NECA-IBEW WELFARE TRUST FUND NEWSLETTER

VOL. 21, No.3	DECATUR, ILLINOIS	Dec. 2005

Vision Benefits Changing to Meet Your Needs

Effective January 1, 2006, Spectera will no longer be the Plan’s vision provider. On and after January 1, you may go to any qualified ophthalmologist, or optician for covered vision services. The Plan will pay 100% of covered vision expenses up to $250 per person per calendar year.
Since the Plan pays up to a maximum of $250, you choose how best to use the vision benefits available to you and your covered dependents. In general, covered vision expenses include:

• Complete eye examination, including dilation of pupil and/or relaxing of focusing muscles by drops and refraction for vision by a legally qualified ophthalmologist or optometrist; and
  
• New frames, replacement frames, lenses, and contact lenses prescribed by an ophthalmologist, optometrist, or optician, including fitting, anti-reflective coatings, and cosmetic extras.
  Since the Plan will no longer provide benefits through a vision network, you must pay for services and materials at the time you receive them and then submit an itemized bill and proof of payment to the Welfare Fund Administrative Office for reimbursement of covered expenses.

Keeping Your Fund Records Up-to-Date

Enclosed with this newsletter is an enrollment card. You only need to return the enrollment card to the Welfare Fund Administrative Office if the information you provided to the Fund last year has changed. If you had no changes to your dependent information during 2005, you do not need to return the card. However, if you need to add of delete a dependent, you must return the card as soon as possible.
The Welfare Fund Administrative Office relies on the information on these cards to ensure that claims are paid accurately and promptly. If there is a change to your dependent information during the year, be sure to notify the Welfare Fund Administrative Office as soon as possible so that payment of your benefits will not be delayed. It is your responsibility to notify the Fund of any changes. If you do not notify the Fund of any changes when required, you may be responsible for any additional costs.
If you move during the year, be sure to notify the Welfare Fund Administrative office as soon as possible. Your current address must be on file to ensure that you receive important information about your benefits.
In addition, it is a good idea to periodically review your beneficiary information and update it as necessary to ensure benefits are paid to the beneficiary of your choice. Remember that in the event of your death, any welfare or pension death benefits will be paid to the beneficiary on file with the Fund (or as otherwise directed by a court action, such as a QDRO). So, if you would like to update your beneficiary information, you should contact the Welfare Fund Administrative Office for the appropriate card.

If Your Spouse has Other Coverage Available

Remember that if your spouse is eligible for other health care coverage through an employer plan, regardless of the cost to your spouse, he or she must take that coverage or he or she will not be covered under the Plan. If your spouse’s employer does not offer health care coverage or if your spouse is not eligible for the coverage offered, you need to submit a letter to the Welfare Fund Administrative Office form the employer to that effect.
If your spouse has other coverage, either through an employer plan or a private insurance policy, the Fund will pay benefits second, after the other coverage. This provision was implemented in 2003 to help manage the Fund’s health care costs. While this provision is beneficial in helping the Fund reduce expenses, it is also beneficial for your spouse because your spouse will have coverage through more than one plan.
It is your responsibility to notify the Fund if your spouse has other coverage through an employer or private policy. If the Fund learns that your spouse has other coverage and does not notify the Fund or refuses to take the available coverage, your spouse will no longer be covered under the Fund’s Plan.
If your spouse is eligible for other coverage and does not enroll for that coverage when eligible, your spouse’s coverage under this Plan will end as of the date your spouse is eligible for such other coverage. In addition, benefits will be backdated to the date your spouse could have enrolled in the other coverage. For example, if your spouse becomes eligible for, but does not elect, coverage through his or her employer on January 1, the Plan will not cover any of your spouses expenses incurred on and after January 1. If the Fund is not aware that your spouse had other coverage available until April 1, your spouse’s coverage will still be considered to have ended as of January 1, not April 1. Therefore, any expenses incurred between January 1 and April 1 will not be covered under the Plan. To avoid any problems that this may cause, your spouse should enroll for any available medical coverage offered by his or her employer.

