PUGET SOUND ELECTRICAL WORKERS HEALTH AND WELFARE TRUST FUND PLAN 2

Transcription

1 PUGET SOUND ELECTRICAL WORKERS HEALTH AND WELFARE TRUST FUND PLAN 2 January 2006

2 Puget Sound Electrical Workers Healthcare Trust Physical Address 7525 SE 24th Street, Suite 200, Mercer Island, WA Mailing Address PO Box 34203, Seattle, WA Phone (206) or (866) Fax (206) Website Administered by Welfare & Pension Administration Service, Inc. September 25, 2017 TO: RE: All Active Plan 2 Participants and Beneficiaries Puget Sound Electrical Workers Healthcare Trust Changes to Dollar Bank Maximum This is a summary of material modification describing recent changes adopted by the Board of Trustees. Please be sure that you and your family read this carefully and keep it with your Summary Plan Description Material. The Board of Trustees review the funding of the Healthcare Plan regularly and may make changes to the dollar bank maximum and the monthly dollar bank deduction based on the financial strength of the Plan. During a recent review of the financial health of the Plan, the Board is pleased to announce that the financial strength of the Plan has improved enough to increase the monthly dollar bank maximum. Dollar Bank Maximum Increased. Effective with hours worked on and after September 1, 2017 (November eligibility), the dollar bank maximum accumulation is increased to $2,800 (4 months of eligibility) from $2,100 (3 months of eligibility). Please note there are no changes to the monthly dollar bank deduction amount. If you have any questions about how this change impacts your eligibility under the Puget Sound Electrical Workers Healthcare Trust, contact the Administration Office at (866) , option 4. Board of Trustees Puget Sound Electrical Workers Healthcare Trust CJ:hkg opeiu#8 S:\Mailings\Individual Trust Fund Mailings (SMM, Benefit Changes, etc.)\f33\f Mailing SMM - Plan 2 - Changes to Dollar Bank Maximum.docx

3 Puget Sound Electrical Workers Healthcare Trust Physical Address 7525 SE 24th Street, Suite 200, Mercer Island, WA Mailing Address PO Box 34203, Seattle, WA Phone (206) or (866) Fax (206) Website Administered by Welfare & Pension Administration Service, Inc. June 30, 2017 TO: All Participants of the Puget Sound Electrical Workers Healthcare Trust (the Plan ) RE: Plan Benefit Changes This is a summary of material modification describing benefit changes adopted by the Board of Trustees. Please be sure that you and your family read it carefully and keep this document with your Summary Plan Description Booklet. The Trustees took recent action to make the following changes to the Plan: Amend the section of the Plan Booklet entitled Other Health Care Professional Services (pages of both the Plan 1, Plan 2 booklet/pages of the Retiree booklet and Special Retiree booklet) Massage Therapist has been added to the list of Other Covered health care professionals. The following sentence is being deleted from this section, Massage therapists are not considered covered health care professionals. Amend the Massage Therapy Exclusion (page 45 of the Plan 1 booklet/page 44 of the Plan 2 booklet/page 40 of the Retiree booklet/page 41 of the Special Retiree booklet) Coverage for massage therapy will be permitted when prescribed by a Physician and provided by a covered health care professional, for medically necessary treatment of an illness, injury or to alleviate pain. The above changes became effective January 1, 2017, consistent with the provisions of the Affordable Care Act. Please keep this important notice with your Plan Document/Summary Plan Description for easy reference to all Plan provisions. If you have any questions about these changes, please contact the Administration Office at (866) , option 1. For additional Plan information and forms visit the trust s website at Summary of Benefits and Coverage The Trust is required to provide a Summary of Benefits and Coverage (SBC) to all participants and beneficiaries. The enclosed SBC is for the Plan in which you are currently enrolled and replaces any prior SBC you may have received. Please note: The SBC furnished to the participant will be considered provided to dependents unless the Plan has been advised of a different address for dependents.

4 It is important to note that the SBC is only a summary and does not replace the Summary Plan Description (Plan booklet). Included in the SBC are coverage examples, which estimate what the Plan benefit would be under common medical situations. If you are eligible or enrolled in Medicare or have primary coverage through another group health plan, this plan s benefits will be coordinated with that other plan and differ from what s indicated in the SBC and the coverage examples. The SBC is not intended to be a cost estimator and should not be used to estimate your actual costs. A Uniform Glossary of Terms has also been published by the government. This document is intended to describe terms commonly used in health insurance coverage, such as deductible and copayment. Both the SBC and the Uniform Glossary of Terms have been posted to the Trust s website at Please keep this important notice with your Plan Document/Summary Plan Description (SPD) for easy reference to all Plan provisions. Should you have any questions, please contact the Administration Office toll free at , option 1. Board of Trustees Puget Sound Electrical Workers Healthcare Trust CJ:lmm opeiu#8 S:\Mailings\Individual Trust Fund Mailings (SMM, Benefit Changes, etc.)\f33\f Mailing SMM - Massage Therapy.docx

