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Joint Plumbing Industry Board
Plumbers Local Union No. 1 Trust Funds
Welfare Fund Vacation and Holiday Fund Trade Education Fund Additional Security Benefit Fund 401(k) Savings Plan
George W. Reilly, Co-Chairman - Labor Walter Saraceni, Administrator Vito Giachetti, Co-Chairman - Management
Important Information Regarding Your Health Fund Benefits
This notice contains important information concerning the benefits provided by the Plumbers Local Union No. 1
Welfare Fund. Please attach this letter to your Summary Plan Description (SPD). It should be read and retained
with your SPD for future reference.
November 19, 2010
Re: Patient Protection and Affordable Care Act
Information (MES Helper)
Dear Plan Member:
We are providing you and your family with this Welfare Fund announcement letter to provide you with
notices required under the Patient Protection and Affordable Care Act and to inform you of benefit
changes effective January 1, 2011.


I. Notices
A. Special Enrollment for Children Under Age 26
If you have a child who is under age 26 (whether married or unmarried), including a child currently receiving continuation coverage under COBRA, that child may be eligible to enroll in the Plan as of January 1, 2011. This special enrollment opportunity applies to:  Children between the ages of 18 and 23 that are currently enrolled in the Plan;
 Children who were not previously eligible to enroll in the Plan;  Children who were previously denied coverage under the Plan; and  Children whose coverage under the Plan already ended. Please note: These children will not be eligible for coverage if they are eligible for any employment-based
coverage other than the plan of a parent or step-parent. This limitation will be in effect until December 31,
2013.

The Plan covers natural children, step children, adopted children and children placed for adoption. The Plan
will continue to cover disabled children under the current Plan’s provisions. Please see your Summary Plan
Description (SPD) for information on coverage for disabled children.
You must request special enrollment on behalf of your child and return a completed enrollment form no later
than December 20, 2010. If you request special enrollment by that date, coverage will be effective on January
1, 2011.
If enrollment materials are not received by December 20, 2010, you will not be able to enroll your
dependent child except as allowed under the HIPAA Special Enrollment rules. You may still enroll your
dependent child late during the 2011 open enrollment period. However, coverage will be effective
January 1, 2012.

158-29 George Meany Boulevard, Howard Beach, New York 11414  Tel [718] 835-2700  Fax [718] 641-8155  www.ualocal1funds.org
If you wish to request special enrollment for your dependent child, please complete the attached enrollment
form and return it to the Fund Office by December 20, 2010. For more information, contact the Fund Office
Welfare Department at (718) 835-2700.
The $1 million per person lifetime limit on the dollar value of benefits under Plumbers Local Union No.
1 Welfare Fund no longer applies.

The $20,000 lifetime limit per family for fertility drugs no longer applies.
Individuals whose coverage ended by reason of reaching the $1 million lifetime limit under the Plan are eligible
to re-enroll in the Plan. Individuals have 30 days from the date of this notice to request enrollment. For more
information, contact the Fund Administrator at (718) 835-2700.
The Plumbers Local Union No. 1 Welfare Fund believes this is a “grandfathered health plan” under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that your plan may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits. Questions regarding which protections apply and which protections do not apply to a grandfathered health plan
and what might cause a plan to change from grandfathered health plan status can be directed to the Plan
Administrator at (718) 835-2700. You may also contact the Employee Benefits Security Administration, U.S.
Department of Labor at 1-866-444-3272 or www.dol.gov/ebsa/healthreform. This website has a table
summarizing which protections do and do not apply to grandfathered health plans.
If you have received this notice by email, you are responsible for providing a copy of this notice to
your family members who are participants in this plan.


II. Plan Changes Effective January 1, 2011
The Plan covers natural children, step children, adopted children and children placed for adoption up to the end of the month in which the child turns age 26. Children who are eligible for other employment-based coverage other than the plan of a parent or step-parent are not eligible for enrollment. This limitation is in effect until December 31, 2013. The $1 million per person lifetime limit on the dollar value of benefits under Plumbers Local Union No. 1 Welfare Fund no longer applies. Also, the $20,000 lifetime limit per family for fertility drugs no longer applies. C. Prescription Drug Benefits