Retiree Coverage and Monumental

If you are age 65 or older and covered under the Monumental insured retiree program for Medicare-eligible individuals, you should only contact Monumental about filing medical claims or to check on the status of a claim. For all other issues, such as premium, to drop coverage, or to change your address, you should contact the Welfare Fund Administrative Office.

Fine Tuning the 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, you should be aware of the following changes.

• Improving Well Child Care Benefits. Well childcare benefits, which are covered like other covered medical expenses, include routine office visits, inoculations, and other kinds of well childcare. Effective January 1, 2006, well child care benefits are being expanded to include all eligible dependent children (as defined by the Plan), which means benefits are no longer limited to a child’s first 24 months. However, well childcare benefits are limited to a lifetime maximum of $2,000 per eligible child.
  
• Adding a Covered Medical Expense – Testosterone Replacement Therapy. Effective June 1, 2005, the Plan will cover testosterone replacement therapy, up to $2,500 per calendar year. However, to be considered a covered expense under the Plan, you must provide verification of the therapy’s medical necessity from your physician, including lab results showing a testosterone deficiency.
  
• Modifying a Covered Medical Expense – Orthotic Devices. Effective January 1, 2006, the Plan will cover orthotic devices once in any five calendar year period instead of once per lifetime.
  
• Clarifying Contraceptive Plan Exclusion. In general, the Plan does not cover any form of contraceptives. However, under limited circumstances, medically necessary contraceptives may be considered a covered expense. Proof of medical necessity must be provided to and approved by the Welfare Fund Administrative Office before the prescription is filled. In addition, proof of medical necessity is then required annually. Effective January 1, 2006, when proof of medical necessity is provided, medically necessary contraceptives will be covered under the Plan’s prescription drug benefits. Once the Welfare Fund Office receives proof of medical necessity, the Fund’s prescription drug provider will be notified and an over ride will be granted so that the prescription can be filled through the prescription drug program. This over ride will remain in effect for 12 months. After 12 months, proof of medical necessity must once again be submitted for the Fund to authorize an over ride for the next 12 months.
  

Protecting Your Privacy

Federal law requires the Fund to ensure the privacy of your health information under the Fund. As a result, the Fund adopted a privacy policy, effective April 14, 2003. For a copy of the Fund’s Privacy Policy, you can:

• Arrange an appointment to review and/or obtain this document at the Welfare Fund Administrative Office;
• Visit the NECA-IBEW web site at www.neca-ibew.org to view and/or download a copy; or
• Request, in writing, a copy from the Welfare Fund Administrative Office.
  

Women’s Health and Cancer Rights Act Annual Notice

The Plan, as required by the Women’s Health and Cancer Rights Act of 1998, provides medical and surgical benefits for mastectomy-related services, including reconstruction and surgery to achieve symmetry between the breasts, prostheses, and complications resulting from a mastectomy (including lymphedema). These benefits are subject to the Plan’s deductible and coinsurance provisions.

Important Prescription Drug Benefits Reminder

On average, the NECA-IBEW Welfare Trust Fund’s prescription drug benefits for all active and retired participants and their dependents are as good as the new standard Medicare Prescription Drug Coverage that will be available January1, 2006. To continue to receive this higher level of coverage under the NECA-IBEW Welfare Trust Fund, you do not need to do anything.
If you are an active participant or the dependent of an active participant and are eligible for and enroll in Medicare, the Fund’s prescription drug benefits will be coordinated with Medicare in accordance with the Plan’s and Medicare’s coordination of benefits provisions.
If you are a surviving spouse, retiree, or dependent of a surviving spouse or retiree and are eligible for and enroll in Medicare Prescription Drug Coverage (Medicare Part D), you will no longer receive prescription drug benefits under the NECA-IBEW Welfare Trust Fund. You will continue to be eligible to receive medical benefits under the Welfare Trust Fund. However, your monthly premium for coverage under the Welfare Trust Fund will not change as a result of not receiving prescription drug benefits from the Fund.

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.