| |
Retirees
Not Working
in the Industry
Rates Effective January 1, 2008 |
| |
|
|
Retiree not on Medicare, no dependents |
$128
per month |
|
Retiree not on Medicare, with dependent not on Medicare |
$256
per month |
|
Retiree not on Medicare, with two or more dependents not
on Medicare |
$384 per month |
|
Retiree not on Medicare, with dependent on Medicare |
$205
per month |
|
Retiree not on Medicare, with dependent on Medicare and
one or more dependents not on Medicare |
$333 per month |
|
Retiree on Medicare, no dependents |
$77 per month |
|
Retiree on Medicare, with dependent on Medicare |
$154
per month |
|
Retiree on Medicare, with dependent not on Medicare |
$205
per month |
|
Retiree on Medicare, with two or more dependents not on
Medicare |
$333
per month |
|
Retiree on Medicare, with dependent on Medicare and one
or more dependents not on Medicare |
$282
per month |
|
Retiree on Medicare, with two dependents on Medicare |
$231
per month |
|
| |
|
|
| |
Retiree Working in
the Industry
Rates Effective January 1,
2008 |
| |
|
|
Retiree not on Medicare, no dependents, running out hour
bank |
$128
per month |
|
Retiree not on Medicare, with one or more dependents not
on Medicare, running out hour bank |
$256
per month |
|
Retiree not on Medicare, no dependents, after hour bank
run out |
$256
per month |
|
Retiree not on Medicare, with one or more dependents not
on Medicare, after hour bank run out |
$512 per month |
|
Retiree not on Medicare, with one or more dependents on
Medicare, running out hour bank |
$205
per month |
|
Retiree not on Medicare, with one or more dependents on
Medicare, after hour bank run out |
$410
per month |
|
Retiree on Medicare, no dependents, running our hour
bank |
$77
per month |
|
Retiree on Medicare, no dependents, after hour bank run
out |
$154
per month |
|
Retiree on Medicare, with one or more dependents not on
Medicare, running out hour bank |
$205
per month |
|
Retiree on Medicare, with one or more dependents not on
Medicare, after hour bank run out |
$410 per month |
|
Retiree on Medicare, with one or more dependents on
Medicare, running out hour bank |
$154
per month |
|
Retiree on Medicare, with one or more dependents on
Medicare, after hour bank run out |
$308
per month |
|
| |
|
|
| |
Disability Retiree with Earnings above $24,000
Rates Effective
January 1, 2008 |
| |
|
Disability Retirees under age 60 with Annual Social
Security wages in excess of $24,000 in the year will pay higher
rates in the following year.
|
Retiree not on Medicare, no dependents |
$214 per
month |
|
Retiree not on Medicare, with one dependent
|
$428 per
month |
|
Retiree not on Medicare, with two or more dependents |
$642 per
month |
|
| |
|
|
| |
Death
Benefits |
| |
|
|
Benefit |
Benefit Amount
or Limitation |
|
Death Benefit
for Retired Employee Only |
$5,000 |
|
| |
|
|
For additional information regarding Death Benefits and
Accidental Death and Dismemberment Benefits refer to the Summary Plan Description (SPD)
Section
4. |
|
| |
|
|
| |
Comprehensive Medical Expense Benefits - Not Yet Eligible for
Medicare |
| |
|
|
Benefit |
Benefit
Amount or Limitation |
|
Medical
Expense Benefits |
|
Calendar
Year Deductible |
$300 per person - $900 Family |
|
Maximum
Benefit |
|
Maximum
per Sickness
or Accident |
$1,000,000 per Person |
|
Spinal
Manipulation Maximum
(including diagnostic tests) |
$1,000 per Calendar Year
(for covered individuals age 16 and older) |
|
Covered
Expenses Payable by the Fund
up to the Usual and Customary Fees |
PPO Charges |
Non PPO
Charges |
|
Physician,
Hospital/Facility
(inpatient and outpatient) |
85% |
75% |
|
Skilled
Nursing Care |
60 days per confinement;
See Sec.