Change in HRA Reimbursement Rules for Over the Counter Medications -
The Plumbers Local Union No.
1 Welfare Fund’s Health Reimbursement Arrangement (HRA) will no longer continue to cover over the counter
(OTC) medications without a prescription effective January 1, 2011.
Please note that for purchases made through December 31, 2010 you will not need to submit a prescription for
over the counter (OTC) medication with your claim for reimbursement from your HRA account. However, you
must submit these reimbursement claims within 18 months from the date of purchase for the claim to be
considered.
EXAMPLE 1: On December 16, 2010, you purchase Prilosec OTC. You may submit a claim for reimbursement
within 18 months from December 16, 2010 by including the receipt of purchase on your claim form.
However, effective January 1, 2011, you must submit a prescription from your doctor for any over the counter
(OTC) medications you purchase in order to be eligible for reimbursement from your HRA account. Once
again, please remember that any HRA reimbursement claims must be submitted within 18 months of the date
of purchase of the medication for the claim to be considered.
EXAMPLE 2: You ask your doctor for a prescription for Prilosec OTC and he/she fills out a prescription for you.
On January 16, 2011, you purchase Prilosec OTC. You may submit your claim for reimbursement up to 18
months from January 16, 2011, but you must attach the doctor’s prescription for the Prilosec OTC and the
receipt of purchase on your claim form.
As always, if you have any questions regarding these benefit modifications, please contact the Fund Office. Sincerely, Plumbers Local Union No. 1 Welfare Fund THE BOARD OF TRUSTEES
PLUMBERS LOCAL UNION No. 1 WELFARE FUND - SPECIAL ENROLLMENT FORM
158-29 George Meany Boulevard, Howard Beach, N.Y. 11414 Tel. (718) 835-2700 Fax. (718) 641-8155
(A) Participant Information: Use a ballpoint pen to complete form
_______________________ _______________________ _______ (1) Social Security Number (2) Last (3) First (4) Init. _______________________________ ________________________________ __________ _______________ (9) Date of Birth (10) Gender M F (11) Home Phone Number / Cell Number (12) E-mail Address _____________________________________________________________________________________________________________________________ _________________________________________________________ (13) Retired (14) Active (15) Current or Last Employer (16) Last date of Employment (B) Adult Child Information: Child’s relationship to you:
_______________________ _______________________ _______ (5) Social Security Number (6) Last (7) First (8) Init. (9) Date of Birth (10) Gender M F (11) Home Phone Number / Cell Number Is your adult child: Currently enrolled in the Plan? Yes No Is your adult child employed? Yes No If yes, complete Section C Is adult child’s spouse employed? Yes No If yes, complete Section C (16) Is your adult child Eligible for other employer-sponsored coverage through his / her own employer? Yes No If yes, complete Section D (17) Is your adult child Eligible for other employer-sponsored coverage through his / her Spouse’s employer? Yes No If yes, complete Section D (C) Employer Name, Address and Phone Number: If your child is employed, provide employer name, address and phone number. If the child is
married and the spouse is employed, provide information about the spouse’s employer. (1) Adult Child’s Employer Name: _________________________________________________________________________________________ (2) Adult Child’s Employer Address and Phone Number:________________________________________________________________________ (3) Adult Child’s Spouse’s Employer Name: _________________________________________________________________________________ (4) Adult Child’s Spouse’s Employer Address and Phone Number:________________________________________________________________ (D) Eligibility for Other Health Coverage: Complete the following section if your adult child is currently eligible for health coverage either through his /
her employment or his / her spouse’s employment.
(1) Policy Name: ______________________________________________________________________________________________________ (2) Policy holders relationship to adult child: Self Child’s spouse (4) Group and Policy #: ___________________________________________________________ (5) Insurance Company/Claims Administrator Name: __________________________________________________________________________ Address: _______________________________________________________________________ Phone #: _____________________________ (E) Participant Affidavit :
I acknowledge by signing this form that all the information provided is true and correct to the best of my knowledge. I understand that if I conceal information, provide false information or otherwise mislead the Fund, my child’s eligibility for Fund coverage will be terminated retroactively and I will be liable for any claims that were paid erroneously based on the false or misleading information. Participant Signature_______________________________________ Date State of: ________________________________________ County of: __________________________ On the _________ day of _____________, 20______ before me came _____________________________, known to me to be the person described in and who executed the foregoing statement and (s)he duly acknowledged to me that (s)he executed the same. ________________________________ Notary Public SPECIAL ENROLLMENT FORM FOR ELIGIBLE ADULT CHILDREN UNDER AGE 26
Instructions:
Complete this form for each adult child you wish to enroll in the Plan. If you have more than one adult child, you
will need to complete a separate form for each adult child. This Plan defines an adult child as an individual over
age 18 and up to age 26 who is a natural child, stepchild, adopted child or child placed for adoption.
This special enrollment opportunity applies to:

 Children between the ages of 18 and 23 that are currently enrolled in the Plan;
 Children who were not previously eligible to enroll in the Plan;  Children who were previously denied coverage under the Plan; and  Children whose coverage under the Plan already ended. You must complete this form in its entirety and then sign and date it before a Notary Public. You must return the
form to the Fund Office by December 20, 2010. If you mail the form, it must be postmarked by December 16,
2010. If you do so, coverage for your adult child will be effective January 1, 2011.
If the Fund Office does not receive this form within the necessary time frame, you will not be able to enroll a child
during this special enrollment opportunity. No adult child will be covered after January 1, 2011 under the Plan
if the Fund Office does not receive the signed and dated enrollment form within the necessary timeframe.

If your child is not currently enrolled in the Plan, you must provide a copy of the child’s birth certificate. For
adopted children or those placed for adoption with you, you must provide a copy of the adoption paperwork. For
a stepchild, you must provide a copy of your and your spouse’s marriage certificate, as well as the child’s birth
certificate.
Additional Information:
The Plan will continue to cover disabled children under the current Plan’s provisions. Please see your SPD for
information on coverage for disabled children.
Mail Completed Form(s) to:
PLUMBERS LOCAL UNION No. 1 WELFARE FUND 158-29 George Meany Boulevard, Howard Beach, New York 11414 Attn: Enrollment Services  If you have any questions in completing this Form, please call the Fund Office Welfare Department at

Source: http://www.ualocal1.org/ULWSiteResources/ualocal1/Resources/file/Funds%20Office/PPACA_Helper_11.2010.pdf

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