PIPE FITTERS’ WELFARE FUND, LOCAL 597

Summary of Material Modifications

All the changes summarized in this notice are effective June 1, 2009. 

1.     Maximum Benefit Under Major Medical Has Changed.

The Trustees have increased the maximum benefits payable under the Comprehensive Major Medical benefit to $2 million from the previous amount of $1 million.  However, going forward, the maximum benefits payable will no longer be applied per Sickness or Accident but instead will be applied to all Major Medical benefits paid in a participant’s lifetime. 

2.     New Services Covered Under the Plan for the Treatment of Autism.

The Trustees have added Applied Behavioral Analysis (ABA) services as a covered expense for the treatment of autism under the Plan’s Mental and Nervous Disorder benefit. 

However, in order for ABA to qualify as a covered expense, it must be provided by an early intervention specialist that is certified and licensed in the state in which the services are provided. 

Such specialists include, Physicians, licensed psychologists, licensed clinical professional counselors in the appropriate field, licensed clinical social workers or other licensed professionals as recognized by the Plan.

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PIPE FITTERS’ WELFARE FUND, LOCAL 597

Summary of Material Modification

1.  Maximum Dental Benefit for Active Employees Has Increased.

Effective January 1, 2010, the Trustees have increased the maximum benefits payable under the Dental Expense Benefit for Active Employees to $1,750 per person per calendar year from the previous amount of $1,250.    

2.  Maximum Chiropractic Benefit for Active Employees and Retired Employees Not Yet Eligible for Medicare Has Increased.

Effective January 1, 2010, the Trustees have increased the maximum benefits payable for Spinal Manipulation and Naprapathic Benefits (including diagnostic testing) for Active Employees and Retired Employees Not Yet Eligible for Medicare to $1,500 per person per calendar year from the previous amount of $1,000.    

3.  Death Benefit for Active Employees Has Increased.

Effective July 1, 2010, the Trustees have increased the Death Benefit payable on behalf of Active Employees to $25,000 from the previous amount of $10,000 ($20,000 in the event of an Accidental Death).  Due to this Death Benefit increase, the Accidental Death Benefit (AD&D) has been eliminated from the Plan. 

4.  Prescription Erectile Dysfunction Drugs Are Now a Covered Expense Under the Plan’s Prescription Drug Benefit. 

Effective July 1, 2010, the Trustees have added certain erectile dysfunction drugs to the list of prescription drugs covered under the Plan.  The Plan will only pay for up to six pills of Viagra, Cialis or Levitra per month.  However, the Plan may temporarily allow a higher quantity with prior authorization from the Plan’s pharmacy benefit manager, ExpressScripts.     

5.  Annual Health Reimbursement Account Credit for Retirees Has Increased. 

     Effective November 1, 2010, the Trustees have increased the annual amount credited to a Retiree’s Health Reimbursement Account (HRA) to $55 per Pension Year from the previous amount of $50 per Pension Year. 

      For example, if you have 35 Pension Years, your HRA will be credited with $1,925 (35 x $55) of tax-free contributions available for reimbursement of certain approved medical expenses.

6.  Michelle’s Law Requires Extension of Coverage for Some Dependents.

Beginning January 1, 2010, federal law requires the Plan to extend coverage to dependents that lose their full-time student status and in turn their coverage under the Plan due to a serious illness or injury.  The Plan will extend coverage to the dependent for up to one year from the date of the medically necessary leave of absence, but may end earlier if the dependent’s coverage terminates for any other reason as set forth in the Plan.  In order to receive such extension, the Plan must receive written certification from the dependent’s physician that the dependent is suffering from a serious illness or injury and a leave of absence is medically necessary.  

7.  Family Medical Leave Act Expanded for Military Families. 

Effective January 16, 2009, the Family and Medical Leave Act (FMLA) expanded the circumstances under which an Employee may take FMLA leave.  The new law adds two new military family leave entitlements for eligible family members.  The hours for which contributions would have been made during your absence will be considered regular Credited Hours as though you had actually worked those hours. 

The duration of FMLA leave available to you will depend on the reasons for which you are taking the leave.   

You may qualify for up to 12 weeks (during any 12-month period) of unpaid leave for your own serious illness, the birth or adoption of a child, to care for a seriously ill spouse, parent or child or the occurrence of a qualifying exigency to deal with the affairs of your spouse, child, or parent because he or she is called to duty.  A qualifying exigency includes short-notice deployment, military events and related activities, childcare and school activities, financial and legal arrangements, counseling, rest and recuperation, post-deployment activities and additional activities as defined under the FMLA in 29 CFR Part 825. 

