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Eligibility - Pile Drivers_ Divers_ Bridge_ Dock _ Wharf Builders

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Eligibility - Pile Drivers_ Divers_ Bridge_ Dock _ Wharf Builders Powered By Docstoc
					                               TABLE OF CONTENTS


LIST OF BENEFITS........................................................................... 3

GENERAL INFORMATION............................................................. 4
 HOW DO YOU ESTABLISH COVERAGE IN THE PLAN? ......... 4
 HOW ARE HOURS REPORTED?................................................... 4
 WHEN DOES COVERAGE START?.............................................. 4
    Hour Bank System ........................................................................ 5
 HOW DO YOU MAINTAIN COVERAGE IF UNEMPLOYED?... 5
 WHEN DOES COVERAGE END? .................................................. 6
 IF COVERAGE ENDS, WHEN WILL COVERAGE START
 AGAIN? ............................................................................................ 6
 IN CASE OF INJURY OR ILLNESS ............................................... 7
 DEPENDENT COVERAGE............................................................. 8
SUMMARY OF BENEFITS............................................................. 10

BENEFIT DESCRIPTIONS............................................................. 13
    … for benefits not described in the Benefits Booklets................ 13
  MEMBER ASSISTANCE PROGRAM .......................................... 13
  BASIC MEDICAL .......................................................................... 14
  DIVERS’ MEDICAL EXAMINATIONS....................................... 14
OTHER BENEFITS NOTES............................................................ 15
 “REASONABLE AND CUSTOMARY”........................................ 15
   What can I do? ............................................................................ 15




                                             Page 1 of 15
NOTICE

This booklet is intended to summarize the principal features of your
plan. This booklet, together with the Summary of Benefits and the
detailed benefit booklets issued by Pacific Blue Cross, Manulife and
Great West Life (“the Benefits Booklets”), contain a summary of your
Plan as of November 1, 2008. The Plan is subject to change at any time.
If the Plan changes, the Trustees will send covered members
information about the change, including an updated Summary of
Benefits.
This booklet does not give the details of your coverage. All rights to
benefits are governed by the group insurance contracts and the terms of
the Plan. For detailed information about your benefits, please see the
Benefits Booklets provided by the insurance carriers.

              GROUP NO. 903404 (Active) and 003604(Retired)
                - Pacific Blue Cross and BC Life and Casualty
              (Extended Health, Dental, Short Term Disability)

GROUP NO. 29005 – The Manufacturers Life Insurance Company
   (Class A – Active Members; Class B – Retired Members)
              (Group Life and AD&D Insurance)

 GROUP NO. 161747 – The Great-West Life Assurance Company
             (Long Term Disability Insurance)

            GROUP NO. 3134046 - Medical Services Plan of BC
                     (Basic Medical Coverage)




Revised: July 20, 2009
                   LIST OF BENEFITS

The Pile Drivers’, Divers’, Bridge Dock and Wharf Builders’ Health &
Benefit Plan covers:
1.      Member Assistance Plan (MAP)*
2.      Basic Medical Coverage
3.      Dental Plan
4.      Extended Health Care (EHC)
5.      Short Term Disability (STD), integrated with EI sick benefits
6.      Long Term Disability (LTD)
7.      Group Life Insurance
8.      Accidental Death and Dismemberment Insurance (AD&D)
9.      Spousal Life Insurance
10.     Divers Medical Examinations (Divers only)
11.     Retired Members Life Insurance**
12.     Retired Members AD&D Insurance**
13.     Retired Members Spousal Life Insurance**
14.     Retired Members Mini-Health Plan**
* available to ALL members in good standing of Local 2404, even if
not covered on the hour bank.
** not eligible unless pension payments started on or before December
1, 2002.
See the Summary of Benefits tables and the individual benefit
descriptions for details of coverage.




                               Page 3 of 15
             GENERAL INFORMATION

HOW DO YOU ESTABLISH COVERAGE IN
THE PLAN?
1.      You must be a member in good standing of the Pile Drivers,
        Bridge, Dock and Wharf Builders Union Local 2404.
2.      You must be enrolled in the Plan by completing an application
        card listing yourself and dependents. You may not claim
        coverage even if you have sufficient hours to qualify, until the
        Application Card has been completed and forwarded to the
        Plan Office.
3.      You must have a minimum of 200 hours, within a period of
        six consecutive months, reported and paid into the Plan by
        your employer(s).

HOW ARE HOURS REPORTED?
Your Collective Agreement requires that employers report by the 15th
day of each month, all hours worked by you in the preceding calendar
month.

