Announcing our Website

Transcription

1 Announcing our Website The Board of Trustees are pleased to provide a website for the participants of this Fund. This easyto-use tool has been designed as an additional source of information to assist you in using and understanding your benefits. Unlike the many other resources the Fund offers, this website is interactive: you can print your own HRA claim forms and previous issues of this Newsletter. If you log in by clicking the IUOE Members Log In box and typing your user name, which is the first four letters of your last name and the last four numbers of your social security number in lower case with no spaces: last1234 and the password provided in the enclosed letter, you can look up your hours, eligibility status and HRA balance. Your log in will always remain the same, but we strongly recom- (Continued on page 2) IMPORTANT NOTICES If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, a Federal law gives you more choices about your prescription drug coverage. Please see pages 6 and 7 for more details. The Summary Annual Report is included on pages 4 and 5, and the Women s Health and Cancer Rights Act Annual Notice is included on page 5. These annual notices contain important information about your rights under the Plan and ERISA. You should read them carefully and keep them for future reference.

2 Page 2 Summer, 2009 News published by The IUOE Local 406 Welfare Fund Trustees Employer Robert S. Boh, Chair Boh Brothers Construction Co. Davis Lauve Turner Industries Union Don Schiro, Vice Chair Business Manager, IUOE Local 406 Carlos Benoit Business Rep., IUOE Local 406 Fund Offices Administrator Rouen Caboche 7651 Airline Highway Baton Rouge, LA Telephone Toll Free IUOE (4863) Assistant Administrator Darlene Brown 7370 Chef Menteur Highway New Orleans, LA Telephone Toll Free IUOE (4863) Change of status If you have any change of status, such as your marital situation, address, phone number, or if a dependent no longer qualifies as a dependent (see definition of Dependent in your Summary Plan Description booklet [blue cover] pages 1 and 2) such as a child age 19 or older attending school who drops from full-time to part-time, it is your responsibility to notify the Fund immediately. This includes if you and/or your spouse obtain other health coverage, whether group or individual. Failure to do so could result in claims being paid erroneously, which could further result in action to recover any overpayment. Your responsibilities as a Plan participant Provide the Fund with all requested information completed properly and in a timely manner. Notify the Fund office of any and all status changes (as mentioned above). Know and confirm your benefits before receiving treatment. Contact an appropriate health care professional when you have a medical need or concern. Access myuhc.com or United Healthcare customer service to verify that your doctor, hospital or other healthcare provider participates in the network. Show your ID card and the ID card of any other insurance you might have before receiving health care services. Pay any necessary co-payments at the time of your visit or treatment. Participate in understanding your health problems and developing mutually agreed-upon treatment goals. Use emergency room services only for injuries and illnesses that, in the judgment of a reasonable person, require immediate treatment to avoid jeopardy to life or health. Keep scheduled appointments. Provide information needed for your care. Follow the agreed-upon instructions and guidelines of doctors and health care professionals. Visit 406wf.org or call the Fund office about yours or your dependents eligibility; or myuhc.com or United Healthcare customer service for questions about benefits, claims and more. (Continued from page 1) mend that you change your password the first time you visit the website. Eventually, we will be posting important notices and the Summary Plan Description booklet. Please contact us if you need assistance or if there are items you would like us to include on the website in the future. The two screens on page 1 represent the first two pages you will encounter upon entering the site.

