The following information is not intended to modify or replace the information provided by the Summary Plan Description (SPD)/Plan Document. For complete information on benefits, please refer to your SPD or contact the Fund Office at 1-812-232-4384.
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Active Employees, Non-Medicare Eligible Retirees and their Eligible Dependents
|
| Calendar-year Medical Deductible (Individual/Family) |
$500/$1,500 |
| Calendar-year Medical Out-of-Pocket Maximum (Individual/Family) |
$1,500/$4,500 |
Annual Deductible for Brand Name Prescription Drugs (Individual/Family)
Note: This includes retail and maintenance drug/mail order programs. This
deductible is separate from the Medical Deductible above.
|
$100/$300 |
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Medicare-Eligible Retirees and their Eligible Dependents
|
| Medicare Part A and B Deductibles |
Plan pays 100% |
Annual Deductible for Brand Name Prescription Drugs (Individual/Family)
Note: This includes retail and maintenance drug/mail order programs. This
deductible is separate from the Medical Deductible above.
|
$100/$300 |
The Plan's Trustees believe this Plan 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 the protections that apply and that do not apply to a grandfathered health plan and what might cause a
plan to lose grandfathered health plan status can be directed to the Plan Administrator at 812-232-4384. You may also contact
the Employee Benefits Security Administration, U.S. Department of Labor at 866-444-3272 or dol.gov/ebsa/healthreform. This
website has a table summarizing which protections do and do not apply to grandfathered health plans.