GREATER KANSAS CITY LABORERS

Transcription

1 GREATER KANSAS CITY LABORERS FRINGE BENEFIT FUNDS Managed for the Trustees by: TIC INTERNATIONAL CORPORATION 6405 Metcalf, Suite 200 Overland Park, Kansas (913) Fax: (913) October 2010 TO: ALL PARTICIPANTS OF THE GKCL WELFARE FUND RE: IMPORTANT PLAN CHANGES EFFECTIVE NOVEMBER 1, 2010 Dear Participant: As the Trustees of the Greater Kansas City Laborers Welfare Fund we are pleased to inform you of several enhancements to your welfare benefits. To comply with the Patient Protection and Affordable Care Act ( ACA or health care reform ), many provisions of the Greater Kansas City Laborers Welfare Plan are changing now and more may be changing in the years ahead. We will notify you immediately of any future changes made to the health benefits the Fund provides to you and your family. In the meantime, this letter provides you with information regarding the Plan provisions that are changing effective November 1, BEGINNING NOVEMBER 1, 2010 Dependent is Changing The Plan may cover your children until they reach age 26. In addition, the Plan s other eligibility requirements, such as a child s residency, marital status, that a non-disabled child must depend on you for support, and that a child between the ages of 19 to 24 must be a full-time student, will no longer apply. Important Notes: 1. If your adult children are employed and eligible to enroll in another health plan sponsored by their employer, they are not eligible for coverage under this Plan. 2. If you ve been appointed the guardian of a child, the Plan will cover the child up to age 26 or until your guardianship is terminated or dissolved, whichever occurs first. 3. If you have a child between the age of 19 and 26 who is currently not covered by the plan, and does not have access to another health plan sponsored by their employer, you must complete and submit a dependent enrollment form during the open enrollment period in order to cover them under this Plan. The Overall Lifetime Maximum is being eliminated The $900,000 overall lifetime maximum will no longer apply. If have reached the lifetime limit of $900,000, you are being given the opportunity to re-enroll in the Plan and submit claims. The Overall Annual Limit Is Being Replaced Refer to Attachment A, which provides a schedule of the Plan s benefit provisions effective November 1, The $400,000 annual limit ($100,000 for first-year participants) is being replaced by an annual limit of $750,000.

2 THE FOLLOWING CHANGES WILL ALSO APPLY AND THE BENEFITS WILL BE SUBJECT TO THE $750,000 ANNUAL LIMIT for Alcoholism and Substance Abuse Treatment Is Being Enhanced The $25,000 per person per lifetime limitation for alcohol and substance abuse treatment will no longer apply. For Chiropractic Treatment Is Being Enhanced The $240 per person per year limitation for chiropractic treatment will no longer apply. For Speech Therapy Treatment Is Being Enhanced The $1,000 per year limitation on speech therapy benefits for dependents up to the age of 12 will no longer apply. The $5,000 per dependent per lifetime limitation on speech therapy benefits for dependents up to the age of 12 will no longer apply. for Prosthetic Devices Is Being Enhanced The $25,000 per person per lifetime limitation on prosthetic devices will no longer apply. for Transplants Is Being Enhanced The dollar limitations on bone marrow, cornea, heart, heart/lung, kidney, kidney/pancreas, liver, lung, and pancreas transplants will no longer apply. for Dental Benefits Is Being Enhanced The $2,000 per person per year limitation on dental benefits for children under the age of 19 will no longer apply. The dollar limitation will only apply for adults age 19 and over. for Vision Benefits Is Being Enhanced The $200 per person per year limitation on vision benefits for children under the age of 19 will no longer apply. The dollar limitation will only apply for adults age 19 and over. for Hearing Benefits Is Being Enhanced The $1,000 per instrument limitation will no longer apply. Instead, the Plan will cover one instrument for each five-year period for adults and each three-year period for dependents under the age of 19. The $75 per person limitation every 24-month period will no longer apply. Instead, the Plan will cover one hearing test per person every 24-months. For THE PREGNANCY OF A DEPENDENT CHILD IS CHANGING The $3000 lifetime limit on coverage for pregnancy related conditions for dependent children will no longer apply. Rescinding Provision Is Changing The Plan may not rescind your coverage unless you are provided with 30 days advance written notice. may not be terminated retroactively except for fraud, intentional material misrepresentation, or non-payment of premiums or contributions.

3 THE PLAN S GRANDFATHERED STATUS It is important you understand that while the Plan is undergoing changes in order to comply with the ACA, it is considered a grandfathered health plan under the ACA, which means that the Plan: 1. Is not required to include certain consumer protections of the ACA that apply to other plans for example, provide preventive health services without any cost sharing. 2. Must comply with certain other consumer protections in the ACA for example, the elimination of lifetime limits on benefits. Call the Fund Office at (913) if you have questions about what grandfathered health plan status means and what might cause a plan to lose its grandfathered status. You may also contact the Employee Benefits Security Administration (EBSA), U.S. Department of Labor at or at The website has a chart that summarizes which protections do and do not apply to grandfathered health plans. FOR MORE INFORMATION Please review the attachments carefully to ensure you understand the benefits available to you and your family beginning November 1, Call the Fund Office at (913) if you have any questions about these Plan changes. Sincerely, BOARD OF TRUSTEES This Summary of Material Modification highlights certain features of the Greater Kansas City Laborers Welfare Fund. You can find full details in the documents (Summary Plan Description, Plan Document, etc.) that establish the Plan provisions. If there is a discrepancy between the wording here and the documents that establish the Plan, the document language will govern. The Trustees reserve the right to amend, modify, or terminate the Plan at any time.

