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  • News Archives 2003

    update November 20, 2003

    Amendments to SPD

    Please be advised that several amendments to the Summary Plan Description(2002 Edition) of the North Central Illinois Laborers' Health & Welfare Fund have been made recently. As you review these, please make note of the effective date of each change.

    Change effective January 1, 2004

    The following bullet point is added to the Covered Prescriptions and Supplies section on pages 30 and 31:

    up to a 90-day supply of proton pump inhibitors per calendar year by prescription. To receive more than a 90-day supply of proton pump inhibitors per calendar year, you must obtain prior authorization from the Plan.

    Change effective January 1, 2004

    The explanation of the In-Network Wellness, Preventative, Well-Child and Well-Baby Care Services section of each of the Schedule of Benefits is changed to add the following provision:

    Well Baby Care Services are covered up to a maximum of $500 in the first year of life.

    Change effective November 1, 2003

    The second paragraph of the Reserve Bank of Eligibility A Employees section on page 9 is deleted and replaced with the following:

    You may accumulate a maximum of one quarterly self-payment in this Reserve Bank and use the money in your Eligibility Reserve Bank to pay for continuing coverage when you lose coverage under the Plan. This money can only be used as a credit to offset or reduce the self-payment you must make to continue coverage through Self-Payment for Eligibility A Employees, through COBRA Continuation Coverage or through Retiree Coverage. The Eligibility Reserve Bank will be used first to pay for your self-payments, COBRA Continuation Coverage payments or Retiree Coverage payments, depending on which continuation coverage option you choose. You will then be required to make payments directly to continue your coverage under the option you have chosen. Your Plan coverage will terminate as explained in the Continued Eligibility and Termination of Eligibility A section. Your continuation coverage will terminate as explained in the Self-Payment Rules for Eligibility A Employees section, the Continuation Coverage (COBRA) section or the Retiree Benefits section.

    Change effective November 1, 2003

    The third bullet point in the first paragraph on the Family and Medical Leave Act section on page 10 is deleted and replaced with the following:

    you arrange with your employer and the Fund to make the required contributions to the Health and Welfare Fund during your leave.

    Change effective November 1, 2003

    The following paragraphs are added after the first paragraph of the Active Participants section of the Self-Payment Rules for Eligibility A Employees section at the top of page 11:

    You may elect to make self-payments for a maximum of 12 months (four
    quarters), unless this period is temporarily extended by resolution of the Board of Trustees due to work conditions. Once you elect continuing coverage through self-payments, you may not elect COBRA continuation
    coverage and you will not be eligible for any extended coverage period
    because of a second Qualifying Event, as explained in the Continuation
    Coverage (COBRA) section. You will also lose your right under federal law to purchase individual health insurance that does not impose any pre-existing condition limitations when your group health coverage through self-payments ends. COBRA continuation coverage will not be offered to you at the end of your self-payment period.

    You may use the amount accumulated in your Reserve Bank to pay for up to one quarter of your self-payments. After your Reserve Bank is exhausted, you must make your self-payments directly.

    Change effective November 1, 2003

    The first paragraph of the Disabled Employees section of the Self-Payment Rules for Eligibility A Employees section at the top of page 12 is deleted and replaced with the following paragraphs:

    If you are a Totally and Permanently Disabled Participant who makes self- payments under these rules, you may continue to make self-payments until the earlier of:

    • The date you become entitled to Medicare coverage;
    • The end of eight quarters of self-payments;
    • The date you do not make a timely payment for coverage; or
    • The date you are no longer disabled.

    • When you become eligible for Medicare while continuing coverage under this
      provision, your family will continue to be able to pay for coverage by making
      the required self-payments for Retiree Benefits, as explained on page 44.
      You will be considered Totally and Permanently Disabled if you are receiving
      a Disability Pension from the Central Laborers' Pension Plan.

    Change effective November 1, 2003

    The second, third and fourth paragraphs of the Continuation Coverage (COBRA) section on pages 13 and 14 are deleted and replaced with the following second, third and fourth paragraphs:

    If you are covered by the North Central Illinois Laborers' Health & Welfare Fund, you have a right to choose COBRA Continuation Coverage if you lose your health coverage because:

    • your employment is terminated (unless you are terminated for gross
      misconduct, such as theft); or,
    • you have a reduction in hours so that you have insufficient hours of
      work to qualify for benefits.

