Welcome to Plasterers Local Union 31
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Plasterers Local 31 Insurance Fund & Plasterers Local 31 Pension Plan

Pittsburgh, Pennsylvania


Summary Plan Description

September 2005

Plasterers Local 31 Insurance Fund

Federal ID # 25-1189104

The Board of Trustees

Employer Trustees

David Balmert
Fred Episcopo

Union Trustees

Doug Taylor
Shawn Potts

Fund Legal Counsel

Domenic A. Bellisario
1000 Law & Finance Bldg.
429 Fourth Avenue
Pittsburgh, PA 15219

Fund Auditor

McElhaney & DiClaudio
1725 Washington Road
Suite – 202
Pittsburgh, PA 15241

Fund Administrator

O.P. & C.M.I.A Combined Funds
Of Western PA, Inc.
1900 Andrew Street
Munhall, PA 15120

Insurance Carriers

Highmark Blue Cross Blue Shield
Fifth Avenue Place
120 Fifth Avenue
Pittsburgh, PA 15222-3099

Notice

This Booklet sets forth the Death, Disability, Hospitalization, Medical-Surgical, Major Medical, Vision, Dental, Prescription Drug, and Maintenance Prescription Drug Option Provisions of the Plan, as well as the Eligibility Requirements for Participants and Retirees of the Plasterers Local 31 Insurance Fund.


The Trustees reserve the right to change or amend this "Plan" at any time, including but not restricted to the amount and extent of all benefits; the eligibility requirements; and the contributions and related regulations, in accordance with the provisions of the Trust Agreement.


PLASTERERS LOCAL NO. 31 INSURANCE FUND

C/O O.P. & C.M.I.A Combined Funds of Western PA, Inc.
1900 Andrew Street, Suite 202
Munhall, PA 15120
Telephone: (412) 464-2851 ext. 11
Toll Free: (800) 628-7914
Fax: (412) 461-9923

Dear Participants,

We are pleased to provide you with this new and revised booklet which contains the new Rules of Eligibility and the Plan of Benefits in effect on May 1, 2005. The Plan provides Death, Accidental Death and Dismemberment, and Weekly Disability Benefits paid directly by the Fund. The Preferred Blue PPO Program provides Hospitalization, basic Surgical, Medical, and Prescription Drug Benefits which are underwritten by Highmark Blue Cross of Western Pennsylvania and Pennsylvania Blue Shield. National Vision Administrators provide the vision benefits and Delta Dental of Pennsylvania provides the dental benefits.


The more important benefits provisions relating to Benefits provided directly by the Fund, Eligibility, General Claim and Appeal Procedures are described in this booklet. The benefits provided by the Preferred Blue PPO Program are described in a separate booklet distributed by Blue Cross of Western Pennsylvania and Pennsylvania Blue Shield. We strongly recommend that you familiarize yourself with both the contents of this booklet and that of the Preferred Blue PPO Program so that you may be fully aware of all the benefits which you and the members of your family may be entitled to in time of need. Should you have any questions or require additional information, please contact the Fund Administrator.


Respectfully yours,

Board of Trustees


SECTION 1.0 - GENERAL INFORMATION

  1. Enrollment Card: Every Participant must submit a completed enrollment card before any claims can be paid. Enrollment cards may be obtained by calling or writing the Fund Office.

  2. Identification Card: Each Employee who has returned a completed enrollment card and who meets the Eligibility Requirements will be issued an Identification Card indicating that he is eligible for benefits under the Plasterers Local 31 Insurance Fund.

  3. Participating Employees: All employees working under the jurisdiction of the Union for an employer who has executed a Collective Bargaining Agreement requiring Welfare Payments to this Fund; the employees of the Union for whom the required Welfare Payments are made.

  4. Participating Employer: Participating Employer means an Employer who is party to a Collective Bargaining Agreement with the Union, such Agreement requiring the Employer to make Welfare Payments to the Plasterers Local 31 Insurance Fund.

  5. Unions Or Participating Unions: Participating Union means the Operative Plasterers and Cement Masons Union, Local 31.

  6. Employees: Employees are defined as persons working under the jurisdiction of the "Union," persons employed by the Union on a full-time basis and any full-time employee, Official or Supervisory Employee of a Participating Employer (providing the Participating Employer has executed an “Assent to Participate") and who has agreed to make the required contributions on their behalf.

  7. Dependent: "Dependents" are defined as your lawful spouse and each unmarried child who has not attained his 19th birthday, or up to age 25 while he is attending on a full-time basis, a college, university, trade or training school beyond the high school level.

    1. "Child" includes stepchild, adopted child, or foster child, provided the child is dependent on the employee for support and maintenance. Dependents who work sufficient hours to be eligible under the Plan shall be insured as employees only.

  8. Physically Handicapped Or Mentally Retarded Children: If an employee's unmarried dependent child is incapable of self-sustaining employment because of mental retardation or a physical handicap and is dependent upon the employee for support and maintenance, his benefits will be continued, provided his incapability commenced prior to attaining age 19. Proof of your dependent child's incapability must be submitted to the Trustees within 31 days after the date he attains 19 years of age. Proof of the continued existence of such incapability must be furnished to the Trustees from time to time as they may request.

  9. Effective Date Of Coverage: An Employee's coverage and that of his dependents will be made effective on the date he becomes eligible. However, if at that time, he is absent or unavailable for work because of illness or injury, his coverage will not be made effective until the date he returns to work or is available to return to work. A dependent who is disabled on the date he would otherwise become covered will not be covered until he has been finally discharged from the hospital. However, if a newborn dependent child incurs charges for services over and above the usual cost of nursery charges for routine well baby care because of sickness, injury, congenital defects or premature birth, insurance begins from birth.

  10. Maintenance Of Coverage: Maintenance of coverage refers to an eligible participant's continuance in the Plan. Such participants must have met the initial eligibility requirements, and be eligible in the current quarter in order to be able to make a SELF-PAYMENT to maintain continuity of coverage in the next Insurance Period.

  11. Change In Family Status: If a change occurs in your family status by reason of marriage, birth of a child, death, divorce or legal separation you must immediately notify the Fund Office. Failure to notify the Fund Office immediately may result in loss of coverage and future benefits.

  12. Plan Description: The plan as described in this booklet is subject to the terms and conditions of the contracts issued by Blue Cross and Blue Shield and any amendments adopted and approved by the Board of Trustees.

  13. Trustees' Right To Amend The Plan: The Trustees reserve the right to alter the Plan of Benefits or the Rules and Regulations of this Plan at any time, in accordance with the terms of the Agreement and Declaration of Trust.