Southern Operators Health Fund
P.O. Box 1449
Goodlettsville, TN 37070-1449
2001 Caldwell Drive
Goodlettsville, TN 37072-3589
Toll Free: (800) 831-4914
Telephone: (615) 859-0131
TO: PARTICIPANTS OF LOCAL 406 WELFARE PLAN ("PLAN")
IMPORTANT NOTICE ABOUT PLAN CHANGES EFFECTIVE JANUARY 1, 2017
Beginning January 1, 2017, we will participate in the Southern Operators Health Fund
("SOHF"), which means your medical benefits, outpatient prescription drug benefits, and other benefits such as group life, accidental death and dismemberment benefits, will be provided by the SOHF.
As of December 31, 2016, the current medical and prescription drug benefit coverage described in the Choice Plus Medical Benefit booklet and administered by United HealthCare, and the current group life (i.e., death benefits), accidental death and dismemberment benefit coverage described in the Certificate of Coverage issued by United HealthCare, will terminate. All claims incurred before January 1, 2017 should be filed with United HealthCare as currently required.
How The Change In Coverage Affects Your Eligibility and Hour Bank
Eligibility - We will purchase coverage under SOHF for the months of January and February 2017, for all participants (i.e., eligible employees of contributing employers and their dependents) who would have qualified for coverage under the Plan for the month of January 2017 based on hours worked through November 30, 2016.
Beginning with the work month of December 2016, employer contributions that would have been made to the IUOE Local 406 Welfare Fund will be made to SOHF. Eligibility for months beginning on or after January 1, 2017 will be determined under SOHF's eligibility rules, subject to the special "buy-in" of two months of coverage described above.
Under SOHF's general initial eligibility rules, you must work at least 375 hours at the prevailing contribution rate, during five or fewer consecutive months, to qualify for initial eligibility. It will be effective as of the first day of the second month (i.e., the "benefit month") after the "work month" in which it is satisfied. Under SOHF's general continuing eligibility rules, you must work at least 125 hours at the prevailing contribution rate in a "work month" to be covered in the corresponding "benefit month". As with our Plan, SOHF has a gap between the "work month" and corresponding "benefit month". For example if you satisfy the 125 hours of work requirement in a "work month" of May, you will have coverage for the corresponding "benefit month" of July.
SOHF will be sending you a Summary Plan Description which describes its eligibility and benefit rules in greater detail. Special eligibility rules apply to non-bargaining employees, owner-operators and non-construction employees. All questions concerning eligibility and benefits under SOHF will be governed by SOHF's plan documents and determined by its Board of Trustees.
Hour Bank - Hour Bank coverage will be handled in the following manner. If you have an Hour Bank balance under the Plan as of November 30, 2016 (after deducting any hours that may be needed to continue your eligibility for January 2017), it will be transferred to an Hour Bank balance under SOHF in accordance with the following rules: (i) if you have 1-130 hours credited to your Plan's Hour Bank, you will receive a SOHF Hour Bank credit for one month of coverage; (ii) if you have 131-260 hours credited to your Plan's Hour Bank, you will receive a SOHF Hour Bank credit for two months of coverage; and (iii) if you have 261-390 hours credited to your Plan's Hour Bank, you will receive a SOHF Hour Bank credit for three months of coverage.
Once your Hour Bank credit under our Plan is transferred to an Hour Bank credit under SOHF, your Plan's Hour Bank balance will be reduced to "0". As of November 30, 2016, the Plan will discontinue the use of Hour Banks. Remember that covered employment performed on or after December 1, 2016 will be credited to SOHF. The extent to which you receive Hour Bank credit under SOHF will be governed by SOHF's rules. The extent to which you may use your Hour Bank credit under SOHF on or after January 1, 2017, will also be governed by SOHF's rules. Under SOHF's current rules, the maximum number of hours which may be credited to an Hour Bank is 375.
