WELFARE FUND
Health & Medical Benefits
The Welfare Fund, International Union of Operating Engineers, Local 295-295C, A.F.L.-C.I.O. (the “Welfare Fund”) was established as the result of Collective Bargaining Agreements between Contributing Employers and Local 295-295C of the International Union of Operating Engineers, A.F.L.-C.I.O. (the “Union”).
General Information
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The Welfare Fund is financed by employer contributions made pursuant to the terms of the existing Collective Bargaining Agreements or other agreements requiring contributions to the Welfare Fund. The Welfare Fund is a separate trust fund. An Agreement and Declaration of Trust established the Welfare Fund for the purpose of paying benefits provided under the Welfare Fund. The Internal Revenue Service has determined that the Plan is tax-qualified, and that the trust is tax exempt. The Summary Plan Description (“SPD”) describes the plan terms and covered benefits under the Welfare Fund. The SPD serves as both the SPD and plan document for the Welfare Fund.
The Welfare Fund is administered by a Board of Trustees (“Trustees”) consisting of an equal number of representatives of the Union and of the Contributing Employers. The Trustees, or any of their duly authorized representatives, reserve the exclusive right and authority, in their sole and absolute discretion, to administer, apply and interpret the Plan, the Trust Agreement, and any other Plan documents and to decide all matters arising in connection with the operation or administration of the Plan or the Trust and the investment of Plan assets.
The Trustees, or any of their duly authorized designees, have the sole and absolute discretionary authority to:
take all actions and make all decisions with respect to the eligibility for, and the amount of benefits payable under the Plan;
formulate, interpret and apply rules, regulations and policies necessary to administer the Plan in accordance with its terms;
decide questions, including legal or factual questions, relating to the calculation and payment of benefits under the Plan;
resolve and/or clarify any ambiguities, inconsistencies and omissions arising under the Plan Trust Agreement or any other Plan documents; and
process, and approve or deny, benefit claims and rule on any benefit exclusions.
All determinations made by the Trustees, or any of their duly authorized representatives, with respect to any matter arising under the Trust Agreement, SPD and any other plan document shall be final and binding on all affected plan participants and their beneficiaries.
No individuals, other than the Trustees, or their duly authorized designees, have any authority to interpret the Welfare Fund or to make any promises to you about the Welfare Fund or your benefits set forth under the SPD. If you have any questions about the Welfare Fund and how its coverage works, the Fund Office staff will be glad to help you. Since telephone conversations and other oral statements can be easily misunderstood, they cannot be relied upon if they are in conflict with what is stated in this summary plan description. Fund personnel are not authorized to confirm or deny entitlement to benefits with any member, dependent, provider of health care services or their representatives. If any such preauthorization or certification of benefits is required, such requests for confirmation or certification must be made in writing to the Fund Office.
As a pre-condition to obtaining benefits under the Welfare Fund, participants are required to cooperate fully with any and all pre-certification, utilization review, and case management programs, which are now in effect or may be added under the Welfare Fund.
Your rights to benefits will be governed solely under the terms of the official plan documents, including the Trust Agreement and SPD, as interpreted by the Trustees, or their duly authorized representatives, in their sole and absolute discretion. The benefits to which you are entitled are determined under the plan terms set forth in the SPD for the Welfare Fund, which are in effect at the time you incur a claim.
The Trustees reserve the right, in their sole and absolute discretion, to amend or modify the Welfare Fund (and the Trust Agreement and SPD) from time to time. The Trustees intend to continue the Welfare Fund (as described in the SPD) indefinitely but, nevertheless, reserve the right, subject to the provisions of any pertinent Collective Bargaining Agreement, to terminate the Welfare Fund, in whole or in part, at any time and for any reason. In addition, the Welfare Fund may be terminated by the Trustees when there is no longer in effect an agreement between an Employer and the Union requiring payment to the Welfare Fund.