5 December 1, 2016 Puget Sound Electrical Workers Healthcare Trust nd Avenue, Suite 300 P.O. Box Seattle, Washington Phone (206) or (866) Fax (206) Website Administered by Welfare & Pension Administration Service, Inc. TO: RE: All Participants of the Puget Sound Electrical Workers Healthcare Trust (the Plan ) Plan Benefit Changes This is a summary of material modification describing benefit changes adopted by the Board of Trustees. Please be sure that you and your family read it carefully and keep this document with your Summary Plan Description Booklet. The Trustees took recent action to make the following changes to the Plan: Coverage of Transgender Healthcare Services Effective January 1, 2017, the Plan will cover medically necessary transgender healthcare services for Gender Dysphoria (also called Gender Identity Disorder), as generally described below. For more information on coverage requirements for transgender healthcare services, please contact the Administration Office at (866) , option 1. You and/or your service provider(s) should submit information to the Plan for a coverage determination prior to beginning treatment. Services covered by the Plan include: Counseling Hormone Therapy Gender reassignment surgery Services typically associated with one sex, which may continue to be required after transition Prescription drugs (as covered under the Prescription Drug Program of this Plan) To be eligible for coverage you must: Be 18 years of age or older, Have a well-documented diagnosis of Gender Dysphoria or Gender Identity Disorder meeting the diagnostic criteria of the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), and In the event of gender reassignment surgery, have no medical contraindications and complete specific evaluation and recommendation requirements. The Plan does not cover services that are considered cosmetic, not medically necessary and/or are otherwise excluded under the Plan. This includes, but is not limited to: Rhinoplasty or nose implants Face-lifts Lip enhancement or reduction Facial bone reduction or enhancement Blepharoplasty (eyelid surgery) Breast Augmentation Liposuction Reduction thyroid chondroplasty (Adam 's Apple reduction) Hair removal Voice modification surgery or training Skin resurfacing Travel expenses

6 Nutritional Therapy/Counseling Effective October 1, 2016, the Plan covers Nutritional Therapy/Counseling as follows: Screening and one on one counseling visits with a covered provider for weight loss for children age 6 and older who are considered obese and for adults with a body mass index of 30kg/meter squared or higher. One on one office visits with a covered provider to manage diabetes or eating disorders diagnosed by a physician. Coinsurance Changes The Trust is pleased to announce the following coinsurance changes for Preferred Providers (in-network) effective February 1, 2017: The Plan 1 payment level will increase from 80% to 85% of the Allowed Amount of covered medical expenses. Your coinsurance level will decrease from 20% to 15% of the Allowed Amount. The Plan 2 payment level will increase from 75% to 80% of the Allowed Amount of covered medical expenses. Your coinsurance level will decrease from 25% to 20%. Annual Deductible Changes Effective February 1, 2017, the deductible for Preferred Providers (in-network) will change as follows: Plan 1 will decrease from $500 per person/$1,000 per family to $400 per person/ $800 per family. Plan 2 will decrease from $500 per person/$1,000 per family to $400 per person/ $800 per family. Dental Changes Effective February 1, 2017 the annual dental benefit will increase from $2,000 to $2,500. Please keep this important notice with your Plan Document/Summary Plan Description for easy reference to all Plan provisions. If you have any questions about these changes, please contact the Administration Office at (866) , option 1. For additional Plan information and forms visit the trust s website at Board of Trustees Puget Sound Electrical Workers Healthcare Trust CJ:hkg opeiu#8 S:\Mailings\Individual Trust Fund Mailings (SMM, Benefit Changes, etc.)\f33\f Mailing SMM.docx Page 2 of 2

7 Puget Sound Electrical Workers Trust Funds nd Avenue, Suite 300 P.O. Box Seattle, Washington Phone (206) or (866) Fax (206) Website Administered by Welfare & Pension Administration Service, Inc. July 1, 2016 TO: All Eligible Plan Participants Puget Sound Electrical Workers Healthcare Trust RE: Benefit Changes Effective August 1, 2016 This is a Summary of Material Modification describing changes adopted by the Board of Trustees. Please be sure that you and your family read this information carefully and keep it with your Plan Booklet. Out-of-Pocket Maximum Changes Effective August 1, 2016, the following changes will be made to the Out-of-Pocket (OOP) maximum: The current Tier 1 and Tier 2 OOP terminology will be eliminated and the current Tier 2 OOP maximum of $6,600 per person/$13,200 per family will be removed. The current $5,000 per person Medical coinsurance limit for Preferred Providers (in-network) will change to a $5,500 per person per calendar year Medical OOP maximum. In addition, an $11,000 per family per calendar year Medical OOP maximum will be established for Preferred Providers (in-network). The calendar year deductible, copays and coinsurance for services from a Preferred Provider will count toward the Preferred Provider (in-network) calendar year OOP maximum. Once the OOP maximum is reached, Preferred Provider (in-network) services will be covered at 100% for the remainder of the calendar year. In addition, coinsurance for the following services performed by a Preferred Provider will now apply towards the Preferred Provider (in-network) OOP maximum: Chiropractic Care Acupuncture Care Naturopathic Care Chemical Dependency Mental Illness Physical, Occupational, and Speech Therapy Foot Orthotics Diabetic Education Skilled Nursing Facility Home Health Care Hospice The Non-Preferred Provider (out-of-network) deductible and coinsurance limit provisions will not change. (over)

