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National Asbestos Workers Medical Fund

20082008

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BenefitsComprehensive Major Medical Benefits

DeductibleDeductible

Annual PlanAnnual Plan

Lifetime PlanLifetime Plan

$250 individual$250 individual $600 family$600 family

Plan pays 80% of Plan pays 80% of $16,500; you pay 20%$16,500; you pay 20%

100% up to $750,000100% up to $750,000

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Benefits

All benefits reduced by 50% if PPO is All benefits reduced by 50% if PPO is available and not usedavailable and not used

Does not apply if outside of 25 miles Does not apply if outside of 25 miles Does not apply in case of emergencyDoes not apply in case of emergency

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Employee Assistance Benefits

Benefits provided by ComPsych – See Benefits provided by ComPsych – See Summary Plan DescriptionSummary Plan Description

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Benefits

Emergency Room Emergency Room Co-PayCo-Pay

$100, unless admitted $100, unless admitted to hospital, or for life to hospital, or for life threatening illness or threatening illness or injuryinjury

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BenefitsFor Active Members Only Death BenefitDeath Benefit

Accidental Death Accidental Death BenefitBenefit

Dismemberment Dismemberment BenefitBenefit

Annual PhysicalAnnual Physical

$25,000$25,000

$25,000$25,000

Up to $20,000Up to $20,000

$600 Annual Max$600 Annual Max

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BenefitsActive Members Only - Loss of Time

MaximumMaximum

Weeks 1 – 26Weeks 1 – 26

Benefits begin on 8Benefits begin on 8thth day of illness, 1day of illness, 1stst day day of injuryof injury

26 Weeks26 Weeks

$200/week$200/week

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Dental Benefits

If additional contribution of $.20 paidIf additional contribution of $.20 paid

Plan covers 80% of UCRPlan covers 80% of UCR

Maximum paid by plan is $800/person/yearMaximum paid by plan is $800/person/year

Ortho limited to $1,500 lifetimeOrtho limited to $1,500 lifetime

Additional Ortho benefit of $2,000 if additional $.08 paidAdditional Ortho benefit of $2,000 if additional $.08 paid

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Vision Benefits

If additional contribution of $.04 paidIf additional contribution of $.04 paid

Plan pays up to $200/person/yearPlan pays up to $200/person/year

Frames every other calendar yearFrames every other calendar year

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Non Medicare - Retiree Benefits

Death Benefit = $10,000 (no AD&D)Death Benefit = $10,000 (no AD&D) Same health benefits as Active, except no Same health benefits as Active, except no

Physical, A&S or Maternity benefitsPhysical, A&S or Maternity benefits Dental and/or Vision only if local union is Dental and/or Vision only if local union is

covered and all retirees pay premiumcovered and all retirees pay premium

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Medicare Retiree Benefits

Death Benefit = $10,000 (no AD&D)Death Benefit = $10,000 (no AD&D) Same health benefits as Active, except $150 deductible for Same health benefits as Active, except $150 deductible for

Medical Benefits only and Medicare is primary coverageMedical Benefits only and Medicare is primary coverage Prescription deductible $750/person – if you sign up for Prescription deductible $750/person – if you sign up for

Medicare D; $2,250/person – if you do not sign up for Medicare D; $2,250/person – if you do not sign up for Medicare DMedicare D

No Physical, A&S or Maternity benefitsNo Physical, A&S or Maternity benefits Dental and/or Vision only if local union is covered and all Dental and/or Vision only if local union is covered and all

retirees pay premiumretirees pay premium

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Eligibility

Initial EligibilityInitial Eligibility 800 hours in two eligibility (calendar) quarters 800 hours in two eligibility (calendar) quarters

provides coverage in benefit quarter, plus 2 provides coverage in benefit quarter, plus 2 preceding monthspreceding months

Maintaining EligibilityMaintaining Eligibility 400 hours in eligibility (calendar) quarter (or 400 hours in eligibility (calendar) quarter (or

800 hours in 2 eligibility quarters) provides 800 hours in 2 eligibility quarters) provides coverage in benefit quartercoverage in benefit quarter

2 month lag2 month lag

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Eligibility Issues Newly Organized Members & Newly Indentured Newly Organized Members & Newly Indentured

ApprenticesApprentices Local Must Notify Fund OfficeLocal Must Notify Fund Office EligibilityEligibility

Never previously been eligibleNever previously been eligibleNewly organized employee or Employee of Newly organized employee or Employee of

Newly Organized CompanyNewly Organized Company135 hours in work month gives eligibility for 135 hours in work month gives eligibility for

following 2 monthsfollowing 2 monthsOnce eligibility terminates, can never be Once eligibility terminates, can never be

considered NOG againconsidered NOG again Separate Plan of BenefitsSeparate Plan of Benefits

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Eligibility Issues (Cont.)