This Plan was effective as of July 1st, 2004, and is amended and/or restated from time to time. The Trustees currently deem the Welfare Fund to be in compliance with the Affordable Care Act as a grandfathered plan. In the case of a plan amendment, you will receive a Summary of Material Modification (“SMM”) (or an Amended and Restated SPD, as the case may be) to inform you of the material change(s) to the Welfare Fund. The most current amended and restated SPD along with all SMMs thereto will supersede any and all prior Summary Plan Description booklet(s).
Eligibility and Participation
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Generally speaking, you’re eligible to participate in the Welfare Fund if:
You are an employee performing covered work for a participating employer who has signed a Collective Bargaining Agreement with IUOE Local 295; or You are a full-time salaried employee of IUOE Local 295 or its affiliated benefit funds and are covered by a Collective Bargaining Agreement or Participation Agreement; AND
Your employer makes contributions to the Welfare Fund on your behalf.
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IUOE Local 295 and your employer negotiate contribution levels. Contributions made by your employer are placed in the Welfare Fund. The Trustees, with the assistance of an independent investment consultant, direct the management of the money in the Welfare Fund. The money is invested and used to pay health and medical benefits and plan administration costs.
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Active Employees
You will become initially eligible for all benefits on the first day of the month after you have completed a 30-day waiting period. The 30-day waiting period begins on the first date for which your employer has made the required contributions to the Welfare Fund.
Eligible Dependents
If you have eligible dependents (lawfully married spouse and children) at the time your coverage starts under the Welfare Fund, their coverage will begin on the same day. If you have no eligible dependents when your coverage starts, dependent coverage will begin on the date a person becomes your eligible dependent and is properly enrolled in the Welfare Fund.
A person is an eligible dependent if he or she is:
your lawful spouse (not legally separated or divorced);
your dependent child to the age of 26 years.
For purposes of the above, the term child means your biological child, stepchild, any legally adopted child, and a child who has been placed with you for adoption. In addition, the Welfare Fund is required to recognize court orders, called Qualified Medical Child Support Orders (QMCSOs), directing you to provide health benefit coverage for your dependent children, even if you do not have custody of the children. If you have any questions about QMSCOs or think you might have received one, please refer to the section of this booklet entitled “Qualified Medical Child Support Orders (QMSCOs)” or contact the Fund Office.
You must complete an enrollment form and furnish appropriate documentation to the Fund Office before any claims can be paid for you or any of your eligible dependents. Please refer to the Enrollment and Documentation under Plan Documents & Forms below for more information about the Welfare Fund’s enrollment requirements.
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Employee Coverage Termination
Your coverage, as an active participant, in the Welfare Fund will terminate:
on the last day of the month for which your employer has paid the required contribution on your behalf;
failure to otherwise meet the eligibility requirements;
if the Welfare Fund is terminated;
on the last day of the month for which COBRA continuation premiums have been paid;
at the end of the allowed COBRA continuation coverage period;
when inducted into the military; or
at the end of an approved FMLA leave if you do not return to employment at the end of the leave.
Dependent Coverage Termination
The coverage of all dependents will terminate:
when your coverage terminates;
at the end of the month after the month you enter military service;
if the Plan is terminated;
on the last day of the month for which COBRA continuation premiums have been paid;
at the end of the allowed COBRA continuation coverage period.
In addition to the reasons listed for termination of dependents’ benefits, your spouse’s coverage will terminate:
on the last day of the month in which you become divorced or legally separated;
on the last day of the month for which COBRA continuation premiums have been paid;
at the end of the allowed COBRA continuation coverage period.
In addition to the reasons listed for termination of dependents’ benefits, your dependent children’s coverage will terminate:
on the last day of the month of their 26th birthday;
on the last day of the month for which COBRA continuation premiums have been paid;
at the end of the allowed COBRA continuation coverage period;
when they are no longer your dependent; or
upon entering the military.
Plan Documents & Forms
Click on the link to be directed to a password-protected page where you can access your forms.
Medical Inquiries Including:
Forms Medical, Dental, and Eye Vouchers
Appeals (US mail or email ONLY)
General medical questions
Email Kim@iuoelocal295.com
Phone (718) 672-7930
Fax (718) 672-1412