New low cost benefit and self-payment option – class a bargaining unit employees only
◄◄ IMPORTANT NOTICE TO PARTICIPANTS ►►
January, 2012 To All Participants and Eligible Dependents:
This Notice is to inform you of the following:
OTC Allegra/Allegra-D products covered at $0 copayment upon a physician’s written
New Reduced Cost Option for Class A Bargaining Unit Employees.
OTC Allegra/Allegra-D Products at $0 Copayment
Effective March 9, 2011, over-the-counter (OTC) Allegra/Allegra-D products are covered at $0 copay if prescribed by a physician. These are FDA-approved OTC products that your physician could conclude are comparable to the brand name prescription medication. New Reduced Cost Option – Class A Bargaining Unit Employees We understand that it is difficult to make the required self-payment amount to continue your coverage when you are unemployed and, therefore, we have decided to offer an option that provides catastrophic coverage at a lesser cost. Effective with hours worked on or after January 1, 2012, there will be a new reduced cost self-payment option available. This option will be an alternative to Self-Payment Option 2 (COBRA) and if you elect the reduced cost option, you will have no further COBRA rights unless you experience a subsequent qualifying event. To qualify for the reduced cost option, you must be completely unemployed and available for work in the Fund’s jurisdiction under the terms of the collective bargaining agreement. You will be given an opportunity to enroll in the reduced cost option at the time you exhaust your Dollar Bank.
Benefits under the reduced cost option include Medical Benefits, Preferred Provider Pharmacy Benefits, and the optional Dental and Vision Benefits only. There are no Life Insurance, Accidental Death and Dismemberment, or Short-Term Disability Benefits under the reduced cost option. Your out-of-pocket expenses under the reduced cost option are increased as stated on the enclosed Schedule of Benefits. All other internal limits and Plan provisions not specifically listed are the same as the Class A Medical Benefits.
The monthly self-payment amount for the reduced cost option is $658.75 for Medical and Preferred Provider Pharmacy Benefits and an additional $95.00 for optional Dental and Vision Benefits. The self-payment amount for the reduced cost option will be reviewed at least annually and is subject to change. If after being unemployed you resume limited employment, contributions for hours worked while eligible under the reduced cost option will apply to your self-payment for the eligibility month that corresponds to the month in which the hours are worked. You may make self-payments for the reduced cost option for as long as you are completely unemployed and available for work in the Fund’s jurisdiction under the terms of the collective bargaining agreement. You will not be eligible for full Plan benefits again until you return to work and work sufficient hours to qualify (first day of the second month following a one-month period during which you work and are credited with at least 134 employer contribution hours). Deductibles and copayments satisfied under either the full Plan benefits option or the reduced cost option will be applied to the other benefit program option if you change from one option to another during the calendar year. If you wish to enroll in the reduced cost option, you must complete the election form furnished to you at the time you become eligible to enroll in this option and return it to the Fund Office within 15 days of the date of the notice. Please keep this Notice with your Summary Plan Description (SPD) booklet. If you have any questions, please call the Fund Office at (952) 854-0795, or toll-free at 1-800-535-6373. Very truly yours, THE BOARD OF TRUSTEES Enclosure 434hw\not\2011\Reduced Cost Option final
REDUCED COST OPTION - SCHEDULE OF BENEFITS
The Reduced Cost Option is available to Class A Bargaining Unit Employees continuing coverage while unemployed and available for work, upon exhaustion of their Dollar Bank, subject to Eligibility Rule 3.8. The benefit provisions and amounts for the Reduced Cost Option are identical to Classes A and C with the following exceptions:
(NOT including deductible or prescription drug or emergency room copayment)
Covered person’s copayment at retail network
pharmacy or through mail service pharmacy
(Copayment is increased by 10% for out-of- network claims.)
1 Deductibles and copayments satisfied under either the full Plan benefits option or the reduced cost option shall
be applied to the other option if such Employee shall change from one option to another during the calendar year.
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