These links are provided as a convenience and for informational purposes only and do not constitute an endorsement by the Northern California Cement Masons Trust Funds.  The Northern California Cement Masons Trust Funds bear no responsibility for the accuracy, legality, or content of the external site or for that of subsequent links.  Contact the external site for answers to questions regarding its content.

Forms:

Application for Retiree Health & Welfare Coverage - Medicare

Application for Retiree Health & Welfare Coverage - Non-Medicare

Change of Address

Enrollment

Notices:

Health Reimbursement Accounts

Notice of Creditable Coverage

Summary Annual Report – PYE 2022

Plan Documents & Amendments:

Formal Plan Rules

Summary Plan Description

1^st Amendment

2^nd Amendment

3^rd Amendment

4^th Amendment

5^th Amendment

6^th Amendment

7^th Amendment

Summary of Benefits & Coverage

Blue Shield Active + HMO Facility Coinsurance 20-20%

Blue Shield Active + HMO Facility Deductible 30-30%/2000

Blue Shield Trio HMO Facility Coinsurance 20-20%

Blue Shield Trio HMO Facility Deductible 30-30%/2000

Kaiser Active DHMO

Kaiser Early Retiree HMO

Evidence of Coverage

Blue Shield Active + HMO Facility Coinsurance 20-20%

Blue Shield Active + HMO Facility Deductible 30-30%/2000

Blue Shield Full PPO Combined Deductible 35-500 80/60

Blue Shield Trio HMO Facility Coinsurance 20-20%

Summary of Material Modifications

Feb 1, 2025 - Retiree Dental Coverage Changes Effective April 1, 2025

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Federal Transparency in Coverage regulations require that as of July 1, 2022, group health plans must post machine readable files containing (1) negotiated in-network rates and (2) out-of-network billed charges and allowed amounts.  To access this information, click the links below.

Blue Shield of California

https://www.blueshieldca.com/en/home/help-and-resources/machine-readable-files

Kaiser Permanente
https://healthy.kaiserpermanente.org/front-door/machine-readable