|
HEALTH & WELFARE
The Operating Engineers Local 234 Health & Welfare Fund provides coveage for eligible active participants, their spouses, and dependent children. This Plan also provides coverage for Retirees and their spouses.
Eligibility Rules for Actives
To be eligible for benefits under the Plan, you must satisfy the eligibility rules and your EMPLOYER must make contributions to the Fund on your behalf.
Eligibility - Presently Eligible Participants
If you are presently eligible, you will remain eligible until you fail to meet the requirements stated in the "Continued Eligibility" section below.
Initial Eligibility - New Participants
If you accumulate 500 hours of COVERED WORK within a consecutive 12-month period, you will become eligible on the first day of the first calendar month following the month that your 500 hours of COVERED WORK are reported.
For example: You work your 500th hour on May 18th. Your EMPLOYER is required to report your hours and pay the contributions by June 10th. You will be eligible for benefits on July 1st.
Continued Eligibility
Once you have met the initial eligibility requirements, you will be eligible for benefits for the rest of the benefit quarter in which you attained initial eligibility AND for the next full benefit quarter. To continue elibigility in future benefit quarters, you must have at least 300 hours paid on your behalf by CONTRIBUTING EMPLOYERS during each contribution quarter or 1200 hours over the corresponding twelve month period. Both of these schedules are as follows:
|
AT LEAST 300 CONTRIBUTION HOURS DURING . . . |
|
Contribution Quarter
(for work performed during) |
Benefit Quarter
(provides eligibility for) |
|
May, June, July |
October, November, December |
|
August, September, October |
January, February, March |
|
November, December, January |
April, May, June |
|
February, March, April |
July, August, September |
** OR **
|
At Least 1200 Contribution Hours During The . . . |
|
12 Month Contribution Period
(for work performed during) |
Benefits Quarter
(provides eligibility for) |
|
May 1 through April 30 |
October, November, December |
|
August 1 through July 31 |
January, February, March |
|
November 1 through October 31 |
April, May, June |
|
February 1 through January 31 |
July, August, September |
|
|
|
|
More Specifically |
|
November 1, 2009 October 31, 2010 |
April June 2011 |
|
February 1, 2010 January 31, 2011 |
July September 2011 |
|
May 1, 2010 April 30, 2011 |
October December 2011 |
|
August 1, 2010 July 31, 2011 |
January March 2012 |
|
November 1, 2010 October 31, 2011 |
April June 2012 |
|
February 1, 2011 January 31, 2011 |
July September 2012 |
|
August 1, 2011 July 31, 2012 |
January March 2013 |
|
November 1, 2011 October 31, 2012 |
April June 2012 |
|
February 1, 2012 January 31, 2012 |
July September 2013 |
|
May 1, 2012 April 30, 2013 |
October December 2013 |
Coverages
The Plan covers the following for Active participants, spouses and children:
-
Medical including Mental Health and Substance Abuse
-
Dental and Orthodontia
-
Prescriptino Drug - Retail and Mail Order
-
Routine Vision
-
Short Term Disability - Participant only
-
Death Benefit - Participant, Spouse, Children
The Plan covers the following for Retired participants and spouse:
- Medical including Mental Health and Substance Abuse
- Dental and Orthodontia
- Prescription Drug - Retail and Mail Order
- Routine Vision
- Death Benefit - Participant only
Medical Coverages:
- In-Patient: 80/20 after $100 calendar year deductible for in Network (PPO)
- In-Patient: 60/40 after $200 calendar year deductible for out of Network (Non-PPO)
- Emergency Room: $100 co-pay each visit; 80/20 for in Network
- Emergency Room: $100 co-pay each visit; 60/40 for out of Network
- Out-Patient Facility: 80/20 after $100 calendar year deductible for in Network
- Out-Patient Facility: 60/40 after $200 calendar year deductibble for out of Network
Deductibles - Calendar year deductible is $100 OR $200 family for in Network; $200 individual OR $400 family for out of Network.
Out-of-Pocket - Calendar year maximum out-of-pocket is $2,500; out-of-pocket includes deductible and coinsurance amounts; it does not include the co-pays.
Pre-Existing - There is no pre-existing condition clauses.
|
|
In Network - $20 office co-pay plus 80/20 for office services (labs, injections, xrays, etc)
Out of Network - $200/$400 calendar year deductible then 60/40
|
|
|
Birth to age 7
In Network Paid in full
Out of Network 40% coinsurance; deductible waived
|
|
|
In Network Paid in full every calendar year
Out of Network - $200 deductible; 60/40; every calendar year
|
|
|
In Network paid at 100%
Out of Network - $200/$400 deductible, then paid at 60/40
Immunizations received at pharmacy paid at 70/30 (travel immunizations are not covered)
|
|
|
Inpatient/Outpatient: In Network 80/20; Out of Network 60/40
Office: In Network 100%; Out of Network 60/40
|
Dental Coverage: 80/20 per person up to a calendar year, maximum payment of $1240
Orthodontia Benefits: 80/20 per person up to a lifetime payment of $2,000
Prescription Drug Benefit: Retail: 20%/30%/40%
Mail Order: $10/$25/$50 for each co-pay with a maximum of 2 co-pays
Routine Vision Benefit: Adults - $200 every 24 months, Children - $150 every 12 months
Short Term Disability: Active participants only. $200 per week, up to 13 weeks for illness or injury, non-work related; $200 per week, up to 4 weeks for work-related injury.
Death Benefit:
|
Active Participant - |
$7,500 |
|
Active Spouse - |
$1,000 |
|
Active Child - |
$ 500 |
|
Retired Participant |
$2,000 |
Accidental Death: Active Participant - $2,000
Chiropractic Care: In Network 80/20; Out of Network 60/40
CONTACT INFORMATION:
Local 234 Health & Welfare Fund
4880 Hubbell Avenue, Suite 1
Des Moines, IA 50317
515-265-0371
NOTICE: If a discrepancy should arise between what is stated here and the Plan Document for the Local 234 Health & Welfare Fund, the Plan Document shall prevail in each and every circumstance.
|
|