WHEN DOES COVERAGE START?
Union members who have filled out an application card will have
coverage commencing on the first day of the month following the
month in which sufficient hours are reported to the Plan by your
employer(s).
  EXAMPLE:
 Month Worked                 Member A                      Member B
                            Hours Reported                Hours Reported
January                          140
February                           -                             140
March                              -                             140
April                             50                          reporting
May                              140                           covered
June                          reporting                           -
July                           covered                            -
  Any hours that are not used within 6 consecutive months to establish
  eligibility for coverage (that is, hours that are 7 or more months old) go
  into the General Fund of the Plan.
  The Plan Office will notify you when you are eligible for coverage.
  Hour Bank System
  Once you are covered, all the hours your employer reports for you
  accumulate in your hour bank. Each month, 100 hours are deducted for
  your coverage.
  You may accumulate up to 1000 hours (10 months of future coverage)
  in your hour bank to carry you through periods of poor employment or
  vacation, providing you remain a member of the Union. Any hours in
  excess of 1000 go into the General Fund of the Plan.
  If your hour bank falls below 100 hours, you may use the self-payment
  option to remain covered, as explained below.

  HOW DO YOU MAINTAIN COVERAGE IF
  UNEMPLOYED?
  When your hour bank has less than 100 hours, you are no longer
  covered by the Plan. However, you have the option of paying for the
  coverage yourself, at the current shortage rate, for up to 12 months.
  NOTE: You do not have STD or LTD coverage while self-paying.
  You will be notified by mail when your hour bank falls below the 100-
  hour minimum and told the amount of self-payment required and the



                                   Page 5 of 15
date by which it must be paid. You may also check your records at any
time with the Plan Office.
Example:
     Monthly coverage required                                 100 hours
     Your hour bank balance is                                  45 hours
     Therefore, you are short                                   55 hours
To retain coverage for that month, you must pay $80.85 (55 hours @
$1.47 per hour). The maximum shortage payment is $147.00 a month,
based on 100 hours @ $1.47 per hour. (Rate as of September 1, 2007.
The rate is adjusted each September to 50% of the cost of benefits,
excluding disability).
Do not ignore the shortage notice!
You could lose your coverage if you fail to respond. If you make a self-
payment and late hours are reported or other adjustments are found
later, all hours will be credited to your hour bank for future coverage.
The only sure way to continue your coverage is to pay the Shortage
by the date specified on the Notice.

WHEN DOES COVERAGE END?
Coverage is always provided on a whole month basis only, and will be
terminated for you and your dependents, when:
1.       Your Hour Bank falls below 100 hours and you fail to make a
         cash payment by the specified date to bring your Hour Bank
         up to the required 100 hours;
2.       You reach the maximum number of self-payments;
3.       You cease to be a member of the Union. However, if you
         transfer to another UBCJ local you may remain covered under
         this Plan until your hours run out, but without a right of self-
         pay; or
4.       Upon your death. However, your hour bank will be run-out to
         provide transitional coverage for your dependents. Dependents
         of deceased members are not allowed to self-pay to continue
         coverage.
IF COVERAGE ENDS, WHEN WILL
COVERAGE START AGAIN?
When 200 hours have been worked and reported to the Plan. This is the
same as new member commencement outlined at the beginning of this
section.
You may not re-qualify by self-payment.

IN CASE OF INJURY OR ILLNESS
If you are injured or become ill, contact your Union office, the Plan
office or BC Life immediately to find out whether you are entitled to
Short term Disability (STD) and Long Term Disability (LTD) benefits.
If you are, the claim form will be sent to you.
The STD and LTD benefits are described in the Benefits Booklets.
Other disability benefits are available from this Plan and other sources.
They include:
A. Continuation of Full Coverage (Short Term)
    You will receive full credit of 100 hours a month to maintain your
    hour bank and coverage in the Plan as long as you are disabled and
    receiving one of the following benefits:
    •    Short term Disability (STD),
    •    Workers Compensation (WCB) Wage Loss (including income
         continuity and rehabilitation allowance), or
    •    Employment Insurance (EI) Sickness.
    BC Life will automatically advise the Plan Office when you are
    receiving STD. You must provide cheque stubs or other
    documentation as proof of WCB, or EI benefits.
B. Other Disability Benefits
    1.   Canada Pension Plan
         Pensions may be available from the Canada Pension Plan
         (CPP) for severe and prolonged disabilities, both occupational
         and non-occupational, provided you meet the qualifications.
         There is a three-month waiting period before benefits begin,


