Welfare Plan Documents & Forms
Summary Plan Description
The Summary Plan Description (also called the SPD), together with the AETNA booklets for Tiers I, II or III and retiree coverage (see below), describe the key features of the Welfare Fund benefits program. Please note that the SPD was last issued in May of 2016.
Plan Changes and Clarifications
05-06-2016 elimination of age 26-29 coverage
10-31-2016 change in tier III eligibility
01-01-2018 self-pay premium rates and various coverage changes
03-23-2018 tier III eligibility and various coverage changes
06-01-2018 enrollment changes, births
12-01-2018 various coverage changes
01-01-2019 self-pay premium rates changes
12-01-2019 fmla and gene therapy
01-01-2020 self-pay premium rates and various coverage changes
03-20-2020 defer self-pay
07-01-2020 recovery tier
01-01-2021 medicare advantage
02-08-2021 eligibility
07-01-2021 eligibility, self-pay rates, retiree
01-01-2022 eligibility, self-pay rates, disability
04-01-2022 eligibility changes
07-01-2022 eligibility changes
07-01-2022 gene therapy
07-01-2022 no surprise act
01-01-2024 medicare advantage
07-01-2024 eligibility changes
Benefit Descriptions:
Basic Tier Summary of Benefits
Tier I Summary of Benefits and Coverage
Tier 2 Summary of Benefits and Coverage
Tier 3 Summary of Benefits and Coverage
Basic Tier Schedule Benefits Booklet
Tier 1 Schedule of Benefits Booklet
Tier 2 Schedule of Benefits Booklet
Tier 3 Schedule of Benefits Booklet
Benefit Summary Chart: The following chart summarizes the benefits the Welfare Plan will provide for the all eligible participants.
Summary Annual Report: This is the most recent basic financial statement sent to participants of the Welfare Funds.
HIPAA Privacy Notice: This notice describes how medical information about you may be used and disclosed and how to get access to this information.
Forms:
Spousal Coverage Confirmation: This form only needs to be completed if you have elected medical coverage for your spouse.
AETNA Claim Form: This form only needs to be completed if the provider is not submitting the claim on your behalf.
Change of Address Form: Please use this form for changes of address or other contact information.
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