Pipe Fitters' Welfare Fund, Local 597
Plan Highlights for Retired Employees

  The Welfare Plan provides comprehensive medical expense benefits and prescription drug benefits for retired employees and their dependents.

The Plan also provides a death benefit for retired employees.

   
    Eligibility for Retiree Medical Benefits
 
    Self-Pay Requirements for Retiree Medical Benefits
   

 

 

Retiree Not Working in the Industry
Retiree Working in the Industry
Disability Retiree with Earnings Above $24,000

 
    Benefits for Retired Employees Not Yet Eligible for Medicare
      Death Benefit
Comprehensive Medical Expense Benefits
Wellness Benefit
Employee Assistance Plan
Hearing Aid Benefits
Prescription Drug Benefits
Dental Care Discounts

 
    Benefits for Retired Employees Eligible for Medicare
     

Death Benefit
Medicare Supplemental Medical Expense Benefits
Prescription Drug Benefits
Dental Care Discounts
Weight Watchers

 

 

 

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  Retirees Not Working in the Industry
Rates Effective January 1, 200
8
   
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: 

  1. Routine physical examination by a licensed M.D. or D.O.
     

  1. Wellness laboratory tests as follows:

    1. Comprehensive metabolic panel (organ function)

    1. Lipid panel and total cholesterol

    1. Occult blood over age 35 (gastrointestinal)

    1. Complete blood count with differential WBC (diseases)

    1. Complete urinalysis (infections, diseases)

    1. Blood glucose (diabetes)
       

  1. 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® .

Benefit

Benefit Amount or Limitation

Weight Watchers

13 Week Session

 

   

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