                                Page 7 of 15
         but you should apply as soon as possible if your disability is
         severe and likely to be prolonged. Apply for these benefits at
         your local CPP office, listed in the blue pages of your
         telephone directory.
    2.   Group Life and AD&D Insurance
         Both your Life and AD&D insurance may be continued to age
         65 if you become “totally disabled” while covered. See the
         Total Disability provisions in those sections of the Benefits
         Booklets. Because this is continued at no cost to you , it is
         called “Waiver of Premium”. If you apply for LTD, you
         should apply for Waiver of Premium at the same time. The
         Plan office can supply and explain the application forms.
C. Continuation of Coverage (Long Term)
    If you remain disabled at the end of your WCB wage loss period,
    and receive a permanent partial or total disability pension from the
    WCB, you may apply to the Trustees to continue coverage on the
    Plan by paying the full cost of benefits.
         Note: This coverage does not include STD or LTD.

DEPENDENT COVERAGE
Your eligible dependents will be covered for Extended Health Care and
Dental Benefits and for Basic Medical (MSP-BC), but you must
register them in the Plan for this coverage to take effect. Your eligible
dependents are:
• your spouse; and
• your dependent children to age 21 (age 19 for MSP-BC); and
• your dependent children to any age (age 25 for MSP-BC) who are
     attending a recognized school or college full time (you must be
     prepared to prove dependency); and
• your dependent children to any age who are physically or mentally
     disabled who dependent on you for support and for whom you are
     entitled to an income tax exemption, provided each child was
     covered by the Plan immediately prior to his or her 21st birthday.
"Spouse" means your legal spouse or a person who has been living with
you in a common-law relationship for at least one full year and who is
publicly represented as your spouse.
Dependents are not included in your Weekly Indemnity, Life Insurance,
and Accidental Death & Dismemberment coverage.
New dependents are not covered until you register them.
Dependent children must be added within sixty days from the date of
birth or from the date the child became a dependent, and spouses within
sixty days of the date of marriage.
To have new dependents included in your coverage, you must provide
Pacific Blue Cross with their names and birthdates. Ask the Plan Office
or the Union for the registration form.




                               Page 9 of 15
              SUMMARY OF BENEFITS

The following tables summarize your plan:
              GROUP LIFE INSURANCE and
    ACCIDENTAL DEATH AND DISMEMBERMENT
                        (AD&D)
  Insured by: The Manufacturers Life Insurance Company
                      (“Manulife”)
                    (GROUP 29005)
             TYPE                         GROUP LIFE
         Active Member                  $75,000 (Member)
                                         $30,000 (Spouse)
        Retired Member*                  $3,000 (Member)
                                         $3,000 (Spouse)

             TYPE                     AD&D Principal Sum
         Active Member                $75,000 (Member only)
        Retired Member*                $3,000 (Member only)
     Life insurance premiums paid by the Plan are a taxable benefit.
        *If covered at retirement on or before December 1, 2002.

            SHORT TERM DISABILITY (STD)
                        Insured by:
  British Columbia Life & Casualty Company (“BC Life”)
                    (GROUP 903404)
     PAYMENT                        MAXIMUM                    MAXIMUM
                                     PAYMENT                    PERIOD
     Flat benefit                     $468/week                 50 weeks*
                              Effective January 1, 2011
           (*7 weeks BC Life, 15 weeks EI, 28 weeks BC Life)
              LONG TERM DISABILITY (LTD)
                          Insured by:
     The Great West Life Assurance Company (“Great West
                             Life”)
                       (GROUP 161747)
       PAYMENT                             MAXIMUM                 MAXIMUM
                                           PAYMENT                  PERIOD
Two-thirds of average pre-                   $2,000                  Age 60
  disability earnings*
  (*reduced by WCB and auto insurance, subject to 80% overall maximum)
             MEDICAL SERVICES PLAN (MSP-BC)
                      (Group 3134046)
BC Provincial Government Basic Medical
Plan Pays Premium for active (non-retired) members and eligible retirees
only, subject to enrollment. Premiums paid by the Plan are a taxable
benefit.

