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What To Do In Event of Interruption of Website Service.
We apologize for the recent interruption in your ability to obtain access to this website. Hopefully the problem has been corrected and there will be no recurrence of same. However, in the event such an interruption recurs in the future, we suggest that you obtain access to the website by entering the website address in the search bar at the top of your computer screen, as opposed to using a search engine such as Google.
Booklet Containing Summary Plan Description and Plan Document.
A Booklet containing the Summary Plan Description (“SPD”) and Plan Document for the ITPE Health & Welfare Plan which contains all Amendments adopted through July 30, 2011, has been published and distributed. Any Amendments adopted after July 1, 2011, are published in the Amendments portion of this site.
Compliance with Affordable Care Act
The ITPE Health & Welfare Plan is in compliance with the Federal Affordable Care Act and will continue to remain in compliance with the law. As part of that compliance:
1. The Funds provide medical coverage for your children up to the age of 26;
2. Effective January 1, 2012, the Fund pays 100% of the cost of all "Preventive Health Services" required
by the Affordable Care Act, such as well-care, baby visits, preventive care physical examinations for adults,
and immunizations and screening tests for children and adults, so long as such services are provided
by Network Healthcare Providers.
Summary of Material Modifications
Effective January 1, 2013, the following modifications to your medical benefits will go into effect:
1. Women's Healthcare
Effective January 1, 2013, the Plan will pay 100% of the cost of the following Women's Healthcare Preventive Health Services:
A. Women's Contraceptives, Sterilization Procedures, and Counseling;
B. Breastfeeding Support, Supplies and Counseling. Benefits for Breat Pumps are limited to one
pump per calendar year;
C. Gestational Diabetes Screening.
2. Fund Maximum Payment Per Calendar Year
The amount of the Fund Maximum Payment per Calendar Year for all Schedules of Benefits shall be increased from $1,250,000.00 to $2,000,000.00.
3. Pre-Certification
Pre-Certification is required for any in-patient admission to a hospital or for certain out-patient medical services. A description of the out-patient services which require Pre-Certification under the Plan is set forth in an Appendix to the Summary Plan Description entitled "Out-Patient Services Requiring Pre-Certification". You may review the out-patient medical services which require Pre-Certification by clicking on the "Appendix".
The details regarding the Pre-Certification requirement are set forth in Amendment 2013-2 to the ITPE Health & Welfare Plan Document and Amendment 2013-3 to the ITPE Health & Welfare Summary Plan Description which you can find in the "Amendments" Section of this Website.
4. Modifications for Class I and II Participants
A. Co-Pays
i. The amount of the Co-Pay for Primary Care Physicians shall be increased from $20.00 to
$25.00 for Class I and II Participants with contribution rates of $4.00/hour or higher;
ii. The amount of the Co-Pay for Specialist Physicians shall be increased from $40.00 to $50.00 for
Class I and II Participants with contribution rates of $4.00/hour or higher; and
iii. Class I and II Participants with contribution rates lower than $4.00/hour shall not have Co-Pays and,
accordingly, all of their visits, whether for Primary Care or Specialist Physicians, shall first be subject to
their deductible, after which the Fund shall pay 75% of the charges for In-Network Physicians, and
65% of the charges for Out-of-Network Physicians.
B. Deductibles
i. The amount of the Annual Calendar Year Deductible for Class I and II Participants with contribution
rates between $2.50 and $3.54/hour shall be increased to $480.00;
ii. The amount of the Annual Calendar Year Deductible for Class I and II Participants with contribution
rates between $3.55/hour and $3.74/hour shall be increased to $420.00;
iii. The amount of the Annual Calendar Year Deductible for Class I and II Participants with contribution
rates between $3.75/hour and $3.99/hour shall be increased to $360.00; and
iv. The amount of the Annual Calendar Year Deductible for Class I and II Participants with contribution
rates of $4.00/hour or higher shall be increased to $300.00.
C. Maximum Out-of-Pocket Per Calendar Year
i. The Maximum Out-of-Pocket, plus deductible, for Class I and II Participants with contribution rates
between $2.50/hour and $3.74/hour shall be $6,500.00;
ii. The Maximum Out-of-Pocket, plus deductible, for Class I and II Participants with contribution rates
between $3.75/hour and $3.99/hour shall be $5,000.00; and
iii. The Maximum Out-of-Pocket, plus deductible, for Class I and II Participants with contribution rates of
$4.00/hour or higher shall be $3,500.00.
5. Modifications for Class III and IV Participants
A. Co-Pays
i. The amount of the Co-Pay for Primary Care Physicians for Class III and IV Participants with
contribution rates of $4.00/hour or higher shall remain at $20.00;
ii. The amount of the Co-Pay for Primary Care Physicians shall be increased from $20.00 to $25.00
for Class III and IV Participants with contribution rates between $3.75/hour and $3.99/hour;
iii. The amount of the Co-Pay for Specialist Physicians for Class III and IV Participants with contribution
rates of $4.00/hour or higher shall remain at $40.00;
iv. The amount of the Co-Pay for Specialist Physicians for Class III and IV Participants with contribution
rates between $3.75/hour and $3.99/hour shall be increased from $40.00 to $50.00; and
v. Class III and IV Participants with contribution rates less than $3.75/hour shall not have Co-Pays and,
accordingly, all of their physician visits, whether for Primary Care or Specialist Physicians, shall first be
subject to their deductible, after which the Fund shall pay 75% of the charges for In-Network Physicians, and 65% of the charges for Out-of-Network Physicians.