3 Summer, 2009 The Health Reimbursement Arrangement (HRA) provides employer funded health care reimbursement accounts as a benefit under the plan for covered employees who work a certain amount of over time each month. It allows these employees to obtain reimbursement of certain eligible medical expenses on a nontaxable basis. How is it credited? A covered employee s HRA account is credited with $3.75 (the current hourly contribution rate) for every hour of over time he or she works in a month up to an annual maximum of $750. For those employers who do not report over time hours separately, the covered employee will be given over time credit (for HRA purposes) for any hours above 173 per month. The HRA account is simply a recordkeeping account that is used to track available HRA reimbursement amounts (over time credits minus reimbursements to date). You cannot be reimbursed for more than your HRA account balance. Any balance remaining in your HRA account at the end of the year will roll over to the next year. What is covered? The purpose of this benefit is to provide a means of being reimbursed for eligible medical expenses incurred by you or your eligible dependents that are not otherwise covered under the Plan or other sources. For example, this may include: * hospital and doctor co-pays * deductibles * co-insurance (the 30% you pay on certain services) * prescription drug co-pays * dental and orthodontic work * vision care (a routine eye exam is covered under the plan every two years with a $40 copay; eyeglasses and contact lenses are not covered under the plan and can also be reimbursed under the HRA) * payment of COBRA premiums Contact either of the Fund offices to determine if other medical services are covered. The Plan provisions generally applicable to benefits provided by the Plan will also apply to the HRA. Filing for reimbursement Unlike the other medical benefits, which are typically paid to the provider after you receive medical treatment and the provider files a claim, you must Page 3 Health Reimbursement Arrangement (HRA): a refresher course file a claim for reimbursement from your HRA account. Except for COBRA premiums, the HRA benefit is designed to reimburse you since your claim will be for out-of-pocket medical expenses that are not reimbursable elsewhere. To file for medical co-pays, deductibles and coinsurance, copies of United Healthcare Explanations of Benefits (EOB) must be submitted. There are two different types of EOBs that are acceptable. One is a single provider EOB that shows what was paid by the Plan and the portion of the doctor or hospital charge that is your responsibility. These EOBs may or may not be mailed to you, but can be printed from United Healthcare s website The other is a monthly statement that shows all claims paid on the entire family in a monthly period. It is important to note that this monthly statement is not for a calendar month. For example, all charges processed in the month of June. It is, instead, a monthly period; such as, June 10 through July 9. Everyone is not on the same monthly cycle. Copies of bills or receipts from providers are not acceptable. To file for prescription drug co-pays, a print-out from your local pharmacy or from Medco is preferred. However, individual receipts are acceptable as long as the date of purchase, name of drug, patient s name and co-pay amount are provided. To file for any other service, such as vision or dental, a bill from the provider is necessary. It must include the provider s name and contact information, the patient s name, date of service, a description of the service and the charge. In addition to the supporting documentation described above, all HRA claims must include a completed and signed HRA Reimbursement Request form. These may be obtained from either Fund office, or you can print one from our website. Please be sure to complete the appropriate sections of both sides. Only one claim form per submission is necessary. If you or a family member has other insurance coverage, whether the other coverage is primary or secondary, you must submit EOBs for both this Plan and the other coverage. The HRA will reimburse you only if you still have an out-of-pocket expense after both coverages have paid. Filing period Claims may be filed at any time during the year; however, they will be payable only to the extent of your HRA account balance. You can submit charges (Continued on page 5)

4 Page 4 Summer, 2009 Summary Annual Report for IUOE LOCAL 406 WELFARE PLAN This is a summary of the annual report for IUOE Local 406 Welfare Plan, EIN , Plan Number 501, for the period January 1, 2008 to December 31, 2008, as filed by the Board of Trustees - IUOE Local 406 Welfare Fund, EIN The annual report has been filed with the Department of Labor, as required under the Employee Retirement Income Security Act of 1974 (ERISA). Insurance Information The Plan is self-funded for all medical benefit and HRA claims. The Plan has a contract with United HealthCare Insurance Company to reimburse the Fund for certain excess medical benefit claims paid under the Plan. The total premiums paid for the plan year ending December 31, 2008 were $653,189. The Plan has a contract with Unimerica to pay life and accidental death and dismemberment claims. The total premiums paid for the plan year ending December 31, 2008 were $29,030. Basic Financial Statements The value of plan assets, after subtracting liabilities of the plan, was $8,437,004 as of December 31, 2008, compared to $7,037,192 as of January 1, During the plan year the plan experienced a change in its net assets of $1,399,812. This increase includes unrealized appreciation and depreciation in the value of plan assets; that is, the difference between the value of the plan s assets at the end of the year and the value of the assets at the beginning of the year or the cost of assets acquired during the year. The plan had total income of $8,544,174, which included employer contributions of $7,970,134, employee contributions of $301,852, realized gain/loss of ($488) from the sale of assets, and earnings from investments of $272,636. Total plan expenses were $7,144,362. These expenses included $697,323 in administrative expenses and $6,447,039 in benefits paid to participants and beneficiaries, and $0 in other expenses. Additional Information The Plan s benefit obligations at December 31, 2008 were $4,814,083, compared to $4,232,213 as of December 31, 2007, an increase in benefit obligations of $581,870. Your Rights To Additional Information You have the right to receive a copy of the full annual report, or any part thereof, on request. The items listed below are included in that report: *An accountant s report *Financial information and information on payments to service providers *Assets held for investment *Insurance information including sales commissions paid by insurance carriers *Transactions in excess of 5% of plan assets To obtain a copy of the full annual report, or any part thereof, write or call the offices of: Board of Trustees of IUOE Local 406 Welfare Fund 7370 Chef Menteur Highway 7651 Airline Highway New Orleans, LA Baton Rouge, LA