                EXTENDED HEALTH CARE (EHC)
                           and DENTAL
               Insured by: Pacific Blue Cross (“PBC”)
              (GROUP E903404, D903404 and E903604)
          EHC                            PAYMENT                   MAXIMUM
         (Active)                   80% Reimbursement,              $1,000,000*
                                    after $50 Deductible,             lifetime
         (Retired)                  80% Reimbursement,               $25,000*
                                    after $50 Deductible,          per 24 months

   Dental (Active only)                     PAYMENT                MAXIMUM
       Part A (Basic)                         90%                   No limit*
 Part B (Crown & Bridge)                      60%                   No limit*
     Part B (Dentures)                        90%                   No limit*
   Part C (Orthodontia)                       50%                 $4,000 lifetime
   (*see the Benefits Booklets for exclusions, and limits on specific services)




                                    Page 11 of 15
          DIVERS’ MEDICAL EXAMINATIONS
               Self-Insured by the Trust
The cost of Divers’ Medical examinations is covered through separate
             funding in the Divers’ collective agreement.
              BENEFIT DESCRIPTIONS

… for benefits not described in the Benefits
Booklets

MEMBER ASSISTANCE PROGRAM
The Member Assistance Program (MAP) benefit provides assessment,
referral, and short-term counseling services to members of Pile Drivers,
Divers, Bridge, Dock & Wharf Builders Local 2404 and their families
who are experiencing problems in their personal, family, or work lives.
This includes problems such as relationship and marital difficulties,
separation and divorce, parenting issues, depression, anxiety, and
stress, addictions and substance abuse, problem gambling, child- and
eldercare issues, and work-related concerns. The MAP benefit is
available to members in good standing of Local 2404 whether Union
Status is Active or Retired, and their spouses and dependent children.
Local 2404’s MAP is provided by Family Services Employee
Assistance Programs (FSEAP), one of Canada’s largest MAP
providers.
As part of your MAP benefit, you and each covered member of your
family are eligible to receive short-term, solution-focused counseling as
determined by your clinical issues and needs. If you or members of
your family need or desire additional counseling beyond that provided
by the MAP, you may continue to see your MAP counselor on a fee-
for-service basis, using your extended health benefits to help pay for
the cost of this counseling, up to the annual plan limits (See “In
Province Eligible Expenses” under Extended Health Care in the
Benefits Booklets.)
Participation in the MAP is completely confidential. No information is
disclosed by the MAP regarding an individual’s participation in it
absent a signed written release, or in circumstances involving an
imminent risk of physical harm, child or elder-abuse, or where ordered
by a court of law.




                                Page 13 of 15
If you wish to access the MAP, please contact FSEAP at 604-732-6933
or 1-800-667-0993. Services for emergencies are provided 24 hours a
day, 365 days a year.

BASIC MEDICAL
When you qualify you will be covered with the Medical Services Plan
of BC (MSP-BC) provided you have completed the required
application form. Your group MSP No. is 3134046.
Every British Columbian should be covered for MSP-BC once and only
once. If you are covered by your spouse and wish to stay covered that
way, please contact the Plan Office to file an “Opt Out” notice.

DIVERS’ MEDICAL EXAMINATIONS
Under the Divers 1996 and subsequent Collective Agreements, diving
contractors remit an additional 33 cents on straight time, reducing to 25
cents effective May 1, 2008. The Trustees used this to establish a
separate fund, which pays for the regular medical examinations
required by WCB to measure how much the pressure is affecting them.
Claims
Send your receipts to the Plan Office for processing. If you are
eligible*, and there is a proper receipt for each necessary procedure,
you will be reimbursed by the Plan following the next month-end
processing.
*        At their meeting held September 15, 2000, the Trustees
         determined that all members in good standing of Local 2404
         are eligible for reimbursement of divers medical examination
         costs.
                  Other Benefits Notes

“REASONABLE AND CUSTOMARY”
As noted in the Benefits Booklets, PBC does not recognize excluding
“Any amount of fees in excess of the usual or recognized fees for the
services performed.” In other words, PBC applies “reasonable and
customary” (R&C) limits to many goods and services.
For some services, such as paramedical practitioners, you can find
PBC’s R&C limits on their web site. However, some services are more
specialized, and PBC does not publish its limits.
There are several reasons for this, including
    Limits change from time to time.
    Limits depend on the specifics of each case - using the current
    example, there might be a reason why one member's orthotics need
    to cost more than another member's - that's certainly true of
    eyeglasses. On the other hand, paramedical charges are more
    standardized.
    If PBC published a "ceiling" price for everything, sooner or later
    everyone selling it would know what that was, and make sure they
    charged at least that much.



What can I do?
Your options, essentially, are
1) Shop around, as you would for anything else, and find out if prices
   vary.
2) Before agreeing to a large medical expense, ask PBC whether they
   consider the proposed fee within Reasonable and Customary
   limits. This is much like what happens when you get pre-approval
   before major dental work.




                                 Page 15 of 15

				
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