B. Deductibles
i. The amount of the Annual Calendar Year Deductible for Class III and IV Participants with contribution
rates between $2.50/hour and $3.54/hour is increased to $420.00;
ii. The amount of the Annual Calendar Year Deductible for Class III and IV Participants with contribution
rates between $3.55/hour and $3.74/hour is increased to $360.00;
iii. The amount of the Annual Calendar Year Deductible for Class III and IV Participants with contribution
rates between $3.75/hour and $3.99/hour is increased to $300.00; and
iv. The amount of the Annual Calendar Year Deductible for Class III and IV Participants with contribution
rates $4.00/hour or higher is increased to $240.00.
C. Maximum Out-Of-Pocket Per Calendar Year
i. The Maximum Out-of-Pocket, plus deductible, for Class III and IV Participants with contribution rates
between $2.50/hour and $3.54/hour shall be $6,500.00;
ii. The Maximum Out-of-Pocket, plus deductible, for Class III and IV Participants with contribution rates
between $3.55/hour and $3.74/hour shall be $5,000.00;
iii. The Maximum Out-of-Pocket, plus deductible, for Class III and IV Participants with contribution rates
between $3.75/hour to $3.99/hour shall be $3,500.00; and
iv. The Maximum Out-of-Pocket, plus deductible, for Class III and IV Participants with contribution rates
of $4.00/hour or over shall be $2,000.00.
6. All Other Benefits Provided by the Plan Remain Unchanged.
For your convenience we are providing a Chart which summarizes the modifications to your Co-Pays, Deductibles and Maximum Out-of-Pocket effective January 1, 2013. If you are a Class III or IV Participant you sould read the Chart from the top down. If you are a Class I and II Participant, please read the Chart from the bottom up.
REMINDER REGARDING MENTAL HEALTH BENEFITS
As we have previously advised, effective July 1, 2012, the Plan no longer provides coverage for any in-patient or out-patient treatment of a Mental Health Disorder.
Time Limit for Filing Claims for Death Benefits and Non-Occupational Accident Death and Dismemberment Benefits or Survivor Benefits
Claims for Death Benefits, Non-Occupational Accidental Death & Dismemberment Benefits, Survivor Death Benefits must be submitted within three (3) years from the date of the death or dismemberment in question).
Claims for all other benefits provided by the Plan must be submitted within one (1 year) from the day the claim is incurred.
Handling of Claims for Medical Benefits and Appeals from Denials of such Claims.
Effective July 1, 2012, all claims for medical benefits and appeals from denials of such claims shall be handled exclusively by Anthem. Claims for all benefits other than medical benefits, and appeals from denials of such claims shall be handled by the Plan Office.
The details of the Medical Claims and Appeals Procedures are set forth in Amendment 2012-2 to the ITPE Health & Welfare Plan and Amendment 2012-2 to the Summary Plan Description of the ITPE Health & Welfare Plan. Those Amendments can be found by clicking on Amendments.
One of the significant changes in the Medical Claims Appeal Procedures is the creation of a voluntary “External Review Process”. Effective July 1, 2012, if you so choose, you will have the right to have a decision denying your appeal from a medical claim reviewed by independent health care professionals who have no association with the Claims Administrator. Again, the details of such External Review Process are contained in the aforedescribed Amendments.
Important Notice regarding Grandfathered Status of ITPE Health & Welfare Plan.
Effective July 1, 2012, the Trustees of the ITPE Health & Welfare Plan believe that this Plan is no longer a “Grandfathered Health Plan” under the Patient Protection and Affordable Care Act (the Affordable Care Act). Accordingly, effective July 1, 2012, the Plan will provide the preventive health services mandated by the Affordable Care Act without any cost sharing by Participants. In addition, effective July 1, 2012, the Plan shall afford Participants an “External Appeal” process as a voluntary final step in connection with the review of denials of medical claims.
A description of the preventive health services provided by the Plan without any cost sharing as of July 1, 2012 is set forth in the Summary Plan Description, and at Section 9.03(c) of the ITPE Health & Welfare Plan.
Questions regarding which protections apply and which protections do not apply to a Grandfathered Health Plan and what might cause a plan to change from Grandfathered health plan status can be directed to the Plan Administrator by calling 1-800-327-5926 or 1-912-352-7169, or writing to Board of Trustees, ITPE Health & Welfare Fund, Attention Plan Administrator, P.O. Box 13817, Savannah, GA 31416. You may also contact the Employee Benefit Security Administration, at U.S. Department of Labor at 1-866-444-3272 or www.dol.gov\ebsa\healthreform. This website has a table summarizing which protections do and do not apply to Grandfathered Health Plans.
ITPE Health & Welfare Fund
When to Contact the Fund Office @ 1-800-327-5926• Verify Coverage for Dental• Verify Coverage for Vision• Verify Coverage for Prescription Drugs• Verify Coverage for Disability• Verify Coverage for Death Benefits• Request a Claim Form for Disability or DeathAlso when you need to:• Change Your Address***• Change a Dependent(s)****** Note: You must fill out a New Enrollment Card When You Change Your Address, Add or Drop a Covered Family Member. You must include Birth Certificates, Adoption Papers, Marriage License or any required Court Documents. Make sure Your Union Representative has a Copy of Your Enrollment Card. Mail - Enrollment Cards and Documents, Dental, Vision, Prescription Drugs, Death and Disability Forms to:ITPE Health & Welfare FundP.O. Box 13817Savannah, GA 31416You can review your benefit program at www.itpebenefits.com, and the Anthem Website is: www.anthem.com You can review your pharmacy benefit program at www.caremark.com Important Information for ITPE Health & Welfare Fund Participants