5 Summer, 2009 Page 5 The report is furnished without charge. You also have the right to receive from the plan administrator, on request and at no charge, a statement of the assets and liabilities of the plan and accompanying notes, or a statement of income and expenses of the plan and accompanying notes, or both. If you request a copy of the full annual report from the plan administrator, these two statements and accompanying notes will be included as part of that report. The charge to cover copying costs does not include a charge for the copying of these portions of the report because these portions are furnished without charge. You also have the legally protected right to examine the annual report at the offices of the plan: Board of Trustees of IUOE Local 406 Welfare Fund 7370 Chef Menteur Highway 7651 Airline Highway New Orleans, LA Baton Rouge, LA and at the U.S. Department of Labor in Washington, DC, or to obtain a copy from the U.S. Department of Labor upon payment of copying costs. Requests to the Department should be addressed to: Public Disclosure Room Room N-1513 Employee Benefits Security Administration U.S. Department of Labor 200 Constitution Avenue, N.W. Washington, DC WOMEN S HEALTH AND CANCER RIGHTS ACT ANNUAL NOTICE The IUOE Local 406 Welfare Plan, as required by the Women s Health and Cancer Rights Act of 1998, provides benefits for mastectomy-related services including reconstruction and surgery to achieve symmetry between the breasts, prostheses and complications resulting from a mastectomy (including lymphedema). Call either Fund office for more information. Self-pay rates for Retirees and COBRA The current retiree and COBRA rates, which became effective January 1, 2009, are: Retiree: single on Medicare... $300 Retiree: member and spouse on Medicare... $537 Retiree: one Medicare, one not on Medicare.. $1,037 Retiree: single not on Medicare... $835 Retiree: member & spouse not on Medicare.. $1,544 COBRA with HRA... $729 COBRA without HRA... $681 COBRA with subsidy qualification... $ (Continued from page 3) that were incurred up to one year before the month in which you are submitting a claim. For example, if you are filing your claim in September, 2009, you can file charges incurred as far back as September, Charges not submitted for reimbursement within this 12-month period are NOT reimbursable. You do not need to wait until the end of the year to file a claim; in fact, we encourage you not to wait. The more claims we receive at one time, the longer it takes to process them. Forfeiture If your eligibility for benefits terminates, you have one year from the date of your termination to use your HRA balance. If you do not again become eligible within the 12-month period following termination, any balance remaining will be forfeited and cannot be reinstated. Should you become eligible again after being terminated for one year, your forfeited balance will NOT be restored; however, you can rebuild your balance as described above. Checking your balance You can check your HRA account balance at any time by calling either Fund office or by logging on to our website.

6 Page 6 Summer, 2009 IMPORTANT NOTICE FROM THE IUOE LOCAL 406 WELFARE PLAN ABOUT YOUR PRESCRIPTION DRUG COVERAGE AND MEDICARE Please read this notice carefully and keep it where you can find it (it will be posted on our website). This notice has information about your current prescription drug coverage with the IUOE Local 406 Welfare Plan ( Plan ) and about your options under Medicare s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. This notice is intended primarily for employees and dependents who are eligible for Medicare or who will soon be eligible for Medicare. Please read this notice carefully and keep it where you can find it. This notice contains information about (1) your current prescription drug coverage with the Plan, and (2) prescription drug coverage for people with Medicare. It also tells you where to find more information if you need to make decisions about your prescription drug coverage. 1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. 2. The Fund has determined that the prescription drug coverage offered under the Plan is, on average for all Plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is considered Creditable Coverage. Because your existing coverage is, on average, at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan. You can join a Medicare drug plan when you first become eligible for Medicare and each year from November 15 th through December 31 st (during Medicare s annual enrollment period). This may mean that you may have to wait to join a Medicare drug plan if you do not enroll when you first become eligible for Medicare and that you may pay a higher premium (a penalty) if you join later and have gone for 63 continuous days or more without creditable prescription drug coverage. You may pay that higher premium (a penalty) as long as you have Medicare prescription drug coverage. However, if you lose creditable prescription drug coverage, through no fault of your own, you will be eligible for a sixty (60) day Special Enrollment Period (SEP) because you lost creditable coverage to join a Part D plan. In addition, if you lose or decide to leave employer/union sponsored coverage, you will be eligible to join a Part D plan at that time using an Employer Group Special Enrollment Period. You should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. As you know, the Plan currently provides prescription drug coverage to eligible active employees and their dependents, as well as to eligible retired employees and their dependents who are not eligible for Medicare. However, once a retired employee or his/her dependent becomes eligible for Medicare, he/she will no longer be eligible for prescription drug coverage under the Plan. The Plan discontinued providing prescription drug coverage to Medicare-eligible retired employees and their dependents effective January 1, If you are an eligible active employee or his/her dependent and you become eligible for Medicare, you can keep your current medical and prescription drug coverage with the Plan and do not have to enroll in a Medicare prescription drug plan. You can also keep your current medical and prescription drug coverage with the Plan and enroll in a Medicare prescription drug plan, in which case your coverage under the Plan will be primary and your coverage under the Medicare prescription drug plan will be secondary. But remember, since your prescription drug coverage under the Plan is considered Creditable Coverage, you do not have to enroll in Medicare pre-... continued on page 7

