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Sheet Metal Workers' Health Plan
of Southern California, Arizona & Nevada Summary Comparison of HMO Medical Plan Options Available under the Retiree Health Plan in the state of California April 2006 To ensure the best coverage available, please review this material very carefully. Once you have elected a medical plan, you may change your election only during the next Annual Open Enrollment. Exceptions are made only if you move outside of your selected plan's service area, so please choose carefully. Important: This is not a contract. This is a summary of the medical plan options avaialbe to you. The group agreements and Plan documents must be consulted to determine the exact terms and conditions of coverage. All benefits and self-pay contributions are subject to change. The HMO Plans (Health Maintenance Organizations) - provide quality care under a managed care environment, within a defined service area. When you enroll in an HMO plan, you must use their medical care and prescription medication needs. No benefits are provided if you, or your eligible dependents, use non-HMO providers or providers of a different HMO, except for certain medical emergencies. There are no claim forms to fill out, and the Fund pays the HMO directly for your health care needs. Health care services are provided to you for specified co-payment amounts at the time of service. There are no calendar-year deductibles and no overall lifetime maximums. Each HMO's service area is defined in their enrollment packet. To enroll in an HMO, you must reside in and have all medical services performed within their defined service area. If you enroll in an HMO and frequently travel, there may be no benefits available while you are outside of your selected plan's service area. For specific benefits available, please call the appropriate Member Service numbers indicated below. MEMBER SERVICE PHONE NUMBERS
Your Monthly Contributions Please refer to the "Retiree Self-Pay Rates for Calendar Year 2004" for your appropriate monthly contribution. These rates are current as of the printing of this material, and are subject to change. All rates are based on your age, Years of Pension Credit and number of years retired, and whether dependents are covered. These rates apply only to retirees and surviving spouses who have elected and continuously maintained coverage under the Sheet Metal Workers' Retiree Health Plan. These rates do not apply to retirees or surviving spouses who have initially declined or previoulsy terminated their coverage. For current "Reinstate Rates", please contact the Administrative Office. Eligible for Medicare? If you (or an eligible dependent) are eligible for Medicare, you (or the dependent) must enroll in Medicare Parts A and B. In addition, you (or the dependent) must enroll in your HMO's Medicare program - Kaiser's Senior Advantage plan, PacifiCare's Secure Horizons plan, or Health Net's Seniority Plus plan, and assign your Medicare benefits to your HMO. Doing so not only reduces your monthly premium, but also provides a reduced cost to the Retiree Health Plan. Failure to comply may result in a termination of your coverage under the Retiree Health Plan! If your HMO Plan does not contract with Medicare in your area, it will be necessary for you to switch plans upon your (or the dependent's) Medicare eligibility date. Moving? Please contact the Administrative Office immediately if you change your mailing address! Unless we are aware of your change of residence, you could experience a lapse in your coverage! The information contained within your enrollment packet includes the current plans available, as well as the current benefits effective April 1, 2004. All benefits and self-pay contributions are subject to change.
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