June 19, 2013   November 1, 2006 Summary Plan Description   Below is the November 1, 2006 Summary Plan Description you received by mail.   IT IS VERY IMPORTANT THAT YOU CHECK THE PLAN UPDATES SECTION OF THIS WEB SITE TO MAKE SURE THAT YOU ARE REVIEWING THE MOST UPDATE INFORMATION ABOUT YOUR BENEFITS.     SYNOPSIS OF BENEFITS     IMPORTANT ADDRESSES AND TELEPHONE NUMBERS     WHERE COVERAGE IS DESCRIBED     OPENING LETTER     SYNOPSIS OF BENEFITS     A. BENEFITS APPLICABLE TO ACTIVE PARTICIPANTS     B. BENEFITS APPLICABLE TO NON-MEDICARE RETIREES     C. BENEFITS APPLICABLE TO MEDICARE RETIREES     D. BENEFITS APPLICABLE TO ALL PARTICIPANTS     E. HOW YOU MAY LOSE BENEFITS   PART I ELIGIBILITY   1.1.1 Eligibility Of Employees   1.1.2 Effective Date Of Employee Coverage - Medical, Dental, Prescription Drug and Wellness   1.1.3 Effective Date Of Employee Coverage – Life and Weekly Disability Income   1.1.4 Eligibility of Dependents – Medical, Dental, Prescription Drug and Wellness   1.1.5 Enrollment of Dependents   1.1.6 Effective Date of Dependent Coverage – Medical, Dental, Prescription Drug and Wellness   1.1.7 Events Resulting In Termination Or Loss Of Coverage – Health Benefits   1.1.8 Events Resulting In Termination Or Loss Of Coverage – Life Insurance   1.1.9 COBRA Continuation Coverage   1.1.10 Continuation Coverage for Retirees   1.1.11 Limited Partial Self-Pay Rule - Medical, Dental, Prescription Drug and Wellness   1.1.12 Continuation of Eligibility Due to Disability – Medical, Dental, Prescription Drug and Wellness   1.1.13 Health Benefit Continuation for Eligible Employees on Family or Medical Leave   1.2 Newly Organized Bargaining Units   1.3 Eligibility Rules Are Subject To Change   1.4 Self-Payment When Employer Is Delinquent or Is Not Obligated to Pay Required Current Contribution Rate   1.5 Failure to Meet Prevailing Contribution Rate - Self-payment Requirement   PART II EMPLOYEE LIFE INSURANCE   2.0 EMPLOYEE LIFE INSURANCE   2.1 Schedule of Benefits for Employees   2.2 Life Insurance   2.2.1 Benefit   2.2.2 Beneficiary   2.2.3 Continuation of Life Insurance During Disability   2.2.4 Accelerated Death Benefit   2.2.5 Conversion Privilege   2.2.6 Increases in Insurance Amount   PART III EMPLOYEE WEEKLY DISABILITY INCOME BENEFITS   3.0 EMPLOYEE WEEKLY DISABILITY INCOME BENEFITS   3.1 Schedule of Benefits for Employees   3.2 Weekly Disability Income Benefits   3.3 Subrogation; Reimbursement from Claims Related to an Accident or Injury; Assignments; and Benefit Offsets   3.4 Continuous Period of Disability   3.5 Changes in Benefits   3.6 FICA Withholding   3.7 Exclusions   PART IV OPEN ACCESS III MEDICAL BENEFITS FOR EMPLOYEES AND DEPENDENTS   4.0 OPEN ACCESS III MEDICAL BENEFITS FOR EMPLOYEES AND DEPENDENTS   4.1 HealthLink Open Access III and Out of Area Schedule of Benefits for Employees and Dependents   4.1.1 HealthLink Open Access III and Out of Area Deductible Requirement   4.1.2 HealthLink Open Access III and Out of Area Percentage Payable   4.1.3 Specified Office Surgical Procedures - 100% Coverage   4.2 Individual Lifetime Maximum Benefit   4.3 Covered Charges   4.3.1 Covered Charges - Generally   4.3.2 Covered Hospital Charges   4.3.3 Covered Medical Charges   4.3.4 Covered Charges With Special Limitations   4.3.5 Covered Mental Illness and Chemical Dependency Charges   4.4 Exclusions   PART V OPEN ACCESS III PRESCRIPTION DRUG BENEFITS   5.0 OPEN ACCESS III PRESCRIPTION DRUG BENEFITS FOR EMPLOYEES AND DEPENDENTS   5.1 Percentage Payable   5.2 Participating Pharmacy Co-Pay Amount   5.3 Out of Pocket Maximums   5.4 Participating Pharmacies   5.5 Maintenance Drug Program   5.6 Dependents With Other Primary Coverage   5.7 Covered Prescriptions   5.8 Exclusions and Limitations   PART VI VALUE PLAN MEDICAL AND PRESCRIPTION DRUG BENEFITS FOR NON-MEDICARE ELIGIBLE RETIREEES, SPOUSES AND CHILDREN   6.0 VALUE PLAN MEDICAL AND PRESCRIPTION DRUG BENEFITS FOR NON-MEDICARE ELIGIBLE RETIREEES, SPOUSES AND CHILDREN   6.1 Value Plan Medical Benefits   6.1.1 Deductible   6.1.2 Benefit Payable   6.1.3 Out-of-Pocket Maximum   6.1.4 Participating Providers   6.1.5 Covered Charges, Exclusions and Limitations   6.2 Value Plan Prescription Drug Benefits   PART VII OPEN ACCESS MEDICARE MEDICAL AND PRESCRIPTION DRUG BENEFITS FOR MEDICARE-ELIGIBLE RETIREES AND DEPENDENTS   7.0 OPEN ACCESS MEDICARE MEDICAL AND PRESCRIPTION