VOL. 19, No. 2	DECATUR, ILLINOIS	November , 2003

Your Hour Bank and Continuing Eligibility for Coverage
For All Bargaining Unit Employees

Once you are 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. The Trustees are pleased to announce that effective January 1, 2004, the number of hours that you are required to work each month to continue coverage is decreasing to 140 from 150, if you are a bargaining unit participant.

While the minimum required is decreasing, if you earn more than 140 hours, the hours between 140 and 150 will be credited to the Fund, and not to your individual Hour Bank. These hours (between 140 and 150) will be used to pay for Fund benefits. Any hours you work over 150 in a month will continue to be credited to your hour bank.

Let’s look at a few different scenarios to give you an idea of how this will work:

• In January 2004, you work 140 hours, which continues your eligibility for coverage for March 2004. However, since you only worked 140 hours, the minimum number of hours needed to continue coverage, no hours are credited to your hour bank.
• In February 2004, you work 145 hours, which continues your eligibility for coverage for April 2004. While you have worked more hours than the minimum needed to continue coverage, no hours will be credited to your hour bank. That’s because you must work 150 or more hours before any hours will be credited to your hour bank. The additional five hours (above the 140 needed to continue coverage) will be credited to the Fund.
• In March 2004, you work 155 hours, which continues your eligibility for coverage for May 2004. In addition, since you have worked more than 150 hours, five hours will be credited to your hour bank (155 hours worked-150 hour minimum before you receive hour bank credit). The additional 10 hours (between the 140 needed to continue coverage and the 150 hours needed to be eligible for hour bank credit) will be credited to the Fund.

Remember that even if you do not work the required number of hours in a month, you may continue your eligibility by using any hours of credit you have in your hour bank to make up the difference. The initial eligibility requirement of 420 hours is not changing. In addition, the maximum balance that you may accumulate in your hour bank will remain at 840 hours. For active employees, see pages 10-15 of the 2003 Edition of your Summary Plan Description for more information.

Increasing Plan Income

Income to the Plan comes from contributions made by employers and self-payments made for retiree and COBRA coverage. This income is used to pay benefits for all participants. As the cost of health care continues to increase, the income needed to pay benefits must also increase. Since most of the Fund’s income comes from employer contributions, effective January 1, 2004, the hourly contribution rate paid by employers is increasing to $4.90 from $4.65. Employer contributions are made for each hour that active employees work.

While the COBRA self-payment rate is not increasing at this time, the monthly self-payment rates for retiree coverage are increasing. Effective January 1, 2004, retiree self-payment will be:

Fine Tuning the Benefit Plan

The Trustees review the Plan regularly to ensure that we are providing comprehensive, high-quality benefits while maintaining the Fund’s financial integrity. As a result of the Trustees’ meeting in October, the Trustees are “fine-tuning” the Benefit Plan, as described in the following information.

• Vasectomies and Sterilization Procedures: The plan covers outpatient charges for vasectomies or sterilization procedures performed on you or your spouse. Expenses incurred for reversals of such vasectomies or sterilization procedures are not covered. The Plan will cover inpatient vasectomies or sterilization procedures only if the attending physician certifies that the patient’s health would be endangered if the procedure were performed on an outpatient basis.
• Dental and Vision Networks Coming Spring 2004: The Trustees are reviewing and finalizing some changes to the way the Plan administers your dental and vision benefits. As we’ve learned through experience with our medical benefits, using a network of providers can save you, and the Plan, money. That’s because network providers have agreed to negotiated, discounted rates that are generally lower-and some networks offer better discounts than other networks. When evaluating providers, we considered participant access to network providers, negotiated discounts, and the savings they could provide, and changes that would be required. Therefore, the plan will be:
  • Adding a dental network. There will be no changes to your dental benefits as a result of adding this network.
  • Changing the vision care provider from Cole Vision to Spectera. Due to this change in providers, there may be some specific benefit level changes. However, any changes or time period limitations will not apply until the change in providers is effective. For example, coverage for an eye exam will be limited to once per calendar year period. This calendar year period will not begin until after Spectera becomes the Plan’s vision care provider.

Once details of these changes are finalized, we will provide you with more information. Remember that to receive discounted rates, you must use network providers (and show your ID card).

• Bone Mass Screening: Effective January 1, 2004, the Plan will cover certain screening and medically necessary tests for the measurement of bone mass (bone density). There are certain limits to this coverage and requirements that must be met for the procedures to be covered. Contact the Fund Office for more information about the specific requirements, what is covered, and whether or not benefits will be paid.
• Colorectal Cancer Screening: Effective January 1, 2004, the Plan will cover certain tests and procedures related to screening for colorectal cancer. This generally applies when recommended by a physician for individuals over age 50 or otherwise at risk. To be covered, certain requirements must be met and certain limits apply. Contact the Fund Office for more specific information.
• Insuring Medicare-Eligible Benefits: The Plan is self-funded, which means benefits are paid by the Fund (not by an insurance company). While this arrangement works well for most benefits, after careful review, the Trustees have determined that it would be more cost effective to insure certain benefits. As a result, the Plan has decided to provide medical coverage to Medicare-eligible participants through an insurance contract with TransAmerica. This change will be effective as soon as administratively possible. In the near future, individuals affected by this change will receive more specific information, including the exact date that this change will be effective.

A Few Reminders

• Spousal Coverage: Remember that effective January 1, 2003, the Fund implemented that if your spouse is eligible for health care coverage through his/her employer, regardless of the cost to your spouse, he/she must take that coverage or he/she will not be covered under the Plan. A participant has an affirmative obligation to report the availability of alternative insurance through his/her spouse’s employment. The participant’s failure to do so can adversely affect past, current, and future benefit availability as well as impose a repayment liability on the participant.
• Women’s Health and Cancer Rights Act Annual Notice: Remember that the Plan, as required by the Women’s Health and Cancer Right’s Act of 1998, provides medical and surgical benefits for mastectomy-related services, including reconstruction and surgery to achieve symmetry between breasts, prostheses, and complications resulting from a mastectomy (including lymphedema). These benefits are subject to the Plan’s deductible and coinsurance provisions.
• Explanation of Benefit (EOB) Forms: Just a reminder that you should keep all EOB’s that you receive for a few years. By keeping these EOB’s you will be able to refer to them whenever needed and they can provide you with a brief summary of your and your family’s medical treatment and expenses.

This 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.