Health & Welfare » Retiree

Retiree Health & Welfare

Requirements

You are eligible for health and welfare benefits if you meet each of the following 5 requirements:

1. You must be in receipt of pension benefits from the Carpenters Pension Trust Fund for Northern California or a related plan that is based on 10 or more years of eligibility credit, based on Hours of Work or Qualified Military Service. You may use qualifying hours from any of the following plans to satisfy the 10 years of eligibility credit requirement:

• Carpenters Pension Trust for Northern California
• Carpenters Fund Administration Office Staff Plan
• Any Lathers Plan merged into the Carpenters Pension Trust Fund for Northern California
• OPEIU Local 3 or 29 (if service was with a Contributing Employer)
• Industrial Carpenters Pension Plan
• Any Pension Plan when required by a Collective Bargaining Agreement and/or Memorandum of Understanding negotiated by the Carpenters 46 Northern California Counties Conference Board and/or any of its affiliates
• In each of the 2 calendar years immediately preceding the calendar year in which your pension effective date occurred, you worked at least 300 hours in covered employment for a Contributing Employer, during which time contributions were required to be paid into the Active Employees’ Plan A, Plan B, or Plan R.
• For purposes of the above 300-hour provision, you may count hours worked in the year of retirement even if you do not work a full calendar year. You may also count hours of disability credit granted under the provisions of the Active Employees’ Plan, hours of disability credit granted under the provisions of the Carpenters Pension Trust Fund for Northern California, and hours worked for a contributing employer in the Southwest Carpenters Health and Welfare Plan.
• In 3 of the last 5 calendar years immediately preceding the calendar year in which your pension effective date occurred, you worked at least 400 hours per year in covered employment for a Contributing Employer, during which time contributions were required to be paid into the Active Employees’ Plan A, Plan B, or Plan R. For purposes of this 400-hour requirement, you can count hours worked in the year of retirement even if you do not work a full calendar year. Hours of disability credit may not be used to satisfy this requirement.
• 4. You did not engage in any hours of work for wages or profit in the Building and Construction Industry for an entity that was not a Contributing Employer to the Active Employees’ Plan, or not a contributing employer to a related plan that is signatory to the International Reciprocal Agreement for Carpenters Health and Welfare Funds (including self-employment) during the calendar year in which your pension effective date occurred, and in each of the two immediately preceding calendar years.
• 5. You make the required self-payments in the form and manner designated by the Board of Trustees. Your eligible Dependents will be enrolled in the same plan you choose for yourself. If you have reciprocal eligibility credits from the Southwest Carpenters Pension Trust, see also “Reciprocity with the Southwest Carpenters Health and Welfare Trust” on page 17 of the Summary Plan Description.

When Participation Begins

If you are a Retiree who meets the requirements discussed above, your participation in this Plan will begin the first day of the 4th month on the following your date of retirement or the first day of the month following exhaustion of eligibility provided by your Hour Bank under the Active Employees’ Plan, whichever is earlier.

For example: If you retired on March 1 and had an Active Hour Bank balance of 600 hours (6 months of Future Eligibility), your Retiree coverage would begin on June 1. (June 1 would be the first day of the fourth month following your date of retirement and would be earlier than the end of the 6 months of eligibility provided by your Active Hour Bank.)

If you retired on March 1 and had an Active Hour Bank balance of 200 hours (2 months of future eligibility), your Retiree coverage would begin on May 1. (The end of the 2 months of eligibility provided by your Active Hour Bank would be earlier than the first day of the fourth month following your date of retirement.)

Indemnity Plan - Vision Benefits

The benefits described below are available to Participants and eligible Dependents of the Indemnity Medical Plan.

You pay the Copayment regardless of whether you use a VSP Member Doctor or a non-VSP provider. The $10 exam Copayment is due only once each year, for the first service you receive each year (unless you qualify for the low vision benefit, which has additional Copayments).

To find a VSP provider, call VSP at (800) 877-7195 or visit www.vsp.com and use the “Find a Doctor” feature.

Schedule of Benefits

Retiree Dental Benefits

Dental benefits are available through a voluntary Retiree dental program insured by Delta Dental. The dental plan requires a separate enrollment, payment of premiums covering the full cost of the coverage and has separate eligibility and termination rules. You can enroll in medical benefits without enrolling in the dental plan.

The Choice is Yours

When it comes to dental health, you want benefits that provide you with the best balance of value and coverage. Delta Dental PPO and DeltaCare® USA both offer comprehensive dental coverage, quality care and excellent customer service. Each plan has its own advantages.

Delta Dental PPO

The PPO plan gives you the freedom to choose any dentist, and the opportunity for meaningful savings on your treatment costs when you visit a PPO dentist.

DeltaCare® USA

With a DeltaCare USA plan, when you receive a treatment from your assigned dentist you have the convenience of knowing what your copayment is for covered procedures before you visit.

Indemnity Plan Prescription Benefits for Retirees

The Prescription Drug Plan is managed by the Fund’s Pharmacy Benefit Manager (PBM). The PBM uses a variety of tools to provide safe access to approved prescription drugs. In addition to an approved list of drugs, known as a formulary, the PBM employs other edits which may include, but not be limited to: Prior Authorization for certain therapies, step therapy edits that require the use of tried and proven prescription drugs prior to the approval of newer more costly drugs, frequency and dosing limits, retail refill allowance that channels participants into the mail order delivery method, and Genetic and/or Efficacy testing. Prescriptions submitted that do not comply with PBM rules will be denied. Additionally, the PBM actively monitors for fraud, waste, and abuse which does occur, and intervenes to case manage such events.

The Plan provides a retail pharmacy program and a mail order option for your prescription drug needs. When you need a medication for a short time – an antibiotic, for example – it is best to choose the retail pharmacy program. If you are taking a medication on a long-term basis, it is usually less costly and more convenient to have it filled through the mail order program.

Non-Medicare Eligible Retiree Copayments

Medicare Eligible Retiree Copayments

Medicare Eligible Retiree Copayments: Your drug copayments after a drug deductible of $360 per person, per calendar year on covered drugs are as follows:

Retiree Health & Welfare Self-Payments