    • When you or your Dependents lose coverage, the Health and Welfare
      Fund Office will notify you of your COBRA rights and the cost to continue
      coverage under this option versus the self-payment coverage described
      previously.

      Your spouse has the right to choose COBRA Continuation Coverage if
      your spouse loses health coverage for any of the following reasons:

    • your death;
    • a termination of your eligibility because of insufficient hours of
      employment of termination of employment; or
    • divorce or legal separation.

      In the case of your Dependent child, he or she has the right to COBRA
      Continuation Coverage if health coverage under the Health and Welfare
      Fund is lost for any of the following reasons:

    • your death;
    • a termination of your eligibility because of insufficient hours of
      employment of termination of employment;
    • divorce or legal separation from your spouse; or
    • the Dependent stops meeting the definition of "Dependent"
      under this Plan.

    Change effective November 1, 2003

    The fourth full paragraph on page 15 is deleted and replaced with the following two paragraphs:

    An 18-month extension of coverage will be available to spouses and
    dependent children who elect continuation coverage if a second qualifying event occurs during the first 18 months of continuation coverage. The maximum amount of continuation coverage available when a second qualifying event occurs is 36 months. Such second qualifying events include the death of a covered employee, divorce or separation from the covered employee, the covered employee's enrolling in Medicare, or a dependent child's ceasing to be eligible for coverage as a dependent under the Plan. You must notify the Administrative Manager within 60 days after a second qualifying event.

    The law also provides that COBRA Continuation Coverage may be cut
    short for any of the following reasons:

    • the Health and Welfare Fund no longer provides group health coverage;
    • the self-payment for your COBRA Continuation Coverage is not paid,
      or it is not paid on time;
    • you become eligible for Medicare;
    • you become covered under a new group health plan; or
    • your self-payment check received by the Health and Welfare Fund
      Office is returned because of insufficient funds in the account to
      cover the amount of the check.

    Change effective November 1, 2003

    The following paragraphs are added after the first paragraph of the Retiree Benefits section at the top of page 44:

    You may elect either Retiree Benefits coverage or COBRA coverage. Once you elect Retiree Benefits coverage, you may not elect COBRA Continuation Coverage and you will not be eligible for any extended coverage period because of a second Qualifying Event, as explained in the Continuation Coverage (COBRA) section. You will also lose your right under federal law to purchase individual health insurance that does not impose any pre-existing condition limitations when your group health coverage through self-payments for Retiree coverage ends. COBRA Continuation Coverage will not be offered to you at the end of your Retiree coverage.

    You may use the amount accumulated in your Reserve Bank to pay for up to one quarter of your self-payments for Retiree Benefits. After your Reserve Bank is exhausted, you must make your self-payments for Retiree Benefits directly.

    If you have any questions about these changes, please contact the Fund Office

    update November 13, 2003

    Important Notice about Blue Cross Blue Shield of Illinois' Website

    It has recently come to the attention of the Board of Trustees that the Blue Cross Blue Shield of Illinois website will potentially provide misleading information to you if you use it to find an in-network healthcare facility or healthcare provider.

    Currently, when using the "Provider Finder" feature of the Blue Cross Blue Shield of Illinois website to find a provider, you are required to enter the letters "nci" in the PPO Search Box in order to identify yourself as a Fund member. You are then asked to enter a zip code or address for the location in which you are trying to find a doctor. The website then provides a list of "in-network" physicians.

    Please be advised that the North Central Illinois Laborers' Health & Welfare Fund considers as "in-network" care received from doctors and in facilities that are within the state of Illinois only.

    Regardless of the provider search results you receive when using the Blue Cross Blue Shield of Illinois website, the North Central Illinois Laborers' Health & Welfare Fund will pay claims for services received from non-Illinois physicians and/or at non-Illinois facilities at out-of-network levels.

    We hope and expect that Blue Cross Blue Shield of Illinois will refine their website's Provider Search feature soon. We also realize that out-of-state claims have been incurred by some members who used the site to find a physician, and in good faith believed that the physician was considered "in-network" by the Fund. As a gesture of good will toward those members, the Board of Trustees will honor those out-of-state claims at the in-network levels for services received through December 31, 2003. All out-of-state claims for services received after this date will be paid at out-of-network levels.

