ELECTRICAL WELFARE TRUST FUND (EWTF) OVERVIEW
Trustee Letter to All Participants
Grandfathered Status Under the Patient Protection and Affordable Care Act (PPACA)
SCHEDULE OF BENEFITS
Prescription Drug Benefits Chart
Accident Dismemberment and Loss of Sight Benefits Chart
Weekly Accident and Sickness Benefits Chart
Supplemental Occupational Accident Benefits Chart
UNDERSTANDING THE EWTF PLAN
Coverage for Participants Covered Twice
Specific Plan / Benefits Exclusions
PLAN PARTICIPATION
Plans Available by Work Categories
Termination of Coverage for Participants in All Categories
ELIGIBILITY
Eligibility for Active Electrical Workers
Eligibility for Active Non-Bargaining Unit Employees
Eligibility for Retired Employees
Eligibility for Dependents (including Spouses)
Annual Enrollment Verification Process
COBRA CONTINUATION COVERAGE
How to Elect COBRA Continuation Coverage
Acquiring a New Dependent(s) while Covered by COBRA
Loss of Other Group Health Plan Coverage or Other Health Insurance Coverage
Confirmation of Coverage to Health Care Providers
Interaction of COBRA, the Affordable Care Act and Medicare – Other Options
Keep Your Plan Informed of Address Changes
LIFE EVENTS
If You Take a Leave of Absence (FMLA)
If You Enter Active Military Service
YOUR MEDICAL BENEFITS
Understanding Your Medical Benefits
Advantages of Using the UHC Choice Plus Network
Out-of-Pocket Maximum (Catastrophic Benefit)
Routine Physical Exam for Member and Spouse
Child Wellness Visits and Examinations
Home Health Care, Nursing Home Care and Hospice Care Benefits
Gynecological Care and Maternity
Mastectomy and Breast Reconstructive Surgery
PRESCRIPTION DRUG BENEFITS
Drug Choice Management Program
Opioid Utilization Management Program
CVS Health Vaccination Program
CVS Over-The-Counter COVID-19 Test Coverage
MENTAL HEALTH/ EMPLOYEE ASSISTANCE PROGRAM (EAP)
How the Employee Assistance Program (EAP) Works
Mental Health and Substance Misuse Benefits
DENTAL BENEFITS
Maximum Annual Benefit (Age 18 & Older)
When a Treatment Plan is Required
Continuing Treatment When Your Coverage Ends
VISION BENEFITS
HEARING AID BENEFITS
SUPPLEMENTAL MEDICARE BENEFITS
WEEKLY ACCIDENT AND SICKNESS BENEFIT
How the Weekly Accident and Sickness Benefit Works
Maintaining Eligibility While On Disability
Multiple Periods of Disability
ACCIDENTAL DISMEMBERMENT AND LOSS OF SIGHT BENEFITS
SUPPLEMENTAL OCCUPATIONAL ACCIDENT BENEFITS
Supplemental Workers’ Compensation Benefits (Insured through Nationwide)
Workers’ Compensation Supplemental Income (Self-insured by EWTF)
When Your Worker’s Compensation Supplemental Income Coverage Ends
DEATH BENEFIT
Eligible Active Electrical Worker or Active Non-Bargaining Unit Employee
FILING YOUR BENEFITS CLAIMS
Federally Issued Identification Numbers
CLAIMS AND APPEALS PROCEDURE
Plan Provisions and Consistent Treatment Requirement
Timing of Notification of Benefit Determination for Initial Claims
Pre-Service Claims Timing Rules
Manner and Content of Notification of Benefit Determination or
Adverse Notification on Appeal
Appeal of Adverse Benefit Determinations
Appeals of Concurrent Care Denials
Right to Consideration of All Documentation
RECOVERY FOR THIRD PARTY LIABILITY (SUBROGATION)
Purpose of Third-Party Liability Provisions
How Third Party Liability Recovery Works
Failure to Comply with Third Party Liability Procedures
COORDINATION OF BENEFITS
Order of Benefit Determination Rules
Steps to Follow if You or Your Family Members are Covered by More Than One Plan
Coordination Of Benefits With Medicare
Motor Vehicle No-Fault Coverage Required By Law
YOUR PRIVACY RIGHTS
How the Plan May Use or Disclose Your Health Information
When The Plan May Not Use or Disclose Your Health Information
When EWTF Must Provide You a Breach Notification
Disclosure of Your Health Information to Family Members
Statement of Your Health Information Rights
Changes to this Notice of Privacy Practices
YOUR ERISA RIGHTS
Receive Information about Your Plan and Benefits
Prudent Actions by Plan Fiduciaries
Assistance with Your Questions
GLOSSARY
PLAN INFORMATION
Agent for Service of Legal Process
IRS Employer Identification Number
Employee Assistance Plan (EAP)
Supplemental Occupational Accident Benefits
Collective Bargaining Agreement
DOCUMENTS FOR EXAMINATION
Documents to Be Made Available for Examination
Summary Plan Descriptions and Summaries of Material Modification
Providing Documents at Employer Establishments or the Union Offices