NECA-IBEW WELFARE TRUST FUND NEWSLETTER

Volume 27, No.1	DECATUR, ILLINOIS	June, 2011

Special Health Care Reform Enrollment Issue

Under the Patient Protection and Affordable Care Act (the “Affordable Care Act,” or health care reform), passed last year, group health plans like the NECA-IBEW Welfare Trust Fund (the Plan) must comply with the requirements on the first day of the plan year immediately following September 23, 2010. Our Plan is making several changes as required by the Affordable Care Act that will go into effect on July 1, 2011.

The Plan is also providing a special enrollment opportunity for participants and/or your dependents who are newly eligible (or re-eligible) for Plan coverage as a result of changes mandated by the Affordable Care Act.

Continue reading this newsletter for more information about Plan changes effective July 1, 2011, and the special enrollment opportunity. This newsletter is designed to help you make informed decisions about your benefits and to help you complete the special enrollment process.

Health Screenings a Success.

This spring, the Plan offered free health screenings to eligible Active participants and their spouses, as well as retirees under age 65 and their spouses, in Peoria, IL, for IBEW Local 34 members and in Terre Haute, IN, for IBEW Local 725 members.

Over 280 people took advantage of the free screenings, which measured their height, weight and Body Mass Index (BMI), and also included a blood sample to measure cholesterol and glucose levels as well as other factors that can lead to health complications. Those who took the screening received a summary report of their results. Those whose tests showed evidence of risk factors will receive a call from a Wellness Coach to discuss those risks and to develop a wellness plan.

Oral Appliances and Sleep Studies Not Covered

The Plan does not provide coverage for oral appliances and home sleep studies that are prescribed by a dentist to treat mild to moderate sleep apnea. Treatments for sleep apnea are covered when medically necessary and prescribed by a medical doctor. Note that this is not a change; just a clarification of your Plan benefits.

COBRA Continuation Coverage Self-Pay Rates

Under certain circumstances, you may be eligible to continue coverage on a self-pay basis as required under federal law, referred to as COBRA Continuation Coverage. Monthly self-pay rates for COBRA Continuation Coverage effective June 1, 2011 are shown below.

Please note that the Fund no longer offers Base Plan COBRA Coverage for Medical, Prescription Drug, Dental, Vision and the HRA Benefit.  See the COBRA Continuation Coverage section of your Summary Plan Description (SPD) for more information.

Health Care Reform: Plan Changes and Special Enrollment Opportunity

Effective July 1, 2011 the Plan is making a number of changes to comply with the Affordable Care Act. The changes include extending coverage for dependents to age 26, removing the lifetime maximum and changing some of the annual maximums. There will also be a special enrollment opportunity for participants and your dependents who are newly eligible (or re-eligible) for Plan coverage as a result of the Affordable Care Act mandates. The Plan changes and the instructions for the special enrollment opportunity are explained in this newsletter.

Statement of Grandfathered Status

The Trustees believe that this Plan is a “grandfathered health plan” under the Affordable Care Act, which permits us to preserve certain basic health coverage already in effect before the law was passed. As with all grandfathered health plans, our Plan does not have to include certain consumer protections of the Affordable Care Act that apply to other plans (for example, providing preventive health services without any cost sharing). However, grandfathered health plans, like our Plan, must comply with other consumer protections in the Affordable Care Act (for example, the extension of coverage for dependent children to age 26).

Contact the Fund Office if you have questions about what it means for a health plan to have grandfathered status and what might cause a plan to lose its grandfathered status. You may also contact the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) at 866-444-3272 or www.dol.gov/ebsa/healthreform. The website includes a chart summarizing the protections that do and do not apply to grandfathered health plans.

Extended Coverage for Eligible Dependent Children

The Affordable Care Act requires our Plan to extend coverage for eligible dependent children up to age 26, regardless of whether they are students, married, living with you, dependent on you for financial support, or have other employment-based coverage available.

Revised Definition of Eligible Dependent Children

Due to this coverage extension, the Plan will revise the definition of an eligible dependent child effective July 1, 2011. Eligible dependent child will include:

• Children, provided they:

  • Are under 26 years of age;

  • Are over age 26, permanently and totally disabled and incapable of any gainful activity and/or self-sustaining employment due to a medically determinable physical or mental impairment that began before the child attained age 26 and is expected to result in death or last for a continuous period of 12 months or more.

  • Are named under a Qualified Medical Child Support Order (QMCSO).

In addition to children named under a Qualified Medical Child Support Order (QMCSO), children may include your:

• Biological children;

• Legally adopted children, including children placed with you for adoption;

• Stepchildren;

• Foster children; and

• Grandchildren.

(Stepchildren, Foster children and grandchildren must also depend on you for more than 50% of their support and maintenance and have a principal place of residence with you for more than one-half of the calendar year.  Legal guardianship is also required for grandchildren.)

Coverage for your enrolled eligible children will end on the last day of the month in which they turn age 26.

