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1 National Asbestos Workers Medical Fund 2008. 2 Benefits Comprehensive Major Medical Benefits Deductible Deductible Annual Plan Annual Plan Lifetime.

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Presentation on theme: "1 National Asbestos Workers Medical Fund 2008. 2 Benefits Comprehensive Major Medical Benefits Deductible Deductible Annual Plan Annual Plan Lifetime."— Presentation transcript:

1 1 National Asbestos Workers Medical Fund 2008

2 2 Benefits Comprehensive Major Medical Benefits Deductible Deductible Annual Plan Annual Plan Lifetime Plan Lifetime Plan $250 individual $600 family Plan pays 80% of $16,500; you pay 20% 100% up to $750,000

3 3 Benefits All benefits reduced by 50% if PPO is available and not used All benefits reduced by 50% if PPO is available and not used  Does not apply if outside of 25 miles  Does not apply in case of emergency

4 4 Employee Assistance Benefits Benefits provided by ComPsych – See Summary Plan Description Benefits provided by ComPsych – See Summary Plan Description

5 5 Benefits Emergency Room Co-Pay Emergency Room Co-Pay $100, unless admitted to hospital, or for life threatening illness or injury

6 6 Benefits For Active Members Only Death Benefit Death Benefit Accidental Death Benefit Accidental Death Benefit Dismemberment Benefit Dismemberment Benefit Annual Physical Annual Physical $25,000 Up to $20,000 $600 Annual Max

7 7 Benefits Active Members Only - Loss of Time Maximum Maximum Weeks 1 – 26 Weeks 1 – 26 Benefits begin on 8 th day of illness, 1 st day of injury Benefits begin on 8 th day of illness, 1 st day of injury 26 Weeks $200/week

8 8 Dental Benefits If additional contribution of $.20 paid If additional contribution of $.20 paid Plan covers 80% of UCR Plan covers 80% of UCR Maximum paid by plan is $800/person/year Maximum paid by plan is $800/person/year Ortho limited to $1,500 lifetime Ortho limited to $1,500 lifetime Additional Ortho benefit of $2,000 if additional $.08 paid Additional Ortho benefit of $2,000 if additional $.08 paid

9 9 Vision Benefits If additional contribution of $.04 paid If additional contribution of $.04 paid Plan pays up to $200/person/year Plan pays up to $200/person/year Frames every other calendar year Frames every other calendar year

10 10 Non Medicare - Retiree Benefits Death Benefit = $10,000 (no AD&D) Death Benefit = $10,000 (no AD&D) Same health benefits as Active, except no Physical, A&S or Maternity benefits Same health benefits as Active, except no Physical, A&S or Maternity benefits Dental and/or Vision only if local union is covered and all retirees pay premium Dental and/or Vision only if local union is covered and all retirees pay premium

11 11 Medicare Retiree Benefits Death Benefit = $10,000 (no AD&D) Death Benefit = $10,000 (no AD&D) Same health benefits as Active, except $150 deductible for Medical Benefits only and Medicare is primary coverage Same health benefits as Active, except $150 deductible for Medical Benefits only and Medicare is primary coverage Prescription deductible $750/person – if you sign up for Medicare D; $2,250/person – if you do not sign up for Medicare D Prescription deductible $750/person – if you sign up for Medicare D; $2,250/person – if you do not sign up for Medicare D No Physical, A&S or Maternity benefits No Physical, A&S or Maternity benefits Dental and/or Vision only if local union is covered and all retirees pay premium Dental and/or Vision only if local union is covered and all retirees pay premium

12 12 Eligibility Initial Eligibility Initial Eligibility  800 hours in two eligibility (calendar) quarters provides coverage in benefit quarter, plus 2 preceding months Maintaining Eligibility Maintaining Eligibility  400 hours in eligibility (calendar) quarter (or 800 hours in 2 eligibility quarters) provides coverage in benefit quarter 2 month lag 2 month lag