You may qualify for up to 26 weeks (during any 12-month period) of unpaid leave to care for a covered service-member with a serious injury or illness if the Employee is the spouse, child, parent or next of kin of the service-member as defined under the FMLA in 29 CFR Part 825.  However, please be aware that this 26-week leave is the maximum time period allowed and is not in addition to the 12-week leave provided above.

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July 14, 2010

Dear Participants: 

As previously announced, the Trustees of Pipe Fitters Welfare Fund, Local 597 increased the death benefit for active employees to $25,000.  The death benefit for retired employees continues to be $5,000.

 In order to assure that the death benefit payments are not taxable to your beneficiary, effective July 1, 2010, the Fund’s death benefits are insured through Dearborn National (Fort Dearborn Life).

 If you have not completed a life insurance beneficiary designation form or if you wish to update your beneficiary designation(s), please complete the enclosed beneficiary designation form and return it to the Fund Office.

 By virtue of insuring our death benefit through Dearborn National, Local 597 participants are entitled to the following benefits offered by Dearborn National at no cost: 

• Accelerated Death Benefit – Pays 75% of the life insurance amount to an employee covered as an active member who is diagnosed with a terminal condition expected to result in death in 24 months.  The remaining benefit is paid to the employee’s designated beneficiary upon the member’s death. 
   
• Conversion Privilege – Allows members to purchase life insurance from Dearborn National upon termination of coverage from Pipe Fitters Welfare Fund, Local 597. 
   
• Online Will Preparation – This service lets you simply and quickly create a will online that is valid in all states – free of charge.  Administered by ComPsych®4, the world’s largest provider of global employee assistance programs, the program guides you through three easy steps:  1.) Answer a series of straightforward questions: 2.) Your will is prepared using advanced technology; 3.) Review and print your will.
   
• Travel Assistance Program – Whether traveling for business or pleasure, a trip can be disrupted by a medical emergency, a lost prescription or instability in a foreign country.  This is why Dearborn National has teamed up with Europ Assistance USA, Inc.  (EA) to offer employees an easy and convenient way to get the assistance they need should the unexpected happen.  EA provides 24-hour services that can help an employee access emergency assistance when traveling 100 or more miles from home, including medical monitoring, medical evaluation, traveling companion assistance, dependent children assistance and visits by family members or friends. 

The Online Will Preparation service and Travel Assistance Program are provided compliments of Dearborn National.  These are not Pipe Fitters Local 597 Welfare Fund benefits nor have they been reviewed or endorsed by its Board of Trustees.

If you are interested in taking advantage of these Dearborn National programs, visit the Pipe Fitters Local 597 Welfare Fund’s website, www.pf597.org, click on Benefit Funds, then click on the Welfare Fund link for information on how to utilize the Online Will Preparation and Travel Assistance Program.   

If you have any questions, please contact the Fund Office. 

                                                                                    Sincerely,

                                                                                    Board of Trustees

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Summary of Material Modification – Plan Changes

Notice Regarding Grandfathered Status

The Trustees of the Pipe Fitters’ Welfare Fund, Local 597 believe this is a “grandfathered health plan” under the Patient Protection and Affordable Care Act (the Affordable Care Act).  As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted.  Being a grandfathered health plan means that your Plan may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing.  However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits.  Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the Fund Office, 45 North Ogden, Chicago, IL 60607, telephone 312-633-0597.  You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at 1 (866) 444-3272 or www.dol.gov/ebsa/healthreform.  This website has a table summarizing which protections do and do not apply to grandfathered health plans.  

1.   Definition of Dependent Has Changed.

Effective January 1, 2011, the Trustees have changed the definition of Dependent to include an employee’s children under the age of 26 regardless of their financial dependency, residence or marital status as required by federal law.  However, the Plan will not cover any child age 19 or older who is eligible for other group coverage, if the other coverage is provided through the child’s employer or through his or her spouse’s employer.  Enrollment forms are provided in this mailing.  If you do not receive an enrollment form and would like to enroll your child, please contact the Fund Office at (312) 633-0597.   