8 In-Network Prescription Drug Changes Effective August 1, 2016, a separate in-network calendar year prescription drug OOP maximum will be established. The OOP maximum will be $1,350 per person/$2,700 per family. Copays for prescriptions filled at an in-network pharmacy for retail, mail order, and specialty drugs will apply to the OOP maximum. Once the OOP maximum for prescription drugs is reached, all copays for in-network prescription drugs will be waived for the remainder of the calendar year. Copays for drugs purchased at out-of-network pharmacies will not count toward the OOP maximum and will not be waived once the OOP maximum is reached. Summary of Benefits and Coverage The Trust is required to provide a Summary of Benefits and Coverage (SBC) to all participants and beneficiaries. The enclosed SBC is for the Plan in which you are currently enrolled and replaces any prior SBC you may have received. Please note: The SBC furnished to the participant will be considered provided to dependents unless the Plan has been advised of a different address for dependents. It is important to note that the SBC is only a summary and does not replace the Summary Plan Description (Plan booklet). Included in the SBC are coverage examples, which estimate what the Plan benefit would be under two common medical situations. If you are eligible or enrolled in Medicare or have primary coverage through another group health plan, this plan s benefits will be coordinated with that other plan and differ from what s indicated in the SBC and the coverage examples. The SBC is not intended to be a cost estimator and should not be used to estimate your actual costs. A Uniform Glossary of Terms has also been published by the government. This document is intended to describe terms commonly used in health insurance coverage, such as deductible and copayment. Both the SBC and the Uniform Glossary of Terms have been posted to the Trust s website at Please keep this important notice with your Plan Document/Summary Plan Description (SPD) for easy reference to all Plan provisions. Should you have any questions, please contact the Administration Office toll free at , option 1. Board of Trustees Puget Sound Electrical Workers Healthcare Trust CJ:hkg opeiu#8 S:\Mailings\Individual Trust Fund Mailings (SMM, Benefit Changes, etc.)\f33\f Mailing SMM.docx (over)

9 Puget Sound Electrical Workers Healthcare Trust nd Avenue, Suite 300 P.O. Box Seattle, Washington Phone (206) or (866) Fax (206) Administered by Welfare & Pension Administration Service, Inc. July 1, 2015 TO: All Participants of the Puget Sound Electrical Workers Healthcare Trust (the Plan ) RE: Benefit Changes Effective August 1, 2015 This is a summary of material modification describing benefit changes adopted by the Board of Trustees. Please be sure that you and your family read it carefully and keep this document with your Summary Plan Description Booklet. The Trustees took action to make the following changes: Overall Out-of-Pocket Maximum Changes Effective August 1, 2015, the Plan s Tier II annual out-of-pocket limit will increase from $6,350 to $6,600 per person and from $12,700 to $13,200 per family. The Tier II out-of-pocket limits now include your prescription drug co-payments and apply to your out-of-pocket costs for: All in-network Coinsurance In-network Emergency Room (ER) Copays In-network Deductible Pediatric Dental and Vision Copays and Coinsurance Prescription Drug Co-payments Dental Benefits The Plan's Dental Benefits include routine examination under Class I Diagnostic Benefits. Currently, routine examinations are limited to once in a 6-month period. Effective August 1, 2015, the limitation for routine examinations will be two routine examinations per calendar year, with the appointments separated by at least five months. This new limit is the same as the limitation for prophylaxis (cleaning). Note: Not all participants are eligible for dental benefits. Please check your Summary Plan Description Booklet or contact the Administration Office for verification of dental eligibility. Step Therapy Prescription Drugs Your out-of-pocket cost for a brand name prescription drug when a generic is available is (1) the copay for the brand name drug plus (2) the difference in cost between the brand name and generic. Effective August 1, 2015, you won t pay the cost difference when you get approval to use a brand name drug (instead of a generic) through the Step Therapy Program. Please refer to the Summary of Material Modification dated October 31, 2014 for a more complete description of the Plan s prescription drug copays and for a more complete description of the Step Therapy Program.

10 Payments for Outpatient Dialysis Treatment Due to the increasing cost of outpatient dialysis treatment, the Trust will implement changes to the coverage of dialysis treatment for End Stage Renal Disease ( ESRD ), effective August 1, Enrollment in Medicare Based on ESRD Prevents Balance Billing. If you or your eligible dependent has been diagnosed with ESRD, you or your dependent may be eligible to enroll in Medicare Part A and B. Although you are not obligated by the Trust to enroll in Medicare, Enrolling in both Parts A and B will help protect you from being balance billed by providers of ESRD dialysis services. Currently, the Trust pays charges for outpatient dialysis as follows: 1. If the provider is a preferred provider, the Trust pays the provider based on the discounted preferred provider amount, subject to deductible and coinsurance, and the provider may not balance bill you for the difference between the discounted amount and their billed charges. 2. If the provider is not a preferred provider, the Trust payment is based on the Usual, Customary and Reasonable (UCR) rate for outpatient dialysis, subject to deductible and coinsurance, but the provider may balance bill you for any amount in excess of UCR. After this change, when you or your dependent is enrolled in Medicare (or is simply eligible for Medicare) based on ESRD, the following payment rates will apply for both preferred and nonpreferred providers: When Medicare becomes the Secondary Payer under the Medicare rules (usually beginning with the 4th month of ESRD treatment) the Trust, as a Primary Payer will pay claims for ESRD services at 150% of the then current Medicare allowable amount. These services will not be subject to deductible or coinsurance. Note: This rule applies when you are eligible for Medicare, even if you do not enroll in Medicare. Unless you are enrolled in Medicare (as noted above), the provider may balance bill you for the difference between 150% of the Medicare allowable amount and the provider s billed charges. When Medicare later becomes the Primary Payer (usually beginning with the 34th month of treatment for ESRD), the Trust, as Secondary Payer, will pay claims for ESRD services at 100% of the then current Medicare allowable amount (subject to coordination of benefits with Medicare). These services will not be subject to deductible or coinsurance. Note: This rule applies when you are eligible for Medicare, even if you do not enroll in Medicare. Unless you are enrolled in Medicare (as noted above), the provider may balance bill you for the difference between the Medicare allowable amount and provider s billed charges. Coverage for all other ESRD dialysis services will remain unchanged. The Trust may, at its sole discretion, agree to a contractual arrangement for payment with a provider of ESRD services. The contract may provide for a different payment rate for ESRD services than described above. But in no circumstances will the contract allow for a payment less than the payments listed above. Any contractual agreement and/or change in payment terms with a provider of ESRD services will be at the sole discretion of the Trust. 2