The Plan has also removed the limitation on the number of stepchildren and foster children that can be considered as your eligible dependents under the Plan.

Removal of Lifetime Maximums

Under the Affordable Care Act, the Plan must remove all lifetime maximum dollar limits by July 1, 2011. Consequently, the Plan will eliminate the $2,000,000 Lifetime Maximum for active participants and non-Medicare-eligible retirees with coverage in the Base Plan, and the $1,000,000 Lifetime Maximum for active participants and non-Medicare-eligible retirees with coverage in the Alternative Plan, effective July 1, 2011.

Other Adjusted Plan Maximums

In addition to eliminating the overall lifetime maximums, the Affordable Care Act requires the Plan to modify or eliminate annual maximums for essential health benefits as of July 1, 2011. The Plan will make the following changes for active participants and non-Medicare-eligible retirees effective July 1, 2011:

• The Annual Maximum for the Base Plan will be $2,000,000 per person, and the annual maximum for the Alternative Plan will be $1,000,000 per person

• The Organ Transplant Lifetime Maximum of $2,000,000 for the Base Plan and $1,000,000 for the Alternative Plan will be eliminated.

• The Well Child Care Lifetime Maximum of $2,000 will be eliminated for both the Base and Alternative Plans.

• The Temporomandibular Joint Dysfunction (TMJ) Lifetime Maximum of $2,000 will be eliminated for both the Base and Alternative Plans for eligible dependent children up to age 18. However, this maximum will continue to apply to you, your spouse and/or your dependent children age 18 and older.

• The Chiropractic Treatment Calendar Year Maximum of $1,500 will be eliminated for both the Base and Alternative Plans.  However, there will be a 24-visit per calendar year maximum.

• The Dental Benefits Calendar Year Maximum of $1,500 will be eliminated for the Base Plan for eligible dependent children up to age 18. However, this maximum will continue to apply to you, your spouse and/or your dependent children age 18 and older. (The Alternative Plan does not offer Dental Benefits.)

• The Vision Benefits Calendar Year Maximum of $300 will be eliminated for the Base Plan for eligible dependent children up to age 18. However, this maximum will continue to apply to you, your spouse and/or your dependent children age 18 and older. (The Alternative Plan does not offer Vision Benefits.) There will be a new Vision Benefit Calendar Year Limit of one set of frames and one set of lenses per year for dependent children up to age 18.

• The Hearing Aid Benefit Limit of $1,250 per ear every five years will be eliminated for both the Base and Alternative Plans for eligible dependent children up to age 18. However, this maximum will continue to apply to you, your spouse and/or your dependent children age 18 and older.

All other Plan maximums, including those for Testosterone Replacement Therapy, Growth Hormones and Physical/Massage Therapy, will continue to apply  since they are considered non-essential benefits under the Affordable Care Act.

Revised Pre-Existing Condition Limitation

The Plan has a Pre-Existing Condition limitation that applies for six months on any expenses related to treatment of a condition that started before you became eligible unless you provide acceptable proof of prior coverage to shorten or eliminate the delay in coverage. A Pre-Existing Condition means a condition, regardless of the cause (whether physical or mental), for which medical advice, diagnosis, care, or treatment was recommended or received.

A requirement of the Affordable Care Act includes removing the Plan’s pre-existing condition limitation for dependent children up to age 19 as of July 1, 2011. This exclusion, however, will continue to apply to you, your spouse and your dependent children age 19 or older. With this change, the Plan will provide coverage for dependent children even if the child received medical advice, diagnosis, care, or treatment before July 1, 2011 or before becoming eligible under the Plan, if later.

Special Enrollment Opportunity Due to Extension of Dependent Child Coverage

If you have a dependent child who is under age 26 (whether married or unmarried), including a child currently receiving continuation coverage under COBRA, you can enroll that child in the Plan as of July 1, 2011.

This special enrollment opportunity applies to:

• Children whose coverage under the Plan has already ended due to their age; and

• Children who were not previously eligible to enroll in the Plan because eligibility for dependent coverage under the prior Plan provisions ended before the children reached age 26.

You must complete the enclosed special enrollment form and return it to the Fund Office no later than June 30, 2011 for coverage to be effective as of July 1, 2011. If you are mailing your completed special enrollment form, it must be postmarked by June 30, 2011.

If you do not enroll your newly eligible child during this initial special enrollment, he or she will not have coverage under the Plan until the first of the month after your enrollment form is received by the Fund Office, or as soon as administratively possible.

NOTE: If you are enrolling a newly eligible child who was never previously covered by the Plan, you will be asked to supply the Plan with documentation verifying your dependent’s eligibility. The Plan will contact you to let you know the documentation requirements, procedures and deadlines.

A Final Note

If you want to make any changes other than adding dependents who are newly eligible (or re-eligible) for coverage as a result of the Affordable Care Act, you must contact the Fund Office. If you have any questions, please contact the Fund Office at 217-875-0254 or toll-free at 800-765-4239.