Cobra Coverage: Eligible employees and/or dependents ineligible for Fund coverage because of termination, layoff, leave without pay, or reduction in hours may have rights to continue certain Plan coverage through COBRA. If the eligible retiree dies or becomes divorced or legally separated, or a dependent ceases to be a dependent, the spouse and/or dependent may have rights to continue certain Plan coverage through COBRA. If any of the events outlined above occurs, the eligible employee or retiree or a dependent MUST inform the Fund of the qualifying event WITHIN 60 days of the later of the event or the date on which coverage would be lost because of the event.
Payment: The procedures for payment of benefits vary. Payments are made either to the retiree directly or to the provider for the particular service. Payments are made in accordance with the level of benefits provided in the Plan and the Fund is not responsible for any amounts due in excess of Plan provisions.
Changes in the Plan: The Trustees may add to, amend, change, delete or modify benefits as well as the rules, regulations and procedures of the Plan.
Review Procedure: A member who has received a notice that his or her claim for a Welfare Fund benefit has been denied may request a review of the denied claim within 30 days of the receipt of the notice of denial. A claimant who has not received a decision on his or her claim for benefits within 180 days may request a review, have the opportunity review pertinent documents and submit issues and comments in writing.
Request for a review of a claim must be made in writing and sent to the Fund Office which will act as follows with respect to the claimant’s transmittal: Send a copy to the insurance organization if an insured benefit is involved, or
Bring it to the attention of the Board of Trustees in the case of benefits provided directly by the Welfare Fund on a self-insured basis.
Decision on Review: If the request for review involves a claim for benefits that are provided directly by the Fund on a self-insured basis, the Board of Trustees will render a decision within 60 days after the receipt of the request for the review unless special circumstances require an extension of time in which case a decision will be rendered within 90 days. The decision of the Board of Trustees will be in writing. The Trustees shall have exclusive authority and discretion, among other things, to interpret the provisions of the trust agreement, and of the plan.