AMENDMENT NO. 40
PLAN DOCUMENT AND SUMMARY PLAN DESCRIPTION
I.B.E.W. 292 HEALTH CARE PLAN
WHEREAS, the section entitled “Trustee Interpretation, Authority and Right” in the Plan
Document and Summary Plan Description of the I.B.E.W. 292 Health Care Plan (Amended and
Restated Effective April 1, 2004) (the “Plan”) empowers the Board of Trustees to amend the
WHEREAS, the Trustees wish to amend the Plan in order to provide for the ability of a
spouse of a Participant to opt-out of coverage under the Plan if they are eligible for an HSA
NOW THEREFORE, BE IT RESOLVED that the Plan is hereby amended as follows:
1. The following section “Opt-Out for Health Savings Account (HSA)
Coverage is added to Page 14 to the Plan after the provision entitled
“Special Enrollment of New Spouses and Dependents” and will provide as
“Opt-Out for Health Savings Account (HSA) Coverage
A Dependent spouse or child of a Participant may elect to opt-out of
coverage under this Plan if they are eligible for a health plan offered by
their employer that is a high deductible health plan with a Health Savings
Account (HSA). The Dependent spouse or child must complete a “Waiver
of Coverage” form to opt-out of coverage under the Plan.
The Dependent spouse or child and Participant understand that by
electing to opt-out of coverage under the Plan, the Dependent spouse
and child will:
1. Not be entitled to any benefits or other payments from the Plan,
including, but not limited to, health care benefits, dental benefits,
accidental death and disability benefits, extended coverage
options under federal law, or retiree benefits.
2. Have no right or claim to any contributions made to the Plan for
the purposes of funding the Dependent spouse’s or child’s
eligibility for coverage.
3. Forfeit any right to benefits under the Plan even if Plan benefits
are superior in some respects to the benefits under the plan
offered by the Dependent spouse’s or child’s employer.
4. Have no right to return to coverage under the Plan until such time
as HSA and high-deductible health plan coverage is lost, the
Dependent otherwise meets the eligibility requirements of the Plan
and provides written notice to the Trustees of the desire to once
again become covered by the Plan.
The “Waiver of Coverage” form can be obtained from the Plan
Administrator. The Dependent must indicate the date upon which the
waiver of coverage will be effective.“
This Amendment will be effective as of March 1, 2008.
IN WITNESS WHEREOF, we hereunto set our hands this 4th day of March, 2008.
UNION TRUSTEES EMPLOYER TRUSTEES