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SECTION 11.0 - OTHER ERISA RIGHTS

  1. Rules and Procedures for Processing Qualified Medical Child Support Orders:

    • All Medical Child Support Orders should be immediately forwarded to the Fund Administrator.
    • The Fund Administrator will notify the participant and the alternate recipients of receipt of the medical child support order. The Fund Administrator will also give each participant and alternate recipient a copy of these Procedures for Processing Qualified Medical Child Support Orders. The required notices will be mailed to the addresses specified in the medical child support order. If the medical child support order does not specify addresses, the required notices will be mailed to the last addresses known to the Fund Administrator.
    • The Medical Child Support Order must contain all of the following information:
      • The name and last known mailing address (if any) of the participant and the name and mailing address of each alternate recipient covered by the medical child support order;
      • A reasonable description of the type of coverage to be provided by the Fund to each alternate recipient, or the manner in which such type of coverage is to be determined;
      • The period to which such medical child support order applies; and
      • The name of the Fund: Plasterers Local No. 31 Insurance Fund

      The medical child support order will not be considered a qualified medical child support orders if it requires the Fund to provide any type or form of benefit, or any option, not otherwise provided for under the Fund, except to the extent necessary to meet the requirements of a law relating to medical child support described in section 1908 of the Social Security Act. The Fund will require receipt of a certified copy of a qualified medical child support order before benefits will be paid to or on behalf of an alternate recipients under the order.

    • The Fund Administrator will review the Medical Child Support order to determine if such Order is a Qualified Medical Child Support Order. If there is any question in regards to whether such Court Order is a Qualified Medical Child Support Order, the Administrator will/may forward such Order to the Fund's attorney for review and advice.
    • Once the Administrator determines that it is a proper Qualified Medical Child Support Order, he will notify the participant, the alternate recipients, the participant's counsel, and the alternate recipient's counsel, if any, of the Fund's determination. The notice given by the Fund Administrator may include information of the amount of benefit each party will receive.
  2. Family and Medical Leave Act: If you become eligible for a family or medical leave of absence in accordance with the Family and Medical Leave Act of 1993 (FMLA) your eligibility may be continued provided your employer makes the required contribution on your behalf. Eligibility may be for up to 12 weeks during the 12 month period, for any of the following reasons:

    1. to care for your child after the birth or placement of a child with you for adoption or foster care; so long as such leave is completed within 12 months after the birth or placement of the child;
    2. to care for your spouse, child, foster child, adopted child, stepchild, or parent who has a serious health condition; or
    3. for your own serious health condition.

    In the event you or your spouse are both covered as eligible participants, the continued coverage under (a) may not exceed a combined total of 12 weeks. In addition, if the leave is taken to care for a parent with a serious health condition, the continued coverage may not exceed a combined total of 12 weeks.

    Conditions

    • You are eligible to continue your coverage under FMLA if:
      • you have worked for your employer for at least one year;
      • you have worked at least 1,250 hours over the previous 12 months for such employer;
      • your employer employs at least 50 employees within 75 miles from your worksite; and
      • your employer continues to pay the required contributions on your behalf.
    • If, on the day your eligibility is to begin, you are already on an FMLA leave of absence, you will be considered actively at work. Benefits for you and any eligible dependents (if applicable) will be in accordance with the terms of the plan as herein set forth.
    • You and your dependents (if applicable) are subject to all conditions and limitations of the plan during your leave, except that anything in conflict with the provisions of the FMLA will be construed in accordance with the FMLA.
    • FMLA continuation ends on the earliest of:
      • the day you return to work;
      • the day you notify your employer that you are not returning to work;
      • the day your coverage would otherwise end under the plan; or
      • the day coverage has been continued for 12 weeks.
  3. Women’s Health and Cancer Rights Act of 1998: Under federal law, group health plans that provide medical and surgical benefits in connection with a mastectomy must provide benefits for certain reconstructive surgery. This covers reconstruction of the breast on which the mastectomy was performed, surgery on the other breast to produce symmetrical appearance, and prostheses and physical complications of all stages of mastectomy, including lymph edemas.


    This coverage is subject to any of the Plan’s normal annual deductibles and co-insurance provisions.

  4. Newborn’s and Mother’s Health Protection Act (NMHPA): Group Health Plans and Health Insurance issuers generally may not, under Federal Law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a Cesarean section. However, Federal Law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours, as applicable). In any case, plans and issuers may not, under Federal Law, require that a provider obtain authorization from the Plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours), as applicable.