11 Summary of Benefits and Coverage The Trust is required to provide a Summary of Benefits and Coverage (SBC) to all participants and beneficiaries. The enclosed SBC is for the Plan in which you are currently enrolled and reflects the benefit changes outlined in this notice. Please note, the SBC furnished to the participant will be considered provided to dependents unless the Plan has been advised of a different address for dependents. It is important to note that the SBC is only a summary and does not replace the Summary Plan Description (Plan booklet). Included in the SBC are coverage examples, which estimate what the plan benefit would be under two common medical situations. If you are eligible or enrolled in Medicare or have primary coverage through another group health plan, this plan s benefits will be coordinated with that other plan and differ from what s indicated in the SBC, and the coverage examples. The SBC is not intended to be a cost estimator and should not be used to estimate your actual costs. A Uniform Glossary of Terms has also been published by the government. This document is intended to describe terms commonly used in health insurance coverage, such as "deductible" and "copayment" Both the SBC and the Uniform Glossary of Terms have been posted to the Trust s website at or you can call the Administration Office at the number below. Please keep this important notice with your Plan Document/Summary Plan Description for easy reference to all Plan provisions. If you have any questions about these changes, please contact the Administration Office at (866) , option 0. Board of Trustees Puget Sound Electrical Workers Healthcare Trust CJ:hkg opeiu#8 S:\Mailings\Individual Trust Fund Mailings (SMM, Benefit Changes, etc.)\f33\f Mailing SMM.docx 3

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13 Puget Sound Electrical Workers Trust Funds nd Avenue, Suite 300 P.O. Box Seattle, Washington Phone (206) or (866) Fax (206) Website Administered by Welfare & Pension Administration Service, Inc. October 31, 2014 TO: All Active Participants, Retirees, Beneficiaries and COBRA Participants Puget Sound Electrical Workers Healthcare Trust (the Plan ) RE: Benefit Changes Effective January 1, 2015 This is a summary of material modification describing benefit changes adopted by the Board of Trustees. Please be sure that you and your family read it carefully and keep this document with your Summary Plan Description Booklet. Effective January 1, 2015, the Plan is being amended with the benefit changes summarized below and where appropriate are reflected on the enclosed Summary of Benefits and Coverage. Prescription Drug Co-pay Changes Retail Co-pay (30-day supply) Costco Mail Order Co-pay (90-day supply) Formulary Updates Tier Current Co-pay Effective January 1, $10 Generic ($0 at Costco) $10 Generic ($3 at Costco) 2 $20 Preferred Brand $25 Preferred Brand 3 $40 Non-Preferred Brand $50 Non-Preferred Brand 1 $0 Generic $7.50 Generic 2 $40 Preferred Brand $62.50 Preferred Brand 3 $80 Non-Preferred Brand $ Non-Preferred Brand Prescription Drug Program Changes What is a Formulary? Your prescription drug benefit features a formulary drug list. A formulary is a list of preferred medications organized into groups, or Tiers. - Tier 1 drugs are generic drugs and are the first choice whenever possible. - Tier 2 drugs are a set of preferred brand-name drugs. - Tier 3 drugs are non-preferred brand-name drugs. For a full formulary listing, please visit select Resource Tools, then click on Preferred Drug List. What are the changes to my benefit? Brand drugs which now have a generic alternative available will be placed on the non-preferred brand tier, with the generic versions of those drugs available on the generic tier. These brand drugs are listed in Table A on the enclosed insert. Please be aware that these changes in tier level may impact your co-pay and/or result in additional penalties if you continue to receive the brand medication when a generic alternative is available.