    Please feel free to contact the Fund Office with any questions.

    more news

    Please note: NCILHWF is not responsible for the content of external internet sites.

    update October 1, 2003

    Amendment to Summary Plan Description

    Please be advised that the Summary Plan Description (2002 Edition) of the North Central Illinois Laborers' Health & Welfare Fund was amended effective September 18, 2003 as follows:

    The following bullet point is added as the second bullet point in the first full paragraph on page 60 that states: "If a plan covers a Dependent child whose parents are divorced or separated, then the following rules apply:

    when a court decree charges each parent with equal responsibility to provide health coverage for their dependent children, the "birthday rule" will apply so that the parent whose birthday anniversary is earlier in the calendar year will pay for Allowable Expenses incurred first; except that if both parents' birthdays are on the same day, the plan covering the parent for the longer period of time will pay first and if a plan does not adhere to the "birthday rule" in determining the order of benefits, then that plan must pay first.

    If you have any questions about this change, please contact the Fund Office

    update October 1, 2003

    Amendment to Summary Plan Description

    Please be advised that the Summary Plan Description (2002 Edition) of the North Central Illinois Laborers' Health & Welfare Fund was amended effective October 1, 2003 as follows:

    The second paragraph on page 12 of the SPD under the heading "Reinstatement of Eligibility for Eligibility A Employees" has now been changed to read

    After reinstatement, you will remain eligible for the balance of the
    quarter in which your coverage is reinstated for up to a maximum
    of three calendar months. To continue coverage after reinstatement,
    you must meet the requirements for continued eligibility as explained
    in the Continued Eligibility and Termination of Eligibility A section.

    If you have any questions about this change, please contact the Fund Office.

    update August 11, 2003

    Clarification of the definition of 'Stepchild(ren)

    In order to clarify the Fund's position on the definition of stepchildren who are eligible for coverage, please refer to the following paragraph, found on page 3 of the Fund's Summary Plan Description:

    Your natural born child will be eligible for coverage on the date of birth. If you adopt a child or have a child placed with you for legal guardianship or adoption, coverage will become effective on the date of placement as long as you are responsible for health care coverage and your child meets the Plan's definition of a Dependent child. Stepchildren who live in your home are eligible for coverage on the date of your marriage, provided that they are living in your home and your spouse is required to maintain medical and/or dental coverage.

    Please note that if the medical and/or dental coverage of a member's stepchildren is not the legal responsibility of the member or the member's spouse, these children will not be covered by the North Central Illinois Laborers' Health & Welfare Fund.

    This clarification should be considered effective September 1, 2003. Claims received for services provided to stepchildren on or after this date will be decided based upon the information that the Fund has received and may be denied unless proof showing the member's spouse as the responsible party is on file at the Fund Office.

    update July, 2003

    All Fund members who have chosen the HFN network and who have already received ID cards should soon receive adhesive labels with the NPPN Network logo. Please affix these labels to your HFN ID cards.

    As an HFN member, you have access to HFN's national partner, NPPN. NPPN has hospital and physician providers in all 50 states. These providers can be used when you are traveling, on vacation, for students in school away from home, etc. Your plan will pay at in-network levels if the provider is part of the NPPN network.

    The NPPN logo must be on your ID card to help with the identification that you are a valid user of the NPPN network.

    To find an NPPN provider, you can look them up on the NPPN website, www.nppn.com or call 800.557-1656.

    If you have any questions, please contact HFN customer service at 800.295-5444.

    Feel free to call the Fund's administrative offices at the numbers shown above with any additional questions.

    update May, 2003

    The NCILHWF Board of Trustees is pleased to announce an enhancement to the benefits described in the Summary Plan Description. Please note that item 16 is added to page 19 of the SPD as follows:

    16) Tubal ligations and vasectomies.
    Item 32 in the list of Plan Exclusions on page 28 of your SPD has also been changed. That item no longer excludes tubal ligations or vasectomies.

    Please note: NCILHWF is not responsible for the content of external internet sites.

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  • North Central Illinois Laborers' Health & Welfare Fund
    4208 W. Partridge Way Unit 3
    Peoria, IL 61615
    Telephone: 309.692-0860
    Toll Free: 866.692-0860
    Facsimile: 309.692-0862
    email: ncil@ncil.us

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