Self PaymentsSelf Payments Difference between hours reported in eligibility Difference between hours reported in eligibility

quarter and 400 hours (or 2 eligibility quarters quarter and 400 hours (or 2 eligibility quarters and 800 hours)and 800 hours)

If member disagrees with hours reported, better If member disagrees with hours reported, better to pay and get refund to pay and get refund

Notify Fund Office if travelingNotify Fund Office if traveling Advise when participants retired – especially Advise when participants retired – especially

when not in National Asbestos Workers when not in National Asbestos Workers Pension FundPension Fund

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Eligibility Issues (Cont.)

Dependent EligibilityDependent Eligibility Initial enrollment does not require Initial enrollment does not require

documentsdocuments Documents required if adding spouse, Documents required if adding spouse,

dependent (marriage certificate, birth dependent (marriage certificate, birth certificate)certificate)

Over Age dependent – submit student Over Age dependent – submit student certification annuallycertification annually

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Eligibility Issues (Cont.)

Retiree EligibilityRetiree Eligibility Eligibility Rules for Retiree Coverage vs. Eligibility Rules for Retiree Coverage vs.

Eligibility Rules for ARESAEligibility Rules for ARESA Need to Elect Retiree Benefits within 60 days Need to Elect Retiree Benefits within 60 days

of termination of active eligibilityof termination of active eligibility Opt-Out/Opt-In Opt-Out/Opt-In Premiums Change With Age & Medicare Premiums Change With Age & Medicare

EligibilityEligibility Premiums are Premiums are QuarterlyQuarterly

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Claims Issues

Routine Physicals for Active Members OnlyRoutine Physicals for Active Members Only Routine Office Visits are Not CoveredRoutine Office Visits are Not Covered Accidental Injuries paid as Any Other IllnessAccidental Injuries paid as Any Other Illness Fund Does Not Pay for Work Related Illness Fund Does Not Pay for Work Related Illness

or Injury – see page 93 of SPDor Injury – see page 93 of SPD Will pay A&S for Denied Work Related Will pay A&S for Denied Work Related

Illness or Injury if Denial ReceivedIllness or Injury if Denial Received

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Claims Issues (Cont.)

If Disabled, can continue Coverage for up If Disabled, can continue Coverage for up to 2 years, then Self Pay for 1 yearto 2 years, then Self Pay for 1 year

Will pay benefits if out of CountryWill pay benefits if out of Country Use Blue prescription reimbursement formsUse Blue prescription reimbursement forms No Precertification Required for Admission No Precertification Required for Admission

to the Hospitalto the Hospital If totally disabled prior to age 60 can If totally disabled prior to age 60 can applyapply

for Active Death Benefitfor Active Death Benefit

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Contribution Issues

Add/Terminate Cards Must Be CompletedAdd/Terminate Cards Must Be Completed Advise when Employer has no employees Advise when Employer has no employees

workingworking Contributions are due on 15Contributions are due on 15 thth of month of month

following month workedfollowing month worked Contributions are assessed late charges if Contributions are assessed late charges if

not in not in Fund OfficeFund Office by 25 by 25thth of month of month following month workedfollowing month worked

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Contribution Issues (Cont.)

Contributions must be submitted for each payroll Contributions must be submitted for each payroll period that ended during the previous monthperiod that ended during the previous month First payroll period ending date must always be First payroll period ending date must always be

7 days or less from the beginning of the month7 days or less from the beginning of the month Last payroll ending date must always be 7 days Last payroll ending date must always be 7 days

or less from the ending date of the monthor less from the ending date of the month

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Contribution Issues (Cont.)

No contributionsNo contributions

No creditNo credit

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Who’s Who

Accounting Department – Amanda Christie Accounting Department – Amanda Christie and Jennifer Rodgersand Jennifer Rodgers

Claims Department – Harriett Wallace & Claims Department – Harriett Wallace & Melanie NajiyMelanie Najiy

Membership Services Department – Beth Membership Services Department – Beth LancyLancy

When All Else Fails – Simone or ReneéWhen All Else Fails – Simone or Reneé

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Union

Definition (Definition (Webster’s New World DictionaryWebster’s New World Dictionary)) A uniting or being unitedA uniting or being united A combining, joining or grouping A combining, joining or grouping

togethertogether Something united or unifiedSomething united or unified An organization uniting various An organization uniting various

individuals, groups, political unitsindividuals, groups, political units