Catastrophic Benefit
The EWTF Plan rules provide that an individual or family who furnishes proof to the Fund Office that the "Out-of-Pocket" expenses that have been paid by the participant exceed the Plan's "Out-of-Pocket" maximum is entitled to have the remainder of their covered medical expenses paid at 100% of allowed costs for the remainder of that calendar year.
This benefit, called the Catastrophic Benefit, was added to the EWTF Plan of Benefits in 1993 -- more than 15 years ago. At that time, the Out of Pocket maximum was $3,000. This expense has never been increased despite immense increases in health care costs and the resulting increases in EWTF benefit payments.
To preserve Plan assets and take into account medical inflation, the EWTF Board of Trustees has amended the Plan effective January 1, 2009 to update the Out-of-Pocket expense maximum at $10,000 per family per calendar year. This means that before anyone can claim 100% coverage for medical expenses exceeding the Out of Pocket maximum, they must furnish documentary proof (receipts, paid invoices, etc.) clearly indicating that the person claiming the benefit has paid Out-of-Pocket medical expenses of $10,000. Claims submitted for the Catastrophic Benefit must be filed with the Fund Office within one year from the end of the calendar year for which out of pocket expense is requested.