|
|
| |
TABLE OF CONTENTS |
| |
E. HOW YOU MAY LOSE BENEFITS |
| |
Here are some ways benefits may be lost or reduced:
1. If you, as an Employee, fail to maintain your eligibility for benefits (see Part I) by
a. failing to earn sufficient Contribution Hours, or
b. failing to make a timely Self Payment in order to keep medical coverage from terminating.
2. Your Dependents may lose coverage by failure to make the required contributions for coverage (See Section 1.1.7) or COBRA Continuation payment when due (See Section 1.1.9);
3. If you (or your beneficiary) fail to file a timely claim for benefits or fail to appeal a denied claim within the required time (See Part XV);
4. If you become disabled prior to age 65, and you fail to submit proof of disability promptly for continuing life insurance (See Section 2.2.3);
5. You may lose your right to convert your life insurance to an individual policy if you fail to make application for conversion within the time limits described in Section 2.2.5;
6. You may lose coverage under an insured benefit if the Trustees fail to pay the required premium to the Insurance Company;
7. If the Trustees decide to terminate the Plan or change, reduce or eliminate some or all of the benefits provided by the Plan (See Section 16.14);
8. If the eligibility rules are changed to reduce periods of eligibility, you may lose some existing period of eligibility that you have achieved or are in the process of achieving (See Section 1.3);
9. Your prescription drug benefits may be reduced if you purchase prescription drugs from a non participating pharmacy or from a participating pharmacy without using your prescription drug card.
10. If you have Open Access III medical coverage and use a Non-Network Hospital or Physician, your benefits will be less than if you had used an HMO or PPO hospital, Physician or other provider (See Section 4.1);
11. If you have Value Plan coverage and use a Non-Network provider (see Section 6.1.4);
12. If you join Medicare Complete Health Maintenance Organization and fail to use your primary care physician or to secure his referral to other providers (See Medicare Complete Evidence of Coverage);
13. If you falsify or withhold material facts concerning your claim (See Part XV);
14. If you fail to comply with your obligations to the Fund arising from subrogation or a reimbursement agreement (See Part X);
15. If you become covered for any health benefits as an Employee under another employer group program;
16. If your employer’s obligation to make contributions to this Fund terminates;
17. If you are a Medicare Retiree you may not be covered under this Fund’s prescription drug benefits if you are enrolled in another Medicare Part D prescription drug plan (PDP). |
| |
TABLE OF CONTENTS |
| |
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. Maintenance and Hosting provided by jWeb. |
|
|
|