7.08
(A) (11) |
|
Out-of-Pocket Maximum per Calendar Year |
$1,000 per Person for
PPO expenses
$2,500 per Person for
Non-PPO expenses |
|
Out-of-Pocket Maximum Does Not Include: |
|
|
·
Deductible
Amount
· Prescription
Drug Co- payments
·
Dental Expense
Payments
· Vision Care
Expense Payments
·
Co-payments for
Outpatient Treatment of Mental and Nervous
Disorders or Chemical Dependency |
|
|
Once you
reach the Out-of-Pocket Maximum, the Plan pays
100% of allowable expenses for the calendar year
up to the Maximum Benefit listed above. Expenses
that apply towards the Non-PPO out-of-pocket
limits apply towards the PPO out-of-pocket
limits and vice versa. |
|
|
Note: Durable Medical Equipment and Local Ambulance
Service for which PPO services are not available will be
covered the same as PPO charges |
|
Mental and
Nervous Disorders |
PPO Charges |
Non PPO Charges |
|
Outpatient |
50% |
50% |
|
Inpatient |
85% |
75% |
|
Chemical
Dependency |
PPO Charges |
Non PPO
Charges |
|
Outpatient |
50% |
50% |
|
Inpatient |
85% |
75% |
|
Inpatient |
$6,000 per Course of Treatment
Limited to Two Courses of Treatment per Lifetime |
|
Benefit |
Benefit Amount
or Limitation |
|
Outpatient
Physical/Speech Therapy Maximum |
$3,500 per
Calendar Year* |
|
Outpatient
Occupational Therapy Maximum |
$3,500 per
Calendar Year* |
|
* After
the $3,500 outpatient maximum is reached, no other payment
is made under the Plan with the following exceptions: if
$3,500 is reached for the outpatient treatment of cerebral
palsy, cerebral vascular incident (stroke), intracranial
bleed, other head traumas, spinal cord injuries, multiple or
complicated fractures or other catastrophic diagnoses with
neurological implications, then the Fund pays 75% and the
Participant co-pay is 25%. |
|
| |
|
|
For additional information regarding Comprehensive Medical
Expense Benefits - Not Yet Eligible for Medicare refer to the Summary Plan Description (SPD)
Section
7. |
|
| |
|
|
| |
Employee Assistance Plan |
| |
|
|
Benefit |
Benefit Amount
or Limitation |
|
Employee
Assistance Plan (EAP) for Retired Employees and Dependents |
|
Initial
Counseling with EAP Staff |
Up to Three Sessions Covered at No Charge
|
|
| |
|
|
For additional information regarding Employee Assistance
Plan refer to the Summary Plan Description (SPD)
Section
12. |
|
| |
|
|
| |
Hearing Aid Benefits |
| |
|
|
Benefit |
Benefit Amount
or Limitation |
|
Hearing Aid
Benefit for Retired Employee and Dependents |
|
Hearing Aid
and Exam |
100% Up to $900 per Ear |
|
Frequency
Limit |
One per ear for any 36 consecutive month
period |
|
| |
|
|
For additional information regarding Employee Assistance
Plan refer to the Summary Plan Description (SPD)
Section
13. |
|
| |
|
|
| |
Prescription Drug Benefits |
| |
|
|
Benefit |
Benefit Amount
or Limitation |
|
Prescription Drug
Benefit for Retired Employee and Dependents |
|
Co-Pay Percentage
(if greater than minimum co-pay amounts) |
20% |
|
Minimum Co-Pay Amount |
Retail (34 day supply) |
Mail (90 day supply) |
|
Generic |
$5 |
$10 |
|
Brand Preferred |
$15 |
$30 |
|
Brand Non-Preferred |
$30 |
$60 |
|
Specialty Drug Co-Pay
Percentage |
20% |
|
Annual Out-of-Pocket Maximum
for Specialty and Prescription Drugs (Excludes
Prescription Narcotics (narcotic agonists) |
$5,000 |
|
The participant co-payment for prescription
narcotics (narcotic agonists) is always
20% and is not subject to any Out-of-Pocket Maximum |
|
| |
|
|
For additional information regarding Prescription Drug
Benefits refer to the Summary Plan Description (SPD)
Section
9. |
|
| |
|
|
| |
Dental Care Discounts |
| |
|
Retired Employees
have access to discounts effective January 1, 2007 under the Blue
Cross Dental PPO.
Retired Employee
Coverage now includes access to discounts under the Blue Cross Blue
Shield Dental PPO network. The Fund does not pay for the services
provided by your dentist. The Fund pays a fee so that Retired
Employees will have access to discounts under the Dental PPO
network. The participant pays the full cost of the discounted
dental services directly to the provider.
|
| |
|
|
| |
Medicare
Supplemental Medical Expense Benefits |
| |
|
|
Supplemental
Medical Expense Benefit |
Amount Paid by Medicare in 2008 |
Amount Paid by Participant in 2008 |
Amount Paid by Plan in 2008 |
|
Amounts Payable During
any Hospital Confinement |
|
First 60 Days |
Amount over $1,024 |
$372 |
$652 |
|
61st
Day Through 90th Day |
Amounts over $256 per Day |
$18 per Day |
$238 per Day |
|
91st
Day Until End of Lifetime Reserve |
Amounts over $512 per Day |
$36 per Day |
$476 per Day |
|
After Lifetime
Reserve is Exhausted |
0% |
20% |
80% |
|
Pints of Blood |
|
First Three
Pints |
|
|
$25 per pint |
|
More than Three
Pints |
100% |
0% |
0% |
|
Medicare Part B
Deductible |
0% |
0% |
100% |
|
Medicare Part B Expenses
After Deductible |
80% |
0% |
20% |
|
Medicare Part B
(Mental Health) |
50% |
30% |
20% |
|
Skilled Nursing
Facility |
|
First 20 Days |
100% |
0% |
0% |
|
21st
Day Through 100th Day |
Amounts over $128 per Day |
$9 per Day |
$119 per Day |
|
Maximum payable by
the Plan
per Sickness or Accident |
$1,000,000 |
|
| |
|
|
For additional information regarding Prescription Drug
Benefits refer to the Summary Plan Description (SPD)
Section
8. |
|
| |
|
|
| |
Wellness Benefit |
| |
|
Covers
Routine Physical Exams and Weight Watchers®.
