible
will be $500 per person up to a family maximum of $1500.
amounts you pay toward the annual deductible are not included
annual out-of-pocket maximum. The new deductible amounts apply to all claims
incurred on and after June 1, 2003. If you had met your annual deductible
before June 1, 2003 you will be required to meet the additional
amount for any claim incurred after June 1, 2003.
active participants, this change affects pages 3, 7, 8, 20 and
the 2003 Edition of your SPD.
New Physician Office Visit Copayment
This applies to all participants except Alabama out-of-area participants and
the plan will continue to pay for physician office visits as you
are used to, effective
June 1, 2003 you will be required to pay a $10 copayment
for each office visit before the Plan pays benefits. Please note that you
do not pay this $10 copayment up front to your physician. Once a claim
to the Fund Office, the Fund Office will deduct the $10 copayment from the
amount that the Fund reimburses you.
This physician office
visit copayment is in addition to any annual medical deductible and
coinsurance amount you are responsible for paying.
Continuing Your Eligibility for Coverage
to all bargaining unit employees.
Once you become
eligible for coverage, your coverage continues on a month-to-month
basis. Your continued eligibility is based on the number of hours you work
each month. Effective June 1, 2003, if you are a bargaining
unit participant, you must work at least 150 hours per month to continue
for coverage. Remember that even if you do not work the
required number of hours
in a month, you may still be able to continue your eligibility by using
any hours of credit you have in your hour bank to make up the
note that the 840-hour maximum balance you may accumulate in your hour
bank is not changing and the 420 hour requirement still applies
for initial eligibility.
Active employees, for more information see pages 10-15 of the 2003 Edition
of your SPD.
employees will have the amount of bank hours they can accumulate
reduced from 20 to 10 each month.
BlueCross BlueShield Network Available in Florida
And Alabama: A Reminder
As was previously announced, the Fund is pleased to offer participants
in Florida and Alabama access to the BlueCross BlueShield (BCBS)
preferred provider network. Remember that when you use a network
provider, you save money on your health care expenses because network
providers have agreed to negotiated rates, which are generally
less than their usual rates.
All Beech Street network claims incurred before January 1, 2003
must be filed with the Fund Office by June 30, 2003. With
BCBS replacing Beech Street
as the Fund’s PPO network as of January 1, 2003, to receive the negotiated
discounts on any Beech Street network provider services received before January
1st, you must submit your claim to the Fund Office by June 30, 2003. If you
do not submit your claim before June 30th, your claim will be paid at the out-of-network
level, which means you’ll end up paying more. So please get those claims
in as soon as possible.
Retirees Needing Additional Information
When you have a question about your benefits, call the Fund Office.
They can provide you with a Summary Plan Description (SPD) which
summarizes the benefits available under the retiree program. In
addition to this SPD, past issues of the newsletter contain any
changes made to your benefits. Be sure to keep this information
for future references.
Well Baby Care: A Reminder
Just a reminder
that while the Plan covers well baby care, such care must occur
your child’s first 24 months of life
to be considered a covered expense. For more information, active
participants can refer to page 21 of the 2003 Edition of your SPD.
Mail Order Prescriptions
If you have any questions about the mail order prescription program
with Merck Medco, call 1-800-711-0917. The Fund Office does not
have the prescription forms. You must call Merck Medco direct for
these forms or any questions you may have.
of you who have a computer, you can go online at www.medcohealth.com and print an order form. You can order refills online and check the status
of your order.
April 14, 2003: New Privacy Rules Go Into Effect
A new federal
law requires the Fund to ensure the privacy of your health information
the Fund. Under the Fund’s
new privacy rules, effective April 14th, local union offices are
no longer able to help you with any issues that involve private
health information, as defined by federal law.
If you need
assistance with any matter relating to your health care benefits,
contact the Fund Office.
From The Administrator
Over the past few years, the Trustees have had to make some very
unpopular decisions. With the rate of medical costs going up anywhere
from 12% to 20% and the prescription drugs rising 15% to 20% a
year, the decisions, although hard to make, were necessary.
the monetary changes listed, the Plan changes have a value of
$.42 per hour. So in total, the changes along with the monetary
$1.42. At best this just keeps us at a break even amount. It adds nothing
to fund our reserves.
have mandated that the Fund Professionals along with the Fund
Office continue to explore any and all methods to save the Fund money which
would include a PPO Plan for Dental, a new Vision Plan, COBRA changes,
as well as many others.
to be no end in sight for cost increases. Legislation changes
are needed, but government obviously has higher priorities at this date
than likely for some time to come. We all need to talk to our legislators,
both Federal and State. It is the only method we have to stop the increases.
Newsletter contains only highlights of certain features
of the NECA-IBEW Welfare Trust Fund. Full details are contained
in the documents that establish the Plan provisions. If
there is a discrepancy between the wording here and the
documents that establish the Plan, the document language
will govern. The Trustees reserve the right to amend, modify,
or terminate the Plan at any time.