7 Summer, 2009 Page 7 scription drug coverage while you are covered under the Plan to avoid paying a higher premium (a penalty) if you later decide to join a Medicare drug plan. If you are an eligible retired employee or his/her dependent and you become eligible for Medicare, you will lose your prescription drug coverage under the Plan and should consider enrolling in a Medicare prescription drug plan at that time to avoid paying a higher premium (a penalty) if you later decide to join a Medicare drug plan. You should also know that if you drop or lose your coverage with the Plan and don t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without prescription drug coverage that s at least as good as Medicare s prescription drug coverage, your monthly premium may go up by at least 1% of the base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without coverage, your premium may consistently be at least 19% higher than the base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following November to join. For more information about this notice or your current prescription drug coverage... Contact the person listed below for further information. NOTE: You ll get this notice each year. You will also get it if prescription drug coverage through the Plan changes so that it is no longer considered creditable or if the Plan no longer provides prescription drug coverage. You also may request a copy. For more information about your options under Medicare prescription drug coverage... More detailed information about Medicare plans that offer prescription drug coverage is in the Medicare & You handbook. You ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage: Visit Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the Medicare & You handbook for their telephone number) for personalized help. Call MEDICARE ( ). TTY users should call If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at or call them at (TTY ). Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and whether or not you are required to pay a higher premium (a penalty). Date: August, 2009 Name of Entity/Sender: IUOE Local 406 Welfare Plan Contact Position/Office: Rouen Caboche, Administrator Address: 7651 Airline Highway, Baton Rouge, LA Phone Number: (225) (800) 406-IUOE (4863)

8 Page 8 Summer, 2009 Risk Factors for Heart Disease Things you can control... And things you can t Your heart s health depends on many factors, including what you eat, how much exercise you get, and even your family history. The Cleveland Clinic lists these attributes that increase your risk for heart disease: High cholesterol High blood pressure Smoking Diabetes Obesity Not getting enough exercise Being older than 45 for men; older than 55 for women What happens during a heart attack? The heart is a muscle that acts as a pump. The heart pumps blood, rich carbon dioxide and depleted oxygen, through the lungs. The lungs remove carbon and add oxygen. Once oxygenated, the blood returns to the heart to be pumped to the rest of the body. After blood circulates through body tissues, it is returned to the heart and the process is repeated. For the heart to do its job, it needs oxygen. There are special blood vessels on the outside of the heart, called coronary arteries, which supply the heart with oxygen. When one or more of these vessels becomes blocked (usually from a clot that has formed in the vessel), blood cannot get through this area and into the heart. Within about 20 minutes of not receiving blood and oxygen, the heart begins to die. When heart tissue dies, it can no longer contract or function as it did before. Heart attacks can destroy different parts of the heart, depending on where the blockage is. When should I go to the hospital if I am experiencing chest pain? If you are having chest discomfort and believe you might be having a heart attack, immediately get to the nearest hospital. Do not drive yourself. Call 911 or your local emergency number. Making the decision to get to the hospital immediately is often the most important factor in determining if you live. Research shows one in three people die from heart attack within the first few hours after the heart attack begins. Denial is the number one reason that most people with chest pain delay treatment. They do not want to admit that they might be having a heart attack, and then they try to dismiss the pain as indigestion or some other less serious illness. Knowing the signs of a heart attack and how heart attacks are treated can help people get help immediately, which can prevent their death or permanent damage. Healing mentally after a heart attack Don t neglect your emotional needs A variety of emotions are common after a heart attack, and it s important to take care of them -as well as your heart. The American Heart Association offers these recommendations to keep your mind in good health: If you are afraid, get all the facts. Talk to your doctor about your concerns, and about what you should expect in the coming months. Soothe anxious feelings by talking to a friend or family member. Get exercise. It s good for your heart, and it can help alleviate anxiety. Spend time doing activities you enjoy. Talk to your doctor if you feel symptoms of depression, which is common after a heart attack.