13 13 Eligibility Issues Newly Organized Members & Newly Indentured Apprentices Newly Organized Members & Newly Indentured Apprentices  Local Must Notify Fund Office  Eligibility  Never previously been eligible  Newly organized employee or Employee of Newly Organized Company  135 hours in work month gives eligibility for following 2 months  Once eligibility terminates, can never be considered NOG again  Separate Plan of Benefits

14 14 Eligibility Issues (Cont.) Self Payments Self Payments  Difference between hours reported in eligibility quarter and 400 hours (or 2 eligibility quarters and 800 hours)  If member disagrees with hours reported, better to pay and get refund  Notify Fund Office if traveling  Advise when participants retired – especially when not in National Asbestos Workers Pension Fund

15 15 Eligibility Issues (Cont.) Dependent Eligibility Dependent Eligibility  Initial enrollment does not require documents  Documents required if adding spouse, dependent (marriage certificate, birth certificate)  Over Age dependent – submit student certification annually

16 16 Eligibility Issues (Cont.) Retiree Eligibility Retiree Eligibility  Eligibility Rules for Retiree Coverage vs. Eligibility Rules for ARESA  Need to Elect Retiree Benefits within 60 days of termination of active eligibility  Opt-Out/Opt-In  Premiums Change With Age & Medicare Eligibility  Premiums are Quarterly

17 17 Claims Issues Routine Physicals for Active Members Only Routine Physicals for Active Members Only Routine Office Visits are Not Covered Routine Office Visits are Not Covered Accidental Injuries paid as Any Other Illness Accidental Injuries paid as Any Other Illness Fund Does Not Pay for Work Related Illness or Injury – see page 93 of SPD Fund Does Not Pay for Work Related Illness or Injury – see page 93 of SPD Will pay A&S for Denied Work Related Illness or Injury if Denial Received Will pay A&S for Denied Work Related Illness or Injury if Denial Received

18 18 Claims Issues (Cont.) If Disabled, can continue Coverage for up to 2 years, then Self Pay for 1 year If Disabled, can continue Coverage for up to 2 years, then Self Pay for 1 year Will pay benefits if out of Country Will pay benefits if out of Country Use Blue prescription reimbursement forms Use Blue prescription reimbursement forms No Precertification Required for Admission to the Hospital No Precertification Required for Admission to the Hospital If totally disabled prior to age 60 can apply for Active Death Benefit If totally disabled prior to age 60 can apply for Active Death Benefit

19 19 Contribution Issues Add/Terminate Cards Must Be Completed Add/Terminate Cards Must Be Completed Advise when Employer has no employees working Advise when Employer has no employees working Contributions are due on 15 th of month following month worked Contributions are due on 15 th of month following month worked Contributions are assessed late charges if not in Fund Office by 25 th of month following month worked Contributions are assessed late charges if not in Fund Office by 25 th of month following month worked

20 20 Contribution Issues (Cont.) Contributions must be submitted for each payroll period that ended during the previous month Contributions must be submitted for each payroll period that ended during the previous month  First payroll period ending date must always be 7 days or less from the beginning of the month  Last payroll ending date must always be 7 days or less from the ending date of the month

21 21 Contribution Issues (Cont.) No contributions No credit

22 22 Who’s Who Accounting Department – Amanda Christie and Jennifer Rodgers Accounting Department – Amanda Christie and Jennifer Rodgers Claims Department – Harriett Wallace & Melanie Najiy Claims Department – Harriett Wallace & Melanie Najiy Membership Services Department – Beth Lancy Membership Services Department – Beth Lancy When All Else Fails – Simone or Reneé When All Else Fails – Simone or Reneé

23 23 Union Definition ( Webster’s New World Dictionary ) Definition ( Webster’s New World Dictionary )  A uniting or being united  A combining, joining or grouping together  Something united or unified  An organization uniting various individuals, groups, political units


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