14 Puget Sound Electrical Workers Healthcare Trust Benefit Changes Effective January 1, 2015 Implementation of Step Therapy Program Effective January 1, 2015 What is a Step Therapy Program? A step therapy program is designed specifically for patients with certain conditions that require taking medications regularly. It is the practice of beginning medication therapy for a medical condition with the most cost-effective medication and progressing to other more costly therapy(s) should the initial medication not provide adequate therapeutic benefit. The step therapy approach to care is a way to provide you with savings without compromising your quality of care. How does the Step Therapy Program work? In step therapy, medications are grouped into two categories. Step 1: First Line medications medications proven safe, effective, and affordable. Step 2: Second Line medications mostly higher costing brand name medications. You will first be required to try a recognized First Line medication (Step 1) before approval of a more costly and complex therapy is approved (Step 2). If the Step 1 therapy does not provide you with the therapeutic benefit desired, your physician may write a prescription for a Step 2 medication. Which drugs will be subject to the Step Therapy Program? There are two lists of drugs attached to this notice that are subject to the new Step Therapy Program. One list includes specialty drugs and the other list includes standard drugs. For specialty drugs, the Step Therapy Program will apply to new prescriptions only. For all drugs on the standard drug list, the Step Therapy Program will apply for any prescriptions or refills on or after January 1, What should I do if I need to take a medication that is a Step 2 on the Step Therapy Program? If you are in need of a medication that is a Step 2 on any of the step therapy programs, you will need to do one of the following: Have your physician write you a prescription for a First Line medication, or You will need to submit a Letter of Medical Necessity in order to recieve the Second Line medication. Have your physician submit a Letter of Medical Necessity request for your current prescription and quantity, stating that it is medically necessary for you to be on the exact dosage and quantity. A Letter of Medical Necessity is a request that must be submitted annually. You or your physician can begin the Letter of Medical Necessity process by contacting the EnvisionRxOptions Help Desk at Should you have questions regarding participating pharmacies or any of these updates within your prescription drug benefit, please contact the EnvisionRxOptions Customer Service Help Desk at The EnvisionRxOptions Help Desk is here to assist you with prescription questions 24 hours a day, 7 days a week. You may also contact the Administration Office for any additional questions at toll free , option 1. Always talk to your doctor before discontinuing or changing any medication. If you have medical questions, please contact your health care provider. We encourage you to work with your physician to determine which medication options are best for you. 2

15 Puget Sound Electrical Workers Healthcare Trust Benefit Changes Effective January 1, 2015 Other Prescription Drug Benefit Changes Specialty Medication Fill Rule All specialty medications are required to be filled at a Costco Specialty Pharmacy. Effective January 1, 2015, first fill at a retail pharmacy will not be allowed. Compound Medication Drug Criteria A Letter of Medical Necessity (LMN) will be required on all compound medications costing more than $200. Erectile Dysfunction Medications Viagra, Levitra, Stendra, Edex, Caverject, Muse, and Cialis will not be covered for erectile dysfunction. The Plan will only cover Cialis for the diagnosis of Benign Prostatic Hyperplasia (BPH) with a Letter of Medical Necessity from your physician and requires prior authorization. Emergency Room Co-pay Effective January 1, 2015, the emergency room co-pay will increase to $100 for all participants. Summary of Benefits and Coverage The Trust is required to provide a Summary of Benefits and Coverage (SBC) to all participants and beneficiaries. The enclosed SBC is for the Plan in which you are currently enrolled and replaces any prior SBC you may have received. Please note: The SBC furnished to the participant will be considered provided to dependents unless the Plan has been advised of a different address for dependents. It is important to note that the SBC is only a summary and does not replace the Summary Plan Description (Plan booklet). Included in the SBC are coverage examples, which estimate what the Plan benefit would be under two common medical situations. If you are eligible or enrolled in Medicare or have primary coverage through another group health plan, this plan s benefits will be coordinated with that other plan and differ from what s indicated in the SBC and the coverage examples. The SBC is not intended to be a cost estimator and should not be used to estimate your actual costs. A Uniform Glossary of Terms has also been published by the government. This document is intended to describe terms commonly used in health insurance coverage, such as deductible and copayment. Both the SBC and the Uniform Glossary of Terms have been posted to the Trust s website at Please keep this important notice with your Plan Document/Summary Plan Description (SPD) for easy reference to all Plan provisions. Should you have any questions, please contact the Administration Office toll free at , option 1. Board of Trustees Puget Sound Electrical Workers Healthcare Trust CJ:hkg opeiu#8 S:\Mailings\Individual Trust Fund Mailings (SMM, Benefit Changes, etc.)\f33\f Mailing All Plans Benefit Changes.docx Enclosures: Envision Table A Formulary Changes Step Therapy Program: specialty and standard drug lists Summary of Benefits and Coverage 3

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18 Puget Sound Electrical Workers Trust Funds nd Avenue, Suite 300 P.O. Box Seattle, Washington Phone (206) or (866) Fax (206) Website Administered by Welfare & Pension Administration Service, Inc. October 15, 2014 To: Re: All Active and Retired Participants and Their Dependents Puget Sound Electrical Workers Healthcare Trust This notice explains certain changes to your Medical Benefits. Please be sure you and your dependents read this notice carefully in order to understand the changes effective November 1, What s Changing? Your benefits aren t changing, but some contacts and administrative processes are, so read this notice carefully and keep it for your reference. Included with this letter is an Important Contacts and Resources chart that lists the appropriate telephone numbers and website addresses available for more information. If you or any of your dependents are on Medicare, the following information does not pertain to you. New Preferred Provider Organization and Claims Administration Effective November 1, 2014, the Trust s current Preferred Provider Organization ( PPO ) in Washington and Alaska will be replaced with Premera Blue Cross. In all other areas of the United States, the Trust will use the BlueCard nationwide network of Blue Cross Blue Shield ( BCBS ) providers and facilities. This change will improve the pricing for medical services for members and for the Trust. For services obtained on or after November 1, 2014, you must use a hospital, physician, or other healthcare provider that participates in the Premera Blue Cross network in Washington and Alaska, or in the local Blue Cross Blue Shield network in any other state outside of Washington and Alaska if you want the lowest out-of-pocket cost. Medicare Eligible Retirees or Dependents It is important to note that members eligible for Medicare are not required to use the Premera Blue Cross Network. You will receive updated ID cards later in November. Continue to use your Envision ID card when you visit medical providers or the pharmacy. How Do I Find a Preferred Provider? If you already have a provider, it s likely that they are already participating with the local Blue Cross Blue Shield network. We suggest that you confirm this directly with your provider, or search for other preferred providers in your area by visiting or calling (800) 810-BLUE (2583). Refer to the Important Contacts and Resources chart for more details.