COBRA Coverage - If, as of January 1, 2017, you would have been eligible for COBRA coverage under the Plan, you will be able to continue your COBRA coverage under SOHF, on a self-payment basis, for the remainder of your COBRA coverage period. The COBRA coverage benefit levels and required self-payment amounts will be determined under SOHF's rules. Information regarding the COBRA rates and payment procedures will be sent to those of you who have or are eligible for COBRA coverage. Payment of the required COBRA self-payment should be made to SOHF.
Retiree Coverage - SOHF provides retiree coverage, on a self-payment basis, in certain circumstances. One of the requirements is that the retiree be continuously covered under SOHF for the 24-consecutive month period immediately before retirement. SOHF has agreed to credit any continuous coverage under our Plan that is immediately followed by coverage under SOHF toward satisfaction of this requirement. All questions concerning eligibility for retiree coverage under SOHF will be governed by SOHF's rules and determined by its Board of Trustees.
How The Change In Coverage Affects Your Benefits
Your Benefits Will Be Changing - Beginning January 1, 2017, all benefits will be provided under SOHF. Enclosed is a copy of the Summary of Benefits and Coverage which describes SOHF's medical and prescription drug coverage for 1/1/2017 - 12/31/2017. You can compare it to our Plan's Summary of Benefits and Coverage for 1/1/2016 - 12/31/2016 to see the differences in coverage.
A Benefits Highlight Sheet is also enclosed. It is a document that we prepared to help highlight the differences between the Medical Benefits, Outpatient Prescription Drug Benefits, and Other Benefits (i.e., life and accidental death and dismemberment benefits, retiree death benefits, health reimbursement account, weekly disability, vision and dental benefits) provided by our Plan and SOHF. The Benefits Highlight Sheet is not an official plan document. In the event of a discrepancy between the Benefits Highlight Sheet and SOHF's plan documents, SOHF's plan documents will prevail.
Your Managed Care Network Will Be Changing - The Plan participates in the United HealthCare Choice Plus Network and provides coverage for both Network and Non-Network providers. The following two changes will occur beginning January 1, 2017:
- The managed care network for SOHF is the CIGNA Open Access Plus (OAP) Network. You should call the CIGNA telephone number, or go online using the CIGNA website, to find providers in the new Network. This contact information will be included on your new ID card; and
- Non-participating (i.e., non-Network) providers are not covered under SOHF except as follows: (i) when there is no Network provider qualified to administer the treatment within 35 miles of your home address; (ii) initial charges incurred for life-threatening emergencies are covered; and (iii) charges incurred for anesthesiology, radiology, pathology, lab services and emergency room physicians in connection with treatment administered at a participating/Network facility and, if applicable, by a
participating/Network attending Physician, are covered.
Your Prescription Drug Card Will Be Changing - The Pharmacy Benefit Manager will also be changing from OptumRx (used by the Plan), to Caremark/CVS (used by SOHF). You will receive a new ID card with information about the prescription drug benefit. In order for a prescription drug to be covered, the prescription must be filled at a participating pharmacy, and you must present your ID card. A mail order program is also available through Caremark. You may contact Caremark at 1-800-213-0879 or online at
www.caremark.com if you have a prescription drug claim or benefit questions.
You Will Be Receiving New ID Cards - SOHF will be sending you an enrollment form, a new Summary Plan Description, and a new ID card in mid-December. The ID card is printed by Caremark and will be a combination medical/prescription drug benefit card. Beginning January 1, 2017, you should present this new card each time you receive medical care or purchase a prescription drug to ensure that your claims are processed correctly.
We think that you will be pleased with the new benefits package. If you have questions or need assistance with the transition in coverage, please contact either Fund Office location as follows:
|7651 Airline Highway
Baton Rouge, LA 70814
Telephone: (225) 924-1311
|7370 Chef Menteur Highway
New Orleans, LA 70126
Telephone: (504) 241-7312
Board of Trustees,
IUOE Local 406 Welfare Plan