The U. A. Local No. 159 Health and Welfare Plan provides for continuation of coverage for a limited period, for qualified employees, retirees, and dependents, subject to payment of a monthly premium ("COBRA continuation coverage"). The COBRA premium rates will be higher than the self-pay rates for qualified employees who are employed under the labor agreement or available for such employment, or for qualified surviving spouses. Employees who may qualify for the more favorable self-payment rate, as well as those individuals who qualify for COBRA continuation coverage under the following regulations, should check with the Trust Fund Office as to the proper monthly premium. Your rights to elect COBRA continuation coverage are briefly summarized below and appear in the Formal Rules on page 51 under the Section entitled "COBRA Continuation Coverage." A more complete explanation is also available from the Trust Fund Office on request and is provided whenever a person receives a COBRA election.

As a participant in the U. A. Local No. 159 Health and Welfare Plan, you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA). ERISA provides that all plan participants shall be entitled to the following rights:

Receive Information About Your Plan and Benefits

• Examine, without charge, at the Plan Administrator’s office and at other specified locations, such as work sites and union halls, all Plan documents governing the Plan. These documents include insurance contracts and collective bargaining agreements and a copy of the latest annual report (Form 5500 Series) filed by the Plan with the S. Department of Labor (DOL)and available at the Public Disclosure Room of the Employee Benefits Security Administration (EBSA) (formerly the Pension and Welfare Benefits Administration). You may also locate a copy of the Form 5500 series on the DOL/EBSA website: www.dol.gov/ebsa/.
• Obtain, upon written request to the Plan Administrator, copies of documents governing the operation of the Plan. These include insurance contracts and collective bargaining agreements and copies of the latest annual report (Form 5500 Series) and updated Summary Plan Description (SPD). The administrator may make a reasonable charge for the copies. You may also locate the Plan’s SPD on the Fund’s website and the Form 5500 series can be located on the DOL/EBSA website: www.dol.gov/ebsa/. 
• Receive a summary of the plan's annual financial report. The plan administrator is required by law to furnish each participant with a copy of this summary annual report.

Continue Group Health Plan Coverage

• Continue health coverage for yourself, spouse or dependents if there is a loss of coverage under the plan as a result of a qualifying event.  You or your dependents may have to pay for such coverage.  Review the summary plan description and the documents governing the plan on the rules governing COBRA continuation coverage rights.

Reduce or eliminate exclusionary periods of coverage for preexisting conditions under your group health plan, if you have creditable coverage from another plan. You should be provided a certificate of creditable coverage, free of charge, from your group health plan or health insurance issuer when you lose coverage under the plan, when you become entitled to elect COBRA continuation coverage, when your COBRA continuation coverage ceases, if you request it before losing coverage, or if you request it up to 24 months after losing coverage. Without evidence of creditable coverage, you may be subject to a preexisting condition exclusion for 12 months (18 months for late enrollees) after your enrollment date in your coverage.

If you work a qualifying number of hours for an employer who employs at least fifty employees, you may be eligible for a leave of absence under the Family and Medical Leave Act ("FMLA"). If the FMLA applies to your employer, your employer is responsible for making contributions for your coverage while you are on FMLA qualifying leave. FMLA leave may be taken because of the birth or placement of a son or daughter with you for adoption or foster care; to care for your spouse, son, daughter, or parent who has a qualifying "serious health condition"; because of your own qualifying "serious health condition"; because of a "qualifying exigency" related to service in the United States Armed Forces by your spouse, son, daughter, or parent; or if you are the spouse, son, daughter, parent or next of kin of a member of the United States Armed Forces who is undergoing medical treatment, recuperation, or therapy, is otherwise in outpatient status, or is otherwise on the temporary disability retired list, for a serious injury or illness, to care for the service member. The definition of qualifying FMLA leave may change as the law is amended. Your Hour Bank, if you have one, will not be charged for coverage while you are on FMLA qualifying leave. If you believe this law applies to you, contact the Trust Fund Office for more information.

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires health plans to comply with privacy rules. These rules are intended to protect your personal health information from being inappropriately used and disclosed. The rules also give you additional rights concerning control of your own healthcare information.

This Plan’s HIPAA Privacy Notice explains how the group health plan uses and discloses your personal health information.  For complete disclosure of protected health information, refer to pages 88-90 of the SPD & Formal Plan Rules.  

No person is covered who is in active military service in the Armed Forces of the United States. If you are called to active military service, you may elect to:

1. have your Hour Bank frozen, and terminate coverage of your dependents, on the first day of the month following your entry into active military service.  (Under this option, you may choose to continue coverage for your dependents for up to 24 months under COBRA.);
2. continue coverage of your dependents at the normal monthly charge against your Hour Bank until it is exhausted. (Thereafter, you may choose to continue coverage for your dependents for up to 24 months under COBRA.); or
3. if you were covered under the Plan by reason of Hour Bank credit for at least 12 out of the 18 months immediately preceding your call to active military duty, continue coverage for your dependents, at one-half the Subsidized Self-Payment rate, until the earlier of 1) the end of your active military service, or 2) 24 months after your entry into active military service.

If you elect option 3, and you stop making the required payments or the 24-month period is exhausted, you may then elect options 1 or 2.

To make your election of one of the three options above, you must notify the Trust Fund Office of your call to active duty. If you do not give proper notice, you will be deemed to have elected option 2 above.

For additional information regarding reemployment after military service, see the SPD & Formal Plan Rules, Section I, Rule A.13.

Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother's or newborn's attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

In accordance with Federal law, women who have had a medically necessary mastectomy are entitled to coverage for:

1. all stages of reconstruction of the breast on which the mastectomy was performed; and
2. surgery and reconstruction of the other breast to produce a symmetrical appearance; and
3. prostheses; and
4. treatment of any physical complication of mastectomy, including lymphedemas.

The care covered under these rules is subject to the standard co-payment or co-insurance requirements which apply to other medical and hospital coverage provided by the plan in which the patient is enrolled.