19 Puget Sound Electrical Workers Healthcare Trust Premera Announcement Notice October 15, 2014 Will I Receive New ID Cards? New identification cards reflecting these changes will be mailed to all Active members and non-medicare Retirees during the last week of October. The new ID card will continue to be a combination medical and prescription drug card and will include the claims submission address for dental and timeloss claims as well. Once you receive your new card, you should present it to your providers (doctors, hospitals, etc.) for services received on and after November 1, Keep your old ID cards with your records for 12 months in the event you need them to resolve claims incurred prior to November 1, What Now? Watch for your new ID cards to be mailed on or after October 23, If you do not receive your new ID cards by November 3, 2014, contact the Administration Office at (866) , option 4. If you live in Washington or Alaska, check to make sure your current providers participate in the Premera Blue Cross Network. If you live in a state other than Washington or Alaska, check to make sure that your current providers participate in their local Blue Cross Blue Shield network. Contact the Administration Office at the numbers listed on the Important Contacts and Resources chart if you have any questions. The Board of Trustees, along with WPAS, Inc. and Premera Blue Cross, will work diligently to make this as smooth a transition as possible. Board of Trustees, Puget Sound Electrical Workers Healthcare Trust CJ:hkg opeiu#8 S:\Mailings\Individual Trust Fund Mailings (SMM, Benefit Changes, etc.)\f33\f Mailing Premera Announcement Notice.docx Enclosure 2

20 Puget Sound Electrical Workers Healthcare Trust Important Contacts and Resources The chart below provides useful contact information for additional details and resources regarding the plan administration changes. Please keep this in a convenient place for future reference. For Information About Eligibility Claims and Benefits Trust forms and documents Contact Trust Administration Office (866) , option 4 Trust Administration Office (866) , option 1 Medicare Retiree Medical and Vision Claims: Where to send claims PSEW Healthcare Trust PO Box Seattle, WA All Dental and Time Loss Claims and Member Paid Medical Claims: PSEW Healthcare Trust PO Box Seattle, WA Premera (800) 810-BLUE (2583) Online: Premera Blue Cross Blue Shield Network providers or facilities Prescription Drug Services Precertification, utilization and case management services Finding a Premera BCBS Provider: Go to Select Find a Doctor from the list of links on the top of the page. Next, select the options that describe the type of provider or facility you are looking for. Click Heritage and Heritage Plus 1 from the drop down options. Enter your ID number prefix (LIT) or select BlueCard PPO from the drop down options. This will give you access to a list of Blue Cross Blue Shield participating providers in your area. Envision Rx Options (800) Online: Qualis Health (800)

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23 Puget Sound Electrical Workers Trust Funds nd Avenue, Suite 300 P.O. Box Seattle, Washington Phone (206) or (866) Fax (206) Website Administered by Welfare & Pension Administration Service, Inc. July 1, 2014 TO: All Active Plan 2 Participants and Beneficiaries Puget Sound Electrical Workers Healthcare Trust (the Plan ) RE: Plan 2 - Benefit Changes Effective August 1, 2014 This is a summary of material modification describing benefit changes adopted by the Board of Trustees. Please be sure that you and your family read it carefully and keep this document with your Summary Plan Description Booklet. Effective August 1, 2014, the Plan is being amended to satisfy requirements of the Patient Protection and Affordable Care, more commonly known as the Affordable Care Act (ACA). The Plan is also implementing other benefit changes. All changes are summarized below. Benefit Current Benefit Effective August 1, 2014 Annual Maximum Benefit $2,000,000 annual limit on essential health benefits. There is no longer a maximum benefit on essential health benefits. Acupuncture/Chiropractic Combined benefit limited to $250 Combined benefit limited to 5 visits annually. annually. Foot Orthotics Limited to $300 once every 4 years. One pair every 4 years. Covered at Covered at 80% PPO/50% non-ppo 75% PPO/50% non-ppo Diabetic educations $300 lifetime limit 2 visit limit per lifetime Naturopath Currently not a covered provider. Naturopaths will be covered the same as any other provider, 75% PPO/50% non-ppo. Neurodevelopmental Therapy Covered for dependent children up to age 6 up to a $5,000 annual maximum. Limited to 52 visits per year, the age limit is removed. Ambulance Covered at 80% PPO/80% non-ppo Covered at 75% PPO/75% non-ppo Hearing Covered at 80% PPO/50% non-ppo Covered at 75% PPO/50% non-ppo Skilled Nursing Covered at 90% PPO/50% non-ppo Covered at 75% PPO/50% non-ppo Home Health Care Covered at 90% PPO/50% non-ppo Covered at 75% PPO/50% non-ppo Rehabilitation Facility Covered at 80% PPO/50% non-ppo Covered at 75% PPO/50% non-ppo Covered at 80% PPO/50% non-ppo, Covered at 75% PPO/50% non-ppo Physical therapy limited to $60 per visit. Limited to $60 per visit. Hospice Covered at 100% Covered at 75% PPO/50% non-ppo Overall Out-of-Pocket Maximum Changes Currently, for in-network providers, the Plan has a $5,000 per person out-of-pocket limit. For non-network providers there is no out-of-pocket limit. The existing co-insurance or out-of-pocket maximums under the Plan will remain in effect (Tier 1). Certain services such as acupuncture, chiropractic, home health care, foot orthotics, skilled nursing and deductible do not apply to this out-of-pocket maximum.

