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NECA-IBEW
WELFARE TRUST FUND NEWSLETTER
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VOL. 23, No.2 |
DECATUR, ILLINOIS |
December 2007 |
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A Fresh Perspective Brings Improvements for the
New Year
 Have
you ever gone back to a job you’ve completed to do
some additional work? Have you looked at the work with a fresh
perspective and thought to yourself, this is good, but it could
be even better. Over time, you learn from experience and you
find new ways to improve on your work. So it is with the Fund.
The Trustees are proud of the comprehensive benefits package
the Fund provides, but sometimes, they step back, look at the
Plan with a fresh perspective – and, they realize, this
is good, but it could be even better. Well, this is one of those
times – and the Trustees are pleased to announce several
Plan improvements. We encourage you to read this newsletter to
learn more about the exciting changes coming your way for 2008.
Better
Weekly Income Benefits for When You Can’t Work – For
All Active Participants
The Plan provides a Weekly Income Benefit for you when you
cannot work due to a total disability (as defined by the
Plan). Effective
January 1, 2008, the amount of the weekly benefit is increasing
from:
The amount of the weekly benefit for weeks 13 through 26
will remain at $500 per week. However, remember that
any disability
lasting 13 weeks or more is subject to review.
Medical
Benefit Improvements – For All Participants
Medical Benefits are available to cover a wide variety
of healthcare needs – from preventive healthcare to broken ankles to
serious illnesses and injuries. Even though the Plan is designed
to meet these varying needs, sometimes, individual coverages
or the way an expense is covered can be improved. Here are the
improvements being made to the Plan’s Medical Benefits
as of January 1, 2008:
-
Lifetime
Maximum Doubling: The lifetime maximum is increasing from
$1,000,000 to $2,000,000. This means
that the total
amount the Plan will pay per person is
twice as much as before. This
change only applies to charges incurred
after January 1, 2008. If you reached the lifetime
maximum before
January 1, you are
not entitled to this increase in the
lifetime maximum.
-
More
Durable Medical Equipment Covered: The Plan is adding
coverage for insulin
pumps and chemo
pumps. These
pumps
will be covered the same as other
durable medical equipment. In
addition, the Plan is increasing
the maximum for hearing aids (which are
considered durable medical equipment)
from $1,000 to $1,250 per ear during a five year
period.
-
Orthotics
Covered More Often: The Plan will now cover orthotics
once every three years,
instead of once every
five years.
-
TMJ
Lifetime Maximum Increasing $500: The lifetime maximum
the Plan will pay for covered
temporomandibular
joint dysfunction
(TMJ) treatment is increasing
from $1,500 per person to $2,000. As a
reminder, the Plan pays
75% of
covered expenses
relating
to TMJ treatment.
-
Respite
Care Hourly Limits Eliminated: The Plan
covers respite care the
same as any other
covered
medical
expense. This means
that once you meet the
deductible, the Plan pays a percent of
covered expenses; there
are no longer
any
maximum
hours per month
or maximum amount per
hour limits.
-
Acute
Rehabilitation Facility Confinement Limit Eliminated: The Plan is eliminating
the 100-day
limit per confinement
and will cover acute
rehabilitation confinements
the same as
any other covered
medical expense.
This means that once
you meet the annual
deductible, the Plan
will pay a
percent
of medically
necessary covered
expenses (90% for PPO or 75% for
non-PPO).
-
More
Expenses Covered: The Plan specifies
certain expenses
that are
not covered.
To provide more
comprehensive
coverage, certain exclusions
are being eliminated,
which
means the
following expenses
will now be covered
under the
Plan:
-
Wound Vac therapy is covered (effective retroactive to December
1, 2006). Wound VAC Therapy, also called Negative Pressure Wound
Therapy (NPWT), is designed to promote faster healing of chronic
and acute ulcers and wounds.
-
Muscle simulators will be covered in a hospital setting as
well as for use at home. Covered expenses for home use include the
rental or purchase price of the machine when medically necessary.
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Cancer prevention exams, tuberculosis exams, sickle cell anemia
exams, and other types of physical exams or tests used to determine
whether a person has a specific sickness or disease. These expenses
will be covered according to nationally recognized guidelines.
Contact the Fund Office for additional information.
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Physician, laboratory, and/or medication expenses for weight
control or treatment of obesity according to generally accepted
medical standards.
Prescription
Drug Benefit Improvements – For All Participants
If
you ever bother
to
watch the commercials,
it’s hard
to miss all the new medications that are continually
being introduced. It seems that the prescription
drug industry is constantly changing.
And so it is important for our prescription
drug benefits to keep up with this evolving
industry. The Trustees are pleased
to announce two exciting prescription drug
benefit changes, effective January 1, 2008:
-
Lower
Prescription
Drug
Benefits
Deductible: The annual deductible
is decreasing from
$100 to $50 per
person.
