Volume 24, No.1	DECATUR, ILLINOIS	December 2008

Maintaining Your Health in a Time of Economic Uncertainty: More Important Than Ever!

As you know, the Board of Trustees of the NECA-IBEW Welfare Trust Fund continually strives to provide you with the best possible benefits at reasonable costs. In these continuing uncertain economic times, that is not always easy to do. But, we believe that helping our participants get and stay healthy also helps our Fund remain financially strong and productive. That is why we are pleased to announce that Wellness and Disease Management benefits are coming your way in 2009. See the article below for more information about these exciting new programs.

We encourage you to read this newsletter to learn more about the exciting changes in store for 2009. The items in this newsletter are designed to help you get the most out of your benefits, make smart choices about your health and your care, and save you and the Plan money during these tough economic times.

New Wellness and Disease Management Benefits!

What better way to start the New Year than by making a resolution to get healthy and stay healthy in 2009! Your new Wellness and Disease Management benefits are designed to promote healthy living—and to reward you for doing so. Through these benefits, you will have access to:

• Weight-loss, tobacco cessation, exercise, stress relief, and nutrition programs. When you participate in and complete one of these programs, you will receive a $100 contribution to your Health Reimbursement Arrangement (HRA) Account.
• A Disease Management program designed to help you manage chronic conditions—Diabetes, Coronary Artery Disease, Heart Failure, Asthma, and Chronic Obstructive Pulmonary Disease—and reduce the risk of complications. When you participate in and complete the Disease Management program, you will receive a $200 contribution to your HRA.
• Wellness Coaches, Nurses, and other healthcare professionals who will help you learn about your condition and ways to modify your lifestyle to reduce your risks and improve your health.
• A Health Risk Assessment. Complete this confidential online questionnaire and get recommendations on how to enhance your health and well-being. When you complete your Health Risk Assessment, you will receive a $50 contribution to your HRA. Earn an extra $50 contribution if you complete the assessment within the first three months of becoming eligible for Plan benefits.

Look for more information about these programs in early 2009.

Get the Most From Your HRA!

A Health Reimbursement Arrangement (HRA) is an account that the Fund sets up and maintains on your behalf. Money in the HRA can be used to pay for certain healthcare-related expenses. There are two ways to accumulate funds in your HRA.

Your local union elects to allocate an employer contribution to an HRA on your behalf. If this is the case, an HRA contribution will be made and credited to your HRA for each hour that you work. You participate in the Wellness and Disease Management programs and receive an award No additional voluntary contributions are allowed.

If you submit a claim for HRA reimbursement of an expense that is also eligible for coverage under this Plan or any other coverage that you have and the expense exceeds that coverage, here is what you need to do to receive reimbursement from your HRA.

• File a claim with the Fund for reimbursement under the Plan or your other coverage, if applicable.
• Receive your reimbursement and an Explanation of Benefits (EOB) form.
• Submit your claim form for the eligible expense not already reimbursed, any EOB’s received for the claim and proof of payment of unreimbursed expenses to the Fund for reimbursement from your HRA

For example, if you want to be reimbursed after you see your eye doctor and purchase a new pair of glasses for $350, you must submit a claim to the Fund Office, for which you will be reimbursed $300—the Vision coverage maximum. After you get your EOB for the eligible expense from the Fund, submit your claim, EOB and paid receipt to the Fund for reimbursement from your HRA for the $50 that exceeds Vision coverage maximum, as long as you have enough funds in your HRA.

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 coverage or the way an expense is covered can be improved. With that in mind, we looked closely at the Plan and have approved the following expenses to be covered under the Plan:

• Dental services have been covered by the Medical Plan when provided by a physician or dentist for treatment within two years of an Injury to the jaw or sound natural teeth. Effective November 1, 2008, if the Injury occurs to an eligible Dependent who is under 18 years of age and it is determined that dental services to treat the Injury should be delayed until the eligible Dependent reaches full growth, the two-year limit does not start until the eligible Dependent reaches age 18. In order for the treatment to be covered by the Plan, the Dependent must still be eligible under the rules of the Plan when the treatment begins.
  
  
• Meniscal Allograft Transplants, a type of surgery in which a new meniscus (a cartilage ring in the knee) is placed into your knee, is covered effective August 1, 2008. This procedure is done in cases of meniscus tears that are so severe that all or nearly all of the meniscus cartilage has to be removed. The new meniscus can help eliminate knee pain and possibly prevent future arthritis. The Fund covers this type of surgery if you meet the following guidelines:

  • Members under the age of 55, and
  • Pre-operative studies (MRI or previous arthroscopy) reveal absence or near-absence of the meniscus, and
  • Degenerative changes in the surrounding articular cartilage must be absent or minimal, and
  • Normal knee alignment and stability (i.e., intact or reconstructed ACL) or stability will be achieved concurrently with meniscal transplant.

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 contact Monumental only 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 must contact the Welfare Fund Administrative Office. Remember: notifying Monumental of a change does not update your information with the Welfare Fund. The information on file with the Welfare Fund is used to determine your eligibility for benefits and to provide you with important updates about your benefits. In addition, in many cases 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.
  
  
• 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 you get divorced or have a death in the family, you must notify the Fund Office. If you do not notify the Fund Office, it may result in you owing money to the Fund. The Fund has the right to recover any overpayment or mistaken payment made to you or to a third party. The Fund may recover those monies by reducing other benefit payments made to you or on your behalf, by commencing a legal action or by any other methods as the Trustees, in their discretion, determine appropriate.
  
  
• 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 this 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 healthcare 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.
  
  
• 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. 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.
  
  
• 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:

  • 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. As required by the Women’s Health and Cancer Rights Act of 1998, the Plan 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.