24 Puget Sound Electrical Workers Healthcare Trust Plan 2 - Benefit Changes Effective August 1, 2014 Pursuant to mandates in the Affordable Care Act, a new annual overall out-of-pocket maximum of $6,350 per person, up to $12,700 per family (Tier 2), will become effective for covered health benefit services received by in-network providers. The new out-of-pocket maximum will apply to: All in-network Coinsurance In-network Emergency Room (ER) Copays In-network Deductible Pediatric Dental and Vision Copays and Coinsurance If an individual or family reaches the new Overall out-of-pocket maximum during the Plan year for services received in-network, then there will be no further out-of-pocket expenses for the individual or family respectively during the remainder of the year as it relates to the deductible, coinsurance, or emergency room visits for in-network services. Penalties for failure to follow the preauthorization requirements of the Plan do not apply to any out-of-pocket maximum. All changes above are reflected on the enclosed Summary of Benefits and Coverage. Coverage for Costs Associated with Certain Clinical Trials ACA requires the Plan to cover certain costs associated with certain clinical trials. Effective August 1, 2014, the Plan will cover routine patient costs for items and services furnished in connection with an approved clinical trial that would otherwise be covered by the Plan. The Plan does not cover: The actual clinical trial or the investigational item, device or service itself, Items and services solely for data collection that are not directly used in the clinical management of the patient, or Services that are clearly inconsistent with widely accepted and established standard of care for a particular diagnosis. An approved clinical trial is a phase I, II, III, or IV clinical trial that is conducted in relation to the prevention, detection, or treatment of cancer or other life-threatening disease or condition. Summary of Benefits and Coverage The Trust is required to provide a Summary of Benefits and Coverage (SBC) to all participants and beneficiaries. The enclosed SBC is for the Plan in which you are currently enrolled. Please note, the SBC furnished to the participant will be considered provided to dependents unless the Plan has been advised of a different address for dependents. It is important to note that the SBC is only a summary and does not replace the Summary Plan Description (Plan booklet). Included in the SBC are coverage examples, which estimate what the plan benefit would be under two common medical situations. If you are eligible or enrolled in Medicare or have primary coverage through another group health plan, this plan s benefits will be coordinated with that other plan and differ from what s indicated in the SBC, and the coverage examples. The SBC is not intended to be a cost estimator and should not be used to estimate your actual costs. A Uniform Glossary of Terms has also been published by the government. This document is intended to describe terms commonly used in health insurance coverage, such as "deductible" and "copayment" Both the SBC and the Uniform Glossary of Terms have been posted to the Trust s website at or you can call the Administration Office at the number below. 2

25 Puget Sound Electrical Workers Healthcare Trust Plan 2 - Benefit Changes Effective August 1, 2014 SAVE THE DATE COALITION HEALTH FAIR 2014 SATURDAYS FROM 8AM 12 NOON Spokane: October 4 th Red Lion Hotel at the Park W. 303 North River Drive Spokane, WA Bothell: October 25 th IUOE Local 302 Union Hall th Ave NE Bothell, WA Seattle: November 1 st IBEW Local 46 Electrician s Hall nd Avenue South Kent, WA The Puget Sound Electrical Workers will be participating again this year in the Health Care Cost Management Corporation (the Coalition) Health Fairs. These events give eligible plan participants and their dependents (age 18 and over) easy access to preventive care services and health screening tests. In addition, flu shots will also be available to eligible participants (age 9 and over) at no cost to you, 100% paid for by the Coalition. Be good to yourself and your family, save one of the dates listed above and attend the Health Fair that is most convenient for you. Watch your mail for more specific information in the coming weeks. Please keep this important notice with your Plan Document/Summary Plan Description (SPD) for easy reference to all Plan provisions. Should you have any questions, please contact the Administration Office toll free at , option 1. Board of Trustees Puget Sound Electrical Workers Healthcare Trust CJ:hkg opeiu#8 S:\Mailings\Individual Trust Fund Mailings (SMM, Benefit Changes, etc.)\f33\f Mailing Plan 2 Benefit Changes.docx Enclosures: SMM - External Review of Certain Medical Claim Decisions Summary of Benefits and Coverage Summary Annual Report 3