2.   Schedule of Benefits for Active Employees Has Changed Pursuant to the PPACA. 

      Effective January 1, 2011, the Trustees have revised the Plan to eliminate certain lifetime and annual limits as required by federal law.  The revised Schedule of Benefits for Active Employees is as follows: 

 
    3.   Schedule of Benefits for Retired Employees Not Yet Eligible for Medicare Has Changed Pursuant to the PPACA.

Effective January 1, 2011, the Trustees have revised the Plan to eliminate certain lifetime and annual limits as required by federal law.  The revised Schedule of Benefits for Retired Employees Not Yet Eligible for Medicare is as follows: 

4.   Schedule of Benefits for Retired Employees Eligible for Medicare Has Changed Pursuant to the PPACA. 

Effective January 1, 2011, the Trustees have revised the Plan to eliminate certain lifetime and annual limits as required by federal law.  The revised Schedule of Benefits for Retired Employees Eligible for Medicare is as follows: 

5.   Covered Dental Expenses are Categorized as Diagnostic, Preventive or All Other Covered Services. 

Effective January 1, 2011, the Trustees revised the Plan to categorize all Dental Services as preventive and diagnostic or all other covered expenses as follows:

1. Diagnostic and Preventive Services

1.  Two routine oral examinations per calendar year.

2.  Two routine prophylaxis treatments by a Dentist or dental hygienist per calendar year.

3.  Dental x-ray, when professionally indicated and Medically Necessary.  Full-mouth dental x-rays are limited to one full-mouth dental x-ray per calendar year.

4.  Dental sealants for each Dependent child under the age of 16.

5. One topical application of sodium or stannous fluoride by a Dentist or dental hygienist per calendar year.

6.  The scaling and cleaning of teeth by a licensed dental hygienist or dental assistant if performed under the supervision and direction of a Dentist and a charge is made for such service by a Dentist, but not more than two times in any calendar year.

1. All Other Covered Services

1. Extractions of teeth (including wisdom teeth) and cutting procedures to the teeth and/or gums, including pre-operative and post-operative care.

2.  Anesthetics administered in connection with oral surgery covered under this benefit.

3.  Injections of antibiotic drugs by the attending Dentist.

4.   Periodontic treatment and surgery, including periodontal cleaning, scaling and other treatment for diseases of the gums and tissues of the mouth.

5.   Endodontic treatment, including root canal therapy and pupal therapy.

6.  Emergency treatment for the relief of dental pain when no other treatment is given during the same visit.

7.  Fillings, inlays, and crowns.  Gold restorations will only be covered if amalgam, silicate or plastic materials will not adequately restore the tooth.

8.  Replacement of previously existing gold restorations, provided that amalgam, silicate or plastic materials will not adequately restore the tooth and if the previous restoration was installed at least five years before the replacement.

9.  Initial installation of a full or partially removable denture, temporary denture or fixed bridgework.

10.  Dental (tooth) implants.

11. Laboratory services for preparation of dental restoration and dental prosthetic devices if the Dentist includes the cost of such services or devices in the charges for these services. 

6.   Definition of Usual and Customary Fee or Charges for Dental Expenses Clarified.

Beginning January 1, 2011, the Plan will determine the Usual and Customary Fee or Charges for Dental Expenses as follows:

1.   For service or supply covered under a Plan PPO or similar organization contract, the fee shall be the amount the service provider has agreed to accept as payment in full under its contract with a Plan PPO or similar organization.

2.   For service or supply where the fee is not determined under (1) above, the fee will be equal to the 90^th percentile of the fee most often charged in the same area by providers with similar training and experience for a comparable service or supply as determined by the Board of Trustees.  “Area” means metropolitan area or a county, or a greater area if needed to find a cross section of providers of a comparable service or supply. 

The Board of Trustees reserves the right under extenuating circumstances to pay an amount greater than the fee determined under subsections (1) and (2) above. 

7.   Retired Employee Eligibility Expanded to Provide Retired Employee Coverage to retirees of the Gary Community School Corporation and the School City of Hammond. 

Effective January 1, 2011, Retired Employee Eligibility is expanded to provide Retired Employee Coverage for persons receiving a defined benefit pension from the Gary Community School Corporation or School City of Hammond if the individual: (a) has at least 25 years of coverage under the Plan, (b) was eligible for Welfare Plan benefits immediately before their retirement and for at least 12 of the preceding 20 Benefit Quarters and (c) pays the applicable premium for Retired Employee Coverage after the run-out of their Accumulation Account.
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