The Plan provides for a new Wellness Benefit that consists of
a Routine Physical Exam Benefit and a Weight-Loss Program.
Routine Physical
Exam Benefit.
The Routine Physical
Exam Benefit applies to active and retired employees and their
dependent spouses, except persons with Retired Employee coverage who
are Medicare eligible. Persons with Retired Employee coverage who
are Medicare eligible are already covered by most of these services
and lab tests through Medicare and the Fund’s Supplement to
Medicare.
Under the Routine
Physical Exam Benefit, the Fund will pay the full Usual and
Customary Fee for the covered service. If you go to an out-of-network provider, this amount may be substantially less than the
amount charged by your provider. Under the Routine Physical Exam
Benefit you can receive the following services once per calendar
year:
-
Routine physical examination by a licensed M.D.
or D.O.
-
Wellness laboratory tests as follows:
-
Comprehensive metabolic panel (organ
function)
-
Lipid panel and total cholesterol
-
Occult blood over age 35 (gastrointestinal)
-
Complete blood count with differential WBC
(diseases)
-
Complete urinalysis (infections, diseases)
-
Blood glucose (diabetes)
-
PSA screen (prostrate) for men over 40 and
Mammogram for women over 40.
No deductible or
co-payments will need to be paid for the above services. Any other
medically necessary tests and services ordered by the physician are
covered under the Comprehensive Major Medical benefit and subject to
deductible and co-payments.
To take full
advantage of the new Wellness Benefit,
download the postcard and present it at your Doctor’s office when
scheduling or undergoing the exam.
Weight-Loss
Program
Pipe Fitters has joined forces with
Weight Watchers® to
bring you convenient weight-loss solutions from the only commercial
weight-loss plan with evidence it works!
The Fund pays for the
full cost of the 13 weeks program or will apply that amount
towards whatever option you select, including Weight
Watchers Online or Weight Watchers At Home. The
benefit pays once per lifetime per employee per spouse.
The Choice is Yours!
Weight Watchers Local
Meeting vouchers:
Local Meeting vouchers are a 13 weeks prepaid program that
offers the flexibility of attending Weight Watchers meeting
in your community when and where it suits you best.
Weight Watchers Online
subscription:
With Online subscription you can follow Weight Watchers
step-by-step online, with interactive tools and resources.
Weight Watcher messages sent directly to your email address,
hundreds of recipes and meal ideas.
Weight Watchers At
Home kit:
The At Home kit gives you information and resources by mail
to follow the plan step-by-step at home. The kit
includes weight-loss tools and bonus products that are
conveniently delivered to your home, along with access to a
Toll-free Helpline with 26 weeks of progress reporting.
Call 1.866.204.1141 to
start a program today or go online to
Weight Watchers® .
|
Benefit |
Benefit Amount
or Limitation |
|
Wellness Benefit
for Retired Employee and Spouse Not Yet Eligible for
Medicare |
|
Physical Exam
(and specified lab tests) |
100% - PPO Only |
|
Weight Watchers |
13 Week Session |
|
| |
|
|
| |
Weight Watchers
Weight-Loss
Program |
| |
|
Pipe Fitters has joined forces
with
Weight Watchers® to
bring you convenient weight-loss solutions from the only commercial
weight-loss plan with evidence it works!
The Fund pays for the full cost
of the 13 weeks program or will apply that amount towards whatever
option you select, including Weight Watchers Online or Weight
Watchers At Home. The benefit pays once per lifetime per
employee per spouse.
The Choice is Yours!
Weight Watchers Local Meeting
vouchers:
Local Meeting vouchers are a 13 weeks prepaid program that offers
the flexibility of attending Weight Watchers meeting in your
community when and where it suits you best.
Weight Watchers Online
subscription:
With Online subscription you can follow Weight Watchers step-by-step
online, with interactive tools and resources. Weight Watcher
messages sent directly to your email address, hundreds of recipes
and meal ideas.
Weight Watchers At Home kit:
The At Home kit gives you information and resources by mail to
follow the plan step-by-step at home. The kit includes
weight-loss tools and bonus products that are conveniently delivered
to your home, along with access to a Toll-free Helpline with 26
weeks of progress reporting.
Call 1.866.204.1141 to start a
program today or go online to
Weight Watchers® .
|
| |
|
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|
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|