26 Puget Sound Electrical Workers Trust Funds nd Avenue, Suite 300 P.O. Box Seattle, Washington Phone (206) or (866) Fax (206) Website Administered by Welfare & Pension Administration Service, Inc. January 31, 2014 To: All Active Participants and Non-Medicare Retirees Puget Sound Electrical Workers Healthcare Trust Re: New Preferred Provider Network - Effective April 1, 2014 This letter describes upcoming changes to the Preferred Provider Network and service areas. Please be sure that you and your family read it carefully. Keep this notice with your benefit booklet for insurance records. Effective April 1, 2014, the Trust will be transitioning from BeechStreet Preferred Provider Organization (PPO) to First Choice Health Network. This change applies ONLY to medical services provided outside the states of Washington, Alaska, Colorado, Idaho, Montana, North Dakota, Oregon, South Dakota and Wyoming. To receive the highest level of benefits within the PPO Service Areas, choose PPO providers and/or hospitals and make sure all providers that may be involved in your medical treatment are PPO providers. The PPO Networks and their Service Areas are outlined in more detail below. PPO Networks and Service Areas First Choice Health Network and First Health Network are different PPO networks. Your health plan uses BOTH networks depending on the State where services are performed. Please note the different (but similar) PPO names when deciding which network to contact for Preferred Provider lists. Washington, Alaska, Colorado, Idaho, Montana, North Dakota, Oregon, South Dakota and Wyoming First Choice Health Network is the PPO in these states. The network includes hospitals, physicians, and other providers. If you plan to receive medical care in one of these states, contact First Choice Health Network at (800) or visit their website at for a current list of providers. Benefits will be reduced if a non-network provider is utilized. All Other States First Health Network is the PPO for all states EXCEPT Washington, Alaska, Colorado, Idaho, Montana, North Dakota, Oregon, South Dakota and Wyoming. If you plan to visit or receive medical care in any other state, contact First Health at (800) or visit their website at for a current list of providers. Your new combination Health and Prescription Drug Identification (ID) cards will be mailed by the end of March. If you do not receive new ID cards by March 29th, please contact the Administration Office at (206) or (866) , option 4. Board of Trustees Puget Sound Electrical Workers Healthcare Trust CJ:hkv opeiu#8 S:\Mailings\Individual Trust Fund Mailings (SMM, Benefit Changes, etc.)\f33\f Mailing Carrier Change Notice.docx

27 Puget Sound Electrical Workers Trust Funds nd Avenue, Suite 300 P.O. Box Seattle, Washington Phone (206) or (866) Fax (206) Website Administered by Welfare & Pension Administration Service, Inc. November 1, 2013 TO: Active Employees, Retirees, Eligible Dependents and COBRA Qualified Beneficiaries covered by the Puget Sound Electrical Workers Healthcare Trust (the Trust ) RE: Plan Changes Effective January 1, 2014 This is a summary of material modification describing changes to the Trust s health plan adopted by the Board of Trustees. Please be sure that you and your family read it carefully and keep this document with your Summary Plan Description Booklet. Effective January 1, 2014, the Trust s health plan (the Plan ) will no longer be considered grandfathered under the Patient Protection and Affordable Care Act (PPACA). Effective January 1, 2014, the Plan is being amended to satisfy PPACA s requirements for non-grandfathered plans and to make changes, including a new self-pay requirement for Special Retirees (62 65) and a rate increase for both Early Retirees and Medicare Retirees. These changes are summarized below. Dependent Eligibility All dependent children who satisfy the Plan s eligibility requirements will be eligible for dependent coverage, regardless of other available coverage. (The Plan will no longer exclude children who are eligible to enroll for group health coverage through their employer or their spouse s employer.) Medical Benefits Emergency Room Services The Plan covers certain emergency services provided in hospital emergency rooms when you are suffering from an emergency medical condition. You do not have to obtain prior authorization before seeking emergency services in a hospital emergency room. The Plan will charge you the same coinsurance whether you obtain those services in the emergency room of a PPO hospital or a non-ppo hospital. However, if you obtain those services in a non-ppo hospital, the provider may bill you the difference between what the provider charges and what the provider collects from the Plan and from you in the form of copayment and coinsurance payment. Percentage Payable For services incurred on and after January 1, 2014, the Plan will increase the overall deductibles for both PPO providers and non-ppo providers. The Plan will also increase your coinsurance level for all medical services. These changes are reflected on the enclosed Summary of Benefits and Coverage. Preventive Care Services - The Plan will pay 100% of the costs incurred for certain preventive care services when those services are provided by a PPO provider. This means that these services will not be subject to any deductible, and you will not have to pay any cost sharing (in other words, you will not have to pay coinsurance for these services). The preventive care services to which this new rule applies are those that are recommended under the Affordable Care Act. The required services include services that are highly recommended by the U.S. Preventive Services Task Force (for example, screening mammography every 1-2 years for women age 40 and older and colorectal cancer screening at specified intervals for adults age 50 to 75). In addition, certain pediatric preventive services, for example, well baby and well child visits at specified intervals, will be covered. You will also have coverage for immunizations for infants, children, adolescents, and adults as recommended by the Federal Centers for Disease Control and Prevention. A complete list can be reviewed at Preventive care services performed at a non-ppo provider continue to be subject to the Plan deductible and coinsurance. (over)