PIPE FITTERS’ WELFARE FUND, LOCAL 597

 Summary of Material Modifications

All the changes summarized in this notice are effective June 1, 2009. 

1.     Maximum Benefit Under Major Medical Has Changed. 

The Trustees have increased the maximum benefits payable under the Comprehensive Major Medical benefit to $2 million from the previous amount of $1 million.  However, going forward, the maximum benefits payable will no longer be applied per Sickness or Accident but instead will be applied to all Major Medical benefits paid in a participant’s lifetime. 

2.     New Services Covered Under the Plan for the Treatment of Autism. 

The Trustees have added Applied Behavioral Analysis (ABA) services as a covered expense for the treatment of autism under the Plan’s Mental and Nervous Disorder benefit. 

However, in order for ABA to qualify as a covered expense, it must be provided by an early intervention specialist that is certified and licensed in the state in which the services are provided. 

Such specialists include, Physicians, licensed psychologists, licensed clinical professional counselors in the appropriate field, licensed clinical social workers or other licensed professionals as recognized by the Plan.

PIPE FITTERS’ WELFARE FUND, LOCAL 597

Summary of Material Modification

1.  1.  Maximum Dental Benefit for Active Employees Has Increased. 

Effective January 1, 2010, the Trustees have increased the maximum benefits payable under the Dental Expense Benefit for Active Employees to $1,750 per person per calendar year from the previous amount of $1,250.    

2.  2.  Maximum Chiropractic Benefit for Active Employees and Retired Employees Not Yet Eligible for Medicare Has Increased. 

Effective January 1, 2010, the Trustees have increased the maximum benefits payable for Spinal Manipulation and Naprapathic Benefits (including diagnostic testing) for Active Employees and Retired Employees Not Yet Eligible for Medicare to $1,500 per person per calendar year from the previous amount of $1,000.    

3.   3.  Death Benefit for Active Employees Has Increased.

Effective July 1, 2010, the Trustees have increased the Death Benefit payable on behalf of Active Employees to $25,000 from the previous amount of $10,000 ($20,000 in the event of an Accidental Death).  Due to this Death Benefit increase, the Accidental Death Benefit (AD&D) has been eliminated from the Plan. 

4.  4.  Prescription Erectile Dysfunction Drugs Are Now a Covered Expense Under the Plan’s Prescription Drug Benefit. 

Effective July 1, 2010, the Trustees have added certain erectile dysfunction drugs to the list of prescription drugs covered under the Plan.  The Plan will only pay for up to six pills of Viagra, Cialis or Levitra per month.  However, the Plan may temporarily allow a higher quantity with prior authorization from the Plan’s pharmacy benefit manager, ExpressScripts.     

5.  5.  Annual Health Reimbursement Account Credit for Retirees Has Increased. 

     Effective November 1, 2010, the Trustees have increased the annual amount credited to a Retiree’s Health Reimbursement Account (HRA) to $55 per Pension Year from the previous amount of $50 per Pension Year. 

      For example, if you have 35 Pension Years, your HRA will be credited with $1,925 (35 x $55) of tax-free contributions available for reimbursement of certain approved medical expenses.

6.  6.  Michelle’s Law Requires Extension of Coverage for Some Dependents. 

Beginning January 1, 2010, federal law requires the Plan to extend coverage to dependents that lose their full-time student status and in turn their coverage under the Plan due to a serious illness or injury.  The Plan will extend coverage to the dependent for up to one year from the date of the medically necessary leave of absence, but may end earlier if the dependent’s coverage terminates for any other reason as set forth in the Plan.  In order to receive such extension, the Plan must receive written certification from the dependent’s physician that the dependent is suffering from a serious illness or injury and a leave of absence is medically necessary.  

7.   7.  Family Medical Leave Act Expanded for Military Families. 

Effective January 16, 2009, the Family and Medical Leave Act (FMLA) expanded the circumstances under which an Employee may take FMLA leave.  The new law adds two new military family leave entitlements for eligible family members.  The hours for which contributions would have been made during your absence will be considered regular Credited Hours as though you had actually worked those hours. 

The duration of FMLA leave available to you will depend on the reasons for which you are taking the leave.   

You may qualify for up to 12 weeks (during any 12-month period) of unpaid leave for your own serious illness, the birth or adoption of a child, to care for a seriously ill spouse, parent or child or the occurrence of a qualifying exigency to deal with the affairs of your spouse, child, or parent because he or she is called to duty.  A qualifying exigency includes short-notice deployment, military events and related activities, childcare and school activities, financial and legal arrangements, counseling, rest and recuperation, post-deployment activities and additional activities as defined under the FMLA in 29 CFR Part 825. 

You may qualify for up to 26 weeks (during any 12-month period) of unpaid leave to care for a covered service-member with a serious injury or illness if the Employee is the spouse, child, parent or next of kin of the service-member as defined under the FMLA in 29 CFR Part 825.  However, please be aware that this 26-week leave is the maximum time period allowed and is not in addition to the 12-week leave provided above.