Date: December 12, 2023
To: Participants and COBRA Beneficiaries in the Union Roofers Health and Welfare Fund
Re: Improved Prescription Drug and Delta Dental PPO Benefits Effective January 1, 2024
This notice advises you of certain material modifications (plan changes) that have been made to the Union Roofers Health and Welfare Fund (the Plan). This information is very important for you and your eligible dependents. Please take the time to read this notice carefully. Also, please keep it along with your Summary Plan Description (SPD) dated January 1, 2020 and other Summaries of Material Modifications (SMMs).
Aviso a los participantes que hablan español: Si tiene alguna pregunta referente a este aviso o requiere alguna otra información referente a su cobertura de salud, por favor de comunicarse con la oficina administrativa al (562-927-1434) donde habrá varios representantes bilingües que le ayudarán.
Prescription Drug Benefit Improvement, effective January 1, 2024
Effective January 1, 2024, the percentage payable for prescription drugs is increasing from 80% to 90% for Plan A+, Plan A, and Plan B. This is applicable to only active employees, Early Retirees (age 55-60), and their dependents, who are enrolled in the Indemnity Plan or HMO medical plans and modifies the tables set out on pages 7, 35, and 93 of the SPD. This improvement does not impact Regular Retirees and their spouses or Domestic Partners, who obtain prescription drugs directly through their HMO.
Delta Dental PPO Orthodontia Benefit Improvement, effective January 1, 2024
Effective January 1, 2024, the maximum lifetime benefit for orthodontia services provided through the Delta Dental PPO Plan is increasing from $2,500 to $5,000. This improvement modifies the table set out on page 68 of the SPD. This change does not impact the Indemnity Dental or Delta Dental DHMO Plans.
Please direct any questions to the Fund office at (562) 927-1434.
Board of Trustees
This document serves as your Summary of Material Modifications (SMM) to the Plan and we are advising you of these Plan changes within 60 days of the adoption of the Plan changes. Receipt of this notice does not constitute a determination of your eligibility. If you wish to verify eligibility, or if you have any questions regarding these Plan changes, contact the Administrative Office.
This group health plan believes that this plan is a “grandfathered health plan” under the Patient Protection and Affordable Care Act (PPACA). As permitted by the PPACA, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that your plan may not include certain consumer protections of the PPACA that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the PPACA, for example, the elimination of lifetime limits on benefits.
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 Union Roofers Health and Welfare Fund. You may also contact the Employee Benefits Security Administration, 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 plans.