4 Comprehensive Medical Benefit For Active Employees, Retired Employees And Dependents Calendar year deductible Copayment Hospital non-notification deductible Calendar year out-of-pocket maximum (includes deductibles and copays) Lifetime Maximum ATTACHMENT A Schedule of Benefits Effective November 1, 2010 $275 per person; $450 per family $375 per person; $750 per family Plan pays 81% of covered charges Plan pays 70% of covered charges $200 for each failure to notify the Fund of planned inpatient hospitalization or emergency hospital admissions $2,000 per person; $4,000 per family $3,000 per person; $6,000 per family None Annual Limit $750,000 Mental and nervous disorder treatment 1, 3 Plan pays 81% of covered charges Plan pays 70% of covered charges Outpatient treatment maximum 52 visits per calendar year Alcoholism and substance abuse treatment 2, 3 First course of treatment in a three calendar-year period: Plan pays 81% of covered charges Plan pays 70% of covered charges Subsequent courses of treatment in a three calendaryear period: Plan pays 51% of covered charges Plan pays 40% of covered charges Maximum days per course of treatment 90 Maximum inpatient days per course of treatment 21 Maximum outpatient visits per course of treatment 45 Lifetime maximum None Chiropractic treatment 3 Limit 12 visits per calendar year 1 & 2 You must satisfy the Plan's calendar year deductible before the Plan begins to pay benefits for covered services. Not subject to the out-of-pocket maximum. 3 Subject to the $750,000 annual limit on a fiscal year basis from November 1 through October 31.

5 Comprehensive Medical Benefit (continued) For Active Employees, Retired Employees And Dependents Laser eye surgery Lasik surgery if you are farsighted and have astigmatism (active Employees only) Radial keratotomy (RK), photorefractive keratectomy (PRK), and automated lamellar keratoplasty (ALK) if your nearsightedness cannot be corrected by glasses or contact lenses to at least minus 1 diopter (active Employees, Retired Employees, and Dependents) Wellness physicals (active Employees and their spouses only) Outpatient speech therapy 4, 5 For restoration of lost speech Plan pays 81% of covered expenses Plan pays 70% of covered expenses For developmentally-related speech therapy for Dependents up to age 12 Coinsurance Plan pays 50% of covered expenses Employee Assistance Program Plan pays 100% Prosthetic devices 5 Plan pays 81% after deductible Plan pays 70% after deductible Hearing benefit 5, 6 Plan pays 81% of covered expenses Plan pays 70% of covered expenses Hearing instrument limitation Hearing test maximum Emergency room visits Copayment Dental expense benefit 7 Deductible In-Network Coinsurance Maximum calendar year benefit $1,500 maximum lifetime allowance per eye for Radial Keratotomy and $800 maximum lifetime allowance for laser eye surgery Plan pays 100% once each calendar year through Concentra Health Services One instrument for each five-year period for adults, including maintenance (every three years up to age 19 for Dependents) 1 exam every 24 months $100 per visit will apply if you visit an emergency room 6 or more times during a calendar year $25 per person; $50 per family $25 per person; $50 per family Plan pays 81% of covered expenses Plan pays 70% of covered expenses $2,000 per adult 8 (no limit for dependent children under age 19) 4 You must satisfy the Plan's calendar year deductible before the Plan begins to pay benefits for covered services. Charges not subject to the out-of-pocket maximum. 5 Subject to the $750,000 annual limit on a fiscal year basis from November 1 through October All hearing tests and aids must be performed and dispensed by a Physician or licensed audiologist. Charges not subject to the deductible or out-of-pocket maximum. 7 Subject to the comprehensive medical calendar year deductible. 8 Adult means a person who has attained his or her 19th birthday.

6 Prescription Drug Benefit For Active Employees And Dependents Retail pharmacy (up to a 34-day supply or 100-unit dose) Mail order program (up to a 90-day supply) Prescription Drug Benefit For Retired Employees And Dependents Retail pharmacy (up to a 34-day supply or 100-unit dose) Mail order program (up to a 90-day supply) You pay 20% copay for brand name You pay 20% copay for generic, up to a maximum of $3.00 You pay 20% copay for brand name You pay 20% copay for generic, up to a maximum of $6.00 You pay 40% copay for brand name You pay 40% copay for generic, up to a maximum of $4.00 You pay 40% copay for brand name You pay 40% copay for generic, up to a maximum of $8.00 Vision Benefit For Active Employees, Retired Employees and Dependents Plan will pay for vision expenses. For adults, 19 or older, there is a $200 maximum per calendar year. Children under age 19 have no maximum dollar limit, but the Plan will only reimburse for one eye exam and one pair of eyeglasses (or contacts) per calendar year. Weekly Accident And Sickness Benefit For Active Employees Only Non-occupational $250 per week for up to 14 weeks 9 Death Benefit For Active Employees, Retired Employees and Dependents Employee $8,000 Dependent spouse $4,000 Dependent children less than 6 months of age $4,000 Retired Employee Accidental Death And Dismemberment Benefit 10 For Active Employees Only Loss of life $3,000 Loss of two limbs, sight of both eyes or one limb and sight of one eye Benefit equal to number of pension credits earned, to a maximum of 10, times $250 (i.e., maximum benefit = $2,500) $3,000 Loss of one limb or sight of one eye $1,500 9 The actual benefit is greater; the amount shown is after deduction for Social Security tax. 10 If more than one of the losses listed is suffered as the result of any one accident, not more than $3,000 will be payable.