-
New
Covered Expenses: The Plan will
now
begin to cover
diabetic
diagnostics. Oral
contraceptives
will also
be covered (for
members and spouses
only).
Plan rules will
apply as outlined
on page 7 of
the
Summary Plan Description.
In
addition to
the
above,
to help our
Plan stay current – as
well as to encourage the use of generics to help you save money – the
Plan will no longer have any exceptions to the generic requirement.
What does this mean? Remember that the Plan requires you to pay
your brand name copayment plus the difference in cost between
the brand name mediation and generic substitute if you choose
a brand name medication when a generic is available. Currently
the Plan includes a list of brand name medications that are exceptions
to this provision. However, since new medications are continually
being developed to treat conditions, maintaining a list of excluded
medications restricts the Plan from changing with the industry.
Which
is why,
effective
January
1, 2008,
there
will
be no
brand
name
exceptions – if
you
choose
a brand
name
medication
when
a generic
is available,
you
will
be required
to pay
the brand
name
copayment
plus
the difference
in cost
between
the
brand
name
mediation
and generic substitute.
Increasing
Dental
and
Vision
Maximums – For
All Active Participants and their Dependents
As
an
active
participant,
you and
your
family
are
eligible
for dental
and
vision
benefits,
as described
in
your
Summary
Plan
Description.
To ensure
that
these
benefits
are
adequate
to
keep
up
with
increasing
costs,
the Plan
is
increasing
the calendar
year
maximum
that
the
Plan
will
pay
for
these
benefits.
Effective
January
1,
2008:
-
Dental
Benefits: The
amount
the
Plan
will
pay
for
covered
dental
expenses
is
increasing
from
$1,250
to
$1,500
per
person.
-
Vision
Benefits: The
amount
the
Plan
will
pay
for
covered
vision
expenses
is
increasing
from
$250
to
$300
per
person.
Retiree
Dental
and
Vision
Benefits
Survey
Results
Earlier
this
year,
the
Trustees
considered
offering
the
Plan’s
dental and
vision benefits
for active
employees
to retirees.
However,
rather than
just offering
this coverage,
the Trustees
wanted to
know how many
retired participants
would be interested
in purchasing
this coverage
at an added
cost.
First,
the
Trustees
would
like
to
thank
all
the
retirees
that
responded.
Almost
600
retirees
responded,
with
more
than
55%
stating
that
they
would
not be
interested
in
purchasing
this
additional
coverage.
Based
on
these
results,
the
retiree
benefit
program
will
not
include
dental
or
vision
benefits.
Some
Helpful
Reminders
-
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
designating
a
beneficiary,
dropping
coverage,
or
changing
an
address,
you
should
contact
the
Welfare
Fund
Administrative
Office.
Please
note
that
notifying
Monumental
of
a
change
does
not
update
your
information
with
the
Welfare
Fund.
The
information
on
file
with
the
Welfare
Fund
is
the
information
that
is
used
to
determine
your
eligibility
for
benefits
and
to
provide
you
with
important
updates
about
your
benefits.
In
addition,
often
Monumental
is
not
aware
of,
or
does
not
have
the
most
up-to-date
information
about,
your
benefits.
For
example,
Monumental
is
not
responsible
for
setting
monthly
payment
amounts,
determining
eligibility,
paying
death
benefits,
or
coordinating
beneficiary
or
dependent
coverage
information.
Another
example
is
if
you
notify
Monumental
of
your
change
in
address,
but
not
the
Welfare
Fund
Administrative
Office,
you
would
not
receive
this
newsletter
and
you
would
not
be
aware
of
the
prescription
drug
improvement
announced
above.
-
Update
Your
Fund
Information. If
you
move
or
have
any
changes
to
your
dependent
information,
be
sure
to
contact
the
Welfare
Fund
Administrative
Office
to
update
your
information.
It
is
also
a
good
idea
to
periodically
review
your
beneficiary
designation
information
and
update
it
as
necessary
to
ensure
benefits
are
paid
to
the
beneficiary
of
your
choice.
-
If
Your
Spouse
has
Other
Coverage.
Remember
that
if
your
spouse
is
eligible
for
other
health
care
coverage
through
an
employer
plan,
regardless
of
the
cost
to
your
spouse,
your
spouse
must
take
that
coverage
or
your
spouse
will
not
be
covered
under
the
Plan. So,
be
sure
your
spouse
enrolls
in
his
or
her
plan
during
that
Plan’s open enrollment. 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 from
the employer
to that effect.
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Prescription
Drug
Benefits
and
Medicare. The
NECA-IBEW
Welfare
Trust
Fund’s
prescription
drug benefits
are, on average,
as good as the
standard Medicare
Prescription
Drug Coverage.
Remember that
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.
-
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.
-
Protecting
Your
Privacy. The Fund has
procedures
in place to ensure
the privacy
of your
health
information under
the Fund. For
a
copy
of the
Fund’s
Privacy Policy,
you can:
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