DRUG BENEFITS FOR MEDICARE-ELIGIBLE RETIREES AND DEPENDENTS   7.1.1 Medical Benefits Payable   7.1.2 Mental Illness and Chemical Dependency Benefits   7.1.3 Payment for Services Not Covered By Medicare   7.2 Prescription Solutions Prescription Drug Benefits for Medicare Retirees and Dependents   PART VIII VOLUNTARY PREDETERMINATION AND OTHER COST CONTAINMENT PROVISIONS   8.0 VOLUNTARY PREDETERMINATION AND OTHER COST CONTAINMENT PROVISIONS   8.1 Voluntary Predetermination Program   8.1.1 Voluntary Predetermination of Hospital Admission   8.1.2 Voluntary Predetermination of Organ Transplants   8.1.3 Voluntary Outpatient Predetermination   8.1.4 Voluntary Concurrent Review   8.1.5 Review of Voluntary Predetermination   8.1.6 Predetermination of Mental Illness and Chemical Dependency Admissions   8.2 Second Surgical Opinion   8.3 High Risk Pregnancy Screening Program   8.4 Hospital Audits by Participants   PART IX COORDINATION OF BENEFITS (COB)   9.0 COORDINATION OF BENEFITS (COB)   9.1 Definitions   9.2 Benefit Determination   9.3 Coordination with Medicaid   9.4 Excess Coverage   9.5 Information Rights   9.6 Payment Adjustments   9.7 Medicare Coordination of Benefits   9.8 Coordination with Wrap-Plans   9.9 Recovery Right   PART X SUBROGATION; REIMBURSEMENT FROM CLAIMS RELATED TO AN ACCIDENT OR INJURY; ASSIGNMENTS; AND BENEFIT OFFSETS   10.0 SUBROGATION; REIMBURSEMENT FROM CLAIMS RELATED TO AN ACCIDENT OR INJURY; ASSIGNMENTS; AND BENEFIT OFFSETS   10.1 Subrogation; Reimbursement From Claims Related To An Accident Or Injury; Assignments; And Benefit Offsets   10.2 Obligation to Pursue Other Sources of Benefits and to Repay Fund   PART XI DEFINITIONS   11.0 DEFINITIONS   PART XII EMPLOYEE ASSISTANCE PROGRAM (EAP) FOR EMPLOYEES, RETIREES AND DEPENDENTS   12.0 EMPLOYEE ASSISTANCE PROGRAM (EAP) FOR EMPLOYEES, RETIREES AND DEPENDENTS   12.1 Confidentiality   12.2 Types of Referral   12.3 Availability   12.4 Cost   12.5 When Should I Use the EAP?   12.6 How Do I Know If I Need Help?   12.7 Why Professional Counseling Is Effective   12.8 Office Hours and Appointments   12.9 Voluntary Predetermination of Treatment for Mental Illness and Substance Abuse   PART XIII WELLNESS PROGRAM FOR EMPLOYEES, RETIREES AND DEPENDENTS   13.0 WELLNESS PROGRAM FOR EMPLOYEES, RETIREES AND DEPENDENTS   13.1 Health Assessment   13.2 Smoking Cessation Classes   13.3 Stress Management Classes   13.4 Nutrition Classes   13.5 Mammograms   13.6 Flu Shots   PART DENTAL BENEFITS FOR EMPLOYEES AND DEPENDENTS   14.0 DENTAL BENEFITS FOR EMPLOYEES AND DEPENDENTS   14.1 Introduction   14.2 Deductible   14.3 Covered Services and Benefits   14.4 Maximum Benefit   14.5 Limitations   14.6 Exclusions   14.7 Coordination of Benefits   14.8 Dental Terminology   PART CLAIMS PROCEDURES   15.0 CLAIMS PROCEDURES   15.1 Claims for Benefits - Where to File   15.1.1 Claims for Life Insurance   15.1.2 Claims for Medical, Dental and Open Access III/ Value Plan Prescription Drug Benefits   15.1.3 Claims for Open Access Medicare Prescription Drug Benefits   15.1.4 Claims for Weekly Disability Income Benefits   15.2 Claims for Other Matters   15.3 Recovery of Overpayments   15.4 Assignment of Benefits   PART GENERAL INFORMATION   16.0 GENERAL INFORMATION   16.1 Name of Plan   16.2 Plan Sponsor and Administrator   16.3 Name and Address of Plan Administrator   16.4 Plan Identification Numbers   16.5 Type of Plan   16.6 Service of Legal Process   16.7 Description of Collective Bargaining Agreements   16.8 Source of Contributions   16.9 Names of Contributing Employers   16.10 Accumulation of Assets and Payment of Benefits   16.11 End of Plan Year   16.12 Controlling Documents   16.13 Plan Documents Are Available To Participants and Beneficiaries   16.14 Reservation of Authority   16.15 Further Information Available   16.16 Limitation of Authority   16.17 Termination of the Plan   16.18 Statement of Rights Under ERISA   PART COMPLETE NOTICE OF PRIVACY PRACTICES   17.0 COMPLETE NOTICE OF PRIVACY PRACTICES   St. Louis Graphic Arts Joint Health & Welfare Fund 14323 South Outer Forty Rd. - Suite S106 Chesterfield, Missouri 63017 Fund Office: (314) 878-1579 twesthues@slgahw.org Fax: (314) 275-2640   If you have any comments about this web site, please contact us at twesthues@slgahw.org.   Site Concept and Design ©2002 jWeb. 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